Economic Health Research Articles

Assessing the role of circular economy and green innovation in mitigating carbon emissions in the Visegrad countries

The shift towards a circular economy is an essential measure in achieving sustainable development because it seeks to separate economic expansion from resource use and environmental deterioration. To meet the European Union green deal, waste management, and the net zero emissions targets various countries are developing and adopting prudent strategies. This study investigates the dynamic affiliation between circular economy (CIR), green innovation (INV), renewable energy (REE), economic progress (GDP), and urbanisation (URB) on carbon emissions (CO2) in the Visegrad (V4) countries, comprising the Czech Republic, Hungary, Poland, and Slovakia. Using the CS-ARDL technique and quantile regression, data curation from 1990-2022 was analysed after checking for cross-sectional, unit root, and cointegration. The outcome demonstrates that circular economy, green innovation, and renewable energy had a negative effect on carbon emissions. In addition, GDP and URB had an immaterially positive influence on carbon emissions. Lastly, the quantile regression confirmed that the study provides useful information for policymakers and stakeholders in the Visegrad countries. It emphasised how important it is to take a broad approach to circular economy initiatives, support eco-friendly innovations, carry out renewable energy projects, and manage the urbanisation process well to achieve long-term economic growth and environmental health.

Patient, financial and environmental impacts of a Medicines Optimisation in Care Homes (MOCH) service on polypharmacy following structured medication reviews

Abstract Introduction An NHS community trust was commissioned in February 2023 to deliver a MOCH service to about 15,000 care home residents across an Integrated Care System (ICS). Pharmacists in the MOCH service undertake Structured Medication Reviews (SMRs) to reduce inappropriate polypharmacy, working closely with care homes, General Practitioners (GPs) and community pharmacies. Pharmacy technicians undertake medication reviews to reduce low clinical value medicines. A patient-centred approach means medicines are stopped or changed following shared-decision making with the resident, carer or family. Aim To find out the impact of the MOCH service on reducing inappropriate polypharmacy, reducing medicines-related harm for residents, and to report financial savings and the environmental impact through reduction of CO2 emissions. Methods This service evaluation was approved by the Trust. No ethics approval was required. Quarterly and 6- monthly data sets covering one week reported by the MOCH service in the financial year 2023/2024 were used. These data sets were extrapolated to a full year. This service reported the number of medicines stopped, started and changed over one week of each quarter for SMRs and, pharmacy technicians reported every six months. Cost savings were calculated using the drug tariff based on continued use of medicines for one year. Pharmacists reported reduction in harm from medicines every six months based on a health interventions risk assessment scoring tool, assessing how many residents had potentially avoided moderate to serious harm following a SMR. The carbon savings were calculated based on financial savings from medicines stopped or changed using the DEFRA SIC 2020 Greenhouse Gases emission factor 0.621(kgCO2e/£) for pharmaceuticals1. Results In the first year the MOCH service completed SMRs for 11,363 residents (75% of care home residents in the ICS). Around 20,000 medicines for residents were stopped (one to two medicines per resident). Pharmacists predicted moderate to high-risk harm from medicines was reduced in approximately 4,200 residents. The cost savings from medicines stopped or changed was approximately £2.8 million, which translated to carbon savings of 1,773,340 kgCO2e, the equivalent of removing 644 cars from the road for one year. Discussion and Conclusion Reducing inappropriate polypharmacy resulted in a reduction of treatment burden, potential harm to residents2 and financial savings. Social impacts include reducing workload for care homes, GPs and community pharmacies, ultimately increasing the capacity of this stretched workforce (less dispensing, reduced risk of error, shorter medicine rounds and more time for residents). The environmental impact goes beyond carbon savings from pharmaceuticals to include reduction in workload, consumables, delivery and cost of waste disposal and prevention of hospital admissions.3 The limitations of this evaluation are that data collected over one week and then extrapolated may not be representative of all the other weeks in terms of cost savings and reduction of harm to residents, however MOCH pharmacists undertake peer reviews of reduction in harms to mitigate this. Costs incurred in making the financial savings were excluded. As the demographic of older people rises in the next 20 years a medication review is increasingly important to residents, the health economy, workforce, and our environment.

Gendered Taxation: IMF Tax Advice and the Unintended Disempowerment of Women

Case research points to the gendered effects of the value added tax (VAT), which may particularly disadvantage women by crowding out their economic participation. A key driver of VAT introductions has been the International Monetary Fund (IMF). To counterbalance of-payments woes, IMF advice for cash-stripped countries has frequently focused on shifting toward broad-based consumption taxes while lowering trade taxes and corporate income taxes. We expect this tax policy advice – while ostensibly gender-blind – to contribute in practice to a deterioration in women’s socioeconomic well-being. To test this hypothesis, we construct a panel dataset for 147 countries from 1980 to 2016 and estimate the effect of IMF programs on women’s economic participation, education and health. Accounting for selection effects, we find that women’s life chances deteriorate relative to men’s if a country undergoes an IMF program with tax conditionality. We corroborate these findings to demonstrate the mechanism underlying these effects by showing a negative effect of IMF-induced de jure VAT adoption on women’s life chances. We provide complementary individual-level evidence from the World Values Surveys based on 98 countries from 1981 to 2019. We show that during an IMF program with tax conditionality, women are significantly less satisfied with home life and report more material hardships. Our results provide evidence of the potential for unintended consequences of IMF revenue prescriptions for women, supporting calls for increased attention to gender-responsive budgeting.

Covid-19 pandemic and its economic and psychological impacts on Saudi workers: An empirical study in the kingdom of Saudi Arabia

Background: The COVID-19 pandemic has had a substantial economic and psychological impact on workers in Saudi Arabia. The objective of the study was to assess the effects of the COVID-19 epidemic on the financial and mental well-being of Saudi employees in the Kingdom of Saudi Arabia. Purpose: The COVID-19 epidemic has resulted in significant economic and societal ramifications. Current study indicates that the pandemic has not only precipitated an economic crisis but has also given rise to several psychological and emotional crises. This article provides a conceptual examination of how the pandemic impacts the economic and mental health conditions of Saudi workers, based on contemporary Structural Equation Modeling (SEM) models. Method: The current study employed a qualitative methodology and utilized a sample survey strategy. The data was gathered from Saudi workers residing in major cities of Saudi Arabia. The samples were obtained from professionals such as managers, doctors, and engineers, as well as non-professionals like unskilled and low-skilled laborers, who are employed in various public and private sectors. A range of statistical tools, including Descriptive statistics, ANOVA, Pearson’s Correlation, Factor analysis, Reliability test, Chi-square test, and regression approach, were employed to analyze and interpret the results. Result: According to the data, the pandemic has caused a wide range of economic problems, including high unemployment and underemployment rates, income instability, and different degrees of pressure on workers to find work. Feelings of insecurity (about food and environmental safety), worry, dread, stress, anxiety, depression, and other mental health concerns have been generated by these challenges. The rate of mental health decline differs among demographics. Conclusions: The COVID-19 pandemic has universally affected all aspects of our lives worldwide. It resulted in an extended shutdown of educational institutions, factories, offices, and businesses. Without a question, it has profoundly transformed the work environment, professions, and lifestyles of billions of individuals worldwide. There is a high occurrence of poor psychological well-being among Saudi workers. However, it has been demonstrated that both economic health and mental health interventions can effectively alleviate the mental health burden in this population.

HIV Self-Testing: A Discussion on the Benefits, Limitations, and Implications for Public Health with a Focus on Poland

Background/Objectives: A late HIV diagnosis represents a significant public health concern in Poland, with approximately 50% of patients being identified as late presenters (LPs), resulting in the delayed initiation of treatment. This study assesses the potential of HIV self-testing (HIVST) to enhance early detection, particularly among heterosexual individuals, and evaluates its advantages and limitations within the Polish context. Methods: This study examines the advantages and disadvantages of HIVST by analyzing data from various studies. It focuses on the acceptability, sensitivity, and specificity of HIVST, comparing blood-based and oral fluid-based tests. Moreover, the economic impact and potential public health benefits of HIVST in Poland are evaluated. Results: HIVST is well-accepted, especially among key populations; it can reduce stigma and enhance privacy. The results of studies conducted in Poland indicate that heterosexuals are more inclined to use self-testing methods than traditional diagnostic procedures. On the other hand, HIVST has the potential for false-negative results due to the serological window and the possibility of missed diagnoses of other sexually transmitted infections (STIs). Moreover, the cost of HIVST remains a significant barrier, as it is not publicly funded in Poland. Conclusions: Despite its limitations, HIVST offers a number of significant benefits, including increased rates of testing and earlier detection, which could prove vital in reducing the transmission of HIV in Poland. This study proposes that increased funding, the integration of HIVST into public health strategies, and further research to enhance its implementation, alongside education and support for its effective use, should be prioritized.

COVID-19 pandemic: mental health (distress as depression) in orthodontists

ABSTRACT Objectives For health professionals, pandemic conditions impacted all societal aspects, including economic, wellness, and mental health. This study analysed sociodemographic factors, post-traumatic stress disorder symptoms (PTSD), and depression levels caused by the coronavirus disease 2019 (COVID-19) pandemic in orthodontists. Materials and Methods A sociodemographic questionnaire, the Impact of Event Scale (IES), and the Patient Health Questionnaire (PHQ-9) were used. Following data collection, multiple statistical analyses were applied: scores were compared using the Mann-Whitney and Kruskal-Wallis tests, followed by Dunnett's multiple comparisons. The association between variables was verified using Chi-square or likelihood ratio tests. Multiple logistic regression models were estimated after bivariate logistic regression tests (p < 0.10). The final models using the Stepwise backward selection method were assessed for variables at 5%. Results Of the respondents, 69.3% were women, and their mental health questionnaire scores were significantly higher (p < 0.001). The IES avoidance and PHQ-9 scores were statistically different between the age groups (p = 0.040 and p < 0.001, respectively). Subjective distress was associated with years of practice, monthly income, fear of contracting COVID-19 during dental care, transmitting COVID-19 to patients, and thinking about the future (p < 0.05). Depression was significantly associated with orthodontic practice type, self-confidence in providing dental care, pandemic impact on dental practice, remote care, monthly income, changes in financial expenses, fear of contracting COVID-19 and thinking about the future (p < 0.05). Conclusion Over half of the orthodontists experienced moderate-to-severe mental distress, and the same number suffered from mild-to-severe depression during the pandemic. Registration: Ethics and Research Committee (CEP) of the Faculty of Dentistry of the University of São Paulo (FOUSP): CAAE: 34223720.1.0000.0075 Protocol: 4.191.353

How Sexism in Institutions and Everyday Interactions Shapes Early Childbearing

Early childbearing is associated with poor outcomes for parents and children, potentially exacerbating inequality within and across generations. Building on the structural sexism and health perspective, we argue that systemic gender inequality is a conceptually important—and understudied—factor in early childbearing. Using survey data from the National Longitudinal Study of Adolescent to Adult Health ( N = 5,052 female respondents and 32,595 person-years) merged to state, county, and school characteristics, we investigate how exposure to structural sexism during adolescence shapes early childbearing. We measure structural sexism in institutional domains with state and county-level measures of economic, cultural, and reproductive health. We also generate a novel measure of structural sexism in interactional domains, capturing gendered expectations, power dynamics, and conservative religious beliefs among school peers. We find that institutional sexism is associated with a higher likelihood of early childbearing among young women racialized as Black, but not among those racialized as White. Interactional sexism is also a significant predictor of early childbearing, and is especially salient for adolescents as they turn to peers for social cues about gender roles. Our results underscore the importance of institutional and interactional forces for shaping families and raise questions about increasingly polarized gender climates post- Dobbs.

Considerations for the use of laboratory-based and field-based estimates of environmental tolerance in water management decisions for an endangered salmonid

Water infrastructure development and operation can provide for human economic activity, health, and safety. However, this infrastructure can also impact native fish populations resulting in regulatory protections that can, in turn, alter operations. Conflict over water allocation for ecological function and human use has come to the forefront at Shasta Reservoir, the largest water storage facility in California, USA. Shasta Reservoir supports irrigation for a multibillion-dollar agricultural industry, provides water for urban and domestic use, provides flood protection for downstream communities, and power generation as part of the larger Central Valley Project in California. Additionally, an endangered run of Chinook Salmon relies on cold water management at the dam for successful spawning and egg incubation. Tradeoffs between these uses can be explored through application of models that assess biological outcomes associated with flow and temperature management scenarios. However, the utility of models for predicting outcomes of management decisions is contingent on the data used to construct them, and data collected to evaluate their predictions. We evaluated laboratory and field data currently available to parameterize temperature-egg survival models for winter run Chinook Salmon that are used to inform Shasta Dam operations. Models based on both laboratory and field data types had poor predictive performance which appears to limit their value for management decisions. The sources of uncertainty that led to poor performance were different for each data type (field or laboratory) but were rooted in the fact that neither data set was collected with the intention to be used in a predictive model. Our findings suggest that if a predictive model is desired to evaluate operational tradeoffs, data should be collected for the specific variables and life stages desired, over an appropriate range of values, and at sufficient frequency to achieve the needed level of precision to address the modeling objective.

Using QALYs as an Outcome for Assessing Global Prediction Accuracy in Diabetes Simulation Models.

(1) To demonstrate the use of quality-adjusted life-years (QALYs) as an outcome measure for comparing performance between simulation models and identifying the most accurate model for economic evaluation and health technology assessment. QALYs relate directly to decision making and combine mortality and diverse clinical events into a single measure using evidence-based weights that reflect population preferences. (2) To explore the usefulness of Q2, the proportional reduction in error, as a model performance metric and compare it with other metrics: mean squared error (MSE), mean absolute error, bias (mean residual), and R2. We simulated all EXSCEL trial participants (N = 14,729) using the UK Prospective Diabetes Study Outcomes Model software versions 1 (UKPDS-OM1) and 2 (UKPDS-OM2). The EXSCEL trial compared once-weekly exenatide with placebo (median 3.2-y follow-up). Default UKPDS-OM2 utilities were used to estimate undiscounted QALYs over the trial period based on the observed events and survival. These were compared with the QALYs predicted by UKPDS-OM1/2 for the same period. UKPDS-OM2 predicted patients' QALYs more accurately than UKPDS-OM1 did (MSE: 0.210 v. 0.253; Q2: 0.822 v. 0.786). UKPDS-OM2 underestimated QALYs by an average of 0.127 versus 0.150 for UKPDS-OM1. UKPDS-OM2 predictions were more accurate for mortality, myocardial infarction, and stroke, whereas UKPDS-OM1 better predicted blindness and heart disease. Q2 facilitated comparisons between subgroups and (unlike R2) was lower for biased predictors. Q2 for QALYs was useful for comparing global prediction accuracy (across all clinical events) of diabetes models. It could be used for model registries, choosing between simulation models for economic evaluation and evaluating the impact of recalibration. Similar methods could be used in other disease areas. Diabetes simulation models are currently validated by examining their ability to predict the incidence of individual events (e.g., myocardial infarction, stroke, amputation) or composite events (e.g., first major adverse cardiovascular event).We introduce Q2, the proportional reduction in error, as a measure that may be useful for evaluating and comparing the prediction accuracy of econometric or simulation models.We propose using the Q2 or mean squared error for QALYs as global measures of model prediction accuracy when comparing diabetes models' performance for health technology assessment; these can be used to select the most accurate simulation model for economic evaluation and to evaluate the impact of model recalibration in diabetes or other conditions.

Bridging the gap: how education transforms health outcomes and influences health inequality in rural China

This study focuses on the impact of education on health and health inequalities in rural areas of China. Education significantly enhances economic status and health, driving economic growth and improving public health standards. Integral to the “Healthy China Strategy,” it provides essential guidance for public policy and underscores the need for strategic human capital investments to achieve these goals. The study utilizes data from the China Family Panel Studies (CFPS) spanning 2010–2020 and employs the average educational level within counties as an instrumental variable. The causal impact of education on health and health inequalities is estimated using the two-stage least squares (2SLS) method. The findings reveal a significant positive correlation between enhancing education levels and health improvements. Specifically, after controlling for endogeneity, the duration of individual education significantly improves both subjective and objective health outcomes. It reduces health inequalities, with these effects being more pronounced among women and low-income groups. Mechanistically, education positively impacts health primarily by altering health behaviors and social network levels and reducing health inequalities through socio-economic factors. This paper provides important implications for public policy, suggesting that enhancing educational investments can drive economic development and improve population health standards.

The impact of drought and climate change on economy, environment and human health in southern Iran: A qualitative study

Drought and climate change are one of the most important environmental health challenges of the current century. It has been predicted that the occurrence of drought, its intensity, and its adverse effects on the environment, human health, societies, and economy will increase in the coming decades. This qualitative content analysis study aimed to explore the impact of drought on the lives of people living in the south of Iran. Data were collected through in-depth semi-structured interviews with farmers, urban and rural officials, and physicians. A total of 25 interviews were conducted. All interviews were recorded and then transcribed. Data were analyzed using MAXQDA version 18. The concepts raised by interviewees regarding the consequences of drought were categorized into four themes, including economic consequences, environmental hazards, health consequences, and adaptation options; and most of these consequences were inter-related. Participants believed that drought has affected the soil, environment, ecosystem, and the quality and quantity of water, and this can lead to extensive effects on humans’ physical, mental, and community wellbeing. Drought can also cause adverse economic effects, which can further intensify its adverse effects. It seems like the adverse effects of drought in Iran are severe and destructive, and this is due to the mismanagement of water and environmental resources and other socio-economic problems. Fundamental changes in the management of water and environmental resources are necessary.

DESCRIMINALIZAÇÃO DE DROGAS: UMA ANÁLISE ENTRE AS COMPETÊNCIAS DO LEGISLATIVO E JUDICIÁRIO

Drug use is proven to be harmful, both physically and intellectually. Currently, drugs are the main social evil, linked to all types of crime. The methodology used was the literature reference, and the STF decisions of 2023 and 2024 on the issue. In this sense, the objective of this research/article is to develop a study on the decriminalization of marijuana possession and its legal, economic, moral, and public health consequences. To do this, initially a definition of competences is made from the perspective of doctrine and jurisprudence regarding the limits of powers to legislate. It also addresses the main aspects related to drug use and its consequences; And, finally, the positive and negative points within the legal, moral, social, economic and public health sphere of this decision. It is concluded that this is a matter that should be entirely up to congress to decide, and that the STF usurps the functions of the Legislative and Executive branches by giving its opinion on topics that would be the responsibility of the technical body ANVISA. Even because they are decisions with broad repercussions, which could have major consequences for society, including in the field of public security, crime, society in general and public health.

Optimizing vaccination to reduce waste and boost coverage in Primary Health Care Units

Abstract Background In immunization, vaccine consumption typically exceeds the number of recipients. The number of doses per vial influences wastage and vaccination coverage goals. In Brazil, 48% of the National Immunization Program’s vaccines are multidose, with 4 having limited shelf-life post-opening. Strategies to reduce wastage aim to optimize dose utilization, enhance process quality, and broaden coverage effectiveness. The objective was to outline strategies for reducing wastage and expanding coverage for children under 5 in 14 São Paulo city Primary Health Care Units (PHCUs). Methods The Lean Six Sigma approach guided the stages. A group conducted contextual analysis to identify PHCU barriers. Data on wasted doses and vaccination were gathered. Weekly meetings for data analysis began in May 2023, following DMAIC phases: Define, Measure, Analyze, Improve, Control. An action plan stemmed from these phases for PHCU implementation. Results Data analysis, from January 2022 to June 2023, revealed a significant vaccine wastage trend, reaching 59% from January to December 2022 and increasing to 63% from January to June 2023. This wastage incurs an average annual cost of R$614,416.26, due to lost doses from expiration after vial opening and expiration of shelf life. The vaccines analyzed were BCG, Oral Polio Vaccine (OPV), Measles, Mumps, and Rubella (MMR), and Yellow Fever. At the project start in May 2023, vaccination coverage was 90%, increasing to 93% afterward. This rise resulted from actions taken and improved data monitoring. Post-project, vaccine wastage reduced by 7 percentage points (from 62% to 56%). Conclusions Addressing vaccine wastage and expanding vaccination coverage for children under 5 are critical in healthcare. Utilizing Lean Six Sigma, key issues in PHCUs were identified, leading to an action plan that reduced wastage, increased coverage, and standardized processes. Key messages • Vaccines are valuable resources and wasting them means reducing financial resources in health. • Vaccination coverage is crucial to protect the population’s health, prevent disease outbreaks, and maintain the country’s economic health, reducing costs for treating preventable diseases.

7.L. Practice session: Is there an investment case for health at older ages?

Abstract The global demographic landscape is undergoing significant transformation due to increases in longevity and declining birth rates. According to the United Nations, the world’s population aged 65 and over is projected to more than double, reaching over 1.5 billion by 2050, while global fertility rates are expected to decline to 2.4 births per woman by 2030 and continue decreasing to 2.2 births per woman by 2050. Ageing populations have frequently concerned decision-makers due to the potential implications of changes in population age-mix for labour markets and the economy, as well as for the sustainability of public programs and spending, particularly the health sector. For example, as the share of the population at older age increases, there are concerns over how to cope with the possible economic implications of having a smaller share of people at traditional working age (with potentially more people obtaining income security through both public and private pensions) and how to respond to greater health and long-term care needs. Without appropriate policy responses, there are worries that demographic changes will have inevitable consequences for households, public finances and possibly for economic growth and development. To support policy decisions related to population ageing it is important to have informative evidence and modelling tools that allow policymakers to better understand both the implications of population ageing as well as the consequences of policy action or inaction. To this end, this session presents three recently developed modelling tools that aim to address a number of policy relevant questions related to ageing: 1) How does ageing affect health financing and are health systems unsustainable? 2) How does ageing affect economic objectives and does health at older ages matter? 3) Can we develop economically relevant measures of health at older ages if older people do not have formal ties to the labour force? Using data and analyses from a range of European countries, we will demonstrate empirically that the way ageing affects health financing systems, economies, and societies more broadly reflects policy choices and is not an inevitable consequence of demographic changes. Key messages • Policymakers must prioritize informed policies to comprehensively understand the impact of aging on health financing and economies, facilitating the development of sustainable solutions. • Immediate action is imperative to address the implications of aging on labor markets and public spending, ensuring future economic stability and safeguarding societal well-being.

Trade as a commerical determinant of health: The health impact of a free trade agreement on Wales

Abstract As a result of the UK’s withdrawal from the European Union (‘Brexit’), the UK can negotiate its own trade agreements for the first time in over 40 years. This includes the Comprehensive and Progressive Trans-Pacific Partnership Agreement (CPTPP). Public Health Wales undertook a mixed-method Health Impact Assessment (HIA) to assess the potential impact of the CPTPP on health, well-being and inequalities in Wales. It is only the second ever HIA carried out on a free trade agreement (FTA) globally. A literature review on the potential impact of the CPTPP on health was conducted. Qualitative interviews with cross-sectoral representation, such as the environment, were undertaken alongside the development of a community health and demographic profile. The HIA identified significant potential impacts across health determinants, e.g., employment, agricultural production and health care, as well as impacts on population groups, e.g., those on low incomes. The Investor State Dispute Settlement (ISDS) mechanism, economic uncertainty and loss of regulatory alignment were identified as potential pathways for health impacts to affect the population. The HIA highlighted trade as a key commercial determinant of health. The findings have been beneficial in informing policy and decision-makers to prepare for the implementation of the CPTPP and take action to maximise opportunities and prevent potential negative impacts. Communicating HIA evidence that links trade to health has also led to valuable cross-sector and cross-UK engagement and sparked a “rethinking” of trade through a well-being economy lens where health, well-being and sustainability are primary objectives. This work has demonstrated the value of a HIA approach to FTAs by mobilising a range of evidence through a transparent process, resulting in transferrable learning for others as well providing an entry point for public health to have direct engagement with trade negotiators and those participating in trade discussions. Key messages • Trade agreements are a key commercial determinant of health across health behaviour, policy and economy. • Multiple population groups are affected by trade agreements both positively and negatively.

Detection of Aspergillus flavus in Figs by Means of Hyperspectral Images and Deep Learning Algorithms

Plant diseases cause economic losses and health risks, such as aflatoxins linked to liver cancer. These toxins, produced by fungi like Aspergillus flavus in figs, are often detected late through invasive methods or visual inspection. Since Spain, particularly Extremadura, is a key fig producer, alternative detection methods are essential to preventing aflatoxins in the food chain. The aim of this research is the early detection of Aspergillus flavus fungus using non-invasive techniques with hyperspectral imaging and applying artificial intelligence techniques, in particular deep learning. The images were taken after inoculation of the microtoxin using 3 different concentrations, related to three different classes and healthy figs (healthy controls). The analysis of the hyperspectral images was performed at the pixel level. Firstly, a fully connected neural network was used to analyze the spectral signature associated with each pixel; secondly, the wavelet transform was applied to each spectral signature. The resulting images were fed to a convolutional neural network. The hyperparameters of the proposed models were adjusted based on the parameter tuning process that was performed. The results are promising, with 83% accuracy, 82.75% recall, and 83.25% F1-measure for the fully connected neural network. The high F1-measure demonstrates that the model’s performance is good. The model has a low incidence of false positives for samples that contain aflatoxin, while a higher number of false positives appears in healthy controls. Due to the presence of false negatives, this class also has a high recall. The convolutional neural network results, accuracy, recall, and F1 are 77.25%, indicating moderate model performance. Only class 3, with higher aflatoxin concentration, achieves high precision and low false positive incidence. Healthy controls exhibit a high presence of false negatives. In conclusion, we demonstrate the effectiveness of pixel-level analysis in identifying the presence of the fungus and the viability of the non-invasive techniques applied in improving food safety. Although further research is needed, in this study, the fully connected neural network model shows good performance with lower energy consumption.

Decision-making under pressure: ethical considerations in COVID-19 policy making in Switzerland

Abstract Background Policy making and science were deeply intertwined during the COVID-19 pandemic, particularly in justifying health policy measures with ethical considerations being at the core of decision-making trade-offs. However, not much is known about the actual ethical challenges encountered by policy makers and scientists involved in policy advice. This study aims to explore the ethical challenges in COVID-19-related political decision-making as perceived by Swiss policy makers and scientists involved in policy making, the role of ethics advice, and what can be learned for future public health crises. Methods Thirteen qualitative expert interviews were conducted with policy makers and scientists involved in COVID-19 policy decisions in Switzerland at regional and national levels. We used inductive thematic content analysis to analyse the interviews. Results Key ethical challenges included making trade-offs between common vs. individual good and economic welfare vs. health of the population, proportionality of policy measures, and public capacity to handle uncertainty. Opinions varied on the sufficiency of ethical considerations on the policy level. Constraints included a lack of time in the fast-paced dynamic of the pandemic, ethics as a complex subject area, its overlap with law, too much focus on few topics such as vaccination-related questions, and individual character traits, such as the dominance of medical professionals over ethicists. While ethics support was deemed adequately present in the decision-making process, there were calls for more ethics training, involvement of the public in the discourse, and for accompanying communication to build trust among the population for the future. Conclusions The study offers empirical insights into the ethical considerations of COVID-19 policy making in practice in Switzerland, providing a basis to enhance ethics support for future crises also in other countries. Key messages • This study uncovers the key ethical considerations in Swiss COVID-19 policy making, emphasizing constraints to sufficient ethical discussions. • Enhanced ethics training and greater public engagement is needed in future health crises to build trust and improve decision-making in future health crises.

Investigation of Staphylococcus Spp and Coliform Bacteria Contamination Sources after Cleaning-in-Place in Production Lines of Dairy Factories in Türkiye.

Microorganisms detected on dairy factory surfaces after disinfection can cause product contamination, leading to economic losses and health hazards for consumers. In this study, the presence of Staphylococcus spp. and Coliform in a total of 450 samples taken from food-contact and non-contact surfaces (stainless steel, plastic, cloth, and tiles surfaces), raw milk and final product (white cheese, kashar cheese, butter, yogurt, and cream) samples in five dairy factories was investigated by conventional techniques. The isolates obtained were identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry. In this study, a total of 54 Staphylococci (16.7% S. aureus and 81.5% coagulase-negative Staphylococci [CNS]) and 44 coliform isolates were identified at the species level. The most common CNS isolated by samples was S. epidermidis followed by S. saprophyticus, S. capitis, S. succinus S. carnosus. S. xylosus, S. sciuri, S. equorum, S. warneri, and S. hominis. Eighteen of the coliform isolates (41%) were identified as E. coli; 13 (29.5%) as E. cloacae; 3 (6.9%) as E. kobei, C. freundii, and K. oxytoca; 2 (4.5%) as K. pneumoniae; 1 (2.3%) as E. ludwigii and C. farmeri. The contamination rate of non-food contact surfaces (71.3%) was found to be higher than food contact surfaces (10.4%), and contaminated surfaces were found to be effective in product contamination. Study results show that some bacterial species obtained from raw milk, surfaces, and final products are factory specific and surface-associated bacteria are prominent in the product microbial profile.

An innovative approach to control fish-borne zoonotic metacercarial infections in aquaculture by utilizing nanoparticles

Fish-borne zoonotic trematodes (FBZTs) pose significant health risks and economic challenges worldwide. This study investigated the prevalence of encysted metacercariae (EMCs) in Nile tilapia (Oreochromis niloticus) from two Egyptian governorates and evaluated the antiparasitic efficacy of chitosan, silver, and selenium nanoparticles against these parasites. A cross-sectional analysis of 453 O. niloticus specimens revealed an overall EMC prevalence of 40.8%, with infection rates of 34.11% in Giza and 49.5% in Dakahlia. Clinostomid and Prohemistomid metacercariae were the most common, with mixed infections observed. Transmission electron microscopy characterized the synthesized nanoparticles, showing average diameters of 9.6–18.7 nm for chitosan, 13.2–19.8 nm for selenium, and 11.7–15.1 nm for silver nanoparticles. In vitro antiparasitic assays demonstrated varying efficacies among the nanoparticles. Against Clinostomum spp. metacercariae, chitosan nanoparticles showed the highest potency, achieving LC50 at 66 μg/ml after 30 min and LC90 at 100 μg/ml after 120 min. For Prohemistomum vivax EMCs, chitosan nanoparticles exhibited superior efficacy, achieving LC50 at 8 μg/ml after 1 h and LC90 at 16 μg/ml after 2 h. Silver and selenium nanoparticles showed lower efficacy for both parasite species. Scanning electron microscopy revealed significant ultrastructural damage to the parasite tegument following nanoparticle exposure, including disappearance of transverse ridges, integument shrinkage, and formation of blebs. This study provided valuable insights into the prevalence of FBZTs in Egyptian Nile tilapia and demonstrated the potential of nanoparticles, particularly chitosan, as effective antiparasitic agents. These findings pave the way for developing novel, targeted strategies to control fish-borne zoonotic trematodes, potentially reducing their impact on public health and aquaculture economies.

COVID-19 and South Asia: an overview

The article explores the global impact of the COVID-19 pandemic, highlighting its severe effects on health systems, economies, and poverty levels. With an estimated 6.9 million deaths worldwide and the deepest recession since World War II, the pandemic had diverse regional impacts. South Asia, for example, experienced varying degrees of health and economic challenges; India faced over 500,000 deaths and a sharp economic downturn, while other nations in the region were less severely affected. The pandemic’s relatively brief duration, aided by global responses like lockdowns, social distancing, and rapid vaccine distribution, facilitated a quicker economic recovery, bolstered by unprecedented counter-cyclical policies. The article also examines South Asian case studies, including regional trade integration, the economic benefits of vaccination, and the socio-economic impacts on women in Bangladesh. It further discusses Pakistan’s response, Sri Lanka’s populist policies, and Indonesia’s monetary policy adjustments, offering valuable lessons for managing global health crises and economic downturns.