Poultry farming in the Netherlands is moving toward more extensive systems to promote animal welfare, a shift that has led to the rising number of organic and free-range farms, which provide poultry with outdoor access, lower maximum stocking densities, and limited flock sizes. However, the effect of these changes on the risk of infectious diseases for poultry remains unclear. In this study, we assessed the effects of these changes on the risk of highly pathogenic avian influenza (HPAI) introduction from the environment into poultry farms and HPAI spread between farms. We focused on the changes in farm production system in broiler and layer farms, which are the majority of the poultry population in the Netherlands. The increasing number of outdoor farms increased the introduction risk of HPAI and HPAI epidemic size (number of affected farms), with outdoor layer farms contributing more substantially to the risk than outdoor broiler farms due to the higher susceptibility of layer farms. Spatial clustering of outdoor farms sharply increased the epidemic size. Farm size reduction and decreasing the number of farms reduced the epidemic sizes. Although outdoor farming practices can promote better animal welfare, they potentially increase risk of HPAI introduction and spread. However, this risk can be mitigated by preventing clusters of outdoor farms, reducing farm size, or decreasing the overall number of farms.
Climate change poses significant public health challenges, particularly in low- and middle-income countries (LMICs), where ethical considerations are critical for equitable research. This systematic review synthesizes existing knowledge on climate change, public health, and research ethics in LMICs to identify key themes and research gaps. A systematic search of PubMed and Medline (2001-2024) identified 643 articles, of which 86 met inclusion criteria. Studies were thematically synthesized, and keyword co-occurrence mapping and cluster analysis were used to explore associations between health and ethical themes. Data visualization, including keyword co-occurrence mapping and hierarchical clustering, was performed to highlight thematic associations and research gaps. Out of 86 studies 53.48 % were were published after the year 2022. Research is predominantly focused on mortality, outbreaks, and epidemics, mostly associated in ethical contextss such as community rights and beneficence. Associations were strongest between "Rights and Liberties" and "Community Rights." However, ethical considerations were inconsistently integrated, with equity and justice particularly underrepresented in studies on non-communicable diseases and maternal health. Most of the studies relied on secondary data, reflecting gaps in localized, context-specific evidence. Geographically, South Asia and parts of Africa were represented, while Southeast Asia and Latin America were markedly underrepresented despite major climate-related health risks. This review highlights increasing research interests in climate change and health but identifies gaps in ethical frameworks and LMIC representation. Strengthening research agendas with context-specific ethical considerations and prioritizing vulnerable populations is essential for equitable health responses towards climate change in resource-limited settings.
Social participation is a key determinant of mental well-being in later life, yet population based research tends to focus on overall activity rather than on how participation is configured. In digitalized societies, unequal access to digital technologies shapes how older adults combine online and offline participation, with important but poorly understood implications for mental health. Using data from 8,427 adults aged 60 years and older in China, this study applied latent class analysis to identify patterns of digital and offline social participation based on eight indicators. Multinomial logistic regression was used to examine sociodemographic and health correlates of class membership. Multiple linear regression and covariate adjusted means were used to assess associations between participation patterns, depressive symptoms, and life satisfaction. Four participation classes were identified: Digital active, Offline active, Digital-offline active, and Low participation. Participation configurations were strongly stratified by age, education, residence, and health status. After adjusting for covariates, older adults in the Digital active and Digital-offline active classes reported significantly lower depressive symptoms and higher life satisfaction than those in the Offline active class, while individuals in the Low participation class showed intermediate mental health outcomes. Mental well-being in later life depends not only on whether older adults are socially active but on how digital and offline participation are configured. In a digitally transforming society, digital engagement appears to function as a socially structured psychosocial resource, contributing to inequalities in mental well-being across later life.
Disparities in interfacility transfer of patients with acute ischemic stroke have been identified at the regional level, but a national analysis has not been conducted. This study aims to evaluate patient-level trends and disparities in transfer rates based on sex, race, ethnicity, and insurance status using the Get With The Guidelines-Stroke registry. The Get With The Guidelines-Stroke registry was used to identify patients admitted with acute ischemic stroke between January 2016 and December 2021. We examined patient transfer rate by race/ethnicity groups and by patient insurance status. Odds of transferring out among each demographic group were calculated using a multivariable generalized linear mixed-effect model accounting for patient- and hospital-level confounders. Models were stratified by sex to test for any potential interaction between sex and race/ethnicity or insurance status. Among 776 556 patients transferred out of 1333 sites, Hispanic and Black patients had lower odds of being transferred compared with non-Hispanic Whites among both males and females after adjustment for stroke severity and hospital characteristics (odds ratio [OR], 0.79 [95% CI, 0.74-0.84] for Hispanic females; OR, 0.88 [95% CI, 0.83-0.93] for Hispanic males; OR, 0.80 [95% CI, 0.76-0.83] for Black females; and OR, 0.84 [95% CI, 0.81-0.88] for Black males). Differences in transfer frequency were also noted based on insurance status. In the unadjusted model and model adjusted for stroke severity, patients of all non-Medicare payment groups had higher odds of being transferred out compared with Medicare patients. However, after also adjusting for hospital characteristics, patients with Medicaid had a lower frequency of transfer compared with patients with Medicare among males and females (OR, 0.75 [95% CI, 0.71-0.78] for females with Medicaid; OR, 0.78 [95% CI, 0.75-0.82] for males with Medicaid). In this large, nationwide cohort of patients with acute ischemic stroke, Black and Hispanic patients were less likely to be transferred than non-Hispanic White patients, and patients with Medicaid were less likely to be transferred than patients with Medicare. Further work is needed to understand the contributors to this disparity and the impact on access to high-quality stroke care.
Idiographic network analysis, where associations between multiple nodes are estimated, can potentially guide choice of interventions in psychological treatment. In this single case experiment using ecological momentary assessment data to estimate continuous time network models, we aimed to test the so-called centrality hypothesis. We did so by comparing effects of interventions guided by the most central node to those guided by the least central node. We used the composite level psychological inflexibility processes lack of openness, lack of awareness, and lack of engagement, alongside an interference outcome, as network nodes. Effects on pain interference, motivation, and pain intensity were examined. We employed a multiple baseline design across six participants. Therapists and participants were blinded to participants' treatment conditions. Baseline length and order of treatment phases were randomized. Four participants had an overall treatment effect on pain interference, but it was generally not possible to discern that one particular phase was more beneficial than another. For three participants, the picture was somewhat clearer, indicating one of the treatment phases as more beneficial, although the results for these participants were not consistently in line with hypotheses. Retrospectively examining other potential guidance methods for these three participants, we saw a potential in discrete time contemporaneous network models. Current results are not in line with previous assumptions or research on idiographic network models for treatment personalization, although the previous research in this area is scarce. Future research should investigate alternative network models or estimation choices to determine the potential utility of data driven idiographic networks.
Ultra-processed foods (UPFs) intake has rapidly increased in global diets, posing a mounting threat to nutritional adequacy and functional health in adults. This narrative review summarizes recent evidence on the relationship between UPF consumption and functional decline, including sarcopenia and reduced handgrip strength, and potential biological mechanisms underlying the detrimental effects of high UPF consumption and aging processes. We examined epidemiological studies, clinical trials, and mechanistic research and evaluated the effectiveness and limitations of mitigation strategies, such as product reformulation, front-of-pack labeling, pricing policies, and community-based nutrition programs. Consistent evidence indicates that higher UPF intake is associated with a greater risk of micronutrient inadequacy, low-grade systemic inflammation and oxidative damage, measurable advances in biological age relative to chronological age, and higher risk of functional impairment. Although evidence linking UPF consumption with health and aging outcomes is steadily increasing, several gaps remain, including the underrepresentation of low- and middle-income settings, the lack of long-term intervention trials with aging and functional endpoints, the heterogeneous assessment of UPFs, and the limited use of mechanistic biomarkers and "omics" approaches in population studies. We suggest an interdisciplinary research approach that combines nutritional epidemiology with validated aging outcomes. In parallel, practical policy measures should prioritize minimally processed foods, fortify regulatory frameworks, and customize community and clinical interventions to meet the needs of older adults, thereby safeguarding healthy aging.
Alcohol-related harms are prevalent late at night, especially on weekends, when high levels of intoxication contribute to increased rates of injury and violence. Reducing or increasing alcohol trading hours late at night in bars and clubs is generally associated with reduced and increased harms, respectively. This study evaluates the impact of later alcohol trading hours in the Scottish cities of Aberdeen and Glasgow on alcohol-related ambulance call-outs and crimes. Under local policy changes, 38 bars in Aberdeen had trading hours extended between 1 and 3 h up to 3am, and 10 nightclubs in Glasgow had a 1-h extension to 4am. Following a natural experiment evaluation framework, we used a controlled interrupted time series design to compare outcomes before and after policy changes, from May 2015 to March 2020. The primary outcome was a count of total weekend night-time alcohol-related ambulance call-outs. Secondary outcomes included weekend night-time crimes. In Aberdeen, the policy led to a significant relative increase of 11.4% (effect size=4.643; 95% CI 0.292 to 8.994; p=0.036) in alcohol-related ambulance call-outs, and 8.5% (effect size=3.442; 95% CI 0.239 to 6.645; p=0.035) in reported crimes, at weekend night-times compared with Edinburgh (control). Findings were not significant and robust across analyses for Glasgow. Later alcohol trading hours had a significant negative impact on alcohol-related ambulance call-outs and reported crimes in Aberdeen (where more premises had longer extensions) but not in Glasgow, suggesting the number, capacity and type of premises moderated outcomes. This is important for the design of future national and local licensing policies and regulations.
Heart failure (HF) is a major global health problem and a leading cause of morbidity and mortality. In Latin America, evidence remains limited, and HF characterization in high-altitude care settings is underreported. Quito (-2,800 m a.s.l.) provides a unique clinical context, although retrospective hospital-based data without standardized hypoxia phenotyping or sea-level comparators cannot support altitude-specific causal inference. This study aims to describe the clinical and epidemiological characteristics of patients diagnosed with HF at the Metropolitan Hospital of Quito, a tertiary care facility located at an altitude of approximately 2,800 meters, from January 2021 to December 2023. A retrospective observational study was conducted using anonymized medical records of 122 patients diagnosed with HF (ICD-10 codes I500, I501, I509). Data on demographic, clinical, and outcome variables were collected. Exploratory comparisons were performed by discharge survival status (alive vs. deceased) using chi-square or Fisher's exact tests for categorical variables and two-sample Student's t-tests for continuous variables (two-sided p < 0.05). Most patients (88.5%) were aged over 65 years, with men comprising 55.7% of the cohort. Hypertension (59.8%), dyslipidemia (18.9%), and atrial fibrillation (44.3%) were the most prevalent comorbidities. Hypertensive heart disease was the most frequent documented etiology of HF (14.8%), although etiology was unavailable in a substantial proportion of records. In-hospital mortality was low (3.3%). Exploratory univariate analyses identified unadjusted associations between in-hospital mortality and dialysis dependency, immunologic diseases, and other vascular diseases. This study provides a contemporary clinical and epidemiological profile of HF patients managed at a high-altitude tertiary hospital in Quito and identifies exploratory factors associated with in-hospital mortality in this care setting. Future multicenter studies incorporating standardized hypoxia-related measurements and appropriate comparator cohorts are needed to better understand HF phenotypes and outcomes in Andean populations.
The aim of this study was to explore the differential associations of mentally active versus passive sedentary behavior with burnout among nurses. A cross-sectional study was conducted among 1,132 nurses in Zhejiang, China, daily SBs were self-reported with The Chinese Adult Sedentary Behavior Questionnaire and burnout was measured by Maslach Burnout Inventory-Human Services Survey. Nurses who accumulated more than 4 h/day of mentally active SBs (working, reading, hobbies, transportation, and chatting) had 47% lower burnout odds than those who reported less than1 h/day (OR = 0.53; 95% CI 0.33-0.86); this inverse association remained after excluding transport-related SB. Mentally passive SB showed no significant association. Engaging in mentally active sedentary behavior was associated with lower odds of burnout among nurses.
Globally, over 10 million youth use e-cigarettes; United States use, in particular, dramatically rose in the late 2010's, exceeding year-over-year increases from any other substance in over four decades. This rise has been partially attributed to youth online e-cigarette marketing exposure, but has not been appropriately studied. We examined youth data from the Population Assessment of Tobacco and Health (PATH) spanning the dramatic increase period (Waves 4, 4.5, and 5; 2016-2019). We estimated average risk differences (RD) for Wave 5 e-cigarette harmfulness perception and use comparing all youth versus no youth reporting past-month online e-cigarette marketing exposure in Waves 4 and 4.5. We used a doubly robust, nonparametric targeted minimum loss-based estimator (TMLE) to estimate RD, incorporating PATH survey weights. Initial analyses adjusted for demographics, mental health issues, and other forms of e-cigarette marketing. Subsequent analyses adjusted for frequency of social media use, other substance use, and tobacco (non-e-cigarette) use. Initial analyses estimated that online marketing was associated with a 9% decrease in e-cigarette harmfulness perception (RD=-0.09, 95% C=-0.12, -0.05), or a Risk Ratio (RR) of 0.85 (95% CI=0.80, 0.91), as well as a 4% increase in current e-cigarette use (RD=0.04, 95% CI=0.02, 0.06; RR=1.36, 95% CI=1.15, 1.62). However, after adjusting for additional potential time-varying confounding variables, point estimates were close to null with 95% confidence intervals spanning the null. Frequency of social media use, other substance use, and/or tobacco use may be important confounding variables related to marketing and e-cigarette use that require further investigation.
White matter hyperintensities (WMH) are robust markers of vascular brain injury and predictors of poorer cognition, but their contributions may differ across racial and ethnic groups. We analyzed 3585 participants from the Health and Aging Brain Study-Health Disparities cohort (1264 non-Hispanic White [NHW], 1003 non-Hispanic Black [NHB], 1318 Hispanic). Baseline demographics, vascular risk factors, apolipoprotein E ε4, magnetic resonance imaging-derived WMH, and domain-specific cognitive z scores were assessed. We used moderated mediation models to evaluate whether WMH mediated the age-cognition relationship by race/ethnicity. Greater WMH volume was associated with poorer memory, executive function, processing speed, and language (all p < 0.01). Mediation by WMH varied across groups: WMH explained ≈ 30% of the age-cognition association in NHWs, 20% to 28% in NHBs, and 12% to 19% in Hispanics. WMHs consistently mediated age-related lower cognition, but group differences highlight the contribution of cardiometabolic, neuropathological, and social determinants beyond WMHs in NHB and Hispanic populations.
Persistent infections with human papillomavirus (HPV) cause approximately 95% of cervical cancers. The introduction of cytology screening has, however, significantly reduced morbidity and mortality rates. More recently, HPV DNA testing has been shown to be more sensitive than traditional cytology-based testing in detecting cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+). Self-sampling for HPV testing offers a viable alternative to clinician-performed sampling and could potentially increase participation rates in organized screening programs. Here, we compared the accuracy of self-collected vaginal samples with clinical-collected cervical samples for HPV-based screening and evaluated the acceptability of HPV self-sampling among Polish women. Women with unclear or abnormal results at their last cytology screening were invited to participate. Each participant submitted two swabs for HPV testing: one clinical-collected cervical swab and one self-collected vaginal swab (Evalyn® Brush). Both sample types were subsequently tested with the EUROArray HPV assay. Participants also completed a questionnaire to assess their experiences with the self-sampling procedure and express their opinions on it. In total, 180 women aged 30 to 70 years were recruited. The prevalence of high-risk (hr) HPV was 56.7% in clinician-collected samples and 55.0% in self-collected samples. Overall concordance for any HPV, hr-HPV and low-risk (lr) HPV detection between self-collected and clinician-collected samples was 88.9%, 86.1%, and 85.0%, respectively. Most participants found self-sampling comfortable (82.4%), useful (87.0%), and convenient (85.8%) and felt low/very low stress (58.0%) while sampling. In total, 81.3% of the women reported that it was practically painless and 77.2% felt less embarrassed. Of the respondents, 51.1% preferred clinician-collected sampling, 40.9% preferred self-sampling, while 4.6% had no preference. Vaginal self-sampling using the Evalyn® Brush showed substantial agreement with cervical clinician-sampling for HPV detection using the EUROArray HPV test. Self-sampling for HPV testing was well-accepted by the participants. It represents a feasible alternative for clinical sampling in Poland, which could be effectively integrated into the national HPV screening program.
Understanding the molecular impact of ionizing radiation exposure is essential for both biomedical research and public health. Among the possible approaches to study this phenomenon, gene expression profiling via transcriptomics assays has been a valuable approach over the last decades to unravel the mechanisms of cellular responses to radiation. To our knowledge, there is no data package gathering well-curated radiation transcriptomic datasets covering microarrays and, more recently, RNA sequencing. Therefore, we present DoReMiTra, an R/Bioconductor data package that represents the first unified radiation transcriptomics dataset collection integrated with Bioconductor's ExperimentHub for efficient distribution. DoReMiTra standardizes and harmonizes sample-level metadata and provides pre-processed SummarizedExperiment objects to facilitate comparative analyses. Additionally, we introduce a lightweight Shiny app interface for interactive visualization and preliminary exploration. DoReMiTra serves as a valuable resource and tool in radiation research for benchmarking, integrative analyses, and biomarker discovery. DoReMiTra is available under the MIT license at https://bioconductor.org/packages/DoReMiTra.
Equine herpesvirus type 1 (EHV-1) is an important viral pathogen in horses, associated with diverse clinical manifestations including fever, upper and lower respiratory disease, neurological signs, ocular disease, and abortion. Currently, EHV-1 variants (genotypes) are classified based on a single nucleotide polymorphism mutation of the open reading frame 30 (ORF30). The aim of this retrospective study was to evaluate the EHV-1 genotypes present in horses with various clinical presentations, including respiratory disease, abortion, and neurological disease, at a referral center in the province of Ontario. Equine herpesvirus type 1 was detected in 11.7% of the tested horses, with clinical presentations including abortion (21%), myeloencephalopathy (64%), fever (11%), pneumonia (3.5%), and asymptomatic cases (3.5%). The neuropathogenic strain was more commonly present in horses with abortions and fevers. Equine herpesvirus myeloencephalopathy was associated with the non-neuropathogenic strain in 50% of the cases and the neuropathogenic strain in 44% of the cases. However, in 6% of the cases, the viral genotype was unknown. These findings highlighted that this is a multifactorial problem and clinical disease may not be solely attributed to viral genome. This variability reinforced the need for continued research into the behavior and epidemiology of EHV-1. Évaluation rétrospective des manifestations cliniques associées au génotype de l’herpèsvirus équin de type 1 (HVE-1) en Ontario. L’herpèsvirus équin de type 1 (HVE-1) est un agent pathogène viral important chez les chevaux, associé à diverses manifestations cliniques, notamment la fièvre, des affections des voies respiratoires supérieures et inférieures, des signes neurologiques, des affections oculaires et des avortements. Actuellement, les variants (génotypes) de HVE-1 sont classés en fonction d’une mutation par polymorphisme nucléotidique unique (SNP) du cadre de lecture ouvert 30 (ORF30). Cette étude rétrospective visait à évaluer les génotypes de HVE-1 présents chez des chevaux présentant diverses manifestations cliniques, incluant des affections respiratoires, des avortements et des affections neurologiques, dans un centre de référence de la province de l’Ontario. L’herpèsvirus équin de type 1 a été détecté chez 11,7 % des chevaux testés et les manifestations cliniques comprenaient des avortements (21 %), une myéloencéphalopathie (64 %), de la fièvre (11 %), une pneumonie (3,5 %) et des cas asymptomatiques (3,5 %). La souche neuropathogène était plus fréquemment présente chez les chevaux présentant des avortements et de la fièvre. La myéloencéphalopathie herpétique équine était associée à la souche non-neuropathogène dans 50 % des cas et à la souche neuropathogène dans 44 % des cas. Cependant, dans 6 % des cas, le génotype viral était inconnu. Ces résultats soulignent le caractère multifactoriel de ce problème et indiquent que la présentation clinique ne peut être uniquement attribuée au génome viral. Cette variabilité renforce la nécessité de poursuivre les recherches sur le comportement et l’épidémiologie de HVE-1.(Traduit par Dr Serge Messier).
The American Society of Hematology convened 2 multidisciplinary panels to develop guidelines for the management of acute lymphoblastic leukemia (ALL) among adolescents and young adults (AYAs). The objectives of this study are to (1) describe the process for selecting and prioritizing outcomes for 32 research questions relevant to the guideline development, (2) summarize the prioritized outcomes, and (3) describe the frequency of reporting of those outcomes in existing studies of AYAs with ALL. The panels prioritized outcomes for each of the 19 questions on frontline management, 9 on the management of relapsed/refractory disease, and 4 related to both topics. A 3-step process was used: (1) initial identification of outcomes, (2) online survey of all panel members to rate each outcome's importance, and (3) iterative discussions among the panels to finalize the prioritized outcomes. We examined the frequency with which each prioritized outcome was reported for systematically reviewed research questions. The panels prioritized 34 unique outcomes across questions (median, 7 outcomes per question). The most common outcomes were overall survival (27 questions [84% of questions]); relapse-, event-, disease-, or progression-free survival/relapse (27 questions [84%]); and quality of life (26 questions [81%]). Across 16 systematic reviews for which we found at least 1 study, each prioritized outcome was reported by a median of 25% (interquartile range, 20-48; range 0-79) of the studies. The outcomes prioritized by multidisciplinary guideline panels can inform future primary studies, systematic reviews, and guidelines on ALL, other blood cancers, and AYAs. Future research should involve the development and adoption of a core outcome set for ALL.
Endocrine-related secondary osteoporosis (ERSOP) comprises disorders in which bone fragility results from hormonal abnormalities other than age-related or menopausal hypogonadism. Its prevalence is underestimated, and timely recognition is essential because many forms improve or reverse when the underlying endocrine disturbance is corrected. This Review highlights the evolving concepts, unmet needs, and research opportunities in ERSOP, with focus on hypercortisolism, primary aldosteronism, male hypogonadism, hypercalciuria, and FGF23-dependent phosphate-wasting disorders. Mild autonomous cortisol secretion (MACS) is increasingly recognized as a contributor to fracture risk even at near-normal cortisol levels.Primary aldosteronism promotes skeletal fragility via mineralocorticoid receptor activation, oxidative stress, hypercalciuria, and secondary hyperparathyroidism.Male hypogonadism is a major driver of bone loss, and optimal fracture prevention may require combined hormonal and anti-osteoporotic therapy.Differentiating PTH-dependent from PTH-independent hypercalciuria is crucial for management.FGF23-mediated phosphate-wasting disorders impair mineralization and may respond to targeted therapy, including burosumab. ERSOP should be considered in patients with atypical osteoporosis phenotypes, including men, younger adults, and individuals with normal BMD but fragility fractures. Optimal care requires structured endocrine assessment, correction of the primary disorder, and integration with bone-specific therapy where appropriate.
Eosinophilic granulomatosis with polyangiitis (EGPA) and hypereosinophilic syndrome (HES) are rare systemic inflammatory diseases with overlapping features. Mepolizumab, a humanized mAb targeting IL-5, has been approved for treatment of both conditions. However, real-world data on its clinical benefit in private practice settings remain limited. We sought to evaluate oral corticosteroid (OCS) use, clinical outcomes, and end-organ manifestations post-mepolizumab initiation in private practice settings using electronic medical records. This retrospective pre-post cohort study used data from the US-based Allergy Partners network electronic medical records (January 1, 2007, to August 17, 2023) to select patients with EGPA or HES who initiated mepolizumab (index date). Participants were 18 years and older (EGPA) or 12 years and older (HES) with 3 or more months of clinical activity pre- and postindex. Outcomes included OCS use and dose, clinical outcomes (response and remission), and end-organ damage manifestations. Overall, 44 patients with EGPA and 16 patients with HES had significant reductions in OCS use and dose (P = .014 for trend over each 6-month period), with improvements in end-organ manifestations over a treatment period up to 2 years. Among patients with EGPA, clinical response, disease control, and remission rates increased significantly. In addition, 86.4% of patients with EGPA experienced an improvement in at least 1 of the outcome measures of OCS use, end-organ manifestations, or blood eosinophil count. Among patients with HES, end-organ manifestations were more common preindex (87.5%) than postindex (56.3%). These findings highlight the long-term OCS-sparing effects of mepolizumab and suggest additional clinical benefits for patients with EGPA and HES in a private practice setting.
Self-rated health is a robust measure of overall health status, encompassing an individual's physical, mental, and social health. This multidimensional characteristic highlights the potential of this variable in studies conducted in regions affected by major disasters. This study assessed the prevalence of poor self-rated health and its association with sociodemographic factors, health behaviors, multimorbidity, and place of residence among adult residents of Brumadinho, Minas Gerais State, Brazil, following the collapse of a mining tailings dam. It is a cross-sectional study based on baseline data from the Brumadinho Health Project, which was conducted in 2021 and included 2,771 individuals aged 18 years or older. The outcome variable was poor self-rated health, while the exploratory variables included sociodemographic characteristics, health behaviors, multimorbidity, and place of residence (area directly affected by the disaster; region with mining activity; unexposed). The association between exploratory variables and the outcome was evaluated using logistic regression. The prevalence of poor self-rated health was 6.4% in the municipality's population, being higher in the region directly affected by the tailings mud (12.7%). The likelihood of perceiving health as poor or very poor was higher among women, current smokers, and those with multimorbidity and lower among those who reported consuming alcoholic beverages one or more times per month. Engaging in physical activities at recommended levels reduced the likelihood of poor self-rated health, but only among the unexposed - residents in areas unaffected by mud and without mining activity (p interaction = 0.002). These results demonstrate that the residential context modifies the effect of physical activity on self-rated health, such that residents in areas affected by tailings mud or with mining activity do not benefit from engaging in physical activity at recommended levels, at least regarding health perception. Greater efforts to improve environmental conditions may be necessary in regions impacted by major disasters or environmental degradation due to mining processes.
Ticks are major ectoparasites affecting the health and productivity of livestock in Ethiopia. However, there exists limited information on the current efficacy of widely used acaricides including ivermectin 1% and amitraz 12.5%. Experimental randomized controlled study design was conducted from February 2023 to June 2023 to evaluate in vitro susceptibility of field-collected Amblyomma variegatum (A. variegatum) and Rhipicephalus (Boophilus) decoloratus (R. decoloratus) in cattle in Gondar Zuria District Northwest Ethiopia to ivermectin1% and amitraz 12.5% at varying concentrations. Collected engorged female ticks (n = 540) were exposed to four concentrations of ivermectin 1% (0.00125, 0.005, 0.01, and 0.025%) for 24 h and three level concentrations of amitraz 12.5% (0.0125, 0.025, and 0.05%) for 48 h. Ivermectin 1% produced rapid and concentration-dependent mortality, with maximum efficacy of 96.66% for A. variegatum and 90% for R. decoloratus at the highest dose (0.025%). Similarly, amitraz 12.5% showed strong dose-dependent activity after 48 h, achieving mortality of up to 80.0 and 90% for A. variegatum and R. decoloratus, respectively. Two-way ANOVA confirmed that ivermectin 1% concentration, observation time and their interaction significantly affected mean mortality rate of A. variegatum (F = 3.34, P = 0.0184; F = 12.51, P < 0.001; F = 4.94, P < 0.001) and R. decoloratus (F = 21.02, P < 0.001; F = 36.81, P < 0.001; F = 3.45, P = 0.0016), respectively. In addition, amitraz 12.5% concentration and exposure time significantly affected mortality in A. variegatum (F = 26.72, p < 0.001; F = 4.20, p = 0.0129) and R. decoloratus (F = 44.41, p < 0.001; F = 12.82, p < 0.001), although the interaction effect was not significant for A. variegatum (P > 0.05) but was significant for R. decoloratus (P < 0.05). These findings indicate that both acaricides remain effective against adult ticks in the study area, with ivermectin 1% acting more rapidly and amitraz 12.5% demonstrating a clear dose-response relationship. Continued surveillance and integrated tick management are recommended to mitigate the risk of emerging acaricide resistance.
There are no official data on the prevalence of end-stage chronic kidney disease with dialysis for the Brazilian state of Pará. To describe the clinical-epidemiological profile of hemodialysis patients at the largest specialist center in the state of Pará. This is an observational, cross-sectional, descriptive, quantitative study. Simple descriptive statistics were calculated. Data were collected from medical records from June to August 2022 at the Hemodialysis Center at the Hospital de Clínicas Gaspar Vianna (HCGV) and the Monteiro Leite Hemodialysis Clinic (CMHL), both in Belém, Pará, Brazil. A total of 191 patients from the chronic hemodialysis program were interviewed. Of the total sample, 28.8% patients were from HCGV and 71.6% from CHML; 57.1% were men and 42.9% were women. Mean age was 54.1 years. Results showed that 65.4% of patients self-reported skin color as brown, 44.5% had completed primary education, 41.9% were single, 71.4% had hypertension, 40.6% had diabetes, and 77.5% had been on renal replacement therapy for a mean time of 4 years. Regarding treatment, 86.9% started treatment with a short-duration catheter, 8.4% were using a long-dwelling catheter, and 4.7% had a definitive dialysis access via a mature arteriovenous fistula (AVF). Currently, 58.1% of these patients have a native AVF, 34% have a long-dwelling catheter, and 3.1% have a short-duration catheter and no AVF. Patients on renal replacement therapy in Pará predominantly initiate hemodialysis in an unplanned manner, using temporary venous catheters, although they transition to definitive vascular access over time. This scenario highlights the need for early diagnosis of chronic kidney disease and timely vascular access planning, aiming to reduce complications and optimize clinical outcomes.