Search Results (55)

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were classified into four dimensions: cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), vulnerability factors (e.g., migrants, refugees, low-literacy groups), and geography (indigenous MENA populations versus diaspora and Mediterranean immigrant communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men’s engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality. Full article

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

The Mediterranean Diet (MD) is globally recognized not only for its well-established benefits to human health but also for its potential as a sustainable dietary model from environmental perspectives. Primarily based on plant-based foods, olive oil, fish, and seasonal and local products, the MD stands out for its ability to reduce overall mortality and the incidence of chronic diseases. At the same time, it is a low environmental impact dietary approach, contributing to the reduction in greenhouse gas emissions, water savings, biodiversity conservation, and soil regeneration. This narrative review was conducted by searching the Scopus and PubMed databases, covering all publications up to 2011, applying predefined inclusion and exclusion criteria, and ultimately including 33 studies. The paper provides a synthesis of the key elements that make the MD a paradigm of sustainability, analyzing critical indicators such as carbon, water, and energy footprints, land use, food waste generation, and carbon sequestration. It also addresses the decline in adherence to the MD, even in Mediterranean countries, highlighting the socio-economic, cultural, and behavioral causes, as well as the necessary strategies to promote its rediscovery and adaptation to contemporary contexts. Full article

Background: Cardiovascular disease (CVD) is very widespread in countries with a Western-style diet, representing one of the major causes of morbidity. Genetic factors, obesity, diabetes, dyslipidemia, smoking, and ageing are risk factors for CVD outcomes. From a pathogenic point of view, the condition of low-grade inflammation of the arteries leads to endothelial damage and atherosclerosis development. Nowadays, a broad range of drugs is available to treat CVD, but many of them are associated with side effects. Therefore, alternative therapeutic remedies need to be discovered in combination with conventional drugs. A balanced diet rich in fruits and vegetables, e.g., the Mediterranean diet, has been shown to lower the incidence of CVD. Plant-derived polyphenols are ingested in food, and these compounds can exert beneficial effects on human health, such as antioxidant and anti-inflammatory activities. Objective: In the present review, the cellular and molecular bases of the beneficial effects of polyphenols in the prevention and treatment of CVD will be pointed out. Methods: This review has been conducted on the basis of a literature review spanning mainly the last two decades. Results: We found that an increased dietary intake of polyphenols is associated with a parallel decrease in chronic disease incidence, including CVD. Conclusion: Despite a plethora of preclinical studies, more clinical trials are needed for a more appropriate treatment of CVD with polyphenols. Full article

Background: In farm animals, the main poisonings are due to the ingestion of toxic plants present in pastures, but their incidence is underestimated, even though they are responsible for serious damage to animal health and livestock production. Atractylis gummifera L. is a plant widespread in Mediterranean countries and in southern Italy that is responsible for serious and often fatal poisonings in both humans and animals. This investigation reports grazing cattle poisoning due to the ingestion of Atractylis gummifera L. roots present in a recently plowed pasture of a Sicilian farm. Methods: The investigation describes the clinical symptoms of poisoned cattle, especially the gastro-intestinal type, the alterations in liver and renal function, the course of poisoning (hyperacute–acute), and the necropsy examination of dead animals. In the surviving cattle, symptomatic drug therapy was administered, and hematological and biochemical analyses (blood, liver, and kidney profiles) were carried out during treatment. Results: The pharmacological therapy, although symptomatic, contributed to the recovery of the intoxicated cattle with a return to normal values of liver and kidney parameters and electrolyte profile 30–40 days after treatment. Conclusions: This investigation could be useful to veterinarians for the diagnosis of Astractylus gummifera L. root poisoning in cattle, which is also responsible for the death of some intoxicated animals, with a negative impact on livestock. Full article

Since the late 20th century, wildfires have increasingly disrupted ecosystems, particularly in Mediterranean-climate countries like Italy. This trend is linked to agroforestry and the abandonment of grazing activities, which is worsened by climate change. This study examines the knowledge within Italian society, using data from a survey conducted as part of the European FIRE-RES project, with 152 answers, mainly from northern Italy. The research explores traditional practices, identifies knowledge gaps, and proposes a program to enhance community resilience and to mitigate the impact of wildfires through preparedness and adaptation measures. Results show that, despite a strong cultural connection to the use of fire in Italy, there is a significant gap in public knowledge and readiness to address wildfire incidents among the population. This shows the need to develop educational programs to improve community awareness and adaptive measures to mitigate the impact of wildfires. Full article

In 2015, the 62nd session of the Regional Committee [RC] of the Eastern Mediterranean Region [EMR] endorsed the Eastern Mediterranean Vaccine Action Plan 2016–2020 (EMVAP) that included postponement of the measles elimination target to before 2020. However, the EMR does not have a regional rubella control or elimination goal. We reviewed the progress of measles and rubella surveillance in context of measles elimination in the Eastern Mediterranean Region during 2019–2022. We compiled data on coverage, reported cases, surveillance indicators, incidence, and genotypes. We conducted an age-cohort analysis to estimate the size of the susceptible population using coverage and SIAs coverage data. We reviewed the dossiers of countries that applied to the Regional Verification Commission [RVC] for the verification of measles and rubella elimination. Between 2019 and 2022, the regional coverage of the vaccine against measles and rubella was stable at 83% for the first dose [MCV1] and increased from 75% to 78% for the second dose [MCV2] after a dip during COVID-19. In the EMRO, eighteen countries are using MR (measles–rubella) and/or measles–mumps–rubella (MMR) vaccines and four are using measles vaccines. The reported regional measles incidence per 1,000,000 was 23.3 in 2019, decreased to 7.4 in 2020, and re-increased to 50 in 2022, with two main genotypes–D8 and B3–in circulation. Both genotypes are considered to be actively circulating in eighteen countries, with different circulating variants of each genotype. There were no genotyping data available from four countries. Measles and rubella surveillance indicators deteriorated in the region. The number of susceptible individuals exceeded one birth cohort in nine of the 22 countries. In 2019–2022, Bahrain, Egypt, Iran, and Oman were verified to have eliminated measles and rubella. While four countries eliminated measles and rubella and another five progressed toward measles and rubella elimination, however, immunity gaps and reported incidence increased in eleven countries. Countries approaching elimination need to prepare verification dossiers, while others need to increase their routine coverage, conduct follow-up campaigns, and improve surveillance. Submission of progress reports to the RVC will measure progress toward the goal. Full article

The European Food Safety Authority has recently listed Q fever as a priority for setting up a coordinated surveillance system. Although Spain is the country with the highest human incidence of the disease in the European Union, updated data on Coxiella burnetii in ruminants are still limited. A total of 780 serum samples from small ruminants and 605 sera from wild ruminants were collected in the Mediterranean ecosystems of southern Spain during the period 2015–2023. Anti-C. burnetii antibodies were detected using a commercial indirect ELISA. The overall individual seroprevalence in the small ruminants was 49.1% (383/780; 95% CI: 45.6–52.6). Antibodies against C. burnetii were identified in 40.0% (156/390) of sheep and in 58.2% (227/390) of goats. At least one seropositive animal was observed in all sheep (100%) and in 92.3% of goat flocks. The species (goat) and the existence of reproductive disorders in primiparous females were potential risk factors for C. burnetii exposure in small ruminant farms. In the wild ruminants, the overall seroprevalence against C. burnetii was 1.5% (9/605; 95% CI: 0.8–2.8). Anti-C. burnetii antibodies were found in 1.8% (2/110) of mouflon, 1.5% (6/390) of red deer, and 1.0% (1/105) of Iberian ibex. The high exposure of the small ruminants to C. burnetii, particularly in goats, detected in the present study is of animal and public health concern. Our results denote that wild ruminants only play a minor role in the epidemiology of this bacterium in southern Spain and suggest an independent epidemiological cycle of C. burnetii in domestic and wild ruminant species in the study area. Full article

As warmer and drier conditions associated with global warming are projected to increase in southern Europe, the Mediterranean countries are currently the most prone to wildfire danger. In the present study, we investigated the statistical relationship between drought and fire weather risks in the context of climate change using drought index and fire weather-related indicators. We focused on the vulnerable and long-suffering area of the Attica region using high-resolution gridded climate datasets. Concerning fire weather components and fire hazard days, the majority of Attica consistently produced values that were moderately to highly anti-correlated (−0.5 to −0.9). This suggests that drier circumstances raise the risk of fires. Additionally, it was shown that the spatial dependence of each variable on the 6-months scale Standardized Precipitation Evapotranspiration Index (SPEI6), varied based on the period and climate scenario. Under both scenarios, an increasing rate of change between the drought index and fire indicators was calculated over future periods versus the historical period. In the case of mean and 95th percentiles of FWI with SPEI6, abrupt changes in linear regression slope values were observed, shifting from lower in the past to higher values in the future periods. Finally, the fire indicators’ future projections demonstrated a tendency towards an increasing fire weather risk for the region’s non-urban (forested and agricultural) areas. This increase was evident from the probability distributions shifting to higher mean and even more extreme values in future periods and scenarios. The study demonstrated the region’s growing vulnerability to future fire incidents in the context of climate change. Full article

Legumes are an inexpensive and essential protein source worldwide. The most consumed legumes include peanuts, soybeans, lentils, lupines, peas, common bean and chickpeas. In addition, the food industry is growing interested in expanding the use of legumes to partially replace or substitute cereals. Legumes were described to cause IgE-mediated allergies, and their growing use may also increase the incidence of allergy. The epidemiology of legume allergy varies by region; peanuts and soybeans are the legumes most involved in food allergies in Western countries, whereas lentils, peas, and chickpeas are reported as culprit allergens mainly in the Mediterranean area and India. This review, edited by the Italian Society of Pediatric Allergology and Immunology, summarizes the scientific literature on legume allergy in children and proposes a diagnostic workup and therapeutic approach. Full article

Olive anthracnose, caused by Colletotrichum fungi, is responsible for major fruit yield losses and poor olive oil quality worldwide. In the Mediterranean basin, some Colletotrichum spp. appear to be replacing others, possibly due to climate change and modification in cultural systems. To update the situation in Portugal, 525 olive groves were surveyed throughout the country over two years, revealing a decrease in disease incidence, associated with scarcer rainfall and new cropping systems using less susceptible cultivars. A collection of 212 isolates was obtained, and phylogenetic analyses using a multi-locus sequencing approach (five and six loci in the acutatum and gloeosporioides species complex, respectively) revealed the presence of seven Colletotrichum species within the collection. Compared to surveys conducted in the first decade of the 21st century, the species composition of olive anthracnose pathogens in Portugal remains mostly unchanged, with C. nymphaeae as the prevalent species, followed by C. godetiae, but with C. acutatum geographically expanding and with C. alienum and C. cigarro being reported for the first time as causal agents of olive anthracnose in Portugal. A close attention to pathogen population shifts, in the context of climate change and modification of cultivation systems, is fundamental for anticipating plant protection measures. Full article

The incidence of type 2 diabetes mellitus (T2DM) is growing in Western countries. Nutritional interventions that promote high-quality dietary patterns could help reverse this trend. We aimed to evaluate whether changes in Nutrient-Rich Food Index 9.3 (NRF9.3) were related to the risk of developing T2DM in patients with coronary heart disease (CHD). The study was carried out in the context of two healthy dietary interventions (a Mediterranean and a low-fat diet). For this purpose, we evaluated all the patients in the CORDIOPREV study without T2DM at baseline. Data were obtained during the first 5 years of dietary intervention. The score was calculated using the Food Frequency Questionnaires at baseline and after 1 year of intervention. After 5 years of follow-up, 106 patients developed T2DM (incident-T2DM), while 316 subjects did not (non-T2DM). Total NRF9.3 score and changes during the first year of intervention were compared between incident-T2DM and non-T2DM. Incident-T2DM showed less improvement in NRF9.3 than non-T2DM (p = 0.010). In the multi-adjusted Cox proportional hazard study, patients with greater improvement in NRF9.3 had over 50% less risk of developing T2DM compared with the lowest tertile (HR 2.10, 95%, CI = 1.12–3.56). In conclusion, improved diet quality in terms of nutrient density after the dietary intervention was associated with a lower risk of T2DM in patients with CHD. Full article

There has been substantial progress in the Mediterranean countries regarding research on viroids. Twenty-nine viroid species, all belonging to Pospiviroidae and Avsunviroidae genera, have been detected in the Mediterranean Basin. Not only have detection methods, such as reverse transcription-quantitative polymerase chain reaction and next-generation sequencing, been used for viroid detection, along with molecular hybridization techniques allowing for rapid detection, identification, and characterization of known and novel viroids in these countries, but eradication measures have also been taken that allowed for the efficient elimination of certain viroids in a number of Mediterranean countries. The eradication measures were followed as recommended by the European and Mediterranean Plant Protection Organization, which is known by its abbreviation, EPPO. The Mediterranean Region has been a niche for viroids since ancient times due to the warm climate and the socio-cultural conditions that facilitate viroid transmission among different host plant species. Full article

Ischemic heart disease (IHD) morbidity and mortality indices, along with medical intervention rates, were analyzed among Mediterranean countries, Croatia, Slovenia, Spain, Italy, and France, in the pre-COVID period. Standardized IHD incidence and prevalence rates from 1990 and mortality rates from 1985 were obtained from the Global Burden of Disease Study 2017 and Health for All databases. Coronary artery bypass graft (CABG) and transluminal coronary angioplasty (TCA) rates in the 2011–2019 period were obtained from Eurostat. Trends were estimated with Joinpoint regression analysis. IHD mortality rates range from 13.6 to 74.3 for females and from 37.8 to 126.03 for males. IHD mortality rates in Croatia were 5.6-fold higher among females and 3.3-fold higher among males compared to France. All countries decreased standardized IHD prevalence and incidence rates, although the magnitude varied. The high-to-low ratio, Croatia vs. Spain, was 3.5-fold for CABG and 3.2-fold for TCA. Slovenia, as opposed to Croatia, reduced the gap for all medical indicators except for relatively high prevalence rates. Despite a significant rise in medical interventions in Croatia, ineffective clinical and public health initiatives have led to only modest declines in IHD mortality rates over the past decade. Full article

Chronic kidney disease (CKD) disproportionately affects minorities in the United States, including the Hispanic/Latine population, and is a public health concern in Latin American countries. An emphasis on healthy dietary patterns, including the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diets, has been suggested as they are associated with a lower incidence of CKD, slower CKD progression, and lower mortality in kidney failure. However, their applicability may be limited in people from Latin America. The Dieta de la Milpa (Diet of the Cornfield) was recently described as the dietary pattern of choice for people from Mesoamerica (Central Mexico and Central America). This dietary pattern highlights the intake of four plant-based staple foods from this geographical region, corn/maize, common beans, pumpkins/squashes, and chilies, complemented with seasonal and local intake of plant-based foods and a lower intake of animal-based foods, collectively classified into ten food groups. Limited preclinical and clinical studies suggest several health benefits, including cardiometabolic health, but there is currently no data concerning CKD. In this narrative review, we describe and highlight the potential benefits of the Dieta de la Milpa in CKD, including acid-base balance, protein source, potassium and phosphorus management, impact on the gut microbiota, inflammation, and cultural appropriateness. Despite these potential benefits, this dietary pattern has not been tested in people with CKD. Therefore, we suggest key research questions targeting measurement of adherence, feasibility, and effectiveness of the Dieta de la Milpa in people with CKD. Full article