Health Triad Research Articles

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient-provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.

Unlocking the Triad of Health: Investigating High Blood Pressure, Obesity and their Impact on PCOS in Women

Polycystic Ovarian Syndrome or PCOS, is a common endocrine illness that affects 3.7% to 22.5% of fertile Indian women. It is characterised by abnormalities related to reproduction, metabolism, and hormones. This six-month prospective cohort study at Chalapathi Institute of Pharmaceutical Sciences examines the relationship between PCOS, obesity and high blood pressure. With 118 cases of PCOS detected among the 1246 participants who completed the comprehensive questionnaire, the study finds a substantial correlation between PCOS, obesity (p = 0.00061) and hypertension (p = 0.00061). Findings show that PCOS is more common in college students, underscoring the importance of lifestyle choices like nutrition, exercise and stress reduction. Additionally, the study finds that academics are more likely than IT workers or stay-at-home moms to have PCOS, which is associated with greater rates of obesity and hypertension. The results highlight the need for focused interventions, such as lifestyle changes and educational initiatives to reduce PCOS risk factors and enhance health outcomes. This study expands our understanding of PCOS and highlights the value of early detection and individualised treatment plans.

Tracking melioidosis in Iran: Utilizing abattoir-based surveillance as a One Health approach.

Burkholderia pseudomallei, an environmental saprophyte bacterium, causes melioidosis in humans and animals. It was first discovered in Iran between 1967 and 1976 in small ruminants, equines, environments and humans. No subsequent studies have been conducted to determine the existence and prevalence of this pathogen in the country. The present study aims to monitor the presence of B. pseudomallei in the ruminant population of the Golestan province of Iran, which largely depends on pastures. The ruminants can serve as sentinels to indicate the presence of the bacteria in the environment and its potential impact on human health in the One Health triad. Liver and lung abscesses from domestic sheep, cattle and goats in three industrial and three conventional slaughterhouses were sampled and analysed using 23S ribosomal DNA polymerase chain reaction (rDNA PCR) with primers CVMP 23-1 and CVP-23-2 for B. pseudomallei, Burkholderia cepacia and Burkholderia vietnamiensis, as well as B. pseudomallei-specific TTS1 real-time PCR, along with microbiological and biochemical assays. Out of the 97 animals sampled, only 14 (15%) tested positive for 23S rDNA PCR. However, the follow-up evaluation using TTS1 real-time PCR and microbiological and biochemical assays did not confirm the presence of B. pseudomallei in the samples. Although B. pseudomallei was not detected in the current survey, conducting abattoir-based surveillance of ruminants is a cost-effective One Health approach to monitor pathogenic Burkholderia. Developing standards of clinical and laboratory good practices for Burkholderia infections is crucial for One Health surveillance.

The development and validation of the One Health Community Assessment

Interdisciplinary collaborations to address human, animal, and environmental health have been emphasized since the inception of the One Health framework. A quantitative survey instrument was developed to measure perceptions of the impacts of pets on One Health. Using the exploratory sequential mixed methods approach, 20 interviews were conducted with individuals from a racially diverse and low-socioeconomic status community in the U.S. to understand their perceptions of One Health. Data from those interviews informed the development of a Likert scale survey measuring individual perceptions of community, human, pet, and environmental health and welfare, as well as the connections between the domains of the One Health triad (human, animal, and environment). The resulting One Health Community Assessment (OHCA) was administered in two urban and two rural underserved U.S. communities longitudinally (2018–2021) through door-to-door data collection as well as phone, email, and text surveys. Validation of the instrument was completed using data collected in the third and fourth years of the study (n = 654). Factor analysis with orthogonal varimax rotation was used to assess the structure and internal consistency of the OHCA. Five subscales explained 42.4% of the variance in our 92-item instrument: community health (Cronbach's α = 0.897), human health (α = 0.842), pet health (α = 0.899), environmental health (α = 0.789), and connections between domains of One Health (α = 0.762). The OHCA represents the first reliable and validated instrument to measure the impacts of pets on One Health.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Microbial associations and transfers across the One Health Triad effects on human and animal adiposity and temperament: a protocol for an observational pilot study.

It is known that humans and pet dogs harbor microbial communities that are important regulators of health and disease. Pet dogs have been shown to promote microbial exchange between members of a household, a process that may have lasting health implications. Infancy marks a unique period of development as environmental exploration and introduction to complementary foods occur. This may lead to greater opportunities for microbial transfer between pet dogs and human infants due to a more confined shared environment, similar means of mobility, greater physical contact, and increased frequency of shared foods. This human-animal bond has led to extensive research in the areas of childhood allergies and behavioral health; however, there is a paucity in the available literature that has evaluated how this unique ecological relationship may impact both human and animal health. Infants who reside in a household with a pet dog will be recruited from the greater Phoenix metropolitan area for this longitudinal, observational pilot study and followed through the complementary feeding period. Infant and pet dog fecal, salivary, and skin samples, as well as environmental samples from feeding areas/surfaces and main indoor play areas from both infants and pet dogs will be collected through in-home visits before (~5 mos), during (~9 mos), and after (~12 mos) the complementary feeding (CF) period. Anthropometrics, temperament, and dietary habits of both infants and pet dogs along with assessment of the home condition will also be collected. Microbial comparisons between infant and pet dog samples and evaluation of microbial changes during the CF period will be evaluated. Further, we will assess relationships between microbial composition and adiposity and temperament of both infants and pet dogs. The proposed observational pilot study will advance the available science by exploring how microbial communities are associated and change between infants and pet dogs before, during, and after the CF period, a unique period of human growth and development. Findings from this study will provide insights into the impact these ecological relationships have on each other and how transfer across the One Health Triad impacts human and animal health.

The Utilization of Recycled Gypsum as a Soil Amendment

Road salt, specifically sodium chloride (NaCl), is commonly used in Canada as a de-icer to keep roadways safe during the winter months. However, the increasing amounts used annually contaminate water systems and soils with hazardous levels of chemicals, posing a threat to humans, non-human animals, and the environment. As previous initiatives to address this issue have been expensive and difficult to implement, a One Health approach is required to minimize the impacts of road salt use. This article proposes a non-toxic solution to reduce the impacts that road salt has on all aspects of the One Health triad. This solution involves the use of recycled gypsum from clean drywall as a soil amendment to reverse road salt-induced damage to the soil. This practice would also reduce the amount of construction waste that ends up in landfills. If deemed successful, this practice could be expanded to other areas in Canada to mitigate the damage of road salts on the ecosystem.

Second Life Plastic Project: Using a One Health Lens to Address Plastic Bottle Pollution

One Health is an intersectional approach to balance and optimize the health of humans, non-human animals, and the environment. Single-use plastics have become a major part of modernity, but their improper disposal has devastating impacts on the One Health triad. Current strategies to address plastic pollution include the ban on single-use plastic items and modification of the trade flow of waste aids. While these strategies are effective, they are not sustainable enough to produce the long-term, large-scale impacts that are needed. This paper proposes the implementation of a smallscale One Health initiative aimed at reducing plastic pollution. Specifically, plastic bottles will be collected, then undergo shredding and repurposing by a 3D printer to create furniture pieces such as chairs and storage containers that will be sold to customers. Repurposing plastic bottles provides a sustainable long-term solution that reduces the amount of plastic waste ending up in landfills, protecting the health of humans, non-human animals, and the environment. If proven successful, this local initiative could be leveraged by additional communities to grow into a worldwide application.

The Triple-E Model: Advancing Equestrian Research with Perspectives from One Health.

Equestrian sport has various welfare issues and educational needs. To address these complex interactions, we propose an integrated approach called the Triple-E Model, which focuses on the equine, equestrian, and environmental triad. A literature review of existing models suggests that complexities of these interactions are overlooked, despite the significant impact of equine industries on economics, healthcare, and animal welfare. This paper discusses current models and theories used to evaluate equine-equestrian-environmental interactions and introduces the Triple-E Model to foster multidisciplinary collaboration. Unlike the One Health triad, which focuses on disease emergence, transmission, and zoonosis, the Triple-E Model extends to non-infectious research, such as musculoskeletal injury. It promotes collaborative care and rehabilitation within the equestrian community by engaging multidisciplinary, multi-setting, and multi-sectoral teams. Given the nature of human-animal interaction and welfare considerations, this model fills the gap in understanding human-horse interactions. The paper highlights the limitations of existing models and explains how the Triple-E Model guides and encourages holistic team collaboration in the equestrian community.

Mobile Colistin Resistance (mcr) Gene-Containing Organisms in Poultry Sector in Low- and Middle-Income Countries: Epidemiology, Characteristics, and One Health Control Strategies.

Mobile colistin resistance (mcr) genes (mcr-1 to mcr-10) are plasmid-encoded genes that threaten the clinical utility of colistin (COL), one of the highest-priority critically important antibiotics (HP-CIAs) used to treat infections caused by multidrug-resistant and extensively drug-resistant bacteria in humans and animals. For more than six decades, COL has been used largely unregulated in the poultry sector in low- and middle-income countries (LMICs), and this has led to the development/spread of mcr gene-containing bacteria (MGCB). The prevalence rates of mcr-positive organisms from the poultry sector in LMICs between January 1970 and May 2023 range between 0.51% and 58.8%. Through horizontal gene transfer, conjugative plasmids possessing insertion sequences (ISs) (especially ISApl1), transposons (predominantly Tn6330), and integrons have enhanced the spread of mcr-1, mcr-2, mcr-3, mcr-4, mcr-5, mcr-7, mcr-8, mcr-9, and mcr-10 in the poultry sector in LMICs. These genes are harboured by Escherichia, Klebsiella, Proteus, Salmonella, Cronobacter, Citrobacter, Enterobacter, Shigella, Providencia, Aeromonas, Raoultella, Pseudomonas, and Acinetobacter species, belonging to diverse clones. The mcr-1, mcr-3, and mcr-10 genes have also been integrated into the chromosomes of these bacteria and are mobilizable by ISs and integrative conjugative elements. These bacteria often coexpress mcr with virulence genes and other genes conferring resistance to HP-CIAs, such as extended-spectrum cephalosporins, carbapenems, fosfomycin, fluoroquinolone, and tigecycline. The transmission routes and dynamics of MGCB from the poultry sector in LMICs within the One Health triad include contact with poultry birds, feed/drinking water, manure, poultry farmers and their farm workwear, farming equipment, the consumption and sale of contaminated poultry meat/egg and associated products, etc. The use of pre/probiotics and other non-antimicrobial alternatives in the raising of birds, the judicious use of non-critically important antibiotics for therapy, the banning of nontherapeutic COL use, improved vaccination, biosecurity, hand hygiene and sanitization, the development of rapid diagnostic test kits, and the intensified surveillance of mcr genes, among others, could effectively control the spread of MGCB from the poultry sector in LMICs.

Epidemiology of companion animal AMR in the United States of America: filling a gap in the one health approach.

Antimicrobial resistance (AMR) is a global health concern that affects all aspects of the One Health Triad, including human, animal, and environmental health. Companion animals, such as cats and dogs, may contribute to the spread of AMR through their close contact with humans and the frequent prescription of antimicrobials. However, research on AMR in companion animals is limited, and there are few surveillance measures in place to monitor the spread of resistant pathogens in the United States. This study aims to explore the practicality of using data from commercial laboratory antimicrobial susceptibility testing (AST) services for epidemiological analyses of AMR in companion animals in the United States. The study analyzed 25,147,300 individual AST results from cats and dogs submitted to a large commercial diagnostic laboratory in the United States between 2019 and 2021, and found that resistance to certain antimicrobials was common in both E. coli and S. pseudintermedius strains. There has been a paucity of information regarding AMR in companion animals in comparison to human, environmental and other animal species. Commercial AST datasets may prove beneficial in providing more representation to companion animals within the One Health framework for AMR.

Equine Gram-Negative Oral Microbiota: An Antimicrobial Resistances Watcher?

Horses are considered as reservoirs of multidrug resistant bacteria that can be spread through the environment and possibly to humans. The aim of this study was to characterize the oral Gram-negative microbiota of healthy horses and evaluate their antimicrobial susceptibility profile in a One Health approach. For this purpose, samples were collected from the gingival margin of healthy horses, free of antimicrobial therapy, cultured in selective mediums, identified, and tested for antimicrobial susceptibility. Fifty-five Gram-negative isolates were identified, with 89.5% being zoonotic and 62% affecting humans, which were also found commonly in the environment. Forty-eight isolates (96%) were MDR. The phenotypic resistance presented as higher to macrolides (81.8%), β-lactams (55.4%), and quinolones (50%), and lower to sulfonamides (27.3%), tetracyclines, and amphenicols (both with 30.9%). In total, 51.5% of the isolates presented resistance to carbapenems. In addition to being the first report on the commensal oral microbiota of horses and respective susceptibility profile, this study highlights the horse as a valuable sentinel that can control the evolution and transmission of multidrug-resistant bacteria between the "One Health triad" since it is in contact with humans, other animals, and the environment, in different geographic locations.

Review on The Impact of Climate Change on Approach to Epidemiology of Livestock Diseases Control

The livestock sector globally is highly dynamic. In developing countries, it is evolving in response to rapidly increasing demand for livestock products. In developed countries, demand for livestock products is stagnating, while many production systems are increasing their efficiency and environmental sustainability. Currently, the world is facing a number of challenges, of which Global climate change is a priority area. Agriculture and livestock are amongst the most climate sensitive economic sectors in the developing countries. Climates comprises many factors including temperature, rainfall, humidity, winds and altitude hat can have both direct and indirect effects on animal production and health. It can also affect the quality and quantity of feedstuffs such as pasture, forage and grain and the severity and distribution of livestock diseases and parasites. Infectious diseases of animals are of huge socioeconomic and public health importance. The earth’s temperature has risen at an average of 0.3 to 0.7 °C since 1900 & 20-30% of all vertebrate animals are expected to get extinct if the average temperature rises by 2-3 °C. The early consequences of global climate change (GCC) are well documented. However, future impacts on ecosystem health, and on the health of humans, domestic animals, and wildlife, are much less well understood. A two-pronged approach must be adapted to tackle the alarming situation arising out of climate change impacts. Adaptation may involve the measures for future adaptation to the disease onslaught and the Mitigation focuses on reducing the level of agents/factors leading to the climate change. One health concept in one health triad needs to be followed in spirit to avert the otherwise sure to come impacts of climate change.

Impact of Emerging Pollutants on a Health Triad: Environment, Animals and Humans

Impact of Emerging Pollutants on a Health Triad: Environment, Animals and Humans

Cognitive, Affective and Psycomotoric Aspects Related Risky Sexual Behavior Among Adolescents at the University Level

The current phenomenon shows that teenagers are into the sexually active period quickly. This condition causes adolescents to be more vulnerable to experiencing adolescent reproductive health triad such as premarital sex, STI/HIV infections and drug abuse. Higher education is an educational institution whose students are teenagers who do not rule out experiencing these problems. This study aims to determine the cognitive, affective and psychomotoric factors related to risky sexual behavior among adolescents at the college level using a cross sectional approach. The research analysis sample was 750 students from 4 study programs in one of the universities in South Sumatra which were taken by using cluster random sampling technique. Data analysis includes univariable and bivariable analysis (chi square test). The results showed that 12% of students had risky sexual behavior where 3.5% had vaginal, anal or oral sex. In addition, the results of the bivariate analysis showed that the variables that were significantly related to risky sexual behavior included cognitive factors (knowledge), affective factors (attitudes, perceptions of norms, parental roles and self-efficacy) and psychomotoric factors (negative peer group behavior). This study recommends the need for access to adolescent-friendly reproductive health services with the principle of peer educator as a means of improving soft skills for adolescents related to adolescent reproductive health.

Knowledge, Attitudes and Behaviors of the Adolescent Reproductive Health Triad

Puberty is experienced by every teenager which is characterized by the maturity of the reproductive organs thus triggering the sexual impulse. If the sexual drive in adolescents is not controlled then it is at risk to the Adolescent Reproductive Health Triad. The purpose of the study was to determine the relationship between knowledge and attitudes with the behavior of the Reproductive Health Triad at SMK Duta Pratama Indonesia Tasikmalaya City in 2021. This type of research is an analytical survey using a cross sectional design. The population and sample of this study are all students of SMK Duta Pratama Indonesia based on inclusion criteria. The instrument uses Gform and the data are analyzed univariately and bivariately. The results showed that the average knowledge score was 4.54, the average attitude score was 17.21, and the average behavior score was 5.51. There is no relationship between knowledge and behavior of the Adolescent Reproductive Health Triad p value = 0.135, and there is a relationship between attitudes and behavior of the Adolescent Reproductive Health Triad p value = 0.043. From the results of the study, it can be concluded that there is no relationship between knowledge and behavior of the Adolescent Reproductive Health Triad and there is a relationship between attitudes and behaviors of the Adolescent Reproductive Health Triad. It is hoped that the school can instill spiritual values and provide adolescent reproductive health education in preventing risky behaviors in students.

Antimicrobial Resistance in New Zealand-A One Health Perspective.

Antimicrobial resistance (AMR) is an increasing global threat that affects human, animal and, often less acknowledged, environmental health. This complex issue requires a multisectoral One Health approach to address the interconnectedness of humans, animals and the natural environment. The prevalence of AMR in these reservoirs varies widely among countries and thus often requires a country-specific approach. In New Zealand (NZ), AMR and antimicrobial usage in humans are relatively well-monitored and -understood, with high human use of antimicrobials and the frequency of resistant pathogens increasing in hospitals and the community. In contrast, on average, NZ is a low user of antimicrobials in animal husbandry systems with low rates of AMR in food-producing animals. AMR in New Zealand’s environment is little understood, and the role of the natural environment in AMR transmission is unclear. Here, we aimed to provide a summary of the current knowledge on AMR in NZ, addressing all three components of the One Health triad with a particular focus on environmental AMR. We aimed to identify knowledge gaps to help develop research strategies, especially towards mitigating AMR in the environment, the often-neglected part of the One Health triad.

The health and environment relationship of the peoples of the Amazon rainforest

The present work arose from the reflections arising from the classes taught in the field of health, society and the environment, at the PPGEAA (Programa de Pós-graduação em Estudos Antrópicos na Amazônia) and aims to articulate the relationships between these conceptions from the intertwining with the thematic proposal arising from the student research project presented to the program. To this end, this article presents a study on cosmologies and indigenous thought with regard to the way in which these societies organize themselves, coexist and conceive the triad of health, society and environment. Even so, it is necessary to understand the multiple ways in which these societies conduct their social practices based on their beliefs recurrently interconnected with elements present in nature. The methodology used in this work consists of bibliographical research from the selection of texts that dialogue with the thematic proposal in question. The theoretical framework of this research is based on the work of authors who focus on the concepts treated or who in some way complement the dialogue of this research. The knowledge, beliefs and practices disseminated through the indigenous tradition were, for a long time, marginalized, ignored or mistakenly viewed by the foreign gaze and the ethnocentric issue in the figure of the colonizer. With that, it is expected with this work, to provide a critical, plural and interdisciplinary interpretation from the reflection on the indigenous thought in the present time.

From gut to mud: dissemination of antimicrobial resistance between animal and agricultural niches.

With increasing reports on antimicrobial resistance (AMR) in humans, animals and the environment, we are at risk of returning to a pre-antibiotic era. Therefore, AMR is recognized as one of the major global health threats of this century. Antibiotics are used extensively in farming systems to treat and prevent infections in food animals or to increase their growth. Besides the risk of a transfer of AMR between the human and the animal sector, there is another yet largely overlooked sector in the One Health triad. Human-dominated ecosystems such as agricultural soils are a major sink for antibiotics and AMR originating from livestock farming. This review summarizes current knowledge on the prevalence of AMR at the interface of animal and agricultural production and discusses the potential implications for human health. Soil resistomes are augmented by the application of manure from treated livestock. Subsequent transfer of AMR into plant microbiomes may likely play a critical role in human exposure to antibiotic resistance in the environment. Based on the knowledge that is currently available we advocate that more attention should be paid to the role of environmental resistomes in the AMR crisis.

Environmental health: The most neglected part of one health

One health concept and perspectives have gained momentum in past few years in global health sector. Keeping in view the increased popularity of “one health” American Veterinary & Medical Association has defined it as the emerging interdisciplinary field that inherently collaborates human, animal and environmental aspects to combat emerging global health problems especially related to zoonotic public health emergencies. According to key findings of “One Health Networks (OHNs)” environmental factor is the most neglected part of one health triad that consists of human-animal-environment interface. Currently, human and animal health has been constantly threatened by rise of novel challenges like antimicrobial resistance, environmental pollution, epizootics, pandemics, development of multifactorial chronic ailments etc which needs an interdisciplinary and intersectoral expertise. Ecosystem heath and its adverse effects on human and animal health have gained greatest attention over recent years as it serves as melting pot for all infectious diseases. Despite of achieving global success in the field of “One health” it is still in embryonic stage in our country. So, the success of one health requires breaking down the shackles that still separate human and veterinary medicine from environmental, evolutionary and ecological sciences that will ultimately lead to desired equilibrium and dynamics in maintaining healthy ecosystems.