Health Implications Research Articles

Association between per- and polyfluoroalkyl substance exposures and thyroid homeostasis parameters

Abstract Context Prevailing studies have shown the disruption effect of per- and polyfluoroalkyl substances (PFAS) on thyroid homeostasis. However, most studies focused on individual thyroid hormones. Objective To explore the associations between PFAS exposures and thyroid homeostasis parameters. Methods A total of 2386 adults from NHANES (2007-2008 and 2011-2012) were included. Thyroid homeostasis parameters included central and peripheral thyroid hormone sensitivity, calculated by thyroid hormones. Multivariable survey-weighted linear regressions were performed to determine the association between PFAS exposure and thyroid homeostasis parameters. The weighted quantile sum (WQS) and the quantile g-computation (QGC) models were used to estimate the mixed effects of co-exposures to PFAS. Results The ratio of free triiodothyronine/free thyroxine (FT3/FT4) and the sum activity of peripheral deiodinases (SPINA-GD) were positively associated with perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid, perfluorononanoic acid and perfluorohexane sulfonic acid, respectively. However, no significant associations were observed between PFAS exposure and central thyroid sensitivity parameters. PFAS co-exposures was positively associated with FT3/FT4 (β = 0.013, P < 0.001) and SPINA-GD (β = 1.230, P < 0.001) in WQS models. Consistently, PFAS concentrations per quantile was linked to an increase in FT3/FT4 (β = 0.004, P = 0.002) and SPINA-GD (β = 0.392, P = 0.008) in GQC models, with PFOA having the highest weight in all models. Conclusion This study revealed that PFAS exposures may affect peripheral thyroid hormone sensitivity instead of central among U.S. general adults, enhancing our understanding of the correlation between PFAS exposure and thyroid hormones and providing insights into potential health implications.

The mental health implications of artificial intelligence adoption: the crucial role of self-efficacy

The mental health implications of artificial intelligence adoption: the crucial role of self-efficacy

Synthesis of hydroxytyrosol analogs with enhanced antioxidant and cytostatic properties against MG-63 human osteoblast-like cells and their potential implications for bone health.

Sixteen novel hydroxytyrosol (HT) analogs with substitutions at the C-1 position of the HT aliphatic side chain were synthesized and evaluated for their cytostatic activity against MG-63 human osteoblast-like cells and for their antioxidant properties. The results revealed that these analogs exhibited significantly higher inhibitory activity compared with HT, which served as the positive control. Among these, the cyclo-substituted compounds stood out as particularly potent, demonstrating strong radical scavenging abilities and notable cytostatic effects against MG-63 cells. These findings suggest that the cyclo-substituted HT analogs hold considerable promise for the development of novel antioxidants with potential applications in bone physiology.

Investigating heart rate responses of children to active travel: a mixed effects modeling analysis.

The active travel concept has gained recognition as an effective method to enhance physical activity in children's everyday mobility. Yet, there is a notable gap of quantitative evidence on its direct impacts, especially regarding physiological outcomes that can concretely demonstrate its influences on physical intensity and overall health of children. This study investigates the effects of active travel on children, focusing on trip-level physiological responses, specifically heart rate. Through a mixed survey design, we obtained a repeated-measures dataset from a cohort of 73 children (average age 13) across three Austrian secondary schools, each observed for 7 days. By applying mixed effects modelling approach, both fixed and random effects to children's heart rates were explored. According to results from developed mixed linear models (maximum R2 = 0.22), it revealed a significant positive association between active travel mode(s) engagement and heightened physiological responses (Low, Medium and High active level of trip compare to None: β = 1.81, 5.01 and 8.34, t-value = 4.70, 10.29 and 21.34), indicating that increased usage of active travel modes led to elevated heart rate values. Additionally, subjective perceptions also played an important role in influencing children's physiological responses. Feelings of exhausted, anxiety, and stress contributing to a higher heart rate (β = 14.79, 16.69 and 1.99, t-value = 20.42, 5.67 and 3.0), while unhappiness was associated with a lower heart rate (β = -5.96, t-value = -14.62). Effects of social interactions were also found during the trip. The presence of adults was associated with a calming effect (β = -1.92, t-value = -5.72), whereas solo travel resulted in lower heart rate compared to travel with peers (β = -1.95, t-value = -6.59). Our article innovatively employs mixed survey methods and heart rate data to quantitatively demonstrate the positive association between engagement in active travel modes and heightened physiological responses in children, elucidating the intricate interplay of subjective perceptions and social interactions during trips, thus offering valuable insights into the health implications of active travel at a trip level. Future research will keep on leveraging survey and experimental methods.

The Hidden Threat of Antimicrobial Resistance: A Case Study from A Private Hospital in Jordan

Antibiotic resistance is considered a widespread problem with global health implications, leading to increased patient morbidity and impacting the selection of effective antibiotics, consequently influencing patient recovery. This study aimed to assess antibiogram resistance patterns of bacterial records at the Islamic Hospital in Jordan using a retrospective study during the period 2020-2022. A total of 9369 samples obtained from different patients were cultured. Data were processed and analyzed with SPSS v.23.0. The results showed that 2841 (30.3%) samples were positive for bacterial infections. Microbial profiles of positive samples indicated the highest proportion for Escherichia coli, 39%, followed by Klebsiella pneumoniae 12% were the most frequent Gram-negative bacterial isolates, whereas Staphylococcus aureus 13% and Streptococcus pneumoniae 4% were the most common Gram-positive bacterial isolates. Interestingly, multidrug-resistant bacteria comprised 61.7% of the isolates. The percentage of multi-drug resistance in isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae was 68.7%, 73.1%, and 72%, respectively. Escherichia coli was most resistant to ampicillin (89%) and most sensitive to imipenem (100%). Klebsiella pneumoniae showed a 100% sensitivity to meropenem but 49% resistance to ceftriaxone. Pseudomonas aeruginosa was the most sensitive to amikacin and colistin (86% and 100%, respectively). Staphylococcus aureus isolates have resistance rates of 78% for ciprofloxacin, 35.6% for clindamycin and an overall resistance rate of 68.7%. These findings indicate multiple resistance for isolated bacteria. Therefore, antimicrobial resistance should be monitored continuously, and patients should be treated based on anti-microbial susceptibility tests.

Precision medicine to identify, prevent, and treat pediatric obesity.

Pediatric obesity is a growing health concern that has many secondary adverse health implications. Personalized medicine is a tool that can be used to optimize diagnosis and treatments of many diseases. In this review, we will focus on three areas related to the genetics of pediatric obesity: (i) genetic causes predisposing to pediatric obesity, (ii) pharmacogenomics that may predict weight gain associated with pharmacotherapy, and (iii) pharmacogenomics of anti-obesity pharmacotherapy. This narrative review evaluates genetic cause of pediatric obesity and how genetic findings can be used to optimize pharmacotherapy to minimize weight gain and optimize obesity treatment in pediatric patients. Pediatric obesity has many genetic causes including genomic obesity syndromes and monogenic obesity disorders. Several genetic etiologies of obesity have current or emerging targeted genetic therapies. Pharmacogenomic (PGx) targets associated with pharmacotherapy-induced weight gain have been identified for antipsychotic, antiepileptic, antidepressant therapies, and steroids, yet to date no clinical guidelines exist for application use of PGx to tailor pharmacotherapy to avoid weight gain. As legislation evolves for genetic testing coverage and technology advances, this will decrease cost and expand access to genetic testing. This will result in identification of potential genetic causes of obesity and genes that predispose to pharmacotherapy-induced weight gain. Advances in precision medicine can ultimately lead to development of clinical practice guidelines on how to apply genetic findings to optimize pharmacotherapy to treat genetic targets of obesity and avoid weight gain as an adverse event associated with pharmacotherapy.

Natal factors influencing newborn's oral microbiome diversity.

The early microbiota of neonates is crucial for developing the postnatal immune system and establishing normal physiological, metabolic, and neurological functions. This study aimed to investigate the factors influencing the diversity of the neonatal oral microbiome, including mother-to-newborn microbial transmission. The study includes a prospective cohort comprising 73 mothers and 87 neonates and a retrospective cohort comprising 991 mothers and 1,121 neonates. Samples from the maternal cervix and neonatal gastric, bronchial, and oral cavities were analyzed using culture-based methods. Neonatal oral swab samples were also analyzed using16S rRNA gene sequencing to characterize microbial diversity and composition. Similar genera were detected in the neonatal gastric, bronchial, and oral samples, and the neonatal gastric culture was the most similar to the maternal cervical culture. In addition to mother-to-newborn microbial transmission, various natal factors including birth type, birth weight, delivery mode, maternal chorioamnionitis, maternal diabetes and the presence of microbes in other sites influenced neonatal oral microbiome diversity. Among these factors, the birth type was the most significant, and preterm neonates exhibited decreased oral microbiome diversity, with fewer beneficial bacteria and more pathogens. These findings could serve as a baseline for research on the establishment of the oral microbiota in preterm neonates and its health implications.

The Emergence of Cat-Transmitted Sporotrichosis Driven by Sporothrix brasiliensis in Piauí, Brazil.

In Brazil, the emergence of feline sporotrichosis, a neglected subcutaneous mycosis primarily transmitted by cats and caused by the fungus Sporothrix brasiliensis, has been monitored via molecular tools. This approach underscores the geographic expansion of this disease and highlights the critical role of molecular surveillance in understanding its epidemiology and guiding public health interventions. We investigated three domestic cats (Felis catus) with multiple skin lesions in Picos, Piauí, Brazil. The cats were examined, and samples were collected for laboratory diagnosis, including cytological evaluation, fungal culture, and molecular characterisation. The molecular analysis involved a one-tube multiplex probe-based qPCR assay for the diagnosis of Sporothrix species, mating-type determination, and amplified fragment length polymorphism (AFLP, EcoRI-GA/MseI-AG) to assess genetic similarity and potential origin. All three cats were diagnosed with sporotrichosis caused by the hypervirulent S. brasiliensis. A probable case of zoonotic transmission has been reported in a 12-year-old girl who developed Parinaud oculoglandular syndrome after contact with one of the cats with sporotrichosis. The molecular analysis revealed that the cat isolates were MAT 1-2 and formed a single cluster according to the AFLP analysis, suggesting direct transmission (cat-cat) and a potential founder effect. The isolates were also closely related to strains from Pernambuco and Southeast Brazil, indicating a possible introduction from these regions. Identifying S. brasiliensis in Piauí emphasises the need for increased awareness and control measures to prevent further spread. The predominance of the MAT1-2 idiomorphs and the genetic similarity among outbreak isolates suggest clonal expansion, which could have significant implications for public health and veterinary practices. Considering its zoonotic potential and environmental adaptability, a One Health approach is crucial for managing and controlling the spread of cat-transmitted sporotrichosis.

Toxicity, mutagenicity, and source identification of polycyclic aromatic hydrocarbons in ambient atmosphere and flue gas.

This study aimed to assess the characteristics of particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) from various stationary and mobile emission sources in Taiwan, with a focus on source apportionment and associated health risks. The northern power plant, equipped with bag filters operating at 150°C, had significantly lower FPM and CPM levels (0.44 and 0.13mg/m3, respectively) compared to the central and southern power plants, which used electrostatic precipitators operating at 250°C (FPM, 1.45-8.35mg/m3; CPM, 2.37-3.73mg/m3). Additionally, emissions from diesel vehicles under both idle and high-speed conditions exhibited higher FPM levels (3.46-4.67mg/m3) than gasoline vehicles (0.19-0.40mg/m3). In terms of PAH toxicity, diesel vehicle emissions had significantly higher BaP-TEQ (87.3ng/m3) and BaP-MEQ (25.9ng/m3) levels compared to power plants (BaP-TEQ, 5.49ng/m3; BaP-MEQ, 2.65ng/m3). The highest ambient concentrations of PM2.5, BaP-TEQ, and BaP-MEQ were recorded at traffic sites, with values of 48 ± 36µg/m3, 0.29ng/m3, and 0.11ng/m3, respectively. Differences in PAH distributions between stationary and mobile sources were influenced by factors such as pollution control technologies, combustion temperatures, and fuel types. Diesel vehicle emissions were dominated by benzo[g,h,i]perylene (BghiP), indeno[1,2,3-cd]pyrene (IND), benzo[a]pyrene (BaP), and benzo[b]fluoranthene (BbF) under idle conditions, while phenanthrene (PA), pyrene (Pyr), and BghiP were prevalent under high-speed conditions. Source apportionment conducted using principal component analysis (PCA) and positive matrix factorization (PMF) identified diesel and gasoline vehicles as the dominant contributors to atmospheric PAHs in Taiwan, accounting for 38% of the total, followed by coal-fired power plants at 35%. The highest lifetime excess cancer risk (ECR) of 2.5 × 10⁻5 was observed in traffic-dense areas, emphasizing the public health implications of vehicle emissions. The study adds credibility to the source apportionment findings, and the health risk analysis highlights variations across different regions, including traffic, urban, rural, and background zones.

Comparing self-rated health among exclusive e-cigarette users and traditional cigarette smokers: an analysis of the Health Survey for England 2019.

The health implications of e-cigarette use compared to traditional cigarette smoking continue to attract significant public health interest. This study examines self-rated health (SRH) outcomes among exclusive e-cigarette users versus exclusive traditional cigarette smokers, using data from the Health Survey for England 2019. From an initial sample of 10,299 participants, the study focused on 8204 adults, excluding those aged 0-15. Further refinement to exclusive nicotine product users led to 274 e-cigarette users and 1017 cigarette smokers, after excluding dual users, never users, ex-users, non-responders, and users of other tobacco products such as pipes and cigars. SRH was derived from participants' responses to a question asking how they rated their general health, with five possible options: "very good", "good", "fair", "bad", and "very bad". For the purposes of this study, these responses were collapsed into two categories: "Good Health" (combining "very good" and "good") and "Poor Health" (combining "fair", "bad", and "very bad"). Consequently, 834 participants were classified as reporting good health, while 457 reported poor health. Binary logistic regression, adjusted for factors such as age, sex, ethnicity, residence, education, body mass index, alcohol use, age started smoking, physical or mental health conditions, and frequency of GP visits, revealed that exclusive e-cigarette users were significantly more likely to report good health compared to exclusive cigarette smokers, with an odds ratio(OR) of 1.59 (95% CI: 1.10 - 2.32, p = 0.014). As a sensitivity analysis, a generalized ordered logistic regression model was performed using the original five SRH categories. The adjusted model confirmed consistent results, with exclusive e-cigarette users showing higher odds of reporting better health across the full range of SRH outcomes (OR = 1.40, 95% CI: 1.08-1.82, p = 0.011). These findings suggest that exclusive e-cigarette users perceive their health more positively than traditional cigarette smokers, contributing useful insights to the discussions around harm reduction strategies.

Irregular meal pattern and later sleep midpoint are associated with increased BMI z-score and waist–height ratio during early adolescence

BackgroundRapid gains in adiposity may have more adverse health implications in later life compared with having stable adiposity throughout childhood and adolescence. A knowledge gap concerns concomitant health behaviors contributing to adiposity gain among adolescents.ObjectivesWe investigated the associations of health behaviors relating to dietary habits, sleep, physical activity (PA), and screen time with an increase in body mass index z-score (BMIz) and waist–height ratio (WHtR) during adolescence.MethodsWe included 4,785 adolescents (53% of girls) aged 11.1 (SD 0.8) years at baseline and followed them for 3 years. We clustered them into decreased, stable, and increased BMIz and WHtR categories using the K-means clustering method. Using Cox regression, we computed hazard ratios (HR) with 95% CI for the associations of self-reported health behaviors (dietary habits, physical activity, sleep midpoint, and sedentary digital media use) with belonging to an increased BMIz or WHtR group. In a subsample (n = 3,840), we ran a sensitivity analysis considering puberty status as an additional covariate.ResultsLater sleep midpoint (having later midpoint of sleep between bedtime and waking time) and irregular meal pattern (not eating lunch and dinner every school day) predicted increased BMIz (HR 1.26 [95% CI 1.13–1.41] and 1.23 [1.08–1.39], respectively) and WHtR (1.23 [1.09–1.39] and 1.18 [1.02–1.36], respectively) over the follow-up period, after adjusting for other health behaviors. Associations remained after considering puberty status as a covariate.ConclusionsEarly bedtime with adequate sleep duration and regular meal pattern should be encouraged to prevent adiposity gain during early adolescence.

Prevalence of Gamer’s Mark on the wrists of dental students in Mumbai: A multicentric study

Repeated friction between the wrist and the mouse pad leads to the development of a lesion on the wrist of the operator known as the ‘Gamer’s mark’. In the context of the rapid development of digital technology and increased dependence of dental students and professionals on the same, the present study aimed to analyze the prevalence of Gamer’s mark among dental students in the city of Mumbai. The present cross-sectional study was on 1412 dental students in four different institutions in Mumbai using a five-point questionnaire comprising questions relevant to the characteristics of gaming history and the presence of the lesion on the wrist. The responses were recorded in an Excel sheet and subjected to data analysis. The prevalence of the lesion across the full cohort was found to be 0.5%. Of the 103 participants reporting a history of gaming, 66.99% (n=69) had the lesion on either of their hands which comprised 50 males and 19 females. There was a statistically significant difference noted (p<0.05) wherein a higher number of males (p=0.02) as well as females (p=0.04) had the lesion as compared to those that did not (p<0.05) The correlation between the duration of the Gamer’s Mark lesion and the intensity of gaming underscores the need for awareness and preventive strategies in the dental community. As dentistry continues to embrace digitalization, it is imperative to address the potential health implications associated with prolonged computer usage.

Trajectories of antidepressant use after tamoxifen initiation among young and middle-aged women with breast cancer.

Antidepressant treatment patterns may change after women with breast cancer (BC) initiate tamoxifen, potentially impacting health outcomes. We characterized trajectories of antidepressant use after initiating tamoxifen among young and middle-aged women with BC, identifying risk factors for trajectory group membership. A retrospective cohort included women 18-64years-old with BC and antidepressant treatment history who received a new tamoxifen dispensing (index date). We measured longitudinal antidepressant use post-index date as 12, monthly, proportion of days covered (PDC) measurements in a 25% random sample of IQVIA PharMetrics® Plus for Academics US claims, 2006-2022. Group-based trajectory models identified latent subgroups of antidepressant use by testing 2-6-group representations; the best model fit determined by the lowest Bayesian Information Criterion, clinical interpretability, and each subgroup comprising ≥ 5% of the cohort. Using multinomial logistic regression, baseline covariates including demographics, depression status and the CYP2D6-inhibitory strength of antidepressants were evaluated as risk factors for the trajectory of antidepressant use after tamoxifen initiation. Our sample of 851 women followed four distinct antidepressant adherence trajectories after tamoxifen initiation: 12% exhibited immediately decreasing use [mean PDC (sd) 8% (± 7)]; 7% exhibited delayed decreasing use [41% (± 14)]; 20% exhibited dynamic-moderate use [54% (± 15)]; and 60% exhibited consistently high use [91% (+ 7)]. Age, depression, and treatment with non CYP2D6-inhibiting antidepressants were associated with women's trajectory of antidepressant use after initiating tamoxifen. Nearly 40% of women were nonadherent to antidepressants after tamoxifen initiation. Future research should explore cancer-related and mental health implications of this nonadherence.

Environmental Antimicrobial Resistance: Implications for Food Safety and Public Health

Antimicrobial resistance (AMR) is a serious global health issue, aggravated by antibiotic overuse and misuse in human medicine, animal care, and agriculture. This study looks at the different mechanisms that drive AMR, such as environmental contamination, horizontal gene transfer, and selective pressure, as well as the severe implications of AMR for human and animal health. This study demonstrates the need for concerted efforts across the scientific, healthcare, agricultural, and policy sectors to control the emergence of AMR. Some crucial strategies discussed include developing antimicrobial stewardship (AMS) programs, encouraging targeted narrow-spectrum antibiotic use, and emphasizing the significance of strict regulatory frameworks and surveillance systems, like the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the Access, Watch, and Reserve (AWaRe) classification. This study also emphasizes the need for national and international action plans in combating AMR and promotes the One Health strategy, which unifies environmental, animal, and human health. This study concludes that preventing the spread of AMR and maintaining the effectiveness of antibiotics for future generations requires a comprehensive, multidisciplinary, and internationally coordinated strategy.

Adverse outcome pathway of Alzheimer's Disease-like changes resulting from autophagy flux blockade after MC-LR exposure.

Microcystins (MCs) pollution is a worldwide environmental issue concerning about human health. Microcystin-leucine-arginine (MC-LR), the most common type of MCs produced by cyanobacteria, could enter the brain and bring about damage to the nervous system. Up to date, it is not clear about the mechanism of MC-LR-induced neurotoxicity. Amyloid-β (Aβ) deposits are hallmark of Alzheimer's disease (AD). In this study, we revealed that MC-LR exposure at environment-related doses (1, 7.5, 15 μg/L) could promote Aβ accumulation in mouse brain. Mechanismly, we firstly found that Aβ accumulation is closely associated with abnormal Aβ degradation due to autophagy flux blockade and lysosome dysfunctions in neurons after MC-LR exposure. Moreover, an adverse outcome pathway (AOP) framework oriented to neurotoxicity of MC-LR was conducted in this study. MC-LR inhibited the activity of protein phosphatase 2A (PP2A) in neurons, which is regarded as a molecular initiating event (MIE). In addition, the abnormalities in autophagy were observed after MC-LR exposure. The hindered autophagosome-lysosome fusion and disrupted lysosomal function were key events (KEs) after MC-LR exposure, which contributed to proteostasis dysregulation, ultimately leading to Aβ abnormal degradation and learning deficits as adverse outcomes (AO) of neurotoxicity. This study provided novel information about MC-LR neurotoxicity and new insights into understanding the mechanisms underlying the environmental chemicals-induced neurodegeneration diseases, which has deep implications for public health.

Hydrochemical assessment of groundwater quality in the coastal belt of Sindh, Pakistan: Implications for human health

Hydrochemical assessment of groundwater quality in the coastal belt of Sindh, Pakistan: Implications for human health

US State Recreational and Medical Cannabis Delivery Laws, 2024.

Objectives. To provide a legal epidemiology review of state-level policies that regulate the direct delivery of recreational and medical cannabis in the United States. Methods. We conducted a comprehensive review to identify all relevant policies as of July 1, 2024. Specifically, we developed a coding scheme to capture laws governing (1) direct delivery of recreational cannabis, (2) licensing for direct delivery of recreational cannabis, (3) direct delivery of medical cannabis to qualifying patients, and (4) medical cannabis delivery solely from caregivers to qualified patients. Results. Fourteen states authorized the direct delivery of recreational cannabis to adults. Twenty-six states and the District of Columbia permitted the direct delivery of medical cannabis to qualifying patients. Twelve states allowed the delivery of medical cannabis to patients exclusively through caregivers. There were numerous variations in the licensing and authorization of recreational and medical cannabis delivery. Conclusions. States varied in how the delivery of cannabis was regulated. Public Health Implications. A comprehensive review of state-level policies on cannabis delivery highlights the diverse approaches and their implications for recreational and medical cannabis access. (Am J Public Health. Published online ahead of print November 14, 2024:e1-e13. https://doi.org/10.2105/AJPH.2024.307874).

Approaching onchocerciasis elimination in Equatorial Guinea: Near zero transmission and public health implication.

Onchocerciasis and lymphatic filariasis (LF) are endemic in Equatorial Guinea with notable variations in disease incidence between island and mainland regions. Historically, efforts to control and map these diseases were concentrated in Bioko Island, where loiasis is absent, allowing for targeted onchocerciasis interruption strategies. With the cessation of onchocerciasis transmission on Bioko and no reported cases on Annobon island, assessing the transmission status in the previously unaddressed mainland region has become imperative. Mapping efforts in mainland Equatorial Guinea have proven low to moderate level of transmission for LF and onchocerciasis, although the results so far have not been very conclusive. The current study aims to update the prevalence estimates for onchocerciasis and LF in mainland Equatorial Guinea using various diagnostic techniques. This is the first cross-sectional study carried out to estimate the prevalence of onchocerciasis and LF in the mainland area of Equatorial Guinea, from September to December 2019, based on the combination of skin snip biopsies, thick blood smears, laboratory serological tests (ELISA tests for the detection of IgG4 antibodies against Onchocerca volvulus recombinant antigen Ov16 and Wuchereria bancrofti recombinant antigen Wb123) and molecular laboratory tests. Frequencies and prevalence rates, along with 95% confidence intervals for interval estimation of a binomial proportion, were computed. The overall onchocerciasis seroprevalence calculated for the study was 0.3% (95% CI: 0.1 to 0.5%). Microscopic examination of skin biopsies from the eight individuals seropositive for Ov16, out of the 3951 individuals initially tested, revealed no O. volvulus microfilariae. However, DNA extracted from one skin snip was successfully amplified, with subsequent sequencing confirming the presence of O. volvulus. Among the 3951 individuals, 182 were found to have anti-Wb123 antibodies, suggesting exposure to W. bancrofti, with an estimated seroprevalence of 4.6% (95% CI: 4.0 to 5.3%). Microscopy and Filaria-real time-PCR (F-RT-PCR) analysis for W. bancrofti were negative across all samples. The findings indicate that onchocerciasis may no longer constitutes a public health problem in Equatorial Guinea, positioning the country on the verge of achieving elimination. Additionally, the mapped prevalence of LF will facilitate the formulation of national strategies aimed at eradicating filariases countrywide.

Prolonged length of stay and associated factors among emergency department patients in Ethiopia: systematic review and meta-analysis.

The duration between a patient's arrival at the Emergency Department (ED) and their actual departure, known as the Emergency Department Length of Stay (EDLOS), can have significant implications for a patient's health. In Ethiopia, various studies have investigated EDLOS, but a comprehensive nationwide pooled prevalence of prolonged EDLOS, which varies across different locations, is currently lacking. Therefore, the objective of this systematic review and meta-analysis is to provide nationally representative pooled prevalence of prolonged EDLOS and identify associated factors. In this study, we conducted a comprehensive systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. We conducted a thorough search of numerous international databases, including PubMed/Medline, SCOPUS, Web of Science, and Google Scholar. The primary outcome was the prevalence of prolonged EDLOS. The secondary outcome was factors affecting the EDLOS. Random-effects model was used to since there was high heterogeneity. We also conducted subgroup analysis and meta-regression to investigate heterogeneity within the included studies. To assess publication bias, we used Egger's regression test and funnel plots. All statistical analyses were performed using STATA version 17.0 software to ensure accurate and reliable findings. We have identified eight articles that met our inclusion criteria with a total sample size of 8,612 participants. The findings of this systematic review and meta-analysis indicate that the pooled estimate for the prevalence of prolonged EDLOS is 63.67% (95% CI = 45.18, 82.16, I2 = 99.56%, P = 0.0001). The study identified several significant factors associated with prolonged EDLOS, including patients admitted to overcrowded emergency departments (OR = 5.25, 95% CI = 1.77, 15.58), delays in receiving laboratory findings (OR = 3.12, 95% CI = 2.16, 4.49), and delays in receiving radiological results (OR = 3.00, 95% CI = 2.16, 4.16). In this review, the EDLOS was found to be very high. Overcrowding, delays in laboratory test findings, and delays in radiology test results make up the factors that have a statistically significant association with prolonged EDLOS. Given the high prevalence of prolonged EDLOS in this review, stakeholders should work to increase the timeliness of ED services in Ethiopia by proper disposition of non-emergency palliative patients to the appropriate destination, and implementing point-of-care testing and imaging.

Cardiorespiratory fitness, body mass index and mortality: a systematic review and meta-analysis

ObjectiveThe purpose of this review was to assess the joint relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all-cause mortality risk.DesignA systematic review and meta-analysis was conducted. Pooled HR and 95% CI were calculated using a three-level restricted maximum likelihood estimation random-effects model with robust variance estimation. The reference group was normal weight-fit and was compared with normal weight-unfit, overweight-unfit and fit, and obese-unfit and fit.Data sourcesElectronic databases (PubMed/MEDLINE, Web of Science and SportDiscus) were searched following registration on PROSPERO.Eligibility criteriaArticles meeting the following criteria were included: (1) published between January 1980 and February 2023, (2) prospective cohort study, (3) CRF assessed using a maximal or VO2peak exercise test, (4) BMI reported and directly measured, (5) joint impact of CRF and BMI on all-cause mortality or CVD mortality were analysed, and (6) the reference group was normal weight, fit individuals.Results20 articles were included in the analysis resulting in a total of 398 716 observations. Compared with the reference group, overweight-fit (CVD HR (95% CI): 1.50 (0.82–2.76), all-cause HR: 0.96 (0.61–1.50)) and obese-fit (CVD: 1.62 (0.87–3.01), all-cause: 1.11 (0.88–1.40)) did not have a statistically different risk of mortality. Normal weight-unfit (CVD: 2.04 (1.32–3.14), all-cause: 1.92 (1.43–2.57)), overweight-unfit (CVD: 2.58 (1.48–4.52), all-cause: 1.82 (1.47–2.24)) and obese-unfit (CVD: 3.35 (1.17–9.61), all-cause: 2.04 (1.54–2.71)) demonstrated 2–3-fold greater mortality risks.ConclusionsCRF is a strong predictor of CVD and all-cause mortality and attenuates risks associated with overweight and obesity. These data have implications for public health and risk mitigation strategies.