Objective: To investigate the correlation between engagement and quality of life at work in nursing professionals, from a public hospital in the interior of the state of São Paulo, Brazil, at the beginning of the Covid-19 pandemic. Methods: Cross-sectional, descriptive, and correlational study, with nursing professionals, conducted between December 2020 and January 2021. We used the Brazilian versions of the Utrecht Work Engagement Scale and the Walton Model scale. Results: The nursing professionals obtained a strong and positive correlation (r≥0.70) between the social integration domain of QWL and vigor dimension of work engagement (r=0.88; p=<0.001); moderate positive correlation (r≥0.40≤0.69) between QWL working conditions and vigor (r=0.40; p=<0.001), dedication (r=0.40; p=<0.001) and overall score (r=0.41; p=<0.001) of the work engagement. The correlations were positive and weak (r≤0.39) for the other domains of QWL and dimensions of work engagement. Conclusion: Professionals with satisfactory levels of quality of life tended to have higher levels of engagement at work. Professionals were strongly engaged and satisfied with their quality of life at work at the beginning of the Covid-19 pandemic.

With increasing interest in understanding contribution of secondary organic aerosol (SOA) to particulate air pollution in urban areas, an exploratory study was carried out to determine levels of carbonaceous aerosols and polycyclic aromatic hydrocarbons (PAHs) in the City of Kuala Lumpur, Malaysia. PM2.5 samples were collected using a high-volume sampler for 24 h in several areas in Kuala Lumpur during the north-easterly monsoon from January to March 2019. Samples were analysed for water soluble organic carbon (WSOC), organic carbon (OC), elemental carbon (EC) and secondary organic carbon (SOC) in PM2.5 was estimated. Particle-bound PAHs were analysed using gas chromatography-flame ionization detector (GC-FID). Average concentrations of WSOC, OC and EC were 2.7 ± 2.2 (range of 0.63-9.1) µg/m3, 6.9 ± 4.9 (3.1-24.1) µg/m3 and 3.7 ± 1.6 (1.3-6.8) µg/m3, respectively, with estimated average SOC of 2.3 µg/m3, contributing 34% to total OC. The average of total PAHs was 1.8 ± 2.7 ng/m3. Source identification methods revealed natural gas and biomass burning, and urban traffic combustion as dominant sources of PAHs in Kuala Lumpur. To understand human health risk posed by PAHs, a deterministic screening health risk assessment was also conducted for several age groups including infant, toddler, children, adolescent and adult. The total concentration of BaPeq is 3.8 ng/m3, with the average of 0.29 (range of 0.001-1.6) ng/m3. Carcinogenic and non-carcinogenic risk of PAH species were well below the acceptable levels recommended by the USEPA. Future work is needed using long-term monitoring data to understand the origin of PAH contributing to SOA formation and to apply source-risk apportionment to know better the potential risk factors posed by the various sources in urban areas in Kuala Lumpur.

Porcine reproductive and respiratory syndrome virus (PRRSV) infections cause significant economic losses to swine producers every year. Aerosols containing infectious PRRSV are an important route of transmission, and proper treatment of air could mitigate the airborne spread of the virus within and between barns. Previous bioaerosol studies focused on the microbiology of PRRSV aerosols; thus, the current study addressed the engineering aspects of virus aerosolization and collection. Specific objectives were to (1) build and test a virus aerosolization system, (2) achieve a uniform and repeatable aerosol generation and collection throughout all replicates, (3) identify and minimize sources of variation, (4) verify that the collection system (impingers) performed similarly. The system for virus aerosolization was built and tested (Obj. 1). The uniform airflow distribution was confirmed using a physical tracer (<12% relative standard deviation) for all treatments and sound engineering control of flow rates (Obj. 2). Theoretical uncertainty analyses and mass balance calculations showed <3% loss of air mass flow rate between the inlet and outlet (Obj. 3). A comparison of TCID₅₀ values among impinger fluids showed no statistical difference between any two of the three trials (p-value = 0.148, 0.357, 0.846) (Obj. 4). These results showed that the readiness of the system for research on virus aerosolization and treatment (e.g., by ultraviolet light), as well as its potential use for research on other types of airborne pathogens and their mitigation on a laboratory scale.

Introduction: Obstructive Sleep Apnea (OSA) is a respiratory condition identified by the partial or complete obstruction of the upper air passages during sleep. These episodes can lead to complications in neurobehavioral and cognitive domains and cardiovascular issues, especially in children. The involvement of OSA in ocular health during adulthood has been reported, but it remains a topic of debate in pediatric cases. Objective: This review aims to analyze the correlation between OSAS and ocular health in children. Specifically, it investigates the effects of OSA on ocular structures and conditions and explores potential improvements through treatment. Subjects and Methods: The research employed three search engines: PUBMED/MEDLINE, SCOPUS, and WebOfScience. After initial identification, 120 irrelevant articles were excluded. Of these, 10 pertained to the adult population, and 110 focused on the pediatric population. Following a careful selection process and the application of enrollment criteria, six relevant articles were included, all in English, focusing on the effects of OSA on children's eyes. Among these, three studies explored correlations with choroidal alterations, while three investigated retinal and optic nerve changes. Two studies analyzed post-otorhinolaryngological intervention ocular changes. Results: OSA leads to increased intraocular pressure and reduced optic nerve thickness in adults, but treatment alleviates this condition. An immediate correlation between OSA and optic nerve thickness in children does not readily emerge, although age appears to play a role. Pediatric patients with OSA exhibit corneal anomalies and an increase in optic nerve thickness, possibly due to intermittent hypoxia. Studies indicate that OSA can influence retinal vascular density in children, with an increase observed after treatment and reduced choroidal thickness in cases of adenotonsillar hypertrophy. Conclusion: This literature review has highlighted how OSA in children can significantly impact ocular health, with observed alterations in the optic nerve, choroid, retina, and cornea. While the direct correlation with the optic nerve may not always be evident, OSA can elevate intraocular pressure and lead to structural changes. However, treatment appears to bring about improvements. The necessity for regular monitoring to detect potential adverse effects underscores the importance of promptly addressing childhood OSA.

This study compared the relative effect of two trace mineral supplementation strategies recom-mended in France for newborn beef calves. 600 calves were supplemented with 20 mg oral sele-nium (OTM group) at birth (D0) or by injection (ITM group) of a multi-mineral solution (60 mg of Zn, 10 mg of Mn, 15 mg of Cu, 5 mg of Se) on D0, D30 and D60. Mortality and the incidence rate of diseases, including diarrhea, omphalitis, pneumonia, as well as medicinal treatments, were recorded from D0 to D210. The incidence rate of omphalitis was significantly lower in the ITM group than in the OTM group (respectively 11% vs. 17%, P = 0.036). The cumulative inci-dence rate of all health troubles was lower in the ITM group than in the OTM group (P=0.007). Except for pneumonia, incidence of diarrhea (24% vs. 22%), use of oral (7% vs. 6%) or IV rehydra-tion therapy (4% vs. 2%) or use of antibiotics (43.3% vs. 38.0%) and mortality (3% vs 2%) were numerically higher in OTM group than in ITM group (n.s.). In this study, ITM supplementation is as efficient as oral supplementation regarding calves' health status. It reduces the risk of ompha-litis at the calf level effectively.

The outbreak of COVID-19 is a public health emergency that caused disastrous results in many countries. The global aim is to stop transmission and prevent the spread of the disease. To achieve it, every country needs to scale up emergency response mechanisms, educate and actively communicate with the public, intensify infected case finding, contact tracing, monitoring, quarantine of contacts, and isolation of cases. Responding to an emergency requires efficient collaboration and a multi-skilled approach (medical, information, statistical, political, social, and other expertise), which makes it hard to define one interface for all. As actors from different perspectives and domain backgrounds need to address diverse functions, the possibility to exchange available information quickly would be desirable. Geoportal provides an entry point to access a variety of data (geospatial data, epidemiological data) and could be used for data discovery, view, download, and transformation. It helps to deal with challenges like data analysis, confirmed cases geocoding, recognition of disease dynamics, vulnerable groups identification, and capacity mapping. Predicting and modeling the spread of infection, along with application support for communication and collaboration, are the biggest challenges. In response to all these challenges, we have established the Epidemic Location Intelligence System (ELIS) using open-source software components in the cloud, as a working platform with all the required functionalities.

This paper reviews the management of the COVID-19 crisis and the difficulty of cost estimation model, comparing centralized management or bureaucratic government coaction and the agile market alternative or spontaneous social coordination. This is a study of Political Economy and Health Economics from the perspective of Austrian Economics. We describe and compare the al-ternative models, which are adapted to the current crisis. The analysis is based on the theorem of the impossibility of the economic calculation under coactive systems, and other principles of economy. In this context we pay also attention to collateral problems of the centralized and coac-tive management. Finally we propose a solution based on dynamic efficiency and the constitutions of wellbeing economics

This short note proposes a national Geographic Information System (GIS) - based health infrastructure to deal with epidemics and pandemics. Currently, there is no pan-India health infrastructure available that can compile, update, and report the spread of epidemic diseases. It not only curtails the opportunity of finding the real-time data on the spatial distribution of a disease but prevents one to inquire into the causes of the disease through epidemiological analysis. The proposed infrastructure in this study is a pan-India one and can broadly be divided into two parts, hotspot mapping and accessibility to services. In the first part, hospitals are proposed to act as nodes of data collection, sending data to a national GIS portal. This portal shall have the capabilities of plotting the data using map rendering services such as Google and Bing Maps. This way, hotspots can be visualized in no time, benefitting the government and common citizenry alike. The second part deals with the accessibility of citizenry to a wide range of services, i.e., healthcare services, grocery outlets, emergency services, baby food, and many other essential services of the day to day life. In order to implement this, we propose that the government need to enforce a mandatory submission of locational coordinates of all Goods and Services Tax (GST) enrolled service providers. Once the coordinates are submitted, the government can effectively control the opening and closing of services and inform the citizenry at the same time. The proposed infrastructure is going to help deal with the extraordinary situations during epidemic and pandemics similar to what the world is currently facing in the form of Corona Virus Disease 2019 (COVID-19). Furthermore, the infrastructure can be scaled up or down as per the spread of a disease. The health-GIS platform proposed in this concept paper, shall help India in controlling and managing the epidemic more efficiently.

Aim: The overall aim of the study was to assess the reasons and experiences of participants involved in Antibody Mediated Prevention (AMP) HIV prevention clinical trial at University of North Carolina (UNC) Project, Lilongwe, Malawi. We determined the participants’ reasons for participating in HIV Prevention clinical trials; and the experiences of participants in HIV Prevention clinical trials. Methods: We adopted the qualitative cross-sectional study method. Data were collected using in-depth interviews (IDIs). Purposive sampling was used to select 12 study participants who consented to take part in the study. All participants were the ones taking part in the AMP HIV prevention study at the UNC Project. Data analysis was done concurrently with data collection using content analysis. Results: Individuals were motivated to participate in HIV research due to a range of perceived benefits. These included personal, health, and financial benefits. Participants' research experiences and their continued participation in HIV research were influenced by the research clinic context and the nature of their interactions with research staff. Conclusion: When the clinical trial study participants’ expectations are met through what they experience in the study, the chances of them adhering to the study visits and procedures are high. Even for those who did not have any expectations prior to the study, feeling welcomed and being able to open up to the study staff encouraged their continued participation. In the end, this outweighed the negative comments made by the people in their communities or their friends

Background: Telemedicine (interconsultation between primary and hospital care teams) has been operating in the counties of Central Catalonia Bages, Moianès and Berguedà since 2011 in the specialties of teledermatology, teleulcers, teleeyelids and teleaudiometries. For the period until the end of 2019, a total of 52,198 visits have been recorded. Objective: To analyse the differential costs between telemedicine and usual care in a semi-urban environment. Methodology: A cost-minimization evaluation, including direct and indirect costs from a societal perspective, distinguishing healthcare and user’s costs, within a three-month period. Results: Telemedicine saved € 780,397 over the period analysed. A differential cost favourable to telemedicine of about € 15/visit has been observed, the patient being the largest beneficiary of this saving (by 85%) in terms of shorter waiting times and travel costs. From the healthcare system perspective, moving the time spent in a hospital care consultation to primary care is efficient in terms of the total time devoted per patient. In social terms and in this context, telemedicine is more efficient than usual care. Conclusion: Users’ saving of time in terms of consultation and travel is the main driver of interconsultation between primary and hospital care savings in a semi-urban context. The telemedicine service is also economically favourable for the healthcare system, enabling it to provide a more agile service, which also benefits the healthcare professionals.

Formula feeding, as an alternative to breastfeeding, offers benefits such as convenience and consistent nutrition. Among the drawbacks of formula feeding, however, is potential dilution or concentration errors in the of formula during preparation that may lead to infant health issues. The present study aimed to investigate the accuracy of caregiver measurements as they prepared infant formula under multiple conditions, compared with manufacturer specifications. A diverse sample of caregivers (N = 84) participated in this cross-over experimental study. Participants hand-scooped infant formula powder and poured water to prepare 4oz and 7oz feedings, using both a standardized set of infant formula products and participants’ own products. Linear mixed effects models were used to estimate fixed effects of target amount (4oz versus 7oz) and products (participant versus researcher) on mean absolute percent error (MAPE) of measurement. Across all conditions MAPE was significantly greater for measuring powder than for water (9.0% vs. 4.4%; p&lt;0.001) with a combined powder and water MAPE at 13.0%. Greater measurement error was associated with the odd-sized 7oz preparation and participants’ own products. We observed considerable variability and substantial error during infant formula preparation, particularly for hand-scooping of powder, which tended toward higher values than the theoretical gold standard.

Adolescent’s access to quality Sexual and Reproductive Health and Rights interventions has been a major issue in most of the low- to middle-income countries (LMICs) across the globe. This systematic review aims to identify the relevant community and school-based interventions that can be implemented in -LMICs to promote adolescent’s sexual and reproductive health and rights outcomes. We identified 54 studies and our review findings suggest that Adolescent’s Sexual and Reproductive Health and Rights (ASRHR) educational interventions, provision of financial incentives, and provision of comprehensive -post-abortion family planning services are effective in increasing adolescent’s knowledge on ASRHR, attitude towards ASRHR, uptake of ASRHR services, contraception and decreased unwanted pregnancy rates among young women. However, we found inconclusive and limited evidence on the effectiveness of the interventions to improve violence prevention and adolescent behaviors towards safe sexual practices. More rigorous studies with long-term follow-ups are needed to assess the effectiveness of such interventions.

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c &lt; 7%; HbA1c &gt;= 9%; BP &lt;140/90 mmHg; LDL-C &lt;100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c &lt;7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c &lt;7%, BP&lt;140/90 mmHg and LDL &lt;100 mg/dl.

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1:n=94, Study 2:¬n=213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control (F2,91=6.37, p=0.003). In Study 2 (depression and psychosis), there were no differences among the three arms (F2,210=2.07, p=0.13). When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos with depression and psychosis (t(31)=-3.04, p=0.005). In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for different strategies based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761

Atrial fibrillation (AF), a complex cardiac arrhythmia, necessitates a shift in management paradigms, emphasizing an integrative approach that incorporates lifestyle modifications. Investigations into the role of interleukins and inflammatory mediators are underway, exploring their potential as diagnostic markers and predictors of cardiovascular events in AF. Despite the identification of biomarkers related to cardiac remodeling, their predictive ability for post-cardioversion outcomes remains controversial. Computational models are being developed to understand proarrhythmic contributions and identify anti-AF targets. Addressing the rising global incidence of AF, linked to stroke and heart failure, presents a critical health challenge. As risk factors like obesity prevail, AF becomes a pervasive public health concern, expected to double in prevalence over the next 50 years. The impact on mortality and morbidity, especially through hospitalizations, underscores the need for early detection and effective clinical management. Identifying individuals at increased AF risk becomes crucial for screening and prevention strategies. Lifestyle modifications, including weight management and physical activity, emerge as influential factors in AF management, offering the potential to alleviate symptoms and modify disease progression. The paper concludes by emphasizing the need for safer antiarrhythmic therapies based on AF mechanisms, promising improvement in global AF management. The multifaceted nature of AF etiology requires a broader perspective beyond traditional medical interventions, acknowledging the importance of integrated care to address this significant public health challenge.

Steel structures, such as bridges, must be continuously maintained. Due to increasing trac loads, design and execution shortcomings, many steel bridges are subject to various types of damage, such as cracks. The bridges must be maintained by crack removal and re-welding the cracks. During this work, the bridge is closed for trac in order to suppress the crack ank movement during welding. As a result, trac loads on other routes are higher, which increases further damage on detour routes and subsequently additional welding work and costs on theses structures. Therefore, the aim is to provide a method that allows welding work on steel structures under running trac, respectively under cyclic loads. First, measurements at a representative steel bridge were conducted to derive gap opening parameters of amplitude and frequency for welding tests under cyclic loads. In a test setup for reproducible and comparable welding tests, specimen were welded under cyclic loads. Deep grinding of the root layer allowed defect-free welding within the range of 0.1 mm amplitude at a frequency of 2 Hz loadings. For such welds, the weld quality and the fatigue strength was comparable to the standard requirements.

Monkeypox virus infection is a recognized public health emergency. Little research has been done on treatment options for this disease. Until recently, there was not a single published work describing the usage of specific drugs in human patients with monkeypox virus infection. This paper gives the first bibliometric analysis of monkeypox treatment options based on data available on PubMed and Scopus. It also reviews the specific drugs used in the treatment of monkeypox. That includes data on Tecovirimat, Cidofovir, Brincidofovir, and Vaccinia Immune Globulin. Tecovirimat is a promising option in progressive disease in terms of efficacy and safety. However, Brincidofovir has been associated with discontinuation of treatment. Cidofovir is also not the preferred drug among physicians. Currently, Tecovirimat can be further used for the management of aggravating cases. More studies should be conducted on Tecovirimat to treat this condition, mainly through controlled trials.

Background: Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. Methods: This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. Results: Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turn-around time to receive their appointment. Conclusions: This study identifies several characteristics associated with the turn-around time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence base.

The Human Gut Microbiome is an important host’s component defining its health. These microorganisms are mutualistic symbionts dependent on factors such as host’s age, subsistence models and sociocultural practices, among others. The conjunction of these factors define the microbial ecosystem dynamics. Using a fecal microbiome approach in children, a comparison of two Mexican communities with contrasting lifestyles: “westernized” (Mexico City) and “non-westernized” (Me’phaa indigenous group) was evaluated. The main differences between these two communities are in bacteria associated with different types of diets (high animal protein and refined sugars vs high fiber food, respectively). In addition, the gut microbiome of Me’phaa children showed higher total diversity and the presence of exclusive phyla, such as Deinococcus-Thermus, Chloroflexi, Elusimicrobia, Acidobacteria and Fibrobacteres. In contrast, Mexico City children had less diversity and the exclusive presence of Saccharibacteria phylum which is associated with the degradation of sugar compounds. This comparison allows further exploration of the selective pressures affecting microbial ecosystemic composition over the course of human evolution and the potential consequences of pathophysiological states correlated with westernization lifestyles.

Excessive vibration of temporary grandstand owing to crowd has lateral rhythmic motions can cause human in panic, which attracted increasing attention in recent years. This paper focuses on experiments that a temporary grandstand occupied 20 participants is oscillated by a shaking table with a series of random waves and induced by crowd with rhythmic swaying motions at lateral direction, respectively. And then a series of vibration perception questionnaires about crowd reaction are obtained. Evaluation of annoying level derives in concept of degree of membership and annoying rate method is proposed, then the human health risk of vibration serviceability of temporary grandstand is assessed with acceleration vibration dose value(VDV). From these results it is clear that standing crowd is more tolerant to vibration than seated crowd. The measured vibrations generated by crowd activities on temporary grandstand can cause panic in crowd. New relationship between the annoyance rate and structural acceleration VDV at logarithmic coordinate is proposed. The findings of this study can be utilized to manage the vibration of temporary grandstand and assess the human health risk.

Hospital-acquired infections (HAIs) contribute to increased length of hospital stay, high mortality and higher health-care costs. Prevention and control of HAIs is a critical public health concern. We conducted a cross-sectional survey of 213 hospital health-care workers in Qassim, Saudi Arabia. We assessed Knowledge, Attitude and Practice (KAP) of standard infection control precautions using a structured questionnaire. Predictors of KAP were investigated using multivaraible logistic regression analyses and independent sample t tests. Prevalence of good (≥80% correct response) knowledge, attitude and practice were 67.6%, 61.5% and 73.2%, respectively. Predictors of good knowledge included age over 34 years (adjusted odds ratio: 30.5, p<0.001), and receiving training (13.3, p<0.001). Predictor of positive attitude was having >6 years of experience (5.5, p<0.001). While, the predictors of good practice were having >6 years of experience (2.9, p<0.01), previous exposure to HAIs (2.5, p<0.05) and training (3.5, p<0.01). However, being female (0.22, p<0.001) and older (>34 years) (0.34, p<0.01) were negatively associated with knowledge. Results indicate that older academic programs might not have adequately covered infection crontrol. Arranging training for HCWs might be useful in improving their knowledge of standard infection control precautions and is also expected to facilitate positive attitude and practice.

As the COVID-19 pandemic begins to abate and national public health systems are treating the SARS-Cov-2 virus as endemic, many public health measures are no longer mandated, but remain recommended with voluntary participation. One of these is the wearing of fitted face masks, initially mandated to contain, or at least slow, the spread of SARS-CoV-2 which is primarily transmitted via aerosols emitted while breathing, coughing, or sneezing. While the habit of once wearing fitted face masks recedes into memory for much of the population, so does the knowledge of the various types of masks that were once en vogue. To create a record for the future, this paper provides the first comprehensive documentation of the nature and range of fitted facemasks that circulated during the COVID-19 pandemic.

In European thought, the relationship among the fields of psychology, education, and health is both complex and obscured. Foucault’s acclaimed work, The Order of Things, offers a framework to evaluate their interconnection by identifying three distinct periods of European thought since the 16th century with respect to the ordering of phenomena—Renaissance, Classical and Modern. Theoretically dense and often difficult to decipher, the book’s categorization of language, value and being has been understandably underused, yet it provides deep insights into what have come to be known as psychology, education and health and remains invaluable in understanding the origin, limits and consequences of these fields. How Foucault’s analysis can be interpreted concerning the development of these areas as to each of the three periods of European thought is investigated. An approach based on narrative research appraises the analysis offered in the book. The results, presented for the first time in table form, compare these three periods, demonstrating a continuing practical value to Foucault’s insights. With the aid of the framework revealed by these tables, the boundaries and relationship of psychology, education and health become clear and their limitations—plus potential solutions to them—can be identified to mitigate anticipated negative consequences.

Background: The oral health-related quality of life (OHRQoL) assessment evaluated the impact of individual’s oral health on the patient's physical and psychosocial status. We evaluated the association between subjective OHRQoL, measured with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and unfavorable body mass index (BMI) (i.e., too high or too low) in a large population-based study on older adults from Southern Italy. Moreover, we assessed which of the seven OHIP-14 domains was most strongly associated with an unfavorable BMI. Methods: We used data on a subpopulation of the Salus in Apulia Study, including 216 older adults. BMI &lt;18.4 kg/m2 and &gt;30 kg/m2 were classified as unfavorable, values between 18.5 and 30 kg/m2 were classified as ideal. Results: Higher OHIP-14 total score increased the risk to have an unfavorable BMI [odds ratio (OR):1.08, 95% confidence interval (CI):1.01-1.15]. In the model adjusted for age, sex, education, hypertension, carbohydrate consumption, and alcohol consumption, this finding was confirmed with higher OHIP-14 total score increasing the risk to have an unfavorable BMI (OR:1.10, 95% CI:1.01-1.22), and higher age linked to a decreased risk to have an unfavorable BMI (OR:0.89, 95% CI:0.82-0.97). In a random forest regression model, the most important predictive domains/sub-scales of OHIP-14 in mean decrease Gini for unfavorable BMI were, in order of decreasing importance, physical pain, functional limitation, psychological discomfort, physical disability, social disability, psychological disability, and handicap. Conclusions: In older age, negative OHRQoL, particularly linked to the physical pain domain, increased the risk of underweight or overweight and obesity.

Rationale: Genetically modified (GM) foods have the potential to reduce food insecurity and address economic and environmental issues. Despite these benefits, GM foods continue to face significant criticism and there is limited information on public awareness and understanding of their nutritional and environmental health benefits in Nigeria. This study aims to fill this gap by investigating public knowledge and perceptions of GM foods in Victoria Island, Lagos. Methods: A convenience sampling method was used to recruit 369 respondents from Victoria Island, Lagos. Data were gathered using a structured questionnaire. The target population comprised employed adults either residing or working on Victoria Island. Statistical analyses were conducted to examine the relationship between sociodemographic factors and awareness of GM foods. Results: The study found that a majority of respondents (62.9%, n=232) were knowledgeable about GM foods and their associated issues. However, many believed that their community was not well-informed on the topic. Awareness of GM foods was significantly associated with sociodemographic factors such as marital status and education (P<0.01). Most respondents were well-informed about the environmental and health benefits of GM foods, with 61.8% believing that GM food production could sustainably reduce reliance on chemical pesticides, fertilizers, and other energy inputs, thus mitigating their ecological impacts. Additionally, most respondents did not feel that purchasing or consuming GM foods conflicted with their beliefs or would affect their food choices. Conclusion: The study concludes that while individual awareness of GM foods is relatively high, there is a perception that community awareness is low. Sociodemographic factors play a significant role in shaping public awareness and perceptions of GM foods. Recommendations: This includes government should actively educate the public on the ecological and health benefits of GM foods and address any safety concerns; Implement strict border controls and food labeling for GM products to protect consumer rights and preferences for organic foods, provide sufficient technical and financial assistance to farmers who participate in organic seed programs to enhance national food security. Significant Statement: This study highlights the importance of public education on GM foods and underscores the need for government intervention to ensure informed consumer choices and support for sustainable agricultural practices.

Pregnancy at advanced maternal age is considered a risk factor for adverse maternal, fetal, and neonatal outcomes. Here we investigated whether maternal age could be associated with differences in the blood levels of newborn screening (NBS) markers for inborn metabolic disorders on the Recommended Universal Screening Panel (RUSP). Population-level NBS data from screen-negative singleton infants were examined, which included blood metabolic markers and covariates such as gestational age, birth weight, age at blood collection, infant sex, parent-reported ethnicity, and maternal age at delivery. Marker levels were compared between maternal age groups (age range: 15-44 years) using effect size analyses, which controlled for group size differences and potential confounding from other covariates. Our results showed that 13% of the markers had maternal age-related differences including newborn metabolites with either increased (C14, C16, C18, C18:1, C3DC) or decreased (C5OH) levels at advanced maternal age group (≥35 years, absolute Cohen’s d ≥ 0.2). The increased C3DC levels in this group correlated with a higher false-positive rate in newborn screening for malonic acidemia (p-value < 0.001), while no significant difference in screening performance was seen for other markers. Maternal age at delivery is associated with inborn metabolic differences and should be considered together with other clinical variables in genetic disease screening.

Older adults in low-and middle-income countries experience a disproportionate burden of non-communicable diseases (NCDs). Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths worldwide, including in Thailand. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI in primary care via trained community health workers (CHWs) and care managers (CMs). STEADI takes a coordinated care approach that consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk in 20 community-dwelling older adults using three key questions and found that all of them had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed balance, vision, footwear, postural hypotension, medications, and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications,75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions to mitigate their specific fall risk factors. CHWs and CMs indicated high acceptability (19.20±.1.31 of 20 total), appropriateness (18.80± 1.79 of 20 total), and feasibility (18.60±1.67 of 20 total) of the Thai-STEADI intervention. Our study showed that the community-based multifactorial Thai-STEADI delivered by CHWs and CMs is feasible and acceptable to prevent falls in older adults with limited access to health care.

There is a skin allergy epidemic in the western world, and the rate of deterioration has increased significantly in the past 5-10 years. It is probable that there are many environmental contributing factors, yet some studies have linked it primarily to the rise in the use of synthetic chemical ingredients in modern cosmetics. Our challenge, therefore, was to find a mechanism to determine the effect these substances have on skin health, and whether they really are a primary cause of long term damage to the skin. The first problem is the lack of any definitive way to measure skin health. Motivated by the overwhelming evidence for a link between deficient gut flora and ill health, we decided to look at whether our skin microbiota could similarly be used as an indicator of skin health. Our research illustrates how it is microbiota diversity alone that can predict whether skin is healthy or not, after we revealed a complete lack of conclusive findings linking the presence or abundance of particular species of microbe to skin problems. This phenomenon is replicated throughout nature, where high biodiversity always leads to healthy ecosystems. ‘Caveman’ skin, untouched by modern civilisation, was far different to ‘western’ skin and displayed unprecedented levels of bacterial diversity. The less exposed communities were to western practices, the higher the skin diversity, which is clear evidence of an environmental factor in the developed world damaging skin. For the first time we propose benchmark values of diversity against which we can measure skin to determine how healthy it is. This gives us the ability to be able to predict which people are more likely to be prone to skin ailments, and start to test whether cosmetic ingredients and products are a main cause of the skin allergy epidemic.

The incidence of infections due to carbapenemase-producing Enterobacteriaceae (CPE) is rising worldwide. We present the case of a 48-year-old female patient, diabetic, with previous episodes of urinary tract infections that was admitted due to pyelonephritis, later identified to be caused by KPC and ESBL-producing Klebsiella pneumoniae. Both the patient and her family had no strong epidemiological link with the healthcare system, and for this reason, this case stands out in regional literature since similar reports are scarce and therefore constitutes a reason for alert in health institutions. Further studies are needed in order to ascertain the real incidence of these infections in community settings in Latin America and the Caribbean.

The following article analyses the relationship between the mental health index and the variables of the Environment, Social and Governance-ESG model in the Italian regions between 2004 and 2023. First of all, a static analysis is proposed aimed at identifying trends relating to mental health in the Italian regions with indication of the regional gaps. Subsequently, a clustering with k-Means algorithm is proposed. Below is a comparison of 11 machine learning algorithms for predicting the performance of the mental health index. Finally, the article offers some economic policy suggestions. The results are critically discussed in light of the scientific literature.

The following article analyses the relationship between the mental health index and the variables of the Environment, Social and Governance-ESG model in the Italian regions between 2004 and 2023. The econometric analysis is aimed at investigating in detail the relationships between the mental health index and the individual components of the ESG model. The results are critically discussed

Health care operations in many hospitals are experiencing increasing demand which is however hindered by the limited resources available. The imbalance between the demand and service provision capacity within the hospitals have resulted in long waiting times for service delivery due to overcrowding, high costs of treatment as well as low levels of patient’s satisfaction. The above problems are attributed to the development of hospital management information system. This dissertation is focused on investigating some of the causes of the increased cost and time consumption as well as low levels of patient’s satisfaction in the application of hospital management information system. The study used comparative design to make a comparison of the respondents from two different hospital facilities where 400 health workers were drawn for research. The questionnaire was used as a survey tool for the study that involved both qualitative and quantitative analysis. The results of the study indicate various playing factors that arise due to the development of the hospital management information system. These factors include the large functionality of the system, the need for training of the end users, the increasing ageing population, and delays. The identified factors play a significant role in the way the information system impacts the time taken, the cost involved, and patient satisfaction. Keywords: health, hospital, doctors, technology, information system, time, and cost.

This case report utilized the primary data gathered from the extension program of the LORMA College of Medical Laboratory Science at the institution’s adopted locale. Arosip is a secluded, difficult-to-reach mountainous barangay in the municipality of Bacnotan, in the province of La Union, Philippines. The study subjects were forty-one (41) kindergarten to grade three students of Arosip Elementary School. Modified Kato-Katz technique was performed to the submitted stool samples. Among 41 participants, nine were screened positive for the helminthic ova of Ascaris lumbricoides, and Trichuris trichiura – yielding a total of 21.95% prevalence rate. Among those 9 participants, 6 (66.67%) were positive for Ascaris lumbricoides ova, and 3 (33.33%) were co-infected with both Ascaris lumbricoides and Trichuris trichiura ova. The findings were relayed and reported to the local government unit. The team recommends for a more comprehensive screening and monitoring of STH cases in the locale, a continuous stewardship of health programs including mass-deworming for the school children and awareness campaigns, and provision of health resources. Ultimately, interagency collaboration between the Department of Health, Department Education, and Local Government Unit remains highly warranted to satisfy the health inequities experienced by this disadvantaged remote community.

Background: Individuals living in rural areas often face challenges in accessing healthcare, increasing their risk of poor health outcomes. Farmers, a sub-population in rural areas, are particularly vulnerable to mental health issues and suicide, yet exhibit low rates of help-seeking behavior. The aim of our study was to develop an in-depth understanding of the issues influencing mental help-seeking among farmers living in rural areas from the perspectives of healthcare providers, as well as to explore the strategies providers use to navigate through these issues to effectively engage with this vulnerable population. Methods: We used a descriptive phenomenological approach to understand healthcare providers’ perspectives, experiences, and approaches to providing mental healthcare to farmer clients in rural areas. Semi-structured interviews were conducted with 21 participants between March and May 2023. Results: Our analysis yielded five thematic areas: (1) ensuring accessibility, (2) establishing relatability, (3) addressing stoicism and stigma, (4) navigating dual roles, and (5) understanding community trauma. Conclusions: Healthcare service delivery for farmers is multifaceted. This study fills a gap in knowledge by translating these the data to inform an evidence-based model and a list of recommendations for implementing agriculturally-informed practices in rural areas.

The human voice has the potential to serve as a valuable biomarker for the early detection, diagnosis, and monitoring of pediatric conditions. This scoping review synthesizes the current knowledge on the application of Artificial Intelligence (AI) in analyzing pediatric voice as a biomarker for health. The included studies featured voice recordings from pediatric populations aged 0-17 years, utilized feature extraction methods, and analyzed pathological biomarkers using AI models. Data from 62 studies were extracted, encompassing study and participant characteristics, recording sources, feature extraction methods, and AI models. The review showed a global representation of pediatric voice studies, with a focus on developmental, respiratory, speech, and language conditions. The most frequently studied conditions were Autism Spectrum Disorder, intellectual disabilities, asphyxia, and asthma. Mel-Frequency Cepstral Coefficients were the most utilized feature extraction method, while Support Vector Machines were the predominant AI model. The analysis of pediatric voice using AI demonstrates promise as a non-invasive, cost-effective biomarker for a broad spectrum of pediatric conditions. However, further research and development are crucial to enhance the accuracy and applicability of these tools in clinical settings.

Rationale - From the year 1 anno Domini until 1855 with the third Plague, major pandemics occurred on average every 348 years. Since then, they have occurred on average every 33 years, with Coronavirus disease 2019 (COVID-19) now underway.Even though current technologies have greatly improved the way of life of human beings, COVID-19, with more than 700 000 000 cases and 6 950 000 deaths worldwide by the end of 2023, reminds us that much remains to be done. Objective - Given the frequency and duration of recent pandemics, it might be wise to start thinking about preventative methods to minimize the impact of future pandemics. This report looks back at 18 months of COVID-19, from March 2020 to August 2021, with the aim of highlighting potential solutions that could prove practical, or even essential, for the future. Material - COVID-19 data, including case and death reports, were extracted daily from the Worldometer platform to build a database for macroscopic analysis of the spread of the virus around the world. Demographic data were integrated into the COVID-19 database for a better understanding of the spatial spread of the SARS-CoV-2 virus in cities/municipalities. Method - Without loss of generality, we only analyzed data from the top 30 (out of 200 and above) countries ranked by total number of COVID-19 cases. Statistics (regression, t-test (p < 0.05), correlation, mean ± std, etc.) were carried out with Excel software. Spectral analysis, using Matlab software, was also used to try to better understand the temporal spread of COVID-19. Results - A good linear correlation was observed between the number of cases and the respective number of deaths depending on the country, i.e. y = 0.0121x + 19559 with R² = 0.8042. The analysis then focused mainly on the number of cases.This study showed that COVID-19 mainly affects G20 countries. The most interesting result is that cities/municipalities with high population density are a powerful activator of the spread of the virus. The current demographic context seems to be becoming a societal problem that must be addressed adequately.Spectral analysis highlighted that the very first months of spread of COVID-19 were the most notable with a strong expansion of the SARS-CoV-2 virus. On the other hand, the following six months showed a certain stability due mainly to multiple preventive measures such as confinement, closure of non-essential services, wearing of masks, distancing of 2 meters, etc. Discussion - Analysis of case and death data showed that COVID-19 mainly affects G20 countries. Nevertheless, the most interesting result of this study is that cities and municipal areas with population densities of several thousand inhabitants per square kilometer largely favored the spread of the SARS-CoV-2 virus. It is believed that such a demographic context is becoming a societal problem that developed countries around the world will sooner or later face and therefore needs to be adequately addressed. Conclusion - COVID-19 has made us understand that it is time to act both preventatively and curatively. Phenomenological insights suggest that the next pandemic could occur in less than 50 years. It may be time to launch new societal projects aimed at relieving congestion in densely populated regions.

Machine Learning is increasingly and ubiquitously being used in the medical domain. Evaluation metrics like accuracy, precision, and recall may indicate the performance of the models but not necessarily the reliability of their outcomes. This paper assesses the effectiveness of a number of machine learning algorithms applied to an important dataset in the medical domain, specifically, mental health, by employing explainability methodologies. Using multiple machine learning algorithms and model explainability techniques, the project provides insights into the model workings to help determine the reliability of the machine learning algorithm predictions. The results are not intuitive. It was found that the models were focusing significantly on less relevant features and at times, unsound ranking of the features to make the predictions. The paper therefore argues that it is important for research in applied machine learning to provide insights into explainability of the models in addition to other performance metrics like accuracy. This is particularly important for applications in critical domains such as healthcare. A future direction is to investigate methods to quantify the effectiveness of the machine learning models in terms of the insights from their explainability.

Background and objectives: Effective management for chronic diseases, hereditary and rare diseases and Thalassaemia in particular constitutes an important indicator for the quality of healthcare systems. We aimed at assessing healthcare services in different countries by using publicly available health indicators and by surveying Thalassaemia patients and their caregivers. Materials and Methods: We reviewed official worldwide databases from the WHO, World Bank, and scientific resources and also used a structured patient tailored self-completed questionnaire to survey Thalassaemia patients and their caregivers in 2023. Results: A total of 2,082 participants were surveyed (mean age 27 years, males 42%). About 1 in 4 respondents had less than high school education, while 24% had a bachelor degree. About a third of respondents were married and had either full- or part-time employment. The vast majority (~80%) had initiated transfusion therapy between 1 – 4 years of age. Only 42% reported no delays in receiving blood transfusion, while 47% reported occasional delays and 8% serious delays. About half of patients reported being very satisfied (11%) or satisfied (38%) with the quality of provided services, while 1 in 3 patients reported being unsatisfied or very unsatisfied, and their access to treatment was difficult or very difficult due to traveling expenses and high cost of treatment. Conclusion: Important improvements in the care of Thalassaemia patients have been documented during the past decades. Nevertheless, our recent survey reveals many unmet needs where additional focus is required through national healthcare systems in order to address them effectively and achieve satisfactory patient outcomes.

A temporary monitoring system was installed on the 175-years-old historical Széchenyi chain bridge under its reconstruction process. The bridge is in the downtown area of the capital city of Hungary and plays a significant role in city life of Budapest. Six-month-long measurements were conducted during the reconstruction process of the bridge, yielding crucial insights into the structural behaviour of the historical structure. Measurement results were evaluated; the findings encompass the rotation capacity of pins between chain elements, and structural response to temperature changes. This information helped the decision-making of designers and construction company during the reconstruction made between 2021 and 2023. For instance, daily temperature fluctuations result in increased bending moments in the chain elements, rising up to 158% compared to the values observed during a proof load test in 2018. Furthermore, the measurements reveal an approximate 42% increase in normal forces compared to the proof load test, which highlights the high sensitivity of chain bridges to temperature fluctuations, where geometric stiffness plays a crucial role. Reconstruction, reducing self-weight, notably intensifies the impact on normal forces and bending moments. These outcomes strongly emphasize the dominance of dead load and self-weight in the case of chain bridges.

In this work, quiescence is added to the Susceptible-Infectious-Recovered (SIR) model with demography. In order to investigate consequences of quiescence in the infection process in more depth, we use stochastic simulations on the stochastic version of model that we built. This method provides a more accurate picture of the dynamics of infectious diseases by taking into consideration the inherent randomness in the disease processes. We examine the effects of quiescence on the number of infected people using simulations. The results, presented in histograms depicting the distribution of infected individuals, reveal a notable trend: the mean number of infected individuals is higher when quiescence is incorporated into the dynamics. These finding emphasizes the dynamic influence of quiescence on infectious disease spread. The higher mean number of infections during periods of quiescence highlights the need for public health strategies that are flexible enough to focused interventions during these times to reduce the possibility of an increase in infections.

Contagious pathogens have very high costs for dairy herds, and they may have zoonotic and reverse-zoonotic potentials, and may contribute in spreading antimicrobial resistance. One of the most important risk factors for spreading these infections is milking, when liner contamination may transfer the pathogens from infected to healthy cows. There is no effective protocol for avoiding the transmission of infection out of the segregation of infected cows. Recently, the availability of elastomers including patented antimicrobial components in their formulations has opened the way to explore alternative methods to decrease infection risk. Two different types of elastomers (rubber and silicon) and 9 different receipts were challenged by three major mastitis pathogens (S. aureus, S. agalactiae, and E. coli). The results showed interesting and unexpected results. Indeed, for the first time to our knowledge, we have shown that basic rubber materials have intrinsic antimicrobial activity. Silicon elastomers did not exhibit the same levels of killing activity, although they did exhibit some antibacterial capacity. Generally, a significant decrease in bacterial survival curves was observed with the tested formulations. The results observed for the various products are likely due to the specific activity of the chemical components, as well as the diverse chemical reactions that occur during their production. The availability of new tools able to reduce the risks for the spread of infections and generally decrease the bacterial load at milking, would be an important step forward to achieve a higher global sustainability of dairy production from a One Health perspective.

This study aimed to assess the diagnostic accuracy of a mobile application by comparing its diagnoses to those of Orofacial Pain and Oral Medicine specialists and further imaging results (TMJ CBCT and MRI) in 500 patients with temporomandibular disorder (TMD). The research focused on three diagnostic categories: initial specialist diagnoses, final diagnoses after imaging, and the mobile app's diagnoses. The concordance rate, sensitivity, specificity, and positive predictive value of the diagnoses were examined, with further imaging serving as the gold standard. The mobile app demonstrated a high concordance rate compared to both final (0.93) and initial specialist diagnoses (0.86). Sensitivity, specificity, and positive predictive values also indicated strong reliability, affirming the app's diagnostic validity. Although the concordance rate was slightly lower when comparing the app's diagnoses to imaging results (CBCT and MRI), specialist diagnoses yielded similar results. The study suggests that user-friendly diagnostic mobile applications, based on the Diagnostic Criteria for Temporomandibular Disorders, could enhance the clinical management of TMD. Given the reliability of mobile applications for diagnostic purposes, their wider implementation could facilitate the provision of appropriate and timely treatments for patients with TMD.

Many relevant health social actors have voiced concerns about the danger of self-medication in times of growing use of over-the-counter medicines and, in some contexts, unregulated selling of them. Previous research has examined the incidence of parental self-medication as well as the use and abuse of antibiotics without professional advice. However, these studies have limited evidence on the role of family doctors and the perceived severity of self-medication in the case of parents. Based on Health Belief Model, our research tested the effects of exposure to medical information on the perceived level of self-treating the children without medical advice. Specifically, we aimed to assess whether exposure to information warning about the risks of treating children without a medical prescription influences parents' attitudes toward administering medicines to their children without medical advice. The results showed that our respondents evaluated the practices of self-medication negatively, especially when it came to treating their children without medical advice. However, their attitudes towards self-medication varied depending on their beliefs about administering certain medications. Additionally, the results showed that the perceived level of satisfaction with the family physician could be a significant factor in controlling and avoiding the treatment of children without professional advice.

Pasture-based production systems are predominant in major beef-producing countries, however, these systems lack validated protocols to assess animal welfare under commercial conditions. The objective of this study was to validate an animal welfare protocol for fattening Zebu cattle farms in tropical pasture systems. The initial protocol was developed with the participation of producers, professionals, the general public, and the Colombian health authority, through workshops with a participatory approach and collaborative knowledge management. The validation was carried out in 24 pasture-based commercial Zebu cattle farms in the middle Magdalena region of Colombia. Visits were made with an average duration of 2.5 hours, which included the evaluation of 788 fattening cattle. The protocol evaluated animal-based, resource-based, and livestock management indicators through a questionnaire-guided interview to evaluate cattle handling and health, animal-based measurements, and documentation management. A protocol validation process was carried out by selecting indicators that remained unchanged, adjusting those that were feasible to implement, and eliminating inadequate or unnecessary indicators. The application of the protocol demonstrated that there are valid and feasible measures to include in the evaluation protocols of pasture-based fattening systems. Likewise, the active participation of producers is crucial to achieving a greater commitment to the implementation of this protocol.

Background and Aims: Paramedics attend an unprecedented number of drug poisoning events daily in British Columbia (BC), Canada due to the ongoing public health crisis related to an increasingly toxic and unregulated supply of illicit drugs. Paramedics have the potential to support alternative models of care to reduce harm, but their perspectives towards harm reduction initiatives are polarized. Understanding the drug-related substance use content in paramedic curriculum documents is important for deploying effective harm mitigating programs. The objective of this study was to understand what drug-related substance use content currently exists within paramedic curriculum documents in British Columbia. Methods: We performed a document analysis of curriculum documents in BC’s paramedic training institutions, the primary program textbook, and the 2011 National Occupational Competency Profile (NOCP). We used the Checklist for Assessment and Reporting of Document Analysis (CARDA) tool to perform our analysis. We analysed and coded documents both inductively and deductively and subsequently combined, refined, and used the codes to inform the development of themes via reflexive thematic analysis. Results: Of the 44 documents analysed, 22 included codes relevant to the research questions. Paramedics are primarily taught to care for people who use drugs in an acute drug-poisoning response only, with little consideration of holistic care, and no meaningful mention of harm reduction. Some stigmatizing language was found within the content. Conclusions: Many opportunities to introduce holistic models of care for people who use drugs along the entire continuum of care are unaddressed by paramedic curriculum documents in BC. Curriculum developers should include people who have lived and living experience of drug use in the co-design of educational programs involving their care. Further qualitative analyses are required to evaluate the relationship between paramedic education and provider-based stigma.

Nurses focus more on curative aspects rather than health promotion and disease prevention, thus weakening primary health care and lessening engagement with the community. Providing a learning environment that can support the professional growth of nurses through engagement with local communities and educational institutions would strengthen primary health care in the community; however, this poses challenges due to the traditional mindset of nurses towards primary health care. This integrative review aimed to explore key features of the potential of the nursing center model as a contracting-out approach to strengthen primary health care services. This integrative review provides lessons for implementing the Nursing Centre model for any country, mainly where nurses are not fully utilized for health promotion and disease prevention.

Cardiovascular diseases (CVD) are prevalent and lead to high morbidity and mortality globally. Physiotherapists regularly interact with patients with or at risk of CVDs (pwCVDs). This study aimed to assess the nature of existing evidence, interventional approaches used, and the population groups included in physiotherapy-led health promotion (PLHP) for pwCVDs. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Medline, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and PEDro databases were searched from inception until June 2023. Two reviewers independently screened the titles, abstracts, full text and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 4992 records were identified, of which 20 full-text articles were included in the review. The studies had varied populations, including those with stroke, coronary artery diseases, peripheral artery diseases, hypertension, diabetes, and multiple CVD risk factors. The interventions ranged from exercise and physical activity programs, dietary interventions, education, and counselling sessions with various supplementary approaches. Most interventions were short-term, with less than 12 months of follow-up. Interventions were personalised and patientcentred to promote adherence and health behaviour change. Among the included studies, 60% employed experimental designs, with the remainder using quasi-experimental designs. Although a wide range of PLHP strategies have been used for pwCVDs, exercise and physical activity were employed in 85% of included studies. Other components of health promotion, such as sleep, smoking, and alcohol abuse, should be investigated within PLHP.

To supply stable and high-quality power according to the advancement of industrial growth, electric power companies have performed maintenance of power facilities using various meth-ods. In the case of domestic power distribution facilities, there are limitations in performing di-agnostic management on all facilities owing to the large number of facilities; therefore, old fa-cilities are managed by the health index assessment method. The health index assessment com-prises only facility operation data and external environmental data and is managed only for four types of distribution facilities, including overhead/underground transformers and switchgear. In the case of extra high–voltage overhead wires, there is no standard for old replacement, despite the large number of wires, such as transformers and switchgear, and the large ripple effect of power failure in the event of a power outage. Therefore, in this paper, a health index assessment methodology for extra-high voltage overhead cables was developed. In this paper, we devel-oped an economic health index assessment methodology that additionally considers risk cost, which is different from the existing health index assessment method that uses only operational data and external environmental data to determine facility performance evaluation and aging replacement criteria. Using the health index assessment methodology developed in this paper, it is possible to expect a reduction in facility operating costs and investment costs from the per-spective of electric power companies through the replacement of old extra-high voltage over-head cables. In addition, from the perspective of consumers, it is expected to increase power re-liability and reduce the ripple effect of failure by preferentially replacing equipment with a high probability of failure.

Microbiological control of dental pathologies presents a significant clinical challenge for dental surgeons, particularly considering drug-resistant microorganisms. To address this issue, Antimi-crobial Photodynamic Therapy (PDT) has emerged as an effective and complementary technique for microbial reduction. This therapy involves the application of a photosensitizer dye (PS) either topically or systemically, followed by exposure to low-power lasers with appropriate visible light wavelengths. PDT has found a valuable place in dentistry across various specialties, including surgery, periodontics, endodontics, dentistry, implantology, orthodontics, and pediatrics. In the realm of pediatric dentistry, managing microorganisms during dental treatments has become a major challenge.This article reviews the evidence supporting the potential of photodynamic therapy in combating bacteria, fungi, and viruses, with a particular focus on areas such as endodontics, restoration in deciduous teeth, implantology, and periodontics for bacterial control. Additionally, PDT has shown promise in stomatology, specifically in the treatment of mucositis and herpes. Considering its promising results and ease of application, photodynamic therapy presents an in-teresting alternative for clinical practice. However, it is important to note that specific protocols must be followed for each application, encompassing the type of photosensitizer, concentration, pre-irradiation time, light type, wavelength, energy, power, and mode of light delivery. Researchers have been steadily refining these protocols to facilitate PDT's integration into clinical practice.

Purpose: Hormone Replacement Therapy (HRT), an FDA-approved treatment for menopausal conditions was found to be associated with increased risk of endometrial cancer and reduced oestrogen. Studies showing benefits of HRT in preventing chronic diseases lead to development of clinical guidelines by American College of Physicians. This study aims to assess effectiveness of HRT treatments across cardiometabolic measures including Triglycerides (TG), Follicle-Stimulating Hormone, LDL cholesterol, HDL cholesterol, and Estradiol in menopausal women. It reports gaps in scientific knowledge and clinical practice to enhance current guidelines and policies.Methods: A systematic methodology designed and published in PROSPERO (CRD42022346057) to report network meta-epidemiology analysis was utilised. We used databases by PubMed, Web of Science, ScienceDirect, EMBASE and MEDLINE for studies published between 30th of April 1980-2022. Effects of HRT treatments were explored using a mixed treatment comparison (MTC) model. Fixed and random-effects models were used to address heterogeneity in published studies. Publication bias was assessed and corrected using funnel plots and Egger’s test.Results: Of 45 eligible studies, our findings indicate a significant statistical heterogeneity between HRTs and reduction of TG, SFH, LDL-C alongside increase of HDL-C and Estradiol among menopausal women. The analysis suggests a lack of direct evidence to support their efficacy in reducing TG, SFH and LDL-C levels or to substantiate HRT’s effectiveness in increasing HDL-C and Estradiol. The results showed no significant publication bias in the meta-analysis of included studies.Conclusion: Our findings demonstrate that use of HRT interventions among menopausal women may reduce TG, FSH and LDL-C levels and increase levels of HDL-C and estradiol via oral and oral + transdermal administration. Our study reaffirms efficacy of HRT in supporting favourable lipid profile in menopausal women whilst highlighting the need for robust and inclusive epidemiology studies and clinical trials to further develop clinical guidelines and policies.

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.

Abstract ObjectivesThe aim of this perspective is to report the use of synthetic data as a viable method in women’s health given the current challenges linked to obtaining life-course data within a short period of time and accessing electronic healthcare data. Methods We used a 3-point perspective method to report an overview of data science, common applications, and ethical implications. Results There are several ethical challenges linked to using real-world data, consequently, generating synthetic data provides an alternative method to conduct comprehensive research when used effectively. The use of clinical characteristics to develop synthetic data is a useful method to consider. Aligning this data as closely as possible to the clinical phenotype would enable researchers to provide data that is very similar to that of the real-world. Discussion Population diversity and disease characterisation is important to optimally use data science. There are several artificial intelligence techniques that can be used to develop synthetic data. ConclusionSynthetic data demonstrates promise and versatility when used efficiently aligned to clinical problems. Therefore, exploring this option as a viable method in women’s health, in particular for epidemiology may be useful.

This systematic review seeks to position online radicalisation within whole system frameworks incorporating individual, family, community and wider structural influences, whilst reporting evidence of public mental health approaches for individuals engaging in radical online content. Methods: Authors searched Medline (via Ovid), PsycInfo (via Ebscohost) and Web of Science (Core Collection), with the use of Boolean operators across ‘extremism’, ‘online content’, and ‘intervention’. Results: Following assessment of full text, all retrieved papers had to be excluded. Results from six excluded articles which did not fit inclusion criteria but identified theoretical relationships between all three elements of online extremism, psychological outcomes, and intervention strategy, were discussed. Authors found no articles outlining public mental health approaches to specifically online radicalisation. Conclusions: There is an immediate need for further research in this field given the increase in different factions of radicalised beliefs resulting from online, particularly social media, usage.

Background: Evidence suggests that children and young people (CYP) who present to the emergency department (ED) for mental health (MH) difficulties may have extended lengths of stay (LOS); however, there is a paucity of research in Australia regarding the factors associated with extended LOS. This study aimed to determine the factors associated with extended LOS for paediatric MH-related presentations to the EDs in South Western Sydney (SWS), a multicultural community in Australia. Methods: We analysed electronic medical records (eMR) of 7,409 MH-related ED encounters of CYP aged 0 up to 18 years from all six public hospitals in SWS from January 2016 to April 2022. Extended LOS was defined as encounters of more than 4 hours. We assessed factors associated with extended LOS using a multilevel logistic regression model, accounting for hospital-level clustering. Results: Approximately 57.6% of all ED presentations for paediatric MH involved extended LOS. ED presentations by adolescents (adjusted odds ratio (AOR) 2.23, 95% CI 1.20-4.17 for 12-14 years and AOR 2.69, 95% CI 1.44-5.00 for 15-17 years), and patients with a preferred language other than English (AOR 1.47, 95% CI 1.15-1.89) had increased odds of extended LOS compared to their counterparts. Deliberate self-harm related presentations, the most commonly presented MH condition, had higher odds of extended LOS than other MH-related presentations (AOR 1.77, 95% CI 1.59-1.98). Patients with MH presentations that required urgent evaluation (triage levels 1-2) had higher odds of extended LOS (AOR 1.38, 95% CI 1.15-1.65) compared to triage level 3, whereas those with triage levels 4-5 had lower odds (AOR 0.66, 95% CI 0.58-0.74). Further, patients with MH-related presentations that came by ambulance (compared to other mode of presentations) and presentations that happened at night and late at night (compared to early morning and daytime presentations). The odds of extended LOS were considerably lower during the COVID-19 period compared to the pre-COVID-19 period (AOR 0.74, 95% CI 0.67-0.82). Additionally, extended paediatric LOS for MH issues in the ED showed notable hospital-level heterogeneity. Conclusion: A large proportion of extended LOS in ED and sociodemographic disparities reflect inequality in access to paediatric MH care. Our findings highlight the need for equitable distribution of resources directed towards at-risk CYP to improve MH outcomes and reduce health system burden.

Antimicrobial resistance (AMR), the capacity of microbial pathogens to survive in the presence of antimicrobials, is considered one of the greatest threats to human health worldwide and is growing rapidly in importance. AMR is thought to be driven in part by the use of antimicrobials (AMU) in livestock production. AMU reduction in agriculture is therefore important, but doing so may endanger farmers’ incomes and hamper broader food security. Understanding drivers for farmers' antibiotics use is essential to designing interventions which avoid harming agricultural output and safeguard farmers’ economic security. In this study, we analyse AMUSE survey data from poultry farmers in Senegal to explore the effects of vaccination, attitudes towards AMR, and biosecurity practices on: AMU, animal mortality, and farm productivity. We found that farmers with more “AMR-aware” attitudes may be less likely to use antibiotics in healthy birds. Stronger on-farm biosecurity was associated with less use of antibiotics in healthy birds, and in some specifications was linked to higher broiler productivity. Vaccination and AMU were both linked with higher disease prevalence, and both factors appeared conducive to higher broiler productivity. Overall, there is evidence that awareness-raising and biosecurity improvements could encourage prudent use of antibiotics, and that biosecurity and vaccination could to some extent replace antibiotic use as productivity-enhancing and disease-management tools in broiler farms. Finally, issues of farm antimicrobial stewardship must be considered at the structural level, with farm behaviours contingent on interaction with state and private stakeholders.

We aimed to study the knowledge of diabetes among high-risk individuals for diabetes in the Indian state of Kerala. The baseline data collected from 1007 participants of the Kerala Diabetes Prevention Program were analyzed. Diabetes knowledge was assessed using a scale adapted from a large nationwide study conducted in India. The composite score of the scale ranges from 0 to 8. The mean age of participants was 46.0 (SD: 7.5) years, and 47.2% were female. The mean diabetes knowledge score was 6.9 (SD: 2.1), with 59.5% having the maximum possible score of 8. Of 1007 participants, 968 (96.1%) had heard the term diabetes, and of them, 84.7% know what diabetes is, 87.2% think more and more people are getting diabetes nowadays, 79.6% know that diabetes can cause complications in organs, and 75.9% know that diabetes can be prevented. While the level of diabetes knowledge was high among our participants, a quarter of them (24.1%) were not aware that diabetes can be prevented. Thus, there is a need for health promotion programs to increase the knowledge of diabetes prevention among high-risk individuals in Kerala.

Background: The number of young Japanese Brazilians, who are return migrants with Japanese ancestral roots, is increasing rapidly in Japan. However, the characteristics of their mental health and the relation between mental health and a complex ethnic identity remains unclear. Methods: This cross-sectional study compared 25 Japanese-Brazilian high school students with 62 Japanese high school students living in the same area. Research using self-report questionnaires on mental health, help-seeking behavior tendencies, and ethnic identity was conducted. The Japanese-Brazilian group was also divided into high and low ethnic identity groups, and their mental health conditions were compared. Results: The Japanese-Brazilian group had significantly poorer mental health conditions and lower ethnic identities than the Japanese group and were less likely to seek help from family members and close relatives. Among the Japanese Brazilians, those with low ethnic identity had significantly poorer mental health than those with high ethnic identity. Conclusions: Young Japanese Brazilians may face conflicts of ethnic identity that can disturb their mental health. To build an inclusive society, the establishment of community services to support mental health and to help return migrants develop their ethnic identity is essential.

The Indonesia’s Tobacco Excise Sharing Fund (DBHCHT) policy mandates that part of the fund should be allocated for tobacco crop diversification – reducing the farmers’ reliance on tobacco industry as well as implementing Article 17 of Framework Convention on Tobacco Control (FCTC). However, very little is known on practical implication of this fund on tobacco farmers livelihood. We collected primary data from key stakeholders in four main tobacco producing municipalities. The data were analyzed using qualitative content analysis with NVivo 12. Numbers of challenges on DBHCHT utilization remained at sub-national levels. The sub-optimal use of DBHCHT could partly be explained by: (i) constantly changing central government regulation; (ii) farmers’ unawareness of DBHCHT regulation; (iii) the delay in DBHCHT allocation; and (iv) supply and demand mismatch. Although Indonesia has not been a part of the FCTC ratification, the DBHCHT mandate is in line with the FCTC article 17, i.e., promoting economically viable alternatives for tobacco farmers. This study concluded that DBHCHT utilization needs to go a long way to void this mandate given the challenges at sub-national level. Therefore, this study recommends more technical and practical regulations involving multisectoral stakeholders and the use of DBHCHT to facilitate financial needs of crop diversification.

The goal of this short communication is to analyze a published discussion that states that long-term residing at a thermoneutral indoor temperature condition hinders human thermal acclimation capacities. According to current research, human thermal acclimation and acclimatization capacities can be easily gained through repeated heat and cold exposures mixed with physical activity over a period of days (often 3–21 days). Furthermore, heat and cold adaptations are not permanent, and heat acclimation would progressively fade away if frequent heat exposures (associated with physical work/exercise) were discontinued. People who have been heat acclimatized for a long period and live in tropical places may progressively lose their physiological and perceptual benefits when they shift to temperate zones. On the other hand, the decay of cold acclimation and cold acclimatization has not been well examined, demanding future research on this area. To summarize, there is no evidence to support the claim that extended exposure to thermoneutral conditions impairs human acclimatization abilities.

Infectious diseases, as COVID-19 is proving, pose a global health threat in an interconnected world. In the last 20 years, resistant infectious diseases such as SARS, MERS, H1N1, Ebola, Zika and now COVID-19 have been impacting global health defences, and aggressively flourishing within the rise of global travel, urbanization, climate change and ecological degradation. In parallel, this extraordinary episode in global human health highlights the potential for artificial intelligence (AI)-enabled disease surveillance to collect and analyse vast amounts of unstructured and real-time data to inform epidemiological and public health emergency responses. The uses of AI in these dynamic environments are increasingly complex, challenging the potential for human autonomous decisions. In this context, our study of qualitative perspectives will consider a responsible AI framework to explore its potential application to disease surveillance in a global health context. Thus far, there is a gap in the literature in considering these multiple and interconnected levels of disease surveillance and emergency health management through the lens of a responsible AI framework.

The use of biomarkers to measure immune responses in serum is crucial for understanding population-level exposure and susceptibility to human pathogens. Advances in sample collection, multiplex testing, and computational modeling are transforming serosurveillance into a powerful tool for public health program design and response to infectious threats. In July 2018, 70 scientists from 20 countries met to perform a landscape analysis of approaches that support an integrated serosurveillance platform, including the consideration of issues for successful implementation. Here, we summarize the group’s insights and proposed roadmap for implementation, including objectives, technical requirements, ethical issues, logistical considerations, and monitoring and evaluation.

CVDs are a leading cause of death globally. In CVDs, the heart is unable to deliver enough blood to other body regions. Since effective and accurate diagnosis of CVDs is essential for CVD prevention and treatment, machine learning (ML) techniques can be effectively and reliably used to discern patients suffering from a CVD from those who do not suffer from any heart condition. Namely, machine learning algorithms (MLAs) play a key role in the diagnosis of CVDs through predictive models that allow us to identify the main risks factors influencing CVD development. In this study, we analyze the performance of ten MLAs on two datasets for CVD prediction and two for CVD diagnosis. Algorithm performance is analyzed on top-two and top-four dataset attributes/features with respect to five performance metrics –accuracy, precision, recall, f1-score, and roc-auc – using the train-test split technique and k-fold cross-validation. Our study identifies the top two and four attributes from each CVD diagnosis/prediction dataset. As our main findings, the ten MLAs exhibited appropriate diagnosis and predictive performance; hence, they can be successfully implemented for improving current CVD diagnosis efforts and help patients around the world, especially in regions where medical staff is lacking.

The global burden of stroke is still high, particularly in developing countries, with hypertension serves as the main risk factor. Knowledge related to stroke is essential to establish better prevention strategies. This study aimed to identify factors associated with stroke awareness among hypertensive patients in Indonesia. This was a cross-sectional study conducted in five Community Health Centers in Indonesia. We used a standardized questionnaire to asses stroke awareness and the influencing factors. The knowledge on hypertension was assessed using Hypertension Knowledge Level Scale (HK-LS). Multivariate logistic regression analysis was performed to measure factors associated with stroke awareness. A total of 457 hypertensive patients were included. Majority of patients (77.46%) had low stroke awareness. Having higher knowledge on hypertension, higher income, and a history of previous stroke were associated with higher level of stroke awareness (odds ratio [OR] 1.878, 95%CI 1.176-2.999, p 0.008; OR 1.887, 95%CI 1.170-3.045, p 0.009; OR 5.276, 95%CI 2.210-12.594, p<0.001, respectively). This study suggests that knowledge on hypertension, income, and history of previous stroke are factors which may influence the level of stroke awareness. This emphasizes the need to provide better campaign and education program to raise stroke awareness in a community setting.

(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child’s concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Survey of the Concept of Pain (SOCOPA) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI=0.814; (4) Conclusions: The findings suggest that SOCOPA is a measure of a child’s concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.

Background: Physical activity is recommended to mitigate the incidence of obesity, but delivery of community wide initiatives is cumbersome. The challenges met by such programs are magnified when implementation transpires in the remote villages of Alaska. To overcome the difficulty of this challenge in the Arctic, the Skiku/AK Nordic cross-country skiing program was developed. The objective of this study was to evaluate whether access to Skiku/AK Nordic program would promote physical activity levels that met the daily recommendations for physical activity in Alaska Native children. Methods: Eight children (4 females and 4 males; 10±2 years/age) were recruited from Kaktovik, Alaska for participation in this study. Expert coaches and staff provided one week of cross-country ski instruction and access to ski equipment. Physical activity was monitored using ActiGraph GT3X+ accelerometers. Data collected from the devices was then downloaded and analyzed using ActiLife software. Results: The participants expended ~586 calories/day devoted to physical activity. Light and moderate physical activity was 68±38 minutes/day and 447±248 minutes/day, respectively. Conclusions: Delivery of the Skiku/AK Nordic program promoted favorable levels of physical activity in Alaska Native children. Further research is needed to assess the longitudinal and seasonal effectiveness of the Skiku/AK Nordic program.

The Coronavirus pandemic is a major challenge to human wellbeing; it directly affects health, and indirectly involves the economic, politic and social spheres. This, in turn, is going to have major systemic, worldwide health, social and environmental consequences. In this paper, I will briefly sum up the history of the pandemic, the worldwide diffusion, the major different political reactions, as well as health and political countermeasures, and the economic consequences / evaluations for the future. The aim of this paper is to show and address all the different spheres involved and their relationships. Emphasis will be placed on the paradoxical presence of a large amount of data and the big uncertainty for the future. The outcomes will be briefly analyzed on a healthcare, political and socio-economical level. The point of view is systemic with human beings, institutions and the environment seen as a whole. Systemic thinking allows interdisciplinary research to be decisive in understanding the worldwide reaction to the pandemic. The global response to this crisis is of historical significance, and therefore potentially decisive for the multi-layered future of the world.

Policy is a lever for initiating the structural and environmental changes that foster health-enhancing physical activity (HEPA) promotion. However, little is known about the evidence in support of local governments regarding their HEPA-promoting policies. This study collected comprehensive information on municipal HEPA policies on the French Riviera to gain an overview of HEPA policy development in this territory. Mid-sized cities from the two counties constituting the French Riviera were targeted (n = 17). In each city, a local tool for HEPA policy analysis, CAPLA-Santé, was used to gain information from key informants heading the departments of sports, health services and social services. Data were collected through semi-structured interviews and document analysis. Ten mid-sized cities volunteered to participate. Key informants from the sports (n = 10), health services (n = 5) and social services (n = 6) departments were interviewed. Written HEPA policy documents were formalized in six cities. These documents (n = 14) were mainly from the sports (n = 8) and health services (n = 4) sectors. The key informants reported that support from that national policy, the commitment of elected officials, and large local stakeholder networks facilitated HEPA promotion, whereas the lack of intersectoral collaboration and limited resources were limitations. The results provide insight into the development of municipal HEPA policies, highlighting some of the barriers, facilitators and perspectives. These findings could be valuable to scale up HEPA promotion at the local level.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population’s movements, work, education, gatherings, and general activities in attempt to ‘flatten the curve’ of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. First, I explain how the initial modeling predictions induced fear and crowd-effects [i.e., groupthink]. Second, I summarize important information that has emerged relevant to the modeling, including about infection fatality rate, high-risk groups, herd immunity thresholds, and exit strategies. Third, I describe how reality started sinking in, with information on significant collateral damage due to the response to the pandemic, and information placing the number of deaths in context and perspective. Fourth, I present a cost-benefit analysis of the response to COVID-19 that finds lockdowns are far more harmful to public health than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. I close with some suggestions for moving forward.

The Matāura River is the sixth largest river system in New Zealand and has long been subject to agricultural, industrial, and residential land use activities. The catchment has geographic and economic value and is of great cultural importance for local Māori, who have concerns over potential adverse impacts that anthropogenic stressors exert on the health of the river. There is a dearth of information on the impacts of these stressors towards the health of native species such as the longfin eel Anguilla dieffenbachii. This study assessed the environmental status of the Matāura River using biological and chemical methodologies incorporating A. dieffenbachii as a bioindicator species for exposure to combined anthroprogenic stressors. A range of biomarker endpoints were measured in caged and wild-caught eels (when available) to characterize site-specific responses to combined anthropogenic stressors. While there was no clear indication of cumulative impacts moving from pristine headwaters to the lower reaches of the Matāura River biomarkers of xenobiotic metabolization were induced in A. dieffenbachia and there was evidence of chemical contamination in sediments and tissues.

Background – The profound impact of COVID-19 on the U.S. healthcare industry cannot be overstated. Telemedicine utilization exploded virtually overnight as healthcare systems, hospitals, and clinical practices rushed to implement this delivery model to ensure accessibility and continuity of patient care access across myriad service lines and dimensions. Objective – The purpose of this systematic literature review is to examine the measures that were implemented to accommodate community and individual patient needs not only to afford access to critical services, but to also maintain safety standards for affected parties. Methods – Boolean operators were crafted with the expressed intent of identifying articles within multiple database domains germane to our chosen topic. Results – 52,206 articles were captured from a general search query and subsequently distilled to 44 through group consensus based on pertinence to our basic research question. The four health service lines identified encountered similar, surmountable obstacles in their care delivery models, but adapted accordingly to the respective needs of their patient populations. Conclusion – This review showcased the healthcare industry’s ability to rapidly acclimate and change due to the pervasive spread of COVID-19 throughout the U.S. Although imperfect, unique responses were developed within telemedicine platforms to broadly and effectively mitigate disruptions in care and treatment modalities.

Introduction: Corona epidemic and quarantine enforcement, various effects on the psychological and social aspects of the population has left. The aim of this study is to investigate the relationship between depression, anxiety and relationship with medical staff and mental health is caused by corona. Methods: For this purpose, samples of 650 health personnel of private hospitals were selected. Inventory DASS, HADS, and selected social cohesion (Keyes) and the Internet and through social media networks were evaluated. To analyze the data, Pearson correlation and regression analysis were used. Results: The results showed that straw anxiety corona) to negative (and social cohesion caused by corona) to positive (mental health correlates. It was also found that anxiety and social cohesion caused by corona, respectively 47 and 26 percent predict changes in mental health. Conclusion: These results show the positive and negative effects of psychosocial interventions in quarantine and it have practical implications in the development of the epidemic crisis is Corona.

Rapidly and repeatedly ascertaining the health status of coral reefs is an ever more pressing issue as part of activities to understand and monitor the damaging impacts of climate change. A combination of increasing ocean temperatures, acidity and frequency of extreme storm events continues to alter the marine environment beyond what sensitive organisms, such as coral, can cope with. It is therefore vital to establish technologies and validated methods to provide a metric or indication into the health of these organisms. There are currently many surveys and techniques used by coral scientists to uncover insights into the status and assessment of coral reefs, from colour wheels to multispectral satellite surveys. Here we outline an array of current techniques and methods focused specifically on coral monitoring and health diagnosis, ranging across the length scales from simple diver-based surveyance to satellite remote sensing. The technique of using hyperspectral fluorescence imaging is also introduced as a viable novel addition to aid and extend the current toolbox of available technologies.

The classic Body Mass Index, (BMI), developed in the 19^th century by the Belgian mathematician Adolphe Quetelet [1] is an important indicator of the risk of death, of obesity, of negative health consequences, body fat percentage and of the shape of the body. While he BMI is assumed to indicate obesity in sedentary people and in people who do not practice sports, it is undisputed and a consensus among researchers [2][3][4][5][9][25] that Body Mass Index (BMI) is not a good indicator for obesity in people who developed their body through heavy physical work or sport but also in other segments of population such as those who appear to have a normal weight but in fact have a high body fat percentage and obese methabolism. The BMI also does not include all the variables essential for a health predictor. The BMI is not always a good predictor of metabolic disease, people who appear of healthy weight according to BMI have in some cases an obese metabolic syndrome. The BMI was developed as a law of natural sciences and “social physics” [1], as it was called then, before the middle of the 19^th century, and it had been used from the 70s for medical purposes, to detect obesity and the risk of mortality [6][7]. The BMI has a huge importance for modern society, affected by an obesity epidemic [8]. BMI has applications in medicine, sport medicine, sport, fitness, bodybuilding, insurance, nutrition, pharmacology. The main limitation of the BMI is that it does not account for body composition including non fat body mass such as muscles, joints, body frame and makes no difference between fat and non fat components of the body weight. The body composition and the proportion of fat and muscles make a difference in health outcomes [12][13][14][25][26][27][35][36][37] [38][39][40][41][42][43][44]…[100]. Body composition makes a difference also in the level of sport performance for athletes of every level. In nearly two centuries since the Body Mass Index was developed, no formula had been successfully developed to account for body composition and make the difference between muscle and fat in a consistent way. This can be considered a longstanding open problem of major importance for society. The objective of this analysis is to develop new formulae taking into account the health implication of body composition measured through indirect, simple indicators and making the difference between muscles and fat, healthy and non healthy metabolism. The formulae developed in this article are the only formula to successfully generalize BMI and make this difference. I develop a direct generalization of BMI, in the mathematical and physiological sense to account for fat and fat free mass and muscles, small and large body frames. It is the first such generalization because the classic BMI can be determined as a particular case of my formulae in the strict mathematical and practical physiologic sense. No other formula generalized the BMI to make the difference between fat and a large frame and muscles has ever been published in nearly two centuries since the BMI formula had been developed. The formulae I developed explain and generalize the conclusions of a large number of highly cited empirical experiments cited in the reference section. [35][36][37][38][38][39] [40][42][43][44]..[100] Most of the experimental proof I bring in support of my formulae and bodyweight quantification theory comes from many highly cited experimental research publications in medicine, sports medicine, sport science and physiology. My formulae explain also performance in decades of competitive sports and athletics

Background and motivation: Combining Deep Reinforcement Learning (Deep RL) and Health Systems Simulations has significant potential, for both research into improving Deep RL performance and safety, and in operational practice. While individual toolkits exist for Deep RL and Health Systems Simulations, no framework to integrate the two has been established. Aim: Provide a framework for integrating Deep RL Networks with Health System Simulations, and to ensure this framework is compatible with Deep RL agents that have been developed and tested using OpenAI Gym. Methods: We developed our framework based on the OpenAI Gym framework, and demonstrate its use on a simple hospital bed capacity model. We built the Deep RL agents using PyTorch, and the Hospital Simulation using SimPy. Results: We demonstrate example models using a Double Deep Q Network or a Duelling Double Deep Q Network as the Deep RL agent. Conclusion: SimPy may be used to create Health System Simulations that are compatible with agents developed and tested on OpenAI Gym environments. GitHub repository of code: https://github.com/MichaelAllen1966/learninghospital

During this epidemic of COVID-19, children are in need of much concentration and profound love of the senior family members. Although the measures taken by the organizations are necessary to prevent the spread of the novel coronavirus, they may be causing widespread mental health issues, including depression and loneliness. Therefore, it is imperative that parents have to spend the lion-share of time with children while listening to them cordially. Parents can participate in sports with them to help them stay fit so that they can enjoy commemorating moments. However, in this additional time, the parents can also make them habituated to practice the rules of health, so does social distancing.

Background: Telemedicine is both effective and can provide efficient care at lower costs. It also enjoys a high acceptance rate among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and comprises three dimensions: the individual context, the technological context and the implementation or organizational context. There is not a short and validated questionnaire to check the acceptance of telemedicine services amongst health care professionals using a technology acceptance model. Objective To translate and validate a telemedicine acceptance questionnaire based in the technology acceptance model. Methods The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation which include construct (exploratory factor analysis), consistency (Cronbach’s alpha) and stability (test-retest). Factor analysis was used to describe variability amongst observed variables. Results After removing incomplete responses 144 responses where considered for analysis. The internal consistency measured with the Cronbach’s alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79-0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852-0.964). The Kaiser-Meyer-Olkin test of sampling was adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl=28; P < .001), indicating that the items were appropriate for a factor analysis. Conclusions The questionnaire validated with this study has robust statistical features that make it a good predictive model of professional’s satisfaction with telemedicine programs.

This study reports on the assessment of the growth potential of five edible vegetables which were grown in Cr (VI) spiked soils. The vegetable plants that were used in this study were Vigna angularis, Cicer arietinum, Spinacia oleracea, Amaranthus dubius Thell and Phaseolus vulgaris. Dried ground samples from roots, stems and leaves were analysed for various oxidation states of Cr. The daily intake of chromium (DIC), hazard quotient (HQ) and hazard index (HI) methods were employed to assess the potential human health risks posed by these Cr oxidation states through vegetable consumption. The results showed that Vigna angularis was the only vegetable that germinated in highly concentrated Cr (VI) in the simulated soil (456 mg/kg). The highest bioaccumulation factor of CrT in the roots was found in Cicer arietinum at 3.5 ± 0.51 mg/kg DW. The highest translocation factor in stem was that of Cicer arietinum and Vigna angularis at 1.0 ± 0.00, while Cicer arietinum and Spinacia oleracea translocated highest Cr to the leaf at 2.1 ± 0.21. A child or an adult consuming such contaminated Cicer arietinum were likely to take in between 508 -785 mg/kg/day of total Cr which were above the World Health Organisation guidelines of 220 and 340 mg/kg/day, respectively. The highest HQ was found in Cicer arietinum at 8.7 and 13.4 for adults and children, respectively. The same species of plants had also high HI at 17.4 and 27.2 for adults and children respectively. This indicated that consumers of the edible vegetables grown in Cr (VI) rich soil may be exposed to health risks and the children were more likely to be vulnerable to these adverse effects than the adult.

Background: India has one-fifth of the world's population and the number of people suffering from mental illness is assumed to be huge considering the contribution of mental disorders to the overall burden of the disease being 13.9 %. Objectives of Study: To estimate prevalence and patterns of mental illnesses to assess the current mental health services and systems in the Madhya Pradesh. Material and Methods: Multi-stage, stratified, random cluster sampling technique, with random selection based on probability proportionate to size at each stage. A total of 3240 individuals aged 18 years and above were interviewed. Both quantitative and qualitative methods were employed. A set of 10 instruments including Mini International Neuro-psychiatric Interview were utilized. Results: The overall weighted prevalence for any mental illness was 16.7% lifetime and 13.9% current. Treatment-gap for all mental health problems is as high as 91% in the state along with huge socioeconomic impact of mental illness. Conclusions: This huge burden of mental, behavioural and substance use disorders, in Madhya Pradesh, calls for immediate attention of political leaders, policy makers, health professionals, opinion-makers and society at large. It is hoped that the data from the study will inform mental health policy and legislation and help shape mental health care delivery systems in the country.

Marine algae have been considered as abundant source of bioactive compounds with cosmeceutical potential. Recently, a great deal of interest has focused on the health-promoting effects of marine bioactive compounds. Carbohydrate is a major and abundant constitute of marine algae that have been utilized in cosmetic formulations, such as moisturizing and thickening agents. In addition, marine carbohydrates have been suggested as promising bioactive biomaterials for various skin beneficial properties, such as anti-oxidant, anti-melanogenic and anti-skin aging. Therefore, marine algae carbohydrates have potential of skin health benefits for value-added cosmeceutical application. The present review focused on the various biological capacities and potential skin health benefits of bioactive marine carbohydrates.

Introduction: Ambient air pollution is major global health problem and commercial drivers are particularly exposed to it. No systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population has been carried out. Methods: We conducted a systematic review using a protocol-driven strategy. Papers published from inception to 20th April 2018 in MEDLINE, EMBASE, CINAHL, African journals online, Cochrane library, ISRCTN and WHO ICTRP databases were screened for inclusion by two independent reviewers. Original articles with at least an available abstract in English or French were included. Results: The initial search retrieved 1454 published articles of which 20 articles were included. 3 Studies reported a significant difference in white blood cells (106/L) among commercial motorcyclists compared to rural inhabitants (5.041±1.209 vs 5.900±1.213,p=0.001), an increased risk of lung cancer (RR=1.6, 95%CI 1.5-1.8) in bus drivers and an increased standardized mortality ratio (SMR) in bus drivers from Hodgkin’s lymphoma (SMR 2.17, 95%CI 1.19-3.87) compared to white collar workers. Other studies also found that drivers had more oxidative DNA damage and chromosome breaks. 4 papers failed to demonstrate that the drivers were more exposed to air pollution than the controls. 3 other studies also reported no significant difference in lung function parameters and respiratory symptoms. The genetic polymorphisms of detoxifying enzymes were not also homogeneously distributed compared to the controls. Conclusion: There is some evidence that occupational exposure to ambient air pollution among commercial drivers is associated with adverse health outcomes but the existing literature is limited with few studies of small sample size, methodological weaknesses and contradictory findings. Further research is recommended.

In the field of agricultural food production, the transition between organic and inorganic farming methods has been an issue of much debate. The debate, on one hand, stresses the urgency for the transition in order to preserve environment and health; and, on the other hand, emphasizes the pressure of maintaining food production for a large growing population. Thus, the dilemma is how to find an agricultural system that would balance between obtaining food security and ensuring a safe sustainably environment-friendly food production system. This article focuses on the debate, in the context of Bangladesh, and questions whether it is the proper time, and stage in the development process, to attempt the transition from inorganic conventional food production methods to organic food production methods. This article contemplates why the organic rice market is not expanding in Bangladesh, and attempts to explain the slow growth of the market through the two main factors of income constraint and lack of awareness among people about the environmental and health detriments of inorganic farming methods. The study is exploratory in nature, and finds that it is not mainly the lack of awareness but the income constraint that can be principally attributed to the slow expansion of the organic rice market in Bangladesh. Through exploring consumers’ awareness about organic farming methods and their demand for organic products, this study shows how income as the major constraint, besides price, affects consumers demand for organic and inorganic rice in Bangladesh. Income being identified as the major barrier reveals the potential of the organic rice market to grow in the future, as Bangladesh continues its journey towards becoming a middle-income country.

Objective: The main purpose of this study was to investigate the mental health of Cypriot citizens, living in the current difficult period of economic recession. Specific objective was to investigate the different factors (gender, age, socio-economic factors, etc.) that may affect the levels of emotional distress, anxiety and depression in visitors of the Rural Health Centre of Kofinou. Materials and Methods: The sample consisted of total 300 Cypriots who visited Kofinou Health Centre in the period between August and September 2015. For the middle-aged citizens the Greek version of the HADS scale (Hospital Anxiety Depression Scale) was administered to 150 persons (Michopoulos I., 2007), while for the visiting senior citizens (aged over 65 years) the Greek version of the GDS scale (Geriatric Depression Scale) was used (Fountoulakis K., et al., 1999). All analyses were performed with the social science analysis package SPSS (version 21). Results: HADS: A total of 150 people of average age 47±11,5 years (23-64), were 56% women, while the 77.3% stated they had drastic reduction of income as well as 46.7% suffered from chronic disease. The 36.6% and 28.7% of the visitors showed moderate and severe forms of anxiety and depression, accordingly. Higher emotional distress is associated with lower educational level (p<0,001). Moreover, patients with low income have higher levels of anxiety (p=0,003), depression (p=0,036) and total emotional distress (p=0,007), while those with chronic disease have a higher stress (p<0,001), depression (p<0,001) and total emotional distress symptoms (p<0,001) compared to non - patients. GDS: 150 patients out of which 77 were women (51.3%). The average age of participants was 72±5,5 years. 93(62%) participants declared a drastic reduction of income due to the financial crisis while 139 (92.7%) stated they had chronic disease. 53 participants (35.3%) think they have symptoms of depression after the economic crisis. The women showed higher level of geriatric depression symptoms than men (p<0.001). Higher levels of depression is associated with lower income (p=0.001). Conclusions: The study shows that stress levels, depression and emotional distress are increased in specific population groups. The main factors affecting the mental health of the participants are the presence of chronic disease, income and level of education.

Background and Objectives: Elders’ needs are rarely examined beforehand, and thus, although technology-based tools can enhance self-management, acceptability rates are still low. This study aimed to examine and compare self-reported needs, priorities, and preferences of elders with heart failure (HF), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD) toward technology use to enhance self-management. Materials and Methods: A convenience sample of 473 participants over 60s (60.5% females), diagnosed with HF (N=156), DM (N=164), or COPD (N=153) was recruited. They were administered a questionnaire about the usefulness of technology in general and in specific areas of disease management. Results: Most participants (84.7%) admitted that technology is needed for better disease management. This was equally recognized across the three groups both for the overall and specific areas of disease management (in order of priority: ‘Information’, ‘Communication with Physicians &amp; Caregivers’, and ‘Quality of Life &amp; Wellbeing’). Sociodemographic differences were found. Cell phones and PCs were the devices of preference. The four common features prioritized by all three groups were related to ‘information about disease management’ (i.e., monitoring symptoms, reminders for medication intake, management and prevention of complications), whereas the fifth one was related to ‘communication with physicians and caregivers (i.e., in case of abnormal or critical signs). The top disease-specific feature was also monitoring systems (of respiratory rate or blood sugar or blood pressure, oxygen), whereas other disease-specific features followed (i.e., maintaining normal weight for HF patients, adjusting insulin dose for DM patients, and training on breathing exercises for COPD patients). Conclusions: Elders in these three samples seem receptive to technology in disease management. mHealth tools, incorporating both common and disease-specific features and addressing different chronic patients, and being personalized at the same time, could be cost-saving and useful adjuncts in routine clinical care to improve self-management.

Background: The global prevalence of anxiety and depressive symptoms in adolescents has increased considerably during the COVID-19 pandemic. Mental health problems may compromise glycemic control in young people with type 1 diabetes; however, evidence of improved glycemic control in adolescents with T1D appeared early during the pandemic. This qualitative study aimed to provide a more in-depth understanding of how the COVID-19 pandemic affected adolescents with type 1 diabetes routines, experiences, T1D management, behaviors, and mental health. Methods: 24 adolescents, aged 15-18 years, with DM1, joined the discussion of focus groups in the context of the summer camp for diabetes. Word frequency and thematic analysis were conducted on adolescents’ narratives. Results: The word Frequency Analysis identified 'friends', 'family', and 'home' as the most frequent terms. Seven themes were identified: (1) COVID-19 and T1D; (2) emotional reactions to the COVID-19 pandemic; (3) changes in daily life; (4) feelings of loss; (5) coping with the COVID-19 pandemic; (6) the COVID-19 pandemic as an opportunity; (7) return to (new) normality. Conclusions The COVID-19 pandemic may have represented a more stressful condition for adolescents with DM1, facing additional challenges compared to their healthy peers. The results offer directions to the diabetes care team for a customized intervention while the consequences of the pandemic on adolescents’ health continue.

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as “the composite of all physical and mental attributes on which an individual can draw”. Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability, since adapted physical activity is the preventive intervention that has shown most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED. The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention, and in a later stage, assessing the effectiveness in a randomized controlled trial.

(1) Background: Mpox was declared an international public health emergency by WHO. Initially, Smallpox vaccine in Italy was offered only to laboratory personnel at direct risk of infection. Currently, Healthcare workers (HCWs) are all considered by European Centre for Disease Prevention and Control (ECDC) to be at low or moderate risk. (2) Methods: To assess smallpox vaccination coverage among HCWs in an Italian hospital with different levels of risk of exposure to Mpox infection and to assess their attitudes toward vaccination, a self-report was administered to HCWs stratified at high and low/moderate risk. (3) Results: Of the 338 HCWs evaluated, 60.36% provided the requested data; among them the percentage of previously vaccinated staff was 38.7%, which corresponds to 23.4% of the total HCWs in the departments considered. Considering those born before 1979 as vaccinated, vaccination coverage increases from 23.4% to 41.4%. The department with the highest percentage of vaccinated is infectious diseases (60.5%); The percentage of HCWs who adhered to vaccination is 23%; only 8.8% of laboratory staff want to vaccinate, compared with 100% of midwives. The department with the highest percentage of vaccination adherence is proctology (85.7%). (4) Conclusions: Given the vaccination adherence rate and the vaccination coverage of the departments analyzed, it would be useful to extend vaccination against Smallpox to frontline HCWs involved in patient care in Italy too.

The primary purpose of this study was to determine the prevalence of drug-drug interaction (DDI) and duplicate therapy in chronic patients in a completely random study population engaged in digital health apps. In this cross-sectional study, polypharmacy checks for 100 completely anonymous patients were analyzed for the occurrence of DDIs and duplicate therapy. Logistic regression models were used to identify factors associated with DDIs and duplicate therapy. DDIs and duplicate therapy prevalence were 34% and 33%, respectively. Chi-Square test discovered a significant association between the DDIs and duplicate therapy variables. Logistic regression models showed a strong association between the number of medications taken and higher odds of DDIs occurring in our population only. In conclusion, our study shows that polypharmacy is a determining factor for the occurrence of unwanted DDIs, and the prevalence of duplicate therapy and DDIs is around 33%, increasing an issue regarding patient safety and its burden to the healthcare system.

Global emerge of zoonotic novel corona virus (COVID-19) became a pandemic and its effect to mankind is talk of the town now a days. This tiny, invisible enemy has affected every country in the world and almost every living directly or indirectly and nationwide complete lockdown has triggered a short-term environmental impact. Since 2003, corona virus came into existence in the form of Severe Acute Respiratory Syndrome (SARS) and more evolved Middle East Respiratory Syndrome (MERS) in 2012. This time, at the end of December 2019, outbreak of novel corona virus COVID-19 (also known as SARS-CoV₂, nCoV-2019) draw attention as global health emergency. World Health Organization (WHO) report says that the outbreak of this virus is so immense, it has already affected 35,57,235 people and caused death to 2,45,150 people worldwide and 46,433 Indians got affected with 1568 death as on 5^th May 2020 (2:00 am) and these numbers are increasing exponentially day by day. Virologist, micro-biologist and science community are hammering their head very hard to find out cure and vaccine against this powerful virus and to prevent mass demise of mankind. In order to curb the spread of COVID-19, Janta curfew on 22.03.2020 and nationwide complete lockdown was implemented in India for 21 days (phase-I, from 25.03.2020 to 14.04.2020) to stop community transmission of third stage, for 19 days (phase-II, 15.04.2020 to 03.05.2020) and 14 days (phase-III, 04.05.2020 to 17.05.2020) complete lockdown to minimize the community transmission effect. During complete lockdown and quarantine period a drastic change in Earth’s atmosphere, including reduction in emission of greenhouse gases, air pollution (~50% fall in air quality index), noise pollution, water pollution and solid waste pollution, have been recorded by government agencies as well as private agencies. In this paper we considered data of Janta curfew, phase-I and phase-II lockdown to link between geological and environmental aspect related to environmental impact due to emerge of COVID-19 and massive reduction in pollution level during complete lockdown in India. We propose future lockdown strategies to minimize the emission of greenhouse gas by ~100 Mt to ~200Mt (3.33% to 6.66%) of GHG_total per year by 2-4 days per month nationwide lockdown or ~70 Mt to ~140 Mt (2.33% to 4.66%) of GHG_total per year by 2-4 days per month complete lockdown of energy sectors only.

Australia’s mental health system is failing young people. Calls for accountability, strategic long-term policy planning, and regional leadership have been identified as solutions to guide mental health reform. Developing system dynamics models using a participatory approach (participatory systems modelling, PSM) is recognised as a useful method that can support decision-making for strategic reform. This paper reports evaluation findings of a youth mental health PSM process conducted in the Australian Capital Territory (ACT). Baseline and follow-up mixed-methods evaluation data were collected in 2022 across diverse stakeholder groups to investigate the feasibility, value, impact, and sustainability of PSM. Though youth mental health system reform was viewed as desirable and a necessity across all stakeholder groups, shared perceptions of disabling powerless was observed regarding their ability to influence current decision-making processes to improve the youth mental health system. This suggests greater accountability is required to support systemic reform in youth mental health. PSM offers promise in improving transparency and accountability of decision-making for youth mental health as exemplified in the ACT. However, more support and time are required to facilitate transformational change. Future research should investigate empowerment strategies to complement the implementation of findings from dynamic models developed through PSM, as well as the effectiveness of regional youth mental health policy decision-making supported by systems modelling.

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.

World Health Organization (WHO) has announced the monkeypox (MPX) epidemic a global public health emergency due to its re-emergence, remarkable increase in the number of MPX cases worldwide, and its potential spread. This paper introduces the symptoms, complications, and features of MPX; its transmission, diagnosis and testing, vaccines and treatment; MPX and sexually transmitted diseases, especially the human immunodeficiency virus (HIV); possible natural hosts or reservoirs of the monkeypox virus (MPXV). A useful tool for MPX and surgical safety recommendations are presented. The challenges in fighting the MPX epidemic, One Health strategy, and future research are discussed.

The Sei Dareh Bridge is a cable-stayed bridge located in West Sumatra Province, Indonesia. The bridge, has a main span of 123 meters length and 9 meters wide, crosses the Batanghari River. Traffic load is transmitted through 4 prestressed cables to a 42.4 meter high pylon made of concrete. Bridge deck and traffic loads are directly supported by steel box girders as main beams that are reinforced laterally with cross beams IWF 800.300.16.24 and stringers IWF 350.350.12.19. This paper discusses static and dynamic testing on the bridge which aims to assess the feasibility before it is opened for public. Based on the test, it was concluded that the 73% static load could not be achieved because the deflection that occurred was beyond the allowable deflection. This is exacerbated by the sound of a loud clanging sound on the ST2-X1 prestressed cable when loading to 240 tons or 58% of the targeted load. In addition, this bridge is included in the "lazy bridge" category because it takes 24 hours to return to an undeformed condition after loading. As a recommendation for this bridge, it is necessary to carry out a structural health monitoring system (SHMS) regularly on the vehicle floor and cables.

While nursing is an ethical profession, unethical behavior among nurses is increasing worldwide. This study examined the effects of an ethics seminar on nurses' moral sensitivity and ethical behavior. A total of 37 nurses (17 experimental, 20 control) were recruited. The ethics seminar was held over a 6-month period from May to October, 2018, and comprised six sessions held once a month for two hours. Moral sensitivity and unethical behavior were measured at the start and end of the seminar. Moral sensitivity and unethical behavior showed a negative correlation (r= -.455, p&lt;0.01). After the ethics seminar, the experimental group's moral sensitivity was significantly increased (t = -1.039, p = 0.314). The mean scores of unethical behavior at pre and post-test in the experimental group were 12.59 and 9.47, respectively. This was a statistically significant difference (t = 3.118, p = 0.004). There was no statistically significant difference in the mean score in both moral sensitivity and unethical behavior in the control group. We conclude that ethics seminars can enhance moral sensitivity and reduce the risk of unethical behavior among nurses. Regular ethics seminars and training must be provided to nurses as a matter of policy.

Abstract Background: Cluster randomized controlled trials are increasingly becoming popular in public health research interventions and health services research in primary health care design and use in low and middle-income countries. However, the majority of researchers in these trials did not account correctly for the effect of confounders and clustering in the design and analysis stages. Objectives: This article aimed to review the main implications of implementing a cluster randomized controlled trials design in public health research and emphasize the practical application of proper analytical methods and the performance of different statistical models. Methods: The practical application of various analytical methods is validated via the utilization of experimental data from a public health research case study. This article also demonstrated the performance of hierarchical models and made comparisons in terms of empirically precise effect size estimates. Results: Three hierarchical statistical models were provided with highly varied effect sizes during the analysis of the intervention effect on outcome, such as model 1 (AOR: 14.32; 95% CI: 3.75–54.68), model 2 (ARR: 3.52; 95% CI: 2.16–5.77), and model 3 (ARR: 4.79; 95% CI: 2.69–5.52).Conclusion: Inaccurate results and potentially misleading conclusions can arise from improper cluster randomized controlled trial designs and analyses. This article has shown that real-world data can be adjusted for the effects of confounders and clustering, and we advocate for the routine use of suitable design and analytical methods. This article concludes that researchers should be careful when selecting hierarchical models to analyze cluster randomized controlled trials.

This systematic review investigates the failure rate and marginal bone loss (MBL) of dental implants placed in Solid-organ transplant (SOT) patients compared to healthy controls. Three databases (PubMed, Web of Sciences and the Cochrane Library) were searched up to June 2020 (PROSPERO CRD42019124896). Case-control and cohort studies reporting data failure rate and marginal bone loss (MBL) of dental implants placed in SOT patients were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Four case-control studies fulfilled the inclusion criteria, all of low risk of bias. Meta-analyses revealed consistently lower implant failure rate than control populations at patient and implant levels. SOT patients had a significant difference of -18% (p-value <0.001) of MLB towards healthy patients. SOT status poses no serious threat to implant survival. Overall, this group of patients presented lower levels of dental implant failure rate and marginal bone loss compared to otherwise healthy patients. Further intervention trials with wider sample size and longer follow-ups are necessary to confirm these summary results.

Social connectedness connection is a core dimension of health and wellness among all populations, yet the experience of moving to, and living in, a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Illustrated in a model of socioecological connectednesssocial connection, Using hybrid (inductive/deductive) qualitative analysis, we identified seven themesdomains of social connection from the perspective of the interviewed participants: 1) Lens of the individual is a filter for the social world; 2) Immigrant experience colors everything; 3) Interpersonal support enhances quality of life; 4) Community belonging fosters a sense of connectedness; 5) Community capital boosts security; 6) Community navigation promotes integration; and 7) Social acceptance strengthens inclusion. In the healthcare field, we lack conceptual clarity of the distinct connectedness domains that drive positive health outcomes in immigrant populations. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of socioecological connectednesssocial connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. health. Additionally, our model of socioecological connectednessthese results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess connectedness social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants.

The aim of this study is to determine the importance and effectiveness of different interventions aimed at improving social skills in people with autism spectrum disorder (ASD) through theatrical techniques. It aims to establish a direct relationship between the interventions and the benefits for socioemotional reciprocity, nonverbal communication behaviors used for social interactions and the development, establishment and understanding of interpersonal relationships. For this purpose, a systematic review of the literature published from 2011 to 2021 in the ERIC, Web of Science, EuropePMC, PubPsych, Índices-Csic, Redalyc, Roderic, Scopus, PubMed, Scielo and Dialnet databases was carried out, and a total of 29 articles were reviewed. The results indicate that theater creates a safe environment in which people with ASD can engage with their own emotions and those of others, thereby offering a therapeutic setting in which to promote communication, motor development and social coexistence. The implications and limitations of the study are discussed.

This study examined carbon footprint as an indicator of soil health at spatiotemporal scales with different land use types and varying soil depths in Morogoro, representing the eastern agroecological zone of Tanzania. Soils are highly weathered and acidic. The specific objectives were twofold: (1) To quantify soil organic carbon (SOC) at varying soil depths (0–15 cm, 15–30 cm) in contrasting land use types, including tractor cultivated, hand-hoe cultivated, ranch land, and reserved/bare land type; (2) To predict carbon management indices (CMI) of the studied land use types through regresses SOC, carbon pool index (CPI), and lability index (LI) at varying soil depths. Composite soil samples were based on transects of three main plots each (replicates) of 20 m by 50 m. Results showed that land use types and soil depths significantly (P <0.001) affected SOC (3.4%) and CMI (126.3). Hand hoe cultivated land at 0–15 cm recorded CMI of 259.8. Regression analysis showed an increase in CMI ranging from 97% to 99%, with standard error ranging from 2.177 to 46.096. Similar trends, but with disparity magnitudes in regressed parameters provide useful insight into transformations of organic carbon in contrasting land use types.

Improving access to sexual health services is critical in light of rising sexually transmitted infections (STIs). We evaluated a Hub and Spoke model for improving access to sexual health services in three general practices in Victoria, Australia. The primary outcome was the impact on HIV and STI (chlamydia, gonorrhoea, syphilis) testing. Segmented linear regression analysis was conducted to examine the trends in the total HIV/STI tests before (from January 2019 to June 2020) and post-implementation (from July 2020 to July 2021). We evaluated the feasibility and acceptability of integrating this model into the general practices using semi-structured individual interviews. There was a statistically significant rise in testing for HIV and STIs in all general practices: post-implementation, there was an increase of an average of 11.2 chlamydia tests per month (p=0.026), 10.5 gonorrhoea tests per month (p=0.001), 4.3 syphilis tests per month (p=0.010), and 5.6 HIV tests per month (p=0.010). Participants reported increases in knowledge level and confidence in offering STI testing and managing more variety of sexual health cases. This study demonstrated the feasibility of implementing a hub and spoke model to enable GPs to deliver sexual health care with support from a sexual health specialist service.

Despite the strong links between sleep, circadian rhythms, and mental health, sleep education has been neglected in mental healthcare provider training programs. The current pilot study examined the potential efficacy and acceptability of a sleep education workshop for trainee psychologists, called the Sleep Psychology Workshop. Eleven students completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the Sleep Psychology Workshop as part of their Health Psychology course, delivered as three, two-hour lectures (total six hours). Trainees’ sleep psychology knowledge quiz scores (% correct) demonstrated significant improvement from pre- (M = 60%, SD = .09) to post-workshop (M = 79%, SD = .08), t (6) = -5.18, p = .002. Trainees also reported increased self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep and circadian rhythm disturbances, along with increased confidence to manage insomnia disorder in clinical practice (all p<.02). Trainees also endorsed the workshop as an acceptable sleep education program for trainee psychologists via a post-workshop feedback survey, focus group, and six-month follow-up survey. This pilot study provides preliminary evidence for the Sleep Psychology Workshop as an effective and acceptable sleep education program for trainee psychologists.