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Our study assessed the link between gastrointestinal (GI) infections in England and the Eat Out to Help Out scheme (EOHO), a government subsidy created to encourage people to eat out during COVID-19 pandemic (03–30 August 2020). We studied national laboratory data between January 2015 and December 2020. We used time series change point analysis to see if there were shifts in reported cases of specific GI infections (Campylobacter spp., Escherichia coli O157, and non-typhoidal Salmonella spp.) associated with the timing of the scheme. Our analysis uniquely applied the Pruned Exact Linear Time method, with generalized linear models to a national dataset of GI infections. This revealed increases in cases closely aligned to the timing of the easing of COVID-19 restrictions, prior to the introduction of the EOHO scheme. Our study showed the scheme had no measurable impact, as there was no significant change on reported cases. Substantial reductions in cases after the first lockdown, followed by an increase as restrictions were phased out, show the wider impact of COVID-19 control measures, for example, public information campaigns aimed at improving hand-hygiene. These findings highlight the complicated interactions between COVID-19 control measures, the public’s behaviour, and the spread of GI infections.
The global syndemic of obesity, undernutrition and climate change – three interconnected challenges – threatens both human and planetary health. This review focuses on one critical intersection: older populations living with overweight and obesity in the context of sustainable nutrition. Obesity and sarcopenia, particularly the co-occurrence called sarcopenic obesity, are often overlooked until the onset or exacerbation of other diseases necessitates secondary care. Preventing sarcopenic obesity requires reducing excess fat mass while preserving muscle mass and function. This involves lowering total energy intake while ensuring adequate protein intake in terms of quantity, quality and distribution, combined with physical activity, particularly resistance exercise. Short-term studies show that both the source and dose of dietary protein significantly influence muscle protein synthesis rates. Longer-term studies examining the impact of plant-based diets on muscle health in older adults with or without overweight or obesity remain limited. Animal protein have shown a modest advantage over most plant-based protein in supporting muscle mass. Qualitative studies suggest that emphasising both the health benefits and palatability of plant-based protein sources is key to promoting dietary changes in older adults. In older adults with obesity, it is challenging to combine energy restriction with higher protein intake, especially when protein sources are plant-based. To prevent and treat sarcopenic obesity in older adults and support planetary health, a shift toward more plant-based protein sources is required, while ensuring sufficient protein quantity and quality to preserve muscle health during weight loss.
This review aims to (1) provide an overview of research investigating the relationship between body composition, specifically fat-free mass (FFM) and fat mass (FM), appetite and energy intake (EI) and (2) to investigate potential mechanisms underlying these relationships, with a focus on ageing. Appetite and EI are influenced by complex, multifactorial pathways involving physiological, psychological, environmental, social and cultural factors. Early research investigating the association of body composition with appetite and EI focused on FM; however, the role of FFM in appetite control is gaining increasing attention. Studies have shown that FFM is positively associated with EI in younger populations, including infants, adolescents and adults. In contrast, FM appears to have no association or a weak inverse association with appetite/EI. However, research in older adults is limited, and the underlying mechanisms are not fully understood. It has been suggested that one way in which FFM may influence appetite and EI is by impacting resting metabolic rate (RMR). FFM, which includes metabolically active tissues including skeletal muscle and organs, represents the largest determinant of RMR and therefore may influence appetite and EI by ensuring the energetic requirements of crucial tissue-organs and metabolic processes are reached. Given that declines in FFM and RMR are common with ageing, they may be possible targets for interventions aimed at improving appetite and EI. While current evidence in older adults supports a positive association between FFM and appetite, further longitudinal studies are needed to explore this relationship in different contexts, along with the underlying mechanisms.
Long-acting injectable (LAI) antipsychotics are not routinely offered and, thus, are underutilized despite their many advantages over oral formulations. In this special collection of articles, the reader will find overviews of the art and science of prescribing this important treatment option. Guidance is offered regarding incorporating LAIs in treatment planning, including inpatient, outpatient, and jail settings. Reviewed is the evidence surrounding the use of LAIs for patients in their first episode of schizophrenia, as well as switching from oral agents and other common issues that come up in day-to-day practice. Also provided is a comprehensive summary of each of the currently available formulations of LAIs, and some pragmatic reasons why one would be considered over another. In the end, the reader will come away with the notion that LAIs are not a “last resort” but an important and useful treatment modality that ought to be considered more often.
Substantial evidence supports the efficacy of cognitive bias modification (CBM) for attention and interpretation. However, CBM targeting memory bias (CBM-M) remains underexplored despite its clinical relevance. This study examines the effectiveness and neurobiological mechanisms of CBM-M.
Methods
Fifty-eight individuals with elevated anxious and depressive personality traits (>1 SD) were randomly assigned to either CBM-M or sham training (n = 29 per group) in a parallel, double-blind, randomized controlled trial. The intervention involved eight sessions over 1 month. CBM-M aimed to enhance positive autobiographical memory (AM) recall by focusing on positive and negative words, whereas sham training lacked this enhancement module. Anxiety and depressive traits and symptoms, explicit and implicit memory biases, and AM specificity were assessed. Additionally, intrinsic functional connectivity was measured via functional magnetic resonance imaging, and cortisol levels were assayed via saliva collected at 10 time points across 2 days before and after the intervention.
Results
Both groups showed reduced anxiety and depressive traits from pre- to post-intervention. Compared with sham training, CBM-M specifically reduced stress vulnerability, negative explicit memory bias, and daytime cortisol levels, with a large effect size. Improvement in memory bias correlated with stress vulnerability and cortisol reductions. CBM-M also enhanced amygdala functional connectivity with the anteromedial orbitofrontal cortex in comparison with sham training from pre- to post-intervention.
Conclusions
CBM-M reduced stress vulnerability and elicited neural changes in amygdala–anteromedial orbitofrontal cortex interactions, which were involved in social reward and AM recall. Future research should identify the most responsive populations and elucidate underlying mechanisms.
Young-onset dementia (YOD), defined by symptom onset before age 65, encompasses diverse aetiologies and presents with prominent neuropsychiatric symptoms (NPS) that often accompany or exacerbate cognitive decline. However, the pathological mechanisms linking NPS, cognition, and biomarkers remain unclear. It was hypothesised that relationships between NPS and cognition would be mediated or moderated by cerebrospinal fluid (CSF) biomarker levels in individuals with YOD.
Methods:
This retrospective, cross-sectional study included 46 participants with YOD (24 with Alzheimer’s disease [AD], 22 with non-AD dementias) diagnosed at the Neuropsychiatry Centre, Royal Melbourne Hospital. NPS were measured using the Depression Anxiety and Stress Scale and Cambridge Behavioural Inventory-Revised. Cognition was assessed using standardised neuropsychological assessments. CSF amyloid-β (Aβ42), phosphorylated tau 181 (P-tau181), total tau (T-tau), and neurofilament light chain protein (NfL) were analysed. General linear models (GLMs) examined associations between biomarkers, cognition, and NPS.
Results:
Higher P-tau181 (unstandardised beta [B] = −0.10, 95% confidence interval = [−0.20, −0.01]) and T-tau (B = −0.06 [−0.13, −0.01]) levels were associated with poorer memory recall in participants with YOD. In non-AD dementias, higher T-tau levels predicted greater NPS severity (B = 0.76 [0.06, 3.52]). NfL showed no significant associations with NPS or cognition.
Conclusion:
Tau-related neurodegeneration (P-tau181 and T-tau) appears more closely linked to memory impairment in YOD than axonal injury markers such as NfL. In non-AD dementias, T-tau was additionally associated with behavioural symptom severity, suggesting tau-related mechanisms across subtypes. These associations require validation in larger, longitudinal, and multimodal studies to clarify temporal and mechanistic pathways.
Syphilis has re-emerged as a public health threat during the 21st century, and updated knowledge of the epidemic and its drivers is needed to halt this worrying development. We present data on the incidence of syphilis in the south Swedish region Skåne from 2007 to 2022 to determine the burden of disease, changes in risk groups, as well as routes for testing. To get a picture of the burden of syphilis, both early (notifiable) syphilis and cases of non-notifiable (late) symptomatic syphilis were included in this register-based study. Mann–Kendall trend analysis (MK) was used to determine statistical significance over time. In all, 584 cases of syphilis were included in the study. The overall syphilis incidence in Skåne increased from 3.1 cases/100000 population in 2007 to 6.3 in 2022 (MK z-stat: 2.57; p = 0.010). The highest increase in absolute numbers was among men who have sex with men (MSM), from eight cases annually in 2007 to 62 in 2022, but also for heterosexually transmitted men and women, with under ten cases yearly from 2007 through 2019 to 22 cases in 2022. We also found that transmission within Sweden was common, indicating that local measures are needed to curb this epidemic.
Avian schistosomatids are blood flukes parasitizing a wide spectrum of aquatic birds. However, its research in the Neotropics is ongoing with several putative new taxa pending description. Although waterfowl represent the most important avian hosts for these flukes, only a small proportion of these birds have been assessed for schistosomatids. This study aimed to describe avian schistosomatids from two native ducks from the Southern Cone of South America. A total of 24 Chiloe wigeon (Mareca sibilatrix) and three Cinnamon teals (Spatula cyanoptera) from different localities in Chile and Argentina were dissected to retrieve schistosomatids. The retrieved worms were described through an integrative approach considering morphology (staining and SEM) and molecular tools (PCR: COI, 28S rRNA genes). The new schistosomatid: Trichobilharzia kulfu sp. nov. was recovered from the viscera of Chiloe wigeon. It was closely related to other undescribed Trichobilharzia taxa from the United States, also from Mareca ducks. The new species was morphologically and molecularly different from other Trichobilharzia species, and it was included in the clade Q. In addition, SEM imaging proved to be an important tool to describe unnoticed traits on the tegument of worms. This new species represents the second Trichobilharzia taxon from the Neotropics described through an integrative approach. Furthermore, the Cinnamon teals harboured Trichobilharzia querquedulae. Considering there are several avian schistosomatids described only through morphological or molecular tools, there is a clear need to include a comprehensive approach in the description of avian schistosomatids, considering the remarkable richness of schistosomatids in Neotropics.
This study examined public attitudes and experiences in using the Internet for first aid guidance in real-life medical emergencies.
Methods
The study involved: (1) an analysis of YouTube comments (n = 6,786) on first aid videos using latent Dirichlet allocation topic modeling; (2) a survey of completers of an online Basic Life Support course (n = 731).
Results
Topic modeling of social media comments revealed users’ frustration with unskippable advertisements, reflecting a collective perception of online videos as a source of immediate advice on first aid in real-life emergencies. According to the survey data, 14.6% of respondents sought online first-aid instructions during a real-life emergency. An additional 8.9% reported similar experiences among friends or relatives. Of those who searched for advice, 90.7% found and implemented instructions. Most respondents showed readiness to attempt this in future as they believe it could be lifesaving.
Conclusions
The existing public demand for, and continued use of, the Internet as a source of advice on first aid, the risks arising from laypeople’s reliance on information of questionable quality, and the potential usefulness of authoritative digital guidance for instances where other means of assistance are unavailable constitute an intricate public health issue that requires attention and comprehensive solutions.
To compare and analyze COVID-19 control outcomes, including case severity, vaccination, and excess mortality, across 6 nations (USA, UK, China, Russia, Japan, and South Africa) from January 2020 to December 2022.
Methods
This study utilized data from the “Our World in Data” dataset to characterize the epidemiological features of COVID-19 across 6 countries. Generalized linear models (GLMs) were employed to examine the associations between Stringency Index (SI), vaccination coverage, and epidemiological outcomes.
Results
The USA had the highest median cases per million and the UK the highest deaths per million, while China reported the lowest for both. Hospitalization and ICU rates were highest in the UK and the USA, respectively, and lowest in Japan. Vaccination coverage was highest in China and lowest in South Africa. Excess mortality was highest in Russia and lowest in Japan. Generalized linear models indicated a negative association between the SI and cases in China (β = −40, P = 0.015), which became stronger after adjusting for vaccination (β = −311, P < 0.001), but positive associations were observed in the USA, UK, and South Africa. SI was negatively associated with excess mortality in most countries.
Conclusions
Effective pandemic control is highly context-dependent. The relationships among vaccination, variant prevalence, and health care burden were complex, shaped by implementation context, public compliance, and health care capacity.
To assess the frequency and correlates of meal-kit use across five countries using population-level data.
Design:
Online surveys conducted in 2022 assessed meal-kit use in the past week. Binary logistic regression models examined sociodemographic and nutrition-related correlates of meal-kit use, including self-reported home meal preparation and cooking skills, commercially prepared meal consumption and healthy eating, weight change and sustainability efforts.
Setting:
Canada, Australia, the UK, the USA and Mexico.
Participants:
20,401 adults aged 18–100 years.
Results:
Overall, 14 % of participants reported using meal-kits in the past week. Use was highest in the USA (18 %) and lowest in Canada (9 %). Meal-kit use was greater among individuals who were younger, male, of minority ethnicity, had high educational attainment, had higher income adequacy or had children living in the household (P < 0·01 for all). Use was greater for those who participated in any food shopping (v. none), those who prepared food sometimes (3–4 d/week or less v. never) and those who reported ‘fair’ or better cooking skills (v. poor; P < 0·05 for all). Consuming any ‘ready-to-eat’ food (v. none) and visiting restaurants more recently (v. > 6 months ago; P < 0·001 for all) were associated with greater meal-kit use. Eating fruits/vegetables more than 2 times/d and engaging in diet modification efforts were also associated with increased meal-kit use, as was engaging in weight change or sustainability efforts (P < 0·001 for all).
Conclusions:
Meal-kits tend to be used by individuals who make efforts to support their health and sustainability, potentially valuing ‘convenient’ alternatives to traditional home meal preparation; however, use is concentrated amongst those with higher income adequacy.
The risk of Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) incidents is increasing due to terrorism, technological advancements, conflicts, and emerging diseases. Hospitals, as critical response centers, face unique challenges during such events. Comprehensive training is crucial to ensure effective response and protect both patients and staff. This scoping review assesses the effectiveness of CBRNE training in enhancing knowledge, competencies, and preparedness among hospital-based health care providers.
Methods
Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and CINAHL using targeted keywords. Papers were screened using Covidence. Data were analyzed to evaluate the effectiveness of various training methods used in hospital settings.
Results
A total of 23 papers were included in this review. Training effectiveness was reported in 91% of the reviewed articles. Nurses were the predominant group participating in hospital-based training programs. Tabletop exercises were the most commonly used training method, and biological hazards were the most frequent scenario type. No study identified a single superior method for improving training effectiveness.
Conclusions
CBRNE training incorporating diverse modalities improves health care providers’ knowledge and competencies. Enhanced preparedness supports better responses to disasters, potentially leading to improved patient outcomes and public safety.
Examine the association between dementia and all-cause 5-year mortality among skilled nursing facility (SNF) residents exposed to Hurricane Sandy flooding.
Methods
This study analyzed Medicare fee-for-service (FFS) beneficiaries aged ≥65 receiving care in SNFs located in flooded ZIP codes in New York, New Jersey, and Connecticut (October 2012). A 20% Medicare FFS sample was linked to Minimum Data Set assessments, LTCFocus, Care Compare, and American Community Survey data. Flooding exposure was defined using 2012 U.S. Geological Survey flood shapefiles. Follow-up extended 5 years. Analysis included Kaplan-Meier curves, multivariable Cox models, and propensity-score matching.
Results
Of 1,627 SNF residents, 767 (47%) had dementia. Compared with those without dementia, they were older (≥85y: 52% vs 38%; P < 0.001), less often non-Hispanic White (67% vs 75%; P < 0.001), and more frequently dually eligible for Medicare/Medicaid (63% vs 40%; P < 0.001); Charlson comorbidity burden was similar (mean 4.9; P = 0.95.). Dementia was associated with higher 5-year mortality after full adjustment (HR 1.20, 95% CI 1.05-1.37), and propensity-score matching (HR 1.24, 95% CI 1.08-1.44). Median survival was 1.68 years vs 2.61 years.
Conclusions
SNF residents with dementia in flooded areas had higher 5-year mortality, underscoring the need for dementia-specific disaster plans.
Long-acting injectable (LAI) antipsychotics are highly effective tools for managing serious mental illness, yet their clinical utility is often compromised by logistical and pharmacological complexities. This review serves as a practical guide to optimizing LAI therapy by addressing common clinical hurdles. Maintaining a consistent injection schedule is essential to successful treatment. To improve adherence, clinicians should implement proactive reminder systems—such as phone calls or text messages—and involve family or caregivers in the care plan. When injections are delayed, management strategies must be tailored to the specific medication and the length of the “dosing window”. For example, aripiprazole monohydrate (Abilify Maintena) allows a ±7 day window, whereas paliperidone palmitate (Invega Sustenna) provides a +14 day window. If these windows are exceeded, catch-up protocols may involve administering the next dose as soon as possible, utilizing supplemental oral antipsychotics for a bridge period (e.g., 14 days for aripiprazole or 21 days for risperidone), or restarting initiation loading regimens entirely. Clinically significant drug interactions, such as the reduction of aripiprazole or risperidone levels by carbamazepine, can lead to symptom breakthrough. Conversely, CYP450 inhibitors like fluvoxamine or fluoxetine may increase antipsychotic concentrations, necessitating dose reductions. Adverse effects, including drug-induced Parkinsonism and akathisia, should be managed by reducing the LAI dose or switching to agents with lower risk profiles, such as aripiprazole-based products. For akathisia, short-term adjunctive treatments like vitamin B6 or mirtazapine may be utilized until dose adjustments reach steady state. Patient-centered care requires a collaborative approach to substance use, which can exacerbate symptoms or interfere with LAI effectiveness. Clinicians must also engage in nonjudgmental discussions when patients request a return to oral therapy, carefully considering the pharmacokinetic properties of the LAI to time the transition safely. Ultimately, a proactive management plan that addresses these clinical variables is essential for reducing relapse risk and improving long-term quality of life.
This study assessed the suitability of nutritional composition data from a commercial dataset for policy evaluation in Brazil.
Design:
We compared the proportions of packaged foods and beverages, classified according to the Nova food classification and the nutritional composition of matched products using data from a commercial database of food labels (Mintel-Global New Products Database (GNPD)) and the Brazilian Food Labels Database (BFLD), collected in 2017 as a ‘gold standard.’ We evaluated the agreement between the two datasets using paired t tests, Wilcoxon–Mann-Whitney test and the Intraclass Correlation Coefficient (ICC) for energy, carbohydrates, total sugars, proteins, total fats, saturated fats, trans-fats, sodium and fiber.
Setting:
Brazil.
Participants:
Totally, 11 434 packaged foods and beverages collected in 2017 provided by BFLD and 67 042 packaged foods and beverages launched from 2001 to 2017 provided by Mintel-GNPD.
Results:
The proportions of ultra-processed foods (UPF) were similar in both datasets. Paired products exhibited an excellent correlation (ICC > 0·80), with no statistically significant difference in the mean values (P ≥ 0·05) of most nutrients analysed. Discrepancies in fibre and fat content were noted in some UPF subcategories, including sweet biscuits, ice cream, candies, dairy beverages, sauces and condiments.
Conclusion:
The Mintel-GNPD dataset closely aligns with the BFLD in UPF distribution and shows a similar nutritional composition to a sample of matched foods available for purchase in stores, indicating its potential contribution to monitoring and evaluating food labelling policies in Brazil and in studies of food and beverages composition in food retail through the verification of policy compliance.
Dextro-transposition of the great arteries is a critical CHD traditionally considered sporadic, with low familial recurrence. Emerging evidence suggests a genetic component in select cases, particularly with rare familial clustering. We report concordant d-TGA in monochorionic diamniotic twins, a highly unusual occurrence, strengthening the argument for a heritable predisposition.
This study explored the prevalence and attributes of triage errors made by emergency responders during virtual reality simulations of mass casualty incidents.
Methods
The study analyzed errors made by 99 emergency responders during their triage and treatment of a mass casualty incident in virtual reality. Responders received training on the Sort, Assess, Life-saving Intervention, Treatment, Transport (SALT) protocol, then responded to a virtual bombed subway station. Responder accuracy, efficiency, and application of treatments were tracked. Error analysis was performed through the lens of human factors. Accordingly, errors were categorized by their nature: either perception, proficiency, or procedure.
Results
Responders correctly triaged 70% of virtual patients, and 78% demonstrated relative efficiency. Interaction times between responders and patients averaged 20 seconds. The time to assess and treat all patients for life-threatening bleeding injuries across the entire scene averaged six minutes. Most errors were related to proficiency (e.g., competence or experience). However, procedural errors (shortcomings of SALT) and perceptual errors (degraded sensory input from programmed environmental chaos, i.e., virtual smoke/debris and louder sound) were also observed. Most errors were related to patients with either respiratory issues or multiple injuries.
Conclusion
Virtual reality (VR) offered a controlled environment for studying errors made by emergency responders in a mass casualty incident, which will lead to improved training and protocols to better prepare them for these events.
Despite efforts by the Volta River Authority (VRA) to provide services for schistosomiasis control in communities along Ghana’s Volta Basin, high rates of transmission and re-infection persist in the region. To strengthen intervention effectiveness, the VRA partnered with the University of Health and Allied Sciences to conduct implementation research aimed at developing context-specific, evidence-based quality improvement strategies. This mixed-method study evaluates the reach, effectiveness, adoption, implementation, and maintenance of the VRA’s quality improvement intervention for their mass drug administration (MDA) for schistosomiasis. Baseline and endline surveys were analysed using STATA and qualitative data from in-depth interviews (IDIs) and focus group discussions (FGDs) were coded and analysed thematically using Taguette. Urogenital schistosomiasis prevalence decreased by 87.83% in Shai Osudoku, 88.98% in South Tongu, and 90.96% in Asuogyaman after the intervention. The findings revealed high training levels among district health management staff and community drug distributors, high health worker satisfaction with the training, and positive community reception of the intervention. However, praziquantel side effects and related opportunity costs may have posed a barrier to drug uptake. Moreover, re-infection remains a challenge, which could be attributed to high domestic and economic reliance on the Volta River.