High-risk Countries Research Articles

Risk of introducing Zika virus in the Canadian cord blood supply: A risk analysis.

In Canada, as many as 24% of mothers are deferred from cord blood (CB) donation due to risk factors for Zika virus (ZIKV). However, the ZIKV epidemic has waned considerably since 2016, and there has not been any report of ZIKV transmission by CB transplantation, which questions this policy. Thus, we performed an analysis of the risk of introducing ZIKV in the CB supply maintained by Héma-Québec (HQ) and Canadian Blood Services (CBS). This simulation considered the following parameters: the risk of travel exposure in a high-risk ZIKV country, the duration of travel, the daily risk of acquiring ZIKV in a high-risk country, the probability of materno-fetal ZIKV transmission, the probability of asymptomatic fetal viremia, and the probability of sexual transmission. A hundred million Monte Carlo simulations were run. In the most-likely scenario (probability of traveling to a high-risk ZIKV country while pregnant = 0.178), the risk was estimated at 0.9 ZIKV-positive donations per million donations (95% confidence interval [CI] = 0.4-1.6)-or one every 868 years at HQ and one every 453 years at CBS. In the pessimistic model (probability of traveling to a high-risk ZIKV country while pregnant = 0.240), the risk was estimated at 1.2 ZIKV-positive donations per million donations (95% CI = 0.6-2.1)-or one every 644 years at HQ and one every 340 years at CBS. We conclude that the risk of introducing ZIKV in the Canadian CB supply is too small to justify maintaining the current policy.

Awareness of personal cardiovascular risk among the adults with an elevated body mass index in a very high-risk country

Abstract Background An elevated body mass index (BMI) is a risk factor for cardiovascular diseases (CVD). The awareness of personal cardiovascular risk (pCVR) may vary in different populations, thus influencing health behaviours and cardiovascular prevention. Purpose To analyse the awareness of pCVR among the adults with an elevated BMI, along with sociodemographic characteristics and cardiovascular risk factors (CRF) possibly associated with the lack of pCVR awareness in a very high-risk country. Methods The pilot study included a convenient sample of 1054 adults. Those with an elevated BMI (≥25 kg/m2) were divided into two groups depending on their awareness of pCVR. The groups were compared according to the sociodemographic characteristics (age, gender, and education) and CRF (BMI, hypertension, dyslipidaemia, diabetes mellitus, smoking, physical inactivity, feeling of frequent exposure to stress, previous myocardial infarction (MI), and family history for CVD). The data were collected by voluntary filling out a survey with multiple-choice questions from April 1st to June 30th, 2022. Results Out of the total number, about half of the participants had an elevated BMI (N=549, 52%). Most of them were aware of their pCVR (69% vs 31%, p<0.01). Those unaware of pCVR were younger (44±13 vs 51±14, p<0.05), mostly females (56% vs 47%, p<0.05), with high education (61% vs 51% with more than high school, p<0.05). The groups had similar average BMI (28±3 kg/m2 vs 29±3 kg/m2, p>0.05), but the participants unaware of pCVR were more frequently overweight than obese (82% vs 64% with BMI ≥25 kg/m2 and <30 kg/m2, p<0.01). They had significantly lower frequencies of hypertension (15% vs 53%, p<0.01), dyslipidaemia (23% vs 46%, p<0.01), diabetes mellitus (2% vs 14%, p<0.01), smoking (50% vs 59%, p<0.05), previous MI (3% vs 26%, p<0.01), and family history for CVD (62% vs 82%, p<0.01). However, the majority in both groups reported physical inactivity (60% vs 64%, p>0.05) and a feeling of frequent stress exposure (70% vs 71%, p>0.05). The participants unaware of pCVR less frequently had over three modifiable CRF (12% vs 37%, p<0.01). Conclusion Most of the adults with an elevated BMI in a very high-risk country are aware of pCVR, usually because of obesity, multiple additional modifiable CRF, previous MI, or family history of CVD. Still, a notable proportion of the adults with an elevated BMI in a very high-risk country is unaware of pCVR, which is associated with younger age, female gender, high education, overweight, fewer additional modifiable CRF, and the absence of previous MI or family history for CVD. This subpopulation should be considered as a target for timely health education to raise the awareness of pCVR. Increasing physical activity through motivational campaigns and developing programmes for stress relief would be important for CVD prevention among the adults with an elevated BMI, independently of pCVR awareness.

Yellow fever in Ghana: Predicting emergence and ecology from historical outbreaks.

Understanding the epidemiology and ecology of yellow fever in endemic regions is critical for preventing future outbreaks. Ghana is a high-risk country for yellow fever. In this study we estimate the disease burden, ecological cycles, and areas at risk for yellow fever in Ghana based on historical outbreaks. We identify 2387 cases and 888 deaths (case fatality rate 37.7%) from yellow fever reported in Ghana from 1910 to 2022. During the approximately 30-year periods before and after implementation of routine childhood vaccination in 1992, the reported mean annual number of cases decreased by 80%. The geographic distribution of yellow fever cases has also changed over the past century. While there have been multiple large historical outbreaks of yellow fever in regions throughout Ghana, recent outbreaks have originated in northern regions. Comparing the locations where yellow fever outbreaks have emerged, we find patterns with seasons and different ecological transmission cycles. Using an ecological niche modeling framework, we predict areas in Ghana that are similar to where prior yellow fever outbreaks have originated based on temperature, precipitation, vegetation, and human population density. We find that these predictions differ depending on the ecological cycles of outbreaks. Ultimately, these findings and methods could be used to inform further subnational risk assessments for yellow fever in Ghana and other high-risk countries.

P183 PERIPARTUM CARDIOMYOPATHY: MONOCENTRIC DESCRIPTION AT THE NORTHERN REGIONAL MATERNITY HOSPITAL OF THE DOMINICAN REPUBLIC

Background: Peripartum cardiomyopathy (PPCM) is a pathology in which the woman's heart dilates and displays signs and symptoms of heart failure. It is a rare pathology, with a high mortality rate, and predominance in black patients. Its diagnosis and management are not standardized, nor adapted to low income countries. This leads to barriers in identifying and treating the disease in higher-risk countries such as Haiti, making it a relevant issue in the Dominican Republic due to high immigration of haitians to the country. Therefore we aimed to evaluate the association of risk factors and the pharmacological regimen of patients in a public healthcare center in the Dominican Republic. Methods: An observational, retrospective, cross-sectional study was carried out with convenience sampling. This included patients who had been admitted to the Presidente Estrella Ureña Regional Hospital with suspected PPCM during the last 3 years. Variables studied include: sociodemographic factors, toxic habits, pathological and gynecological-obstetric history, cardiovascular, pulmonary and general signs and symptoms. Results: A sample of 19 patients with a median age of 27 years was obtained, 73.4% of them were black. All of the patients who had illness onset in the peripartum period (first 28 days after labor) presented adverse events, infectious comorbidities and “other comorbidities” while 75% of them presented cardiac and pulmonary comorbidities. Regarding treatment, only 77.8% of patients with antepartum onset received treatment in this period. Additionally, 66.7% of patients with antepartum onset developed adverse events that required oxygen-supplementation, versus only 33% of those without adverse events. Conclusions: It is relevant to design tools for calculating the risk of developing PPCM and standardize its disparate diagnosis and treatment, particularly aimed at countries with limited resources. This aims to improve the prognosis in patients with risk factors such as: black race, age over 30 years and living in low/middle-resource countries.

Recent update on cerebral sparganosis: A bibliometric analysis and scientific mapping.

Human sparganosis, a parasitic infection prevalent in Asia, can progress to cerebral sparganosis, a severe condition with significant neurological symptoms. Diagnosis and treatment are challenging due to its clinical similarity to other infections, highlighting the need for improved detection and management strategies. The aim of this study was to observe research trends, key contributors, gaps in the existing knowledge, diagnosis challenges, effective treatment options, and prevention strategies, providing recommendations for future research directions and clinical practice improvements on cerebral sparganosis. A bibliometric analysis was conducted by extracting 139 documents from the Scopus database in June 2024. The retrieved data were analyzed using the R package's Bibliometrix (Biblioshiny) and VOSviewer. Spanning 97 different sources, the research exhibited an annual growth rate of 2.5%. Annual scientific production revealed fluctuating research activity with peaks in 2010 and 2011 and notable citation peaks in 1996 and 2005, indicating pivotal studies that significantly influenced subsequent research. Early studies focused on diagnosis and specific parasites, while recent studies (2010-2024) have increasingly addressed clinical outcomes, treatment strategies, and advanced diagnostic techniques. Trends revealed a shift towards clinical and diagnostic advancements, with recent emphasis on diagnostic imaging, immunoassays, and the relationship between cerebral sparganosis and brain tumors. In conclusion, the studies on cerebral sparganosis underscore the potential for enhancing clinical practice by improving diagnostic accuracy, informing treatment decisions, and implementing targeted screening efforts based on epidemiology and risk factors. Recommendation to further study needs to notify the cerebral sparganosis in high-risk countries with similar socioeconomic and cultural characteristics to endemic regions, including Indonesia.

Leveraging social computing for epidemic surveillance: A case study

Social media platforms have become a popular source of information for real-time monitoring of events and user behavior. In particular, Twitter provides invaluable information related to diseases and public health to build real-time disease surveillance systems. Effective use of such social media platforms for public health surveillance requires data-driven AI models which are hindered by the difficult, expensive, and time-consuming task of collecting high-quality and large-scale datasets. In this paper, we build and analyze the Epidemic TweetBank (EpiBank) dataset containing 271 million English tweets related to six epidemic-prone diseases COVID19, Flu, Hepatitis, Dengue, Malaria, and HIV/AIDs. For this purpose, we develop a tool of ESS-T (Epidemic Surveillance Study via Twitter) which collects tweets according to provided input parameters and keywords. Also, our tool assigns location to tweets with 95% accuracy value and performs analysis of collected tweets focusing on temporal distribution, spatial patterns, users, entities, sentiment, and misinformation. Leveraging ESS-T, we build two geo-tagged datasets of EpiBank-global and EpiBank-Pak containing 86 million tweets from 190 countries and 2.6 million tweets from Pakistan, respectively. Our spatial analysis of EpiBank-global for COVID19, Malaria, and Dengue indicates that our framework correctly identifies high-risk epidemic-prone countries according to World Health Organization (WHO) statistics.

Epidemiological analysis of pulmonary tuberculosis and extra-pulmonary tuberculosis in Saudi Arabia: a cross-sectional study

Tuberculosis (TB) is a serious disease that affects people worldwide, including in Saudi Arabia. The study analyzed the frequency of diagnosed TB cases, age-specific incidence rate, year of diagnosis, and prevalence of TB in Saudi Arabia from 2014 to 2020. Based on the National Tuberculosis Program (NTP) data, 21,120 patients were diagnosed with TB. The mean incidence rate of pulmonary TB and extra-pulmonary TB was approximately 6.92 and 2.33 per 100,000 population, respectively. The highest age-specific incidence rate was observed in the 25–35 year age group. The non-Saudi population (11,086 cases; 52.50%) was significantly more affected by both types of TB compared to the Saudi population (10,034 cases; 47.50%). The male population of Saudi and non-Saudi was significantly more affected by both types of TB. The highest overall mean incidence rate per 100,000 population was observed in the Jeddah and Jazan regions. The study's findings may have implications for supporting public health interventions and implementing a more effective TB control strategy program in Saudi Arabia. It suggests that immigrants from TB-endemic countries and religious visitors from high-risk countries should undergo pre and post-arrival screening for TB to reduce its incidence.

How Botswana and Mauritius Exited the EU High-Risk Third Country List by Adapting Their Approaches to Beneficial Ownership and Residence

On 22 February 2022, the Mauritian Ministry of Financial Services and Good Governance issued a communique reporting the country’s removal from the European Union (‘EU’) List of High-Risk Third Countries. This list is also called the Anti-money Laundering and Countering Terrorist Financing List (‘AML/CTF’); or, less affectionately, the Blacklist. Mauritius issued this report a month after the European Union released its Commission Delegated Regulation (EU) 2022/229, removing Botswana and Mauritius from the AML/CTF. The EU placed Mauritius and Botswana on the Blacklist in May 2020 after adopting updated criteria for assessing high-risk third countries and publishing its revised methodology for identifying these high-risk jurisdictions. These updated criteria and procedures relegated the tax regimes of Mauritius and Botswana as strategically ‘[deficient] on anti-money laundering and counter-terrorist financing…,’ such that they ‘pose significant threats to the financial system of the Union.’ Placement on the Blacklist encumbers States with increased monitoring, regulatory requirements, and global trade restrictions that can result in a heavy economic toll. Moreover, to exit the list, countries must remediate deficiencies in cooperation with the EU and Financial Action Task Force (‘FATF’), each of which must be satisfied with the improvements made. Mauritius and Botswana passed a bevy of substantial laws in just over a year to satisfy the EU and FATF, earning an exit from the Blacklist. Among the many changes, enhancements to each country’s transparency measures were central. Adopting new approaches to beneficial ownership and residence in each country is at the core of this transparency. This work will explore how Mauritius and Botswana leveraged new approaches to beneficial ownership and residence to meet EU standards for tax regime transparency, resulting in each country’s removal from the EU Blacklist. This analysis will begin with an economic overview of Mauritius and Botswana. What follows will be an introduction to the EU AML/CTF list, followed by how and why the EU placed Mauritius and Botswana on the list. Finally, this work will look at how Mauritius and Botswana exited the list, and what that exit means for each country and other countries like them.

Molecular epidemiology of enteroviruses from Guatemalan wastewater isolated from human lung fibroblasts.

The Global Specialized Polio Laboratory at CDC supports the Global Poliovirus Laboratory Network with environmental surveillance (ES) to detect the presence of vaccine strain polioviruses, vaccine-derived polioviruses, and wild polioviruses in high-risk countries. Environmental sampling provides valuable supplementary information, particularly in areas with gaps in surveillance of acute flaccid paralysis (AFP) mainly in children less than 15 years. In collaboration with Guatemala's National Health Laboratory (Laboratorio Nacional de Salud Guatemala), monthly sewage collections allowed screening enterovirus (EV) presence without incurring additional costs for sample collection, transport, or concentration. Murine recombinant fibroblast L-cells (L20B) and human rhabdomyosarcoma (RD) cells are used for the isolation of polioviruses following a standard detection algorithm. Though non-polio-Enteroviruses (NPEV) can be isolated, the algorithm is optimized for the detection of polioviruses. To explore if other EV's are present in sewage not found through standard methods, five additional cell lines were piloted in a small-scale experiment, and next-generation sequencing (NGS) was used for the identification of any EV types. Human lung fibroblast cells (HLF) were selected based on their ability to isolate EV-A genus. Sewage concentrates collected between 2020-2021 were isolated in HLF cells and any cytopathic effect positive isolates used for NGS. A large variety of EVs, including echoviruses 1, 3, 6, 7, 11, 13, 18, 19, 25, 29; coxsackievirus A13, B2, and B5, EV-C99, EVB, and polioviruses (Sabin 1 and 3) were identified through genomic typing in NGS. When the EV genotypes were compared by phylogenetic analysis, it showed many EV's were genomically like viruses previously isolated from ES collected in Haiti. Enterovirus occurrence did not follow a seasonality, but more diverse EV types were found in ES collection sites with lower populations. Using the additional cell line in the existing poliovirus ES algorithm may add value by providing data about EV circulation, without additional sample collection or processing. Next-generation sequencing closed gaps in knowledge providing molecular epidemiological information on multiple EV types and full genome sequences of EVs present in wastewater in Guatemala.

Rabies knowledge gaps and risk behaviour in Dutch travellers: An observational cohort study

BackgroundTravellers visiting rabies-endemic countries are at risk of rabies infection. Assessing travellers’ knowledge and risk perception of rabies and risk behaviour during travel can help identify knowledge gaps and improve pre-travel risk education. MethodsCohort study in Dutch adult travellers, using two surveys: one before travel to assess knowledge and perception of rabies, and one after return to identify risk behaviour during travel. ResultsThe pre-travel and post-travel survey were completed by 301 and 276 participants, respectively. 222 participants had travelled to a high-risk rabies-endemic country. 21.6 % of the participants scored their rabies knowledge as poor. Some participants were unaware cats or bats can transmit rabies (26.6 % and 13.6 %, respectively), or that post-exposure prophylaxis (PEP) is required for certain exposures such as skin abrasions without bleeding or licks on damaged skin (35.5 % and 18.9 %, respectively), while 27.9 % of participants did not know PEP needs to be administered within one day. 115 participants (51.8 %) reported any form of contact with any animal during travel. Two participants reported animal exposure, of which one took adequate PEP measures. Risk factors for animal contact abroad were regularly touching cats or dogs at home or abroad, longer travel duration, having pets during childhood and being an animal lover. ConclusionsPre-travel rabies risk education currently does not meet travellers’ needs, which is reflected in knowledge gaps and engagement in risk behaviour during travel. During pre-travel health advice, avoiding animal contact abroad should be emphasized, and additional education is required about indications for PEP.

Prevalence, clinical and virological characteristics and short-term prognosis of hepatitis delta infection among patients with HIV/HBV in Nouakchott, Mauritania.

Patients living with HIV infection (PLWH) are at risk of acquiring HBV and HDV. The present study aimed to determine the prevalence and characteristics of HIV-HDV-HBV tri-infection in comparison with HIV-HBV coinfection and to estimate severities and outcomes of associated liver diseases in Mauritanian PLWH. Two-hundred-ninety-two consecutive HBsAg-positive PLWH were included (mean age: 37 years). Clinical data were recorded. Anti-HDV antibodies, HBV and HDV viral loads (VLs) and genotype were determined. APRI, FIB-4 and FibroScan were performed to evaluate the severity of liver disease. The anti-HDV antibodies prevalence was 37% and HDV RNA was positive in 40.7% of patients. Genetic diversities were found with HDV genotype 1 (93%) and HBV genotypes D (42.5%) and E (38%). The HBV VL was detectable in 108 patients at inclusion, and mutations associated with HBV resistance were found in 20. For almost all variables studied, including FIB-4 and APRI scores, no significant differences were found between anti-HDV-Ab positive or negative patients. FibroScan examination, which was performed in 110 patients at end-of-follow-up showed higher, but NS values, in HDV positive patients. After a mean follow-up of 24.55 ± 8.01 months (n = 217 patients), a highly significant worsening of APRI and FIB-4 scores was found. Moreover, patients with HDV showed more severe liver disease progression despite an efficient therapy. In a substantial Mauritanian cohort of relatively young PLWH, we found high HDV prevalence and worsening liver disease. In high-risk countries, screening for HDV and providing appropriate follow-up and treatments are warranted in PLWH.

A Study of Insurance Company Underwriting Strategies Based on TOPSIS Entropy Weights and Cost-Benefit Analysis

Frequent extreme weather events triggered by climate change pose an increasing risk to property owners and insurance companies. To address this challenge, this paper explores how to optimize resource allocation strategies for property insurance with the aim of improving the ability of the insurance system to pay future claims while safeguarding the long-term stability of the company. In order to give an underwriting strategy for disaster-prone areas, the number of natural disasters, the number of people affected, and the economic losses are screened as key influencing factors. Subsequently, TOPSIS entropy weighting analysis was used to assign appropriate weights to these factors, and the K-mean algorithm was used to cluster these data into low, medium, and high-risk levels. To more accurately assess underwriting risk, I constructed an underwriting risk assessment model using cost-benefit analysis. Applied to the U.S. and Switzerland, the scores were 0.49 and 0.02, respectively. This suggests that the U.S. is a high-risk country and cannot be insured, while Switzerland is in a low-risk area and can be insured.

Validation of the European Society of Cardiology pretest probability models for obstructive coronary artery disease in high-risk population

ObjectiveThe pre-test probability (PTP) model for obstructive coronary artery disease (CAD) was updated in 2019 by the European Society of Cardiology (ESC). To our knowledge, this model was never externally validated in a population with a high incidence of CAD. The aim of this study is to validate the new PTP ESC model in our population, which has a high CAD incidence, and to compare it with the previous PTP ESC model from 2013. MethodsWe retrospectively analysed 1294 symptomatic patients with suspected CAD referred to our centre between 2015 and 2019. In all patients, the PTP score was calculated based on age, gender, and symptoms according to the ESC model from 2013 (2013-ESC-PTP) and 2019 (2019-ESC-PTP). All patients underwent invasive coronary angiography (ICA). ResultsOf the 1294 patients, obstructive CAD was diagnosed in 533 patients (41.2%). The 2019-ESC-PTP model categorised significantly more patients into the low probability group (PTP < 15%) than the 2013-ESC-PTP model (39.8% vs. 5.6%, p < 0.001). Obstructive CAD prevalence was underestimated using 2019-ESC-PTP at all PTP levels (calibration intercept 1.15, calibration slope 0.96). The 2013-ESC-PTP overestimated obstructive CAD prevalence (calibration intercept −0.24, calibration slope 0.73). The discrimination measured with an area under the curve was similar for both models, indicating moderate accuracy of the models. ConclusionIn high-risk Serbian population, both the 2013 and 2019 ESC-PTP models had moderate accuracy in diagnosing CAD, with the 2019-ESC-PTP underestimating the prevalence of CAD and the 2013-ESC-PTP overestimating it. Further studies are warranted to establish PTP models for high-risk countries.

Nursing practices to optimise rheumatic fever prevention in a high-risk country: An integrative review.

New Zealand is one of the last high-income countries in the world experiencing significant rates of rheumatic fever. Nurses play a crucial role in rheumatic fever prevention; however, little is understood as to how nurses can best achieve this. To explore nursing practices that optimise rheumatic fever prevention. An integrative review. Four electronic databases (CINAHL, SCOPUS, Medline via, and Ovid) were searched for peer-reviewed empirical articles published from 2013 to 2023. Grey literature (guidelines/reports) was also sourced. Critical appraisal was applied using the Mixed-Methods Appraisal Tools and the Joanna Briggs Critical Appraisal checklist. Qualitative Research in Psychology, 3(2), 77-101, thematic analysis method was used to generate themes. Seven research articles and three national reports were included. Four themes-in-depth nursing knowledge and improving prophylaxis adherence, cultural competency, and therapeutic nurse-patient relationships-were found. While nursing knowledge and ways to improve injection adherence are essential, being culturally receptive and developing therapeutic relationships are equally important. Without strong and trusting relationships, it is difficult to deliver care required for prevention success. When working with vulnerable populations it is important to be culturally receptive in all interactions with patients and their families. New Zealand has high rates of rheumatic fever, especially among vulnerable populations such as Pacific Islanders and Māori. Nurses are often frontline primary care providers who, when skilled with the right tools, can help reduce the prevalence of this disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow chart. No Patient or Public Contribution was required for this research.

Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study.

Hepatitis B virus (HBV) infection has been associated with chronic hepatitis and cirrhosis. Patients with inflammatory bowel disease (IBD) may be at a higher risk of HBV infection reactivation, especially those on biologic therapies. This study intends to compare the effectiveness of the HBV vaccine in patients with ulcerative colitis (UC) on infliximab (IFX) compared to those on 5-aminosalicylic acid (5-ASA). Patients with UC aged >18 years old were prospectively enrolled in the study. The patients were divided into two groups: patients treated with 5-ASA (control group) and patients treated with IFX (study group). HBV vaccination was administered (20 mcg) following the standard regimen, and Hepatitis B serum antibody (HbsAb) titers were assessed three months after the final dose. The response to HBV vaccines was categorized as an 'adequate' immune response (≥10 IU/L) and 'effective' immune response (≥100 IU/L). In our final analysis of 118 patients with UC, 54.2% were male and 52.5% had extensive colitis. HBsAb titer levels were significantly higher in the 5-ASA group (126.7 ± 37.5) compared to the IFX group (55.5 ± 29.4). Stratifying HBsAb levels into two categories (≥10-99 IU/L and ≥100 IU/L) revealed a significantly greater proportion of subjects in the 5-ASA group with levels ≥100 IU/L compared to the IFX group (76.7% vs. 12.1%, p < 0.001). Logistic regression analysis demonstrated that patients with UC receiving 5-ASA were 23.94 times more likely to exhibit HBsAb levels ≥ 100 compared to those treated with IFX (OR = 23.94, 95% CI 8.89-64.49). The immune response to hepatitis B vaccination in patients with ulcerative colitis treated with IFX is attenuated compared to those treated with 5-ASA. Therefore, emphasizing the importance of HBV vaccination for patients with IBD before starting anti-TNF therapy, especially IFX, and advocating for screening is imperative in high-risk countries. Determining what levels of HBsAb provide protection and what happens to the levels over time after a booster dose are important clinical questions to be answered by follow-up studies.

Twenty years since the Madrid attacks. Spain’s anti-terrorist security issues

The aim of the article is to present the causes, chronological course and effects of the attack carried out on 11 March 2004 in Madrid, taking into account differences and contradictions in reports about these events. The author analyses the actions taken by the Spanish authorities to ensure anti-terrorist security in the country, including the creation of structures to fight Islamic terrorism and Muslim extremism. He also discusses the problems and challenges faced by Spanish services fighting political violence and illegal migration of people from high-risk countries, which affect the state of state security.

Frostbite incidence is a selective term and dependable on methodology — a narrative review

Introduction: Frostbite is freezing of the tissue that mostly affects skin but also the underlying tissues. It results from prolonged exposure to temperatures below the freezing point of water (0°C). One of the many consequences of climate change is extreme cold events, which increase the risk of frostbite in the general population, particularly among individuals who are involuntarily exposed to cold for prolonged periods of time. Although frostbite has been a known phenomenon for a long time, occurring as early as 5000 years ago, the exact incidence of frostbite is not known. This is partly due to variable internal (frostbite susceptibility, hydration status, protective garments) and external etiological factors (wind chill, precipitation, altitude), that never coincide all at the same time. Objectives: The objective was to compare the incidence rates of frostbite in the published studies that focused on frostbite incidence. Methods: Out of a total of 61 studies using the keywords “frostbite” and “incidence” on PubMed, we selected seven that dealt with frostbite incidence over 20 years. We briefly summarized and compared the results of the studies. Results: The comparison of the seven studies shows a great variability of frostbite incidence depending on the population, its size, and the method of data collection. Studies that included civilian populations have significantly lower frostbite incidence rates than studies focusing on individuals who are exposed to temperatures below 0°C for extended periods, such as mountaineers, military personnel, workers in cold storage houses or homeless people. The results highlight different incidence rates for different populations and indicate that retrospectively collected data are insufficiently comparable among studies. Frostbite incidence, expressed as the ratio of injured individuals to non-injured inhabitants, is only comparable in studies using the same methodology. Enhanced frostbite susceptibility is a confirmed fact and was generally not considered in most of the studies. Conclusions: Frostbite incidences of the included studies are insufficiently comparable to draw any conclusions on possible general frostbite incidence in a population. To enhance our ability to estimate or predict frostbite occurrences within the general population, establishing an international or national frostbite registry in high-risk countries could be helpful.

Unveiling the role of climate in spatially synchronized locust outbreak risks.

Desert locusts threaten crop production and food security. Spatially synchronized locust outbreaks further exacerbate these crises. Continental-scale understanding of such compound locust risks and underlying climatic drivers is crucial to designing coordinated and predictive control strategies but remains elusive. Here, we develop a data-driven framework to assess the compound risk of locust outbreaks in the Middle East and North Africa (MENA) and elucidate the role of climate in locust dynamics. We find that more than one-fifth of high-risk country pairs faced spatially synchronized locust risks from 1985 to 2020, dominated by concurrent winds or inundations. Individual locusts are more prone to infest arid areas punched by extreme rainfall. The spatial prevalence of locusts is strongly modulated by climate variability such as El Niño-Southern Oscillation. A warming climate will lead to widespread increases in locust outbreaks with emerging hotspots in west central Asia, posing additional challenges to the global coordination of locust control.

Incorporating One Health into a front-line field epidemiological training programme in Papua New Guinea: lessons learned.

Over the past two decades, there has been increased recognition of the importance of a more holistic approach to preventing, predicting, detecting and responding to public health threats. The COVID-19 pandemic highlighted the need to bring together environmental, human and animal health sectors in addressing public health threats and the need to develop skilled front-line workers to act as surge capacity during health emergencies. Papua New Guinea is a high-risk country for emerging and re-emerging pathogens. The effects of climate change, human-mediated encroachment on natural habitats and destructive land-use practices have threatened ecosystems and caused environmental damage. The movement of goods, animals and people over porous borders provides opportunities for the introduction and spread of new pathogens. In recognition of the importance of multisectoral responses to health threats in Papua New Guinea, and the need to train front-line workers, we designed and piloted a 3-month One Health in-service training programme for front-line workers from across all sectors. The co-creation of curricula was essential in ensuring the relevance of the programme to front-line workers from multiple sectors, and the development of provincial training teams was key to ensuring mentorship and programme sustainability. Bringing front-line workers together in joint trainings facilitated the building of relationships, the understanding of the roles and responsibilities of the various sectors, the identification of sectoral focal points and the development of informal networks. Papua New Guinea's One Health front-line Field Epidemiology Training Program demonstrated that investment in cross-sectoral training programmes can be a catalyst for the implementation of One Health approaches on the front line.

P914 Immunogenecity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Monotherapy : A Prospective Comparative Study

Abstract Background Hepatitis B virus (HBV) infection has been associated with chronic hepatitis and cirrhosis. Patients with inflammatory bowel disease (IBD) maybe at higher risk of HBV infection, especially those on biologic therapies. There is limited data on the effectiveness of HBV vaccination in patients with IBD receiving different types of IBD medications. This study intends to compare the effectiveness of HBV vaccine in patients with ulcerative colitis (UC) on Infliximab (IFX) compared to those on 5-aminosalicylic acid (5-ASA). Methods Patients with UC aged between 18-85 years were prospectively enrolled in the study. The patients were divided into two groups: group 1 ( patients with UC on 5-ASA) and group 2 (patients with UC on IFX). HBV vaccination was administered (20 mcg) following the standard regimen, and Hepatitis B serum antibody (HbsAb) titres were assessed three months after the final dose. The response to HBV vaccines was categorized as 'adequate' immune response (≥10 IU/L) and 'effective' immune response (≥100 IU/L). Results In our final analysis of 118 patients with UC, 54.2% were male, and 52.5% had extensive disease. HBsAb titer levels were significantly higher in the 5ASA group (126.7 ± 37.5) compared to the IFX group (55.5 ± 29.4). Stratifying HBsAb levels into two categories (≥10-99 IU/L and ≥100 IU/L) revealed a significantly greater proportion of subjects in the 5-ASA group with levels ≥100 IU/L (76.7%) compared to the IFX group (12.1%). Conversely, the IFX group showed a higher percentage of subjects with levels between 10-99 IU/L (87.9%) relative to the 5-ASA group (23.3%). Logistic regression analysis demonstrated that patients with UC receiving 5-ASA were 23.94 times more likely to exhibit HBsAb levels ≥100 compared to those on IFX (OR 23.94, 95% CI 8.89-64.49). Conclusion Immune response to hepatitis B vaccination in patient with ulcerative colitis on infliximab is attenuated compared to those on 5-ASA. Therefore emphasizing the importance of HBV vaccination for patients with IBD before starting anti-TNF therapy, especially infliximab, and advocating for screening is imperative in high risk countries.