Public Health and Healthcare

Abstract: Burn injuries can have profound physical and psychological consequences, making holistic rehabilitation essential. This mixed methods service evaluation explored a peer-supported breakfast group delivered as part of routine occupational therapy practice for adult inpatient burn survivors with the aim of understanding acceptability, perceived benefits and feasibility. All English speaking inpatients aged >18 years who attended were invited (n=36; n=9 completed). A convergent design integrated open ended survey responses with PROMIS patient reported outcome items, analysed thematically and interpreted using the RE AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and MMR RHS (Mixed Methods Reporting – Rehabilitation and Health Sciences) frameworks. Quantitative findings suggested high perceived physical function, strong emotional support, low anxiety and depression, low social isolation, and moderate pain interference. Reflexive thematic analysis generated four themes: fostering human connection and emotional wellbeing; restoring autonomy and confidence; preparing physically and psychologically for discharge; and the influence of the rehabilitation environment. Limitations include small sample size, low response rate, absence of baseline or control data and potential selection bias. While descriptive only, findings provide early insight into the acceptability and perceived value of peer supported group activity in inpatient burn care. Larger controlled studies with baseline measurement are needed to evaluate effectiveness and implementation feasibility.

Abstract: Diarrhea causes approximately 500,000 deaths annually among children under five globally, with sub-Saharan Africa disproportionately affected. In Rwanda, prevalence remains 12–15% among under-fives despite improvements in water and sanitation, and evidence on the population-level effectiveness of household water treatment (HWT) remains inconsistent. We analyzed RDHS 2019–2020 data from 7,756 weighted children under five using descriptive statistics, chi-square tests, and multivariable logistic regression, with results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). The overall prevalence of diarrhea was 14.1%; HWT coverage was 33.6%. Diarrhea prevalence was lower in households practicing water treatment (12.5% vs. 15.0%; OR = 0.81; 95% CI: 0.70–0.93; p = 0.003); however, this association was not significant after multivariable adjustment (AOR = 1.02; 95% CI: 0.87–1.20; p = 0.786). Soap availability was the only WASH variable independently protective (AOR = 0.75; 95% CI: 0.63–0.89; p = 0.001). Child age 12–23 months (AOR = 2.086; 95% CI: 1.66–2.61, p < 0.001) and maternal education were strong predictors. Regionally, protective HWT effects were observed only in Kigali and the Southern Province. HWT was not independently associated with childhood diarrhea nationally. Soap availability, maternal education, and child age were the strongest modifiable predictors. Integrated WASH interventions combining handwashing promotion, maternal education, and region-targeted strategies are recommended.

Abstract: Introduction: Trust is a fundamental component of the therapeutic alliance in healthcare, yet research in the dental field has traditionally focused on dentists, often neglecting the distinct role of the dental hygienist. To the best of our knowledge, no validated tools exist specifically for measuring patient trust in dental hygienists. Objectives: This study aimed to develop and validate the Dental Hygienist Trust Scale (DHTS), an instrument adapted to assess patient trust specifically toward dental hy-gienists. Methods: Following a linguistic and contextual adaptation of the original Dentist Trust Scale, a cross-sectional study was conducted at the University Dental Clinic of Chieti. Psychometric properties were assessed using Cronbach’s alpha for in-ternal consistency and Exploratory Factor Analysis (EFA) for factorial validity. Inferential statistics included the Shapiro-Wilk test, independent samples t-tests, and Pearson’s correlation coefficient. Results: A total of 161 participants were recruited (mean age 46.7 ± 19.1 years; 52.2% female). The DHTS showed high internal consistency (al-pha = 0.88) and a robust single-factor structure (62.4% of total variance). Participants reported high trust levels (mean score 3.67 ± 0.18). No significant differences were ob-served regarding gender (p = 0.348) or age (r = 0.04, p = 0.612). Conclusions: The DHTS provides a robust, validated tool for assessing the patient-hygienist relationship, filling a significant gap in dental literature. Further longitudinal research is recommended to explore the temporal stability and clinical impact of these trust perceptions.

Abstract: Condensation remains a significant food safety risk in meat processing environments. The problem is challenging to control and prevent, as food processing facilities experience continuous fluctuations in temperature and humidity. However, there is currently a lack of recent studies specifically focused on condensation in the meat industry. Moisture on the surfaces of the above facilities can lead to the formation of condensation droplets. These droplets can contain and carry various foodborne disease agents, including bacteria, viruses, and fungi, as well as chemical and physical contaminants. This literature review aims to describe the problem and based on existing research, to discuss the actual risks posed by condensation in food processing facilities. In addition, strategies for controlling and preventing condensation are discussed. Condensation droplets into food products or adjacent structures that contact food may compromise hygiene standards and pose a high risk of food contamination, particularly with pathogens such as Listeria monocytogenes. Although the prevention of condensation has been described in several food regulations in the Western world, the accurate assessment of its severity remains debated, especially when hygiene standards are met. The role of other pathogens than Listeria spp. and Salmonella spp. is still poorly understood. Currently, mitigation measures and their effectiveness also remain unclear. More research on risk assessment and management of condensation is needed to help food business operators better control and understand this finding.

Abstract: Background/Objectives: The hospital discharge report is a critical document for care continuity that generates a substantial administrative burden for clinicians. Generative artificial intelligence (AI) offers the potential to reduce this burden while improving documentary quality. This study aims to compare, under real-world conditions with a GDPR-oriented architecture based on prior local anonymisation, the quality of AI-assisted discharge reports produced by the IAIA tool against those drafted by the responsible physician (INF). Methods: A retrospective, paired, expert-evaluation study was conducted at a Spanish university hospital. One hundred and twenty consecutive clinical cases from nine departments were included (240 reports total). Each case was independently evaluated by one of ten primary care physicians using a structured rubric covering 13 clinical dimensions (ordinal scale 1–3) and a global rating scale (1–10). The Wilcoxon signed-rank test was applied to all paired comparisons; effect size was estimated using the paired rank-biserial correlation (r). Results: IAIA achieved a significantly higher overall mean rating than INF (8.14 vs. 7.30 out of 10; p < 0.0001; r ≈ 0.76, large effect). IAIA was superior in 9 of 13 clinical dimensions, with the largest gains in family history, principal diagnosis hierarchy, and structured listing of secondary diagnoses. INF retained an advantage only in allergies and intolerances (2.69 vs. 2.46; p = 0.002), where IAIA tended to use generic formulas. Three dimensions showed no significant difference (prior treatment, physical examination, procedures). Conclusions: AI-assisted discharge reports received higher expert-rated documentary quality scores in a non-blinded paired evaluation across most evaluated dimensions. The physician-written report retained an advantage only in the safety-critical allergy domain, where allergy information must not be inferred by the model but sourced from verified structured fields or explicitly flagged as pending physician validation, supporting the need for a supervised hybrid model in which AI generates the initial draft while the clinician mandatorily validates sensitive content. Prior local anonymisation constitutes a GDPR-oriented approach to generative AI deployment in European hospital settings, substantially reducing the risk of disclosure of identifiable clinical information.

Abstract: São Paulo is the largest city in Brazil and the second in Latin America. Its domestic waste production reached 3,515,678.96 tons in 2024. Historically, the city has a low recycling rate and several laws and policies have been implemented to reverse this situation. The objective of this study was to investigate whether there have been advances in the recycling of household solid waste in São Paulo 15 years after the National Solid Waste Policy, analyzing the period between 2006 and 2024. The methodology consisted of a longitudinal case study with analysis of legislation, official data from SP Regula, legislative documents, research, and evaluation of the fulfillment of the goals of the Integrated Management Plan (MISWMP) of 2014, and search for socio-spatial correlations. The results indicate that the selective collection rate grew from 0.69% in 2006 to 2.85% in 2024, but this volume represents less than 10% of the target originally projected for the period. A socio-spatial inequality was found, with higher recovery rates in central areas and rates below 1% in the peripheries, and a lack of dedicated collection for the organic fraction, which makes up 46.90% of the gravimetric flow. It is concluded that progress is incremental but limited by structural barriers and urban inequities. It proposes the fiscal sustainability of the system, the implementation of pilot projects for organic waste and the improvement of data transparency to enable the goals of decarbonization and universalization of services.

Abstract: Volunteering is recommended as a way for older adults to age healthily due to a variety of biopsychosocial health benefits. There are a range of previously identified enablers and barriers to volunteering participation that have been identified. Policymakers may benefit from knowing which strategies are likely to have the greatest immediate impact on recruitment and retention. This study aimed to prioritise enablers and barriers to volunteering and to compare priorities across four participant groups: Volunteer Pro-gram Representatives, Current volunteers, Former volunteers and Never volunteers. Participants (n=681) completed an online survey scoring enablers and barriers to volunteering using Likert scale responses to indicate the importance of each item to commencement and continuation in volunteering. Data were analysed descriptively for responses to each item for each participant group and simple pairwise comparisons were conducted between groups. Feeling welcome scored the highest for all participant groups (Participant Group (Mean, SD): Representatives (4.86, 0.56); Current (4.70, 0.72); Former (4.25, 1.22); Never 4.57 (0.83). Former volunteers valued four items higher than Current volunteers: reim-bursement vouchers, reliable transport, information technology training and online volunteering. Representatives largely scored items higher than Former and Never vol-unteers. Increasing engagement in older adult volunteering requires targeted strategies due to differences in priorities of potential volunteers. Policymakers should consider these community priorities when assessing current volunteering recruitment strategies and to inform future decision-making for funding and resource allocation.

Abstract: Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous patient group who need individualized blood glucose targets to avoid hypoglycemia. Since elderly presents with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other co-morbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a Patient and Function Centric Approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and allow for individualized glycemic targets, which improves overall diabetes control and mental well-being.

Abstract: Background: Policy and humanitarian decisions often require comparing heterogeneous harms (e.g., infectious disease, injury, disasters, displacement) that are reported in non-commensurate units. Time-based summary measures such as disability-adjusted life years (DALYs) and quality-adjusted life years (QALYs) quantify health loss, but are not designed to provide an explicitly calibrated, experience-based unit that can be applied transparently across health and selected non-health harms. Methods: We define Universal Suffering Units (USU) as an additive aggregate of intensity-over-time profiles on a bounded 0–10 ladder, with optional convexity via an exponent p and an explicit overlap rule for co-occurring harms. The unit is calibrated so that a reference renal-colic trajectory equals 1.0 USU. We propagate parametric uncertainty via Monte Carlo simulation (N = 20,000; fixed seed) and provide fully reproducible worked examples using public data. Results: In two worked examples (dengue illness episodes and flood-related internal displacement), USU combines affected population, modeled intensity, and duration on a common scale and yields medians, uncertainty intervals, and sensitivity analyses. A limited convergence check shows that the dengue results are broadly consistent in rank with a disability-weight framework. Conclusions: USU provides a calibrated unit for aggregating experienced suffering while keeping state mappings, overlap treatment, and uncertainty assumptions explicit. It is intended to complement DALYs/QALYs and operational indicators, not replace them.

Abstract:

Background: Inter-limb asymmetry has been widely studied as a potential determinant of physical performance in able-bodied athletes; however, its functional relevance in athletes with neurological impairments such as spastic hemiparesis remains unclear. This study aimed to examine the associations between lower-limb isometric strength, inter-limb asymmetry, physical performance, and match external-load variables in elite CP football players. Methods: Eleven male football players with spastic hemiparesis from the Spanish national team competing at the 2024 IFCPF World Cup participated in this observational cross-sectional study. Maximal isometric strength of the soleus, adductors, and hamstrings was assessed using a belt-stabilised dynamometer. Inter-limb asymmetry was calculated as a percentage difference between affected and non-affected limbs. Physical performance was evaluated using sprint, change-of-direction, dribbling, and intermittent endurance tests. Match external-load variables were collected during official competition using inertial measurement units. Associations were analysed using Spearman’s rank correlations, and between-group comparisons were conducted using a median split based on asymmetry magnitude. Results: Inter-limb asymmetry did not significantly differentiate physical performance outcomes across any field-based tests (p > .05). Isometric strength showed limited associations with performance variables, with a significant correlation between non-affected adductor strength and intermittent endurance (ρ = 0.63; p < .05). Soleus asymmetry was negatively associated with dribbling performance (ρ = −0.64; p < .05) and showed moderate-to-strong correlations with several match external-load variables, including mechanical work (ρ = −0.84; p < .01) and metabolic power (ρ = −0.83; p < .01). Conclusions: Inter-limb strength asymmetry did not appear to be a primary determinant of physical performance in CP football players with spastic hemiparesis. These findings suggest that asymmetry may represent a structural characteristic rather than a modifiable constraint, with athletes developing compensatory strategies to maintain performance. However, asymmetry in plantar flexor strength may influence match-specific physical demands, highlighting the importance of context-specific interpretation.

Abstract: Caring for dependent children with chronic illnesses or disabilities is a public health challenge that subjects family caregivers to prolonged physical and emotional stressors. The aim of this study was to quantitatively synthesize the relationship between depressive symptomatology and quality of life in this group. To this end, a systematic review methodology with meta-analysis was used following PRISMA and Cochrane guidelines, consulting databases such as PubMed, CINAHL, PsycInfo and Scopus until February 2026. We included 33 original studies that evaluated family caregivers of children under 18 years of age and provided statistical data of association. The results of the meta-analysis revealed a statistically significant negative association, from moderate to strong, between depressive symptoms and overall quality of life (r = -0.532, maintaining similar values in all the dimensions analyzed (physical, mental, social and environmental) and in the components of the SF-36.In conclusion, this study shows that the increase in depressive symptomatology can severely condition the well-being of family caregivers.

Abstract: Background/Objective: Non–IgE-mediated food allergies (non-IgE-FAs) are increasingly recognized in infancy as causes of delayed gastrointestinal symptoms, nutritional com-promise, and impaired growth. This retrospective study aimed to evaluate longitudinal growth outcomes in children with non-IgE-FAs managed with different dietary inter-ventions and to explore phenotype-specific differences and clinical correlations. Methods: Children diagnosed with non-IgE-FAs at the Pediatric Clinic Unit of Salesi Hospital (Ancona, Italy) between July 2022 and June 2025 were included. Auxological, clinical, and laboratory data were collected at baseline (T0) and follow-up visits at 6, 12, and 18 months. Weight-, length-, and BMI-for-age z-scores were calculated using Growth Calculator 4.0. Longitudinal growth trends were assessed through individual linear regression slopes, and dietary intervention effects were evaluated with ANOVA models. Results: Thir-ty-seven children were included (57% male), 95% of whom were diagnosed with CMA. Slope analyses demonstrated significant positive trends for BMI z-scores (mean slope = 0.705 ± 1.720; p = 0.039). BMI slope differed according to phenotype when comparing children with FPE and those with FPIAP (mean slope = 0.068 ± 0.795 vs 0.782 ± 0.873, respectively; p = 0.048). No significant differences in BMI improvement were observed between children on an elimination diet, breastfed children whose mothers followed an elimination diet, and those on a free diet. Conclusion: Dietary management in non-IgE-FAs was associated with improved growth trajectories, particularly in BMI. Phenotype-specific differences in BMI trajectories suggest a less favorable growth trend in children with FPE compared with those with FPIAP. The choice of dietary strategy does not appear to have a significant effect on growth outcomes; nevertheless, the importance of individualized nutritional strategies and the careful indication of elimination diets remain highly relevant. Larger longitudinal studies are needed to optimize nutritional strategies and long-term outcomes.

Abstract: Coxiella burnetii, the bacterium responsible for Q fever, is an obligate intracellular pathogen. Q fever is a global zoonotic disease, except in New Zealand, and has significant economic and public health consequences. In Africa, although studies on human and animal seroprevalence are well documented, knowledge regarding the evolution and phylogenetic structure of circulating C. burnetii strains remains incomplete. This review analyses the genetic diversity, phylogenetic structure, and zoonotic potential of C. burnetii strains circulating in Africa and assesses the zoonotic potential of the various identified genotypes. This study involved reviewing scientific data published in Africa between 2006 and 2026 on molecular characterisation, as well as on the diagnostic methods used: MST (Multispacer Sequence Typing) and MLVA (Multiple-Locus Variable Number Tandem Repeat Analysis). Our analysis show marked genetic heterogeneity, characterised by the predominance of variants specific to the African continent. The MST group QT19 is more prevalent in West Africa, whereas East and North Africa exhibit distinct profiles. An assessment of pathogenicity reveals that African C. burnetii strains harbour important virulence determinants, causing acute forms of Q fever, cases of atypical pneumonia, and chronic endocarditis in humans. Based on these findings, this study highlights the need to implement a comprehensive One Health surveillance strategy that combines systematic genetic characterisation with rigorous clinical monitoring to stay ahead of the threat of emerging zoonotic diseases in Africa. This review offers recommendations aimed at strengthening molecular surveillance, developing African C. burnetii genomics networks, and integrating One Health approaches to improve understanding of the epidemiology of Q fever and its zoonotic potential on the African continent.

Abstract: Introduction: The current shortage in the global nursing workforce underscores the importance of understanding those factors that influence career choice and professional retention. This study aims to identify the background profiles of Hungarian BSc nursing students based on their social and sociocultural characteristics and to examine their relationship with career choice patterns and perceptions of the Graduate Nursing Residency Program (GNRP). Methods: A cross-sectional quantitative survey was conducted among BSc nursing students at seven Hungarian higher education institutions using an anonymous online questionnaire. The final sample included 971 participants. Student background profiles were identified using TwoStep cluster analysis. Results: Four distinct profiles emerged: students from families with a university degree (17.3%), students with healthcare orientation living in rural areas (37.3%), urban middle-class students (24.2%), and students with an urban mobility background (21.2%). The timing of career choice differed significantly across profiles (p<0.001): 44.2% of students with healthcare orientation residing in rural areas decided on a nursing career during elementary school or earlier. Awareness of the GNRP was limited: 69.7% of the respondents had not previously heard of it. Perceptions of the program’s contribution to professional development varied significantly between profiles (p=0.033), although overall attitudes towards the program were positive. Conclusions: Hungarian BSc nursing students represent a socially heterogeneous population with distinct career choice trajectories. The limited awareness of the GNRP suggests a need for more effective dissemination strategies, while generally positive perceptions indicate the Program’s potential to support workforce retention and early career development.

Abstract: Background: Educational technologies support the development of clinical skills in nursing education, especially in procedures that require technical accuracy and patient safety. This study aimed to develop and validate an educational video for teaching capillary blood glucose measurement to nursing students. Method: A methodological design was used, comprising four stages: conceptualization, development, implementation, and evaluation. Experts (nursing professors and clinical nurses) and users (nursing students) assessed the video regarding objectives, content, usability, and efficiency. The Content Validity Index (CVI) was applied, with CVI ≥ 0.80 considered acceptable. Results: The final product was a video organized into nursing prescription, material preparation, patient approach, capillary blood glucose measurement, disposal, and checking/recording. Filming was conducted by an audiovisual professional, and free software was used for editing and distribution. Subtitles in Portuguese and English were added to enhance accessibility. Thirteen professors/clinical nurses and seventeen students evaluated the material, with all domains achieving CVI ≥ 0.80. Conclusion: The video demonstrated strong content validity and is an effective tool for teaching capillary blood glucose measurement in traditional, digital, and virtual learning environments.

Abstract: Background: Immunization programmes deliver substantial public health benefits, but their supply chains depend on energy-intensive cold-chain systems, transport networks, single-use products and waste-treatment pathways that generate greenhouse-gas emissions and environmental health risks. As health systems move towards climate-resilient and low-carbon operations, the environmental footprint of vaccine delivery requires greater policy and programmatic attention. Methods: A narrative review and policy analysis was conducted using peer-reviewed literature, technical reports, programme case studies, institutional guidance, preprints and grey literature published or available between January 2010 and June 2026. Evidence was synthesized across four domains: cold-chain energy use; vaccine transport and logistics; production, packaging and use of vaccines and ancillary supplies; and immunization-related healthcare waste management. The review also examined low-carbon and climate-resilient interventions, including solar refrigeration, logistics optimization, digital stock-management systems, controlled-temperature-chain approaches, safer waste treatment and cold-chain equipment lifecycle management. Findings: The evidence indicates that environmental impacts occur across the vaccine lifecycle but are concentrated in a limited number of supply-chain functions. UNICEF’s international supply-chain emissions baseline estimated 3.9 million tonnes of carbon dioxide equivalent from Scope 3 international supply emissions in 2019, with vaccines, cold-chain equipment, nutrition products and international freight accounting for 80–90% of these emissions. Cold-chain energy use, transport, ancillary supplies and waste treatment emerge as recurring hotspots. Programme evidence from Tunisia, Lebanon, India and Gavi-supported countries demonstrates that solarized cold chains, route optimization, electric vehicles, digital stock visibility and energy-efficient cold-chain equipment can reduce emissions or improve resilience while supporting vaccine availability. However, evidence remains limited on full life-cycle emissions, last-mile transport models, embedded emissions in ancillary supplies, and safe end-of-life management of cold-chain equipment. Interpretation: Low-carbon immunization supply chains are feasible when environmental sustainability is integrated into procurement, energy planning, logistics, digital systems, workforce capacity, waste management and decommissioning. Future assessments should use standardized functional units, such as carbon dioxide equivalent per administered dose and per fully immunized child, to improve comparability and guide investment.

Abstract: Background/Objectives: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with a significant impairment in patients’ quality of life (QoL). However, evidence on QoL assessment in HS remains fragmented, with heterogeneous instruments and domains reported. This scoping review aimed to map the assessment of QoL in individuals with HS, identify the instruments used, and describe the domains explored. Methods: This scoping review was conducted in accordance with the Arksey and O’Malley framework, as refined by Levac et al. and the Joanna Briggs Institute. A systematic search of six databases was performed between November 2025 and March 2026 to identify studies reporting QoL or patient-reported outcomes (PROs) in individuals with HS. Data were extracted and analysed using a narrative synthesis approach. Results: A total of 21 studies met the inclusion criteria. HS was consistently associated with substantial QoL impairment across multiple domains, including physical, psychological, social, sexual, and occupational aspects. Symptom burden was a major determinant of reduced QoL, particularly pain, pruritus, malodor, and discharge. A wide range of instruments was used, with the Dermatology Life Quality Index (DLQI) being the most frequently applied. However, most tools did not adequately capture the multidimensional impact of HS. The use of HS-specific instruments was limited, and most studies adopted cross-sectional designs. Conclusions: QoL in HS is markedly compromised, but current assessment approaches are inconsistent and incomplete. Further research using comprehensive, disease-specific instruments and longitudinal designs is needed to better capture disease burden and support patient-centred care.

Abstract: Stroke is a leading cause of death and disability worldwide. Short-term exposure to ambient air pollutants and the risk of stroke has been reported in many studies, but the results vary greatly among different regions. This study aims to investigate the association of short-term exposure to air pollution and the incidence of total stroke and its subtypes in Luohu District, Shenzhen. A time-stratified case-crossover study was conducted among 21973 newly stroke cases in Luohu, Shenzhen from 2014 to 2022. Residential exposure to air pollution was assessed using validated grid datasets. Distributed lag model (DLM) and conditional logistic regression model were implemented to evaluate the relationship between ambient air pollution and the incidence of stroke and its subtypes. We found a 10 µg/m3 increment of exposure to NO2 and SO₂ was positively associated with a 2.73 % (95 % confidence interval [CI]: 2.21%, 3.25 %) and 24.89 % (20.87 %, 29.06 %) increase in odd of total stroke incidence, respectively. Statistical significance has also been found in subtypes. Stronger associations were observed in females (SO₂) and elderly (NO₂ and SO₂). Our findings indicate that exposure to NO₂ and SO₂ exacerbates the risk of stroke, especially in elderly and females.

Abstract: Background/objectives: Antimicrobial stewardship (AMS) is essential to optimise an-tibiotic use and limit antimicrobial resistance (AMR), particularly in peadiatric popu-lations where diagnostic uncertainty and system constraints complicate care. This study investigated critical AMS indicators; missed antibiotic doses, microbiological diagnostics, and antibiotic prescribing at hospital discharge which are key challenges that may affect treatment outcomes in hospitalized children under five years. Methods: A prospective descriptive study was conducted in two tertiary peadiatric hospitals in Zambia among children aged 29 days to 59 months. Information on missed antibiotic doses, microbiological investigations, and antibiotic prescribing at discharge from hospitalization was obtained from medical records and medication charts. Re-sults: Patients experienced 1–8 missed doses, most commonly involving benzylpenicil-lin and ceftriaxone. Documentation of reasons for missed doses was largely absent. Microbiological testing was requested in 36.6% of patients, but only 14.8% of antibiotic prescriptions were supported by culture and susceptibility testing. Of requested tests, 80.9% of results were unavailable at discharge, limiting clinical utility. Only 19.1% of results were available, with a low culture positivity rate (27.3%). Overall, 41.8% of pa-tients were discharged on antibiotics, predominantly from the WHO “Access” group (78%), though 22% were “Watch” antibiotics, and none from the “Reserve” group. Shorter hospital stay was significantly associated with discharge antibiotic prescribing (p = 0.0079; χ² = 78.577, p < 0.001). Conclusions: Significant AMS gaps exist, includ-ing frequent missed doses, limited diagnostic support, and high discharge antibiotic use. Strengthening medication administration systems, improving laboratory capacity and turnaround times, and optimizing discharge prescribing are critical to enhancing peadiatric AMS and reducing AMR.

Abstract: Flood events have increased significantly in recent decades as a result of climate change, causing severe damage to cultural heritage and, in particular, to archival and library collections. Paper-based materials contaminated by floodwaters and alluvial mud are subject not only to physical and biological deterioration, but also to potential hygienic and sanitary hazards associated with the persistence of human pathogens. Current emergency recovery strategies mainly focus on stabilizing materials through freezing, freeze-drying and mechanical cleaning, while health risk assessment is rarely addressed systematically. This study proposes an operational protocol based on microbiological indicators for assessing health risks during the remediation of flood-damaged archival and library materials. The protocol was applied to collections from the Aurelio Saffi Municipal Library of Forlì (Italy), severely affected by the Emilia-Romagna floods of May 2023. Indicators of recent and past faecal contamination, total microbial loads and se-lected viral targets were analysed before and after freeze-drying and mechanical cleaning. The results demonstrate a substantial reduction in faecal contamination fol-lowing freeze-drying, alongside the persistence of environmentally resistant microbial taxa. These findings highlight the need to integrate health risk considerations into con-servation recovery workflows to ensure the safety of conservation professionals and users of recovered heritage materials.