CONTEXT Poor muscle strength, functional limitations, and disability often coexist, but whether muscle strength during midlife predicts old age functional ability is not known. OBJECTIVE To determine whether hand grip strength measured during midlife predicts old age functional limitations and disability in initially healthy men. DESIGN AND SETTING A 25-year prospective cohort study, the Honolulu Heart Program, which began in 1965 among Japanese-American men living on Oahu, Hawaii. PARTICIPANTS A total of 608945- to 68-year-old men who were healthy at baseline and whose maximal hand grip strength was measured from 1965 through 1970. Altogether, 2259 men died over the follow-up period and 3218 survivors participated in the disability assessment in 1991 through 1993. MAIN OUTCOME MEASURES Functional limitations including slow customary walking speed (< or =0.4 m/s) and inability to rise from a seated position without using the arms, and multiple self-reported upper extremity, mobility, and self-care disability outcomes. RESULTS After adjustment for multiple potential confounders, risk of functional limitations and disability 25 years later increased as baseline hand grip strength, divided into tertiles, declined. The odds ratio (OR) of walking speed of 0.4 m/s or slower was 2.87 (95% confidence interval [CI], 1.76-4.67) in those in the lowest third and 1.79 (95% CI, 1.14-2.81) in the middle third of grip strength vs those in the highest third. The risk of self-care disability was more than 2 times greater in the lowest vs the highest grip strength tertile. Adding chronic conditions identified at follow-up to the models predicting disability reduced the ORs related to grip strength only minimally. CONCLUSIONS Among healthy 45- to 68-year-old men, hand grip strength was highly predictive of functional limitations and disability 25 years later. Good muscle strength in midlife may protect people from old age disability by providing a greater safety margin above the threshold of disability.
This article explores the enduring influence of militarised masculinities in Namibia, examining how the figure of the soldier shapes men’s identities, family dynamics, and everyday experiences. Based on ethnographic research in Windhoek and Swakopmund, it considers how men navigate the shadow of militarism, both as a state-sanctioned ideal and a deeply personal inheritance. Using the concept of the shadow, the article traces how military legacies are embedded in urban spaces, national memory, and father-son relationships, revealing tensions between glorified narratives of heroism and lived realities of trauma, silence, and constraint. While militarised masculinities continue to shape social norms, this study illustrates how men navigate and make sense of these inherited expectations in both public and private life. The article contributes to broader discussions on masculinity, post-conflict identity, and the enduring legacies of militarism in post-Apartheid Namibia.
Joyce L Browne, Grazia Caleo, Patrick Keating
et al.
Background Humanitarian emergencies increase the risk of development or exacerbation of mental health conditions. This study documents how mental health differs between younger and older adults to inform adapted mental health services in humanitarian settings.Methods This multicountry study includes adults who accessed Médecins Sans Frontières-supported mental health services in humanitarian settings across 20 low-income and middle-income countries between July 2019 and July 2024. Mental health symptoms and precipitating events were compared between younger (20–49 years old) and older adults (50 years or older) adjusting for sex and displacement status using logistic regression analyses.Findings Data of 177 228 adults were included. Adults most frequently presented at mental health services with anxiety-related (44%; 70 496/158 665) and mood-related symptoms (26%; 41 732/158 665). Older adults had higher odds of reporting symptoms related to ageing (adjusted Odds Ratio (aOR)=4.44; 95% CI 3.84 to 5.14), physical complaints (aOR=2.74; 95% CI 2.65 to 2.83), social functioning (aOR=1.12; 95% CI 1.03 to 1.23) and neuro-psychiatry (aOR=1.09; 95% CI 1.02 to 1.17), and lower odds of reporting symptoms related to anxiety (aOR=0.68; 95% CI 0.66 to 0.70), mood (aOR=0.64; 95% CI 0.62 to 0.67) and behaviour (aOR=0.57; 95% CI 0.52 to 0.61), with variation by sex and displacement status. Compared with younger women, older women had higher odds of reporting violence, socioeconomic functioning and displacement, with variation by displacement status. Compared with younger men, older men had higher odds of reporting medical illness.Interpretation Significant differences in mental health symptoms were identified between younger and older adults, with variations by sex and displacement status. Older adults were more likely than younger adults to present symptoms related to ageing. Compared with their younger counterparts, older women were more likely to report experiences of violence, and older men were more likely to report medical illness. These findings underscore the need for age-sensitive and sex-sensitive mental health services in humanitarian settings, including staff training on age-related mental health presentations.
Medicine (General), Infectious and parasitic diseases
Abdulsamad Salihu, Ibrahim Jahun, David Olusegun Oyedeji
et al.
<h4>Background</h4>HIV infection remains one of the major diseases of public health importance globally with an estimated 40.4 million deaths and 39 million people living with the virus by 2022. About 40 countries are on track to achieve a 95% reduction in AIDS-related mortality by 2030. This progress is however challenged by sub-optimal progress among affected populations (AP), also known as key populations (AP). Society for Family Health (SFH), with about 3 decades of experiences in AP program present in this paper an account of key strategies and innovations in adapting its service provisioning efforts to rapidly changing socio-cultural and political barriers to service delivery among AP in northern Nigeria.<h4>Methods</h4>SFH is an indigenous nonprofit, non-political, non-governmental organization in Nigeria that has pioneered HIV interventions among AP across most parts of Nigeria. SFH has successfully tailored its interventions to the unique cultural and religious diversity of Nigeria. The predominantly Islamic-orientated population in the northern part of the country and the Christian-oriented population in the southern part, which is culturally inclined to Western orientations, have all been considered in SFH's comprehensive approach instilling confidence in the effectiveness of its strategies. SFH implemented 3 key strategies to circumvent pervasive socio-cultural and political barriers that hindered successful AP program implementation in northern Nigeria by addressing structural barriers, systems barriers (service-provider and client-related barriers) and by deployment of innovations to optimize program performance. For the purposes of this retrospective cross-sectional study, deidentified routine aggregate program data was utilized to conduct secondary data analysis.<h4>Results</h4>Between 2019 - 2023, SFH tested a total of 324,391 AP of whom 30,581 were found to be HIV positives yielding overall positivity rate of 9.4%. People who inject drugs (PWID) demonstrated sustained high positivity rate over the 5 years. About 80% of those initiated on treatment were female sex workers (FSW) and men who have sex with men (MSM) contributing to 41.8% and 38.5% respectively. Year on year, the number of AP receiving ART more than doubled in 2020 and grew by 85%, 43% and 30% in 2021, 2022 and 2023 respectively. There was progressive increase in VL testing coverage between Year 1 - Year 3 across all the three AP typologies and then steady decline between Year 4 - Year 5. Between Year 1 - Year 2 the viral load suppression was at 91% with remarkable improvement to 97% in Year 3 and Year 4 and at 99% in Year 5.<h4>Conclusion</h4>The implementation of people-centered, evidence-driven, culturally, and religiously sensitive program enabled SFH to reach a high number of AP in northern Nigeria. This helps improve equity in access to care by AP. There are specific program areas that need continuous improvement including strategies to reach MSM to avoid the evolution of new structural barriers; expansion of PWID programming to optimize all aspects of harm reduction; and sustained sensitization, education, and awareness creation among AP to improve uptake of PrEP and other prevention and care services.
Emmanuel BOMBA DI MASUANGI, P. Atuba, S. Mulumba
et al.
Introduction
Sexual violence is a major public health issue with immeasurable consequences for survivors. In the Democratic Republic of Congo (DRC), sexual violence is strongly linked to armed conflicts, particularly in the eastern regions, where several studies have been conducted. However, less is known about the situation in the western part of the country.
Purpose
This study aimed to describe the epidemiological features, management, and health outcomes of sexual violence cases at the N’djili General Reference Hospital (HGR N’djili).
Methods
This was a retrospective descriptive study involving 483 consecutive survivors of sexual violence received at HGR N’djili between January 1 and December 31, 2021. Data were analysed using SPSS version 21. Qualitative variables were expressed as percentages, and quantitative variables as means with standard deviations.
Results
The mean age of survivors was 15.1 ± 5.4 years. The prevalence was higher among women (99.2%) than men. Rape was the main type of sexual violence (84.7%). The perpetrators had a mean age of 24.3 ± 10.2 years; 96% were male, of whom 82.4% were known to the victims (39.9% boyfriends, 20.1% neighbours, and 6.8% family members). Unintended pregnancies were recorded in 7.9% of cases, and HIV testing was positive in seven victims (1.5% of 475 tests performed). Victims were mainly referred to the care centre by the Public Prosecutor’s Office (37.7%) and the Congolese National Police (32.9%).
Conclusion
Sexual violence remains a serious public health problem, given the associated health outcomes, including sexually transmitted infections, HIV infection, hepatitis B virus, and unintended pregnancies. The survivors were mainly women and minors.
Despite the impact of the Jesuit educational endeavor on the rise of science, the Ignatian Pedagogical Paradigm (IPP), the signature Jesuit pedagogy, is not frequently used to teach courses in science, technology, engineering and mathematics (STEM), and very little literature exists documenting any such attempts. In this paper, I describe a framework for how to apply the IPP to STEM courses using active-engagement strategies and assessment tools from disciplinary educational research (DBER). I provide three examples of how I have implemented the IPP in physics courses at various levels in the curriculum at a Jesuit University complete with assessment results that demonstrate student learning. I stress that beyond the technical, cyclical elements of the IPP, a truly Ignatian course needs to pay close attention to Jesuit charisms such as cura personalis, magis, and educating men and women with and for others.
Leveraging blockchain in Federated Learning (FL) emerges as a new paradigm for secure collaborative learning on Massive Edge Networks (MENs). As the scale of MENs increases, it becomes more difficult to implement and manage a blockchain among edge devices due to complex communication topologies, heterogeneous computation capabilities, and limited storage capacities. Moreover, the lack of a standard metric for blockchain security becomes a significant issue. To address these challenges, we propose a lightweight blockchain for verifiable and scalable FL, namely LiteChain, to provide efficient and secure services in MENs. Specifically, we develop a distributed clustering algorithm to reorganize MENs into a two-level structure to improve communication and computing efficiency under security requirements. Moreover, we introduce a Comprehensive Byzantine Fault Tolerance (CBFT) consensus mechanism and a secure update mechanism to ensure the security of model transactions through LiteChain. Our experiments based on Hyperledger Fabric demonstrate that LiteChain presents the lowest end-to-end latency and on-chain storage overheads across various network scales, outperforming the other two benchmarks. In addition, LiteChain exhibits a high level of robustness against replay and data poisoning attacks.
The Wasserstein distance is a metric for assessing distributional differences. The measure originates in optimal transport theory and can be interpreted as the minimal cost of transforming one distribution into another. In this paper, the Wasserstein distance is applied to life table age-at-death distributions. The main finding is that, under certain conditions, the Wasserstein distance between two age-at-death distributions equals the corresponding gap in life expectancy at birth ($e_0$). More specifically, the paper shows mathematically and empirically that this equivalence holds whenever the survivorship functions do not cross. For example, this applies when comparing mortality between women and men from 1990 to 2020 using data from the Human Mortality Database. In such cases, the gap in $e_0$ reflects not only a difference in mean ages at death but can also be interpreted directly as a measure of distributional difference.
Social biases can manifest in language agency. However, very limited research has investigated such biases in Large Language Model (LLM)-generated content. In addition, previous works often rely on string-matching techniques to identify agentic and communal words within texts, falling short of accurately classifying language agency. We introduce the Language Agency Bias Evaluation (LABE) benchmark, which comprehensively evaluates biases in LLMs by analyzing agency levels attributed to different demographic groups in model generations. LABE tests for gender, racial, and intersectional language agency biases in LLMs on 3 text generation tasks: biographies, professor reviews, and reference letters. Using LABE, we unveil language agency social biases in 3 recent LLMs: ChatGPT, Llama3, and Mistral. We observe that: (1) LLM generations tend to demonstrate greater gender bias than human-written texts; (2) Models demonstrate remarkably higher levels of intersectional bias than the other bias aspects. (3) Prompt-based mitigation is unstable and frequently leads to bias exacerbation. Based on our observations, we propose Mitigation via Selective Rewrite (MSR), a novel bias mitigation strategy that leverages an agency classifier to identify and selectively revise parts of generated texts that demonstrate communal traits. Empirical results prove MSR to be more effective and reliable than prompt-based mitigation method, showing a promising research direction.
Jocić Ivana, Daković Dragana, Kandolf-Sekulović Lidija
et al.
Introduction. Mucous membrane pemphigoid (MMP) is a rare autoimmune, chronic inflammatory disease that affects mucous membranes, most commonly the eyes and mouth, with or without skin involvement. It is a complex disease with several complications, including scarring, especially on conjunctival mucosa, that can lead to visual loss. Case report. We report four patients (two men and two women) with MMP. In all patients, the disease started between seventy and eighty years of age. The diagnosis was confirmed based on clinical appearance, histology, direct and indirect immunofluorescence studies, indirect split skin technique, and enzyme-linked immunosorbent assay (ELISA) test. The majority of lesions were on the gums and buccal mucosa; one patient had laryngeal involvement and a lesion on the umbilicus. No ocular involvement and no malignancy were detected. Direct immunofluorescence tests revealed continuous linear IgG deposition in the basal membrane zone in two patients, and they were treated with oral nicotinamide and tetracycline hydrochloride. In two patients, we detected IgG along with IgA linear deposition; they received treatment with methylprednisolone. Complete remission was achieved in all patients. Conclusion. Early diagnosis and an adequate therapeutic approach are necessary for the MMP treatment in long-term disease control and reduction of disease-related complications.