Treating obesity in children and adolescents is complex, given the dynamic nature of growth and development during this life stage. The role of pharmacological treatments in the management of pediatric obesity remains uncertain, particularly with respect to outcomes beyond weight reduction, including quality of life and long-term adverse events. To assess the benefits and harms of pharmacological interventions for the treatment of obesity in children and adolescents. We searched CENTRAL, MEDLINE, the World Health Organization (WHO) International Clinical Trials Registry Platform, and ClinicalTrials.gov on 3 July 2023 without language restrictions. In June 2025, we checked the status of ongoing studies and updated results accordingly. We included randomized controlled trials (RCTs) evaluating pharmacological interventions in children (0 to 9 years) and adolescents (10 to 19 years) with essential obesity. Eligible studies administered any medication, at any dose, as monotherapy or in combination, for at least three months and reported outcomes after a minimum follow-up of six months. Critical outcomes were change in body mass index (BMI), change in weight, any adverse events, discontinuation due to adverse events, and incidence or severity of obesity-related outcomes. Important outcomes were health-related quality of life, mental and physical well-being, and obesity-related disability. We used the RoB 2 tool to assess bias in the included RCTs. We calculated mean differences (MDs) and standardized mean differences (SMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, with their corresponding 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for critical outcomes and quality of life. We included 37 RCTs with a total of 4218 participants. Two were cross-over trials; 35 were parallel-group trials. We identified seven ongoing studies and six studies as awaiting classification. Of the included studies, 25 involved adolescents only. Eleven studies planned to include both children and adolescents, but only eight actually did. One study intended to include children but did not specify participants' age at inclusion. Trials randomized participants to pharmacological interventions or control alongside common baseline treatments (e.g. behavioral or lifestyle approaches, diet, and physical activity). Of the 37 included studies, 31 used placebo and six used no intervention (baseline treatment alone) as the comparator. The studies were conducted across 17 high-income, six middle-income, and three low-income countries. Length of follow-up ranged from six to 31 months, with a median of 11 months. Pharmacological interventions versus placebo Compared to placebo, pharmacological interventions (glucagon-like peptide-1 [GLP-1] receptor agonists, metformin, orlistat, sibutramine, topiramate, phentermine plus topiramate) may reduce BMI (change from baseline) by 1.80 kg/m2 (95% CI -2.36 to -1.24; I2 = 87%; 25 studies, 3091 participants; low-certainty evidence) and weight (change from baseline) by 5.47 kg (95% CI -7.45 to -3.50; I2 = 89%; 20 studies, 2380 participants; low-certainty evidence). Adverse events were frequent. Pharmacological interventions (GLP-1 agonists, sibutramine, phentermine, topiramate) likely make little to no difference in the risk of any adverse events compared to placebo (RR 1.03, 95% CI 1.00 to 1.07; I2 = 0%; 8 studies, 1877 participants; moderate-certainty evidence). Pharmacological interventions (GLP-1 agonists, metformin, orlistat, sibutramine, phentermine, topiramate) may make little to no difference in the risk of discontinuation due to adverse events, although the risk was slightly higher with the medications (RR 1.50, 95% CI 0.82 to 2.75; I2 = 17%; 13 studies, 2213 participants; low-certainty evidence). One study (46 participants), comparing sibutramine to placebo, found that there may be little to no difference in the incidence of obesity-related outcomes for adolescents with comorbidities (assessed as changes in glycemia, blood pressure, total cholesterol, and triglycerides). We were unable to pool other data on incidence or severity of obesity-related outcomes. Compared to placebo, pharmacological interventions (GLP-1 agonists, phentermine plus topiramate) likely result in little to no difference in quality of life, assessed with the Impact of Weight on Quality of Life-Kids (IWQOL) questionnaire (MD 1.02, 95% CI -1.94 to 3.98; I2 = 48%; 4 studies, 741 participants; moderate-certainty evidence). Pharmacological interventions versus no intervention Compared to no intervention, metformin may reduce BMI (change from baseline) by 1.51 kg/m2 (95% CI -2.29 to -0.73; I2 = 0%; 3 studies, 151 participants) and weight (change from baseline) by 3.20 kg (95% CI -6.12 to -0.28; 1 study, 42 participants), but the evidence for both outcomes is very uncertain. Compared to no intervention, pharmacological interventions (metformin and orlistat) may increase the risk of discontinuations due to adverse events, but the evidence is very uncertain (RR 13.70, 95% CI 0.83 to 225.43; 2 studies, 84 participants). None of the studies comparing pharmacological interventions to no intervention reported data on adverse events, obesity-related outcomes, and quality of life that could be pooled in meta-analysis. Only eight of the 37 included studies enrolled children, and data were seldom disaggregated by age, limiting the ability to draw conclusions about benefits or harms in children. This review includes clinical trials assessing the benefits and harms of pharmacological treatments - including GLP-1 agonists, metformin, orlistat, phentermine, sibutramine, and topiramate - for weight management in adolescents with obesity. Evidence suggests that pharmacological treatments may result in small reductions in BMI and weight, which could be clinically important, although effects vary by medication. Evidence on desirable and undesirable effects in children is scant. Uncertainties remain about the optimal duration of treatment, consequences of treatment discontinuation, and long-term benefits and harms, particularly considering the physiology of children and impact on growth. Studies with longer follow-up are needed to evaluate outcomes beyond BMI and weight change, including the potential effects of treatment discontinuation. The Department of Nutrition and Food Safety at the WHO commissioned and provided financial support for this work. WHO acknowledges financial support from the Norwegian Agency for Development Cooperation (NORAD), the Swedish International Development Cooperation Agency (SIDA), the Government of the Grand Duchy of Luxembourg, the Government of Germany (BMG), and the Government of Greece to the WHO Department of Nutrition and Food Safety. Our protocol is registered in PROSPERO: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023433123.
Food safety in Afghanistan is challenged by limited infrastructure, food insecurity, and the occurrence of pathogens such as Staphylococcus aureus, Salmonella spp., Listeria monocytogenes, and Escherichia coli O157:H7, creating potential food safety hazards that lead to health complications. These challenges pose serious threats to public health, making it necessary to implement mandatory food safety training and certification programs to improve hygiene standards among dairy wholesalers and retailers in Kandahar City. A cross-sectional study was conducted involving 250 dairy wholesalers and retailers from March to April of 2025. Data were collected through face-to-face interviews using a carefully designed, structured questionnaire. The questionnaire was divided into four sections: sociodemographic information, knowledge of food safety, attitudes, and food safety practices. Our results showed that 92% of dairy wholesalers and retailers had a high level of food safety knowledge, and 93.6% agreed that proper cleaning of equipment reduces the risk of food contamination. However, fewer than 20% of the respondents were aware of infectious diseases. The study found a significant link between household income, holding a health certificate, and the level of food safety knowledge. We recommend the implementation of specialized training programs to improve personal and environmental hygiene and ensure better compliance with food safety regulations. Therefore, it is advisable to develop a comprehensive food safety policy within the One Health framework and foster collaborative efforts to raise awareness among all stakeholders involved in food safety.
This study aims to develop a machine learning model capable of predicting the type of non-compliance (NC) most likely to be detected by competent authorities during official control of food establishments based on their structural, product, and management characteristics. A Bayesian Network (BN) model was developed using data from 145 NCs detected by the Local Health Authority of Messina during 588 official controls performed on 101 approved food establishments between 2018 and 2021. The NCs were classified into 10 distinct categories based on the requirement not met: i) structural and equipment conditions; ii) water supply; iii) fight against pests; iv) hygiene of staff and processing; v) cleaning and sanitizing conditions; vi) raw materials, semi-finished and finished products; vii) labeling; viii) traceability; ix) hazard analysis and critical control points (HACCP); and x) microbiological criteria according to Regulation (EC) 2005/2073. The model was constructed by associating the number and type of NC with the criteria and corresponding evaluations established by the Veterinary Services for each food establishment risk categorization according to Annex 2 of the Intesa Stato-Regioni CSR 212/2016. In detail, 8 different criteria were considered: i) date of construction or renovation; ii) general maintenance conditions; iii) marketing area; iv) food category; v) product intended use; vi) professionalism of management; vii) hygienic-sanitary training of employees; and viii) HACCP self-control plan. The BN model was implemented using the Hugin Lite software, considering the NC type as the parent node and the 8 different criteria as the child nodes. The implemented model allowed the prediction of the most probable type of NCs by inputting the evaluations of each risk categorization criterion for a given food establishment into the child nodes. A total of 25 NCs detected in 10 food establishments during 2024 were used to validate the model. The validation cases were not included in the learning dataset. The model correctly predicted the occurrence of 19 NCs (76%), while 6 NCs (24%) were not predicted, and 3 NCs (12%) were rightly predicted as the most probable ones. Although further efforts are needed to implement the model with a greater amount of data, this study highlights the potential of a BN-based approach as a valuable tool for competent authorities in organizing and performing official controls from a new technological and sustainable perspective.
In developing countries, the urban population's association with street food is significant. Consumers favor street food because of its convenience, affordability, and palatability. Nevertheless, the majority of street foods are detrimental to health. The present study aimed to assess the bacteriological quality of selected street foods in open and closed environments in the city of Lucknow. This study focused on 6 street food samples and 120 vendors' hygiene practices. The 6 food samples were selected from open-air stalls, and the same 6 food samples were selected from indoor shops that were randomly selected from 4 different locations in the city of Lucknow. The results of this study revealed that the samples collected from the open-air stalls were contaminated with pathogenic bacteria ranging from 9.44±0.96 log10 to 6.11±1.06 log10 (p<0.05). According to the questionnaire results, 81% of respondents were unaware of dish towels, hand washing, cutting nails, covering heads, and using gloves, and 94% of vendors were unaware of practices of knife and cutting board contamination. The findings of this study indicate that the street foods from the indoor shops were served under hygienic conditions, whereas the foods from the open-air stalls were served under unhygienic conditions that were not good for human health. However, in order to improve the final quality of these street foods, further strategies are needed, such as the street food makers' training, with the aim of applying good hygienic practices during production.
Food insecurity remains a global challenge, with developing countries enduring more impact. To curb this challenge, school feeding programs (SFP) have played a critical role. Nutrient-rich foods provided through school feeding initiatives must meet strict safety standards to avoid foodborne illnesses. Milk is among the most nutritious foods that are very affordable across the globe; however, it is easily and highly susceptible to contamination. Food safety remains a crucial component of public health, especially in programs targeting vulnerable populations such as school children. Against this background, the present study aimed to investigate the microbial content of milk served to children through the SFP in selected primary schools in Maseru and to assess the knowledge, attitudes, and self-reported behavioral practices of food handlers in relation to milk safety. Pasteurized milk was obtained from a common source by 16 primary schools participating in the SFP. Structured questionnaires were administered to food handlers to gather data on knowledge, attitude, and self-reported behavior. Milk samples were examined for microbial quality using selective microbiological agars. On average, 13% of the food handlers expressed a lack of knowledge of the diseases that are transmitted through contaminated milk, while 44% perceived that clean water could be identified with the naked eye. Less than 50% of the food handlers understood that cold milk implied safe milk, even without refrigeration. Coliforms (2×100 and 2.33×102 CFU mL⁻¹) and yeast and molds (1.43×102 to 9.3×103 CFU mL⁻¹) occurred above threshold limits in all the samples. Escherichia coli counts ranged from 2×100 to 2.3×101 CFU mL⁻¹, which is a call for concern. The total bacterial counts indicate the presence/growth of microorganisms in all the milk samples, thus suggesting contamination. The knowledge, attitude, and self-reported behavior of the food handlers reported in the study could guide the food safety routine program.
Dry aging of beef has recently been defined in Delegated Regulation 2024/1141, amending Regulation 853/2005. The delegated regulation lists specific measures to be applied when processing such a product. Specifically, a point is dedicated to the crust trimming that should be carried out in a hygienic manner, since the interventions performed at the end of the process might determine contamination of the edible parts. Nevertheless, despite the punctual application of good hygiene practices (GHP) and good manufacturing practices (GMP), a certain degree of contamination with pathogenic and spoilage microorganisms of the cut portions cannot be avoided, as demonstrated by some authors reporting contamination of the inner parts of dry-aged meat. In order to investigate the level of contamination occurring in field conditions during trimming and portioning, we performed two different trials: the sterility trial with the aim of evaluating the sterility of the inner parts of beef during aging, and the contamination trial to assess the transfer of microbial populations from the outer to the inner part of the dry-aged beef. All tests were performed by means of cultural and non-cultural methods. Results of the sterility trial show that a very limited percentage of non-host DNA is present in the inner parts of the meat starting from the beginning of the test, and that the detectable DNA increases slightly during the time of aging. Besides, the contamination trial results showed that the contamination of the trimmed meat is qualitatively and quantitatively related to the contamination of the crust. As a consequence, adherence to GHP and GMP during trimming and handling of dry-aged meat according to scientific literature is crucial to avoid/minimize cross-contamination since our data clearly demonstrate that processing practices are fully reflected in the final product quality.
Fish curing is a preservation method that has evolved into a culinary practice, combining traditional techniques with modern food science. Its main aims are to reduce water activity to extend shelf life, inhibit foodborne pathogens, and enhance the flavor and texture of the products. Recently, controlled maturing techniques in dedicated cabinets, previously associated exclusively with meat, have begun to attract interest among chefs, restaurants, and food companies, also in the field of preservation and flavor enhancement of fish. These methods involve exposing fish to controlled temperature, humidity, and airflow in dedicated cabinets for periods ranging from days to weeks, depending on species and desired outcomes. Despite the ongoing global spread of these methods, there is still a lack of specific guidelines for food business operators (FBOs) and regulatory references. This review offers a comprehensive assessment of the literature on fish maturation in dedicated cabinets, exploring food safety principles and identifying tools to support the economic and commercial potential of these technologies. A key distinction for FBOs and consumers is between dry-curing and dry-aging. Both encompass maturation in controlled environments, but dry-curing includes salting and the addition of spices and additives, resulting in ready-to-eat products. In contrast, for dry-aging, fish is simply degutted, scaled, and directly hung within cabinets. Although the literature remains limited, it is evident that monitoring of critical parameters (temperature, humidity, airflow) is essential to minimize spoilage, microbiological risk, and biogenic amine formation. FBOs must apply general good manufacturing practices (GMPs) and good hygiene practices (GHPs) for fish processing and some GMPs and GHPs specific to each dry-aging and dry-curing process, which must be individually validated. Further research is needed to optimize and validate processes for various species and to better understand biochemical and microbial changes. Moreover, specific guidelines for the food industry/operators to properly carry out these processes and ensure that the resulting products are safe for consumers should be drafted.
The European Union has established a rigorous system to control food imported from third countries and ensure consumer safety. However, the illegal trade in prohibited food items remains a significant issue. Non-compliant food, often counterfeited through false labeling, can bypass checks at border inspection points, choosing the least monitored entry points. These products pose a threat to public health, as they may contain products of animal origin, undeclared allergens, or come from unauthorized facilities. A recent example is the investigation initiated by the monitoring plan, which uncovered the illicit trade of food of animal origin in some ethnic shops. The Local Health Authority Naples 1 Center carried out extensive inspections of commercial establishments, finding that some foods labeled as wheat- or soy-based snacks were, in fact, prohibited food items from China. The Italian labels reported false information, hiding the real composition of the products. The operation led to the seizure of tons of food, including fish products and difficult-to-identify foods. The analysis detected undeclared allergens and, in some cases, traces of the African swine fever virus, although inactive. Following these discoveries, the Directorate General for Food Safety launched a program of coordinated controls at national level to combat illegal trade. This episode highlights the need to use advanced technologies and strengthen national and international collaboration to protect consumers.
The correct indication of the commercial life of some products, although specifically regulated by Regulation (EU) 1169/2011, could be difficult to apply for the Food Business Operator. The consequence is to attribute a "date of minimum durability" (DMD) to some foods, which, being perishable from a microbiological point of view, should carry a "use by" date, as they could represent a potential risk for the consumer. This study aims to evaluate the correct use of the "best before" date instead of the "use by" date in different ready-to-eat (RTE) foods, for which it is conceivable that they perish after that date. The analysis was carried out on 43 RTE products, divided into 26 dairy and 17 meat products (4 raw cured and 13 cooked), which had the term "best before" and were characterized by medium perishability, purchasing two sampling units of the same lot to carry out microbiological, chemical-physical, and sensory analyses. The first sampling unit was analyzed at the expiry of the DMD, and the second one 7 days later by storing the sample at 7°C (DMD+7), simulating a condition of thermal abuse at the domestic storage level. The results of the microbiological analysis showed that 13 cooked meat products at DMD 3 (ID 3 - roast turkey; ID 6 - Lyoner; ID 9 - cooked shoulder) and 4 (ID 3 - roast turkey; ID 6 - Lyoner; ID 9 - cooked shoulder; ID 12 - mortadella) at the DMD and DMD+7, respectively, presented "unsatisfactory" microbial loads, such as to be considered "in a state of alteration" according to the Ce.I.R.S.A guideline. Regarding 26 dairy products, at DMD only one sample (ID 20 - sweet gorgonzola) was to be considered "in a state of alteration", while at DMD+7 the samples were 2 (ID 20 - sweet gorgonzola; ID 24 - Brie cheese). Microbiological results were confirmed by the sensory analysis. The state of alteration found in the products examined means that they fully fall within the definition of unsafe food as reported in Regulation (EC) 178/2002, which therefore requires that they be marketed with the "use by" date.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
This investigation focused on the compilation and analysis of the incidence of foodborne diseases and foodborne outbreaks related to protein-based foods, published in official surveillance reports from the European Union (EU), United States of America (USA), Canada, and New Zealand (NZ), in the period of 2010-2023, for foodborne pathogens norovirus, Campylobacter spp., Cryptosporidium spp., Listeria monocytogenes, Salmonella enterica (non-typhoidal, typhoid, and paratyphoid) and Shiga-toxin-producing Escherichia coli (STEC). Most outbreaks reported during this period were caused by non-typhoidal Salmonella, norovirus, and Campylobacter spp., predominantly in European Member States (MS), followed by the USA. This compilation analysis evidenced the heterogeneity between regions/countries in the contribution of protein foods to total strong evidence outbreaks that occurred in the studied period. For instance, whereas in the USA, "cheese" was the most frequent source of listeriosis (52.6%), in EU-MS, "meat" was the topmost contributor (43.1%). In EU-MS, norovirus outbreaks were mainly associated with "crustaceans and mollusks" (80.9%); "eggs" accounted for most salmonellosis (52.1%) outbreaks, followed by "meat" (27.1%), the latter of which was also the largest contributor to campylobacteriosis (66.9%) and STEC outbreaks (52.7%). Strong-evidence cryptosporidiosis outbreaks in EU-MS were attributed to "cheese," while in NZ and the USA, they were all linked to "milk." In the USA and NZ, salmonellosis was frequently associated with "meat" (44.3-46.9%); campylobacteriosis, with "milk" (44.9-45.2%); and norovirus outbreaks were attributed to "crustaceans and mollusks" (21.2-29%), "dough-based derivatives" (9.7-26.7%), and composite meals, i.e., "meat-based meals" (16.3-32.3%) and "seafood-based meals" (12.9-14.1%). STEC was often linked to "milk" in NZ (62.5%) and to "meat" in the USA (54.1%).
This study compares Salmonella monitoring data obtained from food business operator (FBO) self-monitoring and competent authority (CA) official sampling on pig carcasses in a high-throughput Italian slaughterhouse over 10 years (2012-2021 for FBO; 2014-2021 for CA). A total of 1560 FBO and 377 CA samples were analyzed. Salmonella prevalence was 3.46% [95% confidence interval (CI): 2.6-4.5] for FBO and 10.34% (95% CI: 7.3-13.5) for CA, with statistically significant yearly differences in 2015, 2017, 2018, and 2020 (p<0.05). Derby was the predominant serovar (22.6%); however, 20.4% of the FBO isolates were classified only as "No Typhimurium and Enteritidis", highlighting gaps in serotyping protocols. Discrepancies likely reflect differences in sampling frequencies, carcass origins, and the use of different accredited laboratories by FBO and CA (private and official ones, respectively). The study identifies regulatory ambiguities, including a mistranslation in the Italian Ministerial Note, and recommends enhanced farm-level controls and harmonized surveillance.
Although consumers claim to know how to manage food properly, they unconsciously engage in unsafe practices, which calls for tailored communication interventions to enhance health-related behaviours. The present study focuses on the storage of food in household refrigerators, as the poor organisation of the appliance can promote the growth of microorganisms and cross-contamination, posing a risk to consumer health. This work was aimed (i) to assess Italian consumers' refrigerator safety knowledge, perceptions and past behaviour, and (ii) to verify which psychosocial factors drive the implementation of the behaviour, using the Theory of Planned Behaviour (TPB) and its extensions (Model of Goal-directed Behaviour MGB - desire, positive/negative anticipated emotions PAEs/NAEs). Data were collected via an online survey (N = 242) conducted on smartphone app. Even though the respondents were found to have a good attitude and be willing to engage in the target behaviour, they revealed inadequate refrigerator organisation. Perceived behavioural control (PBC) was found to have a strong influence on intentions, together with desire, which was found to mediate the effects of attitudes, positive anticipated emotions, and PBC on intentions. Results suggest that communication interventions to enhance the correct storage of food in the refrigerator should specifically address the positioning of eggs, and messages should leverage PBC, desire, and PAEs.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
A challenge test was conducted to evaluate the efficacy of three Spianata Piccante formulations (A: traditional; B: with a bacteriocin-producing starter culture; C: with added dextrose) in reducing experimentally inoculated Listeria innocua, used as a surrogate for Listeria monocytogenes, and Salmonella spp. The aim was to identify the formulation that best ensured pathogen inactivation in compliance with United States (US) export requirements. Traditional Italian salami are considered shelf-stable due to multiple hurdle technologies, including pH reduction, decreased water activity and competitive microflora. However, these hurdles are often insufficient to reduce foodborne pathogens, particularly L. monocytogenes and Salmonella spp., to the levels required by the Food Safety and Inspection Service (FSIS) regulations (≥3 log₁₀ CFU/g for L. monocytogenes and ≥5 log₁₀ CFU/g for Salmonella spp.). High-pressure processing (HPP), a non-thermal treatment capable of inactivating vegetative pathogens, can be applied to achieve these reductions. In this study, meat batter was inoculated prior to stuffing (6 log₁₀ CFU/g), and pathogen reductions were evaluated after ripening and HPP treatment. Significant differences in microbial inactivation were observed among formulations (p<0.05). Under the worst-case scenario, defined as the lowest log₁₀ reduction among all tested units, only formulation B met the FSIS validation targets, achieving reductions of 3.89 log₁₀ CFU/g for L. innocua and 5.77 log₁₀ CFU/g for Salmonella spp. These findings suggest that the use of bacteriocin-producing starter cultures, combined with HPP, represents an effective strategy to enhance the microbiological safety of fermented dry-cured sausages intended for the US market.
Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
Indonesia ranks as the second-largest global producer of seaweed. To maximize the use of these resources, innovative seaweed-based food products are being developed. This study evaluates the prevalence of chemical and microbiological contamination in Indonesian seaweed-based food products. Microbiological parameters assessed included total viable count, coliforms, Escherichia coli, Staphylococcus aureus, Vibrio species, Salmonella species, and yeast and mold. Chemical contamination was evaluated by measuring aflatoxin B1 and conducting a comprehensive assessment of heavy metals. Results indicated that 20% of samples contained aflatoxin B1 at concentrations ranging from 0.14 to 2.12 µg/kg. Heavy metal analysis showed contamination with lead in 50% of samples, arsenic in 35%, cadmium in 25%, and mercury in 5%. Only 25% of heavy-metal-contaminated samples exceeded the Indonesian National Standard limits. Microbial counts ranged from fewer than 10 to 105 CFU/g, coliforms from fewer than 3 to 830 MPN/g, and yeast and molds from fewer than 10 to 102 CFU/g. All samples had E. coli and S. aureus counts below 10 CFU/g and tested negative for Salmonella and Vibrio species. Most products were assessed as safe for consumption. The findings underscore the need for improved food-processing practices to enhance product quality, ensure higher safety standards, and increase overall market value.
Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants with high mobility and potential health risks. Despite growing regulatory attention, data on tissue-specific distribution in pigs remain scarce. This study aimed to assess PFAS occurrence in pig liver and muscle (longissimus dorsi, semimembranosus) to support risk-based monitoring strategies. A liquid chromatography-tandem mass spectrometry method was developed and validated for 13 PFAS, following European Union Reference Laboratory for Persistent Organic Pollutants and Regulation (EU) 2022/1428 guidelines. Liver and muscle samples from pigs reared under controlled dietary conditions were analyzed. The method showed excellent linearity, precision, and trueness; the limit of quantification (LOQ) was 0.04 μg/kg for all matrices. The perfluorooctanesulfonic acid and perfluorooctanoic acid (PFOA) were consistently detected in liver samples, whereas PFAS concentrations in the two muscle cuts remained mostly below the LOQ, with only occasional PFOA quantification in a subset of samples. None of the samples exceeded current EU maximum levels [Regulation (EU) 2023/915]. Our findings confirm a marked hepatic accumulation of PFAS and negligible contamination in muscle, showing the liver as a priority matrix for biomonitoring. Consumer exposure through pork muscle appears minimal, while offal consumption requires attention. These preliminary data contribute to defining risk-based control strategies in the pork production chain.
In order to investigate the presence of aflatoxins (AFs), a total of 120 samples of paddy rice cultivated by the 'irrigation' and 'rainfed' systems in the main rice-growing regions of Colombia were collected during 2017 and 2018. The Association of Official Analytical Chemists accredited standard method, based on high-performance liquid chromatography, was used to detect and quantify AFs (AFB1, AFB2, AFG1, and AFG2). The results showed that, in 2017, the occurrence of AFs in paddy rice from rainfed systems was 43% (range 2.1 to 119.5 μg/kg), while in the irrigation system, it was 16.7% (range 0.1 to 1.83 μg/kg). By 2018, the occurrence of AFs had decreased to 31% for the rainfed system and 2% for the irrigation system. AFs contamination levels were higher in the rainfed system compared to the irrigated system (p<0.05). No AFG1 or AFG2 was detected, irrespective of the cultivation system used. AFB1 was the most prevalent AF in paddy rice, with a global occurrence of 22.9% in 2017 and 8.62% in 2018. At the national level, the prevalence of AFs in milled rice was 50%. Of the positive samples, 62.5% exceeded the maximum permitted value, with concentrations ranging from 10.3 to 93.9 μg/kg. These findings underscore the critical importance of mycotoxins in the context of food safety, emphasizing the necessity for effective control measures within the rice industry. This study is the first detailed report on the incidence of AFs in paddy rice cultivated in Colombia.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.