Postpartum depression in Vietnam: a scoping review of symptoms, consequences, and management.

BACKGROUND: Postpartum depression (PPD) is a major health issue that can affect both mothers and their newborn children. In Vietnam, approximately 20% of mothers suffer from PPD. However, there is a lack of synthesized evidence regarding the case management of PPD in the Vietnamese context. A review of early symptoms, consequences, and management strategies of PPD will help to inform best practices to reduce complications and shorten the recovery time after parturition. METHODS: This scoping review aims to analyze and synthesize the findings of studies on PPD examining the symptoms, consequences, and management strategies among Vietnamese women. MEDLINE, CINAHL, PubMed, ScienceDirect, EBSCOHost, Google Scholar, and a networked digital library of projects, theses, and dissertations published between 2010 and 2022 in Vietnam were accessed following search terms including "Vietnam", "depression", "postpartum", "symptom/experience", "consequence", and "management". FINDINGS: The most-reported symptoms were sadness, tiredness, the feeling of being ignored, lack of interest in the baby, reduced appetite, and sleep disturbance. The recognized consequences were child stunting and slow growth, without mentioning its long-term effects on mothers. Our findings indicated that PPD in Vietnam has not been sufficiently managed; mothers tend to seek help from 'fortune-tellers' or 'word-of-mouth' practices rather than from evidence-based modern medicine. CONCLUSION: This scoping review provides an initial stage of PPD symptoms, consequences, and management along with facilitating an interventional program to support this vulnerable group of women. A large survey of Vietnamese mothers' symptoms, effects, and management strategies is needed.

Village doctors: a national telephone survey of Bangladesh's lay medical practitioners.

BACKGROUND: Bangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained 'village doctors' able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal 'clinics'. METHODS: The study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: In addition to demographics, village doctors were asked about the characteristics of their 'clinics' including their equipment, their training, income and referral practices. RESULTS: Three quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor 'clinics' are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system. CONCLUSIONS: Bangladesh's village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation's established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications.

Survival of rural telehealth services post-pandemic in Australia: A call to retain the gains in the 'new normal'.

AIM: COVID-19 rapidly transformed how Australians access health care services. This paper considers how the inability for urban patients to access in-person care expediated the introduction of virtual solutions in health service delivery thus creating a new access paradigm for rural and remote Australians. CONTEXT: 'Physical distancing' is a phrase synonymous with public health responses to COVID-19 in Australia, but distance is a decades-long problem for rural health access. Counterintuitively, the pandemic and associated restrictions on mobility have reduced in real terms the distance from, and therefore the time taken to access, critical public services. 'Lockdowns' have unlocked health access for rural and remote Australians in ways that had been rejected prior to 2020. The pandemic has disrupted traditional delivery models and allowed the piloting of novel solutions, at the same time as stress-testing current delivery systems. In the process, it has laid bare a myopia we term 'urban paternalism' in understanding and delivering rural health. APPROACH: This commentary outlines how the COVID-19 operating environment has challenged traditional urban-dominated policy thinking about virtual health care delivery and how greater availability of telehealth appointments goes some way to reducing the health access gap for rural and remote Australians. CONCLUSION: Australian Commonwealth Government policy changes to expand the Medical Benefit Scheme (MBS) to include telephone or online health consultations are a positive initiative towards supporting Australians through the ongoing public health crisis and have also created access parity for some rural and remote patients. Although initially announced as a temporary COVID-19 measure in March 2020, telehealth has now become a permanent feature of the Medicare landscape. This significant public health reform has paved the way for a more flexible and inclusive universal health care system but, more importantly, taken much needed steps towards improving access to primary health care for patients in rural and remote areas. Now the question is: Can the health care system integrate this virtual model of delivery into 'business as usual' to ensure the long-term sustainability of telehealth services to rural and remote Australia?

Development and validation of a structured survey questionnaire on knowledge, attitude, preventive practice, and treatment-seeking behaviour regarding dengue among the resident population of Sabah, Malaysia: an exploratory factor analysis.

BACKGROUND: Several studies have reported a significant association of knowledge, attitude and preventive practice (KAP) regarding dengue infection among community's resident in endemic areas. In this study we aimed to assess and develop a reliable and valid KAP survey on the subject of dengue that is suitable for the resident population of Sabah, Malaysia. METHODS: A community-based cross-sectional study was conducted from October 2019 to February 2020 involving 468 respondents. Information on the socio-demographic characteristics of the participants (six items), their KAP (44, 15 and 18 items on knowledge, attitude and practice, respectively) and treatment-seeking behaviour (five items) towards dengue was collected using a structured questionnaire. Data analysis was performed using SPSS and R software in the R Studio environment. The knowledge section was analysed by two-parameter logistic item response theory (2-PL IRT) using ltm package. The construct validity and reliability of items for sections on attitude, practice and treatment-seeking behaviour were analysed using psy package. RESULTS: For the knowledge section, only 70.5% (31/44) of items were within or close to the parameter acceptable range of -3 to + 3 of difficulty. In terms of discrimination, 65.9% (29/44) of items were within or close to the acceptable range of 0.35 to 2.5, and 24 items (54.5%) failed to fit the 2-PL IRT model (P < 0.05) after assessing by goodness-of-fit analysis. Only eight items were reliable and retained in the attitude section with a Kaiser-Meyer-Olkin (KMO) test value of > 0.7, while based on the communalities, 11 items in the attitude section were excluded due to very low h2, factor loading values and low correlation with the total (< 0.5). The practice section was found suitable for factor analysis because the KMO value was > 0.7. The communalities of the practice section showed that seven items had low h2 values (< 0.3), which were therefore excluded from further analysis, and only 11 items were retained. CONCLUSIONS: The KAP items retained in the final version of the survey were reliable and valid to be use as a questionnaire reference when conducting future similar studies among the population of Sabah.

Otopathogen interactions in the nasopharynx of children, and the predictive value of nasopharyngeal aspirate culture for the aetiology of upper respiratory infections.

AIM: To evaluate nasopharyngeal aspirate cultures for screening otopathogen carriage in the adenoid in children 2-7 years of age. METHODS: Thirty-seven children, 2-7 years of age, scheduled for adenoidectomy were enrolled into this prospective study at Rockhampton, Australia. Adenoid biopsy and nasopharyngeal aspirate bacteriology were assessed by conventional culture. Demographic and environmental data were collected by questionnaire. Statistical analyses for descriptive, comparison and logistic regression tests between microbial, demographic, environmental and clinical groups were applied. RESULTS: Streptococcus pneumoniae, Staphylococcus aureus, non-typeable Haemophilus influenzae and Moraxella catarrhalis were detected in 38, 38, 35 and 24% of cases, respectively. Streptococcus pneumoniae was an independent determinant for non-typeable H. influenzae and S. aureus colonisation, and S. aureus was an independent determinant for S. pneumoniae colonisation. The nasopharyngeal aspirate otopathogen cultures were strong predictors for otopathogens in the adenoid, with moderate-high test accuracy for all otopathogens (receiver operator characteristics area under the curve ranging from 71 to 97% for the otopathogens tested). Children with positive non-typeable H. influenzae, M. catarrhalis, S. pneumoniae and S. aureus nasopharyngeal aspirate cultures were more likely to have the equivalent species in adenoid cultures (positive likelihood ratios = undefined, 15.0, 9.09 and 5.85, respectively). CONCLUSIONS: This study provides evidence that nasopharyngeal aspirate cultures are an indicator of otopathogens in the adenoid. Nasopharyngeal aspirate cultures may provide clinicians with information that informs clinical management. Strategies for improved management to reduce otopathogen carriage could reduce the prevalence of chronic upper respiratory infections that contribute to adenoidectomy.

An Ecologically Framed Comparison of The Potential for Zoonotic Transmission of Non-Human and Human-Infecting Species of Malaria Parasite.

The threats, both real and perceived, surrounding the development of new and emerging infectious diseases of humans are of critical concern to public health and well-being. Among these risks is the potential for zoonotic transmission to humans of species of the malaria parasite, Plasmodium, that have been considered historically to infect exclusively non-human hosts. Recently observed shifts in the mode, transmission, and presentation of malaria among several species studied are evidenced by shared vectors, atypical symptoms, and novel host-seeking behavior. Collectively, these changes indicate the presence of environmental and ecological pressures that are likely to influence the dynamics of these parasite life cycles and physiological make-up. These may be further affected and amplified by such factors as increased urban development and accelerated rate of climate change. In particular, the extended host-seeking behavior of what were once considered non-human malaria species indicates the specialist niche of human malaria parasites is not a limiting factor that drives the success of blood-borne parasites. While zoonotic transmission of non-human malaria parasites is generally considered to not be possible for the vast majority of Plasmodium species, failure to consider the feasibility of its occurrence may lead to the emergence of a potentially life-threatening blood-borne disease of humans. Here, we argue that recent trends in behavior among what were hitherto considered to be non-human malaria parasites to infect humans call for a cross-disciplinary, ecologically-focused approach to understanding the complexities of the vertebrate host/mosquito vector/malaria parasite triangular relationship. This highlights a pressing need to conduct a multi-species investigation for which we recommend the construction of a database to determine ecological differences among all known Plasmodium species, vectors, and hosts. Closing this knowledge gap may help to inform alternative means of malaria prevention and control.

A combinational approach to restore cytokine balance and to inhibit virus growth may promote patient recovery in severe COVID-19 cases.

The COVID-19 pandemic has led to twin public health and economic crises around the world. Not only has it cost hundreds of thousands of lives but also severely impacted livelihoods and placed enormous strain on community healthcare and welfare services. In this review, we explore the events associated with SARS-CoV-2 pathogenesis and host immunopathological reactivity due to the clinical manifestations of this coronavirus infection. We discuss that the metallopeptidase enzyme ADAM17, also known as tumor necrosis factor-α-converting enzyme, TACE, is responsible for shedding of angiotensin-converting enzyme 2 and membrane-bound interleukin (IL)-6 receptor. This leads to elevated pro-inflammatory responses that result in cytokine storm syndrome. We argue that cytokine balance may be restored by recovering an IL-6 trans-signaling neutralizing buffer system through the mediation of recombinant soluble glycoprotein 130 and recombinant ADAM17/TACE prodomain inhibitor. This cytokine restoration, possibly combined with inhibition of SARS-CoV-2 entry as well as replication and coagulopathy, could be introduced as a novel approach to treat patients with severe COVID-19. In cases of co-morbidity, therapies related to the management of associated disease conditions could ameliorate those clinical manifestations.

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia.

BACKGROUND: New-onset diabetes after transplantation (NODAT) is associated with reduced patient and graft survival. This study examined the clinical and selected genetic factors associated with NODAT among renal-transplanted Malaysian patients. METHODS: This study included 168 non-diabetic patients (58% males, 69% of Chinese ethnicity) who received renal transplantation between 1st January 1994 to 31st December 2014, and were followed up in two major renal transplant centres in Malaysia. Fasting blood glucose levels were used to diagnose NODAT in patients who received renal transplantation within 1 year. Two single nucleotide polymorphisms (SNPs), namely; rs1494558 (interleukin-7 receptor, IL-7R) and rs2232365 (mannose-binding leptin-2, MBL2) were selected and genotyped using Sequenom MassArray platform. Cox proportional hazard regression analyses were used to examine the risk of developing NODAT according to the different demographics and clinical covariates, utilizing four time-points (one-month, three-months, six-months, one-year) post-transplant. RESULTS: Seventeen per cent of patients (n = 29, 55% males, 69% Chinese) were found to have developed NODAT within one-year of renal transplantation based on their fasting blood glucose levels. NODAT patients had renal transplantation at an older age compared to non-NODAT (39.3 ± 13.4 vs 33.9 ± 11.8 years, p = 0.03). In multivariate analysis, renal-transplanted patients who received a higher daily dose of cyclosporine (mg) were associated with increased risk of NODAT (Hazard ratio (HR) =1.01 per mg increase in dose, 95% confidence interval (CI) 1.00-1.01, p = 0.002). Other demographic (gender, ethnicities, age at transplant) and clinical factors (primary kidney disease, type of donor, place of transplant, type of calcineurin inhibitors, duration of dialysis pre-transplant, BMI, creatinine levels, and daily doses of tacrolimus and prednisolone) were not found to be significantly associated with risk of NODAT. GA genotype of rs1494558 (HR = 3.15 95% CI 1.26, 7.86) and AG genotype of rs2232365 (HR = 2.57 95% CI 1.07, 6.18) were associated with increased risk of NODAT as compared to AA genotypes. CONCLUSION: The daily dose of cyclosporine and SNPs of IL-7R (rs1494558) and MBL2 (rs2232365) genes are significantly associated with the development of NODAT in the Malaysian renal transplant population.

Decoding the enigma of antiviral crisis: Does one target molecule regulate all?

Disease fatality associated with Ebola, SARS-CoV and dengue infections in humans is attributed to a cytokine storm that is triggered by excessive pro-inflammatory responses. Interleukin (IL)-6 acts as a mediator between pro- and anti-inflammatory reactivity by initiating trans- and classical-signaling, respectively. Hence, IL-6 is assumed to provide a target for a broad range of antiviral agents. Available immunosuppressive antivirals are directed to control an often exaggerated pro-inflammatory response that gives rise to complex clinical conditions such as lymphocytopenia. It is known that IL-6, via its soluble receptor (sIL-6R), initiates a pro-inflammatory response while an anti-inflammatory response is triggered by the membrane-bound IL-6 receptor (IL-6R). Future antivirals should thus aim to target the mechanism that regulates switching between IL-6 trans- and classical-signaling. In this review, we propose that the tumour necrosis factor-α converting enzyme ADAM-17 could be the master molecule involved in regulating IL-6 class switching and through this in controlling pro- and anti-inflammatory responses to viral antigenic stimuli. Therefore, ADAM-17 should be considered as a potential target molecule for novel antiviral drug discovery that would regulate host reactivity to infection and thereby limit or prevent fatal outcomes.

Malaria in Sri Lanka: Investigating causes of the recent elimination and making plans to prevent reintroduction.

Sri Lanka is a country that has long suffered from epidemics of malaria. In this historical context, it is remarkable that in 2016 the Indian Ocean island nation was able to officially celebrate the elimination of this parasitic disease of major public health importance. The most devastating outbreak recorded in Sri Lanka was during 1934-35, when close to 80,000 human deaths were reported. Indoor residual spraying with the insecticides, DDT and malathion commenced in 1947 and was successful in causing a rapid decline in malaria incidence. However, poor vector control measures, resistance of mosquitoes to these insecticides and resistance of blood-stage Plasmodium parasites to the prevailing drugs used are considered the principal reasons for the occurrence of subsequent outbreaks. Despite this, Sri Lanka achieved the significant milestone of zero locally transmitted malaria cases in October 2012 and zero recorded deaths since 2007. Vector surveillance, parasitological examination, and clinical case management were collective effective activities that most likely led to elimination of malaria. Yet, there remains a high risk of reintroduction due to imported cases and an enduring vulnerability to vector transmission. In order to prevent re-establishment of malaria, continued financial support, sustained surveillance for vector species present in Sri Lanka and effective control of imported cases through rapid detection and early diagnosis are all required. In addition to these immediate practical priorities, further studies on vector biology and genetic variations that affect vectorial capacity would help to shed light on how to avoid reintroduction. This review affords an insight into the determinants of past malaria epidemics, strategies deployed to achieve and maintain the current status of elimination, lessons learnt from this success and plans to avoid resurgence of infection.

A comparative analysis of the efficacy of three cryopreservation protocols on the survival of in vitro-derived cattle embryos at pronuclear and blastocyst stages.

The effectiveness of three cryopreservation protocols (slow freezing, short equilibration vitrification and long equilibration vitrification) on in vitro-derived cattle embryos at expanded blastocyst and pronuclear stages was compared. 199 expanded blastocysts of good quality were assigned randomly into four treatment groups [control, non-cryopreserved (fresh, unfrozen); and the three cryopreservation methods]. The re-expansion of the cryopreserved blastocysts after 24 h in vitro culture was similar to that of the fresh control group. However, the hatching rate of expanded blastocysts after 48 h culture was significantly less for the slow freezing group (31/47; 66.0%) than for both the short equilibration vitrification (46/51; 90.2%) and long equilibration vitrification groups (42/50; 84.0%). Denuded presumptive zygotes at the pronuclear stage (14-18 h post-insemination) were assigned randomly to the same four treatment groups and, following thawing, embryos were assessed for their capacity to cleave and to develop into a blastocyst. Overall, cleavage rates of cryopreserved zygotes were significantly less than those of the fresh control. The blastocyst formation rate of slow-frozen zygotes (4/81; 4.9%) was significantly less than that of zygotes subjected either to short equilibration vitrification (18/82; 22.0%) or long equilibration vitrification (16/74; 21.6%). All cryopreservation groups showed rates of blastocyst formation that were significantly less than that of the fresh control (51/92; 55.4%). Collectively, our findings indicate that vitrification is the preferred technology to cryopreserve in vitro-derived cattle embryos at expanded blastocyst and pronuclear stages. Moreover, short equilibration vitrification technology can improve outcomes and be more efficient by taking less time to perform.

Epidemiology of dengue in Nepal: History of incidence, current prevalence and strategies for future control.

Dengue is now established as one of the most important arboviral infections. As the epidemic continues unabated globally, this Aedes mosquito-transmitted pathogen is considered a major re-emerging tropical disease and significant public health concern. Four well-established distinct serotypes of dengue virus, with a fifth one recently proposed, are responsible for causing a spectrum of clinical symptoms in humans ranging from mild fever to severe haemorrhagic manifestations. Indigenous cases of dengue were first recognised in Nepal, a Himalayan country bordered by India and China, just a decade ago in a cluster of tropical and subtropical areas. Subsequently, the range of infection has extended all over the country and now comprises not only low lying regions, but also hilly locations including the capital city Kathmandu. The two major epidemics to date, in 2010 and 2013, have demonstrated the capacity of infection outbreaks to be explosive and challenging to currently available disease control measures. There is a pressing need to undertake effective vector surveillance studies supported by provision of well-equipped diagnostic virology laboratories. However, sincere efforts are being made to map the nationwide prevalence and understand the epidemiology of dengue infection. Yet, the precise burden of dengue in Nepal remains unknown, since most reports are confined to economically affluent areas and do not account for regions of relative social deprivation in which disease is more likely to occur. This review presents a current overview of dengue in Nepal and discusses future prospects for control of this debilitating disease in the country.

The epidemiology of dengue infection: Harnessing past experience and current knowledge to support implementation of future control strategies.

Dengue is the most important mosquito-borne viral infection of humans. Although outbreaks of disease which are now recognized as clinically consistent with dengue have been reported for centuries, it was not until half a century ago that laboratory identification of dengue viruses as the etiological agent of febrile illness was achieved. This debilitating and sometimes fatal disease is widely distributed in >125 countries in tropical and subtropical zones of the world. Asia, South America and the Pacific Islands are hyper-epidemic regions while currently there is less prevalence in Europe, North America and Australia. The estimated global incidence ranges between 200 and 400 million clinical cases per year. While some areas of past epidemics are now considered to be under control, recent decades have witnessed an epidemic rise in dengue worldwide. Major factors facilitating expansion include climate change and increase in urbanization and international travel. Concurrently, the non-availability of an efficacious antiviral drug or vaccine and a lack of effective vector control strategies collectively make dengue a serious public health concern. Thus, it is of paramount importance to analyze the history of the spread of infection and to gain a deeper understanding of patterns of transmission in order to anticipate epidemiological trends more accurately, thereby enabling better preparedness for future outbreaks.

Helicobacter pylori Outer Membrane Proteins and Virulence Factors: Potential Targets for Novel Therapies and Vaccines.

Helicobacter pylori is a gastric oncopathogen that infects over half of the world's human population. It is a Gram-negative, microaerophilic, helix-shaped bacterium that is equipped with flagella, which provide high motility. Colonization of the stomach is asymptomatic in up to 90% of people but is a recognized risk factor for developing various gastric disorders such as gastric ulcers, gastric cancer and gastritis. Invasion of the human stomach occurs via numerous virulence factors such as CagA and VacA. Similarly, outer membrane proteins (OMPs) play an important role in H. pylori pathogenicity as a means to adapt to the epithelial environment and thereby facilitate infection. While some OMPs are porins, others are adhesins. The epithelial cell receptors SabA, BabA, AlpA, OipA, HopQ and HopZ have been extensively researched to evaluate their epidemiology, structure, role and genes. Moreover, numerous studies have been performed to seek to understand the complex relationship between these factors and gastric diseases. Associations exist between different H. pylori virulence factors, the co-expression of which appears to boost the pathogenicity of the bacterium. Improved knowledge of OMPs is a major step towards combatting this global disease. Here, we provide a current overview of different H. pylori OMPs and discuss their pathogenicity, epidemiology and correlation with various gastric diseases.

COVID-19 post-pandemic reflections from sub-Saharan Africa: what we know now that we wish we knew then.

The commonly heard aphorism about history repeating itself suggests an endless cycle of recurring events. However, George Santayana offered a similar sentiment when he said, "Those who do not learn from history are doomed to repeat it". This emphasises that the responsibility for the recurrence of events lies not with history itself, but with humanity. It underscores that if we desire change, it is our responsibility to initiate it, rather than attributing it to external forces such as fate, luck, or time. With this thought in mind, here we offer a narrative view from sub-Saharan Africa, focusing primarily on our own experiences in Nigeria and Uganda, on what harsh lessons can be learnt from the COVID-19 pandemic regarding emergency preparedness to respond effectively to the next major infectious disease outbreak. Four strategies are suggested, the implementation of which may contribute substantially to safeguarding against an experience similar to the catastrophic public health, social and economic costs borne by African nations during COVID-19 and in its immediate aftermath.

Four Years Since COVID-19 Day Zero: A Time to Evaluate Past and Future Pandemic Control Policies and Practices in Sub-Saharan Africa?

Four years after the first case of COVID-19, the world is still determining how best to prevent and control the long-term effects of SARS-CoV-2 infection. Non-pharmaceutical interventions (NPIs) were employed at the start of the pandemic as the only available options, prior to effective vaccines and antiviral agents. The World Health Organization recommended dual vaccination for 70% worldwide as the threshold for a return to "normal" community life. Immunization rates needed to increase in all global regions, irrespective of socioeconomic status, necessitating more equitable access. During the pandemic, wealthier countries hoarded vaccine supplies even when their citizens were immunized. This highlights the already enormous difficulties in healthcare provision faced by low-income sub-Saharan African countries, which remain at risk as industrialized nations have progressed to a post-pandemic era. Thus, in addition to redoubling vaccination efforts public health policymakers should consider ongoing and future use of NPIs. In this narrative account, we advocate that various NPI practices should not be shelved; rather, more research is needed to evaluate their impact in parallel with booster vaccination. This especially applies to so-called "long COVID". Lessons learned from implementing best practices in resource-limited settings should be incorporated into preparedness guidelines for future infectious disease outbreaks.

Digital home-based post-treatment exercise interventions for female cancer survivors: A systematic review and meta-analysis.

BACKGROUND: Although exercise benefits female cancer survivors, clinical decision-making regarding timing, frequency, duration, and intensity is lacking. Optimizing exercise interventions in this population is necessary. This study aimed to describe existing digital home-based exercises and to assess their effectiveness at improving physical health in female cancer survivors upon completion of therapy. DESIGN: We conducted a systematic review using articles from Web of Science, Embase and Medline (Ovid). We included intervention studies examining the effects of digital home-based exercise programs on post-treatment recovery in female cancer survivors. Rob2 and ROBIN I were used to assess quality of studies. Quality-of-life, fatigue score, and physical performance were assessed using meta-analysis. RESULTS: This study involved 1578 female cancer survivors in 21 interventions. Following guidelines and supervised exercise with coaches led to better outcomes than interventions without guidelines, programs without coaches, or lower intensity exercise. Exercise led to significant improvement in some physical performance outcomes. Significant improvements were seen in physical performance outcomes, including the 6-min walk test, metabolic equivalent task, and number of steps per day. CONCLUSION: Providing cancer survivors with standard guidelines for home-based, coach-supervised, vigorous exercise on digital platforms could improve their physical function, health, and quality-of-life.

Combatting anthrax outbreaks across Nigeria's national land borders: need to optimize surveillance with epidemiological surveys.

BACKGROUND: Anthrax is a non-contagious zoonotic disease caused by the Gram-positive, spore-forming bacterium Bacillus anthracis. Infection is common in livestock and wild animals such as cattle, goats, sheep, camels, and antelopes. In humans, anthrax may occur after contact with contaminated carcasses or animal products like milk and meat. The best method to prevent anthrax in people is to ensure livestock are vaccinated, which significantly limits the risk of zoonotic spread to humans. However, the rate of vaccination of domesticated animals kept by nomadic pastoralists in West Africa is low. These groups regularly cross over national boundaries with their grazing herds. Nigeria is a country that historically has done comparatively well to contain this public health threat. However, in 2023 several outbreaks of human disease appear linked to the consumption of anthrax-contaminated animal products brought into Nigeria by pastoralists from neighboring countries. Clinical manifestations include skin sores or ulcers, nausea, vomiting, and fever. This article aims to raise awareness of recent outbreaks of anthrax in West Africa and to call for a renewed focus on measures to combat this neglected public health concern to the region. MAIN BODY: The imperative to pinpoint pivotal issues relating to the ongoing emergence of anthrax cases in Nigeria cannot be overstated. By delving into the prevalence of anthrax in both livestock and human populations residing along Nigeria's borders, unraveling the genetic diversity and potential sources of B. anthracis strains, and identifying the primary animal host(s) responsible for transmission, we stand to enhance our understanding of this critical issue. Furthermore, investigating the multifaceted factors contributing to anthrax transmission, assessing community knowledge and practices, mapping common migratory routes of pastoralists, and formulating targeted intervention strategies tailored to the challenges of border communities, are each crucial steps towards effective control and prevention. CONCLUSION: Closing these knowledge gaps on anthrax is not only essential for safeguarding both animal and human health but also for fostering sustainable and resilient communities. Addressing research questions on these interdisciplinary concerns will undoubtedly pave the way for informed decision-making, proactive measures, and a more secure future for Nigeria and its border regions.

Vietnam's Evolving Healthcare System: Notable Successes and Significant Challenges.

From regional and rural grassroots to a nationwide level, Vietnam has established a four-tiered hierarchical healthcare system, comprising national, provincial, district, and commune healthcare centers. Over the last three decades, alongside increasing provision of universal health insurance coverage and cutting healthcare expenditure, the country has demonstrated its dedication to preventative medicine and health promotion. Recent investment in research, development, and production has led to "homegrown" vaccines for SARS-CoV-2 now undergoing clinical trial. Nevertheless, despite substantial progress in improving health outcomes for the entire population, the healthcare sector experiences significant challenges. The current public system is paper-based, requires digitalization, and lacks information technology support. In common with many other countries, there is a vast disparity in the distribution of healthcare professionals between cities and rural areas, as well as between private and public sectors. Consequently, public healthcare in remote locations is particularly underserved. Moreover, ongoing underfunding caused by high out-of-pocket expenses for the average salary, as well as stigmatization of sensitive health issues by a largely conservative populace, demand a well-articulated and culturally sensitive approach. As the level of smartphone ownership and internet coverage are both comparatively high for Southeast Asia, the introduction of telemedicine, mobile health applications, and other digital health solutions may be both practicable and beneficial. Importantly, in order to develop healthcare facilities and reduce patient direct payments, the key issue of funding must be addressed. In order to overcome disease-related stigma, a locally tailored program of community education, awareness, and engagement is required. In summary, in several ways, Vietnam provides a role model for developing healthcare systems in low- and middle-income countries. There are undoubted hurdles to overcome, but the country continues to construct a healthcare system that is accessible and affordable for the majority.