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Active travel to school is one way youth can incorporate physical activity into their daily schedule. It is unclear the extent to which active travel to school is systematically monitored at local, state, or national levels. To determine the extent of active travel to school surveillance in North America and catalog the types of measures captured, we conducted a systematic review of peer-reviewed literature documenting active travel to school surveillance published from 2004 to February 2018. A study was included if it addressed children’s school travel mode across two or more time-periods in North America. Criteria were applied to determine whether a data source was considered an active travel to school surveillance system. We identified 15 unique data sources; 4 of these met our surveillance system criteria. One system is conducted in the US, is nationally representative, and occurs every 5-8 years. Three are conducted in Canada, are limited geographically to regions and provinces, and are administered with greater frequency (e.g., 2-year cycles). School travel mode was the primary measure assessed, most commonly through parent report. None of the systems collected data on school policies or program supports related to active travel to school. We conclude that incorporating questions related to active travel to school behaviors into existing surveillance systems, and maintaining them over time, would enable more consistent monitoring. Concurrently capturing behavioral information along with related environmental, policy, and program supports may inform efforts to promote active travel to school.

Introduction: Chronic kidney disease of uncertain etiology (CKDu) has been found at high frequency in several lowland agricultural areas including Meso-America and Sri Lanka. Whether CKDu also occurs in other countries with large agricultural populations remains uncertain, primarily due to lack of systematic data on kidney function. Hemoglobin (Hgb) levels could be an ancillary marker for presence of kidney dysfunction. Our goal is to estimate the causal effect of agricultural work on Hgb level in men. A causal effect may indicate the presence of CKDu. Methods: We use Demographic and Health Surveys (DHS) data from seven African and Asian countries (Ethiopia, Lesotho, Namibia, Senegal, Uganda, Zimbabwe, and India). We use optimal full matching and permutation inference to estimate the causal effect of agricultural work on altitude-adjusted Hgb levels after adjusting for six known confounders. To assess potential bias due to unmeasured socioeconomic differences, we use multiple control groups that differ in non-agricultural occupation. We then conduct sensitivity analyses to assess the robustness of our causal conclusions to unmeasured confounding. Results: Data were available for 41,180 agricultural workers and 55,705 non-agricultural workers in seven countries. On average, Hgb levels were 0.09 g/dL (95% CI [-0.12, -0.07]) lower among agricultural workers compared to matched controls. Significant effects were observed in Ethiopia, India, Lesotho, Senegal, and Uganda, with effects from 0.10 to 0.32 g/dL lower hemoglobin among agricultural workers. The effect was not attenuated in sensitivity analyses involving both better-off and worse-off occupational controls. Discussion: We find evidence that men engaged in agricultural work in five of the seven countries studied have modestly lower Hgb levels compared with other men living in rural areas. Since underlying kidney disease could be a potential explanation for this finding, our data support consideration to integrating kidney function assessments within DHS surveys and other population-based surveys.

This review describes major mass gatherings in the MENA region and the public health implications of these events, and provides recommendations for public health officials of the host country. Through our search of the literature for peer-reviewed publications, we identified relevant 77 papers; all were related to the annual Hajj. Using the information obtained from the literature review, the Eastern Mediterranean Public Health Network (EMPHNET) and the Centers for Disease Control and Prevention (CDC) developed and conducted 2 workshops on Public Health Surveillance during Mass Gatherings for field epidemiology training programmes and ministry of health focal points from 10 countries. The main potential public health concerns associated with mass gatherings include: infectious diseases (e.g. respiratory disease, gastro-intestinal tract disease, foodborne disease), injuries, traffic accidents, heat-related illnesses, insect stings, non-communicable diseases and terrorism.

Introduction: The curve of spee plays an important role to create Christensen’s phenomenon in natural dentition. This study was performed to assess the difference in depth of the curve of Spee between normal and attrited dentition. Methods: An analytical cross-sectional study was performed to measure the depth of curve speed in a total of 80 willing participants who met the inclusion criteria, of which 40 had normal dentition and 40 had attrited dentition. Measurements were done on stone casts by using a rigid metal scale and a digital vernier caliper. Analytical statistical analysis (independent t-test) was done using SPSS Statistical Software Package (version 21.0). Results: There was a statistically significant difference in the depth of the curve of Spee between the two groups. Conclusions: The depth of the curve of spee decreases with the advancing of the age of human as attrition of the teeth occurs with age. Although there is a decrease in the depth of the curve of spee it should be maintained and created while performing full mouth rehabilitation and other extensive prosthodontic treatments.

In addition to affecting individual health the COVID-19 pandemic has disrupted efforts to deliver essential health services around the world. In this article we present an overview of the immediate programmatic and epidemiologic impact of the pandemic on polio eradication as well as the adaptive strategic and operational measures taken by the Global Polio Eradication Initiative (GPEI) from March through September 2020. Shortly after the World Health Organization (WHO) declared a global pandemic on 11 March 2020, the GPEI initially redirected the programme’s assets to tackle COVID-19 and suspended house-to-house supplementary immunization activities (SIAs) while also striving to continue essential poliovirus surveillance functions. From March to May 2020, 28 countries suspended a total of 62 polio vaccine SIAs. In spite of efforts to continue poliovirus surveillance, global acute flaccid paralysis (AFP) cases reported from January-July 2020 declined by 34% compared with the same period in 2019 along with decreases in the mean number of environment samples collected per active site in the critical areas of the African and Eastern Mediterranean regions. The GPEI recommended countries should resume planning and implementation of SIAs starting in July 2020 and released guidelines to ensure these could be done safely for front line workers and communities. By the end of September 2020, a total of 14 countries had implemented circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak response vaccination campaigns and Afghanistan and Pakistan restarted SIAs to stop ongoing wild poliovirus type 1 (WPV1) transmission. The longer-term impacts of disruptions to eradication efforts remain to be determined, especially in terms of the effect on poliovirus epidemiology. Adapting to the pandemic situation has imposed new considerations on program implementation and demonstrated not only GPEI’s contribution to global health security, but also identified potential opportunities for coordinated approaches across immunization and health services.

Background Since July 2019, Pakistan and Afghanistan have been facing an outbreak of serotype-2 circulating vaccine derived poliovirus (cVDPV2) in addition to continued transmission of serotype-1 wild poliovirus (WPV1) and SARS-CoV-2 in 2020. Understanding the risks of cVDPV2 transmission due to pause of global vaccination efforts and the impact of potential vaccination response strategies in the current context of COVID-19 mitigation measures is critical. Methods We developed a stochastic, geographically structured mathematical model of cVDPV2 transmission which captures both mucosal and humoral immunity separately and allows for reversion of serotype-2 oral polio vaccine (OPV2) virus to cVDPV2 following vaccine administration. The model includes geographic heterogeneities in vaccination coverage, population immunity and population movement. The model was fitted to historic cVDPV2 cases in Pakistan and Afghanistan between January 2010-April 2016 and July 2019-March 2020 using iterated particle filtering. The model was used to simulate spread of cVDPV2 infection from July 2019 to explore impact of various proposed vaccination responses on stopping transmission and risk of spread of reverted Sabin-2 under varying assumptions of impacts from COVID-19 lockdown measures on movement patterns as well as declines in vaccination coverage. Results Simulated monthly incidence of cVDPV2 from the best-fit model demonstrated general spatio-temporal alignment with observed cVDPV2 cases. The model predicted substantial spread of cVDPV2 infection, with widespread transmission through 2020 in the absence of any vaccination activities. Vaccination responses were predicted to substantially reduce transmission and case burden, with a greater impact from earlier responses and those with larger geographic scope. While the greatest risk of seeding reverted Sabin-2 was predicted in areas targeted with OPV2, subsequent spread was greatest in areas with no or delayed response. The proposed vaccination strategy demonstrated ability to stop the cVDPV2 outbreak (with low risk of reverted Sabin-2 spread) by February 2021. Conclusion Outbreak response vaccination campaigns against cVDPV2 will be challenging throughout the COVID-19 pandemic but must be implemented urgently when feasible to stop transmission of cVDPV2.

Objective Using data from the Ministry of Health of Colombia, we performed an analysis of prevalence and general demographic characteristics of patients with inflammatory myopathies, with data from 2012 to 2018. Design A descriptive cross-sectional study based on data from the Ministry of Health of Colombia. We used as key terms the diagnostic codes of the International Manual of Diseases related to the diagnosis of inflammatory myopathies. Results We founded 12,401 individuals with a diagnosis of inflammatory myopathy and estimated an overall prevalence of 25.7 cases per 100,000 inhabitants. This diagnosis is more common in the age group of 65–69 years, and in the female population (64%), with a female-to-male ratio 1.79:1. In addition, we calculated a prevalence of 15.1 cases per 100,000 inhabitants for dermatomyositis and 7.3 cases per 100,000 inhabitants for polymyositis (based on a total population of 48,203). There is little information on the epidemiology of myopathies in Latin America, and records are essential to know their behaviour in populations. In Colombia, the Ministry of Health collects information from the health system, which has nearly universal coverage (around 95%). This information makes it possible to carry out epidemiological studies on different diseases. For the present study we analysed the available data on inflammatory myopathies in Colombia. Conclusion The present work describes for the first time the demographic characteristics of inflammatory myopathies in the Colombian population based on official data from the Ministry of Health, where the most frequent was dermatomyositis and a predominance in the female population was evidenced.

Afin de tenter de cerner les raisons de la faible inscription de la santé environnementale en France, nous mettons en perspective son développement avec celui observé en Grande-Bretagne. Nous présentons les conditions d’émergence de la relation entre santé et environnement en Angleterre dès la seconde moitié du XVIIème siècle, en la resituant dans le contexte des évolutions religieuses, sociales, politiques et scientifiques de l’époque et l’émergence de l’empirisme. Nous en examinons ensuite les développements au siècle suivant, puis la façon dont ceux-ci, dans un contexte social et économique profondément renouvelé, ont contribué à façonner la constitution de la santé publique avec les Public Health Acts de 1848 et 1875. Nous nous intéressons ensuite à l’évolution française, au développement faible et tardif de la santé publique, à l’émergence également tardive de l’environnement et à son lent rapprochement avec la problématique sanitaire, dans un contexte institutionnel formel et très technique, offrant peu de place à la santé environnementale faute d’une vision suffisamment ouverte et opératoire de l’environnement, avec des avancées limitées dans le champ urbain. In order to try to grasp the reasons for the weak inscription of environmental health in France, we draw a parallel between its development in France and the United Kingdom. We show how the relationship between environment and health emerged in England in the second half of the XVIIth century, in the context of the religious, social, political and scientific transformations of the time and the rise of empiricism. We then examine the collective undertaking it entailed in the XVIIIth century and how it shaped the development of public health through the public Health Acts of 1848 and 1875. We then consider the French development, the weak and late constitution of public health in France, the equally late development of the environment framed by the state as an institutional and technical field, its slow connection to health within an institutional framework late to promote it as a wide concern due to a restricted view of the environment, lacking agency and openness, with limited progresses in the urban field.

Abstract: Background: People who experienced the Great East Japan Earthquake (GEJE) were expected to have additional levels of psychological burden resulting from the stressful conditions imposed during the coronavirus disease 2019 (COVID-19) pandemic; consequently, suicide rates may increase. Aim: We aimed to carry out continuous monitoring of suicide rates in the affected area following the GEJE under COVID-19 pandemic conditions. Method: This descriptive study monitored the suicide rates of the coastal area of Miyagi Prefecture, where disaster-related mental health activities have been continuing following severe damage caused by the tsunami disaster. An exponential smoothing time-series analysis that converted suicide rates into a smooth trend was conducted. Results: Although the suicide rate in the affected area was higher than the national average in February 2020, it showed a declining trend during the COVID-19 pandemic, while showing an increase trend in the national and non-affected areas. Limitations: Uncertainty about the direct reasons for suicide and the short time-scale observation are the limitations of this study. Conclusion: Although the national suicide rate increased, this was not the case for the affected area. Our findings may provide important lessons for suicide prevention during the COVID-19 pandemic, which needs careful regional monitoring of the state of suicide and of high-risk approaches such as disaster-related mental health activities.

An open-ended questionnaire was administered to the participants of a six-part lecture series on self-controlled management of chemical substances regarding the support those participants would need when transitioning to that system, and the required elements of support were examined using a text-mining tool (KH Coder Ver. 3). The subjects were 59 persons who attended the lectures on an overview of self-controlled management of chemical substances and answered a questionnaire after the course. The lectures were organized by the Graduate School of Occupational Health, University of Occupational and Environmental Health from January-February 2022. The participants themselves indicated that they needed knowledge and up-to-date information on the revised law, as well as education about chemical substances. As for the support needed for individuals, the following were considered necessary: to provide support for education; management; information; the latest information; and education about the toxicity and dangers of chemical substances, which are necessary for education and chemical substance management in accordance with the revised law. As for the support needed for organizations, it was considered necessary to support the understanding of top management and the securing of necessary human resources., 化学物質の法規制型管理から自律的管理への移行に直面している関係する産業保健職は様々な情報収集に努めている．本学においても2022年1～2月に産業医科大学大学院医学研究科産業衛生学専攻主催の「自律的化学物質管理の概要」の特別講義が行われた．この講義の受講者に対して，自律的な化学物質管理に移行する際の課題と必要とする支援について自由記述式のアンケート調査を実施し，テキストマイニングツールを用いて，課題と求めている支援について検討を行った．対象者は，受講後アンケートに回答された59名で，テキストマイニングツールには，KH Coder （Ver.3）を用い，階層的クラスター分析および共起ネットワークによる文章中に出現する語と語の関係性について調べた．受講者自身の課題については知識の不足，化学物質やその管理についての教育力，およびリスクを低減させる改善の対策などが挙げられ，個人への必要な支援に関しては，化学物質の有害性や危険性に関する教育，企業の管理（自律的管理を含む）に関することなどが挙げられた．また，組織への必要な支援に関しては，人材育成の機会，化学物質の管理体制や事業場の理解などが挙げられた．これらのことから，個人に関しては，法改正に伴い教育や化学物質管理を行うために必要なことに対する支援，組織に関しては，トップの理解や必要な人材の確保のための支援の必要性が考えられる．

Objectives. To describe health-related behaviors or indicators associated with overall health and well-being using the Global Assessment Tool (GAT), a health behavior and psychosocial questionnaire completed annually by US Army personnel. Methods. We analyzed GAT responses from 2014 to 2018, consisting of 367 000 to 449 000 respondents per year. We used generalized estimating equations to predict the presence of each health behavior or indicator, aggregated by year and stratified on various demographics. Results. Key findings included decreases from 2014 to 2018 in risky health behaviors such as hazardous drinking (7.5% decrease) and tobacco use (7.9% decrease), dietary supplement use (5.0% to 10.6% decrease, depending on type), self-reported musculoskeletal injury (5.1% decrease), and pain interference (3.6% decrease). Physical activity, sleep, and nutritional habits largely remained consistent over time. Conclusions. In the Army, tobacco, alcohol, and risky dietary supplement usage appears to be declining, whereas lifestyle health behaviors have been stable. Whether these trends reflect responses to health education is unknown. The GAT provides useful insights into the health of the Army, which can be leveraged when developing health-related educational programs and policies. Public Health Implications. Health behaviors that have changed less over time (e.g., nutrition, sleep) may require novel approaches compared with those that changed more (e.g., dietary supplement use, drinking). (Am J Public Health. 2021;111(11):2064–2074. https://doi.org/10.2105/AJPH.2021.306456 )

For nearly 2 decades, the Community Health Status Indicators tool reliably supplied communities with standardized, local health data and the capacity for peer-community comparisons. At the same time, it created a large community of users who shared learning in addressing local health needs. The tool survived a transition from the Health Resources and Services Administration to the Centers for Disease Control and Prevention before being shuttered in 2017. While new community data tools have come online, nothing has replaced Community Health Status Indicators, and many stakeholders continue to clamor for something new that will enable local health needs assessments, peer comparisons, and creation of a community of solutions. The National Committee on Vital and Health Statistics heard from many stakeholders that they still need a replacement data source. (Am J Public Health. 2021;111(10):1865–1873. https://doi.org/10.2105/AJPH.2021.306437 )

The current population-based study examines the association between county-level ambient air pollution and childhood asthma. Data from the nationally representative 2010–2015 National Health Interview Survey were linked to nationwide fine particulate matter (PM2.5) air pollution data at the county-level from the National Environmental Public Health Tracking Network which utilizes air quality monitoring stations and modeled PM2.5 measurements (Downscaler model data) and adjusted by county-level socioeconomic characteristics data from the 2010–2015 American Community Survey. Multilevel modeling techniques were used to assess the association between PM2.5 annual concentrations (quartiles < 8.11, 8.11–9.50, 9.51–10.59, ≥ 10.60 µg/m3) and current childhood asthma along with two asthma outcomes (episode in the past year, emergency room (ER) visit due to asthma). From 2010 to 2015, there were significant declines in PM2.5 concentrations and asthma outcomes. In unadjusted models, children living in areas with higher PM2.5 concentrations were more likely to have current asthma, ≥1 asthma episode in the past year, and ≥1 ER visit due to asthma compared with children living in areas with the lowest quartile (< 8.11 µg/m3). After adjusting for characteristics at the county, geographic, and child and family-level, significant associations remained for asthma episode, and ER visit among children living in areas with PM2.5 annual concentrations between 9.51 and 10.59 µg/m3 (3rd quartile) compared with children living in areas with the lowest quartile. This study adds to the limited literature by incorporating nationally representative county-, child-, and family-level data to provide a multi-level analysis of the associations between air pollution and childhood asthma in the U.S.

Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197–S200. https://doi.org/10.2105/AJPH.2021.306421 )

Objectives. To describe excess mortality during the COVID-19 pandemic in Guatemala during 2020 by week, age, sex, and place of death. Methods. We used mortality data from 2015 to 2020, gathered through the vital registration system of Guatemala. We calculated weekly mortality rates, overall and stratified by age, sex, and place of death. We fitted a generalized additive model to calculate excess deaths, adjusting for seasonality and secular trends and compared excess deaths to the official COVID-19 mortality count. Results. We found an initial decline of 26% in mortality rates during the first weeks of the pandemic in 2020, compared with 2015 to 2019. These declines were sustained through October 2020 for the population younger than 20 years and for deaths in public spaces and returned to normal from July onward in the population aged 20 to 39 years. We found a peak of 73% excess mortality in mid-July, especially in the population aged 40 years or older. We estimated a total of 8036 excess deaths (95% confidence interval = 7935, 8137) in 2020, 46% higher than the official COVID-19 mortality count. Conclusions. The extent of this health crisis is underestimated when COVID-19 confirmed death counts are used. (Am J Public Health. 2021;111(10): 1839–1846. https://doi.org/10.2105/AJPH.2021.306452)

In a sample of 28 individuals cohabiting with a partner in NYC, Boston, or Chicago, this study tested whether implementation of stay-home orders to combat the spread of COVID-19 disrupted physical activity and whether high-quality romantic relationships buffered adverse effects. Participants provided FitBit data between February and October, 2020. Stay-home orders were associated with a reduction in daily step counts, B = −1595.72, p = 0.018, increased sedentary minutes, B = 33.75, p = 0.002, and reduced daily minutes of light and moderate physical activity, B = –25.01, p = 0.011; B = –0.72, p = 0.021. No moderation effects emerged.

Objectives. To examine temporal trends in the classification of opioid-involved overdose deaths (OODs) and racial variation in the classification of specific types of opioids used. Methods. We analyzed OODs coded as other or unspecified narcotics from 1999 to 2018 in the United States using data from the National Vital Statistics System and the Centers for Disease Control and Prevention. Results. The total proportion of OODs from unspecified narcotics decreased from 32.4% in 1999 to 1.9% in 2018. The proportion of OODs from unspecified narcotics among African American persons was approximately 2-fold greater than that of non-Hispanic White persons until 2012. Similarly, the proportion of OODs from unspecified narcotics among Hispanic persons was greater than that of White persons until 2015. After we controlled for death investigation system, African American persons had a higher incidence rate of OODs from unspecified narcotics compared with White persons. Conclusions. There have been significant improvements in the specification OODs over the past 20 years, and there has been significant racial disparity in the classification of OODs until about 2015. The findings suggest a health data disparity; the excessive misclassification of OODs is likely attributable to the race/ethnicity of the decedent.

Abstract. As a follow-up to an earlier study demonstrating healthier cardiometabolic profiles among long-term multiple dietary supplement (LTMDS) users, we examined if cardiometabolic health benefits associated with LTMDS use persisted with aging. The study is based on LTMDS users from North America and 2007–2010 NHANES participants who were used for comparison to the LTMDS users. NHANES subjects were classified as non-dietary supplement (NS) users, single supplement/single purpose supplement (SS) users, multivitamin/mineral supplement (MVMS) users, and multiple dietary supplement (MDS) users. Supplement groups were compared for total, HDL and LDL cholesterol; triglycerides; glucose; insulin; CRP and HbA1c ≥ 6.5%, adjusting for age, sex, income, education, BMI, history of CVD, and medications for hypercholesterolemia and diabetes. Geometric mean (95% confidence interval) LDL cholesterol was significantly lower (P

Purpose: To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populatio...

BackgroundWorldwide, binge drinking (BD) today follows being a public health concern among adolescents. This study sought to assess the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence.MethodsThe sample was drawn from a study evaluating the Alerta Alcohol programme. The population consisted of adolescents aged 15–19. Decision tree analysis was used to estimate costs and health outcomes, as measured by number of BD occasions and quality-adjusted life years (QALYs). Incremental Cost-Effectiveness and Cost-Utility Ratios were also calculated from National Health Service (NHS) and societal perspective and for a time horizon of four months. Multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty.ResultsThe intervention was dominant from the societal perspective resulting in savings of €7,986.37 by one BD occasion averted per month. With regard to Incremental Cost-Utility Ratios, the intervention resulted in an incremental cost of €71.05 per QALY gained from NHS perspective and this was dominant, from societal perspective, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention resulted dominant for girls from both perspectives, and for those who were older (17 years or more) from NHS perspective.ConclusionComputer-tailored feedback is a cost-effective way to reduce BD and to increase QALYs among adolescents. However, long-term follow-up would probably be needed to capture major changes both in reduction of BD and in increasing of health-related quality of life.Trial registration(ClinicalTrials.gov): NCT03288896. Registration date: September 20, 2017. “Retrospectively registered”.

Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IR) to prevent systemic infections constitutes a fundamental public health effort. Cost-effectiveness, availability, and high-efficacy against arthropod vectors are key characteristics of an ideal IR. Currently, numerous IRs are available on the market, with DEET (N,N-diethyl-3-methylbenzamide) being the most widely used. DEET has an excellent safety profile and remarkable protection against mosquitoes and various other arthropods. Other EPA-registered IR ingredients (permethrin, picaridin, IR3535, oil of lemon eucalyptus, oil of citronella, catnip oil, and 2-undecanone) are alternative IRs of great interest due to some having efficacies comparable to that of DEET. These alternative IRs possess low toxicity and favorable customer experiences in utilization (e.g., cosmetically pleasant, naturally occurring). This review summarizes currently available EPA-registered IRs: the origins, mechanisms of action, side effect profiles, and available formulations will be discussed. This review will enable the clinician to select the best IR option to meet patients' needs and provide the greatest protection from arthropod bites and sequelae.

Mosquitoes have numerous illnesses and are one of the deadliest animals in the planet. Including Zika, dengue, palaria, West Niles, chikungunya, yellow fever, and more, mosquitoborne illnesses. Various areas suffer from various climate-induced mosquito-borne illnesses, kinds of mosquitoes widespread across the region and access to preventive measures and medicines. Dengue fever is a mosquito-borne disease that is transferred to the dengue virus via the bite of an Aedes mosquito. The bits of the infected female Aedes mosquito, which spreads the virus to others as it feeds on the infected people's blood. Transmission of dengue is susceptible to climate due to many causes, such as temperature, humidity, precipitation, etc. Areas with higher vapor pressure and precipitation rates are more prone to dengue illness transmission. We utilized the classification algorithms to discover the essential characteristics that spread the dengue. Machine learning is one of the most important approaches of current analysis. For medical applications, many algorithms were employed. Dengue disease is one of the worst infectious diseases that require a high level machine to develop good models in order to learn. We employed the Ensemble Machine Learning technique in hybrid integrations to identify characteristics associated with the spread of the Dengue illness and achieve improved performance.

Transitions to a new principal are common, especially within urban public schools, and potentially highly disruptive to a school's culture and operations. We use longitudinal data from New York City to investigate if the effect of principal transitions differs by whether the incoming principal was hired externally or promoted from within the school. We take advantage of variation in the timing of principal transitions within an event-study approach to estimate the causal effect of principal changes. Changing principals has an immediate negative effect on student test scores that is sustained over several years regardless of whether hired internally or externally. However, externally hired principals lead to an increase in teacher turnover and a decline in perceptions of the school's learning environment, whereas transitions to an internally promoted principal have no such effects. This pattern of results raises important questions about leadership transitions and the nature of principal effects on school quality.

Neurodevelopmental disorder, communication problems, and repetitive/stereotypic behaviour are all characteristics of autism, a severe developmental disorder. Even though the pathophysiological causes of autism are still unclear and contested in many cases, genetic and environmental factors (and their interactions) have been identified as contributing factors. While it is widely acknowledged that various factors can cause autism, environmental factors have received a great deal of attention recently. A large part of the international debate has focused on neurotoxins such as Lead, Iron, and Cadmium, with some arguing that these and other toxic metals have a role in the development of the condition. Methods: Between March and December 2020, the study is being performed in Iraq's Al-Anbar province. 75 autistic children and 20 volunteers children served as controls in the study, all of whom had confirmed DSM-V diagnoses. An atomic absorption spectrophotometer is used to test hair samples. Two heavy elements (Lead and Iron) and one trace element (Cadmium) are measured. The results are shown as significant high in Lead ,and Iron concentrations in Autistic compared with Control, and International Normal Value, more than Lead, and Iron considered as risk environment factor for ASD, While a cadmium concentration is expressed significant high in autism and slightly in control compare with International Normal Value, and considered no risk environmental factor in Iraqi populations. It could be due to the pollution of the Iraqi environment.

Nursing homes and other long-term care facilities in the United States have experienced severe COVID-19 outbreaks and elevated mortality rates, often following upon the inadvertent introduction of SARS-CoV-2. Following FDA emergency use approval, widespread distribution of vaccines has resulted in rapid reduction in COVID-19 cases in vulnerable, older populations. Yet, vaccination coverage remains incomplete amongst residents and healthcare workers. As such, mitigation and prevention strategies are needed to reduce the ongoing risk of transmission and mortality amongst vulnerable, nursing home populations. One such strategy is that of ‘shield immunity’, in which recovered individuals increase their contact rates and therefore shield individuals who remain susceptible to infection. Here, we adapt recent population-scale shield immunity models to a network context. To do so, we evaluate network-based shield immunity by evaluating how restructured interactions in a bipartite network (e.g., between healthcare workers and long-term care residents) affects SARS-CoV-2 epidemic dynamics. First, we identify a series of rewiring principles that leverage viral testing, antibody testing, and vaccination information to reassign immunized healthcare workers to care for infected residents while retaining workload balance amidst an outbreak. We find a significant reduction in outbreak size when using infection and immune-based cohorting as a weekly intervention. Second, we also identify a preventative strategy using shield-immunity rewiring principles, by assigning susceptible healthcare workers to care for cohorts of immunized residents; this strategy reduces the risk that an inadvertent introduction of SARS-CoV-2 into the facility via a healthcare worker spreads to susceptible residents. Network-based epidemic modeling reveals that preventative rewiring can control the size of outbreaks at levels similar to that of isolation of infectious healthcare workers. Overall, this assessment of shield immunity provides further support for leveraging infection and immune status in network-based interventions to control and prevent the spread of COVID-19.

BackgroundDespite a high burden, there is limited training available in non-communicable disease research in Nepal. In order to understand research capacity gap in non-communicable diseases in the country, we conducted a needs assessment. We aimed to assess existing research training capacity in academic health institutions of Nepal for the prevention and control of non-communicable diseases, identify gaps in research training in these institutions, and explore the feasibility of developing research training program in Nepal targeting non-communicable diseases and their risk factors. MethodsWe did qualitative and quantitative research and reviewed academic institution curricula review and scientific literature. We conducted 14 Focus Group Discussions with bachelor and Masters level students of public health and community medicine; 25 In-depth Interviews with department heads and faculties, and government stakeholders. We surveyed medical and public health students on their research knowledge and skills development. Further, we reviewed university curricula of bachelors in medicine and public health Masters in community medicine and public health. We also reviewed non-communicable disease related scientific articles authored by Nepali researchers. ResultsWe found that the research methodology component was addressed differently across academic programs. One-third (33.7%) of students expressed lack of skills for analysis and interpretation of data. They felt that there is a wide scope and career-interest in non-communicable diseases research in Nepal. However, specific objectives in the curriculum and practical aspects regarding non-communicable diseases were lacking. Most of the non-communicable diseases research in Nepal are prevalence studies. Most of the studies did not have any financial support. Lack of funding, conflicting priorities with curative services, and inadequate training for advanced research tools were reported as major barriers. Likewise, availability of trained human resources and international funding for non-communicable diseases research were perceived facilitators.ConclusionsNepal must strengthen the whole spectrum of research capacity: epidemiological skills, research management, and fund generation. University curricula should match up with the disease burden and must emphasize on applied practical research projects. Generation of a critical mass of non-communicable disease researchers must go together with improved funding from the government, non-governmental organizations, and external funding organizations.

Resumen Introducción. El pueblo hitnü vive en condiciones sanitarias precarias, con inseguridad alimentaria y víctima de la violencia sociopolítica en Arauca (Colombia). Además, se sospecha que pueden estar afectados por la exposición a los hidrocarburos del petróleo. Objetivo. Identificar los eventos de salud del perfil de morbilidad y mortalidad de los indígenas hitnü que podrían asociarse con la exposición a petróleo crudo. Materiales y métodos. Se realizó un estudio transversal con indígenas hitnü, durante febrero y marzo de 2021, época de sequía. Se aplicó un cuestionario de hogares y uno individual para recolectar datos del ambiente peridomiciliario, ocupaciones y otras actividades, así como datos sociodemográficos, signos, síntomas y hallazgos de un examen médico. La potencial asociación con los hidrocarburos se exploró considerando tres grupos, según su localización: cabecera de Arauca, resguardo Aspejená (no expuestos) y resguardos de San José del Lipa y La Vorágine (expuestos por su cercanía al río Ele y afluentes). Con listados libres, se exploraron las causas de muerte. El estudio incorporó un riguroso manejo intercultural en todos sus componentes. Resultados. Participaron 576 indígenas de 16 asentamientos. El agua consumida pudo servir como medio de exposición a los hidrocarburos. Los problemas de salud fueron muy variados e incluían enfermedades infecciosas y crónicas, malnutrición y trauma. Las masas en el cuello se asociaron con residir en los resguardos ancestrales (RP=3,86; IC95% 1,77-8,39), territorios potencialmente expuestos al petróleo. Las causas de muerte más relevantes fueron el homicidio, los tumores y la tuberculosis. Conclusión: Por su posible asociación con los hidrocarburos, es prioritario el estudio intercultural de linfoadenopatías entre indígenas potencialmente expuestos al petróleo. Abstract Introduction: The Hitnü indigenous people live in precarious sanitary conditions, with food insecurity and being victims of sociopolitical violence in Arauca, Colombia. In addition, it is possible that they may be affected by exposure to hydrocarbons found in oil. Objective: To identify the health outcomes of morbidity and mortality profiles of the Hitnü people that could be associated with the exposure to crude oil. Materials and methods: A cross-sectional study was carried out with Hitnü indigenous people, during February and March, 2021, time of drought. A household questionnaire was applied, and one individual to collect data from the environment around the house, occupations and other activities, as well as data from sociodemographic, signs, symptoms, and findings of a medical examination. The potential association with hydrocarbons was explored considering three groups: inhabitants in Arauca city, Aspejaná reserve (not exposed), and San José del Lipa and La Vorágine reserves (exposed by the Ele river and tributaries). With free listings, causes of death were explored. The study incorporated a rigorous intercultural management in all its components. Results: A total of 576 indigenous people from 16 settlements participated. The water consumed could serve as means of exposure to hydrocarbons. Health problems were very varied, including infectious and chronic diseases, malnutrition, and trauma. The masses on the neck were associated with residing in the ancestral reserves (PR = 3.86; CI95% 1.77-8.39), territories with potential exposure to crude-oil. The most relevant causes of death were homicide, tumors, and tuberculosis. Conclusion: For its possible association with exposure to hydrocarbons, it is a priority to start the intercultural study of lymphadenopathies in indigenous communities potentially exposed to crude oil.

Summary Background & aims Coronavirus disease 2019 (COVID-19) is an ongoing pandemic outbreak leading to more than 1 million deaths worldwide as reported in 2020. Several risk assessment tools, including individual vulnerability to COVID-19, have been developed. The present study aimed to characterize a high-risk population using such a tool and examine risk factors and nutritional status in the national survey data and estimate the region-specific population size. Methods The study included 17,540 Korean adults who participated in the Korea National Health and Nutrition Examination Survey (KNHANES). The risk scores for individual vulnerability to COVID-19 were calculated based on age, sex, smoking status, and comorbidities, and a high-risk population was defined as having risk scores ≥11. Nutritional status was compared between the high-risk population and the remaining participants in the KNHANES data. The region-specific population size was estimated using national statistics. Results The proportion of the high-risk population was estimated to be 10.5%, which corresponds to approximately 4.6 million adults in South Korea. About 20% of them had inadequate intake of all of vitamins A, B1, B2, B3, and C below the estimated average requirement. The high-risk population showed 1.65 [95% confidence interval: 1.39, 1.96] higher odds of inadequate intake of multiple vitamins than the remaining participants. In the ecological analysis, the region-specific numbers of the high-risk population correlated significantly with the actual numbers of deaths due to COVID-19 (P value = 0.013). Conclusions These results suggest that individuals vulnerable to COVID-19, in particular those are living in densely populated regions, should pay particular attention to the protection against this pandemic and have adequate nutritional status, which may support optimal immune function.

Introduction: The aim of the study was to assess the effect of lead concentration and shift work on the occurrence of insomnia in the employees of the Zinc Steelworks in Miasteczko Śląskie in Poland. Materials and Methods : The study group consisted of 240 employees of the zinc smelter, reporting periodic and control examinations to the Occupational Medicine Clinic. Respondents were asked to complete a questionnaire consisting of the Athens Insomnia Scale and questions about the place and nature of work. Results: Analyzing the results of lead and zinc proporphiryn( ZPP) levels in the shift and non-shift subgroups of the study group, a slightly higher mean level of lead and ZPP was found in the shift subgroup. Using logistic regression, the probability of insomnia was determined depending on the concentration of lead and ZPP in the organism. As the level of lead and ZPP increases in the study group, the probability of insomnia increases. It is the largest among the examined group working in shifts. Conclusions: As the blood lead level increases, the likelihood of insomnia in steel plant workers increases.

To improve drinking water accessibility and safety in rural China, the Chinese government launched the rural drinking water program in the 1980s. As part of the program, tap water infrastructure has been constructed in rural areas to supply tap water to rural residents. This policy intervention provides a unique opportunity to examine the impact of early life exposure to tap water on children’s cognitive achievement in later life. Using data extracted from the China Family Panel Studies (CFPS), we find that one additional year of exposure to tap water in early life increases average cognitive test score by 0.109 standard deviations for a sample of rural children aged 10-15 in 2010. The effect is larger for children whose fathers are less-educated. Event study estimates confirm that the beneficial impacts are concentrated in early life with limited additional impact after the time window.

Health-based drinking water violations affect about one in twelve Americans annually, yet the benefits of drinking water regulation are not well understood. I exploit plausibly exogenous variation in water quality violation timing to estimate the impacts on avoidance behavior and child outcomes. Using purchases of bottled water and common stomach remedies, emergency room visits for gastrointestinal illness, and school absences, I provide a comprehensive calculation of costs associated with poor drinking water quality. Individuals avoid the negative health impacts of coliform bacteria violations only when informed immediately. Timely public notification is a cost-effective way to induce avoidance behavior and protect health.

Air pollution is a rapidly growing major health concern around the world. Atmospheric particulate matter that has a diameter of less than 2.5 µm (PM2.5) refers to an air pollutant composed of particles and chemical compounds that originate from various sources. While epidemiological studies have established the association between PM2.5 exposure and cardiovascular diseases, the precise cellular and molecular mechanisms by which PM2.5 promotes cardiovascular complications are yet to be fully elucidated. In this review, we summarize the various sources of PM2.5, its components, and the concentrations of ambient PM2.5 in various settings. We discuss the experimental findings to date that evaluate the potential adverse effects of PM2.5 on cardiovascular homeostasis and function, and the possible therapeutic options that may alleviate PM2.5-driven cardiovascular damage.

Elektrikli ve elektronik cihazların kullanım ömürleri hızlı dolmakta, yeni ürünlere hızlı geçiş olmakta ve elektronik atık (e-atık) olarakbilinen yeni bir atık türü ortaya çıkmaktadır. Çalışmanın amacı, akademisyenlerin ülkemizdeki e-atık düzenlemeleri ile e-atıkların insanve çevre sağlığına etkileri konusundaki bilgi ve düşüncelerini incelemektir. Bu çalışma Karadeniz Teknik Üniversitesi'nde görev yapanakademisyenler üzerinde gerçekleştirilmiş ve çalışmaya 267 akademisyen dahil edilmiştir. Veri toplamak için 50 sorudan oluşançevrimiçi bir anket kullanılmıştır. İstatistiksel analiz için Mann Whitney U, Kruskall Wallis, Pearson ki-kare, Fisher's Exact Test veSpearman korelasyon analizi kullanılmıştır. Katılımcıların %45,3'ü e-atık geri dönüşümüne dikkat etmediğini, e-atık geri dönüşümünedikkat etmeyenlerin ise %90,1'i ülkemizdeki uygulamaları bilmediğini belirtmiştir. Katılımcıların sadece %4,9'u e-atık konusunda eğitimalmıştır. Eğitim alanların ülkemizdeki e-atık mevzuatı ve e-atıkların insan ve çevre sağlığına etkileri konusundaki toplam bilgi puanortalamaları eğitim almayanlara göre istatistiksel olarak önemli bir şekilde yüksek bulunmuştur (p, The useful life of electrical and electronic devices is rapidly ending, there is a rapid transition to new products, and a new type of wasteknown as electronic waste (e-waste) emerges. The aim of this study was to examine the knowledge and opinions of academicsconcerning e-waste regulations in Turkey and the effects of e-waste on human and environmental health. This study involved 267academics working at Karadeniz Technical University. An online questionnaire consisting of 50 questions was used for data collection.The Mann Whitney U, Kruskal Wallis, Pearson chi-square, Fisher's Exact test, and Spearman correlation were used for statisticalanalysis. Analysis showed that 45.3% of the participants reported not paying attention to the recycling, with 90.1% of those beingunaware of the procedures involved. Only 4.9% of the participants had received education concerning e-waste. Participants who hadreceived such education registered significantly higher mean total knowledge scores concerning e-waste regulations and the effects ofe-waste on human and environmental health than those with no such education (p

Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. These elements cannot be neglected, and a wide view of public health aspects by a "one-health" approach is strongly and urgently recommended. According to World Health Organization, 35% of infectious diseases involving the lower respiratory tract depend on environmental factors, and infections from SARS-Cov-2 is not an exception. Furthermore, environmental pollution generates a large burden of non-communicable diseases and disabilities, increasing the individual vulnerability to COVID-19 and the chance for the resilience of large communities worldwide. In this field, the awareness of internists must increase, as privileged healthcare providers. They need to gain a comprehensive knowledge of elements characterizing COVID-19 as part of a syndemic. This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.

Background: This research investigated and identified significant spatial clusters of asthma and chronic obstructive pulmonary disease (COPD)-related emergency department (ED) visits and in-patient...

OBJECTIVES: Drug information systems are commonly used by professionals to assist in the identification of drug interactions and to ensure the safe use of medications. Real-world evidence about the comparison of different drug interaction sources is scarce. We aimed to compare two drug interaction databases to identify interactions in a population-based survey. MATERIALS AND METHODS: This is a cross-sectional study based on a previous survey performed in the city of Manaus, Brazil, in 2019. We included adults aged 18 years and over, who used two or more medicines 15 days before the interview. To assess potential drug interactions, we searched Micromedex and UpToDate databases. The primary outcome was the prevalence of potential drug interactions in each database. Weighted Kappa statistics were calculated to assess agreement on the presence of drug interaction, documentation and severity. RESULTS: A total of 752 participants were included in the study. The prevalence of drug interactions was 43.8% [95% confidence interval (CI): 40.2, 47.3%] in UpToDate and 30.2% (95% CI: 26.9, 33.5%), in Micromedex. The agreement related to drug interactions between the two databases was fair (Kappa: 0.631). For severity (Kappa: 0.398) and documentation (Kappa: 0.311), the agreement was poor. CONCLUSION: Agreement among compared databases was sub-optimal. Better quality and transparency of evidence available in drug interaction sources are needed to support informed healthcare professionals’ decision.

We have lived our lives in the spirit of the COVID-19 pandemic in the latest period, which demanded serious sacrifices in Hungary as well. By the spread of the epidemic, more and more and younger people fought with the disease, several people worried about their relatives’ and friends’ health. The period of the pandemic and the central provisions aiming at stopping the spread of the epidemic affected people in several different ways, but it has no doubt that confinement, restrictions and the lack of interactions had mental effects on everyone. Over the fear from becoming infected, the reorganization of the healthcare system also influenced people’s mental status, and increased their anxiety and health anxiety, since the care of pre-existing chronic diseases and the diagnostics and therapy of new acute diseases were performed based on a new unknown protocol. Our research examined the population’s health anxiety in a highly disadvantaged region of Hungary along more dimensions in the second and third wave of the pandemic. Our research goal was to get to know the level of health anxiety according to different settlement types, genders, ages and occupations, and to compare its change with the measured data of the option and willingness for vaccination. Our special goal was the assessment of the healthcare workers’ mental status and monitoring of its changes. For the on-line survey research, we used standard questionnaires also validated in Hungarian language: the Short Health Anxiety Inventory - Hungarian version (SHAI-H) (Köteles at al, 2011), the 5-item WHO Well-being Index (Susánszky et al, 2006) and the Adult Hope Scale - Hungarian version (AHS-H) (Martos et al, 2014). During data recording, we queried labour market status, relationship status and the size of the residential settlement besides the socio-demographic data (gender, age, education). There was one question about the respondent’s evaluation regarding his/her own health status and another about religiousness. There were further questions about COVID-19 infection or its suspicion in terms of the person’s own and immediate environment, the severity of the perceived symptoms and the form of the necessary health care. Data recording of this current cross-sectional research was performed in the end of November 2020 and in the beginning of December 2020 at first, and then in March 2021, the questionnaire was filled by 528 persons in the second wave and 515 persons in the third wave. Although the survey, the cohort study performed by on-line sampling is not representative, due to the size of the sample, data provide an informative picture about the mental status of the population of the North-eastern region of Hungary and its changes during the second and third wave of the pandemic. Results: The average age of the 528 persons involved in the first phase of the research was 39.4±13.1 years, the willingness to respond was similar in the second phase (N=515), and there was a small decrease in the average age (x=34.7±13.05 years). At the time of the first data recording, 16.7% of the respondents had undergone the COVID-19 infection, while this number was 24.1% in the second phase. At first, most of the people having been infected (50.4%) had mild symptoms, while 47.8% survived the disease with medium strength symptoms. When we asked about the wider environment, they reported essentially more infections: the infection could have been detected in all the respondents’ households. 22.7% of those living in one household had at least one member and 77.3% had more than one infected family members. The severity of the course of the infection was different: 32% judged it very mild, 60.9% said it was medium, 3.1% of them needed hospitalization, and the course of the infection was fatal in the environment of 3.5% of the respondents. In the second phase of the research, most of the people having been infected (45.1%) had mild symptoms, while 52.6% suffered from medium strength symptoms. 37% of those living in one household had at least one member and 63% had more than one infected family members. The severity of the course of the infection was different: 26.5% judged it very mild, 58% said it was medium, 9% of them needed hospitalization, and the course of the infection was fatal in the environment of 4.5% of the respondents. Overall, the pandemic influences the population’s mental status and health anxiety in an obviously negative way in the examined region, it shows correlation with subjective health status, and we do not know its long-term effects at this time.

Alcohol use presents a serious risk to women's health. Of particular interest is the association of harmful alcohol consumption and risky behaviors, such as drinking before sexual intercourse, an understudied phenomenon in the Mexican population. AIM The aim of this study was to identify whether the harmful use of alcohol is associated with an increased probability of presex drinking in Mexican young women. METHOD This was a study with a predictive design. Multiple logistic regressions were performed in a random sample of 304 young college women (between the ages of 18 and 24 years) from Guanajuato and Tamaulipas, Mexico. Participants completed a sociodemographic data survey and the Alcohol Use Disorders Identification Test questionnaire. RESULTS Women with a pattern of harmful use of alcohol were more likely to report drinking before sex (adjusted odds ratio = 4.679, 95% confidence interval [1.619, 13.520], McFadden's pseudo R2 = 25.5%). Further analyses revealed that presex drinking by partners was an even stronger predictor of alcohol use before sexual intercourse in women (adjusted odds ratio = 12.749, 95% confidence interval [4.714, 34.483], McFadden's pseudo R2 = 34.7%). CONCLUSIONS The findings demand additional nursing studies to corroborate-and to better understand-the relationship between harmful use of alcohol in Mexican women, their partners' drinking behavior, and unhealthy behaviors like drinking before sexual intercourse.