Urgent Public Health Issue Research Articles

The dual burden of malnutrition and its associated factors among mother-child pairs at the household level in Ethiopia: An urgent public health issue demanding sector-wide collaboration.

The coexistence of under-nutrition and over-nutrition in developing countries like Ethiopia results in the "mother-child pair double burden of malnutrition," with children experiencing either stunting, wasting or underweight while mothers face overweight or obesity. This poses a major public health challenge, prompting global health organizations to prioritize the issue and urge governments to act quickly. Despite this, there is a lack of research in Ethiopia on the double burden of malnutrition among mother-child pairs at the household level and the factors that worsen it. To assess the magnitude of double burden of malnutrition and its associated factors among mother-child pair at household level in East Ethiopia, 2022. A community-based cross-sectional study was conducted in East Ethiopia from April 15 to June 11, 2022. Multi-stage sampling was used, and data were collected through structured interviews. Child nutrition indicators were processed using WHO Anthro software. Binary logistic regression analysis was performed, calculating both crude and adjusted odds ratios to assess associations. Variables with a P value <0.05 in multivariable analysis were deemed statistically significant. The study revealed that coexisting malnutrition rates for (OM/SC), (OM/WC), and (OM/UC) were 8.5%, 7.0%, and 7.9% respectively. The double burden of malnutrition among mother-child pairs was found to be 12.3% [95% CI: 10.7, 13.7]. Marital status (divorced) [AOR = 1.80; 95% CI: 1.15, 2.82], child birth order (fourth or above) [AOD = 1.88; 95% CI:1.08, 3.26], number of under-five children in the household (five or more under-five children) [AOR = 1.58; 95% CI: 1.04, 2.39], poor maternal and child dietary diversity score [AOR = 2.76; 95% CI: 1.71, 4.45] and [AOR = 8.66; 95% CI: 4.85, 15.44], respectively, household food security status (food insecurity) [AOR = 3.68; 95% CI: 2.36, 5.75], and maternal stature (short stature) [AOR = 2.39; 95% CI: 1.65,3.45] were factors significantly associated with this burden. The study emphasized the double burden of malnutrition affecting both mothers and children, a major public health concern in the area. Early-life nutrition is vital in preventing childhood under nutrition and adult obesity, leading to this dual burden. Breaking the cycle of malnutrition across generations is crucial. Policy makers should prioritize improving child nutrition and maternal health, stressing early-life nutrition to address the mother-child double burden of malnutrition.

Estudio descriptivo de conducta suicida en adolescentes hospitalizados en la Unidad de Psiquiatría de un hospital de Madrid durante 2023.

The suicidal behavior among adolescents has shown a significant increase in the last decade, according to a study by the ANAR Foundation. Subsequently, there is a highlighted increase of 128% in the post-COVID-19 period. This study aims to analyze the reasons for admission and sociodemographic characteristics of adolescents hospitalized in 2023. An observational descriptive study was conducted at the Puerta de Hierro University Hospital. Out of the 229 recorded admissions, 78.6% were females and 21.4% males, with a mean age of 15.07 years. Suicidal ideation and suicide attempts were the main reasons for admission, with drug overdose being the most common method. The main diagnoses at discharge were mixed emotions and behavior disorder onset in childhood and adolescence, and adaptive disorder. The majority had a history of mental health problems. These findings reinforce the importance of prevention and early intervention programs to address suicide as an urgent public health issue.

Fast lane for decision making: The PHIRI Rapid Exchange Forum

Abstract Issue &amp; Problem The COVID-19 pandemic demanded swift, yet structured exchange of knowledge, data and good practices between experts and institutions supporting national governments in decision making for crisis response. Thus, in March 2020 population health experts from several European countries started to meet online, complementing the more formal EU Health Security Committee meetings. The European Commission understood the high need of Member States for evidence-based, and structured cross-country exchange and supported it as part of the Population Health Research Infrastructure (www.PHIRI.eu) project. Since then, the PHIRI Rapid Exchange Forum (REF) is a knowledge-sharing platform that brings together public health researchers, practitioners, policymakers, and other stakeholders to share information, experiences, and best practices in public health implementation research even if the EU co-funded PHIRI project has ended. The forum aims to promote collaboration and networking, facilitate the dissemination of research findings, and accelerate the translation of evidence into policy and practice. Lessons Through the PHIRI REF, participants can engage in interactive discussions, workshops, and presentations on various public health topics, including infectious diseases, digitalisation, health emergency simulations, health systems strengthening, and community health interventions. The platform is designed to be user-friendly and accessible to all, with a particular focus on European countries. By May 2024, the REF-Secretariat at the Austrian National Public Health Institute G&amp;Ouml;G had organised 60 REF meetings, with in average 20 attendees from 12-15 countries. The monthly 1-hour online meetings cover in a moderated, structured format pre-agreed topics that are proposed by the participating countries. All findings and topics are documented and publicly available at the EU Health Information Portal (https://www.healthinformationportal.eu/rapid-exchange-forum). Key messages • The success of the Rapid Exchange Forum highlights the importance of collaboration and information exchange between population health experts in addressing global health challenges. • Having a pre-established information exchange network on urgent public health issues is of utmost importance as it enables rapid and trustworthy communication among relevant stakeholders.

Optimizing Postpartum Depression Prevention in Primary Health Care Services

Post-partum depression (PPD) is a post-natal disorder that not only impacts the mental health of the mother but also has long-term effects on the development and well-being of the child and family. PPD is a preventable disorder, starting from interventions at primary health care facilities. As one of the developing countries with a PPD incidence of 22% per 100,000 births, PPD is considered an urgent public health issue in Indonesia. In practice, evaluation, and improvement of services at primary health care facilities are needed. This study aims to identify and adapt international intervention strategies to reduce post-partum depression prevalence in Indonesian primary health care. A scoping review analysis method was used, involving previous studies on activities from pregnancy to post-partum that can prevent and reduce post-partum depression. The reviewed articles employed Randomized Controlled Trials or Randomized Clinical Trials (RCT) methods with specific inclusion and exclusion criteria. Data were collected from relevant sources, and a synthesis was conducted on 16 articles that met the inclusion criteria. The results show that direct psychological support activities (through health professionals or groups) and indirect support using digital platforms and applications are effective in reducing depression. Strategies such as digital technology, direct support programs, physical therapy, pharmacological therapy, community involvement, and strengthening health services, particularly post-partum psychological counseling, are recommended to enhance prevention. This research supports the expansion of evidence-based strategies that can be implemented in primary healthcare facilities to address post-partum depression.

Relation of ICAM-1 and VCAM-1 markers in COVID-19 patients in Kirkuk province.

The advent of the Coronavirus Disease 2019 (COVID-19) has presented a substantial and urgent global public health issue. Biomarkers have the potential to be utilized for the identification of endothelium and/or alveolar epithelial damage in instances of COVID-19 infection. to evaluate the levels of Intercellular adhesion molecule-1 (ICAM-1) and Vascular cell adhesion molecule (VCAM-1) biomarkers in hospitalized patients who tested positive for COVID-19 infection using Polymerase Chain Reaction (PCR) with the virus specific Immunoglobulins; IgM, and IgG testing. This can help with improved clinical management and treatment programs. A case-control study that involved 90 hospitalized patients who tested positive for COVID-19 and 40 apparently healthy control patients, subjects in both groups underwent nasopharyngeal swabs for PCR and blood sample collection for evaluation of serum; IgM, IgG, ICAM-1 and VCAM-1 levels. Males made up the vast majority of the patients (78.9%), with only a minor percentage of females (21.1%) P value 0.1641. Furthermore, every patient in this study had a minimum of one risk factor for COVID-19. The investigator's results show that COVID-19 patients had higher amounts of endothelial cell adhesion indicators (ICAM-1 and VCAM-1) with mean values of 126.27 ± 89.51 ng/mL and 109.74 ± 96.57 ng/mL respectively. While, ICAM-1 and VCAM-1, were present at normal levels in the control group with difference P value 0.0028 and 0.0032 in comparison to the patient's group respectively. The adhesive markers ICAM and VCAM play a crucial role in the development of COVID-19 and the strong endothelial activation and dysfunction linked to both acute and persistent immunological responses is shown by the substantial correlation found in COVID-19 patients between the presence of IgM and IgG antibodies and higher levels of ICAM-1 and VCAM-1.

Bacteroides uniformis Ameliorates Carbohydrate and Lipid Metabolism Disorders in Diabetic Mice by Regulating Bile Acid Metabolism via the Gut-Liver Axis.

Type 2 diabetes mellitus (T2DM) is a metabolic syndrome characterized by chronic inflammation, insulin resistance, and islet cell damage. The prevention of T2DM and its associated complications is an urgent public health issue that affects hundreds of millions of people globally. Numerous studies suggest that disturbances in gut metabolites are important driving forces for the pathogenesis of diabetes. However, the functions and mechanisms of action of most commensal bacteria in T2DM remain largely unknown. The quantification of bile acids (BAs) in fecal samples was performed using ultra-performance liquid chromatography-tandem mass spectrometer (UPLC-MS/MS). The anti-diabetic effects of Bacteroides uniformis (B. uniformis) and its metabolites cholic acid (CA) and chenodeoxycholic acid (CDCA) were assessed in T2DM mice induced by streptozocin (STZ) plus high-fat diet (HFD). We found that the abundance of B. uniformis in the feces and the contents of CA and CDCA were significantly downregulated in T2DM mice. B. uniformis was diminished in diabetic individuals and this bacterium was sufficient to promote the production of BAs. Colonization of B. uniformis and intragastric gavage of CA and CDCA effectively improved the disorder of glucose and lipid metabolism in T2DM mice by inhibiting gluconeogenesis and lipolysis in the liver. CA and CDCA improved hepatic glucose and lipid metabolism by acting on the Takeda G protein-coupled receptor 5 (TGR5)/adenosine monophosphate-activated protein kinase (AMPK) signaling pathway since knockdown of TGR5 minimized the benefit of CA and CDCA. Furthermore, we screened a natural product-vaccarin (VAC)-that exhibited anti-diabetic effects by promoting the growth of B. uniformis in vitro and in vivo. Gut microbiota pre-depletion abolished the favorable effects of VAC in diabetic mice. These data suggest that supplementation of B. uniformis may be a promising avenue to ameliorate T2DM by linking the gut and liver.

Impact of School Nurse on Managing Pediatric Type 1 Diabetes with Technological Devices Support: A Systematic Review.

Type 1 diabetes (T1D) is a disease that primarily occurs in pediatric populations. A school nurse (SN) can provide valuable support in the school setting for minors affected by this condition. The main objective of this study was to evaluate the impact of nursing care provided to adolescents and children with T1D using technological devices in school. Qualitative and quantitative outcomes considered in the included studies were collected and discussed. A systematic review was conducted in the PubMed, CINAHL, and Scopus databases and reported thought the PRISMA guidelines. Eleven studies were included. The results showed that SNs need to enhance both their skills and organization to effectively manage young patients with T1D using technology. The response of both the pediatric population and their caregivers to the disease management by a SN has been positive. The management of chronic diseases is one of the most urgent public health issues, especially for Western healthcare systems. Proper management of patients with T1D at the school level is definitely an aspect that policymakers and healthcare managers should consider to improve the quality of life of this extremely vulnerable population, particularly those using technological management T1D.

Prevalence of intestinal protozoan parasites among Asian schoolchildren: a systematic review and meta-analysis.

Intestinal protozoan parasites among Asian schoolchildren are a subject of concern due to their prevalence and potential health impact. Understanding and addressing this issue is crucial for public health in the region. We conducted a comprehensive search for articles published up to December 2023 across four databases, including Scopus, PubMed, ProQuest, and Web of Science. To estimate the combined prevalence, a random-effects model with a 95% confidence interval (CI) was applied, and the statistical analysis was performed using meta-analysis packages in R version (3.6.1). This study is registered with PROSPERO (CRD42023481146). Among 131 eligible articles, the prevalence of intestinal protozoan parasites was 0.208 (95% CI = 0.180-0.238). Lebanon and Tajikistan had the highest country-level prevalence at 0.851 and 0.836, respectively, with Giardia duodenalis being the most prevalent species at 0.082. In summary, our study highlights the urgent public health issue of protozoan parasites among Asian schoolchildren due to poor sanitation and water quality. Immediate interventions are essential, considering climate and socioeconomic factors, to combat these infections and improve overall health.

In silico/vitro Study of Antibacterial Effects of Non-toxic Cinnamic Amidoesters on Artemia salina

Abstract: According to the PLOS Neglected Tropical Diseases Journal, infection caused by the Gram-negative bacterium Escherichia coli is a neglected tropical disease. Staphylococcus aureus is the most dangerous Grampositive bacterium among staphylococcal bacteria. Moreover, resistance to Mycobacterium tuberculosis is an urgent public health issue. In this sense, cinnamic acid and acetamide derivatives have been used as strategic nuclei in the design of antimicrobial agents. With the aim of investigating whether antibacterial activity is improved with the junction of cinnamic and acetamide nuclei, cinnamic amidoesters were planned and evaluated as potential antibacterial agents. In silico (ADMET test and molecular docking) and in vitro (antibacterial and antituberculosis evaluation, and toxicity on Artemia salina larvae) studies were performed. Twelve cinnamic amidoesters were synthesized, which present positive characteristics for possible drug candidates, and showed subtle activity against E. coli, however, against S. aureus, unsubstituted and para-substituted compounds (R3 = H, Me, Cl, Br) showed significant activity, with MIC = 156.25-625 μg.mL-1. Only one para-substituted compound (R3 = Bu) showed discrete activity against M. tuberculosis, with MIC = 200 μM. For the most active compounds against S. aureus, the molecular docking study demonstrated affinity with the TtRNA enzyme, which plays a central role in the assembly of amino acids into polypeptide chains. The most active compounds against S. aureus and M. tuberculosis were non-toxic on A. salina, with LC50 &gt; 1000 μg.mL-1. According to in silico/vitro studies, the non-toxic compound 5h (R3 = Cl) stands out as a potential antibacterial agent for further studies.

When Should Patients at the End of Life Get Antimicrobials?

Although antimicrobial medications are commonly prescribed to patients at the end of life (EOL), clinicians might not discuss the benefits and harms of antimicrobials with their patients in the advance care planning process. This commentary on a case discusses challenges and strategies in antimicrobial decision making for patients at the EOL. As antimicrobial use can harm some patients, and as antimicrobial resistance remains an urgent public health issue, this article advocates for ethical reasoning to guide antimicrobial decision making for patients at the EOL.

Pairwise summation as a method for the additive combination of probabilities in qualitative risk assessments.

Qualitative frameworks are widely employed to tackle urgent animal or public health issues when data are scarce and/or urgent decisions need to be made. In qualitative models, the degree of belief regarding the probabilities of the events occurring along the risk pathway(s) and the outcomes is described in nonnumerical terms, typically using words such as Low, Medium, or High. The main methodological challenge, intrinsic in qualitative models, relates to performing mathematical operations and adherence to the rule of probabilities when probabilities are nonnumerical. Although methods to obtain the qualitative probability from the conditional realization of n events are well-established and consistent with the multiplication rule of probabilities, there is a lack of accepted methods for addressing situations where the probability of an event occurring can increase, and the rule of probability P(AUB)=P(A)+P(B)-P(A∩B) should apply. In this work, we propose a method based on the pairwise summation to fill this methodological gap. Our method was tested on two qualitative models and compared by means of scenario analysis to other approaches found in literature. The qualitative nature of the models prevented formal validation; however, when using the pairwise summation, results consistently appeared more coherent with probability rules. Even if the final qualitative estimate can only represent an approximation of the actual probability of the event occurring, qualitative models have proven to be effective in providing scientific-based evidence to support decision-making. The method proposed in this study contributes to reducing the subjectivity that characterizes qualitative models, improving transparency and reproducibility.

Synergistic photocatalytic removal of moxifloxacin from aqueous solutions using ZnO-Fe3O4-chitosan composites

The escalating contamination of water bodies with antibiotic residues is an urgent environmental and public health issue. This study aimed to fabricate an innovative photocatalytic composite (CMZ) by combining chitosan, magnetic iron oxide (Fe3O4), and zinc oxide (ZnO) for efficiently removing antibiotic moxifloxacin (MFX) water. Comprehensive characterization of the fabricated CMZ was performed using various techniques such as X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), Raman spectroscopy, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), ultraviolet–visible diffuse reflectance spectroscopy (UV–Vis DRS), photoluminescence spectroscopy (PL) and nitrogen adsorption/desorption isotherm analysis. The synergistic incorporation of ZnO, Fe3O4, and chitosan in the CMZ composite altered the structural properties of ZnO and chitosan The band gap energy of CMZ was 2.58 eV, significantly boosting its photocatalytic effectiveness under visible light exposure. The CMZ composites exhibited a high efficiency in catalyzing MFX degradation in aqueous environments. The optimal conditions for MFX degradation were established, including a neutral pH level of 7, a 90 min exposure to irradiation, and employing 0.1 g of the CMZ catalyst. The degradation process obeyed closely to the first-order kinetic model. The CMZ material showed consistently high performance in degrading MFX across four consecutive reuse cycles, emphasizing its practical applicability for mitigating antibiotic pollution.

Occupational experiences and their importance for young peoples’ mental health

Background Young peoples’ mental health challenges have increased in recent years to become an urgent public health issue. Research is required to gain a better understanding of how occupations influence young peoples’ everyday lives and support their mental health. Aim How do young people experience engaging in various occupations in their daily lives, and how do these experiences shape their mental health? Method Semi-structured interviews were conducted with 12 Norwegian young people aged 13–16 years. Verbatim transcriptions of the interviews were analysed using thematic analysis. Results Four core themes emerged: ‘doing’ for balance and stability; self-discovery through doing; intentional doing to recharge and feel free; and reflecting on the consequences of doing social media. Conclusions Young peoples’ occupational experiences shape their mental health in several ways: they serve as coping strategies, as a means to experience joy and accomplishment, and as a source of routines and opportunities for relaxation. We suggest that health-promoting initiatives for young people would strongly benefit from the inclusion of an occupational perspective.

Youth Are the Experts! Youth Participatory Action Research to Address the Adolescent Mental Health Crisis.

Adolescent mental health is an urgent global public health issue. Youth participatory action research is an effective strategy to amplify youth voices and can serve as a catalyst for evidence-based action addressing the mental health crisis. To illustrate the benefits of youth participatory action research for informing community health, we describe an ongoing collaboration with a youth council located in the central coast of California, USA. Research methods included an anonymous online self-report survey to gather information about the mental health of high school students in 2020 (n = 176) and 2022 (n = 234), 93% Latinx/Mexican American. Both surveys included a four-item patient health questionnaire to screen for depression and anxiety risk, in addition to scaled and open-ended survey questions selected by the youth leaders based on their research questions. Quantitative and qualitative results indicated a significant but small decrease in mental health risk, and a continued need for resources to access mental health support. Results led to community-based action aimed at improving local youth mental health. The interdisciplinary research team (psychology and public health) and youth leaders share reflections highlighting the innovative, empowering, and transformative impact of youth participatory action research as a tool for improving community health.

Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship.

Antimicrobial resistance (AMR) is a global public health crisis. This study assessed the general public's consumption of antibiotics and associated factors in the Lusaka district of Zambia. This cross-sectional study was conducted among 2038 participants between December 2022 and January 2023. Data were analysed using Stata 13.0. Multivariable regression techniques were used to determine the factors that influenced antibiotic consumption. Of the 2038 participants, 53.4% were female, and 51.5% had attended at least secondary school. Antibiotic use was 99.2%, of which 40.9% were appropriately used. Overall, 79.1% of antibiotics were prescribed in hospitals, while 20.9% were used from leftovers and accessed without prescriptions. This study found that the appropriate use of antibiotics was associated with being female, being aged 35 years and above, attaining secondary school or tertiary education, having a monthly expenditure of 195 USD and above, being aware that antibiotics were not the same as painkillers, and being confident that when someone was hospitalized, they would get well. This study found that the appropriate use of antibiotics was low, and this is an urgent public health issue requiring community engagement in tackling AMR and adherence to treatment guidelines in healthcare facilities. Additionally, there is a need to implement and strengthen antimicrobial stewardship programmes in healthcare facilities to promote the rational use of antibiotics in Zambia. There is also a need to heighten community awareness campaigns and educational activities on the appropriate use of antibiotics.

Association between dietary vitamin A intake from different sources and non-alcoholic fatty liver disease among adults

Non-alcoholic fatty liver disease (NAFLD) has become an urgent public health issue with high global prevalence, but data on NAFLD are inconsistent. The association of total dietary vitamin A intake with the NAFLD risk was not well documented in previous studies. To explore the relationship between dietary vitamin A intake from different sources and NAFLD risk among American adults. Data were collected from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014. Logistic regression and restricted cubic spline models were used to estimate the relationship between total dietary vitamin A intake and NAFLD risk. 6,613 adult participants were included. After adjusting potential confounders, the odds ratios (ORs) with 95% confidence intervals (CIs) of NAFLD for the highest quartile intake of total vitamin A, preformed vitamin A, provitamin A carotenoids were respectively 0.86 (0.69–1.06), 0.97 (0.74–1.28), and 0.78 (0.61–0.99), compared to the lowest quartile. Stratifying gender and age, provitamin A carotenoids intake was inversely associated with NAFLD risk in females and participants aged < 45 years. Dose–response analysis indicated a linear negative relationship between provitamin A carotenoids intake and NAFLD risk. Provitamin A carotenoids intake was inversely associated with NAFLD, especially in women and those aged < 45 years among adult American.

Thirteen years progress: a scoping review of suicide prevention initiatives in post-secondary settings

Objective: Describe the literature on suicide prevention initiatives (SPIs) in post-secondary settings internationally since 2010. Methods: A scoping review and bibliographic search were conducted across MEDLINE, PsycINFO, CINAHL, and Scopus. Two reviewers independently screened articles and extracted data in consultation with a community social work team. Included articles described SPIs in post-secondary settings. Secondary sources and articles unavailable in English were excluded. Results: After identifying 931 citations, 76 articles representing five continents were included. Included articles spanned 2010 to 2023. Most articles represented North America, used quantitative methods, and focused on gatekeepers. SPIs in post-secondary settings were characterized by standardized and commercially available training programs and a wide variety of ‘in-house’ initiatives unique to campus communities. Conclusions: The quantity of research on SPIs in post-secondary settings has not kept pace with escalating mental health issues and the extent to which suicide is an urgent public health issue for young adults.

Impact of Quality and Type of Anticoagulant Treatment, and Inflammatory Biomarkers on Quality of Life and Psychological Morbidity in Patients with Atrial Fibrillation: An Exploratory Study

Background: Owing to increasing worldwide life expectancy, the step rise in the prevalence of atrial fibrillation (AF) represents an urgent public health issue. Indeed, AF can severely affect a patient's quality of life (QoL) since it is associated with serious outcomes, such as stroke, cardiac failure, and cognitive impairment/dementia, resulting in increased morbidity and mortality and a burden for health-care systems. Anticoagulation therapy prevents stroke in individuals with AF, whether with vitamin K antagonists (VKA) or direct oral anticoagulants (DOACs). So far, effective AF management is missing since its etiology is unraveled. Within the research project [Cognitive Decline Risk Profiles and Quality of Life in Atrial Fibrillation: A Longitudinal Study- 2022.072(057-DEFI/058-CE)] a pilot study was conducted to assess a dynamic cohort of AF outpatients who attended the anticoagulation clinic at Santo António University Hospital Center, a Portuguese university public hospital. In this study, QoL, distress and cognitive impairment in patients with AF was assessed considering quality and type of anticoagulant treatment. Methods: With a cross-sectional design, quality of anticoagulation therapy was measured calculating Time in Therapeutic Range (TTR) using Rosendaal method for patients under VKA (TTR&amp;gt;70% as good control); for those patients under DOAC, the presence of plasma therapeutic levels of this drug, taking into account the time of blood sampling, meant an anticoagulant treatment of quality. QoL and distress were assessed by the Atrial Fibrillation Effect on Quality-of-life Questionnaire (AFEQT) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. Cognitive impairment was assessed by the Montreal Cognitive Assessment (MoCA) scale. Data on sociodemographic, clinic [medical history including quality and type of anticoagulation therapy, stroke(CHA2DS2-VASc) and bleeding(HAS-BLED) risk scores, duration of illness) and inflammatory biomarkers were also collected. Results: A total of 62 AF patients were included (mean age 74.4±10.2 years, 59.7% women) with a mean CHA2DS2-VASc of 4.3±1.6 and HAS-BLED of 2.6±1.2. Fifty patients (80.6%) were on VKA and twelve (19.4%) on DOACs (all in apixaban). Those individuals under VKA showed a mean TTR score of 77.1 ± 14.7% (67.4% with a good control) and 11 patients in apixaban presented DOAC therapeutic plasma level. Participants had an illness duration average of 16.02 years±10.62. The mean scores of AFEQT was 2.65 ± .93 showing a good QoL and for MoCA was 21.66 ± 3.90 indicating mild cognitive impairment. Regarding anxiety, depression, and stress (DASS-21) the mean scores were 4.27 ± 4.08, 6.52 ± 4.92 and 7.37 ± 5.37, respectively showing non-clinical psychological morbidity. Patients with higher plasmatic levels of C Reactive Protein (CRP) reported more depression (r= .482; p= .005) and those with a longer illness duration presented a higher level of cognitive impairment, (r= -.398; p= .001). No other associations were found between inflammatory biomarkers and psychological variables. There were significant differences according to sex, age, and illness duration, with women reporting lower QoL (p = .002), higher depression (p = .004), higher stress (p = .005) and older patients (p = .017) as well as patients under VKA and longer disease duration reporting better TTR. (p = .007). No differences were found on patients' QoL (p = .342), anxiety (p = .370), depression (p = .167) and stress (p = .117), cognitive impairment, (p = .084) between good and non-good quality of anticoagulant treatment and between VKA versus DOAC therapy (p = .444). Conclusion: The majority of the patients showed good quality of anticoagulation and QoL, but they revealed mild cognitive impairment. Patients' QoL, distress and cognitive impairment were independent of quality and type of anticoagulation treatment. Older AF patients, particularly those with longer diagnosis, should be assessed for cognitive function on a regular basis, preventing dementia and economic burden. The association of depression with higher levels of CRP in AF patients underlines the nature of these two inflammatory conditions that coexisting associate to worse outcomes. Future studies should assess cognitive function over time to unravel the pathophysiology of cognitive decline and the effect of AF treatments on cognition to optimize and personalize AF therapy.

High Prevalence of Food Insecurity and Related Disparities Among US College and University Students From 2015–2019

ObjectiveWe examined food insecurity prevalence among college students included as part of a large, ongoing, nationally representative survey and examined trends and associations with sociodemographic measures. MethodsData come from the Panel Study of Income Dynamics, a nationally representative longitudinal household panel survey, and include 2,538 college students from 2015–2019. Food security status was assessed using the US Department of Agriculture's 18-item Household Food Security Survey Module. ResultsFrom 2015 to 2019, 11% of college students experienced marginal food security, and 15% experienced food insecurity. Food insecurity was 12% in 2015 and 14% in 2017 and 2019. More Black and Hispanic students experienced food insecurity than White students (21% and 26%, vs 9%, respectively; P <0.001), as did first-generation than non-first-generation students (18% vs 10%; P = 0.01). Conclusions and ImplicationsCollege food insecurity is an urgent public health issue demanding greater response from colleges and universities and state and federal governments.

Post-Pandemic: University Students’ Satisfaction on the Use of E-Learning

In 2020, approximately all universities worldwide abruptly closed due to an urgent public health issue to stop the COVID-19 epidemic from spreading. Unfortunately, even though some universities have undergone online teaching techniques before, they are not prepared to learn online fully. This research examines whether students’ attitudes, convenience flexibility, and schools’ support influence the continuance intention toward e-learning and whether satisfaction with e-learning is the mediator of the relationships above. This study was conducted in Malaysia and Indonesia after the COVID-19 epidemic to assess university students’ intent to continue using e-learning platforms. 160 college students in all took part in the research. This study reveals that satisfaction directly influences continuance intention whereas convenience flexibility and school support influence continuance intention when satisfaction came in and plays a role as a mediator. The link between students’ attitudes, convenience flexibility, school support, and continuance intention are mediated by their satisfaction with e-learning. To bolster students' contentment with e-learning, it is suggested for universities to fortify the convenience and flexibility of the system and improve the level of support provided by the institution.