Important Public Health Challenge Research Articles

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.

Drug-Resistant Tuberculosis: Development Mechanisms and Methods of Molecular Genetic Diagnosis

The widespread occurrence of drug-resistant tuberculosis is an important public health challenge. To better understand this phenomenon, the article summarizes current ideas on the development of mechanisms of Mycobacterium tuberculosis resistance to antituberculosis drugs. Special attention is paid to the mechanism of acquired resistance based on mutations in the genes encoding antituberculosis drug targets or enzymes that translate pro-drug into its active form; the effect of these mutations on fitness of the pathogen is in the focus of the article. It emphasizes the leading role of molecular genetic methods for diagnosing M. tuberculosis drug resistance and importance of these methods for preventing the expansion of the pathogen’s resistance range and the spread of resistant clones in the population. A comparison of sequencing and PCR-based methods capacities led to a conclusion that at the current stage of technological development it is reasonable to use each of these approaches for specific purposes: domestic PCR-based tests — for diagnosis, and sequencing — for basic research of M. tuberculosis evolution and epidemiological monitoring. Promising areas of M. tuberculosis resistance research were proposed to develop new approaches for diagnosis and treatment of drug-resistant tuberculosis and to provide effective personalized therapy.

Genomic insights into the comorbidity between type 2 diabetes and schizophrenia.

Multimorbidity represents an increasingly important public health challenge with far-reaching implications for health management and policy. Mental health and metabolic diseases have a well-established epidemiological association. In this study, we investigate the genetic intersection between type 2 diabetes and schizophrenia. We use Mendelian randomization to examine potential causal relationships between the two conditions and related endophenotypes. We report no compelling evidence that type 2 diabetes genetic liability potentially causally influences schizophrenia risk and vice versa. Our findings show that increased body mass index (BMI) has a protective effect against schizophrenia, in contrast to the well-known risk-increasing effect of BMI on type 2 diabetes risk. We identify evidence of colocalization of association signals for these two conditions at 11 genomic loci, six of which have opposing directions of effect for type 2 diabetes and schizophrenia. To elucidate these colocalizing signals, we integrate multi-omics data from bulk and single-cell gene expression studies, along with functional information. We identify putative effector genes and find that they are enriched for homeostasis and lipid-related pathways. We also highlight drug repurposing opportunities including N-methyl-D-aspartate (NMDA) receptor antagonists. Our findings provide insights into shared biological mechanisms for type 2 diabetes and schizophrenia, highlighting common factors that influence the risk of the two conditions in opposite directions and shedding light on the complex nature of this comorbidity.

Long-term neurotoxicity among childhood acute lymphoblastic leukaemia survivors enrolled between 1971 and 1998 in EORTC Children Leukemia Group studies

Survival after childhood acute lymphoblastic leukemia (ALL) has increased over the last 40 years with an overall survival above 90%. Survivors may experience neurological late effects secondary to chemotherapy and radiotherapy. This observational retrospective study evaluated the cumulative incidence of neurological late effects among 890 childhood ALL survivors treated in EORTC CLG trials (58741, 58831/2 and 58881) between 1971 and 1998. Median follow-up was 19 years and interquartile range of the follow-up was 15–22 years. At 20 years from the end of treatment, approximately 66% of patients from the 58741 trial (accrual time: 1971–1978) and approximately 15% from the more recent trials had cognitive disturbance grade 1 or higher. Cumulative incidences at 20 years from treatment end of seizures, stroke and leukoencephalopathy were respectively 45%, 16% and 62% in study 58741, 13%, 2% and 5% in study 58831/2, and 8%, 2% and 3% in study 58881. Patients who were 10–17 years of age at diagnosis had a higher incidence of stroke and leukoencephalopathy as compared to those less than 6 years of age. Noteworthy, all neurological late effects continued to occur beyond 5 years after end of treatment. This retrospective study highlights the frequency of neurological late effects in survivors of childhood ALL. With the increase of the overall survival of ALL patients, the role and potential benefit of longitudinal neurological screening should be evaluated in further studies as these neurological late effects become an important public health challenge. This study is part of the larger EORTC CLG 58 Late Adverse Effects (LAE) study (ClinicalTrials.gov Identifier NCT01298388, date of registration February 16, 2011).

Frailty and Survivability of Polish Caucasian Nonagenarians and Centenarians.

Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94-99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200-0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.

Walnuts for the eye and vision

The increase in lifespan with the consequent expansion of the aging of the world population has become an important challenge for public health. In recent decades, there has been a progressive increase in the incidence of debilitating diseases related to aging, including neurodegenerative disorders and eye diseases. Oxidative stress and inflammation are believed to play a critical role in several eye disorders, such as age‐related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts, the leading causes of visual loss and blindness worldwide. Neurodegenerative events were also related to AMD and DR.Nutrients such as n‐3 polyunsaturated fatty acids (n‐3 PUFA) and antioxidants, specifically polyphenols, carotenoids, and vitamins C and E, may play a role in preventing both cognitive decline and retinal degenerative processes. Nuts have been described as a “superfood”, containing a notable variety of natural components that may have additive and/or synergistic properties for health and may prevent some pathologies. Nuts in general and walnuts in particular have a rich matrix of these bioactive components and through additive effects, have the potential to beneficially impact neuronal function in the brain and retina. Among different nuts, walnuts contain n‐3 PUFAs, specifically α‐linolenic acid (ALA; C18:3n‐3). It is believed that ALA may improve brain health indirectly through conversion to docosahexaenoic acid (DHA; C22:6n‐3), which has the ability to modulate brain plasticity and counteracts neuroinflammation in experimental studies. Other bioactive compounds in walnuts, such as arginine, tocopherols, folate, melatonin and polyphenols, also support neurological health and cognitive well‐being by modulating blood pressure, HDL function, glucoregulation, endothelial vasodilator function, oxidative status and vascular dysfunction. Polyphenols (including ellagitannins) have high antioxidant and prebiotic properties, which can regulate the gut microbiome, which is related to the increased risk of several inflammatory diseases. There is growing evidence that walnuts may contribute positively to eye disorders such as AMD, DR, and cataract prevention.

Disseminated cysticercosis in humans

AbstractHuman cysticercosis, caused by the parasitic infection of Taenia Solium, is an important challenge for public health in Ecuador and other countries where poor sanitary conditions are a key factor for its appearance. In this series of cases, we publish the imaging findings corresponding to three patients treated in 2022 at the Center of Medical Specialties “Comité del Pueblo” Quito - Ecuador, in which, through radiographic images, multiple radiodense lesions were found in different anatomical regions which follow the typical pattern of distribution parallel to the muscular tissues of the affected region, generating the radiological sign known as “rice grain calcifications”, which corresponds to the presence of Disseminated Cysticercosis (DCC)in the muscular tissue of the host.

Uncovering the Burden of Diabetes in Ekiti State, Nigeria: Insights From a Statewide, Household-Based, Cross-Sectional Study.

Diabetes mellitus (DM) is an important global public health challenge, and the burden of the disease is huge, particularly in low- and middle-income countries (LMICs), where the majority of people with this condition reside. Undiagnosed DM is more prevalent in LMICs. The aim of this study is to determine the prevalence and associated factors for DM in Ekiti State. A cross-sectional, household-based survey using a four-stage multistage sampling design and the World Health Organization (WHO)-STEPS survey manual was conducted from July to September 2020 as a part of the Ekiti State coronavirus disease 2019 (COVID-19) survey. Of the 5,145 sampled households, 4,726 individuals gave consent to participate in the survey. Out of these, 3043 had fasting plasma glucose results available and were included in the analysis. There were 2257 (74.2%) women and 786 (25.8%) men. The prevalence of DM was 6.5% (6.5% in males and 6.6% in females, P = 0.946). Diabetes was found to be more prevalent among those with a secondary school education or higher (10.9%); employed in the formal sector (13.4%); separated, divorced, or widowed (8.5%); with raised blood pressure (9.3%); and who were aged 30-59 years (all P < 0.05). Multivariable logistic regression showed that age, education, occupation, and hypertension were all positively and significantly associated with an increased risk of DM. The prevalence of DM in Ekiti State is high, and its predictors include advancing age, hypertension, education, and occupation. This calls for scaling up public health interventions for controlling DM, targeting the identified risk factors among the people of Ekiti.

Molecular Analysis of Bacterial Meningitis in Suspected Cases

One hundred and seventy-six cases of suspected meningitis (SMN) were included in a cross-sectional study. Their ages ranged from less than 1 year to 80 years, of whom 44.3% were male. The aim was to assess bacterial meningitis (BMN) in terms of incidence and types of causative bacteria. Cerebrospinal fluid (CSF) specimens were collected and polymerase chain reaction (PCR) analysis was conducted with universal primers designed to amplify a DNA fragment (996 bp) of the 16S rRNA gene of eubacteria. Resolving PCR products in agarose-gel electrophoresis revealed that 37.5% of CSF specimens were PCR positive, while 62.5% of CSF specimens showed no band and were considered PCR-negative. Eighty percent of the latter specimens were noted to have pleocytosis, in addition to having protein and/or glucose concentrations lower or higher than those in the normal range (abnormal CSF). The remaining 20.0% of CSF specimens were considered normal regarding pleocytosis, protein, and glucose (normal CSF). When the amplified DNA of PCR-positive specimens was subjected to sequencing and alignment with reference sequences, both Gram-negative (GN) and Gram-positive (GP) bacteria were identified (23 and 9 types, respectively). Acinetobacter spp. and Pseudomonas spp. were the most common GN bacteria (each with 17.8%), while Staphylococcus spp. was the most common GP bacteria (43.75%). The study concluded that BMN presents an important public health challenge, and PCR analysis of the CSF was an effective method for diagnosing pathogenic bacteria in SMN. In addition, leukocytes, glucose, and protein are valuable CSF parameters that may aid in the diagnosis of BMN.

Dynamics of a two-group model for assessing the impacts of pre-exposure prophylaxis, testing and risk behaviour change on the spread and control of HIV/AIDS in an MSM population

Although much progress has been made in reducing the public health burden of the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS), since its emergence in the 1980s (largely due to the large-scale use and availability of potent antiviral therapy, improved diagnostic and intervention and mitigation measures), HIV remains an important public health challenge globally, including in the United States. This study is based on the use of mathematical modeling approaches to assess the population-level impact of pre-exposure prophylaxis (PrEP), voluntary testing (to detect undetected HIV-infected individuals), and changes in human behavior (with respect to risk structure), on the spread and control of HIV/AIDS in an MSM (men-who-have sex-with-men) population. Specifically, a novel two-group mathematical model, which stratifies the total MSM population based on risk (low or high) of acquisition of HIV infection, is formulated. The model undergoes a PrEP-induced backward bifurcation when the control reproduction number of the model is less than one if the efficacy of PrEP to prevent a high-risk susceptible MSM individual from acquiring HIV infection is not perfect (the consequence of which is that, while necessary, having the reproduction number of the model less than one is no longer sufficient for the elimination of the disease in the MSM population). For the case where the efficacy of PrEP is perfect, this study shows that the disease-free equilibrium of the two-group model is globally-asymptotically stable when the associated control reproduction number of the model is less than one. Global sensitivity analysis was carried out to identify the main parameters of the model that have the highest influence on the value of the control reproduction number of the model (thereby, having the highest influence on the disease burden in the MSM population). Numerical simulations of the model, using a plausible range of parameter values, show that if half of the MSM population considered adhere strictly to the specified PrEP regimen (while other interventions are maintained at their baseline values), a reduction of about 22% of the new yearly HIV cases recorded at the peak of the disease could be averted (compared to the worst-case scenario where PrEP-based intervention is not implemented in the MSM population). The yearly reduction at the peak increases to about 50% if the PrEP coverage in the MSM population increases to 80%. This study showed, based on the parameter values used in the simulations, that the prospects of elimination of HIV/AIDS in the MSM community are promising if high-risk susceptible individuals are no more than 15% more likely to acquire HIV infection, in comparison to their low-risk counterparts. Furthermore, these prospects are significantly improved if undetected HIV-infected individuals are detected within an optimal period of time.

A Four-Year Trend of Acute Hepatitis B Virus Infection at a Tertiary Health Facility in Lagos, Nigeria

Hepatitis B virus (HBV) infection is an important public health challenge. More than 350,000,000 people worldwide have chronic hepatitis B (CHB). Hepatitis B core ImmunoglobinM(HBc IgM) is an important marker used to classify whether an existing HBV is a new infection or an existing one, differentiating acute from chronic HBV infection. When an individual is HBc IgM positive, it shows a new infection, while negative IgM indicates a previous infection. The study aimed to determine the trend of acute HBV infections among hepatitis B-positive patients in a tertiary health facility in Lagos, Nigeria, over a four-year period. Patients accessing HBc IgM tests at a tertiary health facility in Lagos, Nigeria. Five (5) ml of blood samples were collected in K+EDTA vacutainers and centrifuged at 3500 rpm for 5 minutes. Plasma (2 ml) was collected in plain tubes, and HBc IgM assay was performed using DIA-Pro (BIORAD) kits according to the manufacturer’s instructions. The study period was from January 2014 to December 2017. The total number of patients who accessed this assay within the study period was 1,422. The male population was 896 (61.1%). Total HBc IgM positive and HBc IgM negative results were 197 (13.8%) and 1,225 (86.1%) respectively, and there was 1 (0.07%) equivocal. Rates of HBc IgM positivity, indicating acute infection, were 12.9%, 13.0%, 11.9%, and 15.1% in the years 2014, 2015, 2016, and 2017 respectively. The rate of acute HBV infection increased from 12.9% in 2014 to 15.1% in 2017, indicating likely new infection transmission ongoing in communities. These high and increasing rates require the sustenance of public health interventions.

Report of the Influenza Vaccination Program in Mexico (2006-2022) and Proposals for Its Improvement.

Influenza has continued to be an important public health challenge, and the WHO recommends that countries consider vaccination for persons at high risk. Mexico has such a program, and we sought to determine its current situation. This study has an ecological, longitudinal, and retrospective design based on secondary information on the acquisition and application of vaccines against influenza from official data from 2006 to 2022. We found annual variability in the numbers of purchases and application of doses, with coverage of less than 90% of the total population every year; in addition, 17 million vaccines were not used in this period. This study shows the situation of the program at the national level. Two institutions acquired fewer the vaccines, while one purchased more for its target population, but the necessary vaccinations were not acquired. On average, 1.7 million of the vaccines purchased annually were not used, but in some years, more vaccines were applied than were purchased in all of the institutions. We also observed that, between institutions, the vaccine coverage was very different, from 21% to 180%. On average, 6.2 million people were not vaccinated annually, between 16% and 22% of the target population, demonstrating low coverage. When we compared the coverage data that we calculated to the data published by the institutions, a great difference was observed. We found inconsistencies in the data, indicating their unreliability and potential disorganization within the program, as the target populations of each institution were not clear. In addition, the application data may have had reporting errors. Adequate coverage was not achieved, and the coverage was different from that reported in the official sources. We propose the implementation of different systems for control, evaluation, and access to the information of the program.

Trends in sexually transmitted and blood-borne infections in China from 2005 to 2021: a joinpoint regression model

BackgroundSexually transmitted and blood-borne infections (STBBIs) is a major public health concern in China. This study assessed the overall trends in STBBIs to improve the comprehensive understanding of the burden of STBBIs and provide evidence for their prevention and control.MethodsData for the period from 2005 to 2021 were analyzed across China on infections with hepatitis B or C; syphilis; gonorrhea; and HIV infection. Trends, annual percent change (APC), and average annual percent change (AAPC) in diagnosis rate was analyzed using joinpoint regression models for the five STBBIs together or individually.ResultsFrom 2005 to 2021, the overall diagnosis rate of all five STBBIs increased, with an AAPC of 1.3% [95% confidence interval (CI) -0.5% to 3.1%]. Diagnosis rates of HIV, syphilis and hepatitis C increased individually, but it decreased for infections of hepatitis B and gonorrhea. Joinpoint analysis identified four phases in diagnosis rate of hepatitis C; three phases in diagnosis rate of hepatitis B, HIV infection, and syphilis; two in diagnosis rate of gonorrhea infection.ConclusionDespite national efforts to prevent and control STBBIs, their overall diagnosis rate has continued to rise in China, and they remain an important public health challenge. Further efforts should be made to educate the general population about STBBIs, particularly HIV. Interventions targeting vulnerable groups should be adopted and their efficacy monitored through regular analysis of trends.

On the Health Impacts of Climatic Shocks: How Heatwaves Reduce Birthweight in Sub‐Saharan Africa

AbstractHeatwaves are among the most important global public health challenges of our time. Yet we know little about how exposure to heatwaves (as opposed to hot days) affects health at birth, which is a key contributor to health, development, and well‐being in later life. This study addresses this shortcoming by investigating the relationship between in utero exposure to heatwave and birthweight by assessing both the timing and mechanisms of heatwave effects. I use novel georeferenced survey data on birth and pregnancy outcomes from the latest round of the Demographic and Health Surveys to link the birth outcomes of 64,210 infants across 11 sub‐Saharan African countries with high‐resolution daily climate data. I find that infants exposed to heatwave in the third trimester of gestation had significantly lower birthweight and that this effect is mediated by reduced gestational age at birth instead of reduced intrauterine growth. The effect of heatwave is concentrated among male babies and mothers with no or little formal education. By highlighting how exposure to environmental conditions early in life shapes health outcomes with far‐reaching consequences, the findings carry lessons for policymakers to protect pregnant women from heatwave exposure to mitigate the negative impact of climate change.

Melittin-Related Peptides Interfere with Sandfly Fever Naples Virus Infection by Interacting with Heparan Sulphate.

Emerging viruses pose an important global public health challenge, and early action is needed to control their spread. The Bunyaviridae family contains a great number of arboviruses which are potentially pathogenic for humans. For example, phleboviruses affect a large range of hosts, including humans and animals. Some infections usually have an asymptomatic course, but others lead to severe complications, such as Toscana virus, which is able to cause meningitis and encephalitis. Unfortunately, to date, no vaccines or antiviral treatments have been found. In the present study, we evaluated the effect of melittin-related peptides, namely the frog-derived RV-23 and AR-23, on sandfly fever Naples virus infection in vitro. Both peptides exhibited a strong antiviral activity by targeting the viral particles and blocking the virus-cell interaction. Their action was directed to an early phase of SFNV infection, in particular at viral adsorption on host cells, by interfering with the binding of common glycosaminoglycan receptors. Given the better antimicrobial behavior of AR-23 and RV-23 compared to melittin in terms of selectivity, our studies expand our understanding of the potential of these peptides as antimicrobials and stimulate further investigations in the direction of novel antiviral strategies against phlebovirus infection.

Metagenome meta-analysis reveals an increase in the abundance of some multidrug efflux pumps and mobile genetic elements in chemically polluted environments.

Many human activities contaminate terrestrial and aquatic environments with numerous chemical pollutants that not only directly alter the environment but also affect microbial communities in ways that are potentially concerning to human health, such as selecting for the spread of antibiotic-resistance genes (ARGs) through horizontal gene transfer. In the present study, metagenomes available in the public domain from polluted (with antibiotics, with petroleum, with metal mining, or with coal-mining effluents) and unpolluted terrestrial and aquatic environments were compared to examine whether pollution has influenced the abundance and composition of ARGs and mobile elements, with specific focus on IS26 and class 1 integrons (intI1). When aggregated together, polluted environments had a greater relative abundance of ARGs than unpolluted environments and a greater relative abundance of IS26 and intI1. In general, chemical pollution, notably with petroleum, was associated with an increase in the prevalence of ARGs linked to multidrug efflux pumps. Included in the suite of efflux pumps were mexK, mexB, mexF, and mexW that are polyspecific and whose substrate ranges include multiple classes of critically important antibiotics. Also, in some instances, β-lactam resistance (TEM181 and OXA-541) genes increased, and genes associated with rifampicin resistance (RNA polymerases subunits rpoB and rpoB2) decreased in relative abundance. This meta-analysis suggests that different types of chemical pollution can enrich populations that carry efflux pump systems associated with resistance to multiple classes of medically critical antibiotics. IMPORTANCE The United Nations has identified chemical pollution as being one of the three greatest threats to environmental health, through which the evolution of antimicrobial resistance, a seminally important public health challenge, may be favored. While this is a very plausible outcome of continued chemical pollution, there is little evidence or research evaluating this risk. The objective of the present study was to examine existing metagenomes from chemically polluted environments and evaluate whether there is evidence that pollution increases the relative abundance of genes and mobile genetic elements that are associated with antibiotic resistance. The key finding is that for some types of pollution, particularly in environments exposed to petroleum, efflux pumps are enriched, and these efflux pumps can confer resistance to multiple classes of medically important antibiotics that are typically associated with Pseudomonas spp. or other Gram-negative bacteria. This finding makes clear the need for more investigation on the impact of chemical pollution on the environmental reservoir of ARGs and their association with mobile genetic elements that can contribute to horizontal gene transfer events.

Socio-economic factors associated with open defecation among agricultural households: a cross-sectional study in Haiti

BackgroundOpen defecation (OD) is recognised as an important public health challenge in low-income and middle-income countries. Although agriculture is the main occupation in these countries, few if any study on...

The role of Mayors in protecting citizens' health: a brief report from Italy.

The World Health Organization has identified urbanization as one of the most important public health challenges of our century. Nowadays, about half of the world's population live in urban areas, thus municipal authorities can influence multiple determinants of health through Urban Health strategies. However, the health policies and welfare systems are usually managed by multi-level political governments. The aim of this report is to describe the legal and operational competences attributed to mayors and municipal councils with reference to health, taking Italy as case study. Our report summarises and analyses the national, regional, and local Italian legislations. Our results identified the mayors as the highest local health authorities. Indeed, the mayor can issue specific regulations for their local area or order contingent and urgent measures for preventing or delimiting serious health hazards for the safety of their citizens. Moreover, among their duties, municipalities play a crucial role in social care. Hence, municipalities are expected to cooperate with National Health Service at the regional level, to integrate their contributions in a single welfare system. In conclusion, mayors represent the institutional figures closest to the citizens. Municipalities and regional governments should coordinate and integrate their strategies and policies to meet health and social needs of citizens, providing easy access to shared pathways. Municipalities also regulate autonomously fundamental aspects related to the urban environment and can promote and protect health and improve the quality of life for citizens.