World Health Organization Guidelines Research Articles

Microbiological and physicochemical water quality assessments of the Upper Basin Litany River, Lebanon.

The Litany River has encountered severe environmental pollution. This study focused on assessing the pollution level in the upper basin of the Litany River by monitoring seasonal variation of water quality and testing physicochemical parameters and microbial qualities. A total of 72 freshwater samples were taken from six sites for 1 year during the four seasons. The microbiological parameters included total coliform, fecal coliform, and Escherichia coli counts. The physicochemical parameters comprised pH, total dissolved solids, nitrate, sodium, potassium, biochemical oxygen demand, chemical oxygen demand, total nitrogen, and total phosphorus. The microbiological quality of samples was evaluated by comparing the fecal pollution indicators loads to the SEQ-EAUX2003 standard for irrigation, and the physicochemical analyses were assessed according to Lebanese Standards Institution (LIBNOR) NL161: 2016 and the World Health Organization (WHO) Guidelines for Water Quality. The results revealed that most physicochemical parameters are not within the permitted limit of LIBNOR and WHO, especially in sites S2, S3, and S6 during the dry seasons. The pH ranged between 6 and 8.16. The total dissolved solids reached 1948 mg/L. The nitrate, sodium, and potassium ranged between 0 and 253 mg/L. The total nitrogen and total phosphorous reached 103 and 5.16 mg/L, respectively. The chemical oxygen demand reached 2210 mg/L, and the biochemical oxygen demand reached 732 mg/L. Concerning the microbiological analysis, fecal pollution was detected in all sites during all seasons, with detectable higher values during the dry seasons, and all samples were considered to be non-conforming, with significant spatiotemporal variation of most parameters. Our results highlight the need to take measures to prevent the high level of pollution. This could be achieved by monthly water quality monitoring of the upper basin and introducing appropriate guidelines to detect pathogens and toxic chemicals that affect the entire ecosystem and lead to severe public health issues.

Protektem pikinini blong yu trial: protocol for a single arm field trial to assess the effectiveness of treating-all pregnant women with hepatitis B infection with tenofovir prophylaxis to prevent mother-to-child transmission in Vanuatu, 2024–2025

BackgroundHepatitis B infection is a major public health concern in Vanuatu, with approximately 9% of the general population estimated to be living with chronic hepatitis B. Most new infections are due to mother-to-child transmission (MTCT). Hepatitis B vaccination is available in Vanuatu, but coverage rates for first dose within 24 h of birth and third dose are suboptimal. While treatment of chronic hepatitis B infection with tenofovir disoproxil fumarate (TDF) is available in country, there is no capacity to test hepatitis B e antigen and limited capacity to test hepatitis B virus (HBV) DNA viral load, which is a current eligibility requirement for women in pregnancy to access hepatitis B prophylaxis for MTCT per National guidelines. Recently, the World Health Organization guidelines have been updated to recommend universal peripartum antiviral prophylaxis (PAP) of pregnant women living with hepatitis B to prevent MTCT of HBV, without assessment of viral load in places without access to testing. However, these recommendations are conditional based on low-certainty evidence. The aim of this trial is to evaluate the effectiveness and safety of universal PAP and provide evidence for the global guidelines.MethodsA single arm field trial compared to real world control sites will be conducted in Vanuatu involving pregnant women attending antenatal care services with positive HBsAg rapid tests. Participants at the control sites will undergo routine care. Participants at the intervention sites will all receive oral TDF prophylaxis from second trimester to completion of infant primary hepatitis B vaccination schedule. Primary data analysis will be by intention-to-treat. Initial analyses will be unadjusted comparisons of the intervention sites and control sites. Adjusted analyses will be performed, as needed, and presented in addition to unadjusted comparisons.DiscussionThis study will provide evidence of acceptability, effectiveness and cost-effectiveness of prophylaxis for all women with hepatitis B during pregnancy, as per the updated WHO guidelines, compared with current practice. The outcome of this trial will provide critical information to inform national and global guidelines around universal peripartum antiviral prophylaxis for hepatitis B during pregnancy.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN: ACTRN12623001202651p. Registered 21 November 2023.

Compliance with the WHO recommended 8+ antenatal care contacts schedule among postpartum mothers in eastern Uganda: A cross-sectional study.

The World Health Organization (WHO) recommends at least 8 antenatal care (ANC) contacts during pregnancy, but many women in low and middle-income countries do not adhere to this schedule, which may contribute to high rates of maternal and neonatal mortality. This study assessed compliance to the WHO recommended 8+ ANC contacts schedule and associated factors among postpartum mothers in eastern Uganda. This was a cross-sectional multicenter study conducted between July and August 2022 at four selected hospitals in Eastern Uganda using quantitative techniques. We recruited postnatal mothers who had given birth within 48 hours with records of their ANC contacts. Compliance to the WHO recommended 8+ ANC contacts schedule was defined as having received the recommended ANC contacts as per the gestational age at childbirth following the current ANC for a positive pregnancy experience WHO guidelines. We conducted multivariable logistic regression analysis to assess the association between compliance to the WHO recommended 8+ ANC contacts schedule and selected independent variables. A total of 1104 postpartum mothers participated in the study with a mean age (± standard deviation) of 26 ± 6.4 years, and a majority had given birth from a referral hospital (n = 624 56.5%). Compliance to the WHO recommended 8+ ANC contacts schedule was low (n = 258, 23.4%), and only 23.2% (196) of the women had attended their first antenatal care contact within the first trimester. Factors associated with compliance to the WHO recommended 8+ ANC contacts were: attending the first antenatal care contact within 12 weeks of gestation [AOR: 6.42; 95% CI: (4.43 to 9.33)], having 2 to 4 children [AOR: 0.65; 95% CI: (0.44 to 0.94)], having a spouse who is unemployed [AOR: 1.71; 95% CI: (0.53 to1.08)] and having insurance coverage [AOR: 2.31; 95% CI: (1.17 to 4.57)]. Compliance with the 8+ ANC contacts schedule remains very low. Efforts should focus on increasing health education, particularly for multiparous women, and encouraging mothers to begin ANC in their first trimester. Exploring the dynamics of partner support, especially with employment status, may offer insights into improving ANC attendance.

Determinants of developing cardiovascular disease risk with emphasis on type-2 diabetes and predictive modeling utilizing machine learning algorithms.

This research aims to enhance our comprehensive understanding of the influence of type-2 diabetes on the development of cardiovascular diseases (CVD) risk, its underlying determinants, and to construct precise predictive models capable of accurately assessing CVD risk within the context of Bangladesh. This study combined data from the 2011 and 2017 to 2018 Bangladesh Demographic and Health Surveys, focusing on individuals with hypertension. CVD development followed World Health Organization (WHO) guidelines. Eight machine learning algorithms (Support Vector Machine, Logistic Regression, Decision Tree, Random Forest, Naïve Bayes, K-Nearest Neighbor, Light GBM, and XGBoost) were analyzed and compared using 6 evaluation metrics to assess model performance. The study reveals that individuals aged 35 to 54 years, 55 to 69 years, and ≥ 70 years face higher CVD risk with adjusted odds ratios (AOR) of 2.140, 3.015, and 3.963, respectively, compared to those aged 18 to 34 years. "Rich" respondents show increased CVD risk (AOR = 1.370, P < .01) compared to "poor" individuals. Also, "normal weight" (AOR = 1.489, P < .01) and "overweight/obese" (AOR = 1.871, P < .01) individuals exhibit higher CVD risk than "underweight" individuals. The predictive models achieve impressive performance, with 75.21% accuracy and an 80.79% AUC, with Random Forest (RF) excelling in specificity at 76.96%. This research holds practical implications for targeted interventions based on identified significant factors, utilizing ML models for early detection and risk assessment, enhancing awareness and education, addressing urbanization-related lifestyle changes, improving healthcare infrastructure in rural areas, and implementing workplace interventions to mitigate stress and promote physical activity.

The 2024 updated WHO guidelines for the prevention and management of chronic hepatitis B: main changes and potential implications for the next major liver society clinical practice guidelines.

Progress towards hepatitis B virus (HBV) global elimination has been slow and most countries are far to reach the elimination targets set up by the World Health Organization (WHO). The burden of chronic hepatitis B is mainly bear by resource-limited countries where only a minority of people living with HBV are diagnosed and treated and international guidelines hardly applicable in real-life. In March 2024, the WHO released its revised guidelines for the prevention and management of chronic hepatitis B. Simplification of care and expansion of treatment criteria represent the core of this revision. Whether and how these updated WHO guidelines will influence the international liver societies (EASL, AASLD and APASL) for their next hepatitis B recommendations remain uncertain. Yet, the European, American and Asian regions encompass multiple low, middle and intermediate-income countries with high HBV endemicity and vulnerable populations that should benefit from simplified clinical algorithms. Here, from an analysis of the WHO guideline development process and its new recommendations, we aimed to identify the anticipated areas of agreements and controversies with the next liver society hepatitis B guidelines which will have to balance clinical risks and benefits for the patients.

International standard of Traditional Chinese Medicine techniques: clinical guidelines for dysmenorrhea (2022).

Dysmenorrhea is a common gynecological condition that is further divided into two categories, namely primary and secondary dysmenorrhea. Traditional Chinese Medicine (TCM) gives good clinical results for the treatment of dysmenorrhea based on the basic principles of holistic view and syndrome differentiation. However, presently, the clinical practice guidelines in TCM for dysmenorrhea treatment are required. The guideline is formulated in strict accordance with the principles of evidence-based medicine with reference to the General Principles for the Compilation of International Guidelines for Diagnosis and Treatment of Traditional Chinese Medicine Syndromes and General Principles for the Compilation of International Clinical Practice Guidelines for Traditional Chinese Medicine Diseases and accordance with the principles and methods of The Appraisal of Guidelines for Research and Evaluation in China (AGREE-China) and World Health Organization guidelines. This guideline includes clinical issues by literature search and questionnaire survey, and eight background questions and 23 prospect questions were finally created. Based on the evidence retrieval, synthesis, consideration of patient preferences and values, intervention costs, advantages, and disadvantages, recommendations are created using the Delphi method and expert consensus method. This guideline clarified the definition, diagnosis, and TCM syndrome classification for dysmenorrhea, and recommends different TCM treatments based on the level of evidence, including Chinese herbal medicine, Chinese patent medicine, acupuncture, and other auxiliary therapies. The present guideline is an international clinical practice guideline for the treatment of dysmenorrhea using TCM. This guideline will provide substantive evidence and standardized guidance for the treatment of dysmenorrhea using TCM, improve the quality and safety of medical services, and standardize diagnosis and treatment plans for dysmenorrhea.

Salivary Statherin as a Dental Caries Biomarker among a Sample of Adolescents in Baghdad City

Background: Dental caries represents a multifaceted disease impacting teenagers across the globe. A combination of factors, including fermentable carbohydrates, acid-producing bacteria, saliva, and host-related characteristics, influences its development. Salivary statherin controls microorganisms by aggregating them and preventing them from adhering to hard tissue and epithelium. Salivary statherin may maintain tooth integrity. Objective: This research investigated the potential of salivary statherin as a biomarker for dental caries, examining its connection to the nutritional status of adolescents. Subjects and Methods: This comparative (observational) research included 90 15-year-old adolescents of both sexes. Participants were divided into two distinct groups: 30 individuals without caries, serving as the control group, and 60 individuals with caries, referred to as the study group. Following the World Health Organization guidelines, adolescents with varying caries experiences were further categorized. Thirty of them exhibited a moderate level of caries, with 1 to 3 affected teeth, while the remaining thirty were classified as having severe caries, with a Decay-Missing-Filled Teeth (DMFT) score greater than 10. The DMFT Index measured caries experience. Salivary statherin analysis from unstimulated saliva. Height, weight, and body mass index measured nutrition, classifying adolescents as normal weight, overweight, or obese. Results: Statherin levels decreased with the severity of caries increasing. There was a significant result in the overweight, healthy, and total sample among caries severity groups (P value &lt;= 0.05). There was a significant difference in the severe caries group, while statherin levels increased with nutritional status (P value ≤ 0.05). Conclusions: Caries severity reduces salivary statherin. In severe caries patients, nutritional status increased salivary statherin. Dietary status and dental caries severity affected statherin levels. No association was found between statherin levels and salivary pH or flow rate across different nutritional statuses or caries severity groups. However, salivary statherin may play a role in maintaining tooth integrity

Role of Unenhanced Computed Tomography of the Chest in the Prediction of Anaemia: A Cross-sectional Study

Introduction: Anaemia is a common clinical condition. The detection of incidental findings on unenhanced Computed Tomography (CT) that predict the presence of anaemia may play a pivotal role in early diagnosis, treatment and prognosis. Aim: To assess the role of unenhanced CT thorax in predicting anaemia by determining the sensitivity and specificity of the Interventricular Septum Sign (IVS) and Aortic Rim Sign (ARS) in the prediction of anaemia. Materials and Methods: This was a cross-sectional study conducted on 300 patients who underwent High-resolution Computed Tomography (HRCT) of the thorax using a 128-slice CT scanner in the Department of Radiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, Nizams Institute of Medical Sciences, Hyderabad, from July 2022 to September 2022. An estimation of haemoglobin levels was performed from a peripheral blood sample within 24 hours of the scan and the diagnosis of anaemia was made based on World Health Organisation (WHO) guidelines of haemoglobin values according to age and gender. On imaging, the following parameters were analysed: the variables considered for each patient included age and gender, the presence or absence of ARS, the presence or absence of an IVS and the Hounsfield Units (HU) values of seven selected Regions of Interest (ROI) on each examination. Three ROIs were placed in the Left Ventricular (LV) cavity, three on the IVS and a single ROI was placed in the aorta at the same level. Mean, percentage, frequency and standard deviation were calculated. The Chi-square test was applied for statistical analysis and a p-value of &lt;0.05 was considered significant. Results: Out of the total sample size of 300, 188 were males and 112 were females with the mean age of 47.16±19.77 years. The mean haemoglobin percentage in the study was 11.62±2.25 gm%. Approximately 195 (65%) out of 300 patients were found to be anaemic based on blood reports. Among them, the majority were diagnosed with moderate anaemia 109 (36.3%), followed by mild anaemia 76 (25.3%) and severe anaemia 10 (3.3%), respectively. The sensitivity of the dense IVS was 100% for severe anaemia, 75.6% for moderate anaemia and 55.3% for mild anaemia. In comparison, the aortic rim sign showed a sensitivity of 100% for severe anaemia, 86.5% for moderate anaemia and 67.69% for mild anaemia, with a specificity of 88.57%. Conclusion: The presence of an IVS on an unenhanced CT predicts the likelihood of underlying anaemia and suggests the need for further evaluation and timely management.

Human papillomavirus DNA detection in cervical samples from women of reproductive age in Mogadishu, Somalia.

Somalia is among the countries with a high burden of human papillomavirus (HPV) infection in Sub-Saharan Africa. In 2022, 660,000 infections are reported among women globally, out of which 350,000 died from the disease. Most of the studies on HPV reported from Somalia are based on cytologic analysis which is a subjective and suboptimal assessment. The recent World Health Organization (WHO) guidelines for HPV recommend DNA-based testing as a better alternative to the traditional pap smear test. This study was undertaken to determine the prevalence of HPV based on the preferred HPV DNA assay on cervical samples of women of reproductive age in Mogadishu, Somalia. The HPV DNA detection was carried out using real-time quantitative polymerase chain reaction (RT-PCR) assays to identify high-risk oncogenic HPV16, HPV18, and other high-risk HPV types. Overall, 31.7% (60/189) of cervical samples were positive for HPV DNA. Out of this, 19.6% were high risk-HPV (hrHPV), 13.8% were HPV16, and 5.3% were HPV18. Moreover, age, income and education level were found to be significant risk factors for HPV infection. These results provide further proof that HPV continues to be a serious public health challenge in Somalia with the risk of progressing to fatal cervical cancer.

Functional analysis of G6PD variants associated with low G6PD activity in the All of Us Research Program.

The glucose-6-phosphate dehydrogenase (G6PD) enzyme protects red blood cells against oxidative damage. Individuals with G6PD-impairing polymorphisms are at risk of hemolytic anemia from oxidative stressors. Prevention of G6PD deficiency-related hemolytic anemia is achievable by identifying affected individuals through G6PD genetic testing. However, accurately predicting the clinical consequence of G6PD variants is limited by over 800 G6PD variants which remain of uncertain significance (VUS). There also remains inconsistency in which deficiency-causing variants are included in genetic testing arrays: many institutions only test c.202G > A, though dozens of other variants can cause G6PD deficiency. Here, we improve G6PD genotype interpretations using the All of Us Research Program data and a yeast functional assay. We confirm that G6PD coding variants are the main contributor to decreased G6PD activity and that 13% of individuals in the All of Us data with deficiency-causing variants would be missed by only genotyping for c.202G > A. We expand clinical interpretation for G6PD VUS, reporting that c.595A > G ("Dagua" or "Açores") and the novel variant c.430C > G reduce activity sufficiently to lead to G6PD deficiency. We also provide evidence that 5 missense VUS are unlikely to lead to G6PD deficiency, and we applied the new World Health Organization (WHO) guidelines to recommend classifying 2 synonymous variants as WHO Class C. In total, we provide new or updated clinical interpretations for 9 G6PD variants. We anticipate these results will improve the accuracy, and prompt increased use, of G6PD genetic tests through a more complete clinical interpretation of G6PD variants.

Update in Asthma Management in Low-Middle Income Countries.

Asthma represents a significant global health burden, particularly in low and middle income countries (LMICs), where its impact is disproportionately severe. In these regions, asthma management is characterized by poorer control and greater mortality rates compared to wealthier nations. The prevalence of asthma is on the rise and demographic trends indicate that there would be a greater burden on children given that they represent a larger proportion of the population pyramid in LMICs. Challenges in addressing asthma in LMICs are various, amongst them: health care systems in these countries predominantly focus on acute and infectious diseases, leading to inadequate attention to chronic illnesses. Access to essential controller medications (inhaled corticosteroids) is often limited and availability tends to fluctuate. Infraestructural deficiencies and difficult health care access are also identified barriers. Furthermore, many LMICs struggle to meet the World Health Organization's (WHO) guidelines that are set for a minimum standard of care for asthma treatment. Suggested approaches should be aimed at: foment commitment from local health care providers and governmental involvement on policies to meet minimum standards of care (emphasis on continuous access to controller medications) Equally significant is the implementation of policies designed to augment educational strategies (health care professionals and general population), reduce smoking rates and air pollution.

Antibiotic use prior to attending a large diarrheal disease hospital among preschool children suffering from bloody or non-bloody diarrhea: A cross-sectional study conducted in Bangladesh.

Among diarrheal children, injudicious use of antibiotics is a major public health concern particularly in low- and middle-income countries. There are evidence-based guidelines by the World Health Organization (WHO) to prescribe antibiotics for bloody diarrhea in children. There is a scarcity of published data regarding the judicious use of antibiotics for bloody diarrhea in children. So, we aimed to evaluate the presenting features of bloody diarrhea at hospital with prior antibiotic use at home and the prevalence of injudicious antibiotic use for bloody diarrhea in children. We screened 7,289 children aged 24-59 months with diarrhea (≥3 loose stools in the last 24 h) at Dhaka Hospital, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), from December 5, 2021 to February 16, 2023. Antibiotic intake at home due to current diarrheal illness was evaluated and confirmed by direct observation of a prescription, the bottle of antibiotics, or asking the caregiver about the name of antibiotics. Out of 7,289 children presented with diarrhea, 3,823 (52.45%) children consumed antibiotics before visiting hospital. 254 (3.48%) children presented with bloody diarrhea, among which 162 ingested antibiotics. Among 162 children, 88 (54.32%) received inappropriate antibiotics due to bloody diarrhea, according to the WHO guidelines. The most prevalent single antibiotic consumed in bloody diarrhea was metronidazole (n = 45, 27.78%), followed by ciprofloxacin (n = 39, 24.07%) and azithromycin (n = 32, 19.75%). After adjusting for relevant covariates like age, sex, presence of straining/tenesmus, fever during admission, history of cough, stunting, wasting, and underweight; children suffering from bloody diarrhea had 1.55 times higher odds of using metronidazole alone or in combination with other antibiotics (aOR:1.55, 95% CI: 1.10-2.19, p-value = 0.012) and 1.93 times higher odds of using multiple antibiotics (aOR:1.93, 95% CI: 1.23-3.02, p-value = 0.004) compared to children with non-bloody diarrhea. The study underscores the excessive use of antimicrobials among children with diarrheal illnesses. It is also evident that metronidazole use and multiple antibiotic use are increasing among children due to bloody diarrhea, which is alarming and calls for antibiotic stewardship by regulating bodies in the country.

Projected health benefits of air pollution reductions in a Swedish population.

A large part of the Swedish population is exposed to higher levels of air pollution than the health-centered air quality guidelines recommended by the World Health Organization (WHO). The aim of the study was to illustrate the potential health benefits of cleaner air in Sweden by conducting a comprehensive health impact assessment, using a population sample of 100,000 individuals representing the country's demographics. Exposure-response functions for various health outcomes were derived from epidemiological literature, mainly from systematic reviews and low-exposure settings. Two hypothetical scenarios were studied: a 1 µg/m3 decrease in particulate matter with an aerodynamic diameter <2.5µm (PM2.5) and nitrogen dioxide (NO2), and a reduction in PM2.5 or NO2 from average exposure corresponding to Sweden's Clean Air objectives to WHO's air quality guidelines. The findings demonstrated that even a modest decrease in air pollution concentrations can yield significant health benefits. For example, reducing PM2.5 by 1 µg/m3 was projected to correspond to a 1% to 2% decrease in mortality, a 2% reduction in myocardial infarction cases, a 4% decrease in stroke incidence, a 2% decline in chronic obstructive pulmonary disease, and a 1% decreases in lung cancer and type 2 diabetes annually. Moreover, this reduction is estimated to lower childhood asthma cases, incidences of hypertension during pregnancy, and premature births by 3%, 3% and 2%, respectively, each year. The results highlighted that even minor enhancements in air quality would lead to substantial improvements in public health.

Features of particle-phase PAHs from traffic emissions using tunnel measurement and urban roadside observation in China

Vehicle emissions are recognized as a primary source of particle-phase polycyclic aromatic hydrocarbons (PAHs), significant contributors to the hazardous properties of PM2.5. This study investigates the profiles of PAHs through measurements conducted in a tunnel and an urban roadside environment in 2020. We quantified real-world vehicle emission factors for mixed fleets in the Zhongshu tunnel in Guizhou, southwest China, and found that the total PAHs had an emission factor of 8.15 μg veh-1km-1, with higher factors observed for high-ring PAHs. Additionally, we analyzed concentrations of 15 PAHs at a roadside environment in Hefei, southern China, with an average concentration of 23.81 ng/m3. PAHs with 4, 5, and 6 rings comprised 80% of total PAHs at the roadside and 87% in the tunnel. Gasoline emissions were the predominant source in both the tunnel and roadside environments, supplemented by non-tailpipe emissions, catering, domestic cooking, and asphalt from road surfaces. Notably, while the total toxicity equivalent concentration of Benzo[a]pyrene (BaP) significantly exceeded the World Health Organization (WHO) guidelines of 1 ng/m3, the presence of additional compounds such as Dibenzo[a,h]anthracene (DahA) markedly increased the toxicological impact of PM2.5 from vehicle emissions. Therefore, it is essential to implement targeted pollution control strategies in central urban areas that address not only the overall concentration of PAHs but also their specific toxic contributions Continuous monitoring and assessment of PAHs in the urban environment are indispensable for effectively reducing their health impacts.

Spatio-temporal variability and trends of air pollutants in the Metropolitan Area of Curitiba

Monitoring air pollutants over time is essential for identifying and addressing trends, which may help improve air quality management and safeguard public health. This study investigates the spatio-temporal variability of air quality in the Metropolitan Area of Curitiba (MAC), Brazil, focusing on six pollutants (SO2, NO2, NOx, O3, CO, and PM10) measured at eight monitoring stations from 2003 to 2017. We conducted statistical analyses, including diurnal cycles, seasonal variability, spatio-temporal correlations, conditional bivariate probability functions, Theil-Sen trend analysis, and comparison with national quality standards (NAQS) and World Health Organization (WHO) guidelines. The analyses revealed large variations in pollutant concentrations across the study area. For instance, stations strongly impacted by industrial emissions presented the highest mean annual SO2 (20–28 μg/m3) and PM10 (32–34 μg/m3) concentrations, while those mostly impacted by traffic showed elevated NO2 (31–39 μg/m3), NOx (63–86 μg/m3) and CO (0.6–0.8 mg/m3) concentrations. The two residential stations recorded the highest O3 concentrations (annual mean of 30–32 μg/m3). Seasonal and diurnal patterns varied by pollutant, with winter experiencing higher concentrations and O3 peaking in spring. SO2 concentrations presented no clear seasonal or diurnal cycle patterns, and showed the highest spatial variability. Significant decreasing annual trends were observed for SO2 (−5.9%), NO2 (−2.6%), NOx (−2.6%), CO (−5.4%), and PM10 (−3.7%), which suggests the success of emission reduction programs implemented in the road transportation and industrial sectors. However, O3 concentrations increased at most stations (+3.3%/yr), likely due to reduced NOx emissions, increased emissions of volatile organic compounds from on-road transport biofuels, and regional O3 transport. Although exceedances of NAQS decreased over time, concentrations of most pollutants remained above WHO guidelines, except for CO. These results highlight the importance of targeted emission control strategies for both industrial and vehicular sources to improve local air quality and inform future policy decisions.

A comparison of the diagnostic capability of Kato-Katz and real-time PCR for the assessment of treatment efficacy of ivermectin and albendazole combination against T. trichiura infections.

Trichuris trichiura is humans' second most prevalent soil-transmitted helminth (STH) infection after Ascaris lumbricoides, affecting approximately 4.6 million people worldwide. Despite its sub-optimal sensitivity, especially in low prevalence and infection intensity settings, the modified Kato-Katz (K-K) is still recommended as a diagnostic method by the World Health organization (WHO) guidelines. Within a randomized clinical trial (RCT) comprising four treatment arms with two different anthelmintics, the present study reports an important secondary research objective to determine the diagnostic agreement between K-K and real-time PCR evaluating treatment efficacy against T. trichiura. The parasitological results were analyzed, including cure rates (CR) of a subgroup of 94 participants positive at baseline for T. trichiura eggs for both techniques. The single-dose albendazole (ALB) arm resulted in significantly lower CRs than experimental arms of albendazole/ivermectin (ALB/IVM) combinations. The overall diagnostic agreement between both techniques was 88.7% [κ = 0.8 (P<0.001)]. Concordance between eggs per gram and Ct values was moderate, with the discordance source likely stemming from lighter infection intensities. These findings indicate that real-time PCR is a suitable alternative for CR estimation in helminthiasis clinical trials. It also highlights the need to identify the most accurate diagnostic tools for RCTs, that would benefit from guiding principles to achieve harmonization across studies and are not necessarily the same as those used for epidemiological surveys. Clinical Trials.gov (NCT04041453).

Assessing antimicrobial consumption in public and private sectors within the Costa Rican health system: current status and future directions

BackgroundAntimicrobial resistance is a significant global health threat. Therefore, robust surveillance systems for antimicrobial consumption (AMC) are essential to develop public health strategies. However, Latin American countries, including Costa Rica, face challenges in regularly reporting AMC data. This study aims to estimate and analyse the overall AMC in Costa Rica for 2019.MethodsThis study is a national-level, retrospective, observational, and descriptive analysis of AMC in Costa Rica from 1 January to 31 December 2019. The study followed the World Health Organization (WHO) guidelines for the Surveillance of National AMC. The Anatomical Therapeutic Chemical (ATC) / Defined Daily Doses (DDD) system was used to analyse types of antimicrobials and DDD per 1000 inhabitants per day (DID). Antimicrobial dispensation data from the Costa Rican Social Security Fund (CCSS) represented the public sector, while the private sector data was sourced from IQVIA. The analysis included data from both inpatient and outpatient sectors.ResultsA total AMC of 14.32 DID, of which 12.75 DID was within the public sector and 4.12 DID was within the private sector. Penicillins had the highest consumption nationally and in the public sector, while macrolides and lincosamides predominate in the private sector. According to the WHO-AWaRe (Access-Watch-Reserve) classification, antibiotics predominantly consumed nationally (74.7%) and in the public (83.0%) sectors are categorized under Access, whereas the private (61.0%) sector predominates the Watch category.ConclusionThis study illustrates the importance of enhancing AMC surveillance by integrating data from both the public and private sectors. The findings indicate an excessive use of “Watch” antimicrobials in the private sector. To address this issue, all sectors and regulatory authorities must play an active and supportive role, in the development of effective, multisectoral policies. The methodology employed in this study is applicable to other Latin American countries, and therefore should be utilized for future analysis AMC in this region.

Understanding the Global Distribution of Groundwater Sulfate and Assessing Population at Risk.

Besides sulfate-induced diarrhea, recent studies have emphasized that groundwater sulfate drives the release of arsenic in groundwater and accelerates water pipeline corrosion. Despite its impact on public health and urban infrastructure, sulfate has been overlooked in water supply research. Here, we used a random forest model to develop a 1 km global map depicting the probability of sulfate exceeding 250 mg/L in groundwater based on the World Health Organization's guidelines. The map was further applied to estimate the exposed population and identify contributors of sulfate exceedance in global hotspot regions. The results revealed that sulfate exceedance in groundwater was widespread in 156 countries. Approximately 194 million people use water with sulfate levels exceeding 250 mg/L. Among them, around 17 million people face groundwater sulfate concentrations surpassing 500 mg/L, with 82% of these individuals residing in ten specific countries. Contributing factor analysis in these countries indicates that annual precipitation and sedimentary rocks are the primary factors contributing to sulfate concentration prediction, while other natural and anthropogenic predictors exhibit region-specific impact patterns. This study uncovered a significant prevalence of elevated sulfate levels in groundwater, highlighting the need to integrate sulfate into water safety management practices.

Association between physical activity patterns of working-age adults and social jetlag, depressive symptoms, and presenteeism.

This study aimed to evaluate the association of physical activity with social jetlag, depressive symptoms, and presenteeism. This cross-sectional study included 8,247 working-age adults (females, 44.6%; age, 20-64 years). Social jetlag was defined as the absolute difference between the midpoint of bedtime and wake time on workdays and free days. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, and presenteeism was evaluated using the Work Functioning Impairment Scale. Exercise habits were classified into four groups based on the World Health Organization guidelines: non-active (NA; n=4,223), insufficiently active (IA; n=3,009: exercise below guideline levels), weekend warriors (WW; n=220: exercise 1-2 times per week meeting guideline levels), and regularly active (RA; n=793: exercise at least 3 days per week meeting guideline levels). Using multiple and Poisson regression analyses, we examined the association between exercise habits and each outcome. Social jetlag, depression, and presenteeism were more favorable with shorter sedentary times and longer durations of moderate- and vigorous-intensity exercise. Compared with the RA group, the NA group had a significantly higher prevalence of social jetlag (prevalence ratio [PR]=1.30), depression (PR=1.31), and presenteeism (PR=1.35). The IA group had a significantly higher prevalence of depression (PR=1.33) and presenteeism (PR=1.38). Exercising with a certain frequency and intensity may help prevent symptoms of depression and social jetlag, and consequently prevent presenteeism.

Comparing the economic burden of disease by physical activity levels among persons with and without disabilities in the Republic of Korea.

The World Health Organization recommends at least 150 min of physical activity per week for persons with and without disabilities. This study compared the differences in the economic burden of diseases between persons with and without disabilities based on their physical activity. What is known in the field is that physical activity is beneficial to health, but there is a disparity between persons without disabilities and persons with disabilities, and our research aims to increase physical activity among persons with disabilities. Economic burden of disease includes service costs such as outpatient, hospitalization, and pharmaceutical expenses for disease treatment, and persons with disabilities are those who have received a disability classification legally registered by the Korean Ministry of Health and Welfare, and there are 15 types of disabilities. For exercise records, we calculated the cost in 2020 for people with exercise records in 2018 so that they can have at least 1 year of exercise records, as health checkups are available from January to December of the year. Physical activity attainment is defined as 150 min or more of physical activity per week based on World Health Organization guidelines. Calculating the economic burden of disease by physical activity for persons with and without disabilities, both experienced a difference in hospitalization costs owing to fewer hospital days with physical activity achievement, with the difference being greater for persons with disabilities. Regarding disability type, achievers showed a 41.1% difference in total costs for mental class disorders, 16.7% for external bodily function disorders, and 11.1% for internal organ disorders. Physical inactivity has a significant impact on the economic burden of persons with disabilities compared to persons without disabilities, with 11.8% fewer persons without disabilities who were physically active for 150 min or more per week compared to 21.4% fewer persons with disabilities. In terms of healthcare spending, exercise can help keep persons with disabilities healthy. Therefore, there is a need for exercise programs tailored to persons with disabilities to increase physical activity in line with World Health Organization recommendations to reduce health inequalities between persons with and without disabilities.