World Health Organization Guidelines Research Articles

Factors associated with access and utilization of sexual abuse emergency healthcare services among street children in Zomba, Malawi: a qualitative study.

Sexual abuse among street children is a problem that renders a burden of sexually transmitted diseases, HIV infection, and early pregnancy. Literature shows that globally 95 million children experience sexual abuse with 1 in 5 girls and 1 in 7 boys exposed to sexual abuse before 18years of age in Malawi. Malawi adopted the World Health Organization guidelines for providing emergency health services for victims of sexual abuse, which include HIV Post Exposure Prophylaxis (PEP) and Emergency Contraceptive Pills (ECP) within 72h of exposure, Sexually Transmitted Infections (STI) treatment, and psychosocial services. However, there are challenges associated with the services that limit access and utilization among street children. This study explored the factors associated with access and utilization of sexual abuse emergency healthcare services among street children in Zomba. This was a cross-sectional phenomenological qualitative study conducted in Zomba City from 2022 to 2023 using in-depth and key informant interviews. We purposively selected street children between 10 to 17years who have been exposed to sexual abuse on the streets and social actors working with street children. The study employed a thematic analysis approach. The study found that street children did not utilize sexual abuse emergency health services. The major factors associated with utilization included the knowledge of sexual abuse, its associated health risks and sexual abuse emergency health services, and perceptions of utilizing sexual abuse emergency health services. The barriers to utilization of sexual abuse emergency health services included perceived shame, fear, discrimination, prolonged treatment process, and attitude of the health service providers. Sexual abuse and its health risks continue to be a challenge among street children. The absence of adequate connections and secure environments for street children to report sexual abuse and seek help without facing judgment has created significant obstacles for them in accessing sexual abuse emergency health services. To curb this challenge it is crucial for successful interventions to specifically address the health needs of street children and involve them in the decision-making processes related to their interventions.

Understanding the Global Distribution of Groundwater Sulfate and Assessing Population at Risk.

Besides sulfate-induced diarrhea, recent studies have emphasized that groundwater sulfate drives the release of arsenic in groundwater and accelerates water pipeline corrosion. Despite its impact on public health and urban infrastructure, sulfate has been overlooked in water supply research. Here, we used a random forest model to develop a 1 km global map depicting the probability of sulfate exceeding 250 mg/L in groundwater based on the World Health Organization's guidelines. The map was further applied to estimate the exposed population and identify contributors of sulfate exceedance in global hotspot regions. The results revealed that sulfate exceedance in groundwater was widespread in 156 countries. Approximately 194 million people use water with sulfate levels exceeding 250 mg/L. Among them, around 17 million people face groundwater sulfate concentrations surpassing 500 mg/L, with 82% of these individuals residing in ten specific countries. Contributing factor analysis in these countries indicates that annual precipitation and sedimentary rocks are the primary factors contributing to sulfate concentration prediction, while other natural and anthropogenic predictors exhibit region-specific impact patterns. This study uncovered a significant prevalence of elevated sulfate levels in groundwater, highlighting the need to integrate sulfate into water safety management practices.

Association between physical activity patterns of working-age adults and social jetlag, depressive symptoms, and presenteeism.

This study aimed to evaluate the association of physical activity with social jetlag, depressive symptoms, and presenteeism. This cross-sectional study included 8,247 working-age adults (females, 44.6%; age, 20-64 years). Social jetlag was defined as the absolute difference between the midpoint of bedtime and wake time on workdays and free days. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, and presenteeism was evaluated using the Work Functioning Impairment Scale. Exercise habits were classified into four groups based on the World Health Organization guidelines: non-active (NA; n=4,223), insufficiently active (IA; n=3,009: exercise below guideline levels), weekend warriors (WW; n=220: exercise 1-2 times per week meeting guideline levels), and regularly active (RA; n=793: exercise at least 3 days per week meeting guideline levels). Using multiple and Poisson regression analyses, we examined the association between exercise habits and each outcome. Social jetlag, depression, and presenteeism were more favorable with shorter sedentary times and longer durations of moderate- and vigorous-intensity exercise. Compared with the RA group, the NA group had a significantly higher prevalence of social jetlag (prevalence ratio [PR]=1.30), depression (PR=1.31), and presenteeism (PR=1.35). The IA group had a significantly higher prevalence of depression (PR=1.33) and presenteeism (PR=1.38). Exercising with a certain frequency and intensity may help prevent symptoms of depression and social jetlag, and consequently prevent presenteeism.

Global trends in importance of 24-hour movement behaviors to pediatric health: Implications for South Korea.

Cultivating a 24-hour movement behavioral profile conducive to health and well-being, marked by adequate levels of physical activity, limited screen time, and sufficient sleep, has emerged as an important avenue for promoting pediatric health. We aimed to provide evidence of this potential, this multiphase, multimethod, and integrative review comprehensively investigated the global trends in health promotion initiatives and status of the Korean pediatric population. This integrative review comprised three phases employing various review methods: an environmental scan of existing guidelines for 24-hour movement behaviors worldwide, a rapid review of physical activity-related indicators from Global Matrix data, and a systematic review of 24-hour movement behaviors among children and adolescents in South Korea. The growing recognition of a holistic approach to the 24-hour movement behavior paradigm in pediatric health promotion has led to the establishment and adoption of 24-hour movement guidelines in different countries and by the World Health Organization (WHO). Korean health authorities have also responded to this need by releasing a translated report of the WHO guidelines for physical activity and sedentary behavior as well as the 2024 update of the Physical Activity Guidelines for Koreans. Accordingly, actions must be followed in policy, research, and practice. This is critical considering that Korean children and adolescents exhibit an unfavorable profile of 24-hour movement behaviors compared to the global average. Among those aged 0-6 years, the weighted averages for guideline adherence were 18.2% for physical activity, 38.1% for sedentary behavior, and 76.2% for sleep. For those aged 12-18 years, the weighted averages for guideline adherence were 20.4% for physical activity, 55.9% for sedentary behavior, and 26.2% for sleep. Building on these current findings, this integrative review provides three priorities for pediatric health promotion policy and practice and three recommendations for future research.

Sustainable management of drinking water quality in the locality of Massouro, Chad

This study evaluates the quality of drinking groundwater in the city of Moussoro using geochemical, bacterial, and multivariate statistical methods. Access to safe drinking water is a major concern for the population in these regions, as the distribution of this resource is unequal across continents and is often affected by human activities, making it vulnerable. The analysis revealed two categories of water: potable and non-potable. The presence of pollutant indicators, such as Escherichia coli (E. coli) and total coliforms, was observed in most samples. This presence indicates water contamination and requiring monitoring and treatment before it is consumed by the population. Overall, most of the physicochemical parameters comply with the World Health Organisation guidelines for drinking water. However, the concentration of ammonium (NH4+) was high. Pollution elements such as ammonium (NH4+) and E. coli, indicate that human activities also contribute to water mineralisation. The study could ensure sustainable access to safe drinking water, thereby enhancing the overall quality of life in Moussoro.

Quantitative Assessment of Human Health Risks Associated with Heavy Metal and Bacterial Pollution in Groundwater from Mankweng in Limpopo Province, South Africa

Heavy metal and microbial pollution in groundwater raises health concerns due to its adverse effects. This study aimed to assess the health risks associated with heavy metal and bacterial pollution in groundwater in Mankweng. Heavy metals and Escherichia coli were detected using inductively coupled plasma mass spectrophotometry and a Colilert system, respectively. The heavy metal pollution index (HPI) and non-carcinogenic and carcinogenic risks were computed. The β-Poisson dose–response model was employed to predict the probability of E. coli infection. The metals’ concentrations were all within the permissible limits of the South African National Standard (SANS). However, Pb levels at sites E and G exceeded the World Health Organization (WHO) guideline (≤0.01 mg/L). HPI values were all less than 100, indicative of low contamination. The hazard quotient values were all less than 1, except for vanadium. The cumulative cancer risk ranged between 3.06 × 10−5 and 1.81 × 10−4 and between 3.55 × 10−5 and 2.20 × 10−4 for adults and children, respectively. E. coli was only detected at site L. The annual risk of E. coli infection exceeded the WHO risk limit of 10−4. The results underscore the need for the regular monitoring of groundwater.

Assessing agricultural practices and insecticides resistance for effective malaria vector control in northwestern Iran

BackgroundAfter three years with no local transmission of malaria, an outbreak occurred in Iran in 2022. Key malaria control methods in Iran are including indoor residual spraying (IRS), long-lasting insecticide-treated nets (LLINs), and prompt diagnosis and treatment of malaria cases. Anopheles sacharovi is one of the main malaria vectors in Iran. This study aimed to determine the insecticides resistance status of An. sacharovi in northwestern Iran, to inform effective vector control programs in this region.MethodsLarval stages of An. sacharovi were collected from various larval habitats located in the villages along the Aras River. Adult susceptibility tests were performed on An. sacharovi using diagnostic doses of insecticides accordance to World Health Organization (WHO) guidelines. The study also evaluated agricultural insecticide and fertilizer usage alongside the presence of natural mosquito predators in breeding sites in the study area.ResultsAlongside various chemicals such as silica, humic acid, superphosphate, sulfur, urea, and solupotasse at different dose levels, organophosphorus and pyrethroid insecticides are commonly used in rice fields and orchards. Anopheles sacharovi displayed diverse reactions to insecticides, demonstrating resistance to DDT but sensitivity to malathion, and showing similar reactions to carbamate and pyrethroid insecticides.ConclusionsThese results provide significant insights into agricultural practices and the presence of mosquito larvae in the study area. The extensive use of a specific herbicide illustrates its popularity among farmers for weed control, while other agricultural products focus on enhancing soil fertility and productivity. The absence of mosquito larvae in habitats with predators indicates the usefulness of these predators in controlling the population of mosquitoes. The resistance of mosquitoes to certain insecticides highlights the need for careful selection and intermittent use of insecticides in vector control programs. These findings can inform the development of targeted strategies to reduce malaria transmission risks. Further research is essential for assessing the effectiveness of these interventions.

Updated Guidelines for the Prevention and Management of Chronic Hepatitis B-World Health Organization 2024 Compared With China 2022 HBV Guidelines.

The year 2024 is the year of new clinical practice and management guidelines for chronic hepatitis B virus (HBV) infection. World Health Organization (WHO) published the updated HBV guidelines in March 2024. In contrast, two key international societies for liver diseases, including the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL), are currently in the process of updating their clinical practice guidelines for HBV. In 2022, China published their HBV guidelines, regarded as one of the most uncompromising ones as the threshold to start antiviral treatment is set at detectable HBV DNA above 10-20 IU/mL. In this chapter, the latest developments in the HBV guidelines with a specific focus on the Chinese & WHO guidelines are discussed. Specifically, the pros and cons of lowering treatment thresholds and the benefits of treating more people to avoid the complications of chronic hepatitis B, specifically HCC, are reviewed.

An assessment of the content of antenatal care provided by obstetricians in Lebanon: A cross-sectional study.

Quality and timely antenatal care is a vital component of pregnancy care for the well-being of mothers and babies. The aim of this study of to assess self-reported obstetricians' adherence to national and international antenatal care guidelines in Lebanon. This cross-sectional study approached all obstetricians registered with the Lebanese Society of Obstetrics and Gynecology and the Lebanese Order of Physicians to participate in an online and telephone-based survey. The study tool included all of the items from the World Health Organization and national guidelines for antenatal care. Obstetricians' self-reported adherence was assessed across five modules including dietary interventions, dietary supplements, antenatal care assessment, fetal growth assessment, and antenatal care preventive measures. A total of 134 obstetricians completed the survey. Overall, adherence was high for most antenatal care guidelines except for providing nutrition services to undernourished pregnant women, screening for intimate partner violence, and providing tetanus vaccines. The number of recommended antenatal care visits (≥8 vs. <8 visits) was higher among obstetricians in Mount Lebanon or Beirut compared to other areas in Lebanon (72.7%vs.48.6%; p-value <0.01). Provision of tetanus or diphtheria, tetanus, and pertussis (DTP) vaccination was lower for obstetricians who provide care for women who pay out-of-pocket compared to obstetricians who provide care to women who use other payment methods (25.3%vs.45.7%; p-value = 0.024). Group B streptococcus screening test and the provision of at least five ultrasounds were higher among obstetricians who provide care in private clinics or clinics in private hospitals compared to clinics in public hospitals or primary healthcare centers (88.8%vs.66.7%; p-value = 0.023) and (83.6%vs.55.6%; p-value = 0.011), respectively. Reinforcing the adherence to all antenatal care guidelines by continuous monitoring of health facilities is crucial for best practice. Subsidies for essential services may be required for those who are unable to afford components of antenatal care.

Determination of seven phenoxy carboxylic acid herbicides in water using dispersive solid phase extraction coupled with ultra-high performance liquid chromatography-tandem mass spectrometry based on metal-organic framework composite aerogel

Phenoxy carboxylic acid herbicides (PCAs) are difficult to degrade and, thus, pose significant threats to the environment and human health. The limit for 2,4-dichlorophenoxyacetic acid is 30 μg/L in China's standards for drinking water quality, 70 μg/L in the United States' drinking water standards, and 30 μg/L in the World Health Organization's guidelines for drinking water quality. Therefore, the development of an effective detection method for trace PCAs in water is a crucial endeavor. Metal-organic frameworks (MOFs) are novel porous materials that possess advantages such as a large specific surface area, adjustable pore size, and abundant active sites. They exhibit excellent adsorption capability for various compounds. However, the applications of MOFs as adsorbents are limited. For example, the process of isolating powdered MOFs from aqueous solutions is laborious, and microporous MOFs exhibit limited surface affinity, which decreases their mass transfer efficiency in the liquid phase. MOF crystals can be embedded in a substrate to overcome these limitations. Aerogels are obtained by drying hydrogels, which are hydrophilic polymers with a three-dimensional crosslinked network structure. Spongy aerogel materials exhibit unique structural properties such as high porosity, large pore volume, ultralow density, and easy tailorability. When MOFs are combined with an aerogel, their efficient and selective adsorption properties are preserved. In addition, MOF aerogels exhibit a hierarchical porous structure, which enhances the affinity and mass transfer efficiency of the MOF for target molecules. At present, MOF aerogels are primarily prepared by freeze-drying or using supercritical carbon dioxide. These drying processes require significant amounts of energy and time. Hence, the development of greener and more efficient methods to prepare skeleton aerogels is urgently needed. In this study, we prepared an environment-friendly aerogel at ambient temperature and pressure without the use of specialized drying equipment. This ambient-dried MOF composite aerogel was then used for the dispersive solid phase extraction (DSPE) of seven PCAs from environmental water, followed by ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). The key parameters affecting the efficiency of DSPE, including the extraction conditions, ratio of MIL-101(Fe)-NH2 to sodium alginate, pH of the aqueous samples, extraction time, ionic strength (salinity), and elution conditions, such as the elution solvent ratio, elution time, and elution volume, were investigated to obtain optimal extraction efficiency. The adsorbent could adsorb the target contaminants within 12 min, and the analytes could be completely desorbed within 30 s by elution with 4 mL of 1.5% (v/v) formic acid in methanol solution. The water samples could be analyzed without pH adjustment. The main adsorption mechanisms were electrostatic interactions and π-π conjugation. Thus, a new method based on MOF aerogels coupled with UHPLC-MS/MS was developed for the determination of the seven PCA residues in water. The calibration curves for the seven PCAs showed good linearity (r2≥0.9986), with limits of detection (LODs) and quantification (LOQs) ranging from 0.30 to 1.52 ng/L and from 1.00 to 5.00 ng/L, respectively. Good intra- and inter-day precision values of 6.5%-17.1% and 7.4%-19.4%, respectively, were achieved under low (8 ng/L), medium (80 ng/L), and high (800 ng/L) spiking levels. The developed method was applied to the detection of PCAs in surface water, seawater, and waste leachate, and the detected mass concentrations ranged from 0.6 to 19.3 ng/L. Spiked recovery experiments were conducted at mass concentrations of 8, 80, and 800 ng/L, and the recoveries ranged from 61.7% to 120.3%. The proposed method demonstrates good sensitivity, precision, and accuracy, and has potential applications in the detection of trace PCAs in environmental water.

Optimizing Lumefantrine Dosing for Young Children in High-Malaria-Burden Countries Using Pharmacokinetic-Pharmacodynamic Simulations.

Artemether-lumefantrine is the most widely used treatment for uncomplicated malaria and it is dosed based on weight bands according to World Health Organization (WHO) guidelines. However, children are vulnerable to underdosing. Inadequate dosing can lead to treatment failure and drug resistance. Nutritional parameters for 372 363 children <5 years old in 25 high-malaria-burden countries were acquired from the Demographic and Health Surveys program. Prevalence of attaining day 7 lumefantrine concentrations ≥200 ng/mL and remaining reinfection free for 42 days were evaluated using a simulation-based approach with a population pharmacokinetic-pharmacodynamic model. Besides the WHO-recommended lumefantrine dosing regimen (twice daily for 3 days), we explored 3 adjusted regimens: extended (2 extra days of dosing), increased (1 extra 120-mg tablet per dose), and intensified (thrice daily for 3 days). We also explored an alternative method dosing malnourished children based on expected weight for age. We estimated that 75% of children reached the 200 ng/mL lumefantrine threshold and 77% were malaria free for 42 days when using WHO treatment guidelines. By switching to the alternative dosing method, 5% more children achieved target lumefantrine levels; 22% more achieved the target using the alternative dosing and the extended regimen. With combined alternative plus extended dosing, 97% of children reached 200 ng/mL lumefantrine and 88% were malaria free for 42 days. This study highlights the inadequacies of weight-based lumefantrine dosing for young and underweight children and supports the need of clinical trials using extended dosing based on expected weight in malnourished children.

IAQ and ventilation measurements at the “ZEB Laboratory” office building in Norway

This study aims to assess indoor environmental quality (IEQ) within a Zero Emission Building (ZEB) office in Norway, focusing on occupant impact (CO2, temperature, humidity) and materials/substances influence (formaldehyde, particulate matter (PM2.5), total volatile organic compounds (TVOC)). It presents a detailed data collection spanning 14 months from March 30th, 2022, to June 1st, 2023.Occupancy varied significantly, affecting measured indoor air quality (IAQ) parameters, with the lowest temperatures recorded on the second floor and specific areas like the canteen experiencing temperature drops during low usage times. Relative humidity levels remained over 20% in winter despite the building's low occupancy, a notable aspect given Norway's dry winters. PM2.5 levels stayed below World Health Organization (WHO) guidelines, indicating effective pollution management.The study also evaluates the impact of reducing the ventilation rates on IAQ, noting no significant IAQ compromise. An analysis correlating IAQ measurements with building occupants' satisfaction post-intervention revealed that temperature is the most significant factor affecting satisfaction levels, excluding acoustic satisfaction. Occupants generally reported satisfaction with the indoor environmental quality (IEQ), with specific dissatisfaction tied to thermal environment and IAQ, suggesting the importance of temperature control in occupant perception.This research not only provides valuable insights into IEQ management in Zero Energy and Zero Emission office buildings but also emphasizes the critical role of indoor temperature and the potential of wooden structures to stabilize humidity levels, contributing to occupant comfort and satisfaction.

Analysis of Heavy Metal Pollution in the Water of the Halda River: A Distinctive Breeding Habitat for Carp Fish in Bangladesh.

The present study aimed to assess the heavy metal concentrations in water from different sampling sites of the Halda River, the only natural breeding ground of Indian major carps. We have analysed the contamination level and seasonal variations of heavy metals (viz. Fe, Cu, Zn, Cr, Cd and Pb). The favourability of the breeding environment was assessed by different contamination indices. Samples were collected from six sampling sites for four different seasons, and the metal concentrations were determined for water samples using Flame atomic absorption spectrophotometer. The obtained order of mean concentrations of heavy metals for four seasons was winter>spring>monsoon>pre-monsoon, and the assessed mean concentrations (mg/L) of heavy metals follow the trend: Fe (9.129)>Pb (0.033)>Zn (0.024)>Cr (0.017)>Cu (0.012)>Cd (0.002). The concentration of Fe was found above the permissible limit set by the World Health Organization (WHO) (Guidelines for Water Quality) and ECR (1997), and the concentrations for Pb were found above the USEPA (2006) limit in all four seasons. Contamination indices (heavy metal pollution Index [HPI] and metal index [MI]) indicate that during winter and monsoon, the river water metal condition is critical (HPI>100) and the sites are moderately as well as slightly (1<MI<2) affected by the studied heavy metals. Contamination indices, such as contamination factors (Cf), degree of contamination (Cdeg) and the pollution load index (PLI), demonstrate the fact that Fe and Pb remarkably contaminated the studied sampling sites. The Pearson correlation matrix and the principal component analysis (PCA) revealed that the studied metals are connected by their sources, which can be geological or anthropogenic. Urgent initiatives need to be taken, and effective strategies must be implemented to control the different sources responsible for the entry of heavy metals into the Halda River water.

Prevalence, Risk Factors, and Clinical Profiles of Hepatitis D Virus in Nigeria: A Systematic Review, 2009–2024

Background: The World Health Organization (WHO) recommends hepatitis D virus (HDV) screening among hepatitis B virus (HBV) infected individuals, with a focus on priority populations in resource-limited settings like Nigeria. HDV infection is a growing public health challenge, particularly among individuals with chronic hepatitis B virus (HBV) infection. HDV accelerates liver disease progression and significantly increases the risk of cirrhosis and hepatocellular carcinoma. Despite this, the epidemiology of HDV in Nigeria remains inadequately documented. This scoping review critically evaluates the prevalence, risk factors, and clinical outcomes of HDV co-infection among HBV patients in Nigeria. Method: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review included observational cross-sectional studies published between 2009 and 2024. We focused on studies that used Immunoglobulin G (IgG) antibody testing or RNA-based diagnostics to assess HDV prevalence. We included PubMed, Google Scholar, and Dimensions databases due to their broad indexing and coverage of peer-reviewed articles and accessibility. We screened the studies for their relevance to HDV prevalence, risk factors, and clinical outcomes, while excluding those that only tested for IgM or HDV antigen. Eleven studies, with a combined sample size of 2308 participants, were included in the final analysis. We performed a narrative synthesis of the findings, considering geographic, gender, and age-based variations in HDV prevalence and clinical impact. Results: HDV prevalence among HBV-infected individuals in Nigeria ranged from 2.0% to 31.6%. The highest prevalence was reported in the Southwest (31.6%) among malaria patients, while lower rates were observed in the Southeast (2.8%). Prevalence was higher in males, particularly those aged 21–30 years in the Southwest and 31–40 years in other regions. RNA-based testing provided more accurate data on active viremia, with viremic HDV prevalence rates ranging from 3.2% to 16%. Triple infection with HIV/HBV/HDV was associated with significantly lower CD4+ cell counts and worse clinical outcomes, including elevated liver enzymes and rapid progression to liver cancer. Key risk factors for HDV co-infection included multiple sexual partners, sharing of needles, and unsafe medical practices. Co-infected patients demonstrated worse clinical outcomes, such as elevated liver enzymes, decompensated cirrhosis, and higher rates of hepatocellular carcinoma. Conclusions: Our review underscores the urgent need for routine HDV screening among HBV patients in Nigeria, especially given the severe clinical consequences of co-infection. The recent WHO guidelines recommending HDV screening align with our findings, which emphasize the importance of RNA-based HDV testing among HBV-positive patients to improve diagnostic accuracy. Public health efforts should prioritize tailored interventions based on geographic, age, and gender disparities in HDV prevalence. Triple infection with HIV/HBV/HDV requires integrated care models to address both immune suppressions as indicated by diminished CD4 cell count and liver disease progression, as these patients face worse outcomes. Targeted HDV screening in mostly affected demographics and geographies and improved Nigeria capacity for cheaper HDV RNA/PCR diagnostics can reduce liver-related morbidity and mortality caused by HBV, which can be worsened and accelerated by HDV coinfection.

Factors associated with physical activity in individuals with metastatic cancer: a UK cross-sectional survey.

Physical activity is safe and feasible for individuals with metastatic cancer and may support symptom management. We investigated the extent to which individuals with metastatic cancer are meeting the World Health Organisation (WHO) moderate-vigorous physical activity (MVPA) guideline, factors associated with meeting the guideline, and perceptions about physical activity and receiving physical activity advice. Data were from UK adults with metastatic breast, prostate, or colorectal cancer who completed the Healthy Lifestyle After Cancer survey (N = 588). Self-reported clinical, demographic, and physical activity (Godin Leisure-Time Exercise Questionnaire) data were collected. Logistic regression models assessed whether clinical and demographic factors were associated with meeting the MVPA guideline. Most (59%) individuals with metastatic cancer were not meeting the WHO guideline of 150min of MVPA per week. Adjusting for cancer type, the odds of meeting the MVPA guideline were lower for unemployed individuals (OR = 0.47, 95% CI = 0.23-0.77) and ethnic minorities (OR = 0.44, 95% CI = 0.22-0.89), but higher for those with a university education (OR = 1.89, 95% CI = 1.0-3.57). Most (63.5%) participants felt they should be doing more physical activity. However, 70.1% did not receive any physical activity advice or support, despite 73.6% wanting to receive it. People with metastatic cancer may need further support to address inadequate levels of physical activity. The differences observed between demographic sub-groups suggest this may be more beneficial for those less likely to engage in physical activity. Individuals with metastatic cancer are likely to benefit from increased physical activity support, which considers the needs of diverse demographic groups.

Physical activity and sedentarism among university students: an approach using a real-life survey

Abstract Background Evidence shows physical activity (PA) and sedentary behavior (SB) impact health-related outcomes. World Health Organization (WHO) provides PA guidelines for different life stages. A recent study revealed that engaging in SB &amp;gt; 6 hours/day increases all-cause mortality risk. Nevertheless many students spend a significant portion of their daily time on SB and PA levels are insufficient. Methods Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included including PA Motivations and barriers. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Out of 2,216 surveys 1,648 were women, 568 men and 59.7% were in first university years. In our sample, 12.9% don’t do PA. Of those doing PA, 47.1% (n = 1043) don’t meet PA recommendations. Regarding SB, 84.7% spend &amp;gt;6 hours/day in SB. When grouped into PA/SB categories 40.5% were extremely sedentary in contrast to 8.8% physically active. Non-university facilities (41.1%) were preferred over university facilities (11.1%). Use of non-university and university facilities correlated with WHO compliance. Main barriers among inactive students were lack of time (48%) and lack of a workout partner (18.6%). Conclusions Most students don’t meet WHO guidelines. Less than 10% are considered active, while 40.5% are extremely sedentary. University sports facilities are underused even if linked to better compliance. To promote facilities as health-promoting spaces and investigate reasons for their underuse is necessary. Lack of company as a reason for not engaging in PA points out the need to strength university sports communities. Key messages • Although many students exercise, the majority do no meet World Health Organization recommendations. • We must intensify university programs to promote physical activity and reduce sedentary behavior.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults.

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants' physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p < 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p < 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80-89% HRmax) and an increase in the percentage of muscle mass (70-79% and 80-89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

Estimating risk using the novel Particulate Matters years index (ePM-years index). A report from the nationwide EP-PARTICLES study

Abstract Background Air pollution is the largest environmental risk factor, especially for cardiovascular disease (CVD). In this study, we present an original concept of estimating the risk associated with exposure to air pollution: the Particulate Matters years index (ePM-years index). Objective To assess the predictive performance of the ePM-years index. Methods The ePM-years index is an indicator of hypothetical exposure to air pollution. It is estimated by multiplying the number of years spent in a given environment by the difference between the average annual PM2.5 concentration and the allowed level of pollution given by World Health Organization (WHO) guidelines (Figure 1). We collected data from 2011 to 2020 on mortality and hospitalizations from National Health Fund and the Central Statistical Office in Poland, respectively. For further analysis, we used an age-standardized rate (SR), established on the European Standard Population structure. The source of air pollution data was GEM-AQ air quality modeling system. All data were connected with TERYT codes, all analyses were conducted at the county level (LAU-1) and then aggregated to the voivodeship level (NUTS-2). Poisson regression models were used to estimate associations between CVD mortality, ePM-years, and population level social and health status. We also estimated the attributable fraction of CVD mortality due to air pollution using AirQ+ methodology from the WHO. Results We recorded 4,010,531 deaths including 1,669,464 (41.6%) deaths due to CVD with a median age of 78.16 (SD=12.54), and 53.4% of females (N=914,932). Current smokers amounted to 29.9% (23.4%-33.2%). The main causes of death were coronary artery disease [405,268 (24.3%)] and heart failure [376,592 (22.6%)]. The mean Gross Domestic Product (GDP) per capita was 9644 EUR (7517-12,048), and the mean yearly PM2.5 concentration was 23.3 (SD=6.3) μg/m3, corresponding with the mean ePM-index 35.8 (21.5-66.6) in analysed time. The SR for CVD mortality was 500.3 (min. 461.9 – max. 604.5), the SR hospitalization rates were as follows: hypertension 312 (299-342), diabetes 90 (78.9-95.9), and HF 557.9 (310-728.4). There was an association of the ePM-years index with CVD mortality (shown as increase per 10 ePM-years): In Model 1 adjusted for GDP, risk ratio (RR) 1.023 (95% confidence interval (CI): 1.002-1.044); in Model 2 adjusted for comorbidities, RR=1.025 (95%CI: 1.004-1.046); in Model 3 adjusted for GDP, comorbidities and weather conditions RR=1.027 (95%CI: 1.005-1.049). We estimated that 16.2% (N=324,460) [95%CI: 12.54% -17.9%] of CVD deaths were attributable to PM2.5 exposure, using the WHO's air quality guideline as the reference. Conclusions The ePM-years index may be used as a tool for risk stratification for patients and incorporated into CVD outcomes prediction models. The index can help with planning of appropriate primary and secondary prevention schemes related to long-term pollution exposure.

8.E. Skills building seminar: Methods for measuring the true health cost of pollution

Abstract Healthy environments are essential for physical and mental wellbeing. Air pollution is considered to be one of the most significant environmental risk factors for ill health and premature death within the European Union. Poor air and noise quality have been linked to the exacerbation of symptoms, hospital admissions, and even premature deaths, especially for those with cardiorespiratory diseases. The associated medical costs and productivity losses therefore also impose a large economic cost. Exposure to environmental stressors disproportionately affects socially disadvantaged groups, and therefore contributes to the large socioeconomic inequities in health observed persistently in Europe. The EU has prioritised action on causes of pollution. For example, its Green Deal outlines ambitious plans to address climate challenges such as pollution and align air quality ambitions closer to the World Health Organization guidelines. Likewise, the European Environmental Agency routinely monitors the mortality burden associated with air pollution, while the impact of environmental noise on European citizens is examined through the Environmental Noise Directive. While in the political scene there is interest to advance the reduction of pollution, efforts are hindered by the lack of an harmonized methodology to quantify the socioeconomic cost of environmental stressors. Currently, researchers working with the burden of disease framework face many challenges in its application in the context of environmental stressors. Among others, these challenges include unmet data needs and major lack of transparency in methodological developments. In this skills-building seminar, we will outline an integrated approach for measuring the true health cost of pollution. This approach is currently being trialled in the EU-funded BEST-COST project, which sets out to improve methodologies for understanding the socioeconomic cost of environmental stressors, focusing on air and noise pollution. The project brings together a consortium of 17 partners from Europe and the USA, and is led by Sciensano, the Belgian institute for health. Through a synergy of theoretical outlines and real-life examples, seminar participants will gain methodological insights in the three key components of this integrated approach - i.e., the quantification of the health burden of environmental stressors via comparative risk assessment, the monetization of Disability-Adjusted Life Years to assess economic impact, and the quantification of environmental health inequalities via a novel area-level based framework. Key messages • There are significant unmet needs with respect to both data and methodologies for quantifying the socioeconomic cost of environmental stressors. • We outline an integrated approach for measuring the true health cost of pollution, combining health burden, economic burden, and environmental health inequalities.

Assessment of Clinical Toxicological Resources in Countries Belonging to the World Health Organization's Regional Office of the Eastern Mediterranean.

Poison Centers are vital to prevent and manage exposures to chemicals, toxins, and ionizing radiation. However, many countries still lack sufficient poison information center services. Within the World Health Organization's Eastern Mediterranean Regional Office (EMRO) region, we were not able to identify a formal assessment of its toxicological resources. We sought to assess the clinical toxicological resources in the EMRO region and the attitudes, needs, andperspective of the workforce in thatregion. METHODS: This was a two part survey study. First, wedeveloped a poison center questionnaire and scoring system based on the World Health Organization's Guidelines for Establishing a Poison Center; thisinstrument wasadministeredby phone to poison center directors and faculty in the EMROregion. Questions assessed for the presence or absence of important poison center capabilities listed in the WHO guidelines, and points were assigned based on response. Secondly, we administered an electronicworkforce survey to clinical toxicology professionals in the region; participanteligibility for the workforce survey was based on themembership roster ofMENATOX. Out of 22 EMRO countries, 16 countries have an established poison center, and 14 of 16 participated in the poison center survey. The results reflected a wide variability in capabilities amongcountries. Areas such as call centers, clinical toxicology units, laboratory services, and data management were relatively lacking while some other areas including toxicovigilance, chemical incidents and emergencies, antidotes/antivenoms, poisoning information sources, and the availability of free services were relatively stronger.Twenty-seven out of 32 workforce respondents were physicians. Results from that survey highlighted a desire for more support from government and better compensation. Our studyidentified areas of need for the EMRO region.The poison center survey results reflect large disparities amongcountries with some areas being stronger than others. The workforce survey highlighted issues such as compensation and government recognition. Overall, a formal assessment of individual poison centers can provide benchmarks to drive improvement of services, but further research is needed to identify and characterize country-specific needs.