Public Health Implications Research Articles

Vegetarian Nutrition in Health Improvement

There is a growing interest in vegetarian diets among the world population, and this has implications for public health [...]

What’s in a word? Defining “gene therapy medicines”

Gene therapy medicinal products (GTMPs) have emerged as a transformative class of medicines. Defining what a certain class of medicines encompasses, and what it does not, is key, with ample implications and consequential regulatory requirements. In April 2023, the European Commission proposed new pharmaceutical legislation safeguarding the public health within the European Union with a new, broader definition of GTMP, including genome editing medicines and nucleic acids of either source, regulating, replacing, or adding a genetic sequence that mediates its effect by transcription or translation. This definition is all-encompassing for any "genetic" intervention and is agnostic to mechanism of action, duration of action, location of action, and associated risk. Here, we take this as a paradigm to discuss how terminology and definitions are more than just words and can have meaningful regulatory, scientific, and public health implications.

Tick-Borne Pathogens in Mongolian Ticks: The High Prevalence of Rickettsia raoultii and Its Public Health Implications.

In Mongolia, a substantial segment of the population is engaged in pastoralism, leading to frequent interactions with livestock and heightened exposure to tick-infested environments. Consequently, ticks and the endemic tick-borne pathogens (TBPs) they harbor present significant health threats. In May 2021, we conducted a study to evaluate the prevalence of 9 TBPs in ticks collected from four regions in Mongolia: Uvurkhangai, Tuv, Bayan-Ulgii, and Khentii. The pathogens surveyed included Anaplasma, Rickettsia, Bartonella, Borrelia, Ehrlichia, Babesia, Toxoplasma, Theileria, and lumpy skin disease virus. Molecular analysis of 1,142 ticks revealed that, although the majority of TBPs were not detected, 89.1% of the ticks were positive for Rickettsia. Genetic characterization using the 16S rRNA and gltA genes identified the pathogen identified the pathogen Rickettsia raoultii. Species identification indicated a predominance of Dermacentor nuttalli (70.0%) and Dermacentor silvarum (30.0%). These findings highlight the extensive prevalence of R. raoultii in Mongolia and underscore the urgent need for heightened awareness and preventive measures due to the high level of interaction between livestock and humans. The genetic similarity of R. raoultii sequences to those found in neighboring countries suggests potential cross-border transmission, underscoring the importance of conducting similar research in surrounding regions. This study advances our understanding of the epidemiology of tick-borne diseases in Mongolia and can inform public health strategies aimed at mitigating the risks associated with these infections.

Assessment of Health Disparities and Sexual Orientation Response Choices Used in Two US National Population-Based Health Surveys, 2020‒2021.

Objectives. To (1) compare responses to 2 survey questions designed to measure sexual orientation and (2) understand how variation in responses is associated with mental health. Methods. Data were from the National Longitudinal Study of Adolescent to Adult Health (Add Health) Sexual Orientation/Gender Identity, Socioeconomic Status, and Health Across the Life Course (SOGI-SES) study (2020-2021) in the United States. We used the adjusted Wald test to compare proportions of respondents who were (1) categorized as heterosexual or straight and sexual minorities using the sexual orientation questions designed for the Add Health study and the National Health Interview Survey (NHIS) and (2) diagnosed with depression or anxiety or panic disorder. Results. The Add Health question detected more than twice as many sexual minority respondents as the NHIS question. Those who responded as sexual minorities to the Add Health question but as heterosexual or straight to the NHIS question, primarily "mostly heterosexuals," had mental health outcomes that were more like those who were consistently classified as sexual minorities versus those consistently classified as heterosexual or straight. Conclusions. Current measures of sexual orientation in national-level surveys may underestimate the sexual minority population and sexual orientation‒related health disparities. Public Health Implications. Results illustrate the need for further research to expand measurement of sexual orientation on population-based health surveys. (Am J Public Health. 2024;114(12):1375-1383. https://doi.org/10.2105/AJPH.2024.307839).

Modification of the association between cold spells and cardiovascular disease by changes in natural gas prices: A nationwide time-series study

BackgroundAlthough the association between low ambient temperature and cardiovascular disease (CVD) is well-established, the effect of winter energy prices on this association remains unknown. AimThis ecological study aimed to investigate whether changes in natural gas prices (NGP), which account for a significant portion of winter energy prices in Korea, affect the association of cold spells with hospital admissions and mortality due to CVD. MethodsData from the National Health Insurance Service and Statistics Korea were used to determine the daily number of hospital admissions and mortality rates associated with CVD. From January 2012 to February 2017, the NGP continually increased by 24.1%. From January 2012 to December 2014 the NGP continually decreased by 32.6% owing to the Korea Gas Corporation’s management decisions, independent of external socioeconomic factors. We investigated the differences in the associations between cold spells and CVD-related outcomes in price-increasing and price-decreasing periods using a Poisson regression with a distributed lag nonlinear model. Cold spells were assessed on two consecutive days at the 5th percentile of the temperature for each region. ResultsThe meteorological factors and air pollution levels were similar between the two periods. The association between cold spells and hospital admissions due to CVD was stronger during the price-increasing period than during the price-decreasing period [ratio of cumulative relative risk (RRR) = 1.71, 95% confidence interval (CI): 1.31–2.22]. The difference in the association with mortality due to CVD between the two periods was not significant, although the point estimate remained >1 (RRR = 1.11, 95% CI: 0.90–1.38). ConclusionsChanges in energy prices may modify the cold spell-related CVD risk, possibly by inducing behavioral changes to manage energy expenditure. Policymakers should take into account the potential public health implications of changes in energy prices, alongside their economic effects.

Impact of Metabolites from Foodborne Pathogens on Cancer

Foodborne pathogens are microorganisms that cause illness through contamination, presenting significant risks to public health and food safety. This review explores the metabolites produced by these pathogens, including toxins and secondary metabolites, and their implications for human health, particularly concerning cancer risk. We examine various pathogens such as Salmonella sp., Campylobacter sp., Escherichia coli, and Listeria monocytogenes, detailing the specific metabolites of concern and their carcinogenic mechanisms. This study discusses analytical techniques for detecting these metabolites, such as chromatography, spectrometry, and immunoassays, along with the challenges associated with their detection. This study covers effective control strategies, including food processing techniques, sanitation practices, regulatory measures, and emerging technologies in pathogen control. This manuscript considers the broader public health implications of pathogen metabolites, highlighting the importance of robust health policies, public awareness, and education. This review identifies research gaps and innovative approaches, recommending advancements in detection methods, preventive strategies, and policy improvements to better manage the risks associated with foodborne pathogens and their metabolites.

MAL À VISTA: CONSEQUÊNCIAS ASSOCIADAS AO USO DO TABACO PARA A SAÚDE DOS OLHOS

Introduction: Smoking is widely recognized as a risk factor for several eye diseases, including age-related macular degeneration (AMD), cataract, glaucoma, and dry eye syndrome. Toxic substances present in cigarettes, such as nicotine and carbon monoxide, directly affect ocular tissues, resulting in oxidative and ischemic damage. This study reviews the literature on the effects of smoking on ocular health, highlighting the main mechanisms involved and the implications for public health. Methodology: A descriptive and analytical literature review was carried out. Scientific articles published between 2000 and 2024 in the PubMed, SciELO, and BVS databases were included. The keywords used were "smoking", "eye health", "cataract", "AMD", "glaucoma", and "dry eye syndrome". Studies that addressed the impact of active and passive smoking on ocular health were selected. Furthermore, clinical trials, systematic reviews and meta-analyses were considered. Discussion and Results: The reviewed studies indicate that smoking significantly increases the risk of eye diseases. Smokers are two to four times more likely to develop AMD compared to non-smokers, in addition to a threefold increased risk of cataracts. Smoking also worsens glaucoma, contributing to progressive vision loss due to increased intraocular pressure. Dry eye syndrome has been identified as one of the most common conditions associated with smoking, with reduced tear quality and quantity. Secondhand smoke has also been shown to be harmful, especially in children, increasing the risk of diseases such as AMD and cataracts. Conclusion: Smoking represents an important and modifiable risk factor for the development of several eye diseases. Smoking cessation can significantly reduce the risk of these conditions and their complications. Awareness campaigns should include information on the impacts of smoking on eye health, both for active smokers and for the population exposed to secondhand smoke. Preventive measures, such as promoting eye health and encouraging smoking cessation, are essential for protecting vision.

Machine learning in personalized cancer treatment: Implications for global public health

Cancer remains a leading cause of mortality worldwide, posing a significant challenge to global public health. Traditional approaches to cancer treatment often adopt a "one-size-fits-all" strategy, which may not be effective for every patient due to the complex and heterogeneous nature of the disease. Personalized cancer treatment aims to tailor therapeutic interventions to the individual characteristics of each patient, enhancing the efficacy and reducing adverse effects. In recent years, machine learning (ML) has emerged as a powerful tool in personalized cancer care, offering the potential to revolutionize diagnosis, prognosis, and treatment by leveraging vast amounts of biomedical data. This review explores the current landscape of machine learning applications in personalized cancer treatment, including its role in imaging, genomics, and drug discovery. We provide an overview of key machine learning techniques, highlight successful case studies from both developed and developing nations, and examine the challenges and limitations associated with the integration of these technologies into clinical practice. Furthermore, we discuss the implications of machine learning-driven personalized cancer care for global public health, emphasizing its potential to address disparities in access to healthcare and improve outcomes in resource-limited settings. Finally, we offer insights into future research directions and policy considerations that could accelerate the adoption of machine learning in global cancer treatment, fostering a more equitable and effective healthcare ecosystem.'

Prevalence of physical inactivity and associated factors among adults in Eastern African countries: a systematic review and meta-analysis protocol

IntroductionPhysical inactivity is a major global public health concern, increasing the risk factor of non-communicable diseases (NCDs) and mortality. The WHO has initiated the Global Action Plan on Physical Activity...

Recent developments in antibiotic resistance: an increasing threat to public health

Abstract Antibiotic resistance (ABR) is a major global health threat that puts decades of medical progress at risk. Bacteria develop resistance through various means, including modifying their targets, deactivating drugs, and utilizing efflux pump systems. The main driving forces behind ABR are excessive antibiotic use in healthcare and agriculture, environmental contamination, and gaps in the drug development process. The use of advanced detection technologies, such as next-generation sequencing (NGS), clustered regularly interspaced short palindromic repeats (CRISPR)-based diagnostics, and metagenomics, has greatly improved the identification of resistant pathogens. The consequences of ABR on public health are significant, increased mortality rates, the endangerment of modern medical procedures, and resulting in higher healthcare expenses. It has been expected that ABR could potentially drive up to 24 million individuals into extreme poverty by 2030. Mitigation strategies focus on antibiotic stewardship, regulatory measures, research incentives, and raising public awareness. Furthermore, future research directions involve exploring the potential of CRISPR-Cas9 (CRISPR-associated protein 9), nanotechnology, and big data analytics as new antibiotic solutions. This review explores antibiotic resistance, including mechanisms, recent trends, drivers, and technological advancements in detection. It also evaluates the implications for public health and presents strategies for mitigating resistance. The review emphasizes the significance of future directions and research needs, stressing the necessity for sustained and collaborative efforts to tackle this issue.

The Evolving Alcohol Landscape: Implications for Public Health and Policy.

The Evolving Alcohol Landscape: Implications for Public Health and Policy.

Comparative metagenomics of microbial communities and resistome in southern farming systems: implications for antimicrobial stewardship and public health

Agricultural practices significantly influence microbial diversity and the distribution of virulence and antimicrobial resistance (AMR) genes, with implications for ecosystem health and food safety. This study used metagenomic sequencing to analyze 60 samples (30 per state) including water, soil, and manure (10 each) from Alabama (a mix of cattle and poultry sources) and Tennessee (primarily from cattle). The results highlighted a rich microbial diversity, predominantly comprising Bacteria (67%) and Viruses (33%), with a total of over 1,950 microbial species identified. The dominant bacterial phyla were Proteobacteria, Cyanobacteria, Actinobacteria, Firmicutes, and Bacteroidetes, with the viral communities primarily represented by Phixviricota and Uroviricota. Distinct state-specific microbial profiles were evident, with Alabama demonstrating a higher prevalence of viral populations and unique bacterial phyla compared to Tennessee. The influence of environmental and agricultural practices was reflected in the microbial compositions: soil samples were notably rich in Actinobacteria, water samples were dominated by Proteobacteria and Cyanobacteria, and manure samples from Alabama showed a predominance of Actinobacteria. Further analyses, including diversity assessment and enterotype clustering, revealed complex microbial structures. Tennessee showed higher microbial diversity and phylogenetic complexity across most sample types compared to Alabama, with poultry-related samples displaying distinct diversity trends. Principal Coordinate Analysis (PCoA) highlighted notable state-specific variations, particularly in manure samples. Differential abundance analysis demonstrated elevated levels of Deinococcus and Ligilactobacillus in Alabama, indicating regional effects on microbial distributions. The virulome analysis revealed a significant presence of virulence genes in samples from Alabama. The community resistome was extensive, encompassing 109 AMR genes across 18 antibiotic classes, with manure samples displaying considerable diversity. Ecological analysis of the interactions between AMR gene subtypes and microbial taxa revealed a sophisticated network, often facilitated by bacteriophages. These findings underscore the critical role of agricultural practices in shaping microbial diversity and resistance patterns, highlighting the need for targeted AMR mitigation strategies in agricultural ecosystems to protect both public health and environmental integrity.

Detection and Characterization of Visceral Anisakid Nematodes in Blue Whiting from Portuguese Waters

This study employs molecular detection techniques, including conventional PCR and Sanger sequencing, to investigate the prevalence, species composition and public health implications of Anisakid nematodes in blue whiting (Micromesistius poutassou) caught off the Portuguese coast. With Portugal’s high fish consumption rates and increasing preference for raw or undercooked seafood, the risk of parasitic infections, particularly anisakidosis, is rising. Fifty blue whiting fish were examined, showing a 100% infection rate with Anisakid larvae. Molecular analysis identified 68.1% of the larvae as Anisakis simplex, 18.1% as Anisakis pegreffii, and 13.8% as Hysterothylacium aduncum, marking the first report of H. aduncum in blue whiting in Portugal. Phylogenetic analysis based on the internal transcribed spacer (ITS) 1, 5.8S ribosomal RNA and ITS-2 confirmed the species classification. Notably, 42.9% of the fish were infected with multiple Anisakid species, increasing the risk of allergenic sensitization. Statistical analysis showed no significant correlation between fish width and parasitic load, and a weak negative correlation was found between fish length and parasitic load. The study contributes to food safety by integrating molecular tools that enable rapid and accurate species identification, offering new insights into the detection of biological contaminants in seafood. These findings are significant considering the rising trend in raw seafood consumption, underscoring the urgent need for enhanced detection strategies and broader parasite monitoring programs to mitigate public health risks. The high prevalence of parasitized fish highlights the necessity for the implementation of safe cooking practices to reduce the risk of anisakidosis. Further research into the allergenic potential of Hysterothylacium spp. and the ecological factors influencing this nematode distribution is recommended.

Ultra-Processed Food and Prostate Cancer Risk: A Systemic Review and Meta-Analysis

Background/Objectives: Prostate cancer is the second leading cause of cancer death among American men, following lung cancer. While diet and exercise have been extensively studied in relation to prostate cancer prevention, the evidence remains inconclusive. Methods: A comprehensive literature search was performed to identify observational studies investigating the association between ultra-processed food (UPF) consumption and prostate cancer risk and mortality, determined by the NOVA classification system. In addition, we conducted subgroup analyses to assess the association based on study design, age, and data collection methods. Results: Six studies were identified, including four cohort studies and two case–control studies. No significant association was found between high UPF consumption and increased risk of prostate cancer [RR = 1.02, 95% confidence interval (CI) = 0.96–1.08, n = 5]. However, there was a slight increase in mortality (RR = 1.15, 95% CI = 0.99–1.35, n = 2). A subgroup analysis by the dietary assessment method revealed an RR of 1.01 (95% CI = 0.93–1.09) for studies using the food frequency questionnaire (FFQ) and 1.04 (95% CI = 0.93–1.16) for studies using 24-h recalls. There was no significant heterogeneity among the studies (I2 = 0, p = 0.82). Conclusions: This meta-analysis suggests no significant association between high UPF consumption and prostate cancer risk. Given the known associations with other chronic diseases, the potential public health implications of reducing UPF consumption remain important. Further research with the use of more robust food assignment systems and more precise dietary assessments is needed to clarify the role of UPF in prostate cancer development.

Cache Valley virus isolation from a horse in Veracruz State, Mexico

Cache Valley virus (CVV) was isolated from a clinically presenting horse in the Mexican Gulf region. CVV is linked to neuroinvasive disease in humans and fetal demise and defects in sheep. This is the first association between CVV and disease in horses. Implications for public and veterinary health are discussed.

Association between nighttime and daytime ambient temperature and insomnia using national emergency department database in the capital city of South Korea.

Insomnia is a growing health concern globally, with significant implications for public health. Most studies have primarily focused on the effects of nighttime temperatures on sleep problems. However, there is a lack of studies comparing nighttime temperatures with daytime temperatures, which are more closely related to daily life activities. This study aimed to explore a short-term association of nighttime and daytime ambient temperature with emergency department (ED) visits for insomnia in the capital city of South Korea. A time-stratified case-crossover design was employed using a conditional logistic regression model. A distributed lag non-linear model was utilized to explore potential non-linear and lag effects of ambient temperature on ED visits for insomnia. Odds ratio (OR) for temperature with maximum ED visits for insomnia (MaxIT) and that for temperature with minimum ED visits for insomnia (MinIT) were calculated and compared. We observed significant associations at high temperatures for both nighttime and daytime (nighttime: 25.0℃ (94.1%) [OR: 1.82, 95% CIs: 1.31-2.55], daytime: 30.6℃ (99.0%) [OR: 2.13, 95% CIs: 1.49-3.06]) compared to MinIT (-8.5℃ (2.7%) and - 8.4℃ (1.0%), respectively). Subgroup analyses found significant associations at high temperatures in females, individuals aged 35-49, and those without comorbidities, and during spring, fall, and winter, for both daytime and nighttime. Our findings provide insights for proactive public health strategies for managing insomnia during global temperature rise.

Evaluating the association between the introduction of mandatory calorie labelling and energy consumed using observational data from the out-of-home food sector in England.

In April 2022, mandatory kilocalorie (kcal) labelling in the out-of-home food sector was introduced as a policy to reduce obesity in England. Here we examined whether the implementation of this policy was associated with a consumer behaviour change. Large out-of-home food sector outlets subject to kcal labelling legislation were visited pre- and post-implementation, and customer exit surveys were conducted with 6,578 customers from 330 outlets. Kcals purchased and consumed, knowledge of purchased kcals and reported noticing and use of kcal labelling were examined. The results suggested that the introduction of the mandatory kcal labelling policy in England was not associated with a significant decrease in self-reported kcals purchased (B = 11.31, P = 0.564, 95% confidence interval (CI) -27.15 to 49.77) or consumed (B = 18.51, P = 0.279, 95% CI -15.01 to 38 52.03). Post-implementation, participants underestimated the energy content of their purchased meal less (B = 61.21, P = 0.002, 95% CI 21.57 to 100.86) and were more likely to report noticing (odds ratio 2.25, P < 0.001, 95% CI 1.84 to 2.73) and using (odds ratio 2.15, P < 0.001, 95% CI 1.62 to 2.85) kcal labelling, which may have wider public health implications.

Chagas disease as an underrecognized cause of stroke: implications for public health

Chagas disease as an underrecognized cause of stroke: implications for public health

Bills to Restrict Access to and Harm From Indoor Tanning Facilities in US State Legislatures, 1992‒2023.

Objectives. To describe progression, content, and stringency of state legislation regulating indoor tanning and association with state government political party leadership. Methods. Trained research assistants used legal mapping methods to code legislative bills on indoor tanning introduced in US states, the District of Columbia, and Puerto Rico. We calculated composite scores on the stringency of age restrictions and of warnings, operator requirements, and enforcement. We evaluated associations of the political party of the legislative sponsor and legislature majority. Results. Between 1992 and 2023, 184 bills were introduced in 49 of 50 states and DC (56 laws were enacted, and 126 bills failed). An under-18 ban was enacted in 22 states and DC. Party affiliation of the bill sponsor and legislature majority combined to affect bill passage and age restrictions. Conclusions. In many states, it took several years and proposed bills before a law on indoor tanning was enacted. Enacted bills were more stringent than failed bills. Public Health Implications. Increasing support for stringent regulations on indoor tanning is evident and may motivate other states or the federal government to prohibit minors from using indoor tanning facilities. (Am J Public Health. Published online ahead of print November 21, 2024:e1-e10. https://doi.org/10.2105/AJPH.2024.307894).

Housing instability and concern about firearm victimisation among Asian Americans

BackgroundRising costs of living, coupled with housing shortages across the USA, have made housing instability a key issue over the past few years. Alongside this problem has also been a...