Unfolding Outbreak Scenarios Can Be a Bite-Size Treat and Other Lessons From New Zealand's First Online Environmental Health Conference

The New Zealand Institute of Environmental Health (NZIEH) is a nongovernmental institute for all environmental health professionals in New Zealand. In 2021, NZIEH held its annual conference as an online virtual event for the first time. One inclusion to the program was an evolving outbreak scenario delivered in installments including "injects" of information (i.e., inserts of information relevant to the scenario) that mimic the evolution of a real-life epidemiological outbreak investigation. Questions were posed to attendees related to each added information inject. The scenario also included discussion in virtual breakout rooms that allowed attendees to network and reach consensus before responding to questions;discussions were also initiated by the scenario facilitators. Details of the scenario, its aims, evaluation of success, and limitations of this approach are discussed.

The effects of COVID-19 on the water sector

The COVID-19 pandemic affected public health, economy, social life, and the environment. It infected and killed millions of people around the world. Most of the recent literature has focused on the medications to combat this virus, including antivirals and vaccines, but studies about its effect on the environment are still rare, particularly on the water sector. Most of the studies concentrate on the effect of water availability on COVID-19, the effect of the used medications on the water, and the probability of transmission of SARS-CoV-2 through water. Herein, we have summarized the effects of COVID-19 on the water sector from many perspectives. We show different methods to detect the effect of the pandemic on water and also methods to investigate the presence of the virus or its RNA in the water. We also show the different effects of its presence in the wastewater, the probability of transmission, the detection of different variants, and the prediction of new waves. We also show the disadvantages and advantages of the pandemic in the water sector. We finally suggest some recommendations to face this pandemic and the future pandemics for the governments and water policymakers, water treatment plants, general population, and researchers. The aim of this review is to show the different aspects of the pandemic in order to give a general idea about what must be done in order to minimize its effect and any probable pandemic in the future.

Societal drivers of antimicrobial resistance

Antimicrobial resistance is caused by and exacerbates social and health inequalities. Human and animal antimicrobial use is contributing as much as societal failures to dispose of and manage our waste and respect our environment. A multisector, multidisciplinary approach is required to resolve these issues.Copyright © ERS 2023.

Declaration of Cuernavaca

The National Public Health Institutes (NPHI), members of the Latin American Regional Network of the International Association of National Institutes of Public Health, met face to face at the headquarters of the National Institute of Public Health of Mexico, in the City of Cuernavaca, from October 5 to 7, 2022, with the participation of the directors or their representatives of the NPHIs of Bolivia, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru and Suriname and representatives of the South American Sub regional Program (SAM), and the Central American Sub regional Program (CAM) of the Pan American Health Organization (PAHO), the Organization of the Amazon Cooperation Treaty (OTCA), the Andean Health Agency/Hipolito Unanue Agreement (ORAS/CONHU) and the Central American Integration System (SICA/COMISCA), analyzing the role of the NPHI in combating health inequities;in confronting the global climate and environmental crisis;combating hunger, food insecurity and malnutrition;successes and challenges in responding to the Covid-19 pandemic;strengthening and continuous improvement of integrated disease surveillance and preparedness for health emergencies;as well as the various existing regional and sub-regional health cooperation programs, noticing that: 1. In the current scenario, the dominating development model is a generator of growing social inequalities, which determine serious inequities in the health conditions of our peoples. 2. Likewise, the current model of production and consumption, adopted at the global level, has increased hunger, food insecurity and malnutrition that possibly constitute nowadays the main health problem in our region. 3. The environmental crisis, which is also a product of the current global development model, has a significant impact on human and animal health and the interaction between both. 4. The NPHIs have played a role of major relevance in confronting the Covid-19 pandemic, not fully applying, however, their full potential for research and for proposing national plans for the disease control. 5. Health surveillance systems, in most of our countries, suffer from significant fragmentation between various sectors and within the health sector itself, implying, in any case, reactive actions that do not allow for anticipating the emergence of new pathologies or health emergencies. 6. The various regional and sub regional cooperation agencies and programs offer an enormous capacity for synergies and mutual cooperation.

Vulnerability and antimicrobial resistance

It is now well-recognised that antimicrobial resistance (AMR), or the ability of organisms to resist currently available antibiotics and other antimicrobial drugs, represents one of the greatest dangers to human health in the 21st Century. As of 2022, AMR is a top-10 global public health threat. Various national and transnational initiatives have been implemented to address accelerating AMR, and the pressure to find local and global solutions is increasing. Despite this urgency, surprisingly limited progress is being made in rolling back or even slowing resistance. A multitude of perspectives exist regarding why this is the case. Key concerns include an enduring dependency on market-driven drug development, the lacklustre governance and habitual over-prescribing of remaining antimicrobial resources, and rampant short-termism across societies. While rarely presented in such terms, these disparate issues all speak to the social production of vulnerability. Yet vulnerability is rarely discussed in the AMR literature, except in terms of 'disproportionate effects' of AMR. In this paper, we offer a reconceptualisation of vulnerability as manifest in the AMR scene, showing that vulnerability is both a predictable consequence of AMR and, critically, productive of AMR to begin with. We underline why comprehending vulnerability as embodied, assembled, multivalent and reproduced through surveillance matters for international efforts to combat resistance.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Dominant Modes of Agricultural Production Helped Structure Initial COVID-19 Spread in the US Midwest

The spread of COVID-19 is geographically uneven in agricultural regions. Explanations proposed include differences in occupational risks, access to healthcare, racial inequalities, and approaches to public health. Here, we additionally explore the impacts of coexisting modes of agricultural production across counties from twelve midwestern U.S. states. In modeling COVID-19 spread before vaccine authorization, we employed and extended spatial statistical methods that make different assumptions about the natures and scales of underlying sociospatial processes. In the process, we also develop a novel approach to visualizing the results of geographically weighted regressions that allows us to identify distinctive regional regimes of epidemiological processes. Our approaches allowed for models using spatial weights (e.g., inverse-squared distances) to be meaningfully improved by also integrating process-specific relations (e.g., the geographical relations of the food system or of commuting). We thus contribute in several ways to methods in health geography and epidemiology for identifying contextually sensitive public engagements in socio-eco-epidemiological issues. Our results further show that agricultural modes of production are associated with the spread of COVID-19, with counties more engaged in modes of regenerative agricultural production having lower COVID-19 rates than those dominated by modes of conventional agricultural production, even when accounting for other factors.

Building capacity on One Health in the midst of the COVID-19 pandemic: Connecting disciplines in the Philippines

Background and Aim: There have been limited capacity-building activities on One Health in the Philippines. To contribute to capacity development in One Health, the authors conducted the first short course on One Health in the country for health, allied health, and collaborating professionals. This study aimed to review the preparation and implementation of the One Health course and describe the challenges and opportunities of conducting the course during the coronavirus disease 2019 (COVID-19) pandemic. Material(s) and Method(s): The course curriculum was developed by a multidisciplinary group of experts. The objectives for the course were as follows: (1) Describe the concept, scope, and applications of One Health;(2) identify social and economic factors influencing food security and safety, control of zoonoses, and combating antimicrobial resistance;and (3) describe the challenges and opportunities in applying the One Health approach to achieve better public health outcomes. Recruitment of participants was based on predetermined criteria. The 3-day course was conducted online through Zoom. Pre and post-tests as well as the evaluation of the course were administered through Google forms. Result(s): The 3-day online course was attended by 136 participants from 15 of the 17 administrative regions of the country. A multidisciplinary group of experts delivered a total of 11 lectures divided into the following sessions: (1) Fundamentals of One Health;(2) Interrelatedness of Human, Animal, and Environmental Health;and (3) Applications of One Health. Conclusion(s): As the first One Health course in the Philippines, this 3-day course demonstrated the feasibility of conducting capacity-building on One Health for a multidisciplinary group of participants during the coronavirus disease-19 pandemic. It may serve as a model for similar and more in-depth courses on One Health for specific groups in the future and has set the stage for intersectoral communication and education, providing an avenue for collaboration for professionals in various disciplines, and facilitating the expansion of One Health network in the Philippines.Copyright © Ampo, et al. This article is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Towards NHS Zero: greener gastroenterology and the impact of virtual clinics on carbon emissions and patient outcomes. A multisite, observational, cross-sectional study.

Objective: The National Health Service (NHS) produces more carbon emissions than any public sector organisation in England. In 2020, it became the first health service worldwide to commit to becoming carbon net zero, the same year as the COVID-19 pandemic forced healthcare systems globally to rapidly adapt service delivery. As part of this, outpatient appointments became largely remote. Although the environmental benefit of this change may seem intuitive the impact on patient outcomes must remain a priority. Previous studies have evaluated the impact of telemedicine on emission reduction and patient outcomes but never before in the gastroenterology outpatient setting. Method: 2140 appointments from general gastroenterology clinics across 11 Trusts were retrospectively analysed prior to and during the pandemic. 100 consecutive appointments during two periods of time, from 1 June 2019 (prepandemic) to 1 June 2020 (during the pandemic), were used. Patients were telephoned to confirm the mode of transport used to attend their appointment and electronic patient records reviewed to assess did-not-attend (DNA) rates, 90-day admission rates and 90-day mortality rates. Results: Remote consultations greatly reduced the carbon emissions associated with each appointment. Although more patients DNA their remote consultations and doctors more frequently requested follow-up blood tests when reviewing patients face-to-face, there was no significant difference in patient 90-day admissions or mortality when consultations were remote. Conclusion: Teleconsultations can provide patients with a flexible and safe means of being reviewed in outpatient clinics while simultaneously having a major impact on the reduction of carbon emissions created by the NHS.

Addressing the challenges of implementing evidence-based prioritisation in global health.

Global health requires evidence-based approaches to improve health and decrease inequalities. In a roundtable discussion between health practitioners, funders, academics and policy-makers, we recognised key areas for improvement to deliver better-informed, sustainable and equitable global health practices. These focus on considering information-sharing mechanisms and developing evidence-based frameworks that take an adaptive function-based approach, grounded in the ability to perform and respond to prioritised needs. Increasing social engagement as well as sector and participant diversity in whole-of-society decision-making, and collaborating with and optimising on hyperlocal and global regional entities, will improve prioritisation of global health capabilities. Since the skills required to navigate drivers of pandemics, and the challenges in prioritising, capacity building and response do not sit squarely in the health sector, it is essential to integrate expertise from a broad range of fields to maximise on available knowledge during decision-making and system development. Here, we review the current assessment tools and provide seven discussion points for how improvements to implementation of evidence-based prioritisation can improve global health.

Supporting One Health for Pandemic Prevention: The Need for Ethical Innovation.

Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as a strategy that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health.

Placing Antimicrobial Resistance in the Context of Competing Public Health Priorities in Sub-Saharan Africa, a Perspective from Malawi

Antimicrobial resistance is a major threat to human health that is predicted to impact most heavily on sub-Saharan Africa, however there is a lack of clinical outcome data from drug-resistant infections in this setting. There are reasons to expect the COVID-19 pandemic to have both positive and negative impacts on AMR in Africa. We have recruited a series of prospective longitudinal cohorts from Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and the surrounding communities in the Southern Region of Malawi. The data from these cohorts has been used to describe the aetiology of febrile illness, the burden of antimicrobial resistance in this setting and the distribution of extended spectrum beta-lactamase producing bacteria in humans, animals and the environment. Amongst a cohort of patients presenting to QECH unwell with febrile illness, 67% were living with human immunodeficiency virus (HIV). We identified a diagnosis in 145 of 225 (64%) participants, most commonly tuberculosis (TB;34%) followed by invasive bacterial infections (17%), arboviral infections (13%), and malaria (9%). In a second cohort with drug resistant infection, resistance to third-generation cephalosporins was associated with an increased probability of in-hospital mortality (hazard ratio [HR] 1.44, 95% CI 1.02-2.04), longer hospital stays (1.5 days, 1.0-2.0) and decreased probability of discharge alive (HR 0.31, 0.22-0.45). In the community cohorts, a paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites and ESBL-Enterobacterales were isolated from 41.8% of human stool, 29.8% of animal stool and 66.2% of river water samples and was associated with the wet season, living in urban areas, advanced age and in household-animal interactions. Life threatening febrile illness is common in Blantyre however, diagnostics are few, however the COVID-19 pandemic has led to rapid expansion of diagnostic capacity. We are, however frequently treating the wrong bugs with ceftriaxone, further there was significant expansion of azithromycin demand and usage during the pandemic. Current management of sepsis has not been optimised and ceftriaxone use is promoting carriage of ESBL bacteria out of the hospital and ESBL E. coli and K. pneumoniae are ubiquitous in the community, where environmental hygiene infrastructure and community antimicrobial stewardship are critically lacking.Copyright © 2023

EPICORE: AN INNOVATIVE GLOBAL DISEASE SURVEILLANCE TOOL FOR HUMAN, ANIMAL, AND ENVIRONMENTAL PUBLIC HEALTH EVENTS

EpiCore was launched in 2013 and is a tool designed to supplement traditional infectious disease surveillance efforts by bringing together human, animal, and environmental experts on a digital platform to provide field-based verification efforts of global public health events1,2. Public health professionals from organizations around the globe, including Ending Pandemics, HealthMap, Geosentinel, MSF-OCBA, ProMED, and EDIS-RSOE, are trained as Moderators and are able to send Requests for Information (RFIs). Moderators utilize nontraditional resources, such as social media and news articles, to identify potential health events. Through EpiCore, moderators send out a RFI to EpiCore members located in a geographic area where a new or known health event is occurring. Health experts who receive the RFI may anonymously respond with information about the health event. A moderator reviews the responses and determines whether the information verifies a new event or updates a known ongoing event. Verified and updated events are summarized and published on the EpiCore public dashboard and shared with WHO EIOS. The study period was January 2020 - July 2022. In the study period, 231 RFIs were sent requesting signals about potential health events;111 of those RFIs received responses with information that allowed moderators to confirm or negate a suspected event, or update a known ongoing event. 82% of those RFIs were responded to within 24 hours. EpiCore is a resource for public health professionals and organizations to supplement traditional infectious disease surveillance efforts. For example, information collected through EpiCore was used to provide timely details on the emerging COVID-19 outbreak in Wuhan, China in January 2020. Additionally, responses to RFIs supported surveillance efforts of the 2022 global monkeypox outbreak. Future efforts include outreach and engagement with existing and new members to expand EpiCore's member base in countries with few to no members. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Air pollution with pm10 for the municipality of Burgas and the monthly cases of disease with COVID 19, 2021

An important environmental problem for the Municipality of Burgas is the relatively high levels of PM10 pollution. Particulate matter PM10 is defined as the fraction of particles with an aerodynamic diameter smaller than 10 pm. The article provides statistical processing and evaluation of daily data on the concentration of PM10 in the air by quarters fix Burgas, 2021. A histogram of the frequency distribution of concentrations by quarters was prepared. A regression model for calculating the monthly concentrations in the atmospheric air is derived The tests and inspections performed show that the performed modelling is suitable for evaluation, analysis and forecast. Air pollution harms human health and the environment. Exposure ID air pollution is associated with a wide range of acute and chronic health effects, ranging from irritating effects to death From the end of 2019 until now in the world, Europe and in particular Bulgaria is raging a dangerous respiratory disease known as COVD19. The average monthly new cases of COVD19 for Burgas were assessed, as well as the respective maximum and minimum monthly values. A qualitative assessment of the relationship between the monthly concentrations of PM10 and the incidence of COVID19 was made.

Fructus aurantii extracts ameliorate intestinal inflammation and regulate the intestinal barrier through Fc epsilon RI signaling pathway

Fructus Aurantii (FA) is the dry and immature fruit of Citrus aurantium L. and its rutaceous cultivars. FA has been widely used to treat digestive system diseases since ancient China, and it promotes gastrointestinal (GI) motility in functional dyspepsia (FD), but its potential therapeutic mechanisms remain unclear. We examined the effects of FA ethanol extracts in an iodoacetamide (IA)-induced FD rat model. Firstly, key FA therapy targets for FD were gathered using systematic pharmacology. Combined with systemic pharmacological analyses, plasma metabolomics based on UPLC-QTOF-MS were conducted. Then, MetaboAnalyst was used to jointly analyze systemic pharmacology targets and metabolomic metabolites to select key metabolic pathways. Finally, the key path is verified by experiments. FA exerted distinct therapeutic effects in anti-inflammation and promoting gastrointestinal motility in our IA-induced FD rat model. When compared with the model group, FA down-regulated the inflammatory factors interleukin 1beta and tumor necrosis factor-a. At the same time, FA up-regulated tight junction proteins in the intestinal epithelial barrier. Through the integrated analysis of metabolomics and systemic pharmacology, we conducted experimental verification on Fc epsilon RI signaling pathway. When compared with the model group, FA down-regulatedphospho-mitogen activated protein kinase, phospho-extracellular signal regulated kinase1/2, myosin light chain kinase, and phospho-myosin regulatory light chain protein levels. Thus, FA ameliorated FD by regulating the Fc epsilon RI signaling pathway. Our integrated strategy identified underlying FA mechanisms toward FD treatment and provided a foundation for FA development as a clinical agent for FD.

Integrated surveillance and early warning system for emerging infectious diseases based on One Health concept: Structures and innovations.

One Health is an upgrade and optimization of health concepts, which recognizes the integrated health of the human-animal-environment. It emphasizes the use of interdisciplinary collaboration, multi-sectoral coordination, and multi-organizational One Health approaches to solve scientific questions. The surveillance and early warning system is the basis of public health emergency prevention and control. The COVID-19 pandemic and the emerging infectious disease (EID) have put great challenges on the existing surveillance and early warning systems worldwide. Guided by the concept of One Health, we attempt to build a new pattern of integrated surveillance and early warning system for EID. We will detail the system including the One Health-based organizational structure, zoonotic and environmental science surveillance network, EID reporting process, and support and guarantee from education and policy. The integrated surveillance and early warning system for EID constructed here has practical and application prospects, and will provide guidance for the prevention and control of COVID-19 and the possible EID in the future.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.

Knowledge, perceptions and preventive practices towards COVID-19 early in the outbreak among Jimma university medical center visitors, Southwest Ethiopia

Background Novel-coronavirus disease-2019 (COVID-19) is currently a pandemic and public health emergency of international concern, as avowed by the World Health Organization (WHO). Ethiopia has become one of the affected countries as of March 15, 2020. Objective This study aimed to assess the knowledge, perceptions, and practices among the Jimma University medical center (JUMC) visitors in Jimma town. Methods A cross-sectional study was conducted on 247 sampled visitors, from 20–24 March 2020. Consecutive sampling was used to recruit the participants. The study tools were adapted from WHO resources. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Descriptive statistics were used to describe the status of knowledge, perception, and practices. Logistic regression was executed to assess the predictors of dominant preventive practices. Results Of the 247 respondents, 205 (83.0%) knew the main clinical symptoms of COVID-19. 72.0% knew that older people who have chronic illnesses are at high risk of developing a severe form of COVID-19. About 95.1% knew that the COVID-19 virus spreads via respiratory droplets of infected people, while 77 (31.2%) of the respondents knew about the possibility of asymptomatic transmission. Only 15 (6.1%) knew that children and young adults had to involve preventive measures. Overall, 41.3% of the visitors had high knowledge. The majority, 170(68.8%), felt self-efficacious to controlling COVID-19. 207(83.3%) believed that COVID-19 is a stigmatized disease. Frequent hand washing (77.3%) and avoidance of shaking hands (53.8%) were the dominant practices. Knowledge status and self-efficacy (positively), older age, and unemployment (negatively) predicted hand washing and avoidance of handshaking. Conclusions The status of knowledge and desirable practices were not sufficient enough to combat this rapidly spreading virus. COVID-19 risk communication and public education efforts should focus on building an appropriate level of knowledge while enhancing the adoption of recommended self-care practices with special emphasis on high-risk audience segments.