Genomic surveillance reveals dynamic shifts in the connectivity of COVID-19 epidemics.

The maturation of genomic surveillance in the past decade has enabled tracking of the emergence and spread of epidemics at an unprecedented level. During the COVID-19 pandemic, for example, genomic data revealed that local epidemics varied considerably in the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage importation and persistence, likely due to a combination of COVID-19 restrictions and changing connectivity. Here, we show that local COVID-19 epidemics are driven by regional transmission, including across international boundaries, but can become increasingly connected to distant locations following the relaxation of public health interventions. By integrating genomic, mobility, and epidemiological data, we find abundant transmission occurring between both adjacent and distant locations, supported by dynamic mobility patterns. We find that changing connectivity significantly influences local COVID-19 incidence. Our findings demonstrate a complex meaning of "local" when investigating connected epidemics and emphasize the importance of collaborative interventions for pandemic prevention and mitigation.

A diverse portfolio of marine protected areas can better advance global conservation and equity.

Marine protected areas (MPAs) are widely used for ocean conservation, yet the relative impacts of various types of MPAs are poorly understood. We estimated impacts on fish biomass from no-take and multiple-use (fished) MPAs, employing a rigorous matched counterfactual design with a global dataset of >14,000 surveys in and around 216 MPAs. Both no-take and multiple-use MPAs generated positive conservation outcomes relative to no protection (58.2% and 12.6% fish biomass increases, respectively), with smaller estimated differences between the two MPA types when controlling for additional confounding factors (8.3% increase). Relative performance depended on context and management: no-take MPAs performed better in areas of high human pressure but similar to multiple-use in remote locations. Multiple-use MPA performance was low in high-pressure areas but improved significantly with better management, producing similar outcomes to no-take MPAs when adequately staffed and appropriate use regulations were applied. For priority conservation areas where no-take restrictions are not possible or ethical, our findings show that a portfolio of well-designed and well-managed multiple-use MPAs represents a viable and potentially equitable pathway to advance local and global conservation.

Rebound of Gonorrhea after Lifting of COVID-19 Preventive Measures, England.

After lifting of all COVID-19 preventive measures in England in July 2021, marked, widespread increases in gonorrhea diagnoses, but not testing numbers, were observed, particularly in persons 15-24 years of age. Continued close surveillance and public health messaging to young persons are needed to control and prevent gonorrhea transmission.

Rehabilitation in patients with newly diagnosed epilepsy: A controlled, 1-year follow-up study on a specialized inpatient rehabilitation program.

OBJECTIVES: To evaluate the efficacy of a specialized inpatient rehabilitation program in patients with newly diagnosed epilepsy (NDE), who had been referred within 1 year after diagnosis. METHODS: We performed an open, prospective, controlled study comparing a 1-year follow-up assessment of patients with NDE after completing a rehabilitation program at an epilepsy center (rehabilitation group) with a control group of patients with similar epilepsy duration, but without rehabilitation in the first year after diagnosis. Primary outcome measures comprised emotional adaptation to epilepsy, depression and anxiety; and secondary outcome measures were overall quality of life (QoL), overall health, perceived restrictions because of epilepsy, level of information about epilepsy, and employment status. RESULTS: Comparison of the admission data of 74 rehabilitation group patients (mean age and SD 47.7 ± 13.0 years) with the pre-rehabilitation assessment of 56 control patients (45.5 ± 12.1 years) revealed no significant differences concerning sociodemographic and health data. Comparison of the follow-up assessment of the rehabilitation group and the pre-rehabilitation assessment of the control group showed significantly better values for the rehabilitation group on emotional adaptation to epilepsy (p = .003), overall QoL (p = .006) and overall health (p = .011), perceived restrictions because of epilepsy, and subjective level of information about epilepsy (both p's < .001). There were no statistically significant differences concerning depression and anxiety or employment status (all p's > .50). One year after rehabilitation, patients in the rehabilitation group were more often seizure-free and less often on sickness absence than control group patients (both p's < .001). SIGNIFICANCE: Since reduced QoL shortly after diagnosis of NDE is associated with seizure recurrence, an early identification of patients with a greater need for support seems important. This epilepsy-related rehabilitation program showed lasting effects on several aspects of adaptation to epilepsy and QoL.

A statement on abortion by 900 professors of obstetrics and gynecology after the reversal of Roe vWade.

In the American Journal of Obstetrics and Gynecology in 1972 and 2013, 100 leaders in obstetrics and gynecology wrote calls to action-in 1972 in anticipation of the Roe v Wade decision and in 2013 in concern over the increasing restrictions to abortion care. In this article, 900 professors support a call to action for reinstating federal protections for abortion. Over a year ago, the Supreme Court handed down the Dobbs decision, overturning nearly 50 years of precedent in retracting the constitutionally protected right to abortion. The medical community is already seeing the harms of this decision on the lives and health of our patients and on the ability to train upcoming physicians in this medically necessary evidence-based care. Further harms are anticipated, including negative effects on maternal mortality. The 900 professors of obstetrics and gynecology whose signatures appear at the conclusion of this article stand together in support of reproductive freedom, including the right to affordable, accessible, safe, and legal abortion care.

Decreasing parvovirus B19 and hepatitis A nucleic acid test positivity rates in Canadian plasma donors following the initiation of COVID-19 restriction in March 2020.

BACKGROUND AND OBJECTIVES: In Canada, plasma sent for fractionation is tested for both parvovirus B19 (B19V) and hepatitis A virus (HAV). This study compared positivity rates of B19 and HAV nucleic acid tests (NATs) in Canadian plasma samples for the pre-COVID-19 restriction era (2015 to end of February 2020 [Q1] 2020) and the post-COVID-19 restriction era. MATERIALS AND METHODS: Pooled EDTA plasma specimens were tested within 24 months of blood draw using the Procleix Panther System (Grifols Diagnostic Solutions Inc, San Diego, CA, USA) for B19V and HAV detection. Reactive pools were resolved by individual specimen testing. RESULTS: Between 1 January 2015, and 31 March 2022, 3,928,619 specimens from Canadian plasma donors were tested for B19V. For the same period, 3,922,954 specimens were tested for HAV. To account for a lag in specimen testing for up to 24 months, the data were divided into: (1) a pre-pandemic period (1 January 2015-31 March 2020; B19V tested n = 2,412,701, B19V NAT-positive n = 240 [0.01%], HAV tested n = 2,407,036, HAV NAT-positive n = 26 [0.001%]); (2) a two-year mixed-impact period (1 April 2020-31 March 2022; B19V tested n = 968,250, B19V NAT-positive n = 14 [0.001%], HAV tested n = 968,250, HAV NAT-positive n = 2 [0.0002%]); and (3) a pandemic-impact period (1 April 2022-31 March, 2023; B19V tested n = 597,668, B19V NAT-positive n = 3 [0.0005%], HAV tested n = 597,668, HAV NAT-positive n = 1 [0.0002%]). CONCLUSION: The percentage of B19V- and HAV-positive donations was significantly reduced from the pre-pandemic period to the pandemic-impact period.

Context Matters: Patterns in Physical Distancing Behavior Across Situations and Over Time During the Covid-19 Pandemic in the Netherlands.

BACKGROUND: Physical distancing is an effective preventative measure during respiratory infectious disease outbreaks. Prior studies on distancing behaviors have largely ignored context characteristics (physical, social) and time. PURPOSE: We investigated patterns in physical distancing over time and across situations, as well as sociodemographic variation herein. METHODS: We employed data from five rounds of a cohort study conducted throughout the pandemic by the Dutch public health institute (RIVM; N ≈ 50.000 per round). We conducted Latent Class Analyses to investigate patterns of physical distancing in a range of situations, followed by regression models to investigate associations between distancing behavior and sociodemographic and context characteristics. RESULTS: Participants differed in their general tendency to adhere to distancing guidelines across situations, but there were also substantial differences in distancing behavior between situations, particularly at work, with friends and family and outdoors. Distancing at work was strongly associated with work environment characteristics. Younger age groups reported less distancing behavior, particularly with close relations (friends or family) and at work. In periods when the pandemic situation was most severe, people adhered more strongly to distancing guidelines and age differences were most pronounced during these periods. CONCLUSIONS: Physical and social context matters for physical distancing, highlighting the importance of developing strategies for pandemic preparedness that improve opportunities for physical distancing (e.g., reducing crowding, one-way traffic) and accommodate young people to safely meet even in times of high pandemic severity and lockdowns. Future studies should account for the physical and social context in which distancing behavior is observed.

Physical distancing helps reduce the transmission of infectious diseases, but people's opportunities and willingness to keep distance from others can vary between situations. In a survey conducted at various time points during the Covid-19 pandemic, The Dutch National Public Health Institute asked people about their distancing behavior in various such situations, such as at work, when grocery shopping or when visiting with friends and family. We found that people mainly differed in their general tendency to keep distance from others: some individuals were more likely to keep distance than others in all situations. However, there were also substantial differences in distancing behavior at work, with friends and family and outdoors. Differences in distancing at work resulted from the specific work context and activities people had to perform. Younger age groups reported less distancing behavior in social situations such as when meeting with friends and family or with colleagues. In periods when the pandemic situation was most severe, people were more likely to keep their distance from others and there were larger age differences in distancing behavior. These results highlight the importance of improving people's opportunities to keep their distance from others and safely meet in times of a severe pandemic.

Compliance to Viral Load Monitoring Schedules Among Women Attending Prevention of Vertical HIV Transmission Services Before and During the COVID-19 Pandemic in Ehlanzeni District, Mpumalanga, South Africa.

Human immunodeficiency virus (HIV) viral load (VL) monitoring was likely interrupted during the Coronavirus disease 2019 (COVID-19) pandemic. We used routine data on repeat VL testing among 667 prevention of vertical HIV transmission (PVT) clients in Ehlanzeni district, to determine compliance to VL testing recommendations and associated factors during different time periods: pre-COVID-19, transition, and COVID-19. Descriptive and multivariable Poisson regression analyses were conducted, with and without including revised PVT-guidelines rolled out in January-2020. Among 405 women with ≥ 2 VL tests, the overall median age was 30 years (interquartile range: 26-35 years). Compliance to recommended VL testing guidelines ranged between 81.5% (172/211) and 92.3% (191/207) at different time periods. Across all three periods and when revised PVT-guidelines were used, being compliant was significantly reduced among those with earliest VL = 50-999 copies/ml (incidence rate ratio (IRR) = 0.71 [95% confidence interval (CI) 0.61-0.82], p value < 0.001) and VL ≥ 1000 copies/ml (IRR = 0.18 [95% CI 0.09-0.36], p value < 0.001). When guideline revisions were excluded, compliance was only significantly reduced among those with VL ≥ 1000 copies/ml (IRR = 0.14 [95% CI 0.06-0.32], p value < 0.001) and increased during the COVID-19 period versus pre-COVID-19 (IRR = 1.10 [95% CI 1.05-1.15], p value < 0.001). Similar significant associations between compliance and VL level were observed when the COVID-19 period was analyzed separately. Significantly increased compliance to VL testing among the 25-34 years age-group versus younger women was also observed across all periods. These results highlight the importance of strengthening strategies such as short message service reminders and educational messaging, reaching all age-groups, to fast-track implementation targets for VL monitoring.

Stimulating the capacity to govern the commons.

The ability to strengthen governance institutions and fisheries restrictions and laws is needed to improve conservation and management of common-pool resources. We evaluated the potential for stimulating change with modest interventions by studying fishing village households before and after a 27-month intervention period in a high-priority coral reef conservation area. Interventions included training in catch monitoring, stock assessment, mapping fishing grounds, microcredit, gender inclusion, theatrical skills, fuel efficient stoves, and participation in the planning of a conservation proposal. There was a background increase in reported formal education, household size, group membership, and household wealth but a decrease in fish consumption and public services. Of conservation importance, the perceived strength of 13 governance institutions and benefits of 6 fisheries restrictions increased over the intervention period. Finally, correspondence between knowledge of and agreement with recent national fisheries laws was moderate to high and positively correlated. The intervention period was stronger than demographic factors that often influence perceptions, such as village, government services, gender, household size, membership in community groups, and age responses. In general, perceptions of strengths of governance and benefits of restrictions increased more among women and youth than adult men respondents. The largest changes in perceptions of increased benefits were among strict restrictions initially ranked low, specifically fisheries closures, parks, and species restrictions. Consequently, capacity building overrode demographic factors common to poor people with limited employment capacity that can have negative perceptions of strict conservation.

Variabilidad demográfica y escalas de aceptación y rechazo sobre las restricciones en el manejo de recursos Resumen Se necesita de la capacidad para fortalecer a las instituciones de gobierno y las leyes y restricciones a la pesca para mejorar la conservación y manejo de los recursos comunes. Evaluamos el potencial para estimular el cambio con intervenciones modestas con un estudio en los hogares de una aldea pesquera antes y después de un periodo de intervención de 27 meses en un área de conservación de gran prioridad para un arrecife de coral. Las intervenciones incluyeron formación en el monitoreo de las capturas, análisis de stock, mapeo de las zonas de pesca, microcréditos, inclusión de género, habilidades teatrales, estufas ecológicas y participación en la planeación de una propuesta de conservación. Hubo un incremento en el trasfondo de la educación formal reportada, el tamaño del hogar, los miembros del grupo y la riqueza del hogar, pero una disminución en el consumo de pescado y en el servicio público. Fue de importancia para la conservación que la fuerza percibida de 13 de las instituciones de gobierno y los beneficios de seis restricciones a la pesquería incrementaron durante el periodo de intervención. Por último, la correspondencia entre el conocimiento sobre y la aceptación de las leyes recientes de pesca fue de moderada a alta y con una correlación positiva. El periodo de intervención fue más fuerte que los factores demográficos que con frecuencia influyen sobre las percepciones, como las respuestas de los servicios de gobierno, aldea, género, tamaño del hogar, membresía en un grupo comunitario y edad. En general, la percepción de la fuerza de la gobernanza y los beneficios de las restricciones incrementó más entre las mujeres y la juventud que entre los hombres respondientes. Los cambios más grandes en la percepción del aumento en beneficios fueron entre las restricciones estrictas marcadas como bajas al inicio, específicamente el cierre de pesquerías, parques y restricción de especies. Como consecuencia, la formación de capacidad sobrepasó los factores demográficos, que con frecuencia son personas con una capacidad limitada de empleo que pueden tener una percepción negativa de la conservación estricta.

The impact of spatial connectivity on NPIs effectiveness.

BACKGROUND: France implemented a combination of non-pharmaceutical interventions (NPIs) to manage the COVID-19 pandemic between September 2020 and June 2021. These included a lockdown in the fall 2020 - the second since the start of the pandemic - to counteract the second wave, followed by a long period of nighttime curfew, and by a third lockdown in the spring 2021 against the Alpha wave. Interventions have so far been evaluated in isolation, neglecting the spatial connectivity between regions through mobility that may impact NPI effectiveness. METHODS: Focusing on September 2020-June 2021, we developed a regionally-based epidemic metapopulation model informed by observed mobility fluxes from daily mobile phone data and fitted the model to regional hospital admissions. The model integrated data on vaccination and variants spread. Scenarios were designed to assess the impact of the Alpha variant, characterized by increased transmissibility and risk of hospitalization, of the vaccination campaign and alternative policy decisions. RESULTS: The spatial model better captured the heterogeneity observed in the regional dynamics, compared to models neglecting inter-regional mobility. The third lockdown was similarly effective to the second lockdown after discounting for immunity, Alpha, and seasonality (51% vs 52% median regional reduction in the reproductive number R0, respectively). The 6pm nighttime curfew with bars and restaurants closed, implemented in January 2021, substantially reduced COVID-19 transmission. It initially led to 49% median regional reduction of R0, decreasing to 43% reduction by March 2021. In absence of vaccination, implemented interventions would have been insufficient against the Alpha wave. Counterfactual scenarios proposing a sequence of lockdowns in a stop-and-go fashion would have reduced hospitalizations and restriction days for low enough thresholds triggering and lifting restrictions. CONCLUSIONS: Spatial connectivity induced by mobility impacted the effectiveness of interventions especially in regions with higher mobility rates. Early evening curfew with gastronomy sector closed allowed authorities to delay the third wave. Stop-and-go lockdowns could have substantially lowered both healthcare and societal burdens if implemented early enough, compared to the observed application of lockdown-curfew-lockdown, but likely at the expense of several labor sectors. These findings contribute to characterize the effectiveness of implemented strategies and improve pandemic preparedness.

Placental growth factor testing at 19-23 weeks of gestation as a guide to subsequent care in pregnancy: A prospective observational study.

OBJECTIVE: To determine whether serum placental growth factor (PlGF) at 19-23 weeks of gestation can improve the identification of risk for adverse outcomes. DESIGN: Prospective observational cohort study. SETTING: Two English maternity units. POPULATION: Unselected singleton pregnancies attending routine ultrasound at 19-23 weeks of gestation. METHODS: Outcomes ascertained by health record review. Diagnostic test properties evaluated clinical risk factors for pre-eclampsia (according to National Institute of Care Excellence) or fetal growth restriction (according to Royal College of Obstetricians and Gynaecologists), low PlGF at 19-23 weeks of gestation (<5th percentile) or both. MAIN OUTCOME MEASURES: Pre-eclampsia, gestational hypertension, stillbirth, birthweight below third percentile or neonatal intensive care unit (NICU) admission for ≥48 h. RESULTS: In 30 013 pregnancies, risk factors were present in 9941 (33.1%), low PlGF was present in 1501 (5.0%) and both ('two-stage' screening) were present in 547 (1.8%) pregnancies. Risk factors detected 41.7%-54.7% of adverse outcomes, and could not meaningfully revise the risk (all positive likelihood ratios, +LR, <5.0; all negative likelihood ratios, -LR, ≥0.2). Low PlGF detected 8.5%-17.4% of adverse outcomes, but meaningfully increased risks (other than NICU admission) associated with delivery <37 weeks of gestation (+LR = 5.03-15.55); all -LRs were ≥0.2. 'Two-stage' screening detected 4.2%-8.9% of adverse outcomes, with meaningful +LRs (6.28-18.61) at <37 weeks of gestation, except for NICU admission of ≥48 h, which had an +LR of 7.56 at <34 weeks of gestation; all -LRs were ≥0.2. No screening strategy meaningfully increased or decreased the detection of adverse outcome risk at term. CONCLUSIONS: Clinical risk factor screening has a high screen-positive rate and a poor detection of adverse outcomes. False positives cannot be reduced by PlGF testing at 19-23 weeks of gestation; therefore, this cannot be recommended as a useful strategy on its own.

Diet restriction enhances the effect of immune checkpoint block by inhibiting the intratumoral mTORC1/B7-H3 axis.

Immune checkpoint blockade therapy has demonstrated significant therapeutic efficacy in certain cancer types; however, the impact of dietary restriction remains scarcely reported in this context. This study aimed to investigate the influence of dietary restriction on anti-PDL-1 therapy and the interplay of immune cells within this context. Using an anti-PDL-1 regimen combined with dietary restrictions, tumor progression was assessed in LLC-bearing mice. Flow cytometry was employed to analyze immune cell infiltration and differentiation levels within the tumor microenvironment. The expression of mTORC1/B7-H3 in tumors subjected to dietary restriction was also examined. LLC tumors with elevated B7-H3 expression were validated in mice to determine its inhibitory effect on immune cell proliferation and differentiation. A CD3/B7-H3 chimeric antibody was developed for therapeutic intervention in B7-H3 overexpressing tumors, with subsequent T cell responses assessed through flow cytometry. Dietary restriction potentiated the effect of anti-PDL1 therapy by suppressing the intratumorally mTORC1/B7-H3 axis. In vivo experiments demonstrated that elevated B7-H3 expression in tumors reduced infiltration and activation of CD8 + T cells within the tumor, while it did not affect tumor-infiltrating Tregs. In vitro studies revealed that high B7-H3 expression influenced the proliferation and activation of CD8 + T cells within a Coculture system. The constructed CD3/B7-H3 chimeric antibody prominently activated TCR within B7-H3 overexpressing tumors and impeded tumor progression. The findings suggest that dietary restriction enhances the efficacy of immune checkpoint blockade by modulating the intratumoral mTORC1/B7-H3 axis.

Local restrictions, population movement, and spillovers during the pandemic: Evidence from Japan's restaurant restriction.

We investigate how a local restaurant restriction aimed at containing the COVID-19 pandemic influenced population movement and COVID-19 prevalence within and outside the restricted districts. Using data on restaurant location and hourly population at the 500-m-mesh level and on COVID-19 prevalence at both prefecture and municipality level in Japan, we employ a triple-difference approach and a difference-in-differences approach with fixed effects. While the policy decreased population movement to restaurant areas in the restricted districts, it caused spillovers of increasing population movement to restaurant areas in the neighboring nonrestricted districts. Consequently, COVID-19 prevalence worsened in the neighboring nonrestricted districts but improved in the restricted districts. Our findings suggest that imposing such local restrictions in the context of the pandemic may contain the pandemic only in the restricted districts while sacrificing economic activities within these districts and public health in neighboring nonrestricted districts.

Ongoing impacts of childhood-onset glomerular diseases during young adulthood.

BACKGROUND: Childhood-onset glomerular disease often requires ongoing treatment and follow-up into adulthood. However, few studies have analyzed the associated impact and distress experienced by patients with this condition during the transition from childhood to adolescence and adulthood. METHODS: At three facilities, we recruited patients who developed idiopathic nephrotic syndrome or IgA nephropathy during childhood and were at least 18 years old at the time of study entry. Among them, a questionnaire-based survey was administered to patients who consented to participate, and the results were analyzed in conjunction with clinical information. RESULTS: Data from a total of 38 patients were analyzed. Of these patients, 15 had idiopathic nephrotic syndrome and 23 had IgA nephropathy. The age of transition from pediatrics to the adult medicine department was correlated with the number of recurrences. Many patients also reported being significantly affected by exercise restrictions and physical decline associated with their diseases and medications. Various impacts, including distress, affected decision-making regarding higher education, with patients engaging in higher education at a significantly higher rate compared with the regional average (66.7% vs. 46.9%, p = 0.028). CONCLUSION: We analyzed the impact of childhood-onset glomerular disease and distress during the transition period from pediatric to adult care. This study highlighted the significant impact of medications and exercise restrictions on patients' decisions regarding higher education. Future prospective studies will be needed to examine patients' distress in more detail and establish management approaches to enhance patient quality of life.

Less restrictions in daily life: a clinical practice guideline for children with cancer.

PURPOSE: In current clinical practice, recommendations regarding restrictions in daily life for children with cancer are often lacking or not evidence-based. Critically reviewing the evidence and formulating recommendations are therefore of great importance as social restrictions (e.g., swimming, school attendance, sports) can impair the quality of life of these children severely. Therefore, our aim was to develop a clinical practice guideline for clinicians, children, and their parents regarding social restrictions in children with cancer. METHODS: A comprehensive multidisciplinary panel was assembled, comprising 21 professionals and patient representatives. A systematic literature review was performed, including dual appraisal of all citations. The GRADE methodology was used to extract, summarize, and assess the evidence. Multiple in-person meetings were held to rank outcomes, discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations. Final recommendations were unanimously supported by all panel members. RESULTS: Six studies, including 758 children, formed the evidence base for the recommendations. Given the scarcity of the available evidence and various designs of studies in children with cancer, additional evidence was extracted from adult oncology guidelines, and shared expert opinions were utilized. In total, 14 recommendations were formulated of which multiple result in changes in current policy and standard of practice in the Netherlands. Topics covered in this guideline are swimming, having pets, visiting the zoo or farm, performing sports or high-velocity events, attending school or kindergarten, and use of public transport. This guideline is not intended to provide recommendations for patients after end of treatment, for palliative care settings, or for children undergoing a stem cell transplantation. CONCLUSIONS: In this clinical practice guideline, we provide recommendations regarding restrictions in daily life in children with cancer. These include evidence-based recommendations and, in the absence of sufficient evidence, recommendations based on expert evidence. With these recommendations, we provide guidance for clinicians, children, and parents and contribute to improving quality of life for children with cancer.

Effects of atmospheric particulate pollution on lung function of athletes.

There is a knowledge gap on how ground-level particulate pollution affects labor productivity in emerging nations due to a lack of study, especially when it comes to outdoor work settings like couriers in the express delivery industry. Combining findings from two research projects, this paper examines the socioeconomic consequences of particulate matter and ground-level particulate pollution. Special panel dataset from China's express delivery companies are used, we study how particulate pollution affects courier productivity. The instrumental variable of our analysis was built by particulate pollution data from upwind towns. Moreover, a comparable rise in particulate levels during the 30 days caused a significant 23.7% decline in worker productivity. This draws attention to a neglected area of the economic effects of particulate pollution, especially in underdeveloped countries. Our results also highlight the wider health hazards connected to outdoor activities in high-pollution locations, drawing comparisons on outdoor exercisers and particulate matter concentrations. The critical need for coordinated policy attention addressing both ground-level Particulate and particle matters in developing nations is highlighted by the increased risk of lung function impairment among outdoor exercisers owing to excessive particulate matter concentrations. The interrelated risks that air pollution poses to public health and economic productivity are clarified by this Comprehensive viewpoint.

Dichotomous Responses to Chronic Fetal Hypoxia Lead to a Predetermined Aging Phenotype.

Hypoxia-induced intrauterine growth restriction increases the risk for cardiovascular, renal, and other chronic diseases in adults, representing thus a major public health problem. Still, not much is known about the fetal mechanisms that predispose these individuals to disease. Using a previously validated mouse model of fetal hypoxia and bottom-up proteomics, we characterize the response of the fetal kidney to chronic hypoxic stress. Fetal kidneys exhibit a dichotomous response to chronic hypoxia, comprising on the one hand cellular adaptations that promote survival (glycolysis, autophagy, and reduced DNA and protein synthesis), but on the other processes that induce a senescence-like phenotype (infiltration of inflammatory cells, DNA damage, and reduced proliferation). Importantly, chronic hypoxia also reduces the expression of the antiaging proteins klotho and Sirt6, a mechanism that is evolutionary conserved between mice and humans. Taken together, we uncover that predetermined aging during fetal development is a key event in chronic hypoxia, establishing a solid foundation for Barker's hypothesis of fetal programming of adult diseases. This phenotype is associated with a characteristic biomarker profile in tissue and serum samples, exploitable for detecting and targeting accelerated aging in chronic hypoxic human diseases.

Development and validity evidence on the scale of perceived social support for university students (EPSSEU) during the period of social restrictions.

AIM: This study aims to validate a Perceived Social Support Scale for University Students (EPSSEU) during periods of social restrictions, by focusing on family and university support. SUBJECT AND METHODS: This cross-sectional study was conducted with undergraduate students from a public higher education institution. The college students who participated in the study-1353 at baseline and 378 after 6 months-answered a virtual questionnaire containing questions on: sociodemographic and lifestyle data, items proposed for the EPSSEU, Satisfaction with Social Support Scale (ESSS), and Depression, Anxiety and Stress Scale (DASS-21). Exploratory factor analysis, Cronbach's alpha reliability analysis, as well as discriminant, convergent, and known-group validations were performed. RESULTS: The results showed two factors support from: i) the university and ii) friends and family- which explained 61.82% of the variance in the data. The EPSSEU showed good reliability (Cronbach's alpha = 0.796) as well as validity, with higher scores among individuals without depression, anxiety, or stress. CONCLUSION: The EPSSEU shows adequate psychometric qualities and may be a useful instrument for assessing university students' social support in pandemics, social distancing, and remote teaching contexts.

Is a tiered restrictions system an effective intervention for COVID-19 control? Results from Portugal, November-December 2020.

BACKGROUND: In November 2020, similar to other European countries, Portugal implemented a tiered restrictions system to control the COVID-19 pandemic. We aimed to compare the COVID-19 growth rate across tiers to assess the effect of a tiered restrictions system in Portugal, using models with different times between tiers assessment. Our hypothesis was that being in a higher tier brings a faster deceleration in the growth rate than being in a lower tier. METHODS: The national database of notified COVID-19 cases and publicly available data were used to analyse the effect of the tiered restrictions system on the COVID-19 incidence growth rate. The tiers were based on the European Centre for Disease Control risk classification: moderate, high, very and extremely high. We used a generalised mixed-effects regression model to estimate the growth rate ratio (GRR) for each tier, comparing the growth rates of higher tiers using moderate tier as reference. Three models were fitted using different times between tiers assessment, separated by 14 days. RESULTS: We included 156 034 cases. Very high tier was the most frequent combination in all the three moments assessed (21.2%), and almost 50% of the municipalities never changed tier during the study period. Immediately after the tiers implementation, a reduction was identified in the municipalities in high tier (GRR high tier: 0.90 [95%CI: 0.79; 1.02]) and very high tier (GRR very high tier: 0.68 [95%CI: 0.61; 0.77]), however with some imprecision in the 95% confidence interval for the high tier. A reduction in very high tier growth rate was identified two weeks (GRR: 0.79 [95%CI: 0.71; 0.88]) and four weeks (GRR: 0.77 [95%CI: 0.74; 0.82]) after the implementation, compared to moderate tier. In high tier, a reduction was also identified in both times, although smaller. CONCLUSIONS: We observed a reduction in the growth rate in very high tier after the tiered restriction system was implemented, but we also observed a lag between tiered restriction system implementation and the onset of consequent effects. This could suggest the importance of early implementation of stricter measures for pandemic control. Thus, studies analysing a broader period of time are needed.

Navigating health challenges: the interplay between occupation-imposed movement restrictions, healthcare access, and community resilience.

BACKGROUND: Transportation plays a significant role in health, community resilience, and access to basic needs such as healthcare, social services, education, and job opportunities. Health and community resilience are, however, impacted by a multitude of complex and unequal factors, such as transportation restrictions exacerbated by the Israeli occupation. The goal of the research was to examine the intricate relationships that exist in Palestine between movement restrictions imposed by occupation, health outcomes, and community resilience. METHOD: A self-structured questionnaire, devised based on expert conversations and previous literature, was used in this descriptive, quantitative study to explore health and resilience outcomes. Age, gender, marital status, place of residence, and means of transportation were among the various factors that were utilized to describe the socio-demographics of the study sample (n = 202). The researchers employed stepwise multiple regression and descriptive statistics for the data analysis. RESULTS: Study findings indicated that transportation restrictions have significant direct and indirect health consequences. A significant direct effect is observed, signifying a negative correlation between restrictions and health; increased transportation restrictions are consistently correlated with a decline in health. The study emphasized how place of residence affects health outcomes, with higher scores for campers and people living in green line areas. It also underscores that public means of transportation are found to be better for health outcomes than private cars. CONCLUSION: This study emphasized that roadblocks, checkpoints, and military incursions make it difficult for Palestinians to receive medical care, which has a detrimental impact on their health and well-being. It also underscores the need for significant reforms in Palestinian health and transportation systems to enhance infrastructure and healthcare access. The Palestinian Authority should invest in public transportation and community resilience programs to address transportation-related health issues, especially in villages, due to frequent settler attacks.