public health

Food hygiene is a crucial aspect of public health, directly impacting societal well-being. From the mid-Qajar period onward, mirroring the broader “medicalization” of public health, traditional folk and religious understandings of food safety were gradually replaced by modern medical teachings. This research employs a descriptive-analytical approach, utilizing primary source documents to examine the components and challenges of food hygiene during the Naseri era alongside government interventions designed to improve it. Key focus areas included water, bread, meat, kitchens, cooks, eating practices, food storage, and fruits/dried fruits. The study analyzes health concerns in each area and the government’s corresponding actions, such as issuing advisory and directive decrees, establishing health institutions, and conducting public health awareness campaigns through print media like newspapers and magazines. The findings highlight the gradual infiltration of new scientific knowledge into traditional Qajar society, supplanting long-established folk practices while simultaneously presenting the inherent challenges accompanying this transition.

Despite the availability of vaccines, measles has remained a significant health threat, with recent global surges in cases. This study focused on factors influencing measles vaccine compliance in barangay C, Northern Mindanao, Philippines. It aimed to identify barriers to compliance and assess differences in compliance levels based on demographic factors like age, decision-maker, and educational attainment. 

This study utilized a non-experimental quantitative descriptive design to examine factors influencing measles vaccination compliance among residents of barangay C. The study data were collected using a structured survey questionnaire that served as the instrument designed to measure compliance across psychosocial factors and behavioral-specific cognitions. The sample comprised 132 respondents aged 18 to 59 who met the inclusion criteria. Statistical analyses, including the t-test and ANOVA/F-tests, were employed to evaluate significant differences in vaccination compliance when grouped by age, family decision-makers, and educational attainment. Results highlighted group-specific variations in compliance, emphasizing psychosocial and behavioral determinants, with significance levels determined at P<0.05.

Younger adults showed higher compliance with psychosocial factors (mean: 3.50) compared to middle-aged adults (mean: 3.42), while middle-aged adults exhibited higher compliance with behavioral-specific cognitions (mean: 3.42). However, t-test revealed no significant differences in compliance levels based on age (P=0.834 for psychosocial factors and P=0.675 for behavioral-specific cognitions). Among decision-makers, mothers exhibited the highest compliance with psychosocial factors (mean: 3.57), and this difference was statistically significant (P=0.029). No significant differences were found in compliance levels based on educational attainment, with P=0.714 for psychosocial factors and P=0.863 for behavioral-specific cognitions.

No significant differences were found based on age and educational attainment; the study underscores the importance of decision-makers, particularly mothers, in shaping vaccination behaviors. These insights suggest that vaccination programs could benefit from improving psychosocial factors and addressing the specific needs of decision-makers, thereby promoting higher compliance with vaccination recommendations.

Context: 

Traditional medicine (TM) is widely used and holds significant potential for increasing Primary Health Care (PHC) coverage and achieving universal health coverage (UHC), especially in developing countries. Persian medicine (PM), an ancient form of TM, encompasses lifestyle principles known as "Hifz-o-Siha," which aim to maintain and improve health.This study seeks to explore whether lifestyle modifications based on PM can effectively promote health within the framework of PHC.

We conducted searches across various databases, including Science Direct, Scopus, PubMed, and Google Scholar. Our search terms included Traditional medicine, Persian, Iranian, Health maintenance, Education, and Primary health care.

Three randomized clinical trials conducted between 2017 and 2019 examined the impact of educating individuals about PM's lifestyle principles on their quality of life and healthcare utilization. The results indicated significant improvements in all measured outcomes. Furthermore, six clinical trials focused on PM dietary modifications in the treatment of conditions such as obesity, infertility, nephrotic syndrome, and non-alcoholic fatty liver disease. In all these studies, PM diets demonstrated significant efficacy compared to conventional medicine.

Lifestyle modifications based on PM recommendations have the potential to positively influence PHC and promote overall health. However, the incorporation of PM into national health systems faces challenges, primarily due to the limited availability of supporting evidence.

Residues of pesticide in animal tissues are an increasing concern due to their potential harm to human health. To assess the associated risks, pesticide concentrations were analyzed in five edible bovine tissues: muscle, liver, kidney, and tongue. Health risk estimates were calculated using the Estimated Daily Intake (EDI), Hazard Quotient (HQ), and Hazard Index (HI) for two age and weight groups: children aged 1–11 years with an average weight of 30 kg, and adults weighing 70 kg. Pesticide residues were detected in the following ranges: 2.38–3.87 g kg-1 in muscle, 3.59–6.4 g kg-1 in liver, 1.88–4.55 g kg-1 in kidney, and 2.55–4.36 g kg-1 in tongue. The order of pesticide residue quantity across the tissues was: Liver > Tongue > Muscle > Kidney. All pesticide levels measured in the tissues were below the established maximum residue limits (MRLs). However, the HQ values for heptachlor epoxide, aldrin, and dieldrin, along with HI values for organochlorines, exceeded 1. This suggests a potential for non-carcinogenic health risks, particularly for infant, from consuming contaminated bovine tissues.

The data on the association between alcohol intake and sleep quality in a community?based setting are lacking. This study examined overall sleep difficulty according to alcohol habits among Korean adults.

We analyzed data from 4937 adults who responded to questions about sleep difficulty and drinking habits from the 2019 Korea National Health and Nutrition Examination Survey. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for substantial sleep difficulty based on the frequency or amount of alcohol consumption in total and age? and sex?stratified subgroup analyses.

Approximately 8.5% of the study population had substantial sleep difficulty.Individuals who drank <1 per week (frequency) or 1–2 cups per time (amount) had the lowest prevalence of substantial sleep difficulty, even compared with nondrinkers. Among drinkers, the association between alcohol use and sleep difficulty was significant in a dose?dependent manner (P for trend: 0.003 in frequency and < 0.001 in amount). Subgroup analysis revealed that significant linear relationships were robust for adults aged <50 years ([ORs] 1.20 [95% CIs 1.03–1.40] for frequency and 1.25 [1.10–1.42] for amount) and females (1.26 [1.10–1.44] for amount).

Alcohol consumption is associated with increased sleep difficulties, especially in younger adults and women, underscoring the need for targeted interventions and in?depth research on the effects of alcohol on sleep.

 The rapid development of COVID-19 vaccines may have raised public concerns about their safety and side effects in the United States (US). This study aimed to assess trends in online searches related to the safety and side effects of COVID-19 vaccines in the US from 2021-2022.

 Google COVID-19 Vaccination Search Insights was used to analyze searches about COVID-19 vaccine safety and side effects in the US from January 4, 2021, to November 21, 2022 (98 weeks). Data were scaled from 0 (low interest) to 100 (high interest) as a fixed scaling factor called scaled normalized interest (SNI) to indicate relative search interest over time and by location. A joinpoint regression analysis was used to determine the search trends during the study period.

 Analysis included 709 counties across 38 US states. Searches of COVID-19 vaccine safety and side effects peaked in April 2021 in the District of Columbia (SNI: 35.8), Massachusetts (29.7), New Hampshire (27.4), Connecticut (27.3), and Maine (26.7), then decreased significantly by an average monthly percentage change (AMPC) of -16.6% (95% CI -19.9 to -13.3) until July 2022. Overall AMPC from January 2021 to November 2022 was -8.9% (95% CI -16.2 to -0.9; P<0.001).

 Online searches related to COVID-19 vaccine safety and side effects decreased dramatically over time, supporting the utility of digital surveillance to track real-time vaccine safety concerns. This study provides insights into public interest in COVID-19 vaccine risks and can help monitor potential safety issues.

This bibliometric study analyses the global output of glaucoma in primary healthcare from 1978 to 2024.

The study surveyed trends in publications, leading research institutions, and principal contributors, utilizing data from the Web of Science (WoS) and Scopus databases. The analysis revealed an increase in scholarly articles focused on glaucoma within primary healthcare, reflecting an enhanced emphasis on early detection and management at the initial level of care. Relevant documents were identified using a reliable search strategy from the WoS and Scopus databases and were reviewed and evaluated using Microsoft Excel and the bibliometrix R-package.

The United States, Portugal, and Brazil were identified as leading countries in glaucoma research, demonstrating a broad commitment to addressing this eye condition. Research has focused on enhancing awareness among patients and healthcare providers, developing effective screening protocols, and improving the quality of life for those affected by glaucoma. The findings highlight the importance of an integrated approach that includes educating primary care providers, adopting advanced diagnostic technologies, and actively involving patients in their care and monitoring. Challenges such as limited access to proficient healthcare services and the incorporation of specialized ophthalmological services within primary care frameworks were also noted.

This bibliometric analysis underscores the need for enhanced cross-disciplinary collaboration and worldwide knowledge exchange regarding early glaucoma detection and management in primary care settings. The insights gained could guide the development of strategies to improve access to glaucoma diagnosis and treatment while heightening public awareness of the condition.

Stunting is a significant public health concern in Indonesia. It represents a form of chronic malnutrition that manifests not only as a short stature for one’s age, but also as a profound challenge affecting children’s physical and cognitive development. This study aims to provide more research basis for the government to formulate stunting policies by exploring the ecological factors associated with stunting, consistent with the goal of reducing stunting according to Sustainable Development Goals (SDGs) targets by 2030. Data were collected on stunting and ecological factors from 34 provinces in Indonesia from 2015-18, sourced from Statistics Indonesia and the Ministry of Health. A framework of ecological factors that influence stunting, consisting of health, socioeconomic status, and the environment was developed. A panel data model to test the influence of each ecological factor on stunting was created. Among the 27 independent variables of health, economic status, and environment, the results of this study show that malnutrition, diarrhea, dependency ratio, and hygiene significantly affect the risk of stunting. Meanwhile, antenatal care, nurses, and sanitation have an effect on reducing the risk of stunting. To achieve the SDGs targets associated with malnutrition by 2030, addressing stunting in Indonesia requires a comprehensive and multisectoral approach that addresses the fundamental causes of stunting, including health, socioeconomic status, and environmental factors. Addressing stunting is crucial for Indonesia, not only to improve the health and well-being of its children, but also for the long-term benefits of enhancing educational outcomes and economic productivity.

This letter underscores the vital role that school nurses play in providing equal educational opportunities for students with disabilities.

Context: 

Metabolic syndrome (MetS) is characterized by a cluster of metabolic disorders, including hypertension, insulin resistance, and dyslipidemia, which collectively heighten the risk of cardiovascular diseases (CVDs). The global prevalence of MetS is steadily increasing, paralleling the rise in obesity and sedentary lifestyles. Pharmacological treatments for MetS often face challenges such as inadequate blood pressure (BP) control and limited improvements in cardiovascular outcomes. Consequently, there is a growing emphasis on non-pharmacological interventions, particularly exercise. Among various exercise modalities, isometric resistance training (IRT), which involves static muscle contractions without joint movement, has emerged as a promising strategy for effectively lowering BP and enhancing endothelial function, both of which are critical for cardiovascular health.

Evidence Acquisition: 

This comprehensive literature review synthesizes existing research on the effects of isometric exercise on BP regulation and endothelial function in individuals diagnosed with MetS. The review examines studies sourced from databases such as PubMed, Scopus, and Web of Science, focusing on randomized controlled trials, meta-analyses, and observational studies published in peer-reviewed journals. Key discussion areas include the underlying physiological mechanisms of IRT, comparisons with other exercise modalities, clinical implications, and recommendations for future research. Articles were selected based on qualitative and descriptive reviews.

Evidence indicates that isometric resistance training effectively reduces both systolic and diastolic BP, achieving results comparable to other exercise forms like aerobic and dynamic resistance training. Furthermore, IRT has significantly improved endothelial function, particularly among populations with MetS. These physiological benefits are attributed to mechanisms such as enhanced nitric oxide bioavailability, reduced oxidative stress, and improved autonomic regulation.

The review supports the integration of isometric exercise into hypertension management protocols, especially for individuals with MetS. Isometric resistance training offers a viable non-pharmacological alternative or adjunct to traditional treatments, with the added advantages of accessibility and adaptability for diverse populations. However, further research is necessary to optimize exercise protocols, determine long-term outcomes, and fully elucidate the molecular mechanisms underlying the cardiovascular benefits of IRT.

Glenn and colleagues carefully conducted a realist review of initiatives introduced in high-income countries intended to improve financial well-being (FWB) or reduce financial strain (FS) during the early days of the pandemic. They found that these initiatives were underpinned by either neoliberal or social equity ideologies, within which, social location acted on different groups. In this commentary, we suggest caution in applying labels such as neoliberalism and social equity when lumping social welfare policies; labour policies; housing and financial services policies; and service provision for health, seniors, childcare, and education across welfare state regimes. We also caution against aggregating equity-deserving groups from different contexts into a single otherness. We suggest a pragmatic reinterpretation of the study’s findings and in future examinations of post-pandemic recovery in accordance with long-standing pragmatic methods of working in public health that seek to improve population health and well-being through collective action.

  Most the Organization for Economic Co-operation and Development (OECD) countries are currently facing the challenges of the health transition, the aging of their populations and the increase in chronic diseases. Effective and comprehensive primary healthcare (PHC) services are considered essential for establishing an equitable, and costeffective healthcare system. Developing care coordination and, on a broader scale, care integration, is a guarantee of quality healthcare delivery. The development of healthcare systems at the meso-level supports this ambition and results in a process of territorial structuring of PHC. In France, the Health Territorial and Professional Communities (HTPC) constitute meso-level organizations in which healthcare professionals (HCPs) from the same territory gather. We conducted a study to determine, in a qualitative step, the key elements of the territorial structuring of PHC in France and, then, to develop, in a quantitative step, a typology of this structuring. 

A sequential-exploratory mixed-method study with a qualitative step using a multiple case approach and a quantitative step as a hierarchical clustering on principal components (HCPC) from a multiple correspondence analysis (MCA). 

  A total of 7 territories were qualitatively explored. Territorial structuring appears to depend on: past collaborations at the micro-level, meso-level coordination among HCPs and multiprofessional structures, diversity of independent professionals, demographic dynamics attracting young professionals, and public health investment through local health contracts (LHCs). The typology identifies 4 clusters of mainland French territories based on their level of structuring: under or unstructured (38.6%), with potential for structuring (34.7%), in the way for structuring (25.3%) and already structured territories (1.4%).

Interest in territorial structuring aligns with challenges in meso-level healthcare organization and the need for integrated care. Typologies of territorial structuring should be used to understand its impact on access, care quality, and medical resources.

There is growing evidence that the alcohol industry seeks to obstruct public health policies that might affect future alcohol sales. In parallel, the alcohol industry funds organisations that engage in “responsible drinking” campaigns. Evidence is growing that the content and delivery of such campaigns serves industry, rather than public health interests, yet these organizations continue to be the subject of partnerships with government health departments. This study aimed to examine the nature and potential impacts of such partnerships by analysing the practices of the alcohol industry-funded charity Drinkaware during the establishment of the Drink Free Days campaign.  

A case study based on an inductive analysis of documents revealed by freedom of information (FoI) request regarding communications between Drinkaware, Public Health England (PHE), and the Portman Group, in the years running up to, and during, the Drink Free Days campaign, a partnership between alcohol industry-funded charity Drinkware, and PHE. 

This study reveals a range of less visible, system-level effects of such partnerships for government departments and civil society. The tensions observed, as exhibited by discrepancies between internal and external communications, the emphasis on managing and mitigating the perception of negative consequences, and the links to wider alcohol industry initiatives and bodies, suggest the need for wider considerations of organizational conflicts of interest, and of possible indirect, harmful consequences to policy-making. These include the marginalization of other civil society voices, the displacing of more effective policy options, and strategic alignment with other industry lobbying activities.

The findings have implications for how public health practitioners and health organisations might better weigh the potential trade-offs of partnership in the context of health promotion campaigns.

The importance of the international food regulatory system to global health, is often overlooked. There are calls to reform this system to promote healthy and sustainable food systems centred on the Codex Alimentarius Commission (Codex), the United Nation’s (UN’s) standard-setting body. Yet this presents a significant political challenge, given Codex has historically prioritized food safety risks over wider harms to public health, and is dominated by powerful food exporting nations and industry groups with a primary interest in trade expansion. To better understand this challenge, we examine who participates and contests Codex standards, using the development of the new Guidelines on Front-of-pack Nutrition Labelling (FOPNL) as a case study. 

The study involved: (i) collecting Codex Committee on Food Labelling (CCFL) documents (2016-2023); (ii) identification, categorization, and enumeration of actors involved in the development of the Guidelines; and (iii) guided by a constructivist framework, analysis of how actors framed and contested key provisions of the Guidelines.  

Country representation was skewed towards high-income (47.9%). Member state delegations were dominated by non-health ministries (59.8%) and industry actors (16.1%). Industry actors comprised the large majority of observers (84.2%) and civil society actors representing public health interests the least (12.2%). Commercial actors used frames supporting positive FOPNL messages (eg, low in salt) opposing negative ones (eg, “high-in” sugar warnings) and called for product exemptions (eg, sports foods and baby foods). Public health actors used frames supporting simplified FOPNL to reduce consumer confusion, that hold up public health goals, and prevent inappropriate marketing. 

  Participation in the Guidelines development process suggests stronger preferences for trade facilitation and commerce over public health. Ambitions to reform the international food regulatory system may require an examination of who participates and how to address this asymmetrical representation of interests. These results suggest the need to greatly strengthen public health representation at Codex.

  Community engagement is key to developing local and context-specific strategies for the prevention and control of COVID-19. However, expedited research design and approval in the early days of the pandemic may have limited the opportunities for community members to influence pandemic-related research. In this study, we sought to understand how a Community Engagement Group (CEG) could impact a large longitudinal COVID-19 research project (Optimise), when involved solely in the interpretation and knowledge translation phases of the research. 

Seven community members were recruited for the CEG, representing a diverse range of groups. Each month, Optimise data of topical importance were compiled into a draft report. The CEG discussed the draft report at their monthly meeting and members’ contributions were incorporated into the final report for distribution to policy-makers. In this study, a document analysis was undertaken of ten consecutive reports produced between February and November 2021. Each report was compared pre- and post- the inclusion of CEG contributions, which were then analysed using thematic analysis.

  Community engagement in the interpretation and knowledge translation phases of Optimise had positive impacts on reports for policy-makers, including grounding the empirical findings in broader community perspectives, identifying policy issues affecting different groups and contributing unique insights beyond the empirical findings. Overall, the CEG contributions demonstrated the complexity of lived experience lying beneath the empirical data.  

  Community engagement in the translation of the Optimise findings resulted in research reports to policymakers that were reflective of a broader range of community perspectives, and that provided potential solutions to emerging policy issues related to COVID-19. This study adds to the evidence base about the impact of community engagement in the later interpretation and knowledge translation phases of research, particularly in the context of reporting to policy-makers during a public health emergency.

Diabetes is a chronic medical condition with severe complications, mainly caused by unhealthy lifestyles in genetically susceptible individuals. There has been a growing interest in the role of mobile health technologies in achieving better self-efficacy in managing diabetes. This study attempts to assess the impact of a web-based model on improving the diabetes status among Type 2 diabetic patients attending a tertiary care hospital in southern India.

A longitudinal study was conducted among patients with type 2 diabetes attending the outpatient department of a tertiary care hospital in Mysuru, southern India, for 6 months. Diabetes Care (https://www.diabetescare.co.in/), which is an online website that can be used as a risk prediction tool for uncontrolled diabetes and recommends lifestyle changes, was used by 456 diabetes patients for 6 months. We assessed the change in glycosylated haemoglobin levels at the beginning and after 6 months of using the software.

The mean HbA1c value at the start of the study was 8.039% ± 1.981. The HbA1c value assessed after 6 months post-intervention showed an improvement of 7.794% ± 1.853 with a mean difference of 0.245. A paired T-test showed a statistically significant association with a P value of 0.049.

Evidence from this study suggests that intervention using a webbased model focusing on risk prediction and educational intervention showed an improvement in the diabetic status of the patients with T2DM