Health Science Reports最新文献

Background

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.

Aim

This study aimed to assess the serological and molecular features of HDV among HBsAg-positive patients in the urban and rural areas of Gabon.

Method

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.

Result

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.

Conclusion

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.

Background and Aims

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.

Methods

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.

Results

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).

Conclusions

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.

Background and Aims

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.

Method

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.

Results

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.

Conclusion

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.

Background and Aims

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.

Methods

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.

Results

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.

Conclusion

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.

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Background

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.

Aim

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.

Method

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.

Results

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.

Conclusion

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.

Background and Aims

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.

Methods

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.

Results

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.

Conclusion

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.

Background and Aims

Nonalcoholic fatty liver disease (NAFLD) is a condition of fat accumulation in hepatocytes, not because of excess alcohol intake and disease-causing etiology. The disease occurrence is increased among patients with type 2 diabetes mellitus (T2DM) because of a strong pathophysiological link. Therefore, the aim of this study was to assess the NAFLD status and its associated factors among patients with T2DM in Adama Hospital Medical College, South Eastern Ethiopia, 2022.

Methods

Systematic random sampling was used in an institution-based cross-sectional study design from March to June 2022. Sociodemographic, behavioral, and clinical data were assessed using a structured questionnaire. Fatty liver was diagnosed using ultrasonography. About 5 mL of blood sample was collected for testing liver enzyme, fasting blood glucose, and lipid profile tests using the Cobas C 311 analyzer. EpiData version 3.1 was used for data input, and Stata version 17 for analysis. Binary and multivariable logistic regression were used to show the association of sociodemographic and clinical variables, and one-way ANOVA with post hoc Bonferroni test was used to show significant mean differences among different liver status grading. p < 0.05 was taken as statistically significant.

Results

The prevalence of NAFLD among patients with T2DM was 85.57% (95% CI: 79.8–89.8). Being female and having a longer duration of diabetes had higher odds of having NAFLD. Fasting blood glucose, alanine transaminase, direct bilirubin, total cholesterol, and triglyceride showed a significant mean difference among different NAFLD status as compared to patients with T2DM without NAFLD.

Conclusion

The prevalence of NAFLD was found high. T2DM patients with longer duration of the diabetes and females were found to have a greater risk for NAFLD.

Background and Aims

Organ donation is a vital component of modern healthcare, yet its acceptance varies across populations. Understanding perceptions among future generations and educators is crucial for effective awareness initiatives. This study aimed to assess the knowledge, attitudes, and willingness regarding organ donation among high school students and teachers in the West Bank, Palestine.

Methods

A cross-sectional study was conducted among 508 participants (370 high school students and 138 teachers) between March and May 2025. Data were collected via a structured online questionnaire following ethical approval. Electronic informed consent was obtained, and anonymity was maintained. Statistical analysis included descriptive statistics, independent-samples t-tests, and one-way analysis of variance.

Results

Participants reported moderate mean scores for attitudes (24.16 ± 7.995) and knowledge (6.87 ± 1.598). Students had significantly higher mean knowledge scores than teachers (7.01 vs. 6.51; p = 0.004). Willingness to donate to strangers (students: 20.0%, teachers: 12.3%) or register at a donation center (students: 28.4%, teachers: 39.1%) was low. Among students, gender was significantly associated with knowledge (p < 0.001) and attitudes (p = 0.02). Among teachers, urban residence was associated with knowledge (p = 0.002) and attitudes (p = 0.03). Key influencing factors included family support, religious guidance, and low trust in the healthcare system.

Conclusion

This study reveals a significant gap between knowledge, attitudes, and willingness to donate organs. Culturally tailored educational programs, religious engagement, and enhanced trust in the healthcare system are essential to promote organ donation in Palestine.

Background and Aims

Preventable blindness remains a leading cause of disability in low-income countries (LICs), with 91.5% of cases in Sierra Leone and 83.9% in Rwanda considered avoidable. Reliance on foreign aid has supported eye care development in Africa, yet has also fostered systemic dependency. As donor fundg declines, the need for sustainable, locally led eye health systems becomes urgent. This perspective examines how Rwanda and Sierra Leone, both postconflict LICs reliant on foreign aid, have pursued divergent approaches to eliminate preventable blindness. Rwanda via a nationally led, integrated strategy and Sierra Leone through a fragmented, donor-dependent model.

Methods

A comparative case study was conducted using national policy documents, peer-reviewed literature, Rapid Assessment of Avoidable Blindness (RAAB) surveys, and program evaluations. We assessed governance structure, financing models, workforce capacity, and service delivery. Outcomes included prevalence of blindness (PB), cataract surgical coverage (CSC), workforce growth, and health financing trends.

Results

Rwanda reduced PB from 1.6% (95% CI: 1.0–2.2) to 1.1% (95% CI: 0.7–1.4) (2006–2015), while CSC increased from 47.2% to 68.4%. National initiatives such as integration of eye health into the health sector strategic plan, community-based health insurance coverage for 83.5% of the population, and task-shifting to 2797 trained primary eye care nurses, expanded access to over 2.4 million people. Sierra Leone's PB increased from 4.9% (95% CI: 3.8–6.0) to 5.4% (95% CI: 4.3–6.7) (2011–2021), and CSC improved from 40.5% to 50.5%. Despite formal eye health policies, 55% of health expenditures remain out-of-pocket, and 36.2% of financing derives from donors, leaving the system fragmented and aid-dependent.

Conclusion

Nationally led, integrated strategies like Rwanda's prove more effective than donor-dependent models in sustainably reducing preventable blindness. This highlights the need for African countries to prioritize integrated financing, workforce development, and data-driven policy frameworks, actions critically urgent amid shrinking global health aid.