Health Perspective Research Articles

Rethinking of phosphodiesterase 5 inhibition: the old, the new and the perspective in human health.

The phosphodiesterases type 5 (PDE5) are catalytic enzymes converting the second messenger cyclic guanosine monophosphate (cGMP) to 5' GMP. While intracellular cGMP reduction is associated with several detrimental effects, cGMP stabilization associates with numerous benefits. The PDE5 specific inhibitors, PDE5i, found their explosive fortune as first-line treatment for erectile dysfunction (ED), due to their powerful vasoactive properties. The favorable effect for ED emerged as side-effect when PDE5i were originally proposed for coronary artery disease (CAD). From that point on, the use of PDE5i captured the attention of researchers, clinicians, and companies. Indeed, PDE5-induced intracellular cGMP stabilization offers a range of therapeutic opportunities associated not only with vasoactive effects, but also with immune regulatory/anti-inflammatory actions. Chronic inflammation is acknowledged as the common link underlying most non-communicable diseases, including metabolic and cardiac diseases, autoimmune and neurodegenerative disorders, cancer. In this scenario, the clinical exploitation of PDE5i is undeniably beyond ED, representing a potential therapeutic tool in several human diseases. This review aims to overview the biological actions exerted by PDE5i, focusing on their ability as modulators of inflammation-related human diseases, with particular attention to inflammatory-related disorders, like cardiac diseases and cancer.

Lost in translation? Qualitative interviews with Australian psychedelic-assisted therapy trial clinicians.

Policy changes in Australia mean that psychedelic-assisted therapy (PAT) is now available to consumers outside of clinical trials. Yet, the regulatory frameworks guiding the practice of PAT are underdeveloped, and the evidence base for guiding clinical practice is diverse and emerging, resulting in anticipated challenges in translation to community practice. Mental health clinicians who have experience delivering PAT in clinical trials are likely to be at the forefront of community practice and training, and influential in discussions about implementation. Yet little is known of their perspectives, preferences, and practices associated with the implementation of PAT. Interviews with 11 clinicians working on clinical trials of PAT were thematically analysed. Four themes were identified, describing the therapeutic frames that interviewees used to understand PAT and shaped their views on its interface with the mental health system: (1) therapeutic eclecticism, (2) enhanced reflexivity for PAT providers, (3) legitimisation of extra-medical perspectives in mental health, and (4) what might be lost in translation? We argue that clinicians' perspectives on PAT are reflective of existing tensions between a medical model of mental health care and other psychosocial, relational models. Therapists' ideals for the delivery of PAT can be conceptualised as a sort of 'enhanced care' approach, but workforce development and economic constraints are likely to challenge the accessible and impactful translation of this vision.

Role of Cattle Egrets in the Dissemination of Multi-drug Resistant Escherichia coli: A One Health Perspective

This study was carried out to establish the role of cattle egrets that feed on a nearby animal farm as a possible source of MDR bacteria. A total of 50 faecal dropping samples of cattle egret were collected from cattle farm and processed in the laboratory for isolation of E. coli. Total 45 isolates were recovered, of which 20 were identified and characterized as E. coli morphologically and biochemically. The antibiogram profile of all E. coli isolates recovered from cattle egret revealed 100% resistance to Ampicillin, Cloxacillin and Cefotaxime. Antibiotics such as Imipenem, Gentamycin, Trimethoprim, and Triple sulphas were found highly sensitive (100%) followed by Streptomycin (90%). The Sensitivity of Norfloxacin and Kanamycin ranged between intermediate to high degree, while Polymyxin was found sensitive for 55% isolates. Multi antimicrobial resistance index of all the isolates was found to be more than 0.27 indicating a “high risk” for the community. These, MDR positive E. coli, were further subjected to phenotypic and genotypic confirmation of ESBL producers by DDST and PCR, respectively. Out of 20, 12 isolates (60%) were confirmed as ESBL producers by DDST and PCR. PCR analysis of ESBL positive isolates revealed the predominance of bla CTX gene. All E. coli were also evaluated for pathogenicity using in vitro tests and 50% and 40% of the isolates were found to be pathogenic on the Congo red binding and hemolysis test, respectively. In the present study, the occurrence of MDR E. coli and ESBL producers in cattle egret is a cause of concern for public health and animal health.

Identification of Antimicrobial-Resistant Zoonotic Bacteria in Swine Production: Implications from the One Health Perspective.

Antimicrobial resistance poses a major threat to global health and food security and is primarily driven by antimicrobial use in human and veterinary medicine. Understanding its epidemiology at farm level is crucial for effective control measures. Despite the significant reduction in antibiotic use in conventional livestock production, the swine sector traditionally has a higher level of antibiotic use in veterinary medicine. Consequently, multidrug resistance (MDR) among microbial isolates of swine origin has been relatively frequent. The aim of this study was to assess the presence of multidrug-resistant (MDR) bacteria, enteric pathogens and resistance genes to the main antibiotics used in clinical practice, both within the environment and in animals across pig farms characterized by varying degrees of sanitary status. A total of 274 samples were collected. Of these, 34 samples were collected from the environment (wall swabs, slat swabs and slurry pit), and 240 samples were collected from animals (sows' and piglets' rectal faeces). All samples were analysed for MDR bacteria and enteric pathogens. The study revealed a high frequency of extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales and Campylobacter spp., with ESBL-producing Enterobacterales predominating in high health status farms (environment and animals) and Campylobacter spp. in both high health status and low health status environments. Additionally, a high percentage of methicillin-resistant Staphylococcus aureus (MRSA) was found, mainly in environmental samples from high health status farms, and Clostridioides difficile was distributed ubiquitously among farms and samples. Furthermore, though less frequently, vancomycin-resistant Enterococcus faecium (VRE) was isolated only in high health status farms, and Gram-negative bacilli resistant to carbapenems were isolated only in environmental samples of high health status and low health status farms. This study underscores the importance of surveillance for MDR bacteria in farm animals and their environment, including their waste. Such ecosystems serve as crucial reservoirs of bacteria, requiring national-level surveillance to promote responsible antibiotic use and pandemic control.

346 Investigating the potential of incorporating indirect genetic effects into genetic evaluations of dairy calf disease traits

Abstract The goal of infectious disease control is often local eradication, but this is theoretically impossible to achieve based on classical quantitative genetic theory. Current methods focus on the susceptibility of individuals to disease and assume that exposure to a pathogen is 1) constant over time, 2) equal among individuals, and (3) due entirely to the environment. For this reason, it is likely that conventional genetic methods are capturing only a fraction of genetic variation in disease occurrence. The incorporation of epidemiological theory into quantitative genetics provides an opportunity to better determine the level of genetic variation in infectious disease traits. This stems from the ability to include the positive feed-back dynamics of infectious disease transmission. From an epidemiolocal perspective, both susceptibility and infectivity also have indirect genetic effects (IGE), because the genotype of one individual impacts the risk of infection of other individuals, and this can drastically affect the rate and direction of response to selection. Epidemiological models unravel the genetic heterogeneity in both susceptibility and infectivity traits, and account for the impact each animal has on its contemporaries compared with conventional quantitative genetic approaches. From a calf health perspective, there is a shift towards group housing dairy calves, primarily due to welfare and social acceptability. In turn, this will lead to increased animal interactions from a young age. Therefore, the aim of this study was to investigate the potential of incorporating IGE into current quantitative approaches to determine its impact on selection potential. Our study looked at two common infectious diseases in calves on dairy farms: respiratory problems (RESP) and diarrhea (DIAR). Producer-recorded data comprised of 19,445 records collected on 34 herds that group housed calves between 2007 and 2020. Calves were allocated into pen groups based on birth dates and herd specific housing practices. Original phenotypes were split into 10 records, each representing a week of life, to determine when exactly calves became sick and infective. Several scenarios were investigated with respect to the time an animal was infective for following a disease case (1 or 2 wk), and the maximum difference in weeks between animal birth dates to be included within the same pen (2 to 5 wk). Variance components were estimated using a generalized linear mixed model fitting a complementary-log-log link function with offset for exposure. Initial heritability estimates for susceptibility on the observed scale for DIAR ranged from 0.03 to 0.07, and from 0.02 to 0.03 for RESP across scenarios. While heritability estimates for infectivity are currently being investigated, the results for susceptibility highlight the potential for incorporating IGE into genetic evaluation of disease traits and provide an introduction towards incorporating epidemiological theory into classical quantitative approaches to better respect the transmission dynamics of infections.

Experiences of Young People in Ireland with the Mental Health of Youth Story (MYSTORY) Photovoice Study

ABSTRACT The Mental Health of Youth Story (MYSTORY) study is a community-university partnership study which involved photovoice and consultation with young people. The MYSTORY study aimed to: (1) better understand adolescents’ perspectives on youth and school mental health and suicide prevention, and (2) communicate insights to schools and the wider community. In this article, we explored adolescents’ experiences of engaging with the MYSTORY study. Reflexive thematic analysis supports the MYSTORY study as a youth-centered study, which involved reflection, discussion and sharing of mental health perspectives and experiences within the study and community contexts. Study engagement was associated with feelings of pride, accomplishment, and connection. This study makes a novel contribution to understanding adolescents’ engagement in photovoice research exploring youth and school mental health, from the perspective of adolescents. Findings are relevant to researchers in wider mental health fields and practitioners interested in mental health promotion and suicide prevention in applied settings.

A pilot study of intestinal protist detection in humans, animals, and the environment in a slum area in Mymensingh, Bangladesh

The purpose of this study was to investigate the presence and transmission of Cryptosporidium spp., Blastocystis sp., Giardia intestinalis and Entamoeba histolytica between different hosts and their shared environment in a slum area of Bangladesh. A total of 102 samples were collected from Mymensingh, Bangladesh. This collection encompassed 16 human samples, 35 soil samples and 51 animal samples from various households within the region. The detection of Cryptosporidium spp., Blastocystis sp., G. intestinalis, and E. histolytica was carried out using nested PCR and/or quantitative PCR methodologies. Among the samples, 24 human, animal, and soil out of 102 were found positive for Blastocystis sp., spanning seven subtypes: ST2, ST3, ST7, ST10, ST23, ST24 and ST25. Additionally, eight samples (8/102) including human, animal and soil tested positive for Cryptosporidium spp., including C. parvum, C. baileyi, C. bovis, and C. meleagridis. Furthermore, one soil sample tested positive for G. intestinalis assemblage B, while no samples tested positive for E. histolytica. The detection of Cryptosporidium spp., Blastocystis sp., and G. intestinalis in this study has provided insights into their presence, extending beyond humans. Moreover, these findings highlight the importance of embracing a One Health perspective with an emphasis on specific parasitic microorganisms.

Colorectal Cancer and Asbestos Exposure: A Women's Health Perspective.

Colorectal cancer (CRC) is considered a "man's disease". However, emerging data show that females may have a higher prevalence of certain risk factors. A potential causal role of asbestos in CRC carcinogenesis has been suggested. This relationship is controversial, and only a few studies have focused on exposed female populations. The aim of this study was to review the scientific literature related to asbestos-related CRC incidence and mortality rates in female populations to address gender bias in the existing research. A systematic review was performed following PRISMA statement. Fourteen studies reporting 92 cases in total were included. Most women were aged 50 years or older and were employed in occupational activities with high asbestos exposure (steel, textile, and asbestos-cement industry) for at least 10 years. In one single case, household asbestos exposure was reported. The colon was the primary location of the tumor in 47 out of 92 cases. Three women were also affected by synchronous or metachronous peritoneal mesotheliomas. This study revealed a general methodological "gender bias" in scientific research. A significantly higher representation of women in clinical studies is needed to clarify the link between asbestos exposure and the development of colorectal cancer.

The Beneficial Elements in Forest Environment Based on Human Health and Well-Being Perspective

The Beneficial Elements in Forest Environment Based on Human Health and Well-Being Perspective

Public Health and Economic Impact of Periodic COVID-19 Vaccination with BNT162b2 for Old Adults and High-Risk Patients in an Illustrative Prefecture of Japan: A Budget Impact Analysis.

Japan will be transitioning from the free-of-charge COVID-19 vaccination program to annual periodic vaccination under a national immunization program for old adults and high-risk patients from 2024 fall/winter season. The policy transition including out-of-pocket payment requirement may discourage vaccination, leading to a lower vaccination rate. This study aimed to estimate the impact of varying vaccination rates with BNT162b2 COVID-19 mRNA vaccine on economics and public health in an illustrative prefecture which administers and promotes the periodic vaccination program, using budget impact analysis. A combined cohort Markov decision tree model estimated the public health outcomes of COVID-19-related symptomatic cases, hospitalizations and deaths; and the economic outcomes including vaccine-related cost, non-vaccine-related medical cost, and productivity loss from the societal perspective. The base case examined the impact on the outcomes when vaccination coverage changed from the reference value of 50% to upper and lower values, respectively. Scenario analyses were performed based on multiple scenarios. Increase in the vaccination rate demonstrated improvement in all public health outcomes. At 50% vaccination, the vaccine-related cost for 3years in a prefecture was estimated at JPY 7.58 billion (USD 57.67 million), the non-vaccine-related medical cost at JPY 79.22 billion (USD 602.48 million), the productivity loss at JPY 253.11 billion (USD 1.92 billion), and the total cost at JPY 339.92 billion (USD 2.59 billion). When the vaccination rate increased to 90%, the total cost decreased by JPY 4.88 billion (USD 37.11 million) (1.4%). When the vaccination rate decreased to 10%, the total cost increased by JPY 5.73 billion (USD 43.58 million) (1.7%). Results were consistent across almost all scenario analyses. Maintaining a high vaccination rate with BNT162b2 is important from both public health and economic perspectives in Japan. The findings highlight to local governments the importance of continued effort to promote vaccination.

Muslims perceptions of safe alcohol use: a qualitative study in the Gulf Council Cooperation countries

AimThe purpose of this study was to explore Muslim’s perceptions and views of raising awareness on safe alcohol use and counterfeit alcohol harms in Islamic countries.Subject and methodsQualitative semi-structured interviews with a purposive sample from the Gulf Council Cooperation (GCC) countries. The data were analysed using a reflexive thematic analysis method.ResultsTwenty-three participants took part in this study. We have identified five themes from the data, including perceptions on alcohol use in the GCC, community’s openness to alcohol discussions, approaches to raising awareness on alcohol use, all forbidden is desirable, and legalisation is the solution. All participants acknowledged the existence of alcohol use in GCC communities and advocated for the need to raise public awareness about the harms of alcohol use. Opinions on approaches to raising awareness varied. Some participants suggested focusing awareness on the religious messages prohibiting alcohol use, emphasising that alcohol is harmful in any quantity. For some, raising awareness of safe alcohol consumption was viewed as accepting and encouraging alcohol use, which goes against Islamic religious beliefs. Some participants attributed alcohol misuse and the consumption of counterfeit alcohol to the ban on alcohol products in some GCC countries.ConclusionsMuslims acknowledge the existence of alcohol use in Muslim communities, yet there is a hesitancy in raising awareness of safe alcohol use. Although challenging, there is a need to combine the public health perspective on safe alcohol use while providing messages that acknowledge the religious aspect.

“The police came in white protective suits and with batons, it was pure disaster” – a multi-stakeholder perspective on infection control in reception centers for asylum seekers during the COVID-19 pandemic in Germany

BackgroundThe COVID-19 pandemic presented unprecedented challenges, particularly for vulnerable populations residing in confined settings such as refugee shelters: Physical distancing measures were challenging to implement in shelters due to shared rooms or communal use of kitchens and sanitary facilities, which increased the risk of infections. Meanwhile, individuals’ capabilities for individual protection strategies were severely impaired by the structure of the shelters. Consequently, shelters had the duty to develop and implement strategies for the prevention and handling of SARS-CoV-2 infections. The aim of this study was to explore the perspectives of refugees, NGO employees, and shelter directors regarding COVID-19-related measures in German refugee shelters. The study aimed to identify challenges and conflicts arising from implemented measures, as well as expectations for improved support during the pandemic.MethodsSemi-structured and narrative interviews were conducted with 6 refugees, 6 facility managers, 12 NGO staff, and 2 social service agency staff from February to August 2022. Qualitative content analysis was employed to analyze the data, identifying overarching themes and codes.ResultsThe study uncovered challenges and conflicts resulting from pandemic measures, particularly mass quarantine orders, within refugee shelters. Lack of transparency and ineffective communication worsened tensions, with refugees feeling distressed and anxious. The quarantine experience had a negative impact on refugees’ mental health, which was exacerbated by limited social interaction and leisure-time activities. Shelter managers encountered administrative challenges when implementing measures due to facility constraints and limited resources, while NGO employees encountered obstacles in providing immediate assistance due to legal regulations and a lack of cooperation from shelter managers.ConclusionsThe study highlights that shelters are problematic institutions from a public health perspective. It shows the importance of implementing customized pandemic interventions in refugee shelters that take account of the diverse needs and experiences of both refugee and staff. To achieve this, we recommend to establish an ethics committee and involve various stakeholders in decision-making processes. Additionally, enhancing information dissemination to promote transparency and public understanding of measures is crucial. These insights can help develop comprehensive and effective pandemic plans for refugee shelters, ensuring better preparedness for future public health crises.

Fifty Years of Psychiatric Classification and Epidemiology Interactions: What is a Mental Disorder?

Psychiatric clinical diagnostic formulation has evolved over time. The changes alter our understanding and our ability to provide a public health perspective on the epidemiology of mental disorders in large populations. Epidemiology is an important perspective and set of tools to assess prevalence, treated prevalence, untreated prevalence, individual risks for mental disorders, and possible links to the etiology of disorders by following the trails of environmental exposures, biological measures, interpersonal dynamics, and genetic risk factors. As communities develop health-care services to treat individuals with mental disorders, knowledge about their prevalence and treatment requirements is also important. Since severe mental disorders may require institutional care, the diagnostic criteria used may either protect an individual’s liability for dangerous behavior (i.e. the insanity defense) or be used to control political and social dissidents. The criteria may also be used to determine evidence-based treatment options and eligibility for disability benefits. In this paper, using my vantage points as a physician scientist and public health officer, with leadership positions in national federal and professional mental health organizations, I address the developments in these areas over the past 50 years that have influenced institutional positions in the U.S. National Institute of Mental Health, the World Health Organization, the American Psychiatric Association, and the Center for the Study of Traumatic Stress. These perspectives may aid the next generation of investigators to advance the epidemiological and mental disorder classification scientific fields.

Using Quality Improvement to Expand and Align State Public Health Long-Term Follow-up Data Collection Across Newborn Screening Conditions

Context: Despite the undeniable success of newborn screening (NBS), numerous barriers exist regarding long-term follow-up (LTFU) of children with conditions included in NBS. Furthermore, there is a focus on condition-specific follow-up with no national guidelines for standard quality measures collected by state public health LTFU programs. Program: Minnesota Department of Health (MDH) Longitudinal Follow-up for NBS. Implementation: A state public health LTFU for NBS quality improvement (QI) project was carried out with collaboration between MDH project team members and a QI Steering Team who provided clinical, public health, education, caregiver, and community perspectives and expertise to MDH. Relevant measures were selected from existing data elements, and additional measures were developed based on exchange between MDH project team and the QI Steering Team. Potential data sources were explored and prioritized. Processes for querying existing data sources such as death records were refined, new sources such as electronic health records and paper/PDF health records were established, and data collection was piloted. The Minnesota Electronic Disease Surveillance System was modified, and an electronic data form was created to promote consistent data abstraction from sources. Throughout the project, progress was evaluated and shared. At project conclusion, MDH project team and the QI Steering Team reviewed project outcomes and approaches to evolve the project into ongoing surveillance. Evaluation: Five common public health LTFU measures were determined. Overall, 77% of attempted measures were successfully collected. Primary and secondary data sources were adopted. In addition, collected data resulted in 7% of cases that were closed to further public health LTFU, often related to a move out of state. Discussion: This project established the feasibility of state public health LTFU surveillance of outcomes and health care use by collecting a common data set applicable across NBS conditions.

The Occurrence of Chlamydia felis in Cats and Dogs in Hungary.

The World Health Organization (WHO) estimates that many human infections are zoonoses, creating a worldwide public health challenge. Among Chlamydia species, Chlamydia felis is the leading cause of conjunctivitis in cats and is a prominent zoonotic species. This study aimed to determine the occurrence and risk of chlamydiosis in cats and dogs in Szeged, Hungary, and surrounding areas. The total nucleic acids from conjunctival swab samples of symptomatic and asymptomatic animals were extracted using an automated nucleic acid extraction system. After that, DNA was amplified by pan-chlamydia PCR. Bacterial and fungal cultures were also performed to detect other microorganisms. Of the 93 animals, 32 (34.4%) were positive for pan-chlamydia PCR. The positivity rates were 33.3% (26/78) in cats and 40.0% (6/15) in dogs. Furthermore, the positivity rates were 37.2% (16/43) in the cat shelter, 42.4% (14/33) in the veterinary clinic, and 11.7% (2/17) in household pets. In total, 103 species were identified through culture-based examinations, including 97 (94.2%) bacterial and 6 fungal (5.8%) species. From both human and animal health perspectives, it is essential to have a detailed understanding of the circumstances of chlamydiosis, given the global impact of zoonotic diseases.

Pathogen Prevalence in Cetaceans Stranded along the Italian Coastline between 2015 and 2020.

The monitoring of stranded marine mammals represents a strategic method to assess their health, conservation status, and ecological role in the marine ecosystem. Networks worldwide track stranding events for the passive monitoring of mortality patterns, emerging and reemerging pathogens, climate change, and environmental degradation from a One Health perspective. This study summarizes pathogen prevalence data from the Italian Stranding Network (ISN) derived from post-mortem investigations on cetaceans found dead stranded along the Italian coastline between 2015 and 2020. The decomposition of the carcasses and logistics limited the post-mortem examination to 585 individuals, out of 1236 single-stranding reports. The most relevant pathogens identified were Cetacean Morbillivirus, Herpesvirus, Brucella spp., and Toxoplasma gondii, whose roles as environmental stressors are well known, despite their real impact still needing to be investigated in depth. Statistical analysis showed that age and sex seem to be positively related to the presence of pathogens. This study represents the first step in harmonizing post-mortem investigations, which is crucial for evidence-based conservation efforts. Implementing diagnostic and forensic frameworks could offer an indirect insight into the systematic monitoring of diseases to improve the identification of regional and temporal hotspots in which to target specific mitigation, management, and conservation strategies.

Public health care staff during the COVID-19 pandemic: a comparison of job demands and work functioning between temporary and permanent staff

BackgroundThe COVID-19 pandemic posed an enormous challenge on the public health workforce, leading to the hiring of much temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. From a public health perspective, we need to know how working conditions are experienced when there is an acute pressure on recruiting sufficient public health care staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health care staff, during the fourth wave of the COVID-19 pandemic in the Netherlands and compare it with available pre-pandemic data from the general working population.MethodsThis cross-sectional study included temporary (n = 193) and permanent (n = 98) public health care staff from a municipal health care service in the north of the Netherlands. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ, range 1-100) and work functioning (Work Role Functioning Questionnaire, WRFQ, range 1-100). The participants’ scores were compared to the general working population and differences between temporary and permanent staff were investigated using linear regression analysis. In addition, explorative analyses were conducted with temporary staff stratified by task and permanent staff by department.ResultsPermanent staff had relatively high scores on job demands compared to the general working population, whereas temporary staff had relatively low scores. On work functioning, permanent staff had similar scores as the general working population and temporary staff had better scores. Compared to permanent staff, temporary staff had lower, i.e. better, scores on quantitative (regression coefficient (B)=-26.7; 95% Confidence Interval (CI) -30.8 to -22.5), cognitive (B=-24.4; 95% CI -29.0 to -19.9), and emotional demands (B=-11.8; 95% CI -16.0 to -7.7), and better scores on work functioning (B = 7.8; 95% CI 4.5 to 11.3).ConclusionsTemporary staff experienced lower job demands and reported better work functioning than permanent staff. The acute expansion of the public health workforce did not seem to negatively impact the job demands and work functioning of temporary public health care staff.

Electrical Safety in Public Healthcare Facilities and Medical Devices Management

In hospitals, electrical hazards pose a serious risk that needs to be continuously assessed and improved. Medical surveillance systems and workplace assessments are frequently disregarded, and workers do not follow workplace instructions on safety precautions. The events are linked to a lack of understanding about the significance of electrical dangers and workplace safety and public health. Ignoring these evaluations could have negative effects on one's health, the quality of one's work, handicap, and impairment. The perspective of occupational safety and health on electrical dangers in hospital settings is described in this paper. Additional preventive actions were suggested in order to provide a list of workable and realistic actions that would create a safer and healthier workplace.

Exploring Pathways from Community Involvement to Empowerment in Sexual and Reproductive Health: A Public Health Perspective

The intersection of community involvement and empowerment in sexual and reproductive health (SRH) initiatives represents a critical area in public health. This scoping review aimed to explore the pathways from community involvement to empowerment within SRH initiatives, providing a comprehensive understanding of how public health strategies engage and build the capacity of communities. The literature from databases such as PubMed, Scopus and Web of Science were reviewed systematically, focusing on studies published between 2000 and 2023. The review identified various public health interventions that initially engage communities through participation, consultation and collaboration. These interventions often serve as the foundation for subsequent empowerment, characterised by capacity building, autonomy and advocacy. Key findings highlight that effective SRH initiatives involve community members in programme activities and foster environments where they can gain the skills, knowledge and confidence needed to take control of their health outcomes. Our analysis revealed that successful pathways from involvement to empowerment are multifaceted, requiring sustained commitment, resources and culturally sensitive approaches. The review underscores the importance of integrating community involvement and empowerment in designing and implementing SRH programmes to ensure sustainable and impactful health outcomes. This scoping review contributes to the existing literature by mapping the relationship between community involvement and empowerment, offering insights for public health practitioners and policymakers aiming to enhance SRH initiatives. Future research should focus on longitudinal studies to better understand the long-term impacts of these pathways on community health and well-being.

Healthcare Access and Financing: A Legal and Public Health Perspective

The welfare provisions of the current Constitution centre on healthcare. The Indian Constitution's Article 42 declares that the state has an obligation to take all reasonable steps to promote public health. Additionally, Article 47 of the Indian Constitution, another article containing Directive Principles of State Policy, mandates that the state carry out its primary duties to improve public health by raising the standard of living, improving nutrition, and improving public health. In particular, the state must work to outlaw the use of drugs and alcohol, unless prescribed, as these substances are harmful to health. It follows that welfare regulations clearly place an obligation on the state to increase its assistance in promoting the health of those individuals who are unable to pay for the expensive medical care needed to treat their illnesses. In light of the urgency and importance of the issue, the World Health Organisation designated Universal Health Coverage (UHC) as its top goal. Ensuring that everyone has access to necessary health services of adequate quality and is shielded from the financial burden of medical expenses is the goal of universal health coverage. In underdeveloped nations, financial security against medical expenses is just as important as access to healthcare.