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Objectives: HIV is a contagious disease with reportedly high transmissibility, being spread worldwide, with certain mortality, allegedly presenting a burden to public health worldwide. The main objective of this study was to determine excessive HIV death risks at any time within any region or country of interest. Study design: Current study presents a novel multivariate public health system bio‐risk assessment approach that is particularly applicable to environmental multi‐regional, biological, and public health systems, being observed over a representative period of time, yielding reliable long‐term HIV deathrate assessment. Hence, the development of a new bio‐statistical approach, that is, population‐based, multicenter, and medical survey‐based. The expansion of extreme value statistics from the univariate to the bivariate situation meets with numerous challenges. Firstly, the univariate extreme value types theorem cannot be directly extended to the bivariate (2D) case, ‐ not to mention challenges with system dimensionality higher than 2D. Methods: Existing bio‐statistical methods that process spatiotemporal clinical observations of multinational bio‐processes often do not have the advantage of efficiently dealing with high regional dimensionalities and complex nonlinear inter‐correlations between different national raw datasets. Hence, this study advocates the direct application of the novel bio‐statistical Gaidai method to a raw unfiltered clinical data set. Results: This investigation described the successful application of a novel bio‐risk assessment approach, yielding reliable long‐term HIV mortality risk assessments. Conclusions: The suggested risk assessment methodology may be utilized in various public bio and public health clinical applications based on available raw patient survey datasets. Key points: A novel public health bio‐risk assessment methodology was developed and successfully applied to HIV (i.e., Human Immunodeficiency Virus) recorded clinical death rates.Disease outbreak's multidimensional spatiotemporal risks estimated.Confidence bands assessed for predicted future HIV deathrates. [ABSTRACT FROM AUTHOR]

The tests for tracking diseases in newborns available through the National Neonatal Screening Program of the Brazilian Unified Health Care System cover six diseases. Mass spectrometer equipment is needed to expand and more efficiently and effectively detect new diseases. However, only four neonatal screening centers have the equipment capable of carrying out the extended test, and the expansion of health service capacity should consider both the rationalization of costs and the comprehensiveness and accessibility of care to the population. This study uses analytics to analyze and estimate the cost of centralized or distributed logistics networks and the level of service to perform the expanded test for newborns throughout Brazil. We evaluate the accessibility of the current infrastructure for the neonatal screening program and propose a novel location–allocation model to create a more integrated infrastructure for reducing disparities and increase the accessibility to neonatal screening services.

Abstract Objectives HIV is a contagious disease with reportedly high transmissibility, being spread worldwide, with certain mortality, allegedly presenting a burden to public health worldwide. The main objective of this study was to determine excessive HIV death risks at any time within any region or country of interest. Study design Current study presents a novel multivariate public health system bio‐risk assessment approach that is particularly applicable to environmental multi‐regional, biological, and public health systems, being observed over a representative period of time, yielding reliable long‐term HIV deathrate assessment. Hence, the development of a new bio‐statistical approach, that is, population‐based, multicenter, and medical survey‐based. The expansion of extreme value statistics from the univariate to the bivariate situation meets with numerous challenges. Firstly, the univariate extreme value types theorem cannot be directly extended to the bivariate (2D) case, ‐ not to mention challenges with system dimensionality higher than 2D. Methods Existing bio‐statistical methods that process spatiotemporal clinical observations of multinational bio‐processes often do not have the advantage of efficiently dealing with high regional dimensionalities and complex nonlinear inter‐correlations between different national raw datasets. Hence, this study advocates the direct application of the novel bio‐statistical Gaidai method to a raw unfiltered clinical data set. Results This investigation described the successful application of a novel bio‐risk assessment approach, yielding reliable long‐term HIV mortality risk assessments. Conclusions The suggested risk assessment methodology may be utilized in various public bio and public health clinical applications based on available raw patient survey datasets.

A cross-sectional and retrospective study design and simple random sampling strategy was conducted in Gondar town veterinary clinic, northern Ethiopia with the aim of evaluating drug use pattern and show public health significance of irrational veterinary drug use. A total of 2117 drugs were prescribed to 1717 veterinary patients randomly selected from the case registry in this study. The result indicates average number of drugs prescribed per case was 1.23 and the maximum of three drugs was prescribed. The percentages of antimicrobial, anthelmintic, endectocide and other drugs prescribed were 1182 (55.7%), 481 (22.7%), 426 (20.1%), and 28 (1.3%), respectively. All patients were treated without correct laboratory support. As a result, antimicrobials were inappropriately prescribed in 1.4% of viral diseases, 0.2% of external parasitic diseases, 0.8% of internal parasitic diseases, 0.3% of metabolic diseases, 0.1% of fungal diseases, and anthelmintics in 0.1% of bacterial diseases and 0.5% of external parasitic diseases. 2013/2117 (95.1%) the route of administration of the prescribed drugs was not stated. Clinic professionals were 80% animal health assistants and 20% veterinarians. The results reveal problems with correct diagnosis, low level of education of prescribers, few essential drugs, absence of standard veterinary drug lists, and inappropriate drug use; these all principals to public health significance. Therefore, the availability of key essential drugs should improve and available drugs be prescribed with its appropriate doses, routes, and regimens. Veterinarians should be made aware of the irrational use of veterinary drugs and their public health implications. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus is an emerging public health threat in South-Asian countries; with the growing number of cases in India, an understanding of local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures. Objective: To analyze the epidemiological features- annual number of cases, age distribution, sex distribution, and seasonal distribution over the four years. To find out the clinical profile, laboratory features and outcomes of cases of scrub typhus, and to identify the predictors of disease severity. Methodology: A comprehensive retrospective review of scrub typhus cases reported over a 4-year period (2019-2023) was done, with a monthly trend of patients admitted. Data was collected from the case records of patients for demographic characteristics, clinical features, treatment, and outcomes, length of stay (LOS), complications, and mortality. Data was presented in frequencies and proportions, odds ratio (OR) was calculated and a p-value of Results: A total of 886 cases were reported over the four-years. There was a declining epidemiological trend in 2020-21 and then an increasing one. Scrub typhus cases exhibited seasonality, with a peak incidence during winter season. Males were more commonly affected (58.01%), and the age group most susceptible was 19-64 years (52.22%), followed by one-month to 18years (32.22%). Clinical presentations typically included fever (96%), eschar formation (8%) and rash (8%). Complications like pneumonia (13.88%) and AKI (11.73%), were observed in a significant proportion of cases. Mortality was reported in 4.40% of cases. Altered sensorium, deranged LFT, hypotension requiring ionotropic support, requirement of ventilatory support predicted poor outcome. Conclusion: Scrub typhus was seen to cause a multi-system infection among the studied population, causing significant morbidity and mortality. The conditions found associated with poor outcome and mortality can be used as risk factor predictors and help patient management.

The persisting growth of wireless telecommunication technology causes increased electrosmog. Exposure to wide-ranging radiofrequency electromagnetic fields is thought to be a concern for all living organism across the globe. Several studies have been conducted to investigate the effects of electromagnetic radiation on various organisms, including the risk of electromagnetic radiation on birds, but the results have been inconclusive. Here, we investigated if there is any impact of electromagnetic radiation on the abundance and habitat use of sympatric House Sparrow and Tree Sparrow in Guwahati City, India. In addition, we did a comparative analysis of previous work that had been conducted on the possible effects of EMR on wild birds in field conditions. We collected sparrow abundance in selected urbanized habitats temporally over a period of two years in 45 locations and spatially covering 168 locations in the eastern part of Guwahati City. Point counts were carried out, and successively we measured the electromagnetic radiation along with other ecological factors that could influence the habitat usage of the species. It was observed that ecological factors had a major role in explaining the fine-scale habitat use of sparrows in Guwahati, but electromagnetic radiation had no impact. We found that House Sparrows had a quadratic relationship and Tree sparrows had a negative association with increasing urbanization. Studies carried out in the past on the impacts of electromagnetic radiation on birds outside the lab conditions had not considered other ecological factors, which could also influence the life history needs of the species. Therefore, future studies on the impact of EMR must also include species specific requirements. Based on our current knowledge, we can infer that low levels of EMR in the field (in urban settings) in cities around the globe are unable to induce thermal effects and so have no impact on sparrows and associated urban avifauna. [ABSTRACT FROM AUTHOR]

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance. [ABSTRACT FROM AUTHOR]

Abstract Background Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts. Methods This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent. Results At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship. Conclusions This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care.

Demographic transitions accompanied with epidemiological shifts are affecting many countries around the globe. These apprehensions have raised the concern for constructing and sustaining healthcare systems especially among resource-constrained low- and middle-income-countries (LMICs) such as India. Introducing Health-Technology-Assessment (HTA) in the educational initiatives could support planners and policy-makers in formulating evidence-based-decision-making along with tackling inequalities/inefficiencies and promoting cost-effectiveness in resource allocation. A mapping exercise has been undertaken for examining the feasibility and implementation of HTA curriculum in the existing courses in India. To gain best possible insight on HTA curriculum, a situational analysis was conducted using systematic search strategy through search engines such as Google, Google Scholar, ProQuest and PubMed. Currently, seventy-one institutes in India are offering one or more courses through regular mode at undergraduate/postgraduate/diploma-certificate/doctorate-level pertaining to Medical-technology (MT), Biostatistics (BS), and Health-economics (HE). MT was offered in 37 institutes (52.12%), followed by BS in 23 (32.39%), and HE in nine (12.67%). Only two institutes (2.81%) are offering certificate-courses on HTA, mainly confined in virtual modules. This review reveals noticeable gaps in the existing curriculum in India and necessitates a novel academic initiative by introducing HTA in a full-fledged manner. Reforms in the research and educational initiatives need to be brought for promoting awareness regarding HTA. The application of domain needs to be widened from the field of health-policy formulators to research and teaching. This should be further strengthened with the strong academic collaborations to generate replicable findings, address challenges, and offer solutions for existing threats to HTA.

The World Health Organization (WHO) declared the Coronavirus Disease (COVID‐19) a pandemic due to the huge upsurge in the number of reported cases worldwide. The COVID‐19 pandemic in India has become a public health threat, and if we go by the number of confirmed cases then the situation seems to be a matter of grave concern. According to real‐time data, the numbers of confirmed cases are growing exponentially. No doubt, substantial public health interventions both at the national and state levels are implemented immediately by the Government of India; there is a need for improved preparedness plans and mitigation strategies along with accurate forecasting. The present study aims to forecast the COVID‐19 outbreak infected cases in India. The data have been obtained from https://www.covid19india.org, https://www.worldometers.info/coronavirus, and ICMR reported publicly available information about COVID‐19 confirmation cases. We have used the double exponential smoothing method for forecasting the trends in terms of confirmed, active, recovered and death cases from COVID‐19 for emergency preparedness and future predictions. Findings reveal that the estimated value of point forecast is just 8.22% of the total number of confirmed cases reported on a daily basis across the country. It was observed that the deaths were lower for the states and union territories with a higher detection rate. It is suggested that by keeping in view the limited healthcare resources in the country, accurate forecasting, early detection, and avoidance of acute care for the majority of infected cases is indispensable. [ABSTRACT FROM AUTHOR]

Water resources contaminated with pathogenic Vibrio species are usually a source of devastating infection outbreaks that have been a public health concern in both developed and developing countries over the decades. The present study assessed the prevalence of six medically significant Vibrio species in some water resources in Eastern Cape Province, South Africa for 12 months. We detected vibrios in all the 194 water samples analyzed using polymerase chain reaction (PCR). The prevalence of Vibrio cholerae, Vibrio mimicus, Vibrio fluvialis, Vibrio vulnificus, Vibrio alginolyticus, and Vibrio parahaemolyticus in freshwater samples was 34, 19, 9, 2, 3, and 2%, and that in brackish water samples was 44, 28, 10, 7, 46, and 51%, respectively. The population of the presumptive Vibrio spp. isolated from freshwater (628) and brackish water (342) samples that were confirmed by PCR was 79% (497/628) and 85% (291/342), respectively. Twenty-two percent of the PCR-confirmed Vibrio isolates from freshwater (n = 497) samples and 41% of the PCR-confirmed Vibrio isolates from brackish water samples (n = 291) fall among the Vibrio species of interest. The incidences of V. cholerae, V. mimicus, V. fluvialis, V. vulnificus, V. alginolyticus, and V. parahaemolyticus amidst these Vibrio spp. of interest that were recovered from freshwater samples were 75, 14, 4, 6, 1, and 1%, whereas those from brackish water samples were 24, 7, 3, 3, 47, and 18%, respectively. Our observation during the study suggests pollution as the reason for the unusual isolation of medically important vibrios in winter. Correlation analysis revealed that temperature drives the frequency of isolation, whereas salinity drives the composition of the targeted Vibrio species at our sampling sites. The finding of the study is of public health importance going by the usefulness of the water resources investigated. Although controlling and preventing most of the factors that contribute to the prevalence of medically important bacteria, such as Vibrio species, at the sampling points might be difficult, regular monitoring for creating health risk awareness will go a long way to prevent possible Vibrio-related infection outbreaks at the sampling sites and their immediate environment.

Water resources contaminated with pathogenic Vibrio species are usually a source of devastating infection outbreaks that have been a public health concern in both developed and developing countries over the decades. The present study assessed the prevalence of six medically significant Vibrio species in some water resources in Eastern Cape Province, South Africa for 12 months. We detected vibrios in all the 194 water samples analyzed using polymerase chain reaction (PCR). The prevalence of Vibrio cholerae , Vibrio mimicus , Vibrio fluvialis , Vibrio vulnificus , Vibrio alginolyticus , and Vibrio parahaemolyticus in freshwater samples was 34, 19, 9, 2, 3, and 2%, and that in brackish water samples was 44, 28, 10, 7, 46, and 51%, respectively. The population of the presumptive Vibrio spp. isolated from freshwater (628) and brackish water (342) samples that were confirmed by PCR was 79% (497/628) and 85% (291/342), respectively. Twenty-two percent of the PCR-confirmed Vibrio isolates from freshwater (n = 497) samples and 41% of the PCR-confirmed Vibrio isolates from brackish water samples (n = 291) fall among the Vibrio species of interest. The incidences of V. cholerae , V. mimicus , V. fluvialis , V. vulnificus , V. alginolyticus , and V. parahaemolyticus amidst these Vibrio spp. of interest that were recovered from freshwater samples were 75, 14, 4, 6, 1, and 1%, whereas those from brackish water samples were 24, 7, 3, 3, 47, and 18%, respectively. Our observation during the study suggests pollution as the reason for the unusual isolation of medically important vibrios in winter. Correlation analysis revealed that temperature drives the frequency of isolation, whereas salinity drives the composition of the targeted Vibrio species at our sampling sites. The finding of the study is of public health importance going by the usefulness of the water resources investigated. Although controlling and preventing most of the factors that contribute to the prevalence of medically important bacteria, such as Vibrio species, at the sampling points might be difficult, regular monitoring for creating health risk awareness will go a long way to prevent possible Vibrio -related infection outbreaks at the sampling sites and their immediate environment. [ABSTRACT FROM AUTHOR]

Demographic transitions accompanied with epidemiological shifts are affecting many countries around the globe. These apprehensions have raised the concern for constructing and sustaining healthcare systems especially among resource-constrained low- and middle-income-countries (LMICs) such as India. Introducing Health-Technology-Assessment (HTA) in the educational initiatives could support planners and policy-makers in formulating evidence-based-decision-making along with tackling inequalities/inefficiencies and promoting cost-effectiveness in resource allocation. A mapping exercise has been undertaken for examining the feasibility and implementation of HTA curriculum in the existing courses in India. To gain best possible insight on HTA curriculum, a situational analysis was conducted using systematic search strategy through search engines such as Google, Google Scholar, ProQuest and PubMed. Currently, seventy-one institutes in India are offering one or more courses through regular mode at undergraduate/postgraduate/diploma-certificate/doctorate-level pertaining to Medical-technology (MT), Biostatistics (BS), and Health-economics (HE). MT was offered in 37 institutes (52.12%), followed by BS in 23 (32.39%), and HE in nine (12.67%). Only two institutes (2.81%) are offering certificate-courses on HTA, mainly confined in virtual modules. This review reveals noticeable gaps in the existing curriculum in India and necessitates a novel academic initiative by introducing HTA in a full-fledged manner. Reforms in the research and educational initiatives need to be brought for promoting awareness regarding HTA. The application of domain needs to be widened from the field of health-policy formulators to research and teaching. This should be further strengthened with the strong academic collaborations to generate replicable findings, address challenges, and offer solutions for existing threats to HTA. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic in India has become the biggest public health challenge. If we go by the number of confirmed cases and casualties, the situation seems to be a matter of grave concern. The lock-down measures and social-distancing practices have played an important role in impeding the spread of COVID-19. However, accurate forecasting is required to prepare the healthcare-system for future plan-of-action. Objectives: The present study aims to predict the trends in the outbreak of COVID-19 in India, by forecasting on the basis of publicly-available data. Methods: The data has been obtained from https://www. covid19india.org, https://www.worldometers.info/coronavirus and ICMR reported publiclyavailable information on COVID-19. The number of confirmed cases are growing exponentially as per the real-time-data. For forecasting the trends in terms of confirmed, active, recovered, and death cases by using the autoregressive-integrated-moving-averages (ARIMA) model. Results: Findings reveal the estimated value of the point-forecast for total confirmed, active, recovered, and death cases. Estimates indicate that the total confirmed cases were increasing at the rate of 3.48%, active cases at 2.92%, recovered cases at 4.09% and death cases at the rate of 3.51% daily across the country. It was also observed that the death rate was lower for the states and union territories with a higher detection rate. Conclusion: Substantial public health interventions were implemented immediately by the Government of India to control the spread of COVID-19. Due to the shortage of healthcare resources in the country, early detection is imperative along with accurate forecasting. It will help in reducing the associated cost of acute care for the majority of infected cases and unnecessary burden on the healthcare system. [ABSTRACT FROM AUTHOR]

Seafood borne enteric disease is a global public-health burden. We have targeted the seafood of hitherto unexplored Indian Gangetic delta, where consumption of seafood is rampant and its export is profuse. We have reported that raw seafood is highly contaminated with E.coli and toxigenic Vibrios [V. parahaemolyticus (tdh+, tlh+, trh+), V. alginolyticus (trh+, tlh+, toxR+), V. cholerae (ctxA+, tcp+, hlyA+)], and cooked items harbor thermotolerant and high-pressure resistant Vibrios. Detection of V. cholerae with cholera toxin producing gene(ctx) and V. parahaemolyticus containing pandemic serotype (O3:K6) in seafood is of major concern to consumers. Additionally, they were found to possess in vitro hemolytic potential (42.66% V. parahaemolyticus, 14.43% V. alginolyticus, and 34.17% V. cholerae) and multidrug resistance ability. All isolates were resistant to β-lactams and most of the cephalosporins. V. alginolyticus were specifically resistant to tetracycline (100%) and quinolones (68%). As per available literature, the present study reports for the first time that seafood borne Vibrios are more threatening with respect to their drug resistance ability rather than potable-water Vibrios of this focus, a phenomenon attributed to resistant gene transfer facilitated in chitinous environments. Seasonal study reveals an upsurge in enteropathogenic-load of seafood in winter and its free-floating progenies in summer. Systemic surveillance of seafood-borne outbreaks and improvement of food preservation techniques is strongly advocated to reduce public health risk. [ABSTRACT FROM AUTHOR]

Background: Nav-CARE is a volunteer-led intervention designed to build upon strategic directions in palliative care: a palliative approach to care, a public health/compassionate community approach to care, and enhancing the capacity of volunteerism. Nav-CARE uses specially trained volunteers to provide lay navigation for older persons and family living at home with advanced chronic illness. The goal of this study was to better understand the implementation factors that influenced the utilization of Nav-CARE in eight diverse Canadian contexts. Methods: This was a Knowledge to Action study using the planned action cycle for Nav-CARE developed through previous studies. Participants were eight community-based hospice societies located in diverse geographic contexts and with diverse capacities. Implementation data was collected at baseline, midpoint, and endpoint using qualitative individual and group interviews. Field notes of all interactions with study sites were also used as part of the data set. Data was analyzed using qualitative descriptive techniques. The study received ethical approval from three university behavioural review boards. All participants provided written consent. Results: At baseline, stakeholders perceived Nav-CARE to be a good fit with the strategic directions of their organization by providing early palliative support, by facilitating outreach into the community and by changing the public perception of palliative care. The contextual factors that determined the ease with which Nav-CARE was implemented included the volunteer coordinator champion, organizational capacity and connection, the ability to successfully recruit older persons, and the adequacy of volunteer preparation and mentorship. Conclusions: This study highlighted the importance of community-based champions for the success of volunteer-led initiatives and the critical need for support and mentorship for both volunteers and those who lead them. Further, although the underutilization of hospice has been widely recognized, it is vital to recognize the limitations of their capacity. New initiatives such as Nav-CARE, which are designed to enhance their contributions to palliative care, need to be accompanied by adequate resources. Finally, this study illustrated the need to think carefully about the language and role of hospice societies as palliative care moves toward a public health approach to care. [ABSTRACT FROM AUTHOR]

Some tobacco researchers have argued that the European Union should remove its ban on a form of low-nitrosamine smokeless tobacco referred to as Swedish 'snus'. This argument has developed in to an international debate over the use of smokeless tobacco as a measure of harm reduction for smokers. Leading authorities in the USA have firmly stated that there is no safe tobacco - a message which does not allow for any discussion of comparative tobacco risks. This commentary is intended to review the origin of the controversy over Swedish 'snus', to examine briefly the meta-analysis on cancer risks by Peter Lee and Jan Hamling (published in July in BMC Medicine) and to discuss the anticipated direction of the debate on tobacco-harm reduction in the USA. We anticipate that much of the debate will shift from the discussion of epidemiologic data to the discussion of the marketing, health communication and economics of smokeless tobacco. While the Food and Drug Administration's newly approved authority over tobacco will undoubtedly affect the smokeless products, it may not be the sole determinant of harm reduction's fate in the USA.

Background: Malnutrition is a major public health problem of developmental concern with both health and socioeconomic consequences. The study was aimed to determine the risk factors of severe acute malnutrition among under-five children. Material and Methods: This hospital-based case control study was conducted from December 2015 to April 2016 whereby a total of 196 children under 5 years (98 cases and 98 controls) whose age ranged from 6 to 60 months were included in the study, data were collected retrospectively using a questionnaire, and mid-upper arm circumference (MUAC) was taken using standard procedures. SPSS statistical software version 19 was used to analyze the dataset. Results: The mean ± standard deviation (SD) age of the cases and controls was 18.34 ± 14.6 and 16.93 ± 14.1 months, respectively, and the mean ± SD MUAC of the cases and controls was 9.36 ± 1.1 and 14.59 ± 2.2 cm, respectively. Risk factors associated with severe acute malnutrition were lack of taking balanced diet more than 3 times/day (adjusted odds ratio [AOR] = 5.355, 95% confidence interval [CI] = 1.162– 24.690), irregular hand washing with soap or other cleaning agents before feeding child (AOR = 0.317, 95% CI = 0.139–0.723), and father’s education level 0–8 class (AOR = 0.190, 95% CI = 0.054–0.676). Conclusions: Severe acute malnutrition was found to be associated with father’s education level, lack of taking balanced diet, and irregular hand washing. Interventions to reduce malnutrition and address the factors contributing to malnutrition should be a policy priority.

INTRODUCTION: Shisha consumption is a growing public health issue all over the globe and public health awareness about its deleterious health consequences is still not sufficiently raised.

Legionella pneumophila cause human infections via inhalation of contaminated water aerosols, resulting in severe pneumonia. Legionella spp. prevalence was monitored in a drinking-water distribution system (DWDS) in Northern Israel. Five points (toilet faucets and showers) were sampled seasonally along a three years period. Toilet faucets and shower use, both generating aerosols, are known transmission routes for this pathogen and thus, present a potential health risk. Quantitative Microbial Risk Assessment (QMRA) was applied in order to assess the health risks posed by Legionella for these two exposure scenarios, while considering Legionella seasonality. The obtained results were compared with estimated tolerable risk levels of infection and of disease set by the USEPA and WHO. Both limits were expressed as Disability-Adjusted Life Years index (DALY) being 1 × 10−4 and 1 × 10−6, respectively. The QMRA revealed that the annual risk levels for both faucets and showers use exceeded the acceptable risk of infection with an average of 5.52 × 10−4 and 2.37 × 10−3 DALY'S per person per year, respectively. Annual risk levels were stable with no significant differences between the three years. Risk levels varied significantly between seasons by up to three orders of magnitude. Risk levels were highest during summer, autumn, and lowest during winter. The highest seasonal infection risk values were found in summer for both faucets and showers, which corresponded to 8.09 × 10−4 and 2.75 × 10−3 DALY'S per person per year, respectively. In conclusion, during summer and autumn there is a significant increase of the infection risk associated with exposure to Legionella -contaminated aerosols, in the studied water system. Public health assessment and prevention measures should focus on these seasons. Unlabelled Image • Three years seasonal Legionella survey was performed in a drinking water system. • Quantitative Microbial Risk Assessment (QMRA) was calculated for Legionella. • The QMRA remained stable and did not vary significantly between the years. • Annual risk levels exceeded the acceptable thresholds regarding Legionella infection. • Risk levels varied significantly between seasons and peaked during summers. [ABSTRACT FROM AUTHOR]

Introduction: shisha consumption is a growing public health issue all over the globe and public health awareness about its deleterious health consequences is still not sufficiently raised. Methods: in this location-based study of nightclubs in Ibadan, Nigeria, 633 patrons of selected nightclubs were interviewed in order to obtain information on prevalence, correlates and predictors of shisha smoking. Results: the overall prevalence of shisha smoking was 7.1%. The age of initiation into shisha smoking was lower among women, p = 0.03, but men were significantly more likely to be more frequent users, daily or weekly users, p < 0.001 and also to be current cigarette smokers, p = 0.03. There was no significant gender variability in the stage of readiness to quit. Regression analysis showed that after adjusting for age, the predictors of shisha smoking were: cigarette smoking, OR = 4.83, 95% CI (1.49-15.70) and more than 12 years of education, OR = 7.55, 95% CI (1.88 - 30.37), while being a rural dweller was a protective factor, OR = 0.05, 95% CI (0.01-0.20). Conclusion: shisha smoking has emerged as a prevalent public health issue in Nigeria. There is a need for an immediate response from policy providers towards shisha smoking intervention in Nigeria. [ABSTRACT FROM AUTHOR]

Limpet (Scutellastra cochlear) serves as seafood recipe and an important member of the aquatic food chain. It is an abundant mollusc in some aquatic environment in South Africa. In this study, we investigated the potential of the molluscs harvested from the Buffalo, Swartkops, and Kowie estuaries in the Eastern Cape Province, South Africa to serve as transient or maintenance reservoir of Vibrio species. The mollusc and source water samples were collected monthly from the rivers between December 2016 and November 2017. The reservoir category of the limpet samples recovered was determined by employing the combination of MPN-PCR method and statistical analysis (comparison of mean and proportion tests). The densities of Vibrio spp. in limpet and their source water samples were determined using MPN-PCR methods. Presumptive isolates were recovered by processing the samples with thiosulfate-citrate-bile salts-sucrose agar and where necessary, samples were enriched with alkaline peptone water. The presumptive isolates were identified using PCR methods with emphasis on six Vibrio species of public health importance. Vibrio spp. were detected in all the limpet samples but not in all the water samples. The densities of Vibrio spp. in the limpet samples were more than the densities of Vibrio species in their source water and these were significant at P < 0.05. In like manner, five out of the six key Vibrio pathogens targeted in this study were more prevalent in limpet samples than in source water samples. Based on our findings, we concluded that our method though could be improved on, is efficient for the determination of reservoir types of bacterial-carrying organisms. We also concluded that the limpet found in the estuaries are not just a transient but a maintenance reservoir of Vibrio spp. which could cause vibrio-related infections.

Shiga toxigenic Escherichia coli (STEC) are pathogenic E . coli that cause infectious diarrhoea. In some cases infection may be complicated by renal failure and death. The incidence of human infection with STEC in Ireland is the highest in Europe. The objective of the study was to examine the spatial incidence of human STEC infection in a region of Ireland with significantly higher rates of STEC incidence than the national average and to identify possible risk factors of STEC incidence at area level. Anonymised laboratory records (n = 379) from 2009 to 2015 were obtained from laboratories serving three counties in the West of Ireland. Data included location and sample date. Population and electoral division (ED) data were obtained from the Irish 2011 Census of Population. STEC incidence was calculated for each ED (n = 498) and used to map hotspots/coldspots using the Getis-Ord Gi* spatial statistic and significant spatial clustering using the Anselin's Local Moran's I statistic. Multivariable regression analysis was used to consider the importance of a number of potential predictors of STEC incidence. Incidence rates for the seven-year period ranged from 0 to 10.9 cases per 1000. A number of areas with significant local clustering of STEC incidence as well as variation in the spatial distribution of the two main serogroups associated with disease in the region i . e . O26 and O157 were identified. Cattle density was found to be a statistically significant predictor of STEC in the region. GIS analysis of routine data indicates that cattle density is associated STEC infection in this high incidence region. This finding points to the importance of agricultural practices for human health and the importance of a “one-health” approach to public policy in relation to agriculture, health and environment. [ABSTRACT FROM AUTHOR]