Diffuse midline gliomas are among the deadliest human cancers and have had little progress in treatment in the last 50 years. Cell cultures of these tumors have been developed recently, but it is unknown the degree to which such cultures retain the characteristics of the source tumors. DNA methylation profiling offers a powerful tool to look at genome-wide epigenetic changes that are biologically meaningful and can help assess the similarity of cultured tumor cells to their in vivo progenitors. Paraffinized diagnostic tissue from three diffuse intrinsic pontine gliomas with H3 K27M mutations was compared with subsequent passages of neurosphere cell cultures from those tumors. Each cell line was passaged 3-4 times and analyzed with DNA methylation arrays and standard algorithms that provided comparison of diagnostic classification and cluster analysis. All samples tested maintained high classifier scores and clustered within the reference group of H3 K27M-mutant diffuse midline gliomas. There was a gain of 1q in all cell lines, with two cell lines initially manifesting the gain of 1q only during culture. In vitro cell cultures of H3 K27M-mutant gliomas maintain high degrees of similarity in DNA methylation profiles to their source tumor, confirming their fidelity even with some chromosomal changes.

Patients with a psychotic disorder frequently report oral health problems, while mental health nurses (MHNs) seem not to be fully aware of these problems and the risk factors. Therefore, this study aims to develop supportive tools for MHNs regarding oral health to increase sensitization among MHNs and to provide MHNs with knowledge to recognize (potential) oral health problems in patients with a psychotic disorder. We used a human-centered design in which the user, MHNs as well as experts by experience, were placed in the centre of the research process. Problems and needs in MHNs working with patients with a psychotic disorder were addressed. To identify key issues of problem as well as the needs in terms of resources, we started with focus groups (n = 9). We analysed the data thematically based on context of patients and MHNs in practice regarding oral health, preferred oral health tools focused on MHN, and intended outcomes of tools. A Multi Criteria Decision Matrix was developed and analysed (n = 9) to identify the most optimal and viable solution based on established criteria and issues that are prevalent in the work of MHNs. Most promising result was the development of a brochure with an awareness screener. The brochure with awareness screener was developed as a low-fidelity prototype for MHNs regarding oral health in patients with a psychotic disorder, based on the latest scientific evidence. After testing it, the feasibility was tested through semi-structured interviews (n=19). MHNs and experts by experience were satisfied with the tool and provided recommendations for adjustments to the content. Significant augmentations to the brochure include a clinical lesson and a toothbrush with toothpaste for patients. We can conclude that a brochure with an awareness screener is feasible for MHNs. Future steps aiming to further refine and optimize care processes for oral health tools in MHNs, should take refining eligibility criteria for psychiatric populations and the language level of the target group of a tool into account.

An observational cohort study of patients diagnosed with endometrial cancer (EC) stage IA G1, or atypical endometrial hyperplasia (AHE), undergoing organ-preserving treatment, was conducted. Objective of the study: to determine CDO1, PITX2, and CDH13 gene methylation levels in early endometrial cancer and atypical hyperplasia specimens obtained before organ-preserving treatment in the patients with adequate response and with insufficient response to hormonal treatment. Materials and methods: 41 endometrial specimens obtained during diagnostic uterine curettage in women with EC (n=28) and AEH (n=13), willing to preserve reproductive function, were studied; 18 specimens of endometrial cancer IA stage G1 from peri- and early postmenopausal women (comparison group) were included in the study. The control group included 18 endometrial specimens from healthy women obtained by diagnostic curettage for missed abortion and/or intrauterine adhesions. Methylation levels were analyzed using the modified MS-HRM method. Results: All 13 women with AEH had complete response (CR) to medical treatment. In the group undergoing organ-preserving treatment for uterine cancer IA stage G1 (n=28), 14 patients had complete response (EC CR group) and 14 had not (non-CR). It was found that all groups had statistically significant differences in CDO1 gene methylation levels with the control group (p<0.001) except for the EC CR group (p=0.21). The p-value of difference between EC CR and EC non-CR groups was <0.001. The differences in PITX2 gene methylation levels between the control and study groups were also significantly different (p<0.001), except for AEH group (p=0.21). For the difference between EC CR and EC non-CR groups, the p-value was 0.43. For CDH13 gene methylation levels, statistically significant differences were found between the control and EC non-CR groups (p<0.001), and the control and EC comparison groups (p=0.005). When comparing the EC CR group with EC non-CR group, the p-value for this gene was <0.001. Simultaneous assessment of CDO1 and CDH13 genes methylation allowed to accurately distinguish between EC CR and EC non-CR groups (AUC=0.96). Conclusion: Assessment of CDO1 and CDH13 gene methylation in endometrial specimens from patients with endometrial cancer (IA stage G1), planned for medical treatment, can predict the treatment outcome.

Prostate cancer is the second leading cause of death in males in America, with advanced prostate cancers exhibiting a 5-year survival rate of only 32%. Castration-resistance is often developed during the course of treatment, though its influences require further understanding. This study explores the human microbiome for its implications in castration-resistance and metastasis in prostate cancer. RNA sequencing data was downloaded for bone and soft tissue biopsies of patients with metastatic castration-resistant prostate cancer. These sequences were mapped to bacterial sequences to yield species-level abundance approximations. Numerous species were found to correlate to the expression of known markers of castration-resistance, including AR, PI3K, and AKT. Castration-resistance-associated signaling pathways were also enriched with these species, including PI3K-AKT signaling and endocrine resistance. For their implications in cancer aggression and metastasis, cancer stem cell markers were further explored for relation to these species. EGFR and SLC3A2 were widely downregulated with greater abundance of most species. Our results suggest that the microbiome is heavily associated with castration-resistance and stemness in prostate cancer. By considering the microbiome’s importance in these factors, we may better understand the highly aggressive and highly invasive nature of prostate cancer, allowing for needed improvement in the treatment of this disease.

Access to maternal healthcare services is a challenge in most low and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access maternal healthcare services. The aim of the study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al. 2008. The study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. The women with hearing impairments had challenges in communication as most facilities did not have sign language interpreters, negative attitudes of health care workers and being ignored when they asked for help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment which is not adjustable such as beds and scales.

Selenium is essential for the synthesis and function of various selenoenzymes, such as glutathione peroxidases, selenoprotein P, and thioredoxin reductase, which play an important role in both antioxidant defense and limiting oxidative damage. Associations between serum selenium concentration and obstetric complications as well as pregnancy outcomes has been reported in many studies. The aim of this study was to determine whether the dietary intake of selenium, its concentration in serum and the activity of glutathione peroxidase in subsequent trimesters of pregnancy affect the birth condition of newborns assessed on the basis of the Apgar score in the 1st and 5th minute of life, birth weight, body length and head and chest circumference in physiological and complicated pregnancy course. Twenty-seven pregnant women at a mean age 29.6 ± 4.8 years from the Lower Silesia region of Poland were recruited to the study, 55% of studied group had pregnancy complications. The mean reported Se intake and serum selenium content for Polish pregnant women was in the first trimester – 56.53 μg/day and 43.75 μg/l, the second trimester – 61.79 μg/day and 41.77 μg/l and the third trimester – 58.37 μg/day and 42.13 μg/l, respectively. In the subgroup of pregnant women with a physiological pregnancy course, a weak, although statistically significant, positive correlation was found in the first trimester between Se intake and the length (R=0.48, p=0.019) and birth weight of newborns (R=0.472, p=0.022), and in the second trimester with the APGAR score at 1 (R=0.680, p=0.005) and 5 minutes (R=0.55, p=0.033), as well as in the third trimester with th APGAR score at 1 minut (R=0.658, p=0.019). The GPX value had a strong positive correlation with the APGAR score at 1 min. (R=0.650, p=0.008) in the second trimester and with the birth weight of the newborns (R=0.598, p=0.039) in the third trimester. There was no correlation between newborns' birth measurements and serum selenium concentration. In the subgroup of pregnant women with pregnancy complications, a strong, statistically significant, negative correlation was found between Se intake in the second trimester and gestational age (R=-0.618, p=0.032), and in the third trimester, a positive correlation between Se concentration in serum and head circumference (R=0.587, p=0.021). The obtained results indicate that there is a relationship between the maternal selenium status during pregnancy, both in terms of the intake of this element, its serum concentration as well as the glutathione peroxidase activity, and the anthropometric parameters of the newborn, such as birth weight, length and APGAR score, especially in the group with physiological course of pregnancy, but when pregnancy complications occur, these relationships lose their importance.

Recent policy and service provision recommends a woman-centered approach to maternity care and encourages the development of personalized models of clinical assistance. As ethnicity has been recognized as determinant in the risk calculation of some obstetric complication, our aim was to assess costs for birth assistance according to the maternal ethnicities. In a five-year period (2012-16) all women admitted for delivery at the Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Rome, Italy were investigated. Economic evaluations were performed by using the ‘diagnosis-related group’ (DRG) approach. Cost analysis was completed by including maternal ethnicity, delivery mode and perinatal complications. A total of 18,093 patients were involved in the analysis. An overall care expense of €42.663.481 was calculated. Caucasian was the main ethnicity (90.7%), leaving the minority groups to 9.3%. Vaginal delivery (VD) was the most common mode of delivery in all ethnic clusters, with a global rate of 59.6%. Not including Asiatic women, increased CS rates were recorded in all minority ethnic groups (Maghreb (51.5%) and Afro-Caribbean (47.8%)). A double incidence of complicated VD was observed in the minority groups, primarily among Afro-Caribbean (69.9%), followed by Asiatic (64.1%), Maghreb (63.2%) and Latin-America (62.7%) patients. By logistic regression, Afro-Caribbean delivering women had a significant increased risk of complicated CS among all subgroups. Minority groups (Afro-Caribbean, in particular) increase the health care cost for birth assistance due to higher incidence of adverse perinatal outcomes.

Background: Disability and caste are two different forms of oppression, however Dalits and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15 – 49 years. Maternal healthcare service utilization was assessed by Ante-Natal Care (ANC), health facility (HF) delivery, and Post-Natal Care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by the inclusion of disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30 – 0.84) and PNC (OR 0.47, CI 0.25 – 0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05 – 0.74). Conclusions: Disabled women – whether Dalit or non-Dalit - had lower rates of utilizing all maternal healthcare services than non-disabled women. However, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention to be re-examined and more nuanced interventions considered to ensure improved access and outcome among all vulnerable groups.

The concept of vulnerable carotid plaques is pivotal in understanding the pathophysiology of is-chemic stroke secondary to large-artery atherosclerosis. At the macroscopic evaluation, vulnera-ble plaques are characterized by one or more of the following features: microcalcification, neo-vascularization, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), thin fibrous caps, plaque surface ulceration, huge dimension determining stenosis, and plaque rupture. Recognizing these macroscopic characteristics is crucial to estimating the risk of cerebrovascular events, also in case of non-significant (less than 50%) stenosis. Inflammatory biomarkers, such as cytokines and adhesion molecules, lipid-related markers like oxidized low-density lipoprotein (LDL), and proteolytic enzymes capable of degrading extracellular matrix components are among the key molecules that will be scrutinized for their associative roles in plaque instability. Through their quantification and evaluation, these biomarkers reveal intricate molecular cross-talking govern-ing plaque inflammation, rupture potential, and thrombogenicity. Current evidence demonstrates that plaque vulnerability phenotypes are multiple and heterogeneous and are associated with as many highly complex molecular pathways that determine the activation of an immune-mediated cascade that culminates in thromboinflammation. This narrative review provides a comprehen-sive analysis of current knowledge on molecular biomarkers expressed by symptomatic carotid plaques. It explores the association of these biomarkers with the structural and compositional at-tributes that characterize vulnerable plaques

The healthcare situation in Africa is characterized by limited resources and a high burden of disease, presenting significant challenges to the healthcare systems in the region. The integration of Artificial Intelligence (AI) technologies in African healthcare holds immense potential for addressing these challenges and improving health outcomes. This paper aims to provide a comprehensive understanding of the current healthcare landscape in Africa and the urgent need for AI-driven solutions.In addition to discussing the potential applications of AI in African healthcare, such as disease diagnosis, treatment planning, and medical imaging analysis, this manuscript seeks to shed light on the specific challenges hindering the implementation of AI in the region. By providing detailed examples and case studies, we aim to offer insights into the obstacles that need to be overcome and potential solutions that can be pursued.By leveraging AI technologies, Africa has the opportunity to revolutionize its health systems, bridging the gap in access to quality healthcare across the continent. The objective of this review article is to not only highlight the potential benefits that AI can bring to African healthcare but also to emphasize the urgent need for action and collaboration in implementing and scaling up AI innovations in the region. By doing so, African countries can pave the way for improved health outcomes and ensure that their populations receive the healthcare services they deserve.

One of the industries with the fastest rate of growth is healthcare, and this industry's enormous data requires extensive cloud storage. The cloud may offer some protection, but there is no assurance that data owners can rely on it for refuge and privacy amenities. Therefore, it is essential to offer security and privacy protection. Increased customer satisfaction with security and privacy preservation is crucial since healthcare big data and its sources are stored in the cloud and contain increasingly private and sensitive information. However, maintaining privacy and security in an untrusted green cloud environment is difficult, thus the data owner should have complete data control. A new work SecPri-BGMPOP(security and privacy of Boost graph Convolutional Network -Pinpointing-Optimization Performance) is suggested that can offer a solution that involves several different steps in order to handle the numerous problems relating to security and protecting privacy. Initially Boost Graph Convolutional Network Clustering (BGCNC) algorithm, which reduces computational complexity in terms of time and memory measurements, is first applied to the input dataset to begin the clustering process. Second, enlarge by employing a piece of the magnifying bit string to generate a safe key, pinpointing based encryption avoids amplify leakage even if a rival or attacker decrypts the key or asymmetric encryption. Finally, to determine the accuracy of the method, an optimal key was created using a meta-heuristic algorithmic framework called Hybrid fragment horde bland lobo Optimization (HFHBLO). Our proposed method currently kept in a cloud environment, allowing analytics users to utilize it without risking their privacy or security.

Healthcare professionals constantly face situations that reflect ecosystems’ degradation. These can negatively affect their mental health. Research suggests that hope and resilience can play an important role in this scenario, since they are related to/predict mental health in highly heterogeneous samples (considering geography, age, profession, health, etc.). In this context, the aims of the present study are: to characterize and explore the relationship between hope, resilient coping and mental health of Portuguese healthcare professionals. Using Google Forms, 276 healthcare professionals answered to the GHQ-28, the (adult) Trait Hope Scale, and the Brief Resilient Coping Scale (cross-sectional study). The minimum and maximum possible scores were reached, with the exception of the maximum score of GHQ-28-Total. Regarding Hope, 19.6% scored below the midpoint (M=43.46, SD=11.97); 29.3% revealed low resilience (M=14.93, SD=4.05); and the average of 4 of the 5 Mental Health scores (exception: Severe Depression) indicates the probability of a psychiatric case. Hope correlated with Social Dysfunction and GHQ-28-Total; resilient coping proved to be a (weak) predictor of 4 of the 5 GHQ-28 indicators (exception: Severe depression). The results support the need to promote the sample's mental health, hope and resilient coping. They also suggest that stimulating resilient coping may contribute to improving healthcare professionals’ mental health.

Artificial intelligence (AI) is increasingly being used to improve the quality control of point-of-care diagnostics. This is caused by a number of factors, including the following: 1. AI can accelerate and improve testing accuracy. In comparison to humans, AI technology can review data more quickly and precisely, reducing errors and improving overall quality assurance. 2. When it comes to improving POC test findings on healthcare issues such as infectious diseases or medical crises such as heart attacks, AI can be used for sophisticated predictive analytics and modeling that aid in better decision-making. 3. Artificial intelligence facilitates process automation, increasing productivity and lowering labor costs in labor-intensive tasks such as testing and analyzing samples collected at point-of-care facilities. 4. The use of AI enables organizations implementing these solutions to gain insights from large volumes of raw diagnostic data generated faster and more accurately, allowing them to build solid frameworks around preventive care initiatives and significantly influence public health outcomes.5. Artificial intelligence (AI) has been demonstrated to be a useful tool for real-time monitoring systems that identify any problems with test results early so that they can be corrected before affected patients receive inaccurate diagnoses or treatment plans based on false information provided by diagnostic tests performed at points of care such as clinics or hospitals.Using these technologies would allow healthcare organizations to spend less on labor while still receiving exact diagnoses and rapid treatment delivery at a fraction of the cost that manual approaches required earlier.

Mediterranean Diet (MD), rich in minimally processed plant foods and in monounsaturated fats, but low in saturated fats, meat and dairy products, represents one of the most studied diets for cardiovascular health. It has been shown, from both observational and randomized controlled trials, that MD reduces body weight, improves cardiovascular disease surrogates such as waist-to-hip ratio, lipids, and inflammation markers, and even prevents the development of fatal and non-fatal cardiovascular disease, diabetes, obesity, and other diseases. However, it is unclear whether it offers cardiovascular benefits from its individual components or as a whole. Furthermore, limitations in the methodology of studies and meta-analyses have raised some concerns on its potential cardiovascular benefits. MD is also associated with characteristic changes in the intestinal microbiota, mediated through its constituents. These include increased growth of species producing short-chain fatty acids, such as Clostridium leptum and Eubacterium rectale, increased growth of Bifidobacteria, Bacteroides and Faecalibacterium prausnitzii species, and reduced growth of Firmicutes and Blautia species. Such changes are known to be favorably associated with inflammation, oxidative status, and overall metabolic health. This review will focus on the effects of MD on cardiovascular health through its action on gut microbioma.

Understanding the dynamics of teamwork and communication among healthcare professionals is crucial in the face of evolving healthcare challenges. This study assessed relational coordination among healthcare professionals in the South Tyrolean healthcare system in Italy, focusing on communication and teamwork dynamics in a cross-sectional survey. Using the validated Relational Coordination Survey (RCS) instrument and 525 completed online responses, the questionnaire aimed to understand the implications of different levels of relational coordination ratings by general practitioners, hospital physicians, nurses, and administrative personnel (response rate 26%). The demographics of the participants revealed a predominance of female professionals (64%), with an average age of 50 and 18 years of service. The resulting RCS scores varied significantly across professional groups, with nurses reporting the highest within-group scores, indicating moderate coordination, and administrators reporting the lowest scores, reflecting areas of weak coordination. Between-group relational coordination was generally perceived as weak across professional groups, with the least weakness observed between general practitioners and nurses. German or Italian language and health district affiliation emerged as significant factors influencing relational coordination ratings, highlighting the need for differentiated understanding and strategies in multilingual and diverse regional settings. Assessments of interdisciplinary feedback and referral practices highlight the variation in teamwork and communication weaknesses and underscore the need for targeted interventions to improve relational coordination. This study provides insights into the complexity of relational dynamics in health care settings. It suggests that improving relational coordination through tailored strategies could significantly improve team effectiveness, quality of patient care, and overall system efficiency.

Despite the importance of influenza vaccination for healthcare workers (HCWs), their uptake remains challenging. This study aimed to measure influenza vaccine hesitancy among HCWs in Nakhon Phanom province, Thailand. A representative cross-sectional survey was conducted at six hospitals during August – September 2020 using a self-administered questionnaire. HCWs delaying getting influenza vaccines, accepting but unsure, or refusing with doubts were categorized as hesitant. Those accepting without any doubts were classified as non-hesitant. Vaccine hesitancy determinants were identified by multivariable logistic regression analysis. A total of 338 participants (97%) completed the questionnaires; most were female nurses working at district hospitals without pre-existing chronic medical conditions. Nearly 60% of participants (197/338) exhibited influenza vaccine hesitancy, and significant factors included age above 50 years adjusted odds ratio [aOR] 3.2, 95% CI 1.3-8.5), fair knowledge of influenza/vaccination (aOR 0.4, 95% CI 0.2-0.8), and negative influence of other HCW (High level– aOR 2.3, 95% CI 1.1-4.8; Moderate level- aOR 2.1, 95% CI 1.1-4.4). Imparting updated information to the HCW combined with positive guidance from influential peers may help reduce this hesitancy.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in maternal mortality rate was reported between 2020-2021, with Limpopo ranking fourth highest out of nine provinces. Vhembe district remained number three with a high maternal death rate. This study explored strategies to reduce the maternal death rate and improve the provision of quality maternal healthcare services in selected hospitals of Vhembe district, Limpopo province. One hospital was purposively sampled from every four municipalities. A qualitative approach using phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data. An audio recorder was also used until data saturation. Data saturation was reached at the 20th participant, but the researcher continued until 28 sampled participants were interviewed. Interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). Results indicate that despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as lack of material resources, shortage of staff, incompetent staff, and poor infection control, affect the quality of maternal health service in Vhembe district. Limpopo Department of Health and hospital management should ensure that hospitals have all necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

This review article focuses on the role of Artificial Intelligence (AI) in transforming healthcare in Africa, specifically in combatting infectious diseases, neglected tropical diseases (NTDs), and antimicrobial resistance. We provide a comprehensive overview of the significance of AI in the healthcare industry, highlighting its urgency and importance in addressing these specific health challenges in Africa. We begin by discussing the role of AI in infectious disease surveillance and outbreak detection. We explore how AI technology can be employed for real-time tracking and prediction of outbreaks, providing examples of successful AI applications in infectious disease surveillance within the African context.Next, we examine the potential of AI-enabled diagnosis and treatment for faster and more accurate diagnoses of infectious diseases and NTDs. We highlight specific examples of AI applications in diagnosing and treating these diseases in Africa, showcasing the potential of AI to improve clinical outcomes and save lives.Furthermore, we focus on how AI-driven drug discovery and development can expedite the search for new treatments for infectious diseases and combat antimicrobial resistance. We present examples of AI applications in drug discovery within the African context, illustrating the potential for AI to revolutionize the development of effective therapeutics.In addition, we delve into how AI-powered public health interventions can enhance the design and implementation of targeted interventions. We explore how AI can optimize resource allocation and facilitate data-driven decision-making processes, providing examples of AI applications in public health in Africa.Finally, we address the challenges and limitations of implementing AI in combatting infectious diseases, NTDs, and antimicrobial resistance in Africa. We discuss potential barriers and ethical concerns surrounding AI applications in healthcare, aiming to encourage informed and responsible utilization of AI technologies.Overall, this review emphasizes the importance and potential of AI in combatting infectious diseases, NTDs, and antimicrobial resistance in Africa. It positions AI as a catalyst for revolutionizing healthcare in the region, leading to more effective disease surveillance, diagnosis, treatment, drug discovery, and public health interventions.

This research addresses a gap in the literature by conducting a comprehensive analysis of patients’ level of satisfaction with dental care. Methods: By combining quantitative and qualitative survey methods with the PSQ questionnaire this study aims to augment ongoing initiatives to enhance dental patients’ experiences by painting a more comprehensive depiction of patients' level of satisfaction; Results: When asked about their overall level of satisfaction 77,1% of the patients said they received excellent services from the office personnel and 72,2% said they trust their doctors; Conclusions: Assessing patient satisfaction in the realm of dental services quality is crucial for enhancing service quality and accuracy, benefiting both patients and dentists, and ultimately improving public health.

Sterol homeostasis in mammalian cells and tissues involves balancing three fundamental processes: de novo sterol biosynthesis; sterol import (e.g., from blood-borne lipoproteins); and sterol export. In complex tissues, composed of multiple different cell types (such as the retina), import and export also may involve intra-tissue, inter-cellular sterol exchange. Disruption of any of these processes can result in pathologies that impact the normal structure and function of the retina. Here, we provide a brief overview of what is known currently about sterol homeostasis in the vertebrate retina and offer a proposed path for future experimental work to further our understanding of these processes, with relevance to the development of novel therapeutic interventions for human diseases involving defective sterol homeostasis.

Maternal and child nutrition has been a critical component of health, sustainable development, and progress in low- and middle-income countries (LMIC). While a decrement in maternal mortality is an important indicator, simply surviving pregnancy and childbirth does not imply better maternal health. One of the fundamental obligations of nations under international human rights law is to enable mothers and teenage girls to endure pregnancy and delivery as an aspect of their enjoyment of reproductive and sexual health and rights and live a dignified life. The aim of this study was to discover the correlation between the Maternal Observation and Motivation (MOM) program and m-Health support for maternal and newborn health. A Comparative study was done among 109 pregnant mothers (study group-94; control group-102 mothers) with not less than 20 weeks of gestation. Maternal outcomes such as Hb, weight gain and newborn results like birth weight and crown- heel length was obtained on the baseline, 28 and 36 weeks of gestation. Other secondary data collected were abortion, stillbirth, low birth weight, major congenital malformations, twin or triplet pregnancies, physical activity and maternal wellbeing. The MOM intervention included initial face to face education, three in-person visits and eight virtual health coaching by WhatsApp. The baseline data on Hb of the mothers show that 31(32.98%) vs 27(28.72%) of the study and control group had anaemia, which improved to 27.66% and 14.98% among study group mothers at 28 and 36 weeks of gestation (p<0.001). The weight gain (p< 0.001), level of physical activity (p< 0.001), and maternal wellbeing (p< 0.01) also had significant differences after the Intervention. Even after controlling for potentially confounding variables, the maternal food practices regression model revealed that birth weight was directly correlated with consumption of milk (p 0.001), fruits (p 0.01), and green vegetables (p 0.05).As per the physical activity and maternal wellbeing regression model, the birth weight and crown heel length were strongly related with the physical activity and maternal wellbeing of mothers at 36 weeks of gestation (p <0.05). Combining the MOM intervention with standard antenatal care is a safe and effective way to improve maternal welfare while upholding pregnant mothers' human rights.

Background: Mental capacity is a fundamental aspect that enables patients to fully par-ticipate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. Objective: This meta-analysis aimed to investigate potential differences in deci-sion-making capacity within the healthcare context among groups of patients with bi-polar disorder (BD) and schizophrenia spectrum disorder (SSD). Methods: A systematic search was conducted on Medline/Pubmed, and Scopus. Addi-tionally, Google Scholar was manually inspected, and a manual search of emerging re-views and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving pa-tients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges g was used as a measure for outcomes. Results: Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better, and the difference was statistically significant, compared to patients with SSD, particularly in the domain of Appreciation (ES=0.23, 95% CI: 0.01 to 0.04, p=0.037). There was no statistically significant difference between the two groups for Understanding (ES=0.09, 95% CI: - 0.10 to 0.27, p=0.352), Reasoning (ES=0.18, 95% CI: - 0.12 to 0.47, p=0.074), and Expression of a choice (ES = 0.23, 95% CI: - 0.01 to 0.48, p=0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES=0.21, 95% CI: -0.04 to 0.46, p=0.102). (ES=0.21, 95% CI: -0.04 to 0.46, p=0.102). Conclusions: These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.

Ambulatory heart rate (HR) monitors that acquire electrocardiogram (ECG) or/and photoplethysmographm (PPG) signals from the torso, wrists, or ears are notably less accurate in tasks associated with high levels of movement compared to clinical measurements. However, reliable estimation of HR can be obtained through data fusion from different sensors. These methods are especially suitable for multimodal hearable devices, where heart rate can be tracked from different modalities, including electrical ECG, optical PPG, and sounds (heart tones). Combined information from different modalities can compensate for single source limitations. In this paper, we evaluate the possible application of data fusion methods in hearables. We assess data fusion for heart rate estimation from simultaneous in-ear ECG and in-ear PPG, recorded on eight subjects while performing 5-minute sitting and walking tasks. Our findings show that data fusion methods provide a similar level of mean absolute error as the best single-source heart rate estimation but with much lower intra-subject variability, especially during walking activities. We conclude that data fusion methods provide more robust HR estimation than a single cardiovascular signal. These methods can enhance the performance of wearable devices, especially multimodal hearables, in heart rate tracking during physical activity.

Background: Maternal diabetes mellitus (MDM) is associated with increased risks for adverse neonatal outcomes. However, the impact of MDM on neonatal outcomes in Bisha, a city in Saudi Arabia, is not well-documented. This study aims to investigate the impact of MDM on neonatal outcomes in the Maternity and Children’s Hospital (MCH), Bisha, Saudi Arabia. Methods: A retrospective cohort study was conducted on 181 pregnant women with diabetes and their neonates diagnosed at Maternity and Children’s Hospital (MCH), Bisha, Saudi Arabia, between October 5, 2020, and November 5, 2022. The primary outcome was a composite of adverse neonatal outcomes, including stillbirth, neonatal death, macrosomia, preterm birth, respiratory distress syndrome, hypoglycemia, and congenital anomalies. Logistic regression analyses were used to adjust for potential confounders. Results: The total sample size was 181. The average age of patients was 34 years (SD=6.45). The majority of the patients were diagnosed with GDM, 147 (81.2%), and pre-GDM, 34 (18.8%). Neonates born to mothers with MDM had a higher risk of adverse neonatal outcomes compared to those born to mothers without MDM (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.25-1.70). The risks of macrosomia (aOR = 1.74, 95% CI: 1.38-2.19), LBW (aOR = 1.32, 95% CI: 1.06-1.66), and RDS (aOR = 1.57, 95% CI: 1.28-1.93) were significantly higher among neonates born to mothers with MDM. Types of DM were statistically significant with some neonatal outcomes: hypoglycemia (p-value = 0.017), macrosomia (p-value = 0.050), and neonatal death (p-value = 0.017). Conclusion: MDM is associated with an increased risk of adverse neonatal outcomes in Bisha. Early identification and management of MDM may improve neonatal outcomes and reduce the burden of neonatal morbidity and mortality in this population.

Maternal type 2 diabetes mellitus (T2DM) has been shown to result in fetal programming of the hypothalamus-pituitary-adrenal (HPA) axis, leading to adverse fetal outcomes. T2DM is preceded by prediabetes and shares similar pathophysiological complications. However, no studies have investigated the effects of maternal prediabetes on fetal HPA axis function and postnatal offspring development, hence this study. Pre-diabetic (PD) and non-pre-diabetic (NPD) female Sprague Dawley rats were mated with non-prediabetic males. After gestation, male pups born from the PD and NPD groups were collected. Markers of HPA axis function, adrenocorticotropin hormone (ACTH) and corticosterone were measured in all dams and pups. Glucose tolerance and expression of mineralocorticoid (MR) and glucocorticoid (GR) receptors were further measured in all pups at birth and their developmental milestones. The results demonstrated increased basal concentrations of ACTH and corticosterone in the dams from the PD group by comparison to NPD. Furthermore, the results show an increase in pups ACTH and corticosterone concentrations, impaired glucose tolerance and dysregulated MR and GR expression in the PD group at all developmental milestones. These observations reveal that pregestational prediabetes is associated with maternal dysregulation of the HPA axis, impacting offspring HPA axis development along with impaired glucose handling.

Pregnancy at advanced maternal age (AMA) is a condition of potential risk for the development of maternal-fetal complications with possible repercussions even in the long-term. Here, we analyzed the changes of plasma redox balance and the effects of plasma on human umbilical cord mesenchymal cells (hUMSCs) in AMA pregnant women (patients) at various timing of pregnancy. One hundred patients and twenty pregnant women younger than 40 years (controls) were recruited, and evaluated at various timings during pregnancy until after delivery. Plasma samples were used to measure the thiobarbituric acid reactive substances (TBARS), glutathione and nitric oxide (NO). In addition, plasma was used to stimulate the hUMSCs, which were tested for cell viability, reactive oxygen species (ROS) and NO release. The obtained results showed that throughout pregnancy until after delivery in patients the levels of plasma glutathione and NO were lower than those of controls, while those of TBARS were higher. Moreover, plasma of patients reduced cell viability and NO release, and increased ROS release in hUMSCs. Our results highlighted alterations in the redox balance and the presence of potentially harmful circulating factors in plasma of patients They could have clinical relevance for the prevention of complications related to AMA pregnancy.

High maternal mortality in the developing countries, particularly in Nigeria, poses serious challenge to achieving the maternal mortality target of the Sustainable Development Goals (SDGs) in the countries. Hence, there is need for multifaceted approach to curtailing the scourge. Women being the victims of maternal mortality, this study finds the effect of their household decision making power in reducing maternal mortality. The study used data from the 2013 Nigeria Health and Demographic Survey (NDHS) and logistic regression model to explore the relationship between women household decision making power and maternal mortality in Nigeria. The finding shows that women who decide and participate in household decision on own health, major purchases and visit to family and relatives were 35% (OR = 0.65, 95% CI: 0.52, 0.83), 27% (OR = 0.73, 95% CI: 0.57, 0.92), and 37% (OR = 0.63, 95% CI: 0.50, 0.80) less likely to experience maternal mortality, respectively, compared to those whose husbands alone decide. Women household decision making power is therefore instrumental to reducing maternal mortality. It is thus important for policy makers, particularly in Nigeria, to pay more attention to social and cultural factors that surround women household decision making ability for speedy reduction in maternal deaths.

Toll-like receptor 4 (TLR4) is a member of the TLR family. Members of the TLR family play an important role in innate immune responses and are induced by recognition of pathogen-associated molecular patterns. They are also involved in cell proliferation and apoptosis in cancer. We investigated the role of TLR4 in apoptotic cell death in gynecological cancer cells; gynecological cancer is associated with infertility and spontaneous abortion. To examine the effect of TLR4 activation on apoptotic signaling in cancer cells, cultured primary cancer cells were treated with the TLR4 agonist lipopolysaccharide (LPS). The morphology of cancer cells was compared with normal myometrial cells. Enhanced growth rate and loss of contact inhibition with cellular overlap was observed in the cancer cells. The molecular mechanism analysis revealed differential expression of tumor suppressor genes in LPS-treated cancer cells. The expression of apoptosis-related caspase-3 was increased significantly in cancer cells with TLR4 activation after exposure to LPS. Taken together, these results suggest the pro-apoptotic activity of TLR4 as a potential therapeutic target for the treatment of gynecological cancers.

The quality of healthcare services is a very important indicator of social welfare in developed and emerging countries. Good quality levels are critical to ensuring patient safety, improving health outcomes, increasing patient satisfaction, optimizing resource utilization, and meeting regulatory requirements. The stable and sustainable operation of medical institutions urgently requires the establishment of a reliable and effective medical quality performance evaluation platform. However, the complexity of the evaluation process, involving numerous evaluators and the consideration of different subjective and objective criteria, poses significant challenges and essentially constitutes a group multi-criteria decision-making problem. This article uses the overall medical environment of the institution, medical service attitude, medical security, administrative service measures, etc. as measurement standards to deal with this challenge. It proposes a medical service quality measurement model suitable for both qualitative and quantitative analysis. In view of the heterogeneity of information, the two-tuple fuzzy language calculation method is introduced to enable evaluators to skillfully manage diverse information and effectively avoid potential information omission problems in the subjective evaluation integration process. The effectiveness and feasibility of the model were demonstrated by applying it to the operational framework of a medical institution in central Taiwan.

Background: Virtual care adoption accelerated during the COVID-19 pandemic, highlighting the need for healthcare professionals to develop relevant competencies. However, limited evidence exists on the core competencies required for quality virtual care delivery. Objective: This study aimed to identify the critical competencies physicians, nurses, and other health professionals need for adequate virtual care provision in Saudi Arabia using a Delphi method. Methods: A 3-round Delphi technique was applied with a panel of 42 experts, including policymakers, healthcare professionals, academicians, and telehealth specialists. In round 1, an open-ended questionnaire elicited competencies needed for virtual care. Competencies were distilled and rated for importance in rounds 2 and 3 until consensus was achieved. Results: Consensus emerged on 151 competencies across 33 domains. The most prominent domains were communication (15 competencies), professionalism (13), leadership (12), health informatics (5), digital literacy (5) and clinical expertise (11).

Introduction: The trophoblast derived angiogenic factors are considered to play an important role in the pathophysiology of various complications of pregnancy. The aim of this study was to establish relationship between concentrations of soluble Human Leukocyte Antigen-G (sHLA-G) in maternal serum and amniotic fluid at 16-22 weeks of gestation and the sonographic measurements of the fetal and placental growth. Materials and methods: sHLA-G in serum and amniotic fluid, as well as fetal biometric data and placental volume and perfusion indices were determined in 41 uncomplicated singleton pregnancies. Results: The sHLA-G levels were unchanged both in amniotic fluid and in serum during mid-pregnancy. The sHLA-G level in serum correlated positively with amniotic sHLA-G level (β=0.63, p<0.01). Significant correlation was found between serum sHLA-G level and abdominal measurement (β=0.41, p<0.05) and estimated fetal weight (β=0.41, p<0.05). The amniotic sHLA-G level and placental perfusion (VI: β = -0.34, p<0.01 and VFI: β = -0.44, p<0.01, respectively) were negatively interrelated. A low amniotic sHLA-G level was significantly associated with nuchal translucency (r = -0.102, p<0.05). Conclusions: sHLA-G assayed in amniotic fluid might be a potential indicator for placental function, whereas the sHLA-G level in serum can be a prognostic modality for feto-placental insufficiency.

Background: The workplace burnout syndrome is often associated with particular aspects of certain job positions, especially those which entail working with people with special needs. The burnout syndrome in healthcare jobs is a serious problem which has grown into an epidemic among healthcare workers and associates. Objectives: The aim of this research is to assess the presence of stress and burnout syndrome at work with healthcare workers, expert workers, professional associates and associates in social service institutions in Belgrade. Material and Methods: This research has been conducted in the form of a cross-sectional study of a representative sample in social institutions in Belgrade. It has been conducted from March to the end of June of 2023. The sample of the study had 491 participants. The questionnaires used were a structured instrument with social-demographic and social-economic characteristics, workplace characteristics, life style characteristics, and the following questionnaires: DASS-21, Copenhagen, Brief Resilience Scale, and Brief Resilient Coping Scale. Results: The end results indicate the following to be significant risk factors for the occurrence of workplace burnout syndrome: overtime (OR=2.62; CI=1.50-4.56), BRS average score (OR=0.28; CI=0.17-0.44), DASS21 D heightened depression (OR=2.09; CI=1.1-4.04), DASS21 A heightened anxiety (OR=2.38; CI=1.34-4.21), DASS21 S heightened stress (OR=2.08; CI=1.11-3.89). The only protective risk factor which stood out was the self-assessment of health levels (OR=0.60; CI=0.42-0.85). Conclusion: Overtime is a significant predictor of workplace burnout. Apart from it, other significant predictors of workplace burnout were heightened depression, anxiety, and stress levels.

Noninvasive brain stimulation technique can be used for modulation of motor behaviors such as reaction time (RT). The main aim of this study was to investigate whether RT during a sequential visual isometric pinch task (SVIPT) can be affected by anodal transcranial direct current stimulation (a-tDCS) over three different stimulation sites such as dorsolateral prefrontal cortex (DLPFC), primary motor cortex (M1) or posterior parietal cortex (PPC). We also aimed to assess if stimulation of these cortical sites affect the transfer of learning during SVIPT. A total of 48 right-handed healthy participants were randomly assigned to one of the four a-tDCS groups: 1) left M1, 2) left DLPFC, 3) left PPC and 4) sham. A-tDCS was applied concurrent with SVIPT in which the participants were precisely controlled their forces to reach seven different target forces from 10 to 40% of maximum voluntary contraction (MVC) presenting on a computer screen with right dominant hand. Four test blocks were randomly performed at baseline and 15 min after the intervention including sequence and random blocks with either hand. Our results showed significant differences between a-tDCS groups on ratio RT in the sequence blocks of both the right trained (P = .041) and left untrained hands (P = .023) for target forces of 15% and 30 % of MVC, respectively. In sequence blocks, M1 showed significant elongation in ratio RT for the target force of 15% and 30 % MVC compared to PPC and Sham groups in the right hand. In sequence blocks with left hand, this negative effect were found between M1-DLPFC and M1-Sham groups. In random blocks, no significant differences were found among four groups at each target forces for the left hand while there were significant differences for 15% (P =. 04) and 40% MVC (P =. 035) in the right hand. Our findings suggest that three different stimulation sites (DLPFC, M1 or PPC) were differentially affected by a single session of a-tDCS at some target forces during SVIPT. The effects of a-tDCS on ratio RT were transferred in the left untrained hand for sequence blocks but not random blocks. Further research is needed to understand fundamental aspects of these main areas of the brain on temporal processing in a precision control task such as SVIPT.

This article focuses on the economic dimensions of maternal health, highlighting the benefits of investing in maternal healthcare and the policy implications for sustainable development. Through a comprehensive review of the literature, the article explores the economic impact of maternal health, including its effects on human capital, productivity, and healthcare costs. It emphasizes the importance of addressing social determinants such as access to healthcare services, education, employment, income, and geographical disparities. By prioritizing maternal health, societies can unlock the economic potential of women, promote inclusive growth, and reduce gender disparities. The article discusses policy interventions, including the importance of healthcare infrastructure, financial support for maternal healthcare, and promoting gender equality. It also emphasizes the need for future research to quantify the economic benefits and evaluate the cost-effectiveness of different interventions. Overall, the article underscores the economic imperative of investing in maternal health and provides valuable insights for policymakers and researchers seeking to enhance maternal health outcomes and promote sustainable economic development.

Prenatal maternal feeding plays an important role in fetal development and has potential to cause long-lasting epigenetic modifications. MicroRNAs (miRNAs) are non-coding, single-stranded RNAs that serve as one epigenetic mechanism. Though miRNAs have crucial roles in fetal programming, growth, and development, there are limited data regarding maternal diet and sheep miRNA expression. Therefore, weanalyzed high and low maternal dietary protein for miRNA expression in sheep fetal longissimus dorsi. Pregnant ewes were fed an isoenergetic high-protein (HP, 160–270 g/day), low-protein (LP, 73–112 g/day), or standard protein diet (SP, 119–198 g/day) during pregnancy. miRNA expression profiles were evaluated using the Affymetrix GeneChip miRNA 4.0 Array. Twelve up-regulated, differentially expressed miRNAs (DE miRNAs) were identified targeting 65 genes. The oar-3957-5p miRNA was highly up-regulated in LP and SP compared to HP. Previous transcriptome analysis identified integrin and non-receptor protein tyrosine phosphatase genes targeted by miRNAs detected in the current experiment. A total of 28 GO terms and 10 pathway-based gene sets were significantly (padj &lt; 0.05) enriched in target genes. Most genes targeted by identified miRNAs are involved in immune and muscle disease pathways. Our study shows dietary protein intake during pregnancy affects fetal skeletal muscle epigenetics via miRNA expression.

Endometriosis is an oestrogen-dependant reproductive disease, with genetic, vascular, neural, inflammatory and auto-immune characteristics. There are many theories about the etiology of endometriosis, however, all of these theories have limitations and do not explain all the locations that endometriosis is found or types of patients with endometriosis. The objective of this paper is to postulate the hypothesis that endometriosis is caused by Maternal Microchimerism, the presence of maternal cells in the fetus. A literature review was conducted, analysing the characteristics, current etiological theories of endometriosis, theory limitations and relationship of maternal microchimerism and endometriosis. At time of writing, there was no literature on maternal microchimerism and endometriosis. These results suggest that Maternal Microchimerism could be a cause of endometriosis. This could account for the genetic and auto-immune characteristics seen in people with endometriosis, inducing a micro-environment for vascular, neural and epigenetic changes. This could also account for account for endometriosis seen in non-menstruating patients, such as men, fetuses and post-menopausal women and endometriosis found in non-peritoneal locations. If the hypothesis of Maternal Microchimerism is correct, endometriosis could be considered a pregnancy-related disease that could affect all humans, changing the accepted demographics of patients and potentially new diagnostic techniques and treatment options for patients with endometriosis. Further studies are needed to test this hypothesis.

Fragile X syndrome (FXS) is the most frequent monogenic form of autism spectrum disorder (ASD). Autistic FXS is caused by loss of the fmr1 gene product, the fragile X mental retardation protein (FMRP), triggering physiological and behavioral abnormalities. It is correlated with clock components for behavioral circadian rhythm. Mutation of this gene causes the disturbances in sleep patterns and circadian behavior commonly observed in patients with autistic FXS, accompanied by frequent dysregulation of melatonin synthesis and melatonin-dependent signaling. These changes impair vigilance, learning and memory, and are also linked to autistic behavior including the abnormal anxiety response. However, although several possible causes, symptoms, and clinical features of ASD have been investigated, the correlation between an altered circadian rhythm and autistic FXS has not been extensively studied. Recent works have highlighted the impact of melatonin on the nervous, immune, and metabolic systems. Even though utilization of melatonin for sleep disorder in ASD has been considered in clinical research, further studies should be aimed at its neuroprotective role in ASD during developmental period. In this review, we focus on the regulatory circuits involved in melatonin dysregulation and circadian system disruption in those with autistic FXS. Additionally, we discuss the neuroprotective effect of melatonin intervention. This may improve neuroplasticity and physical capability. We also review the underlying molecular mechanisms, and suggest that melatonin may be a useful novel treatment for autistic FXS, countering the adverse effects of circadian variation.

Hybrid forecasting methods have emerged as a solution surpassing the limitations of both statistical and deep learning approaches. While the first emphasize the significance of variables, they often produce worse forecasting results when compared to newer techniques. In contrast, deep learning models remain enigmatic "black boxes" in terms of interpretability, although achieving better results in forecasting. This article introduces the Comprehensive Cross-Correlation and Lagged Linear Regression Deep Learning (CCLR-DL) framework, designed to harness the best of both approaches, enhancing forecasting accuracy while retaining model interpretability through a feature selection process. CCLR-DL blens cross-correlation analysis, lagged multiple linear regression and granger's causality procedures with deep learning architectures based on LSTM. In a practical demonstration, CCLR-DL was applied to a real database of clinical visits associated to diagnoses in Catalonia, Spain (tracking a population of 6.3 million patients during 10 years). Predicting visits enables the healthcare managers to be ready for future demand shifts. Results demonstrate a consistent and substantial improvement over standalone statistical and deep learning methods when predicting healthcare demand. This hybrid approach not only showcases its efficacy but also offers a promising solution to the challenge of balancing predictive accuracy with model explicability. In this context, this work aims to design and validate a method for feature selection and forecasting of multivariate high dimensional time series datasets not only to improve prediction accuracy but also to model transparency by identifying a subset of variables that improve predictions and G-cause the target variable.

Tooth decay, also known as caries, is a significant medical problem that harms teeth. Treatment is based on the removal of the carious material and then filling the cavity left in the tooth, most commonly with amalgam or composite resin. The consequences of filling failure include repeating the filling, or performing another treatment, such as a root canal, or extraction. Dental amalgam contains mercury, and there is a global effort to reduce its use. However, no consensus has been reached using randomized clinical trials, regarding whether amalgam or composite resin materials are more durable, and which is the best restorative material. To determine which material is superior, we performed a retrospective cohort study using a large database where members of the 58 dental clinics with 440 dental units were treated. The number of failures of the amalgam compared to composite resin restorations between 2014 and 2021 were compared. Our data included information from over 650,000 patients. Between 2014 - 2021, 260,905 patients were treated. 19,692 out of 113,281 first amalgam restorations failed (17.49%), whereas significantly fewer composite restorations failed (11.98%) 65,943 out of 555,671. This study indicates that composite is superior to amalgam and therefore it is reasonable to cease using mercury containing amalgam.

Maternal infectious disease may pose considerable challenges to the fetal health due to the distribution of important elements of the sanguine and lymphatic system from the mother via the umbilical cord. The mother and the fetus have a degree of interdependence that is similar to the one between the eukaryotic cell and the mitochondrion, particularly during the first half term of the pregnancy, which explains the increased appetite of the expecting mother during the first stages of the fetal development. There is a solid bridge between the adaptive immune system and the encephalon that was only discovered a few decades ago. As a result, scientists may still be in the introductory stages of research, and there might be a significant and profound degree of association between the immune system and a healthy neurological development. There is a significant link between the onset of significant maternal infectious disease and the onset of neurodevelopmental disease in the fetus, and virtually all immune cells play major roles in the promotion and inhibition of neurogenesis alike. Likewise, there is a probability that maternal infectious diseases during pregnancy represent a risk factor of fetal neurodevelopmental disease, as a pressurised development of the adaptive immune memory could result in a pressurised or inhibited neurological development, which both can result in a delayed development of certain sub-regions of the brain. For example, the fetus may display poorer social abilities and sharp analytical skills later in life, which is an important sign of neurodevelopmental disease. A pressurised development of the adaptive immune memory could not require the development of a significant form of disease, but rather just a sharp rate of immune preparation against several important pathogenic agents during the introductory stages of life, when the encephalon experiences the sharpest increase rate in development. The problem per se is not the process of immunisation, but a much sharper process of immunisation over the first stages of life in case of an exposure to one dangerous pathogen or more numerous kinds of pathogens and antigens that normally cause moderate disease morbidity. The more dangerous the microbe is, the sharper the development of the adaptive immune memory will be, and the same happens in the case of an increased number of infectious microbes and antigens that infected the cells of the mothers and the fetuses in cause, and this may, in the majority of the situations, still be the case even if the pathogens are already significantly weakened or lifeless, given that the gain of adaptive immune memory alone constitutes an important factor of neurogenesis and an increased rate of neurological development, and that the infant will become almost or fully protected against the pathogens in cause, despite not having had experienced the disease beforehand. In this case, neurodevelopmental delays are possibly not caused by an impaired neurogenesis, but by an excessive one, whilst maternal infection-associated neurodevelopmental delays may be caused by an impaired neurogenesis. Nevertheless, the aetiology of immunity-related neurodevelopmental delays may be more complex in nature and implicate a chronological and spatial sequence of induced excedentary and deficitary rates of neurogenesis, hence reflecting the incredibly complex nature and various forms of neurodevelopmental disease. It is important to mention that a single dose of infant immunisation brings significantly lower risks of adverse neurological events than the onset of a significant maternal infectious disease during pregnancy. The objective of paediatric neuro-immunological studies may be to improve the understanding of the association between a healthy immune developmental rate and a balanced ratio of the developmental rates of important brain regions and sub-regions.

Gestational Diabetes Mellitus (GDM) is related with adverse outcomes for both the mother and the offspring. Immune and senescence play a crucial role in GDM progression. This study aims to explore the diagnostic significance of immune-related senescence (IRS) genes in GDM. We used weighted gene co-expression network analysis (WGCNA) and single sample gene set enrichment analysis (ssGSEA) to compute the immune score and aging score in control and GDM samples. Machine learning identified core IRS genes. Then we performed unsupervised cluster analysis in GDM patients to explore immune infiltration. Finally, we validated the core genes in clinical samples. We used the intersection of MEblack module from WGCNA and differentially expressed genes (DEGs) to obtain the potential genes. Next, a univariate logistic regression model including 23 potential genes were constructed, and these genes were filtered by least absolute shrinkage and selection operator (LASSO) algorithm. There were 5 potential genes (COX17, RRAS2, RRAGC, CECR1, and TACC2), which defined as biomarkers, remained eventually, and the efficacy of these biomarkers was evaluated by nomogram. Finally, the results from both qRT-PCR and western blot analyses demonstrated CECR1 was down-regulated, while TACC2 was up-regulated in GDM placental tissue. Our study identified CECR1 and TACC2 as diagnostic biomarkers for GDM associating with immune and senescence, providing a new perspective on GDM progression.

(1) Background: Sleep disordered breathing represent a growing public health concern, especially among children and adolescents. Full-night polysomnography is considered the gold standard for diagnosing obstructive sleep apnea. Our goals are to identify personal and environmental risk factors for the onset and persistence of sleep respiratory disorders. We also want to investigate the differences in neuropsychological profiles; (2) Methods: This is an observational, retrospective cohort study. We collected information on adenoidectomy or adenotonsillectomy. We reviewed the clinical history and preoperative visits and collected data through a telephone questionnaire. Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory (PedsQL) are questionnaires used for screening sleep respiratory disorders in children. The data were statistically analyzed it using SPSS version 22.0 for Windows (SPSS Inc., Chicago, IL); (3) Results: The study involved 138 patients, but only 100 parents participated. A higher percentage of patients with sleep disordered breathing were observed to have mothers who smoked during pregnancy. A smaller proportion of patients with sleep disordered breathing had a habit of using a pacifier. A rise in physical results is associated with a reduction in the PSQ at follow-up (p=0.051). An increase of overall academic achievement is associated with an average decrease in the PSQ at follow-up (p&lt;0.0001). A more significant proportion of patients undergoing adenotonsillectomy were observed to have a history of prematurity and cesarean birth (4) Conclusions: These results provide essential information on the effectiveness and effects of adenotonsillectomy intervention compared to adenoidectomy intervention and the factors associated with SDB in children undergoing these interventions.

The Work Ability Index (WAI) is the most widely used questionnaire for the self-assessment of working ability. Because of its different applications, shorter versions, and widespread use in healthcare activities, it is worthwhile assessing its characteristics. The WAI was distributed online among the workers of a healthcare company; the results were compared with data contained in the workers' personal health records and with absence registers. 340 out of 575 workers (59.1%) participated; 6.5% of them reported poor work ability. Exploratory factor analysis indicated that the one-factor version best described the characteristics of the WAI. The scores of the complete WAI, the shorter form without the list of diseases, and the minimal one-item version (WAS) had equal distribution and were significantly correlated. The WAI score was inversely related to age and significantly lower in women than in men, but it was higher in night workers than in colleagues due to the probable effect of selective factors. The WAI score was also correlated with absenteeism, but no differences were found between males and females in the average number of absences, suggesting that cultural or emotional factors influence the self-rating of the WAI. Workers tended to overreport illnesses in the online survey compared to data collected during occupational health checks. Musculoskeletal disorders were the most frequently reported illnesses (53%). Psychiatric illnesses affected 21% of workers and had the greatest impact on work ability. Multilevel ergonomic and human factor intervention seems to be needed to recover the working capacity of healthcare workers.

Obesity in pregnancy induces metabolic syndrome, low-grade inflammation, altered endocrine factors, placental function, and the maternal gut microbiome. All these factors impact fetal growth and development, including brain development. The lipid metabolic transporters of the maternal-fetal-placental unit are dysregulated in obesity. Consequently, the transport of essential long-chain PUFAs for fetal brain development is disturbed. The mother’s gut microbiota is vital in maintaining postnatal energy homeostasis and maternal-fetal immune competence. Obesity during pregnancy changes the gut microbiota, affecting fetal brain development. Obesity and a high-fat diet in pregnancy can induce placental and intrauterine inflammation and thus influence the neurodevelopmental outcomes of the offspring. Several epidemiological studies observed an association between maternal obesity and adverse neurodevelopment. This review discusses the effects of maternal obesity and gut microbiota on fetal neurodevelopment outcomes. In addition, the possible mechanisms of the impacts of obesity and gut microbiota on fetal brain development are discussed.

Parental stresses are normal responses to raising children. They are affected by stresses parents and children accumulate and bring to their interrelations. Background factors like economic difficulties or the relations between the parents may affect parental stresses as well as demographic and environmental factors like noise and access to urban parks. Most studies on parental stress are based on a verified psychological questionnaire. We suggest using frequency domain heart rate variability index (HRV) to measure parental stress enabling, by thus, the measurement of physiological aspects of stress and risk to health. Parental stress is measured as the difference between HRV accumulated at home while staying with the children and without the husband and HRV measured in the neighborhood while staying without the children and the husband. We use the index to compare differences among Muslim and Jewish mothers in exposure to maternal stress at their homes and to expose the factors that predict differences in maternal stress. We found that Muslim mothers suffer from home-related maternal stress while Jewish mother do not. Number of children and ethnically related environmental aspects predict differences in maternal stress between Muslim and Jewish mothers. Muslims' lower access to parks stems from lack of home garden and parks in their neighborhoods in the Arab towns but mainly by restrictions on Muslim women's' freedom of movement to parks. Despite differences in levels of noise at home and in the status of the mother in the household, these factors did not predict differences in parental stress. Instead, the study highlights the crucial role of greenery and freedom of movement to parks in moderating home-related maternal stress.

Background: United Nations Sustainable Development Goals state that by 2030, the Global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. This research aims to study regional trends in maternal mortality in Africa. Methods: We extracted data for Maternal mortality rates per 100,000 births from the UNICE data bank from 2000 to 2017, being 2017 the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9;-3,2%). All regions showed significant downward trends, with the sharpest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining sub-Saharan African regions are still far from achieving the goals. Conclusions: maternal mortality has decreased in Africa, especially in the South Africa region. The only region closed to the United Nations target is North Africa. The remaining sub-Saharan African regions are still far from achieving the goals. These results could be used for the development of Regional Policies.

The iodine intake in a pregnant woman has been closely correlated with development of transient congenital hypothyroidism which leads to decline in neurocognitive abilities of the child later in life as the effects are very subtle at birth. Both low and excess ingestion of iodine has been found to contribute to this cause, although iodine deficiency is more commonly observed in women of underdeveloped nations. It poses risks not only to the foetus but also to the mother leading to obstetric complications such as still birth and spontaneous abortions. It can be prevented using WHO recommended daily iodine supplementation in deficient regions or decreasing the excess load in groups exposed to high iodine. Programmes designed to screen the new-born at birth can also help in improving the quality of life of the child. The deficient iodine condition is managed by administration of levothyroxine in dosage range of 10-15 mcg/kg/day. Generally, the prognosis of infants starting treatment early in life have a better neurocognitive outcome as compared to the treated infants late age at a later age. Avoidance of agents causing iodine exposure has resulted in decrease in the abnormal thyroid function levels.

Alcoholic liver disease (ALD) is a major cause of chronic liver disease. This term covers a broad spectrum of liver lesions, from simple steatosis to alcoholic hepatitis and cirrhosis. The patho-genesis of ALD is multifactorial and not fully elucidated due to complex mechanisms related to direct ethanol toxicity with subsequent hepatic and systemic inflammation. The accumulation of pro-inflammatory cytokines and the reduction of anti-inflammatory cytokines promote the development and progression of ALD. To date, there are no targeted therapies to counteract disease progression and prevent acute liver failure. Corticosteroids reduce mortality by acting on the hepatic-systemic inflammation. On the other hand, several studies analyzed the effect of the inhibition of pro-inflammatory cytokines and the stimulation of anti-inflammatory cytokines as potential therapeutic targets in ALD. This narrative review aims to clarify the role of the cy-tokines in the pathogenesis and treatment of ALD.

One of the most promising advancements in healthcare is the application of digital twin technology. Digital twins are virtual replicas of real-world human patients and can be used for monitoring, and diagnosis, and as a tool to design treatment strategies tailored to individual patients. Furthermore, digital twins could also be helpful in finding novel treatment targets and predicting the effects of drugs and other chemical substances in development. This review article delves into the various data sources and methodologies that contribute to the construction of digital twins. Each data source, including blood glucose levels, heart MRI and CT scans, cardiac electrophysiology, written reports, and multi-omics data, comes with different challenges regarding standardization, integration, and interpretation. We showcase how various datasets and methods are used to overcome these obstacles and generate a digital twin. While digital twin technology has seen significant progress, there are still hurdles in the way to achieving a fully comprehensive patient digital twin. Developments in non-invasive and high-throughput data collection, as well as advancements in modeling and computational power will be crucial to improve digital twin systems. We discuss a few critical developments in light of the current state of digital twin technology. Despite challenges, digital twin research holds great promise for personalized patient care and has the potential to shape the future of healthcare innovation.

HIV infection invariably attracts the attention of medical staff in complex medical specialties. To achieve the goal of elimination by 2020, various approaches are required, including the establishment of prevention, diagnosis, monitoring, treatment, control measures. These should be supported by statistical studies that report on restricted or extended geographical areas, to the level of social class and age. Such an approach, combing the medical and social science perspectives (medicosocial) can prove useful for developing control measures. Due to the complexity of this immunodeficiency pathology, the condition also attracts comorbidities (most notably tuberculosis). Hence, prospective strategies need to be developed and oriented towards the goal of eradicating HIV infection. This paper presents strategies for consideration.

The rise in the volume, variety and complexity of data in healthcare has made it as a fertile-bed for Artificial intelligence (AI) and Machine Learning (ML). Several types of AI are already being employed by healthcare providers and life sciences companies. The review summarises a classical machine learning cycle, different machine learning algorithms; different data analytical approaches and successful implementation in haematology. Although there are many instances where AI has been found to be great tool that can augment the clinician’s ability to provide better health outcomes, implementation factors need to be put in place to ascertain large-scale acceptance and popularity.

Health information technology has been widely used in healthcare, which has contributed a huge amount of data. Health data has four characteristics: high volume; high velocity; high variety and high value. Thus, they can be leveraged to i) discover associations between genes, diseases and drugs to implement precision medicine; ii) predict diseases and identify their corresponding causal factors to prevent or control the diseases at an earlier time; iii) learn risk factors related to clinical outcomes (e.g., patients’ unplanned readmission), to improve care quality and reduce healthcare expenditure; and iv) discover care coordination patterns representing good practice in the implementation of collaborative patient-centered care. At the same time, there are major challenges existing in data-driven healthcare research, which include: i) inefficient health data exchanges across different sources; ii) learned knowledge is biased to specific institution; iii) inefficient strategies to evaluate plausibility of the learned patterns and v) incorrect interpretation and translation of the learned patterns. In this paper, we review various types of health data, discuss opportunities and challenges existing in the data-driven healthcare research, provide solutions to solve the challenges, and state the important role of the data-driven healthcare research in the establishment of smart healthcare system.

Evidence is emerging on the role of maternal diet, gut microbiota, and other lifestyle factors in establishing lifelong health and disease, which are determined by trans-generationally inherited epigenetic modifications. Understanding epigenetic mechanisms may help identify novel biomarkers for pregnancy-related exposure, burden, or disease risk. Such biomarkers are essential for developing tools for the early detection of risk factors and exposure levels. It is necessary to establish the exposure threshold to the fetus due to nutrient deficiencies or other environmental factors that can lead to clinically relevant epigenetic changes that modulate disease risks. This narrative review summarizes the latest updates on the roles of maternal nutrients (n-3 fatty acids, polyphenols, vitamins) and gut microbiota on the placental epigenome and its impacts on fetal brain development.

Based on the traditional Chinese cultural belief of "male breadwinner, female homemaker," as well as the systemic and interactive characteristics of families, this study aims to explore the influence of maternal gatekeeping behavior on the quality and quantity of paternal parenting, as well as adolescent aggressive behavior. A total of 483 seventh-grade students completed questionnaires on maternal gatekeeping behavior, paternal involvement, parenting styles and aggressive behavior. Latent profile analysis identified four parenting combinations: positive, negative, mixed, and neglectful. Adolescents under negative parenting exhibited the highest aggression, while those under positive and neglectful parenting showed the least aggression. Maternal gatekeeping behavior correlated with paternal negative parenting and adolescent aggression. Paternal negative parenting mediated the relationship between maternal gatekeeping and aggression, while paternal involvement moderated this relationship. These findings highlight the role of parental interaction in adolescent behavior and support family-based interventions.

This study focuses on the nuanced phenomenon of gendered parenting by exploring “how” and “when” maternal son preference associates with depressive symptoms among Chinese early adolescents. Focusing on 1,093 junior high school students from a relatively affluent city in western China, the research examined the mediating roles of mother-child attachment and father-child attachment, as well as the moderating role of school connectedness in the relationship between maternal son preference and depressive symptoms. The results revealed a noteworthy positive correlation between maternal son preference and depressive symptoms among female adolescents, with no significant association observed in males. In addition, mother-child attachment and father-child attachment mediated the relationship between maternal son preference and depressive symptoms, which supported the “spillover effect” and “crossover effect”. Moreover, moderation effect analysis indicated that higher level of school connectedness can buffer the effect of maternal son preference on girls’ depressive symptoms, while lower level of school connectedness can enhance the effect of maternal son preference on girls’ depressive symptoms. These insights help to enhance people's understanding of gendered parenting, emphasizing the enduring necessity of addressing son preference within the broader context of promoting gender equality.

Pregnancy at advanced maternal age is considered a risk factor for adverse maternal, fetal, and neonatal outcomes. Here we investigated whether maternal age could be associated with differences in the blood levels of newborn screening (NBS) markers for inborn metabolic disorders on the Recommended Universal Screening Panel (RUSP). Population-level NBS data from screen-negative singleton infants were examined, which included blood metabolic markers and covariates such as gestational age, birth weight, age at blood collection, infant sex, parent-reported ethnicity, and maternal age at delivery. Marker levels were compared between maternal age groups (age range: 15-44 years) using effect size analyses, which controlled for group size differences and potential confounding from other covariates. Our results showed that 13% of the markers had maternal age-related differences including newborn metabolites with either increased (C14, C16, C18, C18:1, C3DC) or decreased (C5OH) levels at advanced maternal age group (≥35 years, absolute Cohen’s d ≥ 0.2). The increased C3DC levels in this group correlated with a higher false-positive rate in newborn screening for malonic acidemia (p-value < 0.001), while no significant difference in screening performance was seen for other markers. Maternal age at delivery is associated with inborn metabolic differences and should be considered together with other clinical variables in genetic disease screening.

Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy 5-months-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (β=-0.22, p<0.05) and SIgA (β=-0.29, p<0.01), while social support was positively associated with milk IgG (β=0.25, p<0.05). Neither anxiety nor social support was related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological well-being and social support may affect milk immune properties.

Metal exposure has been associated with a wide range of adverse birth outcomes and oxidative stress is a leading hypothesis of the mechanism of action of metal toxicity. We assessed the relationship between maternal exposure to essential and non-essential metals and metalloids in pregnancy and oxidative stress markers, and sought to identify windows of vulnerability and effect modification by fetal sex. In our analysis of 215 women from the PROTECT birth cohort study, we measured 14 essential and non-essential metals in urine samples at three time points during pregnancy. The oxidative stress marker 8-iso-prostaglandin F2α (8-iso-PGF2α) and its metabolite 2,3-dinor-5,6-dihydro-15-15-F2t-IsoP, as well as prostaglandin F2α (PGF2α), were also measured in the same urine samples. Using linear mixed models, we examined the main effects of metals on markers of oxidative stress as well as the visit-specific and fetal sex-specific effects. After adjustment for covariates, we found that a few urinary metal concentrations, most notably cesium (Cs) and copper (Cu), were associated with higher 8-iso-PGF2α with effect estimates ranging from 7.3 to 14.9 % for each interquartile range, increase in the metal concentration. The effect estimates were generally in the same direction at the three visits and a few were significant only among women carrying a male fetus. Our data show that higher urinary metal concentrations were associated with elevated biomarkers of oxidative stress. Our results also indicate a potential vulnerability of women carrying a male fetus.

Dietary components are important for the structural and functional development of the brain. Among these, docosahexaenoic acid,22:6n-3 (DHA) is critically required for the structure and development of the growing fetal brain in utero. DHA is the major n-3 long-chain fatty acid in brain gray matter representing about 15% of all fatty acids in the human frontal cortex. DHA affects neurogenesis, neurotransmitter, synaptic plasticity & transmission, and signal transduction in the brain. Studies in animals and humans show that adequate levels of DHA in neural membranes are important for cortical astrocyte maturation and vascular coupling, and helps cortical glucose uptake and metabolism. In addition, specific metabolites of DHA are bioactive molecules that protect tissues from oxidative injury and stress in the brain. A low DHA level in the brain results in behavior changes and is associated with learning problems and memory deficits. In humans, the third trimester-placental supply of maternal DHA to the growing fetus is critically important as the growing brain obligatory requires DHA during this window period. Besides, DHA is also involved in the early placentation process, essential for placental development. This underscores the critical importance of maternal DHA intake for the structural and functional development of the brain. This review describes DHA's multiple roles during gestation, lactation, and the consequences of its lower intake during pregnancy and postnatally on the children's brain development and function.

Preterm birth (PTB), a multi-causal syndrome, is one of the global epidemics. Maternal nutrition, but also neonatal and placental telomere length (TL), are among the factors affecting PTB risk. However, the exact relationship between these factors and the PTB outcome, remains obscure. The aim of this review, was to investigate the association between PTB, maternal nutrition and placental-infant TL. Observational studies were sought, with the keywords: maternal nutrition, placenta TL, newborn, TL, and PTB. No study was found that included all keywords simultaneously, and thus, the keywords, were searched in dyads, to reach assumptive conclusions. The findings show that maternal nutrition affects PTB risk, through its influence on maternal TL. On the other hand, maternal TL independently affects PTB risk, and at the same time PTB is a major determinant of offspring TL regulation. The strength of the associations and the extent of the influence from covariates, remains to be elucidated in future research. Furthermore, the question of whether maternal TL, is simply a biomarker of maternal nutritional status and PTB risk, or a causative factor of PTB, to date, remains to be answered.

Improving the quality and access to healthcare services in rural areas is fundamental to develop sustainable healthcare systems. This research aims to explore the motivations of healthcare professionals to work and settle in rural island areas of Greece with limited access to secondary and tertiary care. The study suggests practical ways to encourage self-motivation and attract more health workers in rural areas. An exploratory qualitative research approach was employed, involving semi-structured interviews with 16 healthcare professionals working in primary care units that lack direct hospital or hospital-health center access. The research was conducted specifically in the rural islands of Cyclades. Thematic analysis was conducted to identify common themes and unique insights from the participants. The analysis revealed three thematic categories. Τhe «attraction» thematic was influenced by personal factors, random selection, origin, accommodation factors, professional factors and obligatoriness. The «recruitment» thematic was associated with understaffing, special care issues, unstable working environment, educational and organizational aspects, and insular lifestyle. The thematic of «retention» highlighted personal issues, accommodation difficulties, economic and work-related issues, and unique challenges posed by an insular lifestyle. This research provides valuable insights into the motivations that drive healthcare professionals to settle, work, and remain in remote island units, as well as the challenges they encounter in making this decision. The study proposes strategies to motivate and attract more healthcare professionals to rural areas. These findings should be considered when formulating or reviewing primary healthcare empowerment policies to ensure equitable healthcare access for all individuals.

Obesity is a complex chronic disease characterized by excess of body fat. It represents a significant public health problem due to the health-related risk factors. There are growing evidences showing that maternal obesity can program the offspring, which influence neonatal phenotype and predispose offspring to a higher prevalence of metabolic disorders such as obesity. This increased risk may also be epigenetically transmitted across generations. Thus, there is an urgent need to find effective reprogramming approaches in order to resume normal fetal development. Polyphenols are bioactive compounds found in fruits and vegetables that exert their anti-obesity effect through its powerful anti-oxidant and anti-inflammatory activities. Polyphenols supplementation has been proven to counteract the deleterious effects of maternal obesity programming on offspring. Indeed, some polyphenols can cross the placenta and protect the fetal predisposition against obesity. The present review summarizes the effects of dietary polyphenols on obesity-induced maternal reprogramming as an offspring anti-obesity approach.

Background: The aim of this experimental work was to confirm the individual uniqueness of lip prints, to verify the presence of recurrent patterns according to the Suzuki and Tsuchihashi classification and to search for characteristics that can be used in establishing the sex of a subject. Methods: Lip prints were taken from a sample of 172 volunteers using liquid lipstick and transparent adhesive tape and were digitally analyzed. Results: 59 prints (35.3%) were not considered for Suzuki and Tsuchihashi classification due to quality errors and the impossibility of visualizing lip wrinkles in one or more sextants, all the digitized prints revealed themselves to be unique after having been analyzed using superimposition. Qualitatively valid prints indicated a prevalence of Type II in both male and female and the presence of sex-linked features. A major problem was that the analysis of the same print by different operators often resulted in a different attribution of a Type. Conclusions: The potential of cheiloscopy lies mainly in the matching of prints, given their uniqueness, and can be a valid tool in gender determination but the absence of a database greatly limits its use. It is necessary to establish an acquisition protocol for taking and analyzing prints that could reduce the errors committed by the operator.

The healthcare system is crucial to the development, standard of living, and sustainability of any country. Amid the pandemic, most developed countries are experiencing varying levels of difficulty managing their healthcare systems. Overloading of healthcare services is common, leading to prolonged waiting times for medical services; thus, the wastage of hospital resources must be addressed seriously. In this paper, we examine the problem of no-shows in outpatient clinics. Through a review of the literature and practical industrial experience, we identify the processes of these clinics. We then propose a robust optimisation approach for overbooking using a traditional overbooking model and a robust system. This model aims to mitigate the significant parameter uncertainties encountered during the pandemic. Considering risk aversion, the optimal policy for overbooking can be established while accounting for the costs associated with overbooking. The main contribution of this paper is the introduction of an alternative method to address the uncertainty of no-shows using an overbooking technique.

Artificial Intelligence (AI) in healthcare has ushered in a revolutionary era by transforming the way we provide care and reduce adverse consequences. This paper explores the field of AI applications in healthcare, including side effect management, streamlined administrative procedures, and customized treatment programs.

Aim: We estimated the correlation between serum bilirubin concentrations and insulin resistance in advanced maternal age without diabetes mellitus. Method: The cross-sectional study involved consecutive 50 women of advanced maternal age without diabetes mellitus, and insulin resistance (IR) was diagnosed according to the homeostatic model assessment insulin resistant (HOMA-IR) formula and the cut-off point was set to more than 2.5. Serum bilirubin and HOMA-IR were compared between the IR (+) and IR (-) groups. Results: We found that serum bilirubin levels in the IR subjects were significantly decreased compared to those without IR (p = 0.0252). Serum bilirubin concentrations were negatively correlated with the weight and the fasting insulin concentrations in all subjects (r=−0.282, p=0.047, r=-0.424, p=0.002). Additionally, serum bilirubin had a negatively correlation with HOMA-IR (r = -0.410, p = 0.003) in all subjects. The multiple linear regression analysis found that serum total bilirubin levels were independently correlated with HOMA-IR (beta = -0.392, p= 0.015) in these subjects. Conclusions: The study demonstrated that serum bilirubin concentrations had negatively correlation with insulin resistance in advanced pregnant women without diabetes mellitus, and decreased serum bilirubin may forebode increased gestational diabetes mellitus risk in our study population.

During the last trimester of gestation and for the first 18 months after birth, both docosahexaenoic acid,22:6n-3 (DHA) and arachidonic acid,20:4n-6 (ARA) are preferentially deposited within the cerebral cortex at a rapid rate. Although, the structural and functional roles of DHA in brain development are well investigated, similar roles of ARA are not well documented. The mode of action of these two fatty acids and their derivatives at different structural-functional roles and their levels in the gene expression and signaling pathways of the brain have been continuously emanating. In addition to DHA, importance of ARA has been much discussed in recent years for fetal and postnatal brain development and the maternal supply of ARA and DHA. These fatty acids are also involved in various brain developmental processes; however, their mechanistic cross talks are not clearly known yet. This review describes the importance of ARA, in addition to DHA to support the optimal brain development and growth and functional roles in the brain.

Introduction The prevalence of adolescent electronic cigarette (e-cigarette) use has increased in most countries. This study determines the relation between the frequency of e-cigarette use and the frequency and intensity of cigarette smoking. Furthermore, it evaluates the association between the reasons for e-cigarette use and the frequency of its use. Materials and Methods Participants were 68,043 middle and high school students aged 13–18 years from the 2015 Korean Youth Risk Behavior Web-Based Survey. Of the 68,043 participants, we analyzed 6,655 adolescents with an experience of e-cigarette use. Results The prevalence of ever using and current (past 30 days) use of e-cigarettes was 10.1% and 3.9%, respectively. Of the ever e-cigarette users, approximately 40% used e-cigarettes for ≥1/month and 8.1% used e-cigarettes daily. Daily e-cigarettes users were 10 times greater among daily cigarette smokers than among cigarette users for <1/month (18.1% vs. 1.8%) and 16 times more prevalent among those smoking ≥20 cigarettes/day than among those smoking <1 cigarette/month (38.9% vs. 2.4%). The most common reason for e-cigarette use was curiosity (22.9%), followed by less harmful than conventional cigarettes (18.9%), smoking cessation (13.1%), and indoor use (10.7%). Curiosity was the most common reason among less frequent e-cigarette users; however, smoking cessation and indoor use were the most common reasons among more frequent users. Conclusions Results showed a positive relation between frequency or intensity of conventional cigarette smoking and frequency of e-cigarette use among Korean adolescents, and frequency of e-cigarette use differed according to the reason for the use of e-cigarettes.

Climate Change is the most serious planetary emergency of our time. Carbon emissions secondary to the healthcare industry account for about ten percent of all emissions in the United States. Health professionals, therefore, need to understand how they can make a difference in their profession, by understanding the health-related impacts of climate change and the importance of healthcare sustainability. An 8-week telementoring Climate Change Healthcare Sustainability ECHO series was developed to educate healthcare professionals in these topics such as the health-related effects of climate change, healthcare sustainability, quality healthcare and carbon accounting. A total of 376 participants from throughout the US and 16 other countries- completed this 8-week series and received no-cost continuing medical education credits. The evaluation consisted of pre and post Zoom polls, weekly post-session surveys and the registration demographics. Participants were primarily physicians and public health professionals who significantly improved their knowledge and communication skills after the course as compared to starting the training.

Artificial Intelligence (AI) describes computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and language translation. Examples of AI techniques are machine learning, neural networks and deep learning. AI can be applied in many different areas, such as econometrics, biometry, e-commerce and the automotive industry. In recent years, AI has found its way into healthcare as well, helping doctors to make better decisions (‘clinical decision support’), localizing tumors in magnetic resonance images, reading and analyzing reports written by radiologists and pathologists, and much more. However, AI has one big risk: it can be perceived as a ‘black box’, limiting trust in its reliability, which is a very big issue in an area in which a decision can mean life or death. As a result, the term Explainable Artificial Intelligence (XAI) has been gaining momentum. XAI tries to ensure that AI algorithms (and the resulting decisions) can be understood by humans. In this narrative review, we will have a look at the current status of XAI in healthcare, describe several issues around XAI, and discuss whether it can really help healthcare to advance, for example by increasing understanding and trust. Finally, alternatives to increase trust in AI are discussed, as well as future research possibilities in the area of XAI.

Background and purpose: Chronic kidney disease (CKD) is a common chronic disease usually associated with cardiovascular disease (CVD), and premature death and millions of people are at increased risk for CKD. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care. Usually, the nephrology units need coopera-tion from several other Healthcare Professionals (HCPs) such as cardiologists, nutritionists, ob-stetricians, and so forth. All modalities of treatments, peritoneal dialysis (PD) and Hemodialysis (HD) require HCPs and patients to develop a variety of skills to effectively deliver and manage dialysis tasks in the center or at home. Information and Communication Technology (ICT) in-terventions can offer tools that provide HCPs and patients with tools that facilitate the manage-ment of kidney patients in centers or at home. ICT interventions can allow to automate registra-tions, videoconferencing, minimize the geographic burden and resource cost savings. ICT can be the best way to promote cost saving on health spending and ensure the sustainability of the health system and, the environment as well. In the Iberian Peninsula, kidney patients consume about 3% of the total cost of healthcare. The cost of kidney transplants and dialysis is around 1.8 billion euros annually, and 75 % of this amount goes to dialysis treatment. Objective: This study aimed to evaluate and analyze the opinion of Healthcare Professionals (HCP) in Nephrology units about the Intervention of ICT in nephrology care and the Clinical benefits results from the use of ICT in Nephrology Services and dialysis Units in Portugal and Spain. Thus we collected the opinion of Health care professionals concerning the role of ICT intervention in nephrology. Understanding HCPs' feelings and attitudes is essential to understand if such technologies are correctly adjusted to the workflow and really bring huge benefits for the clinical practice of nephrology and also what features need improvement and what should be implemented in the future. ICT intervention has been implemented to promote better healthcare in nephrology units and improve patient outcomes. In the Survey, we intended to evaluate nephrology HCPs' opinions concerning the ICT interventions, in nephrology, represented by several tools that al-low the HCPs to implement solutions such as Remote Patient Monitoring(RPM); Remote Moni-toring of Treatment (RMT); Tele homecare; Telehealth (Tele-nephrology); Home Dialysis; mHealth; mobile App; Web Portal, Telemedicine, and so forth. Key Points: In many countries particularly in the Iberian Peninsula (Portugal and Spain) the incidence of CKD is substantially high. The “treatments” for kidney disease have not improved substantially over the past 50 years, leaving too many kidney patients with a poor quality of life and reduced life expectancy. This situation is associated with staggering aggregate annual costs amounting to €140 billion per year in Europe, more than the annual healthcare costs of cancer or diabetes [1]. The increased daily use of information and communication technologies may lead to the need for healthcare professionals to incorporate technology use competencies into practice.

There is a need for strategic healthcare workforce planning to address shortages and ensure universal health coverage, aiming to optimize work-force per population ratio, distribution, and competencies. Amidst rising demands exacerbated by aging populations and events like the COVID-19 pandemic, strategic workforce planning becomes crucial for addressing healthcare inequalities by forecasting needs, bridging skill gaps, and adapting to changing demographics and care models. Israel has invested in strategic planning to tackle healthcare workforce challenges; however, globally there is insufficient planning informed by health labor market analysis, which hinders efforts to address healthcare inequalities. The paper reviews national policies in Israel, Australia, Germany, and Norway, ex-amining statistics and government publications to highlight strategic plan-ning considerations and address challenges in healthcare workforce plan-ning. This paper focuses both on the critical role of physicians in healthcare systems, and on the changing borders between healthcare professions and different national contexts which demand more context dependent strategic workforce planning. We highlight common themes among national policies, including the need for data collection, increasing the capacity of domestic training programs, and the need to address geographic maldistribution of physicians. Ultimately, we aim to guide policy in the development of a re-silient and sustainable healthcare workforce capable of meeting diverse community needs and promoting equity in healthcare services.

Background: United Nations Sustainable Development Goals state that by 2030, the Global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. This research aims to study regional trends in maternal mortality in Africa. Methods: We extracted data for Maternal mortality rates per 100,000 births from the World Bank database from 1990-2015. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of -2.6%. All regions showed significant downward trends, with the sharpest decreases in East Africa. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining sub-Saharan African regions are still far from achieving the goals. Conclusions: maternal mortality has decreased in Africa, especially in East Africa. The only region closed to the United Nations target is North Africa. The remaining sub-Saharan African regions are still far from achieving the goals. These results could be used for the development of Regional Policies.

A variety of environmental factors contribute significantly to age-related cognitive decline and Alzheimer’s Disease (AD). Nutrition can alter epigenetics, improving health outcomes, which transmitted across generations; this process is called epigenetic inheritance. We investigate the beneficial effects of maternal resveratrol supplementation in offspring. We feed females SAMP8 with resveratrol-enriched diet during two months prior to mating. Direct exposed F1 generation and the transgenerational F2 generation were investigated. Object novel recognition and Morris water maze demonstrated improvements in cognition in the 6-month-old F1 and F2 generations from resveratrol fed mothers. A significant increase in global DNA methylation with a decrease in hydroxymethylation in F1 and F2 were found. Accordingly, Dnmt3a/b and Tet2 gene expression changed. Methylation levels of Nrf2 and NF-kβ genes promoters raised in offspring, inducing changes in target genes expression, as well as hydrogen peroxide levels. Offspring resulted from resveratrol fed mother showed increase AMPKα activation, mTOR inhibition and an increase in Pgc-1α gene expression and Beclin-1 protein levels. Endoplasmic reticulum stress sensors were found changed both in F1 and F2 generations. Overall, our results demonstrated that maternal resveratrol supplementation could prevent cognitive impairment in the SAMP8 mice offspring through epigenetic changes and cell signaling pathways.

Objective: To analyse the association between maternal risk factors such as age, body mass index (BMI) and cigarette smoking, with perinatal outcomes. Materials and Methods: This a retrospective analysis from prospectively collected data performed at Hospital Universitario de Torrejón (Madrid, Spain), between September 2017 and December 2019. All pregnant women with singleton pregnancies and non-malformed live fetuses attending their routine ultrasound examination at 11+0 to 13+6 weeks' gestation were invited to participate. Association between preeclampsia, preterm birth, gestational diabetes mellitus (GDM), small for gestational age (SGA) or fetal growth restricted (FGR) neonates and type of delivery according to maternal age, BMI, and cigarrete smoking was studied. Logistic mixed models were used to analyze the data. Results: 1921 patients were included in the analysis. Women of 40 years old had a significantly higher risk of having GDM (Odds Ratio (OR) 1.61, 95% Confidence Interval (CI) 1.08 to 2.36), and SGA neonates (OR 1.54, 95% CI 1.00 to 2.37). Women with a BMI &lt;18 had an increased rate of birth SGA and FGR neonates (OR 3.28, 95% CI 1.51 to 7.05, and OR 3.73, 95% CI 1.54 to 8.37, respectively), whereas women with a BMI ≥35 had a higher risk of GDM (OR 3.10, 95% CI 1.95 to 4.89). Smoking increased the risk of having SGA and FGR neonates (OR 1.83, 95% CI 1.36 to 2.46, and OR 1.91, 95% CI 1.29 to 2.78). Conclusions: Advanced maternal age, low or high BMI, and smoking status are significant risk factors for pregnancy complications. Both clinicians and society should concentrate their efforts on addressing these factors to enhance reproductive health.

Lack of water and salinity are common problems in many parts of the world. Therefore, some types of cacti can represent as promising crops. Therefore, the ability of cactus species to survive and adapt under natural stress conditions should be evaluated. In this study, it was aimed to evaluate the effect of salt stress on germination and emergence of pitaya seeds obtained from different fruit flesh colors, priming with plant growth regulators, namely salicylic acid (SA), oxalic acid (OA) and mepiquat chloride (MC). The experiment had a completely randomized design with a 2×4×3 factorial scheme corresponding to two pitaya cultivars (white and red fleshed), four NaCl concentrations (0, 2500, 5000 and 10000 ppm), and three PGRs (150 ppm/MC, SA, OC). The following variables were analyzed; germination percentage, mean germination time (MGT), germination stress tolerance ındex (GSTI), shoot length, seedling fresh weight and seedling dry weight ratio. According to the results, it was determined that the growing environment of the seed was important in salt stress resistance, while seeds matured in the environment with red fruit flesh were more tolerant to salt stress than white. Although Pitaya species are relatively salt tolerant, growth (about 30%) was significantly reduced above 2500 ppm and germination (about 45%) above 5000 ppm. MC was found promising as a priming agent in seeds obtained from fruits with white fruit flesh, and OA was found promising as a priming agent in seeds obtained from fruits with red fruit flesh in reducing NaCl-induced stress. Germination percentage stood out as the most important trait determining seed quality and was found to have positive effects on germination stress tolerance index (r: 0.63), seedling length (r: 0.74) and fresh seedling weight (r: 0.56). It is thought that the results obtained may contribute to pitaya cultivation and breeding.

There is increasing evidence that the non-cooperative models describe household structures in developing countries more succinctly compared with the unitary model. Domestic violence against women, which is pervasive in Nigeria even though likely to be under-reported, will need to be understood within the framework of non-cooperative relationship between couples. In this study, we identify factors of domestic violence against women within couples who were currently in marital or cohabiting partnerships. Also, we investigate whether domestic violence influences the decision of women to terminate pregnancies. We use data from the 2018 Nigeria Demographic and Health Survey (NDHS). Multivariate logistic regressions were used to model the predictors of domestic violence, and its influence on the decision to terminate pregnancies among married women. Of the 8,910 married women interviewed for domestic violence, 35.33% had ever experienced a form of domestic violence. We discover that women: with higher education, that is not poor, and resides in urban areas have 44%, 18% and 15% reductions in the odds of experience domestic violence respectively. On the other hand, women who are employed, own land, having husbands/partners that are employed in the agricultural sector, and drink alcohol have 1.16, 1.2, 2.07, and 2.8 times increased odds of experiencing domestic violence accordingly. Also, we uncover that currently married women experiencing domestic violence have 1.25 times increased odds of terminating pregnancies compared with their counterparts that are not experiencing domestic violence. Effectively, poverty, low levels of education, residing in rural areas, drinking habit of husbands/partners, employment, marital capital, and land ownership status of women are risk factors of domestic violence against married women in Nigeria but can be affected by policies and programmes. Importantly, public actions to contain domestic violence in order to improve maternal health should be implemented in the context of the dynamics of a non-cooperative relationship existing between married couples.

The importance of frailty in older people is getting constant recognition as an important aspect both in terms of public health, as well in personal level for the appropriate management of an older person health condition. This is reflected by the continuously increasing number of research studies carried out in several settings across different countries. Sometimes this is very solid, but in other cases there is a considerable gap in terms of accurate and well grounded documentation of frailty status. This is the case in Greece, where we are missing clinically validated tools to approach frailty. We are missing frailty screening tools, such as for instance PRISMA 7, the gold standard tool of Fried criteria is somehow problematic since the question referring to physical activity originates from a questionnaire that has not been translated and validated, while Clinical Frailty Scale has been validated for the translation but not for the capacity to detect frailty. Aim of this study is to validate these tools for their accuracy to detect frailty by using a measurable index of frailty, previously proposed for use in clinical studies: the Short Physical Performance Battery (SPPB). 74 male and female participants have been evaluated for their frailty status using different tools. We observed that PRISMA 7 translation detects frailty only when one question is removed at a cut-off of ≥ 2 and indicated a sensitivity of 88.1%, and specificity of 99.9% with a good correlation with SPPB measurements (r = 0.858; p &lt; 0.001). When CFS was validated using SPPB it demonstrated a very good correlation (r = -0.838; p &lt; 0.001 respectively) as it was the case for the modified Fried Criteria (r = -0.725; p &lt; 0.001). All items demonstrated a good correlation between them. We can here propose that we can accurately assess frailty status in the community setting by using a modified version of Fried criteria, Clinical Frailty Scale translation in Greek and we can screen for frailty by using the Greek translation of PRISMA 7 only after removing the item 6 of the questionnaire.

Telemedicine has been increasingly considered an effective strategy to support patients with several diagnosis and therapies, avoiding the on-site visit and drastically reducing the risks to share infections. In the recent years, a number of different technologies have been developed and applied to clinical studies, with the aim to investigate new ways for increase the early diagnoses and monitor the clinical evolution of the most predictable diseases directly from the patients’ home. Telemedicine refers to all those technological interfaces used to remotely perform clinical procedures. Telemedicine applications could be useful in several medical fields, such as preventive medicine, home patient care, education for healthcare professionals and patients, research, public health, and health management. On the other hand, the synergy of these different technologies has a significant impact on the clinical risks analysis, particularly useful in frail patients. Although Telemedicine shows to have important advantages, undoubtedly important issues still remain. The present work aims to shed light on the main advantages and disadvantages related to of each application’s features, which may serve as a useful tool for researchers.

The emergence of blockchain know-how currently presents the opportunity for the health sector to adopt such technologies in electronic health records. Blockchain assists in maintaining and sharing the relevant medical records of the patient with the relevant group of healthcare providers and the hospital. Numerous specific applications include traceability of drug and patient monitoring or Electronic Health Records (EHR). While Blockchain assists in maintaining and sharing the relevant medical records of the patient with the relevant group of healthcare providers and the hospital, it is important to note that the moral consciousness of the healthcare professionals is the main guide of the moral consciousness is ethics. This paper presents an overview of the application of blockchain in the healthcare and medical sector, highlighting the specific challenges and concerns. The study adopted a systematic review of secondary literature in answering the research question.

Pregnancy entails bidirectional interactions between the developing fetus, the maternal tissues, and the organ systems. To this end, the phenomenon of migration of fetal cells (FCs) into the maternal circulation is poorly understood. Here, we review literature underlying the migration of FCs from the placenta to the maternal circulation, which is likely a dynamic process, including trophoblast invasion, placental angiogenesis, modulation of maternal immune responses, and enlargement of maternal organs. As placental neovascularization fosters direct connections between fetal and maternal circulatory systems, the trophoblast, a pivotal to placental development, adeptly deploys an array of invasive strategies to breach maternal tissue barriers, facilitating FC escapade into the maternal circulation. The intricate balance struck by the maternal immune system, which both acts as a guardian against potential foreign cell threats and orchestrates a niche conducive to FC survival and differentiation, is facilitated by finely tuned interactions among regulatory T cells, cytokines, and inhibitory receptors. FC presence in mothers’ circulation may be clinically relevant and unveil novel molecular participants like lncRNA, exosomes, and intricate signaling pathways that drive innovative clinical approaches for diagnostics and therapeutics. Ongoing research should reshape our knowledge of pregnancy and maternal-fetal health by improving our understanding of fetal-maternal interactions.

Background: Supportive supervision has lately been gaining traction in various national health systems as an effective way of boosting the performance of community health workers in a constructive and sustainable way. However, not much is known about the basis/mandate of supportive supervision and its approach in maternal and child health programs in India. The current analysis contributes to a clearer understanding of the paradigms within which supportive supervision is envisioned to operate within India and identifies potential strengths and areas requiring attention. Method: Document analysis of implementation documents such as guidelines/ operational manuals/operationalization modules/ training modules of nationally implemented maternal and child health programs, with data extraction according to a pre-determined domain-based template. Results: Many of the documents reviewed do not mention supportive supervision at all. In the few documents where supportive supervision is mentioned, the paradigms within which it is supposed to operate (who will do it, when will it be done, how to do it, training and logistic support, reporting formats, etc.) have not been clearly identified in most programs. Conclusion: Even though supportive supervision is being increasingly identified as an effective way of performative improvement in national health programs in India, more effort needs to be put into identifying and enforcing the tenets of supportive supervision in practice, in order to bring about the desired change.

Humans are evolutionary-driven to adult mating and conceive social expectations on the quality of their affiliations. The genetic susceptibility to adverse environments in critical periods can alter close relationships. The current research investigates how the promoter region of the Serotonin Transporter Gene (5-HTTLPR) and perceived caregiving behavior in childhood could influence the social expectations on close adult relationships. For this purpose, 5-HTTLPR data was collected from the buccal mucosa of 65 Italian individuals (33 males). The participants filled a) the Parental Bonding Instrument (PBI) to provide the levels of care and overprotection from mother and father, and b) the Experience in Close Relationships-Revised (ECR-R) to report the social expectations on the intimate relationship assessed in terms of anxiety and avoidance from the partner. An interaction effect between 5-HTTLPR and PBI dimensions on the ECR-R scores was hypothesized. Results confirmed that the interplay between the genetic groups and history of maternal overprotection predicted avoidance experienced in romantic relationships in adulthood. Moreover, both adult anxiety and avoidance felt in an intimate relationship were found to covary as a function of maternal overprotection. The present work proposes further evidence of the genetic and parental mechanisms regulating social expectations involved in close relationships.

Long-chain omega-3 fatty acid status during pregnancy may influence newborn anthropometry and duration of gestation. Evidence from high-quality trials from LMICs is limited. We conducted a double-blind, randomized, placebo-controlled trial among 957 pregnant women (singleton gestation, 14-20 weeks’ gestation at enrollment) in India to test the effectiveness of 400 mg/d algal docosahexaenoic acid (DHA) compared to placebo provided from enrollment through delivery. Among 3379 women who were screened, 1171 were found eligible; 957 enrolled and were randomized. The intervention was two microencapsulated algal DHA (200 X 2= 400 mg/d) or two microencapsulated soy and corn oil placebo tablets to be consumed daily from enrollment (20 weeks) through delivery. The primary outcome was newborn anthropometry (birth weight, length, head circumference). Secondary outcomes were gestational age and 1 and 5 min Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score. The groups (DHA; n=478 and placebo; n=479) were well balanced at baseline. There were 902 live births. Compliance with the intervention was similar across groups (DHA: 88.5%; placebo: 87.1%). There were no significant differences between DHA and placebo group for birth weight (2750.6 ± 421.5 vs. 2768.2 ± 436.6 g, p=0.54), length (47.3 ± 2.0 vs. 47.5 ±2.0 cm, p=0.13) or head circumference (33.7 ± 1.4 vs 33.8 ± 1.4 cm, p=0.15). The mean gestational age at delivery was similar between groups (DHA: 38.8 ± 1.7 placebo: 38.8 ± 1.7 wk, p= 0.54) as were APGAR scores at 1 and 5 min. Supplementing mothers through pregnancy with 400mg/d DHA did not impact the offspring birthweight, length or head circumference.

The study explored the community perception of maternal deaths influenced by natural disaster, practice of maternal complications during natural disaster among the rural population in Bangladesh. It also explored the challenges faced by the community for providing health care and referring the complicated pregnant mothers during disaster. Three focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted in the marginalized rural communities in the flood-prone Khaliajhuri sub-district, Netrakona district, Bangladesh. Flood is one of the major risk factors for influencing maternal death. Pregnant mothers seriously suffer from maternal complication, lack of antenatal checkup and even any doctor during flood. During the time of delivery, it is difficult to find even a skilled attendant and referring the patient with delivery complications to the healthcare facility. Boat is the only mode of transport. Majority maternal deaths occur on the boats during transfer from the community to the hospital. The rural people feel that the maternal deaths influenced by natural disaster are the natural phenomena. It needs some pre-preparation to support pregnant women during the disaster. There is unawareness of maternal health, related care and complications during disaster among the local health service providers and volunteers.

(1) Background: Premature infants require mothers’ milk fortification to meet nutrition needs, but breast milk composition may be variable leading to a risk of inadequate nutrition. We aimed at determining factors influencing mothers’ milk macronutrients. (2) Methods: Milk samples were analyzed for the first 5 weeks after premature delivery, by infrared spectroscopy. Mothers’ nutritional intake data were obtained during standardized interviews with dieticians then analyzed with reference software. (3) Results: Composition of 367 milk samples from 81 mothers was (Median [range]g/100mL): Carbohydrates 6.8[4.4-7.3], lipids 3.4[1.3-6.4], proteins 1.3[0.1-3.1]. There was a relationship of milk composition with mothers’ carbohydrates intake only (r=0.164; p<.01). Postnatal age was correlated with milk proteins (r=-0.505 p<.001) & carbohydrates (r=+0.202, p<.001). Multiple linear regression analyses showed (coefficient) a relationship between milk proteins r=0.547 and postnatal age (-0.028), carbohydrates intake (+0.449) and the absence of maturation (-0.066); and between milk lipids r=0.295 and carbohydrates intake (+1.279) and smoking (-0.557). Finally, between milk carbohydrates concentration r=0.266 and postnatal age (+0.012) and smoking (-0.167). (4) Conclusions: Variability of mothers’ milk composition is differentially associated for each macronutrient with maternal carbohydrates intake, antenatal steroids, smoking, and postnatal age. Improvement in milk composition could be achieved by modification of these related factors.

The consumption of alcohol and drugs of abuse among pregnant women has experienced a significant increase in the last decades. Optimal maternal nutritional status is of great importance for proper fetal development, yet is often altered with alcohol or drugs consumption. There is a lack of information on the effects of alcohol and drugs on maternal nutritional status, so the focus of this review was to provide an overview on nutrional status of mother and fetus in abusers pregnant women. Alcohol and drugs consumption can adversely affect the quality and quantity of proper nutrient supply and energy intake, resulting in malnutrition especially of micronutrients (vitamins, omega-3, folic acid, zinc, choline, iron, copper, selenium). When maternal nutritional status is compromised by alcohol and drugs essential nutrients are not available for the fetus, this can result in suboptimal outcomes like Intrauterine Growth Restriction (IUGR) or Fetal Alcohol Spectrum Disorder (FASD). It is critical to determine a means to resolve and reduce the physical and neurological malformations that develop in the fetus as a result of prenatal alcohol and drugs exposure combined with poor maternal nutrition. Prenatal nutrition interventions are required that may prevent or alleviate the development of such abnormalities.

AbstractBackground: In digitalization era, health care system was conditioned with the health worker’s ability to adapt media of digital technology. Digital technology media was used to strengthening and fasted the health care for patient and community. Aims: This study aimed to explore the accurate information of health professional utilization digital technology during doing the job at the health facilities in Timor-Leste. Methods: This study was used correctional study with 56 respondents was participated in the study. Was collected the data from 1 to 30 February 2023. Was used questioner of google form based for data collection. Data collection was distributed via online with google form to social media as WhatsApp’s, email and face book and twitter to completed by respondents. The inclusive Criteria are: health professional living in Timor-Leste, to able response the questioner. Was used descriptive analysis in this study. Finding: This study was indicated that majority of health professional was participated in the study as 54,2% man then women have 45,8%. About 100% health professional used hand phone to facilitate their daily activities including related with their work activities. Other side indicated in digital technology tools use are able to use Microsoft word is 78,3%, able to use Microsoft Excel is 76,7% and able to use Power Point is 81,7%. E-mail use about 89,2%, WhatsApp’s use 81,7%, About 74,2% was used zoom/webinars/Google meet application, about 72,5% sad that they were used computer in the work place until now. Around 96.4% need to improve or deepen their knowledge and skills in using ICT in the future to facilitate they are activity. Conclusion: Majority of health professional in Timor-Leste was used the computer, internet, hand phone in daily activities. Majority need to gate the training to improve their knowledge, attitude and psychomotor in the future.

Introduction: Substance-induced psychotic disorder (SIPD) is a mental health condition linked to the use of a psychotropic substance whose pathogenesis has not been totally clarified. The present retrospective observational study has the objective to identify differences in clinical features and peripheral biomarkers in SIPD patients according to the main substance of abuse.Methods: A total sample of 218 patients was divided in 3 groups according to the type of consumed substance: alcohol, cannabis and psychostimulants. The 3 groups were compared for continuous variables by one-way analyses of variance (ANOVAs) and for qualitative variables by χ² tests. After removing alcohol-induced psychotic disorder group, the same analyses were repeated. Statistically significant variables from these latter analyses were included in a binary logistic regression model to confirm their reliability as predictors for cannabis- or psychostimulants-induced psychotic disorders. Results: Psychotic cannabis abusers were younger (p<0.01) and had an earlier age at onset (p<0.01). On the contrary, alcohol consumers resulted to have a longer duration of illness (p<0.01), more previous hospitalizations (p=0.04), more frequent medical comorbidity (p<0.01), higher mean Modified Sad Person Scale scores (p<0.01). Finally, psychostimulant abusers had more frequently a lifetime history of poly-substance use disorders (p<0.01). Binary logistic regression revealed that higher mean Brief Psychiatric Rating Scale scores (p<0.01) higher sodium (p=0.012) and haemoglobin(p=0.040) plasma levels were predictors of cannabis misuse in SIPD patients.Conclusions: Different clinical factors and biochemical parameters con be associated to SIPD according to the main substance of abuse, thus requiring a specific management by clinicians.

Background: This study explored maternal gut, breast milk and infant gut microbiomes as possi-ble mediators of the observed effects of a relaxation intervention which reduced maternal stress and promoted infant weight gain. Methods: A randomized controlled trial was conducted in healthy Chinese primiparous mother-infant pairs. Mothers were randomly assigned to interven-tion group (IG, listening to relaxation meditation) or control group (CG). Outcomes were differ-ences in microbiome composition and diversity in maternal gut, breast milk and infant gut at 1- and 8-weeks between IG and CG, assessed by 16S rRNA gene amplicon sequencing of fecal and breastmilk samples. Results: 38 mother-infant pairs were included in this analysis (IG=19, CG=19). Overall microbiome community structure in the maternal gut was significantly different between IG and CG at 1-week and the difference was more significant at 8 weeks (Bray-Curtis distance R2=0.04 vs. R2=0.13). Post-intervention, the α-diversity was significantly lower in IG breast milk (observed features: CG=295 vs. IG=255, p=0.032); the Bifidobacterium genera presented higher relative abundance. In parallel, significantly higher α-diversity was observed in IG infant gut (observed features: CG=73 vs. IG=113, p

This study aimed to evaluate the impact of selected pregnancy pathologies statistically depending on overweight/obesity and excessive maternal weight gain during pregnancy on women who gave birth in the years 2013–2015 at the Second Department of Gynecology and Obstetrics at the University Hospital in Bratislava, Slovakia. In a retrospective study, we analyzed data gathered from the sample, which consisted of 7,122 women. Our results indicate a positive statistical dependency of the groups of women with overweight and obesity and gestational hypertension (adjusted odds ratio [AOR]=15.3; 95% CI 9.0−25.8 for obesity), preeclampsia (AOR=3.4; 95% CI 1.9−6.0 for overweight and AOR=13.2; 95% CI 7.7−22.5 for obesity), and gestational diabetes mellitus (AOR=1.9; 95% CI 1.2−2.9 for overweight and AOR=2.4; 95% CI 1.4−4.0 for obesity). A higher incidence of pregnancies terminated by cesarean section was observed in the group of obese women. Gestational weight gain above the IOM (the Institute of Medicine) recommendations was associated with a higher risk of pregnancy terminated by C-section (AOR=1.2; 95% CI 1.0−1.3), gestational hypertension (AOR=1.7; 95% CI 1.0−2.7), and infant macrosomia (AOR=1.7; 95% CI 1.3−2.1). Overweight and obesity during pregnancy significantly contribute to the development of pregnancy pathologies and increased incidence of cesarean section. Systematic efforts to reduce weight before pregnancy through pre-pregnancy dietary counseling, regular physical activity, and healthy lifestyle should be the primary goal.

Over the last decade, the prevalence of health issues has increased by approximately 29.1%, putting a substantial strain on healthcare services. This has accelerated the integration of machine learning in healthcare, particularly following the COVID-19 pandemic. The utilization of machine learning in healthcare has grown significantly, however many present approaches are unsuitable for real-world implementation due to high memory footprints and lack of interpretability. We introduce DeClEx, a pipeline designed to address these issues. DeClEx ensures that data mirrors real-world settings by incorporating gaussian noise and blur and employing autoencoders to learn intermediate feature representations. Subsequently, our convolutional neural network, paired with spatial attention, provides comparable accuracy to state of the art pre-trained models while achieving threefold improvement in training speed. Furthermore, we provide interpretable results using explainable AI techniques. We integrate denoising and deblurring, classification and explainability in a single pipeline called DeClEx.

Management of a healthcare unit demands high prerequisites. It is a challenging organizational job for the healthcare decision-makers or leaders to tackle biomedical threats and deliver care service to huge number of affected populations in different demographic area. Health administration take innovative strategies to provide fundamental and life-saving services to the patients, when keeping the safety of the frontline medical workers is undoubtedly a priority. COVID-19 pandemic has changed the overall functioning of the healthcare system globally with alteration in the health decision-making protocols. Through this article, I have elucidated the challenges of healthcare along with today’s managerial paradigms to tackle the problems and run the system in a regulated manner.

Humming is probably more effective than speech improving mothers' cardiorespiratory function and infants' self-regulation. We intend to understand the effects of: 1) maternal humming vs. speech on preterm infants’ physiological parameters; 2) maternal humming vs. speech on mothers’ physiological parameters; 3) humming melodic contours and of the lengthening of the final note on preterm infants’ physiological parameters. This study was designed as a single group repeated measure, using microanalytical methodology (ELAN software), with a protocol (silent baseline / speech or humming / silence / humming or speech / silence) applied to preterm dyads (N = 36). Audio and video observations were recorded. Infants’ and mothers’ heart rate (HR) and O2 saturation were observed once a minute. Proportion of O2 saturation relative to HR (Prop. O2 saturation/HR) was estimated for both partners during protocol. We found an infants’ HR mean significantly lower during humming (p = .028), a significantly higher Prop. O2 saturation/HR during humming for infants (p = .027) and for mothers (p = .029). The duration of sinusoidal contours together with the lengthening of the final note predict infants’ Prop. O2 saturation/HR. Musical features of humming seem to improve the physiological stability of preterm infants during kangaroo care.

Congenital cytomegalovirus (cCMV) infection resulting from non-primary maternal infection or reactivation during pregnancy can cause serious fetal-neonatal sequelae. We describe a male newborn born at term, with signs of perinatal asphyxia, and intractable acute provoked seizures, in the context of severe cCMV infection. The newborn was delivered in a referral hospital by emergency caesarean section due to fetal distress. Due to signs of asphyxia at birth and clinical moderate encephalopathy (Sarnat 2), he was transferred to our center for therapeutic hypothermia. Continuous full video-electroencephalography monitoring showed no seizures during the first 72 hours, however, soon after rewarming, he presented refractory status epilepticus. Cranial ultrasonography revealed bilateral ventricular and intraparenchymal hemorrhage. Routine infectious screen-ing on urine, blood, cerebrospinal fluid, and nasopharyngeal secretions revealed positive CMV DNA Polymer-ase Chain Reaction (PCR) on all samples. The CMV DNA performed on the bloodspot (Guthrie) card taken at birth yielded a positive result, confirming the intrauterine transmission and congenital origin of the infection. Maternal non-primary CMV infection in pregnancy is transmitted to the fetus in 0.5-2% of cases. When transmitted, it may cause serious fetal abnormalities, complications in the immediate neonatal period, and se-vere sequelae later in childhood. During pregnancy, it is useful to monitor maternal serology for CMV, even in previously immunized mothers, to identify signs of new infection or viral reactivation and implement measures to prevent neonatal sequelae. The possible advantages of standardized CMV screening of all newborns are a pertinent discussion point, as this may enable us to identify affected neonates timeously and prevent long term disabilities.

Background: The new media provides a convenient digital platform to access, use and exchange health information. As a special group of health care, maternal is still of international concern due to their high mortality rate. Improving maternal health as a Millennium Development Goal of the United Nations is an important quest for the health care system. Scientific research provides advice on how to improve maternal health through stringent reasoning and accurate data. However, the dramatic increase of publications, the diversity of themes, and the dispersion of researchers may reduce efficiency. Objective: This study aims to analyze the research progress on maternal health under the global new media environment, exploring the current research hotspots and research frontiers. Methods: A scientometric analysis was carried out by CiteSpace5.7.R1, searching in the core database of Web of Science for articles published in English from 1998 to 2021, and combined topic words such as new media, maternal, and health. In total, 3312 articles have been retrieved, of which 2270 studies have been included for further analysis. Top countries and institutions, potentially high-impact literature, research frontiers, and hotspots were analyzed in this study. Results: The number of publications grew rapidly after 2008, from 29 publications sharply increasing to 472 publications by 2020. Research centers concentrated in Latin America, such as the University of Toronto, the University of California. The work of Larsson M, Lagan BM, Tiedje L, and Helle C had a high potential impact. Most of the research subjects were maternal and newborn babies, and the research frontiers focused on health education and maternal psychological problems. Maternal mental health, maternal and infant nutrition, weight, production technology, and equipment were hotspots. Conclusion: The development of new media has brought a new era for maternal health, characterized by psychological qualities, healthy and reasonable physical conditions, and advanced technology.

Background: Maternal mortality (MM) is a matter of serious concern in low income developing countries (LDCs). Perspective: A great reduction has been observed regarding the maternal deaths globally after huge efforts since 1990 todate. However, the situation continues to be either stagnant or worsening in developing countries, suggesting that the efforts to cope with this issue are either insufficient or not properly implemented. We need to first diagnose the problem areas that are a great hurdle in the road to success towards the reduction of MM. Postpartum haemorrhage and preeclampsia are one of the most common causes of MM. Malnutrition, neurological dysfunction and cancer are among the non-obstetric causes. Trained medical and paramedical staff can be of great help in this regard by increasing awareness among masses at grass root level. Target set by Millennium Development goal has minimized the MM by 44%. But it has not met the target set by Millenium Development Goals 5 and a lot of measures need to be taken in this regard. Conclusions: Majority of the MDs are preventable and can be avoided by adopting appropriate frameworks, linked data sets, surveillance, birth attendants training, preparation for births, etc. Delay in decision to get healthcare, access to healthcare center and receiving these facilities are the main factors in MM.

Embryo implantation is a hallmark of the female reproductive biology of eutherian (placental) mammals and does not exist in a sustainable form in any other vertebrate group. Implantation is the initial process that leads to a sustained fetal-maternal unit engendering a complex functional relationship between the mother and the embryo/fetus. The nature of this relationship is often portrayed as one of conflict between an aggressive embryo and a passive or defensive maternal organism. Recent progress in elucidating the evolutionary origin of eutherian pregnancy leads to a different picture. The emerging scenario suggests that the very initial stages in the evolution of embryo implantation require evolutionary changes to the maternal physiology, which modified an ancestral generic mucosal inflammation in response to the presence of the embryo into an active embedding process. This “female-first” evolutionary scenario also explains the role of endometrial receptivity in human pregnancy. On the marsupial side, where in most animals the fetal-maternal interaction is short and does not lead to a long term sustainable placentation, the relationship is mutual. In these mammals uterine inflammation is followed by parturition in short order. The inflammatory signaling pathways, however, are cooperative, i.e. they are performed by both the fetus and the mother and therefore we call this relationship “cooperative inflammation.” Based on these discoveries we reconceive the narrative of the maternal-fetal relationship.

Considering the multifaceted nature of neurodegenerative diseases like dementia and the neces-sity for interprofessional knowledge, this research extends its scope to encompass professionals with diverse levels of training and experience in dementia care. A need analysis for the project “My INdividual Digital EDucation.RUHR” (MINDED.RUHR) is conducted to develop an au-tomatized recommender system for individual learning content using AI. In this sub-study, the aim was to reveal didactic specialties, knowledge gaps and structural challenges of further edu-cation in dementia care of different health professions and to derive learning preference personae. Eight focus group interviews among nine health professions and up to six participants (n = 34) each took place to survey distinct didactic experiences and learning needs. The results reflect various learning preferences, with a propensity to multimedia, practical and interactive tasks. Health professions are used to digital education but show aversions against certain e-learning formats. The derived learning preference personae constitute profound blueprints for a us-er-centred digital education design process, aiming to establish personalized and representative further education in dementia care applicable to various individual preferences and structural workplace challenges of healthcare professions.

Perinatal stress experienced by mothers of very premature newborns may influence the mother’s milk and the infant’s intestinal microbiota. This prospective study of mothers of very preterm infants fed with mother´s own milk (MOM) was carried out in a tertiary hospital over a 2-year period. Assessment of maternal stress in 45 mothers of 52 very preterm newborns using the parental stress scale (PSS:NICU) that revealed an inverse relationship between stress and MOM production in the first days of life (p=0.012). The greatest contributor to stress was the one related to the establishment of mother-child bond. Maternal stress was lower in mothers in whom the kangaroo method was established early (p=0.011) and in those with a higher educational level (p=0.032). Levels of fecal calprotectin (FC) decrease with the passage of days and were directly correlated with birthweight (p=0.044). FC levels 7 days post-delivery were lower in newborns that received postnatal antibiotics (p=0.027). High levels of maternal stress resulted in progressive decreases and increases in the proportions of Firmicutes and Proteobacteria species, respectively, over 15 days post-delivery, both in MOM and in fecal samples from premature newborns. These findings underscore the importance of recognizing and appropriately managing maternal stress in neonatal units, given its marked influence on both the microbiota of maternal milk and the intestinal microbiota of premature newborns.