Public Health Department

Orthopedic trauma is a major cause of disability worldwide; around half of the people who sustain orthopedic trauma develop chronic pain. Quantitative Sensory Testing (QST) is a standardized method of assessing pain sensitivity, which may be useful in characterizing pain after injury and predicting chronic pain. This primary aim of this project was to test the feasibility of a portable QST battery, administered to adults 6-weeks post major orthopedic trauma and surgery. Twenty-nine participants (62% male; 52% black) who sustained major orthopedic trauma and surgery completed QST testing (including static measures, conditioned pain modulation, and mechanical temporal summation) at their 6-week postoperative visit and were invited to complete a 6-month follow-up survey. We examined feasibility and acceptability indices and explored associations between QST and clinical pain ratings. Of all eligible patients, 77% were recruited. QST procedures were feasible and tolerable. No participant declined participation, withdrew for reasons related to study procedures, or discontinued QST due to discomfort. No patient experienced increased clinical pain after QST. Exploratory analyses identified a positive association between static QST and pain interference at T1. Feasibility challenges included poor 6-month retention (57%) and difficulty administering QST to patients with upper extremity injuries. High rates of analgesic use before testing (38%) poses an additional barrier for future QST studies in this population. QST was acceptable and partially feasible; challenges included poor retention, high rates of analgesic use, and logistical barriers to accessing injury sites for testing. We pose several potential solutions for future research.

Systemic sclerosis (SSc) is a connective tissue disorder characterized by microvascular injury, autoimmunity, and excessive collagen deposition leading to fibrosis. Despite advances in understanding peripheral microvascular changes, the relationship between retinal, peripheral, and systemic vascular involvement remains inadequately explored. To evaluate and correlate optical coherence tomography angiography (OCTA), nailfold capillaroscopy (NC), and transient elastography findings in SSc patients. This prospective single-center study enrolled 40 SSc patients (2013 ACR/EULAR criteria) and 45 healthy controls between December 2024 and August 2025. All participants underwent comprehensive ophthalmologic examination with OCTA imaging, NC evaluation, and liver stiffness measurement (LSM) using transient elastography. Retinal vessel density was assessed in superficial and deep capillary plexuses across macular and peripapillary regions. Clinical parameters including modified Rodnan skin score, disease duration, and organ involvement were recorded. SSc patients showed significantly reduced deep parafoveal (p = 0.048), deep temporal (p = 0.025), and deep inferior (p = 0.019) vessel densities, with decreased superior retinal nerve fiber layer thickness (p = 0.024) versus controls. Active capillaroscopic patterns appeared in 60% of patients. Strong correlations existed between OCTA parameters and age, disease duration, and LSM (r=-0.409 p = 0.011 for DWI-age, r=-0.392 p = 0.015 for DWI-LSM). Diffuse cutaneous SSc demonstrated lower superficial vessel densities than limited disease (p = 0.010-0.023). OCTA-detected retinal microvascular changes correlate significantly with peripheral microvascular damage and systemic fibrotic burden in SSc, representing a valuable non-invasive monitoring tool with preferential deep capillary plexus involvement reflecting systemic vasculopathy.

BackgroundWith the global shift from curative to preventive care, an increasing number of physicians venture in the field of public health (PH), which could entail changes in their scope of practice and professional identity. Professional Identity Formation (PIF) is progressively regarded as a vital part of competency-based medical education. Although it has been extensively studied in clinical settings, less is known about how physicians’ PIF unfolds outside of traditional clinical environments and what is required to support this process. This study aims to explore how medical residents’ PIF unfolds in the context of PH.MethodsIn this study we used a descriptive qualitative approach, from the perspective of a constructivist paradigm. Cruess’s conceptual framework of PIF in medicine served as a sensitizing framework and supported the interpretation of the data. Eleven PH residents and eight recently graduated PH specialists participated in individual interviews or focus groups. Thematic analysis was performed, along with an iterative process of both inductive and deductive coding.ResultsParticipants described the role of a supervisor who is actively involved in the vast landscape of PH and can act as a social catalyzer, as essential in helping them find their professional role. They emphasized the importance of welcoming communities of practice, that give them professional responsibilities to take on tasks aligned with the PH specialty. Participants also expressed the need to reflect on the intersection of personal and professional development. An ambiguous scope of practice and uncertain career perspectives were perceived as inhibiting factors, and could lead to fear of losing legitimacy after residency.ConclusionThis study offers new insights into the role of the supervisor and the sector-specific challenges in PH residency. To counterbalance the negative impact of an unclear scope of practice on PIF, the authors suggest that more attention must be given to the relationship between personal and professional identity and to the complicated participation in the landscape of practice. While this is particularly relevant for PH residents, it may also apply more broadly to all residents who are confronted with the evolving societal and healthcare demands associated with preventive care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08068-9.

Brucella spp. infections in livestock continue to pose significant threats to public and animal health, as well as to local economies. In the European Union, Brucella abortus, which primarily affects cattle and buffaloes, has been successfully eradicated in some Member States and across northern and central Italy through mandatory eradication and control programmes. However, some provinces in southern Italy, including Caserta and Salerno (Campania Region), remain affected, while in other provinces, as in Isernia (Molise Region), brucellosis has temporarily re-emerged. The study examines brucellosis outbreaks occurring between 2019 and 2023 in these territories, focusing on livestock that play a key role in the milk value chain, an essential pillar for economic sustainability, environmental protection and cultural heritage preservation. Since brucellosis is a WOAH Listed Disease subject to mandatory notification, we analyzed data registered in Italian, European Union and International portals concerning these notifications. Furthermore, we correlated these data to the national and regional rules adopted in order to tackle bovine brucellosis, including the methods approved for the serological diagnosis of infection. In Isernia, a mountainous area where cattle ranching and traditional herding are widespread and culturally significant, brucellosis re-emerged in the period 2019-2021, when 30 outbreaks arose, 50% of outbreaks were linked to grazing practices. Outbreaks were promptly extinguished through veterinary intervention due to the low density of farms, which typically house only a few animals, and new cases have not been detected since 2022. The provinces of Caserta and Salerno present a different scenario, as they are major hubs for water buffalo breeding. The stringent tailored control measures, implemented in these provinces through a regional programme, led to a gradual decline in the prevalence of buffalo brucellosis outbreaks in Caserta, that involved 8,766 heads in 2019 and 6,164 heads in 2023, and in the eradication in Salerno, with 369 positive heads in 2019 brought to 0 since 2022. The Caserta programme specifically addresses the province's particular vulnerabilities, which include frequent flooding events and the presence of the largest and most densely concentrated water buffalo population in Italy. The results highlight the fundamental importance of a One Health approach, which includes targeted interventions adapted to the specific context in which they are applied. This approach must actively involve key stakeholders, including farmers, researchers, public health authorities, and policymakers, and be supported by financial investments. Key components include strengthening biosecurity measures, implementing advanced animal traceability systems, continuous professional training programmes (including for farmers), expert-led information-sharing technologies, and promoting voluntary serological self-monitoring practices.

BackgroundThe benefit of regional nodal irradiation in the treatment of breast cancer is well established for patients with pathologically positive axillary nodes, but whether it is also beneficial for patients whose nodes become pathologically tumor free (ypN0) after neoadjuvant chemotherapy remains unclear.MethodsWe evaluated whether regional nodal irradiation improves outcomes in patients with biopsy-proven, node-positive breast cancer who reach ypN0 status after neoadjuvant chemotherapy. Patients with breast cancer with a clinical stage of T1 to T3 (tumor size, ≤2 cm to >5 cm), N1, and M0 (indicating spread to one to three axillary lymph nodes but no distant metastasis) who had ypN0 status after neoadjuvant chemotherapy were randomly assigned to receive regional nodal irradiation or no regional nodal irradiation. The primary end point was the interval of freedom from invasive breast cancer recurrence or death from breast cancer (invasive breast cancer recurrence–free interval). Secondary end points included the locoregional recurrence–free interval, the distant recurrence–free interval, disease-free survival, and overall survival. Safety was also assessed.ResultsA total of 1641 patients were enrolled in the trial; 1556 were included in the primary-event analysis: 772 in the irradiation group and 784 in the no-irradiation group. After a median follow-up of 59.5 months, 109 primary end-point events (50 in the irradiation group and 59 in the no-irradiation group) had occurred. Regional nodal irradiation did not significantly increase the invasive breast cancer recurrence–free interval (hazard ratio, 0.88; 95% confidence interval, 0.60 to 1.28; P=0.51). Point estimates of survival free from the primary end-point events were 92.7% in the irradiation group and 91.8% in the no-irradiation group. Regional nodal irradiation did not increase the locoregional recurrence–free interval, the distant recurrence–free interval, disease-free survival, or overall survival. No deaths related to the protocol-specified therapy were reported, and no unexpected adverse events were observed. Grade 4 adverse events occurred in 0.5% of patients in the irradiation group and 0.1% of those in the no-irradiation group.ConclusionsThe addition of adjuvant regional nodal irradiation did not decrease the risk of invasive breast cancer recurrence or death from breast cancer in patients who had negative axillary nodes after neoadjuvant chemotherapy. (Funded by the National Institutes of Health; NSABP B-51–Radiation Therapy Oncology Group 1304 ClinicalTrials.gov number, NCT01872975.)

There is little information on sexual and reproductive health knowledge (SRHK) and practices in Angola and no data on the prevalence of sexually transmitted infections. The objective of this study was to assess the SRHK and behaviors, and estimate the prevalence of four sexually transmitted infections (STIs) among adolescents and young adults from 4 municipalities in Benguela province, Angola prior to an educational intervention. We performed a cross-sectional study to assess SRHK and sexual behavior using a structured questionnaire among adolescents and young adults aged 15 to 25years old from two urban and two rural municipalities of Benguela province. We also evaluated the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis using rapid tests. A total of 1400 youths were included in the study. Overall, 818 (58.4%) participants had adequate SRHK. Urban origin [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.35-2.04], older age (OR 1.14, 95% CI 1.09-1.20), being female (OR 2.06, 95% CI 1.57-2.71) and having journals and internet as the main sources of information (OR 1.37, 95% CI 1.00-1.86 and OR 2.33, 95% CI 1.69-3.21, respectively) were significantly associated to a good SRHK in the multivariate analysis. Four hundred and fifty-three [45.9% of those who have had sexual intercourse (n=986)] reported risky sexual behavior. We observed that risky sexual behavior was associated with male gender (OR 2.89 95% CI 2.13-3.92, P<.001). Prevalence of STI was: 5 (0.35%) for HIV, 190 (13.6%) for HBV, 4 (0.3%) for HCV, and 20 (1.4%) for syphilis. SRHK was higher than expected although in-depth knowledge was uncommon, especially in men from rural areas with lack of access to journals or the internet. Unsafe sexual behavior was widespread among our sample. Prevalence of HBV was higher than expected. Sexual education campaigns using both digital and non-digital approaches should be focused on reaching the young population dispersed in rural areas where internet connection is difficult and should be accompanied by HBV vaccination promotion.

ContextDengue is a major public health threat in the Lao People’s Democratic Republic (Laos) and Thailand. Dengue transmission is ecologically complex. Concurrently identifying both climate and landscape-based risk factors for dengue virus transmission is necessary to improve dengue prevention and control efforts in Laos and Thailand.ObjectivesThe objective of this study was to determine how changes in climate (temperature and rainfall), and land use (e.g. built-up areas, agricultural crops, fruit orchards, rubber plantations) and land cover (e.g. evergreen and deciduous forests, permanent and temporary wetlands) affect dengue risk in four provinces in southern Laos and north-eastern Thailand during 2002 to 2019.MethodsA conditional autoregressive Bayesian spatiotemporal modeling framework was used to analyze the risk of dengue by spatiotemporal variations in land use and land cover (LULC) and climatic parameters.ResultsThe average annual temperatures in the study area increased by 0.44–0.94 °C during the study period. The model indicated that an increase of 1 °C in weekly average temperatures (up to a 29 °C threshold level) increased the average dengue risk by up to 24% in the two Lao provinces and 18.9% in the two Thai provinces. The model suggested that a rainfall increase of 1 mm up to 60 mm increased dengue risk by 1.8–3.2%. A 0.6–1.6% increase in built-up land use increased dengue risk by 1.8–6.9%. Built-up areas and rubber plantations were positively associated with dengue in the Ubon Ratchathani province of Thailand, while wetlands were negatively associated with dengue cases in the Savannakhet province of Laos.ConclusionsChanges in dengue risk were clearly related to increases in rainfall and temperature as well as changes in LULC in both Laos and Thailand. These insights may inform community-based dengue control activities by targeting geographically localized areas (microgeographic scale) to deploy dengue control activities more effectively in these highly endemic regions.

IntroductionAutistic spectrum disorders belong to the group of neurodevelopmental disorders, where the manifestations of the disorder differ depending on the severity of the autistic condition. These disorders are often associated with intellectual impairments and structural language disorders. In his patients, Asperger described cases with above-average intelligence as well as cases with low language and intellectual abilities. What they had in common was that they had significant disorders in social and affective communication. The diagnosis of autism spectrum disorders is usually made in childhood, but there are also cases where the diagnosis is made at an older age due to the later manifestation of symptoms.ObjectivesTo present a case report of 18 years old girl who was diagnosed with moderate intellectual disability in childhood, while later established with symptoms of Asperger’s syndrome and mild intellectual disability.MethodsPsychiatric interview, medical history, psychological testingResultsAn 18-year-old girl, accompanied by her mother, presented herself to psychiatrist for the first time due to affective disorders that manifested in the form of increased nervousness and outbursts of anger. Early psychomotor development was slow, she started walking at the age of 1.5 years and spoke at the age of two. From early childhood, stereotypies in movements and hypervigilant attention were observed, along with very poor social interactions. Due to difficulties at school, she was categorized at the age of 12 as having moderate intellectual insufficiency and IQ of 35. She underwent long-term speech therapy treatment and finished elementary and high school with the help of teaching assistant. Somewhere in high school, the patient’s pronounced talent for drawing was noticed. Observation during the psychiatric examination reveals emotional immaturity, stereotypes and rigidity in social interactions. The patient is referred again for psychological testing, results show IQ of 88 with a lag in emotional development and development of basic social skills. The patient is referred to another psychiatrist for an additional opinion, who agrees with diagnose of Asperger’s syndrome. Low dose of lamotrigine was included in therapy, after which affective state stabilized. The patient is referred again for categorization.ConclusionsThis case report that a diagnosis established in childhood period does not have to be definitive and that revision of diagnosis is necessary over time and as necessary, initially due to increase of patient’s IQ, as well as due to the later presentation of symptoms characteristic of certain disorder.Disclosure of InterestNone Declared

The role of primary care physicians in mental health services is increasingly significant. However, there is a lack of research on general practitioners' interest and self-efficacy in providing mental health services. This study aims to assess the interest and self-efficacy of general practitioners in mental health services and to identify their educational needs in this area. This study employs a cross-sectional design. A total of 461 family physicians are working in primary care health services in Kayseri, Turkey. The study sample included 415 general practitioners who had not received specialist training in family medicine after graduating from medical school. Face-to-face surveys were conducted with 270 general practitioners who agreed to participate in the study. The survey included questions about demographic characteristics, postgraduate training, experiences related to mental health, knowledge of mental health and medication treatment, self-evaluations of self-efficacy in mental health services, and requests for education on the subject. General practitioners reported low self-efficacy in the use and dosage of psychiatric medications (11.9%), but felt more competent in relation to drugs with addictive potential (34.4%). However, they generally perceived their competence in the use and monitoring of psychiatric medications to be low. The area where they felt least competent in managing mental illnesses in primary care was "intervention in suicide." Their awareness and coordination regarding community mental health centers, as mental health service providers, were found to be low. Overall, general practitioners perceived themselves as inadequately competent in tracking and managing mental illnesses. General practitioners acknowledge that mental health services are a primary care responsibility. However, there is a need to increase their self-efficacy in providing mental health services at the primary care level. Since all participants in this study were public employees, continuing mandatory postgraduate mental health training is crucial. Additionally, strengthening collaboration and coordination mechanisms, as well as providing more effective referrals to community mental health centers, is essential. These efforts will significantly contribute to improving the community's mental health.