Health Approach Research Articles

When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease

Abstract Background With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT. Methods A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included. Results 105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity. Conclusions Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view. Key messages • Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity. • The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.

Backyard flock sampling and artificial intelligence: A dual strategy for early detection of Avian Influenza and Newcastle Disease

Avian Influenza (AI) and Newcastle Disease (ND) are significant avian diseases that pose substantial threats to the commercial poultry industry due to their high contagion rates and potential for severe outcomes. Recent shifts in the epidemiology and ecology of both viruses have led to devastating impacts on wild bird and poultry populations, as well as farms and communities worldwide. These challenges underscore the necessity for One Health approaches to pandemic prevention and preparedness, emphasizing the need for multisectoral collaboration among animal, environmental, and public health sectors. To mitigate future pandemic risks, it is essential to control the transmission of AI and ND viruses among domestic and wild animals as well as humans. This involves addressing the upstream drivers of outbreaks, ensuring rapid response mechanisms, and conducting thorough risk assessments for zoonotic diseases. Effective implementation and maintenance of prevention programs, surveillance, and outbreak responses require strong political commitment and sustainable funding. A robust combination of active and passive surveillance strategies should be applied to monitor and control them. In addition, the integration of modern technologies, such as artificial intelligence and big data analytics, can enhance both active and passive surveillance efforts by improving the accuracy and speed of data collection, analysis, and reporting. The use of backyard flocks as an early warning system for avian diseases represents a proactive approach to understanding and managing the risks associated with AI and ND through targeted surveillance and timely interventions. In response to these challenges, the EpirORNIS Project aimed to leverage these sentinel backyard flocks for early detection of AI and ND, thereby enhancing surveillance and control strategies.

Pathology-Based Animal Cancer Registry of Abruzzo and Molise Regions (Central Italy): A Ten-Year Retrospective Study (2014-2023).

Pets have a crucial role in cancer research. Specifically, dogs and cats share the same environment as their owners and thus may serve as sentinels of naturally occurring tumors that are linked to the exposure to environmental hazards. Quantitative comparison of tumor types may reveal unusual cancer frequencies, providing directions for research and generation of hypotheses of cancer causation in a specific area and identification of risk factors. The aim of this study was to describe the data collected by the pathology-based animal cancer registry, managed by Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise (IZSAM), during 10 years of activity (2014-2023) and to assess its potential epidemiological relevance. Frequencies of tumor topography and morphology in dogs and cats were described, analyzed and compared. Proportional morbidity ratios (PMRs) were calculated, taking into consideration some potential risk factors such as species, breed, sex, diet and living environment. The database comprises 5311 tumors (n = 4719 in dogs and n = 592 in cats), with a higher prevalence in females (67.3% in dogs and 61.2% in cats). The mean age at the first diagnosis of tumors was similar between sexes and slightly lower in dogs compared to cats. PMRs highlighted certain risk and "protective" factors for the development of tumors in specific topography. The risk of developing tumors of the blood and hematopoietic system (PMR = 0.44; 95% CI: 0.21-0.94), skin and subcutaneous tissues (PMR = 0.70; 95% CI: 0.61-0.80), oral cavity and pharynx (PMR = 0.60; 95% CI: 0.24-0.89), urinary organs (PMR = 0.33; 95% CI: 0.11-0.99) and bones, joints and cartilage (PMR = 0.72; 95% CI: 0.22-0.98) was lower in non-neutered male dogs than in neutered male dogs. Non-spayed female dogs had a greater risk of developing tumors of the mammary gland (PMR = 1.75; 95% CI: 1.57-1.96), female sexual organs (PMR = 2.12; 95% CI: 1.01-4.36) and respiratory system (PMR = 2.25; 95% CI: 1.55-6.74) but less risk for cutaneous and subcutaneous tissue tumors (PMR = 0.44; 95% CI: 0.38-0.51) and blood/hematopoietic system tumors (PMR = 0.47; 95% CI: 0.26-0.85) compared to spayed female dogs. Compared with mixed breed, purebred dogs had a significantly greater risk of developing mammary gland tumors (PMR = 1.36; 95% CI: 1.20-1.54) and lower risk for respiratory (PMR = 0.15; 95% CI: 0.07-0.32), gastrointestinal (PMR = 0.63; 95% CI: 0.34-0.94) and oral (PMR = 0.59; 95% CI: 0.36-0.96) neoplasia. Non-neutered male cats had a lower risk of developing skin and subcutaneous tumors (PMR = 0.68; 95% CI: 0.50-0.92) compared with neutered cats. The risk of developing skin and subcutaneous tissues tumors was higher for dogs and cats that lived mostly outdoor (PMR dogs = 1.21; 95% CI: 1.10-1.33; PMR cats = 1.18; 95% CI: 1.08-1.47), while dogs that live mainly indoor had a greater risk to develop mammary gland tumors (PMR = 0.78; 95% CI: 0.68-0.89). Results described herein highlight the fundamental role of animal cancer registration initiatives. These efforts would contribute to the possibility of conducting multicentric collaborative studies to deepen the knowledge of the epidemiology of tumors in dogs and cats from a comparative perspective, thus fulfilling the One Health approach.

Overcoming Challenges in Interdisciplinary Collaboration Between Human and Veterinary Medicine.

Companion animals, such as dogs and cats, have gained considerable attention in translational medicine due to their potential as models for human diseases. The use of these animals in research has opened new avenues for developing treatments that can benefit both human and veterinary patients, aligning with the One Health approach. Unlike traditional laboratory models like mice, rats, and rabbits, companion animals naturally develop diseases that closely mirror those in humans, including but not limited to diabetes, aging, cancer, and neurological disorders, making them particularly valuable in translational research. Recent advances have highlighted the role of companion animals in enhancing the effectiveness of novel therapies during clinical trials, as they are exposed to diverse environmental and lifestyle factors similar to those experienced by humans. However, the integration of companion animals into translational medicine presents challenges, particularly in terms of collaboration between veterinary and human medicine, where terminology differences in anatomy, clinical terminology, and animal classification can lead to miscommunication. In conclusion, these findings underscore the need for better implementation of the One Health approach by uniting the fragmented collaboration between veterinarians and doctors through interdisciplinary training and fostering unified efforts across both fields, with experts from various disciplines contributing their specialized knowledge in clinical practice and research.

Planetary Health in Nursing: A Scoping Review.

To map the extent of the use of the term 'planetary health' in peer-reviewed nursing literature. Scoping Review. CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses and Web of Science were searched in January and February 2024 for English and French-language publications. A follow-up search was conducted on 10 June 2024 to determine if additional literature was published. A scoping review was conducted using the Arksey and O'Malley methodology for scoping reviews. To be included the article had to explicitly use the term 'planetary health' and 'nursing' or 'nurses'. Sixty-eight articles met the criteria for the scoping review and were included in this review, with the majority published between 2017 and 2024. Predominant literature included discussion papers, commentaries and editorials. A lack of original research is apparent. Most of the publications were calls to action for nurses to advance planetary health in nursing education, practice, research and advocacy work. Literature confirms that planetary health is a recent and an important topic in nursing, and nurses have a well-documented role to play in planetary health, given the numerous calls to action in nursing leadership, education, practice and research. There is a need to publish the essential work nurses are doing in planetary health in various nursing domains. This scoping review revealed a clear and urgent call to action for nurses to address planetary health. Given this finding, nurses have a responsibility to advocate for a planetary health approach in the profession and take action to contribute to planetary health through education, research, practice and advocacy. Not applicable, as no patients or public were involved.

Cross-environmental cycling of antimicrobial resistance in agricultural areas fertilized with poultry litter: A one health approach

Poultry litter, commonly used as an organic fertilizer, can contain antimicrobial residues, resistant bacteria, and/or antimicrobial resistance genes. After application to soil, these contaminants can reach crops and be transported to aquatic systems through leaching and runoff. Once in water bodies, they can return to soil and crops through irrigation, establishing a cycle that promotes the selection, spread and persistence of antimicrobial resistance. To investigate the hypothesis of a cyclical event, samples of poultry litter, cultivable soil fertilized with this organic residue, rhizosphere soil from Sechium edule (chayote), water, and sediments from irrigation ponds were collected across two agricultural and poultry-producing areas during the dry and rainy seasons. Clinically significant bacteria, especially bacteria belonging to the Enterobacteriaceae family, were isolated. Fifty-three strains exhibited one or more antimicrobial resistance genes, as detected by PCR amplification, including those conferring resistance to sulfonamides (sul1 and sul2), fluoroquinolones (qnrB, qnrA, and qnrS), and β-lactams (blaGES, blaTEM, blaSHV, blaCTX-M-1/2,blaCTX-M-8, and blaCTX-M-14). Genes encoding integrases related to class-1 and 2 integrons (intI1 and intI2) were also observed. A rare occurrence of the blaGES gene was observed in Stenotrophomonas sp. and Brevundimonas sp. Strains of Escherichia sp. were multidrug resistant. Sequencing of the 16S rRNA encoding gene indicated unique operational taxonomic units (OTUs) originating from poultry litter and found in the soil, rhizosphere, water, and sediment, highlighting the dissemination of this material across agricultural substrates. These findings strongly suggest the spread of antimicrobial-resistant bacteria in agricultural environments, posing potential risks to both human and animal health.

Exploring diseases burden in HIV population: Results from the CHAO (Comorbidities in HIV/AIDS outpatients) cross-sectional study in Kenya

BackgroundAfrica is the epicenter of the HIV epidemic, with over two-thirds of the global population living with HIV. It is also facing a dramatic increase in non-communicable diseases (NCDs) amidst its aging population. This necessitates a healthcare approach that addresses both infectious diseases and NCDs in HIV-positive individuals. In Kenya, with 1.4 million HIV-positive people, efforts include widespread ART access and integrating HIV services into the health system. Challenges remain in healthcare infrastructure, particularly in rural areas. The Comorbidities in HIV/AIDS Outpatients (CHAO) Project, funded by the Italian Cooperation Agency, aims to improve understanding and management of comorbidities in HIV patients, highlighting the need for cost-effective healthcare strategies to address this dual burden. MethodsThe CHAO (Comorbidities in HIV/AIDS Outpatients) project conducted a cross-sectional epidemiological study across 25 clinics in Meru County, Kenya. The study included comprehensive surveys and screenings for various comorbidities among HIV-positive patients receiving treatment, utilizing both clinical evaluations and laboratory tests to assess the prevalence of infectious diseases and NCDs. ResultsA total of 1051 HIV-positive individuals were included in the study: 75 % females, 25 % males, median age 47 years, the majority (96 %) on long-term ART, mostly Dolutegravir-based (95 %). 55.4 % had at least one comorbidity, with NCDs such as dyslipidemia (21.22 %) and hypertension (20.17 %) being the most prevalent. The study also noted significant occurrences of communicable diseases, including syphilis (5.23 %), hepatitis B (2.19 %), and hepatitis C (0.29 %). The prevalence of comorbidities varied with age, highlighting the impact of aging on disease burden. DiscussionThe high prevalence of comorbidities among HIV-positive patients in Meru County underscores the need for integrated healthcare strategies that address both infectious diseases and NCDs. The findings advocate for systematic screening and management of comorbidities within HIV care programs, emphasizing the need for holistic health approaches to improve outcomes for this population.

Developing a compassionate university: Insights from a longitudinal process evaluation

Compassionate communities are gaining momentum as a new public health approach emphasizing community support during times of serious illness, death, and bereavement. However, evidence on their development, particularly in higher education, is limited. This study investigates the development of a Compassionate University, examining the underlying processes and contextual factors shaping its development. A longitudinal process evaluation was conducted, using field notes right-now surveys, individual interviews, focus groups, and strategic learning debriefs. Factors that facilitated the development process included leadership support, the establishment of the Compassionate Schools Learning Network, and alignment with existing university programs. Barriers were the lack of guiding examples, the fragmented university environment, resource constraints, and limited prioritization. Cognitive and social processes that supported the work involved recognizing the value of Compassionate University and adapting implementation strategies based on empirical feedback. However, challenges such as building coherence, engaging stakeholders, and assessing the work hampered the development process.

Challenges for cultural relevance of physiotherapy in the care of the Mapuche population in Chile.

Physiotherapy rehabilitation must address the cultural preferences of the population, and as its main tool, physical activity should be analyzed from an intercultural health approach. This study aims to characterize the experiences of physical therapy care related to physical activity from an intercultural perspective. Using a qualitative approach, between June 2021 and March 2023, eight semi-structured individual interviews were conducted with adult Mapuche individuals, professionals in the field, and workers from the Indigenous Health Program in primary care centers in an urban municipality in Santiago, Chile. There are challenges to implementing interculturality, such as the gap between health programs, lack of professional training, and discrimination against the Mapuche community. In rehabilitation services, particularly in physical activity practices as a treatment strategy for Mapuche individuals, cultural relevance is limited or nonexistent.

Social Relationships and Tooth Loss in Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis.

To systematically assess current evidence on the extent to which social relationships are associated with tooth loss in adults aged 60 years and older. A systematic literature search was conducted on PubMed, Embase, Web of Science, CINAHL and The Cochrane Library databases to identify relevant studies published from 1966 up to March 2024. Cross-sectional or cohort studies investigating the association between structural, functional and/or combined (structural and functional) components of social relationships and the number of remaining teeth or edentulism among community-dwelling or institutionalised older adults were included. Data were extracted on participants' and study characteristics, including study design, the type of measures used to assess social relationships (structural, functional, and combined), outcome measures and association estimates. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the adapted NOS for cross-sectional studies. The reported association between social relationships and the number of remaining teeth or edentulism was summarised using meta-analysis with robust variance estimation. Twenty studies were included in the review and 12 studies (125 553 participants) in the meta-analysis. Across the 12 studies, the average odds ratio (95% confidence interval) was 1.15 (1.01-1.32), indicating a 15% higher likelihood of having a lower number of teeth or edentulism for those with weaker social relationships. The GRADE certainty of the body of evidence was low. Weak social relationships were associated with a lower number of teeth or edentulism in older adults. Our findings may inform potential public health approaches that target and modify social relationships to prevent and address older adults' oral diseases. Still, the directionality and the underlying mechanisms connecting social relationships and tooth loss need to be further explored by longitudinal studies with follow-up long enough for oral health outcomes or changes in social relationships to occur. Protocol Registration: PROSPERO (CRD42023417845).

Surveillance of Food and Waterborne Pathogens in North-East India: Protocol for a Laboratory-Based Sentinel Surveillance Study.

Food safety is a global concern, which is often underestimated owing to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, and shifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented foods pose significant health risks. Despite these challenges, systematic data on foodborne pathogens is lacking in India, highlighting a crucial gap in understanding food safety issues. The aim of this research protocol is to establish an integrated surveillance system to identify enteric pathogens circulating within humans, food animals, and the environment through a health approach in North-East India, and to conduct outbreak investigations. The Indian Council of Medical Research (ICMR) initiated a surveillance study across all 8 North-East states in India, employing a centralized digital database for data collation. The project aims to enhance theinfrastructure for microbial culture, antibiotic sensitivity testing, and molecular epidemiological studies. The study involves laboratory-based surveillance of foodborne pathogens in market foods, hospitalized diarrheal patients, poultry and animal farms, slaughterhouses, butcher shops, and diarrheal outbreaks. A standardized case report form ensures consistent data collection of age, sex, signs, symptoms, and admission dates for diarrheal cases. Stool and rectal swabs will undergo testing for pathogen identification and antimicrobial resistance. Similarly, samples of market foods, food animals, and the environment will be collected. Outbreaks confirmed by the Integrated Disease Surveillance Project (IDSP) will be thoroughly investigated following standardized guidelines. In phase I, 5 surveillance centers were established across 4 states (ie, Assam [Dibrugarh and Guwahati], Tripura, Sikkim, and Arunachal Pradesh) in 2020. Following an interim phase I data assessment and the successful establishment of a streamlined system for data procurement, investigation, recording, and analysis, along with the implementation of regular training and monitoring programs, phase II expansion was initiated in 2023-24. This includes the addition of 7 more centers (including 3 veterinary centers) in the remaining 4 states (ie, Manipur, Meghalaya, Mizoram, and Nagaland), eventually covering the entire North-Eastern Region of India. Food and waterborne diseases are a constant public health problem in many countries. Key challenges to the enhancement of food safety policy include the paucity of systematic data and awareness. With this background, ICMR's initiative is the first systematic surveillance study in the country to adopt a single health approach. Data obtained from this project will help to understand the risk of acquiring food and waterborne pathogens, their transmission pathways, and antimicrobial resistance patterns. The scientific evidence generated through this project will be helpful in formulating and strengthening food safety policy and in initiating government programs to protect the health of the nation. DERR1-10.2196/56469.

Conventionally Reared Wallon Meat Lambs Carry Transiently Multi-Drug-Resistant Escherichia coli with Reduced Sensitivity to Colistin Before Slaughter.

Major efforts have been made to reduce the use of colistin in livestock since the discovery of the plasmid-borne mobile colistin resistance (mcr) gene in E. coli a decade ago, to curb the burden of its potential transmission to other bacterial species, spread between animals, humans and the environment. This study explored the longitudinal prevalence and characteristics of colistin-resistant and extended-spectrum beta-lactamase-producing (ESBL) E. coli via in vivo fecal and ex vivo carcass swabs from two batches of conventional indoor and organic outdoor Wallon meat sheep from birth to slaughter in 2020 and 2021. Antimicrobial susceptibility testing via broth microdilution revealed that n = 16/109 (15%) E. coli isolates from conventional meat lamb fecal samples had a reduced colistin sensitivity (MIC = 0.5 μg/mL) and thereof, n = 9/109 (8%) were multi-drug-resistant E. coli, while no resistant isolates were recovered from their carcasses. Sequencing revealed causative pmrB genes, indicating that the reduced sensitivity to colistin was not plasmid-borne. While the sample size was small (n = 32), no colistin-resistant and ESBL-producing E. coli were isolated from the organic meat sheep and their carcasses, potentially due to the different husbandry conditions. Prudent and judicious antimicrobial use and strict slaughter hygiene remain imperative for effective risk management to protect consumers in a sustainable One Health approach.

Detection of PhoP-mediated colistin resistance in Gram-negative bacteria without mcr genes in human population in the Ho Municipality, Ghana

IntroductionAntimicrobial resistance (AMR) has become a global public health threat, with colistin emerging as a last-resort treatment option for multidrug-resistant Gram-negative infections. However, the emergence of colistin resistance, mediated by mechanisms like mutations in the PhoP gene, raises concerns about the future utility of this antibiotic. This study aimed to determine the prevalence of PhoP-mediated colistin resistance in Gram-negative bacteria isolated from the stool of residents in the Ho Municipality, Ghana. MethodsIn this cross-sectional study, 110 stool samples were collected from June 2021 to December 2022. Gram-negative bacteria were isolated, and colistin susceptibility was determined by broth microdilution. Genomic DNA from resistant isolates was extracted and sequenced using the Nanopore platform to detect the presence of the PhoP gene. ResultsOf the 107 Gram-negative isolates, 57 % were resistant to colistin. The PhoP gene was detected in 61.4 % of the colistin-resistant isolates, with the highest prevalence observed in Proteus mirabilis, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. ConclusionThe study reveals a high prevalence of PhoP-mediated colistin resistance among Gram-negative bacteria colonizing residents in the Ho Municipality, highlighting the role of the gut microbiota as a reservoir for antibiotic resistance. Continued surveillance and a collaborative One Health approach are crucial to address this growing threat.

No-Till and Crop Rotation Are Promising Practices to Enhance Soil Health in Cotton-Producing Semiarid Regions: Insights from Citizen Science

This on-farm study was conducted to assess the impact of six prevalent crop management practices adopted by growers in West Texas on various indicators of soil health. This study is a part of a citizen science project, where we collaborated with cotton growers who helped with standardized sample and data collection from 2017 to 2022. This project aimed to identify soil management practices that increase carbon sequestration, enhance biological activities, and improve overall soil health. We monitored soil moisture, soil organic matter (SOM), inorganic nitrogen (NH4+-N and NO3−-N) and other exchangeable nutrients, and soil microbial abundances as obtained via fatty acid methyl ester (FAME) in 85 fields, incorporating different management practices during the cotton growing season. In our study, volumetric moisture content (VWC) was increased by no-till, irrigation, and crop rotation, but the addition of residue decreased VWC. No-till, irrigation, and crop rotation increased SOM, but a cover crop decreased SOM. No-till and residue retention also increased microbial biomass carbon (MBC). Tillage, irrigation, and crop rotation influenced the abundance of the main microbial groups, including bacterial, fungi, and arbuscular mycorrhizal fungi (AMF). Additionally, water content, SOM, and microbial abundances are correlated with clay percentage. Our results indicate that no-till and crop rotation are the two most crucial soil management approaches for sustainable soil health. As such, implementing both no-till and crop rotation in the cropping systems has the most promising potential to increase the soil resilience in dryland cotton production in semiarid regions, thereby helping growers to maintain cotton production.

Molecular Patterns and Antimicrobial Resistance Characterization of Salmonella enterica Non-Typhoidal from Human, Food, and Environment Samples Isolated in Luanda, Angola

The aim of this study was to characterize the antimicrobial resistance phenotype and genotype of non-typhoidal Salmonella spp. isolated in Luanda, Angola. Between 2013 and 2015, human clinical samples, food, and environmental samples (n = 290) were collected at different regions of Luanda city and screened for the presence of Salmonella spp. Bacterial isolates were preliminarily identified using the API 20E Kit, and their identification was confirmed using PCR and serotyping. All Salmonella spp. isolates were tested by minimum inhibitory concentration against 19 antimicrobials. The isolates were also screened using PCR for the presence of resistance genes (blaOXA-1, blaSHV, blaTEM, sul1, sul2, sul3, qnrA, qnrB, qnrS, qnrC, qnrD, aac(6′)-Ib, dfrIa [targeting dfrA1, dfrA5, dfrA15, dfrA15b, dfrA16, dfrA16b] and dfrA12, cmlA, and floR) and typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Salmonella enterica non-typhoidal was detected in 21.3% of the clinical samples (n = 32/150), 11.1% of the food samples (n = 10/90), and 26% of the environmental samples (n = 13/50). Serotyping revealed that the monophasic variant of Salmonella Typhimurium (Salmonella enterica serovar 4,[5],12:i:-) was detected in 38.1% of the samples. Moreover, serovar Salmonella Enteritidis was the second most frequent. Only 7.3% of the isolates were resistant to at least one antimicrobial. Furthermore, isolates from different origins (clinical, environmental, and food) were associated with the same lineages, Salmonella Enteritidis ST11 and S. enterica ser. Typhimurium ST313. The detection of S. enterica serovar 4,[5],12:i:- in different settings reinforces the need for a One Health approach to control this zoonosis in Angola.

How social class shapes breast cancer risk perspectives and prevention practices of Australian midlife women: a qualitative study using the concept of ‘breast cancer candidacy’

BackgroundThe increasing incidence of breast cancer and disease burden is a significant public health concern. While 30% of breast cancers could be prevented through addressing modifiable risk factors, misconceptions among women about breast cancer risks hamper primary prevention. In the absence of primary prevention, secondary prevention such as mammography increases the early detection of breast cancer and improves health outcomes. However, current population-level screening rates indicate secondary prevention is suboptimal. More effective public health efforts to improve breast cancer prevention are required. Given breast cancer is socially patterned, this work explores how social class impacts women’s breast cancer prevention practices. This study uses the concepts of lay epidemiology and candidacy as a mechanism to understand women’s breast cancer risk perspectives. It engages Bourdieu’s relational social class theory to unpack how women’s social, cultural, and structured life contexts shape these perspectives and their considerations regarding primary and secondary prevention.MethodsIn this qualitative study 43 Australian midlife women (aged 45–64 years), were interviewed to explore their understandings of breast cancer risks, how they perceived their own risk, and how this shaped their prevention behaviours. A theory-informed thematic analysis applying Bourdieu’s concepts of habitus, capital, and fields to understand how women’s social class positions shapes risk perspectives and prevention practices was conducted.ResultsThis social class analysis showed differences in how women engage in breast cancer discourse, consider risks, and participate in breast cancer prevention. Middle-class women prioritise health promoting practices and were more likely than working-class and affluent women to attend mammography screening. Working-class women experience structural factors, like low income, stress and difficult life circumstances, which hamper primary prevention practices and for some screening is not considered or prioritised, and their decisions not to screen are less active. Affluent women often do not consider themselves at-risk due to their healthier ‘lifestyles. ’They suggest that this, and their knowledge of screening benefits and harms allows them to make informed decisions not to screen.ConclusionsWomen interpret and understand breast cancer risks differently and enact prevention practices within the parameters afforded by their social class positions. These findings are useful to inform improved public health approaches regarding both modifiable breast cancer risks and increasing mammography screening. To improve equity in breast cancer prevention efforts, such approaches must respond to limitations based on social class and address structural factors that impact prevention practices.

Quiet Pandemic Amid COVID-19: A literature review on gamification for mental health

Background: COVID-19 affects individuals both physically and mentally. The key is to address emerging needs with a modest technique that helps boost the positive approach in individuals. Gamification offers attempts to engage users with the non-game approach, and its growing popularity in other fields, such as finance and retail, is evident. Objective: This research aims to study the available literature that analyzes and understands using the Gamification approach for mental health in the pandemic. Methods: The author performed a systematic literature review using the PRISMA technique among the selected articles published until Jul 2023, focusing on Gamification, mental health, and COVID in highly reputed record databases, which were peer-reviewed studies. Therefore, the studies using the standard international language of English were eligible for this Study. Results: The Study identified elevated articles exploring Gamification through mobile application software, web-based platforms, and other tools since COVID-19 limited in-person social contact for individual safety during peak time. Conclusion: There are limited studies of Gamification in mental health, and the existing studies suggest that Gamification supports the betterment of mental health. Future studies can explore the different areas of mental health with gamification-based applications or gamified approaches.

Need to demystify One Health approach.

Need to demystify One Health approach.

Escherichia coli Occurrence and Antimicrobial Resistance in a Swine Slaughtering Process.

The swine production chain can be a reservoir of antimicrobial-resistant Escherichia coli, which transfers resistance genes to other bacteria, serving as an important biomarker in the One Health approach. This study aimed to identify the frequency and antimicrobial resistance profile of E. coli in the swine production chain, assess the presence of extended-spectrum beta-lactamases (ESBL), and compare resistance profiles across different sample types. A total of 622 samples of swine carcasses from various points of the slaughter process (n = 400), swine feces (n = 100), commercial cuts (n = 45), environment (n = 67), and feces from employees (n = 10) of a pig slaughterhouse certified by the Federal Inspection Service, located in São Paulo state, Brazil, were collected. A total of 1260 E. coli isolates were obtained from the samples, with 73.6% of the samples testing positive. The agar disk diffusion test was performed with 10 different classes of antimicrobials. To confirm the production of ESBLs, the isolates were submitted to a double-disk synergism test using cefotaxime, ceftazidime, and amoxicillin with clavulanic acid. Of the total isolates, 80.71% were multidrug resistant. All ESBL-producing isolates were multidrug resistant and resistant to amoxicillin, tetracycline, and chloramphenicol. Isolates from human feces samples had less chance of being multidrug resistant than samples from other sources. The diversity of resistance profiles was verified in the samples, not clustering according to the sources, except for human feces isolates that clustered, evidencing lower antimicrobial resistance variability of these samples. Antimicrobial resistance is significantly present in the pork production chain, necessitating a comprehensive multidisciplinary approach to effectively mitigate risks within the One Health framework.

One health and social research in disease ecology: A social contextual study of vector-borne diseases in the Yucatan Peninsula, Mexico

Although disease ecology recognizes the multiplicity of factors involved in the (re)emergence of vector-borne diseases (VBD), it is necessary to strengthen attention to the social context and the social determinants of health. It is essential to integrate a sociocultural approach to health into the biological analysis of VBD ecology. To implement a coherent One Health approach in the prevention and control of VBD, it is pivotal to first understand the social and ecological interactions of the local context. Between October 2021 and June 2022, a social contextual study was made through surveys, semi-structured interviews and participatory activities in 12 localities with diverse ecological, economic and socio-cultural contexts in the Yucatan Peninsula. Through the perceptions of the populations on health and VBD, specifically mosquitoes, we gained knowledge on socio-cultural dynamics that influence people's relationship with pathogens. Local knowledge, management, and control of vectors; interactions with domestic and wild animals; and health-landscape relationship, were identified as factors that determine health-disease processes. This study contributed to a better understanding of local contexts and therefore, to the design of socially pertinent strategies for the reduction of vector-borne diseases risk scenarios in the study sites with an integrated approach.