The Sustainable Development Goals provide a global development agenda that is meant to be inclusive of all people. However, the development needs for vulnerable populations such as youth are not reflected within the policy agenda of some developing countries. One of the reasons for this is that research that explores health and wellbeing concerns for young people are sparse in the region and where they exist, the focus has been on marginalized subgroups. To address this gap, this cross-sectional study explored the health and wellbeing of youth in Kenya. We conducted 10 focus group discussions and 13 in-depth interviews with youth ages 15 to 24 years. A thematic analysis of the data revealed that structural factors are important influencers of youth perceptions and their social constructions of health and wellbeing. Kenyan youth are concerned about the health status and healthcare services in their communities, as well as issues of community trust of youths and perceived risks of political misuse and emotional suffering. Our findings suggest that youth transitioning into adulthood in resource constrained areas experience feelings of being powerless and unable to take charge over their own life. This impacts how they perceive and socially construct health and wellbeing.

Our primary objectives were a) to determine the need for, and the availability of point-of-care testing (POCT) for infectious diseases and b) to recommend point-of-care testing strategies and spatial care paths (SCPs) that enhance public health preparedness in regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted field surveys. Medical professionals in 7 community health centers (CHCs), 7 district hospitals (DHs) and 1 provincial hospital (PH) participated. Survey questions (English and Vietnamese) determined the status of diagnostic testing capabilities for infectious diseases and other acute medical challenges in TTHP. Infectious disease testing was limited: 6 of 7 CHCs (86%) lacked infectious disease tests. One CHC (14%, 1/7) had two forms of diagnostic tests available for the detection of Malaria. All CHCs lacked adequate microbiology laboratories. District hospitals had few diagnostic tests for infectious diseases (Tuberculosis, Syphilis), blood culture (29%, 2/7), and pathogen culture (57%, 4/7) available. The PH had broader diagnostic testing capabilities but lacked preparedness for highly infectious disease threats (e.g., Ebola, MERS-CoV, SARS, Zika, and Monkeypox). All sites reported having COVID-19 rapid antigen tests; COVID-19 RT-PCR tests were limited to higher tier hospitals. We conclude that infectious disease diagnostic testing should be improved and POC tests must be supplied near patients’ homes and in primary care settings for the early detection of infected individuals and mitigation of the spread of new COVID-19 variants and other highly infectious diseases.

Background: Using the COM-B model as a framework, an EU-wide survey aimed to ascertain multidisciplinary healthcare workers’ (HCWs) knowledge, attitudes and behaviours on antibiotics, antibiotic use and antibiotic resistance. The UK findings are presented. Methods: A 43-item questionnaire was developed through a two-round modified Delphi consensus process. The UK target quota was 1,315 respondents. Results: 2,404 participants responded. The highest proportion were nursing and midwifery professionals (42%), pharmacists (23%) and medical doctors (18%). HCWs correctly answered that antibiotics are not effective against viruses (97%), they have associated side effects (97%), unnecessary use makes antibiotics ineffective (97%) and healthy people can carry antibiotic resistant bacteria (90%). However, fewer than 80% correctly answered that using antibiotics increases a patient’s risk of antimicrobial resistant infection or that resistant bacteria can spread from person to person. Whilst the majority of HCWs (81%) agreed there is a connection between their antibiotic prescribing behaviour and the spread of antibiotic resistant bacteria, only 64% felt that they have a key role in controlling antibiotic resistance. The top three barriers to providing advice or resources were lack of resources (19%), insufficient time (11%) and the patient being uninterested in the information (7%). Approximately 35% of UK respondents who were prescribers prescribed an antibiotic at least once in the last week due to fear of patient deterioration or complications. Conclusion: These findings highlight that a multifaceted approach to tackling the barriers to prudent antibiotic use in the UK is required and provides evidence for guiding targeted policy, intervention development and future research. Education and training should focus on patient communication, information on spreading resistant bacteria and increased risk for individuals.

Abstract: Systemic inflammatory response syndrome (SIRS) is a clinical diagnosis based on abnormalities in patients' vital signs and white blood cell count. Neutrophil-lymphocyte ratio (NLR) is used as an easily accessible parameter to assess the patient's inflammatory status and stress. There are some studies showing that NLR affected by the inflammatory response is a criterion to support the diagnosis of SIRS. In this study, it was aimed to compare the interrelation between SIRS (+) and SIRS (-) groups in patients with high positive feline coronavirus (FCoV) in the light of NLR. Based on the anamneses, physical examination findings, laboratory findings, enzyme immunoassay antibody test kit titer were included in the sick groups. These patients were further categorized based on the presence of SIRS symptoms, vital signs and laboratory findings. The NLR as diagnostic marker demonstrated to differ between high antibody titer FCoV positive and healthy cats. However the diagnostic significance of NLR remains questionable between the high antibody titer FCoV positive cats with SIRS (+) and SIRS (-). As a result of our study NLR can be used as a blood parameter like albumin/globulin ratio and elevated total bilirubin in cats with high FCoV antibody titer and high probability of developing FIP.

Although previous studies have focused on the adverse effects of the COVID-19 pandemic on various professional groups (particularly in the health and nursing care sector), this study aims to close a research gap by assessing perspectives of students and young professionals in epidemiology and public health in Germany in terms of shifts in workload, work content, and related challenges caused by the pandemic. We conducted a cross-sectional survey between mid-February and mid-March 2022. Quantitative data were analyzed via standardized mean differences. Qualitative data based on answers to open-ended questions were analyzed via a qualitative content analysis. Overall, 172 individuals participated in this survey. Results indicate that students felt burdened the most by lack of exchange with other students and lecturers. Study participants employed in public health experienced changes in their employment, because they had changes in their work content- and administration-wise, which was accompanied with a high burden due to the workload. Multiple demands that can have an impact on both acquired skills and mental health during the professional qualification phase were mentioned by the participants. Therefore, more in-depth analyses are needed for investigating the impact the pandemic will have on the (future) public health workforce in the long run.

To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. Coronavirus 2019 stress-tested complex healthcare systems, and intensive care was driven to an unprecedented escalation. The main aim of this research was to explain the escalation process of intensive care from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide clinical recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. A novel conceptual model of the escalation process of intensive care emerged, and 41 clinical recommendations concerning the optimal prerequisites for resilient performance were identified. Escalation was conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components space, stuff, staff, system and science with associated continuity plans must be implemented, anchored and communicated to actors at all levels of the system.

Though there has been a decline in the number of new cases of viral hepatitis-induced acute liver failure in Europe and the United States of America, viral hepatitis still remains the leading cause of acute liver failure in Asia-Pacific and South America. However, the epidemiology of viral-hepatitis-induced acute liver failure in sub-Saharan Africa-the world epicenter of viral hepatitis-is unclear. The aim of this review was to collate data on the incidence, prevalence, specific etiologic agents, features/diagnosis, treatment and prognosis of viral-induced acute liver failure in sub-Saharan Africa. One hundred and forty-seven cases of viral-induced acute liver failure were recorded in 11 studies conducted in six countries between 1981-2020. Etiological agents were: Hepatitis viruses A, B, C, and E, as well as Adenovirus, Enterovirus, Parvovirus, Herpes Simplex Virus (HSV) and EBV. HAV was the most frequent in paediatric subjects: (11/16) 69% and (19/30) 63%. HBV was the only etiological agent in the study that only included adults. HEV (genotype 2 in one study) contracted amidst hepatitis E outbreaks was the most commonly reported cause of ALF in pregnant women. Treatment was mainly supportive, and liver transplantation reported only in South Africa. Where reported, case fatality rates were high. In conclusion, viral-hepatitis induced acute liver failure is largely understudied in sub-Saharan Africa. The few available data are consistent with literature from the other parts of the world regarding aetiologic agents. Liver transplantation is not available in most sub-Saharan African countries, and short-term case fatality rates of individuals with acute liver failure could outstrip current rates from the other world regions.

Indigenous peoples around the world are revitalizing their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Māori health and wellbeing related models have emerged, each with their own unique applications and offerings. We sought in these qualitative studies to explore and identify some key sources of wellbeing for Māori individuals. Nine interviews were conducted with members of Māori communities to identify key themes of Māori wellbeing. A Reflexive Thematic Analysis was performed on these data, and then a further fifteen interviews were conducted to revise, refine, and reposition the previously generated themes. The Ngaruroro describes wellbeing as the embodied and active process of being in good relation with your 1) here tāngata (social and familial ties), 2) te taiao (the environment), and 3) taonga tuku iho (cultural treasures), while doing what you can to make lifestyle choices that are conducive to the health of your 4) tinana (body) and 5) wairua (spirit), while cultivating a balanced 6) ngākau (inner-system), fulfilling 7) matea (core needs), and exercising your 8) mana (authority). These themes illustrate and reiterate that Māori wellbeing is dynamic, interconnected, and holistic.

Introduction SARS-CoV-2 infection normally damages respiratory system but may likewise impair endocrine organs’ function. Thyroid dysfunction and hyperglycemia are common endocrine complications of SARS-CoV-2 infection. Onset of T1D and associated complications including DKA, hospitalization and death, are thought to be increased during the COVID-19 pandemic. The aim of this study is to review the available data about the incidence rate of T1D and accompanying complications since the beginning of the COVID-19 pandemic. Methods: A systematic review was conducted using electronic databases PubMed and Google Scholar. The keywords “T1D, T1DM, Type 1 DM or Type 1 Diabetes”, “Coronavirus, SARS-CoV-2 or COVID-19” were used to search these databases. Titles and abstracts were screened for selection, and then relevant studies were reviewed in full text. Result: we selected 21 manuscripts out of 296 identified studies. Data about the incidence rate of T1D, hospitalization and death are not consistent across countries, but DKA incidence and severity seem to be higher during the COVID-19 pandemic. Conclusion: Our data collection demonstrated that COVID-19 may or may not increase the incidence of type 1 diabetes. Nevertheless, it is associated with higher incidence and severity of DKA in T1D patients. Antivirals are not fully protective against endocrine complications of SARS-CoV-2 infection. Combining medications that reduce SARS-CoV-2 entry into the cells and modulate the immune response to infection is an alternative practical approach to treating COVID-19.

This study aims to evaluate the factors influencing the adherence to the 2nd and 3rd doses during each cycle of seasonal malaria chemoprevention (SMC) in Burkina Faso, Mali, and Niger. Overall, 3,132 people were interviewed during surveys between 2019 and 2020 in 15 health districts. The median age was 30 years. In Burkina , Mali, and Niger, the proportions of non-adherence were 4.15% , 5.60%, and 13.30%, respectively (95% CI (-3.27% -0.37 %, p = 0.114 ) for the 2nd dose and 3.98%, 5.60% and 14.39% for the 3rd dose. The main cause of non-adherence to the 2nd and 3rd doses was other illnesses in 28.5% and 29.78% respectively in Burkina, 5.35% and 5.35% in Mali and 1.6% and 0.75% in Niger. It was followed by vomiting in 12.24% and 10.63% for Burkina and 2.45% and 3.78% in Niger. The last causes were refusal in 6.12% and 4.25% in Burkina , 33.9% and 15.25% in Mali and 0.8% and 1.51% in Niger. Non-adherence of doses related to parents was primary due to their absence in 28.5% and 27.65% in Burkina , 16.07% and 16.07% in Mali and 7.37 % and 6.06% in Niger. Travelling was the second cause in 12.24 % and 12.76% in Burkina , 19.64% and 19.64% in Mali and 0.81% and 0.75% in Niger. Non-adherence related to community distributors was mainly due to missing of the doses in 4.08% and 4.25% in Burkina , 23.21% and 23.21% in Mali, 77.04% and 76.51% in Niger. Our study reported very small proportions of non-adherence to 2nd and 3rd doses of SMC and identified the main causes of non-adherence.

By shifting eating hours from daytime to nighttime, Ramadan intermittent fasting (RIF) illustrates how religious beliefs influence human dietary behavior and subsequent anthropometric and metabolic measures. This study aimed to investigate socioeconomic characteristics and examine how observing RIF affects dietary intake, anthropometric indices, and metabolic markers in healthy premenopausal (PRE-M) and post-menopausal (POST-M) Saudi women. Before starting the study, the authors hypothesized that the RIF improves some nutritional aspects and health in respondents, but not after breaking the fast.. The study includes 62 women (31 PRE-M, 21-43 years, and 31 POST-M, 44-68 years). A structured questionnaire was used to collect socioeconomic data. Physical activity, anthropometric, dietary, and biochemical assessments were undertaken before RIF and at the end of the third week of Ramadan fasting month. Socioeconomic data varied among respondents. Observing RIF was associated with significantly (at either p ≤ 0.01 or p ≤ 0.05) lower intake of calories, macronutrients, minerals (except for Na), and vitamins than before RIF for both groups. In terms of body mass index (BMI), and waist-to-height ratio (WHtR) for PRE-M, the percentage of overweight decreased significantly (p≤0.01) while obesity remained unchanged. In contrast, for POST-M, the percentage of overweight increased significantly (p≤0.05), but obesity decreased after RIF. Both groups' waist-to-hip ratio (WHR), body fat (BF), and fat mass (FM) decreased after RIF. High-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), triglycerides (TG), and blood pressure (SBP, DBP) were generally maintained at acceptable normal levels in most responders before and after RIF. However, low-density lipoprotein cholesterol (LDL-C) was significantly decreased during RIF than before, especially for POST-M. Age, occupation, and monthly income were the most important factors influencing women’s nutritional status and body fat. In conclusion, observing RIF by PRE- and POST-M Saudi women was associated with significant improvements in variable health indicators, with a few exceptions, particularly POST-M, and may help lower risk factors for chronic diseases.

Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether the measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parents Attitude about Childhood Vaccination (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake controlling for sociodemographic variables and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was performed, besides area under the curve (AUC) for the PACV was computed. Data was collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicted the uptake of measles vaccine after controlling other potential social confounders such as mother’s age and the number of children (aOR 1.055, 95% CI 1.028-1.028). Additionally, the ROC for the PACV yielded area under the curve (AUC 0.686 (95% CI 0.620-0.751, P <0.001). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.

Objectives: This study aimed to analyze the awareness of local residents regarding healthcare projects and to suggest some ideas for the revision of local ones. Methods: To delve into the opinions of local residents, the author of this study created a questionnaire composed of eight questions on the general characteristics of the respondents, eight questions on satisfaction with health centers, 16 questions on the awareness of healthcare projects, and 22 questions on local healthcare. The survey was conducted for 409 residents who visited public centers in Gimcheon from 15 March to 14 April 2021. Results: Data analysis revealed the following: The proportion of local residents who use health centers was 39.1%, and those users visit health centers, on average, 3.92 times a year. Among healthcare projects, the project known by the highest proportion of people was vaccinations (84.5%), which was also the project that was most used (38.1%). Among healthcare projects needed in the with-COVID-19 age, respondents awarded the highest score to vaccinations (4.15 points on a five-point Likert scale) and the second highest score to infectious disease management (4.12). Conclusions: For healthcare projects, central and local governments should focus on activating vaccinations, solving the problem of medical accessibility through untact remote treatment and establishing national infectious disease-specializing hospitals and local infectious disease management based on such national hospitals.

Background: Maternal mortality remains dire in Nigeria, claiming 40,000 lives yearly due to pregnancy complications. Factors like limited healthcare access, poverty, and early marriage worsen the crisis. Despite efforts to improve skilled birth attendance, Nigeria struggles to meet MDG targets, underscoring the urgent need for more effective interventions. Objectives: The objective of the study is to assess and understand the knowledge of community members regarding the risk factors influencing maternal mortality in the Ede South Local Government Area of Osun State, Nigeria. Methodology: A descriptive cross-sectional study was conducted. The study methodology involves employing the Leslie Kish formula to select 185 participants from the Ede South Local Government Area in Osun State, Nigeria. The selection process involved the use of a systematic sampling technique to ensure a representative sample based on population demographics and characteristics, ensuring a balanced and accurate selection process. Quantitative data was collected through a self-administered questionnaire and analysed using SPSS version 21. Results: The study encompassed 185 participants. 64.9% females with a mean age of 27.3 + 8.3 years. Among them, 60.5% were single, 46.6% being students, 55.7% held a BSc degree, 64.9% were Yoruba and 61.1% identified as Christian. 91.4% were aware about maternal mortality, 74.6% recognized maternal deaths in reproductive-aged women. Participants identified that maternal deaths mostly occur during labour (91.4%). Direct causes, such as bleeding (88.1%), unsafe abortion (88.6%), infection (49.2%), and hypertension (64.9%), were recognized. Results indicated substantial awareness concerning specific risk factors: lack of education (98.9%), poverty (91.6%), poor health care services in facilities (94.0%), alcohol consumption (87.6%) and poor transportation (78.4%). Conclusion: Findings revealed good awareness of maternal deaths and critical factors such as ANC impact and direct causes of maternal mortality like bleeding and unsafe abortion. However, gaps persisted in SDG awareness, suggesting the need for targeted interventions to enhance overall understanding and address identified knowledge gaps.

(1) Background: Childhood immunization is vital for preventing morbidities and mortalities globally. However, rural Pakistan is facing persistent challenges, particularly after recent global health crises in gauging accurate vaccination coverage estimates. This study aimed to apply a novel Lot Quality Assurance Sampling (LQAS) methodology due to its rapid and reliable estimates of the routine immunization rates among children aged 12-23 months old in Shikarpur, Sindh, and to identify priority areas for future interventions. (2) Methods: A cross-sectional household survey design was adopted for an in-depth assessment of vaccination coverage in a previously under-studied rural context. (3) Results: Data were collected from 1,402 children aged 12-23 months across 47/49 Union Councils in Shikarpur within 141 randomly identified clusters. LQAS was innovatively employed along with GIS Mapping which provided a spatial analysis of the distribution of immunization coverage and the spot map of clusters. The weighted average for fully immunized children was 42.4% after applying Direct Adjustment Method. A steep decline in coverage for each successive vaccine dose was observed, and 39 key priority areas were identified on GIS-based plotting for intensive health interventions. Multivariate Logistic Regression Model further revealed informational gaps and fear of side effects as major barriers to achieving complete immunization. (4) Conclusions: The innovative application of LQAS and GIS Mapping in this study has provided a comprehensive glimpse of its utility in future follow-ups and similar assessments. The findings stress the critical need to tackle the foundational reasons behind the vaccination gaps, with a special focus on enhancing awareness and information dissemination in the key priority areas.

Background: Immunization prevents over 4-6 million deaths each year worldwide. Ensuring mother satisfaction is an important means of preventing the death of children caused by communicable diseases. However, in Ethiopia, there is paucity of evidence on maternal satisfaction with immunization services. Thus, this study is aimed at assessing the level of maternal satisfaction with childhood immunization services and associated factors among children’s caregivers. Methods: A facility-based cross-sectional study was conducted among 556 systematically selected children’s caregivers in public health facilities at Gondar Town from May through June, 2022. Data were collected using a pretested structured questionnaire. P≤ 0.25 during the bivariate binary logistic regression analysis was included in the multivariate analysis. From the multivariable analysis, variables with p ≤ 0.05 were declared statistically significant. Results: The prevalence of maternal satisfaction towards childhood immunization services was 69.3%(95%CI: 65.5, 73.1%). Of mothers, 45.3% had adequate knowledge, while 43.9% had favorable attitude. Mothers 19-24 years old [AOR = 5.29; 95%CI:2.58,10.86], mothers who waited less than one hour [AOR = 3.03; 95%CI: 1.92,4.77], mothers less than thirty minutes waiting in health facility[AOR=1.98;95%CI:1.24,3.15], mother feel happy during service[ AOR=4.00; 95%CI: 2.53,6.34], mothers adequate knowledge [AOR=2.91; 95%CI: 1.79, 4.73] and had favorable attitude [AOR=3.64; 95%CI: 2.25, 5.91] were significantly associated with maternal satisfaction during childhood immunization services.Conclusions: The overall level of mothers’ satisfaction with childhood immunization services was considerably lower as compared with other studies. Thus, the town health office and concerned stakeholders need more efforts to improve mothers’ satisfaction with childhood immunization services.

In this review we look at the developments in the field of artificial intelligence (A.I) and their current impact as well as future implications in the field of cardiology, we as physicians and cardiologists have tried to put our perspective on the rapidly evolving field, In light of the fact that many of the healthcare workers and professionals across the world still find the concept of A.I quite complicated, elusive and somewhat paradoxical, we have tried to simplify the concept of artificial intelligence and make it easy for everyone to understand from all walks of life. The Databases utilized for our review are PubMed, PubMed Central, Google Scholar. The Keywords used for our Data Search are “Artificial Intelligence”, “A.I Cardiology”, “A.I in Cardiovascular Medicine”, “Machine Learning in Cardiology”. We screened all relevant since inception till March 25th and included 44 relevant articles after careful consideration into our paper. We have discussed the implementation of and scope of artificial intelligence across a broad spectrum of applications including cardiovascular imaging and diagnostics like electrocardiograms, echocardiograms, cardiac CT/MRIs to novel cardiac monitoring devices, CRISPR gene editing in cardiology and implementation of artificial intelligence in the field of Cardiovascular Bioprinting. This is the initial review in a series of reviews regarding A.I in Cardiology.

Healthcare workers' stress, burnout, and job dissatisfaction were exacerbated by the Covid-19 pandemic, whose mid-term negative effects are still present. The aim of this study was to investigate in healthcare workers the effect of the dimensions of burnout (Psychophysical exhaustion, Relational deterioration, and Professional inefficacy) on Career satisfaction. These relationships were evaluated by considering the direct and mediated effects of Disillusion. For these purposes, the Link Burnout Questionnaire (LBQ) and the Career Satisfaction Scale (Occupational Stress Indicator - OSI) were administered to 295 healthcare professionals working at three Italian public hospitals in Cagliari, Italy. The analyses were conducted using the Partial Least Square Structural Equation Model (PLS-SEM) method. Findings highlight that healthcare workers were in a condition of work distress, high risk of burnout, and career dissatisfaction. Also recognized was the direct negative effect of burnout dimensions on career satisfaction. Finally, the mediated negative effect of Disillusion in the relationship between burnout and career satisfaction was identified. This study emphasizes the relevance of the dimension of Disillusion, and its “bright side” Fulfilment, in healthcare workers, specifically referring to the disregarded relationship between burnout and career satisfaction.

Poliomyelitis, commonly known as “polio” is a paralytic and perilous disease caused by the poliovirus. Due to its highly contagious nature, the virus was a challenge to the world in the late 1980s. . Since 1988 the collective work of the Global Polio Eradication Initiative (GPEI), Centre for Disease Control and Prevention (CDC), and World Health Organization (WHO) through immunizations, communication awareness, and monitoring have helped the world exonerate polio. The mission of polio-free Pakistan was herculean and had confronted enormous challenges in different ways but came out with positive results. In 2019, with only two remaining polio-endemic countries, Pakistan and Afghanistan, GPEI launched an “Endgame strategy 2019-2023” which aims to eradicate polio globally, with a targeted focus, especially on polio-endemic countries, the plan emphasizes the early detection of polio cases for complete eradication and to restrict the spread of polio. Pakistan has achieved a milestone in combating polio despite having a web of factors that have thwarted Pakistan’s polio eradication efforts, but this is not the end, the struggle continues until we really get an internationally verified certification of Polio free nation, for this WHO has designed a multidisciplinary strategy 2022-2026 to really end this polio for once and for all.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in humans in Wuhan City at the end of December 2019. Since then, it has spread to all the countries. Therefore, global interest has been focused on discovering treatments and developing successful vaccines. This study sequenced the complete genome of the SARS-COV-2 Omicron Omicron (BA.1) and sub-variants (BA.1.1, BA.2), which were isolated from 40 individuals in Duhok, Iraq. Ninety-five different mutations were identified when the complete genome of the SARS-COV-2 virus discovered in Wuhan, China (accession number: NC 045512.2) was matched to the virus sequence using sequencing technology (Illumina, USA). Sequence analysis revealed 38 mutations in spike glycoprotein (S), 30 of which were found in ORF1a. Additionally, 11 mutations were found in ORF1b, and 7,3,2,1 mutations were found in Nucleocapsid (N), membrane protein (M), Open Reading Frames 6 (ORF6), Open Reading Frames 9 (ORF9), and Envelope (E) genes, respectively. Phylogenetic analysis and transmission further confirmed that the isolates found in Iraq had distinct infection origins and were closely related to those from other countries and states. According to the findings of this study, a new vaccine can be developed based on identifying new Omicron variant mutations and sub-variants such as BA.2, which were identified for the first time in Iraq.

Health self-tracking is an ongoing trend as software and hardware evolve, making the collection of personal data not only fun for users but also increasingly interesting for public health research. In a quantitative approach we studied German health self-trackers (N=919) for differences in their data disclosure behavior by comparing data showing and sharing behavior among peers and their willingness to donate data to research. In addition, we examined user characteristics that may positively influence willingness to make the self-tracked data available to research and propose a framework for structuring research related to self-measurement. Results show that users' willingness to disclose data as a "donation" more than doubled compared to their "sharing" behavior (willingness to donate= 4.5/10; sharing frequency= 2.09/10). Younger men (up to 34 years), who record their vital signs daily, are less concerned about privacy, regularly donate money, and share their data with third parties because they want to receive feedback, are most likely to donate data to research and are thus a promising target audience for health data donation appeals. The paper adds to qualitative accounts of self-tracking but also engages with discussions around data sharing and privacy.

There has been limited research on improving Internet-delivered Cognitive Behavioural Therapy (ICBT) in routine online therapy clinics that serve people from diverse ethnocultural groups (PDEGs). This article describes a patient-oriented adaptation approach used to address this gap in research. A working group consisting of people with lived experience, community stakeholders, ICBT clinicians, managers, and researchers, was formed. The working group examined archival feedback on ICBT from past clients who self-identified as being from diverse ethnocultural back-grounds (N=278) and results of interviews with current patients (N=16), community stakeholders (N=6), and clinicians (N=3). The archival data and interviews revealed the majority of the pa-tients reported being satisfied with and benefitting from ICBT. Suggestions for improvement were not related to the cognitive-behavioural model and techniques, but rather to making treatment materials more inclusive. Consequently, the ICBT adaptation focused on adding content related to cultural influences on mental health, addressing stigma, diversifying case stories, examples and imagery, adding audiovisual introductions, and replacing English idioms with more descriptive language. Moreover, further training was offered to clinicians and efforts were made to improve community outreach. This study demonstrates a process for using patient-oriented research to improve ICBT within routine care serving patients of diverse backgrounds.

Human papillomavirus (HPV) infection is a widespread sexually transmitted infection linked to various types of cancers. Although vaccination against HPV is available, global HPV vaccination rates remain low. This study aimed to evaluate the awareness and knowledge of the HPV vaccine and to identify predictors associated with vaccine hesitancy among health college students in Saudi Arabia. A cross-sectional survey was distributed to students enrolled in health colleges. The association of vaccine hesitancy with sociodemographic characteristics was examined using logistic regression analysis. The study found that approximately half of the students (49.9%) were aware of the HPV vaccine. Students from the College of Medicine showed the highest level of knowledge. Only a small proportion (5.2%) reported receiving the vaccine. The overall HPV vaccine hesitancy was 59.1% (43.9% for women and 75.9% for men). The most common reasons for vaccine hesitancy was not knowing enough about it. Men were twice as likely as women to believe that they did not need the HPV vaccine. The odds for HPV vaccine hesitancy were greater among men and younger age group compared to women and older age group. In conclusion, the study underscores the importance of awareness campaigns on HPV vaccination, targeting primarily male students.

Burden of diseases measured as disability-adjusted life years per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25 respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus and oesophageal cancer, while females are to cerebrovascular disease. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts and evidence on the impact of interventions to be made available widely.

Gambling among college students can start as a pastime activity. However, this pastime can lead to problem gambling and pathological gambling. This cross-sectional study aimed to identify and explain gambling behavior among university students using a novel fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from a sample of 1,474 university students at a large southwestern university in the U.S. between January 2023 and February 2023, utilizing a validated 39-item survey. The statistical analyses employed in this study encompassed descriptive statistics, independent samples t-tests, and hierarchical regression modeling. Among students who engaged in gambling in the past month, the constructs of participatory dialogue (β = 0.052; p &lt; 0.05), behavioral confidence (β = 0.073; p &lt; 0.0001), and changes in the physical environment (β = 0.040; p = 0.0137) accounted for 27.7% of the variance in the likelihood of initiating the behavior change. Furthermore, the constructs of emotional transformation (β = 0.104; p = 0.0003) and practice for change (β = 0.060; p = 0.0368) accounted for 22.6% of the variance in the likelihood of sustaining quitting gambling behavior. The Multi-Theory Model (MTM) can be employed to design interventions aimed at reducing problem gambling among college students.

The SARS coronavirus 2 (SARS-CoV-2) is the causative agent of the 2019 coronavirus disease (COVID-19) pandemic that has executed 6.9 million people and infected over 765 million. It’s become a major worldwide health alarm and is also known to cause abnormalities in various systems, including the hematologic system. COVID-19 infection primarily affects the lower res-piratory tract and can lead to a cascade of events, including a cytokine storm, intravascular thrombosis, and subsequent complications such as arterial and venous thromboses. COVID-19 can cause thrombocytopenia, lymphopenia, and neutrophilia, which are associated with worse out-comes. Prophylactic anticoagulation is essential to prevent complication and death rate associated with the virus's effect on the coagulation system. It is crucial to recognize these complications early and promptly start therapeutic anticoagulation to improve patient outcomes. While rare, COVID-19-induced disseminated intravascular coagulation exhibits some similarities to DIC induced by sepsis. LDH, D-dimer, ferritin, and CRP biomarker are often increase in serious COVID-19 cases and poor prognosis. Understanding the pathophysiology of the disease and identifying risk factors for adverse outcomes is critical for effective management of COVID-19.

Rickettsia is an important pathogenic entity among tick-borne diseases (TBD), which are considered serious emerging public health problems globally. In India, though the widespread distribution of ticks and TBD has been documented, its real burden remains underreported. In a preliminary attempt, rickettsial surveillance was carried out in ticks collected from Sirumalai, Eastern Ghats in Tamil Nadu by using pathogen genome-based phylogenetic inferences generated through multi-locus sequence typing (MLST), targeting the genes 16s rRNA, OmpA, OmpB, and gltA by nested PCR. The laboratory evidence confirms the circulation of Rickettsia in Haemaphysalis intermedia species collected from this area. Analysis of the four gene sequences detected demonstrates their closest identity to the spotted fever group (SFG) available in the GenBank database. Further, multiple sequence alignment with other sequences derived from the GenBank database showed close relatedness to Rickettsia conorii subsp. raoultii (16s rDNA-99.32%, ompA-93.38%, ompB-97.39%, and gltA-98.57%) and Rickettsia felis (ompA-100%, ompB-100% and gltA-99.41%). With this genomic evidence, the circulation of rickettsial pathogens in the pools of H. intermedia ticks infesting livestock in the Sirumalai foothill area has been demonstrated and to complement the microscopic identification of the tick species, DNA barcodes were generated for H. intermedia using the mitochondrial cytochrome c oxidase subunit I gene (COI). Nevertheless, R. raoultii and R. felis were found to be the aetiological agents of tick-borne lymphadenopathy and flea-borne spotted fever in human cases, respectively. Further study on the determination of their diversity, distribution, clinical relevance, and potential risk to the local community in these areas is highly warranted.

This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed-methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders’ verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people’s experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals’ responses reinforced the poetry’s capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training.

Background: The mental state is important in the health/illness process. Including stress, depression and anxiety. Nature immersion therapies have been implemented as a valid method for reducing these disorders. The aim will evaluate the effect of forest intervention therapies on levels of stress, depression, and anxiety. Methods: We searched for randomized clinical trials related to stress, anxiety and depression levels. Risk of bias was assessed according to the guidelines of the Cochrane Handbook for International Systematic Reviews. Results: We identified and synthesized eight publications. Two studies for cortisol showed significant differences between the pre-test and post-test levels in the intervention groups. One study including Natural killer cells, that reported a significant decrease in the intervention group compared to the control group. Two studies used the Stress Response Inventory, indicated a significant reduction in stress levels in the intervention group compared to the control group. Regarding Restorative Out-come Scale, no significant differences were found. Three studies were selected for the evaluation of anxiety and depression levels according to the Positive and Negative Affect Schedule. Four studies used The Profile of Mood States scale; no significant difference was observed. Conclusions: There is limited evidence to recommend forest bathing for reducing these disorders.

Introduction: The COVID-19 pandemic overwhelmed health systems globally, and affected delivery of other health services. We conducted a study in Uganda to describe interventions for continuity of access to other health services. Methods: We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. Results: Governance strategies included establishment of coordination committees and development and dissemination of guidelines. Infrastructure and commodities strategies included review of drug supply plans and allowing emergency orders. Workforce strategies included provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma concerns. Conclusions: Health service maintenance during emergencies requires coordination to harness existing health system investments. The service continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic.

The sustainable development goals(SDG) of the UNO would be difficult to achieve without prevention of metabolic diseases and other non-communicable diseases (NCDs). Western diet and lifestyle, which are major risk factors of NCDs, are known to cause oxidative stress and decrease in production of molecular hydrogen in the intestines which leads to a decline in endogenous antioxidant status in the body, leading to increase in systemic inflammation. Many experts consider molecular hydrogen as a potential nutrient, which may be administered as gas in the body. There are gaps in the knowledge about the role molecular hydrogen plays, in the treatment of metabolic diseases and other NCDs This review aims to discuss the role of hydrogen in the pathogenesis and prevention of NCDs. Molecular hydrogen (H2) has been studied extensively as a therapeutic gas, with an estimated 2000 publications to date, exploring its potential therapeutic use in 170 disease models across every organ in the mammalian body. Hydrogen therapy can be administered through several methods, such as H2 inhalation, dissolving H2 gas in water to make hydrogen-rich water (HRW) for oral consumption or topical application, or hydrogen-rich saline. The exact mechanism of action of molecular hydrogen is not known but it is in itself a potential antioxidant that can also inhibit hydroxyl and nitrosyl radicals in the cells and tissues. Hydrogen is known to cause a marked decline in oxidative stress, and inflammation that are crucial in the pathogenesis of NCDs. Hydrogen therapy has been found protective against NCDs, including, metabolic diseases, cardiovascular diseases (CVDs), neurodegenerative diseases, chronic kidney disease, cancer and chronic lung diseases.

Rabies, caused by the rabies virus (RABV), remains a significant public health issue in the Philippines despite efforts to control it. To eliminate rabies by 2030, effective surveillance strategies are crucial. In this study, we examined RABV evolution and phylodynamics in the Davao Region using genome sequences from Davao City and nearby provinces. We adapted the RABV ARTIC Protocol for Oxford Nanopore High-Throughput Sequencing to optimize workflow efficiency under limited resources. Comparing new virus samples collected from June 2019 to June 2021 (n=38) with baseline samples from June 2018 to May 2019 (n=49), new sub-clades were observed in the phylogenetic tree, suggesting divergence from older variants that were previously undetected. Most of the new viruses belonged to the Asian SEA4_A1.1.1 lineage, but new (SEA4_B1 and SEA4_B1.1) and emerging (SEA4_B1.1_E1) lineages that have never been reported in the Philippines were also identified. The baseline study reported phylogeographic clustering of RABV isolates from the same areas. However, this pattern was disrupted in the current biosurveillance, with variants detected in areas outside the original cluster. Furthermore, our findings revealed significant transmission routes between Davao City and neighboring provinces, contrasting with the predominantly intra-city transmission observed in the baseline study. These results underscore the need for ongoing and timely genomic surveillance to monitor genetic diversity changes and the emergence of novel strains, as well as to track alterations in transmission pathways. Implementing cost-effective next generation sequencing workflows will facilitate the integration of genomic surveillance into rabies control programs, particularly in resource-limited settings. Collaborations between different sectors can empower local laboratories and experts in genomic technologies and analysis.

The coronavirus (COVID-19) pandemic limitations may negatively affect children and youth in terms of health behaviors, and it might be especially challenging for children who are diagnosed with neurodevelopmental disorders such as children and youth diagnosed with Autism Spectrum Disorder (ASD). The present study assessed alterations in physical activity, screen time, and sleep duration of ASD children and the prevalence of meeting the 24-hour movement guidelines during the COVID-19 outbreak. Forty-six Arab Israeli mothers of children with ASD were surveyed by an online cross-sectional survey. As reported by the mothers, the results show a significant decrease in physical activity, a significant increase in screen time, and a significant increase in sleep duration during the COVID-19 pandemic. Moreover, the proportion of the sample who gained the physical activity and screen time recommendations lessened while the percentage of children who met the sleep duration guidelines increased. The prevalence of ASD children who achieved the overall 24-hour movement guidelines was very small during the COVID-19 outbreak. The outcomes extend the body of knowledge regarding the negative effects of the COVID-19 pandemic on children diagnosed with neurodevelopmental disorders and highlight the need for instant healthcare and interventions and programs for children with ASD.

COVID-19, the fear it engendered, and the policy measures to manage its spread have disproportionately impacted the wellbeing of children and adolescents (CAs). We present an intensive critical realist case study of the impact of COVID-19 on the health and wellbeing of CAs in Rwanda, seeing it as much a social and political crisis as a medical and public health one. To do this, we carried out interviews with a purposive sample of 25 leaders with a working knowledge of children and young people; they were more likely than the CAs themselves to observe changes across the CA population within their remit and more likely to be looking for general explanations rather than individual experiences. The findings show that CAs' responses to the changes wrought on their lives by Covid-19 were conditioned by their age, gender, social class and if they lived in urban or rural areas. However, Covid19 has not just revealed the structural weakness of the Rwandan health system but of education, social protection, child protection, employment, family, and financial systems. The pathway to (adverse) impacts of COVID-19 on CAs is conditioned by these institutions and their interactions together with structural socioeconomic inequalities both within Rwanda and globally.

Coronavirus disease (COVID-19) has had devastating impacts on the global economy and public health. This study aimed to assess the level of COVID-19 vaccine acceptance, hesitancy, and associated factors among staff and students of the Federal University of Health Sciences Otukpo, Benue State, Nigeria. A web-based cross-sectional survey was conducted between November 2021 and April 2022, and data were collected and analyzed using descriptive and inferential statistics. Of the 150 completed and analyzed questionnaires, the majority of respondents (80.0%) were between 16 and 45 years old. The study found that 58.4% of participants indicated vaccine hesitancy, with skepticism about the vaccine's fast production/rollout and fear of vaccine side effects being the most common reasons for hesitation. Respondents' age, religion, and category were significant factors influencing vaccine acceptance and hesitancy (P < 0.05). The university community has a high level of awareness of COVID-19 but low vaccine acceptance, resulting in high levels of vaccine hesitancy. The study recommends that policymakers and public health officials should prioritize testing and vaccination for job categories with higher risk of exposure to COVID-19. They should provide accurate information about COVID-19 testing and vaccination and implement workplace-based testing and vaccination programs. These interventions can help to increase COVID-19 testing and vaccination uptake among the university community and mitigate the spread of COVID-19.

This article introduces existential wellbeing (EWB) as one of the most ignored but also the most important kind of wellbeing, especially for people who experience life-limiting diseases and need palliative care (Wong & Yu, 2021). This article will not only review the literature regarding the nature and practice of existential wellbeing in palliative care, but also propose a preliminary Existential Wellbeing Scale. EWB is defined as the quality-of-life characterized by living well and dying well in spite of pain, obstacles, and the shadow of death; wellbeing within the context of human suffering can only be fully understood from the perspective of existential positive psychology (EPP), dedicated to the study of sustainable wellbeing based on the foundation of transcending suffering. The basic tenets of EPP are (1) redefining positivity or wellbeing in terms of seeing and being the light in the darkness; (2) focusing on the dialectical process of navigating an adaptive balance; and (3) re-orienting one’s life attitude from egotism to self-transcendence (Wong, 2023a). More specifically, EWB depends on some combination of the following experiences: (1) Prior experience of overcoming adversity; (2) Existential intelligence (Gardner, 2020) in addressing existential concerns; (3) Existential wisdom of the soul (Wong 2022a; Wong, Ho, et al, 2023a) to achieve existential wellbeing and sustainable flourishing; (4) Spiritual wellbeing based on spiritual values such as faith, hope, and love (Wong, 2023); (5) Knowledge of meaning-focused coping (Eisenbeck et al., 2021); and (6) The new paradigm of self-transcendence (Reed & Haugan, 2021; Wong, Arslan et al., 2021; Wong, Ho et al., 2023b) to transcend and transform suffering into wellbeing and triumph.

Chronic diseases such as childhood DM are a complex and continuous struggle as well as a great challenge both for the children who face the disease and for their parents. Type 1 DM is characterized by the complex management of the therapeutic treatment thus causing physical and psychological complications in family members. There are many families who, upon hearing the diagnosis of their child with DM, stand still in front of these new facts as their lives change. All these unprecedented conditions cause parents intense stress, discomfort and mental burden as the only thing that concerns them now is how the family will survive in the face of the current conditions they are experiencing as well as the future of the sick child. The purpose of this brief literature review is to present the research findings which are related to the quality of life among parents of children and adolescents with diabetes.

In this particular historical moment, the increase in mortality for cardiovascular disease in adults, the increase of metabolic diseases linked to overweight and obesity, it is necessary to focus the attention of medical doctors, researchers and policy makers on the promotion of correct lifestyles and prevention. The "prevention" and "cure or treatment" have long been considered distinct strategies, the almost exclusive prerogative of the public health authorities for the preventive aspects and of the clinician for the treatments. This approach has led, and still leads, to very high healthcare costs, without having a significant impact on obesity incidence. The promotion of correct lifestyles in the population and in subjects at risk in the fight against obesity/overweight, to contrast the reduction of physical activity and sedentary lifestyle, to promote the consumption of fruit and vegetables, to the reduction of the excessive consumption of salt as "Strategic lines of intervention" need to be pursued in all western countries. Actually, the preventive actions undertaken were not very effective, especially for the individuals in pediatric age. In this narrative review, based on published data, the critical points for obesity prevention will be discussed focusing on action needed during life from pre-conception to childhood, adulthood and in geriatric age to contrast obesity.

Background: Recently the role of nutraceutical compounds in the prevention of human diseases is rapidly increasing. Here, we aim to evaluate the beneficial effect of dietary supplementation with seven active principles, lycopene, sulphoraphane, silymarin, glutathione, escin, tryptophan, green tea catechins, on human health. Methods: An extensive search of PubMed and Medline database was performed with the following keywords: “silymarin”, “sulforaphane”, “lycopene”, “green tea catechins”, “tryptophan”, “glutathione” and “escin” accompanied by the keywords “supplement”, “supplementation”, “nutraceutics”. All pre-clinical and clinical trials have been considered for this review. Results: One-hundred and eighteen full-text articles were eligible for inclusion in this review. The papers examined presented considerable variability due to the wide heterogeneity of dosages administered, population involved and outcomes pursued. Conclusion: Nutritional supplementation with lycopene, sulphoraphane, silymarin, glutathione, escin, tryptophan and green tea catechins appears to exert a wide range of benefits on human health, ranging from mood and cognition to cardiovascular health, fertility, metabolism, antioxidant and anti-inflammatory capabilities, potential anti-cancer effects. Further studies are required to better define the potential synergic effect, optimal dosage, mechanism of action and tolerability profile of these substances.

Objectives: COVID-19 pandemic interrupted the Spanish professional football competition until May 2020, when it was restarted following a surveillance protocol established by LaLiga. The aims were to describe the infective and serological status of professional football players (PLY) and staff (STF) between May 5th 2020 until April 22nd 2021, to analyze the spatial-temporal distribution of the COVID-19 disease in this cohort and its comparison to the Spanish population. Methods: a prospective observational cohort study was carried out. Differences between PLY and STF were assessed by Chi-squared test and test of equality of proportions. Pearson correlation test was used to measure the presence of an association between the percentages of positivity in population and LaLiga cohort. Results: 137,420 RT-PCR and 20,376 IgG serology tests were performed in 7,112 professionals. Positive baseline serology was detected in 10.57% of PLY and 6.38% of STF. Among those who started the follow-up as not infected and before STF vaccination, 11.87% of PLY and 5.03% of STF became positive. Before summer 2020 the prevalence of infection was similar than the observed at national level. The percentage of positivity in the Spanish population was higher than in LaLiga cohort, but both series showed a similar decreasing trend.

The objective of this quantitative study was to examine the impact of selected factors on the level and state of public health in local self-government units in 2021, with the consideration of data from 2020 and 2019. This survey included 77 out of 145 local self-government units in the Republic of Serbia and examined six dimensions defined by the Law on Public Health: social care for the public health of the city/municipality in regard to the physical, mental, and social health of the population; health promotion and disease prevention; the environment and health; working environments and population health; the organization and functioning of the health system; and actions in emergency situations. The results of the Pearson correlation showed that there were statistically significant correlations between the effectiveness of the realized program budget and microbiologically defective drinking water samples from the so-called village water supply systems, defective samples of drinking water from public taps, unsatisfactory analyses of wastewater samples, the total number of air samples on an annual level for PM25s, and the number of mandated fines issued. The results of the logistic regression model showed that the local self-government units that received assistance from the Permanent Conference of Cities and Municipalities were 5.6 times more likely to perform analyses of their health status. Furthermore, we determined that the units of local self-governments that appointed a coordinator of the health council identified vulnerable groups in the analysis of the state of health four and a half times more often. In contrast, the units of local self-governments that prepared health status analyses could be used to identify vulnerable groups to a six times greater extent within the framework of the health status analysis. The results showed that in improving the state of public health at the local level, it is necessary to provide systematic institutional support to cities and municipalities in exercising their responsibilities. Based on these results, recommendations were made for the further development of support, i.e., the planning of further activities aimed at strengthening the capacity of the health councils and local self-government units in this area.

Abstract: Educating healthcare workers (HCWs) to take action against monkeypox (mpox) is an important part of public health prevention efforts. The study aimed to assess the knowledge, attitudes, and willingness to vaccinate against mpox among HCWs in the Kurdistan Region of Iraq. This study utilized an online cross-sectional survey that was disseminated via Google Forms between November, 1, 2022 and January, 15, 2023, employing a convenience sampling method. The researchers utilized logistic regression to ascertain the factors associated with knowledge, attitude and willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years old). The mean overall score and standard deviation of the knowledge, attitude, and willingness assessment on mpox were 8.18±3.37 out of (0–16), 3.40±1.37 out of (0–5), 2.41±1.25 out of (0–5), respectively. The multivariate logistic regression analysis showed that HCWs who heard about mpox before 2022 had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had less than 1 year of practice had a positive attitude about mpox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01). Finally, none of the variable groups had the capacity to predict willingness to be vaccinated against mpox. The research revealed that HCWs exhibit a relatively low level of knowledge and attitude towards mpox, as well as a low level of willingness to receive mpox vaccinations. Further, there is an urgent need to increase their knowledge and attitude, as the success of efforts to control the global epidemic depends on them.

Good health and the promotion of well-being for all is the third of the 17 Global Goals included in the 2030 Agenda for Sustainable Development. Contributing to this goal, the current study aimed to examine the relationships between one kind of athletes’ well-being, namely state organic self-talk, with personality traits, and basic psychological need satisfaction and frustration within their sport. Athletes (N = 691; mean age 21.65) from a variety of individual (n = 270) and team sports (n = 421) completed a multisection questionnaire capturing the targeted variables. Three-step hierarchical regression analyses revealed that: In step 1, all personality traits were to some extent a significant predictor of athletes’ organic, spontaneous self-talk dimensions and goal-directed self-talk functions. In step 2, need satisfaction significantly contributed to all spontaneous self-talk dimensions and goal-directed self-talk functions (except for creating functional deactivated states) over and above personality. Finally, in step 3, need frustration significantly contributed to negative spontaneous self-talk dimensions, and to all goal-directed self-talk functions (except for instruction) over and above personality and need satisfaction. Overall, our results indicate the importance of personality traits as personal antecedents, and perceptions of basic psychological need satisfaction and frustration as social-environmental antecedents, in shaping athletes’ state organic self-talk.

One of the models that could be used to understand the adoption of vaccine uptake is the Health Belief Model (HBM). The aim of this study is to assess the role of HBM constructs and perceived health status (PHS) on vaccination status of individuals and to understand the role of socio-demographic variables on HBM scoring. A comparative cross-sectional telephone survey was conducted among 1,325 vaccinated (60.0%) and non-vaccinated (40.0%) vaccinated individuals aged 40 years and above in July 2021 in Punjab province, Pakistan. A higher level of education was the strongest predictor of positive HBM. All constructs of HBM, PHS and cues-to-action were significant predictors of COVID-19 vaccination uptake with perceived benefits as the strongest predictor. In order to expand the vaccination coverage, doubled pronged interventions utilizing both ICT and human resources should be designed that address each barrier perceived by individuals and understandably communicate the benefits of COVID-19 vaccine to the broader population.

The COVID-19 pandemic, which has affected the entire world, has not only created a number of emerging issues for each country, especially in the field of public health, but has also provided a number of opportunities for risk management, alternative strategies and completely new ways of looking at challenges. This paper examines the COVID-19 pandemic response in Türkiye and the possible implications of the experience for future responses to other health emergencies and disaster risk management, based on the lessons learned. This study uses publicly available literature from government, private sector, and academic sources to analyse the conflicts, changes and lessons learned during the COVID-19 pandemic, which are components of the World Health Organization (WHO) Health Emergency and Disaster Risk Management (Health EDRM) framework. The COVID-19 experience in Türkiye has several aspects, including the significant role of healthcare workers, the existence of an effective health system accustomed to emergencies, applications based on information technologies, partial transparency of public authorities in providing information, and socio-cultural environment related to cooperation on prevention strategies, including wearing masks and vaccination. Challenges in Türkiye include distance learning in schools, lockdowns that particularly affect the elderly, ensuring environmental sustainability, hesitation about the effectiveness of social/financial support programmes, socio-cultural trivialisation of pandemics after a while, and relaxation of prevention strategies. Lessons learned from the COVID-19 pandemic include the value of transparency in public health/healthcare information, the strengthening of all aspects of the health system in terms of health workers, and the importance of a balanced economy prepared for foreseeable risks.

Deficiencies of vitamin B12 (B12) and folate (FA) are of particular interest due to their pleiotropic role in 1-carbon metabolism. In addition to adverse birth outcomes, deficiencies of B12 and FA, or an imbalance in FA/B12 status, are linked to metabolic disorders. Indian diets that are predominantly plant food-based could be deficient in these vitamins, but there are no national estimates of the prevalence of B12 and FA deficiency in Indian children and adolescents, nor of their associations with age, sex, and growth indicators. The recent Comprehensive National Nutrition Survey (CNNS-2016-18) provided estimates of the prevalence of B12 and FA deficiency at the national and state level among preschool (1-4y: 9,976 and 11,004 children respectively), school-age children (5-9y: 12,156 and 14,125) and adolescents (10-19y: 11,748 and 13,621). Serum B12 and erythrocyte FA were measured by the direct chemiluminescence method and their deficiency was defined using WHO cut-offs. The prevalence of B12 and FA deficiency was high among adolescents (31.0%, CI: 28.7-33.5 and 35.6%, CI: 33.1-8.2), compared to school-age (17.3%, CI: 15.4-19.3 and 27.6%, CI: 25.5-29.9) and preschool children (13.8%, CI: 11.7-16.2 and 22.8%, CI: 20.5-25.2, respectively). The prevalence of both B12 and FA deficiency was significantly higher by 8 and 5% points respectively, in adolescent boys compared to girls. The prevalence of B12 deficiency was higher in moderately stunted school children (by 18.9% points) than in normal children, but no such difference was observed for FA deficiency. There was wide regional variation in the prevalence of B12 and FA deficiency, but no rural-urban differences were observed across all age groups. The national prevalence of B12 deficiency among preschool or school-age children was <20% (the cut-off that indicates a public health problem). However, FA deficiency in these age groups and both FA and B12 deficiencies in adolescents were >20%, which warrants further investigation.

Introduction: Interest in infection prevention in healthcare facilities has been renewed with the advent of the COVID – 19 pandemic. Accidental exposures to body fluids occurs under work environments that do not meet occupational safety standards. The aim of the present study was to assess the level of observance of standard precautions including adherence to required vaccinations to prevent healthcare related infections. Methods: A cross sectional descriptive study was carried out from January to April 2022 in six District Hospitals in Yaounde. An auto-administered questionnaire was addressed to consenting healthcare workers. Data were analysed using R statistic version 4.2.3. A p-value < 5% was considered significant. Results: Out of a total of 217 HCW who were enrolled, nearly a quarter (17%) claimed to wash the scalpel blades for reuse. More than half of the participants (53.5%) did not wash their hands after each care. Reasons for not washing hands after each procedure were the perception that the patient care for was risk free (36 %), high workload (35.3 %), distant washing point (20 %). Almost half of HCW (46,5%) experienced a splash during the last 12 month. PPE were always available for only 43.56% of participants. Immunization coverage for COVID-19 was low 44.8 %. Poor vaccine compliance was related to doubts on vaccine content (42 %) and fear of adverse events (39.3 %). Conclusion: Strategies should be implemented to alleviate the AEB burden among healthcare workers and increase compliance with COVID-19 and other vaccines required for healthcare practice.

Abstract. Background: COVID-19's first victim was announced by Chinese health authorities on the 11th of January 2020. On January 13, the first official case was reported outside China, in Thailand. On January 25, the same occurred in São Paulo and on March 8, the first case was recorded in Minas Gerais. From that point onwards until the 3rd of October 2020, a total of 370,911 cases and 9,204 deaths were recorded in the state. This study aims to investigate spatiotemporal patterns of COVID-19 with incidence from March 22 to October 3 of 2020. Methods: The database itself was obtained from Health Division of Minas Gerais state. The vulnerability index was calculated using a principal component analysis. Moran's I autocorrelation was tested, z-score and P-value < 0.05. Results: From March 22 to October 3 of 2020 the incidence level varied from 45.680/100,000 to 312.130/100,000. The most influential variables were: illiteracy, gross domestic product and breath apparel per municipality. The clusters were concentrated in the metropolitan area of Belo Horizonte, Zona da Mata and Triangulo Mineiro. Conclusion: The spatial distribution of COVID-19 from week 13 until week 40 showed that different levels of endemicity and mesoregional vulnerabilities were represented in these maps.

Higher salt (sodium) intake has been associated with a higher blood pressure (BP). The association degree may be influenced by factors such as age, origin and dietary components. This study aimed to evaluate the 24-hours urinary sodium (Na) and potassium (K) excretion in normotensive and hypertensive Dominicans adults and estimate their salt intake. 163 volunteers (18-45, 46-80 years) participated in a cross-sectional study. 24-hours Na and K urinary excretion were measured using an ion selective electrode technique. Na and K urinary excretion (99.4±46.5 and 35.0±17.5 mmol/24h) did not correlated with BP, except in the normotensive group in which K correlated with SBP (0.249, p=0.019). Na and K excretion were similar for normo- and hypertensive subjects. Na-to-K molar ratio (3.1±1.3) was higher in younger subjects (p=0.040). Na-to-K ratio was associated with DBP in the total group (r=0.153, p=0.052), in the hypertensive group (r=0.395, p<0.001) and in the older group with SBP (0.350, p=0.002) and DBP (0.373, p<0.001). In the older group, Na-to-K ratio and DBP correlated after controlling for subjects with hypertension controlled by treatment (r=0.236, p=0.041). The Na-to-K ratio correlated, when salt intake was over 5g/d (52.2%), with SBP (rho=0.219, p=0.044) and DBP (rho=0.259, p=0.017). Determinants of BP were age-dependent and in younger subjects were: sex (SBP, beta: 14.02±2.87, p<0.001) and body mass index (BMI) (beta:-12.07±3.72, p=0.001, beta:9.44±2.87, p=0.001, for SBP and DBP, respectively) and, in the olders, the Na-to-K ratio, for SBP (beta:6.7±2.4, p=0.005) and DBP (beta:3.8±1.1, p<0.001). The mean Na and salt intakes (2.3 and 5.8 g/d) were slightly higher and K intake lower (1.4 g/d) than WHO recommendations.

Pakistan is one of the few countries where poliovirus transmission still persists, despite intensive efforts to eradicate the disease. Adequate vaccination coverage is essential to achieve polio eradication, but misconceptions about polio vaccines have hindered vaccination efforts. To address this issue, we conducted a mixed-methods study to explore knowledge and perceptions regarding polio disease and immunization in high-risk areas of Pakistan. We collected quantitative data from 3780, 1258, and 2100 households in Karachi, Bajaur, and Pishin, respectively, and supplemented this with qualitative data from focus group discussions and in-depth interviews. Our findings reveal a high level of awareness about polio and its immunization; however, misperceptions about the polio vaccine persist, leading to vaccine refusal for both polio and routine immunization. Our study provides up-to-date data on knowledge and perceptions of polio and its immunization and identifies critical gaps. These findings can inform the development of future strategies and innovative approaches to improve the success of the polio program in Pakistan.

Antibiotics are the most magnificent discovery of 20th century that have saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years. The transmission and acquisition of AMR occur primarily via human–human interface both within and outside of the healthcare facilities. A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug resistance mechanisms. The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor. The prevalence of AMR bacteria has attained its incongruous level worldwide and threatening global public health as silent pandemic, necessitating urgent intervention. Therapeutic options of AMR bacterial infections are limited resulting in significant morbidity and mortality with high financial impact. The paucity in discovery and supply of new novel antimicrobials to treat life-threatening AMR infections stands in sharp contrast to demand. Immediate interventions to contain AMR include surveillance and monitoring, minimizing over the counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of legislation. An orchestral collaborative action within and between multiple national and international organizations are required urgently, otherwise, a post-antibiotic era can be a real possibility than an apocalyptic fantasy for the 21st century. This narrative review highlights on the basis, mechanisms and factors in microbial resistance and key strategies to combat antimicrobial resistance.

The Romani are the main European ethnic minority. The Romani people’s situation of social vulnerability and their difficulties in accessing the health system, make their health indicators worse than those of the non-Romani population. The present study will delve into the health beliefs and experiences with health services and their professionals through the perspectives of Romani women. In this qualitative study, 16 women of different ages were interviewed in a city located in the South of Spain. Four themes emerged from the analysis of data: the construction of the identity of Romani women, difficulties in life, health and disease beliefs and barriers in the access to the health system. We conclude that every project for the improvement of the health of the Romani community must take into account the active participation of Romani women and must consider the principles of Cultural Safety, by delving into the intercultural training of health professionals and addressing the social determinants of health which affect the Romani collective.

Background: Vaccine hesitancy was one of India's problems after the COVID-19 vaccine roll-out. Earlier studies carried out to understand people's perception of the vaccine were mainly based on online or offline community-based surveys. These studies do not help to understand the actions taken by people towards vaccination. Hence, this study has been designed to understand the exact behavior of people toward the vaccine. Methods: Age-wise, the population was sub-grouped into three groups, above 18 years, 12-14 years, and 15-18 years. The data analysis has been done using cumulative coverage of vaccines in the said age groups. Results: The study shows a substantial population has missed second and booster doses of vaccine at the state, regional, and national levels in all three age groups. Even for the states that have shown the smallest number of people who missed their dose, their number is in the thousands. Conclusion: Further research is needed to know, in total population, how many people have not even taken a single dose of vaccine. Policy-level efforts are needed to cover the entire population of the country for at least a single dose and vulnerable populations, for additional booster doses after primary doses.

During virus outbreaks in the recent past web behavior mining, modeling, and analysis have served as means to examine, explore, interpret, assess, and forecast the worldwide perception, readiness, reactions, and response linked to these virus outbreaks. The recent outbreak of the Marburg Virus disease (MVD), the high fatality rate of MVD, and the conspiracy theory linking the FEMA alert signal in the United States on October 4, 2023, with MVD and a zombie outbreak, resulted in a diverse range of reactions in the general public which has transpired in a surge in web behavior in this context. This resulted in “Marburg Virus” featuring in the list of the top trending topics on Twitter on October 3, 2023, and “Emergency Alert System” and “Zombie” featuring in the list of top trending topics on Twitter on October 4, 2023. No prior work in this field has mined and analyzed the emerging trends in web behavior in this context. The work presented in this paper aims to address this research gap and makes multiple scientific contributions to this field. First, it presents the results of performing time series forecasting of the search interests related to MVD emerging from 216 different regions on a global scale using ARIMA, LSTM, and Autocorrelation. The results of this analysis present the optimal model for forecasting web behavior related to MVD in each of these regions. Second, the correlation between search interests related to MVD and search interests related to zombies (in the context of this conspiracy theory) was investigated. The findings show that there were several regions where there was a statistically significant correlation between MVD-related searches and zombie-related searches (in the context of this conspiracy theory) on Google on October 4, 2023. Finally, the correlation between zombie-related searches (in the context of this conspiracy theory) in the United States and other regions was investigated. This analysis helped to identify those regions where this correlation was statistically significant.

New information suggests female autistic spectrum disorder (ASD) is much more common than previously thought, with a likely prevalence of 6% and with 80% undiagnosed at the age of 18. ASD then becomes a common comorbidity of female mental illness with nearly one in five women who develop a mental illness being autistic. ASD has heretofore been regarded as a pediatric condition and though now thought to be life long it is still not well recognized by adult health services. Most mental illness first presents in the teens and early twenties. Comorbid ASD is more difficult to diagnose due to diagnostic overshadowing, and ASD comorbidity maks the mental illness more severe and mor difficult to treat. Recognized ASD is readily treatable with an approach sympathetic to neurodiversity. Improving the pathway from adolescence to adulthood by increasing knowledge of autism in adult health services would dramatically improve female mental health at surprisingly little extra cost. It is low hanging fruit in a very fraught area of healthcare. This paper will examine the extent of the problem. It will explore solutions and quantify the gains of appropriate therapy.

This comprehensive review examines the critical issue of antimicrobial resistance (AMR), a growing global concern with profound societal implications. This article presents an overview of the causes of AMR, including the misuse and overuse of antibiotics in healthcare, agriculture, and veterinary practices. Various conventional and advanced detection methodologies have been explored, highlighting the importance of the accurate and timely identification of resistant strains. The challenges associated with tackling AMR, encompassing scientific, economic, and regulatory aspects have been discussed in depth. In addition, this article sheds light on the far-reaching societal implications of AMR, including increased healthcare costs, treatment complexities, and potential disruptions to healthcare systems. This emphasizes the urgency of adopting proactive strategies to combat AMR and underscores the need for global cooperation, policy interventions and public awareness campaigns. By unraveling the multifaceted dimensions of AMR, this review aims to enhance our understanding, stimulate further research, and promote concerted efforts to mitigate the threat of antimicrobial resistance.

Poor medication adherence among older adults is a widespread problem worldwide. As the population ages, the design of smartphone medication management apps is critical to improving medication adherence among older adults. Taking the design of an elderly medication reminder APP as an example, this study proposes a sustainable design research method that integrates the KANO model, Analytic Hierarchy Process (AHP), Quality Function Deployment (QFD), and PUGH decision matrix. The method collects user demands through in-depth interviews, and applies the KANO model to classify these demands. The hierarchical structure of user needs is established by using AHP, and the priority is sorted according to the weight and importance determined by the judgment matrix. QFD is used to translate user needs into design requirements, and the house of quality matrix identifies key design requirements. Finally, design alternatives are evaluated using Pugh's concept selection method. The results of this study demonstrate that the integration of KANO-AHP-QFD-PUGH can be effective as a sustainable optimal design approach for the user experience of a medication reminder application for the elderly. This integrated method not only facilitates innovative optimization and sustainability of application design methods but also provides valuable theoretical and practical insights for future drug-assisted design for elderly users.

Healthcare workers (HCWs) are regarded as role models regarding health-related issues including vaccination. Therefore, it is essential to identify the predictors for COVID-19 vaccine acceptance among them. A cross-sectional study to assess the risk perception, attitudes and knowledge of HCWs toward COVID-19 vaccination was carried out. A total of 710 responses were received between September 2021 to March 2022, from HCWs in the Northern, Western and Eastern regions of Nigeria. Cross tabulations were performed to determine statistical relations between sociodemographic variables, knowledge, attitudes and risk perceptions concerning COVID-19 vaccine acceptance. Multinomial Logistic Regression analysis was performed to determine the predictive variables for COVID-19 vaccine acceptance. Statistical analyses were performed and P-values less than 0.05 were considered statistically significant at a CI of 95%. Results showed that 59.3% of the participants were amenable to COVID-19 vaccines. Multinomial regression analysis identified 14 variables at α <0.05 as predictors for vaccine acceptance. Male HCWs were 2.8 times more likely to accept the vaccine than their female counterparts. HCWs that were knowledgeable of the different kinds of vaccines, willing to recommend the vaccines to their patients, believe that the timing of COVID-19 vaccination was appropriate and had recent vaccination history within three years were 1.6, 24.9, 4.4 and 3.1 times more likely to take COVID-19 vaccine than those not sure. The study found a relatively high trust (51.3%) in the Nigerian Center for Disease Control (NCDC) for information regarding COVID-19 vaccines. Therefore, the NDCD should disseminate more robust insights regarding the safety profiles of various COVID-19 vaccines.

Background Globally the average age of the worlds’ population of older persons continues to upsurge and social support becomes increasingly relevant. Overall, in Malaysia, social support and networking prevalence was found to be lower among older persons at 30.76%. In view of the scarce data on social support and its association with smoking status and its associated factors among the older Malaysian population this study was conducted. Methods Data from the National Health and Morbidity (NHMS) 2018 survey on health of older Malaysian adults was analyzed. This was a cross sectional population-based study using a two-stage stratified random sampling design. Elderly population aged 60 years and above was selected. Data were collected were sociodemographic characteristics, smoking status, and social support. A validated Malay language, interviewer-administered questionnaire of 11-item Duke Social Support Index was applied for assessing social support among the elderly. A complex sampling design analysis was used for the descriptive statistics. The associated risk factors for social support were identified using Multiple Logistic Regression analysis. Results A total of 3923 elderly respondents participated in the study. The prevalence of good social support was significantly higher among the 60-69 years old respondents compared to the > 80 years old (73.1%, 95% CI :69.3% -76.5% vs 50.1 %, 95% CI:41.7 %- 58.6%).Multivariate logistic regression analysis showed that the odds of poor social support were 1.7 times (aOR: 1.72 % ,95%CI: 1.19 -2.48) higher for the respondents aged > 80 years old, than those aged 60-69 years. Respondents with no formal education were 1.93 higher odds of poor social support than the respondents with tertiary education (aOR: 1.93%, 95%CI: 1.13,3.30). Respondents with income < RM 1000 were 1.94 times more likely to have poor social support compared to respondents with income > RM 3000 (aOR: 1.94, 95% CI : 1.21 -3.13). Former smokers have good social support compared to current smokers (73.6% ,95% CI: 67.7-78.7 vs 65.1 %, 95%CI:58.4 -71.2). For current smokers, the odds of poor social support were 42.0% higher than for non-smokers (aOR: 1.42, 95% CI: 1.05 -1.91. Conclusion There is poor social support among the older persons who are current smokers, advancing age, no formal education and low income However, further longitudinal studies are needed to determine the exact effects of the studied variables. These findings could assist the policymakers to develop strategies at the national level to enhance social support among the older smokers to ensure cessation of smoking.

Alzheimer's disease is a neurological illness that worsens gradually. It is known as the most frequent cause of dementia. Moreover, Alzheimer's disease is a general term for memory loss and other cognitive impairments severe enough to disrupt daily life. The disease often grows in middle-aged and elderly people with the gradual loss of cognitive ability. Since the diagnosis of the illness is time consuming, a novel machine learning approach is proposed in this research to diagnose Alzheimer's levels based on Magnetic Resonance Imaging (MRI). More specifically, to provide distinct information for classification we have implemented the proposed method on a native MRI scans dataset containing three MRI channels; namely T1, T2, and, T2 tirm, which are shown in red, blue and green, respectively. The five middle layers of these three types of MRI scans are combined to form five RGB layers. In addition, we use a Convolutional Neural Network to classify each composed layer, and the final disease type is predicted using majority voting. finally, the F1-Score has been used to assess method performance, indicated that 92% of predictions of the proposed model were accurate.

(1) Background: This study aimed to explore how prolonged mask use during the COVID-19 pandemic affected appearance anxiety; (2) Methods: It implemented a quantitative–qualitative mixed-research approach based on a convenience sample of young people in Taiwan; (3) Results: A total of 1,118 participants completed the online questionnaire. A total of 49 participants reached the 55-point threshold of Appearance Anxiety Scale. Higher score of appearance anxiety was correlated to higher state anxiety statistically (r = 0.4, p < 0.001). Ten participants were interviewed and qualitative content analysis revealed 5 main themes and 16 subthemes. Three of the main themes were related to the positive effects of wearing masks for pandemic prevention and reducing appearance anxiety: “Wearing masks indicates compliance with the epidemic prevention requirement,” “Wearing masks functions as protection against lack of confidence in appearance,” and “Wearing masks helps mitigate the fear of being judged by others.” The remaining two “Wearing masks shifts attention from appearance to figure” and “Prolonged mask wearing exacerbates the anxiety about taking it off” were related to the impacts of long-term mask use; (4) Conclusions: results enhance understanding of negative emotional experiences and anxiety related to physical appearance.

Background：Increasingly, epidemiological surveys and experimental research findings indicate the involvement of immune cells in the onset and progression of prostate cancer. However, it remains unclear whether the relationship between specific immune cell types and prostate cancer is causal or influenced by bias. Through a two-sample Mendelian randomization design, our study aims to uncover the association between different immune cells and the risk of prostate cancer.Methods：A comprehensive study was conducted to investigate the association between immunophenotypes and prostate cancer risk. The study included a total of 731 immunophenotypes as potential exposure factors and analyzed data from 182,625 individuals of European ancestry from the UK Biobank. A screening of 12,097,504 single nucleotide polymorphisms (SNPs) was performed. The main analysis utilized the two-sample Mendelian randomization method with inverse variance weighting (IVW). Additionally, multiple analysis methods were combined, and various tests were conducted to assess heterogeneity and pleiotropy.Results：The resulting study showed a causal relationship between a total of 34 immune phenotypes and prostate cancer. Among them, the four immune phenotypes of CD62L- DC AC, CD19 on sw mem, FSC-A on plasmacytoid DC and HLA DR on monocyte simultaneously meet three or more statistical methods, suggesting a significant causal relationship with prostate cancer. Additionally, among the 34 immunophenotypes, CD28-CD8dim AC was shown to be positive in reverse Mendelian randomization. Most of these cell phenotypes have been reported to be potentially associated with prostate cancer.Conclusions：Our study demonstrates a causal link between immune cells and prostate cancer risk. Filled in the possible roles of all current immune cell pathways in the development and progression of prostate cancer. The next step is to verify the content and influencing mechanism of these immune phenotypes in cancer cells and adjacent cells through experiments, so as to provide new ideas and methods for the prevention and treatment of prostate cancer.

Globally 703 000 people commit suicide (4th leading cause of mortality among 15-29 year-olds, 1.4% of all deaths globally) every year, which have a negative effect on families, colleagues, and societies. India accounts for 36.6 percent of global suicide in women and 24.3 percent among men, while having only 17.8 percent of the global population, also remarkable fact is that the suicide ratio for female is 14.7 per 100,000 compared to 21.2 per 100,000 of male which is 2.1 times the global average in female, while 1.4 times higher for men. COVID-19 (coronavirus disease-2019) pandemic has certainly affected the physical, mental, economical and social well being of global population directly or indirectly in different ways. Deteriorating physical, mental, economical and social health of an individual could increase the suicidal tendency, leading to accidents and suicide. This study tried to find out the COVID-19 pandemic situation impact on accidental death as well as suicide rates in India. The study period is from 1st January 1967 to 31st December 2021, to assess the effect of the COVID-19 pandemic situation on suicide and accidental death rates. This study revealed that the suicide deaths percentage among males increased significantly in comparison to females in COVID-19 era and actual count and incidence also increased. This study revealed that the mean accidental death and suicide both increased during COVID period of study as compared to pre-pandemic whole period from 1967 by 25.47 % and 30.61% respectively. Alternatively we can say that the accidental death and suicides increased significantly in India, which is largely preventable.

Is it possible that the addition of wild-growing flowers with anti-inflammatory applications can improve the antioxidant properties of rapeseed and multifloral honey? The study objective was a comparative analysis of two honey varieties enriched by flowers of six plant species, based on the content of the antioxidant capacity as well as total flavonoids and phenolic content. Experiments demonstrated that at each level of enrichment there was an improvement in antioxidant properties compared to honey of both varieties without additives, especially in the case of dried flowers. Primula veris L. and Pulmonaria officinalis L. improved the antioxidant properties and phenolic content most effectively in honey at all levels of enrichment. Rapeseed-type honey produces a better matrix for the incorporation of natural plant metabolites into honey. The content of biologically active substances in honey enriched with flowers gives hope for new applications of health-promoting substances contained in wild plants.

Qatar experienced five SARS-CoV-2 waves dominated sequentially by the original virus, Alpha, Beta, Omicron BA.1 and BA.2, and Omicron BA.4 and BA.5, in addition to a prolonged low-incidence phase dominated by the Delta variant. The two-dose primary series of BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine against SARS-CoV-2 infection has been approved for use in 10µg formulations among children and adolescents aged 12-17 years as of May 16, 2021. This study aimed at estimating the effectiveness of the 30µg BNT162b2 Pfizer-BioNTech mRNA COVID-19 vaccine against the pre-Omicron variants of SARS-CoV-2 infection in children and adolescents aged 12-17 years residing in Qatar. A test-negative matched case-control study was conducted where any child or adolescent aged 12-17 years who had been tested for SARS-CoV-2, RT-PCR tests performed on nasopharyngeal or oropharyngeal swabs, as part of contact tracing, between June and November 2021 and eligible to receive the BNT162b2 vaccine as per the national guidelines. Data regarding 14,161 children/adolescents meeting inclusion-exclusion criteria were retrieved from the national Surveillance and Vaccine Electronic System (SAVES). Of the total, 3.1% (444) were positive for SARSCoV-2. More than half (55.96%) were vaccinated with two doses of Pfizer-BioNTech-mRNA COVID-19 vaccine. Amongst those immunized with two doses, 1.2% tested positive for SARS CoV2, while 5.6% amongst the unvaccinated tested positive. The vaccine effectiveness was calculated to be 79%. Pfizer-BioNTech mRNA COVID-19 vaccine provides protection from COVID-19 infection for children/adolescents, hence it is crucial to ensure they receive the recommended vaccines.

Concerns have been made about how children's health and psychology could be hurt by the growing number of mobile apps they use. This abstract looks at intervention methods and best practices for getting kids to use mobile apps in a healthy way, find a balance with technology, and build up their resilience. Key points include promoting digital literacy and critical thinking, setting clear boundaries and rules, encouraging digital balance, modeling healthy tech habits, building resilience and coping skills, encouraging face-to-face communication, setting up tech-free times and spaces, monitoring app usage and content, promoting mindfulness and self-reflection, and getting professional help when needed. By using these tactics, parents, teachers, and other caretakers can help kids build a healthy relationship with technology, live a balanced life, and build the resilience they need to handle the challenges of the digital world. The goal of these interventions is to make sure that kids' app use is good for their general health, helps them learn and get along with others, and sets them up for long-term success in the digital age.

We studied the weekly number and the growth/decline rates of COVID-19 deaths in the period October 31, 2022 – February 9, 2023, in Italy, finding that that COVID-19 winter wave reached its peak during the three holyday weeks extending from December 16, 2022 to January 5, 2023, and it was definitely trending downward, returning to the same number of deaths of the end of October 2022, in the week February 3 – 9, 2023. During this period of fifteen weeks, that wave caused a number of deaths as large as 8,526. Its average growth rate was +7.89% deaths per week (ten weeks), while the average weekly decline rate was -12.32% (five weeks). Currently, Italy is experiencing a new COVID-19 wave, with the latest six weekly bulletins (October 26, 2023 – December 14, 2023) showing that the deaths have climbed from 148 to 322. The weekly growth rate has risen by +14.08% deaths, on average. In the hypothesis that this 2023-2024 wave have a duration similar to that of 2022-2023, with: i) a comparable extension of both the growing period and of the decline period and ii) similar growth/decline rates, a prediction can be cast regarding the number of COVID-19 deaths in the period November 2023 - January 2024. They could reach the amount of 4100-4200

Background: Nurses are essential members of the healthcare workforce and were among the first line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of contracting the disease, resulting in a significant number of reported deaths among them. Several preventive measures were adopted to contain the spread of this potentially lethal virus. This study aims to explore the knowledge, attitudes, and practices (KAP) of nurses regarding hand hygiene, mask wearing, and social distancing measures in healthcare settings in Barbados during the COVID-19 pandemic. Method: An online survey of nurses working in public hospitals and polyclinics (public primary care clinics) of Barbados from December 2020 to July 2021, was conducted. Participants completed a questionnaire capturing socio-demographic information and knowledge and practices related to hand hygiene, using face masks, and social distancing . Each correct response received one mark. Overall knowledge scores were categorized as poor (<60%), average (60-80%), or good (>80-100%). Results: Of 192 participants, the majority were female (82.8%) and had >5 years of experience (82%). Findings revealed that 45.8% had poor knowledge of hand hygiene, and the knowledge of 43.8% of respondents was average. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 2.1 times increased odds (95% CI 1.0, 4.2) of having good knowledge compared to other nursing categories. Regarding mask-wearing, 53.6% of nurses had average and 27.1% had good knowledge. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 3.3 times increased odds (95% CI 1.5, 7.4) of having good knowledge compared to nursing assistants. 68.6% of respondents followed the correct steps of handwashing every time, and 98.3% wore a mask in public places. More than half of the nurses (51.2%) kept a safe distance from others to avoid spreading SARS-CoV-2; one-third were in a crowded place(s) in the past three months, and 55.8% usually followed guidelines for social isolation as recommended by WHO. Conclusion: The study identified knowledge deficiencies related to hand hygiene and wearing masks among nurses. It is imperative to provide additional training on infection control measures.

The presence of burnout, anxiety and depression among health professionals is a crucial issue that must be carefully addressed. The aim of the present study is to investigate levels of burnout, anxiety and depression among health professionals (medical and nursing staff) during the pandemic crisis, the association of burnout with anxiety and depression as well as the impact of occupational and demographic factors. One hundred twenty-five health professionals (medical and nursing staff) participated who were working in a public hospital in the broader area of Athens (sample of convenience). Specifically, 41 males and 84 females with the majority of them being in the category of 36-45 years of age. For the data collection, the Maslach Burnout Inventory (MBI) and the HADS questionnaire were used. The results showed that there was a statistically significant and negative correlation of emotional exhaustion to HADS total (r= -0,377, p=0,000) as well as HADS anxiety (r= -0,417, p=0,000). Also, there was a statistically significant and negative correlation of depersonalization to HADS total (r= -0,370, p=0,000) as well as HADS anxiety (r= -0,431, p=0,000). Moreover, there was a statistically significant effect (p<0,05) of occupational and demographic characteristics.

Understanding microbial composition in upper respiratory infections (URIs) is critical for effective diagnosis and treatment. Precision Metagenomic next-generation sequencing p(mNGS) can provide a comprehensive yet clinically relevant profile of respiratory infection. The hybridization capture-based targeted sequencing generated a precision metagenomics profile of 29 patients with acute URIs. Nasopharyngeal samples were collected from the subjects suspected of respiratory infection, and p(mNGS) was performed using the Illumina®/IDbyDNA Respiratory Pathogen ID/AMR Panel (RPIP). The dataset obtained from the mNGS analysis contains a wealth of information on the composition of acute URI microbiota, including the relative abundance of known pathogens and potential clinical implications. The dataset represents a valuable resource for future research endeavors in respiratory medicine, infectious disease epidemiology, and therapeutic interventions. In addition, the dataset offers significant potential for reuse and integration with other omics datasets. The comprehensive nature of the mNGS data allows the exploration of associations between the respiratory microbiota and host factors such as clinical outcomes, immune responses, or genetic predisposition. Combining this dataset with other relevant datasets, such as transcriptomics or metabolomics, could provide a deeper understanding of the complex interactions between the microbiota and the host in acute URIs.

Background: Primary cardiac sarcomas (PCS) are extremely rare malignant tumors involving the heart. Only isolated case reports have been described. There is a paucity of data on the epidemiological characteristics of PCS. This study has the objective of investigating the epidemiologic characteristics, survival outcomes, and independent prognostic factors of PCS. Methods: We enrolled a total of 362 patients with PCS, between 2000 and 2017, by retrieving the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of PCS. Variables with a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors. Results: Crude analysis revealed a high OM in age 80+ (HR=5.958, 95% CI 3.357-10.575, p=0), followed by age 60-79 (HR=1.429, 95% CI 1.028-1.986, p=0.033); and PCS with distant metastases (HR=1.888, 95% CI 1.389-2.566, p=0). Patients that underwent surgical resection of the primary tumor and patients with malignant fibrous histiocytomas (HR=0.657, 95% CI 0.455-0.95, p=0.025) had a better OM (HR=0.606, 95% CI 0.465-0.791, p=0). The highest cancer-specific mortality was observed in age 80+ (HR=5.037, 95% CI 2.606-9.736, p=0) and patients with distant metastases (HR=1.953, 95% CI 1.396-2.733, p=0). Patients with malignant fibrous histiocytomas (HR=0.572, 95% CI 0.378-0.865, p=0.008) and those who underwent surgery (HR=0.581, 95% CI 0.436-0.774, p=0) had a lower CSM. Multivariate Cox proportional hazard regression analyses revealed higher OM in the age group 80+ (HR=13.261, 95% CI 5.839-30.119, p=0) and advanced disease with distant metastases (HR=2.013, 95% CI 1.355-2.99, p=0.001). Lower OM was found in patients with rhabdomyosarcoma (HR=0.364, 95% CI 0.154-0.86, p=0.021) and widowed patients (HR=0.506, 95% CI 0.263-0.977, p=0.042). Multivariate Cox proportional hazard regression analyses of CSM also revealed higher mortality in the same groups, and lower mortality in patients with Rhabdomyosarcoma. Conclusion: In this United States population-based retrospective cohort study using the SEER database, we found that cardiac rhabdomyosarcoma was associated with the lowest CSM and OM. Furthermore, as expected, age and advanced disease at diagnosis were independent factors predicting poor prognosis. Surgical resection of the primary tumor showed lower CSM and OM in the crude analysis but when adjusted for covariates in the multivariate analysis, it did not significantly impact the overall mortality or the cancer-specific mortality. These findings allow for treating clinicians to recognize patients that should be referred to palliative/hospice care at the time of diagnosis and avoid any surgical interventions as they did not show any differences in mortality. Surgical resection in patients with poor prognoses should be reserved as a palliative measure rather than an attempt to cure the disease.

Abstract: Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to hospital-based settings. Updated Dutch PPSA guidelines recommending two anesthesiologists and a ventilator during out-of-hospital PPSA have increased costs and raised concerns about the accessibility to specialized high quality dental care for children in the Netherlands. Aim: This study aims to investigate the impact of the updated 2017 guideline on the occurrence rate of adverse events during PPSA, as recorded in the anesthesia complication database of twelve participating Dutch dental clinics, with adjustments made for age, weight, and duration of treatment. Method: Data of 25,872 children treated at 12 dental clinics performing out-of-hospital PPSA between 1997 and 2019 were analyzed. Eligible children were aged 2-18 with ASA classification I and II. A logistic two-level mixed-effects model is used to estimate the updated guideline’s impact on adverse events. Results: In the final model we analyzed the data of 21,759 children in nine dental clinics. The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64 – 0.89) after the implementation of the updated guideline, compared to before the updated guideline. This outcome was significant with a P=0.001, indicating a protective effect. The average odds per clinic of having an adverse event was 0.04 with a 3.81% chance. Conclusion: Our findings demonstrate a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adherence to evidence-based guidelines in improving patient safety and the quality of care provided during pediatric procedural sedation and analgesia in out-of-hospital dental clinics. Our study underlines the necessity of considering the complex underlying mechanisms that play a role in the development and implementation of evidence-based practice and safety initiatives on the occurrence of adverse events.

Benefits of baby swimming have been established, but there is limited knowledge about the methodologies used by practitioners. To address this knowledge gap, this study aimed to categorize and classify the equipment and environmental used in baby swimming programs worldwide. A descriptive categorical content analysis approach was employed to analyse videos of baby swimming programs obtained from YouTube. The framework created was validated for interrater reliability, and a pilot study was conducted to classify videos from different countries based on the equipment and environment used. Results indicated that the physical environments observed were pool tanks and swimming pools with and without depth reduction zones, while the equipment used included assistive devices, toys, and clothes. This study represents a significant first step in the development of a comprehensive tool to systematize and characterize the methodologies used in baby swimming programs globally.

The aim of this study was to analyze other possible new markers of severity that can be assessed in patients with type 2 diabetes and SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) infection. Our study included 90 subjects: 45 patients with type 2 diabetes mellitus and infected with the SARS-CoV-2 virus, and 45 healthy persons as control. The serum level of ceruloplasmin at hospital admission was statistically significant directly correlated with the severity of COVID-19 (Coronavirus disease) (p=0.037) and with the serum level of IL-6 (Interleukine 6) (p=0.000). Ceruloplasmin was statistically significant inversely correlated with serum iron level (p=0.000). However, we observed that ACE (Angiotensin converting enzyme) decreased in severe forms of the infection with SARS-CoV-2 virus in patients with type 2 diabetes (p=0.001). Moreover, the decrease in ACE level was correlated with an increase in IL-6 level in these patients (p=0.001). IL-6 increase was statistically significant inversely correlated with serum iron, transferrin and ACE levels. There was a noticed a decreasing tendency of the transferrin depending on the severity of the COVID-19 infection (p=0.000). In addition to the known severity factors in the context of infection with the new coronavirus, decreased concentrations of ceruloplasmin, ACE and transferrin may represent new markers of COVID-19 severity in patients with type 2 diabetes. These parameters analyzed at the hospital admission could show the evolution towards the severe forms of infection with the SARS-CoV-2 virus.

Bovine mastitis is the most impacting disease of dairy industry, and it is characterized by a complexity of causal agents, which have revealed a geographical variation among regions and countries. The mastitis-related pathogens have been traditionally classified as contagious or environmental, based on habits of the microorganisms and transmission routes. In addition, the severity of mammary infections has been associated with the virulence of the pathogens, and immune and nutritional status of the hosts. Considering this scenario, we investigated the etiological nature, clinical severity scores, and days in milk (DIM) data in 4,273 clinical cases of bovine mastitis among ten large-dairy farms located in the Southeast region of Brazil. Streptococcus dysgalactiae (283/4,273=6.6%), Escherichia coli (190/4,273=4.4%), Prototheca spp. (112/4,273=2.6%), and Streptococcus uberis (95/4,273=2.2%) were the predominant pathogens isolated, all from the environmental origin. Among 4,273 clinical cases, clinical gravity score was available in 43.8% (1,871/4,273) animals. From these, 69.8% (1,306/1,871), 27.3% (510/1,871) and 2.9% (55/1,871) were scored as mild, moderate, and severe, respectively. Most of isolation of pathogens were observed in the first 100 days in milk, and their clinical severity scored as mild (3,612/4,273=84.5%). Our results contribute to the etiological identification, clinical severity scoring, and milking aspects of bovine clinical mastitis in dairy farms with a history of clinical mammary infections.

Mental wellness can be related to healthier living, the learning process and working environments for people in the university community. A wide range of mental wellness programmes have been explored to provide students with pleasant and satisfying experiences. The purpose of this study is to explore the effects of integrating Zen meditation(禪)and music listening on the mindfulness and happiness levels of university music therapy students. Qualitative methodology was used, and data were collected through surveys and semi-structured interviews. To investigate various aspects of data regarding the role of meditation and music (MM) programme for mindfulness and happiness, this study used thematic analysis within a qualitative research design. The results of this study indicate that the 8-week MM programme is effective in enhancing mindfulness and happiness and has positive responses to daily life stress (e.g., exam anxiety, financial difficulties, and emotional distress during the COVID-19 pandemic). The role of meditation and music in promoting mental health and well-being has long been discussed and the combination of the two has been recognised as a beneficial intervention. This paper could contribute to the support of mental health resources and coping strategies in higher education, as well as expand the potential range of integrating practices involving music and meditation.

Early detection of breast cancer, one of the most common cancers in women worldwide, raises survival rates and lowers the cost of treatment. Although breast cancer detection and classification (CAD) tools have improved, some issues and restrictions still require further research. The creation of breast cancer CAD systems, particularly with deep learning models, was significantly impacted by recent advancements in machine learning and image processing techniques. The current deep learning-based CAD system to identify and categorize masses in mammography is presented in a structured manner in this survey. The survey provides the most popular breast cancer CAD system evaluation metrics, publicly available mammographic datasets, and current image modalities. The survey examines the available literature, emphasizing its strengths and limitations. The survey also emphasizes the difficulties and drawbacks of the current methods for classifying and detecting breast cancer. We point out research gaps and make suggestions for further study. This systematic review may be beneficial for clinicians using CAD systems to diagnose breast cancer early on and for researchers looking for knowledge gaps and making more contributions to the field.

Aim: This study aimed to investigate the relationship between dental caries, dental anxiety, and salivary cortisol levels in children visiting pediatric dental clinics and their implications on pediatric oral health. Materials and Methods: A cross-sectional study was conducted at a dental university in the UAE. A total of 60 children, aged 4-12 years, were included. Salivary cortisol levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Dental caries status was evaluated, and dental anxiety levels were assessed using the Modified Dental Anxiety Scale (MDAS). Statistical analyses, including Mann-Whitney U test and Pearson's correlation coefficient, were performed to determine significant differences and associations. Results: The study group showed significantly higher salivary cortisol levels compared to the control group (p<0.0001). A strong positive correlation was found between salivary cortisol levels and dental caries status (p<0.001). However, no significant difference in dental anxiety levels was observed between the study and control groups (p=0.85). A strong positive correlation was found between dental anxiety levels and dental caries status (p<0.001). Conclusion: The findings indicate a significant association between salivary cortisol levels and dental caries, suggesting that higher cortisol levels are associated with active caries. Dental anxiety levels were positively correlated with dental caries. Understanding the relationship between these variables can contribute to better oral health strategies and interventions for children, emphasizing the importance of managing dental anxiety and stress in pediatric dental care. Clinical Significance: This study highlights the potential of salivary cortisol as a biomarker for assessing stress and its impact on oral health in children. By addressing dental anxiety and stress, dental professionals can provide child-friendly dental care, enhance preventive measures, and improve oral health outcomes in pediatric patients.

Introduction: Since its emergence COVID-19 has become a global health threat. In Uganda, a number of COVID-19 Standard Operating Procedures (SOPs) have been put in place by the Ministry of Health Uganda, to mitigate the outbreak of the deadly COVID-19 pandemic among the population. Despite the putting in place COVID-19 SOPs, the deadly COVID-19 pandemic is still ravaging the population of Iganga District. This study investigated the level of compliance to guidelines for prevention of COVID-19 in public places in Iganga District so as to guide decision makers in making recommendations towards the entire public in order to prevent community acquisition and spread of COVID-19. Methodology: To deliver answers to the research objectives, the study adopted a cross-sectional survey design to guide the study process. Quantitative method of data collection using observational checklist were adopted for this study. The same data abstraction form helped to collect data from 3 public places which included: 3 markets, 5 public transport stations and 8 financial banks. Compliance was measured were the YES scored 1 and NO scored 0 and the ten indicators measured included: temperature screening, wearing of face masks, hand washing or sanitizing, physical distancing of at least 2 meters, information display on COVID-19, regular cleaning of public service places, cleaning of communal places, adequate ventilation, adequate waste management facilities and cleanliness of the work area. Overall a 4 point Likert scale used was: 0-2 poor, 3-5 fair, 6-8 good, 9-10 excellent were each indicator was equally important. Data was entered, cleaned and analyzed using Microsoft Excel 2019 spread sheet packages to generate tables and bar graphs. Results: Out of 5 public transportation stations studied, 80% were observed to be poorly compliant to covid-19 SOPs. On the other hand, out of 8 Financial Banks included in this study, 75% were observed to have excellent compliance levels to COVID-19 SOPs. Meanwhile, out of 3 Market places studied, 66.7% were observed to be poorly compliant to covid-19 SOPs. Conclusion; The results of the study revealed that; public places in Iganga district generally have low level of compliance to COVID-19 SOPs in terms of temperature screening, wearing of face masks, hand washing or sanitizing, social distancing of at least 2 meters and information display on COVID-19 Dos and Don’ts. Our findings suggest that there is a need to mobilize the population in Iganga district to comply with COVID-19 SOPs in terms of temperature screening, wearing of face masks, hand washing or sanitizing, social distancing of at least 2 meters and information display on COVID-19 Dos and Don’ts.

Healthy eating behaviour of women is critical not only for their health but also for their children's health and well-being. The present study examined the dietary pattern, nutrition knowledge and attitudes of working women in Western Province, Sri Lanka. In addition, identify the factors associated with Dietary Diversity Score (DDS). A cross-sectional study was conducted among 300 working women, aged 20-60 years, in Western Province, Sri Lanka. The data on so-cio-demography, dietary patterns, and nutrition-related knowledge and attitudes were collected. Overall, 38% of the women were overweight and 13% were obese. The median frequency of intake of chicken, fish, eggs, milk and milk products, green leafy vegetables and fruits were 2, 5, 2, 9, 5 and 10 respectively, per week. A large majority of the women (70%) had tea/coffee with sugar and snacks (60%) at least four times a week. Only a third of the women met the minimum DDS, while more than half of the women had good nutrition-related knowledge and attitudes. Multiple regression analysis showed that age and household income were significantly independently related to DDS, while attitudes were negatively associated. While there was a trend, the association of nutrition-related knowledge with DDS was not statistically significant (p=0.057). The overall F ratio (8.46) was highly significant (p=0.000) and the adjusted R2 was 0.093. The results demonstrated that a significant proportion of working women have good basic nutrition-related knowledge and attitudes, while two-thirds of them do not meet the minimum DDS. Furthermore, age, family income and knowledge were positively associated with DDS, while attitudes were negatively associated. Before designing any intervention, further research is needed using a qualitative approach to understand how nutrition knowledge and eating behaviour are related in this population group.

Background: Since 2000, vaccine coverage in Sub-Saharan Africa (SSA) has surpassed multiple milestones. Its contribution to global health, especially in low-middle-income countries is one of the achievements in global governance of modern medicine, averting 2-3 million child deaths every year. However, in Nigeria, vaccine-preventable-diseases still account for one in eight child deaths before their fifth-year birthday and remains one of the ten countries where 4.3 million children under five are without complete immunization. The reasons for declining childhood vaccine demand are unclear. Therefore, the goal of this contribution is to shed light on the reasons to set a foundation for future interventions. Methods: Four focus group discussions were conducted. The primary targets were mothers of children 0 – 12 months old in Nigeria. A simplified quota sampling approach was used to select mothers in four geographical clusters of Nigeria’s Federal Capital Territory. At least six mothers from each cluster were randomly included, giving a total of 24 participants. An interview guide developed from the 5C psychological antecedence model was used (assessing confidence, complacency, calculation, constraints, collective responsibility); two additional variables were included that had proved meaningful in previous work (religion and masculinity). The data were analyzed using meta-aggregation approach such as framework synthesis, which summarized data in a stepwise fashion. Results: The sample was generally relatively positive towards vaccination. Still, mothers reported low trust in vaccine safety and the healthcare system (confidence). Yet, they had great interest in seeking additional information during antenatal visits (calculation), difficulties in prioritizing vaccination over other equally competing priorities (constraints) and were aware that vaccination translates into overall community health and wellbeing (collective responsibility). They had a bias towards God as ultimate giver of good health (religion) and reported that their husbands played a dominant role in vaccination decision-making (masculinity). Mothers perceived their children vulnerable to disease outbreaks, which motivated them to get them vaccinated (complacency). Conclusion: The 5C model and the added determinants provided a useful qualitative tool for understanding mothers’ vaccination decision-making in low resources settings.

Background: As the world tends to recover from the crisis created by the COVID-19 pandemic, vaccines have served as one of the most valuable tools of combat and large-scale immunization has helped to tide over the catastrophe. However, several reports of post -vaccination neurological complications around the globe have surfaced up in recent literature. This study was conducted with an aim to describe the spectrum of neurological ailments requiring hospitalization following COVID-19 vaccination.Methods: An ambispective observational study was carried out from March 2021 to February 2022 at a tertiary care institute with 25 patients who satisfied the inclusion criteria of a new onset neurological illness requiring hospitalization within 4 days to 42 days of vaccination. The patients were duly followed upto months after discharge.Results: The median age of the sample was 36 years and the median latency of onset of neurological events was 14 days. Guillain-Barré syndrome was documented in 11 patients; majority were acute motor axonal neuropathy (45.45%) followed by acute inflammatory demyelinating polyradiculoneuropathy (36.36%) and acute motor sensory axonal neuropathy (18.18%). Central nervous system demyelination was reported in 9 patients; two patients had acute disseminated encephalomyelitis, 2 patients were diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease, one patient with aquaporin-4 positive neuromyelitis optica spectrum disorder , and the rest were labelled as seronegative central nervous system demyelination. Vascular events were noted in 5 patients comprising of 2 cases each of cerebral venous sinus thrombosis and intracerebral hemorrhage and a case of Moyamoya angiopathy. All patients were conservatively managed and had a complete to partial recovery suggestive of a favorable outcome after 3 months. Conclusion: The pathomechanisms of post -vaccination neurological complications is yet to be elucidatedand any causal association attributable to vaccination warrants further research. Compared to the enormity of the vaccinated population, the adverse effects are miniscule to hinder and discourage vaccination.

Mental health impacts of COVID-19 pandemic have received a great deal of attention by policymakers for the management of present and future cases of the pandemic, especially as new COVID-19 variant cases are on the rise. Thus, this study seeks to conduct a systematic review to address the following research questions: (1) What are the mental health impacts of COVID-19 in the empirical literature? (2) Which categories of people are at higher risk of the mental health impacts of the pandemic based on the extant literature? A sample of 35 studies out of 196 potential studies (from various databases, including Scopus, Google Scholar, , Research Gate, PubMed, , and libraries, from 2020 to 2022) were used after a comprehensive literature search and thorough assessment based on PRISMA-P guidelines. The study reveals that the pandemic has led to severe cases of mental health challenges such as depression, anxiety, post-traumatic stress disorder, psychological disorders, mood disorders, and insomnia. The review identified groups such as health workers, patients with pre-existing psychiatric or mental health issues, COVID-19 survivors, patients with underlying health conditions, and the elderly as the most vulnerable groups to mental health challenges from the pandemic.

The COVID-19 pandemic has become the largest public health crisis since the 1918 influenza pandemic. Despite the extensive research conducted on the SARS-CoV-2 virus in humans, little is still known about animal-related transmission and its consequences. Therefore, this study contributed to a better understanding of this issue by focusing on the serological survey of SARS-CoV-2 in samples from the serum bank of the Bovine Virology Laboratory at the Biological Institute of São Paulo, as well as horses and dogs from the Military Police of the State of São Paulo, and tapirs and bats from the states of Mato Grosso do Sul and São Paulo. To achieve this, the possible presence of anti-SARS-CoV-2 antibodies in domestic and wild animal species was evaluated using the ID Screen® "SARS-CoV-2 Double Antigen Multi Species" ELISA test (ID-Vet.®), following the manufacturer's recommendations. The findings of this study demonstrate a higher occurrence of anti-SARS-CoV-2 antibodies in domestic animals compared to wild animals, as well as different antibody profiles among the species analyzed, with horses showing a wide range of seroconversion comparable to humans.

Through a partnership with three Federally Qualified Health Centers (FQHCs), the local health department in Los Angeles County implemented a produce prescription program (PPR) to increase fresh fruit and vegetable purchases among patients with diabetes or prediabetes. The PPR, which began in 2020, provided eligible patients with a $40 voucher every month for 6 months to promote the purchase of fresh produce at large chain grocery stores. This qualitative assessment describes staff experiences with the PPR, documenting the facilitators and barriers they encountered while implementing the program. Fifteen clinic staff (i.e., PPR implementers) were interviewed for this assessment. Thematic analysis and coding were conducted using the ATLAS.ti software; the coding was carried out by two separate coders. Interviewees discussed the importance of having preexisting partnerships and programs to support the PPR at their clinic site. Hidden costs related to implementing the program included a large and unexpected amount of staff time devoted to enrolling patients into the program. Collecting quality data and having limited expertise to rigorously evaluate the program were other challenges. Because patients often share their food with their family, the monthly $40 incentive was generally not enough to support their needs; interviewees suggested giving a higher inventive amount to those with a larger household. Future PPR efforts and similar food incentive programs should consider these and other facilitators and barriers to implementation and sustainability, especially when making adjustments to these programs to improve services and access to food resources.

COVID-19 vaccine hesitancy and its enablers would shape community uptake of non-covid vaccines such as oral cholera vaccine (OCV) in the post-COVID-19 era. This study assessed the impact of COVID-19 vaccine hesitancy and its drivers on OCV hesitancy in a cholera endemic region of the Democratic Republic of Congo. We conducted a community-based survey in Bukavu. The survey included characteristics, intention to take OCV and COVID-19, reasons for COVID-19 hesitancy, and thinking and feeling about COVID-19 vaccines. Poisson regression analyses were performed. Of the 1708 respondents, 84.66% and 77.57% were hesitant to OCV alone and to both OCV and COVID-19, respectively. Hesitancy to COVID-19 vaccines rose OCV hesitancy by 12% (crude Prevalence Ratio, [cPR]=1.12, 95%CI[1.03-1.21]). Independent predictors of OCV hesitancy were living in semi-urban area (adjusted Prevalence Ratio [aPR]=1.10, 95%CI[1.03-1.12]), religious refusal of vaccines (aPR=1.06, 95%CI[1.02-1.12]), concerns about vaccine safety (aPR=1.05, 95%CI[1.01-1.11]) and adverse effects (aPR=1.06, 95%CI[1.01-1.12]), as well as poor knowledge (aPR=1.07, 95%CI[1.01-1.14]). Conversely, the belief about COVID-19 vaccine effectiveness reduced OCV hesitancy (aPR=0.76, 95%CI[0.62-0.93]). COVID-19 vaccine hesitancy and its drivers exhibiting a significant domino effect on OCV uptake. Addressing vaccine hesitancy through community-based health literacy interventions would likely improve the introduction of novel non-COVID-19 vaccines in post-COVID-19 era.

Carbapenems have long been considered as treatment of choice for Gram-Negative Bacteria (GNB) infections, and today the clinical utility of this class is threatened by the emergence and spread of resistance favored by its increasing use. According to the WHO, Acinetobacter baumannii, nosocomial infection agent, tops the list of priority antibiotic-resistant pathogens, considered to be the most risky for humans. This study sought to determine the prevalence of Acinetobacter baumannii strains producing carbapenemases in four health facilities in the Center and Littoral regions of Cameroon and the associated risk factors. An analytical cross-sectional study was conducted over a six-month period from January to June 2022. All Acinetobacter baumanii or suspected strains isolated from pathological samples at the bacteriology laboratory of different health facilities were systematically collected and underwent a re-identification. After successfully subculturing and growing on nutrient agar, re-identification and antimicrobial susceptibility Testing (AST) were performed using the VITEK 2 System and the Kirby-Bauer method according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Detection and phenotypic characterization of carbapenemases was performed according to adequate standard procedures. A total of 168/226 clinical isolates of Acinetobacter baumannii were confirmed after re-identification of which 52.69% came from male patients, and 55.09% from participants aged between 10-39 years old and 46.71% from pus samples. A very high resistance rates to all families of antibiotics was noted except to colistin (10.2%). About 40.12% of these strains produced carbapenemases with 62.69% of class B and 37.31% of class A. In addition, frequent hospitalisation was significantly associated to the production of carbapenemase among Acinetobacter baumanii (Ajusted-OR=16.53, P-value<0.0001). This study highlighted the emergence of carbapenemase-producing Acinetobacter baumannii which is increasingly growing. Continuous drug-resistant monitoring and preventive measures could help to prevent and curb the dissemination of A.baumanii resistance genes, especially in hospital settings.

BACKGROUND: Social determinants of health are conditions in the environments that significantly influence the health of individuals and communities. Various factors like income, socio-economic status, stress, customs, culture, healthcare services largely affect the health status of individuals and communities. OBJECTIVE: This study was carried out to identify the factors responsible for the social determinants of health among residents of Buari Ishola Isibo in Ede North Local Government Area, Osun State, Nigeria. METHODOLOGY: A descriptive cross – sectional study was utilized, and multi-stage random sampling method was employed in selecting 60 households of Buari Ishola Isibo in Ede North Local Government Area, Osun State, Nigeria. Questionnaire was used for data collection and data was analyzed using SPSS version 21. RESULTS: The respondents’ ages were between 15 – 60 years and above. 29 (48.3%) were between 31 – 60 years old, 31 (52.0%) were males, 40 (66.7%) were married, 57 (95.0%) were Islam and Yoruba. 29 (48.3%) earned 10,000 – 30,000 monthly, 23 (38.3%) had secondary school education, 39 (65.0%) were traders and 27 (45.0%) have 6 – 10 households respectively. Of the 60 respondents, 34 (56.7%) visit government health facility when they are sick, 21 (35.0%) make use of hand dug well in their compound as the source of their water supply, 27 (45.0%) uses flush water closet toilet as the means of disposing off their excreta, 36 (60.0%) lives in concrete with zinc roof house, 27 (45.0%) have between 6 – 10 rooms in their house, 55 (91.7%) sleep in a room and 21 (35.0%) make use of charcoal as source of fuel for their cooking. CONCLUSION: Poverty or lower income affects the health of individuals through a person’s health throughout their life span. Issues that affect social determinants of health of individuals and community in a negative way should be accosted with all seriousness.

PurposeThe purpose of this research was the development and evaluation of an intelligent assistive classification system for the recognition of endometriosis and the improvement of the accuracy of laparoscopic imaging in diagnosis. The research was developed with the use of Deep Learning approaches. Methods Data from 4448 laparoscopy images were used in a retrospective chart analysis. The data were divided into two folders, healthy and pathological including 2157 healthy and 2291 pathological images. Based on simple clinical and imaging information and criteria such as the diagnosis of endometriosis (included in an open-source dataset GLENDA of Kaggle repository), data mining algorithms were used to improve laparoscopic imaging accuracy. Results The final developed computer system based on the ResNet50 algorithm predicted the best outcome for all participants who had laparoscopic surgical therapy. The Keras tool was used and the generated code was implemented in Python programming language providing a mean accuracy of > 95 %. Conclusion The intelligent approach revealed better performance than the commonly used imaging criteria in predicting endometriosis improving the time and the total accuracy of diagnostic approaches.

To examine the association of sleep quality and work from home with physical inactivity (PI) in leisure time during Covid-19 pandemic. A population-based household survey was conducted in two Bra-zilian municipalities from October to December 2020. Leisure-time physical activity (PA) was self-reported, and individuals who practiced less than 150 minutes of moderate PA or 75 minutes of vigorous PA weekly were classified as PI. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). WFH was assessed by: "Currently, how is your work routine regarding location? Associations were investigated using logistic regression and directed acyclic graphs (DAG) for the multivariate models. A total of 1,750 adults were interviewed, 69.1% were PI and 51.9% had poor sleep quality. Furthermore, 79.8% were not in WFH. In multivariate analysis, leisure PI was associated with poor sleep quality (OR:1.59: 95% CI: 1.02-2.48), and not being in WFH (OR:1.62: 95% CI: 1.05-2.50). When performing the combined analysis between these two factors, and who were not in WFH were four times more likely to be PI at leisure (OR=4.22;95%CI:2.05-8.65). The results indicate a high prevalence of PI, with poor quality sleep and non-WFH associated with leisure PI. These combined factors exacer-bated the occurrence of PI.

Newborn screening (NBS) is hailed as a public health success, but little is known about what happens to these children after diagnosis. There has been difficulty gathering long-term follow-up (LTFU) data consistently, reliably, and with minimal effort by state NBS programs from clinicians. Six programs have been working towards a core minimal LTFU dataset, starting with data elements proposed by the Advisory Committee on Heritable Disorders in Newborns and Children’s Follow-up and Treatment workgroup (ACHDNC FUTR). This minimal data set could begin to address the impact of early diagnosis by NBS. After three rounds of data collection and revision to a data collection tool that defines the minimal LTFU data elements, the group agreed that it was most important for the dataset to capture two items for the denominator--diagnosis and if the child moved or died—with three outcomes: if the child was still alive, if the child had contact with a specialist, and if they received appropriate care specific to their diagnosis within the year. All six programs were able to provide these data. In 2022, about 83.8% (563/672) of the children in these LTFU programs were alive, 92.0% saw a specialist, and 87.7% received appropriate care.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by itching, impaired epidermal barrier function and unbalanced inflammatory response. The pathophysiology involves immune dysregulation, with a predominance of T-helper 2 cells. AD is triggered by many known and unknown factors, including oxidative stress. Reactive oxygen species (ROS) contribute to AD pathogenesis by causing cellular damage and inflammation. Moreover, increased oxidative stress in AD leads to hyperactivation of the MAP kinase pathway, extracellular signal-regulated kinase (ERK) and p38, with DNA damage and subsequent skin barrier dysfunction. This narrative review provides a comprehensive overview of the role of natural antioxidant compounds, highlighting their potential therapeutic value in AD management. They include vitamin D, vitamin E, pyridoxine (vitamin B6), Vitamin C, carotenoids and melatonin, in AD. Despite some studies have shown an association between vitamin D, vitamin E, vitamin C and carotenoids levels and AD course, conflicting results exist. Pyridoxine supplementation has shown mixed results, and melatonin has demonstrated antioxidant and anti-inflammatory properties in AD; in fact, melatonin treatment resulted in a decrease in symptoms in patients with AD, although no significant correlation with changes in sleep latency was reported. In addition, iron and zinc (Zn) supplementation can also improve AD symptoms. Further research is needed to elucidate the optimal use of these natural antioxidants in AD treatment

The past several decades have seen a shift in patient care towards digitalisation, which has ushered in a new era of health care delivery and improved sustainability and resilience of health systems, with positive impacts on both internal and external stakeholders. This study’s aim was to understand the role of digital virtual consultations in improving internal and external stakeholders’ health, as well as wellbeing among hospital doctors. A qualitative research approach was used with semi-structured online interviews administered to hospital doctors. The interviews showed that the doctors viewed digital virtual consultations as supplementary to in-person consultations, and as tools to reduce obstacles related to distance and time. If the necessary infrastructure and technology were in place, doctors would be willing to use these options. Implementing these technologies would improve the medical profession’s flexibility on the one hand; but it might affect doctors’ work–life balance if consultations extended beyond standard working hours.

As artificial intelligence takes an increasingly prominent role in healthcare, a growing body of research is being dedicated to its application in the investigation of communication sciences and disorders (CSD). This study conducts a bibliometric analysis of AI-based research in the field of CSD published up to December 2023. Utilizing the Web of Science and Scopus databases, we identified 15,035 publications, with 4,375 meeting our inclusion criteria. From 1985 onwards, there has been a consistent annual increase in publications, averaging at 16.51%, notably surging from 2012 to 2023. The primary communication disorders studied include autism, dysarthria, dementia, Parkinson’s, and aphasia. Noteworthy AI techniques employed in CSD research encompass machine learning, automatic speech recognition, support vector machine, and deep learning. Our analysis provides a comprehensive overview, serving as a valuable resource for researchers, developers, and professionals seeking to comprehend the evolving landscape of AI in CSD research. Moving forward, collaborative efforts need to prioritize addressing ethical concerns, ensuring data privacy, enhancing methodological enhancements, and considering ecological validity in the application of AI in studies related to communication disorders.

The diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. We aimed to compare the opinions of expert groups from the Middle East (n=14) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n=13). These Expert groups voted on statements developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared. Overall, there was consensus amongst both groups of experts. Most experts agreed that symptoms of crying, irritability and colic, as single manifestations, do not suggest CMA. They agreed that amino-acid-based formula (AAF) should be reserved for severe cases (e.g. malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no consensus on the statement that a cow’s milk-based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role of hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle East region. All ESPGHAN experts agreed that there was no added value of probiotics, prebiotics, and synbiotics to the efficacy of elimination diets, whereas 3/14 of the Middle East group thought there was sufficient evidence. Therefore, there is not a consensus on the optimal diagnostic and therapeutic elimination diet for CMA, but the first-choice elimination diet and the stepwise management approach reveal some differences.

The COVID-19 pandemic may have increased interpersonal and intimate violence, harmful use of alcohol and other drugs (AOD), and mental health problems. The present study uses a valid path model to describe relationships between these conditions of young Mexicans during the second year of the pandemic. A sample of 7,420 young Mexicans ages 18 to 24—two-thirds of whom were women—completed the Life Events Checklist, the Alcohol, Smoking, and Substance Involvement Screening Test, the Major-Depressive-Episode Checklist, the Generalized Anxiety Scale, and the Posttraumatic Stress Disorder (PTSD) Checklist. Young Mexicans reported higher rates of victimization and perpetration of interpersonal and intimate violence and mental health symptomatology than those noted pre-pandemic and in the first year of the pandemic. Harmful use of AOD rates were like those reported by adolescents before. Findings suggested asymmetric victimization and perpetration of intimate violence by gender (with women being at a higher risk than men, p≤.05). More men than women engaged in the harmful use of AOD (except for sedatives, which more women abuse). In contrast, more women than men were at risk of all mental health conditions. The path model indicates that being a victim of intimate violence predicts harmful use of tobacco, alcohol, cocaine, and sedatives, depression, anxiety, and specific PTSD symptoms (such as re-experimentation and avoidance symptoms). Being a victim of interpersonal violence resulted in severe PTSD symptoms (including avoidance, negative alterations in cognition-mood, and hyperarousal signs). Harmful use of sedatives predicted depressive symptoms. Men´s victimizing intimate violence model contrasted with that of women, which also included being the victim of interpersonal violence and severe PTSD symptoms. The high school youth model had three paths -victimizing-intimate violence, victimizing-interpersonal abuse, and sedative use, which predicted depression. The findings of this study could serve as the basis for future studies exploring mechanisms that predict violence patterns to develop the most cost-effective preventive programs and public policies and to address mental health conditions during community emergencies.

Mosquito-borne diseases (MBDs) are a group of illnesses transmitted by mosquitoes and can be caused by bacteria, viruses, or parasites. These diseases represent a significant global burden of infectious diseases, including morbidity and mortality. This systematic review delves into the multifaceted factors contributing to the spread of mosquito-borne diseases (MBDs) in the Middle East and North Africa (MENA) region. Following PRISMA guidelines, a thorough analysis of peer-reviewed articles from May 1990 to Jan 2023 was conducted, highlighting the interplay of population, environmental, disease, and mosquito factors in disease transmission and prevalence. The review incorporated 31 studies that revealed a complex relationship between various risk factors and the presence of MBDs. Significant associations were observed with age, certain occupations, environmental conditions such as rainfall and temperature, sanitation practices, specific pathogen variants, clinical symptoms, and Aedes aegypti mosquitoes. Conversely, gender, socioeconomic status, educational status, and certain sanitation-related factors showed inconsistent association with the spread of MBDs. The review underscores the need for targeted interventions, including vector control, improved sanitation, and educational campaigns to mitigate the spread of MBDs in the MENA region. This review could guide research studies to address data gaps and assist in developing effective surveillance programs in the MENA region. This work emphasizes the need for region-specific public health strategies and further research to understand and curb the burden of these diseases effectively.

AbstractBackground: Maternal health service (MHS) use is a key strategy to reduce maternal mortality. However, the existing evidence is scarce to design efficient intervention strategies in Ethiopia. Thus, we aimed to explore community members and health care providers' perceptions of MHS, and barriers, and facilitators of MHS use in southern Ethiopia. Methods: A phenomenological qualitative study was conducted from November 14-30, 2022, in the northern zone of the Sidama region. Sixteen in-depth interviews, nine focus group discussions, and 15 key informant interviews were done with 112 study participants. A maximum variance sampling method was used to select study participants. Data coding and analysis were done using MAXQAD 2020 software and presented in narratives. Results: Communities have positive perceptions and good practices of skilled antenatal care (ANC) and health facility delivery (HFD), but lack awareness of postnatal care (PNC) services and schedules. Some have experienced negative interactions with health care providers, health facilities, and ambulance drivers. The main identified barriers to ANC use were lack of awareness of ANC benefits, distance from a health facility, costs associated with ANC use, long waiting time, lack of access to road, and women being busy with different household chores. Distance from health facility, costs associated with HFD use, unpredicted labour, lack of an ANC visit, lack of a birth preparedness plan, and non-dignified care were the main barriers to HFD. The major identified barriers to PNC use were home delivery, lack of awareness of PNC service and schedule, and socio-cultural beliefs. The main identified facilitators of MHS use were previous experience and fear of obstetric complications, health extension workers and women’s development teams, and pregnant women's forum.Conclusions: Rural women still encounter several challenges when using MHS, even though communities have positive perceptions and good practices of skilled MHS. Bad experiences mothers faced in health facilities, challenges associated with the costs of MHS use, poor awareness of service, and unpredictable labour continued to be basic barriers to MHS use. Intervention approaches should consider inter-sectoral collaboration to address barriers at the community and health facility levels. The programs must emphasize the transportation arrangements during unpredictable labour, the needs of poor mothers, and women who have poor awareness of MHS at the community level.

Wastewater-based epidemiology (WBE) has emerged as a key method for continuous monitoring of COVID-19 prevalence including circulating SARS-CoV-2 lineages. WBE addresses limitations of traditional clinical COVID-19 surveillance such as clinical test availability, fluctuating testing rates and increased reliance on rapid antigen tests. Our study in Perth, Western Australia, found a significant positive correlation between SARS-CoV-2 concentrations in wastewater and clinical PCR positivity rates (rs = 0.772; p < 0.001) over an 18-month period that included four successive COVID-19 waves. A strong positive correlation was apparent between the proportions of SARS-CoV-2 lineages in wastewater and clinical cases within the same region (rs = 0.728; p < 0.001), including earlier detection of Omicron and recombinant lineages in wastewater before clinical case confirmation. The successful integration of WBE with healthcare data underscores its critical role in enhancing public health decision-making and pandemic management. This approach not only demonstrates the value of WBE in current global health surveillance efforts but also highlights the potential of WBE to address future public health challenges, as a comprehensive disease monitoring and response approach.

During the COVID-19 pandemic, the high prevalence of comorbidities in Mexico, as well as the disparities between public and private health subsystems, substantially contributed to the severe impact it had in the country. The objective of this study was to evaluate and compare risk factors present at admission for mortality of hospitalized patients with COVID-19. A 2-year retrospective cohort study of hospitalized adult patients with COVID-19 was conducted at a private tertiary care center. The study population consisted of 1,258 patients with a median age of 56 ± 16.5 years, of whom 1,093 recovered (86.8%) and 165 died (13.1%). In the univariate analysis, older age (p &lt;0.001), comorbidities such as hypertension (p &lt;0.001) and diabetes (p &lt;0.001), signs and symptoms of respiratory distress, and markers of acute inflammatory response were significantly more frequent in non-survivors. The multivariate analysis showed that older age (p &lt;0.001), the presence of cyanosis (p 0.005) and previous myocardial infarction (p 0.032) were independent predictors for mortality. In the studied cohort, risk factors present at admission associated with an increased risk of death were older age, cyanosis and a previous myocardial infarction, which can be used as valuable predictors for patients’ outcomes. To our knowledge, this is the first study analyzing predictors of mortality in COVID-19 patients attended on a private tertiary hospital in Mexico.