Public Health Challenge Research Articles

2.I. Scientific session: Addressing vaccine hesitancy: from understanding determinants to implementing targeted strategies

Abstract Supported by NextGenerationEU (no. PE00000007) and EU4Health (VAXaction), the workshop will present a pan-European perspective on vaccine hesitancy and the effectiveness of counteracting interventions, especially when facing potentially pandemic infectious threats. Analysing human responses to epidemics is crucial to improve mathematical disease modelling and develop strategies to monitor behaviours during outbreaks, including assessing levels of vaccine hesitancy. This session will explore the multifaceted issue of vaccine hesitancy, which remains a significant barrier to achieving optimal vaccination coverage and is identified as one of the top threats to global health. By integrating theoretical frameworks with practical applications, the workshop aims to present a comprehensive overview of strategies employed to mitigate hesitancy across various demographics and regions. The first presentation will cover a thorough overview of the strategies employed to counteract vaccine hesitancy, leveraging existing infrastructure, health promotion policies, and educational initiatives. It will also explore the role of digital health tools and regulatory measures, such as health passes and nudging techniques, in enhancing vaccination uptake. Furthermore, the session will cover a systematic review of immunisation information systems (IISs) and the proposal of an innovative unvaccinated registry. This part of the workshop will delve into technological advancements and the integration of behavioural insights, which are essential for enhancing vaccine coverage and informing public health strategies. Another significant aspect of the discussion will be the evolution of vaccine mandates, from their historical roots to their contemporary applications. This discussion will reflect on policy shifts necessitated by emerging public health challenges and the need for adaptable strategies that can respond effectively to fluctuating vaccine coverage and acceptance rates. Panel discussions will feature notable experts such as Prof. Carlo Signorelli, President of the Italian NITAG, and Prof. Maria Ganczak, Vice President of the EUPHA Infectious Diseases Control section. These discussions will provide a comparative analysis of vaccination policies across different European countries, highlighting diverse approaches to mandates and the implementation of public health interventions aimed at combating vaccine hesitancy. By providing a unified approach to understanding and combating vaccine hesitancy, we aim to facilitate a critical exchange of ideas and strategies among experts in the field. It will serve as a dynamic platform for discussing evidence-based interventions tailored to specific population needs, enhancing public health outcomes across Europe. This engaging session promises to offer valuable insights into the complexities of vaccine hesitancy and the collaborative efforts required to address this global health challenge effectively. Key messages • Enhanced data collection and analysis are essential to combat vaccine hesitancy, allowing for tailored interventions that address specific community needs and barriers to vaccination. • Effective strategies against vaccine hesitancy require historical understanding and flexibility to adapt to new challenges, ensuring public health policies are responsive and culturally sensitive.

Implementing dynamic atrioventricular delay optimization for cardiac resynchronization therapy: an economic analysis in the EU5 countries

Abstract Background Heart failure (HF) poses an escalating public health challenge, contributing significantly to patient morbidity, mortality and healthcare expenditures [1,2]. Cardiac resynchronization therapy (CRT) is a well-established intervention that improves functional capacity and enhances quality of life while mitigating symptoms, hospitalizations, and mortality in HF patients [3]. Nevertheless, the reaction to CRT varies among individuals; some experience positive responses and others show resistance to the therapy, with unfavourable outcomes and increased healthcare costs [4]. The introduction of the dynamic atrioventricular (AV) optimization algorithm aims to enhance CRT response by enabling dynamic optimization of the AV delay [4]. Purpose Despite the strong clinical evidence supporting the effectiveness of dynamic AV optimization algorithm, a comprehensive assessment of its economic implications is still lacking. This study aims to evaluate the economic impact of activating dynamic AV optimization algorithm in patients undergoing CRT treatment across the Big 5 European countries (EU5; France, Germany, Spain, Italy, and the UK). Methods The study examines two scenarios over a 3-year timeframe: a) current scenario, where dynamic AV optimization algorithm activation is limited to a small segment of the population, and b) future scenario, where dynamic AV optimization algorithm activation is progressively expanded per year from 15% to 50%. Treatment efficacy data, measured in terms of HF hospitalization and mortality rates, were sourced from Varma et al. studies [1,4]. Hospitalization and mortality costs were extracted from national DRG tariffs and relevant literature [5–14]. It is important to note that there is no additional cost for algorithm activation if the device is already equipped with it. Results In this hypothetical analysis of 1,000 patients, around 30% undergo CRT implantation compatible with dynamic AV optimization algorithm activation. The treatment cost of patients with the algorithm ON is reduced by -15% compared to patients with the algorithm OFF, considering a weighted average across the EU5 countries (France: -11%, Germany: -16%, Italy: -14%, Spain -17%, UK: -16%), as shown in Table 1. The steady increase in algorithm activation led to an annual expenditure reduction equal to €21,109, calculated on the weighted average across the EU5 countries (France: €15,549, Germany: €33,753, Italy: €13,844, Spain: €20,385, UK: £13,423). When compared to the current scenario, the future scenario saved €36,468 on average across the EU5 countries. Further country-specific cost savings are shown in Table 2. Conclusion The conducted economic analysis gives confidence in dynamic AV optimization algorithm, positioning it as a valuable and economically sustainable asset for enhancing CRT treatment outcomes in patients with HF.

Patterns of alcohol use in Belgium, 2013-2020

Abstract Despite numerous efforts worldwide to reduce the harmful effects of alcohol, its impact on health remains significant, contributing significantly to the loss of healthy life years. In Belgium, alcohol use is still a major public health concern, ranking among the highest in alcohol consumption across Europe. This study aims to use available nationally representative data to estimate and evaluate the time trends of alcohol use patterns in Belgium from 2013 to 2018. We used repeated cross-sectional survey data from the Belgian Health Interview Survey (BHIS), which includes self-reported alcohol use and sociodemographic data, to create a time series of annual consumption from 2013 to 2018. This included current and former drinkers, and lifetime abstainers by year, sex, region, and age groups. We applied a Bayesian hierarchical model, using the Integrated Nested Laplace Approximation to create the time series and forecast trends for 2020. In Belgium, the prevalence of current drinking remained at a similar level of 80% from 2013 to 2020, with similar rates observed in the Flemish (FL) and Walloon (WA) regions. However, the Brussels-Capital region (BR) had a slightly lower prevalence of 70%. Trends remained relatively stable across all regions during this period. The national level of former drinkers increased from 5% in 2013 to 8% in 2020, with BR and FL showing similar increases, while WA experienced a decline. Abstainer rates rose from 15% in 2013 to 19% in 2020 nationally, with varying increases in each region. Specifically, abstainer rates in FL increased from 13% to 17% and in WA from 14% to 20%, while BR saw an increase from 19% to 22%. Overall, declining trends were evident, with men exhibiting higher prevalence rates across all categories. Time trends from the BHIS reveal consistent and high use of alcohol in Belgium over 7 years, emphasizing the ongoing public health challenge. Urgent policy interventions are needed to reduce the impact of alcohol on health Key messages • Alcohol use in Belgium is still a pressing public health issue, with high prevalence rates of current drinking in the population. Different patterns of alcohol use can be seen between regions. • Understanding the role of alcohol on population health as an attributable burden can improve health monitoring.

Empowering Professionals For Health to promote Newly Arrived Migrant vaccination uptake

Abstract Issue/Problem The imperative task of making access to vaccinations equitable and guaranteed for Newly Arrived Migrants (NAM) in Europe not only highlights a public health challenge but also offers a chance to tackle barriers within health systems. NAMs frequently encounter hurdles in accessing healthcare services, with vaccinations often ranking lower on their list of health priorities. The AcToVax4NAM project developed and implemented tailored interventions for Professionals FOR Health (PFH) working with NAMs in 8 EU countries. Description of the problem NAM often overlook vaccinations due to more immediate concerns, and health systems lack a comprehensive approach to vaccinations. Thus, piloted interventions were developed in consortium countries, working with PFH to tackle vaccination barriers. Over 3 months, each country implemented context-specific interventions to enhance health systems’ responsiveness using culturally appropriate tools. Key objectives included developing procedures, improving PFH cultural sensitivity communication skills, and assessing NAM vaccination intentions. Results Initial findings vary depending on the country’s context but generally show notable enhancements in PFH cultural competencies and increased willingness among NAM to get vaccinated. The pilots underscored the importance of tailoring strategies to specific contexts and fostering collaboration among stakeholders for a successful intervention. Lessons The results highlight the pivotal role of tailored interventions in addressing vaccination disparities among NAM. As PFH working with diverse populations, their role in implementing similar training programs in other settings facing similar challenges is invaluable to achieving equitable vaccination processes. Recommendations encompassing the lessons learned and challenges encountered throughout the pilot implementation will further facilitate the dissemination of this knowledge amongst relevant stakeholders.

Antibiotic use and resistance: knowledge, attitudes and practices in Italian healthcare workers

Abstract Background Antimicrobial resistance (AMR) is one of the most significant public health challenges globally. The misuse or incorrect use of antibiotics has led to the emergence of resistant bacteria, making it increasingly difficult to treat infections. This study aims to identify knowledge, attitudes, and practices among Italian healthcare workers (HWs) - medical doctors (MDs) and nurses - regarding antibiotics, antibiotic use, and antibiotic resistance. Methods Cross-sectional study; a validated questionnaire from the European Centre for Disease Prevention and Control was distributed via web survey starting from April 2024 to a voluntary sample of healthcare workers employed in Italy. Descriptive analysis and multivariable logistic regression were performed to investigate predictors of knowledge regarding antibiotic use and AMR. Ethical approval was obtained from the local ethics committee. Results So far, 154 HWs were enrolled, of which 132 were nurses (85.7%). The average level of knowledge regarding AMR and antibiotic use was 6.8/7 (± 0.2) for MDs and 6.1/7 (± 0.2) for nurses, with an overall score, among HWs of 6.19 (± 0.99), compared to a European average of 6.35. The multivariable analysis highlighted that the medical profession reported higher knowledge regarding prudent antibiotic use and AMR (aOR 6.90; 95% CI 1.83-26.01, p-value = 0.004), while concerning professional practice, the unavailability and difficulty of access to guidelines seemed to increase the risk of reporting inadequate knowledge (aOR 2.04; 95% CI 1.01-4.13, p-value = 0.046). Conclusions Our preliminary results provide an insight into the importance of structuring and actively disseminating procedures/protocols and guidelines to deepen the issues of AMR and prudent antibiotic use. Also, there appears to be a need to enhance the delivery of refresher courses targeting HWs, with particular attention to settings at high infection transmission risk. EU funding: Project no. PE00000007, INF-ACT. Key messages • Although a higher knowledge about prudent antibiotic use and AMR, more efforts are needed to increase access to guidelines. • Constant updating of knowledge and practices is necessary to face the challenges of antibiotic resistance in public health.

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

State of oral health in the Portuguese population and associated psychological and social aspects

Abstract Background Oral diseases are a global public health challenge and remain among the most prevalent non-communicable diseases. This study aims to characterize the self-assessment of oral health state, degree of edentulism, oral rehabilitation and the quality of life, namely chewing capacity, and the associated psychological and social aspects in the Portuguese Population. Methods Data were collected by telefone survey, on the 2nd half of 2018 and 1st half of 2019, using the Portuguese population representative, ECOS panel. Descriptive statistics, as well as prevalence estimates, were obtained with weighting for age, sex, region and sample design, for 95% confidence intervals. The modified F-statistic, a variant of the 2nd order Rao-Scott chi-square adjustment, was used to test the bivariate analyses. Results For 53% of the population, the health status of the mouth was perceived as Good or Very Good, for 37% Fair and, in 11% of cases as Bad or Very Bad. It is estimated that around 76% of the population has good oral hygiene habits, approximately 26% have all of their teeth and 8% the total absence of teeth. It is estimated that only around half (49%) underwent rehabilitation using, in the vast majority of cases (78,5%), removable prostheses. It is estimated that 32% of its users have difficulty chewing hard foods and, of these, around 20% have great difficulty or are unable to chew at all. Psychological discomfort due to oral health was higher in the Portuguese population when compared to the European population (17% vs 7 %), psychological limitations due to the appearance of teeth or dentures were equally higher (7% vs 4%), as were social limitations (8,8% vs 4%). Conclusions The oral health panorama in Portugal remains bleak, so strengthening the application and deepening of the national oral health promotion program should constitute a priority aspect in the development of public policies in the country Key messages • Integrating oral health into general health promotion strategies and assessing oral health needs to include psychological and social aspects in the Portuguese Population. • Strengthening the strategies that have been developed in the context of health promotion, prevention and early treatment of oral diseases in Portugal.

Consumers’ attitudes towards healthy eating: a qualitative comparison between older and younger Chinese consumers

PurposeUnhealthy diets are associated with an increased risk of non-communicable diseases and present a significant public health challenge. When developing effective interventions and policies, consideration must be given to the unique social culture in which food choice is embedded. Health vulnerabilities to poor nutrition exist throughout life but may be influenced by socio-cultural factors such as age. This study aimed to assess the attitudes of older or younger Chinese consumers towards healthy eating and explore the factors influencing their food choices.Design/methodology/approachSemi-structured interviews were conducted in Wuhan, China, with 20 consumers aged 18–25 (Group A) and 20 consumers aged 65 and over (Group B).FindingsThematic analysis revealed that the two groups had positive attitudes towards healthy eating, although Group A participants were more knowledgeable. Time pressure, food prices and social networks differentially influence healthy eating practices across age groups.Originality/valueGiven China’s economic and cultural context, healthy eating interventions should consider the individual characteristics and food preferences of the different age groups. This approach can optimize targeted healthy eating interventions, and media communications related to healthy eating.

A mixed method approach to evaluate a vaccine hesitancy assessment among parents in Dutch language

Abstract Vaccine hesitancy (VH), as a driver for falling vaccine uptake rates, is a significant public health challenge. It is important to monitor this phenomenon and compare results in a unambiguous manner. However, in Dutch and possibly other languages, there is no unequivocal translation for VH. Therefore, we aimed to develop and cross culturally validate a method to assess VH in a simple and self-reported manner, using five differently worded alternatives reflecting ‘doubt’, ‘reluctance’, ‘uncertainty’, ‘concerned’ and ‘indecision’. We designed a mixed method study with a quantitative and qualitative evaluation. In the quantitative evaluation, parents were asked to rate experienced vaccine hesitancy in their decision about vaccinations on a 10-item Likert scale, using the five differently worded alternatives. We analyzed internal consistency with Cronbach’s alpha and correlation with the short parental attitudes about childhood vaccination (PACV-5) scale. A total of 532 parents participated in the survey. We found that the five worded alternatives measured the same construct, indicated by a Cronbach’s alpha of 0.95. The wording resembling ‘doubt’ had the highest correlation with the PACV score (coefficient -0.525, p < 0.001). We subsequently conducted cognitive interviews with 12 parents with lower education levels to evaluate their interpretation of the five wording alternatives and the comprehensibility of the question itself. The wordings resembling ‘doubt’ and ‘uncertainty’ were viewed as most clear and reflecting VH, although some participants had a negative association with ‘uncertainty’. Overall, the question was well understood and minor suggestions were provided to improve comprehensibility. Based on the integrated results of both studies, we conclude that using the word resembling ‘doubt’ in Dutch language is the best instrument to assess VH. We encourage uniform translation of vaccine hesitancy in other languages to enable comparison of results across countries. Key messages • Uniform translation of the term vaccine hesitancy in other language is important to enable comparison of results across countries. • In Dutch language, the word resembling ‘doubt’ is the best instrument to assess vaccine hesitancy.

Designing 1,2,3‐Triazole Derivatives for Targeted Inhibition of Proteolytic and Coagulant Activities in Bothrops Jararaca and Bothrops neuwiedi Snake Venoms

AbstractSnakebites inflict significant injuries on humans and animals, posing a severe global public health challenge due to high mortality and morbidity rates. This study presents results against the venoms of Bothrops jararaca and Bothrops neuwiedi using sixteen synthetic hybrid molecules containing thiophene and triazoles, designated as 6a–h and 7a–h. The compounds were assessed for their ability to inhibit proteolytic and plasma coagulant activities induced by the snake venoms, and their toxicity was analyzed. Most derivatives demonstrated nontoxicity through in silico analysis with the Osiris Property Explorer tool and in vitro cytotoxic hemocompatibility on red blood cells. Notably, only derivative 6e exhibited toxicity to erythrocytes, while 6b, 6d, 7c, and 7f displayed mutagenic, tumorigenic, or adverse effects on the reproductive system. Derivatives 6a, 6c–h, 7c–e, 7g, or 7h effectively inhibited the coagulating activity of B. jararaca venom, while 6a–b, 6d–e, 6h, or 7a–f inhibited coagulation induced by B. neuwiedi venom. All derivatives demonstrated inhibition of the proteolytic activity caused by B. jararaca venom, and derivatives 6a–d and 7e–f inhibited the activity of B. neuwiedi venom. Consequently, these derivatives exhibited varying degrees of efficacy in countering two crucial toxic effects of B. jararaca or B. neuwiedi venoms, suggesting their potential as antivenoms against both species.

Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023

Abstract Issue Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services). Problem Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area. Results In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported. Lessons Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions. Key messages • Mass gathering s events put under stress all the main areas of public health system. • Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.

Association of healthy lifestyle on overweight and obesity among adolescents in Luxembourg

Abstract Background Adolescent overweight and obesity are significant public health challenges. Understanding the impact of healthy lifestyle behaviours is crucial for effective intervention strategies. The aim of this study is to analyse the association between healthy lifestyle behaviours with overweight and obesity among adolescents in Luxembourg. Methods The study was based on the HBSC Luxembourg 2022 survey and includes 8415 adolescents aged 11 to 18 years. Adolescents self-reported the frequency of fruit and vegetable consumption, physical activity, height, and body mass. Eating and physical activity behaviours were categorized based on WHO recommendations. Body Mass Index categorization followed International Obesity Task Force criteria. Binomial logistic regression of obesity and overweight with the interaction between healthy diet and physical activity was performed, controlling for age, gender, family affluence, migration background, and family structure. Results The results indicated a significant protective effect of healthy lifestyle behaviours against overweight and obesity. For overweight, adolescents engaging in either fruit and vegetable consumption (OR = 0.829, 95% CI [0.697-0.986]) or physical activity (OR = 0.719, 95% CI [0.566-0.913]) showed reduced odds compared to those with unhealthy behaviours. For obesity, similar associations were observed. Adolescents engaging in physical activity (OR = 0.407, 95% CI [0.235-0.705]) showed reduced odds compared to those with unhealthy behaviours. Combining both behaviours resulted in the lowest risk of obesity (OR = 0.366, 95% CI [0.177-0.760]) and overweight (OR = 0.473, 95% CI [0.340-0.658]). Conclusions Promoting health eating and physical activity behaviours are important strategies for preventing overweight and obesity in youth in Luxembourg. Implementing targeted interventions aimed to promote these behaviours could mitigate the burden of overweight and obesity in this population. Key messages • Healthy lifestyle matters: Fruit and vegetables consumption or regular physical activity significantly reduce the risk of overweight and obesity among adolescents. • Combining behaviours counts: Concurrent engagement in both fruit and vegetables consumption and physical activity offers the greatest protection against overweight and obesity.

Mental health problems identified in early school age and later mental health problems and disorders

Abstract Background Poor mental health in childhood and adolescence youth is an important public health challenge. We aimed to examine the prospective association between mental health problems among primary school children and later diagnosed mental disorders and mental health problems in youth. Methods A prospective cohort study of children participating in school health nurse examination during first years of primary school (approx. 6 years) in 17 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 16th birthday. Baseline data included information from national population registers and school health nurse records. Outcome variables: mental disorders diagnosed at hospital from approx. age 6 until 16 years (N = 6,930) and school health nurse records of mental health problems at approx. age 16 (N = 11,250). Results Problematic relations to peers in early primary school was associated with later neurodevelopmental disorders, including intellectual disability, autism-spectrum disorder and disorders of hyperactivity and inattention (AOR=4.14, 95% CI 2.15-7.97), and poor home related well-being in youth (AOR=1.67, 95% CI 1.02-2.74). Poor school well-being in early primary school was associated with poor school well-being ten years later (AOR=1.67, 95% CI 1.19-2.34) as well as problematic relations to peers (AOR=1.83, 95% CI 1.08-3.10). Further poor general well-being in early primary school was associated with problematic relations to peers in youth (AOR=2.21, 95% CI 1.17-4.18). Conclusions School health nurses identify a group of children in the early years of primary school with mental health problems and an increased risk of later mental health problems and disorders, and therefore they play an important role in the early identification of children at risk. Key messages • Children with problematic relations to peers have up to a fourfold increased risk of later mental disorders. • The school health nurses play an important role in the early identification of children at risk of later mental health problems.

Employment and mental health for adults on probation, 2002-2021.

The 21st century has seen a decline in employment rates in the US at the same time that it has experienced a historically unprecedented rise in the numbers of adults under criminal justice system control. Both low employment and high incarceration have posed serious challenges for public health. Using data from the National Survey on Drug Use and Health from 2002-2021, we estimated employment rates by community supervision status. Variations by sociodemographic subgroups were explored as well as correlations between employment and a range of mental and behavioural health variables. Those on probation were twice as likely as those not to live in poverty. They experienced higher rates of poor mental and behavioural health, including three times the rate of substance use. Employment rates varied little by community supervision status. Health risk factors were associated with more risk and protective factors did less to mitigate risk for those under community supervision. Despite the range of adversities faced by individuals under criminal justice system control, their employment rates are remarkably close to those not. Despite near equivalent involvement in the labour force, this population has substantially poorer health and substantially reduced likelihood of escaping poverty.

Integrated environmental and health economic assessments of novel xeno-keratografts addressing a growing public health crisis

Tissue scarcity poses global challenges for corneal transplantation and public health. Xeno-keratoplasty using animal-derived tissues offers a potential solution, but its environmental and economic implications remain unclear. This study evaluated two xeno-keratoplasty procedures at a single institution: (1) native corneas (Option 1) and (2) tissue-engineered corneal scaffolds derived from slaughterhouse waste (Option 2). Life cycle assessment (LCA) quantified environmental impacts across 18 midpoint indicators, while cost-effectiveness analysis (CEA) incorporated cost and environmental impact using two approaches. Option 1 exhibited significantly lower environmental impact than Option 2 across most indicators, primarily due to the energy and equipment demands of cell culture in Option 2. Both CEA approaches (carbon offset pricing and utility decrement) demonstrated cost-effectiveness dominance for Option 1. Xeno-keratoplasty using native corneas (Option 1) appears more environmentally and economically favorable than tissue-engineered scaffolds (Option 2) in the current analysis. Future studies could explore diverse xeno-keratoplasty techniques for optimizing sustainability.

Ultra-Processed Food Consumption and Its Relationship with Diet Quality Among Malaysian Young Adults

The global rise in ultra-processed food (UPF) consumption presents potential public health challenges. UPFs, laden with additives and extensively marketed, are increasingly prevalent in modern diets. However, there is limited research on UPF consumption among Malaysian young adults, particularly its relationship with diet quality. This cross-sectional study aimed to investigate the relationship between UPF consumption and diet quality among 177 young adults aged 18 to 29 years from Terengganu, Johor, and Perak. A two-day 24-hour dietary recall was used to assess UPF intake, classified by the NOVA system, while diet quality was evaluated using the Standardised-Malaysian Healthy Eating Index (S-MHEI). The S-MHEI was adopted with the scores for each food group (adequacy component) calculated according to the recommended servings per food group expressed per 1,000 kcaL. Statistical analyses, including Spearman correlation, were conducted using SPSS version 25 to determine the relationship between UPF consumption and diet quality with statistical significance set at p<0.05. The median total energy intake was 1,417 kcaL (IQR=735.38), with UPFs contributing 38.6% of this intake. The median S-MHEI score was 44.65 (IQR=12.77), indicating that 74.6% of participants had poor diet quality. Statistical analysis found no significant relationship between UPF consumption and diet quality (p=0.395). Although no significant association was found, this study lays the groundwork for further research on nutrition and health among Malaysian young adults.

Impact of telephone coaching supporting a physical maintenance exercise programme for older adults at risk of falls: a randomised controlled trial

BackgroundEncouraging compliance with recommended levels of exercise for older adults is a public health challenge. A minimal-resource solution is telephone coaching.ObjectivesPrimary aim: to compare timed up and go (TUG) performance 6 months after beginning a home exercise program between a group of older individuals who received additional telephone coaching, and a control group performing the home exercise program alone. Secondary aims: to compare functional and fall-related outcomes between groups at 6 and 12 months.MethodsMulticentre, assessor-blinded, randomised, controlled, open label, prospective study. Inclusion criteria included age ≥ 65 years, ≥ 1 fall in the past year, and discharged home from hospital rehabilitation or outpatient physiotherapy. All participants received a home exercise booklet and were asked to perform a set of exercises as often as possible (daily). The coaching group additionally received a monthly telephone call (total 5 calls) from their previous physiotherapist. Primary outcome was TUG performance at 6 months. Outcomes were measured at inclusion, and at 6 and 12 months. The primary outcome was analysed using a linear mixed model adjusted for the baseline value.ResultsIn total, 99 individuals were included (coaching group n = 50, control group, n = 49; mean [SD] age 83.1 [5.8] years and 77% women). TUG performance did not differ between groups at 6 months (adjusted difference 1.37, SE 1.32, 95% CI 1.26 to 4.01, p = 0.30). Secondary outcomes did not differ between groups at 6 or 12 months except compliance to the exercise program was higher in the coaching than the control group at 6 months (adjusted difference 1.0, SE 0.5, 95% CI 0.02 to 2.0, p = 0.05).ConclusionsThe lack of difference between the groups in the time taken to complete the TUG at 6 months suggests that the monthly telephone coaching sessions did not improve the effectiveness of a home exercise programme in elderly people who had suffered at least one fall. The trial was registered on ClinicalTrials.gov (NCT02828826; 11th of july 2016, last modification 16th of September 2024).

Current Progress on Antibiotic Resistance Genes Removal by Composting in Sewage Sludge: Influencing Factors and Possible Mechanisms

Antibiotic resistance genes (ARGs) present in sewage sludge pose significant environmental and public health challenges. Composting has emerged as a promising method to mitigate these risks by reducing ARGs. This review paper evaluated the current progress in the removal of ARGs through composting, incorporating a bibliometric analysis of 228 publications from January 2010 to January 2024. This review highlights the increasing scholarly interest in this field, with a notable rise in publications since 2010. Key mechanisms identified include the denaturation of proteins and DNA at high temperatures, the adsorption of antibiotics and heavy metals by additives like biochar, and shifts in microbial communities, all contributing to the reduction of ARGs during composting. Despite these findings, challenges remain in achieving consistent ARG removal rates, addressing the potential for ARG regrowth, and understanding horizontal gene transfer post-composting. This review suggests further research into optimizing composting conditions and integrating additional treatment methods to enhance ARG removal and minimize associated risks.

Práticas higiênico-sanitárias em feiras de arte e gastronomia de Niterói/RJ, Brasil

Introduction: Street food is an important market segment with an impact on the generation of jobs, income, and appreciation of food culture. However, it poses a challenge for public health because it increases the risk of transmission of pathogens from foodborne disease. Objective: Evaluate the hygienic-sanitary practices of food handlers at fairs and the physical-functional conditions of gastronomy and arts fairs in the city of Niterói/RJ. Method: The descriptive methodology was applied, using a qualitative and quantitative approach. For data collection, two scripts were developed and applied to evaluate the functional conditions of the fairs and the hygienic-sanitary practices of the handlers during sales, and a questionnaire was administered to outline the socioeconomic profile of the workers. Results: 68.1% were women; average income of 3 minimum wages; 51.1% had completed higher education; 46.8% had never taken a Good Food Handling Practices course; 70.5% did not use hair protection; and 86.8% used adornments. In 40% of the fairs visited, there was the presence of animals/vectors, as well as the absence of toilet facilities for handlers. Conclusions: Thus, despite its socioeconomic importance, the street food trade represents a potential health risk. Therefore, it is necessary to expand the hygienic-sanitary training of handlers and improve the environmental conditions of fairs.

The trajectory of substance use disorder among people formerly in foster care: A survival analysis.

Substance use disorder (SUD) represents a significant public health challenge, especially among individuals who have faced early life adversities. Foster care aims to provide a supportive environment for children; however, the relationship between a history of foster care and SUD development remains unclear. This study aims to examine the likelihood of developing SUD among individuals with a history of foster care, who have used substances during their lifetime, compared to those raised by biological parents. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), we analyzed the prevalence of social demographics and clinical variables among individuals who have used alcohol, nicotine, or cannabis. We calculated the probabilities of developing SUD for each factor, including exposure to foster care. Various covariates that could impact SUD occurrence were also assessed. The duration from initial substance use to SUD onset was calculated for both groups. Survival analysis curves were generated for each substance to depict the probability of SUD development over time. Our analysis revealed that foster care may act as a protective factor against Cannabis Use Disorder (CUD), with a hazard ratio of 0.25 (95% CI [0.07, 0.88]). No significant associations were found with Alcohol Use Disorder (AUD) or Nicotine Use Disorder (NUD). Both foster and non-foster care groups exhibited higher probabilities of developing NUD compared to the general population. For cannabis users, the probability of developing CUD stabilizes after approximately 10 years. Family history of SUD and clinical predictors such as mood disorders consistently showed significant associations across all substance groups, highlighting their importance in SUD development. Our findings suggest that foster care may offer some protective benefits, particularly against CUD, emphasizing the need for further research into its protective factors and the development of targeted interventions to reduce SUD prevalence in this population.