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Mitochondrial genome analysis and molecular identification of two Culex tritaeniorhynchus (Diptera: Culicidae) clades from the Republic of Korea
Full text linkCulex tritaeniorhynchus is the primary vector of Japanese encephalitis virus (JEV) and is thought to exist as 2 forms: the continental type (Ct-C) and the Japanese type (Ct-J), distinguished by variations in the cytochrome oxidase subunit 1 (COI) region of mitochondrial DNA (mtDNA). However, the extent of genetic variation within and between the 2 types remains largely unexamined. To address this gap in the literature, we performed mitochondrial genome sequencing and additionally developed a rapid and cost-effective identification method that may facilitate efficient vector management and research. The method for type identification is based on a restriction fragment length polymorphism (RFLP) assay, targeting type-specific sequence variations in the COI region. Phylogenetic analysis using mtDNA confirmed that Ct-C and Ct-J represent genetically distinct taxa within the genus Culex. The proposed molecular identification method has been validated to effectively differentiate between the 2 types in the ROK. Early detection of cryptic invasions is critical for effective vector management. The results of this study confirm that the 2 types of Cx. tritaeniorhynchus, the primary vector of JEV, represent genetically distinct lineages. These findings may serve as a foundational reference for developing vector control strategies aimed at suppressing JEV in East Asia.</p
Evaluating a Culturally Tailored Digital Storytelling Intervention to Improve Trauma Awareness in Conflict-Affected Eastern Congo: Quasi-Experimental Pilot Study
Full text linkBackground: Posttraumatic stress disorder (PTSD) is highly prevalent in conflict-affected regions like eastern Democratic Republic of Congo; yet, cultural stigma and lack of psychoeducation limit public understanding and help-seeking behaviors. Objective: This study evaluates the effect of a short, culturally adapted animated video on mental health perception, knowledge, and attitudes toward trauma. Methods: A community-based quasi-experimental pre-post design was implemented among 239 participants from South Kivu. The intervention involved viewing a 3-minute animated psychoeducational video portraying locally relevant PTSD symptoms and resilience strategies. Perception, knowledge, and attitude scores were measured before and after the intervention, alongside PTSD prevalence and video appreciation. Results: Out of 239, 40% (n=96) of the participants screened positively for PTSD. Post intervention, significant improvements were observed in perception (P=.01), knowledge (P<.001), and attitudes (P=.001) toward trauma. Appreciation was high; 82% (n= 195) expressed empathy for the characters, and 74% (n= 176) were likely to share the video. Linear regression showed that having PTSD symptoms (β coefficient=3.29, SE=1.09; P=.003), years of education (β coefficient=0.54, SE=0.08; P<.001), empathy toward the portrayed situations (β coefficient=5.07, SE=0.56; P<.001), perceived acquisition of new knowledge (β coefficient=2.58, SE=0.59; P<.001) and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) predicted stronger positive effect. A multiple linear regression including all predictors revealed that PTSD symptoms (β coefficient=1.93, SE=0.90; P=.03), years of education (β coefficient=0.47, SE=0.07; P<.001), empathy toward the portrayed situations (β coefficient=3.50, SE=0.55; P<.001), and willingness to share the video (β coefficient=1.75, SE=0.50; P=.001) remained significant predictors of video impact. Age and perceived acquisition of new knowledge were not significant in the multivariate model. This model accounted for 44.6% of the variance in video impact scores (R2=0.446, F6,231=30.99, P<.001). Conclusions: This study highlights the effectiveness of culturally grounded, low-cost digital media for improving mental health literacy in postconflict settings. Video-based tools may serve as scalable components of trauma-informed care and public health communication in low-resource, high-need areas.</p
Geographic and Gender Representation in Authors of Editorials on Publications from Low- and Middle-Income Countries
No full textThe selection of authors for editorials reflects perceptions of expertise and influence. Our objectives were to determine author geographic and gender distribution, determine temporal trends in editorial authorship, and identify factors associated with the inclusion of authors affiliated with low- and middle-income countries (LMICs) in editorials on research conducted in LMICs. We conducted a cross-sectional study of editorials on research in LMICs published in 15 global health, pediatrics, and general medicine journals from 2014 to 2024. To assess temporal changes in authorship, we plotted the proportion of editorial authors affiliated with LMICs and those with female names by year. We used multivariable logistic regression to identify factors associated with the inclusion of one or more LMIC-affiliated authors. There were 107,629 publications and 1,350 editorials on research in LMICs with 2,401 authors. Authors of editorials were most often affiliated with institutions in North America (38.1%) and high-income countries (71.6%). The proportion of authors of editorials affiliated with institutions in high-income countries decreased from 84.9% in 2014 to 65.3% in 2024. Authors of editorials more commonly had male names than female (60.1% versus 38.7%, P <0.001). The proportion of editorial authors with female names increased from 32.1% in 2014 to 48.2% in 2024. Editorials accompanying publications reporting studies with larger sample sizes (aOR 5 1.52, 95% CI: 1.03–2.26) and research conducted in sub-Saharan Africa (aOR 5 2.84, 95% CI: 1.74–4.68) were more likely to include LMIC-affiliated authors. Additional efforts are needed to include authors affiliated with LMICs in editorials on research conducted in LMICs.</p
Effectiveness of antenatal care delivery of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine in the context of an integrated strategy with seasonal malaria chemoprevention in Mali and Burkina Faso
Full text linkBackground To improve uptake of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP), a cluster-randomised implementation trial of ‘integrated IPTp-SP delivery’ through seasonal malaria chemoprevention (SMC) alongside antenatal care (ANC) was conducted in Mali and Burkina Faso. This nested study assessed ANC provider acceptability and feasibility of the integrated strategy and whether the training they received as part of the intervention (‘enhanced facilities’) improved IPTp-SP delivery effectiveness. Methods A cross-sectional survey was conducted in 20 trial facilities in each country (10 intervention/10 control) from November 2023 to January 2024, involving ANC exit interviews with pregnant women, facility audits and structured interviews with ANC providers. The primary outcome was the proportion of eligible pregnant women receiving IPTp-SP by directly observed therapy (DOT). Predictors of receiving IPTp-SP by DOT were estimated using mixed model logistic regression. ANC provider attitudes towards the integrated strategy were assessed using Likert scales. Results In Mali, 240 and 297 of 703women interviewed were eligible for SP in the intervention and control facilities, respectively, and 323 and 334 of 709women, respectively, interviewed in Burkina Faso. Delivery effectiveness of IPTp-SP was higher in the enhanced facilities in both Mali (79.2% (95% CI 74.0% to 84.3%) vs 68.7% (95% CI 63.4% to 73.9%), p=0.006) and Burkina Faso (52.3% (95% CI 46.9% to 57.8%) vs 28.7% (95% CI 23.9% to 33.6%), p<0.0001). Predictors of receiving IPTp-SP by DOT included attending a routine ANC visit in Mali, and gestational age, multiparity and a routine ANC visit in Burkina Faso. ANC providers interviewed in Mali (44) and Burkina Faso (41) thought that IPTp-SP delivery through SMC increased ANC attendance and reduced malaria cases, and that it was feasible and acceptable. Conclusions ANC provider training improved IPTp-SP delivery effectiveness, showing greater impact in Mali than in Burkina Faso. ANC providers found the integrated IPTp-SP strategy through ANC and SMC acceptable and feasible.</p
Impact of sex on outcomes in patients treated with drug-coated balloons versus drug-eluting stents for de novo coronary artery lesions: Insights from the REC-CAGEFREE I trial
Full text linkBackground: The anatomical and pathophysiological characteristics of coronary artery disease vary between the sexes. This study investigated the impact of sex on outcomes in patients with de novo coronary artery lesions treated with drug-coated balloons (DCB) or drug-eluting stents (DES). Methods: REC-CAGEFREE I was an investigator-initiated, non-inferiority trial conducted at 43 sites in China from Feb 5, 2021, to May 1, 2022, which randomized 2,272 patients for treating de novo coronary lesions, regardless of vessel diameter. After successful lesion pre-dilatation, eligible patients were randomized (1:1) to either DCB angioplasty with the option of rescue stenting or intended DES deployment. In this prespecified subgroup analysis, patients were analyzed by sex based on their medical records. The primary endpoint was device-oriented composite endpoint (DoCE), including cardiovascular death, target-vessel myocardial infarction, and clinically and physiologically indicated target lesion revascularization at 2 years. Between-group differences were compared by Cox proportional-hazards models, and imbalances in baseline characteristics were adjusted with inverse probability of treatment weighting (IPTW). The analyses were conducted in the intention-to-treat population. Results: A total of 2,272 participants underwent randomization, of which 698 (30.7%) were female and 1,574 (69.3%) were male. At 2 years, no statistically significant differences in the incidence of DoCE were observed between sexes (36 [5.2%] for females and 74 [4.7%] for males, HRIPTW:1.04, 95%CI:0.67 to 1.61, P = 0.877). Compared with DES, DCB was associated with a numerically higher risk of DoCE in females (6.3% versus 3.9%, HRIPTW:1.55, 95%CI:0.78 to 3.11, P = 0.210) and a statistically significant higher risk in males (6.4% versus 3.1%, HRIPTW:2.28, 95%CI:1.40 to 3.70, P = 0.001), respectively, with no significant sex-by-treatment (DCB/DES) interaction observed (Pinteraction = 0.575). The prognosis of DCB and DES differed significantly between small vessel disease (SVD) and non-SVD among females (Pinteraction = 0.007), but not among males (Pinteraction = 0.408). Conclusions: For patients with de novo, non-complex coronary artery disease, DCB was associated with a significantly higher risk of 2-year DoCE compared with DES in males, whereas a consistent but non-significant trend was observed in females. Trial registration: ClinicalTrials.gov identifier: NCT04561739.</p
Early neonatal admissions with feeding difficulties to acute paediatric services at a tertiary paediatric hospital in England: sequential audits pre-COVID-19 and during the COVID-19 pandemic
Full text linkIntroduction Our objective was to describe the population of infants <7days of age admitted to the acute general paediatric services at Alder Hey Children’s Hospital and ascertain the proportion with feeding difficulties amenable to community-based support. Methods Sequential retrospective audits of all infants <7days of age admitted to acute paediatrics at Alder Hey Children’s Hospital, Liverpool, England, from March to September 2019 (pre-COVID-19) and March to September 2020 (during COVID-19). All the infants were born and discharged from maternity units in Merseyside, Northwest England. Anonymised data were extracted from the electronic clinical records by three members of the clinical team. Results Pre-COVID-19, 38.6% (93) of the 241 admissions to acute general paediatric services had feeding difficulties. 31.2% (29) presented solely with feeding difficulties and 31.2% (29) were exclusively breastfed. However, during COVID-19, although there were fewer admissions (104), more than half (51%, 54) had feeding difficulties and for 54% (29), this was the only reason for admission. Over half (53.7%, 29) were exclusively breastfed. Conclusion Our audits showed that at least a third of infants <7days of age admitted with feeding difficulties did not have any other features of severe illness. These admissions unnecessarily expose infants to hospital-acquired infections while disrupting the opportunity for families to build close and loving relationships that enhance the establishment of breastfeeding. Co-designing infant feeding strategies with the mothers and stakeholders will be a crucial next step to enhance infant feeding support, particularly in impoverished communities in the region.</p
Harnessing real-world evidence in paediatric randomised controlled trials
Full text linkRandomised controlled trials (RCTs) provide the highest level of evidence by rigorously evaluating treatments to ensure clinical decisions are grounded in robust data that improve patient outcomes. However, in paediatrics, certain factors can make their conduct more difficult, including recruitment challenges and ethical complexities. There is growing interest in using real-world evidence through routinely collected data (RCD) to improve the design, delivery and applicability of paediatric RCTs across diverse healthcare settings worldwide.This editorial is part of a series on RCD-enabled studies and their analysis. Other articles will explore the use of real-world evidence in observational research and examine specific analytical methods, including interrupted time series and difference in differences
Human dimension of urban flood risk and informal resilience in Peshawar, Pakistan
Full text linkThe study aimed to systematically assess community-level risk perceptions and informal resilience capacities concerning urban fluvial hazards within Peshawar, Pakistan. The research addresses the global acceleration of urban flood hazards, a phenomenon increased by unregulated urban expansion and anthropogenic climate change. Methodologically, the study adopted a qualitative inquiry and the study was framed in an Interpretive Phenomenological Approach, utilizing the Socio-Ecological Systems (SES) framework as its theoretical construct. The SES framework operationalizes the local context by integrating the core components of risk (hazard, vulnerability, and exposure) and resilience (defined by anticipatory, adaptive, and restorative capacities) within the paradigm of the human-environment relationship. Data collection employed a multi-modal strategy including nine Focus Group Discussions (FGDs), 15 Key Informant Interviews (KIIs), and five In-Depth Interviews (IDIs), all conducted via purposive sampling. The empirical data reveal that local conceptualizations of urban flooding are primarily attributed to shifts in precipitation regimes and a spectrum of anthropogenic interventions. These interventions include uncontrolled informal settlements (encroachment), faulty urbanization, elevated groundwater tables and deficiencies in critical infrastructure, with all factors being aggravated by pervasive governance deficits. The resultant vulnerability is characterized as multidimensional vulnerabilities extending across socio-economic, physical, environmental and motivational axes. Parallel to it, communities demonstrate emergent resilience mechanisms, specifically manifesting as self-organized early warning systems and adaptive structural modifications such as elevated building plinths. The study suggests that effective urban flood risk management necessitates a paradigm shift from the silos-based top-down governance model toward a holistic, risk-informed urban planning framework. Such transition requires support from institutional reforms and formalized community engagement to effectively use indigenous knowledge and local capacities, thereby adding the system’s inherent capacity to absorb, adapt and transform in response to hydrometeorological stressors.</p
The effect of pneumococcal conjugate vaccine and pneumococcal polysaccharide vaccine on nasopharyngeal colonisation following human infection challenge with serotype 3 and serotype 6B (PREVENTING PNEUMO 2): a double-masked, randomised, controlled, phase 4 trial
Full text linkBackground Although evidence suggests some direct protection from the 13-valent pneumococcal conjugate vaccine (PCV13) against Streptococcus pneumoniae serotype 3 (Spn3), Spn3 remains a frequent cause of pneumococcal disease in the UK, potentially due to lower vaccine effect on colonisation, shorter duration of protection, or the emergence of more successful Spn3 clades. To test these hypotheses, we compared PCV13 and 23-valent pneumococcal polysaccharide vaccine (PPV23) protection against prevalent Spn3 clades. Additionally, we assessed the long-term protection offered by pneumococcal vaccines against colonisation using S pneumoniae serotype 6B (Spn6B), a serotype PCV13 protects against in the short term. Methods This double-masked, randomised, controlled, phase 4 trial recruited healthy participants aged 18–50 years in Liverpool, UK, and assigned them (2:1:2) to PCV13, PPV23, or placebo (0·9% NaCl). Participants assigned to the PPV23 group were challenged with clade Iα, and participants in PCV13 and placebo groups were subsequently randomly assigned to receive clade Iα or II Spn3. Nasal challenge with Spn3 was at 1 month and with Spn6B in a subgroup at 6 months after vaccination. Selection for this subgroup was conducted on a first-come-first-served basis, with participants who enrolled earliest being offered participation in both challenges. Recruitment for the second challenge was discontinued once the target number of participants was reached. The primary outcome was the acquisition risk of the challenge strain as detected by nasal wash culture at 2 days, 7 days, 14 days, or 23 days in the vaccine versus the placebo groups. The analysis was performed in a modified intention-to-treat population, defined as all participants who received vaccination, underwent challenge, and had at least one nasal wash sample collected after the challenge. Randomisation used a computer-generated schedule that only the unmasked team could access. The unmasked team performed vaccinations and did not perform the nasal challenges or nasal washes. The laboratory staff and participants were masked to the vaccination status. This study was prospectively registered with the EU Drug Regulating Authorities Clinical Trials Database, 2019-004742-15, the International Standard Randomised Controlled Trial Number registry, ISRCTN15728847, and ClinicalTrials.gov , NCT04974294 , and is complete. Findings This trial was conducted between July 28, 2021, and Oct 3, 2023. The analysis included 407 participants challenged with Spn3 and 243 challenged with Spn6B. 1 month after vaccination, PCV13 was associated with a non-significant reduction (16%) in Spn3 colonisation acquisition when considering both clades combined(84 [56%] of 153 participants in the PCV13 group vs 101 [65%] of 155 in the placebo group; relative risk 0·84, 95% CI 0·70–1·01; p=0·068). PCV13 was moderately protective (29%) against clade II (0·71, 0·54–0·91; p=0·0090) but was not protective against clade Iα (1·01, 0·77–1·32; p=0·95). No evidence of protection from PPV23 vaccination was found against clade Iα (0·84, 0·63–1·11; p=0·22). At 6 months, PCV13 showed a 60% relative risk reduction against Spn6B (0·40, 0·22–0·69; p=0·0020) with no evidence of protection from PPV23 (0·90, 0·60–1·34; p=0.60). There were no severe or life-threatening adverse events. Interpretation Our findings indicate partial direct protection by PCV13 against Spn3 colonisation acquisition, with differential protection against the clades and no protection by PPV23 against clade Iα. By contrast, PCV13 protected against Spn6B colonisation for at least 6 months. These findings align with epidemiological evidence, indicating that, although PCV13 vaccination against Spn6B offers sustained direct and indirect protection, its effect on Spn3 colonisation and therefore indirect protection is limited. Direct vaccination of at-risk adults might therefore be more appropriate than relying solely on herd immunity from paediatric programmes. The development of next-generation pneumococcal vaccines and further immunological analysis are needed to optimise protection against Spn3. </p
“Should I tell him I have something in my vagina?” Female sex workers’ perceptions and experiences of using a menstrual cup, and client reactions: A qualitative study in Western Kenya
Full text linkIntroduction: The menstrual cup is worn intravaginally, holding blood up to 12 h before emptying and reinserting. It offers protection from sexually transmitted infections and bacterial vaginosis, whilst preserving a Lactobacillus crispatus–dominant vaginal microbiome. The menstrual disc, a type of menstrual cup, is positioned near the cervix and can remain in place during sex, enabling female sex workers (FSWs) to avoid unsafe practices to conceal menstruation during work. In this study, we aim to examine the perceptions and experiences of a convenience sample of FSWs 6 months after they received a menstrual disc, along with client views. Methods: In a qualitative design, our Kenyan study recruited 38 FSWs in 4 focus group discussions (FGDs) and 86 clients in 9 FGDs. Using a semi-structured guide, a Kenyan moderator and note-taker facilitated audio-recorded discussions. Following translation and transcription, the discussions were analysed using deductive thematic analysis. Results: Six themes emerged: Anticipation and reaction to seeing the menstrual cup, Apprehension and determination to use, Benefits, Challenges, Secrecy, and Use during sex. Some FSWs were able to insert the cup on initial attempt, typically others encountered discomfort, pain, or misalignment during insertion or difficulty in removing. By the end of the third month, the majority were using the cup without experiencing any leakage, pain, or concerns. Benefits noted included ease, convenience, reduced leakage, and comfort. Financial advantage over pads and ability to work regularly were also noted. Nearly all FSWs used the cup during sex, despite prior anxiety that a client would detect it and react negatively. In three instances, the FSWs reported that a client “may” have felt the disc, whilst noting just two clients “may” have felt something. None reacted badly. In summing up their experience, the FSWs spoke very positively about the disc, with the intention to keep wearing it in the future. Many clients were supportive of the disc but did not want to know whether an FSW was wearing it. Conclusions: The FSWs quickly adapted to using the disc, finding it a comfortable, reliable menstrual product with financial advantages. With clients remaining mostly unaware of its use, the FSWs enthusiastically embraced the disc with the intention to keep using it. These positive outcomes have implications for future scale-up and roll-out to other vulnerable female populations.</p