Comparing health systems readiness for integrating domestic violence services in Brazil, occupied Palestinian Territories, Nepal and Sri Lanka.

Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.

Chagas Disease: A Silent Threat for Dogs and Humans.

Chagas disease (CD) is a vector-borne Neglected Zoonotic Disease (NZD) caused by a flagellate protozoan, Trypanosoma cruzi, that affects various mammalian species across America, including humans and domestic animals. However, due to an increase in population movements and new routes of transmission, T. cruzi infection is presently considered a worldwide health concern, no longer restricted to endemic countries. Dogs play a major role in the domestic cycle by acting very efficiently as reservoirs and allowing the perpetuation of parasite transmission in endemic areas. Despite the significant progress made in recent years, still there is no vaccine against human and animal disease, there are few drugs available for the treatment of human CD, and there is no standard protocol for the treatment of canine CD. In this review, we highlight human and canine Chagas Disease in its different dimensions and interconnections. Dogs, which are considered to be the most important peridomestic reservoir and sentinel for the transmission of T. cruzi infection in a community, develop CD that is clinically similar to human CD. Therefore, an integrative approach, based on the One Health concept, bringing together the advances in genomics, immunology, and epidemiology can lead to the effective development of vaccines, new treatments, and innovative control strategies to tackle CD.

Association of Meal Timing with Sleep Quality and Anxiety According to Chronotype: A Study of University Students.

There are several determinants of mental health symptoms, ranging from individual characteristics to social factors. Consistent with patterns in the general population, students with evening characteristics tend to exhibit more anxiety symptoms and poorer sleep quality compared to morning students. Meal timing also appears to affect sleep and may be associated with mental health symptoms. In this context, the aim of the present study was to investigate the association of the timing of the main and last meals of the day with sleep quality and anxiety levels, according to the chronotype of university students. This study was conducted in colleges in São Paulo, Brazil, and involved application of a questionnaire to 162 university students. The questionnaire collected sociodemographic information meal and study times, and included scales assessing eveningness and morningness, sleep quality, and anxiety. Students demonstrating a phase delay in both chronotype and dinner timing exhibited higher levels of anxiety compared to morning-type students. Although no associations were observed between meal timing and sleep quality, sleeping later was associated with poorer sleep quality. The study suggests that evening students and those who eat late at night are more prone to presenting mental health symptoms. More studies are needed to further investigate this association.

Assessment of dietary Selenium and its role in Mercury fate in cultured fish rainbow trout with two sustainable aquafeeds.

This study enhances the current limited understanding of the interaction between mercury (Hg) and selenium (Se) species in fish. Rainbow trout (Oncorhynchus mykiss), a model aquaculture fish, was exposed to Hg and Se species through controlled dietary conditions. Over a 6-month feeding trial, the impact of dietary Se on Hg bioaccumulation in fish, including flesh, brain, and liver, was tracked. Twelve dietary conditions were tested, including plant-based diets (0.25 µgSe g-1) and tuna byproduct diets (0.25 µgHg g-1, 8.0 µgSe g-1) enriched with methylmercury and/or Se as selenite or selenomethionine. The tuna byproduct diet resulted in lower Hg levels than the plant-based diets, with muscle Hg content below the European Commission's safe threshold. This study highlights the significant impact of specific Se compounds in the diet, particularly from tuna-based aquafeed, on Hg bioaccumulation. These promising results provide a strong recommendation for future use of fisheries byproducts in sustainable aquafeeds.

Association Between Augmentation Index and Total Sleep Time in Night Shift Workers.

Augmentation index and pulse wave velocity are markers of vascular compromise and independent predictors of cardiovascular risk and mortality. While the link between shift work and heightened cardiovascular risk is established, the intricate genesis of early cardiovascular outcomes in shift workers remains incompletely understood. However, there is evidence that sleep duration plays a role in this regard. Here we evaluate the association of total sleep time with pulse wave velocity, augmentation index, and central blood pressure in night shift workers. This study cross-sectionally evaluated the association of total sleep time evaluated by 10-day monitoring actigraphy with augmentation index, pulse wave velocity, and brachial and central blood pressure evaluated by oscillometry in nursing professionals, 63 shift workers (89% women; age = 45.0 ± 10.5 years), and 17 (100% women; age = 41.8 ± 15.6) day workers. There were no differences in the studied variables between shift workers and day workers. Results of correlation analysis demonstrated that pulse wave velocity, central systolic blood pressure, central diastolic blood pressure, brachial systolic blood pressure, and brachial diastolic blood pressure tended to have significant correlation with each other, while these measures did not have a significant relationship with augmentation index in both groups. However, results of adjusted restricted cubic spline analysis showed a U-shaped-curve association between total sleep time and augmentation index (p < 0.001 for trend) with a nadir at 300-360 min of total sleep time in shift workers. The present study showed that total sleep time, assessed by actigraphy, had a U-shaped association with augmentation index in shift workers, which indicated better characteristics of vascular functionality when sleep time was 5-6 h in the workers studied.

Universal control of a bosonic mode via drive-activated native cubic interactions.

Linear bosonic modes offer a hardware-efficient alternative for quantum information processing but require access to some nonlinearity for universal control. The lack of nonlinearity in photonics has led to encoded measurement-based quantum computing, which relies on linear operations but requires access to resourceful ('nonlinear') quantum states, such as cubic phase states. In contrast, superconducting microwave circuits offer engineerable nonlinearities but suffer from static Kerr nonlinearity. Here, we demonstrate universal control of a bosonic mode composed of a superconducting nonlinear asymmetric inductive element (SNAIL) resonator, enabled by native nonlinearities in the SNAIL element. We suppress static nonlinearities by operating the SNAIL in the vicinity of its Kerr-free point and dynamically activate nonlinearities up to third order by fast flux pulses. We experimentally realize a universal set of generalized squeezing operations, as well as the cubic phase gate, and exploit them to deterministically prepare a cubic phase state in 60 ns. Our results initiate the experimental field of polynomial quantum computing, in the continuous-variables notion originally introduced by Lloyd and Braunstein.

Is addressing violence against women prioritised in health policies? Findings from a WHO policies database.

Violence against women (VAW) affects almost 1 in 3 women and can lead to short and long-term adverse health outcomes. The health sector is an important entry point to respond to VAW. Globally, countries have committed to eliminating VAW through the SDGs and WHO Member States have endorsed a Global Plan of Action on Violence, which asks countries to provide comprehensive health services to VAW survivors. To track progress and establish a baseline for the Global Plan of Action on Violence, WHO developed a VAW Policies Database to assess how countries are addressing VAW in health and multisectoral policies. This paper presents findings from 15 select indicators related to the existence of VAW-related policies and the inclusion of health services for survivors in policies in line with WHO recommendations. Results show that while 80% of countries have multisectoral VAW policies in place, only 34% have national health policies that include VAW response and/or prevention as a strategic priority, and 48% have clinical guidelines for the health sector response. Policies were analysed to identify inclusion of WHO-recommended VAW health services: 75% of countries' policies mention provision of first-line support; while 50% or fewer of countries mention clinical enquiry to identify intimate partner violence, post-rape care services, or mental health assessment, referral and treatment. The high-income countries group had the lowest proportion of countries that specified each of the above-mentioned health services in policies. Findings show that more efforts are needed to raise the awareness of ministries of health about the public health impact of VAW and the importance of including VAW in health policies. Where policies exist, many are not aligned with WHO-recommendations. Policy dialogues should be conducted with governments on how to better align their VAW policies with internationally-agreed, evidence-based standards, and to implement them through programmes and services.

COVID-19-Associated Acute Kidney Injury and Longitudinal Kidney Outcomes.

Importance: COVID-19 infection is associated with a high incidence of acute kidney injury (AKI). Although rapid kidney function decline has been reported in the first few months after COVID-19-associated AKI (COVID-AKI), the longer-term association of COVID-AKI with kidney function remains unknown. Objective: To assess long-term kidney outcomes of patients who had COVID-19-associated AKI. Design, Setting, and Participants: This was a retrospective longitudinal multicenter cohort study conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. Patients were followed up for a maximum of 2 years after hospital discharge. Data analyses were performed from December 2022 to November 2023. Exposure: COVID-19 and influenza. Main Outcomes and Measures: The primary outcome was major adverse kidney events (MAKE), defined as a composite of mortality and worsened kidney function (estimated glomerular filtration rate [eGFR] decline by ≥25% from discharge eGFR or kidney failure requiring dialysis). Multivariable time-to-event analyses were performed to compare MAKE between individuals with COVID-AKI and those who had AKI associated with other illnesses hospitalized during the same period. For further comparison, this outcome was assessed for a historic cohort of patients with influenza-associated AKI. Results: The study cohort included 9624 hospitalized patients (mean [SD] age, 69.0 [15.7] years; 4955 [51.5%] females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). Compared with the other 2 groups, patients with COVID-19-associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower MAKE (adjusted hazard ratio [aHR], 0.67; 95% CI, 0.59-0.75) due to lower all-cause mortality (aHR, 0.31; 95% CI, 0.24-0.39) and lower rates of worsened kidney function (aHR, 0.78; 95% CI, 0.69-0.88). Conclusions and Relevance: The findings of this multicenter cohort study indicate that survivors of hospitalization with COVID-AKI experience lower rates of MAKE, long-term kidney function decline, and mortality compared with patients with AKI associated with other illnesses.

12-week melatonin administration had no effect on diabetes risk markers and fat intake in overweight women night workers.

Introduction: Interactions between circadian clocks and key mediators of chronic low-grade inflammation associated with fat consumption may be important in maintaining metabolic homeostasis and may pose a risk for the development of obesity-associated comorbidities, especially type 2 diabetes (T2DM). Objective: The aims of the present study were to evaluate the effects of melatonin administration on diabetes risk markers according to dietary lipid profile (pro-inflammatory versus anti-inflammatory) in excessive weight night workers, and to determine the effect of administration on fat consumption profile. Methods: A randomized, controlled, double-blind, crossover clinical trial involving 27 nursing professionals working permanent night shifts under a 12×36-hour system. The melatonin group (12 weeks) used synthetic melatonin (3 mg) only on days off and between shifts, while the placebo group (12 weeks) was instructed to take a placebo, also on days off and between shifts. For inflammatory characteristics, participants were divided into pro-inflammatory (saturated fats, trans fats and cholesterol) and anti-inflammatory (monounsaturated, polyunsaturated fats and EPA + DHA) groups according to fatty acid determinations. At baseline and at the end of each phase, blood glucose, insulin, glycosylated hemoglobin plasma concentrations were collected, and HOMA-IR was calculated. Conclusion: Melatonin administration for 12 weeks had no effect on T2DM risk markers according to dietary lipid profile (pro-inflammatory or anti-inflammatory potential) in excessive weight night workers. Among the limitations of the study include the fact that the low dose may have influenced the results expected in the hypothesis, and individual adaptations to night work were not evaluated. The insights discussed are important for future research investigating the influence of melatonin and fats considered anti- or pro-inflammatory on glucose and insulin homeostasis related to night work.

Is time of eating associated with BMI and obesity? A population-based study.

PURPOSE: Time-related eating patterns have been associated with metabolic and nutritional diseases such as obesity. However, there is a lack of representative studies on this subject. This study's aim was to assess the association between the timing of eating and obesity in a large and representative sample of the Brazilian adult population (POF 2008-2009 survey). METHODS: Two days of adults' food diary (n = 21,020) were used to estimate tertiles of first and last meal intake times, eating midpoint, caloric midpoint time, and calories consumed from 18:00 h onwards. BMI was estimated and its values, as well as excess weight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were used as outcomes. Multiple linear and logistic regressions were performed. RESULTS: The first (ß = 0.65, 95% CI 0.37-0.93) and last food intake time (ß = 0.40, 95% CI 0.14-0.66), eating midpoint (ß = 0.61, 95% CI 0.34-0.88) and calories consumed after 21:00 h (ß = 0.74, 95% CI 0.32-1.16) and 22:00 h (ß = 0.75, 95% CI 0.18-1.32) were positively associated with BMI. The likelihood of having excess weight or obesity was significantly higher in the third tertile of the first food intake time (OR = 1.28, 95% CI 1.13-1.45 and OR = 1.34, 95% CI 1.13-1.58, respectively), last food intake time (OR = 1.16, 95% CI 1.03-1.32; and OR = 1.18, 95% CI 1.00-1.41, respectively), eating midpoint (OR = 1.28, 95% CI 1.13-1.45; and OR = 1.35, 95% CI 1.14-1.59, respectively) and energy consumption after 21:00 h (OR = 1.33, 95% CI 1.10-1.59). CONCLUSION: Chrononutrition meal patterns indicative of late meal intake were significantly associated with high BMI, excess weight and obesity in the Brazilian population.

Rationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use.

BACKGROUND: Despite robust evidence and strong guideline recommendations supporting use of mineralocorticoid receptor antagonists (MRAs) to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF), these medications remain underused in clinical practice. OBJECTIVES: The goal is to determine if providing a tailored best practice alert (BPA) to outpatient providers suggesting guideline-recommended MRAs or information about available hyperkalemia treatment, if present, for patients with HFrEF will increase short-term MRA prescriptions. METHODS: PROMPT-MRA (Pragmatic Trial of Messaging to Providers About Treatment With Mineralocorticoid Receptor Antagonists) is a pragmatic, cluster-randomized, controlled study. A total of 119 providers were randomized to receive a BPA or usual care. During an outpatient visit with participating providers, the BPA displayed recent laboratory test values and ejection fraction. The alert suggested guideline-recommended MRAs for eligible patients with a serum potassium of <5.0 mEq/L or novel potassium binders for those with a serum potassium of ≥5.0 mEq/L, each linked to an order set containing the corresponding medication and laboratory monitoring. RESULTS: PROMPT-MRA completed enrollment with 1,210 patients. The primary outcome of PROMPT-MRA is to determine if a tailored BPA for outpatients with HFrEF will lead to higher MRA prescriptions 6 months following randomization compared with usual care. Secondary outcomes included incidence of hyperkalemia, use of novel potassium binders, heart failure hospitalizations, and mortality. CONCLUSIONS: If effective, the BPA can be scaled to improve population health outcomes with increased MRA prescribing among eligible patients with HFrEF, with or without a history of hyperkalemia. (Pragmatic Trial of Alerts for Use of Mineralocorticoid Receptor Antagonists [PROMPT-MRA]; NCT04903717).

Late evening electric light exposure is associated with low sleep regularity in adolescents living in rural areas.

In this study, we tested the prediction that sleep regularity would be lower in adolescents exposed to late evening electric light (LEEL) than in those without exposure to it. The Sleep Regularity Index was calculated based on actigraph recordings from adolescents living in rural communities in Argentina and Brazil that were either exposed to LEEL or not. The effect of the LEEL on sleep variables was tested using linear models considering sex and age, as well as accounting for the differences between countries. Sleep onset was delayed, sleep duration shortened, and Sleep Regularity Index was 4 [1-8] points lower in the group exposed to LEEL (p = .0176, eta2 =0.13). Our results show that beyond sleep phase and duration, which are known to be affected by LEEL in this age group, sleep irregularity should also be considered as an important outcome variable when assessing the adverse effects of evening light on adolescents.

Sympathetic Motor Neuron Dysfunction is a Missing Link in Age-Associated Sympathetic Overactivity.

Overactivity of the sympathetic nervous system is a hallmark of aging. The cellular mechanisms behind this overactivity remain poorly understood, with most attention paid to likely central nervous system components. In this work, we hypothesized that aging also affects the function of motor neurons in the peripheral sympathetic ganglia. To test this hypothesis, we compared the electrophysiological responses and ion-channel activity of neurons isolated from the superior cervical ganglia of young (12 weeks), middle-aged (64 weeks), and old (115 weeks) mice. These approaches showed that aging does impact the intrinsic properties of sympathetic motor neurons, increasing spontaneous and evoked firing responses. A reduction of KCNQ channel currents emerged as a major contributor to age-related hyperexcitability. Thus, it is essential to consider the effect of aging on motor components of the sympathetic reflex as a crucial part of the mechanism involved in sympathetic overactivity.

Calidad de atención en el manejo de enfermedad cerebrovascular isquémica aguda posterior a la iniciativa angels / Acute ischemic cerebrovascular disease management quality of care following the adoption of the angels initiative

Introducción: el ataque cerebrovascular (ACV) es común a nivel mundial, una de cada cuatro personas puede presentarlo a lo largo de la vida. Constituye la segunda causa de muerte y la tercera principal de discapacidad. Es importante la atención integral para lograr un impacto en la calidad de vida. Objetivo: determinar la calidad de atención en el manejo del ACV isquémico agudo de los pacientes que consultaron al servicio de neurología en los Hospitales de San José e Infantil Universitario de San José, Bogotá DC, entre enero 1/2019 y enero 1/2020. Metodología: estudio descriptivo de corte transversal. El criterio de inclusión fue pacientes mayores de 18 años con diagnóstico de ACV isquémico. La información se recolectó de las historias clínicas, se empleó estadística descriptiva para analizar los datos. Resultados: se incluyeron 411 pacientes, 88,8% sin alteración del estado de conciencia, 26,4% ingresaron antes de las 4,5 horas de ventana para trombólisis, se realizaron procedimientos de recanalización endovenosa a 11,4%. El tiempo puerta aguja tuvo una mediana de 37,2 minutos comparado con la mediana nacional de tiempo que fue 56,5 min según lo registrado en la plataforma ResQ. El 72% recibió terapia antiagregante y estatina 88.8%. Discusión y conclusiones: al identificar los síntomas es importante ser estrictos en el tiempo de atención y la implementación de plataformas para óptimos planes de atención. Se requieren campañas masivas de educación, así como que planes de mejora institucionales.

Introduction: cerebrovascular attack (CVA) is common worldwide. One in four people may have a stroke during their lifetime. It is the second leading cause of death and the third leading cause of disability. Thus, it is important to provide integrated care to achieve an impact on quality of life. Objective: to determine ischemic CVA management quality of care among patients seen at the neurology service of the San José and Infantil Universitario de San José hospitals in Bogotá DC, between January 1/2019 and January 1/2020. Methodology: a descriptive, cross-sectional study. The inclusion criteria included patients over 18 years of age diagnosed with ischemic CVA. Information was collected from clinical records. Data was analyzed using descriptive statistics. Results: 411 patients were included; 88.8% had an altered state of consciousness, 26.4% were admitted within the 4.5-hour window for thrombolysis; 11.4% underwent intravenous reperfusion procedures. Door-to-needle time: median was 37.2 minutes versus the national media of 56.5 min according to the ResQ records platform; 72% received anti-platelet therapy and 88.8% received statins. Discussion and conclusions: the establishment of a strict time to care and the implementation of platforms to improve care plans, is essential. Massive education campaigns are required, as well as, institutional improvement plans.

Food safety and biological control; genomic insights and antimicrobial potential of Bacillus velezensis FB2 against agricultural fungal pathogens.

Development of natural, broad-spectrum, and eco-friendly bio-fungicides is of high interest in the agriculture and food industries. In this context, Bacillus genus has shown great potential for producing a wide range of antimicrobial metabolites against various pathogens. A Bacillus velezensis strain FB2 was isolated from an agricultural field of National Institute for Biotechnology and Genetic Engineering (NIBGE) Faisalabad, Pakistan, exhibiting good antifungal properties. The complete genome of this strain was sequenced, and its antifungal potential was assayed by dual culture method. Moreover, structural characterization of its antifungal metabolites, produced in vitro, were studied. Genome analysis and mining revealed the secondary metabolite gene clusters, encoding non-ribosomal peptides (NRPs) production (e.g., surfactin, iturin and fengycin) and polyketide (PK) synthesis (e.g., difficidin, bacillaene and macrolactin). Furthermore, the Bacillus velezensis FB2 strain was observed to possess in vitro antifungal activity; 41.64, 40.38 and 26% growth inhibition against major fungal pathogens i.e. Alternaria alternata, Fusarium oxysporum and Fusarium solani respectively. Its lipopeptide extract obtained by acid precipitation method was also found effective against the above-mentioned fungal pathogens. The ESI-MS/MS analysis indicated various homologs of surfactin and iturin-A, responsible for their antifungal activities. Overall, this study provides a better understanding of Bacillus velezensis FB2, as a promising candidate for biocontrol purposes, acting in a safe and sustainable way, to control plant pathogens.

Classification and distribution of functional groups of birds and mammals in Mexico.

There has been a recent exponential growth in the study of functional trait ecology. Nonetheless, the study of functional traits and functional groups has been limited for terrestrial vertebrates. We conducted a classification update of functional groups (FG) of birds and mammals in Mexico, and determined the distribution patterns of FG species richness in different ecosystems nationwide. We selected six functional traits (feeding habit, locomotion, feeding substrate and technique, activity period, seasonality, and body size) obtained for 987 and 496 species of birds and mammals, respectively. A cophenetic correlation analyses resulted in values of 0.82 for the bird species dendrogram, and 0.79 for the mammal species dendrogram showing that the structures adequately reflected the similarity between observations. We obtained 52 FG for birds, assembled into 9 broader groups based on their feeding habits (16 invertivores, 6 carnivores: 5 herbivores, 9 aquatic vertivore/invertivore, 5 granivores, 1 scavenger, 3 nectarivores, 4 frugivores, and 3 omnivores). We obtained 35 FG for mammals, assembled into 9 broader groups based on their feeding habits (4 granivores, 10 herbivores, 1 nectarivore, 4 frugivores, 8 invertivores, 3 omnivores, 2 aquatic vertivore/invertivore, 1 hematophagous, and 2 carnivores). Overall, the distribution of FG species richness for birds and mammals gradually increased from the Nearctic to the Neotropical region, following a typical latitudinal species richness pattern. Few FG of migratory birds, and FG of granivore and herbivore mammals showed more species in the Nearctic and in the transitional regions. Our study provides a baseline for identifying ecological functions of species of birds and mammals in different ecosystems in Mexico, and contributes to understand the relationship between species diversity, community structure and ecosystem functioning. Identifying spatial patterns of functional trait diversity is important as biodiversity loss has a negative impact on ecosystem functioning and provision of environmental services.

Geospatial assessment of the convergence of communicable and non-communicable diseases in South Africa.

Introduction: Several low-and middle-income countries are undergoing rapid epidemiological transition with a rising burden of non-communicable diseases (NCDs). South Africa (SA) is a country with one of the largest HIV epidemics worldwide and a growing burden of NCDs where the collision of these epidemics poses a major public health challenge. Methods: Using data from a large nationally representative survey, the South Africa Demographic and Health Survey (SADHS 2016), we conducted a geospatial analysis of several diseases including HIV, tuberculosis (TB), cardiovascular, respiratory, and metabolic diseases to identify areas with a high burden of co-morbidity within the country. We explored the spatial structure of each disease and associations between diseases using different spatial and visual data methodologies. We also assessed the individual level co-occurrence of HIV and the other diseases included in the analysis. Results: The spatial distribution for HIV prevalence showed that this epidemic is most intense in the eastern region of the country, mostly within the Gauteng, Mpumalanga, and Kwazulu-Natal provinces. In contrast, chronic diseases had their highest prevalence rates the southern region of the country, particularly in the Eastern and Western Cape provinces. Individual-level analyses were consistent with the spatial correlations and found no statistically significant associations between HIV infection and the presence of any NCDs. Conclusions: We found no evidence of geospatial overlap between the HIV epidemic and NCDs in SA. These results evidence the complex epidemiological landscape of the country, characterized by geographically distinct areas exhibiting different health burdens. The detailed description of the heterogenous prevalence of HIV and NCDs in SA reported in this study could be a useful tool to inform and direct policies to enhance targeted health service delivery according to the local health needs of each community.

Patterns of Women's exposure to psychological violence: A global examination of low- and middle-income countries.

Introduction: Under Sustainable Development Goal 5, prevalence of intimate partner violence (IPV) is a globally reportable indicator. There is a lack of consensus on how to measure and report psychological IPV, affecting prevalence estimates and cross-country comparability. We examine similarities and differences in the patterning of women's experiences of psychological abuse in low- and middle-income countries (LMICs) to inform common cut points. Methods: Data include 13,452 ever-partnered women from six LMICs participating in the WHO multi-country study on women's health and domestic violence against women and 306,101 from 47 LMICs participating in the Demographic and Health Surveys. A confirmatory latent class analysis (LCA) approach was applied to identify the optimal class structure using the 3 DHS and 4 WHO psychological IPV items, assessed the impact of physical and sexual IPV on class structure, and tested class generalizability across countries. We validated the three-class solution by regressing the classes on physical IPV, sexual IPV, controlling behaviors, and injury due to domestic violence. We used item response theory (IRT) methods to assess item-level characteristics of the items. Results: Analysis confirmed the three-class structure in most countries. Addition of physical and sexual IPV did not change overall class structure or improve discrimination or homogeneity of the items. The three-class structure was invariant within most WHO-classified regions. Operationalized classes informed by the LCA resulted in prevalences of roughly 90% low-to-no class, 7% moderate-intensity class, and 3% high-intensity class. Classes showed convergent validity with all outcomes tested. IRT analysis revealed good discriminations but substantial information overlaps over a narrow range of the latent psychological violence construct. Conclusions: This study confirms the three-class pattern but suggests some differences across countries. and regions. We suggest cut points distinguishing violent from non-violent acts and demarcating levels of severity for future study. Findings offer evidence-based guidance to rectify challenges.

Seasonal and Regional Differences in Eating Times in a Representative Sample of the Brazilian Population.

Human food intake and its timing are a complex behavior that can be influenced by a variety of factors, some of which may vary from season to season or from region to region. In this study, our aim was to investigate the seasonal variation in food intake times, with a particular focus on how these may vary across different regions of a country. We conducted an analysis of data from 20,622 adults from the National Household Budget Survey (POF-IBGE), encompassing complete food diaries collected from individuals residing in Brazil, and thereby ensuring representation across different latitudes. Each participant's daily food intake was reported for two non-consecutive days at different times in the same week using food diaries. An ANOVA revealed a later food intake time in the evening in high-latitude regions compared to low-latitude regions. The Sidak post-hoc test showed a significant interaction effect between region and season, demonstrating a pattern of early First Intake Time and Eating Midpoint in the Northeast region during spring/summer. Additionally, we observed an independent effect of the region, as early food intake times were found in low-latitude regions. These findings offer a basis for discussing food intake times among individuals living in different regions located on distinct latitudes.