Search Results (814)

Background/Objectives: This study aimed to evaluate sociodemographic factors, features of the acute infection, and post-infection health status in survivors of COVID-19, assessing their association with post-acute COVID-19 syndrome (PACS). Methods: A multidisciplinary public clinic in Brazil assessed COVID-19 survivors between June 2020 and February 2022. Patients were classified as having PACS or subacute infection (SI). Data on the history of the acute infection, current symptoms, physical examination, and laboratory findings were collected and analyzed using multivariate models with PACS as the outcome. Results: Among the 113 participants, 63.71% were diagnosed with PACS at a median of 130 days (IQR: 53–196) following acute symptom onset. Admission to the intensive care unit was more frequent among individuals with PACS than those with SI (83.3% vs. 65.0% respectively; p = 0.037). Symptoms significantly more prevalent in the PACS group when compared to the SI cohort included hair loss (44.4% vs. 17.1% respectively; p = 0.004), lower limb paresthesia (34.7% vs. 9.8% respectively; p = 0.003), and slow thinking speed (28.2% vs. 0.0% respectively; p < 0.001). Logistic regression revealed that only the time interval between the onset of acute symptoms and the clinical evaluation was independently associated with a PACS diagnosis (β = 0.057; 95% CI: 1.03–1.08; p < 0.001). Conclusions: Patients with PACS had a higher frequency of intensive care unit admission compared to those with subacute infection. However, in the multivariate analysis, the severity of the acute infection did not predict the final diagnosis of PACS, which was associated only with the time elapsed since symptom onset. Full article

Background: Falls are a major public health issue among older adults, often related to postural or orthostatic hypotension (OH). The optimal timing and methods for measuring blood pressure (BP) to assess OH and its relationship with falls are uncertain. Methods: We analyzed data from two older cohorts: the PROHEALTH study (n = 30, aged ≥ 65 years) and the NILVAD-CBF trial (n = 58, aged ≥ 50 years). Continuous beat-to-beat BP was measured during active stand tests. We assessed orthostatic BP responses during sit-to-stand and supine-to-stand maneuvers and calculated the associations between orthostatic BP response variables and falls. Results: In the PROHEALTH cohort, participants with a history of falls exhibited a significantly lower baseline BP (115 ± 13/68 ± 10 vs. 142 ± 21/79 ± 11 mmHg; p = 0.004/0.018) and lower systolic BP (SBP) nadir (90 ± 22 vs. 112 ± 25 mmHg; p = 0.043) than non-fallers. SBP recovery within three minutes post-stand was delayed in fallers but rapid in non-fallers. A lower resting BP was associated with fall risk, and a lower BP nadir within 10 s after standing showed a trend toward a higher fall risk. No significant associations were found in the NILVAD-CBF cohort (prospective falls). Conclusions: Our findings demonstrate that a lower resting SBP and diastolic BP (DBP) are associated with an increased fall risk in older adults, with a lower SBP and DBP nadir after standing also showing a potential association. Persistent OH or delayed BP recovery is identified as a potentially relevant fall risk factor. The supine-to-stand test was more sensitive in detecting OH than the sit-to-stand test. Continuous BP monitoring provides the advantage of detecting pathophysiologic orthostatic BP responses for fall risk assessment in older adults. Further research with larger cohorts is warranted to validate our findings. Full article

Grassland communities consist primarily of perennial herbaceous species, with grasses forming a dominant or significant component. These ecosystems have been utilised for economic purposes since the earliest periods of human history. In the natural environment, they fulfil numerous critical functions that, despite increasing awareness of climate change, often remain undervalued. Grasslands contribute directly to climate regulation, air purification, soil conservation, flood mitigation, and public health—all of which positively affect the well-being of nearby populations. Moreover, they satisfy higher-order human needs known as “cultural” services, providing aesthetic enjoyment and recreational opportunities. These services, in tangible terms, support the development of rural tourism. The objective of this study was to examine the perception of cultural ecosystem services provided by different types of grassland communities—meadows, pastures, and lawns. The study employed a structured questionnaire to evaluate the perceived significance and functions of these communities. Respondents assessed their aesthetic and recreational value based on land-use type. To quantify these dimensions, the study applies the Recreational and Leisure Attractiveness Index (RLAI), the Aesthetic Attractiveness Index (AAI), ranking methods, and contingent valuation techniques. Based on the respondents’ declared WTP (willingness to pay) and WTA (willingness to accept) values, statistically significant differences in the perceived value of land-use types were identified. Lawns were rated highest in terms of recreational attractiveness, meadows in terms of aesthetics, while pastures achieved the highest economic values. Significant differences were also observed depending on respondents’ place of residence and academic background. The results indicate that the valuation of cultural services encompasses both functional and psychological aspects and should be integrated into local land-use and landscape planning policies. Full article

Adult entertainment work may be associated with increased vulnerability to sexually transmitted infections, particularly HIV. In Brazil, pre-exposure prophylaxis (PrEP) for HIV infection has been available through the Brazilian Unified Health System (SUS) since November 2017, representing a significant advancement in public sexual health policy. The objective of this study was to understand the individual and social determinants that promote PrEP use among adult entertainment workers. This was a cross-sectional, analytical, and quantitative study. A multivariate modeling approach was employed to identify factors independently associated with PrEP use. The study included 254 adult entertainment workers using oral PrEP through the SUS, predominantly young adults (141; 55.5%), SUS users (248; 97.6%), single (213; 83.9%), non-white (142; 55.9%), cisgender (148; 58.3%), and heterosexual (152; 59.8%). Factors independently associated with greater PrEP use included having adult entertainment as the main source of income (aPR: 2.69; 95% CI: 1.86–3.95), prior use of PEP (aPR: 2.49; 95% CI: 1.63–3.81), undergoing any type of health treatment (aPR: 1.56; 95% CI: 1.15–2.12), and having a history of STIs (aPR: 1.51; 95% CI: 1.10–2.08). Conclusion: PrEP use in this population was strongly influenced by structural and contextual factors, indicating that the availability of the technology alone does not ensure its effectiveness. Full article

Dietary choices and patterns have enormous consequences along the lines of individual, community, and planetary health. Excess meat consumption has been linked to chronic disease risk, and at large scales, the underlying industries maintain a massive environmental footprint. For these reasons, public and planetary health experts are unified in emphasizing a whole or minimally processed plant-based diet. In response, the purveyors of ultra-processed foods have added “meat alternatives” to their ultra-processed commercial portfolios; multinational corporations have been joined by “start-ups” with new ultra-processed meat analogues. Here, in our Viewpoint, we revisit the 1990s food industry rhetoric and product innovation, a time in which multinational corporations pushed a great “low-fat transition.” We focus on the McLean Deluxe burger, a carrageenan-rich product introduced by the McDonald’s Corporation in 1991. Propelled by a marketing and media-driven fear of dietary fats, the lower-fat burger was presented with great fanfare. We reflect this history off the current “great protein transition,” a period once again rich in rhetoric, with similar displays of industry detachment from concerns about the health consequences of innovation. We scrutinize the safety of carrageenan and argue that the McLean burger should serve as a cautionary tale for planetary health and 21st century food innovation. Full article

Agroecological transitions in collective urban gardens in Toulouse region were studied through the prism of global health (2011–2022). The specific meaning of “global health” in the context of urban gardens concerns the health of gardeners (well-being and physical health), plants, soil, and animals, as well as the interactions between humans and non-humans, which are crucial for gardeners. A sociotechnical research project was developed on four different collective gardening sites, consisting of the following: 1. surveys issued to 100 garden stakeholders to highlight issues and practices, participation in meetings with the social centers in charge of events, and focus groups; 2. participative agronomic and environmental measurements and field observations, including soil quality analyses; and 3. analysis of the available documentary corpus. In order to produce the results, these three research methods (surveys, agronomy, document analysis) were combined through a transdisciplinary approach, in that both the field experimentation outcomes and retrieved scientific publications and technical documents informed the discussions with gardeners. Consideration of the four different sites enabled the exploration of various contextual factors—such as soil or air quality—affecting the production of vegetables. A rise in the concerns of gardeners about the impacts of their activities on global health was observed, including aspects such as creating and enjoying landscapes, taking care of the soil and biodiversity, developing social connections through the transmission of practices, and regular outside physical activity and healthier eating. The increased consideration for global health issues by all stakeholders promotes the implementation of agroecological practices in gardens to improve biodiversity and adherence to circular economy principles. Four concepts emerged from the interviews: health, production of vegetables, living soil, and social interactions. Notably, nuances between the studied sites were observed, according to their history, environment, and organization. These collective gardens can thus be considered as accessible laboratories for social and agroecological experimentation, being areas that can strongly contribute to urban ecosystem services. Full article

Over the past three turbulent decades, research has profoundly reshaped our understanding of chronic Toxoplasma gondii infection—traditionally regarded as harmless in immunocompetent individuals—unveiling its surprising impact on human health, performance, and behavior. This review emphasizes the effects of chronic Toxoplasma infection on physical and mental health, cognitive performance, and behavioral changes, highlighting key findings from studies investigating these domains, with a particular focus on both ultimate and proximate mechanisms underlying the observed effects. To this end, the primary focus will be on human studies; however, animal model studies will also be thoroughly considered when necessary and appropriate, to provide context and additional important information. Research demonstrates that chronic Toxoplasma infection may contribute to a broad spectrum of physical health issues. Ecological studies have revealed correlations between toxoplasmosis prevalence and increased morbidity and mortality from various conditions, including cardiovascular diseases, neurological disorders, and certain cancers. Large-scale cross-sectional studies have further shown that infected individuals report a higher incidence of numerous health complaints and diagnosed diseases, suggesting a significant impact on overall physical well-being. In addition to physical health, lifelong Toxoplasma infection (subclinical toxoplasmosis) has been implicated in cognitive impairments and behavioral changes. Studies have reported associations between infection and poorer performance in areas such as reaction time, processing speed, working memory, and executive function. Many of these behavioral changes likely relate to worsened health and a shift towards a “fast life history strategy.” These cognitive deficits can have significant implications for daily functioning and performance. Furthermore, the role of Toxoplasma infection in the development or exacerbation of mental health disorders has been extensively investigated. Meta-analyses, ecological studies, and large-scale observational studies have demonstrated associations between Toxoplasma infection and an increased risk of disorders such as schizophrenia and obsessive–compulsive disorder. While the precise mechanisms underlying these associations remain under investigation, research suggests that neuroinflammation and alterations in neurotransmitter systems are likely to play a role. Far from being harmless, subclinical toxoplasmosis is increasingly recognized as a hidden factor influencing human health, behavior, and cognitive performance—with implications that extend well beyond the individual to public health at large. Further research is warranted to elucidate the complex interplay between Toxoplasma infection, host physiology, and the development of various physical, cognitive, behavioral, and mental health conditions. Full article

Trichophyton indotineae is emerging globally from its origin in India, presenting with a terbinafine resistance and causing significant clinical burden. We report herein the first four confirmed cases of T. indotineae dermatophytoses in Malaysia, which were diagnosed based on the microscopic examination of skin scrapings using potassium hydroxide (KOH) wet mount, followed by confirmation via culture and Internal Transcribed Spacer (ITS1) sequencing. In contrast to conventional Trichophyton infections, T. indotineae dermatophytoses demonstrate extensive cutaneous involvement and marked inflammation with erythematous lesions. All cases exhibited a chronic course lasting more than three months, with evidence of person-to-person transmission. Although one patient reported a travel to Singapore, three had no recent travel history, suggesting possible local transmission. The isolates produced characteristic white, cottony colonies with radial mycelial growth on Mycosel agar after incubation at 30 °C for four days. Three patients responded well to oral itraconazole (200 mg daily), with reduced inflammation and erythematous lesions observed two weeks after treatment initiation. The occurrence of T. indotineae particularly among patients without a travel history, suggests a potential endemic establishment. This fungal pathogen warrants consideration in cases of extensive or recalcitrant dermatophytoses. Further investigations into the diagnostic methods, antifungal susceptibility profiles, and epidemiological risk factors of Malaysian strains are warranted to enhance clinical management and inform public health interventions. Full article

Purpose: Despite increasing rates of prostate cancer among men, prostate cancer risk assessments continue to rely on invasive laboratory tests like prostate-specific antigen and Gleason score tests. This study aimed to develop a noninvasive, data-driven risk model for patients to evaluate themselves before deciding whether to visit a hospital. Materials and Methods: To train the model, data from the National Health Insurance Sharing Service cohort datasets, comprising 347,575 individuals, including 1928 with malignant neoplasms of the prostate, 5 with malignant neoplasms of the penis, 18 with malignant neoplasms of the testis, and 14 with malignant neoplasms of the epididymis, were used. The risk model harnessed easily accessible inputs, such as history of treatment for diseases including stroke, heart disease, and cancer; height; weight; exercise days per week; and duration of smoking. An additional 286,727 public datasets were obtained from the National Health Insurance Sharing Service, which included 434 (0.15%) prostate cancer incidences. Results: The risk calculator was built based on Cox proportional hazards regression, and I validated the model by calibration using predictions and observations. The concordance index was 0.573. Additional calibration of the risk calculator was performed to ensure confidence in accuracy verification. Ultimately, the actual proof showed a sensitivity of 60 (60.5) for identifying a high-risk population. Conclusions: The feasibility of the model to evaluate prostate cancer risk without invasive tests was demonstrated using a public dataset. As a tool for individuals to use before hospital visits, this model could improve public health and reduce social expenses for medical treatment. Full article

Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000–2023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000–2023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000–2023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social/economic inequity, access barriers, and regional/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance. Full article

Background: Falls are a major public health concern among older adults, often resulting in injury, functional decline, and reduced quality of life. While handgrip strength (HGS), fall efficacy, and balance confidence have individually been associated with fall risk, their combined predictive value is still underexplored, particularly in physically active older adults. This study aimed to investigate the relationship between HGS, fall efficacy, and balance confidence and their association with fall risk in community-dwelling older adults engaged in regular exercise programs; A cross-sectional study was conducted with 280 participants aged 55 and over from community exercise programs near Lisbon, Portugal. Fall risk was assessed through self-reported falls in the past 12 months. HGS was measured with a dynamometer, fall efficacy using the Falls Efficacy Scale-International (FES-I), and balance confidence using the Activities-specific Balance Confidence (ABC) Scale. Statistical analyses included Spearman correlations and binary logistic regression. Results: Falls were reported by 26.4% of participants. Fall efficacy and balance confidence were significantly associated with fall history, while HGS was not. Fall efficacy was significantly associated with increased fall risk, as indicated by the odds ratio (OR = 3.37, p < 0.001), while balance confidence was negatively associated (OR = 0.95, p < 0.001). HGS was positively correlated with balance and confidence but not with fall incidence. Conclusions: Psychological factors, particularly fall efficacy and balance confidence, play a critical role in fall risk among physically active older adults. However, this study included physically active middle-aged and older adults living in the community, which should be considered when interpreting the generalizability of the results. These findings support the integration of simple, validated psychological assessments into fall prevention strategies in community settings. Full article

Hepatitis C virus (HCV) infection is a major public health concern, with more than 58 million people chronically infected worldwide. The management of HCV, once the domain of specialists only, has been revolutionized by the advent of direct-acting antiviral therapies. To reduce the burden of HCV in the United States (US), emphasis is now being placed on the involvement of primary care physicians in the management of HCV patients. Inclusion of more primary care providers in the HCV diagnosis and treatment initiatives can assist in achieving the goal of HCV elimination, especially in the medically underserved areas. To actively engage in the management of HCV, primary care providers must understand its epidemiology, risk factors, natural history, current treatment regimen, and potential complications. This manuscript reviews these key areas, along with presenting the cost-effectiveness of treatment and evidence-based guidelines for follow-up care in adults with chronic HCV infection who have undergone HCV treatment. Equipped with this foundational knowledge about HCV management, primary care physicians can play a vital role in eliminating HCV. Full article

Group A Streptococcus (GAS) imposes a significant global health burden across all age groups, annually causing over 600 million cases of pharyngitis and more than 18 million severe invasive infections or sequelae. The resurgence of scarlet fever globally and streptococcal toxic shock syndrome (STSS) outbreaks in Japan have brought GAS infections back into the spotlight as a pressing global health concern. Unfortunately, no licensed vaccine against GAS is yet available for clinical use. Our comprehensive review examines the developmental history of GAS vaccines, outlining the research trajectory from early inactivated vaccines to contemporary multivalent, conjugate, multi-antigen, and mRNA-based vaccine platforms. It systematically analyzes clinical trial outcomes of GAS vaccines, highlighting recent advances in both M protein-based and non-M protein vaccine candidates while summarizing promising target antigens. The review concludes with critical strategies to accelerate vaccine commercialization, including enhanced investment in research and development, expanded collaborations, leveraging advanced vaccine technologies, streamlined clinical trials, and strengthened public health advocacy. This review critically evaluates the current evidence and future prospects in GAS vaccine development, emphasizing innovative strategies and engaging broader stakeholders to accelerate GAS vaccine development. Full article

Medicaid is a vital public health program, serving over 70 million Americans from many backgrounds. Understanding how Medicaid spending varies by political leadership and demographic factors can inform policy discussions and advocacy efforts. We conducted a cross-sectional descriptive analysis of state Medicaid spending using publicly available data. Our findings show that individuals identifying as White comprise the largest single racial group of Medicaid beneficiaries both nationally and in most states. While the 2020 Census Diversity Index correlated strongly with total Medicaid spending, no significant association was found with per enrollee spending or the federal share of Medicaid funding. States led by Democrats had higher total Medicaid spending when compared to Republican-led states. However, Republican-led states received a larger proportion of federal Medicaid funding. Among political leadership levels, Senate representation showed the strongest relationship with Medicaid spending trends compared to gubernatorial leadership and presidential voting history. In conclusion, we demonstrate that Medicaid spending impacts all racial groups and both major political parties. However, funding structures and political representation reflect distinct spending patterns. Given the evolving demographic and political landscape, ongoing policy discussions should ensure that Medicaid remains a public health program that remains effective at safeguarding human health. Full article

Saxitoxin (STX) is a potent toxin produced by marine dinoflagellates and freshwater or brackish water cyanobacteria, and is a member of the paralytic shellfish toxins (PSTs). As a highly specific blocker of voltage-gated sodium channels (NaVs), STX blocks sodium ion influx, thereby inhibiting nerve impulse transmission and leading to systemic physiological dysfunctions in the nervous, respiratory, cardiovascular, and digestive systems. Severe exposure can lead to paralysis, respiratory failure, and mortality. STX primarily enters the human body through the consumption of contaminated shellfish, posing a significant public health risk as the causative agent of paralytic shellfish poisoning (PSP). Beyond its acute toxicity, STX exerts cascading impacts on food safety, marine ecosystem integrity, and economic stability, particularly in regions affected by harmful algal blooms (HABs). Moreover, the complex molecular structure of STX—tricyclic skeleton and biguanide group—and its diverse analogs (more than 50 derivatives) have made it the focus of research on natural toxins. In this review, we traced the discovery history, chemical structure, molecular biosynthesis, biological enrichment mechanisms, and toxicological actions of STX. Moreover, we highlighted recent advancements in the potential for detection and treatment strategies of STX. By integrating multidisciplinary insights, this review aims to provide a holistic understanding of STX and to guide future research directions for its prevention, management, and potential applications. Full article