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Suicide is a global phenomenon, with implications for HICs and LMICs alike, bec,ause of interconnectedness. Social injustice increases societies’ suicide risk and it is easily and frequently exported. Suicide is preventable but not always individually. Suicide prediction is difficult or impossible, so those measures that effect everyone work best. Hence assuring good quality, timely mental health coverage for the whole population is important. Those with the least resources must be targeted, as they are at greatest risk..
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 prevalence and identify sociodemographic predictors of regular fast-food consumption (R-FFC) among UAE adults to inform public health nutrition responses to growing diet-related ill-health in the region.
Design:
A descriptive cross-sectional study using purposive, convenience sampling. Data was collected using an online survey adapted from two validated surveys and distributed via social media platforms. R-FFC was defined as visiting a fast-food restaurant to eat ≥2 times/week. Pearson chi-squared tests and multiple binary logistic regression models were used to investigate prevalence and predictors of R-FFC. All statistical significance was considered at p-value <0.05.
Setting:
Community, adults living in the UAE.
Participants:
UAE residents, ≥18 years, who consumed fast-food ≥once during the previous month.
Results:
320 respondents met the inclusion criteria (age [mean± SD] = 23.7± 7.7 years). The prevalence of R-FFC was 46.6%. Based on results from the regression model, predictors of R-FFC were (AOR; 95% CI) being female (2.47; 1.06- 5.79), married (3.11; 1.25-7.77), BMI ≥25.0 (2.09; 1.10-4.00) and residing outside Abu Dhabi (32.79; 12.06-89.16). None of the remaining variables reached statistical significance. Taste was the most common reason for FFC (56.9%), followed by convenience (21.6%). Regular fast food consumers were more likely to “super-size” meals (p=0.011), eat alone (p=0.009), and not have regular meal patterns (p=0.004).
Conclusions:
The study revealed a high prevalence of R-FFC among UAE adults, and novel cultural predictors and characteristics of FFC in this context, highlighting the importance of socially and culturally informed research and public health strategies in this region.
Canadian front-of-package (FOP) labelling regulations aim to improve dietary patterns by identifying foods high in sodium, sugars and/or saturated fat with a ‘high in’ FOP nutrition symbol. However, child-appealing marketing on product packaging may undermine these efforts. Therefore, this study (1) compared the prevalence of FOP symbols between products with child-appealing and non-child appealing packaging in the Canadian food supply and (2) identified the number and types of FOP symbols on products with child-appealing packaging (CAP).
Design:
Using the University of Toronto’s Food Label Information and Price 2017 database, 5850 packaged foods were analysed, 746 of which had CAP. Products were assessed against FOP labelling regulations.
Setting:
Large grocery retailers by market share in Canada.
Participants:
Foods and beverages available in 2017. Results: 74·4 % of products with CAP would require a ‘high in’ FOP symbol, significantly higher than the 65·7 % of products with non-CAP. Notably, 54·4 % of products with CAP exceeded FOP labelling thresholds for sugars compared with 37·8 % of products with non-CAP.
Conclusions:
Findings highlight a policy gap in Canadian nutrition regulations, as CAP remains a major source of marketing of unhealthy foods to children, undermining the impact of FOP labelling. To address this, food packaging should be included in Canada’s marketing restrictions, and products displaying a ‘high in’ FOP symbol should be automatically restricted from marketing to children. This study underscores the urgent need to harmonise Canadian nutrition regulations to synergistically promote healthier food choices among children and improve their health.
While much research has addressed the regressive anti-vax protests, this Element focuses on campaigns by progressive social movements to promote the development of vaccines for Covid-19 and ensure their equal access on a global level. Over the course of the pandemic, health and care have become central claims, mobilising health workers and patients as well as citizens in general. Together with various local and national social movement organizations which converged on health rights, through the use of care and cure as bridging frames, transnational campaigns addressing patents on vaccines also unfolded. This Element analyses these transnational campaigns, with particular attention to their organisational models, repertoires of action and collective framing. It assesses their outcomes by considering the complex sets of opportunities and constraints that the Covid-19 pandemic presented for progressive social movements that fight for access to medicines and cures at a global level.
Effective public health decision-making relies on rigorous evidence synthesis and transparent processes to facilitate its use. However, existing methods guidance has primarily been developed within clinical medicine and may not sufficiently address the complexities of public health, such as population-level considerations, multiple evidence streams, and time-sensitive decision-making. This work contributes to the European Centre for Disease Prevention and Control initiative on methods guidance development for evidence synthesis and evidence-based public health advice by systematically identifying and mapping guidance from health and health-related disciplines.
Structured searches were conducted across multiple scientific databases and websites of key institutions, followed by screening and data coding. Of the 17,386 records identified, 247 documents were classified as ‘guidance products’ providing a set of principles or recommendations on the overall process of developing evidence synthesis and evidence-based advice. While many were classified as ‘generic’ in scope, a majority originated from clinical medicine and focused on systematic reviews of intervention effects. Only 41 documents explicitly addressed public health. Key gaps included approaches for rapid evidence synthesis and decision-making and methods for synthesising evidence from laboratory research, disease burden, and prevalence studies.
The findings highlight a need for methodological development that aligns with the realities of public health practice, particularly in emergency contexts. This review provides a key repository for methodologists, researchers, and decision-makers in public health, as well as clinical medicine and health care in Europe and worldwide, supporting the evolution of more inclusive and adaptable approaches to public health evidence synthesis and decision-making.
This research evaluated Australian governmental disaster inquiries to identify evidence of application of the social determinants of health within their recommendations.
Methods
An analysis was conducted of recommendations from published Australian disaster inquiry reports between 2007 and 2020 against the Social Determinants of Health framework’s three overarching principles of action as described by the Commission on Social Determinants of Health, 2005-2008.
Results
Between 2007 and 2020, eight disaster inquiries were conducted, yielding 612 recommendations. Of these reports, 120 recommendations (19.6%) showed alignment with the social determinants of health principles of action. Of these, 48 recommendations (7.8%) demonstrated action on overarching recommendation “Improve daily living conditions”; 59 recommendations (9.6%) demonstrated action on overarching recommendation “Tackle the inequitable distribution of power, money, and resources”; and 13 recommendations (2.1%) demonstrated action on overarching recommendation “Measure and understand the problem and assess the impact of action.”
Conclusions
This low alignment underscores a critical gap in current Australian disaster inquiry practices, which historically prioritize emergency management and response over holistic health outcomes. There are opportunities to examine what roles the social environment and public health practice have in shaping disaster management policy and practice in ways that are conducive to strengthening more healthy, resilient societies.
Creatine is a vital bioenergetic compound that remains largely overlooked within food systems despite its well-established role in human health and performance. Unlike creatinine – a downstream breakdown product of creatine metabolism commonly measured as a biomarker of kidney function – creatine functions as an energy buffer, facilitating the rapid regeneration of ATP in tissues with high metabolic demands such as skeletal muscle, brain and heart. Although a portion of daily creatine requirements is met through endogenous synthesis, dietary intake – primarily from animal-source foods – remains essential to maintain optimal physiological levels. Emerging evidence indicates that suboptimal creatine status, or creatine insufficiency, may be widespread, particularly among vegetarians, vegans, older adults, individuals with chronic illness and those with increased energy needs. This paper examines the evolving role of creatine across four domains: its natural occurrence in foods, incorporation into fortified food products, use as a dietary supplement and potential future classification as a pharmaceutical agent. Special emphasis is placed on differences in regulatory status, intended use, dosage, labelling and public health implications. In light of mounting evidence that creatine insufficiency may contribute to adverse outcomes – including impaired cognition, reduced muscular performance and vulnerability to stressors – integrating creatine into food policy and nutrition strategies represents a promising, scalable and preventive approach to improve population health.
The chapter examines internet addiction as a threat to human rights. Medical research indicates that excessive internet use can lead to mental and physical health issues, behavioural risks, and impaired functioning. Specific features of the internet, such as ease of access and anonymity, may contribute to addiction. Although only a minority develop this addiction, vulnerable groups, especially children and those with pre-existing mental health conditions, are at higher risk. Law and policy responses include public health approaches, consumer protection, and initiatives to protect vulnerable groups. The right to disconnect is emerging as a potential solution, particularly in work contexts, but its effectiveness in addressing internet addiction is limited. International human rights law provides a framework for addressing internet addiction, but specific interpretations are still developing. Multidisciplinary approaches integrating mental health research with legal analysis are crucial for developing effective responses.
Almost a decade has passed since a DEFRA consultation concluded that existing legislation governing the UK puppy trade was “outdated, inflexible, incompatible with current welfare legislation and cumbersome for both enforcers and businesses”. The rapid outgrowth of the trade’s governing legislature, fuelled by contemporary consumer culture and the high degree of trader anonymity provided by the internet, has enabled a high-volume, untraceable and profit-driven market to evolve. Increased demand for puppies, exacerbated by social media trends and the COVID-19 pandemic, is sustained by an online medium that both encourages and capitalises upon modern-day ‘click-and-collect’ purchase behaviour. Moreover, the internet has only intensified the demand for pedigree and designer crossbreeds, many of which are shown to suffer lifelong physiological disorders caused by the positive phenotyping selection necessary to achieve breed standards. These factors have made puppies an attractively lucrative, low-risk commodity. Evidence of multi-level fraud and organised crime involvement has been revealed along the supply chain, resulting in systemic canine health and welfare issues. Whilst large-scale breeding operations reportedly smuggle unvaccinated puppies onto the British market from endemic (rabies, Leishmania) countries, high densities of pet dogs in urban areas is reportedly leaving high faecal-saturation levels, spreading anthelmic- and antibiotic-resistant pathogens. Meanwhile, unsafe concentrations of ectoparasiticides are detected in rivers and lakes. This review collates evidence from available sources that illustrate the current nature and impact of inadequate regulation in the UK puppy trade, aiming to support stakeholders in their efforts for essential and comprehensive regulatory reform.
Button batteries are a common household item that are, unfortunately, attractive to young children. If ingested, they are corrosive and potentially fatal. Button battery ingestion is frequently unwitnessed, delaying the diagnosis. In the USA, approximately 6,000 accidental ingestions occur annually (2.2 deaths per year over a decade on average). Community awareness of this danger appears to be low.
Methods
We conducted a 22-question online questionnaire-based study to assess and raise awareness of this exceptional childhood risk.
Results
A total of 561 survey responses were analysed; 77 per cent were female, and 60 per cent were aged 30–50. Despite 87 per cent using button batteries, 65 per cent did not consider their safety, and 68 per cent found existing packaging warnings inadequate. Notably, 80 per cent recognised the potential for fatality, but 88 per cent were unaware that a spoonful of honey could delay this corrosive process.
Conclusion
Challenges persist regarding the design and marketing of button batteries and public awareness of their ingestion. Action is required to prevent further tragedies.
The first year of life is a critical period when nutrient intakes can affect long-term health outcomes. Although household food insecurity may result in inadequate nutrient intakes or a higher risk of obesity, no studies have comprehensively assessed nutrient intakes of infants from food insecure households. This study aimed to investigate how infant nutrient intakes and BMI differ by household food security.
Design:
Cross-sectional analysis of the First Foods New Zealand study of infants aged 7–10 months. Two 24-h diet recalls assessed nutrient intakes. ‘Usual’ intakes were calculated using the multiple source method. BMI z-scores were calculated using WHO Child Growth Standards.
Setting:
Dunedin and Auckland, New Zealand.
Participants:
Households with infants (n 604) classified as: severely food insecure, moderately food insecure or food secure.
Results:
Nutrient intakes of food insecure and food secure infants were similar, aside from slightly higher free and added sugars intakes in food insecure infants. Energy intakes were adequate, and intakes of most nutrients investigated were likely to be adequate. Severely food insecure infants had a higher mean BMI z-score than food secure infants, although no significant differences in weight categories (underweight, healthy weight and overweight) were observed between groups.
Conclusions:
Household food insecurity, in the short term, does not appear to adversely impact the nutrient intakes and weight status of infants. However, mothers may be protecting their infants from potential nutritional impacts of food insecurity. Future research should investigate how food insecurity affects nutrient intakes of the entire household.
The prevalence, morbidity and mortality of youth substance misuse should mandate public health prioritisation worldwide. Roots in multiple adversity and child mental health problems point to substance misuse as an indicator of the underlying vulnerability of populations, in which case young people in the developed world are not doing so well. Child services should screen and assess all youth for substance use. Investment in the development of new treatments has shown that interventions can be moderately effective, likely to share core characteristics, and given will, training and resources are readily deployable. However, all studies show a substantial subset had not improved following intervention, so that enormous scientific and cultural challenges persist.
Introduction: The COVID-19 pandemic highlighted the critical need for robust crisis standards of care (CSC) protocols to handle extreme strain when scarce resources require rationing. Evaluating how such policies might perform in the real world remains paramount; however, to date, study of their performance has been limited to retrospective cohort designs using virtual simulations.1,2 The Sequential Organ Failure Assessment score (SOFA)—a composite 0-24 score of organ dysfunction incorporating neurologic, pulmonary, cardiovascular, hematologic, hepatobiliary, and renal subscores—remains ubiquitous in nearly all crisis standards of care protocols3,4,5 despite concerns regarding the utilization and potentially exacerbating existing racial inequities.5 Existing simulation studies have handled missing SOFA values by either imputing zero or assuming data are missing at random, followed by complex computational statistical modeling.6,7 This approach may introduce significant bias, with larger outcome implications than missing data in other forms of medical research, as these values directly affect decisions on who receives life-sustaining therapies. Our study aims to better understand the frequency, structure, and consequence of missing data in CSC simulation studies.
This article examines the evolution of breastfeeding practices in twentieth-century China, focusing on the complex interplay between medical knowledge, state policies and social transformation. This study demonstrates how medical recommendations concerning lactation timing, intervals and weaning were shaped by factors beyond purely scientific developments. Mid-twentieth-century biochemical studies validated traditional practices while revolutionising attitudes towards colostrum, marking a critical juncture in Chinese infant nutrition science. Following the establishment of the People’s Republic in 1949, maternal and child health initiatives underwent fundamental changes. Drawing on new understanding of breast milk’s nutritional value, health benefits, and economic advantages, healthcare professionals and state authorities actively promoted scientific breastfeeding methods. Their multifaceted approach reflected both the dissemination of medical knowledge and the state’s strategic consideration of female labour force participation. This study analyses how women’s liberation from feudal constraints, changing employment patterns, Soviet medical influence, and advances in artificial feeding technologies shaped breastfeeding practices. Through examining the intersection of medical advice, health policies, and women’s labour liberation, it provides fresh insights into the evolution of breastfeeding discourse within Chinese medical circles. Situating these developments within broader medical, social and cultural contexts, this research not only illuminates the multiple factors that shaped modern Chinese infant feeding practices but also contributes to our understanding of the complex relationships between medical practice, state policy, and social change in twentieth-century China.
Rural and urban environments are exposed to the same types of climate-induced disasters, but rural populations are considered particularly vulnerable to the adverse health effects associated with these disasters. This study compares individual-level public health preparedness for climate-induced disasters in rural versus urban environments and examines the impact of rurality on variables that influence preparedness attitudes and behaviors.
Methods
A national, online survey was conducted from April to June 2024. Chi-squared tests and multiple logistic regression models with interaction terms were used to compare the preparedness attitudes and behaviors reported by rural and urban populations.
Results
Rural and urban populations generally shared preparedness attitudes and behaviors, but several significant differences were observed. Regression analysis suggested that rurality interacted with age and income to play a significant role in modifying the odds of having an evacuation plan and reporting concern about the severity of future climate-induced disasters.
Conclusions
Rurality appears to influence certain attitudes and behaviors related to preparedness for climate-induced disasters. Should climate-induced behaviors become more frequent and severe in the future, dedicated efforts should be taken to ensure that these events do not exacerbate health disparities between rural and urban environments.
This study investigates the prevalence of coliform contamination in fresh milk and the occurrence of multidrug-resistant (MDR) bacteria within poultry environments on an integrated farm in Minna, Niger State. Bacterial isolates obtained from raw milk, poultry cloacal swabs, and intestinal swabs from commensal rats included Salmonella, Escherichia coli, and Klebsiella species. These isolates were screened for extended-spectrum beta-lactamase (ESBL) production and antimicrobial resistance (AMR) profiles. The results revealed a high level of bacterial contamination in milk samples, with significant associations between contamination levels and poor hygiene practices during milking and handling. Moreover, ESBL-producing bacteria displaying resistance to critically important antibiotics such as third-generation cephalosporins and fluoroquinolones were identified across both dairy and poultry sources. These findings highlight a pressing public health concern and emphasize the need for improved biosecurity, hygiene interventions and integrated AMR surveillance to safeguard food safety and reduce the spread of MDR pathogens in animal-source foods.
We highlight the essential role of law and governance in advancing the transformative potential of One Health. While One Health has traditionally focused on public health and zoonotic disease, its broader application encompasses challenges such as biodiversity loss, climate change, and antimicrobial resistance. Despite its potential, One Health remains underutilised in governance and law, with much of its implementation focused on siloed scientific endeavours.
This book addresses these gaps, demonstrating how legal frameworks can embed and sustain One Health principles. It explores diverse themes, including multilevel governance, Indigenous Knowledge systems, environmental law, and emerging legal mechanisms, to showcase the interdisciplinary nature of One Health. Contributors emphasise the need for multisectoral collaboration, enforceable standards, and cross-disciplinary engagement to address governance barriers and ensure holistic, equitable outcomes.
By presenting a vision for the institutionalisation of One Health through law and policy, this volume challenges traditional approaches and offers pathways for integrating One Health into governance systems.
Drafted by international animal law scholars and attorneys, the Convention on Animal Protection for Public Health, Animal Well-Being, and the Environment (CAP) was designed to help secure the interests of not just animals but also the environment we share. Delving into the context and contours of the CAP as an umbrella convention, this chapter first discusses the need to provide for more robust animal protections as part of a genuine One Health model. Next, the chapter observes how states have failed to enshrine such protections into international law. Then, we explore whether the CAP can manifest meaningful change. Exploring how CAP’s provision for additional protocols will enable the treaty to grow more robust with time, the chapter discusses prospects for its ratification and explores how it would complement existing animal-related treaties and concludes by emphasizing how CAP, if ratified, would dramatically improve the landscape for animals, the environment, and humankind.