Future Health Risks Research Articles

Managing and mitigating future public health risks: Planetary boundaries, global catastrophic risk, and inclusive wealth

AbstractThere are two separate conceptualizations for assessing existential risks: Planetary Boundaries (PBs) and global catastrophic risks (GCRs). While these concepts are similar in principle, their underpinning literatures tend not to engage with each other. Research related to these concepts has tended to be siloed in terms of the study of specific threats and also in terms of how these are assumed to materialize; PBs attribute global catastrophes to slow‐moving and potentially irreversible global changes, while GCRs focuses on cataclysmic short‐term events. We argue that there is a need for a more unified approach to managing global long‐term risks, which recognizes the complex and confounded nature of the interactions between PBs and GCRs. We highlight where the PB and GCR concepts overlap and outline these complexities using an example of public health, namely, pandemics and food insecurity. We also present an existing indicator that we argue can be used for monitoring and managing risk. We argue for greater emphasis on national and global ‘‘inclusive wealth’’ as a way to measure economic activity and thus to monitor and mitigate the unintended consequences of economic activity. In sum, we call for a holistic approach to stewardship aimed at preserving the integrity of natural capital in the face of a broad range of global risks and their respective regional or global manifestations.

Isolation and Molecular Detection of Antimicrobial Resistance Genes in Escherichia coli and Staphylococcus Species from Joint Ill Cases of Calves in Puducherry

Background: Joint ill is a septicemic polyarthritis condition due to the localization of pathogenic bacteria within the joints of young calves. The emergence of antibiotic resistant pathogen in such cases may lead to further complication in treatment. Thus, the present study was aimed to isolate and identify the bacterial pathogens and its antimicrobial resistant genes from joint ill cases in calves. Methods: A total of 31 pus swabs were collected from joint ill cases from calves and subjected for bacterial isolation and identification by phenotypic and genotypic method followed by determination of its antimicrobial resistant genes (tet and mecA gene) and antibiogram. Result: Based on colony characters, microscopic observation, biochemical tests, 17/31 (54.83%) Escherichia coli and 14/31 (45.16%) Staphylococcus aureus were isolated and identified phenotypically. All the isolates were further confirmed by polymerase chain reaction using E. coli and S. aureus species specific primers. The antimicrobial resistant genes carrying E. coli and S. aureus isolates were also detected, in which 4/17 (23.5%) isolates were positive for tet gene and 4/14 (28.57%) were positive for the mecA gene. The antibiotic susceptibility test showed that the isolates were highly sensitive to Enrofloxacin (100%) and Gentamicin (77%), but were resistant to Amoxyclav (70%) and tetracycline (50%). On conclusion, E. coli and S. aureus are the most common bacterial pathogens identified from this study. The presence of antimicrobial resistant genes (tet and mecA) and antibiogram pattern of the bacterial isolates indicating the possible treatment failure and serious public health risks in future.

Temporal changes in hospital readmissions for postpartum hypertension in the US, 2010 to 2019; a serial cross-sectional analysis.

Hypertension is the most common primary diagnosis associated with postpartum readmissions within 42 days of delivery hospitalization. In the United States, nearly half of the cases of eclampsia, a severe form of preeclampsia, develop during the postpartum period, and the postpartum onset of hypertensive disorders of pregnancy, like antepartum hypertension poses long-term health risks to pregnant individuals, including an increased likelihood of developing overall cardiovascular disease, coronary heart disease, heart failure, and chronic hypertension. In this paper, we estimate the trends in the incidence of readmissions for postpartum hypertension within 42 days of delivery discharge in the US, disaggregated by median household income. Using National Readmissions Database, we calculated the readmission rates for postpartum hypertension, both overall and stratified by ZIP Code median household income for each year between 2010 and 2019. We also calculated the percentage change and average annual growth rate (AAGR) in the rate of readmissions for postpartum hypertension between 2010 and 2019 for each income group. We then used a logistic regression model to compare the temporal changes in readmission for postpartum hypertension between the lowest and the highest income quartiles. The estimated incidence of postpartum hypertension readmissions doubled for all the income groups between 2010 and 2019 (0.36% vs. 0.8%). While the incidence of postpartum hypertension cases was higher among the lowest-income quartile, the increase in postpartum hypertension readmissions between 2010 and 2019 was greater in the highest-income quartile. Moreover, the incidence of postpartum hypertension readmissions rose faster in pregnant patients without a history of hypertension compared to those with a history of hypertension (AAGR 8.3% vs. 5.1%). The increasing postpartum hypertension readmission burden suggests rising future health risks among mothers and a growing cost burden to the U.S. healthcare system. The higher rate of increase in postpartum hypertension readmissions among people without a history of hypertension calls for blood pressure checking in the postpartum period for all patients regardless of risk status.

Depression and cardiovascular reactions to acute psychological stress: Is anhedonia the driver?

Blunted cardiovascular reactions in response to acute psychological stress are predictive of future health risk. A large body of research has identified depression as an influential factor associated with blunted cardiovascular reactivity. Separately, there has been a resurgence in focus on anhedonia as a key feature of depression, responsible for poor treatment responses to non-improvement in cardiac event-free survival. In a re-analysis of a previously published study that found depression to be associated with blunted systolic blood pressure (SBP) and heart rate responses (HR), we used cross-sectional network models to examine if anhedonia symptoms were key drivers of this observation. Healthy young adults (N=180) completed measures of depression symptoms (Hospital Anxiety and Depression Scale (HADS)) and had their blood pressure and heart rate monitored throughout a standardized stress testing protocol. Using network analysis, a Walktrap algorithm identified two clusters of depressive symptoms: anhedonia and non-anhedonia. These anhedonia symptoms of depression, but not the non-anhedonia symptoms, were associated with blunted SBP and HR reactivity, such that those scoring higher on HADS-D items capturing anhedonia displayed more blunted cardiovascular response profiles. Moreover, these findings were robust to adjustment for several covariates. This study adds greater clarity on the depression-cardiovascular reactivity to stress association, by demonstrating that anhedonia is a key driver of this observation.

Co-occurrence of arsenic and fluoride in groundwater in Chandrapur district, central India

The study was carried out to assess the co-occurrence of arsenic and fluoride in groundwater in Chandrapur district, Central India, and their possible future health risk to men, women, and children. A total of 36 groundwater sampling locations (n = 34 from hand pump and n = 2 from dug well) were identified using a systematic random sampling method. The sampling was carried out using the grab sampling method in the post-monsoon season. Various physicochemical parameters were analysed as described in APHA. The results showed that the average concentration of arsenic in the groundwater was 0.0316 mg/L (0.0158 - 0.0414 mg/L), while the average concentration of fluoride was 1.18 mg/L (0.5 - 2.32 mg/L). All groundwater samples had arsenic concentrations above the limit permissible by the Indian standard (0.01 mg/L), while they were within the desirable limit (0.05 mg/L). As for the fluoride in groundwater, 12 samples (33.33 %) were below the desirable limit by the Indian standard (< 1.0 mg/L) and five (13.88 %) were above the desirable limit (> 1.5 mg/L). The co-occurrence of arsenic and fluoride in groundwater from the study area was recorded at 47.22 % (n = 17) of the sampling locations. At 14 sampling locations (38.88 %), the concentrations of both arsenic and fluoride in groundwater were higher, while at 35 sampling locations (97.22 %) there was an elevated concentration of either arsenic or fluoride or both of these contaminants. The plausible reason for the presence of arsenic and fluoride in groundwater can be attributed to geogenic origin. The prolonged ingestion of the groundwater from the study area may pose a threat to the health of the inhabitants. The inhabitants should be aware of these contaminants, and local authorities should use these findings to identify hotspots where these contaminants have occurred. It is necessary to develop and apply low-cost, environment-friendly, and easy-to-adopt methods for the removal of arsenic in combination with fluoride.

What can we learn from high background radiation area (HBRA) studies in three Asian countries: India, China and Indonesia? Radiological aspects in various HBRAs.

Radiation is a pervasive natural phenomenon that has been present on earth since its inception. However, exposure to high background radiation levels can pose significant health risks to individuals living in affected areas. In recent years, several studies have been conducted in high background radiation areas (HBRAs), including high radon concentration areas, to understand the radiological aspects and the lessons learned of radiation exposure. The purpose of this article is to provide a comprehensive review of radiological hazards and lessons learned from studies in high-background radiation areas in some countries of Asia (India, China and Indonesia). In this article, we will explore the hazards associated with radiation exposure from terrestrial radiation and additionally radon inhalation, the different studies conducted in HBRA and the lessons learned from these studies. Ultimately, this article aims to provide a better understanding of the radiological aspects of HBRAs and to identify the key lessons learned from previous studies to prevent future health risks. Likewise, research conducted in different high-background radiation areas in some countries of Asia has provided valuable insights into the radiological aspects of these areas and their potential impact on human health.

Unraveling microbial landscapes: high-throughput amplicon sequencing reveals distinct bacterial communities and potential health risks in potable springs of the Indian Himalayas.

Spring water is a vital drinking resource for residents in the Eastern Himalayas' Sikkim, India. While our initial investigations into spring water quality highlighted concerning levels of fecal coliform bacteria, the bacterial community composition (BCC) of these springs remains largely unexplored. This study sought to elucidate the BCC of Himalayan spring water, exploring its effects on water quality and delving into the unique bacterial ecology of these high-altitude springs. Bacterial diversity was assessed using 16S rRNA gene amplicon (V3-V4) library sequencing. The Greengenes reference database facilitated the classification of de-novo assembled operational taxonomic units (OTUs). The findings of this study revealed Proteobacteria (39.78%), Planctomycetes (35.76%), Verrucomicrobia (32.65%), and Bacteroidetes (37.04%) as predominant phyla across the four major districts: East, West, South, and North. Additionally, distinct genera emerged as dominant in each district: Emticicia in the East, Prosthecobacter in the South, and Planctomyces in the North and West. Of potential health concern, pathogenic bacteria like Corynebacterium, Acinetobacter, Legionella, Mycobacterium, and Clostridium were detected, albeit in low abundance. Their presence, even in minor quantities, might indicate potential future health risks for the communities relying on these springs. However, a substantial portion of the bacterial sequence remained unidentified (> = 40.0%), showcasing no sequence similarity with the reference database. This intriguing "dark matter" in bacterial DNA hints at a potential treasure trove of yet-to-be-identified species. Future taxonomic profiling of these novel sequences may offer a deeper understanding of Himalayan springs' microbial makeup. Furthermore, these novel bacterial sequences will be instrumental in enhancing our global understanding of bacterial community structures and their ecological adaptations in high-altitude, low-temperature environments.

Exposure to 2,4-Dichlorophenoxyacetic acid stimulates the calcium/ROS/CK1α pathway to trigger Hemolysis and Eryptosis in red blood cells.

The agricultural herbicide 2,4-dichlorophenoxyacetic (2,4-D) is cytotoxic to human red blood cells (RBCs) by virtue of oxidative hemolysis. Nevertheless, there remains a great paucity of literature detailing the mechanisms by which 2,4-D triggers hemolysis. Also, the eryptotic effects of 2,4-D has thus far been largely overlooked. This study aims to expand current understanding of the cytotoxic properties of 2,4-D in RBCs. Cells were exposed to 2,4-D ranging from 100 to 1,000μM for 24h at 37°C under varied experimental conditions. Hemolysis, LDH, AST, and AChE activities were photometrically measured. Flow cytometry assessed eryptotic markers including cell volume by forward scatter (FSC), phosphatidylserine (PS) externalization by annexin-V positivity, reactive oxygen species by H2DCFDA, and intracellular Ca2+ levels by Fluo4/AM. 2,4-D induced Ca2+-independent, concentration-responsive hemolysis paralleled by increased LDH, AST, and K+ in the supernatant, which was significantly blunted by D4476, isosmotic urea, sucrose, and polyethylene glycol 8,000 (PEG). Notably, 2,4-D caused a significant increase in cells positive for annexin-V-FITC, DCF, and Fluo4 with a concomitant decrease in AChE activity and FSC following KCl release. Furthermore, lymphocytes and reticulocytes were sensitive to 2,4-D within a whole blood milieu. This work introduces novel cytotoxic mechanisms of 2,4-D in RBCs and reveals its pro-eryptotic effects. 2,4-D toxicity is neutralized by blockade of casein kinase 1α signaling and the presence of urea, sucrose, and PEG. These findings have significant implications for public health and inform future health risk assessments to develop novel preventive and therapeutic strategies.

Trichomonad Disease in Wild Turkeys (Meleagris gallopavo): Pathology and Molecular Characterization of Histomonas, Tetratrichomonas, Tritrichomonas, and Simplicimonas spp.

The Wild Turkey (Meleagris gallopavo) is a geographically widespread, popular game bird and conservation icon in North America. Following successful reestablishment in parts of the US and Canada, regional declines have fueled population health concerns; therefore, understanding mortality causes and spatiotemporal patterns of disease is important to uncover potential ongoing and future health risks. Histomonosis, caused by the trichomonad Histomonas meleagridis, is a well-established and potentially fatal disease in Wild Turkeys; however, its prevalence and potential population health impacts remain poorly understood. Moreover, molecular tools recently have allowed for the detection of additional trichomonads that similarly can cause fatal disease in Wild Turkeys. We describe and compare disease due to H. meleagridis with that of Tetratrichomonas gallinarum, Tritrichomonas sp., and Simplicimonas sp. in Wild Turkeys in the southeastern US. Among 857 Wild Turkeys evaluated postmortem from 2002 to 2023, 34 (4.0%) were diagnosed with trichomonad disease, often assumed to be histomonosis prior to molecular testing. However, among 25 debilitating to fatal trichomonad disease cases for which etiologies were confirmed by PCR from 2015 to 2023, H. meleagridis was detected in 16/25 (64.0%), T. gallinarum in 6/25 (24.0%), Tritrichomonas sp. in 2/25 (8.0%) and Simplicimonas sp. in 1/25 (4.0%). These turkeys had similar clinical manifestations, and although lesion patterns varied to some extent, liver and/or intestinal tract was most commonly affected. Coinfections were common among all turkeys with trichomonad disease from 2015 to 2023 (21/25, 84.0%) and included viruses (lymphoproliferative disease virus, avian poxvirus), bacteria (Streptococcus gallolyticus, Listeria monocytogenes, Escherichia coli), and other protozoa (Sarcocystis sp., Haemoproteus sp.). Our results highlight the importance of molecular diagnostic testing in determining etiologies of trichomonad disease in Wild Turkeys. Further evaluation of the epidemiology and pathogenesis of trichomonad disease and its varied etiologies in Wild Turkeys and other birds is warranted to better understand risk factors and potential health impacts.

Risk factors for the gambling, smoking and alcohol consumption triad in Portuguese adolescents

Abstract Background Addiction to gambling, tobacco, and alcohol poses significant risks to mental, social, and physical health, particularly during adolescence, a critical period for habit formation. This study investigates risk factors linked to these habits among Portuguese adolescents. Methods This cross-sectional study used the 2019 ESPAD questionnaire, targeting 16-year-old adolescents. The sample comprised 4,365 responses. Descriptive analysis determined the prevalence of gambling, smoking, and alcohol use, as well as social, economic, and behavioral factors. Bivariate associations were assessed using the Exact Fisher test, and multiple logistic regression identified key predictors for the outcome of interest (cumulative presence of gambling, smoking and alcohol consumption). Statistical analysis was conducted with SPSS version 29.0, with a significance level of p < 0.05. Results Among adolescents, 6.2% presented probable problematic gambling according to the Lie/Bet test, with 3.7% spending at least 30 minutes a day gambling. In the past 30 days, 14.3% smoked, 42.7% drank alcohol, and 10.5% engaged in binge drinking. The behavioral triad was observed in 56 individuals. Male gender (OR = 2.024; 95% CI: 1.097-3.734; p = 0.024), problematic online gaming behavior (OR = 2.041; 95% CI: 1.005-4.144; p = 0.048) and going out at night at least once a week (OR = 1.439; 95% CI: 1.242-1.669; p < 0.001) significantly increased the risk of the behavioral triad. In contrast, parental control (parents knowing where the adolescent is on Saturday night) had a significant protective effect (OR = 0.162; 95% CI: 0.086-0.303; p < 0.001). Conclusions The study underscores the importance of parental supervision to curb risky behaviors in adolescents. It suggests implementing public health programs in schools, leveraging gaming for early screening, and tightening online gambling regulations to mitigate future health risks associated with gambling, smoking, and alcohol use. Key messages • Absence of parental supervision, male gender, problematic online gaming and frequently going out at night are risk factors for this behavioral triad. • Public health strategies are needed to prevent gambling addiction, emphasizing parental awareness, identification of at-risk students, and comprehensive school-based approaches.

10.G. Practice session: Innovation technology to promote healthy lifestyles: teachings from multi-national EU funded projects

Abstract The global burden of disease attributable to lifestyle risk factors is constantly escalating on a worldwide scale. Inadequate diet and sedentary behaviors stand out as particularly impactful contributors to chronic non-communicable diseases, resulting in millions of deaths annually and projecting stable, alarming trends for the foreseeable future. These statistics raise significant concerns among public health experts, particularly regarding the pervasive influence of unhealthy lifestyles on younger generations. This demographic cohort’s susceptibility poses a substantial threat to the future trajectory of non-communicable diseases and places immense strain on healthcare systems and global health outcomes. In light of these challenges, the imperative for public health initiatives and interventions aimed at promoting healthy lifestyles becomes glaringly apparent. Addressing the root causes of unhealthy behaviors through targeted interventions is essential to reverse the projected trends and mitigate future health risks. Public health authorities shoulder the responsibility of prioritizing such endeavors, as they play a pivotal role in shaping environments conducive to healthy living for present and future generations alike. Embracing innovative methodologies, leveraging technological advancements, and adopting modern approaches are imperative to engage and mobilize younger populations effectively. Initiatives funded by entities such as the European Union serve as promising examples, highlighting the potential for collaborative efforts to drive meaningful change. Sharing the methodologies and findings of such projects within the public health community can catalyze knowledge dissemination and foster collaboration, ultimately amplifying the impact of intervention strategies worldwide. By prioritizing intervention studies for behavioral change, stakeholders can collectively address the pressing challenge of lifestyle-related diseases and pave the way for healthier, more resilient communities. The aim of this workshop is to provide an overview of multi-national EU funded projects aiming to promote healthy lifestyles in the Mediterranean region. Key messages • Innovative and more modern approaches are needed to improve the diet in the Mediterranean region. • Children and adolescents are the main targets to counteract the rise of non-communicable diseases.

Extreme precipitation, exacerbated by anthropogenic climate change, drove Peru's record-breaking 2023 dengue outbreak.

Anthropogenic forcing is increasing the likelihood and severity of certain extreme weather events, which may catalyze outbreaks of climate-sensitive infectious diseases. Extreme precipitation events can promote the spread of mosquito-borne illnesses by creating vector habitat, destroying infrastructure, and impeding vector control. Here, we focus on Cyclone Yaku, which caused heavy rainfall in northwestern Peru from March 7th - 20th, 2023 and was followed by the worst dengue outbreak in Peru's history. We apply generalized synthetic control methods to account for baseline climate variation and unobserved confounders when estimating the causal effect of Cyclone Yaku on dengue cases across the 56 districts with the greatest precipitation anomalies. We estimate that 67 (95% CI: 30 - 87) % of cases in cyclone-affected districts were attributable to Cyclone Yaku. The cyclone significantly increased cases for over six months, causing 38,209 (95% CI: 17,454 - 49,928) out of 57,246 cases. The largest increases in dengue incidence due to Cyclone Yaku occurred in districts with a large share of low-quality roofs and walls in residences, greater flood risk, and warmer temperatures above 24°C. Analyzing an ensemble of climate model simulations, we found that extremely intense March precipitation in northwestern Peru is 42% more likely in the current era compared to a preindustrial baseline due to climate forcing. In sum, extreme precipitation like that associated with Cyclone Yaku has become more likely with climate change, and Cyclone Yaku caused the majority of dengue cases across the cyclone-affected districts.

Environmental persistence, bioaccumulation, and hazards of chemicals in e-cigarette e-liquids: short-listing chemicals for risk assessments

Background/MethodsIncreased use and sales of e-cigarettes raises concerns about the potential environmental impacts throughout their life-cycle. However, few available research studies focus on the environmental impacts and ecotoxicity of e-cigarettes....

Gestational diabetes: an update sixty years after O'Sullivan and Mahan.

Sixty years after the landmark publication by O'Sullivan and Mahan, the current paper seeks to review and place into context the importance of gestational diabetes (GDM) both as a marker of increased risk of adverse maternal and fetal pregnancy outcomes and as an indicator of future maternal and infant health risks. We review the evolution of GDM as a diagnosis, the ongoing debate regarding diagnostic approaches, the underlying pathophysiology, the epidemiology and the importance of GDM in the context of the global epidemics of diabetes and obesity. Focusing on clinical management, we review lifestyle based therapy and pharmacotherapy for GDM, consider obstetric management and outline the short term and lifelong health risks posed by a GDM diagnosis.

7326 Breast and Ovarian Cancer are Increased in Women with Primary Ovarian Insufficiency and Early Menopause and Cancer is Increased in Family Members

Abstract Disclosure: K.L. Allen-Brady: None. L. Verrilli: None. M. Alvord: None. M. Kern: None. N. Camp: None. K. Kelley: Consulting Fee; Self; Immunogen. J. Letourneau: None. L. Cannon-Albright: None. E.B. Johnstone: Stock Owner; Self; Abbott Laboratories, Abbvie. C.K. Welt: None. Introduction: Next generation sequencing in women with primary ovarian insufficiency (POI) identified deleterious variants in DNA damage repair and transcription fidelity genes. Based on underlying genetics, we hypothesized that a subset of women with POI may also be predisposed to reproductive or hormonally influenced cancers and that family members may be at risk. Methods: Women with POI (≤40 years) and early menopause >40 and <45 years) were identified using ICD9 and 10 codes in electronic medical records (1995-2021) from two major healthcare systems in Utah and reviewed for accuracy. Women with POI and their relatives were linked to genealogy information using the Utah Population Database (UPDB) and to cancer diagnoses (breast, ovarian, endometrial, colon, testicular and prostate) using the Utah Cancer Registry. The relative risk (RR) of cancer in women with POI and in relatives was estimated by comparison to population rates matched by age, sex, and birthplace. We also identified POI pedigrees with an excess number of observed cancer cases compared to the expected number in population controls. Results: We identified 613 women with POI and 165 women with early menopause. Of these, 416 women with POI had at least three generations of genealogical data with 2,405 first-degree relatives, 6,798 second-degree relatives and 17,666 third-degree relatives. Breast cancer was significantly increased in women with POI (OR [95%CI] 1.89 [1.20, 2.84]; p=0.0056) and there was a borderline increase in ovarian cancer. Probands were 36.5±4.3 years when diagnosed with POI and 59.5±12.7 years (range 43-80 years) at the time of breast cancer diagnosis and only 2 women took hormone replacement therapy after age 50 years. When women with early menopause were added, breast cancer risk remained increased and ovarian cancer was also nominally significant (3.38 [1.15, 8.65]; p=0.032). There was no increased risk of endometrial cancer and there were no cases of colon cancer. Among second-degree relatives of women with POI and 3 generations of family members, there was a significantly increased risk of breast (1.28 [1.08, 1.71]; p=0.0078) and colon cancer (1.50 [1.14, 1.94]; p=0.0036). Prostate cancer was increased in first- (1.64 [1.18, 2.23]; p=0.0026), second- (1.54 [1.32, 1.79]; p<0.001), and third-degree relatives (1.33 [1.20, 1.48]; p<0.001). There were 27 POI pedigrees that were high risk for these reproductive or hormonally influenced cancer diagnoses. Conclusions: Our data suggest common risk factors for POI and reproductive or hormonally influenced cancers. Therefore, clinicians need tools to predict cancer risk and comorbid disease in women with POI and early menopause to adequately counsel about future health risk. This understanding may change recommendations for hormone replacement based on the underlying genetic cause of POI for an individual. Presentation: 6/3/2024

Tracking epidemic viruses in wastewaters.

Classical epidemiology relies on incidence, mortality rates, and clinical data from individual testing, which can be challenging for many countries. Therefore, innovative, flexible, cost-effective, and scalable surveillance techniques are needed. Wastewater-based epidemiology (WBE) has emerged as a highly powerful tool in this regard. WBE analyses substances excreted in human fluids and faeces that enter the sewer system. This approach provides insights into community health status and lifestyle habits. WBE serves as an early warning system for viral surveillance, detecting the emergence of new pathogens, changes in incidence rates, identifying future trends, studying outbreaks, and informing the performance of action plans. While WBE has long been used to study different viruses such as poliovirus and norovirus, its implementation has surged due to the pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2. This has led to the establishment of wastewater surveillance programmes at international, national, and community levels, many of which remain operational. Furthermore, WBE is increasingly applied to study other pathogens, including antibiotic resistance bacteria, parasites, fungi, and emerging viruses, with new methodologies being developed. Consequently, the primary focus now is on creating international frameworks to enhance states' preparedness against future health risks. However, there remains considerable work to be done, particularly in integrating the principles of One Health into epidemiological surveillance to acknowledge the interconnectedness of humans, animals, and the environment in pathogen transmission. Thus, a broader approach to analysing the three pillars of One Health must be developed, transitioning from WBE to wastewater and environmental surveillance, and establishing this approach as a routine practice in public health.

Blockchain-Based Privacy Preservation for the Internet of Medical Things: A Literature Review

The Internet of Medical Things (IoMT) is a rapidly expanding network comprising medical devices, sensors, and software that collect and exchange patient health data. Today, the IoMT has the potential to revolutionize healthcare by offering more personalized care to patients and improving the efficiency of healthcare delivery. However, the IoMT also introduces significant privacy concerns, particularly regarding data privacy. IoMT devices often collect and store large amounts of data about patients’ health. These data could be used to track patients’ movements, monitor their health habits, and even predict their future health risks. This extensive data collection and surveillance could be a major invasion of patient privacy. Thus, privacy-preserving research in an IoMT context is an important area of research that aims to mitigate these privacy issues. This review paper comprehensively applies the PRISMA methodology to analyze, review, classify, and compare current approaches of preserving patient data privacy within IoMT blockchain-based healthcare environments.

Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh?

Dhaka is one of the world's densely populated cities and faces significant public health challenges including high burden of diarrhoeal diseases. Climate change is intensifying existing environmental problems including urban heat island effect and poor water quality. While numerous epidemiological studies have linked meteorological factors to diarrhoeal diseases in Bangladesh, assessment of the impacts of future climate change on diarrhoeal diseases is scarce. We provide the assessment of climate change impacts on diarrhoeal disease in Dhaka and project future health risks under climate change scenarios. About 3 million acute diarrhoea cases presenting to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) during 1981-2010 were linked to daily temperature, rainfall and humidity and association investigated using time series adapted negative binomial regression models employing constrained distributed lag linear models. The findings were applied to climate projections to estimate future risks of diarrhoea under various global warming scenarios. There was a significantly raised risk of diarrhoea hospitalisation in all ages with daily mean temperature (RR: 3.4, 95% CI: 3.0-3.7) after controlling for the confounding effects of heavy rainfall, humidity, autocorrelations, day of the week effect, long-term time, and seasonal trends. Using the incidence rate ratio (IRR) of 1.034, temperature increases based on the global warming targets of 1.5-2°C could result in an increase of diarrhoea hospitalisations by 4.5-7.4% in all age groups by the 2100s. These effects were more pronounced among <5 children where the predicted temperature increases could raise diarrhoea hospitalisation by 5.7% - 9.4%. Diarrhoea hospitalisation will increase significantly in Dhaka even if the global warming targets adopted by the Paris Agreement is reached. This underscores the importance of preparing the city for management and prevention of diarrhoeal diseases.

Maternal diet during pregnancy and adaptive changes in the maternal and fetal pancreas have implications for future metabolic health.

Fetal and neonatal development is a critical period for the establishment of the future metabolic health and disease risk of an individual. Both maternal undernutrition and overnutrition can result in abnormal fetal organ development resulting in inappropriate birth size, child and adult obesity, and increased risk of Type 2 diabetes and cardiovascular diseases. Inappropriate adaptive changes to the maternal pancreas, placental function, and the development of the fetal pancreas in response to nutritional stress during pregnancy are major contributors to a risk trajectory in the offspring. This interconnected maternal-placental-fetal metabolic axis is driven by endocrine signals in response to the availability of nutritional metabolites and can result in cellular stress and premature aging in fetal tissues and the inappropriate expression of key genes involved in metabolic control as a result of long-lasting epigenetic changes. Such changes result is insufficient pancreatic beta-cell mass and function, reduced insulin sensitivity in target tissues such as liver and white adipose and altered development of hypothalamic satiety centres and in basal glucocorticoid levels. Whilst interventions in the obese mother such as dieting and increased exercise, or treatment with insulin or metformin in mothers who develop gestational diabetes, can improve metabolic control and reduce the risk of a large-for-gestational age infant, their effectiveness in changing the adverse metabolic trajectory in the child is as yet unclear.

Geospatial modelling of ambient air pollutants and chronic obstructive pulmonary diseases at regional scale in Pakistan.

Pakistan is among the South Asian countries mostly vulnerable to the negative health impacts of air pollution. In this context, the study aimed to analyze the spatiotemporal patterns of chronic obstructive pulmonary disease (COPD) incidence and its relationship with air pollutants including aerosol absorbing index (AAI), carbon monoxide, sulfur dioxide (SO2), and nitrogen dioxide. Spatial scan statistics were employed to identify temporal, spatial, and spatiotemporal clusters of COPD. Generalized linear regression (GLR) and random forest (RF) models were utilized to evaluate the linear and non-linear relationships between COPD and air pollutants for the years 2019 and 2020. The findings revealed three spatial clusters of COPD in the eastern and central regions, with a high-risk spatiotemporal cluster in the east. The GLR identified a weak linear relationship between the COPD and air pollutants with R2 = 0.1 and weak autocorrelation with Moran's index = -0.09. The spatial outcome of RF model provided more accurate COPD predictions with improved R2 of 0.8 and 0.9 in the respective years and a very low Moran's I = -0.02 showing a random residual distribution. The RF findings also suggested AAI and SO2 to be the most contributing predictors for the year 2019 and 2020. Hence, the strong association of COPD clusters with some air pollutants highlight the urgency of comprehensive measures to combat air pollution in the region to avoid future health risks.