Public Health Outcomes Research Articles

Assessing the potential of activated carbon and anion-exchange in combination to remove organic micropollutants from wastewater - Long term pilot trials at Kungsängsverket WWTP, Uppsala, Sweden.

Pharmaceuticals and per- and polyfluoroalkyl substances (PFAS) are persistent organic micropollutants (OMPs) posing environmental and health risks due to their bioaccumulative nature and potential toxicity. These OMPs spread to the environment due to the extensive use in today's society. Conventional wastewater treatment plants (WWTPs) are not designed to effectively remove these contaminants, making WWTPs an important pathway, especially for pharmaceuticals, to the aquatic environment. This study investigates the efficiency of combining granular activated carbon (GAC) and anion exchange (AIX) for the removal of OMPs from wastewater. While GAC is a well-established method for removal of pharmaceuticals and AIX for PFAS removal, the combination of GAC and AIX for treating municipal wastewater has not been evaluated before. This research therefore focuses on long-term trials assessing the removal efficiencies of GAC and AIX filters in both bench-scale and pilot-scale setups at Kungsängsverket WWTP in Uppsala, Sweden. The combination of GAC and AIX filters showed over 90% removal efficiency for pharmaceuticals such as diclofenac up to 20,000 treated empty bed volumes (EBV). PFAS removal was primarily achieved by AIX after the initial 5000 EBV by GAC, highlighting the complementary roles of the two technologies. The findings contribute with new insights utilizing GAC and AIX as a combined treatment approach for reducing OMPs in municipal wastewater, contributing to improved environmental and public health outcomes.

Parental vaccine hesitancy: Recent evidences support the need to implement targeted communication strategies.

In 2018, Europe experienced a surge in measles cases, revealing the consequences of suboptimal immunization coverage. This trend was exacerbated by long-standing vaccine hesitancy. Parental attitudes toward childhood vaccines have increasingly shifted, influenced by ethical, religious, and safety concerns. Vaccines hesitancy has substantially increased after the Covid-19 pandemic. Using PubMed, we reviewed cross-sectional studies, published during years 2023-2024, related to parents' vaccine hesitancy, with the aim to provide an overview of its prevalence, underlying reasons and consequences for public health. Data summarised highlight various factors contributing to vaccine hesitancy. These include socio-demographic factors, the impact of the Covid-19 pandemic, and widespread misinformation, particularly through social media. Several cross-sectional studies show that vaccine hesitancy is often linked to lower education levels, misinformation, and decreased trust in healthcare systems. The pandemic exacerbated this issue. This article underscores the need for targeted communication strategies to address vaccine hesitancy, focusing on specific populations, such as those in low-income settings or with limited access to healthcare information. It emphasizes the importance of countering misinformation to improve vaccination rates and public health outcomes.

Examining the Association Between Public Health Accreditation and COVID-19 Outcomes.

To examine the association between local health department (LHD) accreditation and COVID-19 community outcomes, including rates of adult vaccination, hospitalization, and death. We examined county level rates of adult vaccination, hospitalization, and death by LHD accreditation status over the course of the COVID pandemic. Additional independent variables included time period, COVID-19 Community Vulnerability Index (CCVI), state public health governance structure, and state policy environment. We used hierarchal linear mixed modeling with random intercept for county level data to account for repeated observations and fixed effects for all other variables. This study examined all communities in the United States of America. LHDs and the communities they serve. Rates of adult vaccination, hospitalization, and death due to COVID-19. Among accredited LHDs, the adult population was more likely to be fully vaccinated when compared to unaccredited LHDs ( P <.01). Additional variables in the model, which were also significant, included time period, CCVI, state policy environment, and state public health governance structure. There were no significant differences in the hospitalization rates in jurisdictions with an accredited LHD compared to jurisdictions where the LHD is not accredited. Death rates in jurisdictions with an accredited LHD were statistically significantly lower than death rates in jurisdictions where the health department was not accredited ( P <.001). This relationship was significant with other key variables in the model, including time, CCVI, state policy environment, and state public health governance structure. This study demonstrates that there is an association between LHD accreditation and community health outcomes. Furthermore, we found that other factors, such as social determinants of health, state policy environment, and state public health governance structure impact community health outcomes.

Community-based model for management and follow-up by non-physician healthcare workers to improve awareness, treatment, and control of hypertension: The COTRACO study protocol.

Cardiovascular diseases are the leading cause of death and morbidity worldwide, with a significantly higher burden in low- and middle-income countries. Hypertension, a major risk factor for cardiovascular morbidity and mortality, remains under-diagnosed and poorly controlled, especially in regions such as Latin America. The HOPE-4 study demonstrated that the involvement of non-physician health workers (NPHWs), the use of standardized treatment algorithms, the provision of free antihypertensive drugs and home follow-up can significantly improve hypertension control and reduce cardiovascular risk, as demonstrated in Colombia and Malaysia. On this basis, the COTRACO study aims to address the barriers to hypertension treatment in low- and middle-income countries by implementing a similar standardized treatment approach delivered by non-specialist health workers. The COTRACO study is a quasi-experimental, parallel-group, non-randomized, before-and-after study. A community-based model will be implemented in 600 patients in Colombia and the Dominican Republic, involving NPHWs to: 1) apply standardized treatment algorithms, 2) promote adherence to healthy lifestyles, and 3) provide standardized pharmacological treatment. Propensity Score Matching will be used to select 300 patients in Chile and 1200 in Spain for comparison with standard care in these populations. The primary outcome at 12 months of follow-up is the percentage of patients achieving controlled hypertension (defined as systolic BP<140mmHg and diastolic BP<90mmHg, or<130mmHg, and diastolic BP<80mmHg for diabetic patients), ensuring it is not inferior to that achieved in the control countries. Secondary outcomes include changes in BP levels, cholesterol levels, BMI, handgrip strength, waist-to-hip ratio, smoking status, Interheart risk score, diet, and physical activity at 6 and 12 months. If this model demonstrates superior outcomes compared to usual care, it is recommended that health authorities in low- and middle-income regions adopt and implement this approach. Using non-medical health professionals, standardized treatment algorithms and free access to antihypertensive medications, these regions can significantly improve awareness, diagnosis and management of hypertension. This strategy has the potential to reduce cardiovascular morbidity and mortality, thereby improving overall public health outcomes.

Revolutionizing public health through digital health technology

ABSTRACT The aging population and increasing chronic diseases strain public health systems. Advancements in digital health promise to tackle these challenges and enhance public health outcomes. Digital health integrates digital health technology (DHT) across healthcare, including smart consumer devices. This article examines the application of DHT in public health and its significant impact on revolutionizing the field. Historically, DHT has not only enhanced the efficiency of disease prevention, diagnosis, and treatment but also facilitated the equitable distribution of global health resources. Looking ahead, DHT holds vast potential in areas such as personalized medicine, telemedicine, and intelligent health management. However, it also encounters challenges such as ethics, privacy, and data security. To further advance DHT, concerted efforts are essential, including policy support, investment in research and development, involvement of medical institutions, and improvement of public digital health literacy.

The humanitarian and public health crisis in Gaza: Impact, challenges, and international responses

Background: The humanitarian crisis in Gaza has escalated to unprecedented levels as of late September 2024, with devastating impacts on civilians and the healthcare infrastructure. Years of the blockade, exacerbated by ongoing military aggression, have led to the collapse of Gaza's health system anddeepened the region's public health crisis. Objective: The aim of this study was to examine the far-reaching public health consequences of the Gaza conflict, with a focus on the destruction of healthcare infrastructure, the rise in communicable diseases, and the psychological trauma affecting the population. Methods: A qualitative analysis was conducted using secondary data from peer-reviewed journal articles, reports from international humanitarian organizations, and official statistics. Thematic analysis identified key challenges, including the impact of infrastructural collapse, barriers to medical care, and the consequences of prolonged conflict on mental and physical health. Results: The findings indicate over 41,615 deaths, including approximately 16,500 children,and thousands are still missing. The destruction of hospitals, roads, and ambulances has severely disrupted medical services andleft tens of thousands without medical care. Chronic lack of medical supplies, clean water, and electricity further aggravates the crisis. Additionally, communicable diseases and psychological trauma have reached critical levels, disproportionately affecting children and vulnerable populations. Conclusions: The findings highlight the urgent need for a coordinated international response to address the healthcare crisis in Gaza. Emergency measures should include curbing military aggression, providing humanitarian aid, and rebuilding healthcare systems. Long-term efforts must focus on building resilient health infrastructure, ensuring access to essential medical care, and addressing the mental health needs of the population. Future research should explore the long-term public health outcomes of conflict and strategies to enhance healthcare resilience in similar settings.

Analyzing the Efficacy of Water Treatment Disinfectants as Vector Control: The Larvicidal Effects of Silver Nitrate, Copper Sulfate Pentahydrate, and Sodium Hypochlorite on Juvenile Aedes Aegypti

For communities without access to uninterrupted, piped water, household water storage (HWS) practices can lead to adverse public health outcomes caused by water degradation and mosquito proliferation. With over 700,000 deaths caused by vector-borne diseases annually, the objective of this study was to determine whether water disinfectants, at concentrations deemed safe for human consumption and beneficial for water treatment, are effective in reducing the emergence of adult mosquitoes that transmit disease. Laboratory bioassays, designed to resemble the context of treating HWS containers, were conducted to assess the larvicidal effects of chemicals at concentrations below regulatory limits for drinking water: silver (20, 40, 80 μg/L Ag), copper (300, 600, 1200 μg/L Cu), and chlorine (500, 1000, 2000 ug/L free chlorine). The water disinfectants demonstrated the ability to significantly reduce the population of juvenile Ae. aegypti. Sodium hypochlorite was found to be the most effective in decreasing the survival rate of late first instar larvae, while silver nitrate exhibited the highest effectiveness in inhibiting the emergence of late third instar larvae. Ultimately, this study highlights the potential of an integrated approach to Water, Sanitation, and Health (WASH) solutions with vector control management.

The Impact of Special Terminals on Community Health Empowerment in the Barito River Basin, Central Kalimantan Province: Advancing Community Well-Being

Objective: This study examines the impact of specialized terminals on public health in Barito Selatan Regency, with a focus on mitigating stunting and improving access to essential health services. It aims to optimize the role of these terminals in community empowerment, reducing stunting prevalence, alleviating poverty, and fostering a sustainable socio-economic ecosystem in alignment with Sustainable Development Goal (SDG) 3 on Good Health and Well-being. Theoretical Framework: Grounded in social welfare and community empowerment theories, the study draws from Bentham’s utility, Sen’s capabilities, and Kartasasmita’s participation principles. Public health frameworks from Marmot, WHO, and Jones link health determinants, infrastructure, and welfare to guide the analysis. Method: A quantitative approach surveyed 400 households within 1 km of specialized terminals using structured questionnaires. Health resilience was assessed via the Berdaya Kesehatan indicator. Structural Equation Modeling (SEM) with SmartPLS 4.0 analyzed relationships among transport infrastructure, community empowerment, and social welfare. Results and Discussion: Findings reveal that specialized terminals significantly contribute to community health empowerment by enhancing access to healthcare, mitigating stunting, and improving social welfare. The results underscore the pivotal role of transport infrastructure and community-centered programs in promoting sustainable development. Research Implications: The study emphasizes the importance of integrated health programs, robust infrastructure, and CSR initiatives in improving public health outcomes. Policymakers are encouraged to prioritize investments in healthcare access, sanitation, and education to achieve sustainable and equitable impacts. Originality/Value: This research provides a novel perspective by linking specialized terminals and CSR initiatives to public health outcomes, offering actionable insights into innovative public-private partnerships to reduce disparities and enhance health resilience in pursuit of SDG 3.

Sleep apnea screening through a news portal using the STOP-bang questionnaire.

Obstructive sleep apnea (OSA) affects up to 936million adults globally and is linked to significant health risks, including neurocognitive impairment, cardiovascular diseases, and metabolic conditions. Despite its prevalence, OSA remains largely underdiagnosed. This study aimed to enhance OSA awareness and risk assessment using the STOP-Bang questionnaire in a telemedicine format. During a six-week campaign on a popular Latin American news portal, 5,966 adults completed the STOP-Bang questionnaire. Participants reporting moderate or severe OSA risk were advised to seek clinical evaluation. Among respondents, 44.7% were identified as having a moderate-to-high risk for OSA. Key risk factors included snoring, witnessed apneas, hypertension, male gender, older age, high BMI, and larger neck circumference. Statistical analyses showed significant associations between these variables and OSA risk. This study highlights the importance of increasing OSA visibility and early detection in the general population. Despite limitations such as selection bias and potential false negatives/positives with the STOP-Bang tool, the findings demonstrate the potential of media campaigns to raise awareness and prompt early medical consultation. Future efforts should include follow-up assessments to evaluate healthcare-seeking behavior and confirm OSA diagnoses, contributing to improved public health outcomes.

Assessing the effectiveness of vaccination strategies against respiratory pathogens⁠

Vaccination has been an effective method in preventing many childhood-related infections and reducing the risk of infections in adults. Between the mid-1960s and 2015, vaccination has been successful in saving more than 10 million lives. Respiratory pathogens have been a main target for vaccination over decades. Many vaccines were developed against respiratory pathogens such as influenza. virus, Streptococcus pneumoniae, and Mycobacterium tuberculosis. Vaccination against respiratory pathogens faces new challenges every year due to different reasons. The following databases were used in systematic research: Medline (PubMed), Web of Science, and Scopus. Summaries of the found studies were exported by EndNote X8, and duplicate studies were removed. Inclusion criteria were any study. Despite the proven effectiveness of various vaccines against respiratory pathogens, several challenges persist in this field. These include the waning of vaccine-induced immunity, prompting the need of developing vaccines that provide long-lasting protection; vaccination harmful side effects; and the emergence of new subtypes are examples of these challenges. In the aftermath of the COVID-19 pandemic, clinical trials are underway to develop more effective vaccines against a range of pathogens. However, greater large-scale efforts are needed, particularly in low-income countries, to enhance global public health outcomes.

Systematic review of multidrug-resistant Klebsiella pneumoniae in the Arabian Peninsula: molecular epidemiology and resistance patterns

BackgroundThe rapid emergence of multidrug-resistant Klebsiella pneumoniae (MDR K. pneumoniae) is a major public health and economic burden worldwide. Various resistance mechanisms complicate treatment, leading to increased morbidity and mortality. Despite numerous studies conducted in Gulf Health Council (GHC) countries, the molecular epidemiology of MDR K. pneumoniae remains not clearly defined. This systematic review aims to analyze the emergence of antimicrobial resistance genes in MDR K. pneumoniae across GHC countries.MethodsA systematic search was conducted using PubMed, ScienceDirect, and OpenMD for articles published up to March 15, 2023. The search strategy focused on the bacterial name, drug-resistance genotypes, and GHC countries. The review followed PRISMA guidelines, with two independent reviewers assessing the risk of bias using NIH Study Quality Assessment tools.ResultsThe primary search yielded 1,663 studies, of which 67 met the inclusion criteria. Saudi Arabia contributed the most studies, with 41 (61.1%), followed by Kuwait with 7 (10.4%), and the UAE with 6 (9%) studies. Oman and Qatar each contributed 4 studies (6%), and Bahrain contributed three studies (4.5%). The remaining 4 studies (4.4%) were from multiple GHC countries. The studies exhibited considerable heterogeneity in detection methods, target genes, and resistance mechanisms. Notably, only one environmental study was conducted in the UAE, and one community-based study in Kuwait, while the remaining studies focused on clinical samples. Various resistance mechanisms and patterns were observed between countries and across different years within the same country. The review highlighted the widespread prevalence of ESBL genes, particularly blaTEM and blaCTX-M-15, and the emergence of carbapenemase genes such as blaOXA-48 and blaNDM-1 and blaKPC-2. Additionally, colistin resistance through the mcr-1 gene and mgrB mutations was reported in Saudi Arabia and the UAE, posing a significant public health challenge.ConclusionData from GHC countries shows significant gaps, particularly in community and environmental and molecular epidemiology studies. Limited molecular and genome-based investigations hinder comprehensive AMR surveillance. Implementing standardized methodologies and fostering molecular and genome-based AMR surveillance programs at both national and regional levels within the GHC are essential for effectively combating the spread of MDR K. pneumoniae and improving public health outcomes in the region.

Navigating vaccine misinformation: a study on users’ motivations, active communicative action and anti-misinformation behavior via chatbots

PurposeThe global prevalence of vaccine misinformation has underscored the crucial necessity to combat false information and explore innovative solutions like chatbots. These artificial intelligence (AI)-powered tools play a pivotal role in disseminating accurate information and mitigating the adverse effects of misinformation. This study aimed to investigate what factors motivated users to combat vaccine misinformation using chatbot tools, and their active communication actions and anti-misinformation behaviors.Design/methodology/approachResearchers surveyed 612 chatbot users in the United States and utilized structural equation modeling for data analysis.FindingsThe findings of this study revealed that both situational and gratification motivations of chatbot users significantly contributed to three essential types of communicative actions: information-seeking, forwarding and forfending. Meanwhile, the data demonstrated that except for information forfending, both information-seeking and forwarding communicative actions could enhance user engagement with anti-misinformation behavior.Originality/valueThe originality of this study lies in its integration of two key motivational frameworks – gratification and situational motivations – within the context of AI-driven tools like chatbots, particularly in combating misinformation. While previous research has explored the use of chatbots or the role of situational motivations in communication separately, this study uniquely combines these concepts to enhance the situational theory of problem-solving (STOPS) model and uses and gratifications (U&amp;G) theory. Additionally, the practical implications for chatbot design and communication strategies targeted at misinformation are a significant contribution, demonstrating how motivation-driven interactions can be used to improve user engagement and public health outcomes.

Can a low emission zone improve academic performance? Evidence from a natural experiment in the city of Madrid

In the last decades, various policies have been implemented to reduce air pollution exposure and improve public health outcomes. Among these, low emission zones (LEZs) have been shown to effectively enhance air quality and health outcomes. However, their potential positive externalities on other outcomes, such as academic performance, remain largely unexplored. This study examines the LEZ introduced in the city of Madrid in late 2018 and investigates its impact on the academic performance of students schooled in the designated area. Using a difference-in-differences design, we demonstrate the policy’s effectiveness in improving air quality during its first 4 years. Subsequently, we find a significant increase of 0.20 standard deviations in the average EvAU scores (a high-stakes examination for university admission) among high schools located within the LEZ, a critical advantage for students seeking entry into the most competitive university programmes. Notably, our findings reveal positive spillover effects in the surroundings of the LEZ area and a greater improvement with longer and earlier exposure to cleaner air. Overall, this study offers compelling evidence of the educational benefits resulting from the implementation of a low emission zone that successfully improves air quality.

Housing conditions and the health and wellbeing impacts of climate change: a scoping review.

Housing conditions are emerging as an important consideration in climate change adaptation. Housing modifications have the potential to improve health outcomes by reducing exposure to changing weather conditions and extreme events. This scoping review aimed to explore the existing evidence examining the contribution of housing conditions to the impacts of climate change on health and identify any research gaps. Literature searches were conducted in Scopus and PubMed from January 2013 to September 2023 and data were analysed using thematic analysis. The review included 38 articles consisting of original studies, reviews, and reports, with broad geographical coverage. The most common focus among included articles was on heat-health impacts; housing conditions found to improve heat-health health outcomes included air conditioning, ventilation, and window shading, and there was support for multifaceted housing adaptations rather than single fixes. Ventilation was found to be a priority for improving indoor air quality, while inappropriate insulation and excessive air tightness were found to increase indoor heat and reduce indoor air quality. The scoping review reveals a need for more empirical and qualitative research into indoor heat in homes, climate change hazards other than heat, and intervention studies to inform climate change adaptation policies around housing and improve public health outcomes.

Utilizing GIS, remote sensing, and AHP-multi-criteria decision analysis for optimal landfill site selection in Kenitra Province, Morocco: a step towards sustainable development goals

The aim of this study is to identify suitable landfill sites in Kenitra Province, Morocco, using ArcGIS 10.8, Remote Sensing, and the Analytic Hierarchy Process (AHP) to enhance site selection and improve environmental and public health outcomes. Additionally, the study seeks to enhance decision-making through multicriteria analysis, align landfill site selection with Sustainable Development Goals (SDGs) to promote long-term sustainability, and provide a model that can be replicated in other Moroccan regions or countries facing similar waste management challenges. Ten criteria were considered in selecting new landfill sites, including distance from surface water, soil permeability, land use land cover (LULC), topographic wetness index, distance from the shoreline, slope, aspect, proximity to urban areas, transportation networks, and villages. Maps for each criterion were generated, and pairwise comparisons were used to assign weights to these factors. A Weighted Overlay Analysis (WOA) was then applied to create a landfill suitability map, classifying areas into high, moderate, low, and unsuitable categories. The results reveal a limited availability of highly suitable landfill areas within the province. To address this, the study proposes two strategically located waste management sites, A and B, to mitigate land constraints. Establishing these sites as centralized landfills for multiple municipalities aligns with Sustainable Development Goals (SDGs) 3, 6, 14, 15, and 17, promoting public health, preventing water pollution, protecting ecosystems, and fostering partnerships for sustainable waste management. This comprehensive approach emphasizes the need for collaboration in achieving long-term sustainability and environmental conservation.

Evaluating the Impact of the “We Can Do This” Campaign’s Heavy-Up Advertising on Initial COVID-19 Vaccine Uptake

ABSTRACT To address vaccine hesitancy, the U.S. Department of Health and Human Services (HHS) launched the “We Can Do This” COVID-19 public education campaign (the Campaign) in 2021 to promote vaccine confidence and increase vaccine uptake. The Campaign introduced a heavy-up media strategy to enhance its reach and engagement with its vaccine hesitant audience. This approach complemented the Campaign’s national media strategy while delivering an additional advertising dose to select priority designated market areas (DMAs) – that is, media markets – each month. We examine the relationship between the Campaign’s heavy-up strategy and initial COVID-19 vaccine uptake from August to December 2021. A stacked difference-in-differences (DID) analysis compared initial COVID-19 vaccine uptake between DMAs that received heavy-up (treatment) and DMAs that did not (control). The Campaign’s short-term heavy-up advertising strategy was associated with increased initial vaccine uptake in treatment DMAs. These results provide valuable insights for public health campaign strategy and evaluation, highlighting the effectiveness of increasing campaign dose in select markets to address vaccine hesitancy and improve public health outcomes.

Assessing the Impact of Reduced Vehicle Volume and Increased Speed on Air Quality in Qom City Using AERMOD

Urbanization and traffic congestion significantly worsen air pollution, leading to serious health risks. This study examines a scenario involving a 9% reduction in vehicle volume and a 4% increase in vehicle speed on the main roads of Area 6 in Qom City (District 2). The focus is on evaluating the impact of these changes on air quality, specifically concerning pollutants carbon monoxide (CO), nitrogen oxides (NOx), and particulate matter (PM2.5), utilizing AERMOD software for modeling. Data were collected through various methods, including statistical analysis, field sampling within the area, archived records from the Road Administration and the Road Transport Organization of Iran, GPS data for Qom City, and local meteorological information. The results reveal that implementing the proposed traffic management scenario can lead to significant reductions in pollutant levels: CO levels could decrease by approximately 20.19%, NOx by 7.29%, and PM2.5 by 9.00%. These findings underscore the potential of strategic adjustments in traffic patterns to improve urban air quality. The insights gained from this study are valuable for policymakers aiming to tackle environmental challenges in rapidly urbanizing regions, highlighting the importance of effective traffic management in promoting healthier urban environments. Ultimately, enhancing air quality through targeted traffic interventions can improve public health outcomes and contribute to a more sustainable urban future.

Infection prevention and control and water, sanitation, and hygiene status of healthcare facilities in the Greater Kampala Metropolitan region during the COVID-19 pandemic in Uganda

Infection Prevention and Control (IPC) and Water Sanitation and Hygiene (WASH) are critical in preventing the spread of healthcare Associated Infections, including COVID-19. However, there was limited evidence on the status of IPC/WASH in healthcare facilities (HCFs) in Uganda amidst the COVID-19 pandemic which complicated IPC/WASH planning for the COVID-19 response. This study assessed IPC/WASH status for HCFs in the Greater Kampala Metropolitan Area (GKMA), during the COVID-19 pandemic, so as to inform programming and policy. A mixed methods cross-sectional study was conducted in 75 HCFs following the first wave of COVID-19 in Uganda. The mWater tool was used to collect quantitative data which were then analyzed into STATA version 16. A key informants’ guide was used to collect qualitative data, which was analyzed thematically and themes and quotes used to support the quantitative findings. Overall, 86.7% (65/75) of HCFs had an IPC committee and 72.3% (47/65) of these were functional. Besides, 90.7% (68/75) of the HCFs had an IPC focal person, and 49.3% (37/75) had a clear annual IPC activity plan. Unfortunately, only 32.3% (21/65) of the functional IPC committees received budgetary support for their activities. In terms of WASH infrastructure, 96.0% (72/75), 10.7% (8/75), 60.0% (45/75), and 22.7% (17/75) had access to a basic water service, a basic sanitation service, a basic hand hygiene service and a basic environmental cleaning respectively. Our study reveals that while most HCFs have IPC committees and focal persons, functional support remains limited, with half having a clear annual plan and less than a third receiving budgetary support. Nearly all HCFs have basic water services, but there are significant gaps in sanitation and environmental cleanliness domains. These findings highlight the urgent need for improved support and investment in IPC/WASH supplies and infrastructure to enhance infection control and public health outcomes in Uganda.

Association between COVID-19 anxiety syndrome and COVID-19 vaccine hesitancy in the postpandemic era: a cross-sectional study in Hong Kong

BackgroundThe COVID-19 pandemic has had profound psychophysiological and socioeconomic effects worldwide. COVID-19 anxiety syndrome (CAS) is a specific cluster of maladaptive coping strategies, including perseveration and avoidance behaviours, in response to the perceived threat and fear of COVID-19. CAS is distinct from general COVID-19 anxiety. The level of CAS in the postpandemic era remained unknown. Despite extensive research on general COVID-19 anxiety and COVID-19 vaccine hesitancy (CVH), few studies have investigated the association between CAS and CVH. The present study aimed to assess the level of CAS and the prevalence of CVH and explore the association between CAS and CVH in the general population of Hong Kong.MethodsThis cross-sectional study was conducted in Hong Kong. Participants were recruited using convenience and snowball sampling methods and completed an online or a paper-based questionnaire comprising two well-validated instruments. The COVID-19 Anxiety Syndrome Scale (C-19ASS), which includes the C-19ASS-P and C-19ASS-A subscales, was used to evaluate CAS in terms of perseveration and avoidance behaviours. The COVID-19 Vaccine Hesitancy Scale (CVHS) was used to determine the presence of CVH.ResultsThis study included 389 participants. The median C-19ASS-P and C-19ASS-A scores were 8 (Interquartile range (IQR) 5–13) and 3 (IQR 0–6), respectively. The CVHS scores revealed a CVH prevalence of 68.1%. A significantly larger proportion of participants with CVH rated “hesitant” compared with those without CVH across all the CVHS items. Furthermore, the median C-19ASS-P and C-19ASS-A scores were significantly higher for participants without CVH than for those with CVH.ConclusionsOur findings revealed that CAS persists and CVH is common in the postpandemic era and that CAS is associated with CVH. Comprehensive interventions addressing both informational and psychological aspects are needed to increase the rate of vaccine acceptance and to mitigate the effect of CAS on public health outcomes.

Role of Cannabis in the Management of Chronic Non-Cancer Pain: A Narrative Review.

Chronic non-cancer pain, defined by the Center for Disease Control and Prevention (CDC) as lasting beyond three months, significantly affects individuals' quality of life and is often linked to various medical conditions or injuries. Its management is complex. Cannabis, containing the key compounds Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), has garnered interest for its potential in pain management, though it remains controversial due to its psychoactive effects and illegal status in many countries. THC provides pain relief by blocking nociceptive stimuli but has psychoactive effects and may potentially induce dependency. CBD has calming and antipsychotic properties. The inhalation of cannabis offers quick relief but poses respiratory risks, while its oral administrations are safer but act more slowly. Short-term cannabis use can impair cognition and motor skills, while long-term use may lead to dependency and cognitive decline, especially if used from an early age. Adverse effects vary by gender and prior use, with addiction mainly linked to THC and influenced by genetics. Despite these risks, patients often report more benefits, such as improved quality of life and reduced opioid use, although the evidence remains inconclusive. The legal landscape for medical cannabis varies globally, with some positive public health outcomes like reduced opioid-related issues in areas where it is legalized. Cannabis shows promise in managing chronic pain, but its psychoactive effects and dependency risks necessitate cautious use. Future research should prioritize long-term clinical trials to establish optimal dosing, efficacy, and safety, aiding in the development of informed guidelines for safe cannabis use in chronic pain management. This review examines the use of cannabis in managing chronic non-cancer pain, focusing on its benefits, drawbacks, mechanisms, delivery methods, and impact on quality of life.