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In 2007, the IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organisations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organisations, including the International Committee of the Red Cross, the IPPNW, the World Medical .Association, the World Federation of Public Health Associations, and the International

In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 seconds before midnight, reflecting the growing risk of nuclear war.1 In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War”.2 The danger has been underlined by growing tensions between many nuclear armed states.1,3 As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet—and urge action to prevent it. Current nuclear arms control and non-proliferation efforts are inadequate to protect the world’s population against the threat of nuclear war by design, error, or miscalculation. The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) commits each of the 190 participating nations “to pursue negotiations in good faith on effective measures relating to cessation of the nuclear arms race at an early date and to nuclear disarmament, and on a treaty on general and complete disarmament under strict and effective international control”.4 Progress has been disappointingly slow and the most recent NPT review conference in 2022 ended without an agreed statement.5 There are many examples of near disasters that have exposed the risks of depending on nuclear deterrence for the indefinite future.6 Modernisation of nuclear arsenals could increase risks: for example, hypersonic missiles decrease the time available to distinguish between an attack and a false alarm, increasing the likelihood of rapid escalation. Any use of nuclear weapons would be catastrophic for humanity. Even a “limited” nuclear war involving only 250 of the 13 000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk.7,8 A large-scale nuclear war between the USA and Russia could kill 200 million people or more in the near term, and potentially cause a global “nuclear winter” that could kill 5–6 billion people, threatening the survival of humanity.7,8 Once a nuclear weapon is detonated, escalation to all-out nuclear war could occur rapidly. The prevention of any use of nuclear weapons is therefore an urgent public health priority and fundamental steps must also be taken to address the root cause of the problem—by abolishing nuclear weapons. The health community has had a crucial role in efforts to reduce the risk of nuclear war and must continue to do so in the future.9 In the 1980s the efforts of health professionals, led by the International Physicians for the Prevention of Nuclear War (IPPNW), helped to end the Cold War arms race by educating policy makers and the public on both sides of the Iron Curtain about the medical consequences of nuclear war. This was recognised when the 1985 Nobel Peace Prize was awarded to the IPPNW.10 In 2007, the IPPNW launched the International Campaign to Abolish Nuclear Weapons, which grew into a global civil society campaign with hundreds of partner organisations. A pathway to nuclear abolition was created with the adoption of the Treaty on the Prohibition of Nuclear Weapons in 2017, for which the International Campaign to Abolish Nuclear Weapons was awarded the 2017 Nobel Peace Prize. International medical organisations, including the International Committee of the Red Cross, the IPPNW, the World Medical Association, the World Federation of Public Health Associations, and the International Council of Nurses, had key roles in the process leading up to the negotiations, and in the negotiations themselves, presenting the scientific evidence about the catastrophic health and environmental consequences of nuclear weapons and nuclear war. They continued this important collaboration during the First Meeting of the States Parties to the Treaty on the Prohibition of Nuclear Weapons, which currently has 92 signatories, including 68 member states.11 We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with the IPPNW to support efforts to reduce the near-term risks of nuclear war, including three immediate steps on the part of nuclear-armed states and their allies: first, adopt a no first use policy;12 second, take their nuclear weapons off hair-trigger alert; and, third, urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts. We further ask them to work for a definitive end to the nuclear threat by supporting the urgent commencement of negotiations among the nuclear-armed states for a verifiable, timebound agreement to eliminate their nuclear weapons in accordance with commitments in the non-proliferation treaty, opening the way for all nations to join the Treaty on the Prohibition of Nuclear Weapons. The danger is great and growing. The nuclear armed states must eliminate their nuclear arsenals before they eliminate us. The health community played a decisive part during the Cold War and more recently in the development of the Treaty on the Prohibition of Nuclear Weapons. We must take up this challenge again as an urgent priority, working with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons.

Introduction Diet is a major modifiable risk factor for cardiometabolic disease; however, interpretable measures capturing impacts of overall diet on health that can be easily used by policymakers at the global/national levels are not readily available.Methods We developed the International Diet-Health Index (IDHI) to measure health impacts of dietary intake across 186 countries in 2010, using age-specific and sex-specific data on country-level dietary intake, effects of dietary factors on cardiometabolic diseases and country-specific cardiometabolic disease profiles. The index encompasses the impact of 11 foods/nutrients on 12 cardiometabolic diseases, the mediation of health effects of specific dietary intakes through blood pressure and body mass index and background disease prevalence in each country–age–sex group. We decomposed the index into IDHIbeneficial for risk-reducing factors, and IDHIadverse for risk-increasing factors. The flexible functional form of the IDHI allows inclusion of additional risk factors and diseases as data become available.Results By sex, women experienced smaller detrimental cardiometabolic effects of diet than men: (females IDHIadverse range: −0.480 (5th percentile, 95th percentile: −0.932, –0.300) to −0.314 (−0.543, –0.213); males IDHIadverse range: (−0.617 (−1.054, –0.384) to −0.346 (−0.624, –0.222)). By age, middle-aged adults had highest IDHIbeneficial (females: 0.392 (0.235, 0.763); males: 0.415 (0.243, 0.949)) and younger adults had most extreme IDHIadverse (females: −0.480 (−0.932, –0.300); males: −0.617 (−1.054, –0.384)). Regionally, Central Latin America had the lowest IDHIoverall (−0.466 (−0.892, –0.159)), while Southeast Asia had the highest IDHIoverall (0.272 (−0.224, 0.903)). IDHIoverall was highest in low-income countries and lowest in upper middle-income countries (−0.039 (−0.317, 0.227) and −0.146 (−0.605, 0.303), respectively). Among 186 countries, Honduras had lowest IDHIoverall (−0.721 (−0.916, –0.207)), while Malaysia had highest IDHIoverall (0.904 (0.435, 1.190)).Conclusion IDHI encompasses dietary intakes, health effects and country disease profiles into a single index, allowing policymakers a useful means of assessing/comparing health impacts of diet quality between populations.

Dengue is a major public health problem worldwide with distinct clinical manifestations: an acute presentation (dengue fever, DF) similar to other febrile illnesses (OFI) and a more severe, life-threatening form (severe dengue, SD). Due to nonspecific clinical presentation during the early phase of dengue infection, differentiating DF from OFI has remained a challenge, and current methods to determine severity of dengue remain poor early predictors. We present a prospective clinical cohort study conducted in Caracas, Venezuela from 2001-2005, designed to determine whether clinical and hematological parameters could distinguish DF from OFI, and identify early prognostic biomarkers of SD. From 204 enrolled suspected dengue patients, there were 111 confirmed dengue cases. Piecewise mixed effects regression and nonparametric statistics were used to analyze longitudinal records. Decreased serum albumin and fibrinogen along with increased D-dimer, thrombin-antithrombin complex, activated partial thromboplastin time and thrombin time were prognostic of SD on the day of defervescence. In the febrile phase, the day-to-day rates of change in serum albumin and fibrinogen concentration, along with platelet counts, were significantly decreased in dengue patients compared to OFI, while the day-to-day rates of change of lymphocytes (%) and thrombin time were increased. In dengue patients, the absolute lymphocytes to neutrophils ratio showed specific temporal increase, enabling classification of dengue patients entering the critical phase with an area under the ROC curve of 0.79. Secondary dengue patients had elongation of Thrombin time compared to primary cases while the D-dimer formation (fibrinolysis marker) remained always lower for secondary compared to primary cases. Based on partial analysis of 31 viral complete genomes, a high frequency of C-to-T transitions located at the third codon position was observed, suggesting deamination events with five major hot spots of amino acid polymorphic sites outside in non-structural proteins. No association of severe outcome was statistically significant for any of the five major polymorphic sites found. This study offers an improved understanding of dengue hemostasis and a novel way of approaching dengue diagnosis and disease prognosis using piecewise mixed effect regression modeling. It also suggests that a better discrimination of the day of disease can improve the diagnostic and prognostic classification power of clinical variables using ROC curve analysis. The piecewise mixed effect regression model corroborated key early clinical determinants of disease, and offers a time-series approach for future vaccine and pathogenesis clinical studies.

BackgroundKnowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital schistosomiasis (treatment, transmission, prevention, symptoms) among science teaches and primary and junior high school students in the Eastern Region of Ghana.MethodsWe developed a 22-question knowledge survey tool and administered it to 875 primary and 938 junior high school students from 74 schools in 37 communities in the Eastern Region of Ghana. Teachers (n = 57) answered 20 questions matched to student questions. We compared knowledge scores (as percent of correct answers) across topics, gender, and class year and assessed associations with teacher's knowledge scores using t-tests, chi-squared tests, univariate, and multivariate linear regression, respectively.ResultsStudents performed best when asked about symptoms (mean±SD: 76±21% correct) and prevention (mean±SD: 69±25% correct) compared with transmission (mean±SD: 50±15% correct) and treatment (mean±SD: 44±23% correct) (pConclusionsOur survey parsed four components of student and teacher knowledge. We found strong knowledge in several realms, as well as knowledge gaps, especially on transmission and treatment. Addressing relevant gaps among students and science teachers in UGS-endemic areas may help high-risk groups recognize risky water contact activities, improve participation in mass drug administration, and spark interest in science by making it practical.

Schistosomiasis is a water-related neglected tropical disease. In many endemic low- and middle-income countries, insufficient surveillance and reporting lead to poor characterization of the demographic and geographic distribution of schistosomiasis cases. Hence, modeling is relied upon to predict areas of high transmission and to inform control strategies. We hypothesized that utilizing remotely sensed (RS) environmental data in combination with water, sanitation, and hygiene (WASH) variables could improve on the current predictive modeling approaches.Schistosoma haematobium prevalence data, collected from 73 rural Ghanaian schools, were used in a random forest model to investigate the predictive capacity of 15 environmental variables derived from RS data (Landsat 8, Sentinel-2, and Global Digital Elevation Model) with fine spatial resolution (10-30 m). Five methods of variable extraction were tested to determine the spatial linkage between school-based prevalence and the environmental conditions of potential transmission sites, including applying the models to known human water contact locations. Lastly, measures of local water access and groundwater quality were incorporated into RS-based models to assess the relative importance of environmental and WASH variables.Predictive models based on environmental characterization of specific locations where people contact surface water bodies offered some improvement as compared to the traditional approach based on environmental characterization of locations where prevalence is measured. A water index (MNDWI) and topographic variables (elevation and slope) were important environmental risk factors, while overall, groundwater iron concentration predominated in the combined model that included WASH variables.The study helps to understand localized drivers of schistosomiasis transmission. Specifically, unsatisfactory water quality in boreholes perpetuates reliance on surface water bodies, indirectly increasing schistosomiasis risk and resulting in rapid reinfection (up to 40% prevalence six months following preventive chemotherapy). Considering WASH-related risk factors in schistosomiasis prediction can help shift the focus of control strategies from treating symptoms to reducing exposure.

Despite availability of high quality medical records, health care systems often do not have the resources or tools to utilize these data efficiently. Yet, hospital-based, laboratory-confirmed records may pave the way for building reliable surveillance systems capable of monitoring temporal trends of emerging infections. In this communication, we present a new tool to compress and visualize medical records with a local population profile (LPP) approach, which transforms information into statistically comparable patterns. We provide a step-by-step tutorial on how to build, interpret, and expand the use of LPP using hospitalization records of laboratory-confirmed cholera. We abstracted case information from the databases maintained by the Department of Clinical Microbiology at Christian Medical College in Vellore, India. We used a single-year age distribution to construct LPPs for O1, O139, and non O1/O139 serotypes of Vibrio cholerae. Disease counts and hospitalization rates were converted into fitted kernel-based probability densities. We formally compared LPPs with the Kolmogorov-Smirnov test, and created multi-panel visuals to depict temporal trend, age distribution, and hospitalization rates simultaneously. Our first implementation of LPPs revealed information that is typically gathered from surveillance systems such as: i) estimates of the demographic distribution of diseases and identification of a population at risk, ii) changes in the dominant pathogen presence; and iii) trends in disease occurrence. The LPP demonstrated the benefit of increased resolution in pattern detection of disease for different Vibrio cholerae serotypes and two demographic categories by showing patterns and anomalies that would be obscured by traditional methods of analysis and visualization. LPP can be used effectively to compile basic patient information such as age, sex, diagnosis, location, and time into compact visuals. Future development of the proposed approach will allow public health researchers and practitioners to broadly utilize and efficiently compress large volumes of medical records without loss of information.

Stunting or reduced linear growth is very prevalent in low-income countries. Recent studies have demonstrated a causal relationship between alterations in the gut microbiome and moderate or severe acute malnutrition in children in these countries. However, there have been no primary longitudinal studies comparing the intestinal microbiota of persistently stunted children to that of non-stunted children in the same community. In this pilot study, we characterized gut microbial community composition and diversity of the fecal microbiota of 10 children with low birth weight and persistent stunting (cases) and 10 children with normal birth weight and no stunting (controls) from a birth cohort every 3 months up to 2 years of age in a slum community in south India. There was an increase in diversity indices (P

Antibiotic pressure contributes to rising antibiotic resistance. Policy guidelines encourage rational prescribing behavior, but effectiveness in containing antibiotic use needs further assessment. This study therefore assessed the patterns of antibiotic use over a decade and analyzed the impact of different modes of guideline development and dissemination on inpatient antibiotic use.Antibiotic use was calculated monthly as defined daily doses (DDD) per 100 bed days for nine antibiotic groups and overall. This time series compared trends in antibiotic use in five adjacent time periods identified as 'Segments,' divided based on differing modes of guideline development and implementation: Segment 1--Baseline prior to antibiotic guidelines development; Segment 2--During preparation of guidelines and booklet dissemination; Segment 3--Dormant period with no guidelines dissemination; Segment 4--Booklet dissemination of revised guidelines; Segment 5--Booklet dissemination of revised guidelines with intranet access. Regression analysis adapted for segmented time series and adjusted for seasonality assessed changes in antibiotic use trend.Overall antibiotic use increased at a monthly rate of 0.95 (SE = 0.18), 0.21 (SE = 0.08) and 0.31 (SE = 0.06) for Segments 1, 2 and 3, stabilized in Segment 4 (0.05; SE = 0.10) and declined in Segment 5 (-0.37; SE = 0.11). Segments 1, 2 and 4 exhibited seasonal fluctuations. Pairwise segmented regression adjusted for seasonality revealed a significant drop in monthly antibiotic use of 0.401 (SE = 0.089; p

We outline a framework for evaluating food- and water-borne surveillance systems using hospitalization records, and demonstrate the approach using data on salmonellosis, campylobacteriosis and giardiasis in persons aged ≥65 years in Massachusetts. For each infection, and for each reporting jurisdiction, we generated smoothed standardized morbidity ratios (SMR) and surveillance to hospitalization ratios (SHR) by comparing observed surveillance counts with expected values or the number of hospitalized cases, respectively. We examined the spatial distribution of SHR and related this to the mean for the entire state. Through this approach municipalities that deviated from the typical experience were identified and suspected of under-reporting. Regression analysis revealed that SHR was a significant predictor of SMR, after adjusting for population age-structure. This confirms that the spatial "signal" depicted by surveillance is in part influenced by inconsistent testing and reporting practices since municipalities that reported fewer cases relative to the number of hospitalizations had a lower relative risk (as estimated by SMR). Periodic assessment of SHR has potential in assessing the performance of surveillance systems.

The absence or deficiency of melanin as in albinos, has detrimental effects on retinal development that include aberrant axonal projections from eye to brain and impaired vision. In pigmented retinal pigment epithelium (RPE), dihydroxyphenalanine (L-Dopa), an intermediate in the synthetic path for melanin, has been hypothesized to regulate the tempo of neurogenesis. The time course of expression of retinal L-Dopa, whether it is harbored exclusively in the RPE, the extent of deficiency in albinos compared to isogenic controls, and whether L-Dopa can be restored if exogenously delivered to the albino have been unknown.L-Dopa and catecholamines including dopamine extracted from retinas of pigmented (C57BL/6J) and congenic albino (C57BL/6J-tyr(c2j) ) mice, were measured throughout development beginning at E10.5 and at maturity. L-Dopa, but not dopamine nor any other catecholamine, appears in pigmented retina as soon as tyrosinase is expressed in RPE at E10.5. In pigmented retina, L-Dopa content increases throughout pre- and postnatal development until the end of the first postnatal month after which it declines sharply. This time course reflects the onset and completion of retinal development. L-Dopa is absent from embryonic albino retina and is greatly reduced in postnatal albino retina compared to pigmented retina. Dopamine is undetectable in both albino and pigmented retinas until after the postnatal expression of the neuronal enzyme tyrosine hydroxylase. If provided to pregnant albino mothers, L-Dopa accumulates in the RPE of the fetuses.L-Dopa in pigmented RPE is most abundant during development after which content declines. This L-Dopa is not converted to dopamine. L-Dopa is absent or at low levels in albino retina and can be restored to the RPE by administration in utero. These findings further implicate L-Dopa as a factor in the RPE that could influence development, and demonstrate that administration of L-Dopa could be a means to rescue developmental abnormalities characteristic of albinos.

Understanding the temporal patterns in disease occurrence is valuable for formulating effective disease preventive programs. Cohort studies present a unique opportunity to explore complex interactions associated with emergence of seasonal patterns of infectious diseases.We used data from 452 children participating in a birth cohort study to assess the seasonal patterns of rotavirus diarrhea by creating a weekly time series of rotavirus incidence and fitting a Poisson harmonic regression with biannual peaks. Age and cohort effects were adjusted for by including the weekly counts of number of children in the study and the median age of cohort in a given week. Weekly average temperature, humidity and an interaction term to reflect the joint effect of temperature and humidity were included to consider the effects of meteorological variables.In the overall rotavirus time series, two significant peaks within a single year were observed--one in winter and the other in summer. The effect of age was found to be the most significant contributor for rotavirus incidence, showing a strong negative association. Seasonality remained a significant factor, even after adjusting for meteorological parameters, and the age and cohort effects.The methodology for assessing seasonality in cohort studies is not yet developed. This is the first attempt to explore seasonal patterns in a cohort study with a dynamic denominator and rapidly changing immune response on individual and group levels, and provides a highly promising approach for a better understanding of the seasonal patterns of infectious diseases, tracking emergence of pathogenic strains and evaluating the efficacy of intervention programs.

Rotavirus infection causes a significant proportion of diarrhea in infants and young children worldwide leading to dehydration, hospitalization, and in some cases death. Rotavirus infection represents a significant burden of disease in developing countries, such as those in South Asia.We conducted a meta-analysis to examine how patterns of rotavirus infection relate to temperature and precipitation in South Asia. Monthly rotavirus data were abstracted from 39 published epidemiological studies and related to monthly aggregated ambient temperature and cumulative precipitation for each study location using linear mixed-effects models. We also considered associations with vegetation index, gathered from remote sensing data. Finally, we assessed whether the relationship varied in tropical climates and humid mid-latitude climates.Overall, as well as in tropical and humid mid-latitude climates, low temperature and precipitation levels are significant predictors of an increased rate of rotaviral diarrhea. A 1°C decrease in monthly ambient temperature and a decrease of 10 mm in precipitation are associated with 1.3% and 0.3% increase above the annual level in rotavirus infections, respectively. When assessing lagged relationships, temperature and precipitation in the previous month remained significant predictors and the association with temperature was stronger in the tropical climate. The same association was seen for vegetation index; a seasonal decline of 0.1 units results in a 3.8% increase in rate of rotavirus.In South Asia the highest rate of rotavirus was seen in the colder, drier months. Meteorological characteristics can be used to better focus and target public health prevention programs.

Visual analytics, a technique aiding data analysis and decision making, is a novel tool that allows for a better understanding of the context of complex systems. Public health professionals can greatly benefit from this technique since context is integral in disease monitoring and biosurveillance. We propose a graphical tool that can reveal the distribution of an outcome by time and age simultaneously.We introduce and demonstrate multi-panel (MP) graphs applied in four different settings: U.S. national influenza-associated and salmonellosis-associated hospitalizations among the older adult population (≥65 years old), 1991-2004; confirmed salmonellosis cases reported to the Massachusetts Department of Public Health for the general population, 2004-2005; and asthma-associated hospital visits for children aged 0-18 at Milwaukee Children's Hospital of Wisconsin, 1997-2006. We illustrate trends and anomalies that otherwise would be obscured by traditional visualization techniques such as case pyramids and time-series plots.MP graphs can weave together two vital dynamics--temporality and demographics--that play important roles in the distribution and spread of diseases, making these graphs a powerful tool for public health and disease biosurveillance efforts.

In temperate regions, influenza epidemics occur annually with the highest activity occurring during the winter months. While seasonal dynamics of the influenza virus, such as time of onset and circulating strains, are well documented by the Centers for Disease Control and Prevention Influenza Surveillance System, an accurate prediction of timing, magnitude, and composition of circulating strains of seasonal influenza remains elusive. To facilitate public health preparedness for seasonal influenza and to obtain better insights into the spatiotemporal behavior of emerging strains, it is important to develop measurable characteristics of seasonal oscillation and to quantify the relationships between those parameters on a spatial scale. The objectives of our research were to examine the seasonality of influenza on a national and state level as well as the relationship between peak timing and intensity of influenza in the United States older adult population.A total of 248,889 hospitalization records were extracted from the Centers for Medicare and Medicaid Services for the influenza seasons 1991-2004. Harmonic regression models were used to quantify the peak timing and absolute intensity for each of the 48 contiguous states and Washington, DC. We found that individual influenza seasons showed spatial synchrony with consistent late or early timing occurring across all 48 states during each influenza season in comparison to the overall average. On a national level, seasons that had an earlier peak also had higher rates of influenza (r(s) = -0.5). We demonstrated a spatial trend in peak timing of influenza; western states such as Nevada, Utah, and California peaked earlier and New England States such as Rhode Island, Maine, and New Hampshire peaked later.Our findings suggest that a systematic description of influenza seasonal patterns is a valuable tool for disease surveillance and can facilitate strategies for prevention of severe disease in the vulnerable, older adult population.

Recurrent exposures to a pathogenic antigen remodel the CD8+ T cell compartment and generate a functional memory repertoire that is polyclonal and complex. At the clonotype level, the response to the conserved influenza antigen, M158–66 has been well characterized in healthy individuals, but not in patients receiving immunosuppressive therapy or with aberrant immunity, such as those with juvenile idiopathic arthritis (JIA). Here we show that patients with JIA have a reduced number of M158–66 specific RS/RA clonotypes, indicating decreased clonal richness and, as a result, have lower repertoire diversity. By using a rank-frequency approach to analyze the distribution of the repertoire, we found several characteristics of the JIA T cell repertoire to be akin to repertoires seen in healthy adults, including an amplified RS/RA-specific antigen response, representing greater clonal unevenness. Unlike mature repertoires, however, there is more fluctuation in clonotype distribution, less clonotype stability, and more variable IFNy response of the M158–66 specific RS/RA clonotypes in JIA. This indicates that functional clonal expansion is altered in patients with JIA on immunosuppressive therapies. We propose that the response to the influenza M158–66 epitope described here is a general phenomenon for JIA patients receiving immunosuppressive therapy, and that the changes in clonal richness and unevenness indicate a retarded and uneven generation of a mature immune response.

In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90s before midnight, reflecting the growing risk of nuclear war. In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War.” The danger has been underlined by growing tensions between many nuclear armed states. Read more in the PDF...

ABSTRACTSome studies have shown that the betel nut Areca catechu L and “binahong” leaves Anredera cordifolia (Ten) Steenis have anti-parasite and wound healing properties. This study evaluated the effect of A. catechu nut and A. cordifolia leaves powder supplementation on faecal parasite number and type, histopathology of the intestine, caecum, associated organs, some serum biochemistry, and egg production of laying hens. Twenty-four 54-week-old ISA-brown laying hens from local layer farmers were assigned randomly into 4-treatment groups: 1) without supplementation (T0), 2) supplemented with 0.25% (T0.25%), 3) 0.5% (T0.5%), 4) 1.0% (T1.0%). We carried out the supplementation for 18 days by administering A. catechu nut powder for 3-days, and subsequently, A. cordifolia leaves powder for another 3-days for 3-rounds to control the parasite larvae. Faecal parasite count and type were enumerated at the beginning and end of treatment. Egg production was recorded daily during the 18 days experiment. Blood was sampled at the end of the experiment to determine serum albumin, globulin, and transaminases. The intestinal tract, liver, and spleen samples were collected at the end of the study for histopathological examination. Faecal Ascaridia galli in control hens increased by 87.5% after 18 days of the experiment, while A. catechu nut and A. cordifolia leaves powder supplementation prevented such an increase. Supplemented hens have a better reduction of Railentina cesticillus compared to control birds. Supplementation improved intestinal and other tissue histopathology, especially in the caecum (free of erosion), improving serum albumin and transaminases without affecting egg production.

No abstract available.

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In January 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 seconds before midnight, reflecting the growing risk of nuclear war. In August 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War.” The danger has been underlined by growing tensions between many nuclear armed states [...]. Note: this Editorial is being published simultaneously in multiple journals. For the full list of journals see: https://www.bmj.com/content/full-list-authors-and-signatories-nuclear-risk-editorial-august-2023.

Any use of nuclear weapons would be catastrophic for humanity. Even a “limited” nuclear war involving only 250 of the 13 000 nuclear weapons in the world could kill 120 million people outright and cause global climate disruption leading to a nuclear famine, putting 2 billion people at risk. We now call on health professional associations to inform their members worldwide about the threat to human survival and to join with the IPPNW to support efforts to reduce the near-term risks of nuclear war.

Abstract Objective In sub-Saharan Africa, 45% of the rural population uses boreholes (BHs). Despite recent gains in improved water access and coverage, parallel use of unimproved sources persists. Periodic infrastructure disrepair contributes to non-exclusive use of BHs. Our study describes functionality of BHs in 2014, 2015, and 2016 in 15 rural towns in the Eastern Region of Ghana sourced from three groundwater quality clusters (high iron, high salinity, and control). We also assess factors affecting cross-sectional and longitudinal functionality using logistic regression. Results BH functionality rates ranged between 81 and 87% and were similar across groundwater quality clusters. Of 51 BHs assessed in all three years, 34 (67%) were consistently functional and only 3 (6%) were consistently broken. There was a shift toward proactive payment for water over the course of the study in the control and high-salinity clusters. Payment mechanism, population served, presence of nearby alternative water sources, and groundwater quality cluster were not significant predictors of cross-sectional or longitudinal BH functionality. However, even in the high iron cluster, where water quality is poor and no structured payment mechanism for water exists, BHs are maintained, showing that they are important community resources.

The immunologic significance of cross-reactivity of TCR recognition of peptide:MHC complexes is still poorly understood. We have described TCR cross-reactivity in a system involving polyclonal CD8 T cell recognition of the well characterized influenza viral M158-66 epitope. While M158-66 is generally conserved between influenza A isolates, error-prone transcription generates stable variant RNA during infection which could act as novel epitopes. If packaged and viable, variant genomic RNA generates an influenza quasispecies. The stable RNA variants would generate a new transmissible epitope that can select a specific repertoire, which itself should have cross-reactive properties. We tested two candidate peptides in which Thr65 is changed to Ala (A65) or Ser (S65) using recall responses to identify responding T cell clonotypes. Both peptides generated large polyclonal T cell repertoires of their own with repertoire characteristics and cross-reactivity patterns like that observed for the M158-66 repertoire. Both substitutions could be present in viral genomes or mRNA at sufficient frequency during an infection to drive immunity. Peptides from the resulting protein would be a target for CD8 cells irrespective of virus viability or transmissibility. These data support the hypothesis that cross-reactivity is important for immunity against RNA virus infections.

Abstract For several decades, the World Health Organization has collected, maintained, and distributed invaluable country-specific disease surveillance data that allow experts to develop new analytical tools for disease tracking and forecasting. To capture the extent of available data within these sources, we proposed a completeness metric based on the effective time series length. Using FluNet records for 29 Pan-American countries from 2005 to 2019, we explored whether completeness was associated with health expenditure indicators adjusting for surveillance system heterogeneity. We observed steady improvements in completeness by 4.2–6.3% annually, especially after the A(H1N1)-2009 pandemic, when 24 countries reached > 95% completeness. Doubling in decadal health expenditure per capita was associated with ~ 7% increase in overall completeness. The proposed metric could navigate experts in assessing open access data quality and quantity for conducting credible statistical analyses, estimating disease trends, and developing outbreak forecasting systems.

Abstract Background Lifelong healthy habits developed during childhood may prevent chronic diseases in adulthood. Interventions to promote these habits must begin early. The BONES (Beat Osteoporosis – Nourish and Exercise Skeletons) project assessed whether early elementary school children participating in a multifaceted health behavior change, after-school based intervention would improve bone quality and muscular strength and engage in more bone-strengthening behaviors. Methods The 2-year BONES (B) intervention included bone-strengthening physical activity (85 min/week), educational materials (2 days/week), and daily calcium-rich snacks (380 mg calcium/day) delivered by after-school program leaders. BONES plus Parent (B + P) included an additional parent education component. From 1999 to 2004, n = 83 after-school programs (N = 1434 children aged 6–9 years) in Massachusetts and Rhode Island participated in a group randomized trial with two intervention arms (B only, n = 25 programs; B + P, n = 33) and a control arm (C, n = 25). Outcome measures (primary: bone quality (stiffness index of the calcaneus) and muscular strength (grip strength and vertical jump); secondary: bone-strengthening behaviors (calcium-rich food knowledge, preference, and intake; and physical activity level (metabolic equivalent time (MET) score, and weight-bearing factor (WBF) score)) were recorded at baseline, and after years one and two. Analyses followed an intent-to-treat protocol, and focused on individual subjects’ trajectories along the three time points adjusting for baseline age and race via a mixed-effects regression framework. Analyses were performed with and without sex stratification. Results Children in B + P increased bone stiffness compared to C (p = 0.05); No significant changes were observed in muscle strength, food knowledge, or vertical jump. Children in B + P showed significant improvement in their MET and WBF scores compared to C (p

Abstract Progress on the nutrition Sustainable Development Goals has been slow. More attention is needed on the ‘sustainable’ part, focused on impact lasting beyond programme implementation. To determine sustained impact of a multisectoral nutrition intervention that provided water, sanitation, hygiene, livelihood, health and nutrition support (2013–2015) in eastern Chad, we utilize longitudinal household data collected 2 years (2017) after the intervention ended. Between 2013 and 2015, children (6–59 months) in the multisectoral intervention were less likely to be severely wasted, underweight and had a higher weight‐for‐height z‐score (WHZ) compared with the control. To measure sustained programme impact, we use data on six nutrition indicators from 517 children between 2015 and 2017. We ran three models: a generalized linear model on cross‐sectional child cohorts; a mixed‐effects model on household panel data; and a mixed‐effects model on child panel data. For children who were born during the programme, we saw significant improvement in underweight, weight for age z‐scores (WAZs) and height‐for‐age z‐scores (HAZs). Boys 6–23 months born after the end of the programme, on the other hand, were significantly more likely to be underweight or wasted and had lower WHZ and WAZ compared with boys born during the programme and girls born during and after the programme. Corresponding to the literature from sub‐Saharan Africa, boys appear to be more vulnerable to malnutrition, which might be why they are more sensitive to programme cessation. Future monitoring, evaluations and research need to consider impact sustainability and that it might not be homogeneous across age and gender.

Background The US population is aging, with concurrent increases in cardiovascular disease (CVD) burdens; however, spatiotemporal and demographic trends in CVD incidence in the US elderly have not been investigated in detail. This study aims to characterize trends from 1991 to 2014 in CVD hospitalizations among US Medicare beneficiaries, aged 65+ years, by single year of age/sex/race/state using records from the US Centers for Medicare & Medicaid, covering 98% of older Americans. Methods and Results We abstracted 181 202 758 US Centers for Medicare & Medicaid hospitalization records indicating CVD in any of 10 diagnosis codes; tabulated total cases of CVD by sex, age, race, state, and calendar year (1991–2014); and normalized hospitalization counts to standardize over data batches. Stratum‐specific hospitalization rates were calculated using US Centers for Medicare & Medicaid records and US Census population counts; a cubic polynomial function was fit to year‐specific distributions of rates by single year of age. Nationwide, CVD‐related hospitalization rates increased from 1991 to 2014. Differences between hospitalization rates at age 65 and 66 years, representing magnitude of healthcare deferral until Medicare onset, increased by 7.49 per 100 people 1991 to 2006 overall, and were largest among blacks and Native Americans. Rates of CVD hospitalizations were consistently highest in the Midwest/Deep South. Evidence of misclassification of race/ethnicity in US Centers for Medicare & Medicaid hospitalization records in the 1990s was noted. Conclusions Trends in CVD‐related hospitalization rates among older Americans highlight the essential need for targeted policies to reduce CVD burdens, to improve reporting of race/ethnicity in large administrative databases, and to enhance access to affordable healthcare.

T-cell memory to pathogens can be envisioned as a receptor-based imprint of the pathogenic environment on the naïve repertoire of clonotypes. Recurrent exposures to a pathogen inform and reinforce memory, leading to a mature state. The complexity and temporal stability of this system in man is only beginning to be adequately described. We have been using a rank-frequency approach for quantitative analysis of CD8 T cell repertoires. Rank acts as a proxy for previous expansion, and rank-frequency, the number of clonotypes at a particular rank, as a proxy for abundance, with the relation of the two estimating the diversity of the system. Previous analyses of circulating antigen-experienced cytotoxic CD8 T-cell repertoires from adults have shown a complex two-component clonotype distribution. Here we show this is also the case for circulating CD8 T cells expressing the BV19 receptor chain from five adult subjects. When the repertoire characteristic of clonotype stability is added to the analysis, an inverse correlation between clonotype rank frequency and stability is observed. Clonotypes making up the second distributional component are stable; indicating that the circulation can be a depot of selected clonotypes. Temporal repertoire dynamics was further examined for influenza-specific T cells from children, middle-aged, and older adults. Taken together, these analyses describe a dynamic process of system development and aging, with increasing distributional complexity, leading to a stable circulating component, followed by loss of both complexity and stability.

People with Parkinson’s disease (PD) often experience a decrease in their facial expressivity, but little is known about how the coordinated movements across regions of the face are impaired in PD. The face has neurologically independent regions that coordinate to articulate distinct social meanings that others perceive as gestalt expressions, and so understanding how different regions of the face are affected is important. Using the Facial Action Coding System, this study comprehensively measured spontaneous facial expression across 600 frames for a multiple case study of people with PD who were rated as having varying degrees of facial expression deficits, and created correlation matrices for frequency and intensity of produced muscle activations across different areas of the face. Data visualization techniques were used to create temporal and correlational mappings of muscle action in the face at different degrees of facial expressivity. Results showed that as severity of facial expression deficit increased, there was a decrease in number, duration, intensity, and coactivation of facial muscle action. This understanding of how regions of the parkinsonian face move independently and in conjunction with other regions will provide a new focus for future research aiming to model how facial expression in PD relates to disease progression, stigma, and quality of life.

One area of food system research that remains overlooked in terms of making urban-rural distinctions explicit is the private emergency food system of food banks, food pantries, soup kitchens, and emergency shelters that exists throughout the United States. This system is an important one for millions of food-insecure individuals and today serves nearly as many individuals as public food assistance. In this article, we present an exploratory case that presents findings from research looking at the private emergency food system of a rural county in northern New England, U.S. Specifically, we examine the history of this national network to contextualize our findings and then discuss possibilities for collaboration between this private system and the local food movement (on behalf of both the public and the state). These collaborations present an opportunity in the short term to improve access to high quality local foods for insecure populations, and in the long term to challenge the systemic income and race-based inequalities that increasingly define the modern food system and are the result of prioritizing market-based reforms that re-create inequality at the local and regional levels. We propose alternatives to these approaches that emphasize the ability to ensure adequate food access for vulnerable populations, as well as the right to define, structure, and control how food is produced beyond food consumerism (i.e., voting with our dollars), but through efforts increasingly aligned with a food sovereignty agenda.

We show that the microsporidian fungus Enterocytozoon bieneusi is associated with lower rates of weight gain in children in Uganda with persistent diarrhea. This relationship remained after controlling for HIV and concurrent cryptosporidiosis. Children with microsporidiosis were predicted to weigh 1.3 kg less than children without microsporidiosis at 5 years of age.

We used the Temporal Exposure Response Surfaces modeling technique to examine the association between gastroenteritis-related emergency room visits and hospitalizations in the elderly and drinking water turbidity before and during the 1993 Milwaukee waterborne Cryptosporidium outbreak. Before the outbreak, the rate of such events increased with age in the elderly (p

Existing climate classification has not been designed for an efficient handling of public health scenarios. This work aims to design an objective spatial climate regionalization method for assessing health risks in response to extreme weather. Specific climate regions for the conterminous United States of America (USA) were defined using satellite remote sensing (RS) data and compared with the conventional Köppen-Geiger (KG) divisions. Using the nationwide database of hospitalisations among the elderly (≥65 year olds), we examined the utility of a RS-based climate regionalization to assess public health risk due to extreme weather, by comparing the rate of hospitalisations in response to thermal extremes across climatic regions. Satellite image composites from 2002-2012 were aggregated, masked and compiled into a multi-dimensional dataset. The conterminous USA was classified into 8 distinct regions using a stepwise regionalization approach to limit noise and collinearity (LKN), which exhibited a high degree of consistency with the KG regions and a well-defined regional delineation by annual and seasonal temperature and precipitation values. The most populous was a temperate wet region (10.9 million), while the highest rate of hospitalisations due to exposure to heat and cold (9.6 and 17.7 cases per 100,000 persons at risk, respectively) was observed in the relatively warm and humid south-eastern region. RS-based regionalization demonstrates strong potential for assessing the adverse effects of severe weather on human health and for decision support. Its utility in forecasting and mitigating these effects has to be further explored.