Due to the burden of influenza, significant efforts have been made to understand its geographical and temporal patterns to advise influenza prevention. Influenza temporal patterns have been affected since the emergence of COVID-19, presumably attributed to nonpharmacological interventions (NPIs). Understanding the changes in influenza activity before and during the COVID-19 pandemic in different climate regions is urgently needed to inform decision-making in future influenza control measures and prevention policies.
This study analysed influenza surveillance data (2012–2022) collected from the FluNet database to compare the patterns of long-term influenza activity in nine selected temperate and tropical countries. The long-term influenza activity in each country was compared before and after the emergence of COVID-19. The level of NPI stringency was measured using the stringency index (SI). Interrupted time series (ITS) analyses were performed to quantify the impact of COVID-19 NPIs on the changes in influenza patterns before and after the stringent implementation of NPIs in the selected countries.
Before the COVID-19 pandemic, influenza activity in temperate countries appeared in winter, while the seasonality patterns in tropical countries were irregular and lasted longer than in temperate countries. During the pandemic, influenza cases decreased drastically in all selected countries, even though the amount of influenza testing remained adequate. The ITS results confirmed a significantly inverse relationship between stringency of NPIs and influenza activity. Although influenza cases have reemerged following the removal of NPIs, the patterns of influenza activity worldwide remain undergoing transitioning shifts post-pandemic. International collaboration is needed to continue monitoring future changes in influenza patterns to prevent large outbreaks.
There has been a change in the temporal patterns of influenza activity worldwide after the pandemic. NPIs have shown a significant effect in reducing influenza activity in all selected countries.
This study evaluated the accuracy of a standalone augmented reality (AR) navigation system using the Microsoft HoloLens 2 for total hip arthroplasty (THA). The system integrates infrared (IR) tracking and a preoperative 3D CT model for intraoperative visualization and guidance. The aim was to assess whether this AR-based solution could achieve clinically acceptable accuracy for use as a surgical navigation tool.
A dedicated AR application was developed to perform six-degrees-of-freedom pose estimation using inside-out tracking. Registration accuracy was assessed using six femur replicas with predefined target points. The registration pipeline combined landmark-based initialization with iterative surface refinement. Target registration error (TRE) was calculated for each point, and the influence of anatomical region, axis, surgical approach (anterior vs. posterior), and user experience level was analyzed.
The system achieved a mean TRE of 3.61 ± 2.18 mm. Significant variations in accuracy were observed between anatomical regions (p = 0.019) and along different axes (p < 0.001), with the highest errors noted along the anteroposterior axis and in distal femoral regions. No significant differences were found between anterior and posterior approaches or among users with varying levels of experience, indicating operator-independent performance.
The AR navigation system demonstrated consistent and accurate registration performance across users and approaches. With a mean TRE of ~3 mm, the system meets accuracy requirements for potential clinical application in THA. Further cadaveric validation is recommended to confirm surgical feasibility and applicability.
HDV, a defective virus dependent on hepatitis B for assembly, can lead to severe liver diseases and an increased risk of progressing to complications such as hepatocellular carcinoma. Given the high prevalence of HDV in Gabon, especially in central Africa, understanding the epidemiology and associated risks is crucial.
This study aimed to assess the serological and molecular features of HDV among HBsAg-positive patients in the urban and rural areas of Gabon.
The study was conducted from April 2019 to December 2022 in the Franceville area and from January to June 2023 in the Libreville area. We enrolled 145 newly diagnosed HBsAg-positive individuals in Franceville (101) and Libreville (44). Plasma samples were collected for serological and molecular analyses, including tests for HDV antibodies and RNA detection.
The results showed an overall HDV prevalence of 26.2%, with higher rates in Libreville (18/44; 40.9%) compared to Franceville (20/101; 19.8%). Molecular analysis identified the circulation of genotypes I, VII, and VIII, with a predominance of replicative forms. The prevalence of replicative HDV RNA activity was 29.4%, indicating a need for accessible treatment options. Demographic analysis revealed a predominantly male population with an average age of 40.
These findings provide valuable insights into the epidemiology of HDV in Gabon and emphasise the importance of targeted interventions and further research to address public health challenges associated with HDV infection in the region.
Sarcopenia, a progressive loss of skeletal muscle mass and function, poses a growing public health challenge in low and middle-income settings. We aimed to quantify its prevalence and identify sex-specific risk factors among older adults attending a public outpatient clinic in Tegucigalpa, Honduras.
In a hospital-based, age-stratified random sample, we enrolled 100 participants (73 women and 27 men; mean age = 69.7 ± 6.9 years) during July 2024. Possible sarcopenia and frailty were assessed using SARC-F and FRAIL questionnaires, respectively. Body mass index was calculated under standardized conditions and mean arterial pressure (MAP) was derived from blood pressure measurements. Normality of continuous variables was evaluated with the Shapiro–Wilk test. Between-sex differences were analyzed using Welch's t-test for continuous variables and χ2 test for categorical variables (α = 0.05). Pearson's correlation was employed to assess associations between SARC-F scores and clinical variables.
Possible sarcopenia (SARC‑F ≥ 4) was present in 48% of participants (95% CI = 38–58), while 40% met criteria for frailty. Women showed a significantly higher mean BMI than men (28.0 ± 5.7 kg m−2 vs. 24.9 ± 4.5 kg m−2; t = 2.8, p = 0.007) yet a comparable MAP (102 ± 13 mmHg vs. 99 ± 13 mmHg; p = 0.33). Frailty prevalence remained higher in women across all age strata (42.5% vs. 37.0%), although the sex difference was not statistically significant (χ2 = 0.2, p = 0.9). SARC‑F scores correlated modestly with MAP (r = 0.3, p = 0.003) but not with age (r = 0.1, p = 0.3) or BMI (r = 0.1, p = 0.4).
Nearly half of older adults were at risk of sarcopenia and two-fifths were frail, with women more affected. Elevated blood pressure was linked to functional decline.
Lower income European countries (LIECs) have more limited financial resources to cover high-cost technologies in rare diseases than higher income European countries (HIECs). Our study explores how treatment recommendations in myelodysplastic syndrome (MDS) can be supported in LIECS by transferring real-world evidence (RWE) generated by target trial emulation (TTE) method in HIECs.
In the HTx project transferability aspects of the MDS case study were considered upfront. HTA agency consortium partners set expectations for the MDS case study team on how to integrate the new TTE methodology into the routine work of HTA bodies. In consecutive workshops consortium members and external HTA experts identified the main challenges of transferring evidence generated by TTE method to LIECs and made conclusions on how to overcome these challenges.
The lack of local real-world data before making reimbursement decisions is an important challenge to apply the TTE method to LIECs. Differences in patient pathways and comparator technologies, limited expertise and resources for adapting international HTA methods are significant barriers of transferring RWE from other countries.
Still, transferring RWE to LIECs from other countries based on the TTE methodology represents an improvement to the current standard HTA methods, especially if joint clinical assessment provides the unbiased judgement on the relative effectiveness of orphan medicines. The TTE approach also provides an opportunity to LIECs to judge the value of high-cost technologies for different patient subgroups. However, HTA professionals in LIECs need training about advanced methodologies.
This is the first study to explore how RWE generated by the TTE method can be transferred to optimize treatment decisions of patients with a rare disease in countries with limited HTA capacities. Five general concluding statements were made on the novelty of the TTE method and on how to overcome main challenges of transferring TTE results to HTA systems in LIECs.
One of today's challenges in terms of understanding the real impact of the environment on pregnancy and its complications is the ability to work with real-life data that are correctly and extensively connected to data on the contamination of living environments and individualized exposures. We present a solution based on a data infrastructure that is directly usable for research. We describe (i) the methodological characteristics of the infrastructure, (ii) the geographical territory and environmental exposures covered by the infrastructure, and (iii) the initial description of the real-life health data of the included population.
The infrastructure is a relational database that integrates routine obstetric care data from CHUB with individual environmental exposure data linked via home addresses. The infrastructure includes all deliveries at Besançon University Hospital (CHUB) from January 1, 2010, to December 31, 2021.
Our infrastructure included information on 20,376 women, 28,344 pregnancies, and 29,190 births. The infrastructure described includes 20% of deliveries in an administrative region of more than 1.5 million inhabitants. The quality of the data is linked to highly contrasted exposure of living areas within this region and temporal coverage of more than 10 years of obstetrical events. This infrastructure is a research tool with the capacity to incorporate data in the future.
This infrastructure can be used to address a wide range of questions aimed at describing the phenomena of environmental exposure during pregnancy, multiple exposures and their cumulative effects, particularly the phenomena of mediation, interaction, or confusion.
To translate and cross-culturally adapt the PROMIS® Self-Efficacy for Managing Daily Activities for Portuguese-speaking populations, ensuring linguistic and conceptual equivalence for future validation, while considering differences between Brazil and Portugal.
The Functional Assessment of Chronic Illness Therapy (FACIT) methodology was followed, including (1) independent translations by Brazilian and Portuguese native speakers; (2) reconciliation into a single version; (3) back-translation; (4) expert review; (5) cognitive debriefing with participants from both countries and (6) final approval by the PROMIS® Statistical Center. Ethical approval was obtained from the Federal University of Rio Grande do Norte.
Minimal linguistic and cultural differences were found between Brazilian and European Portuguese. Vocabulary adjustments were made to ensure clarity (e.g., “tela” vs. “écrã,” “celular” vs. “telemóvel”). The cognitive debriefing involved seven participants (four from Brazil and three from Portugal). A new response option was added for individuals with mobility impairments. The final version preserved the scale's psychometric integrity while ensuring cultural relevance.
The adapted Portuguese version of the PROMIS® Self-Efficacy for Managing Daily Activities maintains its conceptual fidelity and usability across Portuguese-speaking populations. The item bank is ready for validation studies and clinical use in Lusophone healthcare settings.
Menstruation is a natural biological process, yet it remains heavily stigmatized and misunderstood in many communities, particularly in rural and coastal regions. In Bangladesh, gender norms, cultural taboos, and environmental challenges like saline water contribute to the neglect of menstrual health, especially in coastal areas.
This study aims to explore the knowledge, perceptions, and involvement of coastal males in women's menstrual health and hygiene, focusing on how environmental stressors, such as water salinity, impact menstrual practices.
A phenomenological qualitative approach was used to conduct in-depth, semi-structured interviews with 50 adult males (aged 18 and above) from East Kharia village, Khulna District, Bangladesh. Data were analyzed thematically to uncover the key factors influencing men's understanding and support of menstrual health.
The findings reveal that many participants had limited knowledge about the biological aspects of menstruation, largely influenced by myths and informal learning. Cultural silence surrounding menstruation was prevalent, with most men avoiding discussions on the topic. Environmental barriers, such as saline water, were identified as exacerbating menstrual health issues. Emotional detachment and lack of support for women during menstruation were common, though a subset of younger, more educated men showed emerging empathy and a shift toward recognizing menstruation as a shared family responsibility.
The study highlights significant gaps in male knowledge and involvement in menstrual health, compounded by cultural taboos and environmental stressors. It calls for gender-sensitive education and policies that encourage male participation in menstrual hygiene management, as well as addressing the unique challenges faced by coastal communities in managing menstrual health.
Atopic dermatitis (AD) is a chronic inflammatory skin disease with marked immunological heterogeneity. T-cell subsets expressing CLA, CCR4, and CCR10 are involved in skin inflammation, but their frequency and expression patterns in AD remain poorly characterized. This study aimed to define distinct immunological endotypes of AD in the Mexican population by analyzing the frequency of CLA⁺ T cells expressing CCR4 and CCR10, along with their cytokine production profiles.
Flow cytometry quantified CD4⁺ and CD8⁺ T cells in 47 Mexican AD patients, 15 healthy controls, and 16 allergic individuals. Principal component analysis and unsupervised clustering were used to identify immunological patterns.
Two AD endotypes were identified. Endotype 1 exhibited a higher frequency of CD4⁺CLA⁺ T cells (32.1% vs. 21.0%; p = 0.025) and a Th2/Th17-skewed profile, while Endotype 2 showed higher CD8⁺CLA⁺ T-cell frequencies (2.8% vs. 5.5%; p = 0.003) and increased chemokine receptor expression on CD4⁺ T cells (all p < 0.001). Clinically, Endotype 1 presented more active disease at examination (78.9% vs. 35.7%; p < 0.001). Total serum IgE was higher in Endotype 2 (5974 vs. 866 IU/mL; p = 0.032), and both endotypes showed higher IgE than healthy controls. SCORAD, POEM, and DLQI did not clearly separate the endotypes.
AD presents distinct immunological endotypes characterized by specific T-cell profiles, which may inform personalized treatment strategies. This study provides insights into the immunological heterogeneity of AD in the Mexican population and underscores the need for population-specific approaches in disease characterization and management.
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