Meet World Health Organization Research Articles

The Associations Between Physical Activity and Mental Health Problems in Middle-aged Indonesians.

Mental health issues have become a growing concern worldwide. Research has shown that regular physical activity (PA) can positively affect mental health. This study investigated the associations between PA and mental health problems (MHPs) in middle-aged Indonesians. The study utilized data from the 2018 Indonesian Basic Health Research Survey and used a cross-sectional approach. The participants included individuals aged 40-60 years who completed the 20-question Self-Reporting Questionnaire. A logistic regression was performed to analyze a sample of 263 930 data points. Nearly 10.4% of the participants suffered from mental health issues. Notably, among those who did not engage in moderate and vigorous PA, a sign of MHPs was found in 12.5% of participants. Those who met World Health Organization standards for PA were less likely to experience MHPs (10.1%). This study found a significant association between PA and mental health. After adjusting for smoking, alcohol consumption, non-communicable diseases, and socio-demographic variables like age, sex, education, occupation, marital status, and residence, the connection between PA and mental health became even stronger (adjusted odds ratio, 0.81; 95% confidence interval, 0.78 to 0.85; p<0.001). Regular PA has been shown to affect mental health positively. Therefore, it is important to improve health education and efforts to raise awareness among middle-aged Indonesians about the importance of PA in maintaining good mental health.

Development of a Constructed Wetland for Greywater Treatment for Reuse in Arid Regions: Case Study in Rural Burkina Faso

This study implemented and assessed, over a period of four weeks, a full-scale constructed wetland designed to collect and treat the greywater for a rural household located in an arid environment typical of Africa’s Sahel region. The system was constructed from local materials and consisted of a shower room, a receiving basin, a pre-treatment filter, and a subsurface horizontal flow wetland planted with Chrysopogon zizanioides. Results showed the overall removal of organic matter was greater than 90%, and orthophosphate and ammonium were reduced by 73% and 60%, respectively, allowing for the treated water to retain some embedded nutrients. The removal efficiency of fecal bacteria varied from 3.41 (enterococci) to 4.19 (fecal coliforms) log10 units which meets World Health Organization Guidelines for restricted irrigation. Our assessment of the full-scale household constructed wetland technology adds to the relatively low number of constructed wetland studies conducted outside a laboratory setting. Furthermore, it supports efforts to promote safe reuse of an underutilized resource at the rural household level in Sub-Saharan Africa and other arid regions in the developing world, supporting prospects for using treated greywater for agricultural reuse in regions that experience water scarcity, climate variability, and land degradation.

Multivariate statistical methods for analysis of physicochemical and microbiological parameters of well water from the village M’Pody

The pollution of surface water and groundwater is a real public health problem that is currently receiving particular attention throughout the world. The use of water for food or hygiene purposes requires excellent physicochemical and microbiological quality. Well water is used for many purposes by the inhabitants of M’pody, a village in the Anyama district of Côte d’Ivoire. In this village, an epidemic of diarrhoea was detected in January 2020. This epidemic claimed sixty-nine (69) victims. This study aims to evaluate well water quality controls using the methods of principal component analysis (PCA), correspondence factorial analysis (CFA), analysis of variance (ANOVA) and self-organizing map (SOM) algorithm. The parameters studied were, turbidity (Tur), conductivity (Cond), hydrogen potential (pH), temperature (T), nitrate (NO3-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$NO_{3^{-}}$$\\end{document}), nitrite (NO2-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$NO_{2^{-}}$$\\end{document}), ammonium (NH4+\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$NH_{4^{+}}$$\\end{document}), phosphates (PO43-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$PO_{4}^{3^{-}}$$\\end{document}), chlorides (Cl-)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(Cl^{-})$$\\end{document}, total hydrotimetric degree (DHT), sulfates (SO42-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$SO_{4}^{2^{-}}$$\\end{document}), bicarbonate (HCO3-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$HCO_{3^{-}}$$\\end{document}), total alkalinity contents (TAC), escherichia coli (E.coli), thermotolerant coliforms (CTH) and enterococcus faecalis (E.faecalis). Data were collected from seventy-two (72) wells in the village during four campaigns in 2020. Physicochemical parameters were determined by electrochemical and spectrophotometric methods. Microbiological analysis was carried out using membrane filtration technique. Descriptive statistics revealed that Tur, Cond, pH and T parameters did not meet world health organization (WHO, 2017) standards. However, the parameters NO3-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$NO_{3^{-}}$$\\end{document}, NO2-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$NO_{2^{-}}$$\\end{document}, NH4+\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$NH_{4^{+}}$$\\end{document}, PO43-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$PO_{4}^{3^{-}}$$\\end{document}, Cl-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$Cl^{-}$$\\end{document}, DHT, TAC, SO42-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$SO_{4}^{2^{-}}$$\\end{document} and HCO3-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$HCO_{3^{-}}$$\\end{document} comply with WHO standards. The results of bacteriological analyzes confirm the presence in very significant numbers of indicators of faecal contamination (CTH, E.coli and E.faecalis) in all wells. The logical explanations for faecal pollution would come from the infiltration of septic tanks located near the wells and the run-off of waste water carrying human and animal faecal matter. The diarrhea epidemic would therefore be caused by the consumption of this polluted water. PCA, FCA and hierarchical cluster analysis (HCA) were jointly employed to identify the structure of wells and deduce the principal factors controlling the parameters of these well waters. ANOVA revealed the effect of human-induced activities as the main factors influencing the physicochemical and microbiological parameters of the studied well waters. Further studies should focus on multivariate statistical techniques for effective forecasting and monitoring of emerging pollution for improved water quality.

District-Level Forecast of Achieving Trachoma Elimination as a Public Health Problem By 2030: An Ensemble Modelling Approach.

Assessing the feasibility of 2030 as a target date for global elimination of trachoma, and identification of districts that may require enhanced treatment to meet World Health Organization (WHO) elimination criteria by this date are key challenges in operational planning for trachoma programmes. Here we address these challenges by prospectively evaluating forecasting models of trachomatous inflammation-follicular (TF) prevalence, leveraging ensemble-based approaches. Seven candidate probabilistic models were developed to forecast district-wise TF prevalence in 11 760 districts, trained using district-level data on the population prevalence of TF in children aged 1-9 years from 2004 to 2022. Geographical location, history of mass drug administration treatment, and previously measured prevalence data were included in these models as key predictors. The best-performing models were included in an ensemble, using weights derived from their relative likelihood scores. To incorporate the inherent stochasticity of disease transmission and challenges of population-level surveillance, we forecasted probability distributions for the TF prevalence in each geographic district, rather than predicting a single value. Based on our probabilistic forecasts, 1.46% (95% confidence interval [CI]: 1.43-1.48%) of all districts in trachoma-endemic countries, equivalent to 172 districts, will exceed the 5% TF control threshold in 2030 with the current interventions. Global elimination of trachoma as a public health problem by 2030 may require enhanced intervention and/or surveillance of high-risk districts.

Physical activity during COVID-19 in people with systemic sclerosis: A Scleroderma Patient-centred Intervention Network COVID-19 Cohort longitudinal study.

People with systemic sclerosis (SSc) face barriers to physical activity. Few studies have described physical activity in SSc, and none have explored physical activity longitudinally during COVID-19. We evaluated physical activity from April 2020 to March 2022 among people with SSc. The Scleroderma Patient-centred Intervention Network (SPIN) COVID-19 Cohort was launched in April 2020 and included participants from the ongoing SPIN Cohort plus external enrolees. Participants completed measures bi-weekly through July 2020, then every 4 weeks afterwards (28 assessments). Physical activity was assessed via the self-reported International Physical Activity Questionnaire-Elderly. Analyses included estimated means with 95% confidence intervals for physical activity across assessments. Missing data were imputed for main analyses. Sensitivity analyses included evaluating only participants who completed >90% of items for >21 of 28 possible assessments ('completers') and stratified analyses by sex, age, country and SSc subtype. A total of 800 people with SSc enrolled. Mean age was 55.6 (standard deviation (SD) = 12.6) years. Physical activity significantly decreased from April 2020 to March 2021 (standardized mean difference (SMD) = -0.17, 95% confidence interval (CI) = -0.26 to -0.07) and was stable from March 2021 to March 2022 (SMD = -0.05, 95% CI = -0.15 to 0.05). Results were similar for completers and subgroups. The proportion of participants who met World Health Organization minimum physical activity recommendations of at least 150 min of moderate-to-vigorous activity per week ranged from 63% to 82% across assessments. Physical activity decreased by a relatively small amount, on average, across the pandemic. Most participants met recommended physical activity levels.

Impact of new direct-acting antiviral therapy on the prevalence and undiagnosed proportion of chronic hepatitis C infection.

Patients with chronic hepatitis C (CHC) can be cured with the new highly effective interferon-free combination treatments (DAA) that were approved in 2014. However, CHC is a largely silent disease, and many individuals are unaware of their infections until the late stages of the disease. The impact of wider access to effective treatments and improved awareness of the disease on the number of infections and the number of patients who remain undiagnosed is not known in Canada. Such evidence can guide the development of strategies and interventions to reduce the burden of CHC and meet World Health Organization's (WHO) 2030 elimination targets. The purpose of this study is to use a back-calculation framework informed by provincial population-level health administrative data to estimate the prevalence of CHC and the proportion of cases that remain undiagnosed in the three most populated provinces in Canada: British Columbia (BC), Ontario and Quebec. We have conducted a population-based retrospective analysis of health administrative data for the three provinces to generate the annual incidence of newly diagnosed CHC cases, decompensated cirrhosis (DC), hepatocellular carcinoma (HCC) and HCV treatment initiations. For each province, the data were stratified in three birth cohorts: individuals born prior to 1945, individuals born between 1945 and 1965 and individuals born after 1965. We used a back-calculation modelling approach to estimate prevalence and the undiagnosed proportion of CHC. The historical prevalence of CHC was inferred through a calibration process based on a Bayesian Markov chain Monte Carlo (MCMC) algorithm. The algorithm constructs the historical prevalence of CHC for each cohort by comparing the model-generated outcomes of the annual incidence of the CHC-related health events against the data set of observed diagnosed cases generated in the retrospective analysis. The results show a decreasing trend in both CHC prevalence and undiagnosed proportion in BC, Ontario and Quebec. In 2018, CHC prevalence was estimated to be 1.23% (95% CI: .96%-1.62%), .91% (95% CI: .82%-1.04%) and .57% (95% CI: .51%-.64%) in BC, Ontario and Quebec respectively. The CHC undiagnosed proportion was assessed to be 35.44% (95% CI: 27.07%-45.83%), 34.28% (95% CI: 26.74%-41.62%) and 46.32% (95% CI: 37.85%-52.80%) in BC, Ontario and Quebec, respectively, in 2018. Also, since the introduction of new DAA treatment in 2014, CHC prevalence decreased from 1.39% to 1.23%, .97% to .91% and .65% to .57% in BC, Ontario and Quebec respectively. Similarly, the CHC undiagnosed proportion decreased from 38.78% to 35.44%, 38.70% to 34.28% and 47.54% to 46.32% in BC, Ontario and Quebec, respectively, from 2014 to 2018. We estimated that the CHC prevalence and undiagnosed proportion have declined for all three provinces since the new DAA treatment has been approved in 2014. Yet, our findings show that a significant proportion of HCV cases remain undiagnosed across all provinces highlighting the need to increase investment in screening. Our findings provide essential evidence to guide decisions about current and future HCV strategies and help achieve the WHO goal of eliminating hepatitis C in Canada by 2030.

Photovoltaic-integrated advancements for sustainable water production: Developing and evaluating an enhanced hybrid solar desalination system

The global water crisis demands innovative solutions, and solar desalination is a promising avenue. However, traditional systems often suffer from low yields. This study centres on the development, assessment, and economic feasibility of the Enhanced Hybrid Solar Still (EHSS), a pioneering approach to sustainable clean water production. Integrating photovoltaic technology, the EHSS targets a minimum daily output of 15 L/m2. Computational Fluid Dynamics (CFD) simulations guide the design optimisation, identifying an optimal configuration of 4 mm basin thickness, a 2 mm glass cover thickness, and a 56° slope. The EHSS is a single component that comprises of passive operation and advanced components integration, including monocrystalline solar panels, a hybrid MPPT inverter, a deep cycle battery, and a custom water heater, to enhance the yield. The EHSS undergoes a comprehensive assessment encompassing distillate quality, efficiency, and economic viability. In passive mode operation (solely using solar radiation), clean water yields range from 4.7111 L/m2·day to 2.1309 L/m2·day. Transitioning to active mode operation (employing photovoltaics and additional components) significantly enhances yields to a range of 19.7 L/m2·day. Impressively, the EHSS consistently delivers an average daily water yield of 16.85 L/m2, and also its purity meets World Health Organization standards for drinking water. The PV systems exhibit a charge rate of 14.28 % per hour on clear days and 9 to 11 % per hour on semi-cloudy days, with the battery depleting at 16.66 % per hour at 70 °C operational temperature. Comparative analysis against traditional systems showcases an efficiency increase from 25.61 % to an outstanding 64.01 % for the optimised EHSS (PV system and appurtenances). A strong correlation (coefficient of 0.9701) between experimental and simulation results indicates robust relationships. Over a 20-year lifespan, cost analysis reveals a per-litre cost of 0.0892 US dollars for the EHSS, compared to 0.0374 US dollars for traditional systems. Extended lifespans further underscore the economic feasibility of the EHSS, emphasizing its role in providing sustainable clean water solutions.

Meeting muscle-strengthening recommendation is associated with lower adiposity, higher physical fitness and healthier lifestyle in adolescents: The EHDLA study.

To determine the prevalence of adolescents who meet muscle-strengthening activities (MSA) recommendation and their associations with anthropometric variables, physical fitness, and lifestyle behaviours in a sample of Spanish adolescents aged 12-17 years. This was a cross-sectional study using data from The Eating Healthy and Daily Life Activities (EHDLA) Study. Participants reported the days on which they engaged in MSA (≥3 days per week were considered to meet World Health Organization recommendation). Physical fitness was assessed with the ALPHA fitness battery. Additionally, body mass index, waist circumference, skinfolds and body fat percentage were assessed. Lifestyle variables were recreational screen time, sleep time and adherence to the Mediterranean diet. The associations between MSA and outcome variables were tested with linear and logistic regressions. Of the 852 participants, 48% met MSA recommendation. Meeting MSA recommendation was associated with lower adiposity and higher performance in the shuttle run test, maximal oxygen consumption, standing long jump, speed-agility, flexibility, lower screen time (in weekdays) and higher adherence to the Mediterranean diet. Engaging in MSA once or twice a week was linked with more desirable health outcomes than not engaging in such activities. However, meet with MSA recommendation (i.e., at least 3 days per week) reinforced these benefits.

Impact of vortioxetine on psychosocial functioning moderated by symptoms of fatigue in post-COVID-19 condition: a secondary analysis.

Fatigue is a prominent symptom in post-COVID condition (PCC) sequelae, termed "long COVID." Herein, we aim to ascertain the effect of fatigue on psychosocial function in persons living with PCC. This post hoc analysis evaluated the effects of vortioxetine on measures of fatigue as assessed by the Fatigue Severity Scale (FSS) in psychosocial function as measured by the Sheehan Disability Scale (SDS) in persons with PCC. We also evaluated the change in FSS on psychosocial functioning as measured by the Sheehan Disability Scale (SDS). This post hoc analysis obtained data from a recently published placebo-controlled study evaluating vortioxetine's effect on objective cognitive functions in persons living with PCC. One hundred forty-four participants meeting World Health Organization (WHO) criteria for PCC were included in this analysis. At the end of 8weeks of vortioxetine treatment, significant improvement of all domains was observed for psychosocial functioning. There was a significant between-group difference at treatment endpoint in the family, social, and work SDS subcategories (p < 0.001). There was a statistically significant interaction effect between the treatment condition time point and FSS effect on the SDS social(χ2 = 10.640, p = 0.014) and work (χ2 = 9.342, p = 0.025)categories but a statistically insignificant effect on the family categories ((χ2 = 5.201, p = 0.158)). This post hoc analysis suggests that vortioxetine treatment significantly improves psychosocial function in persons with PCC. Our results also indicate that the improvement in psychosocial function was significantly mediated by improvement in measures of fatigue. Our results provide empirical support for recommendations to identify therapeutics for fatigue in persons living with PCC with a broader aim to improve psychosocial function in this common and severely impaired population.

Assessing pattern of the Pediatric Multisystem Inflammatory Syndrome (PMIS) in children during the COVID-19 pandemic: experience from the emergency department of tertiary care center of a low-middle-income country

BackgroundPediatric Multisystem Inflammatory Syndrome (PMIS) is a hyperinflammatory condition affecting multiple organs in children, often resembling incomplete Kawasaki Disease during later phases of COVID-19 infection. Data on PMIS in low-middle-income countries, particularly in emergency department settings, is limited.ObjectivesThis prospective observational study at Aga Khan University Hospital, Karachi, aimed to determine the frequency, clinical presentation patterns, and laboratory parameters of children with PMIS visiting the emergency department during the COVID-19 pandemic. Secondary objectives included assessing factors associated with in-hospital mortality.MethodsFrom March 2020 to September 2021, patients meeting World Health Organization PMIS criteria were enrolled. COVID-19 testing included PCR and antibody testing. Data was collected through a questionnaire and analyzed statistically.ResultsAmong 56 PMIS patients (85.7% male, mean age 7.67 ± 4.8 years), respiratory symptoms (70%), neurological symptoms (57%), and gastrointestinal symptoms (54%) were common presentations. Signs included delayed capillary refill time (93%), low-volume pulses (89%), and hypotension (68%). COVID-19 antibodies were positive in the majority (78.6%) while PCR was positive in 18%. Risk factors for mortality included prolonged emergency department stay, and high Ferritin and Lactate Dehydrogenase levels.ConclusionPMIS affects children of all ages. Respiratory and gastrointestinal symptoms are the most frequent presentations. Elevated inflammatory markers, including LDH, Ferritin, D-dimer, and Pro-BNP, correlate with higher mortality risk.

Green nanocatalyst for the photocatalytic degradation of organic pollutants in petroleum refinery wastewater: Synthesis, characterization, and optimization

The synthesis of green nanocatalysts is an emerging branch of current nanotechnology due to its numerous advantages, including high efficiency, sustainability, cost-effectiveness, biocompatibility, and eco-friendliness. In this study, a thermal technique was employed to prepare a novel green nanocatalyst (GNC) from the sepals of waste tomato (WT) plants, and this GNC was investigated to determine its efficiency in degrading the chemical oxygen demand (COD) during a photocatalytic process of simulated petroleum refinery wastewater (PRW). The characterization of the waste tomato-green nanocatalyst (WT-GNC) was performed using various techniques, including X-ray diffraction (XRD), field-emission scanning electron microscopy (FE-SEM), energy dispersive X-ray (EDX), Brunauer–Emmett–Teller (BET) analysis, and Fourier-transform infrared (FTIR) spectroscopy, which revealed that the synthesized WT-GNC possessed an excellent catalytic quality. This work examined the key factors affecting the degradation rates, such as the type of light source (UV or LED) and its arrangement (outside or inside the reactor), aeration rate, pH, catalyst dose, irradiation time, temperature, and initial COD concentration. The WT-GNC degraded 99.9 % of the COD (residual = 1 ppm) under the optimal operating conditions (pH = 7, WT-GNC dose = 0.25 g/L, irradiation time = 90 min, temperature = 25 °C, and initial COD = 1326 ppm) under UV lamps located around the inside of the reactor wall. Ultraviolet (UV) light is highly effective in degrading the COD compared to visible LED lights. The reaction followed the pseudo-first-order kinetic model (R2= 0.998) with k = 0.0367 min−1. The WT-GNC exhibited good reusability and stability and could reduce 76.3 % of the COD after the fifth consecutive cycle. Therefore, this novel GNC can serve as a cost-effective, efficient, stable, and eco-friendly photocatalyst to lower the COD of PRW to meet the World Health Organization (WHO) standards. In addition, it can be recovered and reused several times.

Accuracy of C-Reactive Protein for Tuberculosis Detection in General-Population Screening and Ambulatory-Care Triage in Uganda.

Rationale: C-reactive protein (CRP) has demonstrated utility as a point-of-care triage test for tuberculosis (TB) in clinical settings, particularly among people with human immunodeficiency virus (HIV), but its performance for general-population TB screening is not well characterized. Objective: To assess the accuracy of CRP for detecting pulmonary TB disease among individuals undergoing community-based screening or presenting for evaluation of TB symptoms in Kampala, Uganda. Methods: We pooled data from two case-control studies conducted between May 2018 and December 2022 among adolescents and adults (⩾15 yr) in Kampala, Uganda. We conducted community-based screening for TB, regardless of symptoms. We enrolled people with Xpert MTB/RIF Ultra-positive (including trace) sputum results and a sample of people with Ultra-negative results. We also enrolled symptomatic patients diagnosed with TB and controls with negative TB evaluations from ambulatory care settings. Participants underwent further evaluation, including sputum culture, CRP, and HIV testing. We assessed the accuracy of CRP alone or with symptom screening against a bacteriologic reference standard. Our primary analysis evaluated the sensitivity and specificity of CRP at a cutoff of 5 mg/L. Diagnostic performance was summarized by calculating the area under the receiver operating curve (AUC). Results: In the community setting (n = 544), CRP ⩾ 5 mg/L had a sensitivity of 55.3% (95% confidence interval, 47.0-63.4%) and specificity of 84.7% (79.7-88.8%) for confirmed TB; AUC was 0.75 (0.70-0.79). Screening for CRP ⩾ 5 mg/L or positive symptoms increased sensitivity to 92.0% (86.4-95.8%) at the expense of specificity (57.1% [50.8-63.2%]). In the ambulatory care setting (n = 944), sensitivity of CRP ⩾ 5 mg/L was 86.7% (81.8-90.7%), specificity was 68.6% (64.8-72.2%), and AUC (0.84 [0.81-0.87]) did not differ significantly by HIV status. CRP ⩾ 5 mg/L was >90% sensitive among individuals with a medium or high semiquantitative Xpert result in both settings. Conclusions: Although CRP did not meet World Health Organization (WHO) TB screening benchmarks in the community, it demonstrated high specificity, and sensitivity was high among individuals with high sputum bacillary burden who are likely to be most infectious. In ambulatory care, estimated sensitivity and specificity were each within 4 percentage points of WHO benchmarks, with no meaningful difference in performance by HIV status.

Accelerometer and Survey Assessed Physical Activity in Children With Epilepsy: A Case-Controlled Study.

Anecdotal evidence suggests that children with epilepsy (CWE) are limited in the frequency of their daily physical activity (PA). However, there is limited research utilizing device-based measures of PA. We compared levels of PA and sedentary behavior in CWE (11-15y) and age- and gender-matched healthy controls. Participants (n = 60 CWE [25 males, 35 females] and n = 49 controls [25 males, 24 females]) wore a Actigraph accelerometer (GT3X or GT3X+) for 7 consecutive days during waking hours and self-reported their PA and sedentary behaviors. CWE were compared with control children on time spent in different intensities of PA and on self-reported PA and sedentary behavior. Factors associated with PA were analyzed using linear regression. CWE spent less time in accelerometer assessed light (189.15 vs 215.01min/d, P < .05) and vigorous PA (35.14 vs 44.28min/d, P < .05) on weekdays compared with controls. There were no significant differences between CWE and control participants in accelerometer assessed time spent sedentary or time spent in PA on weekends. Among CWE, older children engaged in more reported sedentary behavior and younger children spent more time in most domains of PA (P < .05). Furthermore, CWE reported less PA than controls (P = .006). Sixteen percent of controls met World Health Organization PA guidelines compared with 10% of CWE. There was a positive relationship between accelerometer assessed PA and quality of life for CWE. CWE spent less time in light and moderate to vigorous PA on weekdays. Further research is needed to understand reasons for these differences.

Insights into enhanced oxidation of benzophenone-type UV filters (BPs) by ferrate(VI)/ferrihydrite: Increased conversion of Fe(VI) to Fe(V)/Fe(IV)

In this work, the oxidation performance of a new ferrate(VI)/ferrihydrite (Fe(VI)/Fh) system was systematically explored to degrade efficiently six kinds of benzophenone-type UV filters (BPs). Fe(VI)/Fh system not only had a superior degradation capacity towards different BPs, but also exhibited higher reactivity over a pH range of 6.0–9.0. The second-order kinetic model successfully described the process of BP-4 degradation by heterogeneous Fh catalyzed Fe(VI) system (R2 = 0.93), and the presence of Fh could increase the BP-4 degradation rate by Fe(VI) by an order of magnitude (198 M−1·s−1 v.s. 14.2 M−1·s−1). Remarkably, there are higher utilization efficiency and potential of Fe(VI) in Fe(VI)/Fh system than in Fe(VI) alone system. Moreover, characterization and recycling experiments demonstrated that Fh achieved certain long-term running performance, and the residual Fe content of solution after clarifying process meet World Health Organization (WHO) guidelines for drinking water. The contributions of reactive species could be ranked as Fe(V)/Fe(IV) > Fe(VI) > •OH. Fe(IV)/Fe(V) were the dominant species for the enhanced removal in the Fe(VI)/Fh system, whose percentage contribution (72 %–36 %) were much higher than those in Fe(VI) alone system (5 %–17 %). However, the contribution of Fe(VI) in oxidizing BP-4 should not be underestimated (20 %–56 %). These findings reasonably exploit available Fh resources to reduce the relatively high cost of Fe(VI), which offers a proper strategies for efficient utilization of high-valent iron species and may be used as a highly-efficient and cost-effective BPs purification method.

Risk Stratified Treatment for Patients with Newly Diagnosed Juvenile Myelomonocytic Leukemia: A Phase 1/2 Non-Randomized Study of Trametinib and Azacitidine with or without Chemotherapy

Background: Juvenile myelomonocytic leukemia (JMML) is an aggressive myeloproliferative disorder of childhood. The biochemical hallmark of JMML is aberrant signaling through the Ras pathway caused by initiating mutations in NF1, NRAS, KRAS, RRAS, RRAS2, SH2B3, PTPN11,or CBL. While hematopoietic stem cell transplantation (HSCT) can be curative, 5-year event-free survival of children with JMML after HSCT is only ~50%. Recently, several studies have identified mutational burden and DNA methylation as predictive of clinical outcomes in patients with JMML. In the T2020-004 phase 1/2 clinical trial, we will define lower-risk patients as those with one somatic alteration and low DNA methylation and high-risk patients as those with more than one somatic alteration or intermediate/high DNA methylation. Trametinib is an orally bioavailable, reversible, highly selective allosteric inhibitor of MEK1/2 in the Ras/MAPK signaling pathway. Trametinib is FDA-approved for the treatment of adults with advanced melanoma with BRAF V600E or V600K mutations and in children with Ras-mutant solid tumors in combination with dabrafenib. Clinical investigation of trametinib monotherapy via the Children's Oncology Group ADVL1521 phase 2 trial (NCT03190915) showed efficacy in children with relapsed/refractory JMML. Phase 2 clinical trial evaluation of azacitidine in children with newly-diagnosed JMML was also efficacious and led to its FDA approval. In this trial, trametinib will be tested in combination with azacitidine in lower-risk patients and in combination with azacitidine and chemotherapy for high-risk patients. Study Design and Methods: This is a non-randomized, risk stratified, Phase 1/2 study for patients with newly-diagnosed JMML (NCT05849662) conducted via the Therapeutic Advances in Childhood Leukemia and Lymphoma (TACL) Consortium with safety and efficacy phases for both lower-risk and high-risk cohorts. Lower-risk patients will receive trametinib once-daily for 28 days in combination with azacitidine administered daily for five days per cycle. Lower-risk patients can receive up to 12 cycles and will proceed to HSCT only if they experience progressive disease or relapse. High-risk patients will receive trametinib administered once-daily for 28 days in combination with azacitidine, fludarabine, and cytarabine (aza/FLA) administered daily for five days per cycle. High-risk patients will receive up to two cycles of therapy before proceeding to HSCT off protocol. Key Eligibility: Patients aged 1 month to 21 years who meet World Health Organization criteria for JMML will be eligible. Objectives: The primary safety objectives are to determine the safety of combining trametinib with azacitidine for lower-risk patients and combining trametinib with aza/FLA for high-risk patients. The secondary efficacy objectives are to determine the event-free survival for lower-risk patients in the absence of HSCT and the molecular response rates pre-HSCT for high-risk patients. Sample Size and Statistical Design: A rolling 6 trial design will be used during Phase 1 of the study to determine the recommended phase II dose (RP2D) of trametinib for lower-risk and high-risk patients in combination with their respective therapies. Starting trametinib dose is 0.032mg/kg daily if less than 6 years of age, or 0.025mg/kg daily if 6 years or older, with one dose level de-escalation if indicated. Phase II of the study involves lower-risk and high-risk cohort expansions at the RP2D of trametinib. Target accrual is 22 patients in the lower-risk arm and 42 patients in the high-risk arm. The study is open to accrual at all TACL consortium sites. We acknowledge the TACL Consortium's scientific contribution to and participation in this study, including participating member institutions, investigators, research teams, and the TACL Operations Center. Novartis Pharmaceuticals Corporation provided the investigative drug in support of this trial. This study is supported by the National Institute of Health, National Cancer Institute (R37CA266550), the Pediatric Cancer Research Foundation, and the Cannonball Kids Cancer Foundation.

Turbidity Reduction by Using Variations of Filtration Media Sizes (Case Study of Treated Water PT. X Jakarta)

Turbidity is one of the main water quality parameters in drinking water quality. One way to reduce turbidity levels is by filtration. The filtration unit in the water treatment plant must use appropriate media so that the processed raw water meets World Health Organization (WHO) standards. WHO states that the turbidity of processed water before disinfection is 1 NTU. This research was conducted to know the efficiency of filtration processing with various media in reducing the concentration of turbidity in raw water. This study used three types of media, namely 50% silica sand with a mesh size of 12-16 and 50% silica sand with a mesh size of 8-12 (C), 100% silica sand with a mesh size of 12-16 (K), and 100% silica sand in mesh size. 8-12 (B). Porosity value for each sample C, K, and B is 0.412; 0.423; and 0.388. The detention time at maximum discharge for samples C, K, and B was 3.6, respectively; 3.76; and 3.45 minutes. The flow rates used for media samples C, K, and B were 4125 L/s and 2500 L/s, respectively. The removal efficiency produced by the highest turbidity was obtained in medium C with values of 90.8% and 89.9%, respectively. Meanwhile, media B gave the lowest turbidity removal efficiency, namely 86.3% and 86.4%. The results of all variations of the media used have met WHO standards, where the processed results have produced turbidity concentrations of 0.25 - 0.32 NTU.

Abstract 13310: TTN Variants and Arrhythmic Risk Among Countywide Sudden Deaths: From the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death Study

Background: Titin, encoded by TTN , is a sarcomeric protein necessary for normal cardiac and skeletal muscle function. Truncating variants in the A-band are a frequent cause of isolated and familial dilated cardiomyopathy (DCM) in living cohorts. Whether variants outside of the A-band confer arrhythmic risk remains unclear. We investigated the yield and distribution of TTN variants in a postmortem study of presumed sudden cardiac deaths (pSCDs) in San Francisco County. Methods: From 2/1/2011 to 12/31/2017, the Postmortem Systematic Investigation of Sudden Cardiac Death study performed complete autopsies on 889 incident deaths (age 16-90) meeting World Health Organization criteria for SCD (pSCD). Using clinical records, autopsy findings, and family history, we performed deep phenotyping to adjudicate underlying arrhythmic “SAD” (potentially rescuable with defibrillation) or non-arrhythmic “non-SAD” (tamponade, overdose, etc.) cause of pSCD. We performed clinical whole exome testing on cases with next of kin consent. Results: Of the 322 pSCDs tested (196 SAD, 126 non-SAD), we detected 5 truncating/splice variants located in non-A-band regions (p=0.03 vs. none found in the A-band) in 4 cases, all SAD. No truncating/splice variants were detected in 47 cases with autopsy evidence of DCM (cardiomegaly and short axis &gt; 3.5cm). Overall, 89 cases had at least 1 TTN variant of uncertain significance (VUS): 61 (68.5%) SADs and 28 (31.5%) non-SADs, with a trend towards more TTN VUSs among SADs (p =0.10). A total of 110 VUSs were found: 10 (9.1%) in the Z-disc, 38 (34.5%) in the I-band, 50 (45.5%) in the A-band, and 12 (10.9%) in the M-band. TTN VUSs clustered similarly throughout the gene in SADs and non-SADs. Conclusion: In this 7-year postmortem genetic study of unselected countywide sudden deaths using autopsy to adjudicate arrhythmic cause, we found TTN truncating/splice variants in non-A-band regions were associated with SAD and a trend toward association with SAD among TTN VUS carriers. In contrast to living cohorts with diagnosed DCM, no cases meeting autopsy criteria for DCM had a truncating/splice variant. Since non-survivors (i.e., SCDs) are underrepresented in DCM cohorts, our results suggest a potential role for non-A band TTN variants in arrhythmic risk.

Adolescence is characterized by more sedentary behaviour and less physical activity even among highly active forager-farmers.

Over 80% of adolescents worldwide are insufficiently active, posing massive public health and economic challenges. Declining physical activity (PA) and sex differences in PA consistently accompany transitions from childhood to adulthood in post-industrialized populations and are attributed to psychosocial and environmental factors. An overarching evolutionary theoretical framework and data from pre-industrialized populations are lacking. This cross-sectional study tests hypotheses from life history theory, that adolescent PA is inversely related to age, but this association is mediated by Tanner stage, reflecting higher and sex-specific energetic demands for growth and reproductive maturation. Detailed measures of PA and pubertal maturation are assessed among Tsimane forager-farmers (age: 7-22 years; 50% female, n = 110). Most Tsimane sampled (71%) meet World Health Organization PA guidelines (greater than or equal to 60 min/day of moderate-to-vigorous PA). Like post-industrialized populations, sex differences and inverse age-activity associations were observed. Tanner stage significantly mediated age-activity associations. Adolescence presents difficulties to PA engagement that warrant further consideration in PA intervention approaches to improve public health.

Homelessness and Incidence and Causes of Sudden Death

Over 580 000 people in the US experience homelessness, with one of the largest concentrations residing in San Francisco, California. Unhoused individuals have a life expectancy of approximately 50 years, yet how sudden death contributes to this early mortality is unknown. To compare incidence and causes of sudden death by autopsy among housed and unhoused individuals in San Francisco County. This cohort study used data from the Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) study, a prospective cohort of consecutive out-of-hospital cardiac arrest deaths countywide among individuals aged 18 to 90 years. Cases meeting World Health Organization criteria for presumed SCD underwent autopsy, toxicologic analysis, and medical record review. For rate calculations, all 525 incident SCDs in the initial cohort were used (February 1, 2011, to March 1, 2014). For analysis of causes, 343 SCDs (incident cases approximately every third day) were added from the extended cohort (March 1, 2014, to December 16, 2018). Data analysis was performed from July 1, 2022, to July 1, 2023. The main outcomes were incidence and causes of presumed SCD by housing status. Causes of sudden death were adjudicated as arrhythmic (potentially rescuable with implantable cardioverter-defibrillator), cardiac nonarrhythmic (eg, tamponade), or noncardiac (eg, overdose). A total of 868 presumed SCDs over 8 years were identified: 151 unhoused individuals (17.4%) and 717 housed individuals (82.6%). Unhoused individuals compared with housed individuals were younger (mean [SD] age, 56.7 [0.8] vs 61.0 [0.5] years, respectively) and more often male (132 [87.4%] vs 499 [69.6%]), with statistically significant racial differences. Paramedic response times were similar (mean [SD] time to arrival, unhoused individuals: 5.6 [0.4] minutes; housed individuals: 5.6 [0.2] minutes; P = .99), while proportion of witnessed sudden deaths was lower among unhoused individuals compared with housed individuals (27 [18.0%] vs 184 [25.7%], respectively, P = .04). Unhoused individuals had higher rates of sudden death (incidence rate ratio [IRR], 16.2; 95% CI, 5.1-51.2; P < .001) and arrhythmic death (IRR, 7.2; 95% CI, 1.3-40.1; P = .02). These associations remained statistically significant after adjustment for differences in age and sex. Noncardiac causes (96 [63.6%] vs 270 [37.7%], P < .001), including occult overdose (48 [31.8%] vs 90 [12.6%], P < .001), gastrointestinal causes (8 [5.3%] vs 15 [2.1%], P = .03), and infection (11 [7.3%] vs 20 [2.8%], P = .01), were more common among sudden deaths in unhoused individuals. A lower proportion of sudden deaths in unhoused individuals were due to arrhythmic causes (48 of 151 [31.8%] vs 420 of 717 [58.6%], P < .001), including acute and chronic coronary disease. In this cohort study among individuals who experienced sudden death in San Francisco County, homelessness was associated with greater risk of sudden death from both noncardiac causes and arrhythmic causes potentially preventable with a defibrillator.

Cardiometabolic health in adults born with very low birth weight—a sibling study

BackgroundPreterm survivors have increased risk for impaired cardiometabolic health. We assessed glucose regulation and cardiometabolic biomarkers in adult very low birth weight (VLBW, <1500 g) survivors, using siblings as controls.MethodsVLBW-participants were matched with term-born, same-sex siblings. At mean age 29.2 years (SD 3.9), 74 VLBW-adults and 70 siblings underwent a 2-h 75 g oral glucose tolerance test and blood tests for assessment of cardiometabolic biomarkers.ResultsOf participants, 23 (31%) VLBW and 11 (16%) sibling-controls met World Health Organization criteria for impaired glucose regulation (OR adjusted for age and sex 2.5, 95% CI: 1.1 to 5.8).Adjusting for age and sex, VLBW-participants showed 9.2% higher 2-h glucose (95% CI: 0.4% to 18.8%) than their siblings. Also, fasting (13.4%, −0.3% to 29.0%) and 2-h free fatty acids (15.6%, −2.4% to 36.9%) were higher in VLBW-participants. These differences were statistically significant only after further adjusting for confounders. No statistically significant differences were found regarding other measured biomarkers, including insulin resistance, atherogenic lipid profiles or liver tests.ConclusionsVLBW-adults showed more impaired fatty acid metabolism and glucose regulation. Differences in cardiometabolic biomarkers were smaller than in previous non-sibling studies. This may partly be explained by shared familial, genetic, or environmental factors.ImpactAt young adult age, odds for impaired glucose regulation were 3.4-fold in those born at very low birth weight, compared to same-sex term-born siblings.Taking into consideration possible unmeasured, shared familial confounders, we compared cardiometabolic markers in adults born preterm at very low birth weight with term-born siblings.Prematurity increased risk for impaired glucose regulation, unrelated to current participant characteristics, including body mass index.In contrast to previous studies, differences in insulin resistance were not apparent, suggesting that insulin resistance may partially be explained by factors shared between siblings. Also, common cardiometabolic biomarkers were similar within sibling pairs.