Conectar
by Mequanent Dessie Bitewa, Thomas Kidanemariam Yewodiaw, Aysheshim Asnake Abneh, Mikias Getahun Molla, Mulat Belay Simegn, Tadele Sinishaw Jemere, Mequannt Alemu Endayehu, Aysheshim Belaineh Haimanot, Werkneh Melkie Tilahun, Atirsaw Assefa Melikamu, Tadele Derbew Kassie
BackgroundCervical cancer is preventable, yet it remains a leading cause of cancer death in women. About 90% of cases and 94% of deaths occur in low- and middle-income countries (LMICs). Limited access to screening drives high incidence and mortality. Screening is central to secondary prevention and global elimination efforts.
ObjectiveThis study aimed to assess determinants of cervical cancer screening among women aged 30–49 years in low- and middle-income countries: a multilevel analysis.
MethodsA cross-sectional study used nationally representative data from 148,605 weighted women aged 30–49 years in 20 LMICs (2019–2024). Multilevel logistic regression identified factors associated with cervical cancer screening while accounting for cluster-level variation. Statistical significance was set at p Result
Overall cervical cancer screening uptake was 14.03% (95% CI: 13.63–14.45%), ranging from 0.92% in Mauritania to 42.98% in Zambia. Higher screening was associated with older age 40–49 years (AOR = 1.48; 95% CI: 1.41–1.54), occupation (AOR = 1.15; 95% CI: 1.10–1.21), contraceptive use (AOR = 1.38; 95% CI: 1.31–1.44), recent health-facility visit (AOR = 1.93; 95% CI: 1.84–2.02), prior abortion (AOR = 1.28; 95% CI: 1.22–1.34), female-headed households (AOR = 1.11; 95% CI: 1.05–1.18), high community education (AOR = 1.63; 95% CI: 1.49–1.79), and high media exposure (AOR = 2.54; 95% CI: 2.30–2.80). Lower uptake was observed among individuals in high-poverty communities (AOR = 0.63; 95% CI: 0.57–0.68), higher parity (1–4 birth) (AOR = 0.86; 95% CI: 0.78–0.94); (five or more births) (AOR=0.66 95% CI: 59–0.73), and those residing in rural areas (AOR = 0.89; 95% CI: 0.82–0.97).
ConclusionCervical cancer screening uptake in LMICs is far below the WHO 2030 target, with wide country disparities. Socio-demographic factors, health-facility contact, and community education increase uptake, while poverty and geographic barriers reduce it. Integrating screening into routine reproductive and maternal care, strengthening community and media education, and addressing structural barriers to access are essential to improving coverage.
by Gen Tsujio, Masakazu Yashiro, Yuichiro Miki, Kohei Matsuoka, Koji Maruo, Mami Yoshii, Tatsuro Tamura, Katsunobu Sakurai, Takahiro Toyokawa, Naoshi Kubo, Shigeru Lee, Tomohisa Okuno, Kishu Kitayama, Go Masuda, Masaichi Ohira, Kiyoshi Maeda
BackgroundOur group revealed that the combination of intra-operative stamp cytology and peritoneal lavage cytology (CY) improved the identification of individuals with high risk of peritoneal metastasis. In this exploratory Phase II study, we aimed to evaluate the effect on relapse-free survival (RFS) of extensive intraoperative peritoneal lavage (EIPL) for gastric cancer with positive peritoneal cytology (CY1) and/or stamp cytology positive (stamp+).
Materials and methodsThis study was a single arm, multi-institutional, exploratory phase 2 trial to assess the effects of EIPL after open gastrectomy for gastric cancer with CY1 and/ or stamp+. The primary endpoint was RFS. Secondary endpoints were overall survival (OS), postoperative recurrence site and incidence of postoperative adverse events.
ResultsBetween 2017 and 2021, 13 patients from 2 institutions were enrolled in this study. Because of the recent decline in open abdominal surgery, the number of cases did not increase and the trial was closed due to lack of applicants at 13 cases. Median 3-year RFS was 14.5 months (95% CI 5.4-NA), median 3-year OS was not reached (95% CI 14.5-NA) and median3-year peritoneal RFS was 16.0 months (95% CI 5.4-NA). Median 3-year peritoneal RFS rate was 83% in CY0 and stamp+ cases (n=6), and 0% in CY1 and stamp+/- cases (n=7). (Log-rank p=0.015).
ConclusionBecause of the slow accrual pace and early stop of the trial, we were not able to evaluate the prespecified endpoints thoroughly. However, EIPL might be effective to prevent perineal recurrence, especially in CY0 and stamp+ case.
by Kazuyuki Iwakiri, Keiichi Miki, Takeshi Sasaki
BackgroundOccupational low back pain (LBP) has increased in Japanese social welfare facilities and hospitals. Understanding its occurrence is the first step in addressing this issue.
AimThis study investigated the caregiving activities that cause occupational LBP incidents in these contexts.
MethodsThe study analyzed 2,722 incidents of occupational LBP among staff in social welfare facilities and hospitals resulting in four or more days absent from work. Data were extracted from accident occurrences and causes in the 2018–2019 Reports of Worker Casualties. The caregiving situations related to the occupational LBP incidents at each facility were then analyzed.
ResultsApproximately half of the occupational LBP incidents surveyed occurred during transfer assistance. This assistance was mainly associated with eating, bathing, and toileting in both facilities and frequently occurred during patient transfers between a bed and a wheelchair. In social welfare facilities, nontransfer assistance also contributed significantly, which included bathing, toileting, childcare, diaper changing, lying, standing, sitting, walking, and car transportation. In hospitals, nontransfer assistance such as providing support for lying, diaper changing, medical care, and sitting were occupational LBP risk factors. Furthermore, most incidents of occupational LBP occurred among staff who worked alone during day shifts.
ConclusionCaregiving activities involving transfer assistance, such as bathing, toileting, and eating, were common risk factors in social welfare facilities and hospitals. However, the specific nontransfer assistance activities contributing to occupational LBP varied by facility. To effectively reduce the incidence of occupational LBP, prevention strategies should focus on these high-risk activities according to facility type and the types of caregiving required.
by Aditya Sri Listyoko, Ryota Okazaki, Tomoya Harada, Genki Inui, Hiroki Kohno, Miyu Nishigami, Miki Takata, Masato Morita, Akira Yamasaki
BackgroundThe interaction between viral components and type 1 or type 2 cytokines during asthma exacerbations in the airway epithelium may contribute to worsening inflammation. However, these interactions in the small airway epithelium—particularly those involving alarmins (TSLP, IL-25, and IL-33) and IL-8—remain unclear. Dupilumab, a biologic agent used in severe asthma, blocks IL-4 receptor alpha (IL-4Rα) and may offer therapeutic benefits in virus-induced asthma exacerbations. In this study, we evaluate the effects of double-stranded RNA (dsRNA), in combination with various cytokines and dupilumab, on the Human Small Airway Epithelial Cells (HSAECs) line.
MethodsPrimary HSAECs were preincubated with dsRNA to induce the gene and protein expression of alarmins and IL-8. To evaluate the effects of cytokines on dsRNA-induced alarmin and IL-8 expression, various type 1 and type 2 cytokines were co-stimulated with dsRNA. Dupilumab was used as a pretreatment prior to co-stimulation with dsRNA and IL-4 or IL-13. Gene expression of TSLP, IL-25, IL-33, and IL-8 was assessed by quantitative PCR, and protein expression was evaluated by Western Blotting.
ResultsdsRNA significantly increased the expression of TSLP and IL-8. IL-4 and IL-13 further enhanced dsRNA-induced TSLP and IL-8 gene and protein expression. In contrast, TNF-α reduced dsRNA-induced TSLP expression but enhanced IL-8 gene and protein expression. Dupilumab attenuated the expression of TSLP and IL-8 induced by co-stimulation with dsRNA and IL-4 or IL-13 in HSAECs.
ConclusionIn the microenvironment of small airway epithelial cells, particularly during viral infections, the presence of IL-4 or IL-13 may enhance the expression of TSLP and IL-8. Dupilumab attenuates this expression, potentially offering additional benefits in the treatment of asthma, especially during virus-induced asthma exacerbations.
This scoping review addresses the underexplored issue of abuse of people with mental illnesses by healthcare professionals. We mapped the existing literature to establish the nature, prevalence, contributing factors and experiences of this abuse.
Scoping review based on the Joanna Briggs Institute framework.
We searched MEDLINE, CINAHL Complete, PsycINFO, ProQuest, Web of Science, Cochrane Central Register of Controlled Trials and Ichushi-Web during the period from 3 July to 22 August 2024. Eligible studies reported abuse of people with mental illnesses by healthcare professionals, with no restrictions on year or language.
Two reviewers independently extracted data from the selected articles. The data were synthesised to examine prevalence, associated factors and experiences of people with mental illnesses.
Of 5793 records, 61 met the inclusion criteria, with 32 from the USA and Japan (16 from each). Abuse types reported across 17 countries included physical, psychological, sexual and economic abuse, neglect and human rights violations. Histories of physical and sexual abuse were frequently reported as possible contributing factors to further abuse. Recommendations for prevention were identified at multiple levels, including individual care, organisational and institutional systems, and broader policy and society.
This review mapped the literature on abuse by healthcare professionals in mental health services and identified critical research gaps, including a lack of methodologically robust studies. Further research is needed to build an evidence base for prevention strategies and to establish institutional safeguards.
by Jieyu Zhao, Kota Kurisu, Kazuki Ohashi, Toshiya Osanai, Katsuhiko Ogasawara, Miki Fujimura
In this work, we aimed to assess the impact of clazosentan on clinical labour time costs within Japan’s value-based healthcare system using time-driven activity-based costing. Time-driven activity-based costing was employed to analyse the labour time costs associated with preventing cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Time-driven activity-based costing simplifies cost analysis by utilising time as the primary cost driver. We compared two treatment approaches: conventional therapy with fasudil hydrochloride and postoperative therapy with clazosentan. Scenario and sensitivity analyses were performed to assess the impact of physicians’ costs on the results. The use of clazosentan for the prevention of cerebral vasospasm significantly reduced human resource costs, particularly in cases where symptomatic vasospasm did not occur, yielding savings of approximately 51,343 yen. The greatest cost reductions were observed among nursing staff, with a 30% decrease in the absence of symptomatic vasospasm and a 15% reduction when symptomatic vasospasm was present. The cost reductions for physicians were comparatively smaller, particularly in cases where symptomatic vasospasm occurred. Sensitivity analyses indicated that clazosentan reduced overall costs by approximately 35,000–50,000 yen; however, costs increased in the presence of symptomatic vasospasm. Clazosentan for subarachnoid haemorrhage treatment significantly reduces human resource costs, especially in nursing staff. These findings support the potential of clazosentan for broader clinical use, given its cost-savings and clinical benefits in reducing cerebral vasospasm following aneurysmal subarachnoid haemorrhage.
To assess the level of knowledge, attitudes and practices (KAP) among patients with type 2 diabetes mellitus (T2DM) regarding cardiovascular risk factors (CVRF) and diabetes-related complications in two hospitals in the West Region of Cameroon during the COVID-19 pandemic.
This was a prospective cross-sectional study conducted over 5 months from April to September 2022.
This study was conducted in two tertiary hospitals in the West Region of Cameroon, in Central Africa.
It included all patients with T2DM receiving care at these two hospitals, having agreed to participate and followed up in both hospitals for at least 3 months.
Sociodemographic, clinical and treatment data were collected using a data sheet, and KAP scores were based on the Essi and Njoya framework. Data collection and analysis were performed using SPSS V.23.0 software. Logistic regression was used to identify the factors associated with unacceptable KAP (p
A total of 140 participants (71 women) with an average age of 63 years and an average diabetes duration of 6.14±5.7 years were included. Most (55%) were managed by general practitioners. The main CVRFs identified were hypertension (11%) and overweight (6%), while the leading complications included visual disorders (10.7%), hypoglycaemia (6.4%) and erectile dysfunction (2.1%). Knowledge was good in 34.3% of participants, only 25.7% demonstrated correct attitudes, and merely 15.7% engaged in adequate practices. Unacceptable knowledge was associated with diabetes duration between 3 months and 5 years (OR: 0.34 (95% CI 0.14 to 0.85), p=0.021), follow-up by a specialist (OR: 0.31 (95% CI 0.13 to 0.74), p=0.009), the presence of at least one CVRF (OR: 0.03 (95% CI 0.00 to 0.23), p
Few people with T2DM presented good knowledge, right attitudes and adequate practices. Enhanced patient education and increasing specialist numbers are essential to promote self-management of the condition and to decrease the incidence of complications and mortality.
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