Medical Sciences Forum

The paper examined legal impediments to sustainable health in Nigeria due to the impact of climate change (CC) exacerbated by coronavirus (COVID-19). COVID-19 has presented the world with a crisis greatly accentuated by the urgency with which we need to fight the CC debacle, making the need for sustainable development (SD) more obviously acute than ever and requiring a response rooted in the principles of SD. On 29 September 2020, a total of 1 million COVID-19 deaths had occurred worldwide, while in Africa, there were about 35,954 cumulative fatalities. In Nigeria, the situation was similar. This paper found that despite the ravaging COVID-19 pandemic, health is still a low priority in Nigeria; 4.526 percent of the country’s budget was appropriated to the health sector in 2021 and 4.3 percent in 2022, contrary to the 2001 Abuja Declaration by African leaders and the 15 percent value stipulated by the WHO. The challenge is that Nigeria’s efforts in attaining sustainable health and eradication of COVID-19 are arbitrary and have been hampered by the absence of tested laws on CC andCOVID-19, thereby resulting in avoidable fatalities. Using analytical research methodology and drawing from global best practices to achieve sustainable health, this paper recommended the incorporation of legal and institutional frameworks to combat COVID-19 pandemic in Nigeria. Full article

The Project Planning, Monitoring, Systematizing, and Learning (PlaMSyL) method was developed in a period of ten years (1996–2005) and has expanded since then to improve the results of development and emergency projects in developing countries, focusing mainly on the monitoring and learning process of different local stakeholders beyond the deliverables into the changes and impacts of outcomes. It has been applied in different countries in Asia, Africa, and Latin America between 2006 and 2016. Today, it is taught in universities to students of pre- and post-grade levels. The 17 Sustainable Development Goals are part of the UN Agenda 2030, signed by 193 governments in 2015, contain 169 Targets, and 232 indicators of social well-being (health, education, zero hunger, equality, and gender), and for economic (food production, industry, zero poverty, consumption, infrastructure, and technology), and ecological development (water, climate, governance, and biodiversity) preserving the planet from a collapse and ensuring the sustainable well-being of all. The SDGs provide the framework for a new circular economy based on clean energy and zero greenhouse gases. One basic principle of the SDG 2030 is “Leave No One Behind” and is what drives to work with the local governments and communities in a bottom-up approach, coordinating with the national level to set up appropriate policies. The PlaMSyL method has been practiced by different professional teams of education, health, engineering, agriculture, disaster risk reduction, and ecologists, and for this reason, the paper explains the use of the PlaMSyL method with the indicators and targets of the SDGs, and the resilience to facilitate local project teams and stakeholders to use the SDGs participatively as a framework, and as a metrics and communication tool. Full article

Heat waves (HWs) are becoming more frequent due to climate change. Their impact on cardiovascular (CV) health has been widely studied, and results vary depending on the disease and the geographic area. Our aim was to study this phenomenon using emergency medical service (EMS) data relevant to CV events that occurred out-of-hospital during May–Sept in 2020 and 2021 in Milan, Italy. Mean daily temperature (MDT) was computed in the city, and normal (NL), HW, or extreme HW were defined as days with MDT <90th, ≥90th, and ≥98th percentiles, respectively, resulting in 232 NL and 74 HW days, of which 16 were extreme. In total, 20,266 CV events were reported by EMS (53% in women, 55% in ≥65 yo). A case-crossover design was applied to calculate the odds ratio of the events in HW and extreme HW compared to NL days, accounting for diagnosis and geolocation. Increased odds were found for acute myocardial infarction (1.53 and 1.56), congestive heart failure (2.47 and 2.81), and intermediate coronary syndrome (2.08 and 6.11). Our study showed the potential of using EMS for analyzing the effects of HW on CV health, thus the confirming negative impact of rising temperature. Full article

Evidence regarding the strong links between emotional exhaustion, personal accomplishment, depersonalization, total occupational burnout and workplace environment, and their consequences for the general well-being of employees in public health inspection workforce services, is limited. The aim of this study was to report the burnout of the public health workforce in Greece and investigate possible relationships with the workplace environment during the COVID-19 pandemic. This was a quantitative, cross-sectional, nationwide research study in Greece, conducted in the second quarter of 2021. An online survey was conducted. The response rate was 27%. Burnout was measured using the Maslach Burnout Inventory Questionnaire; 19.46% of participants reported low burnout levels, 37.84% of participants reported medium burnout levels, and 42.70% reported high (above average) burnout levels. The total burnout score of rural environments was higher compared to all other groups (χ² = 16.017), (β = 0.455), p < 0.001. Medium levels of emotional exhaustion were reported. Depersonalization scores were low. The personal accomplishment score was higher in rural environments compared to all other groups (χ² = 26.417). The depersonalization score was higher in semi-urban environments compared to all other groups (χ² = 6.188). The findings indicate that burnout has proven to be an issue. This study contributes to the limited evidence supporting links associations and correlations between burnout and workplace environment and adds new information regarding occupational health and safety factors for workplace environment, which could be exploited to advance the quality of public health services provision during the COVID-19 pandemic in Greece. Full article

Introduction: The “migrant” term indicates a resident born in a country other than the host country. Resident foreigners made up 8.4% of the total Italian population in 2020. The Sicilian trend reflects the national one, with 190,974 resident foreigners as of 1th January 2020. The aim of this study was to identify the presence of tumors in foreign patients residing in the RTI’s provinces of interest in 2003–2017 and to analyze the clinical-biological variables. Materials and Methods: We analyzed 3541 foreign patients with tumors (out of a total of 160,912 patients) residing in the RTI’s provinces of interest in 2003–2017. Foreign patients were identified by tax code. Tumors are described ((number and percentage). Results: Of the 3541 foreign patients, 36% were male and 64% were female. They resided in the provinces of Catania (42.6%), Messina (29.9%), Siracusa (20.7%), and Enna (6.6%). They came from Europe (57%), Africa (22.4%), the Americas (12.03%), Asia (5.08%), and Oceania (1.80%); 0.3% were stateless. The average age was 58 for males and 54.4 for females. The number of tumors (excluding non-melanoma skin tumors) was 3715. Sixty-two males and 98 females had one or more multiple tumors. In foreign females, the three most common tumors were breast (28%), thyroid (9%), and cervical (6%) tumors. Most breast cancers were diagnosed as stage T1 (35%) or T2 (26%). In foreign males, the three most common tumors were lung (13%), bladder (12%), and prostate (11%) tumors. Conclusions: The growing presence of foreign citizens in the provinces studied calls for more attention on oncology-related problems and more careful surveillance of changes in incidence and mortality by the RTI. Full article

In terms of evidence of the strong links between occupational risks, training needs, and quality, research on the occupational risks and their consequences to the general wellbeing of public health inspectors has been very limited, despite the fact that the nature of the work presents a range of threats to physical and psychological health. The aim of this study was to report the risks presented to public health inspectors (PHIs’) and to investigate their possible relationships with training needs. The study was a cross-sectional, nationwide investigation in Greece, conducted in one phase during the third quarter of 2021. For data collection, an online survey was created, and the web link was distributed to respondents by email. A number of participants were contacted, providing N = 185 responses, which accounted for 27% (185/684) of the population under study. Job risks were measured using a novel instrument, classification, a checklist for risk assessment, and an instrument was developed for measuring training needs and training quality. The findings indicated that 87% of participants provided high ratings in response to psychosocial risks and ergonomic risks, followed by 78% for organizational risks and 74% for biological risks. Physical risks and chemical risks were 55% and 56%, respectively. For organizational risks (β = −0.282, p = 0.001) and perceived training quality (β = 0.195, p = 0.002), 65.41% reported high training requirements. PHIs face a variety of job risks, these findings were among the first to address the occupational health and safety of PHIs worldwide. Adding new information to PHI occupational health and safety could be used to advance the quality of public health services provision. Full article

Microplastics (MPs) pollution has increasingly exposed the pelagic biota to physical harm. The small size of micro-particles makes them more suitable for passive ingestion by a wide variety of organisms with serious effects on growth rates, respiration and vital functions, bioaccumulation of pollutants, and, ultimately, species survival. Nevertheless, our knowledge of plastic intake in nursery habitats is still very limited. When encounters with MPs occur at the larval stage, it is suggested that fish can develop altered feeding behaviors with cascading effects on the entire food web. This study provides a step-by-step protocol to identify and enumerate polymer particles found in fish diets. The procedure is intended for the analysis of larval and juvenile fish populations with a developed digestive tract. It includes guiding questions for research design, a list of supplies and reagents to extract and mount the fish diets on microscope slides for semi-permanent conservation, the protocol for microscopic and statistical analysis, and the interpretation of the results. We suggest that the gut content could be used to assess (i) the bioavailability of polymers in water systems, (ii) the incidence of an encounter between larval fish and MPs, and (iii) the possible alternations in fish’ feeding behaviors as soon as they leave their parental stage. Full article

During the coronavirus (COVID-19) pandemic, we saw significant decreases in the incidence of bloodstream infections (BSIs), antibiotic-resistant infections, and the burden of resistant infections. The reasons for this are complex and multifactorial, but likely, at least in part, due to changes in healthcare delivery and healthcare seeking behavior. As healthcare systems return to pre-pandemic ways of working, now is a pivotal moment to ensure focus remains on what is often referred to as the ‘silent pandemic’: antimicrobial resistance (AMR). The ninth English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR) report provides an overview of the national data on antibiotic prescribing and resistance, antimicrobial stewardship implementation, and awareness activities. The active contribution from and collaboration with the ESPAUR oversight group and the engagement of stakeholder organizations, including the devolved administrations, are also reported. Findings from the ESPAUR report were presented at a webinar on 23 November 2022. Full article

Salvia hispanica is a plant widespread in Central America. Chia is the common name for it. The seeds obtained from the current plant are most usually used. As public health awareness grows around the world, so does the need for functional foods with many health advantages. They are also known as “health food” due to their strong nutritional and therapeutic properties. When the seeds are soaked in a suitable solvent, such as water, they exude a sticky gel-like substance that can be employed as an excipient in both culinary and pharmaceutical compositions. This paper will go over all of the therapeutic benefits of the present plant and its parts, as well as the plant’s use as an ingredient in foods and pharmaceuticals. Full article

Nutrition and health claims have been regulated by Standard 1.2.7 of the Food Standards Code since 2016. Standard 1.2.7 was introduced in 2013, with a three-year transition period. This study aims to evaluate the impact of Standard 1.2.7 by a) identifying the number of nutrition and health claims across 16 product categories, and b) identifying changes in the use of claims since the introduction of the Standard by comparing the present findings against those of previous similar surveys (in 2014/15 and 2016/7). Packaged food labels (700) were randomly selected from 16 prespecified categories in GS1 NZ’s On Pack label database, representative of foods and beverages available in New Zealand retail. Labels were assessed for the presence of nutrition and health claims, and against regulations. A total of 44% of products had at least one nutrition content claim (NCC) or general level health claim (GLHC). Since 2016/17, the proportion of products carrying claims increased among the categories “meat and meat products”, “dairy and dairy products” and “eggs”. Among the remaining 13 categories, the proportion of claims decreased or remained the same. NCCs appeared in 43% of products, but among categories this ranged from 10% (alcohol) to 70% (special-purpose foods). The three most common types of NCCs (in descending order) were about vitamins (mostly vitamin C and B vitamins), “gluten free” and minerals (mostly iron and calcium). In comparison with 2016/17, NCCs regarding vitamins, minerals, sugar and protein were more common, while NCCs for dietary fibre, sodium and fat (including cholesterol) were less common. “Gluten free claims” remain consistently popular. Individual use of GLHCs has increased since 2016/17 (6% compared with 3%), with the highest numbers in “special purpose foods” (40%). Further analysis of these survey data will reveal the proportion of claims that meet the regulatory requirements and identify areas requiring further guidance. Full article

Selenium is essential for human health because it produces selenoproteins, which have antioxidant and anti-inflammatory roles. Recently published data have suggested high selenium status (high hair selenium concentration) improved outcomes in patients with COVID-19 infections. Our objective was to investigate the occurrence of infectious symptoms and selenium status among postpartum women. This is a secondary analysis of data collected in the Mother and Infant Nutrition Investigation—an observational, longitudinal cohort study spanning the first postpartum year of mother and infant pairs (n = 87) in Palmerston North, New Zealand. Plasma selenium was measured in women at six months postpartum (6MPP), and the validated Carr Infection Symptom Checklist (CISC) measured the type and frequency of infection symptoms experienced at 6MPP and twelve months postpartum (12MPP). The checklist contains 30 symptoms of infection; each symptom is scored from 0 (no symptoms) to 4 (severe symptoms), thus the possible total score ranges from zero to 120. The data were expressed as the median (q25, q75). The median maternal plasma selenium was 105.8 (95.6, 115.3) µg/L, with 41% of women meeting the criteria for the maximum expression of selenoprotein P (>110 µg/L). The median CISC scores were 12 (8, 18) at 6MPP and 13 (8, 21) at 12MPP, which were weakly correlated (r = 0.363, p = 0.002). Plasma selenium levels among women with a low CISC score ≤ 15 (n = 56) at 6MPP were significantly higher (110.05 µg/L) than those women with a high score of symptoms of infection (score > 15, n = 23) at 102.18 µg/L (p = 0.048, Mann–Whitney U test). Further research is warranted to investigate whether higher plasma selenium levels contribute to a lower rate of maternal infection during the postpartum period. The association between wider selenium biomarkers and maternal immune function should be determined by examining inflammatory markers or immunoglobulin concentrations. Full article

Appropriately planned vegetarian diets can be nutritionally adequate; however, without careful planning, some nutrients may be at risk of inadequacy, especially in adolescence, when energy and nutrient requirements are higher relative to body mass. The aim of this study was to compare intakes of at-risk micronutrients in a group of New Zealand female adolescents consuming vegetarian and non-vegetarian diets. A cross-sectional Survey of Nutrition, Dietary Assessment and Lifestyle (SuNDiAL project) was conducted among females aged 15 to 18 years, recruited from across NZ. Data were collected via an online questionnaire, and anthropometric measurements were taken to determine body mass index (BMI; kg/m²). Energy and dietary intake of calcium, iron, zinc, selenium, folate, vitamin A and vitamin B12 (B12) were determined using two 24 h recalls, adjusted to reflect usual intake. In total, 254 adolescents provided dietary intake data, comprising 38 self-identified vegetarians. The majority of the participants were NZ European and Other (NZEO) (78%), lived in neighbourhoods of low to medium deprivation (81.5%), and were a healthy weight (66.5%). Across the total sample, more than 80% did not meet the recommended intake for calcium, with values of 71% for selenium and 58% for folate. Dietary intakes among vegetarians were significantly lower than non-vegetarians, resulting in a higher prevalence of inadequacy for zinc (42% vs. 19%), selenium (92% vs. 67%) and vitamin B12 (40% vs. 16%), respectively. Vegetarians were six times more likely to have inadequate selenium intake, at a three-times-greater risk of having inadequate zinc intake and four times more likely to not meet the recommendations for B12 intake compared to non-vegetarians. In conclusion, adolescents had inadequate intakes of calcium, selenium and folate, whereas vegetarian adolescents had suboptimal intakes of selenium, zinc and B12, leading to an increased risk of deficiency. Full article

The survival and cytotoxicity of reprogrammed human CD8⁺ T-cells (hrT-cells) were evaluated in a culture of cancer stem cells (CSCs) isolated from a patient with small-cell lung cancer (SCLC). T-cells were isolated from the blood of healthy volunteers and patients with lung diseases. Reprogramming with MEK and PD-1 inhibitors increased the survival and cytotoxicity of allogeneic T-cells in vitro. The positive effect of reprogramming is more pronounced in patients with lung diseases than in healthy donors. Autologous hrT-cells showed high effectiveness in eliminating CSCs. Thus, in vitro studies are significant in the selection of potential cell donors and evaluating the effectiveness of their reprogramming. Full article

The Research Chapter (Chapter 8) of the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2021–2022 showcases the research that has been undertaken and that is ongoing at the UK Health Security Agency (UKHSA) in the field of healthcare-associated infections (HCAIs) and antimicrobial resistance (AMR) from April 2021 to March 2022 [...] Full article

NHS England designs and administers improvement and assurance schemes that include elements to incentivize prudent use of antimicrobials, optimise patient outcomes, minimise avoidable exposure to antimicrobials, and reduce selection pressure for antimicrobial resistance (AMR). These schemes include the NHS System Oversight Framework, the Pharmacy Quality Scheme for community pharmacies, the NHS Standard Contract, and the Commissioning for Quality and Innovation (CQUIN) framework. This report describes the schemes implemented from 2021 to 2022, and it reports the scheme performance of NHS commissioners and healthcare provider organisations. A summary of improvement and assurance schemes from 2022 to 2023 is also provided. Full article

Antimicrobial resistance is a growing, complex, and global threat. Health partnerships are working to address antimicrobial resistance through antimicrobial stewardship activities. To support this work, the Commonwealth Partnerships for Antimicrobial Stewardship programme developed four antimicrobial stewardship explainer animation videos in eight different accents, with input from over 50 stakeholders across eight African countries and the UK. The videos highlight different scenarios and explain AMS in easy-to-understand ways for both health practitioners and the public. Health partnerships piloted the videos in several ways, including in clinical waiting rooms, trainings, and AMS meetings, and provided feedback in a survey. In total, 94% of survey respondents gave the videos either a ‘5’ or ‘4’ for usefulness, with ‘5’ indicating ‘very useful’. Moving forward, through collaboration with the health partnerships, the videos will continue to be disseminated and adapted. Full article

A summary of key national primary and secondary care antimicrobial stewardship interventions led by the UK Health Security Agency (UKHSA) are highlighted. This includes development and implementation of TARGET Antibiotics Toolkit resources in community pharmacy and General Practice and the development of a national intravenous-to-oral switch (IVOS) criteria for use in secondary care. Full article

In the pre-antibiotic era, deaths from dental infections were common. Dentists are responsible for prescribing around 10% of antibiotics across healthcare globally. During 2020, dental antibiotic prescribing increased dramatically due to COVID-19 pandemic restrictions on dental procedures, which are vital for preventing and managing dental infections. FDI World Dental Federation responded with a framework about the essential role of dental teams in tackling antibiotic resistance, setting out a program to engage the global dental profession. Three exemplars include an open online course (with >2300 learners enrolled from >100 countries), a pledge for national dental organizations, and an early career researcher network. Full article