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  • Week 16 Recap: Goalkeeper Goal! Goalkeeper Goal! Goalkeeper Goal! | National Women’s Soccer League Official Site

    Week 16 Recap: Goalkeeper Goal! Goalkeeper Goal! Goalkeeper Goal! | National Women’s Soccer League Official Site

    Chaos reigned at Lumen Field on Monday night to close out the match week, as Seattle and Chicago dueled to a late-game draw. Jess Fishlock and Jordyn Huitema powered the Reign to a commanding advantage, with Emeri Adames adding a third immediately after halftime. Not to be counted out, however, Chicago stormed back, with goals from Ludmila and Camryn Biegalski narrowing the gap. But the moment everyone is talking about came in the final minutes of the game. Before a wild corner kick scramble, goalkeeper Alyssa Naeher ran across the field to join the fray, ultimately smashing home the loose ball. The result left Seattle fans frustrated but for fans of chaos and lore, it was a game to remember.


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  • Resident Evil Requiem release date, gameplay, trailers and setting details revealed at Gamescom 2025

    Resident Evil Requiem release date, gameplay, trailers and setting details revealed at Gamescom 2025

    Capcom has confirmed that Resident Evil Requiem, the next entry in the long-running survival horror series, will release on February 27 2026.

    The game was first revealed during Summer Game Fest 2025 and received a new gameplay trailer at Gamescom 2025.

    The Gamescom trailer introduced protagonist Grace Ashcroft, an FBI technical analyst investigating a string of deaths linked to a mysterious disease.

    Alongside her mother Alyssa, Grace attempts to escape their apartment during a blackout before encountering a robed figure. The sequence ends before Alyssa’s fate is revealed, though Capcom has confirmed her death occurs before the main story.

    Resident Evil Requiem returns to Raccoon City, 30 years after its destruction by missile strike. Trailers show remnants of the Raccoon City Police Department and a crater at the city’s centre, hinting at a return to iconic locations.

    Insider claims suggest Requiem may adopt an open-world structure, spanning both Raccoon City and a fictional island town in Southeast Asia, though this remains unconfirmed by Capcom.

    Grace Ashcroft is the only officially revealed character so far, with her connection to Alyssa Ashcroft, a survivor of the original outbreak, central to the story. Long-standing characters such as Leon Kennedy and Rose Winters have been linked to the project by industry leaker Dusk Golem, though neither appeared in trailers.

    Director Koshi Nakanishi stated during a Capcom Spotlight that Leon was considered as a protagonist but did not align with the game’s tone.

    Gameplay will combine survival horror with action elements. Players can freely switch between first-person and third-person views, with chase sequences reminiscent of previous instalments.

    Capcom confirmed that both horror-driven exploration and high-stakes combat will feature prominently.

    Resident Evil Requiem will be released on PlayStation 5, Xbox Series X|S, and PC via Steam, with no confirmation of a Switch 2 version.

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  • Association Between Residual Kidney Function and Frailty in End-Stage

    Association Between Residual Kidney Function and Frailty in End-Stage

    Introduction

    Currently, renal replacement therapy (RRT) extends life and alleviates symptoms in patients with end-stage renal disease (ESRD) by removing metabolic waste products and excess fluid from the blood. Despite advancements in dialysis technology and management strategies, hemodialysis patients continue to experience high rates of morbidity and mortality. ESRD patients often have an average life expectancy of only about 30% compared to the general population of the same age.1 This reduced life expectancy is influenced by multiple factors, often overlooked or inadequately addressed, including frailty2 and sarcopenia.3

    Frailty, a syndrome characterized by decreased physiological reserve and increased vulnerability to stressors,4 is increasingly prevalent in ESRD patients, with rates two to four times higher than in individuals with normal kidney function.5 In Thailand, frailty affects 22.1% of the general aged population, while in ESRD patients, the prevalence ranges from 14% to 73%, significantly impacting health by increasing mortality rates, hospitalization rates, confusion, falls, and the likelihood of becoming bedridden.6 Anemia, inflammation, reduced food intake, acid-base abnormalities, and hormone imbalances all contribute to frailty and protein-energy wasting in ESRD patients.7

    Sarcopenia, characterized by decreased muscle mass, muscle strength, and physical performance, leads to reduced physical ability, decreased quality of life, increased falls, morbidity, and mortality in older adults.8 The prevalence of sarcopenia in ESRD patients can be as high as 28.5%.9 Sarcopenia in these patients is associated with higher rates of physical disability and nearly doubles the mortality risk compared to those without sarcopenia. The key mechanism involves both increased muscle breakdown and decreased muscle synthesis, associated with heightened inflammation in ESRD patients.10

    Residual kidney function (RKF), defined as a urine output of at least 100 mL per day in patients undergoing RRT, plays a crucial role in maintaining adequate blood filtration, fluid balance, acid-base regulation, and erythropoietin production.11

    The relationship between RKF and frailty in hemodialysis patients remains poorly understood. To address this gap in knowledge, this study aims to investigate the association between RKF and frailty in hemodialysis patients. Recognizing the role of RKF in frailty could prompt healthcare providers to refer ESRD patients without RKF for frailty assessment. Early detection of frailty would enable tailored prevention and treatment strategies, such as optimizing dialysis, managing anemia, reviewing, and minimizing unnecessary medications, preventing falls, recommending appropriate exercise, and addressing nutritional deficiencies, depression, and cognitive impairment.

    The primary objective of this study was to investigate the association between residual kidney function (RKF) and frailty in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Secondary objectives included determining the prevalence of frailty and sarcopenia in this population, as well as exploring the association between frailty, sarcopenia, and RKF with baseline demographic and clinical characteristics.

    Materials and Methods

    Study Design

    This was a cross-sectional study conducted from October 2023 to February 2024 on ESRD patients attending the Division of Nephrology and Renal Replacement Therapy, at one urban teaching hospital in Bangkok, Thailand. Participants included adults aged over 18 years who had been undergoing regular hemodialysis for more than six months. Exclusion criteria comprised patients with neurological deficits, recent cerebrovascular accidents within the previous 6 months, severe cognitive impairment or dementia, secondary hypertension, cancer, overt cardiovascular disease, obstructive pulmonary disease, other severe illnesses, wheelchair dependency, a life expectancy of less than six months, or an inability to comply with medical treatment. The sample size was calculated using statistical methods, setting α at 0.05, a power of 80%, and incorporating risk differences in frailty occurrence between patients with and without residual kidney function (RKF). Based on these parameters, the required sample size was determined to be 89 participants, adjusted to 107 to account for a 20% loss to follow-up.

    This study was conducted following the approval of the Clinical Research Ethics Committee of the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand (Certificate of Approval No. 044/2566). The Institutional Review Board is in full compliance with international guidelines for human research protection, including the Declaration of Helsinki, The Belmont Report, CIOMS Guideline, and the International Conference on Harmonization in Good Clinical Practice (ICH-GCP).

    Data Collection

    Written informed consent was obtained from all participants after providing detailed information about the study objectives, procedures, and potential risks. Confidentiality and privacy of the participants’ data were ensured, adhering to the principles of the Declaration of Helsinki.

    Participants were recruited through the hospital’s electronic medical record system. Demographic data, including age, gender, and body mass index (BMI), and clinical information, such as underlying medical conditions, current medications, original kidney disease, dialysis duration, vascular access type, dialysis frequency, adequacy of dialysis, urea reduction ratio (URR), normalized protein catabolic rate (nPCR), history of intradialytic hypotension, oral nutrition supplementation (ONS), and dialysis ultrafiltration volumes, were extracted. Dialysis adequacy was assessed using Kt/V, calculated as the product of dialyzer urea clearance (K) and dialysis time (t), divided by the volume of distribution of urea (V).

    Laboratory and Residual Kidney Function Measurement

    Participants received instructions and containers for collecting a 24-hour urine sample prior to a dialysis day. The collected urine samples were brought to the hospital, where blood samples were also drawn. The following laboratory parameters were assessed:

    Pre-Dialysis Blood Parameters

    Hemoglobin, potassium, alkaline phosphatase (ALP), calcium, phosphorus, parathyroid hormone, albumin, vitamin D, blood urea nitrogen (BUN), iron, total iron-binding capacity (TIBC), and ferritin.

    Residual Kidney Function (RKF)

    Calculated using the residual renal urea clearance (KRU) formula:12


    Where:

    KRU: Residual renal urea clearance,

    UUN: Urine urea nitrogen concentration from the 24-hour urine sample.

    Urine Flow Rate: Calculated as:


    TAC of SUN: Time-averaged concentration of serum urea nitrogen, derived as:13


    Within two weeks of submitting the 24-hour urine sample, participants underwent assessments for frailty, nutritional status, and sarcopenia, conducted by physiotherapists at the Department of Rehabilitation Medicine, Faculty of Physical Therapy, Vajira Hospital.

    Frailty Assessment

    Frailty was assessed using the Thai version of the FRAIL Scale,14 a validated translation of the Simple Frailty Questionnaire15 for use in Thailand. This tool comprises five domains: Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight. Each domain is evaluated through self-reported responses, scored as either 0 or 1 point based on the presence of specific criteria. The total score ranges from 0 to 5, with higher scores reflecting a greater degree of frailty. A cutoff score of 3 or higher indicates frailty.

    Sarcopenia Assessment

    Sarcopenia was diagnosed following the Asian Working Group on Sarcopenia (AWGS) 2019 recommendations. Diagnosing sarcopenia involves three main components: reduced muscle mass, decreased muscle strength, and impaired physical performance. Additionally, this condition can be categorized into three levels: pre-sarcopenia, sarcopenia, and severe sarcopenia, as shown in Table 1. Muscle strength was evaluated with the Handgrip Strength Test using a digital dynamometer, with normal values defined as <28 kg for males and <18 kg for females. Physical performance was measured using the Five Time Chair Stand Test, with an abnormal score ≥12 seconds. Muscle mass was determined using the Fresenius Bioelectrical Impedance Analysis (BIA) device, and the appendicular skeletal muscle mass index (ASMI) was calculated as follows.16 Low muscle mass was defined as <7 kg/m² for males and <5.7 kg/m² for females.

    Table 1 The Diagnostic Criteria for Sarcopenia According to the Recommendations of the European Working Group on Sarcopenia in Older People (EWGSOP) in 201017 and the Asian Working Group of Sarcopenia (AWGS) in 20198


    Where: ASM: Appendicular skeletal muscle mass, calculated as:


    Nutritional Status Assessment

    Nutritional status was assessed using the Thai version of the Malnutrition Inflammation Score (MIS), based on the Clinical Practice Recommendation for Nutritional Management in Adult Kidney Patients 2018 by the Society of Parenteral and Enteral Nutrition of Thailand and the Nephrology Society of Thailand.18 MIS scores were categorized as follows: 1–2: Well-nourished, 3–5: Mild to moderate malnutrition, and ≥6: Severe malnutrition.

    Statistical Analysis

    The general data analysis of the sample group involved analyzing and presenting the data in two parts based on the data types. These included qualitative data presented in reports through frequency distribution and percentages, categorized by the RKF into two groups: one with RKF and the other without. The comparison of the groups was performed using either the Chi-squared test or Fisher’s exact test, depending on the appropriateness of the data.

    For quantitative data presented in reports, the mean, standard deviation, median, and interquartile range were used. The data were classified by the RKF into two groups: one with RKF and the other without. The comparison between groups was done using either the Student’s t-test or Mann–Whitney U-test, depending on the appropriateness of the data.

    The prevalence of frailty and sarcopenia conditions was reported through frequency distribution and percentages, along with a 95% confidence interval. The comparison of the differences between the group with RKF and the group without was conducted using either the Chi-squared test or Fisher’s exact test, depending on the appropriateness of the data.

    The relationship between RKF and factors associated with frailty and sarcopenia in ESRD patients undergoing hemodialysis was analyzed using a multivariable logistic regression approach. Odds Ratios (OR) and 95% confidence intervals (95% CI) were reported to evaluate the strength and direction of associations between variables. Variables with a p-value < 0.2 from the univariable logistic regression analysis were considered for inclusion in the multivariable model. The final model was developed using a stepwise selection method, with criteria for variable entry set at p < 0.10 and removal at p < 0.05.

    All data analyses were performed using the computer program SPSS version 24.0, with the statistical significance level set at 0.05.

    Results

    Baseline Characteristics

    A total of 138 patients were initially enrolled in the study after meeting the inclusion criteria. However, 28 patients were unable to provide a 24-hour urine sample prior to a dialysis day and were lost to follow-up for assessments of frailty, nutritional status, and sarcopenia, which were conducted by physiotherapists. Consequently, the final study population consisted of 110 patients. Among them, 78 patients (70.91%) were classified as having no RKF, while 32 patients (29.09%) had RKF (Figure 1).

    Figure 1 Flowchart of patient enrollment and classification based on the presence of RKF.

    Baseline demographic analysis revealed that patients without RKF were younger, with a mean age of 58.58 ± 11.76 years, compared to 64.65 ± 11.28 years in those with RKF (P = 0.014). Additionally, the dialysis duration was significantly longer in the group without RKF (56 months vs 30 months; P = 0.002). While there were no significant differences between the two groups in terms of gender, comorbidities, causes of chronic kidney disease, or laboratory parameters, beta-blocker use was markedly more prevalent among patients without RKF compared to those with RKF (75.95% vs 37.50%; P = 0.001) (Table 2).

    Table 2 Demographic, Clinical and Laboratory Data According to Residual Renal Function (RKF), Frailty, and Sarcopenia

    In the frailty analysis, frail participants were predominantly female. The Charlson Comorbidity Index was significantly higher in the frail group compared to the non-frail group [median in frail group=6 (IQR 3,7) vs median in non-frail group =5 (IQR 3,6); P = 0.041]. Additionally, the frail group had a lower mean ultrafiltration (UF) rate (2.3 L vs 2.77 L; P = 0.032), lower hemoglobin levels (9.95 g/dL vs 10.93 g/dL; P = 0.027), and lower blood urea nitrogen (BUN) levels (36.93 mg/dL vs 47.29 mg/dL; P = 0.036) (Table 2).

    In the sarcopenia analysis, participants with sarcopenia were older, with a mean age of 62 years compared to 57 years in those without sarcopenia (P = 0.028). The sarcopenia group also had a significantly lower BMI (21.49 kg/m² vs 27.09 kg/m²; P = 0.001). The prevalence of diabetes mellitus (DM) and dyslipidemia (DLP) was lower among participants with sarcopenia compared to those without (DM: 41.67% vs 63.16%, P = 0.032; DLP: 33.33% vs 60.53%, P = 0.006). Measures of dialysis adequacy, including Kt/V and the urea reduction ratio (URR), were higher in the sarcopenia group (Kt/V: 1.84 vs 1.54, P = 0.002; URR: 77.23 vs 73.37, P = 0.001). In contrast, the ultrafiltration (UF) rate was significantly lower in the sarcopenia group (2.59 L vs 2.93 L; P = 0.029). The use of calcium channel blockers (CCBs) was less frequent in the sarcopenia group (59.72% vs 84.21%; P = 0.010). Laboratory analysis revealed that hemoglobin levels were significantly higher in the sarcopenia group (11.03 g/dL vs 10.35 g/dL; P = 0.029), while blood urea nitrogen (BUN) levels were lower (43.25 mg/dL vs 50.86 mg/dL; P = 0.032) (Table 2).

    Primary Outcomes

    The comparison of Frailty according to RKF status between the two groups is summarized in Table 3. Frailty rates did not differ significantly between groups with and without RKF (21.88% vs 10.26%; P > 0.05). Multivariate logistic regression found no association between RKF and frailty (Table 4).

    Table 3 Frailty According to Residual Renal Function (RKF) Status

    Table 4 Univariate and Multivariate Analysis of Factors Associated with Frailty

    Secondary Outcomes

    Frailty classifications included robust (37 patients, 33.64%), pre-frailty (58 patients, 52.73%), and frailty (15 patients, 13.64%) (Figure 2).

    Figure 2 Rate of frailty.

    Sarcopenia was classified into three categories: no sarcopenia (38 patients, 34.55%), sarcopenia (35 patients, 31.82%), and severe sarcopenia (37 patients, 33.64%). The overall prevalence of sarcopenia, including both sarcopenia and severe sarcopenia, was 72 patients (65.45%) (Figure 3).

    Figure 3 Rate of sarcopenia.

    Factors associated with frailty included a history of cerebrovascular accident (CVA) (adjusted OR 10.303, 95% CI 1.168–90.887; P=0.036) and TIBC levels (adjusted OR 0.972, 95% CI 0.946–0.999; P=0.047) (Table 4). Factors associated with the absence of RKF included age (adjusted OR 0.93, 95% CI 0.888–0.974; P=0.002), longer dialysis duration (adjusted OR 1.020, 95% CI 1.004–1.036; P=0.009), and higher Malnutrition Inflammation Score (MIS) (adjusted OR 1.203, 95% CI 1.007–1.437; P=0.041) (Table 5). Sarcopenia was associated with age (adjusted OR 1.054, 95% CI 1.008–1.102; P=0.02) and Kt/V values (adjusted OR 0.417, 95% CI 0.238–0.728; P=0.002) (Table 6).

    Table 5 Univariate and Multivariate Analysis of Factors Associated with Absence Residual Renal Function

    Table 6 Univariate and Multivariate Analysis of Factors Associated with Sarcopenia

    Discussion

    Previous studies have demonstrated an association between kidney function and frailty in patients with chronic kidney disease (CKD). Lower estimated glomerular filtration rate (eGFR) levels have been linked to a higher prevalence of frailty, while an increase of 5 eGFR units has been inversely associated with frailty.19 As CKD progresses to end-stage renal disease (ESRD) requiring hemodialysis, most patients retain some residual kidney function (RKF), which is essential for maintaining fluid and metabolic balance and positively contributing to overall health.

    Frailty and sarcopenia prevalence were examined in this study. The prevalence of frailty was 13.64% (15 patients), consistent with global data showing frailty rates among ESRD patients on dialysis range from 14% to 73%.6 Conversely, sarcopenia was observed in 31.82% (35 patients), higher than the reported prevalence of 28.5% in ESRD patients.9

    Our study provides insights into the relationship between RKF and frailty in ESRD patients undergoing hemodialysis. However, we did not find a significant correlation between RKF and frailty in this population. This contrasts with CKD patients, where kidney function appears to play a central role in the development of frailty. One possible explanation is the multifactorial nature of frailty in ESRD, which involves factors beyond kidney function alone. For instance, a history of cerebrovascular accident (CVA) emerged as a significant predictor of frailty, increasing the risk by up to 10-fold. This aligns with existing data linking CVA and frailty, often referred to as “cognitive frailty.” Features of cognitive frailty, such as leukoaraiosis, atrophy, and old vascular lesions or infarcts, are associated with poorer functional and cognitive outcomes post-stroke.20 These findings underscore the need for further research to elucidate the mechanisms linking CVA and frailty in ESRD patients.

    Our study also identified an intriguing association between frailty and lower total iron-binding capacity (TIBC). Frail patients in this study had a median TIBC of 186 μg/dL, which is significantly lower than the normal range of 250–450 μg/dL. This finding is consistent with previous research showing that low TIBC levels are linked to slower walking speeds, a key component of frailty syndrome.21 The role of TIBC in frailty development may be related to its influence on nutritional status and iron metabolism. These results underscore potential intervention points, such as optimizing nutritional and hematologic parameters, to reduce frailty risk in patients with end-stage renal disease (ESRD).

    Factors contributing to RKF loss include younger age, longer dialysis duration, and higher Malnutrition Inflammation Score (MIS). Younger patients often experience acute, severe kidney failure necessitating dialysis initiation, which may lead to RKF loss over time. Prolonged dialysis is associated with a decline in RKF, with an estimated decrease of 0.18–0.33 mL/min/month during the first year, followed by a gradual decline.22 Additionally, higher MIS scores, indicative of malnutrition, are linked to the accumulation of waste products and metabolic abnormalities, further contributing to RKF loss.23 Risk factors for sarcopenia include advanced age and low Kt/V, a measure of dialysis adequacy in hemodialysis patients. Insufficient Kt/V values are associated with the development of uremic sarcopenia, a specific type of sarcopenia caused by inadequate dialysis. Inadequate dialysis leads to metabolic acidosis, insulin resistance, systemic inflammation, and increased expression of angiotensin II and myostatin.24 These factors activate the ATP-dependent ubiquitin-proteasome system, the primary pathway for skeletal muscle protein degradation. Additionally, the retention of indoxyl sulfate, a uremic toxin, exacerbates mitochondrial dysfunction and promotes the overexpression of muscle atrophy-related genes, including atrogin-1 and myostatin, further driving muscle loss in uremic sarcopenia.25

    This study has several strengths worth acknowledging, although these should be interpreted within the study’s context and limitations. To our knowledge, it is among the first studies to explore the relationship between RKF and frailty in ESRD patients undergoing hemodialysis, with an adequate sample size to allow for meaningful analysis. Additionally, 24-hour urine samples were collected prior to dialysis sessions to minimize reliance on self-reported urine volumes, and frailty screening was conducted within two weeks of urine collection, alongside laboratory testing, to reduce confounding from acute illness. The study also assessed malnutrition using the MIS and sarcopenia using hand grip tests, the five-time chair stand test, and bioelectrical impedance analysis (BIA), with trained physical therapists ensuring consistency in evaluations.

    Nevertheless, this study has its limitations. The cross-sectional design restricts our ability to establish causality or determine temporal relationships between RKF and frailty. Prospective longitudinal studies are needed to better understand these associations. Additionally, the lack of a standardized frailty assessment tool for ESRD patients introduces variability, as different tools might yield different results. Potential unmeasured confounders, such as socioeconomic status, dietary habits, and physical activity, could also influence the outcomes. Lastly, self-reporting bias or misclassification in variables like the Thai version of the FRAIL Scale and MIS score may have affected the findings.

    Conclusion

    While there was no significant association between RKF and frailty in hemodialysis patients, our study did reveal that a history of CVA and low TIBC levels were significant contributing factors for frailty. These findings underscore the importance of comprehensive frailty screening and interventions targeting nutritional and hematologic parameters. Future longitudinal studies are needed to explore causal relationships and inform strategies for improving patient outcomes.

    Acknowledgments

    This study was supported by the Navamindradhiraj University Research Fund, Navamindradhiraj University (Contract No. 032/2566).

    The authors would like to thank the Division of Nephrology and Renal Replacement Therapy and the Division of Geriatrics, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, for their support and collaboration throughout the study.

    The authors also appreciate Associate Professor Varalak Srinonprasert (Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University) for granting permission to use the Thai version of the FRAIL scale.

    Disclosure

    The authors reported no conflicts of interest in this work.

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    2. Srinonprasert V, Chalermsri C, Aekplakorn W. Frailty index to predict all-cause mortality in Thai community-dwelling older population: a result from a National Health Examination Survey cohort. Arch Gerontol Geriatrics. 2018;77:124–128. doi:10.1016/j.archger.2018.05.002

    3. de Luca Corrêa H, Gadelha AB, Vainshelboim B, et al. Could sarcopenia-related mortality in end-stage renal disease be underpinned by the number of hospitalizations and cardiovascular diseases? Int Urol Nephrol. 2023;55(1):157–163. doi:10.1007/s11255-022-03291-5

    4. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–1375. doi:10.1016/S0140-6736(19)31786-6

    5. Chowdhury R, Peel NM, Krosch M, Hubbard RE. Frailty and chronic kidney disease: a systematic review. Arch Gerontol Geriatrics. 2017;68:135–142. doi:10.1016/j.archger.2016.10.007

    6. Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing Res Rev. 2013;12(2):719–736. doi:10.1016/j.arr.2012.03.001

    7. Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol. 2013;24(3):337–351. doi:10.1681/ASN.2012010047

    8. Chen L-K, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Directors Assoc. 2020;21(3):300–7.e2. doi:10.1016/j.jamda.2019.12.012

    9. Shu X, Lin T, Wang H, et al. Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta‐analysis. J Cachexia Sarcopenia Muscle. 2022;13(1):145–158. doi:10.1002/jcsm.12890

    10. Auyeung T, Arai H, Chen L, Woo J. Normative data of handgrip strength in 26344 older adults-a pooled dataset from eight cohorts in Asia. J Nutr Health Aging. 2020;24:125–126. doi:10.1007/s12603-019-1287-6

    11. Obi Y, Rhee CM, Mathew AT, et al. Residual kidney function decline and mortality in incident hemodialysis patients. J Am Soc Nephrol. 2016;27(12):3758. doi:10.1681/ASN.2015101142

    12. Chin AI, Depner TA, Daugirdas JT, editors. Assessing the adequacy of small solute clearance for various dialysis modalities, with inclusion of residual native kidney function. In: Seminars in Dialysis. Wiley Online Library; 2017.

    13. Daugirdas JT, editor. Estimating time-averaged serum urea nitrogen concentration during various urine collection periods: a prediction equation for thrice weekly and biweekly dialysis schedules. In: Seminars in Dialysis. Wiley Online Library; 2016.

    14. T. Sriwong W, Mahavisessin W, Srinonprasert V, et al. Validity and reliability of the Thai version of the simple frailty questionnaire (T-FRAIL) with modifications to improve its diagnostic properties in the preoperative setting. BMC Geriatr. 2022;22(1):161. doi:10.1186/s12877-022-02863-5

    15. Sukkriang N, Punsawad C. Comparison of geriatric assessment tools for frailty among community elderly. Heliyon. 2020;6(9):e04797. doi:10.1016/j.heliyon.2020.e04797

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    17. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in older people. Age Ageing. 2010;39(4):412–423. doi:10.1093/ageing/afq034

    18. Jiwakanon S, Warodomwichit D, Supasyndh O, Chattranukulchai P, Pisprasert V, Nongnuch A. Clinical practice recommendations for nutritional management in adult kidney patients 2018. Thai J Parent Enteral Nutr. 2020;28(2):18–67.

    19. Yang C, Xiao C, Zeng J, et al. Prevalence and associated factors of frailty in patients with chronic kidney disease: a cross-sectional analysis of PEAKING study. Int Urol Nephrol. 2024;56(2):751–758. doi:10.1007/s11255-023-03720-z

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    25. Lin Y-L, Hsu B-G. Assessment of uremic sarcopenia in dialysis patients: an update. Tzu-Chi Medl J. 2022;34(2):182.

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  • Thousands of Airbus workers in UK to go on strike in dispute over pay | Airbus

    Thousands of Airbus workers in UK to go on strike in dispute over pay | Airbus

    Thousands of Airbus workers in the UK are set to go on strike for 10 days in September in a row over pay which threatens to disrupt the production of aircraft wings.

    A series of two-day strikes are planned to begin on 2 September and continue throughout the month at Airbus’s factories at Broughton, north Wales, and Filton, near Bristol, according to Unite.

    The union represents more than 3,000 of the company’s aircraft fitters and engineers, with 8,500 workers employed across the two sites.

    Unite said 90% of its Airbus members had voted in favour of the industrial actionand that the strikes would go ahead unless the European planemaker improves its pay offer.

    The factories could be forced to halt production temporarily during the strike. Wings for Airbus’s A320, A330 and A350 planes are produced at Broughton and Filton, and any slowdown in production could put pressure on the company’s supply chain.

    Unite said the strikes would disrupt production of wings for Airbus’s core commercial and military aircraft and would delay deliveries.

    Airbus said, however, that it was not concerned about the impact of the industrial action on its year-end deliveries.

    Sue Partridge, Airbus UK’s country manager for commercial aircraft, said: “We have made a competitive and fair pay offer in 2025 that builds on the strong foundations of pay increases totalling over 20% in the last three years and a £2,644 bonus payment made in April this year.

    “Our priority remains to find a resolution together with the trade union that ensures the long-term competitiveness and success of Airbus in the UK.”

    Unite called on Airbus to return to talks as it seeks a pay offer that accounts for inflation and cost of living increases. UK inflation rose again in July to a higher-than-expected 3.8%, according to official figures released earlier on Wednesday, amid price increases for food and travel.

    The union added that the offer should reflect “the value of members’ highly specialised skills”, allowing Airbus to deliver aircraft on schedule.

    Sharon Graham, Unite’s general secretary, said: “Airbus is generating billions in profit; workers deserve a fair deal. Our members are simply seeking fairness not favours. Airbus workers have the total support of their union in this dispute.”

    The world’s largest planemaker describes Broughton as a “global centre of excellent for wing manufacturing”, and wing structures for Airbus aircraft have been produced at the site for more than 50 years.

    Filton is home to the largest concentration of aerospace engineers in northern Europe, according to the company, and leads in wing design and support.

    The planemaker is looking to increase production this year, in response to demand from airlines.

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  • Major Belgian telecom firm says cyberattack compromised data on 850,000 accounts

    Major Belgian telecom firm says cyberattack compromised data on 850,000 accounts

    Orange Belgium announced on Wednesday that it had discovered a cyberattack at the end of July that compromised data from 850,000 customer accounts.

    The Belgian subsidiary stated “no critical data was compromised: no passwords, email addresses, banking or financial details were hacked,” however it warned: “The hacker has gained access to one of our IT systems that contains the following data: name, first name, telephone number, SIM card number, PUK code, tariff plan.”

    PUK (Personal Unblocking Key) codes are 8-digit security codes that allow customers to unblock their SIM cards if they enter the wrong PIN multiple times, the company advised.

    The company did not immediately respond to questions about the timing of the incident’s discovery and disclosure, but in its statement it said its teams “blocked access to the affected system and strengthened our security measures” as soon as it was identified. “Orange Belgium also alerted the relevant authorities and filed an official complaint with the judicial authorities,” it added.

    The attack follows its parent company Orange Group detecting a cyberattack affecting one of its internal systems on July 25. At the time, Orange Group said there was no evidence any customer data had been extracted. Orange did not say whether these incidents were related and has not updated its earlier statement. The nature of either of the attacks has not been disclosed.

    The Belgian subsidiary’s affected customers are being notified by email and text message, the official statement added, and are being urged to be alert for phishing attempts on a dedicated web page.

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  • Wasim Akram reveals his era’s top five cricketers

    Wasim Akram reveals his era’s top five cricketers

    (left to right) Javed Miandad, Wasim Akram and Waqar Younis relax during the Pakistan v South Africa ODI at the Manuka Oval in Canberra on February 15, 1992. — AFP

    Former Pakistan captain and legendary pacer Wasim Akram has revealed his top five cricketers from his illustrious playing days, naming Sir Vivian Richards as the toughest batter he bowled to.

    Speaking on the Stick to Cricket podcast alongside England greats Michael Vaughan, Sir Alastair Cook, David Lloyd, and Phil Tufnell, Akram reflected on the highlights of his 17-year career.

    When asked to name the best batter, the 59-year-old picked West Indies legend Sir Vivian Richards.

    “People often ask me who the best batsman I bowled to was. For me, it has to be Sir Vivian Richards. It’s not just about his batting — it was the whole package, the charisma he carried with him,” Akram said.

    He added that he also faced many other greats, including Allan Border, Graham Gooch, Sachin Tendulkar, and Brian Lara.

    “Sir Viv was at the end of his career in 1987-88, but what a character he was — everyone’s hero,” Akram added.

    The legendary left-arm pacer went on to name the five best cricketers he played against during his career.

    “My top has to be Imran Khan, because of what he did for Pakistan. Then Viv Richards, Martin Crowe, Brian Lara, and Sachin Tendulkar,” he revealed.

    Akram also recalled some of the toughest contests he faced, singling out Australian wicketkeeper-batter Adam Gilchrist in ODIs.

    “I very rarely played against the great Ricky Ponting, but in ODIs, Adam Gilchrist was one who really troubled me,” he admitted.

    When asked about the best countries to play cricket in, Akram chose England and Australia.

    “It’s hard to pick just one. England is special because of its rich history, excellent facilities, knowledge of the game, and easy travel. And then, of course, Australia,” he said.

    “I remember touring there in 1989 after my first year with Lancashire, and Imran [Khan] told me, ‘If you perform against Australia in their own conditions, you’ll be recognised straight away.’ And that’s exactly what happened,” Akram concluded.


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  • NICE draft guidance ‘biggest shake-up’ to type 2 diabetes treatment in a decade – The Pharmaceutical Journal

    1. NICE draft guidance ‘biggest shake-up’ to type 2 diabetes treatment in a decade  The Pharmaceutical Journal
    2. We welcome new NICE plans to widen access to newer type 2 diabetes medications  Diabetes UK
    3. Millions more NHS patients could be offered weight-loss jabs  The Telegraph
    4. SGLT-2 inhibitors to become first-choice treatments for type 2 diabetes  The Diabetes Times
    5. Biggest shake-up in type 2 diabetes care in a decade announced  NICE website

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  • 10 things to watch in the stock market Wednesday including TJX’s surge and new Target CEO

    10 things to watch in the stock market Wednesday including TJX’s surge and new Target CEO

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  • Steve Platnick Steps Down from NASA After 34 Years of Service

    Steve Platnick Steps Down from NASA After 34 Years of Service

    Dr. Steven “Steve” Platnick took the NASA agency Deferred Resignation Program (DRP). His last work day was August 8, 2025. Steve spent more than three decades at, or associated with, NASA. While he began his civil servant career at the NASA’s Goddard Space Flight Center (GSFC) in 2002, his Goddard association went back to 1993, first as a contractor and then as one of the earliest employees of the Joint Center for Earth Systems Technology (JCET), a cooperative agreement between the University of Maryland, Baltimore County (UMBC) and GSFC’s Earth Science Division. At JCET Steve helped lead the development of the Atmosphere Physics Track curricula. Previously, he had held an NRC post-doctoral fellow at the NASA’s Ames Research Center. Along with his research work on cloud remote sensing from satellite and airborne sensors, Steve served as the Deputy Director for Atmospheres in GSFC’s Earth Sciences Division from January 2015–July 2024.

    During his time at NASA, Steve played an integral role in the sustainability and advancement of NASA’s Earth Observing System platforms and data. In 2008, he took over as the Earth Observing System (EOS) Senior Project Scientist from Michael King. In this role, he led the EOS Project Science Office, which included support for related EOS facility airborne sensors, ground networks, and calibration labs. The office also supported The Earth Observer newsletter, the NASA Earth Observatory, and other outreach and exhibit activities on behalf of NASA Headquarter’s Earth Science Division and Science Mission Directorate (further details below). From January 2003 – February 2010, Steve served as the Aqua Deputy Project Scientist.

    Improving Imager Cloud Algorithms

    Steve was actively involved in the Moderate Resolution Imaging Spectroradiometer (MODIS) Science Team serving as the Lead for the MODIS Atmosphere Discipline Team (cloud, aerosol and clear sky products) since 2008 and as the NASA Suomi National Polar-orbiting Partnership (Suomi NPP)/JPSS Atmosphere Discipline Lead/co-Lead from 2012–2020. His research team enhanced, maintained, and evaluated MODIS and Visible Infrared Imaging Radiometer Suite (VIIRS) cloud algorithms that included Level-2 (L2) Cloud Optical/Microphysical Properties components (MOD06 and MYD06 for MODIS on Terra and Aqua, respectively) and the Atmosphere Discipline Team Level-3 (L3) spatial/temporal products (MOD08, MYD08). The L2 cloud algorithms were developed to retrieve thermodynamic phase, optical thickness, effective particle radius, and derived water path for liquid and ice clouds, among other associated datasets. Working closely with longtime University of Wisconsin-Madison colleagues, the team also developed the CLDPROP continuity products designed to bridge the MODIS and VIIRS cloud data records by addressing differences in the spectral coverage between the two sensors; this product is currently in production for VIIRS on Suomi NPP and NOAA-20, as well as MODIS Aqua. The team also ported their CLDPROP code to Geostationary Operational Environmental Satellites (GOES) R-series Advanced Baseline Imager (ABI) and sister sensors as a research demonstration effort.

    Steve’s working group participation included the Global Energy and Water Exchanges (GEWEX) Cloud Assessment Working Group (2008–present); the International Cloud Working Group (ICWG), which is part of the Coordination Group for Meteorological Satellites (CGMS), and its original incarnation, the Cloud Retrieval Evaluation Working (CREW) since 2009; and the NASA Observations for Modeling Intercomparison Studies (obs4MIPs) Working Group (2011–2013). Other notable roles included Deputy Chair of the Plankton, Aerosol, Cloud, ocean Ecosystem (PACE) Science Definition Team (2011–2012) and membership in the Advanced Composition Explorer (ACE) Science Definition Team (2009–2011), the ABI Cloud Team (2005–2009), and the Climate Absolute Radiance and Refractivity Observatory (CLARREO) Mission Concept Team (2010-2011).

    Steve has participated in numerous major airborne field campaigns over his career. His key ER-2 flight scientist and/or science team management roles included the Monterey Area Ship Track experiment (MAST,1994), First (International Satellite Cloud Climatology Project (ISCCP) Regional Experiment – Arctic Cloud Experiment [FIRE-ACE, 1998], Southern Africa Fire-Atmosphere Research Initiative (SAFARI-2000), Cirrus Regional Study of Tropical Anvils and Cirrus Layers – Florida Area Cirrus Experiment (CRYSTAL-FACE, 2002), and Tropical Composition, Cloud and Climate Coupling (TC4, 2007).

    Supporting Earth Science Communications

    Through his EOS Project Science Office role, Steve has been supportive of the activities of NASA’s Science Support Office (SSO) and personally participated in many NASA Science exhibits at both national and international scientific conferences, including serving as a Hyperwall presenter numerous times.

    For The Earth Observer newsletter publication team in particular, Steve replaced Michael King as Acting EOS Senior Project Scientist in June 2008, taking over the authorship of “The Editor’s Corner” beginning with the May–June 2008 issue [Volume 20, Issue 3]. The Acting label was removed beginning with the January–February 2010 issue [Volume 22, Issue 1]. Steve has been a champion of continuing to retain a historical record of NASA science team meetings to maintain a chronology of advances made by different groups within the NASA Earth Science community. He was supportive of the Executive Editor’s efforts to create a series called “Perspectives on EOS,” which ran from 2008–2011 and told the stories of the early years of the EOS Program from the point of view of those who lived them. He also supported the development of articles to commemorate the 25th and 30th anniversary of The Earth Observer. Later, Steve helped guide the transition of the newsletter from a print publication – the November–December 2022 issue was the last printed issue – to fully online by July 2024, a few months after the publication’s 35th anniversary. The Earth Observer team will miss Steve’s keen insight, historical perspective, and encouragement that he has shown through his leadership for the past 85 issues of print and online publications.

    A Career Recognized through Awards and Honors

    Throughout his career, Steve has amassed numerous honors, including the Goddard William Nordberg Memorial Award for Earth Science in 2023 and the Verner E. Suomi Award from the American Meteorological Society (AMS) in 2016. He was named an AMS Fellow that same year. He received two NASA Agency Honor Awards – the Exceptional Achievement Medal in 2008 and the Exceptional Service Medal in 2015.

    Steve received his bachelor’s degree and master’s degree in electrical engineering from Duke University and the University of California, Berkeley, respectively. He earned a Ph.D. in atmospheric sciences from the University of Arizona.

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  • Factors associated with cervical cancer screening uptake among women a

    Factors associated with cervical cancer screening uptake among women a

    Jimmy Ekinu,1 Emmanuel Tiyo Ayikobua,2 Elizabeth Icodu,1 Hellen Akurut,1 Olympia Olivia Akot,1 Steven Oder,1 John Micheal Opinya,1 Tonny Egau,1 David Aderu,3 Moses Eremu,4 James Daniel Odongo,5 Walter Dreak Erabu,5 Ronald Opito1

    1Department of Public Health, School of Health Sciences, Soroti University, Soroti, Uganda; 2Department of Physiology, School of Health Sciences, Soroti University, Soroti, Uganda; 3Department of Anatomy, School of Health Sciences, Soroti University, Soroti, Uganda; 4Department of Health, Serere District Local Government, Soroti, Uganda; 5Department of Health, Kaberamaido District Local Government, Soroti, Uganda

    Background: Sub-Saharan Africa (SSA) faces persistently low cervical cancer screening uptake, averaging only 13% over the past five years, with Uganda reporting less than 5%. This study aimed to assess the factors influencing cervical cancer screening uptake in a rural district hospital to inform targeted interventions that enhance screening coverage for the rural community.
    Methods: This was a cross-sectional study conducted at Kaberamaido General Hospital (KGH) outpatient department. A total of 422 participants aged between 25 and 49 years were interviewed and data analyzed using STATA version 16.0. Bivariate and multivariate analyses were performed using modified Poisson regression with robust error estimates to identify key factors associated with cervical cancer screening uptake. Variables with P-value < 0.05 were considered statistically significant.
    Results: The average age of participants was 32 (SD ± 7) years. 77.5% (n=327) of participants were married, had primary level of education, 69.2% (n=292), and were unemployed, 89.3% (n=377). Awareness about screening was high as 85.5% (n=360) of respondents had heard about cervical cancer screening. Cervical cancer screening uptake was low, as only 20.4% (n=86) had been screened in the past five years. Factors significantly associated with increased screening uptake, including age older than 35 years, adjusted Prevalence Ratio [aPR]= 1.7 (95% CI: 1.08– 2.69), availability of free government screening services, aPR = 1.6 (95% CI: 1.09– 2.38), provision of screening service at the nearest health facility, aPR = 2.1 (95% CI: 1.09– 3.97), and a positive family history of cervical cancer, aPR = 1.7 (95% CI: 1.14– 2.65).
    Conclusion: Our study confirms that cervical cancer screening uptake in Kaberamaido District remains low, highlighting the need for enhanced awareness campaigns and improved access to screening services. Our findings emphasize the need for policies that strengthen community outreach programs and expand cervical cancer screening services at primary healthcare facilities.

    Keywords: uterine cervical neoplasms, cervical cancer screening, women, cervical cancer awareness

    Introduction

    Cervical cancer remains one of the most significant yet preventable public health challenges among women of reproductive age globally.1,2 It is estimated that over 570,000 new cases are reported annually, accounting for approximately 7.9% of all cancer cases in women worldwide.3,4 The burden of cervical cancer is disproportionately higher in low- and middle-income countries (LMICs), with sub-Saharan Africa (SSA) bearing 84% of the global incidence.5

    Persistent infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer, making it a preventable disease if effective screening and vaccination programs are implemented.3,6 However, in SSA, where health systems are fragile, access to screening and early detection services remains limited, with an average screening rate of only 13% for the eligible women,7 exacerbating disease progression to advanced, often untreatable stages.8

    Cervical cancer remains among the leading cause of cancer-related deaths among women in over 36 LMICs countries.7 In 2022 alone, there were 661,021 new cases and 348,198 deaths resulting from cervical cancer, making it the 4th leading cause of morbidity and mortality among female cancers globally.9 Currently, cervical cancer is the second leading cause of morbidity and mortality in SSA, with an incidence of 35 new cases per 100,000 women, and a mortality rate of 23 per 100,000 women.9,10 East Africa experiences the highest burden, with Uganda reporting an incidence of 54.8 per 100,000 women and a mortality rate of 40.5 per 100,000 women—far exceeding the global average of 6.8 per 100,00, translating to approximately 6959 women diagnosed with cervical cancer each year and 4607 deaths.11 These statistics highlight a critical gap in preventive healthcare services, particularly in rural and underserved populations.

    Despite advancements in cervical cancer screening technologies—such as visual inspection with acetic acid (VIA), cytology (Pap smears), and HPV DNA testing—uptake remains suboptimal in SSA.12–14 Most of cases of cervical cancer disease in the region are diagnosed at an advanced stage when treatment options such as radiotherapy, chemotherapy, and surgery are either ineffective, unavailable, or prohibitively expensive.10,15,16 The uptake of cervical cancer screening in low-income countries (LICs) is alarmingly low at less than 20%, a stark contrast to the 63% screening coverage in high-income countries (HICs), translating to a 44% disparity.17,18 Specifically, Uganda has one of the lowest cervical cancer screening rates in rural communities at 4.8%.19 These figures underscore the urgent need for targeted strategies to improve screening uptake, particularly in remote areas where existing interventions are limited.

    Recognizing the global disparities in cervical cancer prevention and control, the World Health Organization (WHO) launched the Cervical Cancer Elimination Strategy in 2020, aiming to reduce cervical cancer incidence to fewer than four cases per 100,000 women. This ambitious goal is anchored on a “90–70–90” target: vaccinating 90% of girls against HPV by age 15, screening 70% of women between ages 25 and 49, and ensuring that at least 90% of those diagnosed with precancerous lesions or invasive cancer receive treatment.20 Among these interventions, cervical cancer screening has been identified as a crucial component for early detection and improved treatment outcomes. Evidence suggests that widespread HPV vaccination and routine screening can prevent up to 80% of cervical cancer cases, significantly reducing mortality.12,21,22

    Women in SSA face significant barriers to accessing cervical cancer screening services. Multiple socio-ecological factors—including limited healthcare infrastructure, cultural beliefs, financial constraints, lack of awareness, and fear of diagnosis—contribute to low screening uptake.2,23,24 The success of cervical cancer screening programs in resource-limited settings therefore hinges on identifying and addressing these barriers through context-specific interventions and policy implementation.

    We aimed to investigate the factors influencing the uptake of cervical cancer screening in Kaberamaido District, Uganda, to inform evidence-based strategies to enhance screening coverage and ultimately contribute to the broader goal of cervical cancer elimination in low-resource settings.

    Materials and Methods

    Study Design

    This study employed a cross-sectional design to assess factors influencing the uptake of cervical cancer screening among women aged 25–49 years attending outpatient services at Kaberamaido General Hospital (KGH), Kaberamaido District, Uganda. A quantitative approach was used to measure cervical cancer screening uptake and identify associated factors.

    Study Site

    The study was conducted at Kaberamaido General Hospital (KGH), a district-level healthcare facility serving Kaberamaido District, Uganda. The district has an estimated population of 215,026 people.25 KGH serves as a primary healthcare provider for the district and is a referral center for lower health facilities. The outpatient department (OPD) was chosen as the study site because it receives a diverse patient population, including women within the recommended age bracket for cervical cancer screening (25–49 years).

    Sampling Strategy

    A consecutive sampling technique was used to recruit women aged 25–49 years attending the OPD clinic at KGH between March and May 2024 until the sample size of 422 was reached. This approach was chosen due to the varied patient flow at the OPD, which experiences peak attendance on Mondays and lower attendance on other days. The sampling approach, therefore, was able to give a mix of participant population since it was stretched over a 3-month period.

    Sample Size Determination

    The Kish Leslie formula for sample size estimation in cross-sectional studies was used to calculate the required sample size of 384 participants, based on an assumed prevalence of cervical cancer screening uptake of 50% to give the maximum sample size possible. To account for non-responses and incomplete responses, the sample size was adjusted by 10%, giving a final sample size of 422 respondents.

    Data Collection

    Data was collected using a structured questionnaire entered into the kobo toolkit and administered through face-to-face interviews. The questionnaire was designed to capture socio-demographic characteristics (age, education level, marital status, occupation, and income level), Knowledge and awareness of cervical cancer screening (awareness of risk factors, availability of screening services, and perceived benefits), Health system-related factors (accessibility of screening services, availability of healthcare providers, affordability, and previous interactions with the health system). The primary outcome was prevalence of cervical cancer screening defined as having ever been screened within a 5-year period prior to the interview with a Yes/No response and the secondary outcome was the factors associated with cervical cancer screening. The questionnaire was pre-tested among a small sample of women attending a different health facility in the region to ensure clarity, reliability, and validity before the actual data collection.

    Data Management and Analysis

    Collected data were exported to STATA version 16.0 for analysis. Descriptive statistics (frequencies and percentages) were used to summarize categorical variables, while means and standard deviations were computed for continuous variables. Bivariate analysis was conducted using modified Poisson regression with robust error estimates to determine the levels of association between independent variables and outcome of interest. The final multivariable modified Poisson regression model was built based on variables whose p-value were less than 0.1 at bivariate level, those with confounding effects and those with known biological plausibility. Variables whose confidence interval did not contain a null (1.0) were considered statistically significant.

    Results

    Social Demographic Characteristic of Study Respondents

    Out of 422 women in this study. Most were aged 25 to 35 years (303, 71.8%), with an average age of 32 (SD ±7) years, majority (327, 77.5%) were married, with almost half (178, 42.2%) were catholic. Regarding education, about (292, 69.2%) had primary education, majority (377, 89.3%) were unemployed, and about (261, 61.8%) had a parity of fewer than 5 (Table 1).

    Table 1 Social Demographic Characteristics of Study Participants

    Awareness and Uptake of Cervical Cancer Screening

    The majority (360, 85.3%) of respondents had heard about cervical cancer screening, but only 86 (20.4%) had been screened in the past five years, while 336 (79.6%) had never undergone screening (Table 2).

    Table 2 Awareness and Uptake of Cervical Cancer Screening

    Factors Associated with Cervical Cancer Screen

    Multivariate analysis revealed that a mother’s age, source of funds for hospital visits, availability of cervical cancer screening services at the nearest health facility, and a family history of cervical cancer were statistically significant factors associated with cervical cancer screening. Women aged over 35 years were 1.7 times more likely to undergo cervical cancer screening (aPR = 1.7, 95% CI: 1.08–2.69) compared to those aged 25 to 35 years. Women who relied on other sources of hospital income (salary, business, and borrowing) were 1.6 times more likely to be screened (aPR = 1.6, 95% CI: 1.09–2.38) compared to those who depended on free government service. Women whose nearest health facility offered cervical cancer screening services were 2.1 times more likely to be screened (aPR = 2.1, 95% CI: 1.09–3.97) than those without access to such services. Additionally, women with a family history of cervical cancer were 1.7 times more likely to be screened (aPR = 1.7, 95% CI: 1.14–2.65) compared to those with no family history (Table 3).

    Table 3 Multivariate Analysis of Factors Associated with Cervical Cancer Screening

    Discussion

    Our study aimed at assessing the level of uptake of cervical cancer screening and associated factors among women in the reproductive age (25–49years) and eligible for screening as per the national and WHO guidelines.26,27 The average age of participants was 32 years, with three in four (3/4) of participants married, about 7 in 10 having attained only the primary level of education and 9 in 10 being unemployed.

    Awareness about cervical cancer screening services among the study participants was high as 85.5% of respondents had heard about cervical cancer screening. Cervical cancer screening awareness has significantly improved in the recent years across multiple settings, with studies in Eastern Uganda and Dodoma-Tanzania reporting 7 in 10 women to have heard about cervical cancer screening from the various sources.28,29 Earlier studies have shown that cervical cancer screening awareness or the lack of it is directly linked to uptake of cervical cancer screening services.2,10,17,30,31 However, the high awareness of cervical cancer screening services in our study did not translate to receiving the service and there was no significant difference in screening between participants who were aware and those not aware of cervical cancer screening. The uptake of screening services in KGH could therefore be linked to other factors such as the availability of the free screening services in the nearest health facilities.

    Uptake of cervical cancer screening in KGH was low as only 20% of participants had been screened in the past five years. This screening level is still suboptimal and below the WHO 2030 target of 70% screening.26 Cervical cancer screening uptake in Uganda and SSA has been generally low, with reported prevalence of <5% in rural Uganda19 and 20% in urban areas.32 Even among high risk populations of women in Uganda, such as female sex workers, cervical cancer screening is still suboptimal at only 32%.33 The average uptake of cervical cancer screening in SSA has been at about 13%,7 with significant variations across countries, that is, 8% in Tanzania,29 18.7% Kenya,8 3–5% in Cameroon,18 and 39% in Ethiopia.6 The observed uptake of 20% in our study therefore indicates some progress, though not very satisfactory.

    We observed that women older than 35 were about twice more likely to have received cervical cancer screening compared to women below 35 years. Older women have been generally noted to have received cervical cancer screening services in different settings.34,35 As women get older, they perceive themselves to be at a higher risk of cervical cancer disease, and therefore their tendencies to seek cervical cancer screening services increase.1 Chances are that eventually the odds of obtaining information about cervical cancer screening and eventually being screened increases.34

    Similarly, our study found that women with a positive family history of cervical cancer were more likely to have been screened for cervical cancer. Our previous study on cervical cancer screening uptake among female sex workers in Northeastern Uganda demonstrated high acceptability of the service by the women who had family history of cervical cancer.33 Other studies in Ethiopia have equally shown a positive correlation between cervical cancer screening and family history of the disease.13,21 The higher uptake of cervical cancer screening among women with a family history of cervical cancer is positively linked to increased knowledge, risk perception and awareness of cervical cancer and higher exposer to chances of screening.21

    The source of funding to finance hospital visits was a significant determinant of the uptake of cervical cancer screening in our study. Women who solely depended on free government services and had no other source of income were less likely to have been screened for cervical cancer than those who depended on other sources for their medical bills. Financial capability has been identified in other studies as a significant predictor and access to healthcare-seeking practices.1,36 Kaberamaido being a rural setting in a low-income country, and the unemployed population is disproportionately higher, partly explaining the low uptake we observed.24

    In KGH, participants whose nearest health centre provided cervical cancer screening were twice more likely to have screened for cervical cancer than those whose health facilities do not provide the service. More often because of financial limitations as earlier noted, women in this rural communities are more likely to attend the nearest health centre, which, if it provides cervical cancer screening, were more likely to be screened. In Uganda, one of the major contributors to low uptake of cervical cancer screening in rural areas is the associated cost, mostly in terms of transport, because women in rural areas are faced with a greater geographical accessibility burden to health care facilities.37 Because of the absence of Cervical cancer screening services in majority of rural health centres, research has also reported that doctors in these areas are less likely to recommend women from cervical cancer screening further escalating the reduced uptake.37

    Limitations of the Study

    Our study was not free of limitations. First, the study adopted a quantitative survey design that does not study reasons and motivations behind the observed hinderances of cervical cancer screening. Such reasons inform targeted interventions. Secondly, this study was prone to social desirability bias since the outcomes of this study were entirely dependent on participant reports. Third, the sampling method used was a consecutive sampling approach which introduces selection and temporal bias.

    Conclusion

    Although cervical cancer screening awareness was high in Kaberamaido district, its uptake is far below the WHO target by 2030, with only 1 out of 5 participants having been screened. It is paramount to strengthen access to cervical cancer screening services through primary health care facilities and community outreaches targeting young women who are unable to visits the health facility due to financial constraints or other unknown fears, thus, enabling early detection and treatment of precancerous lesions.

    Ethical Considerations

    Our study complied with the Declaration of Helsinki guidelines by ensuring the health and well-being of participants as our first consideration and ensuring respect for all participants and protection of their health and rights. Ethical approval for the study was obtained from the Mbale Regional Referral Hospital Research and Ethics Committee (REC), approval number- MRRH-2024-402. Administrative clearance was granted by the Kaberamaido District Health Officer (DHO) and the KGH Medical Superintendent before the study commenced. Written informed consent was obtained from all study participants before their inclusion in the study. Participants were assured of their voluntary participation and the right to withdraw at any point without consequences. All interviews were conducted in a private setting to ensure participant confidentiality. No identifiable personal information (such as names, phone numbers, or national identification details) was collected. Data were stored securely in a locked cabinet, and digital data were password-protected, accessible only to the research team.

    Acknowledgment

    The authors would like to acknowledge the contributions of the staff of the Department of Public Health, School of Health Sciences, Soroti University for their guidance through the processes of proposal development, data collection, analysis and manuscript writing. In addition, the authors acknowledge the support and contribution of Dr. Eric Auna, the Medical Superintendent of Kaberamaido General Hospital, who provided invaluable guidance and support for us during our stay at the facility for data collection.

    Author Contributions

    All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

    Funding

    There was no funding received for this study.

    Disclosure

    The authors declare no conflicts of interest in this work.

    References

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