Prevalence and predictors of hand hygiene compliance in clinical, surgical and intensive care unit wards: results of a second cross-sectional study at the Umberto I teaching hospital of Rome.

Introduction: Hand hygiene is the most cost-effective procedure for the prevention of healthcare-associated infections, but healthcare worker compliance is often insufficient. Research design: The objective of this second cross-sectional study was to quantify hand hygiene compliance among the healthcare workers of a large teaching hospital, to explore associated factors and to compare results to those of the 2021 study. Methods: In 2022, educational sessions were conducted within each hospital department during which hospital healthcare workers received tailored feedback on the hand hygiene compliance registered in the previous year. Then, one month later, direct observations of hand hygiene compliance with five World Health Organization recommendations were collected again by anonymous observers in each ward. Data were grouped by healthcare area (clinical, surgical and intensive care), and three multivariable logistic regression models were built to identify predictors of hand hygiene compliance. Results: Overall, 5,426 observations were collected by 73 observers in three weeks. Hand hygiene compliance was 79.7%, 73.5% and 63.1% in clinical, surgical and intensive care areas, respectively, increasing in clinical wards but decreasing in surgical departments compared to the 2021 study. The multivariable analyses showed that hand hygiene compliance after patient contact was consistently higher than before patient contact, while there was some variability in compliance with other factors across the three areas. Conclusion: The study found suboptimal adherence to good hand hygiene practice, with the lowest rates observed before patient interaction, which, together with the variability recorded across departments, underscores the challenges involved in achieving a uniform level of compliance. Hence, additional training is essential to raise awareness among healthcare workers, while repeating this survey over time will also be crucial, so that hand hygiene compliance can be monitored and any major issue identified.

Prevalence and genomic characteristics of becAB-carrying Clostridium perfringens strains.

Clostridium perfringens, as a foodborne pathogen, can cause various intestinal diseases in both humans and animals according to its repertoire of toxins. In recent years, a multitude of studies have highlighted its threat to infants and young children. C. perfringens carries numerous toxins, with the newly identified BEC toxin confirmed as the second toxin to cause diarrheal illness, after CPE. However, the global dissemination of C. perfringens strains carrying becAB genes, which encode BEC toxins, has not been extensively studied. Following epidemiological surveillance of the prevalence of C. perfringens from different sources in various provinces of China, we identified two becAB-carrying strains and one strain carrying a sequence similar to becAB from distinct provinces and sources. When combined with genomic analysis of other becAB-carrying C. perfringens strains from public databases, we found that becAB was present in strains from different lineages. Our analysis of the plasmid and genetic environment corroborates previous findings on becAB-carrying strains, confirming that it currently achieves horizontal transmission through one type of evolutionarily conserved Pcp plasmid. This study provides a comprehensive analysis of the prevalence and transmission patterns of the newly emerged toxin gene locus, becAB, in C. perfringens. Despite the relatively low identification rate of becAB-carrying strains, their potential impact requires ongoing surveillance and investigation of their features, particularly their antimicrobial resistance.

DIU no morro: vivência do acesso aos direitos reprodutivos em Florianópolis, Santa Catarina / IUD at the slum: experience of access to reproductive rights in Florianópolis, Santa Catarina, Brazil / DIU no morro: experiencia de acceso a derechos reproductivos en Florianópolis, Santa Catarina, Brasil

Introdução: O dispositivo intrauterino de cobre (DIU) é um método contraceptivo eficaz, oferecido pelo Sistema Único de Saúde (SUS), mas pouco usado pelas mulheres brasileiras. Alguns motivos são: poucas profissionais habilitadas para inseri-lo, muitas etapas entre o desejo de usá-lo e a inserção e desconhecimento sobre o método. Objetivo: O objetivo deste estudo foi compreender o acesso e a vivência de mulheres que inseriram o DIU fora do espaço do centro de saúde (CS), no espaço da escola/creche de sua comunidade em Florianópolis, Santa Catarina. Métodos: As profissionais de saúde do CS Agronômica em Florianópolis organizaram ações "extramuros" dentro do território, aos sábados, durante os anos de 2022 e 2023. As ações aconteceram nas escolas/creches nos territórios menos privilegiados de cobertura do CS Agronômica nas comunidades do Morro do 25/Nova Trento, do Morro do Horácio e do Morro do Macaco. Essas ações objetivaram facilitar o acesso de toda a população a alguns serviços disponibilizados pela Atenção Primária à Saúde, entre eles a inserção do DIU. Esta é uma pesquisa exploratória, descritiva com abordagem qualitativa. Os dados foram coletados a partir de entrevistas semiestruturadas. As participantes do estudo foram mulheres que inseriram o DIU durante alguma das ações e voluntariamente demonstraram interesse em participar da pesquisa. Das 40 mulheres que acessaram a inserção do DIU, nove fizeram a entrevista, tendo seu áudio gravado e transcrito. Foi realizada uma análise temática em quatro fases: pré-análise; exploração do material; tratamento dos resultados; e elaboração de diagrama dos achados. Resultados: Todas as mulheres entrevistadas inseriram o DIU como segunda ou terceira opção de método contraceptivo por má adaptação aos outros, como pílula e injetáveis. Algumas apresentaram medo quanto à higiene e à privacidade do local, porém após visitarem as salas adaptadas, consideraram-nas limpas e adequadas. Também referiram que o espaço era mais acolhedor se comparado ao CS. Todas elas afirmaram que o acesso para a inserção do DIU foi facilitado pela ação, e isso ocorreu por vários motivos, como: horário de folga do trabalho; proximidade com suas casas; possibilidade de levar seus filhos; e não necessidade de agendamento. Conclusões: A inserção do DIU fora do local convencional, por ser mais próximo das casas e em horário alternativo ao de trabalho, favoreceu o acesso ao procedimento. Portanto, essas ações podem ser um caminho para a garantia do planejamento familiar e do direito reprodutivo no Brasil.

Introduction: The copper intrauterine device (IUD) is an effective contraceptive method, offered by the Brazilian National Health System (SUS), but little used by Brazilian women. Some reasons are: few professionals qualified to insert it, many steps between the desire to use it and insertion and lack of knowledge about the method. Objective: The aim of this study is to understand the access and experience of women who inserted the IUD outside the Health Center space, at schools/nurseries in their community in Florianópolis. Methods: Health professionals from Agronômica's Primary Care Health Center (PCHC) localized in Florianópolis, Brazil, organized actions on Saturdays between 2022 and 2023. The actions took place in schools of less privileged territories covered by Agronômica PCHC in the communities of Morro do 25/Nova Trento, Morro do Horácio, and Morro do Macaco. These actions aimed to facilitate access for the entire population to some services provided by Primary Health Care, including the insertion of the IUD. This is an exploratory, descriptive research with a qualitative approach. Data were collected from semi-structured interviews. The study participants were women who inserted the IUD during one of the actions and voluntarily demonstrated interest in participating in the research. Of the 40 women who accessed the IUD insertion, 9 completed the interview, which had its audio recorded and transcribed. A thematic analysis was carried out in four phases: pre-analysis; exploration of the material; treatment of results and preparation of a diagram of findings. Results: All women interviewed inserted the IUD as a second or third contraceptive method option due to poor adaptation to others, such as pills and injectables. Some were afraid about the hygiene and privacy of the place, but after visiting the adapted rooms they considered it clean and adequate. They also mentioned that the space was more welcoming compared to the PCHC. They all stated that access for IUD insertion was facilitated by the Saturday's actions due to several reasons, such as: time off work; proximity to their homes; Possibility to bring their children and no need to make an appointment. Conclusions: Inserting the IUD near the house where these women live and outside of the health center, at the slum at an alternative time to work, favored access to the procedure. Therefore, these actions can be a path to guaranteeing family planning and reproductive rights in Brazil.

Introducción: El dispositivo intrauterino (DIU) de cobre es un método anticonceptivo eficaz, ofrecido por el Sistema Único de Salud (SUS), pero poco utilizado por las mujeres brasileñas. Algunas razones son: pocos profesionales capacitados para insertarlo, muchos pasos entre el deseo de utilizarlo y la inserción y desconocimiento sobre el método. Objetivo: El objetivo de este estudio era comprender el acceso y la experiencia de mujeres que insertaron el DIU fuera del espacio del Centro de Salud (CS), en el espacio de las escuelas/guarderías de su comunidad en Florianópolis. Métodos: Profesionales de la salud de CS Agronômica en Florianópolis organizaron acciones "extramuros" dentro del territorio, los sábados, durante 2022 y 2023. Las acciones tuvieron lugar en escuelas/guarderías de los territorios menos privilegiados cubiertos por CS Agronômica en las comunidades del Morro do 25/Nova Trento, Morro do Horácio y Morro do Macaco. Estas acciones tuvieron como objetivo facilitar el acceso de toda la población a algunos servicios brindados por la Atención Primaria de Salud, incluida la inserción del DIU. Se trata de una investigación exploratoria, descriptiva y con enfoque cualitativo. Los datos fueron recolectados a partir de entrevistas semiestructuradas. Las participantes del estudio fueron mujeres que insertaron el DIU durante una de las acciones y demostraron voluntariamente interés en participar de la investigación. De las 40 mujeres que accedieron a la inserción del DIU, 9 completaron la entrevista, cuyo audio fue grabado y transcrito. Se realizó un análisis temático en cuatro fases: preanálisis; exploración del material; tratamiento de resultados y elaboración de un diagrama de hallazgos. Resultados: Todas las mujeres entrevistadas insertaron el DIU como segunda o tercera opción de método anticonceptivo debido a la mala adaptación a otros, como píldoras e inyectables. Algunos temían por la higiene y privacidad del lugar adaptado, pero al visitar las habitaciones adaptadas las consideraron limpias y adecuadas. También mencionaron que el espacio era más acogedor en comparación con CS. Todas manifestaron que la acción facilitó el acceso para la inserción del DIU y esto se debió a varios motivos, tales como: horario alternativo; proximidad a sus hogares; posibilidad de traer sus hijos y la ausencia de necesidad de cita previa. Conclusiones: La inserción del DIU fuera del CS, por estar más cerca de casa y en un horario alternativo al trabajo, favoreció el acceso al procedimiento. Por lo tanto, estas acciones pueden ser un camino para garantizar la planificación familiar y los derechos reproductivos en Brasil.

Vivência de grupo de apoio em saúde mental na atenção primária: um relato de experiência / Mental health support group in primary health care: an experience report / Grupo de apoyo de salud mental en atención primaria: un informe de experiencia

Problema: Entre os desafios enfrentados na temática de transtornos mentais no Brasil, é pertinente destacar a escassez de recursos e serviços, sua integração e o estigma em torno da doença mental. Apesar das dificuldades, alguns progressos significativos estão sendo inseridos nesse cuidado, como é o exemplo das intervenções em grupo na atenção básica. Método: Este relato de experiência descreve e analisa a implementação de um grupo terapêutico em uma Unidade Básica de Saúde para contribuir com o enriquecimento da intervenção coletiva em pacientes com queixas de saúde mental. A proposta foi trabalhar em conjunto com pacientes com queixa de ansiedade ou depressão após analisar a grande demanda da população adscrita na área por esse cuidado. Resultados: Após dois meses de encontros semanais, foi possível ir além das práticas convencionais oferecidas nos grupos, proporcionando às equipes de saúde a oportunidade de refletir sobre alternativas para promover mudanças nas formas de atenção à saúde mental. Conclusão: Além de estimular a troca de saberes entre universitários, profissionais e comunidade, a implementação de grupos terapêuticos se mostrou promissora no cuidado aos transtornos mentais e como forma de reabilitação psicossocial na atenção básica.

Problem: Among the challenges faced in the mental disorders field in Brazil, it is pertinent to highlight the scarcity of resources and services, their integration, and the stigma surrounding mental illness. Despite the difficulties, some significant progress is being achieved in this care such as group interventions in primary health care. Methods: The implementation of a therapeutic group in a Health Center is described and analyzed in this experience report, aiming at contributing to the enrichment of collective intervention in patients with mental health complaints. The aim was to work together with patients complaining about anxiety or depression after analyzing a great demand in the area for this care. Results: After two months of weekly meetings, we could go beyond the conventional practices offered in groups, providing the health teams with the opportunity to reflect on alternatives to promote changes in the forms of mental health care. Conclusions: In addition to stimulating the exchange of knowledge between university students, professionals, and the community, the implementation of therapeutic groups showed to be promising in the care of mental disorders and as a psychosocial rehabilitation method in primary health care.

Problema: entre los desafíos enfrentados en el campo de los trastornos mentales en Brasil, es pertinente destacar la escasez de recursos y servicios, su integración y el estigma que rodea a la enfermedad mental. A pesar de las dificultades, se están insertando algunos avances significativos en esta atención, como es el ejemplo de las intervenciones grupales en la atención primaria. Método: Este relato de experiencia describe y analiza la implementación de un grupo terapéutico en una Unidad Básica de Salud para contribuir al enriquecimiento de la intervención colectiva en pacientes con problemas de salud mental. La propuesta fue trabajar en conjunto con pacientes que se quejan de ansiedad o depresión luego de analizar la gran demanda de la población inscrita en el área para esta atención. Resultados: Después de dos meses de encuentros semanales, fue posible ir más allá de las prácticas convencionales ofrecidas en los grupos, brindando a los equipos de salud la oportunidad de reflexionar sobre alternativas para promover cambios en las formas de atención a la salud mental. Conclusión: además de estimular el intercambio de conocimientos entre universitarios, profesionales y la comunidad, la implementación de grupos terapéuticos se ha mostrado prometedora en la atención de los trastornos mentales y como forma de rehabilitación psicosocial en la atención primaria.

Retos y alcances de la salud pública para la comprensión de problemáticas psicosociales contemporáneas / Challenges and Scope of Public Health for the Understanding of Contemporary Psychosocial Problems

Resumen Introducción: El concepto de salud pública aparece con frecuencia en las prácticas disciplinares de las ciencias de la salud, sociales y humanas. Sin embargo, la salud pública es objeto de debate debido a su naturaleza multifacética e interdisciplinaria. Esta variabilidad se atribuye a las diferencias en cómo cada disciplina interpreta y aplica el concepto, basándose en su propia comprensión de las problemáticas que buscan intervenir. Objetivo: Analizar críticamente el concepto de salud pública y su objeto de estudio a partir de su relación y diferenciación con distintos enfoques en psicología y medicina. Método: Se trató de un estudio de reflexión y análisis crítico de las diferentes conceptualizaciones y aplicaciones de la salud pública. Reflexión: Se abordaron tres debates relevantes: los vínculos de la salud pública con la psicología y la medicina (1), el objeto de estudio de la salud pública (2) y los retos para abordar problemas sociales y de salud actuales (3). Se discute la evolución histórica del concepto de salud pública, su carácter interdisciplinar y su adaptabilidad a los contextos sociopolíticos y a las emergentes problemáticas sociales contemporáneas. Conclusión: Se destaca la interdisciplinariedad para atender los retos emergentes, centrando esfuerzos en mitigar factores multidimensionales asociados con la salud y el bienestar global, así como la relevancia de fortalecer las estructuras organizativas, desarrollar políticas adecuadas y contar con sistemas epidemiológicos robustos para enfrentar desafíos actuales y futuros.

Abstract Introduction: The concept of public health appears frequently in the disciplinary practices of health, social, and human sciences. However, the concept of public health is controversial because of its multifaceted and interdisciplinary nature. This happens because its meaning, theorization, and application vary according to how each discipline understands the issues it seeks to address. Objective: To critically analyze the concept of public health and its object of study, based on its relationship and differentiation with different approaches in psychology and medicine. Methodology: This was a study of reflection and critical analysis of the different conceptualizations and applications of public health. Reflection: Three relevant debates have been addressed: the links of public health with psychology and medicine (1), the object of study of public health (2), and the challenges to address current social and health problems (3). The historical evolution of the concept of public health, its interdisciplinary nature, and its adaptability to sociopolitical contexts and emerging contemporary social issues are discussed. Conclusion: Interdisciplinarity is emphasized to address emerging challenges, focusing efforts on mitigating multidimensional factors associated with global health and well-being, as well as the importance of strengthening organizational structures, developing appropriate policies, and having robust epidemiological systems to face current and future challenges.

Implementación de un modelo de complementación público-privado (AMSJ - ASSE) de Asistencia Paliativa en el departamento de San José, Uruguay

Introducción: En inicios del año 2015 se implementa el convenio de complementación público-privado entre los dos principales prestadores del Departamento de San José - Uruguay: AMSJ y ASSE San José, conformándose así la Unidad Departamental de Medicina Paliativa de San José (UDMP). El convenio tiene como principal objetivo asegurar la asistencia paliativa a todos los usuarios de los prestadores involucrados con los principios fundamentales de calidad, equidad y accesibilidad, siguiendo los lineamientos del Plan Nacional de Cuidados Paliativos del Ministerio de Salud Pública de Uruguay. El objetivo es describir y analizar la experiencia de la implementación del primer modelo de complementación público-privado del país en Cuidados Paliativos (CP). Metodología: Estudio descriptivo analítico, retrospectivo que incluye datos de los primeros siete años de funcionamiento del convenio. Resultados: El convenio de complementación público-privado en el Departamento de San José, permitió la creación de un equipo interdisciplinario que asistió en forma continua a 1422 pacientes provenientes de zonas urbanas y rurales, portadores de diversas patologías. La cobertura departamental de CP aumentó de forma significativa, pasando de 24 % en 2014 a 57% en 2021. Estos resultados se lograron implementando un modelo de asistencia paliativa que asegura la continuidad asistencial en internación, consultorio y domicilio, que permitió respetar la autonomía del paciente, logrando el fallecimiento de 67% de los pacientes en su hogar. La satisfacción de usuarios y familiares de la asistencia brindada fue evaluada como muy buena. Conclusiones: El convenio de complementación resultó ser una herramienta eficiente para favorecer el acceso a CP, evitando la superposición de equipos en la asistencia domiciliaria en todo el departamento de San José.

Introduction: At the beginning of 2015, the public-private complementarity agreement was implemented between the two main providers of the Department of San José Uruguay: AMSJ and ASSE San José, thus forming the Departmental Unit of Palliative Medicine of San José (UDMP). The main objective of the agreement is to ensure palliative care to all users of the providers involved, with the fundamental principles of quality, equity and accessibility, following the guidelines of the National Palliative Care Plan of the Ministry of Public Health of Uruguay. The objective is describe and analyze the experience of implementing the country's first public-private complementation model in Palliative Care (PC). Methodology: Descriptive, analytical, retrospective study that includes data from the first seven years of operation of the agreement. Results: The public-private complementation agreement in the Department of San José allowed the creation of an interdisciplinary team that continuously assisted 1,422 patients from urban and rural areas, with various pathologies. Departmental CP coverage increased significantly, from 24% in 2014 to 57% in 2021. These results were achieved by implementing a palliative care model that ensures continuity of care in hospitalization, office and home, which allowed the patient's autonomy to be respected, achieving the death of 67% of patients at home. The satisfaction of users and family members with the assistance provided was evaluated as very good. Conclusions: The complementation agreement turned out to be an efficient tool to promote access to CP, avoiding the overlap of teams in home care throughout the department of San José.

Introdução: No início de 2015, foi implementado o acordo de complementaridade público-privado entre os dois principais prestadores do Departamento de San José Uruguai: AMSJ e ASSE San José, formando assim a Unidade Departamental de Medicina Paliativa de San José (UDMP). O principal objetivo do acordo é garantir cuidados paliativos a todos os usuários dos prestadores envolvidos, com os princípios fundamentais de qualidade, equidade e acessibilidade, seguindo as diretrizes do Plano Nacional de Cuidados Paliativos do Ministério de Saúde Pública do Uruguai. El objetivo es descrever e analisar a experiência de implementação do primeiro modelo de complementação público-privada em Cuidados Paliativos (CP) do país. Metodologia: Estudo descritivo, analítico, retrospectivo que inclui dados dos primeiros sete anos de vigência do convênio. Resultados: O acordo de complementação público-privada no Departamento de San José permitiu a criação de uma equipe interdisciplinar que atendeu continuamente 1.422 pacientes de áreas urbanas e rurais, com diversas patologias. A cobertura departamental do CP aumentou significativamente, de 24% em 2014 para 57% em 2021. Estes resultados foram alcançados através da implementação de um modelo de cuidados paliativos que garante a continuidade dos cuidados no internamento, no consultório e no domicílio, o que permitiu respeitar a autonomia do doente, atingindo a morte de 67% dos doentes no domicílio. A satisfação dos usuários e familiares com a assistência prestada foi avaliada como muito boa. Conclusões: O convênio de complementação revelou-se uma ferramenta eficiente para promover o acesso à CP, evitando a sobreposição de equipes na atenção domiciliar em todo o departamento de San José.

Comparative analysis of the incidence of enteroparasitosis andthe COVID-19 pandemic profile in the city of Bananeiras - PB / Análise comparativa da incidência de enteroparasitoses e doperfil pandêmico da COVID-19 na cidade de Bananeiras - PB

Enteroparasitosis are diseases caused by parasitic agents present in the environment and in the gastrointestinal tract of living beings. In addition, they are still considered neglected diseases, but of great importance for public health, especially when they are related to secondary infections and currently their co-infection profile with COVID-19. The interaction of protozoa and/or helminths with the SARS-CoV-2 virus is timely and its signs and symptoms are confused with other pathogen relationships. In this way, this study aims to correlate the incidence of enteroparasitosis and COVID-19, in the pandemic period from 2020 to April 2022. This is a documentary and exploratory study of secondary data from laboratory tests of patients who were treated and diagnosed with COVID-19 and enteroparasitosis at Hospital Doutor Cloves Bezerra Cavalcante, Municipal Hospital of Bananeiras, Paraíba, Brazil. In the analysis of the database, a significant increase of approximately 48.85% in the incidence of COVID-19 cases from 2020 to 2021 stands out, remaining high until 2022. In contrast, cases of enteroparasites peaked at 48.74% in 2021, followed by an average reduction of 23.12%, with a deviation of 1.49%, in relation to the years 2020 and 2022. It was concluded that COVID-19 is predominantly associated with an increase in secondary infections, highlighting the crucial need to promote health education, improve basic sanitation and guarantee access to health services as essential components in combating the increase in parasitic infections, especially those related to viral pathologies.

As enteroparasitoses são enfermidades originadas por agentes parasitários presentes no meio ambiente e no trato gastrointestinal dos seres vivos. Ademais, ainda são consideradas doenças negligenciadas, porém de grande importância para a saúde pública, em especial, quando estão relacionadas com infecções secundárias e atualmente seu perfil de coinfecção com a COVID-19. A interação de protozoários e/ou helmintos com o vírus SARS-CoV-2 é oportuna e seus sinais e sintomas são confundidos com outras relações de patógenos. Desta maneira, este estudo visa correlacionar a incidência de enteroparasitoses e COVID-19, no período pandêmico de 2020 a abril de 2022. Trata--se de uma pesquisa documental e exploratória, de dados secundários dos exames laboratoriais de pacientes que foram atendidos e diagnosticados com COVID-19 e enteroparasitoses no Hospital Doutor Cloves Bezerra Cavalcante, Hospital Municipal de Bananeiras, Paraíba, Brasil. Na análise da base de dados, destaca-se um aumento significativo de aproximadamente 48,85% na incidência de casos de COVID-19 de 2020 a 2021, mantendo-se elevado até 2022. Em contraste, os casos de enteroparasitas atingiram um pico de 48,74% em 2021, seguido por uma redução média de 23,12%, com um desvio de 1,49%, em relação aos anos de 2020 e 2022. Conclui-se que a COVID-19 está predominantemente associada ao aumento de infecções secundárias, destacando a necessidade crucial de promover a educação em saúde, melhorar o saneamento básico e garantir o acesso aos serviços de saúde como componentes essenciais no combate ao aumento de infecções parasitárias, especialmente aquelas relacionadas a patologias virais.

'They Don't Want to Label It': Insights from Communities Not Enrolled in the Network of Age-Friendly States and Communities.

More than 800 municipalities and 11 states and territories in the United States have joined the Network of Age-Friendly States and Communities (NAFSC); however, to our knowledge, no studies have examined the many communities that have not joined. The present study explored the factors that inhibit communities from joining the NAFSC. Data were drawn from semi-structured interviews conducted with 12 community leaders in Massachusetts and Maine. Results indicated variation in perceptions and attitudes, with some participants seeing benefits to joining but encountering barriers to doing so, while others did not see sufficient benefit to joining to make the effort worthwhile. Key themes included lack of human and financial capacity, concerns over aspects of the NAFSC model, and desire to maintain local control over the process and components of age-friendly efforts. Participants voiced a need for funding and technical assistance in order to expand their age-friendly work.

The impact of lactose intolerance diagnosis: costs, timing, and quality-of-life.

Lactose intolerance (LI) is a very common condition but, despite many efforts of the Italian National Health Service to reduce diagnostic delay of chronic disorders and provide prompt treatments, its early diagnosis remains an unmet need. In addition, the COVID-19 pandemic has exacerbated this problem, due to the conversion of many public health services to COVID centers. This study aims to analyze the diagnostic journey of patients suffering from LI, taking into account the duration of the process, associated costs, and impact on quality of life. Anonymous surveys were designed and distributed to patients with LI as well as physicians involved in LI management. The data were analyzed to determine the time required for a reliable LI diagnosis and average costs. Diagnostic delay of LI proved to be longer than 2 years, its impact on quality of life proved to be moderate to high in most of participants, especially in their psychosocial domain, and average costs proved to be high. Further investigations are needed to determine the economic burden of maintaining an asymptomatic status in patients with LI.

Murine typhus: an underappreciated influence on human disease transmission dynamics.

Murine typhus, a vector-borne illness transmitted by fleas and caused by Rickettsia typhi, presents significant public health challenges globally. Despite its impact, it often remains underrecognized in health systems. This disease is characterized by non-specific symptoms such as fever, rash, and severe complications in cases involving neurological or multi-organ involvement. The complexity of its clinical presentation frequently leads to misdiagnosis and underreporting, obscuring true transmission dynamics and impeding effective management. Highlighting the need for enhanced diagnostic methods, targeted public health interventions, and increased awareness, this review calls for a strategic focus to better understand and mitigate the influence of murine typhus on global health.

"Effect of improving sustainable transportation indicators on quality of life in Tehran".

Although transportation has a fundamental role in economic development and the urban life cycle, its negative consequences, such as air pollution, global warming, traffic, accidents, destruction of natural habitats, significant consumption of fossil fuels, and noise pollution, are non-negligible. These adverse effects have reduced citizens' quality of life (QOL). To decrease the complications caused by urban transportation, sustainable transportation (ST) has been recommended, which simultaneously considers three dimensions (environmental, social, and economic). Like other big cities, the metropolis of Tehran, with a population of over nine million people, is experiencing many challenges due to the lack of integration in the transportation network despite the presence of private transportation (PRT) and public transportation (PT). Air pollution, traffic, accidents, and travel time have affected the reduction of (QOL) in Tehran city. This research goal is to design an integrated model (SD) using indicators (ST) for Tehran transportation to evaluate the impact of these indicators on the (QOL) of residents of Tehran. This model using widely used (ST) indicators are designed and simulated in vansim software with four distinct scenarios. The simulation showed that with the continuation of the current conditions, the performance of ninety percent of indicators will worsen, and the (QOL) in Tehran will decrease (-60%). The best performance of the indicators is related to the simulation of the fourth scenario (doubling the price of gasoline and the capacity of (PT) and reducing the cost of access to (PT) by 50%, which improves the 93% performance of indicators and the (QOL) in Tehran by +206% (up from -60 % to +146%) compared to the current conditions.

Preventive Human Genome Editing and Enhancement: Candidate Criteria for Governance.

While somatic cell editing to treat disease is widely accepted, the use of human genome editing for "enhancement" remains contested. Scientists and policy-makers routinely cite the prospect of enhancement as a salient ethical challenge for human genome editing research. If preventive genome editing projects are perceived as pursuing human enhancement, they could face heightened barriers to scientific, public, and regulatory approval. This article outlines what we call "preventive strengthening research" (or "PSR") to explore, through this example, how working to strengthen individuals' resistance to disease beyond what biomedicine considers to be the human functional range may be interpreted as pursuing human enhancement. Those involved in developing guidance for PSR will need to navigate the interface between preventive goals and enhancement implications. This article identifies and critiques three of these ideas in the interest of anticipating the wider emergence of PSR and the need for a normative approach for its pursuit. All three "candidate criteria" merit attention, but each also faces challenges that will need to be addressed as further research policy is developed.

Induction of IGHV3-53 public antibodies with broadly neutralising activity against SARS-CoV-2 including Omicron subvariants in a Delta breakthrough infection case.

BACKGROUND: Emergence of SARS-CoV-2 variants that escape neutralising antibodies hampers the development of vaccines and therapeutic antibodies against SARS-CoV-2. IGHV3-53/3-66-derived public antibodies, which are generally specific to the prototype virus and are frequently induced in infected or vaccinated individuals, show minimal affinity maturation and high potency against prototype SARS-CoV-2. METHODS: Monoclonal antibodies isolated from a Delta breakthrough infection case were analysed for cross-neutralising activities against SARS-CoV-2 variants. The broadly neutralising antibody K4-66 was further analysed in a hamster model, and the effect of somatic hypermutations was assessed using the inferred germline precursor. FINDINGS: Antibodies derived from IGHV3-53/3-66 showed broader neutralising activity than antibodies derived from IGHV1-69 and other IGHV genes. IGHV3-53/3-66 antibodies neutralised the Delta variant better than the IGHV1-69 antibodies, suggesting that the IGHV3-53/3-66 antibodies were further maturated by Delta breakthrough infection. One IGHV3-53/3-66 antibody, K4-66, neutralised all Omicron subvariants tested, including EG.5.1, BA.2.86, and JN.1, and decreased the viral load in the lungs of hamsters infected with Omicron subvariant XBB.1.5. The importance of somatic hypermutations was demonstrated by the loss of neutralising activity of the inferred germline precursor of K4-66 against Beta and Omicron variants. INTERPRETATION: Broadly neutralising IGHV3-53/3-66 antibodies have potential as a target for the development of effective vaccines and therapeutic antibodies against newly emerging SARS-CoV-2 variants. FUNDING: This work was supported by grants from AMED (JP23ym0126048, JP22ym0126048, JP21ym0126048, JP23wm0125002, JP233fa627001, JP223fa627009, JP24jf0126002, and JP22fk0108572), and the JSPS (JP21H02970, JK23K20041, and JPJSCCA20240006).

Heatwaves, biodiversity and health in times of climate change.

OBJECTIVES: This article discusses heatwaves (HWs), their definitions, and increasing frequencies associated with climate change, as well as their effects on human health, especially on children and vulnerable groups. It emphasizes the need for interdisciplinary studies to better understand the effects of HWs and preventive actions to mitigate the effects caused by this phenomenon. DATA SOURCE: The data were obtained from recent studies, conducted in Brazil and abroad, on the impacts of HWs. The figures were attained with data provided by the Climate Change Knowledge Portal. DATA SUMMARY: HWs are periods of extreme heat, modulated by climate phenomena such as El Niño and the Pacific Decadal Oscillations. The frequency and intensity of HWs have increased since the 1950s, driven by climate change. HWs affect public health by increasing the risk of mortality from respiratory and cardiovascular diseases. Children are more vulnerable to problems such as fever caused by heatstroke, respiratory and kidney infections, as well as risks such as sudden infant death syndrome. Almost half of the HW episodes observed in South America in this century occurred in Brazil, mainly in socioeconomically vulnerable regions. CONCLUSIONS: The increase in the number of HWs is a direct consequence of climate change and has severe impacts on public health and biodiversity. Vulnerable groups suffer more from these phenomena, and social inequalities aggravate the problems. It is essential to promote awareness, implement effective public policies and encourage interdisciplinary research to mitigate the effects of HWs on society.

Genome-Wide Association Study of Temporomandibular Disorder-Related Pain in Finnish Populations.

BACKGROUND: Temporomandibular disorders (TMD) are multifactorial musculoskeletal pain and dysfunctions in temporomandibular joints (TMJs) and masticatory muscles. Genetic factors play a role in TMD-related pain, but only a few genome-wide association studies (GWAS) have been conducted. OBJECTIVE: The aim of this GWAS was to explore genetic factors associated with painful TMD in Finnish populations. METHODS: Data from two epidemiological surveys, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Health 2000 Survey in Finland, including altogether 468 cases and 6833 controls, were used. Case definition was based on pain on palpation of masticatory muscles and/or TMJs. GWASs of the whole data and stratified by sex were conducted from both cohorts using additive models, followed by meta-analysis of the two cohorts. Replications of the previously reported TMD risk loci (rs73460075, DMD; rs4794106, SGCA; rs73271865, SP4; rs60249166, RXP2; rs1531554, BAHCCI; rs5862730, OTUD4/SMAD1; rs10092633, SFRP1; rs34612513, SOX14/CLDN18; rs878962, TSPAN9) were also investigated. RESULTS: Four genome-wide significant loci were found in sex-stratified analysis of NFBC1966, including associations at three loci in males (rs1023114, PRIM2, p = 5 × 10-9; rs4244867, ALG10, p = 3 × 10-8; rs79841648, ADCYAP1, p = 4 × 10-9) and one locus in females (rs148476652, DNER, p = 4 × 10-9). However, the results could not be replicated in the Health 2000 Survey or in the meta-analysis of these two cohorts. The previous TMD GWAS associations did not replicate in our data either. CONCLUSION: Several TMD pain-associated variants were found in sex-stratified analysis of NFBC1966, suggesting the role of neuroendocrine stress responses and central nervous system. These findings need to be confirmed in future studies.

Mathematical modeling of infectious diseases and the impact of vaccination strategies.

Mathematical modeling plays a crucial role in understanding and combating infectious diseases, offering predictive insights into disease spread and the impact of vaccination strategies. This paper explored the significance of mathematical modeling in epidemic control efforts, focusing on the interplay between vaccination strategies, disease transmission rates, and population immunity. To facilitate meaningful comparisons of vaccination strategies, we maintained a consistent framework by fixing the vaccination capacity to vary from 10 to 100% of the total population. As an example, at a 50% vaccination capacity, the pulse strategy averted approximately 45.61% of deaths, while continuous and hybrid strategies averted around 45.18 and 45.69%, respectively. Sensitivity analysis further indicated that continuous vaccination has a more direct impact on reducing the basic reproduction number $ R_0 $ compared to pulse vaccination. By analyzing key parameters such as $ R_0 $, pulse vaccination coefficients, and continuous vaccination parameters, the study underscores the value of mathematical modeling in shaping public health policies and guiding decision-making during disease outbreaks.

The negative impact of the COVID-19 pandemic on breast cancer care in Brazil: a time series study in regions with different human development indices.

BACKGROUND: The impact of the COVID-19 pandemic on breast cancer care across Brazilian regions with varying Human Development Index (HDI) levels remains unclear. This study evaluates the pandemic's effects on screening mammograms, tumor staging at diagnosis, and treatment initiation in the Brazilian Public Health System between 2017 and 2022, focusing on regions with different HDI levels. METHODS: This ecological time series study uses an inflection point regression model and monthly percentage change (MPC) to analyze an open-access Brazilian Public Healthcare System dataset. The study focuses on trends and variations in these variables among women aged 50-69 in three state groups classified by HDI: Group A (very high), Group B (medium), and Group C (high). RESULTS: The average monthly rate of screening mammograms was highest in Group A (10.70) and lowest in Group B (8.38). At the onset of the COVID-19 pandemic, screening rates dropped significantly, with the most significant decline in Group B (58.6% decrease) and the smallest in Group A (45.7% decrease), lasting for three months. Subsequently, this variable recovered until December 2022 but was insufficient to restore the total series MPC to pre-pandemic levels. Group B had the lowest average rate of early-stage (0-II) diagnoses (2.88), while Group C had the highest (3.68). Early-stage diagnoses declined in the first three months of the pandemic, followed by a partial recovery that was insufficient to restore the pre-pandemic MPC levels. The proportion of advanced-stage diagnoses was highest in Group B (49.02%) and lowest in Group A (45.97%). The pandemic maintained the upward trend of advanced-stage (III-IV) diagnoses across all groups in the total time series. The average proportion of treatments initiated after 60 days of diagnosis was above 60% across all groups, with Group B at 64.50%. This variable began to rise 3 to 4 months after the pandemic and continued increasing until December 2022, with a greater intensity than the pre-pandemic period across all groups. CONCLUSION: The COVID-19 pandemic reduced breast cancer screening and early diagnosis in Brazil, leading to more advanced cases and treatment delays across all regions, with varying impacts according to regional HDI levels.