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Nanotechnology and machine learning: a promising confluence for the advancement of precision medicine
Get PDFThe fusion of molecular-scale engineering in nanotechnology with machine learning (ML) analytics is reshaping the field of precision medicine. Nanoparticles enable ultrasensitive diagnostics, targeted drug and gene delivery, and high-resolution imaging, whereas ML models mine vast multimodal datasets to optimize nanoparticle design, enhance predictive accuracy, and personalize treatment in real-time. Recent breakthroughs include ML-guided formulations of lipid, polymeric, and inorganic carriers that cross biological barriers; AI-enhanced nanosensors that flag early disease from breath, sweat, or blood; and nanotheranostic agents that simultaneously track and treat tumors. Comparative insights into Retrieval-Augmented Generation and supervised learning pipelines reveal distinct advantages for nanodevice engineering across diverse data environments. An expanded focus on explainable AI tools, such as SHAP, LIME, Grad-CAM, and Integrated Gradients, highlights their role in enhancing transparency, trust, and interpretability in nano-enabled clinical decisions. A structured narrative review method was applied, and key ML model performances were synthesized to strengthen analytical clarity. Emerging biodegradable nanomaterials, autonomous micro-nanorobots, and hybrid lab-on-chip systems promise faster point-of-care decisions but raise pressing questions about data integrity, interpretability, scalability, regulation, ethics, and equitable access. Addressing these hurdles will require robust data standards, privacy safeguards, interdisciplinary R&D networks, and flexible approval pathways to translate bench advances into bedside benefits for patients. This review synthesizes the current landscape, critical challenges, and future directions at the intersection of nanotechnology and ML in precision medicine
Interpregnancy Weight Change and Adverse Birth Outcomes: Cohort Study Using Brazil's Routine Register-Based Linked Data.
Get PDFThe effects of interpregnancy weight change (IPWC) on the risk of adverse birth outcomes in subsequent pregnancies are still not fully understood. Existing studies present conflicting results regarding the association between IPWC and preterm birth, while evidence of its relationship with low birth weight (LBW) or macrosomia is limited, particularly in low- and middle-income countries. This population-based longitudinal study used Brazil's routine register-based linked data from 2008 to 2015 to evaluate the association between IPWC and adverse birth outcomes in a subsequent pregnancy. Preterm birth, LBW, and macrosomia were compared across categories of IPWC between pregnancies (including changes in BMI unit, changes in BMI category, and percentage of weight change). Logistic and multinomial logistic regressions were used to estimate the association between IPWC and adverse birth outcomes. We analysed 15,570 live births from 7785 multiparous women. Women who reduced their BMI between pregnancies had an increased chance of delivering preterm neonates (OR 1.27; 95% CI 1.01-1.60) and those who increased their BMI by ≥ 4 units between pregnancies had an increased chance of macrosomia (OR 1.60; 95% CI 1.21-2.12) compared to those who maintained their BMI. Similar results were observed when IPWC was defined as changes in BMI categories and percentage changes in weight. The results of this study show that IPCW were associated with changes in both the newborn's maturity and size in a subsequent pregnancy. These findings support the need to develop experimental studies on the effects of maternal weight management within and between pregnancies to improve outcomes for both mothers and babies
Transphobia in the United Kingdom: a public health crisis.
Get PDFBACKGROUND: The moral panic surrounding trans, non-binary, and gender diverse (TGD) lives in the United Kingdom (UK) has been incited by high-level political and government actors and exacerbated by pervasive misinformation in social and press media. This hostile environment contributes to increasing interpersonal violence and social exclusion experienced by TGD people. Structural and interpersonal discrimination—conceptualised as minority stress—is understood to elicit physiological and psychological stress responses that predispose TGD individuals to a range of adverse health outcomes, including cardiovascular disease, and risk behaviours such as alcohol use. MAIN BODY: Health disparities among TGD people in the UK are driven by a combination of minority stress, barriers to general healthcare, and disadvantage across multiple social determinants of health. Limited access to gender-affirming healthcare compounds these disparities, contributing to stark differences in morbidity and mortality relative to cisgender populations. Preventive healthcare engagement is also disproportionately low among TGD individuals, further exacerbating long-term health risks. The intersection of social exclusion, policy-driven discrimination, and systemic healthcare inequities places TGD people at significant and potentially increasing risk of poor health outcomes. CONCLUSIONS: The health disparities faced by TGD people in the UK constitute a real-time public health crisis that demands urgent and sustained intervention. TGD people must be central to shaping the strategic direction of a coordinated and adequately resourced response to these harms
Malnutrition in infants aged under 6 months: prevalence and anthropometric assessment - analysis of 56 low- and middle-income country DHS datasets.
Get PDFINTRODUCTION: Tackling malnutrition in infants aged under 6 months (u6m) is a major global priority yet evidence around this vulnerable group is weak. We aimed to support the rollout of new 2023 WHO guidelines by examining the burden of infant malnutrition and potential programme caseloads with new enrolment criteria. METHODS: Secondary analysis of Demographic and Health Survey (DHS) datasets. We calculated the number of underweight (low weight-for-age), wasting (low weight-for-length), stunting (low length-for-age) and low birth weight (LBW) infants. We assessed data quality by recording extreme or missing values. We calculated the population-weighted prevalence of anthropometric deficit and extrapolated to all low- and middle-income countries (LMICs). We regressed being underweight and wasti on infant, maternal and household characteristics using logistic regression. RESULTS: We analysed 56 DHS surveys. There were more extreme (flagged) values for length-based measures (7.5% flagged for weight-for-length, 3.8% for length-for-age) than for weight-for-age (0.6% flagged). Overall, 17.4% of infants (95% CI: 16.9 to 18.0) were underweight, 15.5% (15.0-16.0) were wasted, 19.9% (19.3-20.5) were stunted and 15.0% (14.5-15.5) were LBW. This corresponds to an estimated burden in LMICs of 10.3 million underweight infants (4.1 million severely underweight), 9.2 million wasted (4.0 million severely wasted), 11.8 million stunted (5.4 million severely stunted) and 8.9 million LBW infants. Overlap of the indicators varied markedly in different regions/countries. Numerous factors were associated with both underweight and wasting; associations tended to be stronger and have greater biological plausibility with being underweight. CONCLUSION: Malnutrition in infants u6m is a major problem in LMICs. Local epidemiology should inform case identification in contextualised care services across health and nutrition. Data quality and stronger associations with health and social characteristics support the use of underweight as a key enrolment criterion. Since vulnerability may be due to or exacerbated by multiple factors, management must go beyond feeding support to address wider infant, maternal and mental health and social circumstances through integrated, multidisciplinary care systems
Intervention co-design to reduce the impact of heat exposure on pregnant and postpartum women and newborns in Burkina Faso.
Get PDFInterventions are needed to reduce the impact of heat on the health and wellbeing of women and newborns in Burkina Faso where seasonal temperatures can be extremely high. In this article, we share our experience and lessons learned from co-designing an intervention to improve maternal and neonatal health, about heat in a rural and an urban district of Burkina Faso. We performed community engagement and a series of workshops with 49 community members (health workers, women group representatives, youth leaders, religious leaders, traditional leader, and mothers-in-law) and 36 implementers, stakeholders and professionals (officials from the Ministry of Health, midwives and related health workers, meteorologists, and environmental health practitioners). Following the discussions and group reflections, emerging intervention priorities were ranked based on their perceived likelihood of success, cost effectiveness, implementation feasibility, and sustainability. The co-design workshops identified behaviour change interventions encompassing raising awareness of the effects of heat through targeted messages on adaptative behaviour to adopt. The effective operationalisation of these interventions was further achieved through co-planning involving health system actors in contact with women and local stakeholders with relevant expertise. We aimed to engage health professionals and community health workers to integrate heat and dehydration messages into their routine work with pregnant and postpartum women with the aim of changing behaviour through communication: educational group talks, interpersonal exchanges in the consultation room and broadcasts of information to the public who attend the clinic (video played on a television set in the waiting room). The co-design workshops were an opportunity to build capacity among facilitators and participants as well as to prioritize and develop interventions to address the impact of heat exposure-amplified by climate change-on pregnant and postpartum women, and on newborns
Self-reported COVID-19 severity among persons with tuberculosis infection in western Kenya, 2021.
Get PDFWhilst a quarter of the world's population is estimated to be infected with Mycobacterium tuberculosis, it is unknown whether TB infection (TBI) increases the risk of severe COVID-19, which is relevant in TB-endemic settings, especially where HIV co-infection is also common. A convenience cohort of symptomatic and asymptomatic COVID-19 patients aged 8-80 years in western Kenya was followed daily for 14 days to assess disease progression using the validated inFLUenza-Patient-Reported-Outcome Plus signs and symptom tool. Nasal swabbing for SARS-CoV-2 was conducted to confirm the virus using polymerase chain reaction. QuantiFERON-TB Gold Plus was used to diagnose TBI. HIV status was based on self-reports. Between January 3, 2021, and January 20, 2022, 373 out of 387 participants had conclusive QuantiFERON results. At baseline, 5.9% (22/373) had self-reported severe COVID-19, 33.2% (124/373) had TBI, and 11.1% (38/341) reported being HIV-infected. Median follow-up of the cohort was 105 days (range 0-368). Self-reported severe COVID-19 was experienced by 10 of 124 (8.1%) participants compared with 12 of 249 (4.8%) without TBI (odds ratio [OR] 1.73, 95% CI 0.73-4.12, p = 0.21). HIV was not associated with self-reported severe COVID-19 (OR 3.13, 0.96-8.77, p = 0.039, adjusted OR 2.77, 95%CI 0.84-7.93, p = 0.070), but age ≥ 50 years was associated with self-reported severe COVID-19 (OR 3.73, 1.47-9.07, p = 0.004, adjusted OR 2.91, 95%CI 1.02-7.69, p = 0.035). One participant died of COVID-19 three days after diagnosis, and another participant developed active TB 128 days after his COVID-19 diagnosis and was successfully treated. Both were QuantiFERON positive. Self-reported severe COVID-19 was associated with older age and not TBI. Our finding that increased age was associated with self-reported severe COVID-19 is consistent with findings in multiple settings around the world
Comparison of central obesity prevalence among adults living with and without HIV in Botswana: a cross-sectional study.
Get PDFOBJECTIVES: The aim was to establish the community prevalence of central obesity in Botswana and assess its association with HIV status. DESIGN: We performed a one-time central obesity assessment nested within a community-based cluster-randomised controlled HIV treatment and prevention trial (Botswana Combination Prevention Project (BCPP)) conducted in Botswana. SETTING: The BCPP enrolled consenting adults from a random sample of 20% of households in 30 rural/peri-urban communities. PARTICIPANTS: A subset of participants from 22 communities was selected for a nested central obesity study. PRIMARY AND SECONDARY OUTCOME MEASURES: Central obesity was defined as a waist-to-hip ratio (WHR)>0.90 for males and >0.85 for females or as a waist circumference (WC) ≥94 cm for males and ≥80 cm for females. A modified Poisson regression model was used to ascertain the association between central obesity and HIV status. Additionally, the same model was used to estimate the adjusted prevalence ratio (aPR) for central obesity among participants with missing waist and hip measurements by applying inverse probability weighting, and then adjusting for sex and age in the final multivariate models. RESULTS: Of the 3981 adults, 2039 (51%) completed central obesity assessment (67% female, 29% people living with HIV and median age 35.4 years (IQR 26.4-48.3 years). Central obesity prevalence was 43.5% (95% CI 41.4% to 45.7%) and 50.8% (95% CI 48.6% to 52.9%) as defined by WHR and WC, respectively, and was higher among females than males by WHR (46.9% (95% CI 44.2% to 49.5%) vs 36.7% (95% CI 33.1% to 40.4%)) and WC 68.5% ((95% CI 65.9% to 70.9%) vs 15.1% (95% CI 12.4% to 17.8%)) and increased with age. In fully adjusted models, there was no difference in central obesity by HIV status for both WHR and WC, aPR 0.99 (95% CI 0.90 to 1.09), p value 0.88, and 0.93 (95% CI 0.85 to 1.01), p value 0.06, respectively. CONCLUSION: Over two-thirds of adult females in Botswana had central obesity; however, living with HIV was not consistently associated with central obesity. TRIAL REGISTERATION NUMBER: NCT01965470
Antenatal Screening for Hepatitis B Virus in Uganda: Missed Opportunities for Diagnosis and Treatment.
Get PDFBACKGROUND: Hepatitis B virus (HBV) infection is a significant cause of morbidity and mortality globally. The World Health Organization estimates that just 10.5% of individuals living with HBV globally are aware of their status. Antenatal care provides an opportunity to screen pregnant women for HBV and to treat those who are eligible to reduce the risk of vertical transmission. We conducted an observational study to determine the proportion of pregnant women with active HBV infection delivering at a government-funded hospital in Kampala, Uganda, to estimate the number of missed opportunities to prevent vertical transmission. METHODS: Eligible participants were enrolled via the PROGRESS study, an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021. Results presented here describe data from April 2019 to November 2020. Five milliliters of venous blood was drawn shortly after delivery. Serum aliquots were analyzed for hepatitis B surface antigen (HBsAg). HBsAg-positive participants were informed of their result by telephone and referred to the gastroenterology service for specialist management. RESULTS: In total, 6062 women were enrolled between April 2019 and November 2020. Results were available for 6012 (99.6%) participants, among whom 131 (2.2%) were HBsAg positive. Only 10 of 131 (7.6%) HBsAg-positive participants were successfully referred to the gastroenterology service at Mulago Hospital for treatment of their infection. CONCLUSIONS: Our study identified a number of missed opportunities to identify active HBV infection among our pregnant cohort. Additional resources are urgently required to increase the coverage of antenatal HBV screening while also improving treatment pathways for pregnant women with HBV infection in this region
Effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on maternal gestational weight gain in low-income and middle-income countries: a systematic review and individual participant data meta-analysis of randomised clinical trials.
Get PDFBACKGROUND: Studies have consistently demonstrated beneficial effects of intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) on reducing malaria infection and improving birth outcomes among pregnant women in endemic areas. However, data on its impact on maternal gestational weight gain (GWG) are very limited. We aimed to conduct a two-stage meta-analysis of individual participant data to examine the effect of IPT with SP on GWG compared to other antimalarial regimens. METHODS: In this systematic review and individual participant data meta-analysis, we conducted electronic literature searches of PubMed, Embase, Web of Science, and the Cochrane Library to identify eligible RCTs among pregnant women. We did not apply any language or publication date restrictions in the search. The initial search was conducted on August 4th, 2021, and updated on February 15th, 2025. The study-level inclusion criteria were as follow: 1) the studies must be randomised controlled trials (RCTs), which could be individually randomised, cluster randomised, or a combination of both; 2) study participants were pregnant at enrollment or enrolled before pregnancy and followed up in pregnancy; 3) studies were conducted in a low-income, lower-middle-income, or upper-middle-income economy defined by the World Bank country classification for the 2021 fiscal year; 4) antimalaria and/or antibiotic interventions were provided during pregnancy; and 5) the intervention was provided alone or in combination with a co-intervention that was similar across arms. Since we focused on the intervention's effect on GWG in generally healthy pregnant women, we applied the following study-level exclusion criteria: 1) studies without any measures of maternal weight during pregnancy; and 2) studies conducted exclusively among women with pre-existing health conditions, such as anemia, human immunodeficiency virus (HIV) infection, or diabetes. Within each eligible trial, we further applied individual-level criteria to identify eligible individual participants, including 1) singleton pregnancies, 2) at least one weight measurement in the second or third trimesters, 3) known gestational ages at the time of weight measurements, and 4) availability of maternal height measure. Risk of bias for each trial was assessed using the Cochrane risk-of-bias tool, version 2 (RoB 2). GWG percent adequacy (%) and total weight gain (gram) at delivery were calculated according to the Institute of Medicine 2009 guidelines. Linear regression models were used to estimate mean difference (MD) and 95% confidence intervals (CIs) in GWG percent adequacy and total weight gain across intervention arms. Results from individual trials were pooled using fixed-effects inverse-variance meta-analysis models. This study is registered with PROSPERO, CRD42023428794. FINDINGS: A total of 97 trials were identified in the search and sough for IPD, of them eight trials including 8550 pregnant women were included in the current analysis. Women who received IPTp with only 2 doses of SP had a greater GWG percent adequacy (MD: 5.61%; 95% CI: 2.61%, 8.60%; P = 0.0002; I2 = 84.26%), and total GWG in grams at delivery (MD: 702; 95% CI: 321, 1083; P = 0.0003; I2 = 83.78%) than those who received weekly chloroquine as prophylaxis. No significant differences in GWG percent adequacy (MD: -0.53%; 95% CI: -2.89%%, 1.83%; P = 0.66; I2 = 0.00%) or GWG grams (MD: -80; 95% CI: -380, 221; P = 0.60; I2 = 0.00%) were found between IPTp with 2-dose SP and monthly IPTp-SP (3-dose or more). Compared to women who received monthly IPTp-SP, those who received monthly IPTp with dihydroartemisinin-piperaquine (IPTp-DHA + PPQ) had a lower GWG percent adequacy (MD: -5.56%; 95% CI: -8.22%, -2.90%; P < 0.0001; I2 = 13.47%) and total GWG in grams (MD: -723; 95% CI: -1037, -410; P < 0.0001; I2 = 46.29%). Adding azithromycin to an antimalarial regimen was associated with a greater GWG percent adequacy (MD: 2.75%; 95% CI: 0.46%, 5.05%; P = 0.19; I2 = 0.00%) and total GWG in gram at delivery (MD: 485; 95% CI: 210, 760; P = 0.0005; I2 = 75.66%). INTERPRETATION: Our findings suggest that monthly IPTp-SP has superior effect on GWG compared to weekly chloroquine or IPTp-DHA + PPQ in malaria-endemic areas. The result provides further evidence indicating that IPTp-SP improves maternal weight gain, an important determinant of fetal growth beyond its antimalarial effects. Due to the limited number of trials with weight and height measures available for the IPD meta-analysis we were likely underpowered to detect any significant difference between 2-dose SP and monthly IPTp-SP. More efforts are warranted to examine the potential beneficial effect of adding azithromycin or DHA + PPQ to the standard antimalarial regimens. FUNDING: Gates Foundation
Impact of digital communication message on HPV vaccine decision-making among Japanese mothers: A randomized controlled trial.
Get PDFBACKGROUND: In Japan, human papillomavirus (HPV) vaccine uptake has been hindered by public distrust and misinformation. Understanding which message components can effectively influence mothers' vaccine decision-making is critical for restoring confidence and improving coverage. OBJECTIVE: To assess the impact of different message components on mothers' willingness to vaccinate their daughters against HPV. METHODS: This study employed an online 2 × 2 × 2 × 2 between-person factorial randomized controlled trial with a nationally representative sample of 1439 Japanese mothers of daughters aged 11-18. Participants were randomly assigned to view one of 16 digital text-based messages varying by four components: messenger (individual or organization), content (effectiveness or safety), style (storytelling or scientific data), and misinformation (misinformation or factual information). Outcomes were willingness to vaccinate, confidence in vaccine safety and effectiveness, message trust, and concern about HPV-related diseases. Logistic regression and model fit statistics were used to assess the impact of components. RESULTS: Among 1324 mothers analyzed, messages with factual information significantly increased willingness to vaccinate daughters compared to misinformation (25.9 % vs. 11.3 %; OR = 2.75; 95 % CI = 2.02-3.74), while trust was higher for organizational messages (91.6 %; OR = 1.58; 95 % CI = 1.10-2.27). Storytelling messages increased concerns about HPV-related diseases more than scientific data (40.4 % vs. 31.9 %, OR = 1.45; 95 % CI = 1.15-1.82). Although factual information and trusted sources positively influenced attitudes, a single digital message was insufficient to significantly increase vaccination uptake. Furthermore, misinformation reduced confidence in vaccine safety and effectiveness. CONCLUSIONS: Digital messages containing factual information and delivered by organizations positively influence mothers' intentions to vaccinate their daughters against HPV in Japan. These findings support strategies that emphasize trusted sources and factual content while countering misinformation to improve vaccine confidence and uptake. The study was registered at Clinicaltrials.gov (NCT06347627)