Health Strategy Research Articles

Hypertension and iron deficiency anemia: Exploring genetic associations and causal inference

Background and aimObservational studies have suggested a potential association between hypertension and Iron deficiency anemia (IDA). However, it is unclear whether there is a genetic and causal link between hypertension and IDA. Methods and resultsGenome-Wide Association Studies (GWAS) data for hypertension were sourced from the UK Biobank and FinnGen. Genetic variants data for IDA were extracted from FinnGen and the IEU Open GWAS project, all derived from European populations. The genetic association between hypertension and IDA was assessed using Linkage Disequilibrium Score Regression (LDSC), with MR employed to determine causality. Inverse variance weighted (IVW) as a major analytical method for MR. Sensitivity and heterogeneity analyses were conducted to ensure result reliability. Furthermore, validation analysis was performed to further strengthen the robustness of the findings. A genetic association between hypertension and IDA was observed (rg = 0.121, P = 0.002). Our findings suggest that hypertension increases the risk of developing IDA (OR = 2.493,P = 0.038), and IDA maybe serve as a risk factor for hypertension (OR = 1.006,P < 0.001). Validation analysis yielded consistent results. Importantly, our findings demonstrated no heterogeneity or horizontal pleiotropy. ConclusionRegular testing of iron ions and anemia-related markers in hypertensive patients is crucial for early identification of IDA. If necessary, oral iron supplementation can be prescribed to prevent IDA for hypertensive patients. Furthermore, it is imperative to closely monitor the blood pressure of patients with IDA to promptly identify and diagnose hypertension. The implementation of these integrated health strategies is vital for global efforts to tackle the dual challenges of hypertension and IDA.

Comparison of the Burden and Temporal Pattern of Hospitalisations Associated With Respiratory Syncytial Virus (RSV) Before and After COVID-19 in New Zealand.

Changes in the epidemiology of illnesses caused by respiratory syncytial virus (RSV) infection following the COVID-19 pandemic are reported. The New Zealand (NZ) COVID-19 situation was unique; RSV community transmission was eliminated with the 2020 border closure, with a rapid and large increase in hospitalizations following the relaxation of social isolation measures and the opening of an exclusive border with Australia. This active population-based surveillance compared the age-specific incidence and seasonality of RSV-associated hospitalizations in Auckland, NZ, for 2 years before and after the 2020 border closures. Hospitalisation rates between years were compared by age, ethnicity (European/other, Māori, Pacific and Asian) and socioeconomic group (1 = least, 5 = most deprived). There was no RSV transmission in 2020. In all other years, hospitalisation rates were highest for people of Pacific versus other ethnic groups and for people living in the most deprived quintile of households. RSV hospitalisation rates were higher in 2021 and 2022 than in 2018-19. The epidemic peak was higher in 2021, but not 2022, and the duration was shorter than in 2018-19. In 2021, the increase in RSV hospitalisation rates was significant across all age, sex, ethnic and socioeconomic groups. In 2022, the increase in hospitalisation rates was only significant in one age (1- < 3 years), one ethnic (Asian) and one socioeconomic group (quintile 2). COVID pandemic responses altered RSV-related hospitalisation seasonal patterns. Atypical features of RSV hospitalisation epidemiology were the increase in rates in older children and young adults, which lessened in 2022. Despite these variations, RSV hospitalisations in NZ continue to disproportionately affect individuals of Pacific ethnicity and those living in more socioeconomically deprived households. Whilst future public health strategies focused on RSV disease mitigation need to consider the potential shifts in epidemiological patterns when the transmission is disrupted, these variances must be considered in the context of longer-standing patterns of unequal disease distribution.

'We are pulled to the four corners': Qualitative role descriptions of advanced practice children's nurses in Malawi.

This study investigated emerging roles among specialist child health nurses (CHNs) in Malawi. Advanced nursing role development is globally advocated. Nursing role descriptions provide an evidential basis for workforce planning. Rigorously developed role descriptions are scarce worldwide, especially for Africa. Advanced nursing roles were introduced in Malawi's child health system a decade ago. We followed guidance on generating nursing role descriptions to collect and analyse qualitative data from interviews and focus groups, using qualitative content analysis. We used COREQ reporting standards. More than half (41/80) of Malawi's child health nursing workforce participated. Richly descriptive accounts of roles elicited three themes: leading and developing new services and improving existing ones; holding rare knowledge which uplifts care quality; and responsibility for developing the role. These responsibilities are experienced as a privilege and a burden, often meaning CHNs are 'pulled to the four corners'. We found evidence of remarkable achievements by Malawi's CHNs but also suggestions that they are under heavy strain. Because multi-stakeholder agreement about role content is crucial to successfully implementing advanced nursing roles, we hope the approach taken by this study, and the information generated, could be useful as part of human resources for health strategy development in other lower-resourced countries globally.

Which test results to believe? Comparison of different ELISA kits for detection of SARS-CoV-2-neutralizing antibody among COVID-vaccinated individuals

BackgroundIn the context of SARS-CoV-2, infection and immunization lead to varied levels of neutralizing antibodies (NAbs) crucial for protective immunity. In the lack of universal availability of plaque reduction neutralization tests, the gold standard centers rely on surrogate kits, for which performance standards and validation are lacking. Hence, we assessed three NAb kits available in India to determine their agreement and concordance. MethodsIt's a single-center cross-sectional observation study conducted during the third wave of the pandemic starting in January 2022 amongst individuals (n: 247) who received the first two doses of CovishieldTM. Samples were analysed using kit-A (Indian Council of Medical Research (ICMR) approved NAb microlisa kit, J. Mitra & Co. Pvt. Ltd), kit-B (Food and Drug Administration–approved NAb surrogate virus neutralisation test, GenscriptTM), and kit-C (NARI- and ICMR-approved anti–SARS-CoV-2 IgG antibodies kit using indirect ELISA principle, ErbaLisa® COVID-19 IgG). Cohen's kappa and concordance were analyzed using JMPver20.0.0. ResultsNAb was detected in 80.4%, 82.9%, and 21% samples using the three different kits. Discordance was observed in 19.68%, 65.7%, and 62.6% between Kit A-B, A-C, and B-C, respectively. The agreement was fair between Kit A-B (κ-0.35; p: 0.06) and Kit B-C (κ-0.09; p: 0.0005). Kit-B showed higher mean percentage inhibition (74.6 ± 32.1%) than Kit-A (68.1 ± 35.7%) (p: 0.0347). The correlation between kit-A and kit-B was moderate (r: 0.57; p < 0.0001). ConclusionThere is significant discordance between various commercials, which raises questions about their validity. The research underscores the need for robust validation and standardization of NAb tests to ensure their reliability and effectiveness in guiding public health strategies.

Comparison of the Burden and Temporal Pattern of Hospitalisations Associated With Respiratory Syncytial Virus (RSV) Before and After COVID-19 in New Zealand.

Changes in the epidemiology of illnesses caused by respiratory syncytial virus (RSV) infection following the COVID-19 pandemic are reported. The New Zealand (NZ) COVID-19 situation was unique; RSV community transmission was eliminated with the 2020 border closure, with a rapid and large increase in hospitalizations following the relaxation of social isolation measures and the opening of an exclusive border with Australia. This active population-based surveillance compared the age-specific incidence and seasonality of RSV-associated hospitalizations in Auckland, NZ, for 2 years before and after the 2020 border closures. Hospitalisation rates between years were compared by age, ethnicity (European/other, Māori, Pacific and Asian) and socioeconomic group (1 = least, 5 = most deprived). There was no RSV transmission in 2020. In all other years, hospitalisation rates were highest for people of Pacific versus other ethnic groups and for people living in the most deprived quintile of households. RSV hospitalisation rates were higher in 2021 and 2022 than in 2018-19. The epidemic peak was higher in 2021, but not 2022, and the duration was shorter than in 2018-19. In 2021, the increase in RSV hospitalisation rates was significant across all age, sex, ethnic and socioeconomic groups. In 2022, the increase in hospitalisation rates was only significant in one age (1- < 3 years), one ethnic (Asian) and one socioeconomic group (quintile 2). COVID pandemic responses altered RSV-related hospitalisation seasonal patterns. Atypical features of RSV hospitalisation epidemiology were the increase in rates in older children and young adults, which lessened in 2022. Despite these variations, RSV hospitalisations in NZ continue to disproportionately affect individuals of Pacific ethnicity and those living in more socioeconomically deprived households. Whilst future public health strategies focused on RSV disease mitigation need to consider the potential shifts in epidemiological patterns when the transmission is disrupted, these variances must be considered in the context of longer-standing patterns of unequal disease distribution.

Dispersal history of SARS-CoV-2 in Galicia, Spain.

The dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission are influenced by a variety of factors, including social restrictions and the emergence of distinct variants. In this study, we delve into the origins and dissemination of the Alpha, Delta, and Omicron-BA.1 variants of concern in Galicia, northwest Spain. For this, we leveraged genomic data collected by the EPICOVIGAL Consortium and from the GISAID database, along with mobility information from other Spanish regions and foreign countries. Our analysis indicates that initial introductions during the Alpha phase were predominantly from other Spanish regions and France. However, as the pandemic progressed, introductions from Portugal and the United States became increasingly significant. The number of detected introductions varied from 96 and 101 for Alpha and Delta to 39 for Omicron-BA.1. Most of these introductions left a low number of descendants (<10), suggesting a limited impact on the evolution of the pandemic in Galicia. Notably, Galicia's major coastal cities emerged as critical hubs for viral transmission, highlighting their role in sustaining and spreading the virus. This research emphasizes the critical role of regional connectivity in the spread of SARS-CoV-2 and offers essential insights for enhancing public health strategies and surveillance measures.

Spatial dynamics of COVID-19 in São Paulo: A cellular automata and GIS approach

This study examines the spread of COVID-19 in São Paulo, Brazil, using a combination of cellular automata and geographic information systems to model the epidemic’s spatial dynamics. By integrating epidemiological models with georeferenced data and social indicators, we analyze how the virus propagates in a complex urban setting, characterized by significant social and economic disparities. The research highlights the role of various factors, including mobility patterns, neighbourhood configurations, and local inequalities, in the spatial spreading of COVID-19 throughout São Paulo. We simulate disease transmission across the city’s 96 districts, offering insights into the impact of network topology and district-specific variables on the spread of infections. The study seeks to fine-tune the model to extract epidemiological parameters for further use in a statistical analysis of social variables. Our findings underline the critical importance of spatial analysis in public health strategies and emphasize the necessity for targeted interventions in vulnerable communities. Additionally, the study explores the potential of mathematical modelling in understanding and mitigating the effects of pandemics in urban environments.

Intact fruit intake is nonlinear inversely associated with visceral adipose tissue area in US adults: a cross-sectional study.

Excess visceral adipose tissue (VAT) plays a crucial role in leading to obesity-related diseases. However, the association between fruit intake (excluding fruit juice) and VAT is not well-known. We aim to further explore this association in a large population. We hypothesized that higher intact fruit intake would be inversely associated with VAT. A total of 9,582 adult participants from the National Health and Nutrition Examination Survey and the Food Patterns Equivalents Database 2011-2018 were included. Weighted linear regression models were utilized to evaluate the association between intact fruit intake (from two 24-hour dietary recalls) and VAT area (measured by dual-energy X-ray absorptiometry). Subgroup analysis was conducted to test the robustness of the results. Restricted cubic spline (RCS) analysis was performed to find the nonlinear association. The median of intact fruit intake was 0.32 cup-equivalent per day, and the mean of VAT was 104.87±1.23 cm2. Intact fruit intake (increased by 1 cup-equivalent/d) demonstrated an inverse association with VAT area across three adjusted models, with β(95%CI) values of -7(-8.49, -5.51), -6(-7.50, -4.51), and -3.02(-4.11, -1.94) in model 1, model 2, and model 3, respectively. Subgroup analysis revealed no interactions were found among age, sex, ethnicity, BMI, and physical activity subgroups. RCS revealed the inverse association was more significant when intact fruit intake was less than 1.7 cups-equivalent/d. These findings suggest that increasing intact fruit consumption could be an effective public health strategy to mitigate VAT accumulation and associated health risks, advancing our understanding of dietary impacts on adiposity.

The impact of malnutrition on secondary diabetes and calcific pancreatitis: A comprehensive review

Introduction: Malnutrition in low- and middle-income countries significantly impacts the development of secondary diabetes and calcific pancreatitis. Aim and Methods: This review summarizes the prevalence, characteristics, and findings from key studies over the past decade on the link between malnutrition and secondary diabetes, focusing on protein-deficient pancreatic diabetes (PDPD) and fibro-calculous pancreatic diabetes (FCPD). A comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar for articles published between 1995 and 2023. Studies included were peer-reviewed articles focusing on the link between malnutrition and secondary diabetes, conducted in LMICs, and discussing the prevalence, clinical characteristics, and outcomes of PDPD and FCPD. Both observational and interventional studies were considered. Results: The review of studies revealed several key findings: · PDPD is characterized by lower C-peptide levels and varied responses to glibenclamide post-nutritional rehabilitation. · FCPD patients show rapid calcification, diminished exocrine and beta-cell function, and more severe exocrine deficiency compared to PDPD. · Both PDPD and FCPD patients often present with lower BMI and significant renal involvement. · Recent studies indicate improved nutritional status and prognosis of FCPD patients with enhanced medical care. · Insulin-requiring diabetes in Ethiopia is strongly linked with poor education, poverty markers, and childhood malnutrition. · Lean diabetes, linked to childhood malnutrition, is characterized by low-normal BMI, early onset, and rapid beta-cell failure. Discussion: The development of diabetes following early malnutrition can be attributed to several interconnected mechanisms involving metabolic, endocrine, and epigenetic factors. Early nutritional intervention trials are crucial to prevent glucose abnormalities and diabetes later in life. Studies highlight that improving early-life nutrition can enhance beta-cell function, reduce insulin resistance, and mitigate long-term metabolic dysfunction. Lean diabetes, linked to childhood malnutrition, presents unique challenges but can be addressed through targeted nutritional support. Conclusion: The review underscores the significant impact of malnutrition on the development of secondary diabetes and calcific pancreatitis in LMICs. Addressing malnutrition through early nutritional interventions is crucial to mitigate the risk of chronic conditions and improve metabolic health outcomes. Continued research and targeted public health strategies are essential to break the cycle of malnutrition and disease in vulnerable populations.

Bibliometric Analysis of Community Nursing Trends on the Role of Nurses in Community Health Improvement

This study employs bibliometric analysis using VOSviewer to map the landscape of health promotion research from 2004 to 2014. By analyzing research publications in this field, we identify thematic clusters, research trends, and emerging opportunities for future investigations. Our analysis reveals several thematic clusters central to health promotion, including health education, empowerment, community engagement, and the role of healthcare professionals. A temporal analysis of the research trends indicates a shift in focus from basic educational and community engagement strategies to more specialized areas, with a notable increase in research on mental health towards the end of the period studied. The examination of less illuminated areas within the network visualization highlights underexplored topics such as the roles of community pharmacists and integrative reviews, suggesting them as potential rich fields for future research. The study underscores the evolution of health promotion over the decade and points to new directions for comprehensive health strategies, aiming to bridge research gaps and foster interdisciplinary collaboration.

Hepatitis E Vaccines Updates

The development of a hepatitis E vaccine is imperative given its prevalence and the heightened risk it poses to specific populations. Hepatitis E virus infection, though often self-limiting, poses a significant threat to pregnant individuals and immunocompromised populations. This review delves into the historical trajectory of hepatitis E vaccine development and explores its potential impact on at-risk populations. Historically, efforts to formulate an effective vaccine against hepatitis E have been underway to mitigate the severity of the disease, particularly in regions where the infection is commonplace. As a self-limiting disease, the necessity of a vaccine becomes more pronounced when considering vulnerable demographics. Pregnant individuals face heightened complications, with potential adverse outcomes for both mother and child. Similarly, immunocompromised individuals experience prolonged and severe manifestations of the infection, necessitating targeted preventive measures. This review aims to provide a comprehensive overview of the milestones in hepatitis E vaccine development. By examining the historical progression, we aim to underscore the critical need for a vaccine to safeguard not only the general population but also those at elevated risk. The elucidation of the vaccine’s journey will contribute valuable insights into its potential benefits, aiding in the formulation of informed public health strategies to combat hepatitis E effectively.

KidsTUMove-A Holistic Program for Children with Chronic Diseases, Increasing Physical Activity and Mental Health.

The prevalence of chronic diseases in children and adolescents has risen alarmingly worldwide. Diseases such as asthma, diabetes, obesity, mental disorders, and congenital heart defects are increasingly affecting the lives of children and pose significant challenges for the healthcare system. Physical activity plays a crucial role in preventing and treating these diseases. Numerous studies have shown that regular exercise improves physical performance, increases well-being, and leads to better health in the long term. Specially tailored sports programs that meet the individual needs and abilities of the children and adolescents affected are particularly important. The KidsTUMove project addresses this by developing tailored exercise programs for children with chronic diseases' specific needs, medical conditions, and physical abilities. Therefore, it closes the gap in care provision and can thus sustainably improve the health prospects of these children and adolescents. KidsTUMove is positioned to make a significant impact on the lives of affected children across Europe. Promotion of such programs should therefore be an integral part of future health strategies.

Demographic Study on Enteric Fever: A Single Centre Experiences

Background: Typhoid fever, caused by Salmonella typhi and Salmonella paratyphi, infects various organs after entering the bloodstream. It typically presents with headache, fever, splenomegaly, abdominal pain, and leucopenia, among other symptoms. Globally, it affects 11-21 million people annually, causing 120,000-160,000 deaths, with Southeast Asia being the most impacted region. Improved water, sanitation, and hygiene (WASH) practices are crucial for prevention, alongside targeted public health strategies in endemic regions like Bangladesh. Aim of the study: The study aims to identify demographic risk factors associated with typhoid fever in Bangladesh. Methods: This cross-sectional observational study was conducted at the Department of Medicine, North Bengal Medical College Hospital, Sirajganj, Bangladesh, over 12 months. We included 72 patients presenting with fever, headache, and abdominal pain, with positive blood culture reports for Salmonella typhi and Salmonella paratyphi, aged 18 years and above, who provided informed consent. Excluded were patients on antibiotics and those with multiple blood culture samples. A short questionnaire, validated through a pilot study, captured demographic and clinical data. Result: Mostly 76.39% of participants were aged 18-45. Males comprised 58.33% of participants, and females 41.67%. Occupationally, 48.61% were civil servants, 16.67% housewives, 13.89% students, 12.50% businessmen, and 8.33% farmers. Socio-economically, 16.67% were upper class, 37.50% middle class, and 45.83% lower class. Urban residents made up 40.28% and rural residents 59.72%. All participants had a fever, with other symptoms including headache (69.44%), abdominal pain (48.61%), vomiting (20.83%), coated tongue (27.78%), and constipation (61.11%). Conclusion: This study examines factors influencing enteric fever in Bangladesh, noting higher prevalence among males aged 18-45 due to occupational risks. Lower socio-economic status and rural living also increase risk, highlighting healthcare disparities. Common symptoms included fever, headache, and abdominal pain. Improving sanitation and targeting high-risk groups can reduce incidence.

WHO strategies to improve child and adolescents health in Europe

Across Europe, the health and wellbeing of children and adolescents requires attention. After the COVID-19 pandemic, the prevalence of mental health conditions has doubled, affecting 1 in 4 adolescents under the age of 18. Overweight and obesity are increasing: 1 in 3 primary school children are overweight or obese. Inequalities in weight and mental health are increasing in many countries, driven by socioeconomic circumstances. Reduction in child mortality, particularly of neonates, is stagnating in several countries, especially in Eastern Europe and Central Asia, and reversing in some.To rally member states to action, WHO is developing a new regional Child and Adolescent Health Strategy. The development commenced in 2019 with the identification of problem statements of issues affecting children and adolescents. These were then converted into actionable standards. They were updated considering the COVID-19 experience and the effects of regional crises on children. Children and adolescents were engaged in the development of the strategy, to identify and take their priorities into account, and stakeholders inside and outside WHO were consulted, including pediatricians and their societies. During a Member States consultation, European countries will have the opportunity to review and revise the draft strategy before it will be presented to the WHO Regional Committee for Europe for adoption.The main components of the strategy are: Early childhood development, school and adolescent health, strengthening health systems and improving quality of care, recognizing and acting on the needs of the most vulnerable and galvanizing societal action on the commercial, social, environmental and digital determinants of health affecting children and adolescents.The strategy forms the basis for monitoring regional progress. It will enable the development of national child and adolescent health and wellbeing strategies and monitoring frameworks. The implementation of the strategy will enable children and adolescents to realize their right to physical, social and mental health and well-being in healthy and enabling environments, so that they can fully participate in shaping prosperous and sustainable societies.

Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004–2019)

BackgroundInterest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.MethodsWe used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).ResultsThe overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.ConclusionsIn England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Clostridioides difficile Infection in the Elderly: Trend Analysis from 2000 to 2019.

Background/Objective: Clostridioides difficile infection (CDI) is a common healthcare-associated ailment, presenting major health and economic challenges, especially for the elderly. Despite its prevalence, comprehensive data about CDI's impact on the elderly are limited. Methods: This study used the Global Burden of Disease Study 2019 data to analyze CDI trends from 2000 to 2019, considering factors like sex, region, and sociodemographic index (SDI). Results: This study revealed that CDI caused approximately 18,181 deaths and 252,709 disability-adjusted life years (DALYs) among the elderly worldwide. The Americas showed the highest CDI burden, while the Eastern Mediterranean saw the steepest rate increase from 2000 to 2019. Regions with a high SDI also displayed substantial CDI impact. Conclusions: The escalating burden of CDI in the elderly, especially in high-SDI areas and the Americas, emphasizes an urgent need for targeted public health strategies.

Current insights into the effects of cationic biocides exposure on Enterococcus spp.

Cationic biocides (CBs), such as quaternary ammonium compounds and biguanides, are critical for controlling the spread of bacterial pathogens like Enterococcus spp., a leading cause of multidrug-resistant healthcare-associated infections. The widespread use of CBs in recent decades has prompted concerns about the potential emergence of Enterococcus spp. populations exhibiting resistance to both biocides and antibiotics. Such concerns arise from their frequent exposure to subinhibitory concentrations of CBs in clinical, food chain and diverse environmental settings. This comprehensive narrative review aimed to explore the complexity of the Enterococcus' response to CBs and of their possible evolution toward resistance. To that end, CBs' activity against diverse Enterococcus spp. collections, the prevalence and roles of genes associated with decreased susceptibility to CBs, and the potential for co- and cross-resistance between CBs and antibiotics are reviewed. Significant methodological and knowledge gaps are identified, highlighting areas that future studies should address to enhance our comprehension of the impact of exposure to CBs on Enterococcus spp. populations' epidemiology. This knowledge is essential for developing effective One Health strategies that ensure the continued efficacy of these critical agents in safeguarding Public Health.

Effects of vaccination against COVID-19 on overactive bladder symptoms on young population.

The vaccines developed against COVID-19 have different modes of action, with a primary focus on the spike protein of the virus. Adverse effects following vaccination have been reported, including local and systemic symptoms. Understanding the potential side effects on the urinary tract after vaccination is of importance. Actively investigating and comprehending the potential impact on the urinary tract, we can enhance public health strategies and pave the way for safer and more effective vaccination programs. The study was based on an online survey that included the Spanish Version of the Overactive Bladder Symptom Score (OABSS-S); 2,362 men and women replied to the survey. After the application of the exclusion criteria, 1,563 participants were insured. In the context of COVID-19, individuals were questioned regarding several key factors related to their vaccination status and medical history. These factors included the number of vaccine doses received, the specific type of vaccine administered, whether they had previously contracted COVID-19, and the frequency of prior infections, if applicable. A total of 1,563 (74.7% women and 27.3% men) subjects between the ages of 18 and 45 completed the survey and were included in the final analyses. The most frequently administered vaccine type was Pfizer-BioNTech (42.2%), and most subjects received three doses. The proportion of females who received the AstraZeneca vaccine and do not require to urinate during the night is significantly higher compared to males (59.1% vs. 33.3%; p<0.05). The proportion of individuals who urinate five or more times during the night is higher in those who have received a single vaccine dose than in those who have received three doses (2.2% vs. 0.1%; p<0.05). COVID-19 vaccination has been found to impact the lower urinary tract (LUT) and overactive bladder (OAB). Initially, LUT symptoms worsened, and OABSS-S scores increased after the first vaccine dose in individuals under 45 years old. However, symptoms improved after receiving the third and fourth doses. Gender differences were observed in the vaccination effects. Men vaccinated with AstraZeneca reported a higher number of nighttime voids, while women vaccinated with Moderna reported more daytime voids.

Is alcohol outlet availability associated with binge drinking in Canadian young adults? Findings from British Columbia and Quebec.

Alcohol availability is associated with alcohol consumption and related harms, but there is less evidence on associations with heavy episodic drinking (HED), a drinking pattern prevalent among young adults. This study aimed to assess the associations between alcohol availability and HED among young Canadians. We used a population-based sample of Canadian urban-dwelling young adult drinkers (18‒29years) from the cross-sectional Canadian Community Health Survey (CCHS; cycles 2015‒2019). We linked data from CCHS respondents in British Columbia and Quebec with two measures of alcohol availability for both offsite and onsite outlets: density (AOD) and accessibility (SAI) within dissemination areas (N = 1,067,747). We used logistic regression to estimate the associations between alcohol availability and monthly HED, adjusting for covariates. The associations between availability and HED differed by province, and availability measure. In British Columbia, offsite and onsite accessibility using SAI was inversely associated with HED. For example, living in neighbourhoods with medium alcohol accessibility (as compared to low) was significantly associated with reduced odds of HED (offsite OR = 0.33, 95% CI 0.17‒0.64; onsite OR = 0.49, 95% CI 0.27‒0.89). In Quebec, offsite availability was positively associated with HED using SAI (although not statistically significant) while no clear trend was seen for onsite availability. Results were consistent with previous evidence. Restricting spatial availability of alcohol remains an important public health strategy for decreasing the ease/convenience of access. Understanding why patterns of availability and drinking differ across regions could inform regionally tailored policies.

Comparação dos modelos de trabalho na atenção primária em saúde por meio da análise de indicadores de desempenho

This study aims to compare two working models in health care developed in Primary Health Care (PHC), through the evaluation of the results of performance indicators postulated by the Previne Brasil Program to compare the performance of two PHC units in Ribeirão Preto-SP – Brazil, with similar enrolled populations: the first with a conventional work model (Family Health Strategy – ESF), called Unit A, and the second, with a “parametrized” composition (Primary Care Team – EAB), called Unit B. The data were obtained through the Hygia system, e-Gestor AB and statistical data from B.I. (Business Intelligence), between January and December 2021. Unit A achieved a Final Synthetic Indicator (ISF), represented by the average of the Weighted Scores of the Indicators of each unit, equivalent to the value of 6 for the year 2021, while the Unit B recorded an ISF of 3.4 over the same period, verifying that the Family Health Strategy (ESF) model demonstrated superior performance to the parameterized Primary Care Team (EAB), with a percentage discrepancy of 76.47%. According to the indicators of the Previne Brasil Program for the year 2021, the performance in managing the work process of the assistance model called conventional ESF was greater than that of the model called parameterized EAB, with a difference of more than 75%