World Health Organization Guidelines Research Articles

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.

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 > 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 >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.

Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.

The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

The non-inferiority of piperonyl-butoxide Yorkool® G3 insecticide-treated nets compared to Olyset®Plus measured by Anopheles arabiensis mortality in experimental huts in Tanzania

BackgroundNon-inferiority trials are recommended by the World Health Organization (WHO) to demonstrate that health products show comparable efficacy to that of existing standard of care. As part of the WHO Global Malaria Programme (GMP) process of assessment of malaria vector control products, a second-in-class insecticide-treated net (ITN) must be shown to be non-inferior to a first-in-class product based on mosquito mortality. The public health impact of the first-in-class pyrethroid-piperonyl butoxide (PBO) ITN, Olyset® Plus, has been demonstrated in epidemiological trials in areas with insecticide-resistant mosquitoes, but there is a need to determine the efficacy of other pyrethroid-PBO nets to ensure timely market availability of nets in order to increase access to ITNs. The non-inferiority of a deltamethrin-PBO ITN Yorkool® G3 was evaluated entomologically against Olyset® Plus in experimental huts in Tanzania, following WHO guidelines for non-inferiority trials.MethodsThe trial of the two pyrethroid-PBO ITNs was conducted in experimental huts in Lupiro, Tanzania, using a randomized 7 × 7 Latin square block design. The study ran for 49 nights in 14 huts assessing the mosquito mortality and blood-feeding of wild, free-flying, pyrethroid-resistant Anopheles arabiensis. Using the non-inferiority approach, the comparative efficacy (primary endpoint was mosquito mortality at 24 h and secondary endpoint was blood-feeding) of unwashed and 20 times field-washed pyrethroid-PBO Yorkool® G3 ITNs, were compared with the first-in-class product Olyset® Plus and against a pyrethroid-only ITN, PermaNet® 2.0 ITNs, as a standard comparator.ResultsThe experimental hut trial demonstrated non-inferiority and superiority of Yorkool® G3 to Olyset® Plus based on mosquito mortality [51% vs. 39%, OR 1.68 (95% CI 1.50–1.88)], given that lower 95% CI exceeded 0.74 (delta of 39%) and the margin of no difference (1). Blood-feeding inhibition was high for all treated ITNs (> 90%) and Yorkool® G3 was non-inferior to Olyset® Plus [4% vs. 2%, OR 1.81 (95% CI 1.46–2.39)], given that upper 95% CI was less than 4.85 (delta of 4%). The pyrethroid-PBO ITNs were superior to the pyrethroid-only net, PermaNet® 2.0, as determined by both the proportion of mortality and blood-feeding of mosquitoes (p-value < 0.05).ConclusionYorkool® G3 ITNs demonstrated non-inferiority to the first-in-class Olyset® Plus and superiority over the standard pyrethroid-only ITN, PermaNet® 2.0 as measured by mortality and blood-feeding inhibition of wild pyrethroid-resistant An. arabiensis mosquitoes. Yorkool® G3 ITNs are potential tools for the control of metabolic insecticide-resistant malaria vectors, and their market availability will contribute to the cost-effective selection of ITNs by malaria control programmes to improve population access to ITNs.

Post-marketing quality evaluation of oxytocin injection and assessment of associated factors among selected health facilities in Addis Ababa, Ethiopia

Oxytocin is the principal drug and the primary choice for labor induction and postpartum hemorrhage prevention and treatment. The problems associated with oxytocin are not usually from its effectiveness, but they are from its compromised quality which may occur at the point of manufacturing, transportation, and storage. The main objective of this study was to assess the status of oxytocin injection quality and associated factors in the health facilities located in Addis Ababa city, Ethiopia. A laboratory based instrumental quality testing alongside a cross sectional study design was used to evaluate oxytocin injection quality in Addis Ababa city administration from January to June, 2022 according to United States Pharmacopeia (USP 20), and the World Health Organization guideline of post-market medicine quality assessment. Binary logistic regression and cross tabulation analysis were conducted using SPSS 26. Significance was considered at p ≤ 0.05. Out of 107 tested oxytocin injection samples, 92.5% met the limit for oxytocin content, 81.3% for sterility test, and 91.6% for pH value. Overall, quality failure rate was 23.4%, while sterility test failure rate was 18.7%. Lack of reliable refrigerated storage condition [(AOR = 5.62, 95% CI: (1.87, 16.88)], lack of effective cold chain system during distribution [(AOR = 5.5, 95% CI: (1.53, 19.74)], and weak national medicine regulatory system [(AOR = 3.23, 95% CI: (1.13, 9.23)] were among the significantly associated factors for the failure of some of the brands. The study demonstrated that oxytocin injection quality failure rate, failing to meet at least one quality test requirement, is demonstrated in the health facilities of Addis Ababa. The determinant factors for the reported failures are related to storage, distribution, and regulatory system. Hence, these should be addressed by strictly adhering in to the national regulation and providing a comprehensive health promotion on rational use of oxytocin injection should be implemented to assure its quality and safety.

Characterizing indoor air quality and identifying factors influencing air quality at home microenvironment in Dhaka city

In low- and middle-income countries, indoor air pollution stands as a significant contributor to morbidity and mortality, prompting research into the factors influencing exposure at home in urban environments. Thus, this study was designed to investigate the indoor air quality and identifying factors influencing indoor air quality which help in targeting intervention to reduce indoor home air quality. The study conducted in Dhaka city involved 43 homes, where continuous monitoring of PM2.5 concentration was carried out over a 24-h period. Various factors related to home characteristics (i.e., home area and cooking fuel type), ventilation practices (i.e., duration of window opening), and indoor activities (i.e., cooking frequency, daily average cooking duration per meal, cleaning, smoking and use of mosquito coil and spray) were assessed to explore their impact on indoor air quality. Through the multiple linear regression model, the relationship between the factors and indoor pollutant concentrations was analyzed. The average PM2.5 concentration recorded in this investigation was five time higher in comparison to the World Health Organization's (WHO) 24-h guideline level for ambient air pollution. Four factors including outdoor air, home area, cooking duration and cleaning frequency were found to be significantly linked to indoor concentrations, collectively explaining 64 % of the variability in indoor PM2.5 levels. Outdoor air infiltration emerged as the most influential predictor of indoor levels, contributing significantly to indoor concentrations. The identified factors could assist in targeting interventions to reduce microenvironmental PM2.5 concentration at home.

Excess dietary sugar and its impact on periodontal inflammation: a narrative review.

Sugar is omnipresent in the current food environment and sugar consumption has drastically risen over the past century. Extensive evidence highlights the negative health consequences of consuming excess dietary sugars, leading the World Health Organization (WHO) and the American Heart Association (AHA) to devise guidelines to restrict sugar intake. According to the WHO's Global Oral Health Status Report of 2022, oral diseases and severe periodontitis are a massive public health problem, and dietary sugars are a modifiable risk factor. We conducted a literature review using key databases to summarise the health effects of excessive sugar consumption and their potential role in periodontal inflammation. Available evidence suggests that excess dietary fructose and sucrose can cause low-grade systemic inflammation; and induce dysbiosis in both gut and the oral microbiota. Also, dietary sugar is potentially addictive and hypercaloric and its overconsumption can lead to obesity, metabolic syndrome, and other risk factors for periodontal inflammation. Hence, an unbalanced diet with excess dietary sugars holds the potential to initiate and aggravate periodontal inflammation. In the modern food environment that enables and facilitates a high-sugar diet, adopting a diverse diet and restricting sugar intake according to WHO and AHA guidelines seem beneficial to systemic and periodontal health. Since clinical evidence is limited, future research should study the effectiveness of dietary interventions that control sugar consumption in preventing and managing the global public health problem of periodontal inflammation.

In vivo efficacy of chloroquine plus primaquine combination therapy against uncomplicated Plasmodium vivax malaria in Limu Kossa District, Jimma Zone, Southwest Ethiopia.

Plasmodium vivaxis the second most common malaria parasite in Ethiopia. It has been treated with chloroquine (CQ) for the past seven decades. However, the emergence of CQ-resistant strains in the nation urged the Federal Ministry of Health of Ethiopia to review its national malaria treatment guideline in 2018.In the revised guideline, thefirst-line treatment for uncomplicatedP. vivaxinfection is a combination of CQ and primaquine (PQ). Thus, the present study was designed to evaluate the in vivo efficacy of CQ and PQ combination therapy against clinicalP. vivaxmono-infection in one of the malaria-endemic areas of Ethiopia. Anopen-label prospective clinical trialwas conducted in the Limmu Kossa District, Jimma zone, Southwest Ethiopia, from September 2023 to March 2024. A total of 108 patients were recruited for the study. All participants received treatment with CQ at a dosage of 25mg/kg over three days, followed by PQ at 0.25mg/kg for 14 consecutive days. Patients were monitored for 42days for any signs of treatment failure and malaria clinical symptoms, as per the World Health Organization (WHO) guidelines for anti-malarial drug evaluation. Additionally, haemoglobin (Hb) levels, body temperature,any adverse events, and signs of haemolysis were assessed.Data was analysed using R-software (version 4.0.0) and a significant level was considered at p < 0.05. The median age of the patients was 23years, ranging from 2.5 to 62years. Of the 108 patients initially recruited, 100 completed the 42-day follow-up period. The combination therapy of CQ and PQ for uncomplicated clinicalP. vivaxmalaria demonstrated excellent therapeutic efficacy, with a 100% cure rate observed at both day 28 and day 42. Additionally, the recommended low dose of PQ (0.25mg/kg) was well-tolerated, with no signs of. Additionally, most common malaria symptoms were disappeared early in the follow-up period. The combination of CQ plus PQ has exhibited excellent efficacy against uncomplicatedP. vivaxmalaria mono-infections. To preserve this efficacy, it is critical to ensure patients adhere to the full course of PQ treatment, despite its extended duration. Therefore, health authorities should put emphasis on the boosting of the public on the importance of finishing the prescribed medication regimen.

Association between physical activity and costs in very mild to moderately frail community-dwelling older adults: a cross-sectional study.

Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults. This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates. Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]). Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.

Assessing drinking water quality in Eloued, south-East Algeria, using the groundwater pollution index (GPI) and the synthetic pollution index (SPI) model.

Groundwater quality degradation is a significant environmental issue worldwide, with potentially severe economic consequences and harm to ecosystems and biodiversity. This can directly affect human health, particularly in developing countries where rapid and uncontrolled urbanization is on the rise. Groundwater is the primary resource for meeting the water needs of the Eloued region, located in southeastern Algeria. Water is considered unfit for human consumption if its physico-chemical elements exceed national or international standards or guidelines. We used the GPI and SPI indices to evaluate the quality of groundwater suited for drinking. Groundwater samples were obtained from 22 wells at depths of more than 250m. Standard analytical procedures were used to determine the physicochemical characteristics of the collected samples, which included pH, EC, TDS, Na+, Ca+2, Mg+2, K+, Cl-, HCO3-, SO4-2, NO3-, NO2-, NH4+ and PO4-3. Multivariate statistical analysis and GIS techniques were used to process the results. The results of the selected physicochemical parameters were compared with World Health Organization (WHO) guidelines to determine the quality of drinking water. The findings indicate that the waters of the terminal complex aquifer are salty and contain medium to high quantities of main ions that surpass the established drinking water limits. The primary ions' relative abundance is Cl- > SO4-2 > HCO3- > NO3 for anions and Na+ > Ca+2 > Mg+2 > K+ for cations. Groundwater chemical types were dominated by Na+, Ca+2, Cl-, and SO4-2. Principal Component Analysis (PCA) showed that alteration and dissolution of carbonates, evaporates, salts, partly silicates, and evaporation, are the main reasons affecting the chemical composition of water in Eloued. The GPI results show that 18.18%, 54.54%, and 27.27% of the water samples were classed as lightly polluted, moderately polluted, or substantially polluted for drinking purposes, respectively. According to the SPI study, 9.09%, 36.36%, 36.36%, and 18.18% were considered drinkable, mildly contaminated, moderately polluted, and seriously polluted for drinking purposes, respectively. According to the GPI and SPI models' geographical distribution maps, potable water is generally scarce and concentrated in the northeastern section of the research area, near the town of Ourmes.

Adaptation of WHO COVID-19 guidelines by Caribbean countries and territories.

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean.

Spatiotemporal evolution of the physicochemical parameters of the waters of the Oum Errabiaa watershed dams (Morocco)

This study was conducted to determine the characteristics of the physicochemical parameters of the water of the dams of the Oum Errabiaa watershed during flood and low water periods. Data were collected by water sampling and measurements performed in the various dams from 2016 to 2021. The results showed that the water temperature varied from 11.77 °C to 30.20 °C, depending mainly on the sunshine. The water was alkaline with an average pH of 8.23 and had a weak to high electrical conductivity (143-3180µS/cm). The water was relatively well oxygenated at the surface and oxygen depleted in depth (1.44 – 15.04mg/L). The average concentration of suspended solids (SS) was 19.76mg/L, indicating that the dam water is relatively unpolluted. The average values of nutrients, NH4+, NTK and NO3- of 0.18mg/L, 0.53mg/L and 3.51mg/L, respectively, were in compliance with the WHO guidelines for drinking water production. The average concentration of SO42- was 90.60mg/L, which is considered high, exceeding the World Health Organization (WHO) water quality standard of 50mg/l. The average chlorophyll a was 5.51µg/L, which is considered to be low to moderate in dams. Overall, the Oum Errabiaa’s water dams of watershed have good physicochemical quality, except for the high concentration of sulfates. This pollution is likely due to agricultural and industrial activities in the watershed. The use of multivariate techniques (ACPN) enabled us to define the origin of nutrients through surface inputs, on the one hand, and through the photosynthetic activity of cyanobacteria, on the other hand.

Strengthening guideline contextualization in the WHO European Region.

The World Health Organization (WHO) plays an important role in developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE-Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations.

Hindi Translation, Cultural Adaptation, and Validation of Modified Weight Bias Internalization Scale (WBIS-M): A Cross-Sectional Study from the Metabolic Surgery Clinic in North India

Background: The lack of culturally-sensitive tool masks the epidemiology of weight-bias and internalized-stigma. This study aimed to translate, adapt, and validate the Modified Weight-Bias Internalization Scale (WBIS-M) into Hindi. Methods: The translation and adaptation process followed the World Health Organization guidelines. Three psychiatrists translated the original WBIS-M into Hindi. The bilingual panel comprised four psychiatrists, two laparoscopic bariatric surgeons, a professor of English, and an individual with severe obesity (with an International English Language Testing System (IELTS) score of Band 8.5) who was familiar with Western culture. The panel identified and resolved inadequate expressions of translations or discrepancies. An independent translator, whose mother tongue was English, back-translated it into the English language. Focused group discussions with individuals with severe obesity were conducted. The final H-WBIS-M was administered to undergraduates ( n = 120) after seven days. Test–retest reliability was assessed. The original WBIS-M, Eating Disorder Diagnostic Screen, and Fat Phobia Scale-Short Form were administered to 120 undergraduates and 55 individuals with severe obesity ( n = 175)]. Reliability and validity of H-WBIS-M were analyzed. Results: Kaiser–Meyer–Olkin measure of sampling adequacy was 0.788, and Bartlett’s test of sphericity was χ2 = 1381.892, p = 0.000. The exploratory factor analysis extracted three components. Spearman-Brown coefficient for H-WBIS-M was 0.875. The internal consistency was α = 0.875 ( p = 0.000), intraclass correlation coefficient was 0.857 (95% confidence interval [CI] = 0.812–0.893) ( p = 0.000), and Pearson correlation ranged from 0.869 to 0.989 ( p = 0.000). Cross-language concordance revealed a significant intraclass correlation coefficient (0.877–0.986) ( p = 0.000) and Pearson correlation ranging from 0.781 to 0.972 ( p = 0.000). Conclusions: The H-WBIS-M demonstrated good psychometric properties based on standard testing procedures.

A cross-sectional descriptive study: Evaluation of pharmaceutical marketing materials in implementing world health organization guidelines.

A cross-sectional descriptive study: Evaluation of pharmaceutical marketing materials in implementing world health organization guidelines.