Major Public Health Crisis Research Articles

Comparing the association between heavy metals and cognitive status and depression in miners and non-miners: A study from southeast of Iran

Heavy metal toxicity is a major public health crisis worldwide, especially in mining environments. The association between chronic heavy metals exposure and cognitive impairment has not been studied broadly in adults and mining fields. This study aimed to compare the association between arsenic (As), lead (Pb), and copper (Cu) concentration in blood and cognitive status and depression in copper miners and non-miners. Participants were selected from the Rafsanjan cohort study (RCS) as non-miners and miners from Sarcheshmeh Copper Complex. For evaluation of cognitive performance and creativity, comprehensive neurological tests were performed as follows: Mini-Mental Status Examination (MMSE), Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Psychomotor Vigilance Task (PVT), creativity tests including remote association task (RAT) and alternative uses task (AUT). Beck Depression Inventory-II was used to evaluate depression. Standard laboratory tests were also performed. Atomic absorption spectrophotometry was used to estimate the blood's concentration of As, Pb and Cu. We observed a significant difference between arsenic, lead, copper, and depression scores (all P < 0.001) in the two groups (miners and non-miners). Miners had a better performance in cognitive fields except in MMSE and PVT tests. Linear regression analyses showed that the lead had a negative association with the PVT test and depression score. The results suggest that the development of depression, cognitive impairments, and other health problems is possible in chronic heavy metal exposure, especially lead (Pb). Confirmation of our claim requires further study in the coming years.

92 ‘Greenprint’ for integrated care clinics—the hub and spoke model

Abstract Background Climate change is a major public health crisis requiring attention at an individual, local and national policy level. Transport is the largest source of energy related carbon emissions in Ireland. The development of integrated care occurs alongside climate emergency. Care previously delivered in hospital outpatients, or a central ‘hub’ is now being delivered in integrated care clinics, ‘spokes’. We aimed to assess the environmental impact of transport to integrated care clinics compared to travel to hospital clinic. Methods Geriatric Medicine Integrated Care attendances from January 2023 to March 2023 were included. Distance from the patient’s home address to the location of Integrated Care Clinic (spoke), and to the affiliated hospital (hub) were recorded in kilometres. For the primary analysis we have not considered staff travel as there was heterogeneity in number of staff per clinic and distance travelled per staff member. Where more than one route was available, the shortest distance was recorded. Carbon emissions were estimated based on kilometres travelled by a standard new passenger car. Results Among 206 clinic attendances, the mean distance to ‘spoke’ clinic was 16.06 km (15.98). The mean distance to the ‘hub’ clinic was 39.29 km (17.82). The estimated total distance travelled by patients to integrated care clinics was 3293.45 km, whereas the distance which would have been travelled to ‘hub’ clinics was 8055.85 km. Total carbon emissions for 3 month travel to ‘spoke’ clinics were estimated at 371 kg, compared to 907 kg to the ‘hub’. Conclusion The development of integrated care services, which provides necessary care to older adults, may also have an environmental advantage. Healthcare’s contribution to climate change action is another incentive to invest in integrated care services.

Acceptability of COVID-19 Vaccination by Doctors: Cross-Sectional Survey from Mohammed VI University Hospital in Marrakech

Covid-19 has rapidly became a major public health crisis. Several public health and containment measures were deployed to contain this epidemy; however, a return to a normal life could only be expected after the generalization of anti-Covid 19 vaccination, allowing a global collective immunity. The success of this campaign depends essentially on the acceptance of the new Covid-19 vaccines. We conducted a descriptive and analytical observational cross-sectional study to evaluate the acceptability of Covid-19 vaccines, among resident and intern doctors at the Mohammed VI University Hospital in Marrakech, to determine the factors associated with vaccine acceptance, and the reasons for hesitation or nonacceptance of vaccination. Out of 145 participants (59.1% female, mean age 26.6 years), 89.7% received the vaccine at least partially. 49% of our population did not delay their vaccination and intended to complete it, so we considered them accepting. However, 40.7% were considered hesitant because of delayed or abandoned Covid-19 vaccination. People living alone and resident physicians in medical or biological specialties were the most likely to accept vaccination. Factors influencing refusal or hesitation included: speed of vaccine development, fear of adverse effects, lack of information on vaccine efficacy, acquisition of natural immunity following previous infection with Covid-19, lack of confidence in the pharmaceutical industry. Doctors' general attitudes towards COVID-19 vaccination, in our study, are positive, but specific concerns about the COVID-19 vaccine are widespread. Addressing barriers to vaccination in these groups will be essential to avoid exacerbating the health inequalities highlighted by this pandemic.

SARS-CoV-2 neutralizing antibody bebtelovimab - a systematic scoping review and meta-analysis.

The COVID-19 pandemic is a major global public health crisis. More than 2 years into the pandemic, effective therapeutic options remain limited due to rapid viral evolution. Stemming from the emergence of multiple variants, several monoclonal antibodies are no longer suitable for clinical use. This scoping review aimed to summarize the preclinical and clinical evidence for bebtelovimab in treating newly emerging SARS-CoV-2 variants. We systematically searched five electronic databases (PubMed, CENTRAL, Embase, Global Health, and PsycINFO) from date of inception to September 30, 2022, for studies reporting on the effect of bebtelovimab in SARS-CoV-2 infection, using a combination of search terms around -bebtelovimab‖, -LY-CoV1404‖, -LY3853113‖, and -coronavirus infection‖. All citations were screened independently by two researchers. Data were extracted and thematically analyzed based on study design by adhering to the stipulated scoping review approaches. Thirty-nine studies were included, thirty-four non-clinical studies were narratively synthesized, and five clinical studies were meta-analyzed. The non-clinical studies revealed bebtelovimab not only potently neutralized wide-type SARS-CoV-2 and existing variants of concern such as B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), and B.1.617.2 (Delta), but also retained appreciable activity against Omicron lineages, including BA.2.75, BA.4, BA.4.6, and BA.5. Unlike other monoclonal antibodies, bebtelovimab was able to bind to epitope of the SARS-CoV-2 S protein by exploiting loop mobility or by minimizing side-chain interactions. Pooled analysis from clinical studies depicted that the rates of hospitalization, ICU admission, and death were similar between bebtelovimab and other COVID-19 therapies. Bebtelovimab was associated with a low incidence of treatment-emergent adverse events. Preclinical evidence suggests bebtelovimab be a potential treatment for COVID-19 amidst viral evolution. Bebtelovimab has comparable efficacy to other COVID-19 therapies without evident safety concerns.

The role of the gut microbiome and microbial metabolism in mediating opioid-induced changes in the epigenome.

The current opioid pandemic is a major public health crisis in the United States, affecting millions of people and imposing significant health and socioeconomic burdens. Preclinical and clinical research over the past few decades has delineated certain molecular mechanisms and identified various genetic, epigenetic, and environmental factors responsible for the pathophysiology and comorbidities associated with opioid use. Opioid use-induced epigenetic modifications have been identified as one of the important factors that mediate genetic changes in brain regions that control reward and drug-seeking behavior and are also implicated in the development of tolerance. Recently, it has been shown that opioid use results in microbial dysbiosis, leading to gut barrier disruption, which drives systemic inflammation, impacting the perception of pain, the development of analgesic tolerance, and behavioral outcomes. In this review, we highlight the potential role of microbiota and microbial metabolites in mediating the epigenetic modifications induced by opioid use.

Discovery of highly potent covalent SARS-CoV-2 3CLpro inhibitors bearing 2-sulfoxyl-1,3,4-oxadiazole scaffold for combating COVID-19

The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged as a major public health crisis, posing a significant threat to human well-being. Despite the availability of vaccines, COVID-19 continues to spread owing to the emergence of SARS-CoV-2 mutants. This highlights the urgent need for the discovery of more effective drugs to combat COVID-19. As an important target for COVID-19 treatment, 3C-like protease (3CLpro) plays a crucial role in the replication of SARS-CoV-2. In our previous research, we demonstrated the potent inhibitory activities of compound A1, which contains a 2-sulfonyl-1,3,4-oxadiazole scaffold, against SARS-CoV-2 3CLpro. Herein, we present a detailed investigation of structural optimization of A1 and conduct a study on the structure-activity relationship. Among the various compounds tested, sulfoxide D6 demonstrates a potent irreversible inhibitory activity (IC50 = 0.030 μM) against SARS-CoV-2 3CLpro, as well as a favorable selectivity towards host cysteine proteases such as cathepsin B and cathepsin L. Utilizing mass spectrometry-based peptide profiling, we found that D6 covalently binds to Cys145 of SARS-CoV-2 3CLpro. Some representative compounds, namely C11, D9 and D10 also demonstrates antiviral activity against SARS-CoV-2 in Vero E6 cells. Overall, the investigation of the 2-sulfoxyl-1,3,4-oxadiazole scaffold as a novel cysteine reactive warhead would provide valuable insights into the design of potent covalent 3CLpro inhibitors for COVID-19 treatment.

Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness.

Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities. In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated. Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up. Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial. This trial was registered with ClinicalTrials.gov under identifier NCT04800432.

COVID As a Catalyst: A Qualitative Study Of Professional Identity Formation among U.S. Medical Students During COVID-19

Phenomenon Students become physicians not only by mastering medical knowledge, but also through a process of Professional Identity Formation (PIF). In this study, we used the conceptual framework of Jarvis-Selinger et al. to explore the impact of COVID, as a major public health crisis, on the PIF of preclinical medical students in our country. Approach At two U.S. medical schools, we interviewed 28 medical students twice as they moved from first to second year during the 2020-2021 COVID pandemic and explored the impact of COVID-19 on PIF. We coded the transcribed interviews and identified themes using constructivist thematic analysis. Findings We identified three themes: 1) mental health and wellness impacts; 2) inhabiting identity as a health professional during COVID; and 3) questioning the role of physicians in society. Routines and support systems were disrupted, undermining wellness and confidence in professional choices. Students noted the need to be public health role models, and COVID prompted feelings of pride, while also causing them to question expectations of self-sacrifice amid a new politicization of medicine. Students felt that physicians must be increasingly engaged in public health and political communication. Insights Our findings inform medical educators seeking to build a scaffolding to support PIF during a public health crisis, and highlight the importance of current events and politics on PIF. Our recommendations include the need for student support, longitudinal mentorship, curricular space to discuss the impact of sociopolitical factors on PIF, and revisiting foundational concepts such as professionalism to take into account the social and political context. Our findings add to understanding of PIF during the COVID pandemic, but are also relevant to teaching and learning during future public health crises.

Protective Effects of Medicinal Plant-Based Foods against Diabetes: A Review on Pharmacology, Phytochemistry, and Molecular Mechanisms.

Diabetes mellitus (DM) comprises a range of metabolic disorders characterized by high blood glucose levels caused by defects in insulin release, insulin action, or both. DM is a widespread condition that affects a substantial portion of the global population, causing high morbidity and mortality rates. The prevalence of this major public health crisis is predicted to increase in the forthcoming years. Although several drugs are available to manage DM, these are associated with adverse side effects, which limits their use. In underdeveloped countries, where such drugs are often costly and not widely available, many people continue to rely on alternative traditional medicine, including medicinal plants. The latter serves as a source of primary healthcare and plant-based foods in many low- and middle-income countries. Interestingly, many of the phytochemicals they contain have been demonstrated to possess antidiabetic activity such as lowering blood glucose levels, stimulating insulin secretion, and alleviating diabetic complications. Therefore, such plants may provide protective effects that could be used in the management of DM. The purpose of this article was to review the medicinal plant-based foods traditionally used for the management of DM, including their therapeutic effects, pharmacologically active phytoconstituents, and antidiabetic mode of action at the molecular level. It also presents future avenues for research in this field.

Testing the interpersonal theory of suicide in adolescents: A multi-wave longitudinal study.

Suicide is a major public health crisis among youth. Several prominent theories, including the Interpersonal Theory of Suicide (IPTS), aim to characterize the factors leading from suicide ideation to action. These theories are largely based on findings in adults and require testing and elaboration in adolescents. Data were examined from high-risk 13-18-year-old adolescents (N = 167) participating in a multi-wave, longitudinal study; 63% of the sample exhibited current suicidal thoughts or recent behaviors (n = 105). The study included a 6-month follow-up period with clinical interviews and self-report measures at each of the four assessments as well as weekly smartphone-based assessments of suicidal thoughts and behaviors. Regression and structural equation models were used to probe hypotheses related to the core tenets of the IPTS. Feelings of perceived burdensomeness were associated with more severe self-reported suicidal ideation (b = 0.58, t(158) = 7.64, p < .001). Similarly, burdensomeness was associated with more frequent ideation based on weekly smartphone ratings (b = 0.11, t(1460) = 3.41, p < .001). Contrary to IPTS hypotheses, neither feelings of thwarted belongingness, nor interactions between burdensomeness and thwarted belongingness were significantly associated with ideation (ps > .05). Only elevated depression severity was associated with greater odds of suicide events (i.e., suicide attempts, psychiatric hospitalizations, and/or emergency department visits for suicide concerns) during the follow-up period (OR = 1.83, t(158) = 2.44, p = .01). No effect of acquired capability was found. Perceptions of burdensomeness to others reflect a critical risk factor for suicidal ideation among high-risk adolescents. Null findings with other IPTS constructs may suggest a need to adopt more developmentally sensitive models or measures of interpersonal and acquired capability risk factors for youth. Refining methods and theoretical models of suicide risk may help improve the identification of high-risk cases and inform clinical intervention.

Emotional support among partnered sexual minority and heterosexual individuals during the COVID-19 pandemic

Emotional support, particularly support from family and friends, is essential to health outcomes especially for marginalized communities. Although emotional support is recognized as a critical resource, especially during the COVID-19 pandemic, to date no research has examined access to support during the pandemic for sexual diverse populations. This study aims to apply minority stress theory by drawing on a new population-based data source of 3,642 respondents, the National Couples’ Health and Time Study (NCHAT), which oversampled sexual and gender diverse populations during the pandemic. We focus on two sources of emotional support: family members and friends. Exclusively heterosexual respondents relied more on emotional support from family than respondents who identified as exclusively gay/lesbian, bisexual including pan, omni, and queer, and those reporting another sexual identity or multiple sexual identities. However, respondents who did not identify as heterosexual relied more on emotional support from friends compared to exclusively heterosexual respondents. There were no significant differences among respondents with sexual minority identities in regard to family or friend support. Other factors, such as outness to friends and family, identity centrality, aggressions, and relationship satisfaction are found to be associated support from friends and family. The findings presented here add to a growing body of work on social support while adding sexual minority-specific factors that may affect receipt of, need for, and outcomes relating to support. This work contributes to understanding of the social climate and resources available to sexual diverse populations during a major public health crisis.

Antimicrobial Resistance Genes (ARGs), the Gut Microbiome, and Infant Nutrition.

The spread of antimicrobial resistance genes (ARGs) is a major public health crisis, with the ongoing spread of ARGs leading to reduced efficacy of antibiotic treatments. The gut microbiome is a key reservoir for ARGs, and because diet shapes the gut microbiome, diet also has the potential to shape the resistome. This diet-gut microbiome-resistome relationship may also be important in infants and young children. This narrative review examines what is known about the interaction between the infant gut microbiome, the infant resistome, and infant nutrition, including exploring the potential of diet to mitigate infant ARG carriage. While more research is needed, diet has the potential to reduce infant and toddler carriage of ARGs, an important goal as part of maintaining the efficacy of available antibiotics and preserving infant and toddler health.

The relationship between loneliness and problematic smartphone use among adolescents during the COVID-19 pandemic: The mediating role of negative emotions and maladaptive coping.

Given the observed increased feelings of loneliness and problematic smartphone use among adolescents during the COVID-19 pandemic, further research was needed to determine whether and how the increased loneliness of adolescents during such major public health crisis events affects the risk of problematic smartphone use among adolescents. This study aimed to examine the relationship between loneliness and problematic smartphone use among Chinese adolescents (aged 10-16 years) during the COVID-19 pandemic and to investigate the possible mediating role of negative emotions and maladaptive coping. A total of 672 Chinese adolescents (Mage = 13.05, SD = 1.51, 50.4% boys, 93.8% from rural areas, 22.5% of whom were only children) took part in this cross-sectional study in April 2022 by completing the Chinese adolescent version of the Loneliness Scale, the Positive and Negative Affect Scale (subscale), the Ways of Coping Questionnaire, and the Mobile Phone Addiction Index Scale. The serial mediation model revealed that negative emotions and maladaptive coping independently mediated the relationship between adolescents'loneliness and problematic smartphone use. In addition, the mediation effects of "negative emotions-maladaptive coping" could also mediate the relationship between loneliness and problematic smartphone use. Loneliness may be positively related to problematic smartphone use through negative emotions and maladaptive coping among adolescents during major public health crisis events, such as the COVID-19 pandemic.

Trends in Opioid Toxicity–Related Deaths in the US Before and After the Start of the COVID-19 Pandemic, 2011-2021

Opioid-related harms constitute a major public health crisis in the US, and this crisis has worsened during the COVID-19 pandemic. To characterize the societal burden of unintentional opioid-related deaths in the US and describe changing mortality patterns during the COVID-19 pandemic. A serial cross-sectional study examined all unintentional opioid-related deaths in the US, evaluated annually from calendar years 2011 to 2021. The public health burden of opioid toxicity-related deaths was estimated in 2 ways. First, the proportion of all deaths that were attributable to unintentional opioid toxicity by year (2011, 2013, 2015, 2017, 2019, and 2021) and age group (15-19, 20-29, 30-39, 40-49, 50-59, and 60-74 years) were calculated, using age-specific estimates of all-cause mortality as the denominator. Second, the total years of life lost (YLL) due to unintentional opioid toxicity was estimated, overall and by sex and age group, for each year studied. Among the 422 605 unintentional deaths due to opioid toxicity between 2011 and 2021, the median age of the individuals was 39 (IQR, 30-51) years, and 69.7% were male. The number of unintentional deaths due to opioid toxicity increased 289% over the study period, from 19 395 (2011) to 75 477 (2021). Similarly, the percentage of all deaths that were attributed to opioid toxicity increased from 1.8% in 2011 to 4.5% in 2021. By 2021, opioid toxicity was responsible for 10.2% of all deaths among those aged 15 to 19 years, 21.7% of deaths among those aged 20 to 29 years, and 21.0% of deaths among those aged 30 to 39 years. The YLL due to opioid toxicity increased 276% over the study period, from 777 597 in 2011 to 2 922 497 in 2021. While YLL plateaued between 2017 (7.0 YLL per 1000) and 2019 (7.2 YLL per 1000), it increased by 62.9% between 2019 and 2021 coincident with the COVID-19 pandemic, reaching 11.7 YLL per 1000 population. This relative increase was similar across all age groups and sexes with the exception of those aged 15 to 19 years, in whom the YLL nearly tripled, from 1.5 to 3.9 YLL per 1000 population. In this cross-sectional study, deaths due to opioid toxicity increased substantially during the COVID-19 pandemic. By 2021, 1 of every 22 deaths in the US was attributable to unintentional opioid toxicity, underscoring the urgent need to support people at risk of substance-related harm, particularly men, younger adults, and adolescents.

Pressure, state and response: configurational analysis of organizational resilience in tourism businesses following the COVID-19 pandemic crisis

Organizational resilience is key for tourism companies in coping with crises; however, little is known about how tourism companies can become more resilient. Furthermore, much of the empirical evidence in the extant literature comes from developed countries. The study identifies key factors affecting organizational resilience based on a “resource–capacity-relationship” theoretical framework, incorporating the number of COVID-19 cases as an external factor in the stress-state-response (PSR) model, with the epidemic as pressure, corporate governance, and redundant resources as the enterprise state, and CSR performance as the response. The fsQCA method was used to analyse the interaction and joint effects among multisource influencing factors such as pressure, state and response. Based on an empirical analysis of 35 listed tourism companies in China from 2010 to 2020, the research found the following: (1) Four groupings of high organizational resilience: redundant resource deficit under epidemic pressure with high pay incentive compensation, low financial risk, and CSR driven under low epidemic pressure, resource deployment and CSR driven under low financial risk and CSR driven under low financial risk. Of these, CSR at the response level as a core condition is key to developing high organizational resilience. (2) Corporate governance capabilities play a high role in fostering organizational resilience under epidemic pressure and can compensate for organizational deficiencies in resources and relationships. (3) Under specific objective endowment conditions, unabsorbed redundant resources and absorbed redundant resources can substitute to some extent for deficiencies in capabilities and relationships. (4) The low organizational resilience configurations suggest that potentially redundant resources may be the key to low organizational resilience. CSR is not the ‘golden key’ to organizational resilience but is influenced by redundant resources. Furthermore, the key variables affecting organizational resilience were significant during the studied period. The research provides a theoretical reference and practical guidance for the sustainable development of tourism enterprises in the context of major public health crises.

Dexamethasone-Enhanced Continuous Online Microdialysis for Neuromonitoring of O2 after Brain Injury.

Traumatic brain injury (TBI) is a major public health crisis in many regions of the world. Severe TBI may cause a primary brain lesion with a surrounding penumbra of tissue that is vulnerable to secondary injury. Secondary injury presents as progressive expansion of the lesion, possibly leading to severe disability, a persistent vegetive state, or death. Real time neuromonitoring to detect and monitor secondary injury is urgently needed. Dexamethasone-enhanced continuous online microdialysis (Dex-enhanced coMD) is an emerging paradigm for chronic neuromonitoring after brain injury. The present study employed Dex-enhanced coMD to monitor brain K+ and O2 during manually induced spreading depolarization in the cortex of anesthetized rats and after controlled cortical impact, a widely used rodent model of TBI, in behaving rats. Consistent with prior reports on glucose, O2 exhibited a variety of responses to spreading depolarization and a prolonged, essentially permanent decline in the days after controlled cortical impact. These findings confirm that Dex-enhanced coMD delivers valuable information regarding the impact of spreading depolarization and controlled cortical impact on O2 levels in the rat cortex.

Epidemiology and etiology of brain cancer in Africa: A systematic review.

Cancer is a significant threat to public health and a leading cause of morbidity across the globe. Of all cancers, brain cancer can be particularly catastrophic as treatment often fails to achieve the desired degree of effectiveness and diagnosis remains associated with a high mortality rate. Africa, as a continent with resource-limited countries, needs to allocate the necessary proper healthcare infrastructure to significantly reduce cancer rates and improve patient survival. In addition, the relative paucity of data within this field in Africa makes effective management a challenge. This review is aimed at elucidating the currently available evidence base with regard to the epidemiology and etiology of brain cancer within resource-limited African countries. This review hopes to bring to the attention of the wider clinical community the growing burden of brain cancer within Africa and to encourage future research into this field of research. The available literature for this Systematic Review was searched on two bibliographic databases, PubMed and Scopus, using an individually verified, prespecified approach. In addition, the Global Cancer Observatory and Global Burden of Disease databases were also utilized. Studies reporting on the epidemiology, etiology, and impact of brain cancer in Africa were suitable for inclusion. The level of evidence of the included studies was considered as per the Centre for Evidence-Based Medicine recommendations. Out of the four databases searched, 3848 articles were initially screened rigorously, filtered into 54 articles, and finally assessed qualitatively and quantitatively. We have demonstrated a poor survival rate and lack of proper funds/resources necessary to report, identify, and treat cases, as well as the dearth of comprehensive research on the subject of brain cancer that has become a challenging healthcareconcern in many African developing nations. Also, because of the gradual improvement in healthcare facilities and the increasing population within many countries in Africa, the number of patients with central nervous system and intracranial tumors is rising specifically in the elder population. In addition, the population in West Africa is at a higher risk of HIV-related malignancies due to the high prevalence of HIV in West Africa. The burden of brain cancer in Africa is increasing in comparison with the developed parts of the world in which it is decreasing. Moreover, the mismanagement of cancers in Africa leads to higher morbidity and mortality and decreased quality of life. This study addresses the burden of brain cancer as a major public health crisis in Africa. Improved treatment modalities and access to screening are required to better address the burden of this disease. Therefore, there is a clear need for more substantial and comprehensive research on etiology, epidemiology, and treatment of brain cancer within Africa to understand its epidemiological distribution and provide a means for managing and reducing the associated morbidity and mortality.

Hesitancytowards theCOVID-19vaccineamonghealthcarepractitionersin theKingdom ofSaudi Arabia:a cross-sectional study.

Thecoronavirus disease 2019 (COVID-19) pandemic is a major public health crisis worldwide. In less than 12 months since the World Health Organization declared the outbreak, severaldifferent COVID-19 vaccines have beenapprovedand deployed mostly indevelopedcountries sinceJanuary2021.However, hesitancy to accept the newlydeveloped vaccines is a well-known public health challenge that needs to be addressed.Theaimof this study wasto measurewillingness and hesitancy toward COVID-19 vaccines amonghealth care practitioners' (HCPs)in Saudi Arabia. Methods:A cross-sectional study using an online self-reported surveywas conducted among HCPsin Saudi Arabia betweenApril4thtoApril25th2021using snowball sampling. Multivariate logistic regression was employed to identify the possible factors affectingHCPs'willingnessand hesitancytoreceiveCOVID-19 vaccines. Results:Out of 776 participants who started the survey, 505 (65%) completed itand were included in the results. Among all HCPs,47 (9.3%) either said "no" to receive the vaccine[20 (4%)]or were hesitant to receive it[27 (5.3%)]. Of the total number of the HCPs, 376 (74.5%) already received the COVID-19 vaccine,and48 (9.50%) were registered to receive it.The main reason of agreement toreceivethe COVID-19 vaccine was "wanting to protect self and others from getting the infection" (24%). Conclusion:Our findings have shown that hesitancy toward receiving COVID-19 vaccines among HCPs in Saudi Arabia is limited and therefore may not be a serious issue.The outcomes of this studymayhelp to understand factors that lead to vaccine hesitancy in Saudi Arabia and help public health authorities to design targeted health education interventions aiming to increaseuptakeof these vaccines.

Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries

Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries

Viability of Transplanted Organs Based on Donor’s Age

Organ transplantation is becoming a major public health issue in many countries due to its attributable death rate and the excessive cost. There is a growing gap between organ supply and demand for organ transplantation in the US, which is causing major public health crisis. Twenty people on average die each day while waiting for a transplant because the supply of available organs from deceased donors does not meet the demand. National organ donation has increased in the past two decades; however, the number of individuals who need transplants has risen much faster as new patient is added to the national transplant waiting list every ten minutes. To address this disparity, not only the number of donors must be increased, but also the discard rate of available organs must be reduced. The kidney discard rate has increased by almost four times from the late 1980s to 2009, from approximately five percent to nearly 20 percent. So, it is important to investigate factors that may decrease the chance of an organ to be discarded as well as increase the survival time of transplanted organs. In this paper, we perform statistical survival analysis to study the impact of donor’s age on organ survival. Transplanted kidneys, livers, and intestines between 1987 and 2010 are investigated in this study. The results show that donor's age is an important factor for transplanted kidneys and livers donated by younger donors and survive for longer times while donor's age does not seem to be correlated with the survival time of transplanted intestines.