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Ambient ozone (O3) is a critical atmospheric pollutant with significant potential threats to human health and the environment. Geographic information systems (GIS) techniques have opened up a wide range of methods for the assessment of health risks associated with pollutant exposure in urban environments. Accordingly, this study aimed to identify the sources and spatial-temporal distribution of O3 in regions under hot, arid climates. GIS-based geostatistical interpolation approaches were applied to analyze and locate the sources and spatial-temporal distribution of O3 in the state of Kuwait, which was taken as a case study. The spatial distribution of O3 in Kuwait was mapped using GIS functions. Hourly observation data for O3 concentration along with air pollutants and meteorological condition data for five years were collected from four air-monitoring stations representing open, residential, industrial, and commercial areas. To evaluate the accuracy of several spatial interpolation approaches, O3 concentration was estimated using the inverse distance weighted (IDW) and kriging approaches. Both attribute and geographic data were analyzed and mapped along with meteorological data to investigate the sources and the spatial-temporal distribution of O3. The results showed the O3 and NO2 concentrations during the four seasons were less than that in the regional and international limits. Seasonal spatial variability showed that the opposite trend of variations between O3 and NO2 recorded high concentrations in the summer and spring seasons for O3, while it was in the winter and autumn seasons for NO2. A high correlation was found between O3 pollutants and meteorological parameters. The highest O3 concentration was recorded in the summer season, followed by spring. The minimum O3 concentration was during the winter season. The concentrations of NO during the summer and spring seasons were lower than during the winter and autumn seasons. The strongest correlation was found between O3 and NO2 during the summer and autumn in the four regions. [ABSTRACT FROM AUTHOR]

Studies have shown that the environmental conditions of the home are important predictors of health, especially in low-income communities. Understanding the relationship between the environment and health is crucial in the management of certain diseases. One health outcome related to the home environment among urban, minority, and low-income children is childhood lead poisoning. The most common sources of lead exposure for children are lead paint in older, dilapidated housing and contaminated dust and soil produced by accumulated residue of leaded gasoline. Blood lead levels (BLL) as low as 10 microg/dL in children are associated with impaired cognitive function, behavior difficulties, and reduced intelligence. Recently, it is suggested that the standard for intervention be lowered to BLL of 5 microg/dl. The objectives of our report were to assess the prevalence of lead poisoning among children under six years of age and to quantify and test the correlations between BLL in children and lead exposure levels in their environment. This cross-sectional analysis was restricted to 75 children under six years of age who lived in 6 zip code areas of inner city Miami. These locations exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Using the 5 microg/dL as the cutoff point, the prevalence of lead poisoning among the study sample was 13.33%. The study revealed that lead levels in floor dust and window sill samples were positively and significantly correlated with BLL among children (p < 0.05). However, the correlations between BLL and the soil, air, and water samples were not significant. Based on this pilot study, a more comprehensive environmental study in surrounding inner city areas is warranted. Parental education on proper housecleaning techniques may also benefit those living in the high lead-exposed communities of inner city Miami.

This project studied the frequency and intensity of water contamination at the source, during transportation, and at home to determine the causes of contamination and its impact on the health of children aged 0 to 5 years. The methods used were construction of the infrastructure for three sources of potable water, administration of a questionnaire about socioeconomic status and sanitation behavior, anthropometric measurement of children, and analysis of water and feces. The contamination, first thought to be only a function of rainfall, turned out to be a very complex phenomenon. Water in homes was contaminated (43.4%) with more than 1100 total coliforms/100 ml due to the use of unclean utensils to transport and store water. This socioeconomic and cultural problem should be addressed with health education about sanitation. The latrines (found in 43.8% of families) presented a double-edged problem. The extremely high population density reduced the surface area of land per family, which resulted in a severe nutritional deficit (15% of the children) affecting mainly young children, rendering them more susceptible to diarrhea (three episodes/child/year).

Objectives: The purpose of the study was to evaluate the magnitude of environmental lead contamination in the downtown area of Miami., Methods: Lead inspections took place at 121 homes in Little Haiti and Liberty City and involved the collection of representative samples from floors, window wells, tap water, soil and air. Community health workers (CHWs) trained in interview and safety techniques went from door to door to enlist participation. On-site investigations were tailored to areas most utilized by children under the age of 6 years. The presence of lead-containing paint was also investigated in situ via X-ray fluorescence (XRF) analysis., Results: Of the sampling areas, the window wells area had the most abundant occurrence of lead. On analysis, 24% of sites returned window well samples with lead levels above Department of Housing and Urban Development (HUD) guidelines. Of the soil samples, the playgrounds around the house had the highest concentration of lead. Soil sampling demonstrated that 27.5% of sites returned samples with lead levels (400 to 1600 ppm) in excess of HUD/Environmental Protection Agency (EPA) standards. Positive XRF readings in one or more components were returned by 18% of sites., Conclusions: More than half of the houses in these two neighborhoods exhibited unacceptably high levels of lead dust and soil in areas where children live and play. Limitations of this study did not allow the assessment of how many children in this area are affected. A more comprehensive study including other areas of Miami-Dade County with older housing stock is recommended.

A one-year study was conducted to evaluate the impact of air pollution and roof coating on runoff quality. An existing 440 sq meter bitumen roof of a single-story building was coated with an extensive green roof layer on one half. Rainfall and runoff samples from both roofs were collected during 11 rainfall events after the separation of the first flush. The study monitored several key parameters, including pH, electrical conductivity (EC), turbidity, chemical oxygen demand (COD), ammonium nitrogen, nitrate nitrogen, and phosphates. The study revealed that both types of roofs altered the rainfall quality, but the changes caused by the green roof were more substantial. Although the retention of runoff from green roofs has a widely acknowledged positive impact on collecting systems, our study shows that green roofs also result in a 7.5- fold increase in COD concentrations, a 5.4-fold increase in the sum of ammonium and nitrate nitrogen, and a 2.3-fold increase in phosphates compared to bitumen roofs. A clear link between the quality of rainwater/runoff and air pollution was not established. The study's findings will aid in the development and management of local rainwater harvesting systems and enhance global understanding of the primary quality parameters of various roof types, particularly in regions with air pollution. [ABSTRACT FROM AUTHOR]

Background: One of the sustainable development goals (SDGs) is universal access to clean water and basic sanitation by 2030. Water, sanitation, and hygiene (WASH) support SDG targets such as eliminating poverty and improving health and education. Methods: The sample of this study amounted to 30 schools consisting of 10 elementary schools, 10 junior high schools, and 10 senior high schools. Sampling was based on stakeholder decisions on several issues related to washing. Results: This study was conducted by directly observing schools regarding the amount of drinking water, number of toilets, bathrooms, handwashing facilities alone, and handwashing facilities with water and soap. The results showed that elementary and junior high schools have insufficient toilet facilities and low handwashing facilities with water and soap. The average number of handwashing facilities with water and soap in schools in Bekasi City, Indonesia, was 1 for elementary schools, followed by junior high schools and high schools for 4-5 points. Conclusion: As soap is still unavailable in many Bekasi City schools, and there are inadequate handwashing facilities, it is recommended that handwashing facilities must be available with soap and water. [ABSTRACT FROM AUTHOR]

Purpose: To effectively combat the increasing rates of obesity, it is crucial to explore how environmental factors like sidewalk access impact weight-related outcomes. This study aimed to systematically examine the association between sidewalk accessibility and weight-related outcomes. Design/methodology/approach: Databases were searched by keywords for relevant articles, which were published before March 3, 2024, to report the role of neighborhood sidewalk access on weight-related outcomes. The main findings of the selected articles were extracted from eligible studies by two independent reviewers. Findings: A total of 20 out of 33 studies indicated a significant negative relationship between access to sidewalks and weight-related outcomes. Three studies demonstrated an indirect relationship between access to sidewalks and weight-related outcomes by greater access to physical environments. In addition, five studies reported no clear relationship, and three studies reported a significantly positive relationship between access to sidewalks and weight-related outcomes. Practical implications: In general, people who live in urban areas with better sidewalk access benefit from better weight-related outcomes. Adults showed this correlation more prominently than adolescents and children. Therefore, sidewalks that have a positive effect on physical activity levels could be considered as a preventive measure against obesity. Originality/value: One of the weight-related outcomes is obesity. Every community faces numerous challenges due to obesity, which adversely affects the quality of life and health. Environmental factors such as access to sidewalks could be associated with body weight due to lifestyle influences. [ABSTRACT FROM AUTHOR]

One-third of humanity harbors a lifelong infection with Toxoplasma gondii, and probably about 80% are infected with human cytomegalovirus (CMV). This study aims to delineate the associations between toxoplasmosis and cognitive abilities and compare these to the associations with CMV. We evaluated the cognitive performance of 557 students, who had been examined for Toxoplasma and CMV infections, using intelligence, memory, and psychomotor tests. The results indicated cognitive impairments in seropositive individuals for both pathogens, with variations in cognitive impact related to sex and the Rh factor. Specifically, Toxoplasma infection was associated with lower IQ in men, whereas CMV was predominantly associated with worse performance by women when testing memory and reaction speeds. Analysis of the antibody concentrations indicated that certain Toxoplasma-associated cognitive detrimental effects may wane (impaired intelligence) or worsen (impaired reaction times) over time following infection. The findings imply that the cognitive impairments caused by both neurotropic pathogens are likely due to pathological changes in the brain rather than from direct manipulative action by the parasites. [ABSTRACT FROM AUTHOR]

Africa faces a significant burden of infectious diseases, including Malaria and HIV/AIDS, along with an increasing prevalence of non-infectious diseases such as diabetes and cancer. This dual health challenge is amplified by socioeconomic difficulties, restricted access to healthcare, and lifestyle changes, thus present unique scientific needs. Effectively addressing these issues requires a skilled scientific workforce adept in comprehensive healthcare strategies. This analysis explores the critical landscape of health research in Africa, emphasizing the unique opportunity presented by the continent's youthful population, projected to reach almost 1 billion by 2050. The youth's innovative potential and fresh perspectives offer a chance to overcome development barriers in health research. Nevertheless, challenges such as under-resourced education, limited research training, inadequate mentorship, and funding difficulties persist. This paper urgently calls upon African leaders, international partners, and stakeholders to prioritize health research, mobilize funding, forge strategic partnerships, and empower the youth as essential steps to capitalize on the continent's dynamic youth for breakthrough health outcomes. Such investments are vital not just for health but for the overall economic, social, and strategic growth of the continent. Through shared responsibility and a united effort, the potential of African youth can be harnessed, leading to transformative research, improved health outcomes, and a prosperous future. This perspective represents the collective voice of passionate young researchers and advocates across Africa, calling for a new era of health research on the continent. [ABSTRACT FROM AUTHOR]

Background: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) represents a complex condition characterized by shared clinical and pathophysiological features of asthma and COPD in older individuals. However, the pathophysiology of ACO remains unexplored. We aimed to identify the major inflammatory cells in ACO, examine senescence within these cells, and elucidate the genes responsible for regulating senescence. Methods: Bioinformatic analyses were performed to investigate major cell types and cellular senescence signatures in a public single-cell RNA sequencing (scRNA-Seq) dataset derived from the lung tissues of patients with ACO. Similar analyses were carried out in an independent cohort study Immune Mechanisms Severe Asthma (IMSA), which included bulk RNA-Seq and CyTOF data from bronchoalveolar lavage fluid (BALF) samples. Results: The analysis of the scRNA-Seq data revealed that monocytes/ macrophages were the predominant cell type in the lung tissues of ACO patients, constituting more than 50% of the cells analyzed. Lung monocytes/macrophages from patients with ACO exhibited a lower prevalence of senescence as defined by lower enrichment scores of SenMayo and expression levels of cellular senescence markers. Intriguingly, analysis of the IMSA dataset showed similar results in patients with severe asthma. They also exhibited a lower prevalence of senescence, particularly in airway CD206 + macrophages, along with increased cytokine expression (e.g., IL-4, IL-13, and IL-22). Further exploration identified alveolar macrophages as a major subtype of monocytes/macrophages driving cellular senescence in ACO. Differentially expressed genes related to oxidation-reduction, cytokines, and growth factors were implicated in regulating senescence in alveolar macrophages. PPARγ (Peroxisome Proliferator-Activated Receptor Gamma) emerged as one of the predominant regulators modulating the senescent signature of alveolar macrophages in ACO. Conclusion: The findings suggest that senescence in macrophages, particularly alveolar macrophages, plays a crucial role in the pathophysiology of ACO. Furthermore, PPARγ may represent a potential therapeutic target for interventions aimed at modulating senescence-associated processes in ACO.Key words ACO, Asthma, COPD, Macrophages, Senescence, PPARγ. [ABSTRACT FROM AUTHOR]

Background: Diarrheal disease is a major problem in developing countries, including Indonesia. Apart from being a cause of death, diarrhea is also a major cause of malnutrition and can cause extraordinary events. This study aimed to analyze and estimate the effect of washing hands with soap and availability of latrines on the incidence of diarrhea in toddlers, with a meta-analysis based on previous primary studies. Subjects and Method: The meta-analysis was carried out using the PICO format including: (1) Population: Children under five; (2) Intervention: Mother washing hands with soap and having latrines available; (3) Comparison: Mothers who don't wash their hands with soap and don't have latrines available; and (4) Outcome: Incidence of diarrhea. Article searches were performed using several databases such as PubMed, Google Scholar, ScienceDirect, BioMed Central, and PLOS ONE. The keywords used are "Hand Washing OR Hand Hygiene AND "Latrine OR Latrine Availability" AND "Infection" AND "Diarrhea Childhood" AND "Children". The inclusion criteria for the included articles were full text articles with a cross-sectional design, published years from 2013 to 2022. This study was conducted according to PRISMA guidelines (Preferred Reporting Item for Systematic Reviews and Meta-Analysis). Data were analyzed using the Review Manager 5.3 application. Results: A total of 14 cross-sectional studies were included in this meta-analysis study which contained a total of 12,851 children under five who were at risk of diarrhea. This research article comes from Ethiopia which is on the African continent. The results of this meta-analysis show that mothers who wash their hands with soap can reduce the incidence of diarrhea in toddlers by 0.31 times compared to mothers who do not wash their hands with soap (aOR= 0.31; 95% CI= 0.17 to 0.57; p= 0.001), and the availability of latrines can reduce the incidence of diarrhea in toddlers by 0.38 times compared to the unavailability of latrines (aOR= 0.38; 95% CI= 0.15 to 0.96; p= 0.040). Conclusion: The behavior of washing hands with soap and the availability of latrines can reduce the incidence of diarrhea in toddlers. [ABSTRACT FROM AUTHOR]

The last decade of microbiome research has highlighted its fundamental role in systemic immune and metabolic homeostasis. The microbiome plays a prominent role during gestation and into early life, when maternal lifestyle factors shape immune development of the newborn. Breast milk further shapes gut colonization, supporting the development of tolerance to commensal bacteria and harmless antigens while preventing outgrowth of pathogens. Environmental microbial and lifestyle factors that disrupt this process can dysregulate immune homeostasis, predisposing infants to atopic disease and childhood asthma. In health, the low-biomass lung microbiome, together with inhaled environmental microbial constituents, establishes the immunological set point that is necessary to maintain pulmonary immune defense. However, in disease perturbations to immunological and physiological processes allow the upper respiratory tract to act as a reservoir of pathogenic bacteria, which can colonize the diseased lung and cause severe inflammation. Studying these host-microbe interactions in respiratory diseases holds great promise to stratify patients for suitable treatment regimens and biomarker discovery to predict disease progression. Preclinical studies show that commensal gut microbes are in a constant flux of cell division and death, releasing microbial constituents, metabolic by-products, and vesicles that shape the immune system and can protect against respiratory diseases. The next major advances may come from testing and utilizing these microbial factors for clinical benefit and exploiting the predictive power of the microbiome by employing multiomics analysis approaches. [ABSTRACT FROM AUTHOR]

Background: While national adoption of universal HIV treatment guidelines has led to improved, timely uptake of antiretroviral therapy (ART), longer-term care outcomes are understudied. There is little data from real-world service delivery settings on patient attrition, viral load (VL) monitoring, and viral suppression (VS) at 24 and 36 months after HIV treatment initiation. Methods and findings: For this retrospective cohort analysis, we used observational data from 25 countries in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium's Asia-Pacific, Central Africa, East Africa, Central/South America, and North America regions for patients who were ART naïve and aged ≥15 years at care enrollment between 24 months before and 12 months after national adoption of universal treatment guidelines, occurring 2012 to 2018. We estimated crude cumulative incidence of loss-to-clinic (CI-LTC) at 12, 24, and 36 months after enrollment among patients enrolling in care before and after guideline adoption using competing risks regression. Guideline change–associated hazard ratios of LTC at each time point after enrollment were estimated via cause-specific Cox proportional hazards regression models. Modified Poisson regression was used to estimate relative risks of retention, VL monitoring, and VS at 12, 24, and 36 months after ART initiation. There were 66,963 patients enrolling in HIV care at 109 clinics with ≥12 months of follow-up time after enrollment (46,484 [69.4%] enrolling before guideline adoption and 20,479 [30.6%] enrolling afterwards). More than half (54.9%) were females, and median age was 34 years (interquartile range [IQR]: 27 to 43). Mean follow-up time was 51 months (standard deviation: 17 months; range: 12, 110 months). Among patients enrolling before guideline adoption, crude CI-LTC was 23.8% (95% confidence interval [95% CI] 23.4, 24.2) at 12 months, 31.0% (95% CI [30.6, 31.5]) at 24 months, and 37.2% (95% [CI 36.8, 37.7]) at 36 months after enrollment. Adjusting for sex, age group, enrollment CD4, clinic location and type, and country income level, enrolling in care and initiating ART after guideline adoption was associated with increased hazard of LTC at 12 months (adjusted hazard ratio [aHR] 1.25 [95% CI 1.08, 1.44]; p = 0.003); 24 months (aHR 1.38 [95% CI 1.19, 1.59]; p <.001); and 36 months (aHR 1.34 [95% CI 1.18, 1.53], p <.001) compared with enrollment before guideline adoption, with no before–after differences among patients with no record of ART initiation by end of follow-up. Among patients retained after ART initiation, VL monitoring was low, with marginal improvements associated with guideline adoption only at 12 months after ART initiation. Among those with VL monitoring, VS was high at each time point among patients enrolling before guideline adoption (86.0% to 88.8%) and afterwards (86.2% to 90.3%), with no substantive difference associated with guideline adoption. Study limitations include lags in and potential underascertainment of care outcomes in real-world service delivery data and potential lack of generalizability beyond IeDEA sites and regions included in this analysis. Conclusions: In this study, adoption of universal HIV treatment guidelines was associated with lower retention after ART initiation out to 36 months of follow-up, with little change in VL monitoring or VS among retained patients. Monitoring long-term HIV care outcomes remains critical to identify and address causes of attrition and gaps in HIV care quality. Using real-world service delivery data, Ellen Brazier and team examine long-term HIV care outcomes under universal HIV treatment guidelines across 25 countries. Author summary: Why was this study done?: Although universal HIV treatment recommendations have been adopted in national HIV treatment guidelines, longer-term HIV care outcomes under such guidelines are poorly documented and largely limited to single-country studies with short follow-up times. No multicountry studies using real-world service delivery data have examined long-term HIV care outcomes associated under universal HIV treatment guidelines. What did the researchers do and find?: With data on 66,963 patients enrolling in HIV care at 109 clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium across 25 countries where universal HIV treatment guidelines were adopted, we estimated the hazard ratios of loss-to-clinic (LTC) at 12, 24, and 36 months after enrollment, comparing those enrolling in HIV care after guideline adoption to those enrolling before guideline adoption. Among 57,615 patients with documented initiation of antiretroviral therapy (ART), we also estimated the relative risks of clinic retention, viral load (VL) monitoring, and viral suppression (VS) at 12, 24, and 36 months after ART initiation, comparing those enrolling after versus before national adoption of universal treatment guidelines. Compared with patients enrolling in HIV care and initiating HIV treatment before national adoption of universal treatment guidelines, those enrolling and initiating treatment after guideline adoption had higher risk of being LTC at 12 months, 24 months, and 36 months after enrollment. Among patients retained in care after ART initiation, those enrolling in HIV care after the adoption of universal HIV treatment guidelines were more likely to have VL monitoring at 12 months after ART initiation and less likely at 36 months, with no difference at 24 months. VS was high at each time point among patients enrolling before and after the adoption of universal HIV treatment guidelines, with no substantive change associated with guideline adoption. What do these findings mean?: Our results raise concerns about long-term retention of patients after ART initiation, as well as the capacity of HIV programs to provide essential aspects of HIV care, including annual VL monitoring for timely identification of adherence problems and treatment failure. Our findings that patient retention in care at the clinic where ART was initiated decreased after the adoption of universal HIV treatment guidelines and that there has been no improvement in annual VL monitoring among patients retained in care should motivate efforts to identify and address factors associated with attrition among patients enrolling in HIV care, as well as barriers to routine VL testing in the era of universal treatment of all people living with HIV. Study limitations include potential underascertainment of patient outcomes in real-world service delivery data, lags in the availability of real-world service delivery data, and the nonrepresentativeness of the clinics and countries reflected in IeDEA datasets available for analysis. [ABSTRACT FROM AUTHOR]

Adolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers' and healthcare workers' responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: "HIV service delivery to adolescents during the COVID-19 pandemic" and "Lessons learnt—the way forward". The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment. [ABSTRACT FROM AUTHOR]

Background: The impact of non‐pharmacological interventions (NPIs) on asthma prevention and management is insufficiently examined. We aim to comprehensively evaluate and synthesize existing evidence regarding the effectiveness of various NPIs throughout the life course. Methods: We conducted a systematic search and screening of reviews that examined the effectiveness of various NPIs on asthma prevention and control in the Cochrane Library, PubMed, Embase, and Ovid databases. Data extraction was performed by considering the type of NPIs and the life course stages of the target population. Recommendations were provided by considering the quality of review assessed using the AMSTAR2 tool and the consistency of findings across reviews. Results: We identified 145 reviews and mapped the evidence on the impact of 25 subtypes of NPIs on asthma prevention and control based on five stages of life course. Reviews indicated a shift of focus and various impacts of major NPIs on asthma prevention and control across life courses, while a few types of NPIs, such as physical exercise, appeared to be beneficial in children, adolescents and adults. Consistent and high‐level evidence was observed only for psychological intervention on asthma control and quality of life among adults and older adults. Potential benefit with high‐level evidence was reported on certain NPIs, such as vitamin D in reducing risk of developing asthma in offsprings in the prenatal stage, digital health interventions in improving asthma control from childhood to older adulthood, and breathing exercise in improving quality of life, asthma‐related symptoms and lung function in adulthood and older adulthood. Conclusion: This study emphasizes the significance of delivering NPIs to improve asthma prevention and management and highlights the heterogeneity regarding the impact of NPIs across life courses. High‐quality research is urgently needed to further strengthen the evidence base of NPIs and tailored interventions should be considered in guideline development. [ABSTRACT FROM AUTHOR]

Approximately 28% of American adults meet both the physical activity (PA) and strength training guidelines despite the numerous health benefits associated with a physically active lifestyle. The purpose of this paper is to provide an update of the 2017 Society of Behavioral Medicine PA Special Interest Group article that outlined future directions in sedentary time reduction interventions, technology-based PA interventions, and the dissemination and implementation of PA interventions. Since the prior review, there has been significant progress on effective interventions for reducing sedentary time. However, there has been less progress for improving the specificity of sedentary time guidelines. There has been a dramatic increase in the number of studies examining PA mHealth interventions and support for mHealth intervention has generally been positive, though sustaining engagement in mHealth interventions remains a challenge. Promising newer technologies that have been explored more extensively since the prior review including artificial intelligence (AI). Knowledge of how to implement and scale-up effective PA interventions has also increased. Several current trends in PA intervention research that continue to advance the field include examining the moderating effect of the built environment on the effectiveness of behavioral interventions, cultural tailoring of interventions, Just in Time Adaptive Interventions (JITAIs), and exercise snacks (vigorous intensity PA sessions that are less than one minute). Overall, there has been significant progress in the PA intervention field but significant work remains for creating effective interventions that can be readily implemented into real world settings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

HIV-related stigma is associated with negative effects on mental health and lower health-related quality of life in pediatric and young adult populations living with HIV. We reviewed literature on the impact of HIV-related stigma on suboptimal antiretroviral therapy (ART) adherence, engagement and retention in HIV care, and transition to adult HIV care in children, adolescents, and young adults living with HIV. PubMed and Embase ® were searched for publications reporting relevant data published from January 1, 2012, to April 13, 2023. The output was not a systematic review; it was a targeted literature review. Overall, 67 studies were selected for analysis based on pre-specified criteria (eg, quality). Most quantitative studies supported negative associations between HIV-related stigma and ART adherence (n = 8/11), engagement and retention in HIV care (n = 3/4), and transition to adult HIV care (n = 2/3) in pediatric and young adult populations living with HIV. Qualitative studies reported that stigma was a barrier to ART adherence (n = 26), engagement and retention in HIV care (n = 18), and transitioning to adult HIV care (n = 11). Prominent interview themes across all topics included anticipated stigma, enacted stigma, and fear of HIV status disclosure. Results reaffirm that HIV-related stigma is a significant barrier to ART adherence, engagement and retention in HIV care, and transition to adult HIV care among pediatric and young adult populations living with HIV, potentially impacting virologic suppression, onward transmission, and longer-term health. Additional interventional studies are needed to evaluate and reduce the impact of stigma in these important populations., (© 2024. The Author(s).)

Background: Schizophrenia, a complex neuropsychiatric disorder, is believed to be influenced by various factors including environmental exposures. A potential environmental factor is the infection by the obligate intracellular parasitic protozoan, Toxoplasma gondii which affects neurotransmitter levels, which could potentially exacerbate, trigger symptoms of schizophrenia or make them worst. Objective: To investigate the association between Toxoplasma gondii seropositivity and psychopathological presentation in persons with schizophrenia in Ecuador. Methods: This study was conducted at the Neuroscience Institute of Guayaquil, Ecuador. Among 368 inpatients, 104 were selected based on specific inclusion and exclusion criteria. Descriptive statistics captured patient characteristics and mental health outcomes. Logistic regression models estimated the effect of toxoplasmosis on various mental health outcomes, controlling for demographic and health-related variables. Results: 86.5% of participants were seropositive for toxoplasmosis. Toxoplasma-seropositive schizophrenic patients had a lower risk of depression but a significantly higher risk of disorientation. The most prevalent mental health outcomes were Language Impairments (70.2%) and Bizarre Behavior (76.0%). Conclusion: Our findings suggest that Toxoplasma gondii seropositivity may have specific effects on mental functions in schizophrenic patients, particularly reducing the risk of depression but increasing the risk of disorientation. Further studies are required to clarify these associations and the potential underlying mechanisms. [ABSTRACT FROM AUTHOR]

Developing a sustainable water infrastructure entails the planning and management of water systems to ensure the availability, access, quality, and affordability of water resources in the face of social, environmental, and economic challenges. Sub-Saharan Africa (SSA) is currently in an era where it must make significant changes to improve the sustainability of its water infrastructure. This paper reviews the factors affecting water infrastructure sustainability and the interventions taken globally to address these challenges. In parallel, it reflects on the relevance of these interventions to the context of Sub-Saharan Africa through the lens of the STEEP (societal, technological, economic, environmental, political) framework. The paper goes on to recommend an extended analysis that captures additional critical dimensions when applying the concept of sustainability. Furthermore, this paper sheds light on the practice of sustainable development and fosters a deeper understanding of the issues, thereby forming the basis for further research and the development of sustainable and resilient solutions for water infrastructure and water asset management more generally. [ABSTRACT FROM AUTHOR]

Inadequate physical activity (PA) among university students, a growing concern, hinders their holistic health development and the formation of healthy habits. Current evidence regarding the impact of interventions to promote PA in this group remains inconclusive. Through a systematic review and meta-analysis, this study aims to evaluate the efficacy of PA interventions in promoting PA among university students. A search of six electronic databases up to 30 June 2023 was conducted to identify randomized controlled trials (RCTs) assessing PA interventions in university students. Thirty-one RCTs were included for systematic review and meta-analysis. The eligible studies' quality was assessed via the Cochrane Collaboration tool for evaluating the risk of bias. The results indicated a significant increase in total PA (TPA), moderate-to-vigorous PA (MVPA), and step counts at post-intervention compared to control groups, with effect sizes approaching large for MVPA and an increase of 19,245 steps per week. TPA also showed significant improvements during follow-up periods from three weeks to 12 months. Subgroup analyses revealed significant intervention effects across all subgroups, with the subgroups of post-COVID and sample sizes ≤100 showing larger effect sizes within their respective group. This review identified that interventions could enhance TPA, MVPA, and step counts among university students, with sustainable effects on TPA, while further research is needed for other outcomes. The university environment is conducive to PA interventions, and future interventions integrating e-health with in-person modes, coupled with matched theories and behavior change techniques, show promise. This review protocol has been registered on the platform of the International Prospective Register for Systematic Reviews (PROSPERO, CRD42023486749). [ABSTRACT FROM AUTHOR]

Objectives: To assess the incidence and predictors of time to Tuberculosis (TB) development among Human Immunodeficiency Virus (HIV) positive patients attending follow-up care in health facilities of Hawassa, Ethiopia. Methods: We conducted a retrospective cohort study from April 1–30, 2023. A total of 422 participants were selected using a simple random sampling method. Data was collected from the medical records of patients enrolled between January 1, 2018 –December 31, 2022, using the Kobo toolbox. We used Statistical Package for Social Studies (SPSS) version 26.0 for data analysis. To estimate the duration of TB-free survival, we applied the Kaplan-Meier survival function and fitted Cox proportional hazard models to identify the predictors of time to TB development. Adjusted hazard ratios (AHR) with 95% confidence intervals were calculated and statistical significance was declared at a P-value of 0.05. Results: The overall incidence rate of TB among HIV-positive patients was 6.26 (95% CI: 4.79–8.17) per 100 person-years (PYs). Patients who did not complete TB Preventive Therapy (TPT) were more likely to have TB than those who did (AHR = 6.2, 95% CI: 2.34–16.34). In comparison to those who began antiretroviral therapy (ART) within a week, those who began after a week of linkage had a lower risk of TB development (AHR = 0.44, 95% CI: 0.21–0.89). Patients who received ART for six to twelve months (AHR = 0.18, 95% CI: 0.05–0.61) and for twelve months or longer (AHR = 0.004, 95% CI: 0.001–0.02) exhibited a decreased risk of TB development in comparison to those who had ART for less than six months. Conclusion: The incidence of TB among HIV-positive patients is still high. To alleviate this burden, special attention should be given to regimen optimization and provision of adherence support for better completion of TPT, sufficient patient preparation, thorough clinical evaluation for major (Opportunistic Infections) OIs prior to starting ART, and ensuring retention on ART. [ABSTRACT FROM AUTHOR]

While several studies have shown associations between hearing disorders and congenital toxoplasmosis, the present study investigated the impact of chronic, latent Toxoplasma gondii (T. gondii) infection on hearing loss. We used a regression analysis to explore whether latent T. gondii infection modulates changes in hearing thresholds over an age range from 20 to 70 years. We analyzed audiometric data of 162 T. gondii IgG-positive and 430 T. gondii-negative participants, collected in the Dortmund Vital Study (DVS, ClinicalTrials.gov Identifier: NCT05155397), a prospective study on healthy cognitive aging. The regression analysis indicated that latent toxoplasmosis was associated with an accelerated development in hearing loss over the observed age range. Hearing loss was less frequent in IgG-positive than in IgG-negative participants up to the age of about 40 for a low (0.125–1 kHz)-frequency range. For high (2–8 kHz) frequencies, this pattern reversed for ages above 65 years. We discuss these findings on hearing function in the context of a recently proposed model, suggesting that latent toxoplasmosis can differentially affect brain functions across a lifespan. [ABSTRACT FROM AUTHOR]

Adequate nutrition during breastfeeding is crucial for ensuring the good health of mothers and babies. Despite the high energy and nutrient demands of breastfeeding, lactating women are often vulnerable from a nutritional perspective. The nutritional focus during breastfeeding tends to be on the newborn, often neglecting the mother's diet. Therefore, in the present narrative review, nutrient intakes were compared with the dietary reference values (DRVs) proposed by the European Food Safety Authority (EFSA) as well as by the World Health Organization/Food and Agriculture Organization (WHO/FAO). In the diets of lactating mothers, dietary inadequacies were observed in the intake of some vitamins, such as folic acid, vitamin B12, vitamin A, and vitamin D, and in the intake of certain minerals like calcium, iron, and iodine; polyunsaturated omega-3 fatty acid deficiencies, primarily in eicosapentaenoic acid and docosahexaenoic acid, were also observed. On the other hand, the debate on the necessity of supplementation during lactation continues; the need for nutritional supplementation during lactation depends on many factors, such us mothers' eating habits. There seems to be a positive association between nutritional supplementation of the lactating mother and the concentration of certain nutrients in human milk. The present narrative review provides an update on the nutritional status (fatty acids and micronutrients) of breastfeeding mothers and the impact of diet and dietary supplementation on human milk composition. [ABSTRACT FROM AUTHOR]

Simple Summary: Ex vivo, mouse, and human studies have pointed to the gut microbiota as playing roles in many diseases, including asthma susceptibility and severity. Equine asthma shares many similarities with human asthma, and gut microbiota could also be critical components in the pathophysiology of the disease. The purpose of this review was to describe the current knowledge on the potential role of the understudied gut–lung axis in the pathophysiology of equine asthma. Both microbe–microbe and host–microbe interactions can have effects beyond the local environment and influence immunological responses in remote organs such as the lungs. The crosstalk between the gut and the lungs, which is supported by complex connections and intricate pathways, is defined as the gut–lung axis. This review aimed to report on the potential role of the gut–lung gut–lung axis in the development and persistence of equine asthma. We summarized significant determinants in the development of asthma in horses and humans. The article discusses the gut–lung axis and proposes an integrative view of the relationship between gut microbiota and asthma. It also explores therapies for modulating the gut microbiota in horses with asthma. Improving our understanding of the horse gut–lung axis could lead to the development of techniques such as fecal microbiota transplants, probiotics, or prebiotics to manipulate the gut microbiota specifically for improving the management of asthma in horses. [ABSTRACT FROM AUTHOR]

Introduction: in developing countries, diarrhea is a major cause of child death among those under five years old. Dehydration, malnutrition, delayed physical development and early childhood mortality are the major consequences of diarrheal diseases. In Somaliland, diarrheal diseases have been endemic and a major problem since 1994, with epidemics occurring annually. This study aimed to assess the prevalence and risk factors of acute diarrhea among children under five years old living in Hargeisa Internally Displaced Persons (IDPs), Somaliland. Methods: a community-based cross-sectional study was conducted among mothers of children under five from August to September 2020 in Hargeisa IDPs. A total of 383 mothers were selected using single population proportional formula. Data was entered, cleaned, and analyzed using SPSS version 22. To explore the association between variables, bivariate logistic regression was performed for each independent variable with the dependent variable. Variables with a p-value of < 0.05 were adjusted in multivariate logistic regression. Finally, variables with a p-value < 0.05 were recognized as determinants of acute diarrheal disease. Results: the prevalence of diarrhea among children under five living in Hargeisa IDPs was 51% (95% CI: 46%-56%). Children older than one year (AOR= 3.59, 95% CI: 2.05-5.20), those not exclusively breastfed (AOR= 4.01, 95% CI: 3.27-4.60), those not given colostrum milk (AOR= 36.41, 95% CI: 25.76-47.90), those drinking water stored in jerry-cans (AOR = 4.90, 95% CI: 1.31-8.39), and those with poor hand washing practices (AOR = 5.74, 95% CI: 1.38-7.82) were more likely to develop diarrhea than their counterparts. Conclusion: this study concludes that the prevalence of diarrhea was very high (51%). Lack of awareness of exclusive breastfeeding and colostrum feeding, storing drinking water in unprotected containers, and poor hand-washing practices were identified as significant predictors for childhood diarrhea (pvalue < 0.05). [ABSTRACT FROM AUTHOR]

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The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In response to the growing concern of air pollution in Dubai, this study was undertaken to measure and analyze indoor and outdoor particulate matter (PM) concentrations in residential buildings during the spring dust storm period. The research focused on the infiltration of PM into indoor spaces and its impact on indoor air quality, exploring the relationship between PM particle diameter, building infiltration rates, and the indoor influence of outdoor PM. Conducted in a two-bedroom residential unit near a busy road, the study utilized particle size analysis and the indoor-outdoor (I/O) ratio for measurements. The findings revealed that smaller particles, particularly ultrafine PM2.5, had a more substantial influence on indoor PM concentrations than larger particles. It was noted that buildings with higher infiltration rates, especially those with natural ventilation, were more susceptible to outdoor PM infiltration. Additionally, the study highlighted the significant role of occupant behavior, such as cooking and cleaning, in generating indoor PM. However, further research is necessary to better understand the correlation between architectural characteristics, infiltration rates, and the indoor influence of outdoor PM in residential buildings. The study underscores the importance of improved ventilation systems, raising awareness of indoor air quality, and implementing effective mitigation strategies to reduce indoor air pollution and enhance indoor air quality in urban environments like Dubai. These findings contribute significantly to our understanding of indoor and outdoor PM dynamics, emphasizing the urgent need to address indoor air pollution in urban areas. [ABSTRACT FROM AUTHOR]

Background: Acute bronchiolitis and air pollution are both risk factor of pediatric asthma. This study aimed to assess subsequent exposure to air pollutants related to the inception of preschool asthma in infants with acute bronchiolitis. This study aimed to assess subsequent exposure to air pollutants related to the inception of preschool asthma in infants with acute bronchiolitis. Methods: A nested case-control retrospective study was performed at the Kaohsiung Medical University Hospital systems between 2009 and 2019. The average concentration of PM10, PM2.5, SO2, NO, NO2, and NOX was collected for three, six, and twelve months after the first infected episode. Adjusted regression models were employed to evaluate the association between asthma and air pollution exposure after bronchiolitis. Results: Two thousand six hundred thirty-seven children with acute bronchiolitis were included. Exposure to PM10, PM2.5, SO2, NO, NO2, and NOX in the three, six, and twelve months following an episode of bronchiolitis was found to significantly increase the risk of preschool asthma in infants with a history of bronchiolitis.(OR, 95%CI: PM10 = 1.517-1.559, 1.354–1.744; PM2.5 = 2.510-2.603, 2.148–3.061; SO2 = 1.970-2.040, 1.724–2.342; ; NO = 1.915-1.950, 1.647–2.272; NO2 = 1.915-1.950, 1.647–2.272; NOX = 1.752-1.970, 1.508–2.252) In a sensitive analysis of hospitalized infants, only PM10, PM2.5, SO2, and NO were found to have significant effects during all time periods. (OR, 95%CI: PM10 = 1.613-1.650, 1.240–2.140; PM2.5 = 2.208-2.286, 1.568–3.061; SO2 = 1.679-1.622, 1.197–2.292; NO = 1.525-1.557, 1.094–2.181) Conclusion: The presence of ambient PM10, PM2.5, SO2 and NO in the three, six, and twelve months following an episode of acute bronchiolitis has been linked to the development of preschool asthma in infants with a history of acute bronchiolitis. [ABSTRACT FROM AUTHOR]

This paper uses micro-level data from the 2013 official Kuwait Household expenditure survey covering 2961 households; and three 2020 COVID-19 shock-related CEO, labor force and household surveys to juxtapose the consumption profiles of foreign workers in Kuwait. The paper contributes to a growing literature on foreign workers by focusing on foreign workers' employment and earnings and consumption profiles following the COVID-19 pandemic. The paper compares differential consumption responses of 250 foreign and Kuwaiti households during the COVID-19 shock with profiles that existed during 2013, which was a shock-free year. Moreover, since foreigners represent nearly 70% of the population, OLS regressions were applied to the 2013 microdata and the 2020 household survey to inquire if standard consumption functions deployed in the economic literature hold in the case of foreign households in Kuwait and vets how their consumption responded to income shocks. Our data and empirical analysis corroborate that Kuwait's foreign community bore the brunt of COVID-19 in terms of employment, earnings and living conditions. Moreover, our results broadly indicate congruence with Friedman's permanent income hypothesis, and that for given income levels, consumption heterogeneity holds for foreign workers according to age cohorts, giving support to the life cycle hypothesis. The findings carry significant implications to Kuwait's dichotomous labor markets, and to households' income and consumption policies especially to Kuwait's transformative policy to realize sustainable growth. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the association between serum polyunsaturated fatty acids (PUFAs) and bone mineral density (BMD). Methods: We performed a cross-sectional study based on data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. The weighted multiple linear regression model was utilized to determine the association between serum PUFAs and BMD. Further smoothed curve fitting and threshold effect analysis were conducted. Finally, we performed a subgroup analysis. Results: In total, 1979 participants aged 20-59 years were enrolled. After adjusting for all covariates, we found that serum docosapentaenoic acid (DPA) was positively associated with head BMD (b = 0.0015, 95% Cl: 0.0004, 0.0026, P = 0.008296) and lumbar spine BMD (b = 0.0005, 95% Cl: 0.0000, 0.0010, P = 0.036093), and serum eicosadienoic acid (EDA) was negatively associated with thoracic spine BMD (β = -0.0008, 95% Cl: -0.0016, -0.0000, P = 0.045355). Smoothed curve fitting revealed a nonlinear positive association between serum DPA and lumbar spine BMD. Threshold effect analysis indicated that the threshold of serum DPA was 81.4 µmol/L. Subgroup analysis revealed a positive correlation between serum DPA and head BMD in the subgroup aged 50-59 years (β = 0.0025, 95% Cl: 0.0002, 0.0049, P = 0.035249) and females (β = 0.0026, 95% Cl: 0.0008, 0.0044, P = 0.005005). There was a positive relationship between serum DPA and lumbar spine BMD in females (β = 0.0008, 95% Cl: 0.0001, 0.0015, P = 0.017900) and a negative association between serum EDA and thoracic spine BMD in the subgroup aged 30-39 years (β = -0.0016, 95% Cl: -0.0031, -0.0001, P = 0.041331), males (β = -0.0012, 95% Cl: -0.0023, -0.0001, P = 0.039364) and other races (β = -0.0021, 95% Cl: -0.0037, -0.0006, P = 0.008059). Conclusion: This study demonstrated a linear positive relationship between serum DPA and head BMD, a nonlinear positive association between serum DPA and lumbar spine BMD, and a linear negative correlation between serum EDA and thoracic spine BMD in US adults. [ABSTRACT FROM AUTHOR]

The peak of the coronavirus-19 (COVID-19) in New York City significantly impacted communities that lived in the New York City Housing Authority (NYCHA). However, these same communities have been historically reported to test positive for lead poisoning due to neglect of proper lead abatement and the removal of lead sources within these buildings. The consequences of these failed actions by NYCHA resulted in multiple generations of lead-poisoned children, which can be argued as a form of mass atrocity and genocide. The long-term neurodevelopmental and socio-economic outcomes of children exposed to lead and COVID-19 remain to be elucidated. This short communication attempts to bring attention to this overlooked matter and draws upon the scarce, but emerging, reports in the literature to start a conversation on the synergistic potential of these looming public health issues. Further, suggestions for providing consistent blood lead screening and COVID-19 testing could serve to clarify whether a "two-hit" hypothesis of a neurotoxicant (lead) and a neuroimmune (COVID-19) virus that produces an Adverse Childhood Experience (ACE-19). More work is needed in this area to (dis)confirm the potential for this "two-hit" hypothesis, and only time will tell. [ABSTRACT FROM AUTHOR]

Background: The prevalence of oral diseases among Taiwanese prisoners has rarely been investigated. This study aimed to estimate the gender-specific prevalence of oral disease in a sample of Taiwanese prisoners. Methods: We included 83,048 participants from the National Health Insurance (NHI) Program. Outcomes were measured using the clinical version of the International Classification of Diseases, Ninth Revision (ICD-9-CM). For prevalence, we provide absolute values and percentages. We also performed a χ2 test to assess sex and age group differences in the percentage of disease in the oral cavity, salivary glands, and jaw. Results: The prevalence rate of oral diseases was 25.90%, which was higher than that of the general population. The prevalence of oral diseases in female prisoners was higher than that in male prisoners (p < 0.001), and the prevalence of oral diseases in prisoners aged ≤ 40 was higher than that of prisoners aged > 40. Among all cases of diagnosed oral diseases, the top three diseases were dental hard tissue diseases (13.28%), other cellulitis and abscesses (9.79%), and pruritus and related conditions (2.88%), respectively. The prevalence of various oral diseases in female prisoners was significantly higher than that in male prisoners. Conclusion: Oral disease is common among Taiwanese prisoners. Female prisoners had a higher prevalence of oral, salivary gland, and jaw diseases than male prisoners. Therefore, early prevention and appropriate treatment are required and also a need for gender-specific oral disease products given the differences in the prevalence of oral disease among male and female prisoners.Key points: The prevalence of oral diseases in Taiwanese prisoners is higher than that of the general population. Dental hard tissue diseases and gingival and periodontal diseases are the most prevalent oral diseases among male and female prisoners. The results indicate the need for early prevention and appropriate treatment of oral diseases in Taiwan's criminal justice system. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization recommended the initiation of antiretroviral therapy (ART) for people living with HIV (PLHIV) regardless of CD4 cell counts. Tanzania adopted this recommendation known as test-and-treat policy in 2016. However, programmatic implementation of this policy has not been assessed since its initiation. The objective of the study was to assess the impact of this policy in Tanzania. Methods: This was a cross-sectional study among PLHIV aged 15 years and older using routinely collected program data. The dependent variable was interruption in treatment (IIT), defined as no clinical contact for at least 90 days after the last clinical appointment. The main independent variable was test-and-treat policy status which categorized PLHIV into the before and after groups. Co-variates were age, sex, facility type, clinical stage, CD4 count, ART duration, and body mass index. The associations were assessed using the generalized estimating equation with inverse probability weighting. Results: The study involved 33,979 PLHIV—14,442 (42.5%) and 19,537 (57.5%) were in the before and after the policy groups, respectively. Among those who experienced IIT, 4,219 (29%) and 7,322 (38%) were in the before and after the policy groups respectively. Multivariable analysis showed PLHIV after the policy was instated had twice [AOR 2.03; 95%CI 1.74–2.38] the odds of experiencing IIT than those before the policy was adopted. Additionally, higher odds of experiencing IIT were observed among younger adults, males, and those with advanced HIV disease. Conclusion: Demographic and clinical status variables were associated with IIT, as well as the test-and-treat policy. To achieve epidemic control, programmatic adjustments on continuity of treatment may are needed to complement the programmatic implementation of the policy. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to analyze recent literature on heat effects on cardiovascular morbidity and mortality, focusing on the adopted heat definitions and their eventual impact on the results of the analysis. Methods: The search was performed on PubMed, ScienceDirect, and Scopus databases: 54 articles, published between January 2018 and September 2022, were selected as relevant. Results: In total, 21 different combinations of criteria were found for defining heat, 12 of which were based on air temperature, while the others combined it with other meteorological factors. By a simulation study, we showed how such complex indices could result in different values at reference conditions depending on temperature. Heat thresholds, mostly set using percentile or absolute values of the index, were applied to compare the risk of a cardiovascular health event in heat days with the respective risk in non-heat days. The larger threshold's deviation fromthe mean annual temperature, as well as higher temperature thresholds within the same study location, led to stronger negative effects. Conclusion: To better analyze trends in the characteristics of heatwaves, and their impact on cardiovascular health, an international harmonization effort to define a common standard is recommendable. [ABSTRACT FROM AUTHOR]

Carbon nanotube (CNT) sensors provide a versatile chemical platform for ambient monitoring of ozone (O3) and nitrogen dioxide (NO2), two important airborne pollutants known to cause acute respiratory and cardiovascular health problems. CNTs have shown great potential for use as sensing layers due to their unique properties, including high surface to volume ratio, numerous active sites and crystal facets with high surface reactivity, and high thermal and electrical conductivity. With operational advantages such as compactness, low-power operation, and easy integration with electronics devices, nanotechnology is expected to have a significant impact on portable low-cost environmental sensors. Enhanced sensitivity is feasible by functionalizing the CNTs with polymers, metals, and metal oxides. This paper focuses on the design and performance of a two-element array of O3 and NO2 sensors comprising single-walled CNTs functionalized by covalent modification with organic functional groups. Unlike the conventional chemiresistor in which the change in DC resistance across the sensor terminals is measured, we characterize the sensor array response by measuring both the magnitude and phase of the AC impedance. Multivariate response provides higher degrees of freedom in sensor array data processing. The complex impedance of each sensor is measured at 5 kHz in a controlled gas-flow chamber using gas mixtures with O3 in the 60–120 ppb range and NO2 between 20 and 80 ppb. The measured data reveal response change in the 26–36% range for the O3 sensor and 5–31% for the NO2 sensor. Multivariate optimization is used to fit the laboratory measurements to a response surface mathematical model, from which sensitivity and selectivity are calculated. The ozone sensor exhibits high sensitivity (e.g., 5 to 6 MΩ/ppb for the impedance magnitude) and high selectivity (0.8 to 0.9) for interferent (NO2) levels below 30 ppb. However, the NO2 sensor is not selective. [ABSTRACT FROM AUTHOR]