Editor’s Choice Articles

Background/Objectives: West Nile virus (WNV) is a persistent mosquito-borne threat in Greece. This study examined whether online information-seeking patterns reflected official WNV surveillance during 2024–2025, with Crete providing descriptive field-level One Health preparedness context. Methods: Official national surveillance data were compared with country-level Google Trends relative search volume and Greek-language Wikipedia pageviews, focusing on weekly locally acquired West Nile neuroinvasive disease/central nervous system (WNND/CNS) cases. The Crete component separately summarized regional One Health preparedness. Results: Greece reported 220 locally acquired WNV cases (157 WNND/CNS) in 2024 and 96 (76 WNND/CNS) in 2025. Wikipedia pageviews showed the strongest full-year associations with WNND/CNS activity when pageviews followed cases by one week (2024: Spearman rho = 0.802; 2025: rho = 0.763; both p < 0.001). Google Trends showed weaker associations at the same lag (2024: rho = 0.402, p = 0.003; 2025: rho = 0.452, p < 0.001). Transmission-period sensitivity analyses attenuated several associations: the 2025 Wikipedia associations and the Google Trends associations in both years were not statistically significant. The first-difference lag analysis identified no leading digital signal. Conclusions: Wikipedia showed more stable language-specific temporal concordance with national surveillance than Google Trends. However, the digital indicators reflected concurrent or lagging public attention and did not demonstrate predictive capacity. The Crete component separately illustrates how regional One Health preparedness complements national surveillance and risk communication. Full article

Background/Objectives: Since June 2025, Japan has mandated countermeasures to prevent outdoor laborers from developing heat-related illness at work. However, the extent to which preventive behaviors can reduce the actual heatstroke risk has not been quantified. The present study aimed to (i) project future trends in the daily number of heat-related ambulance transports in the working population under climate change, and (ii) evaluate the population-level preventive impact of workplace-adopted preventive behaviors using effect estimates from observational data. Methods: Using daily maximum wet-bulb globe temperature, a long-term future projection of heat-related ambulance transports was performed in the working population. A cross-sectional survey was carried out to infer the effect size of behavioral interventions. The effectiveness of taking preventive behaviors was evaluated by increasing the coverage rate of workers adhering to all four behaviors (current: 23%): (i) regular hydration, (ii) use of an air-cooling vest, (iii) checking their own health condition before work, and (iv) recognizing warning signs. Theoretical scenarios in which workplace instructions to workers or teams increased adherence by 50%, 100%, and 300% relative to baseline were considered, corresponding to coverage rates at 34%, 45%, and 91%, respectively, and we evaluated the associated reduction in heatstroke risk. Results: Many future years were projected to have higher annual levels of heat-related ambulance transports than the median value from 2018–2024, indicating a long-term increasing trend. Even when all four possible countermeasures were implemented at an additional 50%, 100% or 300% from the current rate, the expected relative risk reduction in transports was 3.2%, 6.3%, and 19.0%, respectively, indicating only a small effect on future projected heat-related illnesses. Conclusions: The number of heat-related ambulance transports is expected to increase; however, the relative risk reduction with behavioral intervention is likely limited. A fundamental overhaul of working regulations and environment (e.g., drastic shift in working hours to earlier morning) is required via adaptation policies, and mitigation of climate change is vital. Full article

Background/Objectives: Adults with intellectual disability are known to experience complex health needs, including an elevated presence of chronic conditions. Cardiovascular risk factors are a concern, yet the evidence base is fragmented, and the scope and focus of current research are not well understood. Methods: We conducted a scoping review to map the existing evidence on cardiovascular risk factors among adults with intellectual disability. The review included studies reporting on risk factor prevalence as well as participant characteristics (ethnicity, living arrangements, age, sex, and type of disability). Cardiovascular-related outcomes were extracted to clarify the health disparities documented in this population. Results: Searches of seven databases for studies published from 2013 onward yielded 15,598records, of which 85 met the inclusion criteria. Evidence was dominated by cross-sectional studies, with a few randomized controlled trials. Hypertension, Type 2 diabetes and obesity were commonly reported. Patterns appeared to reflect lifestyle, medication effects, genetic syndromes—particularly Down syndrome and Prader–Willi syndrome—and the severity of the disability. A notable share of the studies originated from the United Kingdom and the United States. Findings reveal a complex cardiovascular risk profile, emphasizing the need for tailored prevention and management. Conclusions: Adults with intellectual disability face a substantial burden of cardiovascular risk factors. Evidence on effective interventions remains limited, highlighting a need for targeted, evidence-informed approaches to improve cardiovascular health and long-term outcomes. Full article

Background: The Karamoja sub-region of Uganda addresses significant challenges in water, sanitation, and hygiene (WaSH), deeply linked to public and environmental health and regional development. Objectives: This study applied a Knowledge, Attitudes, and Practices (KAP) survey within a One Health framework to assess WaSH conditions, hygiene behaviour, livestock management, and disease prevention in the Moroto and Napak districts. Methods: A total of 195 respondents were surveyed, providing insights into socio-demographic factors, hygiene practices, livestock management, and disease prevention. Results: Findings highlighted gender disparities, with women less likely to achieve good knowledge compared to men (OR = 0.04; p = 0.002), probably reflecting limited access to information in traditionally male-focused community settings, and their greater involvement in water collection tasks. Age significantly influenced WaSH knowledge, with older individuals (aged ≥ 30 years) showing higher odds of good knowledge (OR = 20.39; 95% CI: 2.74–151.83; p = 0.003), probably due to their roles in knowledge transmission within the community. Proximity to water sources shaped behaviours, with greater distances associated with improved attitudes (OR = 3.56; p = 0.002) but reduced hygienic practices (OR = 0.20; p = 0.01). Livestock ownership, particularly of small ruminants, strongly correlates with good hygiene knowledge (OR = 16.89; p = 0.02), probably due to interactions with veterinarians and authorities during vaccination campaigns. Integrated communication strategies, including community meetings, home visits, and radio outreach, were strongly associated with improved practices (e.g., home visits: OR = 30.78; p < 0.001). Conclusions: Despite progress, challenges such as water scarcity, waste management, and gender disparities persist. Improving water infrastructure, promoting equitable access, and integrating tailored communication strategies are essential for fostering sustainable development, health equity, and the empowerment of women in Karamoja. Full article

The COVID-19 pandemic caused stark global mortality disparities, influenced by a complex interplay of demographic, economic, and health factors. This ecological study investigates associations between country macroscopic variables and COVID-19 accumulated mortality ratio (AMR) across 174 countries and may serve as a preparation for new pandemics. Methods: The study applies bidirectional stepwise multiple linear regression. To ensure statistical validity, we conducted diagnostic tests for multicollinearity and heteroscedasticity, applying robust M-estimation where necessary to minimize root mean squared error. The analysis covered six distinct stratifications based on development status (developed, developing, least developed, and combinations), and incorporated temporal analyses across three specific annual periods: 21 January 2020–20 January 2021; 21 January 2021–20 January 2022; and 21 January 2022–10 January 2023. Data: AMR per country values, accumulated between 21 January 2020 and 10 January 2023, and data on the prevalence of health conditions, and socioeconomic descriptive variables were extracted from Our World in Data (OWID) and other public data sites, like the World Bank. Results: The percentage of population aged over 65 years has the most consistent association with increased AMR globally. Obesity prevalence and income inequality (Gini index) were positively associated with AMR regardless of country development status. Conversely, the study finds a consistent negative correlation with diabetes prevalence, while the prevalence of respiratory diseases is a significant association only for developed nations. Socioeconomic factors were significantly associated with AMR, but this influence is stronger in developed countries than in the developing and least developed countries. Conclusions: While population aging is the primary association with increased AMR, the mortality impact of comorbidities and socioeconomic factors is heavily conditioned by a country’s development stage, pointing to the necessity of development-status-aware public health strategies for incoming pandemics. Full article

Background: In modern society, increased awareness of stress stems mainly from the pressures of competitive environments, where the pursuit of academic and professional success places substantial demands on individuals, who must adapt. Drawing on the Transactional Model and the Interactive Model of Human Adaptation to Stress, this paper presents a battery of instruments designed to comprehensively assess university students’ adaptation to stress. Methods: Data were collected from two academic years, using two independent samples of students: a calibration sample (n = 561) and a validation sample (n = 370) to test the psychometric properties of the instruments. The evaluation protocol included the Stress Questionnaire for Students (SQS), the Primary and Secondary Cognitive Appraisal Scale (PSCAS), the Reduced Coping Inventory (Coping-R), and the Academic Achievement Expectations (AAE). Results: Psychometric validation analyses indicated the best versions of the instruments’ battery. Namely, an 18-item version and a six-factor structure for the SQS, a 10-item version and a five-factor structure for the PSCAS, a 12-item version and a four-factor structure for the Coping-R, and a five-item, one-factor structure for the AAE. Conclusions: The proposed instruments can serve as a compound resource for screening for academic stress experiences in university students, and as an original tool to understand the entire process of stress adaptation. Full article

Background/Objectives: The Charlson Comorbidity Index (CCI), which focuses on 19 comorbid diseases and conditions, has been widely used as a valid predictor of mortality. This study aimed to comprehensively examine the prevalence of nearly all comorbidities and concomitant medications according to CCI classification (CCI = 0 and CCI ≥ 4) and age group (aged 40–44 and 70–74 years) in middle-aged Japanese adults. Methods: The present study included 9,182,226 individuals who underwent health checkups from April 2018 to March 2019. A total of 15,916 cases of diagnosed diseases and conditions, including communicable diseases; diseases of the eye, ear, skin, and musculoskeletal system; and psychiatric disorders, were investigated alongside 16,886 prescribed medications. Results: The prevalence of allergic rhinitis was ranked among the leading comorbidities in all age groups and CCI categories. Individuals with a CCI ≥ 4 in the 40–44 age group showed a higher prevalence of cardiometabolic diseases such as hypertension, diabetes, and dyslipidemia compared with individuals with a CCI = 0 in the 70–74 age group. Furthermore, individuals with a CCI ≥ 4 in the 40–44 age group also had a higher prevalence of communicable diseases, gastrointestinal symptoms, iron deficiency anemia, and psychiatric disorders compared with individuals with a CCI = 0 in the 70–74 age group. The ranking for prescribed medications was essentially the same between age groups, but was found to differ between CCI categories. Conclusions: This study identified overlooked comorbidities and concomitant medications that are not accounted for in the 19 conditions included in the CCI, which may be important prognostic factors in determining mortality. Although patients with more comorbidities were found to be more frequently diagnosed with cardiometabolic diseases regardless of their age, the presence of pharmacotherapy may be dependent on age. Full article

Background/Objectives: Randomized controlled trials (RCTs) are the gold standard for evaluating treatment efficacy, yet recruitment and retention remain challenging, particularly when placebo arms are required. Using historical placebo data may reduce the need for contemporaneous placebo groups, but comparability between historical and real-time placebo responses is uncertain. This study assessed the feasibility of replacing a placebo control group with a historical placebo arm in osteoarthritis (OA) RCTs using several matching approaches. Methods: Data from three published knee OA RCTs (2009, 2013, 2017) were analyzed. The study followed three steps: (1) development of matching techniques using the 2009 and 2013 trials, (2) validation in the 2017 trial, and (3) post hoc analyses comparing placebo responses across trials. Methods included direct covariate adjustment, exact and nearest-neighbor matching, and propensity score matching based on baseline characteristics (age, sex, BMI, OA duration, baseline pain). The main outcome was change in 100 mm visual analogue scale (VAS) pain. Results: Initial attempts showed moderate to good success in adjusting historical placebo response on the VAS using various adjustment methods. However, in the validation process, a significant discrepancy was observed between real placebo VAS changes data and historical placebo VAS changes data, and various matching techniques failed to sufficiently reduce this discrepancy. In the post hoc analysis, despite the application of advanced matching techniques, substantial variability in VAS placebo responses persisted across trials. Even among placebo patients with highly similar baseline characteristics, the VAS changes over time differed significantly between studies. Conclusions: The findings indicate that replacing a real placebo group with a historical placebo in osteoarthritis RCTs is hardly feasible. These results underscore the complexity of placebo effects in osteoarthritis trials and the limitations of historical control data in this context. Full article

Global health faces unprecedented challenges driven by communicable diseases, which are increasingly amplified by persistent health inequities, the impact of climate change, and the speed of emerging crises. Prevention is not merely a component but the foundational strategy for an effective, sustainable, and fiscally responsible public health response. This paper delves into the pivotal role of core prevention levers: robust vaccination programs, stringent hygiene standards, advanced epidemiological surveillance, and targeted health education. We detail how contemporary technological advancements, including Artificial Intelligence (AI), big data analytics, and genomics, are fundamentally reshaping infectious disease management, enabling superior predictive capabilities, faster early warning systems, and personalized prevention models. Furthermore, we thoroughly examine the imperative of integrating the One Health approach, which formally recognizes the close, interdependent links between human, animal, and environmental health as critical for combating complex threats like zoonoses and Antimicrobial Resistance (AMR). Despite significant scientific progress, persistent socio-economic disparities, the pervasive influence of health-related misinformation (infodemics), and structural weaknesses in global preparedness underscore the urgent need for decisive international cooperation and equitable financing models. We conclude that only through integrated, multidisciplinary, and resource-equitable strategies can the global community ensure effective prevention, mitigate severe socio-economic disruption, and successfully build resilient healthcare systems capable of withstanding future global health threats. Full article

Background/Objectives: The aging process is typically marked by a reduction in functional fitness, which heightens the likelihood of falling. Although obesity is established as a determinant of poor mobility, the interplay between excess weight and advanced age is still a topic of research interest. Therefore, this research investigated how age, sex, and Body Mass Index (BMI) interact to influence fall risk among older adults living in the community. Methods: This cross-sectional investigation involved 815 participants (M_age = 70.45 ± 6.10 years), stratified by age (sexagenarians, septuagenarians, octogenarians) and BMI (normal weight, overweight, obesity). Fall risk was assessed using the Timed Up and Go test. A Three-Way ANOVA examined the main and interaction effects. Results: No significant three-way interaction (p = 0.334) or main effect of sex (p = 0.079) was found. However, a significant age x BMI interaction was observed (p = 0.007). In sexagenarians and septuagenarians, obesity was associated with significantly slower fall risk performance compared to normal weight (p < 0.001). Conversely, in octogenarians, this difference was not significant (p = 1.000) with normal-weight individuals. Conclusions: Obesity may be a significant risk factor for falls, especially in adults aged 60 to 79 years. In octogenarians, the protective benefit of normal weight disappears, revealing a “weight paradox” likely driven by sarcopenia. Fall risk assessments and weight management strategies should be tailored to age, focusing on preserving muscle mass in octogenarians. Full article

Background and objectives: During an outbreak, measles cases tend to aggregate into increasingly bigger clusters that show specific characteristics, different from the non-cluster cases. As the measles threat continues throughout Europe in 2025 with a high notification rate in Romania as well, exploring how clustering affects the disease propagation can provide additional insights into how to improve measles surveillance and control. Methods: National measles cases from 2020 to 2024 have been split into cluster (at least three related cases) and non-cluster-related cases and analyzed comparatively based on vaccination status, disease-related data (hospitalization) and patient-related data (age, location). Large outbreaks with at least 150 cases, allowing for more comprehensive R₀ analysis, have been described and the basic reproduction numbers computed for each of them. Results: There are statistically significant differences in vaccination status, age, and hospital stay between outbreak and non-outbreak cases. Large outbreaks (≥150 cases) show a high degree of variability, with R₀ values varying from as low to 1 to as high as 3.92, indicating limited measles transmission control. Conclusions: The findings in this research highlight the critical impact of clustering on measles transmission dynamics during outbreaks. Significant differences in vaccination status, age, and hospitalization rates between cluster and non-cluster cases underscore the importance of targeted surveillance and intervention strategies while the wide range of R₀ values observed in large outbreaks points to inconsistent control measures and emphasizes the need for strengthened vaccination campaigns and improved outbreak response protocols to better contain measles spread. Full article

Background/Objectives: Discovered in 2019, COVID-19 spread rapidly worldwide, leading from mild forms of the disease to critical forms or death, predominantly among vulnerable patients. Severity scores help clinicians in stratifying the risk of complications and death among patients diagnosed with SARS-CoV-2 infection. Methods: This study aims to identify the severity scores used in this type of infection, while bibliometric analysis carried out provided a comprehensive overview of global research patterns, trends, and cooperation in scientific literature on the chosen topic. Results: We conducted a literature screening to identify severity scores used in SARS-CoV-2 infection. Scores including CURB-54, COVID-GRAM, NEWS, APACHE II, SOFA, qSOFA, CALL, MuLBSTA, ISARIC 4C, and PADUA were identified with different performance indices. Conclusions: There were different results obtained depending on the geographical area of applicability, patient groups analyzed, and individual patient characteristics. Full article

Aim: This study aimed to assess self-reported oral and orofacial health, hygiene habits, and oral health knowledge among Croatian athletes, and to determine factors influencing that knowledge. Differences between contact and non-contact sports, as well as the occurrence of dental trauma and temporomandibular joint (TMJ) symptoms, were also examined. Methods: A cross-sectional, questionnaire-based study was conducted among 1007 athletes (56% male, 44% female) aged 18–42 years, recruited through national sports federations and university sports clubs. The instrument comprised 85 items divided into five domains: sociodemographic data, oral hygiene habits, self-assessed oral health, TMJ symptoms, and oral health knowledge. Data were analysed using descriptive statistics, Chi-square and Fisher’s exact tests, and generalised linear modelling (p < 0.05). Results: Athletes demonstrated moderate oral health knowledge (mean score 11.3 ± 4.4/18). While 92.2% recognised that poor oral hygiene leads to caries and periodontitis, only 52.4% correctly identified the ideal time to replant an avulsed tooth. Female participants, older age groups, and those with higher education had significantly better knowledge (p ≤ 0.05). Recreational athletes scored higher than amateurs (p = 0.002), and those with prior dental trauma experience also showed greater awareness (p = 0.028). No significant difference was found between contact and non-contact sports (p = 0.287). Despite good brushing habits (86.9% brushed twice daily), only 25.4% regularly used dental floss or interdental brushes. A small proportion of athletes reported symptoms related to temporomandibular joint function, most commonly joint clicking (18.2%), tooth wear (13.4%), and nocturnal bruxism (14.3%). There were no significant differences between contact and non-contact sports, except for muscle stiffness near the temples (p = 0.024) and daytime or stress-related teeth grinding (p = 0.013 and p = 0.018). Conclusions: Croatian athletes demonstrated moderate oral health knowledge and satisfactory hygiene habits, but preventive practices remain inadequate. Education level, gender, and previous dental trauma were key determinants of knowledge. Systematic preventive programmes and targeted education are necessary to improve oral health awareness in sports populations. Full article

Background/Objectives: The purpose of this study was to identify shared and differing characteristics of individuals testing for both SARS-CoV-2 and MPXV in 2022 in the greater Houston metro area. Methods: Data from the Houston Electronic Disease Surveillance System (HEDSS) identified 7,754,198 SARS-CoV-2 PCR lab results and 1246 MPXVV PCR lab results in 2022. Three cohorts for analysis were created where tests were performed, as follows: those positive for both viruses, those negative for COVID-19 but positive for MPXV, and those positive for COVID-19 but negative for MPXV. Results: We identified 88 individuals positive for both viral infections, those negative for COVID-19 but positive for MPXV (n = 38), and those positive for COVID-19 but negative for MPXV (n = 96). While groups were generally similar in regard to demographics (age, sex, and race) and risk factors reported, key differences in timing of testing and risk factors were reported. Notably, there was statistically significant difference in the time between t-tests for dual-infected individuals (99 days) compared to MPXV-positive only (58 days, p < 0.01) or COVID-19 positive only (63 days, p < 0.01). Conclusions: In the setting of multiple disease outbreaks, the characteristics of infected patients may be largely similar. Some people with dual infection may show unusual test results or symptom patterns compared with those with only one infection. Large public health studies with robust reporting systems and laboratory screening are vital for early detection of dual infections. Public health strategies to educate providers and outreach teams enhance response during concurrent outbreaks. Further research is needed on behavior and risk factors in communities with simultaneous outbreaks. Full article

Background and Objective: Evaluating vaccine effectiveness (VE) is essential to implementing prevention strategies, and our objective was to estimate the VE of SARS-CoV-2 messenger RNA (mRNA) vaccines in preventing SARS-CoV-2 infection. Materials and Methods: We carried out a population-based, prospective cohort study on the Borriana COVID-19 cohort (Valencia Community, Spain) during the 2021–2023 period, considering all SARS-CoV-2 cases that occurred after the SARS-CoV-2 vaccine campaign started in January 2021 (first approach), as well as only symptomatic cases (second approach). Multivariable robust Poisson regression models were employed. Results: In this cohort with 301 participants, 285 were vaccinated, among whom 228 received only SARS-CoV-2 mRNA vaccines, and 57 received mRNA vaccines and other vaccines. In the first approach, there were 226 cases and 75 non-cases. The adjusted VE for three doses of vaccine was 37% (95% confidence interval [CI]: 22–49%) to prevent infection. In the second approach, with 153 symptomatic cases after excluding 73 asymptomatic cases, the adjusted VE for three doses of vaccine was 50% (95% CI 33–63%) to prevent symptomatic infection. Three doses of vaccine exhibited modest but significant protection against infection and symptomatic infection. Conclusions: This study recommends surveilling SARS-CoV-2 infections and variants, vaccinating at-risk populations, and developing new vaccines. Full article

Background/Objectives: COVID-19 and long COVID remain prevalent, with household transmission being an important mode of spread. To quantify household transmission of subclinical SARS-COV-2 infection and identify sociodemographic risk factors that may explain disparities in transmission, we conducted a case-ascertained antibody surveillance study of households in Cincinnati, Ohio. Methods: A partnership was formed between the Cincinnati Health Department and Cincinnati Children’s Hospital Medical Center. The Health Department identified cases of COVID-19. Infected individuals, along with their household contacts (n = 245), completed multiple questionnaires about symptoms, demographics, psychosocial (Adverse Childhood Experiences Scale and Everyday Discrimination Scale) and social risk factors, and conditions before and during the pandemic. In addition, they completed a non-fasting blood draw for IgG, IgM, IgA, and nucleocapsid protein serology testing. Results: Household contacts experienced few symptoms of COVID-19. However, according to the presence of the nucleocapsid protein, nearly 50% contracted the SARS-CoV-2 virus. This rate was similar by vaccination status but it was higher for household contacts who experienced high levels of early life adversity compared with those with lower levels. Conclusions: Our results confirm the high transmission of subclinical disease among household contacts, which may vary due to psychosocial factors. This reinforces the importance of isolating cases to prevent transmission, regardless of vaccination status. Full article

Background: Babesiosis and malaria are infectious diseases caused by the intraerythrocytic parasites Babesia and Plasmodium, respectively. While no human red blood cell (RBC) receptors have been shown to be essential for B. microti (Bm) invasion, Duffy (ACKR1) was reported to be essential for P. knowlesi and P. vivax invasion in 1975 and 1976, respectively. This suggests additional medical progress is needed for babesiosis, warranting a detailed analysis. Methods: Given similarities in the target cell of infection, data about babesiosis and malaria cases in the US were obtained from the Centers for Disease Control and Prevention (CDC). Research funding was quantified using National Institutes of Health (NIH) data, and medical progress was evaluated through a literature review. Results: Over the 5-year span of 2018–22, there were 9799 and 7722 confirmed babesiosis and malaria cases, respectively. Confirmed babesiosis cases exceeded malaria cases in 4 of 5 years. In 2022, babesiosis and malaria data were either not reported or unavailable to the CDC by ten and one US state(s), respectively. Regarding babesiosis, it is likely that the vast majority of cases were due to domestically acquired Bm, in the context of no chemoprophylaxis. Concerning malaria, >90% of US cases were imported from foreign locations, ~95% of cases were linked with not taking chemoprophylaxis, and P. falciparum (Pf) was the most common cause. From 2018–22, babesiosis and malaria were the underlying cause of death for 70 and 32 US residents, respectively. NIH funding estimates suggest ~$4 million in support of babesiosis and ~$169 million for malaria in 2024. There are many malaria-inspired medications, two malaria vaccines, and hundreds of characterized Plasmodium proteins, while these measures of medical progress are far behind for babesiosis. Outside of the US, there are >200 million malaria cases per year, while babesiosis is rare. Conclusions: In the US from 2018–22, there were more babesiosis cases and deaths than malaria. Decades of robust CDC and NIH funding for malaria led to its elimination from the US, improved medical knowledge and interventions, and reduced foreign morbidity and mortality. These data suggest that leveraging similar approaches used for malaria, including increased NIH and CDC funding for babesiosis, would likely lead to progress (e.g., improved treatment). Babesiosis qualifies as both a rare and an orphan disease. Full article

Background: In late January 2025, a measles outbreak began in Gaines County, Texas, USA, and the outbreak extended to New Mexico. We used a variety of mathematical models to estimate the growth rate of the Texas–New Mexico measles outbreak of 2025. Methods: We used both empirical and mechanistic models based on differential equations to make the estimations that allow us to characterize this measles outbreak. Regarding empirical models, we used the exponential growth model to compute and estimate the growth rate, basic reproduction number, ${\mathcal{R}}_0$, and effective reproduction number ${\mathcal{R}}_t$. With regard to mechanistic models, we use the SIR and SEIR models to estimate the growth rate, basic reproduction number ${\mathcal{R}}_0$, and effective reproduction number ${\mathcal{R}}_t$. We used new weekly measles cases and also cumulative cases. Results: Using the exponential growth model, we estimated a basic reproduction number between 32 and 40. For the classical SIR model, we estimated that the basic reproduction number is approximately 30. Conclusion: We found that the current Texas–New Mexico measles outbreak of 2025 has a slightly higher growth rate and effective reproduction number ${\mathcal{R}}_t$ compared to several previous measles outbreaks around the world. Full article

Background/Objectives: Medroxyprogesterone acetate (MPA) is a synthetic contraceptive that can be used orally or as a once-every-three-month injection (i.e., depot MPA [dMPA]). Prior research has reported an increased association between dMPA and cerebral meningioma but has been limited in generalizability to meningioma cases treated with surgery or cases derived from an administrative database of commercial insurance enrollees. The current study builds upon prior research by examining the association among public insurance enrollees utilizing both a non-active and active comparator. Methods: Utilizing Alabama Medicaid data, cases of cerebral meningioma were matched to up to ten controls based on age and year of Medicaid enrollment. A conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MPA and dMPA exposure and cerebral meningioma were compared to both an active and non-active comparator. Results: Among 469 cases and 4690 matched controls, there was no association between oral MPA and cerebral meningioma. Associations for dMPA exposure were similar when using a non-active (OR 1.87, 95% CI 1.16–3.00) or active comparator (OR 1.93, 95% CI 01.01–3.69). These associations were strongest for prolonged exposure compared to a non-active (OR 3.80, 95% CI 1.88–7.68) and active comparator (OR 3.67, 95% CI 1.09–12.29). Conclusion: The current results are consistent with the prior literature that dMPA exposure is associated with an increased likelihood of meningioma for prolonged use. More research is needed to examine whether the association is limited to a certain histology or grade of meningioma. Clinicians should consider discussing with patients these reported associations prior to using dMPA. Full article

Objectives: This study aimed to synthesize evidence of the influence of multilevel social determinants of health (SDOHs) on asthma and allergic disease outcomes and healthcare utilization in children and adolescents, with a specific focus on how these determinants generate or widen health inequities, through a systematic review of the current literature and evidence. Methods: A literature search was performed in the PubMed, EBSCO, and Scopus databases. The search period for all databases was from 1 January 2020 to 15 January 2025. Studies published in English that evaluated the association between at least one SDOH, as a primary exposure or effect modifier, and asthma and/or allergic disease outcomes and healthcare utilization in children and adolescents aged ≤ 18 years were included. A narrative synthesis was conducted to systematically explore and compare findings across studies, grouped by SDOH domains and disease outcomes. The grouping of SDOH domains was based on the framework established by the Healthy People 2030 Initiative. The selected studies underwent a quality assessment. Results: After the eligibility assessment, 44 studies were included in this review. Regarding study design, twenty-one studies were cohort, followed by eighteen cross-sectional, three ecological, and two case-crossover studies. Disease outcomes covered incidence, severity/exacerbations, lung function, and healthcare use in asthma, and analogous measures also reported for atopic dermatitis, allergic rhinitis, and food allergy. The most frequently studied domain of SDOHs was Neighborhood and Built Environment (n = 26), followed by Economic Stability (n = 24), Social and Community Context (n = 21), Healthcare Access and Quality (n = 12), and Education Access and Stability (n = 10). The vast majority of studies (n = 31) found positive associations between the examined SDOH factors and asthma and/or allergic disease outcomes and healthcare utilization. The most frequently evaluated SDOH with positive associations were neighborhood and residential conditions (n = 10), discrimination (n = 8), parental education (n = 7), housing quality (n = 6), air pollution (n = 6), and household income (n = 5). Risk-of-bias appraisal showed that the evidence base was largely at low risk, with most cohort, cross-sectional, ecological and case-crossover studies rated good quality, and only a few cohort studies classified as fair because of limitations in exposure assessment and residual confounding control. Conclusions: These findings highlight the urgent need for coordinated interventions and policies addressing social, environmental, and economic factors to reduce health disparities and improve outcomes for vulnerable children, while stressing the importance of interventional studies to provide stronger evidence. Full article

Background: Adherence to the Mediterranean diet (MD) is associated with improved health outcomes, however limited evidence exists on the socio-demographic and behavioral determinants of MD adherence among university students, a population at risk of developing unhealthy habits during a critical life stage. Methods: A cross-sectional study was conducted among 2697 students (70.6% female) enrolled at a university in Northern Italy. MD adherence was measured using the validated Medi-Lite score. Multivariable logistic and linear regression models were used to identify socio-demographic and behavioral associations with high adherence to the MD (score ≥12). Principal component analysis was performed to explore multivariate patterns across dietary components and participant characteristics. Results: Overall, 25.6% of participants were classified as having high adherence to the MD. Higher adherence was more frequent among women, non-smokers, older students, and those living with their families. Students in health sciences showed greater adherence compared to those in other fields of study. Conversely, frequent users of mobile food ordering applications and smokers were less likely to adhere to the MD. These associations remained consistent after adjusting for age and sex. Conclusions: Adherence to the MD is suboptimal among university students and influenced by socio-demographic and behavioral factors. Targeted interventions should prioritize younger males, smokers, and convenience food users, while promoting sustainability and social support as facilitators of healthier dietary patterns. Full article

Background: Vaccine hesitancy is a major threat to public health. As part of efforts to increase vaccine uptake, the focus is on optimizing the quality of communication among healthcare workers. Physician shortages and workloads create time constraints, making communication interventions in primary care challenging. This study aimed to propose strategies to improve communication between general practitioners and vaccine-hesitant individuals. This narrative review addresses the specific needs of general practitioners for effective communication and proposes strategies to combat vaccine hesitancy in culturally and linguistically diverse regions. Methods: Systematic searches of EMBASE and PubMed were performed using terms related to vaccine hesitancy, communication strategies, primary care, and cultural diversity. Additionally, the websites of major health organizations were searched for relevant reports and guidelines. Selection criteria were based on the relevance and quality of the selected studies. Results: The findings highlight the importance of empathy, transparency, and personalized information in communication strategies. The need for communication training and addressing policy and workload barriers for healthcare providers is significant. The proposed strategy includes regular communication skills and cultural competency workshops, language training, the development of multilingual resources, implementation of telemedicine services, and active community engagement. Conclusions: Policy recommendations advocate for increased primary care resources, support from general practitioner unions, and the integration of digital tools. These strategies are essential to improve vaccine uptake and public health outcomes by enhancing the capacity of general practitioners to effectively engage with vaccine-hesitant patients. Full article

Objectives: This study aimed to assess the knowledge, attitudes, and self-confidence of physicians and dentists in Croatia regarding the relationship between oral and systemic health, focusing on periodontal disease and oral manifestations of systemic diseases. Methods: A cross-sectional, web-based survey was conducted among physicians and dentists in Croatian primary healthcare. The questionnaire addressed six thematic domains, including demographic information, knowledge, self-assessment, and clinical practice. Descriptive and comparative statistical analyses were performed. Results: A total of 529 respondents were included (291 physicians and 238 dentists). The mean knowledge score for the association between periodontitis and systemic diseases was 6.8 ± 3.6 out of 15, indicating limited knowledge. For oral manifestations of systemic diseases, the mean score was 10.0 ± 3.8 out of 16, reflecting moderate proficiency. Dentists scored higher than physicians in both domains, though not significantly (p > 0.05). Routine oral mucosal examinations were reported by 89.5% of dentists and 43.0% of physicians (p ≤ 0.001). Only 21.3% of physicians correctly identified the link between periodontitis and adverse pregnancy outcomes, compared to 58.8% of dentists. The primary barriers to effective clinical management were a lack of experience (52.7%) and inadequate education. While 68.3% of dentists felt adequately educated on oral–systemic links, only 22.7% of physicians reported the same. Conclusions: Significant gaps in knowledge and confidence were observed, particularly among physicians. These findings underscore the need to integrate oral–systemic health topics into medical education and to promote interprofessional collaboration to improve patient outcomes. Full article

Aseptic abscess syndrome is a clinical entity that is being increasingly documented. Unfortunately, apart from the French registry, there are no other studies presenting collective data. In this review, we sought to analyze clinical and laboratory data from case reports published from the rest of the world. A total of 107 articles were found through our literature search in PubMed, Scopus, and Google, which contained 108 patients who met our eligibility criteria, including pediatric cases. The mean age at diagnosis was 39.1 years, and 54.6% of the patients were female. Cases were found affecting almost every organ, but the most common abscess locations were the spleen (51.9%), liver (35.2%), and lung (23.1%); 34.3% of the patients had multiorgan disease at diagnosis. An inflammatory syndrome was evident, with fever (79.6%), pain (66.7%), median white blood cell count of 16,200/μL, median C-reactive protein level of 15.5 mg/dL, and mean erythrocyte sedimentation rate of 79 mm/h. In total, 88.9% had an associated disease, with the most frequent being neutrophilic dermatosis (43.5%) and inflammatory bowel disease (31.5%); associated disease was inactive during abscess diagnosis in approximately one-quarter of patients. Moreover, 93.5% received corticosteroids with or without other agents, while 21.3% underwent excision surgery, which led to relapse if immunosuppressants were not concomitantly administered. No deaths were reported due to the syndrome, but 42.4% of cases that provided relevant data relapsed despite the relatively short follow-up period (median 1 year), either in the same or different organs. Combined immunomodulatory treatment, based on subgroup analysis, appeared protective against relapse in females and patients with splenic abscess or C-reactive protein >12 mg/dL (odds ratio 0.16 [95% CI 0.04–0.59]/p = 0.004, 0.09 [95% CI 0.01–0.62]/p = 0.008 and 0.23 [95% CI 0.06–0.92]/p = 0.03, respectively). Infection should always be the working diagnosis in patients with abscesses. However, if the infectious workup is negative, antimicrobials have failed, and no sepsis is present, then aseptic abscess syndrome should be considered; response to high-dose corticosteroids is a therapeutic criterion in almost all cases. Full article

Background: he surge in the use of Pre-hospital Emergency Medical Systems (EMS) and Emergency Departments (ED) has become a pressing issue worldwide after the COVID-19 pandemic. To address this challenge, we developed an experimental and innovative care pathway supported by telemedicine. The aim of this study is to describe the activity of the Integrated Medical Center (CMI): a new telemedicine-based care model for patients referring to the Emergency Medical System. Methods: A prospective observational study was conducted from January 2022 to December 2022. The CMI was established to manage patients referring to the Emergency Medical System. Results: From January to December 2022, a total of 8680 calls were managed by CMI, with an average of 24 calls per day. 6243 patients (71.9%) were managed without ED access of whom 4884 patients (78.2%) were managed through telemedicine evaluation only, and 1359 (21.8%) with telemedicine evaluation and dispatch of the Home Rapid Response Team (HRRT). The population treated by the HRRT exhibited a higher age. The mean satisfaction score was 9.1/10. Conclusions: Telemedicine evaluation allowed for remote assessments, treatment prescriptions, and teleconsultation for HRRT and was associated with high patient satisfaction. This model could be useful in future pandemics for managing patients with non-urgent illnesses at home, preventing hospital admissions for potentially infectious patients, and thereby reducing in-hospital transmission. Full article

Background/Objectives: The COVID-19 pandemic highlighted the critical need for accurate predictive models to guide public health interventions and optimize healthcare resource allocation. This study evaluates how the complexity of compartmental infectious disease models influences their forecasting accuracy and utility for pandemic resource planning. Methods: We analyzed a range of compartmental models, including simple susceptible-infected-recovered (SIR) models and more complex frameworks incorporating asymptomatic carriers and deaths. These models were calibrated and tested using real-world COVID-19 data from the United States to assess their performance in predicting symptomatic and asymptomatic infection counts, peak infection timing, and resource demands. Both adaptive models (updating parameters with real-time data) and non-adaptive models were evaluated. Results: Numerical results show that while more complex models capture detailed disease dynamics, simpler models often yield better forecast accuracy, especially during early pandemic stages or when predicting peak infection periods. Adaptive models provided the most accurate short-term forecasts but required substantial computational resources, making them less practical for long-term planning. Non-adaptive models produced stable long-term forecasts useful for strategic resource allocation, such as hospital bed and ICU planning. Conclusions: Model selection should align with the pandemic stage and decision-making horizon. Simpler models are effective for rapid early-stage interventions, adaptive models excel in short-term operational forecasting, and non-adaptive models remain valuable for long-term resource planning. These findings can inform policymakers on selecting appropriate modeling approaches to improve pandemic response effectiveness. Full article

Background/Objectives: Mental health conditions represent a growing global health concern, disproportionately impacting populations in low- and middle-income countries like Pakistan. Limited epidemiological data, coupled with recent socioeconomic and environmental disruptions, has intensified the need for current insights into psychological burden and coping capacities in the Pakistani population. Methods: A descriptive, cross-sectional survey was conducted from January to May 2023 among 400 community-dwelling adults attending outpatient departments in Islamabad and Rawalpindi. A structured 75-item questionnaire incorporating validated tools (PHQ-9, GAD-7, WHO-5, CSES, and SRQ-20) was used to assess depression, anxiety, well-being, coping self-efficacy, and mental distress. Descriptive statistics, χ² and Fisher’s exact tests, and Spearman’s rank correlation (r_s) analyses were performed using IBM SPSS 22.0. Results: Most respondents were male (73.0%), aged 25–34 (60.0%), and urban-dwelling (80.0%). Clinically relevant depression and anxiety were observed in 57.0% and 19.5% of participants, respectively; 38.0% reported mental distress. Conversely, 76.5% demonstrated fair-to-good coping efficacy and 51.0% had high well-being scores. Younger age (≤34 years), higher income, urban residence, and male gender were associated with significantly better mental health outcomes. Strong positive correlation was found between PHQ-9 and GAD-7 scores (r_s = 0.672), and moderate negative correlations were found between GAD-7 and WHO-5 (r_s = −0.496), and PHQ-9 and WHO-5 (r_s = −0.310). Conclusions: Our findings highlight the significant psychological burden among urban Pakistani adults, alongside promising levels of resilience and coping self-efficacy. These results emphasize the urgent need for early, culturally adapted mental health screening and intervention programs in outpatient settings. Integrating such strategies into primary care, particularly for vulnerable subgroups like women, older adults, and those with lower income could facilitate timely diagnosis, improve outcomes, and reduce stigma surrounding mental health. Full article

Background: Newly licensed physicians play a significant role in healthcare systems. However, they often lack knowledge about vaccine practices. This study aims to evaluate their ability to distinguish between fake news and the actual side effects of vaccines. Methods: We distributed a questionnaire to assess newly licensed physicians’ knowledge of side effects of vaccines and widespread fake news about them. We enrolled 317 newly licensed Italian physicians. Results: The average questionnaire score was 6.21/10 (SD = ±1.25). Work experience and age did not correlate with scores. Conclusions: Many participants were not able to distinguish between fake news and real vaccines’ side effects (e.g., the possible association between varicella vaccine and seizures). Furthermore, many physicians have been shown to believe in fake news. This lack of knowledge could lead to the inability to scientifically respond to anti-vaccinationists, thus increasing mistrust in medical counseling. Addressing knowledge gaps among recently licensed physicians is crucial to improving proper counseling and increasing public adherence to vaccination campaigns. Full article

Background/Objectives: The 1742–1743 plague epidemic had a profound impact on populations along the Royal Road (Camino Real), the principal trade route connecting Buenos Aires and Lima. This study aimed to quantify the demographic and socioeconomic consequences of the epidemic in Cordova and Santa Fe, with a focus on excess mortality and its broader implications for marginalized groups. Methods: This research utilized parish death records and complementary historical sources to calculate excess mortality in Cordova and Santa Fe during the epidemic. Mortality rates were compared across pre-epidemic (1740–1741), epidemic (1742–1743), and post-epidemic (1744–1745) periods. Additional data on demographic variables such as age, gender, marital status, and ethnicity were analyzed to identify patterns of vulnerability and resilience. Results: Excess mortality during the epidemic was significant, with death rates in Cordova peaking at 12 times the pre-epidemic average in May 1743, while Santa Fe experienced a 45% increase in mortality, peaking in December 1743. Marginalized groups, including enslaved and Indigenous populations, were disproportionately affected, exacerbating existing social inequalities. The epidemic also disrupted socioeconomic structures and highlighted systemic vulnerabilities in both urban centers. Conclusions: This study demonstrates the critical role of excess mortality as a metric for understanding the demographic and socioeconomic impacts of historical epidemics. By integrating quantitative and qualitative analyses, it underscores the intersection of public health crises with social structures in colonial Latin America. The findings offer insights into resilience and recovery mechanisms relevant to both historical and contemporary public health strategies. Full article

Background/Objectives: In recent years, non-contact room disinfection devices using ultraviolet light and hydrogen peroxide have emerged as disinfection methods. However, data on their usefulness in neonatal intensive care units (NICUs) are limited. Therefore, the aim of the present study was to evaluate the effectiveness of environmental disinfection in controlling methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in a NICU/growing care unit (GCU). Methods: Daily cleaning/disinfection of the patient environment was changed from using a cloth containing quaternary ammonium salts to an agent containing ethanol and surfactant, and terminal cleaning with a pulsed xenon ultraviolet light (PX-UV) non-contact disinfection device was added for patients with confirmed MRSA and those on contact precautions. MRSA incidence and environmental culture results were then compared before and after the method change. Results: The MRSA infection rate was 2.81/1000 patient days before the method change and 0.90/1000 patient days after the change (p = 0.008). Environmental cultures were positive in 12/137 (8.8%) before the change and 0 after the change. There were no adverse events in the neonates due to PX-UV irradiation of the environment. Conclusions: Daily cleaning and disinfection with ethanol and surfactant-containing cleaning disinfectants and a final cleaning with a PX-UV non-contact disinfection device reduced environmental MRSA contamination. In addition to adherence to hand hygiene and contact precautions, reducing MRSA present in the environment may contribute to MRSA control in NICUs and GCUs. Full article

Epidemiological studies indicate that heart failure (HF) prevalence and associated mortality are significantly higher among Eastern European countries as compared to their Western European counterparts. The significant financial burden on the healthcare system matches these sobering data. Thus, efficient programs for patients with HF have been called for. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) represents a widely used, cost-effective, and readily available test that can be used to evaluate HF risk. However, it should not be used as a universal assessment, given the existing variability in proposed cut-off scores for various subgroups of patients. Thus, the clinical context needs to always be considered, and alternative diagnoses need to be ruled out. Based upon evidence from the literature for the above assumptions, the advantages and limitations of using NT-proBNP in primary care settings, along with other HF diagnostic modalities, are discussed in this paper. Also, this paper argues that an effective primary care network, in collaboration with specialist providers, may avoid a delay in HF diagnoses, may help provide on-time treatments, and may ultimately cut unnecessary healthcare expenditures associated with HF hospitalizations. Therefore, the present paper proposes an algorithm for diagnosing HF in primary care settings and discusses specific knowledge and skills that family physicians should be well equipped with in order to successfully respond to the needs of their patients with HF. Full article

Irisin is a protein resulting from a proteolytic cleavage of fibronectin type III domain-containing protein 5 (FND5). The ability of irisin to modulate adipocyte and control glucose metabolism in human metabolic diseases gave rise to the hypothesis that irisin could have a pivotal role in aging-related diseases. Although in animal models, increased levels of irisin have been positively associated with better health outcomes, in humans, its role remains controversial. To provide an overview of the main finding on irisin in older adults, a comprehensive search was performed through the MEDLINE-PubMed, Web of Science, Scopus, and Cochrane databases for studies conducted in older adults (≥60 years) published since 2012. After grouping and analyzing the articles based on diseases associated with older adults, the main conclusion of this narrative review is that the included studies did not yield consistent evidence regarding the association between irisin and health or disease in older adults. Further studies are necessary to clarify the effective role of this protein in promoting health and longevity. Full article

Background: Ministerial Decree (D.M.) 77/2022 aims to reform Italy’s primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in the Autonomous Province of Bolzano, South Tyrol, emphasising interprofessional trust and collaboration issues. Methods: Using a narrative custom review approach guided by the SANRA checklist, this study synthesised findings from PubMed, official health websites, and regional surveys on frailty, workforce dynamics, interprofessional collaboration, and digital infrastructure in South Tyrol. Results: General practitioners (GPs) exhibited high professional motivation but expressed concerns about autonomy and administrative burdens in collaborative care models. Trust issues between GPs and specialists hinder workforce cohesion and care coordination, highlighting the need for structured inter-professional communication. Frailty assessments, such as the PRISMA-7 tool, identify over 33% of community-dwelling individuals aged 75 years and older as frail, necessitating targeted interventions. Digital health adoption, particularly electronic health records and telemedicine, is slow because of workforce shortages and infrastructure limitations. Conclusions: The successful implementation of D.M. 77/2022 in South Tyrol requires addressing workforce challenges, improving interprofessional trust, expanding digital infrastructure, and integrating frailty assessment findings into care strategies. These measures are critical for achieving a more resilient, equitable, and effective primary healthcare system. Full article

Introduction: Bovine neosporosis represents a significant threat to reproduction and production in livestock systems worldwide. This disease is caused by the protozoan Neospora caninum, resulting in abortions of cows and neurological signs in newborn calves. This leads to significant economic losses, decreasing meat and milk production, especially in tropical regions. The infection has an endogenous and exogenous cycle of transmission involving dogs that shed the oocysts, with the highest transmission successes in humid areas. Similarly, there is a lack of knowledge about the epidemiological risk factors and management practices involved in the transmission success in tropical humid regions. Methods: In this sense, a cross-sectional epidemiological survey was conducted on 150 farms from 24 municipalities of the Huila area. A total of 360 cattle were sampled, and information about the production system was collected using a structured poll with 128 questions. Results: In these cattle, 53% (191/360) were positive for antibodies against Neospora caninum using ELISA. The logistic regression analysis using the information collected from the poll identified the presence of flooring type, water access, production systems, and feed management as risk factors. Among the protective factors were identified the geographical area, molasses supplementation, and biosecurity practices such as animal separation and access control. Discussion: This study identified for the first time the epidemiological risk factors associated mainly with the exogenous cycle of neosporosis. The present study contributes to the design of intervention strategies oriented to minimize the impact of parasitism in Colombian herds. Full article

Background: Vitamin D and iron deficiencies are prevalent among Moroccan women of reproductive age (WRA). Research suggests that Vitamin D deficiency (VDD) may impair iron bioavailability, potentially leading to iron deficiency (ID) and anemia. Objectives: This study investigates associations between vitamin D status, iron levels, and anemia risk in WRA, aged 18–49, from Meknes, Morocco. Methods: A cross-sectional study was conducted among 463 participants, measuring serum 25(OH)D, blood count parameters, iron, ferritin, C-reactive protein, and creatinine. Lifestyle factors, including dietary intake, sun exposure, and physical activity, were assessed through validated questionnaires, and anthropometric data were collected. Linear and logistic regression models analyzed associations, while ROC analysis evaluated VDD’s predictive accuracy for ID and anemia. Results: VDD (25(OH)D < 20 ng/mL) was significantly associated with reduced hemoglobin, hematocrit, red blood cells, and ferritin (all p < 0.01), indicating vitamin D’s role in erythropoiesis and iron storage. Multivariate logistic regression showed that VDD increased the risk of anemia (OR: 7.17, 95% CI: 3.19–19.28, p < 0.001), ID (OR: 2.20, 95% CI: 1.32–3.77, p = 0.007), and IDA (OR: 4.10, 95% CI: 1.73–12.08, p = 0.004). Dietary iron intake was inadequate, showing minimal protective effects against anemia and ID (β(SE): −0.08(0.03), p = 0.030 and β(SE): −0.05(0.02), p = 0.037). Conclusions: VDD is a significant risk factor for impaired iron status and anemia in Moroccan WRA, highlighting the need for targeted nutritional interventions and further research. Full article

Background: Tracheal Bronchus and Lung cancers (TBL) represent one of the leading causes of cancer deaths worldwide. This study aimed to examine the disease and economic burden of TBL cancers in 185 countries worldwide in 2022. Methods: The estimates of TBL cancer incidence and mortality (counts and age-standardized rates) were obtained from the GLOBOCAN 2022 data produced by the International Agency for Research on Cancer. Mortality-to-incidence ratios (MIR) were utilized as a proxy of 5-year survival rates. Multivariate regression was utilized to examine the association between TBL cancer burden and tobacco use prevalence. Results: Globally, there were 2.48 million incident cases and 1.82 million deaths due to TBL cancers in 2022. Males accounted for 63.4% of incident cases (1.57 million) and 67.85% of TBL deaths (1.23 million) in 2022. For both sexes combined, the age-standardized rate was 23.1 per 100,000, and the age-standardized mortality rate was 16.8/100,000. The Mortality-to-incidence ratio (MIR) at the global level stood at 0.71. Eastern Asia had the largest burden of TBL cancers among the 21 UN-defined regions, with around 51% of incident cases (1.24 million) and 46.9% of global deaths (851,876), followed by Northern America (incidence: 257,284; deaths: 150,675) and Eastern Europe (incidence: 158,141; deaths: 126,840). At the country level, human development index (HDI) and adult tobacco use prevalence could explain 67% and 64% variation in ASIR and ASMR, respectively. HDI was statistically significantly related to MIR, explaining a 48% variation in MIR. Conclusions: With 1.9 million deaths in 2022, TBL cancer is a significant global cause of mortality. Despite the knowledge and awareness of smoking and lung cancer, adult smoking rates remain high in many countries, including the United States and China. Renewed and sustained global efforts are needed to reduce smoking prevalence and PM2.5 levels, particularly in China and low- and middle-income countries. Full article

Background/Objectives: To support women’s informed decisions and reproductive self-care, confident reproductive health-related knowledge is needed, supported by adequate health literacy (HL). No corresponding survey has been carried out in Hungary on inequalities to provide information addressing education. Materials and Methods: In the current cross-sectional online survey, 301 women of reproductive age (27.16 ± 0.36 years) were asked with the Hungarian versions of validated and standardised questionnaires about reproductive knowledge on hormones, ovulation, menstrual cycle, pregnancy signs and birth control (Knowledge of Female Body Scale—KFB), and HL (Brief Health Literacy Screening Tool—BRIEF). Spearman correlation and multivariable linear regression analyses were utilised, with a significance level set at p < 0.05. IBM SPSS version 28.0 (IBM SPSS, Armonk, NY, USA: IBM Corp.) and G*Power (version 3.1.9.7; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany) software. The STROBE checklist was followed. The Clinical Trial Registry Nr. is NCT06146673. Results: The KFB composite score was high (20.01 ± 2.33); 86.374% had “high knowledge”. Still, lacking information was identified for the mechanisms of certain contraceptive methods and early physical signs of pregnancy. A significant difference was also found in the KFB scores in the case of higher age (p = 0.019), higher education level (p = 0.018) and previous live birth (p = 0.028). A positive correlation was found between KFB and HL (p < 0.001), education (p = 0.005), and age (p = 0.021). A multiple regression analysis (R² = 0.087, p < 0.001) indicated that both HL (p < 0.001) and age (p = 0.003) are potential positive predictors of adequate reproductive knowledge, whereas induced abortion (p = 0.013) might serve as an inverse predictor. Conclusions: Inequalities in women’s knowledge about their reproductive system and HL were found, and it was significantly the lowest in their highest conception probability age. Therefore, in addition to targeted education, HL also needs improvement. Full article

Stroke is the second leading cause of death and disability in Latin America; however, few epidemiological studies have been conducted in South America. An observational study was conducted to analyze trends in stroke mortality in South American (SA) countries. Age-standardized mortality rates and proportional mortality due to stroke in the populations of SA countries between 1990 and 2019 were assessed by extracting data from the Global Burden of Disease 2019 study. Joinpoint regression models were employed to identify trends in the annual percentage change in mortality rates for each segment. Considering the data collected over the 30 years that were studied, the age-standardized stroke mortality trend decreased in Argentina (−1.6%), Uruguay (−0.6%), Brazil (−0.5%), Guyana (−0.5%), and Bolivia (−0.4%), while Venezuela (+1.6%) and Suriname (+1.0%) showed an increasing trend. The proportional stroke mortality trend decreased in Argentina (−1.7%), Paraguay (−0.9%), Uruguay (−0.7%), Guyana (−0.7%), Brazil (−0.5%), and Chile (−0.5%), whereas Bolivia (+1.0%), Suriname (+0.6%), and Peru (+0.4%) exhibited an increasing trend. The trends in stroke mortality between 1990 and 2019 demonstrated considerable variability. While most SA countries experienced significant decreases in stroke mortality trends, Venezuela and Suriname showed increases in age-standardized mortality rates, and Bolivia, Suriname, and Peru exhibited increases in proportional mortality rates. No decreasing stroke mortality trend was observed in the segment after the last joinpoint, highlighting the need for improvement in prevention and treatment. Full article

Background: Compared to the general population, individuals with special needs tend to have worse oral health, potentially diminishing their quality of life. This study aimed to evaluate the perception of parents and caregivers regarding the effect of oral health on the quality of life of individuals with special needs who received dental treatment under general anaesthesia, as well as the impact on their and their families’ quality of life. Materials and methods: This cross-sectional study involved participants with special needs who had undergone a dental treatment under general anaesthesia. Before the intervention, an oral examination was conducted to count the number of teeth affected by caries. Parents or caregivers filled out a specially designed questionnaire that included sociodemographic information, details about the children’s oral hygiene and dietary habits, and questionnaires on the impact of their child’s oral health on their quality of life (P-CPQ) and the influence of the oral health of children with psychophysical difficulties on the family (FIS). The data collected were analysed both descriptively and using the chi-square test, Fisher’s exact test, Kruskal–Wallis test, and Spearman’s correlation analysis. The level of significance was set at p ≤ 0.05. Results: This study involved 42 children (24 females and 18 males) with an average age of 21.14 ± 8.34 years. The average number of carious teeth per participant was 9.74 ± 5.63. About 66% of respondents reported that their children performed oral hygiene with their help, while 9.5% of them did not do so at all. Individuals with a higher number of caries had statistically significantly higher scores on the emotional well-being (p = 0.004) and social well-being (p = 0.033) subscales of P-CPQ, as well as on the parental emotions subscale of FIS (p = 0.020). Also, there was a difference in the number of carious teeth in participants due to unhealthy habits (drinking sweetened beverages, p = 0.030) and due to comforting with food (p = 0.004). Conclusion: The increase in the number of carious teeth in individuals with special needs has been associated with the quality of life of their families. To address this, it is crucial to promote the prevention of oral health issues by educating individuals with special needs and their caregivers on proper oral hygiene techniques and diets tailored to their specific requirements. Full article

Background: The perception of the risk of sexually transmitted infections (STIs) is a well-researched phenomenon, but not in relation to cyberchondria and health literacy. Therefore, our aim was to examine the association between the assessment of the risk of sexually transmitted diseases and HIV, cyberchondria, and health literacy. Materials and methods: This study was conducted in 2020–2021 in Croatia. The experimental group consisted of patients from the Centre for Voluntary Counselling and Testing for HIV (N = 134). The control group consisted of other patients recruited from daily epidemiological practices (N = 171). The instruments that were used were questionnaires that measure the perception of risk of sexually transmitted infections and HIV, health literacy, and cyberchondria. Results: Out of 305 respondents, 134 (43.9%) were in the STI counselling group, and 171 (56.1%) were in the control group. Generally, the participants in the former perceived the risk of sexually transmitted infections and HIV to be higher (but still low) than those in the latter. There was no difference in health literacy between the STI and control group; the health literacy score was average in both groups. There were differences in almost all the cyberchondria factors, except for Mistrust. Health literacy, belonging to the STI counselling group, and risk behaviours were positively associated with CH in the logistic regression analysis. Conclusions: People with a risk for STIs tend to minimize this risk, have higher cyberchondria levels, and have average health literacy. Cyberchondria is positively associated with health literacy, and more education about excessive health-related internet research is needed. Full article

Psoriasis, a systemic autoimmune disorder primarily affecting the skin, manifests through erythematous plaques and scales, impacting approximately 2–3% of the global population. Chronic periodontitis, a prevalent oral disease characterized by the destruction of tooth-supporting tissues, affects roughly 10–15% of adults worldwide. Emerging evidence suggests a bidirectional relationship between psoriasis and chronic periodontitis, supported by epidemiological studies indicating a higher prevalence of periodontitis among individuals with psoriasis and vice versa. Both conditions are chronic inflammatory diseases marked by dysregulated immune responses and altered cytokine profiles, notably involving proinflammatory cytokines such as TNF-α and IL-17. Clinical studies highlight a reciprocal impact of treating one condition on the other, underscoring the necessity of interdisciplinary collaboration between dermatologists and periodontists in managing patients with both conditions. This narrative review provides a comprehensive overview of the relationship between psoriasis and chronic periodontitis, examining epidemiological associations, shared inflammatory pathways, genetic insights, microbial dysbiosis, environmental factors, and clinical implications. The review emphasizes the importance of integrated care approaches and the potential for targeted therapeutic interventions to improve both psoriatic and periodontal patient outcomes, advocating for further research into the molecular and cellular mechanisms underpinning the comorbidity of these diseases. Full article

A dysregulated host response to infection causes organ dysfunction in sepsis and septic shock, two potentially fatal diseases. They continue to be major worldwide health burdens with high rates of morbidity and mortality despite advancements in medical care. The goal of this thorough review was to present a thorough summary of the current body of knowledge about the prevalence of sepsis and septic shock worldwide. Using widely used computerized databases, a comprehensive search of the literature was carried out, and relevant studies were chosen in accordance with predetermined inclusion and exclusion criteria. A narrative technique was used to synthesize the data that were retrieved. The review’s conclusions show how widely different locations and nations differ in terms of sepsis and septic shock’s incidence, prevalence, and fatality rates. Compared to high-income countries (HICs), low- and middle-income countries (LMICs) are disproportionately burdened more heavily. We talk about risk factors, comorbidities, and difficulties in clinical management and diagnosis in a range of healthcare settings. The review highlights the need for more research, enhanced awareness, and context-specific interventions in order to successfully address the global burden of sepsis and septic shock. Full article

An increasing base of evidence suggests that respiratory syncytial virus (RSV) infections may be associated with neurological complications. In accord with the PRISMA statement, we performed a systematic review and meta-analysis on the occurrence of encephalitis and encephalopathy associated with documented RSV infections. PubMed, Embase, and Scopus databases were searched for eligible observational studies published up to 10 April 2024. Raw data included the occurrence of RSV infections among cases of encephalitis and/or encephalopathy and cases of encephalitis and/or encephalopathy among series of RSV infections. Data were pooled in a random effects model. Case reports were also collected, and their data pooled as a cumulative series. Heterogeneity was assessed using the I² measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 15 studies for a total of 7719 RSV infections and 1631 cases of encephalitis were analyzed. Moreover, 27 case reports and case series were retrieved, for a total of 84 individual cases of encephalitis/encephalopathy occurring during a documented RSV infection. A pooled prevalence of 2.20 cases of encephalitis/encephalopathy per 100 RSV cases (I² = 99%) was calculated, while a prevalence of RSV infections among cases of encephalitis/encephalopathy was estimated to 3.53 per 100 cases for studies on respiratory specimens (I² = 48%) and 0.37 per cases on central nervous system (CNS) specimens (I² = 0%). Detection of RSV within the CNS was relatively rare (17.86% of pooled case reports), being associated with male gender (adjusted odds ratio [aOR] 5.021, 95% confidence interval [95%CI] 1.104 to 22.831) and recovery with long-term sequelae (aOR 5.699, 95%CI 1.152; 28.183). Case fatality ratio was estimated to be 0.43 per 100 cases on observational studies and 10.71% in case reports, a difference likely due to publication bias. In summary, RSV represented a not frequent but notable cause of encephalitis/encephalopathy in adults and children. The paucity of available studies not only recommends a cautious appraisal of our results but stresses the clinical significance of future studies on incident cases of encephalitis and/or encephalopathy. Full article

This study aimed to achieve two primary objectives. Firstly, to compare physical fitness levels based on sex, age groups, and body composition. Secondly, to examine physical fitness of the older adults against criterion-referenced fitness standard values using a representative sample from the district of Leiria in Portugal, a region undergoing exponential population growth, including a rise in the elderly population. Data from cross-sectional assessments of the Portuguese older adult community living in the Municipality of Leiria from 2014 to 2022 were collected. This study comprised a sample of 664 community-dwelling older adults (female = 480; male = 184) aged between 60 and 90 years (M = 70.34; SD = 12.67). Participants had a body mass ranging from 45 kg to 122 kg (M = 71.48; SD = 12.34) and a height ranging from 1.30 m to 1.89 m (M = 1.59; SD = 0.08). The Senior Fitness Test battery was used to evaluate parameters of physical fitness, body mass index was calculated, and abdominal circumference was measured. Females displayed a tendency to greater physical fitness compared to males, specifically in terms of lower and upper body flexibility compared to older male adults (p < 0.05). In addition, sexagenarian and older adults with normal weight tended to display greater physical fitness compared to septuagenarian and octogenarian, and overweight adults and those with obesity (p < 0.05), respectively. Information concerning physical fitness is crucial for guiding policymakers and other stakeholders in Leiria for the promotion of healthy aging among the older adult community. Furthermore, this study has established the preliminary reference standards for physical fitness, serving as a tool to promote healthy aging among Portuguese older adults residing in Leiria. Full article

In the wake of the COVID-19 pandemic, the surveillance and safety measures of indoor Cultural Heritage sites have become a paramount concern due to the unique challenges posed by their enclosed environments and high visitor volumes. This communication explores the integration of Artificial Intelligence (AI) in enhancing epidemiological surveillance and health safety protocols in these culturally significant spaces. AI technologies, including machine learning algorithms and Internet of Things (IoT) sensors, have shown promising potential in monitoring air quality, detecting pathogens, and managing crowd dynamics to mitigate the spread of infectious diseases. We review various applications of AI that have been employed to address both direct health risks and indirect impacts such as visitor experience and preservation practices. Additionally, this paper discusses the challenges and limitations of AI deployment, such as ethical considerations, privacy issues, and financial constraints. By harnessing AI, Cultural Heritage sites can not only improve their resilience against future pandemics but also ensure the safety and well-being of visitors and staff, thus preserving these treasured sites for future generations. This exploration into AI’s role in post-COVID surveillance at Cultural Heritage sites opens new frontiers in combining technology with traditional conservation and public health efforts, providing a blueprint for enhanced safety and operational efficiency in response to global health challenges. Full article

Background and Objectives: From the year 1 anno Domini until 1855, with the third plague, major pandemics occurred on average every 348 years. Since then, they have occurred on average every 33 years, with coronavirus disease 2019 (COVID-19) now underway. Even though current technologies have greatly improved the way of life of human beings, COVID-19, with more than 700,000,000 cases and 6,950,000 deaths worldwide by the end of 2023, reminds us that much remains to be done. This report looks back at 18 months of COVID-19, from March 2020 to August 2021, with the aim of highlighting potential solutions that could help mitigate the impact of future pandemics. Materials and Methods: COVID-19 data, including case and death reports, were extracted daily from the Worldometer platform to build a database for the macroscopic analysis of the spread of the virus around the world. Demographic data were integrated into the COVID-19 database for a better understanding of the spatial spread of the SARS-CoV-2 virus in cities/municipalities. Without loss of generality, only data from the top 30 (out of 200 and above) countries ranked by total number of COVID-19 cases were analyzed. Statistics (regression, t-test (p < 0.05), correlation, mean ± std, etc.) were carried out with Excel software (Microsoft^® Excel^® 2013 (15.0.5579.1001)). Spectral analysis, using Matlab software (license number: 227725), was also used to try to better understand the temporal spread of COVID-19. Results: This study showed that COVID-19 mainly affects G20 countries and that cities/municipalities with high population density are a powerful activator of the spread of the virus. In addition, spectral analysis highlighted that the very first months of the spread of COVID-19 were the most notable, with a strong expansion of the SARS-CoV-2 virus. On the other hand, the following six months showed a certain level of stability, mainly due to multiple preventive measures such as confinement, the closure of non-essential services, the wearing of masks, distancing of 2 m, etc. Conclusion: Given that densely populated cities and municipal areas have largely favored the spread of the SARS-CoV-2 virus, it is believed that such a demographic context is becoming a societal problem that developed countries must address in a manner that is adequate and urgent. COVID-19 has made us understand that it is time to act both preventatively and curatively. With phenomenological evidence suggesting that the next pandemic could occur in less than 50 years, it may be time to launch new societal projects aimed at relieving congestion in densely populated regions. Full article

Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the “Clinical Trial Quality Team”, which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA. Full article

Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental health issues, especially since its partial decriminalisation in some part of the United States and Australia. The objective of this scoping review was to investigate the mental health impact of cannabis use among young people in Australia and the United States. A scoping review was conducted according to the Joanna Briggs Institute (JBI) protocol, and articles were searched from ProQuest Central and EBSCO Host (MEDLINE and CINAHL databases). A total of 24 articles were analysed, including systematic reviews, meta-analyses, and cohort, longitudinal, and cross-sectional studies. The findings indicate that cannabis use is associated with depression, psychosis, suicide, cannabis use disorder, dependence, decline in cognitive function, and the development of externalising behaviour, particularly attention deficit hyperactivity disorder. However, the relationship between cannabis use and anxiety is equivocal. Mental health issues were more prevalent with increased frequency, duration, intensity, and type of use. Female, minority, LGBTQI, African American, Aboriginal, and Torres Strait Islander youth and the age of onset of cannabis use were significant factors for the development of mental health problems. The increasing prevalence of cannabis use among high school and college students suggests the need for intervention by teachers, parents, and community health professionals to make them aware of its potential negative mental health outcomes. Moreover, policy-level interventions by the government are required to discourage young people from using cannabis. Full article

Epizootic hemorrhagic disease (EHD) is an infectious, non-contagious viral disease seriously affecting cattle and some wild ruminants and has a worldwide distribution. All viruses can be subdivided into “Eastern” and “Western” topotypes according to geographic distribution via the phylogenetic analysis of internal genes. In Israel, during the last decade, three outbreaks were registered: caused by EHDV-6 in 2015, by EHDV-1 in 2016, and by EHDV-7 in 2020. Additionally, RNA of EHDV-8 was found in imported calves from Portugal in 2023. During the same period in other countries of the region, non-Israeli-like EHDV-6 and EHDV-8 were identified. Full genome sequencing, BLAST, and phylogenetic analyses of the locally and globally known EHDV genomes allowed us to presume the probable route and origin of these viruses detected in Israel. Thus, EHDV-6 has probably been circulating in the region for a long period when EHDV-1 and -8 appeared here for the last years, while their route of introduction into the new areas was probably natural; all of them belonged to the “Western” topotype. In contrast, EHDV-7 probably had the “Eastern”, anthropogenic origin. Data from the study can facilitate the evaluation of the appearance or reappearance of EHDVs in the Mediterranean area and enhance the planning of prevention measures. Full article

Homeless people (HP) are disproportionally affected by respiratory disorders, including pneumococcal and mycobacterial infections. On the contrary, more limited evidence has been previously gathered on influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and very little is known about the occurrence of human respiratory syncytial virus (RSV), a common cause of respiratory tract infections among children and the elderly. The present systematic review was designed to collect available evidence about RSV, influenza and SARS-CoV-2 infections in HP, focusing on those from urban homeless shelters. Three medical databases (PubMed, Embase and Scopus) and the preprint repository medRxiv.org were therefore searched for eligible observational studies published up to 30 December 2023, and the collected cases were pooled in a random-effects model. Heterogeneity was assessed using the I² statistics. Reporting bias was assessed by funnel plots and a regression analysis. Overall, 31 studies were retrieved, and of them, 17 reported on the point prevalence of respiratory pathogens, with pooled estimates of 4.91 cases per 1000 HP (95%CI: 2.46 to 9.80) for RSV, 3.47 per 1000 HP for influenza and 40.21 cases per 1000 HP (95%CI: 14.66 to 105.55) for SARS-CoV-2. Incidence estimates were calculated from 12 studies, and SARS-CoV-2 was characterized by the highest occurrence (9.58 diagnoses per 1000 persons-months, 95%CI: 3.00 to 16.16), followed by influenza (6.07, 95%CI: 0.00 to 15.06) and RSV (1.71, 95%CI: 0.00 to 4.13). Only four studies reported on the outcome of viral infections in HP: the assessed pathogens were associated with a high likelihood of hospitalization, while high rates of recurrence and eventual deaths were reported in cases of RSV infections. In summary, RSV, influenza and SARS-CoV-2 infections were documented in HP from urban shelters, and their potential outcomes stress the importance of specifically tailored preventive strategies. Full article