SAGE Open Medicine最新文献

Background: Skin bleaching is the cosmetic use of hazardous substances or skin lightening agents to change one's natural skin pigment. Skin bleaching products contain substances such as corticosteroids, hydroquinone, mercury salts, and other compounds that decrease the melanin.

Objective: To assess the prevalence of skin bleaching and identify the motivating factors among female university students in Mogadishu, Somalia.

Design and methods: This cross-sectional study included 317 female university students in Mogadishu, Somalia, from February to July 2024. Structured questionnaires were used for data collection. Data analysis was performed using IBM SPSS Statistics version 27.0, reporting categorical variables as frequencies and percentages; significance was determined at p < 0.05 for both crude odds ratios in univariate analyses and adjusted odds ratios (AORs) in multivariate analyses.

Results: Almost 77.3% of participants showed awareness of skin bleaching, with main information sources mentioned as media (39.7%) and friends (34.1%). Two-thirds (63.4%) reported experiencing skin conditions like acne (27.1%). Univariate and multiple logistic regression analyses were conducted. From the results, only female students with a monthly income between USD 50 and 100 were 1.21 (AOR = 1.21, 95% confidence interval: 1.102-1.6341) more likely to bleach their skin compared to those with an income less than USD 50.

Conclusions: The study reveals a high prevalence of skin bleaching practices among female university students despite widespread awareness. Media and peer influence play a major role, and many participants reported adverse skin effects. Monthly income emerged as the key factor associated with skin bleaching, underscoring the need for targeted public health education and interventions.

Background: Patient safety during intra-hospital transport (IHT) of critically ill patients is a major global concern, as transfers expose patients to risks including physiological deterioration, equipment malfunction, and adverse events. Despite its importance, Iran lacks a standardized, culturally adapted tool to evaluate IHT safety from nurses' perspectives. This study aimed to translate, culturally adapt, and psychometrically validate the Persian version of the Intra-hospital Transport Safety Scale (IHTSS) for use among Iranian intensive care unit (ICU) nurses.

Methods: A methodological cross-sectional design was employed in three phases from April to June 2025. Phase 1 involved forward-backward translation and cultural adaptation of the IHTSS. Phase 2 assessed face and content validity through ICU nurses and expert panels using Content Validity Ratio (CVR) and Content Validity Index (CVI). Phase 3 comprised psychometric evaluation among 315 ICU nurses recruited from hospitals in western Iran. Exploratory and confirmatory factor analyses were conducted to examine construct validity. Reliability was assessed through Cronbach's α, McDonald's ω, and test-retest analysis.

Results: The Persian IHTSS demonstrated strong content validity (CVR = 0.93; S-CVI = 0.91). Exploratory factor analysis identified a four-factor structure Organization, Teamwork & Transport-related Tasks, Tools and Technologies, and Environment, explaining 63.1% of the total variance. Confirmatory factor analysis supported model adequacy (CFI = 0.96, RMSEA = 0.067, SRMR = 0.048). Internal consistency was high (Cronbach's α = 0.891; ω = 0.877), and test-retest reliability confirmed temporal stability (r = 0.881).

Conclusion: The Persian version of the IHTSS is a valid, reliable, and culturally adapted instrument for assessing IHT safety in Iranian ICUs. Its application can help identify system-level strengths and weaknesses, guide targeted interventions, and enhance patient safety during critical care transfers.

Objective: To evaluate the impact of multiple-dose PB-119 injection (a pegylated exenatide formulation) on the pharmacokinetics of single-dose Digoxin or Warfarin sodium and on the pharmacodynamics of Warfarin sodium in healthy Chinese adults.

Methods: This study is a single-centre, open-label, randomized, two-period, two-sequence, parallel-group design phase I clinical trial of drug interactions, aiming to evaluate the pharmacokinetic and pharmacodynamic effects of multiple administrations of PB-119 injection (a pegylated exenatide formulation) on single-dose oral Digoxin and Warfarin sodium in healthy Chinese adults. Sixteen healthy subjects were enrolled in each of two cohorts: Digoxin (Digoxin 0.5 mg versus Digoxin 0.5 mg + PB-119 150 μg) and Warfarin sodium (Warfarin 5 mg versus Warfarin 5 mg + PB-119 150 μg). Treatments were administered in a fixed sequence. The total duration of the study for each subject was 33 days, consisting of a 14-day screening phase (day -14 to day -1), a 9-day inpatient treatment phase (day 1 to day 9 for the Digoxin cohort; day 1 to day 16 for the Warfarin cohort to allow international normalized ratio follow-up), and a 10-day post-treatment safety follow-up (day 10 or day 17 to day 23 or day 30, respectively).

Statistical analysis: Pharmacokinetic parameters for Digoxin and Warfarin sodium, as well as pharmacodynamic parameters (INR_AUC0-last and INR_max) for Warfarin, were calculated using non-compartmental analysis with SAS^® 9.4 (SAS Institute, Inc., Cary, NC, United States). Bioequivalence and safety were assessed in both cohorts.

Results: The rate and extent of absorption of Digoxin or Warfarin sodium administered alone were comparable to those observed when co-administered with PB-119. The 90% confidence intervals of the geometric mean ratios for the primary pharmacokinetic parameters (C _max, AUC_0-inf and AUC_0-last) in the Digoxin and Warfarin cohorts, and for the primary pharmacodynamic parameters (INR_AUC0-last and INR_max) in the Warfarin cohort, all fell within the predefined bioequivalence range of 80.00%-125.00%. No unexpected or serious adverse events were reported during the study.

Conclusions: Multiple-dose PB-119 injection does neither alter the pharmacokinetic characteristics of single-dose Digoxin or Warfarin sodium, nor does it influence the pharmacodynamic characteristics of Warfarin sodium, in healthy Chinese subjects.

[This retracts the article DOI: 10.1177/20503121231216585.].

Background: Ankylosing spondylitis often presents with nonspecific symptoms, making the identification of high-risk individuals challenging in clinical practice.

Objective: This study aimed to utilize blood cell indices to construct interpretable machine learning models to assist in clinical triage and the identification of patients at high risk for ankylosing spondylitis.

Methods: A retrospective case-control study was conducted involving 17,504 participants, comprising 4903 patients with ankylosing spondylitis and 12,601 controls with low back pain. Recursive feature elimination was applied to identify key variables, and six machine learning models were developed to diagnose ankylosing spondylitis using blood cell indices. The best-performing model was identified and compared with established biomarkers through receiver operating characteristic curve analysis. External validation was carried out using data from the Fourth People's Hospital of Nanning. The SHapley Additive Explanations method was applied to interpret the model and evaluate the contribution of individual indices to diagnostic predictions. In addition, to examine the independent associations between blood cell indices and ankylosing spondylitis risk while minimizing selection bias, propensity score matching was conducted, followed by binary logistic regression on the matched cohort.

Results: Among the diagnostic models, the light gradient boosting machine model demonstrated the best performance, with areas under the curve of 0.866 in the test set and 0.872 in the external validation set. Several blood cell indices showed significant associations with ankylosing spondylitis.

Conclusion: The light gradient boosting machine model exhibited reliable diagnostic performance for ankylosing spondylitis, and interpretable machine learning approaches provided insights into the contributions of specific hematologic parameters. These findings suggest that blood cell indices, as inexpensive and widely available markers, may serve as a tool for clinical triage and prioritizing high-risk individuals for further diagnostic evaluation.

Objective: Improving quality of life is one of the most important outcomes following cochlear implantation, and this can be effectively evaluated using disease-specific questionnaires. However, no such quality of life questionnaire currently exists in the Thai language for cochlear implant recipients. This study aimed to translate and validate the Cochlear Implant Quality of Life questionnaire into Thai.

Methods: The original Cochlear Implant Quality of Life questionnaire consists of 35 items across six subdomains. The translation followed Hall's guideline for cross-cultural adaptation. Content validity was reviewed by three experts and 10 healthy participants.

Results: After the translation process, the Thai version of the Cochlear Implant Quality of Life demonstrated strong content validity, achieving an Index of Item-Objective Congruence score of 1.0 across all items as assessed by three experts. A review by 10 healthy participants using a five-point Likert scale yielded a mean score of 4.71 (SD = 0.20; range: 4.35-5.00), confirming item clarity and relevance. In testing with 19 cochlear implant users, the Thai version of the Cochlear Implant Quality of Life demonstrated high internal consistency (Cronbach's alpha > 0.6) and good test-retest reliability (r > 0.75) across most subdomains. Moderate reliability was observed in three subdomains: communication (r = 0.512), environment (r = 0.745), and listening effort (r = 0.426).

Conclusion: The Thai version of the Cochlear Implant Quality of Life is a valid and reliable instrument for assessing quality of life in adult cochlear implant users. It is suitable for use in clinical settings for Thai-speaking cochlear implant patients.

Background: Rheumatoid arthritis might increase the risk of lung diseases, such as interstitial lung disease and lung cancer. However, the causal relationships remained unclear. Herein, we utilized Mendelian randomization to study the causal relationships.

Material and methods: Genetic Data from European ancestry and East Asian ancestry were used. The main Mendelian randomization approaches included inverse variance weighted, weighted median, and Mendelian randomization-Egger. We also conducted a series of analyses to validate the robustness of the Mendelian randomization estimates by integrating complementary Mendelian randomization models, Cochran's Q test, Mendelian randomization-Egger intercept analysis, leave-one-out analysis, RadialMR, Steiger filtering test, multivariable Mendelian randomization and colocalization analysis.

Results: In East Asian, inverse variance weighted indicated a significant association between rheumatoid arthritis and lung cancer after Bonferroni correction (odds ratio = 1.11, 95% confidence interval: 1.05-1.18); in both East Asian and European ancestries, rheumatoid arthritis was found to increase risk for interstitial lung disease (odds ratio_{East Asian} = 1.29, 95% confidence interval: 1.17-1.42, which remained significant after Bonferroni correction; odds ratio_European = 1.08, 95% confidence interval: 1.02-1.16). The observed significant associations between rheumatoid arthritis and interstitial lung disease remained in both ancestries after accounting for smoking behavior in multivariable Mendelian randomization analyses. The detected impact of rheumatoid arthritis on the risk of lung cancer in East Asian ancestry vanished after adjusted with smoking initiation.

Conclusion: Using Mendelian randomization analysis, our results unveiled that rheumatoid arthritis augmented the risks of IL, independent of smoking initiation in both European and East Asian ancestry. These revelations might have implications for clinicians to be more vigilant and enhance routine interstitial lung disease screening in rheumatoid arthritis patients.

Background: In low- and middle-income countries (LMICs), nearly 21 million adolescents become pregnant every year. Half of these pregnancies are unplanned, and more than half of unintended pregnancies result in unsafe abortion, which accounts for a major proportion of adolescent pregnancies worldwide. This study intended to assess the pooled proportion of adolescent pregnancy and associated factors in LMICs.

Methods: A community-based cross-sectional study design was employed. The data were taken from 47 LMICs from 2015 to 2024. A total of 327,394 (weighted = 323,767) adolescents aged 15 to 19 years were included. The data were sourced from the demographic and health survey (DHS) datasets available online. Data were analyzed using STATA V.17. We used multivariable multilevel logit regression for the outcome variable. The p-values < 0.05 were regarded as statistically significant, and the adjusted odds ratios with 95% confidence intervals (CIs) were computed from the final model. The candidate model was evaluated using the Deviance Information Criterion.

Results: The pooled proportion of adolescent pregnancy among all adolescent girls in 47 LMICs was 23% (95% CI: [20, 26]). It ranges from 10% (95% CI: [6, 14]) in North Africa/West Asia/Europe to 28% (95% CI: [25, 32]) in sub-Saharan Africa (SSA). No formal education (AOR = 1.10, 95% CI: [1.04, 1.16]), primary education (AOR = 1.58, 95% CI: [1.51, 1.66]), middle wealth index (AOR = 0.83, 95% CI: [0.80, 0.87]), rich wealth index (AOR = 0.58, [0.55, 0.61]), media exposure (AOR = 0.86, 95% CI: [0.83, 0.89]), aged 18 to 20 (AOR = 4.33, 95% CI: [4.17, 4.49]), female household heads (AOR = 1.40, 95% CI: [1.35, 1.46]), condom use (AOR = 0.79, 95% CI: [0.74, 0.85]), contraceptive use (AOR = 0.44, 95% CI: [0.42, 0.46]), knowledge of contraception (AOR = 0.38, 95% CI: [0.35, 0.41]), being married (AOR = 9.02, 95% CI: [8.91, 9.73]), having a bank account (AOR = 0.89, 95% CI: [0.83, 0.96]), being from SSA (AOR = 8.79, 95% CI: [6.96, 10.24]), Central Asia (AOR = 2.96, 95% CI: [2.16, 3.67]), South and Southeast Asia (AOR = 1.65, 95% CI: [1.35, 2.03]), Oceania (AOR = 4.11, 95% CI: [2.66, 5.01]), Latin America and the Caribbean (AOR = 5.83, 95% CI: [4.93, 6.49]) were significantly associated with adolescent pregnancy.

Conclusion: The pooled proportion of adolescent pregnancy is high in the study area with significant disparity. Improving women's education, media exposure, financial support, knowledge, and access to contraceptive and condom use among adolescents were potential modifiable factors to reduce adolescent pregnancy. The WHO regions, such as SSA and the South and Southeast Asia regions, need particular attention to lower adolescent pregnancy rates.

Objective: Endometriosis is a chronic gynecological disease associated with inflammation and severe pelvic pain in 6%-10% of women of reproductive age. Although the pathophysiology and management of endometriosis are currently understood, further research is needed to develop new diagnostic methods, particularly those involving inflammatory pathways, which could guide targeted therapies. This study aims to analyze the differences in levels of Chitinase-3-like protein 1 (CHI3L1) and Cyclooxygenase-2 (COX-2) in the walls of endometriosis cysts compared to non-endometriosis cysts (controls) and to evaluate the correlation of CHI3L1 with COX-2 and menstrual pain level using the Visual Analog Scale (VAS).

Methods: This observational analytical study utilized a cross-sectional design and included 64 samples divided into 2 groups: 32 endometriosis cysts and 32 non-endometriosis cysts. Diagnosis is made through ultrasound and laparoscopic surgery or laparotomy, with histopathological confirmation. Samples were taken from the cyst walls and analyzed for CHI3L1 and COX-2 levels using the Enzyme-linked immunosorbent assay (ELISA) method. Statistical analysis was conducted using the Mann-Whitney test and Spearman's Rank correlation.

Results: The results showed that CHI3L1 and COX-2 levels in the walls of endometriosis cysts were significantly higher than in controls (p < 0.001). A strong positive correlation was found between CHI3L1 and COX-2 (r_s = 0.767; p < 0.001) and between CHI3L1 and menstrual pain level (VAS) (r_s = 0.511; p = 0.003).

Conclusion: This study concludes that CHI3L1 may play a role in the pathogenesis of endometriosis through an inflammatory pain pathway involving COX-2 and prostaglandins.

Background: Adolescents' engagement in risky sexual behaviours poses a significant risk to their sexual and reproductive health, particularly in low- and middle-income nations. Risky sexual behaviour includes actions that heighten the risk of sexually transmitted infections and unintended pregnancies. This study aims to identify strategies for managing risky sexual behaviours among adolescents, focusing on understanding their prevalence, risk factors, consequences and effective interventions.

Methods: A systematic review was performed following the PRISMA 2020 guidelines. We searched electronic databases (PubMed, Cochrane Library, Web of Science, Science Direct, Google Scholar) for English-language studies published between January 2012 and May 2024, using keywords and MeSH terms related to 'risky sexual behaviour', 'adolescents', 'high school students', 'prevalence', 'factors', 'consequences' and 'interventions'. The review involved identification, screening, eligibility assessment and data extraction, with methodological quality assessed using Joanna Briggs Institute checklists, guided by inclusion and exclusion criteria.

Results: A total of 26 studies showed global risky sexual behaviour prevalence ranging from 7.6% in Uganda to 85.1% in Indonesia. Key risky behaviours included multiple partners and inconsistent condom use. Influencing factors were socioeconomic status, substance use, peer/media influence, family dynamics and individual traits. Consequences included sexually transmitted infections, unintended pregnancies and school dropouts. Peer pressure and inadequate parental involvement were identified as major drivers of high-risk activities.

Conclusion: Effective strategies identified include sexual education, healthcare, family support and policy changes. A multifaceted approach involving education, parental involvement and peer engagement is essential for reducing adolescent risky sexual behaviour and promoting healthier outcomes for youth.