BackgroundBirths that are small-for-gestational-age (SGA) represent a major cause of neonatal morbidity and mortality, particularly in sub-Saharan Africa. The contribution of specific placental histopathological lesions and their association with maternal risk factors remain poorly characterized in this high-burden setting. This study aimed to determine the incidence of adverse neonatal outcomes in SGA births and to identify associated placental and maternal predictors in northern Uganda.MethodsA prospective cohort study was conducted at Lira Regional Referral and Kiryandongo General Hospitals in Uganda from 15th April 2025 to 15th August 2025. A total of 151 women delivering singleton SGA infants were enrolled. Maternal sociodemographic, clinical, and obstetric data were collected via a structured questionnaire, and placentas were examined using standardized histopathological protocols. The primary outcome was a composite of adverse neonatal events, including admission to the neonatal intensive care unit (NICU), Apgar score <7 at 5 minutes, preterm birth, or early neonatal death. Multivariable Poisson regression was used to identify independent predictors of the composite outcome.ResultsThe incidence of adverse neonatal outcomes was 48.3% (95% CI: 40.4–56.4). Placental abnormalities were identified in 47.7% of cases, with inflammatory lesions (8.6%), vascular lesions (7.9%), and villous infarctions (6.0%) being the most prevalent findings. After adjusting for confounders, the presence of any placental abnormality was the strongest independent predictor of adverse outcomes (adjusted Relative Risk = 2.23; 95% CI: 1.45–3.43; p < 0.001). Maternal obesity (Body Mass Index ≥30 kg/m2; aRR = 1.61; 95% CI: 1.06–2.46; p = 0.027) and higher maternal income (>200,000 Ugandan Shillings; aRR = 1.66; 95% CI: 1.03–2.69; p = 0.037) were also significantly associated with an increased risk of adverse outcomes.ConclusionNearly half of SGA neonates in this northern Ugandan cohort experienced an adverse neonatal outcome. Placental abnormalities were common and were associated with adverse outcomes, and maternal obesity was identified as a potentially modifiable risk factor. These findings support the value of structured placental examination after SGA deliveries for etiologic classification and risk stratification and highlight the need for further research to determine whether targeted antenatal interventions addressing maternal nutrition and weight management can reduce adverse neonatal outcomes.

Objective:To integrate the Structure–Process–Outcome framework with the SERVQUAL model to develop a performance evaluation index system tailored for internet hospitals in Qingdao, China. This study provides a scientific tool for assessing and optimizing the service quality of internet hospitals.Methods:Following the Structure–Process–Outcome framework and the SERVQUAL model, evaluation indicators were systematically collected through literature review and policy analysis. A preliminary index system was constructed and refined through two rounds of Delphi expert consultations. Experts from hospitals, universities, and research institutions in Qingdao, Nanjing, and Lianyungang participated, providing ratings and recommendations. The research team assessed questionnaire reliability, expert positivity, expert authority, and opinion consistency using statistical methods, including Cronbach’s coefficient alpha, authority coefficient, and Kendall’s coefficient of concordance W.Results:The preliminary index system identified through literature review and a pre-survey included three primary, seven secondary, and 28 tertiary indicators. After Delphi Round 1, some indicators were revised, three tertiary indicators were added, and no indicators were removed. After Delphi Round 2, further revisions were made, and the consultation was concluded when the p value of the test for Kendall’s coefficient of concordance W was <0.001 and the coefficient of variation was within acceptable limits (<0.3). The final index system comprises three primary, seven secondary, and 31 tertiary indicators. The overall Cronbach’s coefficient alpha was 0.962, with values of 0.903, 0.903, and 0.857 for the three primary dimensions, indicating high reliability. The authority coefficient was 0.885, all above the 0.7 threshold. Kendall’s coefficient of concordance W values for secondary and tertiary indicators in the second round were 0.286 and 0.285 (all p < 0.001), reflecting moderate consensus among experts.Conclusion:This study provides a practical, outcome-oriented, security-first tool for promoting high-quality development of internet hospitals in China, with potential applicability to similar settings. This study contributes by explicitly integrating Structure–Process–Outcome and SERVQUAL into a unified framework, enabling simultaneous assessment and optimization of process quality and multidimensional service quality in internet hospitals.

Background:Chronic kidney disease is on the rise globally and poses a significant public health concern. Patients with chronic kidney disease are receiving sustainable treatment through hemodialysis. However, hemodialysis is intensive, costly, and requires regular treatment. This study aims to explore the lived experiences of patients undergoing hemodialysis treatment.Methods:This study employed a phenomenological qualitative approach conducted between May and August 2023. Semi-structured, in-depth interviews were used with 16 participants selected purposively. Data were collected using an audio tape recorder and a notebook, and data collection ceased upon achieving thematic saturation. The data were analyzed using thematic analysis.Results:Seven themes were identified: (1) Threads of survival, (2) the price of survival, (3) the thirst of survival, (4) psychological and emotional distress, (5) physical effects, (6) social concerns, and (7) coping with treatment and the disease.Conclusion:Understanding the lived experiences of patients with end-stage renal disease and their coping mechanisms is crucial for healthcare providers in planning and delivering quality care, that is, centered on patient experiences. By focusing on what patients go through daily and how they manage their condition, healthcare providers can develop care plans that are not only effective but also empathetic and supportive. Expanding dialysis services, reducing costs, and emphasizing early chronic kidney disease detection and prevention are critical to reduce the burden.

Background and objectives The rising demand for computed tomography (CT) has put pressure on radiology departments to optimize workflows and turnaround times (TATs). TATs in CT encompass the entire process from order to report finalization. Optimizing the TAT is essential to improving patient satisfaction and workflow. This study aimed to evaluate the TAT of CT scans and the influencing factors at Palestinian hospitals. Methods A cross-sectional retrospective study on 8,220 CT scan orders from three Palestinian hospitals was conducted. Data from CT scans, completed from 01/07/2023 to 31/12/2023, were collected from the medical records stored in the Enterprise Resource Planning (ERP) system. The collected data included times of CT scan order, acceptance, and final report, order status, encounter type, the ordering day and time, and whether CT scans were with or without contrast media. Then, the order-to-accept TAT, the accept-to-result TAT, and the order-to-result TAT were calculated in minutes. Nonparametric statistical analyses were employed to identify associations between TATs and encounter type, scan day, working shift, and contrast media utilization. Results The median TATs from order to acceptance, from order to result, and from acceptance to result were 78, 837, and 462 minutes, respectively. TATs varied significantly depending on working shifts, the day of the week, encounter type, and the use of contrast media. The order-to-accept TAT was higher for inpatient CT scans, CT scans ordered on C shifts, and those with contrast media. The accept-to-result TAT was higher for outpatient CT scans, CT scans ordered on B shift compared to A shift, CT scans ordered on weekends, and those with contrast media. The order-to-result TAT was higher for outpatient compared to emergency CT scans, CT scans ordered on C shift, CT scans ordered on weekends, and CT scans with contrast media. Conclusion CT scan TATs constitute essential indicators of operational efficiency in radiology departments. Several factors significantly influence these metrics, including the order day, the working shift, the request source, and the administration of contrast agents. To improve CT scan throughputs, targeted strategies must be implemented to optimize workforce allocation, streamline intra-departmental workflows, and mitigate patient-related delays. Such evidence-informed interventions hold promise for advancing both diagnostic efficiency and the overall quality of radiological services.

Introduction:Vaccination significantly reduces morbidity and mortality among children from vaccine-preventable diseases. Despite a global and regional immunization coverage estimate of 74%, Ethiopia has ~1,146,000 zero-dose children. Therefore, this study estimated the prevalence of zero-dose vaccination and identified factors and barriers among children under 2 years of age in South West Ethiopia.Method:An explanatory sequential mixed-methods design was employed; the quantitative component consisted of a community-based cross-sectional study, and the qualitative component was assessed using a qualitative descriptive approach through in-depth interviews. Following data cleansing, the status of the first dose of the pentavalent vaccination was classified as either “vaccinated for first dose of the pentavalent vaccine” or “not vaccinated for first dose of the pentavalent vaccine.” Then, associated factors of being zero-dose at p < 0.05 were identified using logistic regression analysis. Subsequently, reflexive thematic analysis was employed for qualitative data analysis because it enables both interpretive developments of latent meanings underlying barriers to zero-dose vaccination and inductive coding based on participant narratives.Result:The results indicated that 17% of children were zero-dose, and lack of antenatal care visit (adjusted odds ratio = 4.005; 95% confidence interval: 2.011–7.975, p = 0.000), lack of information regarding immunization services (adjusted odds ratio = 2.493; 95% confidence interval: 1.293–4.809, p = 0.006), and maternal gravidity of ⩽3 (adjusted odds ratio = 4.198; 95% confidence interval: 1.425–12.370, p = 0.009) were significant factors for zero-dose vaccination. From the majority of in-depth interview participants’ expressions, myths and misinformation about vaccination, far distance from the health facility, and lack of convenient means of transport were important barriers for childhood vaccination.Conclusion and recommendation:This study revealed that the magnitude of zero-dose children is 17%, and demonstrated that zero-dose vaccination in Southwest Ethiopia is best understood through a multi-level ecological lens. While quantitative analysis identified antenatal care attendance, maternal knowledge/information, and gravidity as significant predictors, qualitative findings revealed how individual knowledge gaps, interpersonal influences, institutional service limitations, and broader structural barriers in underserved agrarian and pastoralist settings intersect to shape immunization behavior.

We review the chronic phase ventilation (CPV) strategy recommended in infants with the most severe bronchopulmonary dysplasia (msBPD, mechanically ventilated at 36–40 weeks post-menstrual age). The safety and efficacy of CPV was important to scrutinize because msBPD is increasingly common, and infants with msBPD are often transferred to the Pediatric Intensive Care Unit (PICU) where the CPV strategy started in neonatal intensive care is expected to continue as the standard of care. First, we describe the CPV strategy, and the supporting evidence given by expert proponents. Second, we subject the supporting evidence to critical scrutiny and explain flaws that weaken support. Third, we give evidence that the strategy is based upon unsound pathophysiology and hence may be harmful. Fourth, we put this all together by making unstated (and unsupported) premises in explaining the benefit of CPV explicit. We made four conclusions. First, the literature suggested that CPV is based upon circular referencing among chapters and narrative reviews written by the same respected experts, and therefore, upon literature inadequately subjected to critical scrutiny. Second, these reviews explained physiologic theory with little supportive evidence that had likely been misinterpreted, and referred to outcome studies that did not examine the effect of the CPV strategy. Third, when implicit assumptions are made explicit, there is evidence to show a lack of consensus about and potential harms of the CPV strategy, and inaccurate interpretations of msBPD physiology. Fourth, there was no rationale that withstands critical scrutiny to suppose ventilated children with msBPD might be an exception to using a standard of care ventilation strategy used in acute lung disease. If the CPV strategy is beneficial, we urgently need better data to that effect; otherwise, it is too early to widely adopt what may be a harmful strategy as standard of care.

Background:The intensive care unit (ICU) is a setting where critically ill and high-risk patients undergo intensive therapy under continuous monitoring. Throughout their stay, patients undergo multiple tests and a range of medical and surgical procedures, with each case presenting various risk factors and complications. The study sought to evaluate risk factors in ICUs and identify those that present the greatest risk.Methods:A cross-sectional study was conducted among ICU patients with risk factors who developed complications during their stay. Forty-seven patients of diverse ages and genders were admitted to the ICU. The analysis was conducted using IBM SPSS 26.Results:Analysis of the patient data regarding hospital stay and discharge conditions indicated no statistically significant difference (P > 0.05). In relation to ventilation techniques, a statistically significant difference (P < 0.05) was observed when comparing it with hospital stay duration; patients who remained in the ICU for more than 20 days encountered various ventilation techniques (18 patients). A statistically significant association was observed on Day 5 for the Cured group (P = 0.034). Fluid balance on Day 2 showed a highly statistically significant relationship with the Cancer system (P < 0.001). The odds ratio (OR) was 1.081 (95% CI: 1.076–1.086). A negative fluid balance correlated with decreased mortality rates, shorter hospitalization durations, and a reduced incidence of sepsis.Conclusions:A prolonged hospital stay correlates with elevated mortality rates, increased infection risk, and a higher incidence of complications. The past medical history and fluid balance of each patient are essential factors in identifying the most appropriate therapeutic strategy.

Skin bleaching is the cosmetic use of hazardous substances or skin lightening agents to change one's natural skin pigment. Skin bleaching products contain substances such as corticosteroids, hydroquinone, mercury salts, and other compounds that decrease the melanin. To assess the prevalence of skin bleaching and identify the motivating factors among female university students in Mogadishu, Somalia. This cross-sectional study included 317 female university students in Mogadishu, Somalia, from February to July 2024. Structured questionnaires were used for data collection. Data analysis was performed using IBM SPSS Statistics version 27.0, reporting categorical variables as frequencies and percentages; significance was determined at p < 0.05 for both crude odds ratios in univariate analyses and adjusted odds ratios (AORs) in multivariate analyses. Almost 77.3% of participants showed awareness of skin bleaching, with main information sources mentioned as media (39.7%) and friends (34.1%). Two-thirds (63.4%) reported experiencing skin conditions like acne (27.1%). Univariate and multiple logistic regression analyses were conducted. From the results, only female students with a monthly income between USD 50 and 100 were 1.21 (AOR = 1.21, 95% confidence interval: 1.102-1.6341) more likely to bleach their skin compared to those with an income less than USD 50. The study reveals a high prevalence of skin bleaching practices among female university students despite widespread awareness. Media and peer influence play a major role, and many participants reported adverse skin effects. Monthly income emerged as the key factor associated with skin bleaching, underscoring the need for targeted public health education and interventions.

Latent tuberculosis infection, an infection caused by Mycobacterium tuberculosis, affects one-quarter of the world's population. The World Health Organization recommends screening for latent tuberculosis infection in at-risk populations to reduce morbidity and mortality risks associated with tuberculosis using the tuberculin skin test and interferon-gamma release assays, including the QuantiFERON-TB Gold Plus® test (QTF-Plus® test). This study aimed to assess the place of QTF-Plus test in latent tuberculosis infection screening among a high-risk population. A total of 969 biotherapy candidates were included in the study (52.63% female and 47.36% male; sex ratio = 0.9). The mean age was 38.29 ± 15.83 years. The frequency of latent tuberculosis infection, according to QTF-Plus test results, was 20.22%. Factors such as age and history of tuberculosis were significantly associated with QTF-Plus test results (p = 0.002 and p < 0.0001, respectively). QTF-Plus test and tuberculin skin test were performed simultaneously on 632 patients. A weak agreement between these tests was found (77.50%, Cohen's kappa coefficient of 0.13). However, a good correlation between TB antigen tube 1 and TB antigen tube 2 (r = 0.72, p < 0.0001; 95% CI: 0.68-0.74) was observed. Our findings demonstrate that the QTF-Plus test is useful for latent tuberculosis infection screening in a highly vaccinated population with an intermediate prevalence of tuberculosis.

Pertussis remains a major public health concern in low- and middle-income countries despite the availability of effective vaccines. In Ethiopia, recurrent outbreaks continue to occur, particularly in hard-to-reach rural settings. The aim of this study was to investigate a pertussis outbreak, identify associated risk factors, and evaluate the effectiveness of implemented interventions in Sayient Woreda, Northwest Ethiopia. An observational, community-based, unmatched case-control study with a house-to-house approach was conducted from October 25, 2018, to January 22, 2019. A total of 50 cases and 100 controls were selected using simple random sampling. Data were collected through face-to-face interviews using a pre-tested World Health Organization-adopted questionnaire. Data were cleaned, coded, and entered into Epi Info™ (version 7.2.1.0) and exported to SPSS (version 23) for analysis. Variables with a p < 0.05 with 95% confidence interval were considered independent risk factors for pertussis infection in multivariable logistic regression analysis. The overall attack rate was 3.1/1000 population. The age of the affected individuals ranged from 3 months to 28 years, with a median age of 10 years (Interquartile Range (IQR): 0.7-12). Females accounted for 56.6% of the reported cases. Following the implementation of cephalexin therapy and active case search, a substantial decline in incident cases was observed. Independent risk factors for pertussis infection were inadequate awareness on transmission mode (adjusted odds ratio = 1.61, 95% confidence interval: 1.33-9.54), inadequate prevention and control measures (adjusted odds ratio = 4.64, 95% confidence interval: 2.19-9.83), household contact with a confirmed case (adjusted odds ratio = 6.99, 95% confidence interval: 1.19-41.15), being unvaccinated (adjusted odds ratio = 3.62, 95% confidence interval: 1.97-5.50), and unknown vaccination status (adjusted odds ratio = 1.77, 95% confidence interval: 1.96-16.08). A substantial pertussis outbreak occurred in Sayient Woreda, predominantly affecting children and adolescents. Inadequate community awareness, close household contact, and incomplete or unknown vaccination status significantly contributed to transmission. Strengthening routine immunization and enhancing community awareness are important for preventing future outbreaks.