Public Health Perspective Research Articles

Fungal Diversity in Wet and Dry Ripe Plantains: Isolation, Identification, and Implications for Public Health

The persistent inadequacy of storage facilities in in globally and more prevalent in developing nations leads to substantial annual losses of harvested agricultural produce, severely impacting the economic stability of local farmers. This investigation focuses on the critical public health implications arising from the fungal contamination of stored plantain chips, a delicacy snack in Nigeria, West Africa. Notably, the fungal species isolated, which are Aspergillus flavus, Aspergillus niger, Penicillium chrysogenum, Saccharomyces cerevisiae, Aspergillus fumigatus, Fusarium spp., Rhizopus stolonifer, and Mucor spp. are critical from a public health perspective. Species such as Aspergillus flavus and Aspergillus niger are particularly concerning due to their capacity to produce aflatoxins, which are among the most carcinogenic substances known and have been linked to liver cancer and immune system suppression. The prevalence of these mycotoxins not only compromises the nutritional integrity and safety of the plantain chips but poses severe risks to consumers, highlighting a broader issue of food security and safety. This study brings to the fore the pressing need for interventions that enhance the storage conditions and decrease fungal contamination, thereby reducing the exposure of the population to mycotoxins. The implications of this research extend beyond the economic damage to encompass significant public health concerns, emphasizing the critical need for regulatory, technical, and infrastructural developments to uphold the microbial quality of plantain both in wet and dry states, ensuring safe consumption.

From static snapshots to dynamic panoramas: the evolution and future vision of palliative care atlas in cross-national perspectives

Palliative care is essential to global health services as it improves the quality of life of patients, their families and caregivers. The ATLANTES Global Observatory of Palliative Care (University of Navarra) was created a decade ago to promote a positive attitude towards patients with advanced illness in society and medicine. To do so, and over the past 15 years, ATLANTES has mapped palliative care data worldwide using public health, macro and comparative perspectives in different atlases. These have enabled data to be contextualised and good examples to be identified concisely and graphically. Atlases have been widely employed as advocacy tools within international institutions and ministries of health. While the aim and the perspective have remained unalterable over time, the methods and design have evolved throughout the publications from sober cartography and static infographics to big interactive data visualisation web tools. By embracing technology, ATLANTES has developed an open-access web mapping tool reuniting information from regional atlases, favouring global access to data. In 2022, matching the increasingly recognised need for robust monitoring of palliative care worldwide, ATLANTES became a WHO Collaborating Centre for the Global Monitoring of Palliative Care Development. This attempt to bridge the gap and ensure equitable care information in countries with limited palliative care access has resulted today in more accessible, self-explanatory, and visually appealing palliative care data.

Young adults from disadvantaged groups experience more stress and deterioration in mental health associated with polycrisis.

The recent polycrisis (COVID-19, Ukraine war, climate change, economic crisis) has been associated with mental health through cumulative stress, with young people being particularly vulnerable. We surveyed 403 college students from Poland to examine their psychological responses to the experienced crises. The results showed that polycrisis was associated with worse mental health of college students from disadvantaged groups (based on gender, sexual orientation, and financial situation) compared to other college students, in four areas: sense of proximity to the crises, stress caused by the crises, sense of responsibility for mitigating the crises, and experiencing everyday moral dilemmas regarding the crises. These young adults also suffered more in terms of negative affectivity, depressive symptoms, and subjective physical and mental health. Our findings suggest that when discussing public mental health perspectives, it is important to consider consequences of cumulative stress and its greater impact on young people from disadvantaged groups.

Effectiveness of substance use disorder treatment as an alternative to imprisonment

IntroductionDrug courts are criminal justice programs to divert people with substance use disorders from incarceration into treatment. Drug courts have become increasingly popular in the US and other countries. However, their effectiveness in reducing important public health outcomes such as recidivism and substance-related health harms remains ambiguous and contested. We used nationwide register data from Sweden to evaluate the effectiveness of contract treatment sanction, the Swedish version of drug court, in reducing substance misuse, adverse somatic and mental health outcomes, and recidivism.MethodsIn this prospective cohort study, two quasi-experimental designs were used: difference-in-differences and the within-individual design. In the latter, we compared the risk of outcomes during time on contract treatment to, 1) parole after imprisonment and, 2) probation.ResultsThe cohort included 11,893 individuals (13% women) who underwent contract treatment. Contract treatment was associated with a reduction of 7 percentage points (95% CI: -.088, -.055) in substance misuse, 5 percentage points (-.064, -.034) in adverse mental health events, 9 percentage points (-.113, -.076) in adverse somatic health events, and 3 fewer charges (-3.16, -2.85) for crime in difference-in-differences analyses. Within-individual associations suggested that the same individual had longer times-to-event for all outcomes during contract treatment than on parole or on probation.ConclusionsContract treatment is an effective intervention from both public health and criminal justice perspective. Our findings suggest that it is a superior alternative to incarceration in its target group. Further, we find that an implementation approach that is less punitive and more inclusive than what is typical in the US can be successful.

The role of the (in)accessibility of social media data for infodemic management: a public health perspective on the situation in the European Union in March 2024.

Public health institutions rely on the access to social media data to better understand the dynamics and impact of infodemics - an overabundance of information during a disease outbreak, potentially including mis-and disinformation. The scope of the COVID-19 infodemic has led to growing concern in the public health community. The spread of harmful information or information voids may negatively impact public health. In this context, social media are of particular relevance as an integral part of our society, where much information is consumed. In this perspective paper, we discuss the current state of (in)accessibility of social media data of the main platforms in the European Union. The European Union's relatively new Digital Services Act introduces the obligation for platforms to provide data access to a wide range of researchers, likely including researchers at public health institutions without formal academic affiliation. We examined eight platforms (Facebook, Instagram, LinkedIn, Pinterest, Snapchat, TikTok, X, YouTube) affected by the new legislation in regard to data accessibility. We found that all platforms apart from TikTok offer data access through the Digital Services Act. Potentially, this presents a fundamentally new situation for research, as before the Digital Services Act, few platforms granted data access or only to very selective groups of researchers. The access regime under the Digital Services Act is, however, still evolving. Specifics such as the application procedure for researcher access are still being worked out and results can be expected in spring 2024. The impact of the Digital Services Act on research will therefore only become fully apparent in the future.

Milk: A Natural Guardian for the Gut Barrier.

The gut barrier plays an important role in health maintenance by preventing the invasion of dietary pathogens and toxins. Disruption of the gut barrier can cause severe intestinal inflammation. As a natural source, milk is enriched with many active constituents that contribute to numerous beneficial functions, including immune regulation. These components collectively serve as a shield for the gut barrier, protecting against various threats such as biological, chemical, mechanical, and immunological threats. This comprehensive review delves into the active ingredients in milk, encompassing casein, α-lactalbumin, β-lactoglobulin, lactoferrin, the milk fat globular membrane, lactose, transforming growth factor, and glycopeptides. The primary focus is to elucidate their impact on the integrity and function of the gut barrier. Furthermore, the implications of different processing methods of dairy products on the gut barrier protection are discussed. In conclusion, this study aimed to underscore the vital role of milk and dairy products in sustaining gut barrier health, potentially contributing to broader perspectives in nutritional sciences and public health.

Missed Opportunities in Screening for Glaucoma.

To create a holistic and realistic view regarding current knowledge, understanding, and challenges of screening in general and in glaucoma. Based upon available literature, all systems suffer from the same challenges: huge variability of care practices (despite guidelines), simultaneous under care and over care, as well as the unsustainable increase of costs. While the magnitude of these challenges differs immoderately between well-off and developing countries, the Western world has already demonstrated that simply doing more than what we currently do is not the solution. System outcomes also matter in screening, that is, its benefits should outweigh any harms (over-care, false positives/negatives, uncertain findings, etc.) and be cost-effective. However, even when the evidence does not support screening (as is currently the case in glaucoma), it may feel justified as "at least we are doing something." Strong commercial interests, lobbying and politics star as well and will influence the control arm even in high-quality randomized screening trials (RCT). As resources will never be sufficient for all health care activities that providers wish to deliver and what people wish to receive, we need to ask big questions and adopt a public health perspective in glaucoma and eye care. How can we create and maintain a sustainable balance between finding and treating underserved high-risk patients without burdening the broader patient population and societies with over-diagnostics and treatments? Considering numerous biases related to screening, including the variability in care practices, a high-quality RCT for the screening of glaucoma would be very challenging to organize and evaluate its universal usefulness.

Urban Transportation Planning in the Perspective of Public Health in the City of Jakarta, Indonesia

Public health is one of the basic sectors that are influenced by transportation. Public health factors related with transportation performances are environmental quality, people access to health facilities, traffic safety, mode choice and its relationship with health, and disease spreading risk. Based on the case of Transportation Master Plan (Rencana Induk Transportasi Jakarta, RITJ) of Capital Jakarta, Indonesia, this paper explores the topic of how adequate urban transportation planning in Indonesia accommodate health factors in its process and substance. This study takes quantitative method to identify Jakarta transportation condition in relation with health sector and to understand to what extent transportation planning accommodate health factors. Qualitative method is also used to analyze people perception regarding the level of the transportation planning process in accommodating their interest in health. The research concludes that the negative impact of transportation activities to the health sector in Jakarta such as air pollution, traffic accident, and passive mode choice are still high. The RITJ planning process did not accommodate urban health criteria adequately. This paper suggests a better transportation planning to assure adequate accommodation of urban health criteria both in its process and substances.

Cost–Utility Analysis of Prophylactic Laser Peripheral Iridotomy for Primary Angle Closure Suspects

To assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS). Economic evaluation. Our Markov model randomized PACS eyes to LPI or observation for 40 one-year cycles (100,000 iterations per strategy). Each cycle, an eye remained in its current health state, advanced linearly through PAC, mild, moderate, severe, and end-stage PAC glaucoma (PACG), or died. Transition rates were derived from the literature including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Eyes with acute-angle closure advanced to either PAC or directly to various PACG severities. A tracker monitored accumulated perimetric decibel reduction to progress PACG through increasing severities, with an annual probability of either stable or severity-dependent perimetry loss. We set a willingness to pay of an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life-years. At age 50 years, LPI was cost-saving using ZAP data and cost-effective using ANA-LIS data. The ZAP iterations became cost-effective from the societal perspective when the model started at age 55 years and third-party perspective at age 70 years. LPI was no longer cost-effective from the societal perspective using ANA-LIS data at age 80 years or from the societal perspective using ZAP data or third-party perspective with ANA-LIS data at age 85. Probabilistic sensitivity analyses favored LPI until starting age 85. Prophylactic LPI for PACS is cost-effective across a spectrum of ages and should be considered from a public health perspective.

Predictors and components of inpatient asthma hospital cost: A retrospective cohort study. Analysis from a sample of 14 Belgian hospitals.

Addressing the challenges of asthma has involved various approaches, including the examination of costs associated with hospitalization. However, there is a limited number of studies that have investigated the actual expenses incurred by hospital settings in caring for asthma patients. This study aims to describe the costs, predictors, and breakdown of expenditures in different categories. A retrospective cohort study was conducted, involving 314 hospital stays of patients over 12 years old who were admitted for asthma and classified under APR-DRG 141 (asthma). Univariate and multiple linear regression analyses were performed. The median cost, regardless of DRG severity, amounted to 2.314€ (1.550€-3.847€). Significant variations were observed when the sample was stratified based on the severity of DRG, revealing a cost gradient that increases with severity. The length of stay followed a similar trend. Six predictors were identified: age, admission to intensive care, asthma severity, severity level of the DRG, winter admission, and length of stay. The cost breakdown showed that 44% constituted direct costs, 25% were indirect costs, 26% were attributed to medical procedures performed outside the patient unit, and 5% were related to medication administration. This study initiates a discussion on the role of reducing hospital costs in strategies aiming at controlling asthma-related costs. We argue that cost reduction cannot be achieved solely at the hospital level but must be approached from a public health perspective. This includes promoting high-quality outpatient care and addressing factors leading to poor adherence to the care plan.

Policy Approaches for Regulating Alcohol Marketing in a Global Context: A Public Health Perspective.

Alcohol consumption is responsible for 3.3 million deaths globally or nearly 6% of all deaths. Alcohol use contributes to both communicable and noncommunicable diseases, as well as violence and injuries. The purpose of this review is to discuss, in the context of the expansion of transnational alcohol corporations and harms associated with alcohol use, policy options for regulating exposure to alcohol marketing. We first provide an overview of the public health problem of harmful alcohol consumption and describe the association between exposure to alcohol marketing and alcohol consumption. We then discuss the growth and concentration of global alcohol corporations and their marketing practices in low- and middle-income countries, as well as in higher-income societies. We review the use and effectiveness of various approaches for regulating alcohol marketing in various countries before discussing challenges and opportunities to protect public health.

Toward Digital Resilience: Strategies for Promoting Positive Mental Health in the Age of Social Media

The advent of social media may be considered as the most profound modification in communication patterns, particularly among young people. This research elucidates the tie between social media use and the mental health performance of young adults from a public health perspective. The study showed relationship between social media engagement and mental well-being is quite complex. Besides, positive social relationships and social support were found among online communities, analyzing the given research it was shown that this one could stem the negativity. Moreover, research urges the government to enhance public health activities to encourage young people to have good social media habits and they should be digitally resistant. This study takes a holistic approach to the involvement of social media in mental health hack issues with the purpose of developing strategic measures to mitigate the negative aspects and improve well-being in the digital era.

Nurses’ preferences regarding MenACWY conjugate vaccines attributes: a discrete choice experiment in Spain

ObjectivesImmunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. Study designA national-level discrete choice experiment (DCE) was conducted. MethodsA literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). ResultsThirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210–3.002), smaller volumes (OR = 1.494, 95%CI = 1.264–1.767), liquid formulations (OR = 1.283, 95%CI = 1.108–1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108–1.486). No statistical evidence was found for the remaining attributes. ConclusionsEvidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses’ preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.

Synthetic Cathinones: Epidemiology, Toxicity, Potential for Abuse, and Current Public Health Perspective.

Synthetic cathinones, derived from cathinone found in the plant Catha edulis, represent the second largest and most frequently seized group of new psychoactive substances. They are considered as β-keto analogs of amphetamine, sharing pharmacological effects with amphetamine and cocaine. This review describes the neurotoxic properties of synthetic cathinones, encompassing their capacity to induce neuroinflammation, dysregulate neurotransmitter systems, and alter monoamine transporters and receptors. Additionally, it discusses the rewarding and abuse potential of synthetic cathinones drawing from findings obtained through various preclinical animal models, contextualized with other classical psychostimulants. The review also offers an overview of current abuse trends of synthetic cathinones on the illicit drug market, specifying the aspects covered, and underscores the risks they pose to public health. Finally, the review discusses public health initiatives and efforts to reduce the hazards of synthetic cathinones, including harm reduction methods, education, and current clinical management strategies.

Dietary intake with supplementation of vitamin D, vitamin B6, and magnesium on depressive symptoms: a public health perspective.

This study aims to understand the impact of dietary intake through supplementation of vitamins D, B6, and magnesium on elevated depressive symptoms, a mental health illness that is a leading contributor to global disability and a public health concern. Multiple datasets from the National Health and Nutrition Examination Survey 2017-March 2020 investigated the associations between vitamin D, B6, and magnesium on depression screening scores. A cross-sectional sample of adults over 20 was extracted (n = 9,232). Chi-square tests and logistic regression analyses were used to investigate the associations. Individuals with low amounts of vitamin D (p = 0.0481) were more likely to report elevated depressive symptoms relative to those with low amounts of vitamin B6 (p = 0.0225). These results remained significant among those with high magnesium (p = 0.0133) proportionate to high vitamin B6 (p = 0.0225). In the age-adjusted model, a lower intake of vitamin D, vitamin B6, and magnesium showed a relationship with elevated depressive symptoms (Vitamin D: OR = 0.611, 95% CI 0.382-0.980 Vitamin B6: OR = 0.503, 95% CI 0.291-0.867 Magnesium: OR = 0.458, 95% CI 0.277-0.759). The fully adjusted regression model (gender, race/ethnicity, and household food security) showed that a lower intake of vitamin B6 and magnesium correlated with elevated depressive symptoms (Vitamin B6: OR = 0.439, 95% CI 0.260-0.738 Magnesium: OR = 0.465, 95% CI 0.303-0.714). Preventive measures could be addressed by identifying the risks of vitamin deficiencies. Further epidemiological research is needed for the individual effects of vitamin supplementation and depression screening scores. Future prospective cohort studies exploring these associations, focusing on daily dietary intake, are needed to validate the direction of causation further and understand the underlying mechanisms.

Protocol for designing and evaluating an undergraduate public health course on sexual and reproductive health at a public university in California

IntroductionComprehensive sexuality education (CSE) is associated with positive sexual and reproductive health (SRH) outcomes, including increased contraceptive use, lower rates of unintended pregnancy and prevention of sexual violence. However, implementation of and requirements for CSE vary across the United States which can negatively impact students, both during and beyond high school, including among college students. Methodsand Analysis: This paper describes the research protocol for a multi-staged approach for designing, implementing and evaluating an SRH course for up to 60 undergraduate students at a public university in California. Before the class is offered, we will conduct 20 in-depth interviews with current students, educators and course design experts to learn from their experiences and seek their guidance on course design. To evaluate the course, enrolled students will complete a pre-course and a post-course survey before and after class is taught, to assess students’ attitudes and values relevant to educational concepts and the format and delivery of the course and its modules and activities. Approximately 20 students will take part in an in-depth exit interview, after completing the course, to gather perceptions about how the course impacted their knowledge and behavior. The goal is to refine materials for future in-person course offerings and develop a prototype for a fully online version of the course. DiscussionThis study introduces a novel university-level course to provide young adult students comprehensive, evidence-based education on sexual and reproductive health from a public health perspective. The program leverages existing CSE efforts, enhancing them with academic rigor, inclusive content and digital inclusion. This approach, inclusive of diverse sexual orientations, content on pleasure and sexual violence prevention, aims to fill existing gaps in university curricula and also set a new standard in CSE. The project's innovative and multidisciplinary design offers a model for broader impact within a large public university system and beyond.

Water, Sanitation, and Hygiene (WASH) and Diarrheal Diseases Among Under-fives: A Public Health Perspective

Water, Sanitation, and Hygiene (WASH) and Diarrheal Diseases Among Under-fives: A Public Health Perspective

The Research Interest in ChatGPT and Other Natural Language Processing Tools from a Public Health Perspective: A Bibliometric Analysis

Background: Natural language processing, such as ChatGPT, demonstrates growing potential across numerous research scenarios, also raising interest in its applications in public health and epidemiology. Here, we applied a bibliometric analysis for a systematic assessment of the current literature related to the applications of ChatGPT in epidemiology and public health. Methods: A bibliometric analysis was conducted on the Biblioshiny web-app, by collecting original articles indexed in the Scopus database between 2010 and 2023. Results: On a total of 3431 original medical articles, “Article” and “Conference paper”, mostly constituting the total of retrieved documents, highlighting that the term “ChatGPT” becomes an interesting topic from 2023. The annual publications escalated from 39 in 2010 to 719 in 2023, with an average annual growth rate of 25.1%. In terms of country production over time, the USA led with the highest overall production from 2010 to 2023. Concerning citations, the most frequently cited countries were the USA, UK, and China. Interestingly, Harvard Medical School emerges as the leading contributor, accounting for 18% of all articles among the top ten affiliations. Conclusions: Our study provides an overall examination of the existing research interest in ChatGPT’s applications for public health by outlining pivotal themes and uncovering emerging trends.

Risk Prediction for Sudden Cardiac Death in the General Population: A Systematic Review and Meta-Analysis.

Objective: Identification of SCD risk is important in the general population from a public health perspective. The objective is to summarize and appraise the available prediction models for the risk of SCD among the general population. Methods: Data were obtained searching six electronic databases and reporting prediction models of SCD risk in the general population. Studies with duplicate cohorts and missing information were excluded from the meta-analysis. Results: Out of 8,407 studies identified, fifteen studies were included in the systematic review, while five studies were included in the meta-analysis. The Cox proportional hazards model was used in thirteen studies (96.67%). Study locations were limited to Europe and the United States. Our pooled meta-analyses included four predictors: diabetes mellitus (ES = 2.69, 95%CI: 1.93, 3.76), QRS duration (ES = 1.16, 95%CI: 1.06, 1.26), spatial QRS-T angle (ES = 1.46, 95%CI: 1.27, 1.69) and factional shortening (ES = 1.37, 95%CI: 1.15, 1.64). Conclusion: Risk prediction model may be useful as an adjunct for risk stratification strategies for SCD in the general population. Further studies among people except for white participants and more accessible factors are necessary to explore.

Abstract P211: Burden and Temporal Trend of Peripheral Artery Disease in the United States and Its Attributable Risk Factors From 1990-2019: An Insights From the Global Burden of Disease Study 2019

Background: Peripheral Artery Disease (PAD) ranks as the 10th primary cause of mortality and the 11th for disability among all cardiovascular diseases in the U.S. Method: We employed the Global Burden of Disease 2019 framework. PAD non-fatal health outcomes were analyzed using the DisMod MR 2.1 (Bayesian meta-regression tool) and determined fatal health outcome with the cause of death ensemble model (CODEm), segmented by age, gender, year, and location from 1990-2019 across the U.S. Results: The annual percentage change (APC) revealed a 26% (9.9-12.4 million) increase in overall prevalence and incidence, a significant 152% (5,757-14,527) rise in deaths, and a 98% (119,253-236,031) uptick in DALYs during 1990-2019. Notably, while the age-standardized incidence rate dipped by 28% (267-193), death and DALY rates climbed by 33% (1.7-2.27) and 11% (36-39) respectively. Delaware witnessed the highest APC in deaths 118% (2.33-5.08) per 100,000, trailed by Colorado with a 58% (35-55) rise in DALYs. Individuals under 70 experienced a 118% (1052-2294) surge in APC for deaths and a 28% (458,357-588,135) increase in incidence. In absolute numbers, males bore a heavier PAD burden, yet females exhibited elevated age-standardized rates from 1990-2019. Conclusion: The study underscores a concerning rise in PAD in the U.S. from 1990-2019, accounted for 1.52% deaths of all cardiovascular related casualties in 2019. Delaware and Colorado have notably high increases in PAD-related outcomes. From both a clinical and public health perspective, addressing high fasting plasma glucose and sodium-rich diets is crucial, as they stand as leading risk factors in PAD's burgeoning prevalence.