Community Medicine Research Articles

A Global Systematic Review and Meta-Analysis of Giardia duodenalis in Rabbits: Epidemiology, Genetic Diversity and Possible Zoonotic Concerns.

Giardia duodenalis is a pathogenic protozoan responsible for gastrointestinal infections in various hosts, including rabbits. Understanding its epidemiology, genetic diversity and zoonotic implications is vital for public health and veterinary medicine. This systematic review and meta-analysis aimed to synthesize global data on the prevalence of G. duodenalis in rabbit populations, assess the genetic diversity of the isolates and evaluate the associated zoonotic potential. We conducted a thorough literature search across multiple databases (PubMed, Scopus, Web of Science and Google Scholar) for studies published until 18 October 2024. Only peer-reviewed articles reporting original research on G. duodenalis in rabbits were included. We extracted data on prevalence rates, testing times, publication years, countries, continents, WHO regions, diagnostic methods, genes used, assemblages and sub-assemblages. A meta-analysis using random-effects models was performed to calculate pooled prevalence rates, with the I2 index used to assess heterogeneity. A total of 26 studies/datasets were analysed, covering data from 5543 rabbits across 15 countries. The estimated pooled prevalence of G. duodenalis in rabbits was 12.1% (95% CI: 7%-20%), with substantial heterogeneity (I2 = 96.5%). Geographic analysis showed higher prevalence rates in Africa and the AFR WHO region (72.3%, 95% CI: 61.7%-80.8%). Genetic analysis revealed three zoonotic assemblages (A, B and E) and two zoonotic sub-assemblages (AI and BIV) of G. duodenalis in rabbits, highlighting concerns over zoonotic transmission. The findings highlight the global presence and genetic diversity of G. duodenalis in rabbits, indicating potential zoonotic risks. Ongoing monitoring and research are essential to clarify the transmission dynamics and public health implications of G. duodenalis in these animals. Raising awareness among pet owners, veterinarians and public health officials is vital to mitigate potential zoonosis.

Organic vs. Conventional Milk: Uncovering the Link to Antibiotic Resistance in Bacillus cereus sensu lato

Bacillus cereus sensu lato (B. cereus s.l.) comprises mesophilic and psychrotolerant bacteria commonly found in natural environments as well as in organic and conventional milk. Due to their potential toxigenicity and antibiotic resistance, these bacteria pose a significant threat to consumer health. Organic milk production, which prohibits the use of antibiotics and artificial additives, may influence the composition of microbiota between milk types. This study aimed to compare the antibiotic resistance profiles and enterotoxic potential of B. cereus s.l. isolates from organic and conventional milk. The results indicate that, although conventional milk contains on average 3 times fewer B. cereus s.l. isolates, it has 10–15% more resistant isolates to selected beta-lactams, macrolides, and aminoglycosides. Regarding drug resistance, 21% of B. cereus s.l. isolates were multidrug-resistant, and as many as 42% were non-susceptible to two classes of antibiotics. Even among the sensitive isolates, bacteria from conventional milk exhibited on average 2.05 times higher MICs (minimal inhibitory concentrations) for beta-lactams, 1.49 times higher for erythromycin, 1.38 times higher for vancomycin, and 1.38 times higher for azithromycin. Antibiotic resistance was mostly associated with the origin of the isolates. These findings underscore the need for ongoing monitoring of antibiotic resistance and enterotoxicity among opportunistic B. cereus s.l. strains, which may pose challenges for public health and veterinary medicine. The results highlight that selective pressure associated with antibiotic use can drive resistance development in bacteria that are not the primary targets of antimicrobial therapy.

Assessing the Safety and Efficacy of Self-Expanding Metallic Y Stents in a Community Medicine Setting

Self-Expanding Metallic (SEM) Y stents are a newer form of stent that is gaining popularity outside the USA, but still has limited data, especially in a community medicine setting. This study analyzed efficacy and complication rates in 14 patients who had a SEM Y stent placed between August 2022 and June 2024 at Harris Methodist Hospital in Fort Worth, Texas for either central airway obstruction (CAO) or fistulae. Of the 14 patients, 11 were requiring supplemental oxygen or mechanical ventilation prior to stent placement. Post-stenting 42.9% had decreased oxygen requirements, 21.4% unchanged, 14.3% increased, and 21.4% remained on room air. Complications included mucus plugging (42.9%), infection (35.7%), and granulation tissue (14.3%). There was no statistically significant correlation between gender/age and complications (p = 0.879/0.490, respectively). Complication rates were similar when compared to silicone Y stents based on literature review. In conclusion, SEM Y stents are a safe and effective alternative stent intended for palliative treatment with similar success and complications that can be easily and effectively implemented in a community hospital, with the added benefit of being able to be placed with flexible bronchoscopy.

Prediction of cyanotic and acyanotic congenital heart disease using machine learning models.

Congenital heart disease is most commonly seen in neonates and it is a major cause of pediatric illness and childhood morbidity and mortality. To identify and build the best predictive model for predicting cyanotic and acyanotic congenital heart disease in children during pregnancy and identify their potential risk factors. The data were collected from the Pediatric Cardiology Department at Chaudhry Pervaiz Elahi Institute of Cardiology Multan, Pakistan from December 2017 to October 2019. A sample of 3900 mothers whose children were diagnosed with cyanotic or acyanotic congenital heart disease was taken. Multivariate outlier detection methods were used to identify the potential outliers. Different machine learning models were compared, and the best-fitted model was selected using the area under the curve, sensitivity, and specificity of the models. Out of 3900 patients included, about 69.5% had acyanotic and 30.5% had cyanotic congenital heart disease. Males had more cases of acyanotic (53.6%) and cyanotic (54.5%) congenital heart disease as compared to females. The odds of having cyanotic was 1.28 times higher for children whose mothers used more fast food frequently during pregnancy. The artificial neural network model was selected as the best predictive model with an area under the curve of 0.9012, sensitivity of 65.76%, and specificity of 97.23%. Children having a positive family history are at very high risk of having cyanotic and acyanotic congenital heart disease. Males are more at risk and their mothers need more care, good food, and physical activity during pregnancy. The best-fitted model for predicting cyanotic and acyanotic congenital heart disease is the artificial neural network. The results obtained and the best model identified will be useful for medical practitioners and public health scientists for an informed decision-making process about the earlier diagnosis and improve the health condition of children in Pakistan.

The Roles of Pharmacists and Pharmacies in Sustainable Medical Care: Current Status and Outlook Three Years After the Issuance of Recommendations by the Science Council of Japan

Three years have passed since the Science Council of Japan issued its recommendations entitled "Profession and lifelong learning of pharmacists responsible for sustainable medical care." These recommendations include active involvement in community medicine, securing patient information necessary for pharmaceutical management, harmonizing undergraduate and post-graduate education, reform of the certification system for specialty-credentialed pharmacists, and development of the pharmacist resident system. This paper provides an overview of recent trends and future prospects for pharmacists and pharmacies in Japan.

Activities of a Pharmacist in Community Medicine in Nagasaki, Japan

With the increasing separation of dispensing and prescribing, Japanese pharmacists have changed over the past 50 years. Changes affecting pharmacists include the bashing of the separation of dispensing and prescribing, the formulation of the "Vision for Patient-centered Pharmacies" and the implementation of the Action Plan to realize this vision, and the amendment of the "Pharmaceuticals and Medical Devices Act." By 2025, when many baby boomers will be 75 years of age and older, the construction of the "Integrated Community Care System" is being promoted in various regions, and pharmacists are expected to be involved in community healthcare as members of community support networks based on multidisciplinary cooperation. In Nagasaki City, Japan, a regional medical cooperation system centered on the "Nagasaki Home Doctor Net" has been established, and a multidisciplinary network supports the region. In 2007, volunteers, mainly pharmacy managers, established the "Nagasaki Pharmaceutical Care Net (P-net)" to provide home medical care. To date, these volunteers have been involved in community healthcare while continuing their studies through the group. At the symposium, I introduced my active involvement in community healthcare as a pharmacist and as a member of P-net. I hope this symposium will help pharmacists' involvement and collaboration in community healthcare.

Protecting Her Health: A Position Paper on Breast and Cervical Cancer

Abstract Breast cancer and cervical cancer are the two most prevalent cancers in women that screening programs can identify early. This study explores the epidemiology and screening of breast cancer, and cervical cancer from an Indian perspective, human papillomavirus (HPV) screening and artificial intelligence (AI) in cervical cancer screening, as discussed in the “Protecting her Health” session of the 6th Amrita International Public Health Conference. The conference was organized by the Department of Community Medicine, Public Health and Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India, in collaboration with iTMO University and the Eurasian Federation of Oncology on December 1, 2023 and December 2, 2023 with the theme “Advancing Public Health Strategies for Cancer Control.” The following conclusions were suggested during discussions under the subtheme “Protecting her Health”: Even though mammography (MAM) is recommended by the World Health Organization (WHO) for screening breast cancer, clinical breast examination is a reasonable strategy in low- and middle-income countries with the lack of MAM-based screening.There should be a robust commitment from the Government to implement the WHO’s 90-70-90 elimination strategy into practice to eradicate cervical cancer. Scientific evidence from India reported the effectiveness of screening for cervical cancer through Visual Inspection with Acetic acid or HPV test.Adding HPV vaccination into the immunization program along with the screening activities can eradicate cervical cancer in the long run.With the least infrastructure, AI may be used to screen for cervical cancer in environments with limited resources.

Experiences of Women who Faced Insecurity in Public Transport and its Impact on their Emotional Well-being: A Qualitative Study from Urban Area of Tamil Nadu, India

Introduction: Harassment in public transport faced by women passengers has been pushed to the sidelines failing to acknowledge the impact it has on both physical and mental health. Most incidents do not reach the authorities or the media, who often turn a blind eye to the existing problems. As a result, women develop a sense of insecurity that prevents them from using the public transport system. Women from economically challenged backgrounds often have no choice but to use public transport, as it is the cheapest and sometimes the only available mode of transportation. Aim: To understand the experiences of women passengers commuting by public transport in Chennai city, Tamil Nadu, and the incidents that led to their insecurity about using the public transport system. Materials and Methods: This qualitative study was conducted in the Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India between November 2023 and March 2024 among women over 18 years of age who had been using public transport for daily transit for atleast six months. Qualitative data were collected through indepth interviews based on grounded theory among women who faced insecurity while traveling alone on public transport. Data saturation was reached after interviewing 20 participants. The transcribed data were analysed using Qualcoder software to identify relevant themes and subthemes. Results: In the current study, the majority of the women interviewed were between the ages of 18 and 50 years. Four major themes and 18 subthemes were identified through qualitative analysis. The four major themes were factors related to fear, social life, personal factors, and travel safety. Conclusion: The themes and subthemes highlight the gaps that have been overlooked by the authorities in the public transport system. It is crucial to understand that harassment occurring during transit, if not addressed immediately, will leave a lasting impression on women travelers, leading them to develop an irrational fear of crime that can have detrimental effects on their mental, physical, and social well-being. Further, research can be conducted using these themes, subthemes, and codes to develop a relevant research hypothesis that could be tested using quantitative study designs such as case-control and cohort studies.

Perception of Medical Students in Cenderawasih University towards the Public Health Science Quetions of the Computer Based Test UKMPPD

This study aims to find out the perception of Medical students in Cenderawasih University towards the CBT UKMPPD Public Health Science problems. This research is qualitative research with a phenomenological design with data collection techniques, namely in-depth interviews and empirical observations to determine the theme. The themes found in this study are: 1) PH questions are classified as moderate-difficult, because the topic of PH Science is broad and not studied in depth, 2) Increasing practice of PH questions, 3) PH questions are confusing because they are rarely studied during education, 4) Topics that are considered difficult are research methodologies and national health insurance, 5) The time used to answer PH questions during the CBT is considered long because they have to remember the rules, analyze and calculate, 6) Even though the presentation of questions is small, PH questions affect the passing of CBT UKMPPD.

To Study the Iodine Concentration of Mothers’ Consumed Salt, Water, and Staple Food in the Neonatal Screening Program of Rural and Urban Vidarbha Region

ABSTRACT Background: This study aimed to examine the iodine concentration in the food items consumed by mothers participating in neonatal screening programs in both areas of the Vidarbha region. A developing fetus relies on a consistent supply of iodine for proper brain and body development. During pregnancy, only the mother can provide the necessary iodine levels. If the mother is iodine-deficient, the child will also lack this essential nutrient. Severe deficiency in the mother can lead to significant stunting of the child’s brain and body, potentially preventing normal walking, talking, or cognitive function. Even if the mother’s deficiency is mild, the child can still be adversely affected, even if they appear healthy at first glance. The detrimental effects on brain development may manifest later in life as poor academic performance and difficulties in managing daily tasks. Material and Method: The present cross-sectional research will be performed in collaboration with the Departments of Biochemistry, Obstetrics and Gynecology, Community Medicine, and Pediatrics at Jawaharlal Nehru Medical College Sawangi (Meghe) Wardha, along with Datta Meghe Institute of Medical Science (Deemed University) in Maharashtra, India. Mothers who gave birth agreed to participate by providing written consent for the study. Results: The average iodine concentrations are quite similar across all sources, though hand pumps show slightly more variability. Different staple foods contain varying levels of iodine, with some foods (like pulses) exhibiting a lot of variation, while others (like rice and potatoes) are more consistent in their iodine content. Conclusion: The current study is a hospital-based investigation aimed at screening neonates for congenital hypothyroidism (CH) and does not reflect the broader population. To identify CH, screening of neonates will be conducted within the study area, providing a representative view of the condition. The clinical and pathological effects of CH are subtle and often remain unnoticed. Our findings suggest that the prevalence of iodine reflects dietary quality, educational background, and socioeconomic status, all of which can influence growth and development. There are various factors contributing to CH and inadequate fetal growth beyond low iodine levels, which can disrupt thyroid function. The study indicates that iodine levels are indicative of dietary quality as well as educational and social statuses, potentially impacting growth and development through both dietary deficiencies and other factors.

To Study the Thyroid Hormone Levels in Neonates of Rural and Urban Vidarbha Region

ABSTRACT Background: This study aimed to evaluate thyroid hormone levels in neonates from the rural and urban Vidarbha region. Over the past decade, neonatal hypothyroidism screening has been conducted using filter paper techniques to identify congenital hypothyroidism (CH). In some screening programs, only T4 is measured initially, with TSH assessed if the T4 levels fall below normal. Conversely, some programs exclusively measure TSH to screen for CH. Currently, initial TSH screening can identify subclinical hypothyroidism in cases where T4 levels are normal, while preliminary T4 testing can reveal congenital hypothyroidism when TSH is elevated. If either T4 or TSH is found to be abnormal during preliminary screening, the other parameter should be monitored. Early diagnosis and prompt treatment are crucial in preventing intellectual disabilities in newborns. Material and Method: The present cross-sectional research will be conducted in collaboration with the Departments of Biochemistry, Obstetrics and Gynecology, Community Medicine, and Pediatrics at Jawaharlal-Nehru Medical College Sawangi (Meghe) Wardha, along with the Datta-Meghe Institute of Medical Science (Deemed University) in Maharashtra, India, and Datta-Meghe Medical College, Shalinitai Meghe Hospital and Research Centre, Nagpur. Results: A total of 272 neonates were tested for Congenital Hypothyroidism (CH) from the study area of the Vidarba region in which 138 neonates were from the rural area and 134 neonates were from the urban area. A total of 144 (53%) males and 128 (47%) females were born in rural and urban areas. In the neonates, it was observed that the Mean ± SD for free T4 and TSH was 0.84 ± 0.15 and 3.83 ± 2.12, respectively. If the free T4 value was less than the lower limit, the TSH value CB ≥25 μIU/ml and plasma ≥10 μIU/ml was considered as screen positive in the present study. Conclusion: Newborn screening programs were established to assess neonates at birth by measuring (TSH) levels. In many screening programs, TSH is the primary marker for evaluating thyroid function and is the preferred test for clinicians diagnosing various thyroid disorders. However, TSH levels can vary significantly and exhibit a broad reference range within the general population, which presents challenges in interpreting the results during newborn screening and in using it later as a clinical diagnostic tool for thyroid function.

Cardio-metabolic risk and morbidity of a cohort in a rural community of Bangladesh

Background and objectives: Of the ever-increasing non-communicable diseases (NCDs), cardiometabolic morbidity and mortality constitute the major health burden world-wide. Several cross-sectional studies revealed the increasing prevalence of NCDs irrespective of cast, culture, ethnicity, socio-economic growth and geopolitical environment. Recent cross-sectional studies revealed South Asians are the most susceptible to cardiovascular diseases (CVD). Few cohort studies addressed cardiometabolic morbidity and related risks, particularly in the rural population.This study was carried out to find out the prevalence of metabolic syndrome (MetSyn) and its changes overtime in a rural cohort of Bangladesh. Methods: The study used baseline data of a study conducted in 2011- 2013 on prevalence of coronary artery disease among a cohort living in 16 villages. During 2021-2023, the baseline data collected in 2011-2013 were retrieved and the participants were searched and categorized into a) physically present, b) died and c) missing. Those who were present were requested to volunteer for re-investigations. Briefly the investigations included interviewing on social, family, personal and clinical history, anthropometry, blood pressure measurement, blood biochemistry and electrocardiography (ECG). Results: A total of 3928 people participated in baseline study of 2011- 2013. Of them, 1075 could be tracked by village and household. Of them, 953 were found alive. Of the 953 available participants, 651 (254 men and 397 women) volunteered to participate in 2021-2023 study. Compared to 2011-2013 baseline, the prevalence of MetSyn and type 2 diabetes mellitus (T2DM) increased to 31.6% and 5.2% from 7.5% and 0.8% respectively in 2021-2023. Similarly, compared to baseline, the prevalence of obesity and hypertension also showed significant increase overtime. Estimated incidence of MetSyn was 260.8 per 1000 population, which was more profound in women than men (W: M= 300.3:200.8). Conclusions: The study revealed a significant increase of obesity, hypertension, diabetes and metabolic syndrome within a decade indicating an emerging health burden among the rural people of Bangladesh. January 2025; Vol. 19(1):003. DOI:https://doi.org/10.55010/imcjms.19.003 *Correspondence: MA Sayeed, Department of Community Medicine, Ibrahim Medical College, 1/A Ibrahim Sarani, Segunbagicha, Dhaka 1000, Bangladesh. Email: sayeed950@gmail.com; © 2025 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License(CC BY 4.0).

Performance evaluation of secured storage access control system for public health records in cloud computing

Performance evaluation of secured storage access control system for public health records in cloud computing

Identification and Immunological Characterization of Annexin B8 and Annexin E1 from Spirometra Erinaceieuropaei Spargana.

Sparganosis is a parasitic zoonotic disease that poses a serious threat to public hygiene and human health. Annexin is a phospholipid-binding protein with calcium ion binding activity, serving various important functions, including interaction with the parasite and regulation of the host's immune response. In this study, two annexin (ANX) family genes, Spirometra erinaceieuropaei (S. erinaceieuropaei) Annexin B8 (SeANXB8) and E1 (SeANXE1), isolated from spargana, were cloned and immunologically characterized. Both recombinant S. erinaceieuropaei Annexin B8 (rSeANXB8) and E1 (rSeANXE1) were specifically recognized by serum from rats immunized with the recombinant proteins, displaying strong immunoreactivity. They are also among the major components of sparganum excretion/secretion products (ESPs). SeANXE1 was identified in the parasite's tegument, testis, genital pore, ovary, and eggs, while SeANXB8 was found in the parasite's tegument and eggs. Plasminogen (PLG)-binding assays revealed that the two annexins could bind to human PLG in a concentration-dependent manner, which was blocked by the corresponding antibodies. These findings suggest that SeANXB8 and SeANXE1 may be involved in host-parasite interaction and may influence the host's immune response during sparganosis. They could be potential diagnosis and vaccination targets for sparganosis.

Analysis of Cross-Sectional Study in Adverse Childhood Experiences

Abstract: Adverse Childhood Experiences (ACEs) are a burgeoning issue that has gained increasing attention from scientists. The general traumatic effect of ACEs can be found all over the world. With the serious potential effect, public health scientists are now devoted to mitigating its adverse effects by uncovering its relationship with various health issues and trying to mitigate its negative effects. This article has discussed how scientists, use Cross-Sectional Study as an analysis approach. The Cross-Sectional Study allows public health scientists to reveal the relationship between ACEs and various health problems. The findings of the research have provided crucial information for public health strategy and promote the mitigation of ACEs negative effects within communities. This research uses a cross-sectional study to analyze how ACEs affect different populations, allowing for the collection of large-scale population data at a specific time and facilitating the examination of associations between different variables. This method is particularly well-suited for analyzing ACEs. By gathering and analyzing data on ACEs from a diverse population, the correlation between ACEs and health problems across different demographic groups can be uncovered. ACEs will cause significant mental health for people and remain even when they become adults. Thus, it is necessary for public health organizations to mitigate the effects of ACEs.

A peer teaching module for medical residents on critical appraisal of medical articles: context and pilot testing

BackgroundThe ability of healthcare providers to access and use published research correctly is crucial for the quality of healthcare services, enabling selection of the most effective treatment modalities, and avoidance of medical errors. Physicians need strong critical appraisal (CA) skills to manage rapidly evolving medical knowledge.MethodsA standard peer-teaching module was prepared for medical residents on CA. The module included topic-specific educational materials, discussion articles, and question sets and was pilot-tested among medical residents, allowing for revisions based on participants’ feedback. Training module was prepared by a senior epidemiologist and a community medicine (public health) resident, based on the context of a similar graduate course; the resident underwent four months of personal training preceding the pilot testing, which was conducted as a 12-week program in September-November 2023, supervised by experts. Online training extended our reach to resident working nationwide. Recruitment was enabled via social media and various medical specialty organizations. Evaluations included initial, session-specific, and final tests for measuring progress in knowledge on CA, based on participants’ self-assessments, and external auditors’ scoring of the process.ResultsA total of 52 residents from 19 universities and nine specialty programs participated in pilot testing. Of these, 48 completed the program through the post-test, with 83% (n = 40) scoring above 65%, received a certificate of achievement. Median scores showed a 32% increase in knowledge, a 75% increase in confidence in CA skills, and a 50% decrease in stress-related to CA practice. Additionally, 82.5% (n = 33) of those who completed the module expressed interest in offering similar training sessions to their local peers.ConclusionThe online peer teaching of the CA module successfully increased participants’ knowledge and self-confidence in critical appraisal.Clinical trial numberNot applicable.

Developing and validating a knowledge, attitude, and practice questionnaire regarding dengue among secondary schoolchildren in Malaysia

IntroductionDengue is a viral disease borne by mosquitoes that infects humans that is a significant public health concern and socio-economic burden globally, especially in countries in the tropics and subtropics. Health education and community participation are the most powerful prevention strategies. Assessing local community knowledge, attitude, and practice (KAP) on dengue is essential for targeted interventions, as enhancing KAP helps communities recognize risks, adopt preventive attitudes, and implement effective measures to reduce dengue transmission. This study developed and validated a questionnaire on dengue KAP among secondary schoolchildren. Questionnaires serve as essential tools in research, allowing for standardized measurement of knowledge, attitudes, and practices, which supports accurate data collection and meaningful analysis.MethodsThe development and evaluation process (structure and content) involved consultations with eight experts including public health medicine specialists, medical officers, behavioural insights officer, academician, and entomologist, to ensure the relevance and comprehensiveness of the questionnaires. A QDengue-KAP questionnaire was administered to 30 secondary schoolchildren in Kuala Lumpur, Malaysia. The online questionnaire was self-administered, closed-ended, distributed anonymously, and participation was voluntary.ResultsThe final questionnaire comprised four sections and 50 items after the initial version had undergone a rigorous evaluation to ensure its reliability and validity. The content validity index (CVI) and content validity ratio (CVR) values exceeded the minimum requirement and indicated that all items met the minimum standards for content validity. Compared to the initial version, the final version of the questionnaire had improved Cronbach alpha values for each dengue KAP domain: knowledge [Cronbach’s alpha: 0.765 (items: 15)], attitude [0.894 (15)], practice Part A [0.735 (15)], and practice Part B [0.876 (5)]. Thus, each statement in the Knowledge (K), Attitude (A), and Practice (P) domains was deemed valid through validity and reliability evaluation, ensuring their relevance and accuracy in assessing dengue-related factors.ConclusionThe validation process demonstrated that each statement in the KAP domains was relevant, accurate, and aligned with the study's objectives, supported by expert validation and representation of the target population. This rigorous approach strengthens the validity and reliability of the questionnaire, making it a valid tool for assessing and improving dengue-related behaviours within the target population.

Pesticides and risk of pancreatic adenocarcinoma in France: a nationwide spatiotemporal ecological study between 2011 and 2021.

While pancreatic adenocarcinoma (PA) incidence is increasing, especially in France, the association between pesticides and PA remains unclear. The aims of this study were to assess the spatiotemporal distribution of the incidence of PA in France between 2011 and 2021 and to determine whether pesticide exposure was associated with higher risk of PA. We employed a disease-mapping and ecological regression approach with medicoadministrative data covering 99% of the French population. Exposure data were drawn from an open purchase database. A pesticide exposure intensity index (PEXI), defined as the logged and scaled median of the ratio quantity of substance over agricultural surface per spatial unit was used for total quantity (total PEXI) and 9 specific substances. The analyses were adjusted for tobacco-induced diseases, deprivation, community medicine accessibility, alcohol-related disease and morbid obesity. A Bayesian hierarchical spatiotemporal model was used to both model the incidence over time and space, and to estimate the risk of PA for pesticide use. We identified 134102 incident cases of PA between 2011 and 2021. The relative risk of PA was heterogeneous across space with greater risk around Paris, central France and the Mediterranean coast. We observed an association, albeit small, between the total PEXI and PA incidence over the study period (RR: 1.0130; CI95% [1.0057;1.0204]). Sulphur for spraying, mancozeb, and glyphosate showedevidence of an association of the same magnitude. These findings show that new cases of PA occur heterogeneously in space, raising questions about our understanding of PA environmental risk factors. The association with pesticide exposure should be confirmed and underlying mechanisms understood using individual-level studies.

Vaccine Hesitancy and Its Epistemic Antecedents: A Meta-Analysis

ABSTRACT Although much attention has been given to vaccine hesitancy, there is still considerable ambiguity regarding its epistemological antecedents. The current meta-analysis addresses this theoretical and practical gap by focusing on the interplay between trust, belief in conspiracy theories, and COVID-19 vaccine hesitancy (k = 32), as well as key moderators such as the availability of the vaccine and the state and progress of the pandemic. Overall, results indicate that while both trust and beliefs in conspiracy theories are important correlates of vaccine hesitancy, considerable difference emerges when adopting a more granular approach that distinguishes between types of trust (government, public health organizations, science, and healthcare professionals/providers) and conspiracies (specific versus general). These findings cement the importance of health communication, not only as a useful framework to study and understand vaccine hesitancy but also as a potential way to intervene in order to prepare for future infectious disease outbreaks.

Strengthening Academic Public Health Programs and Workforce Development Through Fieldwork: Insights From a Novel Partnership Between New Mexico's Two Major Universities.

Our collaboration to strengthen applied practice in public health training between two public universities in New Mexico has offered us insight into the types of institutional, administrative, and programmatic support beneficial for navigating work with limited resources and varying geographic considerations. We share some lessons from this burgeoning partnership between University of New Mexico's (UNM) College of Population Health and New Mexico State University's (NMSU) Department of Public Health Sciences which began in 2022. The main areas of learning focus on exchanging resources to extend relationships with fieldwork sites and site supervisors, engage and support students in their planning and implementation of their fieldwork, and identify institutional resources to maintain and grow programmatic quality. Implications from this work include efforts to reinforce the public health workforce pipeline, especially to ensure the participation and success of students from underrepresented backgrounds.