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Factors contributing to low tuberculosis diagnosis among children aged 0–14 years in Gem Sub County in Siaya County, Kenya

Tuberculosis (TB) is a top global health challenge, with 1.2 million children aged 0–14 years becoming ill with TB every year. Yet, a significant proportion remain undiagnosed or missed due to diagnostic barriers. This cross-sectional study employing an embedded mixed method approach investigated factors contributing to low tuberculosis diagnosis among children in Gem Sub County, Siaya County Kenya, a high burden region. Data was collected from 71 healthcare workers (HCWs) and 16 respondents across six wards using semi-structured questionnaires and TB register abstraction. Qualitative data underwent deductive thematic analysis while quantitative data was analyzed using descriptive statistics and logistic regression in SPSS version 27. About a third (31.3%) of TB cases in children required three or more facility visits before diagnosis, with some needing up to 12 visits. Costly and inaccessible chest X-rays and GeneXpert underutilization due to difficulties in sputum and alternative sample (gastric lavage, nasopharyngeal aspirates) collection were key diagnostic constraints. Delayed care-seeking due to stigma, misconceptions (56.3% linked childhood TB to HIV) and low TB symptom awareness (37.5% of children presented with ≤2 symptoms) were patient related factors associated with low TB diagnosis. About 56.3% of caregivers sought routine TB screening, but 62.5% sought care only after persistent symptoms. Clinical officers showed substantially higher odds of reporting confidence in sample collection (OR=34, 95% CI 3.81–303.21, p = 0.002) and GeneXpert interpretation (OR=15, 95% CI 3.20–70.39, p < 0.001) than nurses. Trained HCWs were 7.16 times more likely to interpret X-rays accurately (95% CI 2.16–23.67, p < 0.001). Enhanced HCW training, improved diagnostic access, targeted community education on stigma and misconceptions are critical for early TB detection in children.

Climate predictors of child undernutrition: Insights from a machine learning model

Background Climate variability is increasingly recognized as a driver of child undernutrition, yet the non-linear relationships between specific climatic variables and nutrition remain unclear. This study uses machine learning to identify and quantify key climatic predictors of undernutrition among children. Methods In a mixed-method approach, a cross-sectional study assessed nutrition and child health outcomes in May 2024, while retrospective climate data was assessed spanning January 2022 to December 2023. The cross-sectional study recruited two hundred and seventy (270) children aged 6–23 months from rural areas in the Bosomtwe district. Anthropometry, hemoglobin concentrations, and food frequency were assessed using standard procedures. The collected data was standardized and subjected to principal component analyses to identify dietary patterns. Household food security was assessed using the USDA Household Food Security questionnaire, while the climate data was obtained from ERA5 reanalysis. Random forest algorithms were employed to evaluate the relative importance of various climatic factors in predicting undernutrition and morbidity. Decision trees were then derived from the models to examine interactions and thresholds. Results Rainfall emerged as the most critical climate predictors of stunting, while severe acute malnutrition was more sensitive to shortwave radiations. Temperature was the top predictor of fever, anaemia and diarrhoea. Low rainfall and high temperature substantially increased the possibility of undernutrition and morbidity. Threshold effects showed that rainfall below 4.78 mm and temperature under 23.40°C, increased stunting risk, especially when SW radiation drops below 6.01 W/m 2 . For severe acute malnutrition, rainfall below 5.53 mm and temperatures above 27.67°C significantly increased the risk. Conclusion This study finds significant influences of climate variables on child undernutrition, highlighting the importance of integrated climate health strategies that account for compound climate effects. These findings can inform the development of early warning systems and targeted interventions to mitigate climate-related health risks in vulnerable populations.

Burnout dimensions and associated risk factors in medical students: A cross-sectional study in Serbia

Introduction Burnout syndrome presents a serious problem for medical students in their training and professional career. The aim of this study was to investigate the dimensions of burnout syndrome and associated risk factors among medical students in Serbia. Methods This was a cross-sectional study. Prevalence of high risk of burnout in medical students was determined following the three-dimensional criteria, based on high levels of emotional exhaustion, cynicism, and low academic efficacy, according to the Maslach Burnout Inventory Student Survey. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were determined using multivariate logistic regression analysis. Results Risk for high level of all three burnout dimensions (emotional exhaustion, cynicism, and academic inefficacy) was increasing with higher frequency of alcohol consumption (p for trend = 0.008, p = 0.030, p = 0.040, respectively) in medical students. Risk for high level of emotional exhaustion was associated with clinical training level of studies (OR = 1.82, 95% CI = 1.38–2.80, p = .007) and use of sedatives (OR = 3.08, 95% CI = 1.29–7.38, p = 0.011). Length of study >6 years and use of sedatives were associated with high level of cynicism in medical students (OR = 1.98, 95% CI = 1.08–3.62, p = 0.027; OR = 3.19, 95% CI = 1.31–7.75, p = 0.010, respectively). Higher grade point average (>8) was most common in medical students with lower risk of academic inefficacy (OR = 0.65, 95%CI = 0.44–0.95, p = 0.026). Positive personal medical history (presence of any chronic disease) was frequently reported in medical students who had a high risk of academic inefficacy (OR = 2.45, 95% CI = 1.30–4.61, p = 0.006). Conclusion Some characteristics of medical students were associated with high risk of burnout, indicating the need for psychological support aimed at providing appropriate help and assistance to medical students.

Development of nanoemulsion formulation loaded with Enteromorpha intestinalis extract: Characterization and evaluation for topical use

Enteromorpha intestinalis is a green seaweed enriched with diverse bioactive compounds that possess substantial pharmacological and biotechnological properties. Despite the focus on their therapeutic applications, research on the development of nano-formulations is limited. Therefore, this study aimed to develop an E. intestinalis (EI) extract-based nanoemulsion for topical use. Olive oil, Tween-80 (surfactant), and PEG-400 (co-surfactant) were selected for the formulation of the nanoemulsion. The Smix ratio was set to 1:1 using a pseudo-ternary phase diagram. Moreover, a design experiment ascertained the composition of the formulation, followed by physicochemical characterization. The optimal formulation, based on droplet size, was selected for further analysis. Stability studies, antioxidant and anti-inflammatory properties of selected nanoemulsion formulation were determined and acute dermal toxicity assay was also performed. The best formulation (F6) displayed a droplet size of 183.27 ± 20.04 nm, PDI of 0.6, and viscosity of 290 ± 5.77 m-Pa.S. The developed nanoemulsion exhibited good skin compatibility and a slightly acidic pH. Both the extract and nanoemulsion formulation exhibited concentration-dependent antioxidant activity. The nanoemulsion had a lower IC 50 value of 163.19 μg/mL, showing greater efficacy than the seaweed extract alone. Formulation (F6) also significantly (p < 0.05) inhibited paw volume (8–31%) compared to the control, while diclofenac sodium achieved a maximum inhibition of 41%. The designed formulation was stable, effective, and non-irritating demonstrating its potential topical application. This study presents, for the first time, a nanoemulsion formulation that incorporates E. intestinalis extract. This advancement paves the way for further in vivo studies to assess the efficacy and safety of this formulation for clinical applications.

Transmission of Salmonella clones between different animal species in a horse and cattle breeding region in Japan

Acceptability and adherence of Balanced Energy Protein (BEP) supplementation among pregnant women in Addis Ababa, Ethiopia: A Formative Study

Background Balanced energy protein (BEP) supplements during pregnancy have shown promise in reducing small-for-gestational-age births and low birth weight in low- and middle-income countries, but practical gaps remain in implementing this supplementation. This formative study assessed the acceptability, adherence, and sharing practices of a ready-to-use BEP supplement among pregnant women in Addis Ababa, Ethiopia. Subjects and method From January to February 2023, 45 pregnant women were purposively selected from nine public health centers and provided a 4-week BEP supply with usage guidance. Thirty-nine participants completed in-depth interviews. The framework analysis focused on acceptability, adherence, and sharing. Adherence was calculated as the proportion of sachets consumed or returned empty; partially used or unopened sachets were considered unconsumed. Results Acceptability was high, with positive feedback on texture (32/39, 82.1%), smell (35/39, 89.7%), color (38/39, 97.4%), and ease of consumption (33/39, 84.6%). However, 23/39 participants (59%) found the taste overly sweet, which occasionally led to nausea or reduced intake. Over the one month, supplement consumption ranged from 0 to 30 sachets, with a mean intake of 21.9 (SD = 9.5). High adherence (≥80% consumption) was observed in 25/39 (64.1%) of participants. Intake was facilitated by provider counseling and family support, while fasting, travel, and weight concerns influenced consumption patterns. Sharing was minimal and discouraged through counseling. Most participants expressed willingness to continue supplementation, recommending reduced sweetness. Conclusion Pregnant women demonstrated high acceptability and adherence to the BEP supplement. Findings support its feasibility for informing intervention design in the main trial.

Quantifying crustal stress in the Sinai Peninsula caused by gravitational potential energy and its tectonic implications

What is the evidence on indirect drivers of biodiversity loss worldwide? A systematic map protocol

An estimated 1 million species of animals and plants are threatened with extinction. While much research has concentrated on direct drivers (e.g., land use change) of biodiversity loss, understanding the indirect (e.g., economic, demographic, and institutional, etc.) drivers triggering these direct drivers is a research priority. Systematic reviews of literature mapping the links between indirect and direct drivers and where, when, how, and what biodiversity they affect are missing. The primary research question of this systematic map will be: What is the evidence on indirect drivers of biodiversity loss worldwide ? Eligible studies must include information on the links between direct and indirect drivers and how they affect biodiversity. Outcomes will be categorized by species, taxonomic groups, ecological levels of organization, geographical scope, and both direct and indirect drivers of biodiversity loss. We will implement a thorough and repeatable three-stage screening process through peer-reviewed articles, and a searchable database will be made publicly accessible as an interactive online resource. This systematic map will help identify knowledge gaps and enhance our understanding of the underlying causes of biodiversity loss.

Synthesis and structural insights of tunable NiOX–MoO3–MoS2 nanocomposites with enhanced photocatalytic performance

Comparative analysis of social issues toward medical abortion using mifepristone in South Korea and the United States: Topic modeling and sentiment analysis

This study aimed to compare social issues influencing the use of mifepristone for medical abortion between South Korea and the United States by analyzing media coverage through text mining techniques. News articles published between 2006 and 2022 related to mifepristone were collected using web scraping from representative news platforms in both countries. The collected data underwent preprocessing, followed by text analysis using the bag-of-words model. Topic modeling was conducted through Latent Dirichlet Allocation, and sentiment analysis involved using the lexicon-based methods specific to Korean and English texts. Analysis of 7,938 Korean and 650 United States articles revealed distinct patterns in media discourse on mifepristone and medical abortion. The United States coverage was polarized, encompassing clinical, legal, and access-related debates, whereas Korean articles prioritized access barriers, safety concerns, and the urgency for domestic approval, reflecting predominantly negative sentiments related to cultural stigma. This study highlights differences in the media portrayals and public perceptions of mifepristone between South Korea and the United States, underscoring the influence of regulatory contexts, public concerns and cultural attitudes on medical abortion discourse.

Comprehensive molecular characterization and comparison of venom proteins and transcripts in three Gloydius species from South Korea

Abstract In Korea, Gloydius brevicaudus , G. ussuriensis , and G. intermedius are the primary venomous species causing human envenomation. Although these species belong to the same genus, their envenomations induce distinct clinical symptoms, and the inconsistent efficacy of antivenoms underscores the need for species-specific therapeutic strategies. However, comprehensive molecular and toxicological profiling of Korean Gloydius species has remained unexplored. In this study, we quantitatively distinguished the venoms of three Gloydius species using two-dimensional gel electrophoresis and MALDI-TOF mass spectrometry. The results revealed that each species has evolved distinct venom protein profiles. To further investigate their expression regulation, we identified transcripts coding the major venomous proteins, which revealed species-specific regulatory differences at the transcriptional level. To verify the functionality of the identified transcripts, recombinant expression of two SVMPs was successfully expressed and their proteolytic activities were tested. This study establishes a systematic framework for understanding the molecular diversity of Korean Gloydius venoms and identifies species-specific toxin candidates that could serve as potential leads for the development of tailored antivenoms, diagnostic tools, and therapeutic vaccines.

Correction: Dynamical analysis of scabies delayed epidemic model with second-order global stability

A multi-state cross-sectional assessment of essential medicine availability in Sudan during armed conflict

Health literacy and preventive behaviors toward microplastic contamination among communities in the major river basins of northeastern Thailand

Background Microplastic contamination in freshwater systems poses increasing environmental and public health risks, particularly for riverine communities. Health literacy may critically influence individuals’ capacity to recognize exposure pathways and adopt preventive behaviors. Objective This study assessed health literacy and preventive behaviors related to microplastic contamination and examined factors associated with poor health literacy and preventive practices among communities in northeastern Thailand. Methods A cross-sectional survey was conducted among 942 adults residing along the Mekong, Chi, and Mun River basins. Health literacy and preventive behaviors were assessed using a structured questionnaire. Multivariable logistic regression was performed to identify associated factors, whilst adjusted odds ratios (aOR) with 95% confidence intervals (CI) and statistical significance set at p < 0.05. Results Nearly half of the participants exhibited insufficient health literacy, with decision-making identified as the weakest domain. While approximately half reported good preventive behaviors, insufficient health literacy was the strongest determinant of poor preventive practices (aOR=9.18; 95%CI: 6.62–12.72). Residents of rural (aOR=6.47; 95%CI: 4.47–9.37) and semi-urban (aOR=2.45; 95%CI: 1.76–3.41) communities and younger age groups were significantly more likely to have poor health literacy. Community type (semi-urban: aOR=2.61; 95%CI: 1.81–3.78) and longer duration of residence (>60 years: aOR=2.36; 95%CI: 1.37–4.06) were also significantly associated with preventive behaviors. Conclusion Health literacy is a critical determinant of microplastic-related preventive behaviors. Interventions targeting higher-order literacy skills, particularly decision-making, should be integrated into environmental health and public health strategies to reduce microplastic exposure and promote sustainable preventive practices in riverine communities .

The AHEAD-NLR score: a novel inflammatory-comorbidity integrated tool for predicting long-term mortality in patients with heart failure after acute myocardial infarction

Gender differences in body dissatisfaction: A large-scale investigation among adolescents using two international surveys

Body dissatisfaction is closely linked to low self-esteem, reduced well-being, as well as mental health issues, and eating-related pathologies, which are increasingly prevalent worldwide, particularly among women. Understanding gender differences in body dissatisfaction is therefore an important issue. Yet most prior studies rely on small, non-representative samples from single developed countries. This study’s overarching goal is to provide a cross-national assessment of the magnitude and potential drivers of these gender differences. We analyze gender differences in body dissatisfaction using two large-scale international surveys, covering over 70,000 teenagers aged 15–16 across 9 countries and over 220,000 teenagers aged 11–16 across 41 countries. Girls report significantly higher body dissatisfaction than boys, regardless of Body Mass Index, socioeconomic background, age, or country. Moreover, body dissatisfaction appears more central for girls, showing stronger negative associations with life satisfaction and self-efficacy. Within countries, the gender gap is larger among high-performing students, teenagers from higher socioeconomic backgrounds, older teenagers, and those with higher BMI. The size of the gender gap varies across countries, driven mainly by variability in girls’ body dissatisfaction. Countries with larger gender gaps also show wider gender disparities in life satisfaction, eating disorders, and depression. Notably, body dissatisfaction satisfies the Gender Equality Paradox, with larger gender differences in more developed countries, mainly due to higher dissatisfaction among girls. We also examine the role of social norms. Stereotypes associating women more with physical appearance than abilities are stronger in developed countries. These stereotypes are linked to higher female body dissatisfaction and larger gender differences, and may partly explain the Gender Equality Paradox. This study identifies patterns and potential drivers of gender differences in body dissatisfaction using representative, cross-national data combined with societal indicators, and provides a foundation for more effective interventions.

Estimated glucose disposal rate and cardiovascular risk in metabolically healthy adults: a nationwide prospective cohort study

Molecular-based detection of Ehrlichia spp. in stray dogs-infesting Rhipicephalus ticks in high-altitude of northern Pakistan

Although ticks are recognized as carriers of zoonotic pathogens, the risks of tick-borne infections associated with dogs have received limited attention. The close interaction between humans and dogs increases the zoonotic potential of pathogens, increasing the urgency of addressing this overlooked vector-borne health risk, especially in developing regions. This study sought to identify tick-borne zoonotic pathogens by collecting ticks from dogs and screening for Ehrlichia species, a group known to pose significant yet often neglected health risks to both humans and animals, particularly in the northern area of Khyber Pakhtunkhwa (KP), Pakistan. Ticks were collected from dogs in the Mardan and Dir Lower districts of Pakistan from June 2024 to May 2025. The collected ticks were morphologically identified and processed for molecular identification using 16S ribosomal DNA (16S rDNA) and cytochrome c oxidase ( cox1 ) sequences for ticks, and 16S rRNA and dsb sequences were used for their associated Ehrlichia spp. Among the 223 dogs observed, 147 were infested with ticks, resulting in an overall prevalence of 66%. Rhipicephalus ticks’ infestation were more common in female dogs (91/113, 80.53%) than in male dogs (56/110, 51%). The occurrence of adult females was highest (173/432, 40%), followed by males (158/432, 36.57%) and nymphs (101/432, 23.37%). Two tick species were identified: Rhipicephalus haemaphysaloides and Rhipicephalus sp., which was identified as a member of the Rhipicephalus sanguineus species complex. This was confirmed by 16S rDNA and cox1 sequences, which showed 99–100% maximum identity. In the phylogenetic trees, Rh. haemaphysaloides clustered with the same species reported from Pakistan, while Rhipicephalus sp. grouped with Rhipicephalus sp. morphotype III from Pakistan and India. Regarding their associated bacterial species, such as Ehrlichia spp., they were detected in both Rhipicephalus sp. and Rh. haemaphysaloides based on 16S rDNA and dsb sequences, which revealed maximum identity with Ehrlichia minasensis and Ehrlichia spp., respectively. These species phylogenetically clustered with the corresponding Ehrlichia species. The high infection rate observed in ticks suggests a significant relationship between companion animals and pathogen vectors. Further studies are necessary to investigate the potential health risks of tick-borne Ehrlichia spp. and their zoonotic implications in the region.

Clinical, radiological and laboratory features and outcomes of diffuse alveolar hemorrhage

Abstract Diffuse alveolar hemorrhage (DAH) is a rare and potentially life-threatening syndrome with heterogeneous etiologies and limited regional data from Latin America. We conducted a retrospective cohort study of adults with bronchoalveolar lavage–confirmed DAH managed at two tertiary referral centers in Bogotá, Colombia, between 2019 and 2024. Clinical, radiological, laboratory characteristics, treatments and in-hospital outcomes were analyzed, and factors associated with mortality were explored using logistic regression models. A total of 95 patients were included, with a mean age of 49 ± 18 years; 51% were male. Autoimmune diseases were the most frequent etiology (80%), and ground-glass opacities were observed in 94% of chest computed tomography scans. Immunosuppressive therapy was administered to most patients. Overall, in-hospital mortality was 12%. In univariable analyses, hypoxemia, chest pain, microbiological isolation and use of blood products were associated with mortality, whereas autoimmune etiology was associated with lower risk of death. In multivariable analysis, hypoxemia at admission remained independently associated with in-hospital mortality. These findings highlight the predominance of autoimmune causes of DAH and underscore the importance of early etiological identification and assessment of respiratory severity to improve clinical outcomes.

Professional, organizational and policy-level barriers and facilitators to perinatal mental health care in the United Arab Emirates: A qualitative study

Background Perinatal mental health (PMH) is a critical component of maternal and child health, yet significant gaps persist in its integration into routine maternity care in the United Arab Emirates (UAE). Frontline healthcare professionals (HCPs) are central to identifying and addressing PMH concerns; however, their effectiveness is often hampered by multi-level barriers. This qualitative study aimed to identify the professional, organizational, and political-level barriers and facilitators influencing the implementation of PMH care from the perspective of HCPs in the UAE. Methods and findings A descriptive qualitative design was employed. 43 HCPs, including lactation consultants, midwives, maternity nurses, obstetricians, family physicians, paediatricians, and psychiatrists/psychologists, were recruited using purposeful sampling. Data were collected through semi-structured interviews and focus group discussions. Thematic analysis was employed, and barriers and facilitators were categorized to identify key themes. The study identified 31 barriers and 33 facilitators across three ecological levels. Major barriers included PMH awareness and training gaps, low self-efficacy, role-based avoidance, fragmented services, staffing shortages, unclear protocols, and limited insurance coverage. Key facilitators encompassed professional development initiatives, core provider qualities like empathy and advocacy, interprofessional collaboration, integrated care models, supportive organizational policies, and government-led training programs. A critical finding was the role of the multicultural healthcare workforce as a significant facilitator for providing culturally competent care. Conclusion The study identified multi-level barriers and facilitators that shape PMH care delivery in the UAE. Addressing these factors requires a systemic approach, including standardized PMH training, integrated care pathways, clear protocols, and policy reforms for insurance coverage. Leveraging the strengths of the multicultural workforce is essential for developing effective, culturally sensitive PMH services. These findings can guide the development of strategies to support HCPs and improve mental health outcomes for mothers and families.