European Rates Research Articles

EPID-16. GENOMIC ANCESTRY-RELATED RISK RATIOS FOR GLIOBLASTOMA INCIDENCE AMONG GLOBAL POPULATIONS AND RACIAL/ETHNIC GROUPS WITHIN THE UNITED STATES

Abstract Glioblastoma (GBM) incidence varies globally, elevated rates in Europe and lower rates in Asia, Latin America, and Africa. While partially attributable to national differences in cancer diagnosis and reporting practices, analogous patterns exist within diverse Western nations. Ancestry-associated differences in GBM risk allele frequencies (RAFs) could contribute, a hypothesis supported by our prior multiethnic genome-wide association studies (GWAS). Leveraging variant effect estimates from large GBM GWAS datasets and ancestry-stratified allele frequency data from diverse reference populations (ALFA, GNOMAD, 1000 Genomes Project), we estimate the extent of GBM incidence differences across populations that can be attributed to underlying variation in RAF at the seventeen known GBM risk loci. Aggregate differences in RAF between global populations (Europe, West-Africa, East Asia) were associated with a >20% reduction in the normalized GBM risk-ratio (RR) in Africans compared to Europeans (RR=0.78) and a >50% reduction in East Asians compared to Europeans (RR=0.47). The frequency of GBM risk alleles was generally highest in Europeans, but four alleles found most commonly in Africans are at loci regulating telomere maintenance (TERC, TERT, OBFC1/STN1, RTEL1). We repeated analyses using RAF data from U.S. populations (African-Americans, Latinos, and non-Hispanic Whites). Compared to non-Hispanic Whites, aggregate differences in RAF were associated with a 15% reduction in GBM risk among African-Americans (RR=0.85) and a 28% reduction among Latinos (RR=0.72). We conclude that a sizable proportion of the reduced GBM incidence in Latinos and Asians, relative to non-Hispanic Whites, can be accounted for by population-level differences in RAF at known loci. However, registry-based analyses consistently report a two-fold lower incidence of GBM in African Americans relative to non-Hispanic Whites which is poorly explained by RAF differences at known loci. Further work is needed to identify structural, environmental, and biological factors contributing to unresolved differences in GBM incidence.

A Health Economics Inquiry into Regulatory Constraints on the European Tobacco Market.

Despite the implementation of significant measures by European countries in recent years, smoking rates in Europe remain persistently high. TheEuropean Commission is currently undertaking a comprehensive review of itstobacco regulations. This article aims to address critical inquiries that arise during the amendment of the regulatory framework. We evaluate the effectiveness of existing tobacco control methods and observe a diminishing impact on promoting smoking cessation. Additionally, we explore how individuals of varying genders respond to the regulatory environment. We propose a comprehensive and evidence-based framework for implementing a taxation system in response to the proliferation of emerging products, including e-cigarettes and heated tobacco. This system is designed to align effectively with health policy objectives, providing a strategic approach to curbing tobacco use and promoting public health.

Planning policies to restrict fast food and inequalities in child weight in England: a quasi-experimental analysis.

England has one of the highest childhood obesity rates in Europe. To promote a healthier food environment in 2015, Gateshead Council in North East England introduced planning guidelines effectively banning any new fast-food outlets. Our aim was to investigate whether this policy led to any reductions in childhood overweight and obesity prevalence and the inequalities in these outcomes. We used data from the National Child Measurement Programme, the Food Standards Agency Food Hygiene Rating Scheme data, and the Office of National Statistics between 2012 and 2020. We estimated a difference-in-differences model employing propensity score matching to identify a control group. We found no significant change in population-level childhood overweight and obesity in Gateshead compared with control areas. In subgroup analysis by area-level deprivation, we found that the quintile of deprivation with the highest proportion of fast-food outlets had a statistically significant reduction of 4.8% in the prevalence of childhood overweight and obesity compared with control areas. Restricting fast-food outlets in areas with a high concentration of such outlets as part of a package of policies to reduce childhood obesity may help to reduce prevalence and inequalities in childhood overweight and obesity.

The Association between the Firmicutes/Bacteroidetes Ratio and Body Mass among European Population with the Highest Proportion of Adults with Obesity: An Observational Follow-Up Study from Croatia.

Background/Objectives: The phyla Firmicutes and Bacteroidetes are the main constituents of the gut microbiota. An imbalance in the gut microbiota is a sign of dysbiosis, and the Firmicutes-to-Bacteroidetes ratio has been proposed to be a marker of it, especially in the context of obesity. Since Croatia is the country with one of the highest obesity rates in Europe, a pilot observational study was conducted. The aim of the study was to investigate the validity of this potential biomarker in a methodological study using sample processing, DNA sequence analysis and characterization of recruited participants, including various health factors. Methods: A study involving Croatian population was conducted. Participants age, body weight, gender, health history and lifestyle factors were recorded. Gut microbiota composition was analyzed using 16S rRNA sequencing. The F/B ratio was calculated and evaluated in the context of health factors. Statistical analysis was performed to detect the possible association of F/B ratio and excess body weight (kg) and possible impact of certain lifestyle factors. Results: No association between the F/B ratio and excess body weight (kg) was found. Excess body weight was significantly associated with higher age, male gender, and history of appendectomy. No significant health predictors of the F/B ratio were found, but weight gain was positively associated with a higher average F/B ratio. Conclusions: Although this study could not confirm the predictive value of the F/B ratio or any other phyla-related biomarker for excess body weight in the study population, it demonstrated interesting insights into the obesity-associated gut microbiota.

The Epidemiology of Biliary Tract Cancer and Associated Prevalence of MDM2 Amplification: A Targeted Literature Review.

Biliary tract cancer (BTC) is a rare and aggressive malignancy that is anatomically classified as gallbladder cancer (GBC), extra- and intra-hepatic cholangiocarcinoma (eCCA and iCCA) and ampullary cancer (AC). BTC is often diagnosed at an advanced stage when treatment options are limited and patients have a poor prognosis, so the identification of new drug targets is of critical importance. BTC is molecularly diverse and harbours different therapeutically actionable biomarkers, including mouse double minute 2 homolog (MDM2), which is currently being investigated as a drug target. The aim of this targeted review was to evaluate and synthesise evidence on the epidemiology of BTC and its subtypes in different geographic regions and on the frequency of MDM2 amplifications in BTC tumours. Epidemiological studies (N=33) consistently demonstrated high incidence rates in South and Central Asia for BTC overall (up to 9.00/100,000) and for all subtypes, with much lower rates in Europe and the US. Among the different types of BTC, the highest global incidence was observed for CCA, mainly driven by iCCA (1.4/100,000), followed by GBC (1.2/100,000) and AC (0.18-0.93 per 100,000). Studies of MDM2 in BTC (N=19) demonstrated variable frequency of MDM2 amplification according to subtype, with consistently high MDM2 amplification rates in GBC (up to 17.5%), and lower rates in CCA (up to 4.4%). The results from this literature review highlight the geographic heterogeneity of BTC and the need for standardised clinicopathologic assessment and reporting to allow cross-study comparisons.

Strategies for Worker Training and Information in Occupational Safety and Health (OSH)

Introduction: All workers have the right to work in safe and healthy conditions, a fundamental right recognized in several global regulations. Portugal, however, has one of the highest accident rates in Europe, which raises doubts about the adequate implementation of labor legislation. Methodology: This study analyzes the contents of the training courses offered by several companies, verifying whether they are up to date and relevant to the specific risks of each sector and function of the workers. In addition, the teaching methodologies and the means used to communicate information are evaluated. Results: The study identifies strategies that allow for the delivery of training in occupational health and safety in a differentiated way, aiming at building a more solid safety culture. Discussion: The results indicate that, although there is training in occupational health and safety, it is necessary to better adapt the contents to the specificities of the sectors and ensure that the methodologies are effective in transmitting knowledge. Conclusions: The implementation of differentiated and updated training can significantly contribute to the creation of a robust safety culture and the reduction of workplace accidents in Portugal.

Are Younger Students More Likely to Drop Out? Spanish Evidence on the Moderator Role of Gender and Social Origin

ABSTRACTEarly school leaving (ESL) is considered one of the most serious problems in the functioning of European education systems. In particular, Spain has traditionally exhibited one of the largest ESL rates in Europe. This study aimed to shed light on the role of the month of birth as a factor conditioning the probability of ESL. Using high‐quality census data and a regression discontinuity design, we documented that Spanish males from lower social strata born before the school‐entry cut‐off are substantially more likely to be observed as early school leavers than their counterparts born after that date. We do not find such effect among females or males from other social strata. Overall, educational policy should target more seriously the inequalities associated with the month of birth as they do not vanish before affecting relevant decisions such as leaving education early, at least for males from lower social strata.

The impact of the first year of COVID-19 pandemic on suicides in a collection of 27 EU-related countries

Disasters, including epidemics, have a characteristic course, both in terms of the specific events and the human reactions to them. However, it is difficult to predict whether the COVID-19 pandemic will eventually lead to an increase in suicide rates. We aimed to provide a general pattern of the change in suicide rates in the countries linked to the European Union by direct comparison of the years 2019 and 2020 by gender and age group, grouped according to the predominant religions. Overall, 27 countries were included in the analysis. Incidence rate ratios and their 95% confidence intervals were calculated to characterise annual changes in the incidence of suicide deaths. In almost two-thirds of the countries studied, suicide rates did not increase. The largest increases were observed in Catholic-majority and ‘mixed’ Catholic-Protestant countries, but this was significant only for the oldest age group (over 65 years). This increase was even more marked within some Catholic-majority countries (Hungary, Ireland, and Spain) during the first months of the pandemic. There was no statistically significant increase overall in the suicide death rates in Europe. However, the pattern of suicide rates has changed significantly in some countries, and by age group and religion, respectively.

A Mediation Model of Food Literacy: A Potential Relationship between Body Image Dissatisfaction and Body Mass Index.

Background and Objectives: The global rise in obesity presents a significant public health challenge, with Turkey exhibiting one of the highest obesity rates in Europe. Body image dissatisfaction (BID) and lower food literacy (FL) have been associated with obesity, yet their interplay remains underexplored. This study aimed to investigate the relationship between body mass index (BMI), body image dissatisfaction, and FL in adults in Turkey. Materials and Methods: In total, 759 women and 419 men aged 18-64 years old were included in this study. The mean age was 31.34 ± 11.92. A total of 1178 participants completed an online questionnaire assessing anthropometric measurements, BID, using the Stunkard Figure Rating Scale, and FL, using a validated questionnaire. The data were analyzed using descriptive statistics, correlation analysis, and mediation analysis to explore the relationships between variables in SPSS 24.0. Results: Women desired to be thinner more frequently than men, and those with negative BID were predominantly individuals with overweight or obesity. Moreover, those with higher FL scores were more likely to be satisfied with their bodies. Correlation analysis demonstrated a negative relationship between BMI and FL (r = -0.94; p = 0.001) and a positive relationship between BMI and BID (r = 0.628; p < 0.001). Mediation analysis revealed that FL mediated the relationship between BID and BMI (β = -2.281; lower limit = -3.334, upper limit = -1.228). Conclusions: The findings highlight the importance of addressing BID and enhancing FL to mitigate obesity risk factors. This study contributes to understanding the complex interplay between BID, FL, and obesity, providing insights for public health interventions aimed at obesity prevention and management.

Redefining family structures: Births out of wedlock in 21st century Greece

AbstractThis study explores Greece's unique position as the country with the lowest nonmarital childbearing rate in Europe. The socio‐demographic profile of mothers is being analysed in three categories of marital status: married, unmarried, and in civil partnership. Unpublished data, custom‐made exclusively for this study from the Hellenic Statistical Authority (ELSTAT), have been used, spanning from 2019 to 2021. Key focus areas include maternal age at childbirth, educational attainment, and nationality (Greek, EU27 except for Greek, and non‐EU). Geographical analysis is conducted at the Regional Unit level (Nomenclature of territorial units for statistics [NUTS] 3 classification). Findings reveal that Greek teenage and early twenties mothers, as well as those with low educational level, are more likely to be unwed, implying that maternity might have come because of an unplanned pregnancy. On the other hand, those in civil partnerships resemble married mothers in age and educational attainment. Non‐Greek nationals show a higher prevalence of nonmarital births, and a sociodemographic profile that implies that unwed maternity constitutes a conscious choice for them. This study not only illuminates the characteristics of unwed mothers in Greece but also provides empirical insights for evaluating prevailing theoretical frameworks regarding family dynamics in countries facing low fertility rates.

INVESTMENT ENVIRONMENT OF THE NETHERLANDS

The paper offers a comprehensive review of the investment environment in the Netherlands, a nation noted for its advanced economy, robust international trade links, and a solid legal framework that supports business activity. The Netherlands features a stable political environment, transparent governance, and administrative efficiency, creating a reliable backdrop for investment. This climate is conducive to innovation and attracts foreign direct investment, especially due to an advantageous tax system. The workforce in the Netherlands is highly skilled and multilingual, which is a critical asset, though the high labor costs could be seen as a deterrent. However, these costs are often offset by the high productivity and the business-friendly policies of the government. The Dutch market is well-connected and integral to the European trade landscape, making it a strategic entry point into the European Union. Transport and logistics infrastructure, particularly the Port of Rotterdam—the largest port in Europe—plays a crucial role in facilitating trade not only across Europe but globally. This infrastructure is supported by a top-tier digital network and service sector, with the Netherlands boasting one of the highest broadband penetration rates in Europe. Despite its many advantages, the investment climate in the Netherlands does face challenges such as regulatory complexity and stringent environmental regulations. These challenges are balanced by the country’s commitment to sustainability and the green economy, which opens up new investment opportunities in renewable energy and sustainable technologies. Furthermore, the Netherlands is proactive in fostering a favorable business environment through various government initiatives. These include incentives for research and development, enhancements in sustainable business practices, and subsidies for green energy projects, all aimed at maintaining the country’s competitive edge. The Dutch government’s approach to international business is also characterized by a network of treaties designed to protect foreign investments and prevent double taxation, making the Netherlands an attractive destination for multinational corporations. The presence of a strong legal system ensures that property rights and contracts are well protected, which is a critical consideration for investors. In conclusion, the Netherlands presents a balanced spectrum of opportunities and challenges. While the high cost of operations and regulatory demands pose hurdles, the strategic advantages, robust infrastructure, and government incentives create a favorable environment for significant investment returns. This detailed analysis serves as an essential guide for potential investors, providing insights into both the macroeconomic stability and sector-specific prospects within the Dutch market.

PENGARUH EKONOMI EKSTERNAL DAN INTERNAL TERHADAP TABUNGAN DI NEGARA-NEGARA MAJU DI EROPA

Savings are very important because they can provide financial security by setting aside a portion of income, so that you have reserve funds for urgent or future needs, and can overcome unexpected financial situations and provide long-term financial freedom. There are two factors influence savings, namely internal factors include economic growth and general government debt, while external factors include fuel imports and foreign direct investment. The aim of this research is to determine the impact of the external and internal economy on savings in developed countries with the highest economic growth rates in Europe. The data analysis technique used is panel regression. The research results show that economic growth has a positive effect on savings, while imports of steel materials and direct investment have a negative effect on savings. Only the general government debt variable has a negative and insignificant effect on savings in developed European countries, including Germany, Italy, Spain, the Netherlands, Switzerland.

The relationship between a comprehensive index of prosperity and suicide rates in former Soviet countries, including a comparison with European and Asian countries: Discussion from a new perspective

Investigations of suicide in countries of the former Soviet Union, which broke into 15 different countries in the early 1990s, require examinations of a combination of economic, social, and health factors. It is important to address these factors individually and to examine the various composite indicators for each. Moreover, it would be worthwhile to explore the potential applicability of a comprehensive worldwide index. We analyzed data from nine of the former Soviet countries for which both the annual suicide rate and the Global Competitiveness Index (GCI) were available for the years 2006–2017. We determined the precise relationships between the suicide rate and the GCI during this period in these nine countries as well as in nine countries with high suicide rates in Europe and Asia. The results indicated the following: (i) In six of the nine former Soviet countries with complete data, the suicide rate showed a relationship with the GCI. Notably, this relationship was inverse in all but one country. (ii) Among the nine European and Asian countries with high suicide rates, three exhibited a correlation between the suicide rate and the GCI. Measures to prevent suicide should be devised especially in countries of the former Soviet Union through collaboration among multiple fields and organizations, as necessary, with particular attention paid to countries with worse or worsening GCI values.

Global and regional prevalence of polypharmacy and related factors, 1997–2022: An umbrella review

ObjectiveLimited comprehensive evidence exists on the global prevalence of polypharmacy. This knowledge gap contributes to increased healthcare system costs and related public health concerns. Thus, we aimed to synthesize the current evidence on polypharmacy prevalence and associated factors in the general and older populations using an umbrella review. MethodsOur primary outcomes were global prevalence and related indicators of polypharmacy. We systematically searched Google Scholar, PubMed/MEDLINE, Embase, and CINAHL for studies published between the inception of each database until April 30, 2023. ResultsEleven meta-analyses incorporating 295 studies and 59,552,762 participants from 41 countries across six continents were identified. The global prevalence of polypharmacy in the general population is 37 %, with higher rates in older individuals (45 %), outpatients (48 %), and inpatients (52 %). North America showed a higher prevalence (52 %) than Asia (36 %) and Europe (36 %). Among frail elderly individuals, the prevalence of polypharmacy is 59 %, with the highest rates in Europe (68 %) and hospital settings (71 %). ConclusionThe global prevalence of polypharmacy and its associated factors in older adults present a complex, multifaceted, and conflicting picture. Understanding the prevalence of polypharmacy and its associated factors may help reduce the number of multidrug prescriptions.

Systematic Literature Review on the Incidence of Herpes Zoster in Populations at Increased Risk of Disease in the EU/EEA, Switzerland, and the UK.

Older adults and patients with underlying conditions such as immunocompromised (IC) populations (e.g., due to medical conditions or immunosuppressive medication) are at increased risk for herpes zoster (HZ). The first HZ recombinant vaccine for IC patients was approved in 2020. Limited evidence exists to inform decision-makers on HZ incidence in high-risk patients in Europe. This systematic literature review (SLR) assessed HZ incidence across 14 high-risk populations in the European Union/European Economic Area, Switzerland, and the United Kingdom. An SLR (Embase, Medline, 2002-2022, observational studies) was performed to identify HZ incidence (i.e., primary outcomes: rate or cumulative; secondary: relative incidence) in type 1 and 2 diabetes mellitus (DM); chronic obstructive pulmonary disease and asthma; depression; rheumatic disorders (RD); multiple sclerosis (MS); inflammatory bowel diseases (IBD); psoriasis; lupus; human immunodeficiency virus (HIV); solid organ transplantation (SOT); solid organ malignancy (SOM); hematologic malignancy (HM); and stem cell transplantation (SCT). Of 776 unique records screened, 59 studies were included (24 reported incidence rate per 1000 person-years; two, cumulative incidence per 1000 persons; and 33, relative incidence). The highest incidence rates were reported for SOT (12.1-78.8) and SCT (37.2-56.1); HM (2.9-32.0); RD (0.41-21.5); lupus (11.0-16.5); IC mixed population (11.3-15.5); HIV/AIDS (11.8-13.0); chronic respiratory diseases (4.7-11.4); SOM (8.8-11.0); IBD (7.0-10.8); DM (4.3-9.4); depression (7.2-7.6); MS (5.7-6.3); and psoriasis (5.3-6.1). In many high-risk populations, HZ incidence was higher for older age groups, women, and some treatments. The HZ incidence rate in Europe increased with age and varied across high-risk populations, with high rates for solid organ and stem cell transplants, cancer, and rheumatoid arthritis. Most studies were retrospective with methodological differences affecting generalizability and comparability. Future studies should stratify data by IC population, age, sex, severity, medication, and study timeframe.

Potential cellular intravesical therapy for non-muscle invasive bladder cancer: Nectin-4 targeted CAR-T cell therapy

Bladder cancer poses a significant global health challenge, particularly with its prevalence in males and the increasing incidence rates in Europe. While non-muscle invasive bladder cancer can be managed with localized treatments, its recurrence remains a concern. Intravesical Bacillus Calmette-Guérin therapy triggers an immune response against cancer cells, yet recurrences post- transurethral resection of bladder tumor persist. Thus, innovative strategies are needed. We propose the use of Nectin-4 targeted chimeric antigen receptor T cell therapy to prevent non-muscle invasive bladder cancer recurrence and progression. Nectin-4 is expressed in non-muscle invasive bladder cancer, making it an ideal target. CAR-T cells engineered with Nectin-4 receptors can specifically eliminate cancer cells. By directly applying these cells intravesically, the limitations of CAR-T cell access to solid tumors are circumvented. However, challenges persist, such as the immunosuppressive microenvironment of bladder cancer. This can be addressed by combining intravesical Bacillus Calmette-Guérin with CAR-T therapy or utilizing immune checkpoint inhibitors. CAR-T therapy-related toxicities, like cytokine release syndrome, can be managed with IL-6 and IL-1 receptor inhibitors. Our hypothesis suggests that Nectin-4 targeted CAR-T cells have the potential to revolutionize bladder cancer treatment. This therapy could not only eliminate cancer cells but also prevent recurrence and progression by inducing immune memory. Although further research is needed, this innovative approach shows promise in the treatment of non-muscle invasive bladder cancer.

The ‘demographic winter’ in Italy: Crisis factors, problematic issues and policy actions

Demographic issues are becoming key to the debate on the future of Europe, and of Italy in particular, which has the lowest birth rate in Europe but is among the top-ranked countries for demographic ageing. The general improvement of living conditions and the ageing of large cohorts cannot be supported by the economic activity of the younger generations, which calls into question the security of certain aspects of the social pact, such as the provision of pensions and health care. While encouraging an awareness among Italians of the trends and problems they will have to deal with, all national actors must cooperate to ensure the recovery of the birth rate, and to harness the economic benefits of incoming migrants and the experiences of older people. It is equally necessary to meet the needs of young people and enhance their social role. Only through such cooperation will it be possible to create a favourable climate for actions that will allow us to control and direct these demographic phenomena and not to suffer from them.

Analysis of the impact of socio-economic factors on the number of suicide cases in European countries

Suicide rates in Europe have in the recent years reached a disturbingly high level, sparking frequent discussions on the topic of mental health and suicide prevention, which significantly affect not only individuals but also their environment. The aim of this paper was to analyse the impact of the socio-economic situation on suicide rates using panel data analysis. The study presents an overview of the related literature and the definitions of essential terms concerning suicide, as well as the socio-economic factors determining suicide rates. The parameters of a fixed effects model were estimated, interpreted and compared with the results of earlier research. The analysis of the selected dataset showed that GDP per capita and the Gini coefficient have a negative and statistically insignificant impact on suicide rates. On the other hand, the conducted research showed that high divorce and unemployment rates, risk of poverty, social exclusion and excessive alcohol consumption proved to be statistically significant, thus increasing suicide rates.

The effect of temperature on birth rates in Europe

Using data from 32 European countries for nearly 244 million live births between 1969 and 2021, this paper examines the effects of temperatures on birth rates. The results show that exposure to hot days slightly reduces birth rates five to eight months later, while much stronger negative effects are observed nine to ten months after exposure to hot temperatures. Thereafter, a partial recovery is observed, with slightly increased birth rates. This study also shows that the effect of high-humidity hot days is much stronger than that of hot days with low humidity. Besides, the effect of heatwave days has been found to be more severe than that of hot days that are not preceded by other hot days. This study finds that some adaptation to heat might be expected only in the long run.

A Review: Hospital Acquired Infection in Some Gram Negative Pathogenic Bacterial Strains

Objective: This review aims to update healthcare workers on the current scientific understanding of hospital-acquired infections, witha focus on describing the pathophysiology and patterns of antimicrobial resistance, particularly concerning Pseudomonas aeruginosa,Acinetobacter baumannii, and Klebsiella pneumoniae. Methods: Data on hospital-acquired infections were collected globally, with a specific emphasis on the Eastern Mediterranean, South-East Asia, Europe, and the Western Pacific regions. Infection rates, predominant pathogens, and antimicrobial resistance patterns were analyzed to provide insights into the current landscape of nosocomial infections. Results: Hospitals in the Eastern Mediterranean and South-East Asia regions reported the highest rates of nosocomial infections (11.8%and 10.0%, respectively), while rates in Europe and the Western Pacific were 7.7% and 9.0%, respectively. Infections typically arise frominvasive medical equipment and surgical operations, with lower respiratory tract and bloodstream infections being particularly hazardous. Gram-negative bacterial infections, notably, exhibit worrisome antibiotic resistance patterns, potentially developing multiple mechanisms against various antibiotics. Conclusion: The emergence of antimicrobial resistance presents a significant threat to patient safety, compounded by challenges indiscovering new antibiotics. Factors such as high costs and lengthy drug development processes contribute to this concern. Healthcareworkers must remain abreast of evolving antimicrobial resistance patterns, especially concerning pathogens like Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, to implement effective infection control measures and preserve the efficacy of existing antimicrobial agents.