Microorganisms

While microbiome is increasingly recognized as crucial for human health, translating this knowledge into effective healthcare and preventive strategies remains challenging. Many studies focus on identifying changes in microbiome composition associated with disease and evaluating the potential of such disease-associated microbial profiles as biomarkers for disease diagnosis. Under the hypothesis that microbiome dysbiosis may reflect physiological alterations present long before disease onset, in this work, we analyse the potential of disease-specific microbial signatures not as a diagnostic tool when the disease is already present, but as a means of health assessment in the general population. Moreover, instead of trying to define a single health measure, we believe it is necessary to consider several ways in which the microbiome departs from health, according to different disease-related physiological changes. To evaluate our assumptions, we designed a two-stage study: the identification of disease-specific microbial signatures (discovery stage) and, subsequently, the study of their distribution in the general population to assess associations with general health (external validation stage). Specifically, in the discovery phase we characterized 16 disease-specific bacterial signatures from large public microbiome data using a compositional data analysis methodology. In the second phase, we quantified these microbial signatures in the Lifelines-DMP cohort, a large population-based cohort, and evaluated their association with self-reported health status. Results indicate that most disease-specific microbial signatures associate with health status, supporting our assumption that microbial composition can capture physiological alterations before disease onset, and highlighting the importance of considering multiple ways in which microbiome departs from a healthy state. These findings reaffirm the potential of microbial information as an additional tool in preventive medicine.

In spite of well-established global immune landscape, SARS-CoV-2 is still able to further spread and continue causing infection waves. The current understanding about the reason behind is limited, and it is still difficult to predict the evolution or spreading tread of SARS-CoV-2. Therefore, it is necessary to investigate whether the establishment of population immunity has changed the virus evolution or spreading pattern. In this investigation, one overall analysis of the SARS-CoV-2 spreading in the past several years have been carried out through one thorough genomic epidemiology study, with Germany being chosen as one representative location in view of the systemic efforts for genomic surveillance. The growth advantage of a few predominant variants in its early spreading period has been evaluated through a logistic regression model. The results have revealed that the major circulating SARS-CoV-2 variants since 2023 are mainly derived from the Omicron BA.2 family. Since middle of 2024, most predominant variants were produced primarily through recombination, indicating that the evolution derived from recombination might be the major driving force for the continuous spread of SARS-CoV-2 despite the existence of population immunity. Furthermore, the lower growth advantage of recently emerged variants might possibly lead to a tread of reduction in the frequency of infection wave. The information revealed from this investigation suggests that although short-term spreading tread can be affected by specific virus feature as well as local immunity landscape, the long-term spreading tread is mainly decided by the genomic diversity of the viruses, and can be predicted through phylogenetic and genomic epidemiology investigation. The results have emphasized the importance of maintaining the efforts for genomic surveillance of SARS-CoV-2, which is essential from both medical and research perspectives.

Use of fungal mycelia, which has antiviral properties, constitutes a novel strategy for addressing existing and newly emerging viral diseases. We evaluated safety and feasibility of fungal mycelia (Fomitopsis officinalis and Trametes versicolor, FoTv) for treatment of COVID-19 and assessed its antiviral effects and potential to reduce symptoms. In a randomized, double-blind, placebo-controlled, dual site (UCSD/UCLA medical centers) clinical trial we examined non-hospitalized patients who contracted mild-to-moderate COVID-19 [≤] 96 hours, and experienced symptom onset [≤] nine days, before enrollment. FoTv was safe, well-tolerated, and feasible for COVID-19 treatment. Minor differences in biochemical markers were observed between groups (26 FoTv, 24 Placebo). FoTv significantly reduced the number and severity of symptoms, particularly sore throat/cough, and in vitro SARS-CoV-2 (pseudovirus) cellular infection. In conclusion, FoTv was safe and reduced COVID-19 symptoms and cellular viral infection. Future studies should investigate therapeutic benefits of fungal mycelia for SARS-CoV-2 and other viruses. Clinicaltrials.gov registration:NCT04667247.

Background: In resource-limited settings, a critical bottleneck in cervical cancer prevention is the lack of practical strategies to triage high-risk human papillomavirus (HR-HPV)- positive women. Therefore, this study aimed to develop and internally validate a genotype-specific risk stratification model. Methods: A cross-sectional study enrolled 555 women in Cameroon. Data collection integrated cervical cytology and HPV genotyping using Abbott m2000rt and Sacace multiplex systems. An iterative modeling approach with bootstrap validation was used to develop the model and address model instability. HR-HPV genotypes were transformed into a hierarchical risk variable due to sparsity and integrated with significant predictors. The final model was translated into a scoring system, and the risk gradients and performances were evaluated at two thresholds. Data was analyzed using SPSS 27.0. Results: The mean age was 44.8 years, and the prevalence of HR-HPV was 26.5% (147/555). The final model, incorporating HPV categories, age, and tobacco, demonstrated moderate discriminative ability (AUC=0.702, 0.642-0.762) with a good calibration (Hosmer-Lemeshow {chi}{superscript 2}=4.05, p=0.399). The scoring system assigned women to risk groups based on their total scores which produced a clear monotonic risk gradient; the observed probability of high-grade lesions/cancer ranged from 15% (score 0) to >65% (score [≥]4). At a conservative threshold ([≥]4 points), 4.7% (26/555) of women were classified as high-risk, concentrating 46% (6/13) of cancers (positive predictive value[PPV]=58%) while a sensitive threshold ([≥]3 points) had 16.8% (93/555) high-risk, concentrating 77% (10/13) cancers (PPV=38%). Both thresholds maintained a high negative predictive value (>95%). Conclusion: This bootstrap-validated, risk-stratification tool is a proof-of-concept in resource limited settings that assigns HR-HPV-positive women to distinct management pathways using three variables. After refining through a longitudinal study and external validation, this scoring system can improve the efficiency of cervical cancer screening programs in low-resource settings.

Background: Reliable inference of Plasmodium vivax recurrence states - relapse, recrudescence and reinfection (the ``3Rs'') - improves estimates of antimalarial efficacy. The R package Pv3Rs features a Bayesian model designed for P. vivax molecular correction, i.e., using parasite genetic data to infer recurrence states. The model is an extension of a prototype built to analyse microsatellite data from the Vivax History (VHX) and Best Primaquine Dose (BPD) trials. Methods: We re-analysed data from 212 VHX and BPD trial participants (493 recurrences) using Pv3Rs, comparing results with those from the prototype and with genetic relatedness estimated using Dcifer, a tool for estimating relatedness based on identity-by-descent. Posterior recurrence state probabilities were computed using both uniform and time-to-event priors: artificial but equal prior probabilities facilitate posterior interpretation, while time-to-event priors leverage all available information and enable re-computation of failure rates. Relatedness estimates were used to identify and correct instances of model misspecification. Results: The Pv3Rs model generated posterior probabilities for all recurrences and was able to jointly model data on all episodes per participant for 89% of participants, compared with 73% using the prototype. Recurrence state probabilities were broadly consistent across methods, though the Pv3Rs model elevated reinfection probabilities slightly. Relatedness estimates exposed various outliers consistent with half-sibling parasites and/or genotyping errors. Outlier correction impacted some per-participant failure probabilities, but reinfection-adjusted radical-cure failure rates of high-dose primaquine remained near 3%, in line with previous findings. Conclusion: Re-analysis of VHX and BPD P. vivax genetic data restates earlier reinfection-adjusted efficacy estimates. It demonstrates the increased computational capability and misspecification sensitivity of Pv3Rs, highlighting a need for careful analyses. Using relatedness-based diagnostics alongside model-based inference, we were able to harness the advantages of model-based inference and provide a framework for future P. vivax molecular correction.

Background: Cervical cancer is the fourth most common cancer in women worldwide and remains a major public health challenge. In Ethiopia, it is the second leading cause of cancer deaths, with around 8,000 new cases and 6,000 deaths each year. Region?specific data on the prevalence and predictors of precancerous lesions remain scarce, yet such information is vital for guiding targeted reproductive health strategies. This study therefore examined the prevalence and predictors of cervical precancerous lesions among women aged 21-60 years undergoing Pap smear screening in public hospitals in Hawassa City, Sidama Region. Methods: An institution-based cross-sectional study was conducted among 241 women attending Pap smear screening at public hospitals in Hawassa City from March to August 2025. Sociodemographic and clinical data were collected via interviews and medical records. Lesions were classified based on the standardized international framework for reporting cervical cytology results from Pap smears per the Bethesda system. Multivariable logistic regression identified predictors p<0.05). Result: Of 241 women screened (mean age 35.3 years), cervical epithelial abnormalities were detected in 52 (prevalence 21.6%). Atypical squamous cells of undetermined significance was the most common abnormality (16.6%). Multivariable analysis showed HIV infection was significantly associated with precancerous lesions (AOR = 3.7, 95% CI: 1.69-8.12, p<0.05), while hormonal contraceptive use was protective (AOR = 0.27, 95% CI: 0.11-0.67, p<0.05). Conclusion: These results underscore the urgent need to strengthen cervical cancer prevention through targeted screening and early intervention. Integrating routine HIV testing with Pap smear programs would be especially valuable. Health authorities should expand accessible screening for women aged 21-60, with particular attention to those living with HIV, to help reduce the burden of precancerous lesions.

Introduction: Malaria, primarily transmitted by Anopheles mosquitoes, remains a major public health concern in Maiduguri, Borno State, Nigeria. While conventional control methods (e.g., ITNs) face challenges due to insecticide resistance and accessibility constraints, many communities rely on locally sourced natural products. This study aimed to assess the prevalence, usage patterns, and associated factors of these natural alternatives. Methods: A cross-sectional survey was conducted across three purposefully selected communities in Maiduguri (Mairi, Furi, Lagos Street). A total of 450 household heads were interviewed using a structured questionnaire, collecting data on socio-demographics, specific natural products used, method of application, frequency, and perceived efficacy. Data were analyzed using descriptive statistics and binary logistic regression. Results: Overall usage prevalence of natural products was high at 68.4%. The most common products identified were Neem (Azadirachta indica) extract (45.9%) and burnt Lemon Grass (Cymbopogon citratus) (31.2%). Usage pattern was predominantly indoor fumigation (burning), and over 70% of users prepared the products crudely at home. Logistic regression revealed that rural residence (Odds Ratio (OR): 2.1; p<0.01) and low education level (OR: 1.8; p<0.05) were significant independent predictors of higher natural product reliance. Conclusion: Natural products constitute a widely adopted, community-driven vector control method in Borno State. The high prevalence and association with vulnerable populations suggest an urgent need to standardize the preparation and application of these products for potential integration into regional malaria control programs. Keywords: Anopheles, Adulticides, Borno State, Malaria, Natural Repellents, Vector Control, Usage Pattern.

Introduction Reducing delays in leprosy case detection is essential for achieving global leprosy targets. Accurate measurement of these delays and their determinants relies largely on patient-reported data, as routine health records are often inadequate. The leprosy case detection delay (CDD) questionnaire, developed under the Post Exposure Prophylaxis for Leprosy (PEP4LEP) project, has been validated in Ethiopia, Mozambique, Tanzania, and Indonesia. However, it has not been adapted or validated for Nigeria or any major Nigerian indigenous language. This study aimed to culturally adapt and validate the CDD questionnaire for Igbo-speaking populations in Nigeria. Methodology/Principal Findings The CDD questionnaire underwent a standardized cross-cultural adaptation process. Content validity was assessed using item- and scale-level content validity indices, while construct validity was evaluated through hypothesis testing. Reproducibility was assessed using test-retest and inter-rater reliability; agreement using the Bland-Altman method and the Wilcoxon Signed-Rank test; reliability using Spearmans rank correlation coefficient and the Intraclass Correlation Coefficient (ICC); and internal consistency using Cronbachs alpha. Data were collected through face-to-face interviews with persons affected by leprosy at two time points separated by at least two weeks. Participants (n=100) had a mean age of 45.1 years (SD=18.7). Mean CDD was 77.2 months at baseline and 77.9 months at retest. The instrument demonstrated excellent content validity (I-CVI/S-CVI: 0.90-1.00), good internal consistency (Cronbachs =0.77), and excellent test-retest reliability (ICC=0.996, 95% CI: 0.994-0.997). Test and retest measurements were highly correlated ({rho}=0.985, p<0.001), with no evidence of systematic change over time (p=0.864). Seventy-two percent of participants reported identical CDD values across assessments. All items from the original English version were retained without modification. Conclusion/Significance The Igbo version of the CDD questionnaire demonstrated good validity and reliability and is suitable for assessing leprosy case detection delay among Igbo-speaking populations in Nigeria

Background Coeliac disease (CD) diagnosis on duodenal biopsies is limited by interobserver variability. We have previously demonstrated pathologist-level performance with our artificial intelligence (AI) model for the histopathological diagnosis of adult CD, but not in paediatric practice. As paediatric CD screening programmes expand internationally, accurate and scalable diagnostic tools are needed. We investigated whether an AI model trained exclusively on adult whole-slide images (WSIs) can generalise to paediatric CD diagnosis across independent centres. Methods A training and validation dataset of 9,958 WSIs from 8,421 adult patients (961 CD) from five centres was used to develop an ensemble of multiple-instance learning models using features from a foundation model. Testing was performed on 708 consecutive paediatric patients (86 CD) from two centres (Edinburgh and Southampton) not included in training. Model calibration was assessed, and probability outputs were grouped into clinically interpretable categories. Findings In adult cross-validation, the AI model achieved an area under the receiver operating characteristic curve (AUC) of 98.7%, sensitivity of 84.9%, specificity of 99.0%, and negative predictive value (NPV) of 98.1%. On testing (paediatric) datasets, performance remained high (AUC 98.8%, sensitivity 80.2%, specificity 98.4%, NPV 97.3%). Restricting analysis to predictions outside the intermediate-probability range (predicted CD probability <10% or [&ge;]65%; 85.3% of cases) improved sensitivity to 100% and specificity to 98.7%. No misclassifications were observed among high-confidence predictions (<2% or [&ge;]85%; 66.0% of cases). The expected calibration error was 0.03. Performance improved significantly when biopsies from both duodenal sites (bulb [D1] and descending [D2/3]) were considered. Interpretation Our AI model, trained on adult biopsies, generalises to paediatric CD diagnosis across centres and scanner platforms. Well-calibrated probability outputs provide clinically interpretable measures of diagnostic confidence and could support safe identification of CD-negative biopsies within defined thresholds. These findings demonstrate the feasibility of applying adult-derived AI models in paediatric populations and reinforce the importance of multi-site (D1 & D2) biopsy sampling.

Mosquito-borne diseases continue to pose significant public health challenges worldwide, particularly in densely populated regions of South Asia and parts of North America experiencing increasing vector prevalence due to climate and environmental changes. Commercial mosquito repellents are widely used as a primary preventive measure; however, their efficacy, safety, and public health impacts vary depending on formulation, active ingredients, environmental conditions, and user practices. This study presents a comparative evaluation of commonly used mosquito repellent products in South Asia and North America, including coils, vaporizers, sprays, creams, and Natural repellents. The research aims to assess repellent efficacy against major mosquito vectors, evaluate potential health and respiratory effects associated with prolonged exposure, and analyze consumer awareness and usage patterns across different regions. Laboratory-based efficacy testing and field observations were conducted to compare protection duration, repellency rate, and environmental performance under varying climatic conditions. Safety assessments included analysis of chemical composition, indoor air quality impact, and reported adverse health symptoms among users. The findings indicate significant differences in effectiveness and safety profiles among product categories and geographical regions. Synthetic repellents generally demonstrated higher repellency duration, while herbal formulations showed improved safety and environmental compatibility. The study highlights the importance of standardized evaluation protocols, regulatory oversight, and public awareness in promoting safe and effective mosquito control strategies. These findings may support policymakers, healthcare professionals, and manufacturers in improving mosquito repellent technologies and reducing the burden of mosquito-borne diseases globally.

Objective: To characterize pregnancy outcomes and menstrual irregularities in Mexican women with systemic lupus erythematosus (SLE) and identify clinical factors associated with adverse pregnancy outcomes and early-onset menopause. Methods: We conducted a cross-sectional study of women with SLE enrolled in the Mexican Lupus Registry (LupusRGMX) between May 2021 and September 2024. Clinical and reproductive data were collected using standardized questionnaires. Menopause was defined as the absence of menstruation for [&ge;]12 consecutive months, and early menopause as onset before age 40. Univariable and multivariable logistic regression analyses were used to identify factors associated with pregnancy complications and early menopause. Results: A total of 210 women were included. Median age was 38 years (IQR 29-46) and median disease duration was 4 years (IQR 1-10). Among women with a history of pregnancy (47%), full-term delivery predominated (61%), while pregnancy loss occurred in 26% and preterm delivery in 13%. Pregnancy complications were reported in 9.6%, most commonly preeclampsia (6.7%). Younger maternal age was independently associated with pregnancy complications (OR 0.89, 95% CI 0.83-0.95) and adverse outcomes (OR 0.95, 95% CI 0.92-0.98). Higher disease activity was associated with complications in univariable analysis. Most pregnancies (68.3%) occurred before diagnosis. Early menopause was observed in 6.2% and independently associated with longer disease duration and older age. Conclusion: Younger maternal age was independently associated with adverse pregnancy outcomes, whereas disease activity showed an association in univariable analysis. Most pregnancies occurred prior to SLE diagnosis. Early menopause was associated with longer disease duration, suggesting impact of cumulative disease burden on ovarian function.

Introduction Menopause is a central marker of reproductive ageing, but national evidence on menstrual cessation among Nigerian women in the late reproductive ages remains limited. This study examined the prevalence and socio-demographic correlates of prolonged amenorrhea/possible menopausal transition among Nigerian women aged 30-49 years. Methods The study used the women's individual recode file from the 2024 Nigeria Demographic and Health Survey. The analytic sample was restricted to women aged 30-49 years, excluding women who were currently pregnant, currently or postpartum amenorrheic, and those with invalid or special responses on time since last menstrual period. The final sample comprised 14,223 women. The outcome combined women whose last menstrual period occurred 12 or more months before the survey, and women reported as being in menopause. Weighted descriptive statistics, design-adjusted bivariate tests and survey-weighted binary logistic regression were used. Results The weighted prevalence of prolonged amenorrhea/possible menopausal transition was 7.6%. Prevalence rose from 1.2% among women aged 30-34 years to 23.6% among women aged 45-49 years. In the adjusted model, women aged 35-39 years (OR=1.64; p=0.030), 40-44 years (OR=6.20; p<0.001) and 45-49 years (OR=24.51; p<0.001) had higher odds than women aged 30-34 years. Primary education (OR=1.65; p=0.004), middle wealth status (OR=1.37; p=0.043) and poorest wealth status (OR=1.60; p=0.024) were associated with higher odds. Muslim affiliation (OR=0.72; p=0.024) and traditional contraceptive use (OR=0.24; p<0.001) were associated with lower odds. Conclusion Prolonged amenorrhea/possible menopausal transition among Nigerian women aged 30-49 is strongly age-patterned and socially differentiated. The findings support the need to make midlife menstrual health more visible within reproductive, family planning and primary healthcare services. Because the measure is based on survey-reported menstrual recency, it should not be interpreted as clinically confirmed natural menopause.

Ultra-processed food (UPF) may contribute to increased energy intake and weight gain, but evidence synthesis from randomised controlled trials (RCT) is lacking. A pre-registered systematic review and meta-analysis of RCTs was conducted comparing UPF with less processed food (LPF) on energy intake and/or body weight in humans. Secondary analyses (meta-regression and sub-group) examined effects of UPF on appetite sensations, eating rate, palatability and considered the role of nutrient profile in explaining results. Ten eligible studies were included. UPF trial arms tended to have higher energy intake (standardised mean differences [SMDs]=0.18-0.44), but statistical significance varied between analytic models. Weight gain (SMD=0.65) and eating rate (SMD=0.96) were significantly greater in UPF trial arms. No significant differences in palatability, appetite sensations or energy intake later in the day were observed. Diets (UPF vs. LPF) used in trials were not matched for nutrient profile. Effects on energy intake varied if UPFs were higher (SMD=0.71) or similar (SMD=0.02) in energy density. Current RCTs are suggestive that UPFs may increase energy intake and body weight; however, results may be explained by energy density of foods used. Further research is needed to understand whether the level of processing impacts health outcomes independent to nutrient profile.

Purpose: The purpose of this study was to examine the barriers and facilitators experienced by non-U.S. born persons during the diagnosis and treatment of latent tuberculosis infection (LTBI) in primary care settings, including the impact of culturally and linguistically congruent care navigation. Design: 25 interviews with non-U.S. born patients, along with focus groups and surveys with 31 primary care team members and leadership, were conducted. Setting: The study was conducted within a network of Federally Qualified Health Center (FQHC) clinics. Participants: Participants were adult non-U.S. born patients with LTBI and FQHC care team members. A purposefully selected subsample of randomized participants was interviewed. Intervention: Care navigators followed participants randomized to receive care navigation after a positive test for tuberculosis (TB) infection and offered health navigation and education about the importance of TB screening and treatment. Method: Data collection was followed by thematic analysis guided by a critical ideological paradigm. Results: Culturally and linguistically congruent navigation emerged as central to potentially reducing barriers, fostering trust, and improving treatment continuity. Participants without navigation support reported confusion and disengagement from care, while those with culturally aligned navigators described clarity and comfort, with influence overall by intrinsic motivation, relational support, and culturally shaped beliefs about care. Conclusion: Care navigation that includes culturally and linguistically congruent navigators whenever possible may help increase LTBI treatment completion among non-U.S. born populations. Limitations of the study include the potential influence of cultural norms, power dynamics, and selection bias.

Introduction: Cardiovascular diseases (CVDs) are the leading cause for death and disability worldwide accounting for 75% of deaths in low- and middle-income countries (LMICs) like Nepal. Urbanization and globalization remains the major cause of rise in CVDs among urban poor population along with growth in slum settlements. This study aims to assess the knowledge, attitude and practice (KAP) of CVDs and its risk factors among women of one such urban poor community in Nepal. Methodology: This cross-sectional study (n=388) in the Sinamangal-Minbhawan slum area was conducted using semi structured questionnaire based on STEPs survey and HARDIC study among the participants selected through convenient sampling. Descriptive analysis was done using SPSS version 21 and KAP scores were further categorized based on median score to perform multivariate logistic analysis. Additionally, Anthropometric and blood pressure measurements were also recorded and analyzed. Results: The median age (Interquartile range) of participants was 33 years (17) with majority of them being Dalit by ethnicity, housewives, with up to primary level education belonging to upper lower socioeconomic class. More than half (53.3%) of the participants were obese and over 23% were hypertensive. While half of the hypertensive women were aware of their status, only 3% had their blood pressure under control.The median knowledge, attitude and practice (KAP) scores were 12, 60 and 10 respectively. The KAP scores were positively associated with socioeconomic status of the participants. Conclusion: The study revealed low knowledge with high prevalence of behavioral risk factors of CVDs along with high prevalence of other metabolic risk factors like high body mass index, high waist hip ratio and hypertension among women of slum area with a positive attitude to prevent CVDs and its risk factors.

This study aims to assess women's perceptions of artificial intelligence (AI) used in breast cancer screening in France by examining their knowledge of AI and the barriers to their participation in organized screening. The results of a survey conducted in June 2025 among a national sample of 2000 women (aged 40-75) reveal limited participation and persistent concerns among women. Nevertheless, despite a low awareness of specific AI applications, a large majority of the women surveyed are very favorable to the use of AI in breast cancer diagnosis, even considering it a lever to increase screening participation.

Introduction: Synthetic oligopeptides provide a rapid and cost-efficient approach to developing antibodies and diagnostics for emerging viral variants. Methods: This study computationally and experimentally characterized a synthetic peptide analog of the SARS-CoV-2 spike subdomain 2 major disulfide loop (SD2MDL), designated S621 (CPVAIHADQLTPTWRVYSTC). Binding affinity was computationally estimated using the Heuristic Affinity Prediction Tool for Immune Complexes (HAPTIC), while experimental validation was performed using enzyme-linked immunosorbent assay (ELISA) with rabbit-derived antipeptide antibodies. Clinical diagnostic accuracy testing was done using plasma samples from RT-PCR-confirmed COVID-19 patients and pre-COVID-19 controls. Results: S621 demonstrated nanomolar binding affinity (Kdapp = 1.14 nM) and high avidity (3.67 nM), closely matching HAPTIC predictions (3.54 nM). Diagnostic evaluation yielded a sensitivity of 89.92% and specificity of 27.79%, corresponding to an overall accuracy of 71.79%. Discussion: These findings demonstrate that a single synthetic peptide derived from a conserved spike subdomain can function as a high-affinity surrogate for full-length antigens, supporting its potential application in rapid peptide-based immunodiagnostics.

Background and Objectives: Arts and cultural engagement may contribute to well-being in later life. However, evidence from longitudinal studies from Asia, including Japan, remains limited. This study examined the association of arts and cultural engagement with subsequent multidimensional well-being among older adults in Japan, one of the fastest-aging countries. Research Design and Methods: This longitudinal study used panel data from 354 individuals aged 60 and older (mean age 74.0 years; 78.6% women) who completed self-administered questionnaires by mail between 2022 and 2024. The PERMA-Profiler was used to assess five multifaceted aspects of psychological well-being: positive emotion, engagement, relationships, meaning, and accomplishment. Frequencies of arts and cultural engagement at baseline were measured for active (e.g., activities by individuals and participation in groups, such as music and painting) and receptive (e.g., visiting museums, galleries, and theaters) forms. Results: Multivariable linear regression analysis, adjusted for the covariates including baseline PERMA scores, showed that higher frequencies of active engagement were positively associated with higher PERMA scores for all domains. Higher frequencies of receptive engagement were associated with the domains of positive emotion, meaning, and accomplishment, but not clearly associated with engagement and relationships. Restricted cubic spline analyses suggested clearer positive frequency-response patterns for active engagement than for receptive engagement. Discussion and Implications: Arts and cultural engagement, both active and receptive forms, was associated with subsequent multiple aspects of well-being in later life. These findings suggest the importance of ensuring access to arts and cultural opportunities for older adults to create, participate, and connect.

Background: Mass gathering events (MGEs) are associated with several public health challenges and may cause a strain on healthcare services. Literature findings on the impact of MGEs on emergency departments (EDs) are heterogeneous. Objectives: To examine shifts in ED attendance characteristics during a major sporting tournament, namely the UEFA European Football Championship 2024 held in Germany. Methods: We conducted a retrospective observational study using ED data from the Emergency Department Data Registry. We compared baseline ED attendance characteristics between the tournament and the reference period, defined as two weeks before and two weeks after the tournament, and between Germany game days and non-Germany game days. Hourly attendance patterns were analysed for all Germany games using a reference range. Results: We included data from 41 EDs, totalling 253,493 attendances during the study period. A 1.57% increase in attendance was observed during the tournament compared to the reference period, with baseline characteristics remaining similar. The median daily attendance within all EDs was slightly lower on Germany game days (4066) compared to non-Germany game days (4128). Modest changes were observed in the hourly attendance on Germany game days, most notable during the last Germany game where a decrease in attendance below the reference range extended over three hours. Conclusions: The observed shifts in ED attendance were minimal, suggesting that no major changes of public health relevance occurred in ED attendance during the tournament. We highlight the utility of using ED data for monitoring and for enhancing the understanding of the public health risks and challenges associated with MGEs.

Introduction: Respiratory infections are a leading cause of morbidity. Newly available vaccines to prevent respiratory syncytial virus (RSV) disease and encouraging clinical progress on vaccines for human metapneumovirus (hMPV) and parainfluenza (PIV) could reduce the disease burden beyond existing influenza and SARS-CoV-2 immunisation programs. However, evidence on the contribution of these viruses to respiratory disease burden across the lifespan remains limited. Methods: We reviewed studies from 01/2002-11/2025 reporting age-stratified, medically attended cases of influenza, and at least one of RSV, hMPV, or PIV, in high-income countries, excluding periods substantially overlapping with the COVID-19 pandemic. Using only studies that tested for all four viruses, we estimated the age-specific proportion of cases that were non-influenza (total across RSV, hMPV and PIV) compared to influenza using a mixed-effects logistic regression model. Results: Following exclusions and screening, 61 studies were included in the primary analysis comprising >500,000 detections of the four viruses. We found that a substantial proportion of medically attended respiratory illness in infants and young children was due to PIV, hMPV and RSV, rather than influenza, with a non-influenza virus proportion of 90.2% (95% CI 85.9-93.2%) in young infants aged 0-6 months. The converse was true for school-aged children, with a non-influenza virus proportion of 34.8% (95% CI 26.5-44.2%) in children aged 5-18 years. In adults aged 65+ years, non-influenza causes of medically attended disease were common at 60.2% (95% CI 50.0-69.5%). Restricting to studies reporting hospitalised cases (n=19) produced broadly similar age-specific trends in relative virus burden contributions. Discussion: We highlight the significant burden of medically attended illness due to PIV, hMPV and RSV across ages, particularly in infant and preschool-aged children and older adults, supporting the need for effective vaccines targeting this burden.