Antimicrobial resistance - moving forward?

BACKGROUND: When microorganisms (such as bacteria or viruses) are highly exposed to antimicrobial drugs, they can develop the capacity to defeat the drugs designed to eradicate them. Long-term accumulation of adaptations to survive drug exposure can lead to the development of antimicrobial resistance (AMR). The success of antibiotics has led to their widespread overuse and misuse in humans, animals and plants. MAIN TEXT: AMR is a global concern and solutions are not vertical actions in a single buy business model. Even if a transectoral approach is key, there is a lack of multi-disciplinary partnerships that allow for strategic cooperation between different sectors such as the pharmaceutical industry, agro-alimentary complex, patient care and education, NGOs and research and development. Global public health voices should lead this integration to align the progress of existing AMR successes. Maintaining the public's trust in preventive medicine, health systems and food production safety, together with public health driven, non-profit drug development, is a key factor. In its "Call for integrated action on AMR", signed by about 70 national and international organizations the World Federation of Public Health Associations (WFPHA) called "on all governments, the private sector, non-governmental organizations, health professionals, public and private research organizations, and all stakeholders to ensure that public health remains at the centre of all policy and scientific endeavours in the field of antimicrobial resistance". CONCLUSIONS: The "Global Charter for the Public's Health", developed by the WFPHA in association with WHO, is proposed in this article as a tool for implementation of complex public health actions such as AMR.

Nutrition for European Elite Fencers: A Practical Tool for Coaches and Athletes.

The aim of this narrative review is to create a comprehensive, innovative, and pragmatic resource to guide elite fencers and coaches in making strategic nutritional choices to enhance performance and facilitate recovery. The literature review identified only 12 articles specifically addressing the topic of nutrition for fencers. Thus, the recommendations provided in this review derive also from articles dealing with similar sports, such as martial arts, and from investigations with European elite fencers and their coaches. For elite fencers, it is suggested to consume daily 7-11 g/kg of body weight (BW) of carbohydrates and 1.5-2 g/kg of BW of proteins and allocate 25% to 30% of the total energy intake to essential fats, with a specific focus on omega-3 fatty acids. The timing of meals, ideally within one hour after exertion, plays a pivotal role in restoring glycogen reserves and preventing injuries. The intake of leucine, creatine, omega-3, collagen, and vitamins C and D is proposed as a strategy for injury recovery. It is worth acknowledging that even when personalized plans are provided, implementation can be challenging, especially during competitions and training camps.

Strategies used to improve vaccine uptake among healthcare providers: A systematic review.

Background: Vaccination is one of the most effective available public health tools, preventing infectious diseases to safeguard public health and save millions of lives annually. However, in recent years vaccine hesitancy has increased among all populations, including healthcare workers. Healthcare providers are central to vaccination efforts due to their increased exposure to disease and vulnerable patients, and their role in patient confidence and decision-making. These decreasing uptake rates highlight a critical need to address specific barriers within this target group. This systematic review aims to explore the strategies used to improve vaccine uptake among healthcare providers. Methods: A literature search was conducted in PubMed, EMBASE, and MEDLINE databases, alongside a grey literature search, to identify studies describing interventions to improve vaccine uptake among healthcare providers. This was followed by de-duplication and double-blinded screening processes using Rayyan. Data extraction and thematic analysis focused on categorising interventions and identifying frequencies of use, to develop recommendations for further interventions tailored to target regions. Results: 60 studies were identified, predominantly concerning influenza vaccination. Interventions included educational initiatives, reminders, incentives, access solutions, feedback, and policy implementation. Key strategies included targeted educational lectures, posters, and pamphlets; mobile vaccination units; extended vaccination hours; and leadership engagement. The findings underscore the importance of a multifaceted approach combining educational efforts, enhanced accessibility, and motivational incentives to improve vaccination rates within the healthcare providers, especially where mandatory vaccination is controversial. Conclusions: This review evaluates tailored strategies to enhance vaccine confidence and uptake among healthcare providers, advocating for a holistic approach that includes educational initiatives, reminder systems, incentives, improved access, feedback mechanisms, and policy enactment to effectively address hesitancy and promote public health.

Driving Paediatric Vaccine Recovery in Europe.

BACKGROUND: Childhood vaccination coverage has increased throughout Europe in recent decades. However, challenges persist in many areas within the European Union (EU), resulting in declining coverage rates in many countries in the period between 2010 and 2021. This general trend requires increased efforts to combat barriers around vaccination uptake. Thus, this article aims to summarise key learnings and trends in paediatric vaccination within the EU, with a focus on current challenges and enablers. METHODS: Methodology is based on analysis of primary data, mainly vaccination coverage rates, as well as review and analysis of the select relevant literature, including peer-reviewed articles, academic research papers, official reports, policies, and other publicly available sources. RESULTS: For all vaccines assessed (DTP 1st dose, DTP 3rd dose, Hib3, HepB3, measles 1st dose, measles 2nd dose, and polio 3rd dose), a high degree of variation and fluctuation in coverage can be observed. There is a general trend of declining coverage in 2019 compared to 2010, with lower performing countries, such as Romania and Austria, showing increasingly severe coverage fluctuations between the years examined across the analysed vaccines. CONCLUSIONS: Evidence suggests that increasing both accessibility and information regarding vaccines are key enablers to vaccination uptake. Moreover, given the current challenges the EU is facing, crisis preparedness plans are pertinent to ensure immunity gaps do not further exacerbate the disruption of vaccination systems.

Determinants of Acceptance of COVID-19 Vaccination in Healthcare and Public Health Professionals: A Review.

Vaccinations of healthcare workers (HCWs) aim to directly protect them from occupational diseases, and indirectly protect their patients and communities. However, studies increasingly highlight that HCWs can be vaccine hesitant. This review aims to analyze HCWs' and public health professionals' sentiments toward COVID-19 (Coronavirus Disease 2019) vaccination and determinants across different countries. A search strategy was conducted in PubMed using keywords such as "COVID-19", "sentiment/acceptance", "healthcare workers", "vaccine hesitancy", and "influenza". A total of 56 articles were selected for in-depth analyses. The highest COVID-19 vaccination uptake was found in an Italian study (98.9%), and the lowest in Cyprus (30%). Older age, male gender, the medical profession, higher education level, presence of comorbidities, and previous influenza vaccination were associated with vaccine acceptance. Factors for low acceptance were perceived side effects of the vaccine, perceived lack of effectiveness and efficacy, and lack of information and knowledge. Factors for acceptance were knowledge, confidence in the vaccine, government, and health authorities, and increased perception of fear and susceptibility. All studies focused on healthcare providers; no studies focusing on public health professionals' sentiments could be found, indicating a gap in research that needs to be addressed. Interventions must be implemented with vaccination campaigns to improve COVID-19 vaccine acceptance.

Global public health policies: gathering public health associations' perspectives.

BACKGROUND: Advocacy is one of the core functions of public health and is a key tool for achieving Sustainable Development Goals. Public health associations play a key role in advocating for the development and implementation of strategies to prevent diseases and promote health and well-being. OBJECTIVE: This study aims to map out the focus of public health advocacy carried out by selected national public health associations over 4 years, between 2018 and 2021, in order to identify gaps and strengths and support associations and professionals in their advocacy efforts. METHODS: Twelve national public health associations participated in the study. Official policy documents produced between 2018 and 2021 were collected and analysed. The title and summary of the policy documents were examined line by line and coded into the main subject categories and themes. A qualitative thematic analysis was conducted. Policies were assessed from global and regional perspectives. RESULTS: A total of 220 policy documents were analysed. Overall, the largest number of policy documents came from high-income countries and dealt with environmental health and communicable diseases, including COVID-19, with, however, important differences among regions. In the African region, public health advocacy focused mainly on strengthening health systems; Europe and South America were mostly concerned with communicable diseases and pandemic management; and North America and the Western Pacific regions focused primarily on climate change. Limited attention was paid to international health and health as a human right in all regions. CONCLUSION: Our study showed that, especially in high-income countries, public health associations actively engage in advocacy; however, more effort needs to be devoted to implementing a more international and intersectoral approach at the global level, anchored in health as a human right and aligned with the Sustainable Development Goals.

Protecting the healthcare workers in low- and lower-middle-income countries through vaccination: barriers, leverages, and next steps.

Healthcare workers play a critical role in providing medical care to individuals and communities. Due to the nature of their work, compared to the general public, healthcare workers are at a higher risk of exposure to infectious diseases, including vaccine-preventable ones. The routine vaccination of healthcare workers in low- and lower-middle-income countries is a critical issue. Vaccination not only protects healthcare workers from contracting infectious diseases but also prevents the spread of diseases to the patients, reduces healthcare costs, increases healthcare workers' morale and productivity, and demonstrates a commitment to health and safety. However, the implementation of policies for routine vaccination of healthcare workers in low- and lower-middle-income countries faces several challenges, including lack of funds, lack of evidence-based data, vaccination hesitancy through misguided beliefs, and low literacy among healthcare workers. In this article, we discuss the need for a policy for routine vaccination of healthcare workers in low- and lower-middle-income countries. We also analyse the barriers and recommendations for policy implementation and the role of partnerships. Additionally, we highlight the main points of the World Federation of Public Health Associations' policy statement 'Protecting the Healthcare Workforce in Low- and Middle-Income Countries through Vaccination' which has the potential to drive policy-makers and healthcare organisations worldwide into prioritising routine vaccination of healthcare workers in low- and lower-middle-income countries.

A scoping review on e-cigarette environmental impacts.

INTRODUCTION: The use of e-cigarettes has grown in popularity worldwide. From their manufacturing, use, and disposal, the environmental impacts of e-cigarettes present a novel public health concern that needs to be urgently investigated. However, very limited studies have focused on the subject matter. The present study aims to review available studies to identify the environmental impacts of e-cigarettes. METHODS: In this scoping review, we undertook a search in two databases (PubMed and Web of Science) from inception until 21 March 2023, and a gray literature search in Google Scholar. Reference lists of publications included in the scoping review were screened manually for additional relevant publications. Scientific publications that were in English and focused on the potential impacts of e-cigarettes on the environment were included. RESULTS: A total of 693 publications were identified, of which 33 were subjected to full-text review and 9 publications were finally included in the review. The impacts on air quality, water, land use, and animals, water and energy consumption, with associated environmental impacts, increased pollution and emissions due to greater e-cigarette production, having harmful and toxic components, creating pollution and waste issues, and global environmental impacts due to manufacturing and importing ingredients and components from low- and middle-income countries, were identified as the environmental impacts of e-cigarettes. CONCLUSIONS: Despite the emphasis on the environmental threat of e-cigarettes, there are limited scientific studies on the environmental impacts of the e-cigarette life cycle. Considering the rapid expansion of e-cigarette usage, there is an urgent need for a rigorous assessment of their life-cycle environmental burden of the various potential health, environmental, and other consequences.

A review of health worker vaccination programs in low, middle and upper middle-income countries.

Objectives: Health workers (HW) are at risk of contracting vaccine preventable diseases when caring for patients and communities. This study aims to evaluate the existing literature on the routine vaccination of health workers against a variety of antigens in low and middle income countries, focusing on facilitators, barriers, and considerations in the implementation of immunization programs and campaigns. Study design: A PubMed Literature search. Methods: A PubMed search was conducted to find articles that addressed vaccination programs and policies for HW in low-income countries (LIC), lower middle-income countries (LMIC), and upper middle-income countries (UMIC). Original articles, meta-analyses, and reviews published in English between January 2000 and July 2022 were included in the search. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and considerations in the implementation of immunization programs and campaigns. Results: The search identified 4240 studies, 90 were used for analysis as they provided antigen specific details on immunization policies or programs. Hepatitis B was the most frequently discussed antigen, followed by Influenza, then Measles, Rubella and Mumps. With considerable variability by vaccine and country, in most cases the vaccination was not offered free to HW or included in a regular vaccination schedule. Utilizing existing immunization infrastructure such as the Expanded Programme on Immunization (EPI) and having effective management of vaccination programs were found to be key facilitators to vaccinate HW. Conclusions: The low vaccination coverage of health workers in LMIC is of concern; attention towards the key considerations, barriers and facilitators of immunization implementation is central to the advancement of health worker vaccination coverage in LMIC's. The COVID-19 pandemic necessitated the swift vaccination of HW. Many LIC countries lacking established HW immunization infrastructure are now administering COVID-19 vaccines. As we move beyond the pandemic's acute phase, there is a chance for those countries to enhance their immunization initiatives and policies for HW concerning other antigens, even if it is not a standard practice currently.

Public health leadership in the COVID-19 era: how does it fit? A scoping review.

The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

RGS2 modulates coupling between GABAB receptors and GIRK channels in dopamine neurons of the ventral tegmental area.

Agonists of GABA(B) receptors exert a bi-directional effect on the activity of dopamine (DA) neurons of the ventral tegmental area, which can be explained by the fact that coupling between GABA(B) receptors and G protein-gated inwardly rectifying potassium (GIRK) channels is significantly weaker in DA neurons than in GABA neurons. Thus, low concentrations of agonists preferentially inhibit GABA neurons and thereby disinhibit DA neurons. This disinhibition might confer reinforcing properties on addictive GABA(B) receptor agonists such as gamma-hydroxybutyrate (GHB) and its derivatives. Here we show that, in DA neurons of mice, the low coupling efficiency reflects the selective expression of heteromeric GIRK2/3 channels and is dynamically modulated by a member of the regulator of G protein signaling (RGS) protein family. Moreover, repetitive exposure to GHB increases the GABA(B) receptor-GIRK channel coupling efficiency through downregulation of RGS2. Finally, oral self-administration of GHB at a concentration that is normally rewarding becomes aversive after chronic exposure. On the basis of these results, we propose a mechanism that might underlie tolerance to GHB.

Analysing the Launch of COVID-19 Vaccine National Rollouts: Nine Case Studies.

In late 2020 and early 2021, with the eagerly anticipated regulatory approval of vaccines against SARS-CoV-2, the urgent global effort to inoculate populations against this devastating virus was underway. These case studies examine the early stages of COVID-19 vaccine rollouts across nine regions from around the world (Brazil, India, Indonesia, Ireland, Israel, Nigeria, Taiwan, United Kingdom and United States). By evaluating and comparing different approaches used to immunize against a novel pathogen, it is possible to learn a great deal about which methods were successful, and in which areas strategies can be improved. This information is applicable to the ongoing global vaccination against this virus, as well as in the event of future pandemics. Research was conducted by following and tracking the progress of vaccine rollouts in the nine regions, using published clinical trials, government documents and news reports as sources of data. Results relate to the proportion of populations that had received at least one COVID-19 dose by 28 February 2021. Outcomes are discussed in the context of three key pillars integral to all immunization programs: procurement of vaccines, communication with the public and distribution of doses to individuals.

Silver Diamine Fluoride: Transforming Community Dental Caries Program.

INTRODUCTION: Untreated dental caries is the most frequent childhood chronic disease worldwide. Silver diamine fluoride (SDF) offers a safe and effective alternative treatment, especially for children. OBJECTIVE: To inform the dental community about the efficacy of SDF in community dental caries programs and to advocate for its use as an affordable and equitable approach to promote health and well-being within the dental setting. METHODS: A summary of the literature shared during a webinar about the use and efficacy of SDF in community dental programs hosted by the Oral Health Working Group of the World Federation of Public Health Associations RESULTS: Based on the traditional "drill-and-fill" approach, the current treatment for severe caries is associated with pain, fear, and poor oral health outcomes in later life. Innovative approaches to prevent and control caries are needed. SDF offers an alternative treatment option for caries. It is a practical, affordable, and acceptable option for caries treatment, eliminating the need for general anaesthetic in young children, and improving long-term oral health outcomes. CONCLUSION: SDF can improve oral health outcomes for community members, especially for individuals from low-socioeconomic settings.

Analysis of the labelling of a sample of commercial foods for infants and young children in 13 countries.

The World Health Organisation (WHO), European Commission (EC) and Public Health England (PHE) published evidence of inappropriate content, marketing and labelling of commercial foods for infants and young children. Despite this, EC regulations are not yet established. To reduce rates of noncommunicable diseases (NCDs) a better understanding of the food environment is needed. This study aimed to assess the labelling and listed macronutrient and sodium content of commercially available pureed foods marketed for infants and young children under 3 years of age (0-36 months) in 13 countries. A standardized protocol was developed to guide photograph collection and a sample of 155 products were obtained. All products were within current WHO and EC guidelines. However, 103 (67.7%) products were marketed for infants between 4 and 6 months, and many and contained added sugars. Action is needed to improve the nutrient composition, marketing and labelling of these products to reduce NCDs.

From "learning from the field" to jointly driving change.

The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: learning from the field. While 'the field' often denotes people, patients, communities, and healthcare workers, we challenge the notion and its usage. A group of like-minded conference participants set up a working group to examine the term 'the field' and look at questions related to language, power, participation, and rights. By highlighting deficiencies of existing terms and jargon, we explain why language is a form of power that matters in public health. We describe global, regional, and national case studies that facilitate full participation to achieve more equitable health outcomes. By concluding with concrete recommendations, we hope to contribute to these shared goals: to correct power imbalances between health authorities and the people that they intend, and are expected, to serve. The authors are all members of the working group.

Implementation of a sugar-sweetened beverage tax in low- and middle-income countries: recommendations for policymakers.

Longitudinal and observational studies have found a link between the consumption of sugar-sweetened beverages (SSBs) and non-communicable diseases (NCDs) including obesity and diabetes. Following World Health Organization (WHO) recommendations, SSB taxes have been implemented in over 40 countries and cities to reduce sugar consumption. Despite continuing battles with communicable diseases in low- and middle-income countries (LMICs), an epidemiological transition towards NCDs warrants SSB tax implementation. However, LMICs face challenges when implementing SSB taxes including a lack of resources and opposing arguments from industry. Sharing experiences among countries can help to improve the likelihood of successful SSB tax implementation. We review experiences of tobacco, alcohol, and SSB tax implementation in LMICs. We discuss potential pitfalls for policymakers and how they might be overcome. We provide recommendations based on implementation experiences in LMICs to help governments improve implementation capacity and advance public health.

A cross-country exploratory study to investigate the labelling, energy, carbohydrate and sugar content of formula milk products marketed for infants.

Aims The first aim was to describe the energy, carbohydrate and sugar contents of formula milk products in eleven countries. The second was to assess the labelling methods used. Based on the findings, approaches to facilitate the selection of infant-appropriate formula milk products were proposed.Background Consumption of excess sugar during infancy can increase the risk of non-communicable diseases (NCDs) including obesity, diabetes and dental caries. Reduction of sugar consumption has been high on the global public health agenda. Although most infants are fed formula milk products in addition to, or instead of, breastmilk (with only 38% exclusively breastfed), the sugar content of these products is often not included in sugar reduction strategies.Methods An exploratory study was conducted to describe the labelling and nutritional composition of a sample of infant formula products available in 11 countries. The sample, which was collected between May and August 2019, included commercially available formula products (n = 257) targeted at infants aged <3 years of age. The products were sold in supermarkets and by other major retailers across the sample countries. Primary data were obtained from labels on the packaging of the formula products.Results Findings suggest that the majority of products sampled were higher in total carbohydrate and carbohydrates of which sugar and lactose, than breastmilk, supporting previous research. The nutrition information presented on the products was often unclear and was inconsistent across the 11 counties sampled. None of the products had front-of-pack (FOP) nutritional information.Conclusion Findings suggest that globally, infant formula products are higher in carbohydrates, sugar and lactose than breastmilk. Labelling is unclear and inconsistent across brands and between countries. Based on the findings of this study, mandatory regulation of sugar content in formula products is needed with clear FOP nutrition information to help consumers choose the healthy option for their infants.

Addictive drugs modulate GIRK-channel signaling by regulating RGS proteins.

Regulator of G-protein signaling (RGS) proteins are strong modulators of G-protein-mediated pathways in the nervous system. One function of RGS proteins is to accelerate the activation-deactivation kinetics of G-protein-coupled inwardly rectifying potassium (GIRK) channels. The opening of GIRK channels reduces the firing rates of neurons. Recent studies indicate that RGS proteins also modulate the coupling efficiency between gamma-aminobutyric acid type B (GABA(B)) receptors and GIRK channels in dopamine neurons of the ventral tegmental area (VTA), the initial target for addictive drugs in the brain reward pathway. Chronic drug exposure can dynamically regulate the expression levels of RGS. Functional and behavioral studies now reveal that levels of RGS2 protein, through selective association with GIRK3, critically determine whether GABA(B) agonists are excitatory or inhibitory in the VTA. The regulation of RGS protein in the reward pathway might underlie adaptation to different types of addictive drugs.