Browse papers

461 papers

Combining Treatment of Acute Malnutrition With Integrated Community Case Management: A Cluster-Randomised Controlled Trial (SETiPlus).

Cronin G et al. · Jul 1, 2026

Achieving good treatment coverage and outcomes for acutely malnourished children is challenging in resource limited and remote settings. Inclusion of treatment within integrated community case management (iCCM) programmes has shown promise, but evidence is limited. We conducted a cluster randomised controlled trial in rural villages within the districts of Hargeisa, Gabiley, and Faraweyne in Somaliland. We compared treatment coverage and outcomes between 18 villages implementing iCCM, where cases of malnutrition (mid-upper arm circumference (MUAC) < 12.5 cm and/or oedema) were referred to MCH clinics, and 19 villages implementing iCCM +, where malnutrition treatment was provided by family health workers (FHW) at village level. Coverage was measured in a closed household cohort at baseline and after 6 months of intervention. Treatment outcomes were determined in an open cohort of cases that were identified by the iCCM FHW and followed up on each month. The prevalence of acute malnutrition diagnosed using MUAC was four-fold lower compared to that diagnosed using weight-for-height z-scores (WHZ) (3% vs. 13%). This larger than expected difference resulted in the study being underpowered. Treatment coverage was 27% and 23% in the control and intervention arms at baseline and increased sharply in the intervention arm with an adjusted difference of 20 percentage points. However, the improvement was not statistically significant (adjusted OR 2.55 (95% CI 0.4, 18.8) p = 0.344). Cases were more likely to start treatment in the intervention arm (difference 71.9% (95% CI 58.1, 85.7) p < 0.001), but relapse and non-response were more frequent (p = 0.041 & p = 0.004). Over diagnosis of acute malnutrition by FHW was high, with 67.4% and 77.4% of cases being misdiagnosed in the control and intervention arm, respectively. While the integration of malnutrition treatment with iCCM shows potential for improving treatment coverage in some contexts, careful consideration should be given to the level of training and supervision required. TRIAL REGISTRATION: ISRCTN31437934. Registered 3/10/2023.

Nursing

The enduring power of social context: Pre-war contact opportunity amplifies the effects of post-war contact.

Afandiyev Z et al. · Jul 1, 2026

Intergroup contact is one of the most established approaches for improving relations between adversary groups in conflict settings; yet little is known about whether its effects might be shaped by the social context. In this paper, we examine whether pre-war contact opportunity with the adversary group shapes the relationship between post-war intergroup contact and willingness to engage with the adversary group, measured at two post-war time points. We operationalize pre-war contact opportunity objectively, using pre-war census data on adversary group share. We analyse data from two studies conducted in post-war Bosnia and Herzegovina. Study 1, conducted approximately 10 years after the war's outbreak (N = 1967), demonstrates that post-war intergroup contact is more strongly associated with contact willingness among individuals who, before the war, lived in municipalities with higher contact opportunity. Study 2, conducted more than 30 years after the war, does not provide evidence for the same moderating pattern (N = 330), but supplementary analyses indicate persistent significant yet attenuated effects of contact opportunity. These findings highlight the relevance of the pre-conflict social context and temporal dynamics for understanding intergroup contact effects in post-conflict societies.

Social Sciences

Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care: A Randomized Clinical Trial.

Hay AD et al. · Jul 1, 2026

Importance Most antibiotic prescribing takes place in primary care, driving antimicrobial resistance, a top-10 threat to global public health. There is considerable international interest in whether rapid multiplex microbiological point-of-care testing (RM-POCT) can safely reduce antibiotic prescribing in primary care. Objective To investigate whether the use of a RM-POCT can safely reduce same-day antibiotic prescribing for children and adults presenting to primary care with respiratory infections. Design, setting, and participants This parallel-group randomized clinical trial was conducted at 16 general practices in Southwest England between December 2022 and April 2024. Patients were eligible if they were aged 12 months or older, presented with any clinician-diagnosed acute (≤21 days) respiratory tract infection, and the patient or clinician believed antibiotic treatment was, or might be, necessary. Participants were randomized (1:1) to RM-POCT or usual care. The research team, including those conducting statistical analyses, were unaware of group allocation. Data were analyzed from November 21, 2024, to March 13, 2025. Intervention Patients in the intervention group were tested with RM-POCT to indicate the presence or absence of 19 respiratory viral pathogens and 4 atypical bacteria in approximately 45 minutes. Main outcomes and measures The primary outcome was same-day antibiotic prescribing. The safety outcome was patient-reported symptom severity on days 2 to 4. Results Among 552 included patients (mean [SD] age, 40.0 [21.2] years; 349 [63%] female), 276 were randomized to the intervention group and 276 to usual care. Primary outcome data were available for all participants, and safety outcome data were available in 216 intervention participants (78%) and 203 usual care participants (74%). Same-day antibiotics were prescribed to 124 participants (45%) in each group (odds ratio [OR], 1.00 [95% CI, 0.71 to 1.41]; P > .99). Prespecified subgroup analyses showed evidence of differentially reduced antibiotic prescribing in participants from whom a virus was detected (OR, 0.35 [95% CI, 0.20 to 0.63]; P for interaction Conclusions and relevance In this randomized clinical trial among patients with respiratory tract infections being considered for antibiotic treatment in primary care, use of an RM-POCT did not reduce same-day antibiotic prescribing or worsen patient outcomes. Trial registration isrctn.org Identifier: ISRCTN16039192.

Immunology and Microbiology

Mothers' responses to relational savoring as a function of attachment: A qualitative study.

Marvin MJ et al. · Jul 1, 2026

A person's state of mind with respect to attachment, measured by the Adult Attachment Interview (AAI), represents how the individual perceives, accesses, and processes attachment-related content. One's state of mind with respect to attachment is thought to guide behavior in relationships, including caregiving relationships, and thus may have important implications for parents' engagement in parenting interventions. Relational savoring (RS) is a brief attachment-based intervention that has been shown to increase mothers' parenting sensitivity, feelings of closeness to their child, and positive emotion. However, it remains unknown how mothers with different attachment profiles respond to this intervention. In the current illustrative multiple case study, we examine how three mothers (M age = 31.0 years, SD age = 1.0) of young children in the United States classified with different states of mind with respect to attachment respond to RS. First, we provide samples of mothers' AAI discourse to illustrate their states of mind with respect to attachment. Next, we analyze their responses during RS sessions using a qualitative approach. Results demonstrate differences in mothers' attachment-related discourse, capacity for reflection, and change processes during the intervention that varied by attachment profile. We discuss the implications of these findings for RS and other parenting interventions.

Psychology

Pregnancy and kidney transplantation: optimized clinical and obstetric management to reduce maternal and perinatal complications.

Santos ACM et al. · Jul 1, 2026

Objective Review the literature to provide guidance on the appropriate clinical and obstetric management of pregnant women with kidney transplants to reduce maternal and perinatal complications. Methods The PubMed and SciELO databases, which evaluated pregnancy and kidney transplantation, were searched, focusing on clinical and obstetric management. Other variables of interest were preconception counseling, fertility, the safety of immunosuppressants, maternal complications, perinatal complications, graft worsening during pregnancy, and postpartum guidance. Results A total of 354 articles were identified, of which 76 were included in the analysis. Studies suggest that attempts to conceive should begin at least one year after kidney transplantation in the absence of graft rejection, with stable renal function (creatinine Conclusion Pregnancy in kidney transplant recipients is challenging due to maternal and perinatal risks. However, the present review demonstrates that clinical and obstetric management by an experienced multidisciplinary team contributes to better maternal and perinatal outcomes in pregnancies among kidney transplant recipients.

Medicine

Efficacy and safety of sacubitril/valsartan in patients on peritoneal dialysis: a systematic review and meta-analysis.

Silva CLD et al. · Jul 1, 2026

Background Sacubitril/valsartan is a recommended medication for managing heart failure (HF). However, its role in peritoneal dialysis (PD) patients remains uncertain. We conducted this systematic review and singlearm meta-analysis to assess the efficacy and safety of sacubitril/valsartan in this population. Methods We systematically searched PubMed, EMBASE, and Cochrane Central until December 2024 for randomized controlled trials (RCTs) and observational studies assessing changes in left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, systolic blood pressure (SBP), left atrial diameter (LAD), and left ventricular end-diastolic dimension (LVDd) with sacubitril/valsartan use in PD patients. Safety endpoints included hyperkalemia, hypotension, and angioedema. Statistical analyses were performed in R, using proportions for binary and mean differences (MDs) for continuous outcomes. Results Nine studies were included, comprising 8 observational studies and 1 RCT, involving 343 PD patients. LVEF improved significantly (MD 5.22; 95% CI, 3.86 to 6.58; p Conclusion Sacubitril/valsartan was associated with improvements in cardiac function surrogates and blood pressure in PD patients with HF, with an overall acceptable safety profile despite a modest increase in hyperkalemia. These findings suggest potential benefit in this understudied population, though confirmation in adequately powered RCTs remains necessary.

Medicine

RagC and Map4K3 deficiency in high-grade gliomas drives proliferation and modulates mTORC1-dependent cellular functions.

Kahr J et al. · Jul 1, 2026

Cellular growth and homeostasis via amino acid-responsive pathways are mediated by the mTOR signaling pathway. Rag GTPases and Map4K3 modify mTOR signaling as amino acid sensors. Altered mTOR signaling in relation to amino acid sensors might represent factors that modify proliferation and treatment responses in astrocytic tumors. To investigate this hypothesis, RagC and Map4K3 expression was studied in human gliomas, glioma cells (U87MG/U138MG), and nonglial cells (MCF-7, IOMM-Lee). RagC and Map4K3 knockout in glioma cells was generated using CRISPR-Cas and shRNA. High-grade astrocytomas had significantly reduced immunoreactivity for RagC and Map4K3 compared to low-grade astrocytomas. RagC- and Map4K3-deficient glioma cells had significantly increased proliferation and showed altered morphology and motility. Induced amino acid deficiency (leucine deprivation) reduced proliferation in Map4K3- but not in RagC-deficient cells. mTOR signaling in RagC- and Map4K3-deficient U87 cells was altered with increased phosphorylation of p70S6K and increased expression of RagD and transcription factor EB. In this context, uncoupled, exaggerated autophagy occurred in Map4K3-deficient U87 cells. In contrast, RagC-deficient U87 cells showed increased senescence but no autophagy induction. These data show that losses of RagC and Map4K3 in malignant gliomas have proliferation-inducing effects and differentially modulate key mTOR signaling-dependent cellular mechanisms.

Medicine

From Tradition to Future in Veterinary Public Health Education: Students' Attitudes, Anxiety and Experiences With AI-Supported Learning.

Alan S et al. · Jul 1, 2026

Background Artificial intelligence (AI) has the potential to reshape learning processes, especially through tools such as ChatGPT. Objectives This study aims to evaluate veterinary students' attitudes towards AI-supported veterinary public health education applications, their anxiety levels and their experiences regarding the education process. Methods The study adopted a mixed method design in which quantitative and qualitative methods were used together. The study was conducted with final-year veterinary students (n = 60) enrolled in the Veterinary Public Health course. This study consisted of four phases: (1) the Artificial Intelligence Anxiety Scale (AIAS) was administered as a pre-test, (2) traditional face-to-face training was given, (3) the same topic was repeated with a ChatGPT-based AI-supported exercise and (4) after the trainings, the AIAS was administered again and post-test was conducted and a questionnaire consisting of closed and open-ended questions was administered to the students. Factor analysis revealed that the scale had high internal consistency (Cronbach's α > 0.90). Results Analysis of the scale scores revealed that veterinary students exhibited moderate anxiety towards AI and that AI-focused education did not significantly alter this anxiety in the short term. In the content analysis of qualitative data, students stated that they benefited from the aspects of AI such as fast access to information, practicality and time-saving; the same time, they expressed concerns about ethical concerns, information reliability and professional role change. Conclusion Overall, the findings indicate a duality in students' potential attitudes towards AI. These findings indicate the applicability of AI-based educational practices in the context of veterinary public health education and point to the need for multidimensional evaluation of student attitudes.

Medicine

Connection after correction: Parent-child relationships following early cardiac surgery.

Clancy TA et al. · Jul 1, 2026

Early cardiac surgery for congenital heart disease (CHD) may have enduring effects on the parent-child emotional connection and a child's capacity for regulation. This study explored emotional availability in parent-child interaction following early cardiac surgery in relation to emotional and behavioral regulation in children and identified early predictors. Participants were 23 preschool-aged children with CHD and their parents from a longitudinal cohort assessed at infancy (post-surgery) and preschool age in Australia. Dyadic interaction was assessed using the Emotional Availability Scales (EA), and parents reported on child's emotional and behavioral regulation. Predictors included infant social-emotional functioning, parental attachment feelings and traumatic stress, hospitalization length, timing of diagnosis and duration of contact at birth. Over 50% of dyads demonstrated emotional availability, however 30% were classified as complicated and 12% detached. Greater parental sensitivity was associated with less externalizing behavior. Longer hospitalization was associated with lower child involvement and greater parental intrusiveness. Contact at birth was associated with greater emotional availability and more optimal parental structuring at preschool. Findings highlight the enduring impact of early medical adversity on emotional availability in CHD and illuminate effects on both child and parent. Future research should explore targeted interventions that buffer relational disruptions in medically vulnerable dyads.

Medicine

Malignant Hyperthermia in Sweden: Clinical Presentations and Genetic Findings.

Hellblom A et al. · Jul 1, 2026

Introduction Malignant hyperthermia (MH) is a pharmacogenetic, hypermetabolic and potentially lethal reaction to potent volatile anaesthetics and the muscle relaxant succinylcholine. To improve the understanding of MH, the aim of this retrospective study was to describe the Swedish cohort with respect to clinical manifestations, demographics and genetic findings. Method The Swedish MH Registry covers a total of 2852 individuals belonging to 544 different families investigated for MH since 1980. For this study, the index case in each family was included for further description. Results In total, MH was confirmed in 1555 individuals. Among the 288 index cases with a history of an MH reaction and confirmed MH, 58% were male and 57% were Conclusions We found that MH reactions predominantly occur in young individuals and that case fatality has declined over recent decades, with no deaths reported in the past 20 years. Less than 40% of the genetically investigated MH families, corresponding to around 20% of all Swedish MH families, currently have an identified genetic diagnostic variant. Editorial comment This analysis of the national Swedish Malignant Hyperthermia patient registry presents case factors and outcomes from cases among recognised families from the last 45 years. Presenting symptoms and then case confirmation details are presented, along with results from cases and families where genetic variants has been assessed.

Biochemistry, Genetics and Molecular Biology