Health Approach Research Articles

A One Health Approach to Reducing Livestock Disease Prevalence in Developing Countries: Advances, Challenges, and Prospects.

Challenges in livestock production in developing countries are often linked to a high disease prevalence and may be related to poor husbandry, feeding, and nutrition practices, as well as to inadequate access to preventive veterinary care. Structural barriers including chronic poverty, gender roles, inadequate supply chains, and limitations in surveillance infrastructure further complicate progress. Despite many challenges, the livestock sector substantially contributes to agricultural GDP, and reducing livestock disease prevalence is a goal for many countries. One Health initiatives that work across disciplines and sectors to reduce livestock diseases are underway around the world and use integrated approaches that consider the connections between humans, animals, and their shared environments. The growing recognition of the role livestock play in sustainability and livelihoods, as well as their involvement in zoonotic disease transmission and global health security, has highlighted the need for disease reduction strategies as described in this review.

The burden of gastrointestinal cancers in north east India with special reference to Helicobacter pylori infection

Gastrointestinal (GI) cancers, particularly gastric and esophageal cancers, are a significant health burden in North East (NE) India, with incidence rates substantially higher than the national average. This region is marked by high prevalence of () infection, a major risk factor for gastric cancer. Additionally, dietary habits, such as the consumption of smoked and fermented foods, widespread use of betel nut and tobacco, and excessive alcohol intake, contribute to the elevated cancer risk. This narrative review examines the burden of GI cancers in NE India, focusing on the role of in gastric carcinogenesis. The bacterium induces chronic inflammation that can progress to gastric adenocarcinoma, compounded by genetic predisposition in the region's population. Despite advances in diagnostic methods, healthcare infrastructure limitations and late-stage diagnoses hinder early detection. Preventive strategies, including eradication, public awareness campaigns, dietary modifications, and tobacco control, are essential to curb the rising cancer rates. Strengthening healthcare systems and promoting research are crucial for effective cancer control in this high-risk region.This review highlights the urgent need for a comprehensive public health approach to mitigate the growing burden of GI cancers in NE India.

Child Fatalities Resulting From Caregiver Behavior: A Public Health Approach to Child Maltreatment Classification.

Limited research describes approaches for applying a public health lens to fatal child maltreatment classification. Specialized terminology and tools could help improve consistency in classifying deaths resulting from caregiver behavior. A six-criterion classification tool was developed via expert panel review of over 100 child deaths by the Alaska Division of Public Health's Child Death Review (CDR) program. Next, accuracy and acceptability were assessed by inviting staff from other CDRs using a national listserv to classify 21 brief case scenarios with the tool. Among the 47 respondents, sensitivity was 0.87, specificity 0.77, and accuracy 0.84. Variability by tool criterion ranged from 97% to 74% accurate. Most respondents (66%) reported the tool as being helpful for classifying deaths and moderate reliability was found. Study participants found it difficult to consistently apply specific criteria which resulted in a modification of the tool to improve the potential for universal adoption.

Multilocus sequence typing of clinical Burkholderia pseudomallei isolates from Cambodia.

Melioidosis is a neglected tropical disease caused by Burkholderia pseudomallei, endemic to Southeast Asia and Northern Australia. Despite its increasing global public health and clinical significance, the molecular epidemiology of melioidosis and genetic diversity of B. pseudomallei in Cambodia remains poorly understood. This study aims to elucidate the genetic diversity and antibiotic susceptibility profiles of B. pseudomallei isolates responsible for melioidosis in humans. For this purpose, 14 clinical isolates cryopreserved at the Medical Biology Laboratory at Institut Pasteur du Cambodge from 2016 to 2020 were subjected to antimicrobial susceptibility testing and Multilocus Sequence Typing (MLST). Phenotypic testing revealed that 92.86% (13/14) of the isolates were sensitive to all tested antibiotics, while one isolate exhibited resistance to trimethoprim-sulfamethoxazole. MLST analysis resolved our isolates into 14 unique Sequence Types (STs), including 10 previously documented in Southeast Asia. Notably, ST1858, ST2064, ST2065, and ST2066 were identified as novel STs, while ST54, ST99, ST211, and ST1359 were reported in Cambodia for the first time in this study. Comparing our MLST data with available sequences on PubMLST (n = 165), our study unveiled a high genetic diversity of B. pseudomallei in Cambodia. The identified STs were closely associated with isolates from other Southeast Asian countries, particularly Thailand, Vietnam, and Malaysia. In conclusion, this study provided insight into the genetic diversity among B. pseudomallei clinical isolates in Cambodia and their close genetic association with Southeast Asian isolates. To further our understanding, a One Health approach, incorporating human, environmental (mainly soil), and animal compartments, is essential to decipher the epidemiology of B. pseudomallei in Cambodia.

DYnamics of Contraception in Eswatini (DYCE): protocol for a high-frequency, longitudinal cell phone survey

IntroductionBy 2030, an estimated 42% of the world’s adolescent girls and young women (AGYW) will live in sub-Saharan Africa (SSA), where a quarter of AGYW pregnancies are undesired and AGYW...

Distribution and Implications of Mycobacterium Tuberculosis Genotypes in Animals: A Comprehensive Review

This narrative review discusses the spread of Mycobacterium tuberculosis among animal populations, focusing on M. tuberculosis genotype distribution and frequency across different species. To develop comprehensive tuberculosis control strategies under the One Health approach, it is important to have an understanding of the genotypes of M. tuberculosis in animals. Animal infections are discussed, as well as the pathogenesis and epidemiology of M. tuberculosis. Various genotyping methods, including spoligotyping, MIRU-VNTR, and whole genome sequencing, are discussed in the review, emphasizing their role in understanding strain diversity and transmission dynamics. There are many factors influencing the distribution of M. tuberculosis genotypes in animals, including environmental conditions, host factors, human-animal interactions, and animal trade practices. It is clear from the review that the Euro-American lineage is widely distributed across animal species, with the Beijing genotype becoming increasingly prevalent in regions where it is prevalent in humans. The study highlights the need for more comprehensive genotyping studies as well as the development of better diagnostic tools. This will enhance our understanding of M. tuberculosis in animal populations. A conclusion to the review, emphasizes that standardizing genotyping protocols, utilizing whole genome sequencing, and fostering international collaboration are essential for improving our understanding of M. tuberculosis diversity in animals and developing targeted tuberculosis control strategies. The impact of Mycobacterium tuberculosis genotypes in animals is multi-faceted, affecting both public health and veterinary practices. Addressing these challenges requires a coordinated and comprehensive approach that considers the interconnectedness of human and animal health systems, fosters research, enhances surveillance, and implements effective control strategies.

Should the current radiation protection paradigm and its recommendations be modified to make them more fit to protect the public in future nuclear emergencies?

The present radiation protection paradigm and its associated recommendations as developed by bodies such as the ICRP have performed very well over past decades both for those occupationally exposed to radiation and for the public in planned exposures. There is, however, growing evidence that the role played by this paradigm in the decision-making process to protect the public in nuclear emergencies in the past may have, unwittingly and unintentionally, caused more harm than good to some sections of the public. This seems to have been the case in the use of population evacuation as the principal protection response to the Chernobyl (1986) and Fukushima (2011) accidents. There is thus a need to develop improved guidelines or tools on how to apply radiation protection recommendations for the public compatible with the Principle of Justification in the event of any future major radiation emergencies. It can also be argued that the present radiation protection paradigm, with its emphasis primarily on the physical health detriments from radiation, should be more inclusive and needs to shift to a more holistic or total health approach than heretofore to include mental health effects associated with nuclear emergencies. For severe mental health effects, some of the consequences, such as suicide, can even be as or more severe than most physical detriments likely to be suffered by those affected.

Climate Change and Veterinary Medicine: A Call to Action for a Healthier Planet

Abstract Climate change is rapidly transforming ecosystems and reshaping the landscapes of animal health, with profound consequences for public health, food security, and biodiversity. Rising temperatures, shifting weather patterns, and increased frequency of natural disasters are driving the emergence and spread of infectious diseases, particularly zoonotic and vector-borne diseases. These environmental shifts endanger the health and welfare of animals and the delicate balance between human populations, livestock, and wildlife. As the stewards of animal health, veterinarians are uniquely positioned to lead the change in addressing these complex challenges at the nexus of human, animal, and environmental health and well-being. This article calls for urgent actions to integrate climate adaptation and mitigation strategies into veterinary practice and education. It underscores the critical need for veterinarians to embrace the One Health approach to tackle climate-driven disease outbreaks and the growing threat of antimicrobial resistance to safeguard human and animal populations while protecting natural ecosystems. The article further explores the role of veterinarians in fostering sustainable agricultural practices, reducing the environmental impact of livestock production, conserving biodiversity and advocating for policy reforms that protect both animal and planetary health. As we face an era of unprecedented climate disruption, this call to action aims to inspire the global veterinary community to actively get involved in combating climate change and its worst impacts. By building climate-resilient practices, enhancing disease surveillance, and championing environmental stewardship, veterinarians can contribute significantly to a healthier, more sustainable future for all species on Earth.

Psychological and social factors associated with mental health of European dual career athletes: A systematic review.

Dual careers (DCs) are challenging trajectories followed by athletes willing to develop their academic/professional career with their athletic careers. These trajectories usually entail additional stressors, which can decrease athletes' mental health or even increase their risk of mental ill-health. While existing research has recognized the importance of psychological and social factors in both of these areas separately, we lack systematic knowledge on which factors are associated with European DC athlete mental health outcomes, making evidence-based practice more challenging. In this regard, to advance the European DC tradition and to provide a strong base for researchers and practitioners working within this field, this systematic review aims to appraise this evidence identifying and categorizing the psychological and social factors associated with the European DC athletes' mental health. We conducted this review according to Preferred Reporting for Systematic Reviews and Meta-Analysis guidelines and performed the systematic search in six databases, finding 56 eligible articles. Our analysis identified 35 different psychological and social factors, most showing significant associations with athletes' mental health. Notably, affect, stress, motivational climate, mindfulness, resilience, perfectionism, goal orientation, motivation, and basic psychological need satisfaction showed the strongest evidence associated with mental health. Overall, this review provides a comprehensive synthesis of psychological and social factors, advancing the holistic ecological approach in dual careers and athlete mental health. Yet, our results highlight the need to strengthen the evidence regarding these factors and provide specific research avenues, such as focus on DC-specific factors and consideration of DC athlete definition and career trajectories.

Developing a Statewide Strategic Plan for Prevention, Early Identification, and Treatment of Psychosis.

Access to evidence-based programs that address early psychosis is a substantial public health concern. The authors describe the community-engaged, data-driven process that informed the development of the Massachusetts Strategic Plan for Early Psychosis, an effort to identify actionable priorities to build a system of prevention and care that responds to the needs of individuals who experience psychosis and their caregivers. A multiphase, mixed-methods approach was used to gather knowledge from young adults experiencing early psychosis and their caregivers, including two symposia with diverse stakeholders. Six overarching goals were identified, each with possible action steps and stigma reduction strategies: connecting and supporting individuals who experience psychosis and their families, promoting early identification of and intervention for psychosis through community education, providing specialized support to key community members, providing specialized support to medical and behavioral health care professionals, supporting specialized treatment teams in the delivery of evidence-based care, and developing a statewide system of psychosis services. Next steps for and operationalization of the statewide strategic plan for psychosis in Massachusetts will require a population health approach that engages the community through intersectoral and multisectoral strategies.

Factors associated with loneliness in Latin-American family care partners during the COVID-19 pandemic.

COVID-19-related restrictions led to an increase in overall loneliness and social isolation. Before the pandemic, care partners reported higher levels of loneliness and higher loneliness prevalence compared to non-care partners. Because of the spread and severity of the infections, and the access to support spread, we expect a different impact of the COVID-19 pandemic on LATAM care partners. To describe the loneliness levels of LATAM caregivers and to identify socioeconomic and health factors associated. An international online cross-sectional survey for care partners, embedded within the 'Coping with Loneliness and Isolation during COVID-19' (CLIC) Study conducted between June 2020- and November 2020. We analysed data from 246 family care partners living in Latin American countries (46% Mexico, 26% Chile,18% Brazil, and 10% from Argentina, Peru, Venezuela, Panama, Guatemala y Costa Rica). We assessed loneliness using the 6-items of De Jong Gierveld loneliness Scale. We described the levels of overall, emotional, and social loneliness pre and during Covid, and reported the distribution of care partners who improved, worsened or maintained their levels of loneliness. Moreover, we used longitudinal multiple linear regression models with bootstraps errors of 1,000 iterations to identify factors associated with the levels of overall, emotional, and social loneliness during the pandemic. Participants were mostly women, 50 years and older, in a partnership, highly educated and with finances meeting their needs, with good to excellent physical and mental health. Among the total of care partners, 55% perceived higher overall loneliness, 56% higher emotional loneliness, and 21% higher social loneliness during the pandemic in comparison with pre-COVID-19 levels. Perceived mental health was associated with the overall, emotional, and social loneliness. Regardless of their living and health situation, during the pandemic, loneliness increased in all groups of care partners. These should be taken in consideration when planning public health approaches for crises such as pandemics or other large-scale disruptive events.

Prevalence and correlates of severe problematic cannabis use: analysis of a population-based survey in Jamaica.

There is an increasing demand for the treatment of problematic cannabis use (PCU) in low-income and middle-income countries. Jamaica's historical inclination towards cannabis use underscores the need for research in addressing this issue. To determine the prevalence and patterns of cannabis use and assess the sociodemographic factors, psychosocial correlates, knowledge and perceptions associated with severe PCU among Jamaicans using nationally representative data. This study involved a secondary data analysis of the last Jamaica National Drug Prevalence Survey. It included 786 participants who used cannabis in the past year and completed the Cannabis Abuse Screening Test (CAST). The CAST has been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM), with a score ≥ 7 meeting the criteria for severe PCU. CAST scores were dichotomized utilizing these thresholds, and data generated were analyzed with SPSS version 25 using Pearson's χ2 test and logistic regression. In the past year, 53.3% of Jamaicans who smoked cannabis had a score of 7 or higher on the CAST and smoked an average of 62.21 joints per month. Male respondents were twice as likely to have severe PCU as females. Additionally, young, middle, and older adults were respectively 3, 5 and 3 times more likely to report severe PCU compared to adolescent respondents. Participants who started cannabis use at 11 years and under, 12-17 years, and 18-25 years were respectively 5, 7 and 7 times more likely to report severe PCU than those at 26 years and older. Moreover, easy access to cannabis, a high perceived need for treatment, belief in increased national drug use prevalence, and awareness of the National Drug Control and Prevention Agency were associated with increased odds of reporting severe PCU. One out of every two Jamaicans who used cannabis in the past year reported severe PCU and smoked an average of two cannabis joints per day. Early initiation increases the risk of severe PCU. Accordingly, a public health approach involving multiple sectors is needed to provide treatment options.

Lassa fever in Nigeria: epidemiology and risk perception

Annual outbreaks of Lassa fever have resulted in a public health threat in Nigeria and other endemic countries in Sub-Saharan Africa. While the Lassa Virus (LASV) is endemic in rodent populations, zoonotic spillover to humans causes annual outbreaks. This study reviewed the burden of Lassa fever (LF) in Nigeria between 2020 and 2023 and conducted a cross-sectional survey of Nigerians to evaluate their risk perceptions of LF. During the period under review, 28,780 suspected and 4,036 confirmed cases of LF were reported from 34 of the 37 states of Nigeria. These cases resulted in 762 deaths (a CFR of 18.9%). The overall case positivity rate was 14% (4,036/28,780), with more positive cases in 2020 (17.5%, n = 1,189/6,791). A total of 2,150 study participants were enrolled in the prospective cross-sectional study, with most of them (87.5%, n = 1,881/2,150) having previously heard of Lassa fever (LF). The numerical scoring system revealed that 35.43% (n = 762/1,881) of those aware of LF have poor knowledge of its preventive measures, route of transmission, and control measures. Approximately 6.84% (n = 147/2,150) of them were at a high risk of contracting LF, with 27.6% (n = 584/2,150) of study participants feeling concerned about contracting LF because of the presence of rodents in their immediate vicinity, occupational exposure to healthcare workers, and the probability of contamination of food by infected rodents without necessary food safety measures. Multivariable logistic regression analysis revealed that tertiary education was associated with an increased likelihood of better LF knowledge (OR: 17.32; 95% CI: 10.62, 28.26; p < 0.01) and a lower risk of contracting LF when compared to respondents with no formal education. In addition, study participants who reside in low-burden states have lower LF perception than those residents in high-LF-burden states (OR: 0.59; 95% CI: 0.38–0.91; p = 0.049). On the other hand, study participants with poor risk perception (knowledge) of LF had a higher likelihood (RR: 0.33; 95% CI: 0.20, 0.53; p < 0.01) of contracting LF when compared to those with good knowledge of LF. Similarly, those residents in low LF burden states were less likely (OR: 0.09; 95% CI: 0.05,0.17; p < 0.01) to contract LF when compared to those residents in high burden states. There is a need to improve LF diagnostics capacity, infection prevention and control measures, and implementation of the One Health approach to controlling LASV from animal reservoirs. In addition, public enlightenment campaigns to address fundamental knowledge gaps are crucial to mitigating the ongoing and future impact of LF in Nigeria.

Effectiveness of Public Messaging Within the Gambling Domain: A Systematic Review

AbstractGambling messaging is one potential component of a public health approach towards reducing gambling-related harm (GRH). This systematic review examined the effectiveness of existing public health gambling messaging interventions. Four databases were searched from inception to June 2023. Twenty-one papers met inclusion criteria. Studies were conducted in diverse settings, employed various designs, and evaluated messaging interventions that differed in their aims and reported outcomes. Interventions were categorised into three groups: general population-level messaging, gambling harm reduction messages, and product risk warnings. The evidence—currently limited—suggests that existing gambling messaging interventions are ineffective in changing behaviours but can raise awareness of GRH. Our findings underpinned recommendations for how the format and presentation of currently used ‘safer’ gambling messages and product warning labels may be improved. Research is required to develop and test messages that can help prevent and reduce GRH both for the general population and people who gamble.

Environmental health and human health-unifying strategies, conceptual framework and green prescriptions: a review

The intricate relationship between environmental conditions and human health is increasingly acknowledged as a critical area of public health research. As global challenges such as climate change, urbanization, and biodiversity loss become more pronounced, understanding the connections between these environmental factors and health outcomes is essential for developing effective public health strategies. This analysis delves into the complex interactions that exist between environmental influences and health, emphasizing the urgent need for integrated approaches that simultaneously promote ecological sustainability and enhance community well-being. Environmental degradation has significant implications for human health, with many deaths linked to preventable environmental health risks. These risks encompass a wide range of issues, including air and water pollution, exposure to hazardous substances, and the impacts of climate change, all of which disproportionately affect vulnerable populations. A conceptual framework is proposed to elucidate the multifaceted connections between environmental exposures, health determinants, and health outcomes, enabling a clearer understanding of how these elements interrelate. Cohesive strategies, such as the one health approach, advocate for collaboration across various sectors, including public health, veterinary health, and environmental management, to address the shared challenges of health and environmental degradation. Additionally, the principles of planetary health highlight the interdependence of ecosystems and human well-being, underscoring the need for sustainable management of natural resources to safeguard health outcomes. This article also explores the concept of "green prescriptions," which involve recommending nature-based interventions to enhance physical, mental, and social well-being. These prescriptions have demonstrated effectiveness in promoting health while fostering a sense of environmental stewardship. By synthesizing current evidence and successful case studies, this review emphasizes the significance of adopting a holistic perspective that integrates environmental considerations into healthcare practices. Ultimately, fostering collaboration among various stakeholders will contribute to the development of resilient communities that are better equipped to navigate the intertwined challenges of health and environmental sustainability.

Public, Private and Public-Private Partnerships (PPP) to Implement a One Health Approach to Combat Antimicrobial Resistance in Colombia

Abstract The establishment of public-private partnerships (PPPs) within Colombia, Latin America, is a recent, innovative effort within the nation’s agricultural industry to tackle antimicrobial resistance (AMR) under a One Health approach. PPPs are a formal alliance between representatives from the public and private sectors that aim to promote cross-sectoral collaboration, stewardship and accountability. Members agree on shared objectives and responsibilities, resources and risks to establish monitoring, prevention and mitigation activities against AMR within the farming industry. Key learnings of this initiative within the context of Colombia include: maximisation of results when monitoring is assigned to the private sector, and this may apply to other lower-middle-income countries (LMICs); objectives are better achieved when they are pre-defined according to time, budget and human resource constraints of member institutions; and confidentiality agreements must be consistent with the sensitive nature of surveillance information. Barriers to implementation were also identified, such as frequent changes of government personnel at decision making levels that make governance planning and adaptation challenging, while legal formalities and bureaucracy hinder formalisation of agreements. The success of this PPP is a useful example for other LMICs to aid in the control and prevention of animal diseases, promotion of food safety and reduction in poor animal health which limit commerce, while at the same time, minimising production loss and ensuring the provision of a fair income for producers. Information © The Authors 2024

Extended-Spectrum Beta-Lactamase-Producing and Multidrug-Resistant Escherichia coli and Klebsiella spp. from the Human–Animal–Environment Interface on Cattle Farms in Burkina Faso

Extended-spectrum beta-lactamase (ESBL)-producing and multidrug-resistant Enterobacterales pose a major threat to both human and animal health. This study assessed the prevalence of ESBL-producing Escherichia coli (ESBL-Ec) and Klebsiella spp. (ESBL-K) on cattle farms in Ouagadougou, Burkina Faso, using a One Health approach. From May 2021 to September 2022, cattle faeces, farmers’ stools, their drinking water and farm soil samples were collected from semi-intensive and traditional farms. An ESBL-selective medium was used to obtain resistant isolates, which were further characterised using biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. ESBL-Ec and/or ESBL-K were detected in 188 of 322 samples (58.0%). The prevalence of ESBL-Ec isolates was 42.2% (136/322) and that of ESBL-K isolates was 24.5% (79/322). Notably, 156 of the 188 ESBL isolates (83.0%) exhibited multidrug resistance. The highest resistance rates were observed against tetracycline and cotrimoxazole. Importantly, no isolates showed resistance to meropenem, which was used to test for carbapenem resistance. This study highlights the presence of ESBL-Ec and ESBL-K among the humans, animals and environment of the cattle farms. Good hygiene and biosafety practices are essential to limit the potential spread of multidrug-resistant bacteria between different interfaces on farms.

Oral Health and Systemic Disease: A Systematic Review of the Impact of Dental Care on Overall Health

Oral health is increasingly recognized as a critical component of overall health, with research highlighting its potential impact on various systemic diseases. This systematic review examines the current evidence on the association between oral health, particularly dental care, and systemic conditions such as cardiovascular disease, diabetes, respiratory illnesses, and adverse pregnancy outcomes. A comprehensive literature search was conducted across multiple databases, focusing on studies published from 2016 onward. Studies indicate that periodontal disease and other oral health issues may contribute to systemic inflammation, a common factor in many chronic conditions. Specifically, findings suggest that managing oral health can have beneficial effects on cardiovascular health, glycemic control in diabetic patients, and respiratory function, as well as reduce risks for adverse pregnancy outcomes. However, while associations are evident, causality remains difficult to establish, and further longitudinal research is needed to clarify these relationships. This review underscores the importance of incorporating dental care into holistic health approaches, advocating for greater collaboration between dental and medical professionals. Public health initiatives promoting regular dental check-ups and preventive care may play a crucial role in improving overall health outcomes.

Zambia's battle against cholera outbreaks and the path to public health resilience: a narrative review

ABSTRACT In Zambia, cholera has been a persistent public health concern for decades, mainly attributed to inadequate sanitation and restricted access to clean water in some parts of the country. The literature was collected from PubMed, Google Scholar, and public health organization websites, focusing on cholera outbreaks in Zambia since 2000. Key search terms included ‘cholera prevention’ and ‘Zambia outbreaks.’ A total of 30 articles were analyzed to assess public health strategies and identify gaps for future planning. Periodic outbreaks of cholera have characterized Zambia's history by significant fluctuations in case numbers and fatalities since 1977. Notably, the years 1993, 1999, 2003/2004, 2005/2006, 2010, 2017/2018, and the most recent outbreak from October 2023 to February 2024 have marked significant episodes in the country's struggle against this waterborne disease. This narrative review examines the recurrent outbreaks of cholera in Zambia to understand the recent outbreak's extraordinary spread and severity in the context of public health resilience. The most recent outbreak with staggering 19,719 cases and 682 deaths, underscores the unprecedented scale and severity of the current public health emergency. The findings highlight the need for a holistic public health approach that prioritizes resilience in disease prevention.

Modelling the impacts generated by reclaimed wastewater reuse in agriculture: From literature gaps to an integrated risk assessment in a One Health perspective

The reuse of reclaimed wastewater is increasingly recognized as a viable alternative water source for irrigation. Its application, whether direct or indirect, impacts several interconnected compartments, including groundwater, surface water, soil, crops, and humans. Reclaimed wastewater provides essential resources for crops, like water and nutrients. However, it also introduces pathogens, and contaminants of emerging concern (CECs), defined as chemicals that may pose risks to human health and ecosystems but are not yet fully regulated, such as pharmaceuticals and personal care products, among others. Additionally, reclaimed wastewater may contain antibiotic-resistant bacteria (ARBs) and disinfection by-products (DBPs), all of which present potential health and environmental risks. Therefore, regulatory bodies stress the need for preventive risk assessments to ensure safe reuse.This paper critically reviews available models for assessing the impacts of reclaimed wastewater reuse in agriculture. It identifies gaps in current modelling approaches and outlines future research directions. Key areas requiring further investigation include the fate and transfer of CECs, ARBs and DBPs, and the co-occurrence of multiple risks in such interconnected systems, especially in the indirect reuse. To address these gaps, we proposed a simplified approach to integrate three types of risk associated with CECs in indirect reuse, focusing on risks posed by antibiotics and other pharmaceuticals: human health risk, environmental risk and risk from antibiotic resistance development. This approach aids in identifying the most critical endpoints within the One Health approach, supporting (i) CECs prioritization in regulations based on their critical endpoints and (ii) the adoption of CEC-specific mitigation measures.