Editor’s Choice Articles

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

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

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

Background: The Mediterranean diet (MD) has been related with a decreased probability of overweight/obesity as well as central obesity at all stages of the human life, decreasing the risk of diverse disease states and improving quality of life. Over the last few years, the prevalence of childhood overweight/obesity and especially abdominal obesity has highly increased worldwide, being associated with a higher likelihood of overweight/obesity as well as central obesity at the next stages of the life during adulthood. The purpose of the present study was to explore the relationship of MD compliance with sociodemographic, anthropometry and lifestyle features in pre-school children aged 2–5 years old. Methods: This is a cross-sectional study, which includes 5188 pre-school children from diverse regions of Greece. Relevant questionnaires were applied to evaluate the sociodemographic features of the enrolled children. Anthropometric parameters were measured by relevant techniques. Qualified questionnaires were utilized for assessing several lifestyle factors such as physical activity, quality of life, breastfeeding practices, MD adherence, as well as the prevalence of childhood asthma and diabetes mellitus type I. Results: Of the enrolled children, 41.7% showed low MD compliance and 36.4% of them indicated moderated compliance, while only 21.9% of them showed a high MD adherence. Overweight/obesity was noted in 24.2% of the assigned children, while abdominal obesity was noticed in 18.2% of them. Higher MD compliance was related with an elevated prevalence of sex (boys, p = 0.0005), Greek nationality (p = 0.0088), rural type of residence (p = 0.0099), childhood overweight/obesity (p < 0.0001) and abdominal obesity (p < 0.0001), lower childbirth weight (p < 0.0001), increased physical activity (p = 0.0041), improved quality of life (p = 0.0008), exclusive breastfeeding (p < 0.0001), childhood asthma (p = 0.0001) and diabetes mellitus type 1 (p = 0.0002). Conclusions: A higher MD adherence is associated with specific sociodemographic, better anthropometric, and beneficial lifestyle factors in pre-school children. However, MD compliance remains low or moderate in the vast majority of children aged 2–5 years old. Thus, future public strategies and policies should be performed to inform parents of the potential beneficial effects of MD against obesity and related chronic diseases at the next stage of their children’s lives. Full article

Background: Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. Methods: The analytic sample included 30,418 Americans aged ≥50 years from the 2006–2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. Results: Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8–17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). Conclusions: This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions. Full article

Informal caregivers’ own quality of life, health status, and determinants are poorly understood despite their concern for the health of the individuals they assist. To compare the quality of life and the health determinants of older informal caregivers with those of older adults without caregiving responsibilities. An online survey was designed to investigate the quality of life and the health determinants of people aged 65 years and over, with a focus on informal caregivers. In addition to socio-demographic data, the number of informal caregivers was ascertained and the Zarit scale of caregiver burden was applied. Quality of life (SF-12) and health determinants (access to technology and level of physical activity (IPAQ)) were assessed and compared between informal caregivers and non-caregivers. A total of 111 participants were included in the study (70 ± 3.83 years, 71.2% women). The majority of respondents (91.8%) were Belgian. One-third of the respondents identified themselves as informal caregivers and declared themselves as having a severe burden (61.9 ± 15.2/88). Socio-demographic characteristics and access to technology were similar between informal caregivers and non-caregivers (p > 0.05). However, informal caregivers had a lower SF-12 score in the mental score domain (44.3 ± 10.2 vs. 50.7 ± 7.0; p = 0.004) and a lower level of physical activity (434 ± 312 METS/min/week vs. 1126 ± 815 METS/min/week; p = 0.01) than their peers. Informal caregivers reported a lower quality of life and a lower level of physical activity than their peers. Given the recognized importance of physical activity for overall health, this survey highlights the need to promote physical activity among older informal caregivers. Full article

Infectious disease epidemics are challenging for medical and public health practitioners. They require prompt treatment, but it is challenging to recognize and define epidemics in real time. Knowing the prediction of an infectious disease epidemic can evaluate and prevent the disease’s impact. Mathematical models of epidemics that work in real time are important tools for preventing disease, and data-driven deep learning enables practical algorithms for identifying parameters in mathematical models. In this paper, the SIR model was reduced to a logistic differential equation involving a constant parameter and a time-dependent function. The time-dependent function leads to constant, rational, and birational models. These models use several constant parameters from the available data to predict the time and number of people reported to be infected with the COVID-19 Omicron variant. Two out of these three models, rational and birational, provide accurate predictions for countries that practice strict mitigation measures, but fail to provide accurate predictions for countries that practice partial mitigation measures. Therefore, we introduce a time-series model based on neural networks to predict the time and number of people reported to be infected with the COVID-19 Omicron variant in a given country that practices both partial and strict mitigation measures. A logistics-informed neural network algorithm was also introduced. This algorithm takes as input the daily and cumulative number of people who are reported to be infected with the COVID-19 Omicron variant in the given country. The algorithm helps determine the analytical solution involving several constant parameters for each model from the available data. The accuracy of these models is demonstrated using error metrics on Omicron variant data for Portugal, Italy, and China. Our findings demonstrate that the constant model could not accurately predict the daily or cumulative infections of the COVID-19 Omicron variant in the observed country because of the long series of existing data of the epidemics. However, the rational and birational models accurately predicted cumulative infections in countries adopting strict mitigation measures, but they fell short in predicting the daily infections. Furthermore, both models performed poorly in countries with partial mitigation measures. Notably, the time-series model stood out for its versatility, effectively predicting both daily and cumulative infections in countries irrespective of the stringency of their mitigation measures. Full article

South Africa has the highest number of people living with the human immunodeficiency virus (HIV) in the world, accounting for nearly one in five people living with HIV globally. As of 2021, 8 million people in South Africa were infected with HIV, which is 13% of the country’s total population. Approximately 450,000 people in the country develop tuberculosis (TB) disease every year, and 270,000 of those are HIV positive. This suggests that being HIV positive significantly increases one’s susceptibility to TB, accelerating the spread of the epidemic. To better understand the disease burden at the population level, a Susceptible–Infected–Recovered–Dead (SIRD) TB–HIV co-infection epidemic model is presented. Parameter values are estimated using the method of moments. The disease-free equilibrium and basic reproduction number of the model are also obtained. Finally, numeric simulations are carried out for a 30-year period to give insights into the transmission dynamics of the co-infection. Full article

This index meta-analysis estimated the pooled prevalence of human immunodeficiency virus (HIV) among individuals with monkeypox (mpox) globally. We searched seven databases: PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane, for human studies published in English till 4 January 2023, as per International Prospective Register of Systematic Reviews (PROSPERO) registration protocol (CRD42022383275). A random effects regression model was used to estimate the pooled prevalence owing to high heterogeneity. The risk of bias in the included studies was assessed using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool. The systematic search yielded 677 articles; finally, 32 studies were found eligible for systematic review and 29 studies for meta-analysis. The pooled prevalence of HIV infection was 41% (95% confidence interval [CI], 35–48). All studies were rated as fair or good quality. Studies from Europe and North America reported a high prevalence of HIV infection among individuals with mpox- 41% (95% CI 33–49) and 52% (95% CI 28–76), respectively, while studies from Nigeria, Africa reported a relatively low prevalence of HIV infection of 21% (95% CI 15–26). A history of sexual orientation and sexual partners in the last 21 days must be taken from individuals with mpox to identify the potential source and contacts for quarantining and testing them. Full article

With the United Nations Sustainable Development Goals (SDG) (2015–2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990–2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of −2.6% (95% CI −2.7; −2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target. Full article

The timely identification of expected surges of cases during infectious disease epidemics is essential for allocating resources and preparing interventions. Failing to detect critical phases in time may lead to delayed implementation of interventions and have serious consequences. This study describes a simple way to evaluate whether an epidemic wave is likely to be present based solely on daily new case count data. The proposed measure compares two models that assume exponential or linear dynamics, respectively. The most important assumption of this approach is that epidemic waves are characterized rather by exponential than linear growth in the daily number of new cases. Technically, the coefficient of determination of two regression analyses is used to approximate a Bayes factor, which quantifies the support for the exponential over the linear model and can be used for epidemic wave detection. The trajectory of the coronavirus epidemic in three countries is analyzed and discussed for illustration. The proposed measure detects epidemic waves at an early stage, which are otherwise visible only by inspecting the development of case count data retrospectively. Major limitations include missing evidence on generalizability and performance compared to other methods. Nevertheless, the outlined approach may inform public health decision-making and serve as a starting point for scientific discussions on epidemic waves. Full article

In March 2020, a ministerial directive issued by the Government of the Community of Madrid (CoM) in Spain included disability-based exclusion criteria and recommendations against hospital referral of patients with respiratory conditions living in long-term care homes (LTCHs). Our objective was to assess whether the hospitalization mortality ratio (HMR) is greater than unity, as would be expected had the more severe COVID-19 cases been hospitalized. Thirteen research publications were identified in this systematic review of mortality by place of death of COVID-19-diagnosed LTCH residents in Spain. In the two CoM studies, the HMRs were 0.9 (95%CI 0.8;1.1) and 0.7 (95%CI 0.5;0.9), respectively. Outside of the CoM, in 9 out of 11 studies, the reported HMRs were between 1.7 and 5, with lower 95% CI limits over one. Evaluation of the disability-based triage of LTCH residents during March–April 2020 in public hospitals in the CoM should be conducted. Full article

This study aims to determine and compare the prevalence and correlates of obesity and abdominal obesity in India among participants aged 18–54 years. Data were acquired from the nationally representative National Family Health Survey 2019–21. Age and sex standardized descriptive analyses were conducted to determine the prevalence of obesity and abdominal obesity, and multivariable multilevel logistic regression was performed to identify the factors associated with these conditions. Gender-specific analyses were also conducted. The sample weight was adjusted throughout. The final sample size for this study was 698,286. The prevalence of obesity and abdominal obesity was 13.85% and 57.71%, respectively. Older age, being female, increased educational status and increased wealth index, being married at any point, and residing in an urban area all increased the odds of both obesity and abdominal obesity. Being a resident of the North zone and having a current alcohol intake increased the odds of abdominal obesity. On the other hand, being a resident of the South zone of India increased the odds of obesity. Targeting these high-risk groups can be a strategy for public health promotion programs. Full article

Fear of crime is an important public health problem that impacts people’s quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated health and anxiety among women residing in a county in east-central Sweden. A sample (n = 3002) of women aged 18–84 years surveyed in the Health on Equal Terms survey carried out in 2018 was included in the study. Bivariate and multivariate regression analysis was performed on the relationship between the composite variables fear of crime, educational attainment, and self-rated health and anxiety. Women with primary education or similar who reported fear of crime had increased odds of poor health (odds ratio (OR) 3.17; 95% confidence interval (CI) 2.40–4.18) compared with women with primary education/similar and no fear of crime (OR 2.90; CI 1.90–3.20). A statistically significant relationship persisted in the multivariate analysis after controlling for other covariates, although the odds were reduced (OR 1.70; CI 1.14–2.53 and 1.73; CI 1.21–2.48, respectively). Similarly, in the bivariate analysis, women who reported fear of crime and who only had primary education had statistically significant odds of anxiety (OR 2.12; CI 1.64–2.74); the significance was removed, and the odds were reduced (OR 1.30; CI 0.93–1.82) after adjusting for demographic, socioeconomic, and health-related covariates. Women with only primary education or similar who reported fear of crime had higher odds of poor health and anxiety compared with those with university education or similar, with and without fear of crime. Future studies (including longitudinal ones) are warranted—on the one hand, to understand possible mechanisms of the relationship between educational attainment and fear of crime and its consequences to health, and on the other, to explore low-educated women’s own perceptions regarding factors underlining their fear of crime (qualitative studies). Full article

Complementary and Alternative Medicines/Therapies (CAM) are commonly used by US asthma adults, yet little is known about recent trends in their use. Our aim was to report trends in CAM use among US adults with current asthma. We conducted a serial cross-sectional study using nationally representative data from the BRFSS Asthma Call-Back Survey (ACBS) collected between 2008 and 2019 (sample size per cycle, 8222 to 14,227). The exposure was calendar time, as represented by ACBS cycle, while the main outcomes were use of at least one CAM and eleven alternative therapies. We analyzed CAM use overall and by population subgroups based on age, gender, race/ethnicity, income, and daytime and night-time asthma symptoms. Our findings show that there was an increase in the use of at least one CAM from 41.3% in 2008 to 47.9% in 2019 (p-trend < 0.001) and an upward trend in the use of herbs, aromatherapy, yoga, breathing exercises, homeopathy, and naturopathy (p-trend < 0.05). However, the use of vitamins, acupuncture, acupressure, reflexology, and other CAM therapies remained stable (p-trend > 0.05). These trends varied according to population characteristics (age, sex, race, income) and asthma symptoms. In conclusion, our study suggests that CAM use among US adults with current asthma is either increasing or stable, and further studies are needed to explore the factors influencing these trends. Full article

Our objective was to estimate the incidence of COVID-19 and the ABO blood Groups in the mass-gathering events (MGEs) during the Falles Festival in Borriana (Spain) from 6–10 March 2020. We conducted a population-based retrospective cohort study and measured anti-SARS-CoV-2 antibodies and the ABO of participants. We performed laboratory COVID-19 tests and obtained the ABO in 775 subjects (72.8% of the original exposed cohort): O-group (45.2%), A-group (43.1%), B-group (8.5%) and AB-group (3.4%). Adjusted for confounding factors, including COVID-19 exposure during the MGEs, attack rates of COVID-19 for each ABO group were 55.4%, 59.6%, 60.2%, and 63.7%. The adjusted relative risks were for O-group 0.93 (95% Confidence Interval [CI] 0.83–1.04), for A-group 1.06 (95% CI 0.94–1.18), for B-group 1.04 (95%CI 0.88–1.24), and for AB-group 1.11 (95% CI 0.81–1.51) with no significant differences. Conclusions: Our results suggest no effect of ABO on COVID-19 incidence. We observed weak but not significant protection of the O-group and not a significantly greater infection risk for the remaining groups compared with the O-group. More studies are needed to resolve the controversies regarding the association between ABO and COVID-19. Full article