Health Control Measures Research Articles

Goat seropositivity as an indicator of Rift Valley fever (RVF) infection in human populations: A case-control study of the 2018 Rift Valley fever outbreak in Wajir County, Kenya

Rift Valley fever (RVF) is a viral zoonosis, which is considered as a threat to food security in the Horn of Africa. In Kenya, RVF is the 5th ranked priority zoonotic disease due to its high morbidity and mortality, frequent outbreak events, and associated socioeconomic impacts during outbreak events. In 2018, an RVF outbreak was confirmed in Kenya's Siaya, Wajir, and Marsabit counties. During this outbreak, 30 people were confirmed infected with RVF through laboratory tests; 21 in Wajir, 8 in Marsabit, and 1 in Siaya Counties.Seventy-five (75) households (15 cases and 60 controls) were selected and interviewed using a case-control study design in 2021 (?). A case was a household with a member who was diagnosed with RVF in 2018. In addition, a total of 1029 animals were purposively selected within these households and serologically tested for RVF. The study aimed to estimate the contribution of various risk factors to RVF human occurrence in Kenya with a special focus on Wajir County. Wajir County was chosen due to high number of confirmed human cases reported in the 2018 outbreak. A univariable regression model revealed that owner-reported RVF virus exposure in livestock significantly increased the odds of an RVF human case in the household by 32.7 times (95 % CI 4.0–267.4). The respondent being linked to a goat flock that was IgG-positive increased the odds of an RVF human case by 3.8 times (95 % CI 1.17–12.3). In the final multivariable analysis, the respondent being linked to their own animals affected by RVF increased odds of having an RVF human case in the household by 56.9 times (95 % CI 4.6–700.4), while the respondent being linked to a neighbor household member affected decreased odds of having a RVF human case by 0.1 times (95 % CI 0.08–0.75).In summary, these results have revealed a potential link for the spread of RVF infection from animals to humans in pastoralist households, hence it is critical to carry out targeted, community education, One Health surveillance, prevention, and control measures against the disease. This will be critical to protecting humans against potential spillovers of infections during outbreak events in livestock.

Optical quality changes of the eye during peak SARS-CoV-2 pandemic in young adults

IntroductionTo determine whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection affects corneal morphology and optical quality. MethodsIn this cross-sectional study, ophthalmological indicators were examined during the peak of SARS-CoV-2 infection after adjusting for public health control measures. Participants were divided into control (remained uninfected), A (infected during follow-up), and B (infected prior to the first consultation) groups. Effects of varying SARS-CoV-2 infection levels were determined using reverse transcription polymerase chain reaction. Changes in corneal morphology, backscatter, and aberrations were measured. Corneal parameters, such as flat keratometry, steep keratometry, and surface variance, vertical asymmetry, height asymmetry, and height decentration indices were considered. ResultsOverall, 110 participants (208 eyes, 42.7% male; age 17–31 years) were enrolled. Eighteen (16.3%) were infection-free during the outbreak with unchanged corneal morphology, backscatter, and aberration. In group A, 34.73 ± 9.30 days after infection, the backscatter of the anterior corneal layer and central layer (both p=0.000) decreased. Total low-order aberration, defocus, horizontal coma, and spherical aberration of the cornea increased (p<0.05), while corneal morphology after infection did not change (p>0.05). In group B, a decrease in backscattering in the corneal middle layer and an increase in horizontal coma (p<0.05) were noted. ConclusionBackscattering of the anterior and intermediate layers of the cornea decreased and corneal aberrations increased after SARS-CoV-2 infection, which affected corneal optical quality. However, corneal morphology and thickness remained unchanged. Ophthalmological indicators and optical quality should be monitored during SARS-CoV-2 infection.

Clinical and epidemiological profile of patients with ovarian cancer

The objective of this study was to describe the profile of patients with ovarian cancer from 2015 to 2019 in Montes Claros, Minas Gerais State, Brazil. This is a descriptive study with a quantitative approach using data from patients living in Montes Claros, Minas Gerais, Brazil, with a diagnosis of ovarian cancer in the hospital records of the José Alencar Gomes da Silva National Cancer Institute. 312 cases of ovarian cancer were identified in Montes Claros, Minas Gerais. Regarding sociodemographic variables, most women were between 35 and 59 years old (44.9%), 26 patients (29.8%) denied the use of tobacco or tobacco products, 64.3% of the patients were former consumers and 5 (5.9%) were active consumers. 195 patients (79.3%) had a positive family history of cancer, the combined use of tobacco and alcohol was recorded among 83.4 of the population, the detailed primary location of the neoplasm was in the ovary itself in 161 (51.7%) of the cases. Regarding the histological type of the neoplasms, squamous cell carcinoma was found in 303 records (97.4%) and in relation to the TNM staging, most referred to others (53.6%), followed by A4 (46.4%). The data indicate an advanced picture of the disease in this population and suggest that more effective health education and control measures should be implemented.

Assessing the impact of Delta and Omicron in German intensive care units: a retrospective, nationwide multistate analysis

BackgroundThe spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.MethodsA retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany. A multivariable Poisson regression analysis was performed to estimate the incidence rate ratios (IRRs) of transfer (to another hospital during inpatient care), discharge (alive) and death of COVID-19 intensive care patients associated with Delta or Omicron, adjusted for age group and sex. In addition, a multistate approach was used for the clinical trajectories of COVID-19 intensive care patients to estimate their competing risk of transfer, discharge or death associated with Delta or Omicron, specifically concerning patient age.ResultsA total of 6046 transfers, 33256 discharges, and 12114 deaths were included. Poisson regression analysis comparing Omicron versus Delta yielded an estimated adjusted IRR of 1.23 (95% CI 1.16–1.30) for transfers, 2.27 (95% CI 2.20–2.34) for discharges and 0.98 (95% CI 0.94–1.02) for deaths. For ICU deaths in particular, the estimated adjusted IRR increased from 0.14 (95% CI 0.08–0.22) for the 0–9 age group to 4.09 (95% CI 3.74–4.47) for those aged 90 and older compared to the reference group of 60-69-year-olds. Multistate analysis revealed that Omicron was associated with a higher estimated risk of discharge for COVID-19 intensive care patients across all ages, while Delta infection was associated with a higher estimated risk of transfer and death.ConclusionsRetrospective, nationwide comparisons of transfers, discharges and deaths of COVID-19 intensive care patients during Delta- and Omicron-dominated periods in Germany suggested overall less severe clinical trajectories associated with Omicron. Age was confirmed to be an important determinant of fatal clinical outcomes in COVID-19 intensive care patients, necessitating close therapeutic care for elderly people and appropriate public health control measures.

A systematic survey of environmental DNA in Palau's lakes and waterfalls reveals an increase in Leptospira levels after flooding

ObjectiveLeptospirosis is an important bacterial zoonosis which is widespread in tropical and subtropical islands and influences human and animal health which has secondary economic effects. Although leptospirosis is endemic in Palau, an Oceanian Pacific Island country, few systematic surveys of potential risk factors for Leptospira infection, such as weather and host animals, have been conducted in the natural environment. We used environmental DNA metabarcoding to assess the distribution, species diversity, and abundance of pathogenic Leptospira in this endemic region to investigate the potential environmental risks. MethodsForty-two paired water samples, representing fine and rainy weather conditions, were collected from four representative waterfalls and lakes on Babeldaob Island, the largest island in Palau. High-throughput sequencing analysis was conducted for polymerase chain reaction products of leptospiral 16S rRNA and vertebrate animal mitochondrial 12S rRNA genes. ResultsWe revealed greater Leptospira diversity and abundance in samples collected after continuous rain, particularly in the presence of flooding, compared with samples collected under typhoon, monsoon, or fine weather conditions. From same samples, six mammalian species including cats (Felis catus), mice (Mus musculus), Yap flying fox (Pteropus yapensis), rats (Rattus spp.), and pigs (Sus scrofa) were repeatedly detected. These may be candidates of host animals of Leptospira in Palau; however, their detection was not clearly correlated with that of Leptospira. ConclusionWe repeatedly detected several species of pathogenic Leptospira from water samples of a wide region of Babeldaob Island. We confirmed that Leptospira contamination in freshwater environments increased under rainy conditions, particularly in the presence of flooding. This information could be used to improve public health control measures in this region.

Genetic heterogeneity in the Salmonella Typhi Vi capsule locus: a population genomic study from Fiji.

Typhoid fever is endemic in many parts of the world and remains a major public health concern in tropical and sub-tropical developing nations, including Fiji. To address high rates of typhoid fever, the Northern Division of Fiji implemented a mass vaccination with typhoid conjugate vaccine (Vi-polysaccharide conjugated to tetanus toxoid) as a public health control measure in 2023. In this study we define the genomic epidemiology of Salmonella Typhi in the Northern Division prior to island-wide vaccination, sequencing 85% (n=419) of the total cases from the Northern and Central Divisions of Fiji that occurred in the period 2017-2019. We found elevated rates of nucleotide polymorphisms in the tviD and tviE genes (responsible for Vi-polysaccharide synthesis) relative to core genome levels within the Fiji endemic S. Typhi genotype 4.2. Expansion of these findings within a globally representative database of 12 382 S. Typhi (86 genotyphi clusters) showed evidence of convergent evolution of the same tviE mutations across the S. Typhi population, indicating that tvi selection has occurred both independently and globally. The functional impact of tvi mutations on the Vi-capsular structure and other phenotypic characteristics are not fully elucidated, yet commonly occurring tviE polymorphisms localize adjacent to predicted active site residues when overlayed against the predicted TviE protein structure. Given the central role of the Vi-polysaccharide in S. Typhi biology and vaccination, further integrated epidemiological, genomic and phenotypic surveillance is required to determine the spread and functional implications of these mutations.

Restricted health service utilization and subsequent positive self-care behavior during the early COVID-19 pandemic in China.

The reallocation of health resources, epidemic prevention and control measures during the COVID-19 pandemic triggered widespread restricted health service utilization, some residents and patients tried positive self-care behavior to maintain their health, yet the efficacy of this intervention remains unclear. Based on the reasoned action approach (RAA) theory, this study aimed to investigate the correlation between self-care behavior and restricted health service utilization among adults in China, trying to discover the vulnerable groups and external and intrinsic factors that affect self-care behavior among Chinese adults. Data on demographics, socioeconomic, health status, and self-care behavior were collected in "The Early China COVID-19 Survey," a cross-sectional anonymous online survey of the general population in China. Self-care behavior was measured by four indicators: weight control (WC), physical activity (PA), prevention behavior (PB), and online medical consultation (OMC). The multiple linear models and binary logistic regression were used to examine whether restricted health service utilization (RHSU) is associated with self-care behaviors; also, adjusted multivariate logistic regression was used to analyze subgroup heterogeneity. In total, 8,428 adult participants completed the survey, the mean OMC score was 1.51 (SD 1.34), the mean PB score was 18.17 (SD 3.44), and the proportion of participants who engaged in WC and PA was 42.30 and 62.57%, respectively. According to the multiple regression model, the RHSU was significantly positively correlated with all four indicators of self-care (WC: OR = 1.34, p < 0.001, PA: OR = 1.34, p < 0.05, MC: OR = 1.30, p < 0.001, PB: coef = 0.16, p < 0.05). We also observed some significant differences in the intensity of this relationship by subgroup analysis, precisely, OMC (high vs. moderate vs. low infection-risk level: OR = 1.48; 1.41; 1.19, p < 0.1), PA (male vs. female: OR = 1.27;1.06; p < 0.05, high vs. Moderate and low infection-risk level: OR = 1.51; 1.17; 1.02, p < 0.05), PB (Chronic disease groups vs. no: coef = 0.46; 0.1, p < 0.05). Restricted health service utilization predicts more positive self-care behavior, and the intensity of partial correlation was significantly different in the subgroups of sex, actual infection risk level of the living area, and chronic diseases. These findings highlight the urgent demand for self-care behavior among Chinese adults during the pandemic and provide new insights for developing self-care and reducing the burden on the healthcare system in the long term.

Monkeypox: A Viral Zoonotic Disease of Rising Global Concern

Abstract Monkeypox (mpox) is a rare viral zoonotic disease, endemic to Central and West Africa, caused by the monkeypox virus, an orthopoxvirus similar to the variola virus (smallpox). Although sporadic travel-associated cases have historically occurred outside Africa, in May 2022, mpox began spreading globally in multiple nonendemic countries across several continents. In 2024, there has been an increase in globally reported confirmed cases of mpox and deaths from mpox, making it a public health emergency of international concern. The reasons for the unusual global spread are under investigation but likely relate to increased travel and waning population immunity to orthopoxviruses. Transmission now appears to be mainly through close, intimate contact, especially among men who have sex with men. Mpox is usually a self-limited disease. Although limited approved antiviral treatments are available, such as tecovirimat, which the European Medicines Agency approved in January 2022 for the treatment of mpox, their widespread availability and effectiveness in the current outbreak remain to be investigated. Public health control measures include surveillance, case identification/isolation, contact tracing, and targeted vaccination of contacts at high risk of exposure. However, challenges remain in curtailing the current unprecedented outbreak. Critical knowledge gaps include animal reservoir(s) responsible for initial spillover events, viral mutations that may enhance transmissibility, optimal diagnostics for noninvasive specimens, effective antiviral therapies, next-generation vaccines providing longer-term immunity, and building global capacity for outbreak response. This review summarizes the current literature on mpox virology, epidemiology, pathogenesis, clinical manifestations, diagnostics, treatment, prevention, and public health control measures. Ongoing investigation and research are needed to better understand mpox’s evolving epidemiology, pathogenicity, transmissibility, and ecology to guide strategies for containing the outbreak and preventing future global emergence.

Isolation and Molecular Evidence of Tunisian Sheep-like Pestivirus (Pestivirus N) in Persistently Infected Sheep in Northern Italy, 2023.

Over the last few decades, several pestiviruses have been discovered in ruminants, pigs, and, more recently, in non-ungulate hosts. Consequently, the nomenclature and taxonomy of pestiviruses have been updated. The Tunisian sheep-like pestivirus (TSV, Pestivirus N) is an additional ovine pestivirus genetically closely related to classical swine fever virus (CSFV). In this study, during a survey of pestivirus infections in ovine farms in the Lombardy region of Northern Italy, we identified and isolated a pestivirus strain from a sheep that was found to belong to Pestivirus N species based on its genomic nucleotide identity. The sheep itself and its lamb were found to be persistently infected. We performed molecular characterization and phylogenetic analysis of three viral genomic regions (a fragment of 5'-UTR, partial Npro, and the whole E2 region). In conclusion, these results confirmed circulating TSV in Northern Italy after notification in Sicily, Italy, and France. Correlation with Italian, Tunisian, and French strains showed that detection might have resulted from the trading of live animals between countries, which supports the need for health control measures.

Factors affecting the number of influenza patients before and during COVID-19 pandemic, Thailand.

This study was aimed to explore the association between potential factors including public health and social measures and the number of influenza patients in Thailand between 2014-2021. Secondary data from relevant agencies were collected. Generalized Estimating Equation (GEE) and regression coefficient (β) were performed at a significance level of 0.05. We found factors associated with number of influenza patients during the time prior to COVID-19 pandemic were monthly income per household (Adjusted β = -0.02; 95% CI: -0.03, -0.01), population density (Adjusted β = 1.00; 95% CI: 0.82, 1.18), rainy season (Adjusted β = 137.15; 95% CI: 86.17, 188.13) and winter time (Adjusted β = 56.46; 95% CI: 3.21, 109.71). During the time of COVID-19 pandemic, population density (Adjusted β = 0.20; 95% CI: 0.15, 0.26), rainy season (Adjusted β = -164.23; 95% CI: -229.93, -98.52), winter time (Adjusted β = 61.06; 95% CI: 0.71, 121.41), public health control measures (prohibition of entering to into an area with high number of COVID-19 infections (Adjusted β = -169.34; 95% CI: -233.52, -105.16), and restriction of travelling also reduced the number of influenza patients (Adjusted β = -66.88; 95% CI: -125.15, -8.62) were associated with number of influenza patients. This study commends strategies in monitoring influenza patients to focus on the areas with low income, high population density, and in specific seasons. Public health and social measures which can be implemented are prohibition of entering to risk-areas (lock down), and restriction of travelling across provinces which their effectiveness in reducing influenza infections.

Multiple introductions of monkeypox virus to Ireland during the international mpox outbreak, May 2022 to October 2023.

BackgroundMpox, caused by monkeypox virus (MPXV), was considered a rare zoonotic disease before May 2022, when a global epidemic of cases in non-endemic countries led to the declaration of a Public Health Emergency of International Concern. Cases of mpox in Ireland, a country without previous mpox reports, could reflect extended local transmission or multiple epidemiological introductions.AimTo elucidate the origins and molecular characteristics of MPXV circulating in Ireland between May 2022 and October 2023.MethodsWhole genome sequencing of MPXV from 75% of all Irish mpox cases (182/242) was performed and compared to sequences retrieved from public databases (n = 3,362). Bayesian approaches were used to infer divergence time between sequences from different subclades and evaluate putative importation events from other countries.ResultsOf 242 detected mpox cases, 99% were males (median age: 35 years; range: 15-60). All 182 analysed genomes were assigned to Clade IIb and, presence of 12 distinguishable subclades suggests multiple introductions into Ireland. Estimation of time to divergence of subclades further supports the hypothesis for multiple importation events from numerous countries, indicative of extended and sustained international spread of mpox. Further analysis of sequences revealed that 92% of nucleotide mutations were from cytosine to thymine (or from guanine to adenine), leading to a high number of non-synonymous mutations across subclades; mutations associated with tecovirimat resistance were not observed.ConclusionWe provide insights into the international transmission dynamics supporting multiple introductions of MPXV into Ireland. Such information supported the implementation of evidence-informed public health control measures.

Perceptions of Medical Staff on COVID-19 Vaccination: A Qualitative Analysis

Background: The COVID-19 pandemic has caused almost unimaginable damage to the lives, health, and economies of many countries. Alongside health and behavioral control measures, vaccination has been considered the most successful method to control the COVID-19 epidemic. Although vaccination is an effective way to reduce and eliminate diseases, its effectiveness depends on the willingness of the population to receive the vaccine. The purpose of this study is to explore the perceptions of medical staff on COVID-19 vaccination through qualitative content analysis. Objectives: This study aims to explore the perceptions of medical staff on COVID-19 vaccination through qualitative content analysis. Methods: A qualitative study employing a content analysis approach was conducted at Khoy city hospitals in Iran. The researchers explored the perceptions of 16 medical staff members who were among the first group to receive the vaccine in 2021 - 2022. Health staff of various ages, genders, and professions including doctors, nurses, midwives, pharmacists, laboratory staff, and radiologists were included in the research. Sampling was purposeful, and data collection utilized face-to-face semi-structured individual interviews. Data analysis followed the method of “conventional qualitative content analysis.” Results: Data analysis revealed three main categories and seven sub-categories as follows: “Conflicting feelings” (confidence or doubt, hope or worry, complications and benefits), “continuing to fight against COVID-19” (responding to social/professional responsibility, encouraging people to accept the vaccine), and “getting rid of COVID-19” (return to normal life, reduction of mortality). Conclusions: The medical staff expressed a desire to receive the COVID-19 vaccine to continue fighting the disease and eliminate it, but they also had conflicting feelings about receiving it. The perceptions of healthcare workers about healthcare issues serve as a reliable source of knowledge for the public and play a crucial role in deciding whether to accept or reject critical health interventions. Therefore, health policymakers dealing with epidemic diseases should prioritize creating scientific and psychological support for acceptance among healthcare workers, who serve as a reference for the public.

Respiratory virus surveillance in Australia: past, present and future

Surveillance for respiratory viruses has developed from being solely focused on influenza notification to a more sophisticated system that allows for a more comprehensive picture of the burden, severity and impact of several respiratory viruses. Although all surveillance is associated with some degree of bias, when combined these provide useful information on the respiratory virus activity. However, further improvements are possible using new sources of surveillance, such as linked administrative databases, and taking a broader view of surveillance that provides information for forecasting and on public health control measures.

Locked out or let in? Learning from victim-survivors’ remote help-seeking experiences during COVID-19

As COVID-19 traversed the world, public health control measures introduced to reduce the spread of the virus restricted people’s movements and confined many victim-survivors to homes with their abusers. These restrictions raised challenges for services providing support to victims of domestic and family violence (DFV) leading many to rapidly pivot to remote service delivery models. Much of the existing knowledge about victim-survivor service use during COVID-19 is based on the reflections and observations of practitioners and service providers. This article centres on the experiences and expertise of victim-survivors, using findings from an Australian study that investigated victim-survivors’ use of DFV services during lockdowns. Our exploratory survey data revealed that lockdowns created conditions in homes that made it challenging to receive support remotely with concerns about privacy looming large. At the same time, several victim-survivors reported that the widescale shift to remote service provision during lockdowns improved the accessibility of support services. Positive experiences of remote service provision during COVID-19 provide support for the retention of hybrid service models in the future to cater for diverse victim-survivor needs and communities.

Patient-provider experiences with chronic non-communicable disease care during COVID-19 lockdowns in rural Uganda: A qualitative analysis

Non-communicable diseases (NCDs) are a growing health burden in Sub-Saharan Africa and especially Uganda, where they account for over one third of all deaths. During the COVID-19 pandemic, public health control measures such as societal “lockdowns” had a significant impact on longitudinal NCD care though no studies have looked at the lived experience around NCD care during the pandemic. Our objective was to understand the experience of NCD care for both patients and providers in southwestern Uganda during the COVID-19 pandemic. We conducted in-depth, in-person qualitative interviews with 20 patients living with hypertension, diabetes, and/or cardiac disease purposefully selected from the outpatient clinics at Mbarara Regional Referral Hospital and 11 healthcare providers from public health facilities in Mbarara, southwestern Uganda. We analyzed transcripts according to conventional content analysis. We identified four major themes that emerged from the interviews; (1) difficulty accessing medication; (2) food insecurity; (3) barriers to the delivery of NCD clinical care and (4) alternative forms of care. Pre-existing challenges with NCD care were exacerbated during COVID-19 lockdown periods and care was severely disrupted, leading to worsened patient health and even death. The barriers to care were exacerbations of underlying systemic problems with NCD care delivery that require targeted interventions. Future work should leverage digital health interventions, de-centralizing NCD care, improving follow-up, providing social supports to NCD patients, and rectifying supply chain issues.

Lessons Learned From the COVID-19 Pandemic in the United States by Domestic Violence Coalition Leaders.

This U.S. study explores lessons learned about domestic violence service delivery during the COVID-19 pandemic identified by state, territory, and tribal coalition leadership to advance preparedness and guide structural improvements for future disasters. Semi-structured interviews with 25 Coalition leaders identified public health control measures and victim-centered strategies used to mitigate the pandemic's impacts on services and advocacy. Three main themes emerged: workforce innovations, system empowerment, and the simultaneous pandemic of racial injustice. The COVID-19 pandemic inspired Coalitions to respond creatively and highlighted resources needed to support survivors and the domestic violence (DV) workforce going forward, including reassessing the current state of the DV movement.

Effects of proactive and reactive health control measures on public transport preferences of passengers – A stated preference study during the COVID-19 pandemic

The outbreak of COVID-19 has caused unprecedented disruptions to public transportation services, passengers' mode choice preferences, and their behavioral pattern. Recent studies have updated the systemic shift from shared travel to private mode due to the perceived higher health risk of shared mobility. However, findings from these studies may not be applicable to public transport-oriented cities with very low rate of private car ownership. In the long term when we arrive at a stabilized ‘New Normal’, the need to promote public transport is likely to be re-emphasized with high priority. This study presents insights into the factors affecting public transport (PT) preferences and potential modal shifts within various modes of PT when proactive and reactive health control measures are implemented. An online stated preference survey was conducted in Hong Kong, where public buses, public light buses, MTR, and taxis are the popular modes of public transport. The regret-based panel mixed multinomial logit model was applied in this study, aiming to capture individual’s regret aversion psychology in the context of the COVID-19 pandemic. The results of our random regret model suggest that travelers generally have lower regrets for the chosen mode when having passenger temperature screening, COVID tracing app, and more frequent disinfection, while seem to be unaware of the in-vehicle air quality. Interaction effects between health control measures and personal characteristics (e.g., age and risk attitudes) were also considered. Trip characteristics, including in-vehicle crowding level, fares, in-vehicle travel time, waiting time at a station, walking time, and trip purpose, were found to influence passengers' choices of travel modes. Policy simulations of possible changes in public transport modal preferences in the presence of various health control measures have also been undertaken. The findings suggest that overall health control measures are appreciated by passengers and do align with promotion of a return to public transport use. However, their effects are quite moderate and should be selectively used for different transport modes. Increasing service frequency can be a promising solution, which reduces crowding and waiting time of passengers using public transport modes, and reduces virus transmission risk. This study contributes to a better understanding of public acceptance and preference toward health control measures in public transport, and call for in-depth cost-benefit analysis in the related fields so that better response can be made in possible future public health crisis.

Detection of multidrug-resistant Campylobacter species from food-producing animals and humans in Nigeria: Public health implications and one health control measures

Antimicrobial-resistant thermophilic Campylobacter species (TCS) pose tremendous public health problems because they are zoonotic, difficult to treat and usually harboured by food-producing animals (FPAs). This study ascertained the phenotypic antimicrobial resistance (AMR) in 56 phenotypically identified TCS from slaughtered cattle, poultry, and humans in Enugu State, Nigeria. The presence of selected AMR and virulence genes harboured by the animal and human isolates were also detected and compared in 36 PCR-confirmed Campylobacter species. All the 56 TCS were multidrug-resistant as none were susceptible to ampicillin, penicillin-G, amoxicillin-clavulanic acid, cephalothin and metronidazole. The isolates were 92.9 %, 62.5 %, 92.9 %, 42.9 %, 26.8 %, 25 %, 28.6 %, 53.7 %, 30.1 %, 32.1 % and 55.4 % resistant to ceftriaxone, nalidixic acid, cefotaxime, enrofloxacin, ciprofloxacin, streptomycin, gentamycin, erythromycin, azithromycin, chloramphenicol and tetracycline, respectively. The top four most effective classes of antimicrobials were aminoglycosides > macrolides > amphenicol > fluoroquinolones. The AMR genes detected and the percentage of the isolates that harboured them were: aadE-1 (33.3 %), aphA-3–1 (36.1 %), tetO (44.4%), Blaoxa-61 (61.1 %) and the multidrug efflux pump, cmeB (86.1%). Virulence genes detected and the corresponding percentage of TCS that harboured them were: cdtB (61.1 %), flaA (47.2 %), ciaB (38.9 %), and pldA (38.9 %). The cmeB was significantly detected in animal isolates (p = 0.018, OR = 5.1, CI = 0.7–6.6) while BlaOXA-61 predominated in human isolates (p = 0.019, OR = 6.2). Likewise, ciaB virulence gene was mostly detected (p = 0.019, OR = 6.4, CI = 1.3–25) in animal isolates. The findings underscore the roles of FPAs in the zoonotic dissemination of Campylobacter-associated AMR and virulence genes in the study area. This warrants the adoption of One Health control strategies to limit spread of the multidrug-resistant zoonotic Campylobacter species.

Handling Externalities In Environmental Accounting at XYZ Hospital: A Perspective of Amanah Metaphors

This research aims to determine the handling of externalities and their implications for the implementation of environmental accounting at RSUD XYZ (XYZ Hospital) from the perspective of the amanah metaphor. The method used is qualitative research with a case study approach at XYZ Hospital. Data was collected through observation, interviews, and documentation. Data validity was also tested using two types of triangulation. The results show XYZ's Hospital commitment to maintaining environmental balance and reducing the negative impacts of its operations by taking health, safety, and environmental control measures in accordance with Minister of Health Regulation No. 7 of 2019 concerning hospital environmental health. In terms of the application of environmental accounting, XYZ Hospital still does not specifically separate environmental burdens from supply and service burdens. From the perspective of amanah metaphors XYZ Hospital has fulfilled its responsibilities, including those of the trust giver, the trust recipient, and the trust itself.

Barriers to the effective implementation of One health policies against AMR in the EU

Abstract Funded by the EU4Health 2021 Programme, Tetra Tech conducted a study for the European Commission on the “Barriers to the effective implementation of policies against antimicrobial resistance (AMR)” in the EU Member States, Norway and Iceland. The study provides input to support the EU's overall goal to combat AMR by improving the development and implementation of One Health national action plans (NAPs) which, in turn, shall contain effective measures in infection prevention and control and prudent use of antimicrobials. The research was conducted under the following study areas: development and implementation of One Health NAPs, infection prevention and control (IPC) measures in hospitals and long-term care facilities (LTCFs); antimicrobial stewardship measures (AMS) in hospitals, LTCFs, primary care and pharmacies. The research revealed some common problems across all countries, such as insufficient funding to deliver on the measures foreseen in the NAPs, the shortages of qualified staff at all levels of care, the lack of measures targeting LTCFs specifically, the limited involvement of pharmacies in AMS, and the disruptions caused by the COVID-19 pandemic in the health sector. The barriers affect each country differently but they are nevertheless common to all, independently of their size and socio-economic situation. Limitations to deliver on the NAPs objectives were also due to lack of other resources besides funding and staff: old infrastructure, insufficient material and equipment, as well as testing capacity, inadequate information systems. Other barriers identified include: limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; lack of harmonised indicators for monitoring the implementation of plans; limited coverage of AMR, AMS and IPC in education and training; and limited public awareness of AMR. Key messages • Countries face common barriers to the effective implementation of One health policies against AMR, such as lack of dedicated funds, shortages of qualified staff, and disruptions caused by the pandemic. • Actions are needed for improving the implementation of One Health national action plans in the EU, including effective measures in infection prevention and control and prudent use of antimicrobials.