Implementation Of Strategies Research Articles

Review article: Prevention of inflammatory bowel disease-The path forward.

The possibility of preventing inflammatory bowel disease (IBD) is becoming more plausible due to advances in understanding preclinical disease and successful prevention trials in other immune-mediated diseases, such as type 1 diabetes and rheumatoid arthritis. However, before that possibility becomes reality, several efforts need to occur in parallel and in a coordinated way. To propose some critical steps necessary for advancing the field of IBD prediction and prevention. We reviewed the current literature to identify the necessary steps toward a preventive strategy for IBD. The first step should determine the most robust predictive biomarkers and validate them across independent cohorts, creating a multidimensional predictive tool. The second step is to gain a better understanding of the preferences of first-degree relatives and people at risk for IBD, informing the implementation of screening and preventive strategies. Third, these efforts should contribute to the development of high-risk clinics and establish the necessary networks for disease prevention trials. Advancing the field of IBD prediction and prevention will require a multifaceted approach, integrating biomarker discovery, understanding patient preferences, and establishing infrastructure for a collaborative network to support the practical implementation of IBD prevention strategies.

Life Cycle Assessment of an Avocado: Grown in South Africa-Enjoyed in Europe.

Food production is known to have significant environmental impacts, with the main contributors residing in the farming and transportation life cycle phases. Of the various food products transported around the world, avocados have increasingly gained attention as a high-commodity superfood. Avocados require specific climatic and agricultural conditions for farming, with the most fertile land and conditions located outside Europe. Consequently, most avocados consumed in Europe are imported over vast geographical distances, with little information available to quantify the environmental impacts of this imported superfood. This paper aims to present the most detailed life cycle assessment results of an avocado cultivated, grown and harvested in the Limpopo Province of South Africa and exported to the European market for sale and consumption. A life cycle assessment was developed for the farming, harvesting, handling, packaging, ripening, transportation, and carbon sequestration potential of the avocado, and it was used to conduct a holistic life cycle assessment. Input data was obtained through an 18-month data collection campaign across the relevant stakeholders. A baseline 'business-as-usual' scenario is focused on throughout this study, and scope for optimisation is identified for each life cycle phase where applicable, accompanied by uncertainty analyses. Results show a total carbon input of 904.85 kg CO2e/tonne. Mitigating this, 521.88 kg CO2e/tonne is offset, resulting in a net carbon footprint of 382.97 kg CO2e/tonne with uncertainty ranges of -23.22 to +58.69 kg CO2e/tonne, normalised to 57.45 g CO2e/avocado grown in South Africa and sold in Europe. The environmental impacts of the avocado industry under consideration are largely mitigated by the "nature first" philosophy of the farming and logistics enterprises, which have made significant investments in reducing emissions. Sensitivity analyses indicate that implementing large-scale renewable energy, using alternative packaging instead of cardboard, and selling avocados unripened could further enable the farming enterprise to achieve Net Zero objectives. These measures could reduce baseline emissions from 382.97 kg CO2e/tonne to a theoretical -68.54 kg CO2e/tonne, representing a 117.9% decrease. Although this study does not quantify climate change impacts, qualitative analyses suggest that climate change will have a net negative effect on the avocado industry in South Africa. These regions, typically located in micro-climates, are projected to become wetter and warmer, adversely affecting crop phenology, pest control, road conditions, management complexity, farmer livelihoods, and food security. The study recommends large-scale implementation of the optimisation strategies identified to achieve Net Zero objectives and the development of proactive climate change mitigation strategies to enhance the resilience of avocado supply chains to future stressors. These insights are crucial for policymakers, industry stakeholders, and consumers aiming to promote sustainability in the avocado market.

Molecular surveillance of A. baumannii in intensive care units: exploration of transmission chains

Abstract Background Multidrug-resistant Acinetobacter baumannii (MDR-Ab) is one of the main causes of healthcare associated infections (HAIs). During the SARS-CoV-2 pandemic there was an increase in MDR-Ab infections, especially in intensive care units (ICUs). This study aimed to assess the potential spread or emergence of specific clusters of MDR-Ab across four different ICUs at the Umberto I teaching hospital of Rome. Methods From January 2020 to January 2022 microbiological surveillance was conducted in four ICUs: two dedicated to COVID-19 patients (ICU-1C, ICU-2C) and two to non-COVID-19 patients (ICU-1R, ICU-2R). The genetic relatedness between A. baumannii isolates was assessed using pulsed-field gel electrophoresis (PFGE). Illumina whole genome sequencing was conducted on 26 representative isolates. Results In total, 178 A. baumannii isolates were obtained from 129 COVID-19 patients and 49 non-COVID-19 patients. The isolates were classified into 17 PFGE pulsotypes, being two major (A, B) and five intermediate (C, D, E, H, Q). Clone A was present in all ICUs, while Clone B was present only in ICU-1C and ICU-2R. Overall, 117 isolates belonged to clone A and exhibited a MDR phenotype; all of them were placed within the international clonal lineage II. All isolates showed carbapenems resistance primarily attributed to the presence of the blaOXA-23 gene, while aminoglycosides resistance observed in almost all isolates was attributed to the presence of the armA gene. Small outbreaks involving intermediate pulsotypes were detected between ICU-1R and ICU-2R, ICU-1C and ICU-2R, ICU-1C and ICU-2C, ICU-1C and ICU-1R. Conclusions The observed outbreaks could be attributed to a decline in attention to normal care practices for the prevention of HAIs during the COVID-19 pandemic, favouring the spread of MDR-Ab. Therefore, it is recommended the strengthen of control measures and the implementation of long-term strategies targeting MDR microorganisms in the ICUs. Key messages • Acinetobacter baumannii was frequently found infecting patients across four different ICUs at the Umberto I teaching hospital of Rome. • Acinetobacter baumanni outbreaks and multidrug resistance were observed. Therefore, the implementation of long-term strategies targeting MDR microorganisms in the ICUs is highly recommended.

Musculoskeletal disorders and risk factors in the modern era: results from the Specchio cohort

Abstract Background Musculoskeletal disorders (MSDs) represent a major challenge for occupational and public health, but data are scarce in Switzerland or concentrated on a few sectors of activities. The aim of this study is to provide results on the prevalence and risk and protective factors of MSDs in the general working-age population of the Geneva canton, Switzerland. Methods A cross-sectional analysis was conducted as part of Specchio population-based cohort study. Prevalence and associations between MSDs and sociodemographic variables, individual behaviour (smoking, physical activity, sleep), health conditions (BMI, chronic diseases), physical and psychological risks at work were examined using regression models. The impact of teleworking was also evaluated. Results 2’733 participants took part in the survey, of which 38% were men, and mean age was 50. Overall prevalence of MSDs was 74% among men and 84% among women. 80% of the individuals experience back pain and 56% shoulder pain. Among individuals who experienced MSDs, 55.2% consulted a healthcare professional. The risk factors for MSDs were female sex (OR = 1.95; 95% IC = 1.55-2.28), body mass index (obese) (2.2; 1.51-3.32), lower education (1.77; 0.84-4.37), smoking (1.65; 1.19-2.35), exposure to physical risks (3.54; 2.78-4.51), stress at work (effort-reward imbalance) (3.23; 2.45-4.29) and a poor work-life balance (2.36; 1.88-2.97). The prevalence of MSDs remained high among workers who telework (78% versus 84% in working population). Conclusions This study, carried out in a large population-based cohort, confirmed several risk factors for MSDs. These results will contribute to the implementation of prevention strategies, especially as teleworking has gained in importance in recent years, which may have aggravated workers’ isolation and stress, sedentariness, and poor body posture. Main message: These data confirm the weight of musculoskeletal disorders and will help implementation of prevention health strategies. Key messages • The relationship between psychosocial risks at work and the occurrence of Musculoskeletal Disorders (MSDs) persists even following adjustment for exposure to physical risks and individual risk factors. • The prevalence of musculoskeletal (MSDs) disorders remained high among workers who telework.

Holistic Approach to Strategic Management in Islamic Education

This study aims to analyze the strategic management of Islamic education through the process of formulation, implementation, monitoring, and evaluation. The methodology used is qualitative research with data collection techniques in the form of in-depth interviews, observations, and document analysis. The results of the study indicate that the process of formulating strategies in Islamic education involves identifying clear visions, missions, and objectives, as well as analyzing the internal and external environment. Implementation of strategies is carried out through the preparation of work programs, allocating resources, and developing appropriate curriculum. Monitoring and evaluation are carried out periodically to ensure the achievement of objectives and make improvements if necessary. The conclusion of this study is that effective strategic management in Islamic education requires careful planning, consistent implementation, and continuous evaluation. The recommendations given include: (1) strengthening the managerial capacity of Islamic education leaders, (2) increasing stakeholder participation in the planning and evaluation process, and (3) developing a management information system that supports appropriate decision making

Review of national rare disease strategies: innovation driving change

Abstract Background A rare disease affects fewer than 5 in 10,000 people. More than 6,000 known rare diseases affect up to 6% of the European population. A national rare disease strategy sets out a country’s plan to reduce disease burden and improve quality of care for people with rare diseases. This review, requested by the Department of Health in Ireland to inform a new national strategy, described national rare disease strategies in 13 selected countries. Methods Strategies published from 2013 to 2023 were identified via online searches for Austria, Australia, Denmark, England, Finland, France, Germany, Ireland, the Netherlands, Northern Ireland, Portugal, Scotland and Wales. National representatives were contacted to confirm the identified resources. Data were extracted for the domains of: aims, priorities, implementation, governance and funding models. Descriptive analysis and narrative synthesis was undertaken. Results Improving treatment and coordination of care was a common overall aim. Priorities noted in all strategies were: screening and diagnosis; access to healthcare and coordination of services; rare disease research; and patient representation and empowerment. Implementation details varied to reflect the national context and time of strategy development. More recently-developed strategies included more precise actions and greater emphasis on innovations in genomics than older strategies. Strategies were developed, implemented, monitored and evaluated via combinations of newly-established bodies and or existing health authorities. Six countries did not specify a funding model or dedicated budget for strategy implementation. Conclusions National rare disease strategy contents and implementation approaches varied between countries and reflected innovations over time. This review will inform the development of Ireland’s new national rare disease strategy. Key messages • This review provided insights into national rare disease strategies over a 10-year period. • The findings will inform strategy development in Ireland, and are relevant to other countries.

Coordinating Standard Procedures of Disciplinary Actions to Conflict Resolution Techniques to Facilitate Conducive Working Environment in Zamboanga Sibugay Division

Ensuring a productive and happy work environment in educational institutions requires effective management of employee discipline and conflict resolution. This study fills in the knowledge gap about how Zamboanga Sibugay school administrators handle conflicts and use disciplinary measures. It aims to provide insights into better administrative tactics by assessing the efficacy of these practices and their effects on the workplace. This study uses a mixed-methods approach to evaluate how school administrators handle disciplinary measures and resolve conflicts. Structured questionnaires were utilized to gather quantitative data, and interviews with school officials yielded qualitative insights. The data was analyzed using statistical methods such as t-tests and z-tests, which revealed significant differences and correlations in the use of these practices. Results of the study showed that formal written warnings, formal disciplinary sessions, and verbal warnings are routinely used by school administration as forms of discipline, and the most common disciplinary action is suspension or loss of privileges, whereas termination is the least common. Furthermore, the most often used conflict resolution strategies include compromise, problem-solving teamwork, and compromise. Lastly, there were minimal relationships between the two sets of data, but significant variations were observed in the implementation of disciplinary actions and dispute-resolution strategies. The study concludes that although Zamboanga Sibugay school administrators generally follow established disciplinary procedures and conflict resolution strategies, there are variances in how they implement them. The most common disciplinary measure is suspension or loss of privileges, while the most common method of resolving conflicts is compromise. The results emphasize the necessity of a more coordinated strategy to improve company culture and successfully resolve conflicts. The study thus recommends modifications to improve organizational culture and offers insights into the effectiveness of present methods.

Accounting for adaptation when projecting climate change impacts on health: a review of methods

Abstract Exposure to high and low temperatures can cause harm to health. Temperature related health effects are likely to increase in the future, due to global warming, unless populations can adapt to a warming environment. Adaptation occurs through multiple mechanisms, however, the amount that populations may adapt to rising temperatures is unclear. There are currently a variety of methods used to include adaptation in projections, but it is unclear how underlying assumptions are made and whether they are based on evidence. With increasing interest from decisionmakers around implementation of adaptation strategies, an important step in responding to climate change will be to understand how adaptation can statistically be incorporated when estimating future health burdens. A systematic scoping review was conducted to identify all quantitative methods to include adaptation in studies projecting future temperature-related health impacts under climate change. Approaches employed in studies were coded into methodological categories. Advantages and disadvantages of each method were also explored, along with the empirical basis for model assumptions. Eight methodological categories were identified from the included fifty-nine studies. More recent methods of including adaptation in projections use a combination of approaches or modelling adaptation based on specific adaptation strategies or socioeconomic conditions. The most used approaches in the literature to model adaptation are heat threshold shifts and reductions in the exposure-response slope. Just under 20% of studies were categorised as using an empirical basis for statistical assumptions. Including adaptation in projections considerably reduced the projected temperature-mortality burden in the future. Researchers should ensure that all future impact assessments include adaptation uncertainty in projections and assumptions are based on empirical evidence where possible. Key messages • Including adaptation in future projections considerably affects temperature-related mortality numbers. • All future impact assessments should include adaptation uncertainty and assumptions should be based on evidence where possible.

Multi-attribute-based procedure for seismic loss scenario in a historical area

AbstractSeismic events have shown to be exceedingly damaging to structures over time, with serious social and economic consequences. As a result, large-scale seismic risk assessments are essential for reducing the potential damage from future earthquakes. Therefore, the proposed study attempts to examine the vulnerability and risk of unreinforced masonry buildings (URM) placed in aggregate conditions in a historical area of the city centre of Lisbon. To this purpose, a comprehensive exposure model was developed combining satellite remote sensing, GIS software, and census data. Subsequently, seismic hazard was evaluated in the area, considering both Peak Ground Acceleration (PGA) and macro-seismic intensity for different return periods (i.e. 2-50-100-475-975-2500-5000 years). Vulnerability was assessed by introducing a novel approach to earthquake risk assessment using Multi-Criteria Decision-Making methodologies. Specifically, the method employs the Analytic Hierarchy Process (AHP) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) computational methods to evaluate parameter weights and vulnerability index. Damage scenarios, fragility curves and mean damage ratios curves were provided to offer an overview of the vulnerability of the assets exposed to risk. Finally, the expected consequences were evaluated in terms of direct economic losses showing an economic loss of 595 M€ for a 475-years return period, while 1108 M€ for 5000-years. This study significantly enhances seismic analysis for urban areas by introducing a Multi-Criteria Approach. This method simplifies vulnerability assessment, ensuring ease of application and reproducibility. Its insights offer valuable support for disaster risk management decisions, facilitating the implementation of resilience and risk-reduction strategies.

Making Conscientious Decisions: Engaging in Venous Leg Ulcer Self-Management Following Nurse-Led Patient Education.

Venous leg ulcers (VLUs) provoke multiple symptoms and impact individuals and society as a whole. Their treatment and prevention strategies require individual's involvement in self-management strategies. Insufficient knowledge with regard to prevention, management, and treatment has been identified as a critical factor related to VLUs and their recurrence. Therapeutic patient education (TPE) proposed as part of a management strategy for this population provides unclear benefits regarding wounds healing or prevention of recurrence. The aim of the study was to develop a theory explaining how individuals with a VLU experience an individualized nurse-led TPE program regarding self-management strategies. The constructivist approach of Charmaz to the grounded theory method was used to develop the theory. A total of 26 individuals contributed to the co-construction of the theory through face-to-face or telephone semi-structured interviews. Data analysis and data collection occurs simultaneously with a comparative process to reveal the conceptual categories, apply theoretical sampling, and define theoretical saturation. The theory of "Conscientiously Engaging in Self-Management" was co-constructed with the participants encapsulating four categories: "Being influenced by my own story," "Being personally informed," "Making conscientious decisions to engage in self-adapted management strategies," and "Integrating a conscientious way of living." This theory highlights individuals' voices and stories toward their journey of VLU self-management taking contextual factors into consideration. This new theory offers new knowledge about implementation of self-management strategies for individuals living with a VLU and will inform clinical practice and contribute to the development of targeted interventions.

Refugee mental health - systematic review and meta-analysis

Abstract Background Mental health conditions of forcibly displaced persons are unknown as the characteristics of the population change over the years. This study aims to estimate the prevalence rates of mental health conditions among refugees (depression, anxiety and posttraumatic stress). Methods We conducted a systematic review using MEDLINE (Ovid), Embase, Web of Science Core Collection (Clarivate), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), and PTSDPubs (ProQuest) published between 1994-2022. We set up clear eligibility criteria and developed a data extraction sheet. The risk of bias of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Heterogeneity was assessed using I² statistics. Results The search yielded 4,381 records, of which 171 were included in the full-text review. 54 studies were included in the final review. These 54 studies comprised of 62,522 forcibly displaced populations (49.22% males, 50.78% females). Pooled prevalence rates for anxiety, depression, and PTSD were 36.3% (95% CI 30.0-43.2), 35.9% (95% CI 31.9-41.3), and 35.4% (95% CI 29.0-42.4) respectively. Conclusions The prevalence of PTSD, depression and anxiety is significant among forcibly displaced persons. Screening for mental health conditions among these populations might prove beneficial to prevent more severe mental health conditions through the implementation of early intervention strategies.

Assessment of controlled assistance from e-bikes as a mitigation strategy for individual PM exposure

Abstract Background While promoting active mobility and outdoor activities can benefit health (HLT), it also increases Exposure (EXP) to air pollutants, such as particulate matter (PM), due to the increased ventilation rate (VR) under physical activity. Traditional assessments of individual (IND) PM EXP involve costly equipment inaccessible to the public, but real-time low-cost sensors (LCS) are now emerging. This study presents a proof of concept to demonstrate the use of LCS for examining the real-time IND respiratory dose deposited (RDD) to PM cycling across the Brescia province. Methods An e-bike was ridden 33 times between 2022 and 2023 wearing a LCS for PM concentration [PM] linked to a GPS. Respiratory dose deposited(RDD) was calculated for six different locations within each route based on experimental PM and various VR. Results The LCS allows for the study of the spatial and temporal variability of [PM], revealing a significant difference (p < 0.01) according to the heating system operation and no significant difference (p > 0.05) depending on the location. RDD increases with [PM] and VR. Real-time and integrated RDD is calculated for routes with high (> 50 µg/m3), medium (25 µg/m3), and low (<10 µg/m3) [PM2.5]. The e-bike assistance is activated when the WHO interim target 4 of [PM] is reached to reduce VR, which corresponds to a shift to a lower physical activity intensity. The RDD calculated using the e-bike assistance over the path reduces RDD by about 23% and 11% over the high and medium [PM], while it never activates for the low [PM]. Conclusions This study demonstrates that the use of LCS allows the estimation of IND RDD, and the implementation of mitigation strategies based on controlled assistance from e-bikes would enable the reduction of PM individual EXP. Key messages • The integration of HLT data from wearable and air quality LCS enables the promotion of active mobility and outdoor activities controlling the EXP to air pollutants. • Establishing generalized guidelines based on this mitigation strategies for individual exposure reduction may also inform policy recommendations for promoting active and green mobility.

E-waste challenges of generative artificial intelligence.

Generative artificial intelligence (GAI) requires substantial computational resources for model training and inference, but the electronic-waste (e-waste) implications of GAI and its management strategies remain underexplored. Here we introduce a computational power-driven material flow analysis framework to quantify and explore ways of managing the e-waste generated by GAI, with a particular focus on large language models. Our findings indicate that this e-waste stream could increase, potentially reaching a total accumulation of 1.2-5.0 million tons during 2020-2030, under different future GAI development settings. This may be intensified in the context of geopolitical restrictions on semiconductor imports and the rapid server turnover for operational cost savings. Meanwhile, we show that the implementation of circular economy strategies along the GAI value chain could reduce e-waste generation by 16-86%. This underscores the importance of proactive e-waste management in the face of advancing GAI technologies.

Empowerment and interprofessional collaboration in health promotion centre Murska Sobota

Abstract Background Health promotion centres (HPCs) were introduced in Slovenian primary health care centres to provide interventions against risk factors for noncommunicable diseases (NCDs). HPCs integrate a multidisciplinary and community-based primary care approach to the prevention of NCDs and provide free lifestyle intervention programmes. This study aims to explore the perspectives of health care professionals on promoting health of local community members, as well as their perceptions of interprofessional collaboration in HPCs. Methods Two group discussions were conducted with a total of 11 health care professionals at the HPC Murska Sobota. Data collection was accompanied by a dual role interpreter in accordance with the principles of cross-language qualitative research. The data was transcribed, semantically translated and thematically analysed. Results Health care professionals emphasize the importance of health-related empowerment of individuals for the success of health promotion activities and therefore for the improvement of individuals’ quality of life. This is based on shared decision-making, self-management and educational measures in a combination of population- and individual-based approaches. The need for efficient interprofessional communication, characterized by a flat hierarchy, is stressed. Structured cooperation with other health care facilities, as well as close collaboration with communities and local media, are described as crucial for reaching all individuals and promoting health equity. Conclusions Interprofessional collaboration, health-related empowerment of individuals and collaboration with local communities are fundamental for the success of health promotion activities, achieving health equity and preventing NCDs. Understanding how these activities are implemented from the health care professionals’ perspective can help other health facilities developing and improving local health promotion strategies. Key messages • Slovenian health care professionals see interprofessional collaboration as fundamental for the implementation of health-promotion strategies. • Health-related empowerment of individuals and collaboration with local communities play an important role in achieving health equity in health promotion activities.

Insights into cardiac amyloidosis screening in TAVI from a Greek/Cypriot Cohort: the GRECA-TAVI registry

Abstract Background Transthyretin amyloid cardiomyopathy (ATTR-CM) is a disease with a poor prognosis and an unknown prevalence in the general population. Specific patient subgroups are at higher risk, such as patients with severe aortic stenosis (AS). Purpose To investigate the prevalence of ATTR-CM in Greek and Cypriot patients with severe AS that undergo Transcatheter Aortic Valve Implantation (TAVI). Methods A total of eight (n=8) tertiary hospital centers from Greece and Cyprus formed part of the GRECA-TAVI registry to evaluate the prevalence of ATTR-CM in patients undergoing TAVI. The inclusion criteria were diagnosis of severe AS in the presence of left ventricular hypertrophy (i.e. ≥12mm). Patients were referred for ATTR-CM screening by Tc99m-DPD or Tc99m-PYP bone scintigraphy. A complete hematologic workup was performed in all patients to rule out plasma cell dyscrasias. Cases with equivocal bone scintigraphy findings were not included in analysis. Results A total number of n=303 AS patients were screened from January 2023 until February 2024. Screening for CA with Tc99m-DPD/PYP bone scintigraphy and hematological tests was complete for all the patients included in the study. A positive bone scan (i.e. Perugini scale 2 or 3) was found in n=31 or 10.2% of the patients. The mean age of patients was not significantly different between AS patients with and without ATTR-CM (82,25 ±1,8 vs. 81,21 ±0,44 respectively, p=0.478). A male predominance was found in the ATTR-CM subgroup, although this was not statistically significant compared to non-ATTR-CM patients (%male: 64.5% vs. 49.3%, respectively, p=0.13). ATTR-CM patients had a lower LVEF compared to non-ATTR-CM patients (47.5% ±2.13 vs. 55% ±0.75, p=0.046). Conclusions The prevalence of ATTR-CM in this cohort of patients with severe AS undergoing TAVI was ~10%. These findings call for the implementation of national screening strategies for ATTR-CM which still remains significantly underdiagnosed in many geographic parts of the globe.

Macrophyte Diversity and Ecosystem Services in Wetlands of Eastern Ranchi: A Multi-site Analysis of Abundance, Frequency, and Importance Value Index Patterns

Macrophytes, visible aquatic and semi-aquatic plants, are integral components of wetland ecosystems, playing crucial roles in maintaining biodiversity, providing ecosystem services, and ensuring ecological stability. This research examines the distribution, abundance, frequency, diversity, and ecosystem services of macrophytes in several wetlands (W1-W7) located in the eastern part of Ranchi district, Jharkhand, India. The study sites include Bundu Lake, Hindalco Pond, Choga Bada Talab, Raja Bandh, Kita Uparbandh, Tamar Bada Talab, and Rukka Dam. A quantitative assessment using quadrat sampling and phytosociological methods was conducted from September 2022 to March 2023 to ensure accurate data collection and analysis. The study documented 78 macrophyte species belonging to 33 families and 58 genera. Emergent macrophytes were found to be the dominant life form, constituting 69% of the recorded species. Several species demonstrated high frequency and abundance across multiple study sites, including Pontederia crassipes Mart., Alternanthera philoxeroides (Mart) Griseb., Hydrilla verticillata (L.f.) Royle, Ipomoea aquaticaForssk., and Nymphoides hydrophyllum (Lour.) kuntze. To assess the diversity and ecological characteristics of the macrophyte communities, various diversity indices were calculated. These included the Shannon-Wiener index, Simpson's index, Margalef index, and Pielou's Evenness index. The results of these analyses revealed high levels of macrophyte diversity and evenness within the studied wetlands. Twenty-one macrophytes were identified as key species and nine species as rare species based on their IVI (Importance Value Index) scores. The key species were found to provide essential ecosystem services, including erosion control, water quality improvement, nutrient cycling, carbon sequestration, and habitat provision for other organisms. This research contributes significantly to our understanding of macrophyte diversity patterns and traits-based ecosystem services in wetland ecosystems. The findings of this study have important implications for the development and implementation of effective conservation strategies for these vital wetland ecosystems in the eastern Ranchi (W1- W7).

Assaults against pandemic heroes: an observational study in the Metropolitan City of Genoa in Italy

Abstract Background Escalating violence against healthcare workers is a significant public health issue that undermines care quality and workers’ health. This descriptive study aims to examine trends in aggression across different pandemic phases. Methods The study analysed reported violence among healthcare workers from 2018 to 2023 within a Local Health Authority in Genoa, Italy. Variables of interest included the severity of aggression, the professionals affected, and the locations of incidents. Data was analysed using appropriate statistical methods, including multinomial logistic regression, to assess relationships across pandemic phases. Results Reported aggressions rose from 48 incidents in 2018 to 103 in 2023, totaling 463. Pre-pandemic physical violence was at 39%, dropping to 27% during and after the pandemic (χ²=7.4, df = 2, p < 0.025). Nurses experienced the highest violence rates, with an average of 72% pre-pandemic and 74% post-pandemic, reducing to 51% during the pandemic if compared with doctors (Coef -0.80; 95%CI -1.45|-0.15). Over half of incidents occurred in Emergency and Psychiatric Services, from 77% before to 51% after pandemic. Conversely, violence in Local Services rose from 7% before to 24% during and 28% after pandemic (χ²=56.9, df = 6, p < 0.000). If compared to Hospitals, violence in Local Services increased during (Coef 1.44; 95%CI 0.40|2.48) and post-pandemic (Coef 1.001; 95%CI 0.13|1.87), and in Psychiatric Services decreased post-pandemic (Coef -0.98; 95%CI -1.67|-0.29). Conclusions Violence against healthcare workers shifted during and post-pandemic, mirroring the decentralisation of healthcare due to pandemic. The urgent development and implementation of effective violence prevention strategies are imperative. These should include training, psychological support, security enhancements, and a strong organisational culture that prioritises safety and respect. Protecting healthcare workers is crucial for their well-being and to ensure high healthcare quality. Key messages • Escalating violence undermines care quality and healthcare worker well-being. Effective prevention strategies are essential, including training, support, and an organisation that prioritises safety. • Nurses are the main victims of violence. Violence is higher in Emergency Departments, but incidents are increasing in Local Health Services, due to organisational changes during and post-pandemic.

Evaluating trends and insights in cardiovascular risk among the polish population

Abstract Introduction Cardiovascular diseases (CVD) are the leading cause of death in Poland and worldwide. Lifestyle changes and early diagnosis can reverse this unfavorable trend. In the face of escalating global health challenges, the identification of CVD risk factors becomes paramount, especially within national contexts where demographic shifts and lifestyle changes can significantly impact the health profile of the population. Aim of the study. Determining the prevalence of CVD risk factors in the Polish population and analyzing their changes over time. Material and Methods Data of 705,420 Poles aged 35-55 years who were enrolled in CVD disease prevention programme between 2012 and 2021 were analysed. The prevalence of the following CVD risk factors was determined: nicotinism, hypertension, elevated total cholesterol, elevated LDL, reduced HDL, elevated triglycerides, elevated glucose (indicating pre-diabetes), low physical activity, overweight, obesity, SCORE ≥5%. In addition, we assessed how the mean SCORE, BMI, systolic blood pressure, diastolic blood pressure, total cholesterol, LDL cholesterol, LDL cholesterol, triglycerides, glucose levels and waist circumference changed over time. Results Nicotinism affected 17.98%-24% of women (W) and 27.29%-36% of men (M). Hypertension was in 7.04%-8.58% of W and 17.45%-19.62% of M. Elevated total cholesterol were in 55.69%-63.64% of W and 65.91%-72.68% of M. Elevated LDL were in 44.77%-54.2% of W and 58.26%-65.48% of M. Reduced HDL were in 9.84%-11.52% of W and 14.48%-16.57% of M. Elevated triglyceride were in 13.44%-15.37% of W and in 33.81%-36.29% of M. Elevated glucose indicating a pre-diabetic status were in 10.70%-13.16% of W and in 18.91%-22.76% of M. Low physical activity was in 75.96%-82.2% of W and 73.32%-81.67% of M. Overweight conditions were in 30.37%-31.67% of W and 48.61%-49.45% of M. Obesity affected 14.04%-17.12% of W and 20.67%-24.69% of M. SCORE ≥ 5% was in 0.23%-0.38% of W and in 13.08%-18.72% of M. There was a decrease in the mean SCORE value (-0.08; 95%CI: -0.09 - -0.06) from 2012. An increase over time was noted in mean BMI (-0.01; 95%CI: -0.05 - 0.04). There was a slight decrease followed by a notable increase over time in mean systolic (-0.35; 95%CI: -0.47 - -0.24) and diastolic blood pressure (-0.25; 95%CI: -0.32 - -0.18). There was a decrease in mean total cholesterol (-3.29; 95%CI: -4.27 - -2.31) and mean LDL cholesterol (-3.11 95%CI: -4.22 - -2.01). A notable increase was observed in mean glucose values (0.01; 95%CI: 0-0.01). Over time, there was an increase in mean waist circumference value (-0.19; 95%CI: -0.54-0.16). Conclusions The escalation of CVD risk among the Polish population is illustrated, with a marked increase in obesity, sedentary lifestyles and indicators of metabolic syndrome. These trends highlight the urgent need for targeted public health initiatives and for the implementation of comprehensive strategies to mitigate these risks

Real-world implementation of a genotype-guided p2y12-inhibitor de-escalation strategy in acute coronary syndrome patients

Abstract Background CYP2C19 genotype-guided de-escalation from ticagrelor or prasugrel to clopidogrel, may optimize the balance between ischemic and bleeding risk in ACS patients. Purpose Compare bleeding and ischemic event rates in genotyped patients versus standard care. Methods Since 2015, ACS patients in the FORCE-ACS registry received standard dual antiplatelet therapy (DAPT). Since 2021, immediate genotype-guided P2Y12-inhibitor de-escalation was applied, switching non-carriers of the loss-of-function allele CYP2C19*3 or CYP2C19*2 from ticagrelor or prasugrel to clopidogrel, while loss-of-function carriers, carrying at least one loss-of-function allele, remained on ticagrelor or prasugrel. The primary ischemic endpoint, a composite of cardiovascular mortality, myocardial infarction (MI) or stroke and the primary bleeding endpoint, BARC 2, 3, or 5 bleeding, were compared between genotyped those on standard DAPT after one year. Results Among 5,321 enrolled ACS patients, 406 underwent genotyping, compared with 4,915 non-genotyped ACS patients on standard DAPT. In the genotyped cohort, 65.3% (n=265) were non-carriers, whereas 34.7% (n=141) were loss-of-function carriers. The primary ischemic endpoint occurred in 5.2% of patients in the genotyped cohort compared to 6.9% in the standard care cohort (adjHR 0.88, 95% CI 0.56–1.38). The rate of the primary bleeding endpoint was lower in the genotyped cohort compared to the standard care cohort (4.7% vs. 9.8%; adjHR 0.50, 95% CI 0.31-0.78). Conclusion These results demonstrate the feasibility of a CYP2C19 genotype-guided P2Y12-inhibitor de-escalation strategy in a real-world ACS population. This strategy reduced bleeding events, while ischemic events were not increased as compared to a standard DAPT regime.Primary ischemic endpointBARC 2, 3 or 5 bleeding

Implementation of Mindfulness-Based Emotion Regulation Strategies: A Systematic Review and Meta-analysis

Implementation of Mindfulness-Based Emotion Regulation Strategies: A Systematic Review and Meta-analysis