Important Public Health Challenge Research Articles

Anemia in pregnancy and adverse maternal health outcomes - birth-registry based study from Georgia

Abstract Anemia in pregnancy is an important public health challenge; however, it has not been thoroughly studied in Georgia. We assessed the prevalence of anemia during pregnancy across Georgia and the association between anemia in the third trimester of pregnancy and adverse maternal outcomes. We used data from the Georgian Birth Registry and included pregnant women who delivered between January 1, 2019, and August 31, 2022 (n = 158,668). The prevalence of anemia (hemoglobin (Hb) < 110 g/L) at any time during pregnancy was calculated per region. Women in the third trimester were classified into three groups, based on their lowest measured Hb value: no (Hb ≥ 110 g/L, reference group); mild (Hb 100-109 g/L); and moderate to severe anemia (Hb < 99 g/L). Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated for the associations between anemia status and post-delivery intensive care unit (ICU) admission and preterm delivery. The prevalence of anemia occurring at least once during pregnancy was 40.6%, with large regional differences in anemia prevalence (25.1%-47.0%). Of 105,811 pregnant women with Hb measurements in the third trimester, 71.0% had no anemia; 20.9%, mild anemia; and 8.1%, moderate or severe anemia. The odds of post-delivery ICU admission did not increase linearly with decreasing Hb value (P for trend .13), and the relationship was inverse for preterm delivery (P for trend .01). Key messages • A considerable proportion of pregnant women in Georgia have anemia during pregnancy, and the prevalence and quality of reporting differ across regions. • To accelerate national progress toward the SDGs and mitigate the consequences of anemia, equal countrywide access to high-quality ANC programs and complete registration of Hb values should be ensured.

Mental health problems identified in early school age and later mental health problems and disorders

Abstract Background Poor mental health in childhood and adolescence youth is an important public health challenge. We aimed to examine the prospective association between mental health problems among primary school children and later diagnosed mental disorders and mental health problems in youth. Methods A prospective cohort study of children participating in school health nurse examination during first years of primary school (approx. 6 years) in 17 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 16th birthday. Baseline data included information from national population registers and school health nurse records. Outcome variables: mental disorders diagnosed at hospital from approx. age 6 until 16 years (N = 6,930) and school health nurse records of mental health problems at approx. age 16 (N = 11,250). Results Problematic relations to peers in early primary school was associated with later neurodevelopmental disorders, including intellectual disability, autism-spectrum disorder and disorders of hyperactivity and inattention (AOR=4.14, 95% CI 2.15-7.97), and poor home related well-being in youth (AOR=1.67, 95% CI 1.02-2.74). Poor school well-being in early primary school was associated with poor school well-being ten years later (AOR=1.67, 95% CI 1.19-2.34) as well as problematic relations to peers (AOR=1.83, 95% CI 1.08-3.10). Further poor general well-being in early primary school was associated with problematic relations to peers in youth (AOR=2.21, 95% CI 1.17-4.18). Conclusions School health nurses identify a group of children in the early years of primary school with mental health problems and an increased risk of later mental health problems and disorders, and therefore they play an important role in the early identification of children at risk. Key messages • Children with problematic relations to peers have up to a fourfold increased risk of later mental disorders. • The school health nurses play an important role in the early identification of children at risk of later mental health problems.

11.A. Scientific session: Overcoming Real-World Challenges in Setting up Health Data Linkages for Public Health Policy

Abstract Background Linking available administrative data has gained momentum in the last years to enhance public health research and public health formulation. Linkage of diverse data sources can be leveraged to understand social-determinants of health, the cost-effectiveness of an intervention, and to evaluate impact of policies. For instance, data linkage has been proven to be a powerful approach to periodically analyze real-world progress of the COVID-19 pandemic. Today, we are witnessing an unparalleled increase in electronic health data stemming from citizens who interact with services such as healthcare providers, employers, sick funds, and other governmental structures. This enormous amount of data opens many innovative possibilities in epidemiological research. The main advantages of the secondary use of data are the following: 1) it is enriching for new collected data (e.g. survey study), 2) it provides comprehensive information of the target population, and 3) it is cheaper than new data collection. Data linkage between data sources is, however, often a herculean task, and it comes with considerable challenges such as: 1) juridical complexity related to intra-national and cross-border data governance procedures, 2) fragmented data integration, 3) data delivery delays. Addressing these challenges is essential to unlocking the true potential of data linkages for timely responses to emerging public health questions, thereby contributing to evidence-based policy and care and transforming our health research into a One Health approach. Objectives The workshop’s main aim is to present the researcher’s lessons-learned and approaches in applying data linkage from an European, and a country-level perspective through case-studies while creating a space for the public to share their own view. In this workshop we aim to 1) provide a helicopter overview of current data linkages approaches in Europe, 2) illustrate this with case studies from an international, and a country-level perspective, and 3) emphasize the challenges and disadvantages of those data linkages, while sharing potential solutions. Workshop outline The workshop is divided into a knowledge translation, and an interactive part. In the first part of the workshop, three speakers will give a presentation of each 10 minutes with a Q&A of 5 minutes between each presentation where data linkage will be introduced, and three case studies on how data linkage can be used will be presented. The first presentation will introduce approaches to data linkages in Europe, and will delve into how AI can be used during routine data linkage. The second presentation will show a case-study on how an international data linkages can be done in an European federated manner. The third presentation will further illustrate how nationally data can be linked to investigate health inequalities. In the second part of the workshop, the audience will be invited to interact with the speakers and share their experiences. Key messages • A comprehensive overview of different current data linkages approaches are provided, setting the stage for discussions on methods and best practices. • Administrative data linkages are a powerful tool to answer important public health challenges, but important challenges related to data governance need to be addressed to realize the full potential.

Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023

Abstract Issue Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services). Problem Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area. Results In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported. Lessons Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions. Key messages • Mass gathering s events put under stress all the main areas of public health system. • Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.

Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a -5.78 mm Hg (95% CI -7.97 mm Hg to -3.59 mm Hg; P<.001) reduction in systolic BP and a -3.28 mm Hg (95% CI -4.39 mm Hg to -2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: -6.50 mm Hg, 95% CI -9.00 mm Hg to -3.99 mm Hg vs -1.54 mm Hg, 95% CI -4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: -10.06 mm Hg, 95% CI -16.42 mm Hg to -3.70 mm Hg vs -4.13 mm Hg, 95% CI -5.50 to -2.75 mm Hg; P=.07); intervention duration (3 vs ≥6 months: -8.87 mm Hg, 95% CI -10.90 mm Hg to -6.83 mm Hg vs -5.76 mm Hg, 95% CI -8.74 mm Hg to -2.77 mm Hg; P=.09); and the number of BCTs (≥11 vs <11 BCTs: -9.68 mm Hg, 95% CI -13.49 mm Hg to -5.87 mm Hg vs -2.88 mm Hg, 95% CI -3.90 mm Hg to -1.86 mm Hg; P<.001). The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT.

Anxiety, Depression and Resilience among University Staff in Herat, Afghanistan – 2021

AbstractAnxiety and depression are the two most common mental illnesses in the world. Multiple risk factors contributein developing anxiety and depression; the latter leading to suicide. The aim of this study is to identify theprevalence and associated factors of anxiety and depression, and assess their association with the level ofresilience among academic and non-academic staff of Herat University. This cross-sectional study wasconducted between November 1st and December 28th 2021. Sociodemographic data was collected using astructured questionnaire. Data on depression and anxiety was collected using the validated Dari version ofDASS-42 questionnaire. Data on resilience was obtained using the 10-item Connor-Davidson Resilience Scale(CD-RICS-10). Statistical analyses were performed in IBM SPSS Statistics (version 27). A total of 210university staff including 154 (73.3%) male and 56 (26.7%) female, with a mean age of 37.67 ± 9.62 years wereincluded in the study. Of All participant in this study, 58.6% and 54.8% had anxiety and depression,respectively. There was a significant association between resilience with depression and anxiety. A significantassociation was found between depression, anxiety and resilience with economic status, general healthcondition, concern about food shortage, losing house, and losing job. While no significant association was foundbetween depression, anxiety and resilience with gender, marital status, and losing family member in childhood.The prevalence of mental illnesses is considerably high among Herat University staff. The leadership of HeratUniversity and public health authorities should implement strategies to tackle this important public healthchallenge.

Simvastatin-Loaded Polymeric Nanoparticles: Targeting Inflammatory Macrophages for Local Adipose Tissue Browning in Obesity Treatment.

Obesity is defined as chronic, low-grade inflammation within specific tissues. Given the escalating prevalence of obesity among individuals of all ages, obesity has reached epidemic proportions, posing an important public health challenge. Despite significant advancements in treating obesity, conventional approaches remain largely ineffective or involve severe side effects, thus underscoring the pressing need to explore and develop treatment approaches. Targeted and local immunomodulation using nanoparticles (NPs) can influence fat production and utilization processes. Statins, known for their anti-inflammatory properties, show the potential for mitigating obesity-related inflammation. A localized delivery option offers several advantages over oral and parenteral delivery methods. Here, we developed simvastatin (Sim) encapsulated within PLGA NPs (Sim-NP) for localized delivery of Sim to adipose tissues (ATs) for immunomodulation to treat obesity. In vitro experiments revealed the strong anti-inflammatory effects of Sim-NPs, which resulted in enhanced modulation of macrophage (MΦ) polarization and induction of AT browning. We then extended our investigation to an in vivo mouse model of high-fat-diet (HFD)-induced obesity. Sim-NP administration led to the controlled release of Sim within AT, directly impacting MΦ activity and inducing AT browning while inducing weight loss. Our findings demonstrated that Sim-NP administration effectively inhibited the progression of obesity-related inflammation, controlled white fat production, and enhanced AT modulation. These results highlight the potential of Sim-NP as a potent nanotherapy for treating obesity by modulating the immune system.

Intimate Partner Violence Among Female Croatian University Students

Aim: Intimate partner violence (IPV) among university student populations is an important public health challenge with persistent negative consequences. This study aimed to explore the prevalence of IPV among female Croatian university students and to investigate possible risk factors for its occurrence. Methods: This cross-sectional questionnaire study was conducted on a convenient sample of undergraduate and graduate female university students at the University of Osijek in April 2015. Results: The overall prevalence of all forms of IPV in the studied population was 64.3%. Physical violence was reported by 3.3%, psychological violence by 59.8%, controlling behavior or coercive control as a special form of psychological violence by 40.2%, sexual violence by 4.8%, and economic abuse by 9.6% of female students. Sexual violence and economic abuse were more frequent among graduate female students (p&amp;lt;0.001 and p=0.010, respectively). Female students who repeated the year of study were more frequently exposed to sexual violence (p=0.005). Overall IPV was more frequent among female students who studied within the field of humanities (p=0.045). Female students who studied within the field of humanities were more frequently exposed to physical violence, psychological violence, sexual violence, and economic abuse (p&amp;lt;0.001, p=0.006, p&amp;lt;0.001, and p=0.033, respectively). Conclusion: IPV was highly prevalent among female Croatian university students and some sociodemographic and academic characteristics of those students seem to influence the observed prevalence of various IPV forms. Specific preventive programs adjusted to university settings are needed to successfully combat IPV in the studied population.

Postoperative body weight change and its influencing factors in patients with gastric cancer.

The high incidence and mortality of gastric cancer (GC) pose a significant threat to human life and health, and it has become an important public health challenge in China. Body weight loss is a common complication after surgical treatment in patients with GC and is associated with poor prognosis and GC recurrence. However, current attention to postoperative weight change in GC patients remains insufficient, and the descriptions of postoperative weight change and its influencing factors are also different. To investigate body weight changes in patients with GC within 6 mo after gastrectomy and identify factors that influence dynamic body weight changes. We conducted a prospective longitudinal study of 121 patients with GC and collected data before (T0) and 1 (T1), 3 (T2), and 6 (T3) mo after gastrectomy using a general data questionnaire, psychological distress thermometer, and body weight measurements. The general estimation equation (GEE) was used to analyze the dynamic trends of body weight changes and factors that influence body weight changes in patients with GC within 6 mo of gastrectomy. The median weight loss at T1, T2, and T3 was 7.29% (2.84%, 9.40%), 11.11% (7.64%, 14.91%), and 14.75% (8.80%, 19.84%), respectively. The GEE results showed that preoperative body mass index (BMI), significant psychological distress, religious beliefs, and sex were risk factors for weight loss in patients with GC within 6 mo after gastrectomy (P < 0.05). Compared with preoperative low-weight patients, preoperative obese patients were more likely to have weight loss (β = 14.685, P < 0.001). Furthermore, patients with significant psychological distress were more likely to lose weight than those without (β = 2.490, P < 0.001), and religious patients were less likely to lose weight 6 mo after gastrectomy than those without religious beliefs (β = -6.844, P = 0.001). Compared to female patients, male patients were more likely to experience weight loss 6 mo after gastrectomy (β = 4.262, P = 0.038). Male patients with GC with high preoperative BMI, significant psychological distress, and no religious beliefs are more likely to lose weight after gastrectomy.

Economic and Social Determinants of Micronutrient Consumption and Supplementation Among Children Under Five Years in Cameroon

Malnutrition among children less than five years is an important public health challenge in resources limited countries. This study analyzes the economic and social determinants of micronutrient consumption and supplementation among Cameroonian’s children under five years. A cross-sectional study design was undertaken using a stratified nationwide, two-level sampling with a sample of 4,074 children under five years and their mothers. Data were analyzed using a logistic regression model with the level of statistical significance set at p&amp;lt;0.05. The slightly majority of children were male (50.8%). Children in age groups older than 23 months were less likely (OR&amp;lt;1; p&amp;lt;0.01) to be consuming and/or supplemented with micronutrients compared to children aged 6 to 23 months. Children of mothers of middle and high income quintiles were more likely to be consuming and/or supplemented with micronutrients compared to children of mothers of low and very low income quintiles, while those in the very high income quintiles were less likely (OR=0.994 p&amp;gt;0.05). Children of mothers with low (primary) and average (secondary) education were likely (OR=0.854 and 0.870 respectively), while children of mothers with high (tertiary) education were non-significantly more likely (OR=1.093; p&amp;gt;0.05) to be consuming and/or supplemented with micronutrients compared to children of non-educated mothers. Overall, these study’s findings showed that the gender of the child, the child&amp;apos;s birth order, the children from married mothers, the education’s level of mothers, standard of living, the non-use of any contraceptive method by mothers with intention to use one, employment, religion, and the children from mothers in the low, middle and high income quintiles were significant determinants associated with the function of micronutriments’ consumption and/or supplementation in children under five in Cameroon. Policy makers should therefore strive to improve the socio-economic conditions of women while raising their awareness of the harmful effects of child malnutrition.

The Prevalence of and Trend in Drug Use among Adolescents in Mississippi and the United States: Youth Risk Behavior Surveillance System (YRBSS) 2001-2021.

Mississippi youth are demographically unique compared to those of the nation. The aim of the study was to examine the drug use among adolescents in Mississippi compared to that in the US, which included determining prevalence and trends in drug use as well as drugs on school property and estimating the differences in drug use prevalence by gender and by race. National and Mississippi Youth Risk Behavior Surveillance System (YRBSS) data from 2001 to 2021 were obtained for analysis. Summary statistics, prevalence ratio, and survey Chi-squared tests of independence statistics were generated for the comparison for all students, and by gender and race separately. Trend analysis was conducted using logistic regression combined with joinpoint regression. The six survey questions being studied were the following: have you ever used marijuana, an inhalant, heroin, methamphetamines, or injected drugs, and were you offered, sold, or given an illegal drug on school property during the last 12 months. Survey packages in R were used to account for the complex sampling design of YRBSS data. On the national level, all six drug-related risk behaviors being studied showed a significant decrease from 2001 to 2021. In Mississippi, however, only "ever used marijuana" showed a decrease trend, while three remain unchanged, and two increased. The 2021 YRBSS data show that Mississippi adolescents exhibited a significantly higher prevalence of drug use, and are more likely to be offered, sold or given an illegal drug on school property. This research showed detailed findings on drug use-related issues in Mississippi, which is alarming. This poses an important challenge for public health in Mississippi and sounds an urgent call for drug use intervention among Mississippi adolescents. More concerted actions at the community, school and government level are needed for reducing youth drug use and controlling the drug traffic on school property.

Emerging Strategies against Non-Typhoidal Salmonella: From Pathogenesis to Treatment.

Even with the intensive efforts by public health programs to control and prevent it, non-typhoidal Salmonella (NTS) infection remains an important public health challenge. It is responsible for approximately 150 million illnesses and 60,000 deaths worldwide annually. NTS infection poses significant risks with high rates of morbidity and mortality, leading to potential short- and long-term complications. There is growing concern among health authorities about the increasing incidence of antimicrobial resistance, with multidrug resistance totaling 22.6% in Europe, highlighting an urgent need for new therapeutic approaches. Our review aims to provide a comprehensive overview of NTS infection. We outline the molecular mechanisms involved in the pathogenesis of NTS infection, as well as the events leading to invasive NTS infection and the subsequent complications associated with it. Given the widespread implications of antimicrobial resistance, our review also presents the global landscape of resistance, including multidrug resistance, and delve into the underlying mechanisms driving this resistance. The rising rates of antibiotic resistance frequently lead to treatment failures, emphasizing the importance of investigating alternative therapeutic options. Therefore, in this review we also explore potential alternative therapies that could offer promising approaches to treating NTS infections.

Association of Medicaid coverage with emergency department utilization after self-harm in Korea: A nationwide registry-based study.

Self-harm presents an important public health challenge. It imposes a notable burden on the utilization of emergency department (ED) services and medical expenses from patients and family. The Medicaid system is vital in providing financial support for individuals who struggle with medical expenses. This study explored the association of Medicaid coverage with ED visits following incidents of self-harm, utilizing nationwide ED surveillance data in Korea. Data of all patients older than 14 years who presented to EDs following incidents of self-harm irrespective of intention to end their life, including cases of self-poisoning, were gathered from the National ED Information System (NEDIS). The annual self-harm visit rate (SHVR) per 100,000 people was calculated for each province and a generalized linear model analysis was conducted, with SHVR as a dependent variable and factors related to Medicaid coverage as independent variables. A 1% increase in Medicaid enrollment rate was linked to a significant decrease of 14% in SHVR. Each additional 1,000 Korean Won of Medicaid spending per enrollee was correlated with a 1% reduction in SHVR. However, an increase in Medicaid visits per enrollee and an extension of Medicaid coverage days were associated with an increase in SHVR. SHVR exhibited a stronger associated with parameters of Medicaid coverage in adolescents and young adults than in older adult population. Expansion of Medicaid coverage coupled with careful monitoring of shifts in Medicaid utilization patterns can mitigate ED overloading by reducing visits related to self-harm.

Feasibility and effectiveness of a distance-adapted physical activity intervention in adolescents with obesity during the COVID-19 pandemic.

Pediatric obesity represents one of the most important public health challenges and its prevalence significantly increased during the COVID-19 pandemic. Our prospective study aimed to assess the feasibility of a remote adapted physical activity (PA) intervention and its effectiveness in improving anthropometric indices, metabolic health parameters, as well as cardiopulmonary function and fitness in adolescents with obesity. A PA intervention involving synchronous online lessons combined with asynchronous sessions and promotion of independent PA and "active breaks" to interrupt prolonged sedentary behaviors was proposed to 20 adolescents aged 11-17 years with obesity over a 4-month period. Clinical and anthropometric parameters (weight, height, waist, body composition, blood pressure), metabolic parameters (glycemia, insulinemia, glycated hemoglobin, oral glucose tolerance test [OGTT], lipid profile, presence of hepatic steatosis), cardiopulmonary function and fitness indices (VO<inf>2</inf>max, six-minute walking test [6MWT], upper and lower limb strength test) were evaluated before and after the intervention. Twenty adolescents with obesity were enrolled (11 male [55%], aged 14.1±1.5 years, BMI SDS 3.1±0.5). Eighteen participants (90%) successfully completed the project, and no adverse events were reported. We observed an increase in cardiovascular and muscle fitness [higher VO2peak, maximal workload, better performance at limb strength and 6MWT (all P<0.05)], increased lean body mass (P=0.005), and an improvement of glucose metabolism response with a reduction of insulin concentrations during OGTT (P=0.043). Participation in the training program was feasible and effective in improving cardiovascular fitness, glucose metabolism, body composition, strength, and endurance in adolescents with obesity during the COVID-19 pandemic.

Public transit mobility as a leading indicator of COVID-19 transmission in 40 cities during the first wave of the pandemic.

The rapid global emergence of the COVID-19 pandemic in early 2020 created urgent demand for leading indicators to track the spread of the virus and assess the consequences of public health measures designed to limit transmission. Public transit mobility, which has been shown to be responsive to previous societal disruptions such as disease outbreaks and terrorist attacks, emerged as an early candidate. We conducted a longitudinal ecological study of the association between public transit mobility reductions and COVID-19 transmission using publicly available data from a public transit app in 40 global cities from March 16 to April 12, 2020. Multilevel linear regression models were used to estimate the association between COVID-19 transmission and the value of the mobility index 2 weeks prior using two different outcome measures: weekly case ratio and effective reproduction number. Over the course of March 2020, median public transit mobility, measured by the volume of trips planned in the app, dropped from 100% (first quartile (Q1)-third quartile (Q3) = 94-108%) of typical usage to 10% (Q1-Q3 = 6-15%). Mobility was strongly associated with COVID-19 transmission 2 weeks later: a 10% decline in mobility was associated with a 12.3% decrease in the weekly case ratio (exp(β) = 0.877; 95% confidence interval (CI): [0.859-0.896]) and a decrease in the effective reproduction number (β = -0.058; 95% CI: [-0.068 to -0.048]). The mobility-only models explained nearly 60% of variance in the data for both outcomes. The adjustment for epidemic timing attenuated the associations between mobility and subsequent COVID-19 transmission but only slightly increased the variance explained by the models. Our analysis demonstrated the value of public transit mobility as a leading indicator of COVID-19 transmission during the first wave of the pandemic in 40 global cities, at a time when few such indicators were available. Factors such as persistently depressed demand for public transit since the onset of the pandemic limit the ongoing utility of a mobility index based on public transit usage. This study illustrates an innovative use of "big data" from industry to inform the response to a global pandemic, providing support for future collaborations aimed at important public health challenges.

The Association between Bone Mineral Density and Risk of Mortality: A Prospective Cohort Study of 233,397 Taiwanese

PurposeOsteoporosis is an important public health challenge given its high prevalence in western populations and the prevalence has shown an upward trend in recent decades in Asia. However, epidemiological evidence on the association between bone mineral density (BMD) and mortality risk in the Asian population is sparse. MethodsThe Cox proportional hazards model and cause-specific hazard models were used to investigate the association of BMD with the risk of all-cause mortality and cause-specific mortality. ResultsThe present study comprised of 3,332,207 person-years with a median follow-up of 14.6 years. 27,508 participants (15,967 men and 11,541 women) died among 233,397 participants (112,348 men and 121,049 women) during the follow-up period. Compared to those with normal BMD level, both men and women with low BMD had a significantly higher risk of all-cause, cardiovascular disease (CVD), and cancer mortality after adjusting for the covariates. [For men with osteoporosis: all-cause: 1.37 (1.27–1.49); CVD: 1.28 (1.08–1.52); cancer: 1.29 (1.12–1.49); For women with osteoporosis: all-cause: 1.72 (1.63–1.82); CVD: 1.85 (1.64–2.08); cancer: 1.47 (1.35–1.61)]. The P for interactions for BMD with sex were significant for all-cause and CVD mortality. The adverse effects of BMD on the risk of all-cause and CVD were higher in women than in men [men vs. women: all-cause: 1.37 (1.27–1.49) vs. 1.72 (1.63–1.82); CVD: 1.28 (1.08–1.52) vs. 1.85 (1.64–2.08)]. In the nonlinear dose-response analyses, the association between BMD increments and all-cause mortality risk shows an L-shaped pattern in men and a similar U-shaped trend in women (P for non-linear association: <0.001). Likewise, a similar L-shaped association was observed between BMD levels and cancer mortality risk in men. ConclusionsLow BMD had an increased risk of all-cause, CVD, and cancer mortality in both men and women. Women had a stronger positive association between low BMD and an increased risk of all-cause and CVD mortality compared to men.

Skin and Digital–The 2024 Narrative

The global burden of skin diseases affects over 3 billion individuals, posing important public health challenges worldwide, with profound impacts in both high-income and low-income and middle-income countries. These challenges are exacerbated by widespread disparities in access to dermatologic care and the prevalence of misinformation. This article, derived from the Skin and Digital Summit at the International Master Course on Aging Science critically evaluates how digital technologies such as artificial intelligence, teledermatology, and large language models can bridge these access gaps. It explores practical applications and case studies demonstrating the impact of these technologies in various settings, with a particular focus on adapting solutions to meet the diverse needs of low-income and middle-income countries. In addition, the narrative highlights the ongoing conversation within the dermatologic community about the role of digital advances in health care, emphasizing that this discussion is dynamic and the one that is continuously evolving. Dermatologists play an essential role in this transition, integrating digital tools into mainstream care to complement a patient-centered, culturally sensitive approach. The article advocates for a globally coordinated digital response that not only addresses current disparities in skin health care but also promotes equitable access to digital health resources, making dermatologic care more representative of all skin types and accessible worldwide.

Smoking Impacts Alzheimer's Disease Progression Through Oral Microbiota Modulation.

Alzheimer's disease (AD) is an important public health challenge with a limited understanding of its pathogenesis. Smoking is a significant modifiable risk factor for AD progression, and its specific mechanism is often interpreted from a toxicological perspective. However, microbial infections also contribute to AD, with oral microbiota playing a crucial role in its progression. Notably, smoking alters the ecological structure and pathogenicity of the oral microbiota. Currently, there is no systematic review or summary of the relationship between these three factors; thus, understanding this association can help in the development of new treatments. This review summarizes the connections between smoking, AD, and oral microbiota from existing research. It also explores how smoking affects the occurrence and development of AD through oral microbiota, and examines treatments for oral microbiota that delay the progression of AD. Furthermore, this review emphasizes the potential of the oral microbiota to act as a biomarker for AD. Finally, it considers the feasibility of probiotics and oral antibacterial therapy to expand treatment methods for AD.

Beyond screentime: a 7-day mobile tracking study among college students to disentangle smartphone screentime and content effects on sleep

ABSTRACT Health professionals and scholars alike consider evening smartphone use an important public health challenge. Existing research on the effects of smartphone usage on sleep has three limitations, namely reliance on self-report measures of smartphone use and/or sleep, limited attention to within-person effects, and a focus on general screentime rather than specific app usage. The current study addressed these limitations by conducting a seven-day study assessing smartphone use and sleep with a combination of subjective and objective measures among 75 students. The findings do not support the assumption that evening smartphone interferes with sleep. We did observe between-person relationships between specific indicators of smartphone usage and sleep, e.g. sleep quality was positively related to the use of meditation apps, and negatively related to the use of work-related apps. These findings indicate research should focus on what individuals do on their phones instead of how much time they spend.

The antibacterial potential and effects of Rhodiola sp. on gut microbiota

AbstractThe challenge of antimicrobial resistance requires new solutions, and Rhodiola sp. is a promising candidate due to its rich medicinal history. This review focuses on Rhodiola sp., especially R. rosea, highlighting its phytochemical constituents, such as salidroside, rosavins, and other phenolics, and their antimicrobial potential. We investigate the efficacy of Rhodiola sp. against various pathogenic bacteria, suggesting their value in combating antimicrobial resistance. Additionally, Rhodiola compounds are being investigated both as direct antimicrobials and as resistance modifiers that increase the efficacy of antibiotics. Rhodiola extracts and salidroside modulate gut microbiota, thereby affecting health and physiological and metabolic disorders. This illustrates the comprehensive therapeutic potential of Rhodiola sp. We emphasize the importance of understanding the complex interactions between Rhodiola phytochemicals, their antimicrobial effects, and their effects on gut microbiota as well as the need for in-depth research. Further studies will be crucial for the development of holistic treatment approaches. Finally, Rhodiola sp. is highlighted as an important natural resource in the fight against microbial pathogens and antibiotic resistance. Research on Rhodiola sp. should continue to further unravel pharmacological and health-promoting potential and thus address an important public health challenge.