BACKGROUND: In Morocco, much progress has been made in breast cancer treatment. However, there is limited information on survival outcomes of breast cancer patients according to their therapeutic management.
METHODS: A pattern-of-care study was conducted in Morocco\'s two main oncology centres: Rabat and Casablanca and has shown that major progress has been made in the quality of care with survival rates comparable to those in developed countries. The present study focuses on the different therapeutic strategies used in breast cancer and their impact on prognosis. Patients were classified into two categories: those considered as appropriately managed and those who were not.
RESULTS: A total of 1901 women with stage I to III breast cancer were included in this study, the majority (53%) were adequately managed and had better disease-free survival (DFS) rates than those who were not: DFS at 3 years (88% versus 62%) and at 5 years (80% versus 50%). Potential significant determinants of better management were: treatment in Rabat\'s oncology centre, treatment between 2008 and 2012, being aged younger than 60 years, and early TN stage.
CONCLUSIONS: This study demonstrated the value of proper integrated and coordinated management in a comprehensive cancer centre, to improve breast cancer survival.

UNASSIGNED: To analyze the effectiveness of the \"Xinjiang Model\" for tuberculosis prevention and control in Kashgar Prefecture, Xinjiang, and to explore the determinants of the policy implementation effect.
UNASSIGNED: The registration data of pulmonary tuberculosis (PTB) patients in Kashgar Prefecture from 2012 to 2021 were collected to describe the temporal trend of registered incidence. A questionnaire survey was conducted among PTB patients registered and treated in the tuberculosis management information system in Zepu and Shache Counties from January 2022 to July 2023 to collect and analyze \"Xinjiang model\" determinants of effectiveness.
UNASSIGNED: The PTB registered incidence in Kashgar Prefecture showed a significant increasing trend from 2012 to 2018 (APC=18.7%) and a significant decreasing trend from 2018-2021 (APC=-28.8%). Among the Kashgar Prefecture, compared with average registered incidence in 2012-2017, registered incidence in 2021 in Shufu, Maigaiti, and Zepu Counties had a greater decline rate of 58.68%, 57.16%, and 54.02%, respectively, while the registered incidence in 2021 in Shache County increased by 6.32%. According to the comprehensive analysis of the factors affecting the effect of policy implementation, the proportion of PTB patients in Zepu County whose health status has now significantly improved compared with that before treatment was significantly greater than that in Shache County (P<0.05); patients in Shache County were significantly less aware than those in Zepu County of how to take tuberculosis drugs, precautions, adverse reactions, and regular reviews during treatment; the factors that accounted for the greater proportion of heavy treatment burden in both Shache and Zepu Counties were discomfort caused by taking or injecting drugs, accounting for 12.8% and 8.7%, respectively.
UNASSIGNED: The \"Xinjiang model\" can effectively control the epidemic situation of tuberculosis in Kashgar, and the knowledge of tuberculosis treatment, adverse reactions to tuberculosis drugs, and treatment costs were the determinants of the effectiveness of policy implementation.

UNASSIGNED: West Bengal is experiencing an unanticipated risk of eclampsia among pregnant women and it persists as the leading cause of maternal mortality. This study aimed to investigate the predictors for maternal deaths due to eclampsia in West Bengal.
UNASSIGNED: The study adopted retrospective mixed methods covering facility and community-based maternal death review approaches. Facility-based data were used for 317 deceased cases wherein the community-based review approach was used in 40 cases. An in-depth interview was also performed among 12 caregivers.
UNASSIGNED: One-third of maternal deaths occurred due to eclampsia, and this accounted for the leading cause of maternal deaths in West Bengal. A younger age, a primigravida or nulliparous status, absence of antenatal care (ANC), and residence in rural areas appeared to have the highest risk of developing eclampsia. The majority of pregnant women had an irregular antenatal check-up history, particularly during the second trimester of pregnancy. The rate of eclampsia-related maternal death was higher in women residing more than 49 km from the studied hospitals. Most of the deceased women were referred to three or more hospitals before their death. Gravidity, the number of ANC visits, the mode of delivery, and delays at different levels were significant confounders of death due to eclampsia. The risk of death due to eclampsia was two times higher among women without ANC and those who had a cesarean section than that in their counterparts.
UNASSIGNED: Women in West Bengal have a high risk of preeclampsia and eclampsia resulting in maternal mortality and morbidity. Gravidity, the number of ANC visits, the mode of delivery, and delays in recognition of eclampsia contribute to the risk of maternal deaths. The establishment of separate eclampsia units, enhanced screening, and preventive and treatment procedures may optimize managing eclampsia.

BACKGROUND: Burnout syndrome attributable to cumulative stressors is highly prevalent among teachers. Despite this, knowledge of burnout syndrome among schoolteachers in lower-middle-income countries are limited, therefore we aimed to investigate self-reported occupational burnout syndrome and associated factors among schoolteachers in Nepal.
METHODS: A survey was conducted among randomly selected 37 community schools in Kathmandu, Nepal in 2022, with a total sample of 218 schoolteachers (70% male). Occupational burnout was assessed using the Nepali version of the validated Maslach Burnout Inventory (MBI-ES). MBI-ES consists of 22 items assessing occupational burnout, which were classified into emotional exhaustion (EE, 9 items, score range: 0-45), depersonalization (DP, 5 items, 0-23), and personal accomplishment (PA, 8 items; 3-48). The greater score in EE and DP and the lower score in PA indicate a higher level of burnout. Various socio-demographic, lifestyle, and work-related factors were examined as determinants of occupational burnout using ANOVA and multivariable linear regression models.
RESULTS: The mean scores of EE, DP, and PA were 14.99 (Standard Deviation, SD = 9.79), 4.18 (SD = 4.57), and 42.11 (SD = 6.82) respectively. Poor/moderate work ability contributed to poorer ratings of all three dimensions. Teaching special needs students contributed to EE and DP, whereas low physical activity and alcohol intake were associated with PA only. Younger age, being married, language of teaching, having a disability, sub-optimal physical fitness, poor sleep quality, and ever smoking contributed to EE only.
CONCLUSIONS: Occupational burnout among schoolteachers was relatively high. Marital status, lifestyle behavioral, and work-related factors were associated especially with EE and workability was a strong determinant of all three dimensions.
BACKGROUND: NCT05626543.

Infections with Shiga toxin-producing Escherichia coli (STEC) are increasing in Denmark and elsewhere. STEC is also the most frequent cause of haemolytic uraemic syndrome (HUS) in Danish children. Most cases are considered sporadic, while approximately one-third can be attributed to a known source of infection. Hence, we examined sources of sporadic STEC infection in Denmark. From January 2018 to December 2020, we conducted a prospective nationwide case-control study among Danish adults and children. Cases with confirmed positive STEC infection were notified infections within the national laboratory surveillance system. Control persons were randomly selected from the Danish Civil Registration System, individually matched in age in 5-year bands and sex. Participants were invited by an electronic letter to complete either an adult or child questionnaire online. Univariate and adjusted matched odds ratios were computed for adults and children using conditional logistic regression. The study recruited 1583 STEC cases and 6228 controls. A total of 658 cases (42%) and 2155 controls (35%) were included in the analysis. Depending on age, univariate analysis adjusted for socio-demographic determinants showed that the consumption of boiled beef (mOR = 2.2, 95% confidence interval (CI): 1.6-3.1) and fried minced beef (mOR = 1.6, CI: 1.2-2.1), drinking raw (unpasteurized) milk (mOR = 11, CI 1.1-110), eating grilled food (mOR = 9.8, CI: 5.6-17) and having a household member using diapers (mOR = 2.1, CI: 1.4-3.2) were determinants of sporadic STEC infection. Further multivariate adjusted analysis resulted in the same determinants. This study confirms that beef is an overall important risk factor for STEC infection in Denmark. We also present evidence that a proportion of sporadic STEC infections in Denmark are determined by age-specific eating habits, environmental exposures and household structure, rather than being exclusively food-related. These findings are relevant for targeted public health actions and guidelines.

BACKGROUND: Ethiopia\'s viral suppression rate was less than 90% by 2020, and more than 10% of adult clients on ART in Woliso Town were unsuppressed at the end of March 2022. This study aims to identify determinants of virologic failure among adult clients on ART at health facilities in Oromia region of Ethiopia.
METHODS: A facility-based unmatched case-control study was conducted at health facilities in Oromia region from August 1 to September 1, 2022. The study cases were clients with virologic-confirmed first-line ART failure, while controls were clients on first-line ART with a suppressed viral load. A total of 135 cases and 268 control participants were selected using simple random sampling techniques, and data were collected by reviewing the client\'s document. Epi-Info7 was used for data entry and SPSS version 20 for data analysis. Variables having a P-value of less than 0.25 in the bi-variable analysis were included in multivariable logistic regression. Determinants of virologic failure were determined based on an adjusted odds ratio using 95% CI and a P-value of < 0.05.
RESULTS: In this study, clients with an age ≥ 35 years (AOR = 3.4, 95% CI: 1.6, 7.0), clients with a baseline regimen of AZT + 3TC + NVP (AOR = 3.5, 95% CI: 1.4, 8.8), clients with a base-line CD4 count < 350 mm3 (AOR = 2.3, 95% CI: 1.1, 4.5), being single marital status (AOR = 3.7, 95% CI: 1.4, 10.5), TB-HIV coinfection (AOR = 2.58, 95% CI: 1.3, 5.1), and having opportunistic infection other than TB in the last six months (AOR = 3.06, 95% CI: 1.5, 6.3) were factors significantly associated with virologic failure while clients within the appointment spacing model (AOR = 0.05, 95% CI: 0.03, 0.10) is inversely associated with virologic failure.
CONCLUSIONS: This study showed that age ≥ 35 years, being single, baseline ART regimen with (AZT + 3TC + NVP), baseline CD4 cell count < 350 mm3, Tb-co infection, and opportunistic infection in the last 6 months were factors associated with virologic failure. Involvement in the appointment spacing model was found to be protective.

UNASSIGNED: Neonatal seizure is a common medical emergency that signals severe insult to the neonatal brain. It is a major risk factor for neonatal morbidity and mortality. It has a wide worldwide variation, ranging from 5 per 1000 live births in the United States of America to 39.5 per 1000 live births in Kenya. To decrease this significant figure, it is better to investigate its causes further. Therefore, this study aimed to assess its determinants since there was no prior evidence about it in the context of study area.
UNASSIGNED: Aim to assess the determinants of neonatal seizures among neonates admitted to neonatal intensive care units in the Awi Zone Hospitals, 2023.
UNASSIGNED: An institution based unmatched case-control study was conducted on 531 admitted eligible neonates from January 1, 2023, to May 30, 2023. A pretested tool was employed to collect data. The collected data were coded, edited, and entered into Epi-data version 3.1 and then exported to SPSS 26. Chi-square and odds ratios were used to assess the relationship between factors associated with the occurrence of neonatal seizure. Model goodness of fit was tested by Hosmer and Lemeshow. Bivariate and multivariate analysis was declared at P < 0.25 and P < 0.05 respectively to show a significant association with neonatal seizure at a 95 % level of significance.
UNASSIGNED: A total of 506 (130 cases and 376 controls) of admitted neonates were used in the final analysis model. Neonates admitted within 24 h of birth [AOR; 5.98 (95 %, CI: 2.18-16.43)], gestational age <32 weeks [AOR; 2.89 (95 %, CI: 1.29-6.53)], body temperature >37.5 °C [AOR; 4.82 (95 %, CI: 1.82-12.76)], blood glucose level <40 g/dl [AOR; 4.95 (95 %, CI: 2.06,11.88)], neonatal sepsis [AOR; 2.79 (95 %, CI: 1.46-5.35)] and perinatal asphyxia [AOR; 8.25 (95 %, CI: 4.23, 16.12)] were found to be determinants of neonatal seizure.
UNASSIGNED: and recommendations: In this study, neonatal seizure was determined by the factors of neonatal age, gestational age<32 weeks, body temperature >37.5 °C, blood glucose level <40 g/dl, neonatal sepsis, and perinatal asphyxia. Therefore, the presence of such factors requires prompt recognition and treatment.

UNASSIGNED: Digital health literacy (DHL) is a key competency for individuals\' daily decisions toward their health behavior and wellbeing. While there is much focus on health literacy (HL) among the general population, teachers have been rarely addressed. Given the shortages in the teaching workforce in Europe and the impact of demanding working conditions on their health, it is important to address DHL in teachers. This paper examines the DHL of primary and secondary teachers and its associations with sociodemographic and school-related factors.
UNASSIGNED: An online cross-sectional study was conducted with 1,600 German primary and secondary school teachers between October and December 2022. To assess DHL, the Digital Health Literacy Instrument (DHLI) including seven subscales was used. Statistical analyses were conducted on item and subscale level and an overall DHL score was calculated. Next to descriptive analyses, bivariate and regression analyses were conducted to explore potential associations with sociodemographic and school-related factors.
UNASSIGNED: The frequency of difficulty in using digital health information varied across DHL dimensions and was greatest for protecting privacy (70.9%) and evaluating reliability (40.0%). In multivariate analysis, females more often reported a sufficient ability of adding content (OR = 1.61, CI = 1.05-2.48), while males more often reported a sufficient ability to protect their privacy (OR = 0.45, CI = 0.27-0.75). Teachers with leadership positions more often reported a sufficient ability in adding content (OR = 1.78, CI = 1.07-2.98). Regarding the ability to determine the relevance of online health-related information, no associations with a predictor variable were found.
UNASSIGNED: The results suggest that it is important to examine the individual dimensions of DHL and their distinct associations with sociodemographic and school-level factors, rather than just to rely on the overall level of DHL. The differential patterns identified in this study suggest a greater intervention need for teachers from higher age groups, primary and secondary general schools, and those without leadership roles. However, based on the limited predictive power of the variables included, further individual and school-level factors and their potential association with DHL should be investigated in the future. The promotion of DHL should be integrated into both teacher education and in-service training.

UNASSIGNED: Mauritius has implemented a range of stringent policies to control smoking and promote public health. Regular monitoring focuses on the prevalence of tobacco use, yet there is a gap in understanding its socio-economic patterns.
UNASSIGNED: The aim of this study was to estimate the prevalence of tobacco smoking and to identify the social determinants associated with smoking among men in Mauritius in 2021.
UNASSIGNED: This is a cross-sectional population-based study conducted by the Ministry of Health and Wellness during 2021. In total, 3622 individuals participated (response rate of 84.1%), of which 1663 were men (45.9%). The study mainly focused on men given the low prevalence of smoking among women. Daily smoking was the outcome and a series of sociodemographic and socioeconomic factors were included as independent variables. Prevalence ratios (PR) and their 95% confidence intervals (95% CI) were estimated to fulfill the study objective.
UNASSIGNED: The prevalence of smoking among men was 30.4%. People in the 25-34 age group (PR = 1.65; 95% CI: 1.12-2.41), those separated, divorced or widowed (PR = 1.57; 95% CI: 1.16-2.11), the ethnic groups Muslim-Mauritians (PR = 1.70; 95% CI: 1.00-2.89) and Creoles (PR = 1.97; 95% CI: 1.16-3.35), and those with secondary (PR = 1.29; 95% CI: 1.00-1.67) and primary education (PR = 1.47; 95% CI: 1.10-1.98) were statistically significantly associated with daily smoking.
UNASSIGNED: Although a gradual decline in smoking prevalence was observed compared with the previous 2015 survey, the Ministry of Health and Wellness should persist in fortifying its anti-smoking measures and concentrate on crafting tailored interventions aimed at the vulnerable groups identified in this study.
Main findings: This study found a prevalence of smoking of 30.4% among men in Mauritius, identifying the young population, those not married, the Muslim-Mauritians and Creole ethnic groups and those with secondary and primary education as at-risk groups for smoking.Added knowledge: The study provides updated information on the prevalence of smoking and its distribution among different socioeconomic groups in Mauritius.Global health impact for policy and action: The anti-smoking policies implemented by the Ministry of Health and Wellness should continue to be strengthened, and specific interventions for the identified at-risk groups be developed. This can serve as a model for other countries with similar socio-economic profiles, aiming to reduce smoking consumption.

OBJECTIVE: This study aimed to assess the trends of healthy aging and investigate its determinants in the middle-aged population.
METHODS: This was a longitudinal study.
METHODS: The sample comprised 3043 participants aged 45-59 years from the China Longitudinal Study of Health and Retirement 2011-2018. We plotted the prevalence across four waves and used ordered logistic models to investigate the determinants of cumulative times of healthy aging.
RESULTS: We enrolled 3043 middle-aged people in our study. The prevalence of healthy aging is 28.2% at baseline but subsequently decreased to 19.72% at wave 4. Active socializing consistently ranked the lowest among the five dimensions. Participants with older age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94-0.97), low monthly income (OR = 0.82, 95% CI: 0.69-0.97) or lived in urban (OR = 0.81, 95% CI: 0.70-0.94) were less likely to have per time increase in healthy aging. Participants with more than primary school degree (OR = 1.79, 95% CI: 1.31-2.46), high life satisfaction (OR = 2.38, 95% CI: 1.86-3.06), and good self-report health (OR = 1.97, 95% CI: 1.66-2.34) were more likely to have healthy aging.
CONCLUSIONS: The number of middle-aged individuals in China who achieved healthy aging is declining and eventually less than one in five, which was far from ideal. Particular attention should be paid to older, women, urban dwellers, individuals with low income, low life satisfaction or poor self-report health. It is urgent to develop public health policies to improve the health and well-being of the middle-aged population.