Pre-existing Conditions Research Articles

Nephro- and Cardiotoxic Effects of Etoricoxib: Insights into Arachidonic Acid Metabolism and Beta-Adrenergic Receptor Expression in Experimental Mice

Background: Etoricoxib is a widely used anti-inflammatory drug, but its safety profile concerning cardiovascular and renal health remains inadequately explored. This study aimed to assess the nephro- and cardiotoxic effects of etoricoxib in a murine model, with a focus on its impact on arachidonic acid-metabolizing enzymes and beta-adrenergic receptors associated with drug-induced toxicity. Methods: Thirty-five BALB/C mice were randomly assigned to five groups: control, low-dose etoricoxib, high-dose etoricoxib, low-dose celecoxib, and high-dose celecoxib (a well-known nephro- and cardiotoxic NSAID). The treatments were administered for 28 days, after which hearts and kidneys were excised for physical and histopathological analysis, and the expression of arachidonic acid-metabolizing enzymes (cytochrome P450s, lipoxygenases, cyclooxygenases) and beta-1 adrenergic receptor (adrb1) and angiotensin-converting enzyme (ace2) genes were quantified using quantitative reverse transcription PCR (qRT-PCR). Results: Etoricoxib administration resulted in dose-dependent nephro- and cardiotoxic effects. Renal histology revealed glomerular atrophy or hypertrophy and significant damage to the proximal and distal convoluted tubules, including epithelial flattening, cytoplasmic vacuolation, and luminal widening. Cardiac analysis showed disorganized muscle fibers and hyaline degeneration. These changes were associated with altered gene expression: the downregulation of cox2, cyp1a1, and cyp2c29 in the kidneys and the upregulation of cyp4a12, cox2, and adrb1, along with the downregulation of cyp2c29 and ace2 in the heart. Conclusions: Etoricoxib induces nephro- and cardiotoxicity, marked by alterations in arachidonic acid metabolism and beta-adrenergic signaling pathways. The drug affects the expression of arachidonic acid-metabolizing enzymes and adrb1 in the heart while downregulating cox2 and other related enzymes in the kidneys. These findings underscore the need for caution when prescribing etoricoxib, particularly in patients with pre-existing renal or cardiac conditions.

Isotretinoin-associated chronic diarrhea as a complication of systemic isotretinoin therapy

Objective: Isotretinoin is a synthetic derivative of vitamin A that is highly effective in treating acne vulgaris. Although its common side effects include skin dryness, photosensitivity, epistaxis, and depressive disorders, gastrointestinal side effects should also be considered, though they are less frequently highlighted. Case: We aim to present a 28-year-old female patient who developed chronic diarrhea and associated hypokalemic paralysis during isotretinoin treatment, prescribed for acne management. This case underlines the importance of recognizing gastrointestinal side effects, alongside the more commonly known adverse effects of isotretinoin. Conclusion: Chronic diarrhea is a rare but significant side effect of isotretinoin that may lead to serious complications such as hypokalemic paralysis. In this case, we demonstrated how isotretinoin can cause metabolic imbalances, even in relatively healthy young adults, by inducing diarrhea. While the association between isotretinoin and inflammatory bowel disease remains inconclusive, clinicians should remain vigilant regarding the gastrointestinal side effects of isotretinoin. Early recognition and discontinuation of the drug, combined with appropriate supportive treatments, are essential in preventing further complications. Dermatologists and gastroenterologists should collaborate in identifying patients at higher risk, such as those with pre-existing gastrointestinal conditions, and closely monitor for any adverse effects during isotretinoin treatment. Future studies, particularly large-scale randomized controlled trials, are needed to better understand the relationship between isotretinoin and gastrointestinal side effects.

Traditional and Emerging Strategies for Managing Polymyalgia Rheumatica: Insights into New Treatments.

Background/Objectives: Polymyalgia Rheumatica (PMR) is an inflammatory condition that primarily affects individuals aged 50 and older, especially in Western countries. Although glucocorticoids are the cornerstone of PMR treatment, these drugs are associated with side effects, making it advisable to use them for the shortest duration possible. However, tapering or discontinuation of glucocorticoids often leads to disease relapses. In this review, we focus on the traditional management of PMR, as well as the potential for therapies that may reduce glucocorticoid use. Special attention is given to the efficacy of biologic agents in PMR management. Methods: A literature review, primarily based on articles published in PubMed, was conducted. In addition to discussing various glucocorticoids and conventional disease-modifying drugs used for the management of isolated PMR, this review specifically focused on the information reported regarding new therapies, with particular emphasis on biologic agents. Results: Prednisone or prednisolone at a dose ranging between 12.5 and 25 mg/day is the agreed-upon treatment for PMR. Due to the side effects associated with prolonged glucocorticoid use and the high frequency of relapses when glucocorticoids are tapered, glucocorticoid-sparing agents have emerged as tools in the management of PMR. Methotrexate has traditionally been the conventional disease-modifying antirheumatic drug (DMARD) unanimously recommended for use in PMR. Other conventional DMARDs, such as leflunomide, have shown promising results but require further study. The use of biologic agents has marked a significant step forward in the management of PMR. While anti-TNF agents failed to provide beneficial effects in isolated PMR, anti-IL-6 receptor agents, such as tocilizumab and sarilumab, have demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease. Other biologic agents, many of which have been used in giant cell arteritis, as well as Janus kinase (JAK) inhibitors, are currently under investigation. Conclusions: Glucocorticoids are the primary treatment for isolated PMR but are associated with comorbidities, especially in patients with pre-existing conditions or frequent relapses. Glucocorticoid-sparing agents, such as methotrexate and biologics, in particular tocilizumab and sarilumab, offer alternatives, improving symptoms and reducing glucocorticoid use. While biologic agents reduce long-term side effects and help achieve disease remission, their use must consider potential side effects and higher costs compared to traditional therapies.

Do Children With Accidental Gunshot-related Fractures Experience Greater Risk of Mental Illness and Psychiatric Disorders? A Propensity-matched Study.

Firearm violence is the leading cause of death and is a major source of morbidity for children in the United States. While gunshot wounds (GSWs) are known to cause lasting psychological repercussions beyond physical injury, these effects are not well documented compared with the physical implications. Our study explores the association between accidental gunshot-related fractures in children and subsequent psychiatric outcomes. Relative to non-GSW-related fractures, do children sustaining an accidental GSW-related fracture experience higher risk of mental illness and psychiatric disorders? This study utilized the TriNetX US Collaborative Network as it provides comprehensive inpatient and outpatient data, longitudinal follow-up, and complete medical records across different facilities, closely reflecting real-world patient outcomes in orthopaedic practice. We retrospectively evaluated children diagnosed with an accidental GSW-related fracture and compared mental health diagnoses to children who experienced non-GSW-related fractures. Between January 1, 2003, and March 1, 2023, a total of 5071 children in the United States without preexisting anxiety, mood, psychotic, substance use, or insomnia disorders were reported to have experienced an accidental GSW-related fracture. Among these patients, 55% (2773) had a follow-up period of at least 1 year and met the inclusion criteria for the exposure cohort. In the non-GSW-related fracture cohort, a total of 61% (985,070) of children among 1,613,891 without the preexisting aforementioned conditions had a minimum follow-up period of 1 year and met the inclusion criteria. A total of 2769 children were successfully matched in each cohort using a greedy nearest neighbor propensity score-matching algorithm. Matching was based on age, gender, race, fracture location, and BMI, as these characteristics were identified through a regression analysis as potentially associated with psychiatric outcomes (p < 0.01). The mean ± SD age was 15 ± 4 years, and 16% (451) in the GSW cohort were girls. In the non-GSW cohort 17% (474) were girls. With respect to race and ethnicity, 62% (1709 in the GSW cohort; 1679 in the non-GSW cohort) were Black and 14% (384 in the GSW cohort; 386 in the non-GSW cohort) were Hispanic. Outcomes of interest were recorded for up to 3 years after the index event. The accidental GSW-related fracture cohort experienced a greater hazard of developing anxiety disorders (HR 3.8 [95% confidence interval (CI) 3.2 to 4.6]; p < 0.001), substance use disorders (HR 3.6 [95% CI 3.0 to 4.2]; p < 0.001), mood disorders (HR 2.4 [95% CI 1.9 to 3.1]; p < 0.001), non-mood psychotic disorders (HR 2.4 [95% CI 1.5 to 3.9]; p < 0.001), and insomnia (HR 1.8 [95% CI 1.4 to 2.3]; p < 0.001). Orthopaedic surgeons should implement early psychiatric screenings and integrate mental health support for children with gunshot-related fractures to address elevated risk of anxiety disorders, psychotic disorders, mood disorders, substance abuse, and insomnia. Future studies should focus on identifying effective interventions that mitigate these long-term psychological outcomes, with an emphasis on practical, targeted approaches in clinical care. Level III, prognostic study.

Risk of long COVID in migrants and the contribution of vaccinations, disease severity, social inequalities and preexisting health: A nationwide register study in Sweden

Abstract Background and aim A number of studies have found higher COVID-19 infection rates, hospitalizations and deaths in migrants and ethnic minorities throughout the Corona Pandemic. Some recent evidence also suggests higher risk of long COVID in migrants although less is known about the risk factors for long COVID in this population. The objective of our study is to examine the risk of long COVID in migrants and to examine whether preexisting health conditions, disease severity, social inequalities and vaccinations contribute to the association. Methods We used linked Swedish administrative registers to estimate the risk of a long COVID diagnosis in the population that had a confirmed COVID-19 infection. Poisson regressions were used to calculate incidence rate ratios between the Swedish born and migrant groups. Adjustments for preexisting health conditions, disease severity, vaccinations and social inequalities were separately introduced. Results Higher risks of long COVID were found among migrants from Africa, Asia, Eastern Europe, Finland, Middle-East and South America. While the contribution of vaccinations and social inequalities were modest, we found that disease severity (i.e. whether the person was hospitalized or treated in an intensive care unit) primarily contributed to the higher risk of long COVID found in migrants. Conclusions The greater exposure and impact of the COVID-19 virus among migrants during the pandemic also affected the longer-term consequences of infection in this at-risk population.

Diagnostic pathways and outcomes by comorbidity in cancer patients: a study in Northern Italy

Abstract Background Pre-existing chronic conditions can influence cancer diagnosis and outcomes. The study aimed to examine variations in diagnostic pathways and outcomes in colorectal cancer (CRC) patients by comorbidity status and socio-demographic characteristics in the provinces of Milan and Lodi, Northern Italy. Methods A population-based cohort study using linked administrative health data from the Agency for Health Protection (ATS) of Milan was conducted on individuals aged ≥18 years diagnosed with CRC in 2014-2017. We examined pathways to cancer diagnosis, stage at diagnosis and short-term mortality by specific comorbidities and sociodemographic factors. Results Among the 5,272 colon cancer and 2,120 rectal cancer patients, 43.9% and 61.5%, respectively, had at least one pre-existing comorbidity, most frequently hypertension (52.7% and 49.9%) and cardiovascular disease (CVD, 23.2% and 18.5%). Cancer diagnostic pathways included screening (4.1% colon and 4.4% rectal cancer patients), EP (22.8% and 12.6%) and inpatient/outpatient admission (73.1% and 82.9%). At multivariable logistic regression, patients with pre-existing cerebrovascular or neurological diseases had significantly higher odds of EP for CRC. In the multinomial logistic regression analysis, the odds of EP were significantly higher for patients aged &amp;lt;50 or ≥ 80 (vs 60-69), belonging to the highest deprivation group and being widowed (vs married). The odds of screen-detected CRC were lower for patients with multimorbidity (2 vs 0 comorbidities: adjusted OR = 0.32, 95% CI 0.14-0.75). 30-day and one-year mortality were higher in colon cancer patients with EP vs inpatient/outpatient (aOR=2.46, 95%CI 1.95-3.09; aOR=2.02, 95%CI 1.74-2.35 respectively). As the number of chronic conditions increased, mortality increased especially at one year. One-year mortality was also higher for rectal cancer patients with 3+ comorbidities (vs no comorbidities). Key messages • Patients with pre-existing chronic conditions had a lower likelihood of screening, higher odds of emergency CRC diagnosis and higher mortality. EPs occur in one in five CRC patients. • Tailored interventions might be needed to facilitate CRC screening, reducing emergency diagnoses and improving health outcomes for the large number of patients with chronic conditions.

Developing an infodemic management toolkit for immunization: An iterative consultation process

Abstract Issue An infodemic is an overwhelming amount of information, accurate and otherwise, that accompanies health emergencies such as outbreaks and other health crises. Infodemic management work is done by people from different positions and professions, with differing resources at their disposal, and applied to a range of health issues. An infodemic insights report can help identify questions, concerns, information voids and circulating mis- disinformation to help inform an emergency response. Health issue specific guidance can be useful for those who may have infodemic management as part of their regular work but want to identify infodemic insights and contextualize these insights in relation to other programme data. Description The WHO and UNICEF ‘how to build an infodemic insights report in 6 steps’ document provides general guidance. A more immunization specific document, with practical and specific tools in standalone short focus areas was developed to guide infodemic managers or those working on vaccine demand and acceptance, and by vaccination field workers. The toolkit is intended for vaccines across the life course, including for children, adolescents, pregnant people, adults, and people with pre-existing conditions or have other vulnerabilities. Results Rounds of iteration with experts both internal and external to WHO provided useful feedback, review and suggestions. The toolkit provides information targeted at different resource and capacity levels. Lessons The consultative process resulted in a toolkit informed by experts and those who are likely end-users of the document. The consultations sought to align the toolkit with immunization programme processes and with other tools and interventions for improving vaccine uptake. Having health issue specific guidance is a useful addition to the infodemic manager toolbox and tools such as these can be an important component of community resilience and health security initiatives. Key messages • For immunization, infodemic management can support programme activities to build vaccine confidence and improve uptake, and manage vaccine-related events. • Expert informed guidance on health topic specific areas can be a useful addition to the infodemic manager toolbox.

Finding cool spaces in Frankfurt/Main–a heat protection measure for the population of a major city

Abstract With the European continent heating up faster than ever, cities are facing major challenges protecting their population from the effects of climate change. Heat can have devastating effects on people’s physical and mental health with particular significance for the known vulnerable groups - the elderly and young children, people with pre-existing conditions, those who are pregnant and those who cannot protect themselves sufficiently for various reasons plus of course people working outdoors. Following the 2003 heat wave, the city of Frankfurt/Main registered a significant rise in mortality and morbidity, leading the Health Protection Authority to be increasingly concerned with heat-related health problems in the Frankfurt metropolitan area. The city has since developed various systems to protect the population from extreme heat and developed an all-encompassing climate change action plan (CCAP). Part of the CCAP is the provision of cool spaces to provide refuge from the heat for the public and implementation of this project started in the summer of 2022. However, with no legislative basis on which to build such a platform, some creative measures were required to ensure its success. Here, we will not only present the challenges we faced but the solutions we found - and the results of our currently ongoing evaluation of the actual use of our cool spaces to help other cities make their journey to similar measures easier. Starting with a brief overview of the CCAP, we will show the cool spaces’ place within the strategy, followed by our original plan of action and what happened when this plan came into contact with the reality of life in a large and diverse city. We will touch on climate injustice and the difficulties in reaching those parts of the population who actually need protection the most. Finally, we present our evaluation strategy and results together with the adjustments we are considering in moving forward with this climate change protection measure. Key messages • (Establishment of) climate change adaptation measures should urgently be enshrined in law. • Health inequality corresponds to climate inequality and continiously challenges adaptation measures.

Clinical usefulness of the serum levels of neuroinflammatory and lung fibrosis biomarkers in the assessment of cognitive dysfunction in post-COVID19 patients

A growing body of evidence indicates there is an increasing incidence of cognitive dysfunction in patients after coronavirus disease 2019 (COVID-19) infection. However, still lack diagnostic tools, which allow us to predict prognosis in such cases and improve the stratification of the disease. This study aims to evaluate the usefulness of the biomarkers that could allow to predict the severity and progression of COVID-19 in patients with post-COVID syndrome and cognitive problems. Data regarding clinical history, pre-existing conditions, chest CT scan, and therapy (remdesivir, steroids) were acquired. A total of 44 patients with hospitalized COVID-19, and healthy controls were enrolled in the investigation, and serum blood was obtained. After 6 months of observations, patients with COVID-19 were divided into two groups: first - without post-COVID syndrome and memory complaints, and second - with post-COVID and cognitive problems. Measurements of YKL-40 and MR-pro-ADM were taken in the serum with enzyme immunoassay kits at the time of admission (visit 1) and 6 months after discharge from the hospital (visit 2). Significantly higher concentrations of YKL-40 were found in patients with COVID-19 as compared to healthy individuals (p = 0.016). Moreover, YKL-40 ratio allowed to differentiate patients with and without post-COVID syndrome (median: 0.94 vs. 1.55, p = 0.004). Additionally, COVID-19 patients with dyspnea presented significantly elevated levels of MR-pro-ADM as compared to the group of COVID-19 survivors without dyspnea (p = 0.015). In the group of patients without post-COVID syndrome, the concentrations of YKL-40 and MR-pro-ADM decreased after treatment as compared to levels before therapy (77 vs. 36 ng/ml and 607 vs. 456 pmol/L). However, in patients with post-COVID syndrome and cognitive problems, the levels of both markers did not alter 6 months after hospital discharge in comparison to basal levels. Furthermore, after dexamethasone treatment the YKL-40 concentrations declined significantly (p = 0.003) in patients with COVID-19. This study demonstrated the predictive usefulness of YKL-40 as an indicator of successful treatment in patients with COVID-19 infection allowing risk stratification of hospitalized patients. It seems that indicators of neuroinflammation might have the potential to track development of cognitive complaints, however, it requires further investigations.

Unlocking equity: assessing for gaps in cardiovascular guidelines for pregnant women

Abstract Introduction Cardiovascular disease is the primary contributor to pregnancy-related fatalities in the United States, displaying a gradual rise over the years. Pregnancy introduces unique physiological changes that can impact pre-existing cardiovascular conditions and trigger new complications. Considerable inequalities in pregnancy-related mortality built on race and ethnicity are unmistakable, with the highest rates observed in black non-Hispanic women. Purpose This study aims to evaluate current gaps in racial/ethnic minority participation in randomized control trials (RCTs) cited in major cardiology guidelines. Methods Citations in the 2018 ESC Guidelines for the Management of Cardiovascular Diseases During Pregnancy were evaluated for RCTs. The American Heart Association and American College of Cardiology guidelines were also examined. Manuscripts and supplementary data were examined for participant-level racial or ethnic data, including age, race, and ethnicity. Results Thirteen RCTs, representing 20,665 participants, spanning the period from 2002 to 2017, were reviewed. European guidelines referenced thirteen of the RCTS, while American guidelines referenced two RCTs. The average age of participants was 31 years old. Most of the trials were conducted in Europe (46%). Forty-six percent of RCTs reported race/ethnicity breakdowns, with pooled participation showing a majority of non-Hispanic white participants (76.7%), with limited representation from other racial groups (table). Eight trials focused on hypertension, two on venous thromboembolism, and one on heart failure. Conclusion Pregnant women are frequently excluded from RCTs due to concerns about potential harm to the developing fetus. Consequently, current guidelines lack robust RCTs tailored to pregnant women with various cardiovascular diseases. The underrepresentation of ethnic minorities in cardiovascular disease trials contributes to a scarcity of evidence-based recommendations for managing these conditions during pregnancy and postpartum. Future clinical practice guidelines should advocate for a more personalized and evidence-based approach to managing cardiovascular diseases in pregnancy.

Personality and cardiovascular mortality risk: a multi-cohort analysis in individuals with and without pre-existing cardiovascular disease

AbstractThis study investigated the associations between personality traits of the Five Factor Model and cardiovascular mortality, with a specific focus on whether pre-existing cardiovascular conditions modified these associations. We used data from 43,027 participants across five cohort studies: Health and Retirement Study (HRS); Wisconsin Longitudinal Study (WLS); National Social Life, Health, and Aging Project (NSHAP); Midlife in the United States (MIDUS); Household, Income, and Labour Dynamics in Australia (HILDA) with a mean age 55.9 years and 6493 individuals with pre-existing cardiovascular disease. We conducted meta-analyses examining conscientiousness, emotional stability, agreeableness, openness to experience, and extraversion in relation to mortality due to coronary heart disease and stroke. During a mean follow-up of 12.1 years, 1620 participants died from coronary heart disease and 454 from stroke. Lower conscientiousness was associated with higher mortality risk from both coronary heart disease (hazard ratio per 1SD = 0.82, 95%CI = 0.75–0.90) and stroke (HR = 0.84, CI = 0.72–0.99). Lower emotional stability predicted increased coronary heart disease mortality (HR = 0.91, CI = 0.85–0.97). The association between conscientiousness and cardiovascular mortality did not differ between individuals with or without baseline cardiovascular conditions. In addition, adjustments for health behaviors and other covariates only slightly attenuated this association. Other personality traits were not associated with cardiovascular disease mortality. Our findings highlight the role of low conscientiousness, and to a lesser extent low emotional stability, in the development and progression of fatal cardiovascular disease through pathways that may extend beyond established health behaviors.

5.D. Scientific session: Climate Change and Inequalities: Addressing Intersections and Impacts

Abstract Climate change poses one of the greatest challenges of our time, with far-reaching implications for environmental sustainability, social equity, and economic development. In recent years, growing attention has been paid to the intersecting dynamics between climate change and inequalities, recognizing that vulnerable populations are disproportionately affected by climate-related risks and impacts. This workshop aims to explore the multifaceted relationship between climate change and inequalities and examine the root causes of disparities. In this workshop we will explore intersectionality by examining how climate change intersects with various forms of inequality, including socio-economic and health status, gender, age, indigenous status, and geography, shaping differential vulnerabilities and experiences of climate impacts. This workshop aims to facilitate dialogue, knowledge exchange, and collaboration among public health researchers and professionals. We offer a unique opportunity to deepen our understanding of the complex interplay between climate change and inequalities, shedding light on overlooked aspects [?]. By bringing together diverse perspectives and expertise, the workshop aims to generate actionable insights and solutions that promote social justice, sustainability, and human rights in the face of climate change. The presentations in this workshop are thematically interconnected, addressing key aspects of climate change and inequalities from multiple angles. Topics include: Gender and climate justice, Climate change adaptation equity, Legal perspectives on climate change and inequalities and Climate Change Impacts on Respiratory Health. In conclusion, this workshop serves as a critical platform for advancing understanding, dialogue, and action on the intersection of climate change and inequalities. Key messages • Climate change interacts with socio-economic, health, gender, age, indigenous status, and geography, influencing vulnerabilities and impacts. • Vulnerable populations bear a disproportionate burden of climate change effects, including individuals with pre-existing lung conditions and children.

Difference in long COVID prevalence due to different definitions and long COVID related risk factors

Abstract Several definitions of long COVID are used in research and practice what challenges epidemiological investigations. Here we present differences in long COVID prevalence accounting for several definitions and concordance between the definitions, as well as the risk factors associated with long COVID. Definitions considered were WHO post-COVID19 condition (PCC) definition with several thresholds (at least low - standard definition, moderate or strong impact on daily activities), NICE1 and NICE2 definitions (reported at least one or at least two symptoms), United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions and perceived long COVID. Prevalence of long COVID among French adult population (N = 10 615) in autumn 2022 ranged from 1.2% to 13.4%, conditional of the definition. The concordance between the definitions was at best moderate. Next, on a smaller representative sample of a French adult population (N = 1 813) eight potential risk factors groups for long COVID were assessed in a systematic epidemiological investigation, following a conceptual model. Fifteen factors from seven groups were associated with long COVID including early-defined sociodemographic characteristics, pre-existing chronic conditions, short-term work-related factors, current socioeconomic position, health behaviours, infection-related factors, and perception of COVID-19 severity and long COVID. The likelihood of long COVID was higher for individuals with higher number of diseases and for nineteen out of twenty-six most prevalent dyads and a triad. A more standardized definition would facilitate research and surveillance of long COVID. Furthermore, long COVID should be observed as an interplay of social, medical and contextual factors rather than a mere complication of SARS-COV-2 infection, while patients with multimorbidity may present some of the particularly vulnerable population groups.

Climate Change Impacts on Respiratory Health: Bridging Inequalities in Children and Adults

Abstract Respiratory diseases rank as the third leading global cause of mortality, with climate change exacerbating their prevalence and severity. Wild fires, floods, extreme heat events, infectious diseases, urban air pollution and aeroallergen exposure contribute to respiratory health deterioration. Vulnerable populations, including individuals with pre-existing lung conditions and children, bear a disproportionate burden of these effects. We centrepiece the connection of climate change to respiratory health inequalities, while bridging the evidence gap regarding increasing extreme heat and cold events, ambient and indoor air pollution exposure with significant ramifications on respiratory health. Specifically, we will showcase research on the tailored, multidisciplinary NCD prevention package named FRESHAIR4Life, targeting air pollution exposure in mid- to late adolescents from disadvantaged populations. Given the high burden of non-communicable diseases (NCDs) and air pollution exposure as major contributors, urgent preventive interventions are required, particularly in disadvantaged populations. Initiating preventive interventions during adolescence is considered an optimal window of opportunity for long-term health benefits. Furthermore, we will present a robust evidence base delineating climate change’s impact on lung health among vulnerable European populations. We will discuss how narratives on climate-induced lung health issues are co-created with affected communities and stakeholders to facilitate policy translation. The aim of these presentations is to break silos among health professionals, fostering collaboration from the respiratory community to the public health community. Through lung health collaborations we seek to deepen understanding and catalyze action to address the intersection of climate change, respiratory health, and inequalities, ultimately working towards a healthier and more equitable health for all.

Legal perspectives on climate change and inequalities

Abstract In many areas of public health policy, litigation has delivered significant, long-lasting impacts. Examples include tobacco control, increasing access to treatments for HIV, and addressing air pollution and climate change. Litigation is an established part of public health’s advocacy toolbox in national courts, and increasingly in international courts and tribunals. In responding to climate change, in addition to potential policy and law reform, climate change litigation creates opportunities for public scrutiny and debate by raising awareness of inaction or harm caused by governments or private sector polluters, and sparking wider community mobilisation for climate action. Where climate change litigation is based on human rights claims, credible science-based evidence of the health and other human rights impacts of climate change is essential. Public health professionals are increasingly involved in assembling and presenting such evidence, often focusing on vulnerable populations. However, the multiple intersecting identities of vulnerable populations have not been sufficiently explored. For example, how does intersectional disadvantage influence the ways in which evidence of the impact of climate change is assembled and assessed? How are these issues addressed in the courts? Examples include older women (KlimaSeniorinnen v. Switzerland), young people, from both the global South and global North, in urban or remote areas, or with different pre-existing health conditions (Sacchi et al. v. Argentina et al), and Indigenous people, including women and children (Daniel Billy and others v. Australia; Teitiota and others v. New Zealand). Multiple identities can compound vulnerability. For example, young people may be more vulnerable both due to their physical immaturity and due to eco-anxiety and other mental health impacts. This presentation will explore these issues, and the critical role of public health professionals in legal action to address climate change.

Determinants of Acute Watery Diarrhea in Children Under Five Years: A Comprehensive Analysis

Background: Acute watery diarrhea (AWD), which has a sudden onset and is associated with a risk of severe dehydration, is primarily spread through unsafe water, poor sanitation, and inadequate hygiene. Socioeconomic factors, like low parental education and poverty, further increase risks. WHO-recommended interventions, including oral rehydration therapy, zinc supplementation, and rotavirus vaccinations, have reduced diarrhea-related deaths globally. Aim of the study: This study aims to explore the socio-demographic, environmental, and behavioral factors associated with childhood watery diarrhea, particularly in high-risk regions. Methods: This prospective observational study was conducted at the Department of Pediatric, 250 Bedded General Hospital, Khulna, Bangladesh, with 210 children aged 0–60 months presenting acute watery diarrhea, enrolled over one year July 2023 to June 2024. Eligible children met specific inclusion criteria, while exclusion was applied to cases of chronic diarrhea or unrelated pre-existing conditions. Data confidentiality was maintained, with ethical approval granted. The analysis involved descriptive statistics in SPSS (version 26) for comprehensive result interpretation. Result: The study included 210 children under five, with a mean age of 14.51±5.34 months; most were aged 7-12 months (38.10%), and 54.29% were male. Caregivers were predominantly aged 28.39±4.11 years, with 73.81% having completed primary education. Key findings included high MMR vaccination rates (62.38%), significant exclusive breastfeeding for six months (58.57%), and recent diarrhea reports among 20.95% of caregivers. In terms of WASH practices, 60.48% used piped water, 57.62% stored drinking water separately, and 95.71% had toilet facilities. Notably, 67.14% used water only for handwashing, and 45.24% washed hands with soap post-toilet use. Conclusion: Safe water, sanitation, and handwashing practices are essential to reducing acute watery diarrhea in children under five. Children in households with untreated water and inconsistent caregiver handwashing face higher risks. Targeted public health initiatives to improve water treatment and hygiene could greatly reduce diarrhea incidence and improve child health outcomes.

Impact of Noncommunicable Diseases on Years of Life Lost in FB&amp;H During the COVID-19 Pandemic

Abstract This study aims to comprehensively investigate the impact of noncommunicable diseases (NCDs) on years of life lost (YLL) within the Federation of Bosnia and Herzegovina (FB&amp;H) across distinct phases: pre-pandemic, pandemic, and post-pandemic periods. Given that NCDs currently represent more than half of the global disease burden, our focus lies in assessing YLL specifically for cerebral infarction (I63-I64) and diabetes mellitus (E10-E14). Conducting a retrospective data analysis, we utilized mortality data sourced from the Institute for Statistics of FB&amp;H to quantify YLL. This assessment involved multiplying age-specific mortality figures by the remaining life expectancy at the corresponding age, utilizing the GBD 2019 life expectancy table. Examining the period between 2019 and 2022, our analysis aimed to elucidate the pandemic’s potential influence on NCD burden, through the examination of age-standardized YLL rates based on the world standard population. In 2019, YLL attributable to I63-I64 for both sexes totaled 41,244 in 2019, escalating to 44,790 in 2020, and subsequently decreasing to 39,439 and 32,055 in the pandemic years of 2021 and 2022, respectively. For diabetes mellitus (E10-E14), YLL in 2019 amounted to 23,675, with figures for 2020, 2021, and 2022 standing retrospectively at 24,329, 24,114, 19,125. The increase in 2020 may be attributed, in part, to initial healthcare hesitancy during the pandemic’s onset, leading to delayed treatment and heightened mortality rates. Furthermore, patients who died in 2020 from C-19 without being tested may have skewed mortality registration by inflating rates attributed to pre-existing conditions. The declining rates thereafter could be due to a harvesting pandemic effect, in that people who were previously ill died prematurely from C-19. These insights show the pandemic’s profound impact on NCD-related mortality, underscoring the urgent need for targeted interventions and healthcare strategies. Key messages • A substantial reduction in years of life lost (YLL) related to certain noncommunicable diseases was observed during the pandemic. • The pandemic significantly influenced mortality among individuals with noncommunicable diseases, driven partly by healthcare hesitancy and potential misregistration of causes of death.

Thyroid Function in the Time of COVID-19: A Systematic Review of Disease Progression and Vaccination Effect

Objectives: This systematic review sought to address three key questions: (1) what differences in abnormal thyroid function test results are observed between COVID-19 patients and healthy individuals? (2) How does the severity of COVID-19 infection influence the development of thyroid dysfunction? (3) What impact do COVID-19 vaccines have on thyroid function and autoimmune processes? Methods: A literature search was conducted in PubMed, Web of Science, and Scopus from December 2019 to April 2023 to identify studies on thyroid dysfunction in COVID-19 patients without pre-existing thyroid conditions. The search focused on observational and case-control studies. Results: The literature search yielded 329 reports, from which duplicates and unrelated publications were excluded. Ultimately, 21 studies met the inclusion criteria and were selected for review. A second literature search yielded 605 reports, from which 5 studies were selected for inclusion in the systematic review. Conclusions: The findings suggest that SARS-CoV-2 infection can induce transient and reversible thyroid dysfunction, possibly through direct viral effects on the thyroid gland or via indirect immune-mediated mechanisms. Clinicians should be mindful of the potential, albeit rare, thyroid-related adverse effects of COVID-19 vaccines and monitor thyroid function, particularly in high-risk individuals.

AUMENTO DO USO DE ANSIOLÍTICOS APÓS A PANDEMIA – REVISÃO DA LITERATURA

Introduction: Anxiety disorders are significant areas of research due to the high incidence of anxiety being diagnosed in the population, leading to temporary or permanent disability. Investigations conducted on the mental health of Brazilian residents during the COVID-19 outbreak indicate an increase in diagnoses of anxiety, depression, and stress. The deterioration of mental well-being was influenced by multiple factors, including the absence of proper funeral ceremonies, the escalation of unemployment, and the decline in financial capacity, which heightened tension and anguish among those needing a source of income to support their families. This scenario significantly contributed to the increase in the use of anxiolytics, as many individuals resorted to these medications as a form of immediate relief for the symptoms of anxiety and stress exacerbated by the pandemic, highlighting the need for a broader and more integrated approach to mental health treatment in the current context. Objectives: To analyze the increase in the use of anxiolytics after the COVID-19 pandemic and its implications for public health. Methodology: This study is structured as a literature review, aiming to compile and analyze existing information on the topic. Additionally, the research is exploratory and descriptive, with the objective of mapping existing knowledge on the subject and outlining its nuances. The platforms Scielo, Portal de Periódicos CAPES, and Medline were used. The period considered was from 2018 to 2023, with texts fully available online, in Portuguese. Results: The results indicate a significant increase in the use of anxiolytics during and after the COVID-19 pandemic, especially among more vulnerable groups, such as the elderly and people with pre-existing health conditions. The use of medications like Alprazolam increased by 35% in 2020, reflecting the intensification of anxiety in the population. Conclusion: The pandemic exposed the fragility of mental health systems, highlighting the need for public policies that combine pharmacological treatment with continuous support. Future research is essential to monitor the long-term effects of anxiolytic use in the post-pandemic period.

'I am more stressed if my infection affects others': development of a COVID-19-related stress scale in older people and examination of its validity and associations with mental health risks.

COVID-19 was a collective traumatic event; however, different individuals may have perceived it differently. This study investigated what older people in a collective culture perceived as stressful during COVID-19 and examined how different stressors related to COVID-19 infection and mental health risks. Thirty-six participants from diverse backgrounds engaged in a three-round Delphi study to generate items for a COVID-19-related stress scale for older adults (CSS-OA). Subsequently, 4674 people (aged ≥60 years) participated in a cross-sectional telephone survey; interviewers collected their responses to CSS-OA and information about COVID-19 infection, depressive symptoms, anxiety, loneliness and demographics. Exploratory factor analysis and confirmatory factor analysis were conducted on CSS-OA. A multiple indicator multiple cause (MIMIC) model was used to examine associations between CSS-OA and other measures. The Delphi process generated eight items, all secondary or tertiary stressors related to infection. Exploratory factor analysis revealed a three-factor model, and confirmatory factor analysis confirmed an excellent fit (comparative fit index = 0.99, root mean square error of approximation = 0.06). Pre-existing mental health conditions, having family members/friends infected with COVID-19, loneliness, anxiety and depressive symptoms were associated with higher stress. Conversely, self-infection with COVID-19, older age, being female and living alone were negatively associated with some domains of CSS-OA (all P < 0.05). The Delphi process enhanced our understanding of what older people perceived as stressful, much of which resulted from certain healthcare strategies and reflected cultural influences. These and the MIMIC results highlight the need to balance public health policies with respect to infectious diseases and older people's mental health and quality of life.