Search Results (55)

Background: Mega-events like the FIFA World Cup (FWC) present unique and substantial challenges for individuals in recovery from substance use disorders (SUDs), primarily by increasing the risk of relapse. We employed a qualitative design using reflexive thematic analysis to explore the behavior of patients with SUDs during the 2022 FWC and to evaluate institutional strategies for mitigating related risks. Methods: We purposively sampled 32 participants who were present at the Naufar Center during the 2022 FWC: (i) thirteen adult patients with SUDs who were receiving treatment, and (ii) nineteen healthcare practitioners. Semi-structured patient interviews were conducted, and focus group discussions were held with a multidisciplinary team, including psychologists, nurses, and physicians. Individuals’ experiences regarding patterns in substance use behavior, environmental triggers, and the effects of institutional interventions were examined. Thematic analysis was employed to identify patterns, risks, and effective strategies. Results: Most patients maintained abstinence and only had cravings for alcohol. Triggers included public celebrations, emotional excitement, and the increased availability of addictive substances. Psychologists and physicians reported signs of behavioral destabilization; nurses observed some behavioral changes and noted logistical challenges. The participants acknowledged the supportive measures provided by Naufar, including the accessibility of clinical services, individualized therapy, social and recreational programming, and protective fan zones, which enabled them to participate in various activities during the event. Conclusions: The 2022 FWC created considerable psychological and environmental triggers for high exposure to alcohol and other substances. The supportive structured activities and tailored interventions were helpful in mitigating the risk of relapse, maintaining treatment engagement and ensuring recovery. Further research is required to explore the implications for recovery-oriented practices during culturally and socially high-risk events. Full article

The Mediterranean mussel, Mytilus galloprovincialis, is currently facing unprecedented mass mortality events (MMEs) that threaten the economic and ecological stability of Mediterranean aquaculture. The present review gathered and analyzed current knowledge on climate change and environmental disorders that may cause MMEs in Mediterranean mussels, compromising mussel physiology and immune competence. Biological agents, which proliferate under stress conditions, can either trigger direct disease or act as co-factors in mortality. The impact of the economic loss following MMEs in mussel production in the Mediterranean Sea is also described. The main key drivers used in the analysis of the literature were “M. galloprovincialis”, “MMEs”, “environmental stressors”, “climate change”, “pathogens”, “pollutants”, “economical losses”. The One Health–One Welfare framework recognizes the inextricable interconnection between the health of human, mussel, and marine ecosystems. This approach is essential for developing holistic monitoring programs, robust risk assessment strategies, and adaptive management policies capable of ensuring the long-term sustainability of Mediterranean mussel production and the ecological stability of coastal systems. In the future, the development of integrated water monitoring systems where mussels are both farmed species and active biological sentinels is possible. The implementation of a digital monitoring system will offer a transformative strategy for mitigating MMEs in Mediterranean mussel populations. Full article

Air pollution during mass-gathering events such as festivals and firework shows is a growing concern globally. Fireworks at festivals on average almost double the observed particulate pollution levels, while food trucks and associated diesel generators are known to result in very local air pollution hotspots that are an emerging important area of research regarding sources of urban volatile organic compounds. This study adds to the scientific body of evidence of the impact of festival fireworks and cooking pollution in the USA by quantifying the impact of fireworks and cooking emissions during short summer festivals in June and July 2023 in Utah’s Salt Lake Valley using paired PM_2.5, ozone, and BC sensors located at two distances nearby to the sources. Both fireworks and cooking increased PM_2.5 and BC during the evening dinner and firework displays, while evening ozone was observed to drop during fireworks. The ozone concentration reductions during fireworks displays are likely associated with NO_x titration due to fireworks and cooking emissions. Regulating fireworks and cooking emissions during annual festivals has resulted in significant reductions in PM_2.5 pollution and corresponding benefits to human health. These findings can support policy decisions to reduce exposure to emissions locally. Full article

Elexacaftor/tezacaftor/ivacaftor (ETI) is a cystic fibrosis (CF) transmembrane conductance regulator modulator, which has shown efficacy in people with CF (pwCF) carrying the F508del (F) variant, both in homozygosity and heterozygosity with a minimal function (MF) variant. Limited data exist on the effects of ETI in pwCF with advanced lung disease. Our aim was to investigate ETI safety and effectiveness in this patient group in a real-life setting over 2 years. A multicenter observational cohort study was designed to gather real-world information on the effect of ETI treatment on CF patients (aged >12 years, genotype: F/MF mutation) with advanced lung disease as defined by a FEV1 < 40% predicted. Retrospective demographic and clinical data were recorded for the two years preceding and the two years following ETI initiation. The following outcomes were investigated: treatment-associated adverse events (AEs), drug interruptions (temporary or permanent), variations in percent predicted FEV1 (ppFEV1), sweat chloride concentration (SwCl), antibiotic use, body mass index (BMI), and quality of life. A total of 124 (51.6% males) pwCF were treated with ETI over 2 years. The median (IQR) age and ppFEV₁ were 34 (26, 43) years and 34 (29, 41) percentage points, respectively. ETI was discontinued in two pwCF due to lung transplantation, and temporarily interrupted in two because of skin rash, and in three following elevated levels of aminotransferase. Most AEs were mild and short-lasting. In 12.1% pwCF, we registered an increase greater than twice the upper limit of the normal range in alanine aminotransferase, and in 16% we registered an increase in conjugated bilirubin with no increase in aminotransferase. Both increases were recurrent in about half of the subjects. The mean differences (95% CI) for ppFEV₁ and SwCl, assessed as mean values in the pre-ETI and ETI treatment periods, were +11.8 (11.1 to 12.6) and −43.7 (−47.6 to −39.9) mmol/L. A modest increase in ppFEV₁ persisted during the second year of treatment. Number of oral and IV antibiotic cycles/year, as well as hospitalizations/year, decreased significantly from 3.6 to 1.2, from 2.4 to 0.6, and from 2.1 to 0.5 during ETI treatment. A total of 8 of 16 (50%) pwCF were taken off the waiting list for lung transplantation, and significant reductions in the percentages of pwCF using long-term oxygen therapy and non-invasive ventilation were observed. A poor concordance between ppFEV1 and SwCl was found. In only 3/82 (3.7%), subjects with chronic airway infection by Pseudomonas aeruginosa cultures were always negative during ETI treatment. In CF patients with advanced lung disease on ETI treatment, we observed an improvement in a number of clinically significant outcomes over a 2-year study period. However, several additional observations, such as liver dysfunction, variable degrees of lung function improvement, and limited impact on chronic airway infection, underscore the fact that the benefit–risk profile of ETI treatment in cystic fibrosis patients with advanced lung disease has not been fully elucidated and warrants prolonged-term monitoring. Full article

Air pollution is a global issue affecting health and the environment. This study investigated associations between PM₁₀, NO₂, and admissions from cardiovascular and respiratory diseases in Makkah (2019–2022), comparing Hajj cultural events and the COVID-19 lockdown with non-event periods, using time-series Poisson regression models adjusted for time and seasonality. Event interactions, particularly the impact of the Hajj and COVID-19 periods, were examined to assess potential effects on morbidity. The study findings showed that PM₁₀ was significantly associated with increased respiratory admissions during the Hajj period (lag 0: RR = 1.066; 95% CI: 1.030–1.104), and with decreased risk during the non-Hajj period (lag 0: RR = 0.966; 95% CI: 0.942–0.991) and non-COVID periods (lag 0: RR = 0.946; 95% CI: 0.920–0.973). NO₂ demonstrated a strong positive association with respiratory admissions during the Hajj period across all lags, peaking at lag 0 with a 16.2% increased risk (RR = 1.162; 95% CI: 1.118–1.207). Exposure to PM₁₀ during Hajj was associated with a 3.1% increased risk of cardiovascular admissions (lag 0: RR = 1.031; 95% CI: 1.012–1.050) and decreased risk during non-Hajj (lag 0: RR = 0.981; 95% CI: 0.963–0.999) and non-COVID periods (lag 0: RR = 0.962; 95% CI: 0.942–0.983). NO₂ exposure was positively associated with cardiovascular admissions during Hajj (lag 0: RR = 1.039; 95% CI: 1.019–1.056) and non-COVID periods (lag 0: RR = 1.037; 95% CI: 1.007–1.068). These findings provide event-specific evidence to guide targeted air quality management during mass gatherings, helping policymakers protect the health of Makkah’s residents and visitors. Full article

Mass gatherings such as the annual Hajj pilgrimage in Makkah, Saudi Arabia, generate extreme, short-term anthropogenic emission loads with significant air quality and public health implications. This study assesses the spatiotemporal dynamics of key atmospheric pollutants—including nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂), formaldehyde (HCHO), and aerosols—across Makkah and its holy sites before and during the Hajj seasons of 2023 and 2024. Using high-resolution Sentinel-5P TROPOMI satellite data, pollutant fields were reconstructed at 100 m spatial resolution via cloud-based geospatial analysis on the Google Earth Engine. During Hajj 2023, spatially resolved NO₂ concentrations ranged from 15.4 μg/m³ to 38.3 μg/m³ with an average of 24.7 μg/m³, while SO₂ during the 2024 event peaked at 51.2 μg/m³ in key hotspots, occasionally exceeding World Health Organization (WHO) guideline values. Aerosol index values showed episodic surges (up to 1.43), particularly over transportation corridors, parking areas, and logistics facilities. CO concentrations reached values as high as 1069.8 μg/m³ in crowded zones, and HCHO concentrations surged up to 9.99 μg/m³ during peak periods. Quantitative correlation analysis revealed that during Hajj, atmospheric chemistry diverged from urban baseline: the NO₂–SO₂ relationship shifted from strongly negative pre-Hajj (r = −0.74) to moderately positive during the event (r = 0.35), while aerosol–HCHO correlations intensified negatively from r = −0.23 pre-Hajj to r = −0.50 during Hajj. Meteorological analysis indicated significant positive correlations between wind speed and NO₂ (r = 0.35) and wind speed and CO (r = 0.35) during 2024, demonstrating that extreme emission rates overwhelmed typical dispersive processes. Relative humidity was positively correlated with aerosol loading (r = 0.37), pointing to hygroscopic growth patterns. These results quantitatively demonstrate that Hajj drives a distinct, event-specific pollution regime, characterized by sharp increases in key pollutant concentrations, altered inter-pollutant and pollutant–meteorology relationships, and spatially explicit hotspots driven by human activity and infrastructure. The integrated satellite–meteorology workflow enabled near-real-time monitoring in a data-sparse environment and establishes a scalable framework for evidence-based air quality management and health risk reduction in mass gatherings. Full article

Objectives: In view of a lack of evidence on the subject, we aimed to perform a scoping review to understand the impact of health education among people attending mass gatherings. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines. PubMed, EMBASE, Scopus, and Cochrane Library were searched from inception to March 2025 to identify eligible studies. Observational and interventional studies that reported the impact of health education on any health-related outcome among those attending a mass gathering were considered. A narrative synthesis of review results was performed to gather evidence. Recommendations were framed in the context of this evidence. Results: Of the 1731 records, only 17 studies met the inclusion criteria. These included cross-sectional (n = 10), pre-post design (n = 3), quasi-experimental (n = 2), randomized controlled trial (n = 1), and ethnographic (n = 1) studies. These studies involved participants attending hajj, umrah, and basketball events. The current evidence on health education in mass gatherings is highly varied in its objectives, intervention strategy, educational plan, mode of delivery, design, and reported outcomes. Most studies agreed that health education should be initiated by the country of origin and continued throughout the event. It is recommended that this education should be tailored to patient needs based on age, medical condition, and other personal factors, and given in the local language for better acceptability. Such sources can be provided in various forms, either online or offline, as per the participant’s convenience. Conclusions: The current evidence on the effectiveness of health education during mass gatherings, particularly in pilgrimage settings, is varied and inconsistent. Participant-tailored health education should be provided, preferably in the local language, through convenient formats. Full article

Background: While efforts have been made to control meningococcal disease or carriage during mass gatherings (MGs), it is still a significant problem. This meta-analysis aims to assess the prevalence and predictors of meningitis carriage during MGs and travel. Methodology: PubMed, Scopus, Embase, and Cochrane were searched from their conception to January 2025. Cohort and cross-sectional studies assessing the prevalence of meningitis carriage and its serotype related to MGs and/or travel, and risk factors associated with its spread, were considered. The Newcastle–Ottawa scale was used for the quality assessment of studies. Results: Out of 1301 studies, 25 were considered for this meta-analysis. The largest geographic area involved was Saudi Arabia. A meta-analysis of 24 studies identified a pooled prevalence rate of meningococcal disease or carriage of 15.9% (95%CI: 4.45–27.4%) and the most frequent infecting organisms to be Serotype C (13.9%; 95%CI: −14.7 to 42.5; 4 studies) and A (11.5%; 95%CI: −2.13 to 25.2; 9 studies) among those at MGs or traveling. Age, gender, smoking history, and the vaccination status did not affect the infection risk. Conclusions: There is an increased prevalence of meningococcal disease and carriage, especially Serogroups A and C, associated with MGs and travel. New interventions and methodologies should be undertaken to control and prevent meningococcal disease or carriage transmission during such events. Full article

Background: Disasters pose significant challenges to public health by disrupting essential services, especially during mass gatherings such as the Hajj pilgrimage. These complex events demand swifts coordinated action from healthcare professionals. However, many remain insufficiently equipped for large-scale emergencies due to gaps in triage training, disaster knowledge, and established response protocols—issues that are particularly critical in high-risk settings. Aim: This systematic literature review aims to explore the clinical insights of registered nurses and other healthcare professionals in disaster preparedness and response during the Hajj pilgrimage in Saudi Arabia. Methods: A systematic literature review was conducted following PRISMA guidelines. A comprehensive database search was performed across CINAHL, Scopus, Medline, Embase, and APA PsycINFO, focusing on studies published between 2012 and 2025. Eligible studies addressed disaster nursing education, preparedness, and response. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment. Results: Twenty-three studies met the inclusion criteria. Three main themes emerged: disaster preparedness, experiences and challenges in disaster response, and education and training. The review revealed lack in nurses’ readiness, policy awareness, and real-world disaster experience. Training and curriculum improvements are essential to enhance disaster response capabilities. Conclusions: This review highlights the urgent need for standardized disaster nursing curricula to enhance preparedness and response competencies. Incorporating structured disaster training into nursing education will strengthen healthcare system resilience. Future research should adopt qualitative methods to capture healthcare professionals lived experiences during the Hajj. Including diverse participants and focusing on the unique cultural context can enhance disaster preparedness and response strategies. Full article

Objectives—Health screening data were collected from participants at Native American community and celebratory events to evaluate their health status and identify common health concerns. These results will form the basis for developing community-based health care interventions to address health inequalities. Design—A descriptive, observational design was used to gather data in line with STROBE guidelines. Results—The screening data revealed that this population was largely obese, had low bone mass, and were in various states of dehydration. These characteristics can lead to major health risks and morbidities including diabetes, hypertension, cancer, hormone and neurotransmitter imbalances, bone fractures, and psychological disorders such as depression and anxiety. Conclusions—Professional and community efforts are essential to meet the health care needs of this population and avoid the repercussions of obesity, low bone mass, and dehydration. By incorporating collaborative input from the Native American community, we intend to develop partnerships for goals of promoting effective, culturally appropriate interventions to meet these health inequalities and promote good health and well-being. Full article

Studies have indicated that there was a disease interaction of pandemic influenza with respiratory tuberculosis (TB) in Malta, which could explain the heightened mortality recorded in young adults. We revisit the 1918/19 influenza and TB syndemic potential on the island of Malta. Borrowing from crisis studies that explore the harvesting effect, we used the method of assessing changes in pre-pandemic, pandemic, fallow, and post-pandemic mortality/life expectancy to reveal the syndemic experience. Pre-pandemic (1914–1917) life expectancy at birth was significantly higher, at 37.91 years, than during the pandemic (1918), when life expectancy dropped to 33.26 years (Z = 10.56, p < 0.0001). Post-pandemic (1919) life expectancy rose to 43.49 years, which was an even longer life expectancy than pre-pandemic (Z = 17.61, p < 0.0001). There were significant changes in TB mortality death rates during the four periods in those of reproductive age. Augmenting our framework for studies of syndemics involving short-term events, we proposed the identification of contributing, driving, and limiting factors. Underlying living conditions contributed to the syndemic. The exacerbation of housing conditions, the economy associated with the First World War, and meteorological measures—temperature, relative humidity, and rainfall—were driving factors. The early implementation of mitigation strategies, such as restrictions on mass gatherings, were limiting factors of the syndemic. Full article

Background: Long-distance running impacts many organ systems. Aside from musculoskeletal and cardiopulmonary events, the gastrointestinal and renal system as well as metabolic homeostasis and electrolyte balance can be affected. A respective medical support strategy enabling rapid diagnosis, triage, and treatment in the context of large sports events is thus of utmost importance. Incidents can be assessed and graded via point-of-care (POC) blood gas analysis (BGA). We thus aimed to evaluate the feasibility and benefits of its use during a large sports event. Methods: All documented patient contacts during the race of the Vienna City Marathon (VCM) 2023 were retrospectively assessed. Additionally, the BGAs conducted in all patients requiring intravenous access were analyzed. Data are presented in a descriptive manner. Results: There were 39,871 participants at the VCM 2023. Of these, 277 (0.7%) required medical support, localized most commonly in the finishing area of the race (n = 239, 86% of all incidents). Fifty-eight (20.9%) patients had to be hospitalized. The most frequent chief complaints were syncope or collapse (24.9%), followed by general pain (20.6%) and trauma (14.8%). Five patients (1.8%) suffered from seizures, and one experienced (0.4%) from spontaneous pneumothorax. Thirty-one patients (11.2%) received venous blood gas analyses, showing mean creatinine levels of 1.82 (±0.517) mg/dL, mean lactate concentrations of 6.03 (±4.5) mmol/L, mean pH of 7.42 (±0.0721), and a mean base excess of −0.72 (±3.72) mmol/L. No cases of hyponatremia occurred in the documented samples. In eight cases (25.8%), sodium concentrations were above 145 mmol/L, with a maximum of 149 mmol/L. No cardiac arrests occurred. Conclusions: The physical exertion during the assessed long-distance running race resulted in numerous contacts with the medical support teams. The use of POC BGA at a large-scale marathon event was shown to be easy and feasible, allowing for more extensive diagnostics on-site. It can be integrated into a medical support strategy and might be beneficial for decision-making regarding patient triage, treatment, hospitalization, or patient discharge. Full article

Background/Objectives: The Munich Oktoberfest is the largest Volksfest in the world, attracting more than 6 million visitors every year to the city of Munich and surroundings, posing challenges to healthcare providers. Since 2022, a CT has been installed on the festival site to decrease patient transport to emergency departments (EDs) and relieve EDs of a significant number of patients. The aim of our studies was to determine the economic impact of on-site CT on the healthcare system, both from a German and a U.S. perspective. Methods: A decision model was built using patient data from the Munich Oktoberfest. Two scenarios were investigated where patients with mild traumatic brain injuries were either scanned for intracranial hemorrhage (ICH) with CT on-site or brought directly to an ED for further investigation. Costs for patient transportation and CT scans were derived from German national reimbursement rates as well as U.S. Medicare data. Costs were calculated by diagnosis in the national currency. Results: In all scenarios, on-site CT scans were associated with reduced costs per patient (EUR 243 vs. EUR 908 in the German setting and EUR 438 vs. EUR 1635 in the international setting, as well as USD 160 vs. USD 403 in the U.S. setting). For the U.S. scenario, the proportion of ICH in the patient group, as well as the transport distance, had the strongest impact on average costs per patient. Conclusions: On-site CT scanning is a cost-reducing as well as clinically beneficial method for triaging patients at the Munich Oktoberfest. Full article

This paper proposes a novel model to determine occupancy density for outdoor events to prevent infectious disease transmission caused by the impossibility of proper dilution of human effluents in the atmosphere. It uses standardization processes to calculate natural ventilation air renewal and establishes theoretical occupancy based on activity and exhaled air percentage, aiming for indoor air quality comparable to the IDA2 standards. The study focuses on mass events in Mostoles (Spain), analyzing street activities and bullring events. It found that above a certain height in the open air, infection risk is low, eliminating capacity limitations. The resulting mathematical expressions can be adapted to different pathogens, ensuring the quality of indoor air conditions through capacity control. The process determines the ventilation required based on physical activity, considering both unrestricted and restricted situations. The relationship between required and available ventilation prevents disease transmission. The method’s effectiveness is demonstrated through comparisons between estimates and environmental measurements during Mostoles events. The maximum outdoor occupancy at ground level to achieve air quality comparable to the IDA2 standards is determined to be 2.36 persons/m², while to prevent the transmission of SARS-CoV-2 it is determined to be 1.98 persons/m². In addition, transmission will not occur during mass gatherings in locations over five meters above ground level. In conclusion, this model provides an adaptable tool to prevent the spread of infectious diseases at outdoor events by ensuring adequate air quality through occupancy control. Full article

Background/Objectives: The COVID-19 pandemic underscored the urgent need for rapid, efficient testing methods at large-scale events to control virus spread. This study leverages queueing theory to explore how different floor plan configurations affect the efficiency of Rapid Antigen Diagnostic Test (RADT) centers at mass gatherings, aiming to enhance throughput and minimize wait times. Methods: Employing the MAP/PH/c model (Markovian Arrival Process/phase-type service distribution with c servers), this study compared the operational efficiency of RADT centers using U-shaped and straight-line floor plans. The research involved 500 healthy participants, who underwent the RADT process, including queue number issuance, registration, sample collection, sample mixing, and results dissemination. Agile management techniques were implemented to optimize operations. Results: The findings demonstrated that the U-shaped layout was more efficient than the straight-line configuration, reducing the average time from sample collection to results acquisition—1.6 minutes in the U-shaped layout versus 1.8 minutes in the straight-line layout. The efficiency of the U-shaped layout was particularly notable at the results stage, with statistically significant differences (p < 0.05) in reducing congestion and improving resource allocation. Conclusions: The study confirms the feasibility of implementing RADT procedures at mass gatherings and identifies the U-shaped floor plan as the optimal configuration. This layout significantly enhances testing efficiency and effectiveness, suggesting its suitability for future large-scale testing scenarios. The research contributes to optimizing mass testing strategies, vital for public health emergency management during pandemics. Full article