Planetary health risks in urban agriculture

Urban agriculture is gaining recognition for its potential contributions to environmental resilience and climate change adaptation,providing advantages such as urban greening,reduced heat island effects,and decreased air pollution.Moreover,it indirectly supports communities during weather events and natural disasters,ensuring food security and fostering community cohesion.However,concerns about planetary health risks persist in highly urbanized and climate-affected areas.Employing electronic databases such as Web of Science and PubMed and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,we identified 55 relevant papers to comprehend the planetary health risks associated with urban agriculture,The literature review identified five distinct health risks related to urban agriculture:(1)trace metal risks in urban farms;(2)health risks associated with wastewater irrigation;(3)zoonotic risks;(4)other health risks;and(5)social and economic risks.The study highlights that urban agriculture,while emphasizing environmental benefits,particularly raises concerns about trace metal bioaccumulation in soil and vegetables,posing health risks for populations.Other well studied risks included wastewater irrigation and backyard livestock farming.The main limitations in the available literature were in studying infectious diseases and antibiotic resistance associated with urban agriculture.

Plain language in the healthcare of Japan:a systematic review of“plain Japanese”

Objective:Despite the decrease in the number of foreign visitors and residents in Japan due to the coronavirus disease 2019,a resurgence is remarkable from 2022.However,Japan's medical support system for foreign patients,especially residents,is inadequate,with language barriers potentially causing health disparities.Comprehensive interpretation and translation services are challenging,but“plain Japanese”may be a viable alternative for foreign patients with basic Japanese language skills.This study explores the application and obstacles of plain Japanese in the medical sector.Methods:A literature review was performed across these databases:Web of Science,PubMed,Google Scholar,Scopus,CINAHL Plus,Springer Link and Ichushi-Web(Japanese medical literature).The search covered themes related to healthcare,care for foreign patients,and scholarly articles,and was conducted in July 2023.Results:The study incorporated five papers.Each paper emphasized the language barriers foreign residents in Japan face when accessing healthcare,highlighting the critical role and necessity of plain Japanese in medical environments.Most of the reports focused on the challenges of delivering medical care to foreign patients and the training of healthcare professionals in using plain Japanese for communication.Conclusion:The knowledge and application of plain Japanese among healthcare professionals are inadequate,and literature also remains scarce.With the increasing number of foreign residents in Japan,the establishment of a healthcare system that effectively uses plain Japanese is essential.However,plain Japanese may not be the optimal linguistic assistance in certain situations,thus it is imperative to encourage more research and reports on healthcare services using plain Japanese.

Exploring the intersection of the medical metaverse and healthcare ethics:future considerations and caveats

The medical metaverse and digital twin are set to revolutionise healthcare.Like all emerging technologies their benefits must be weighed against their ethical and social,impacts.If we consider the advances of medical technology as an expression of our values,such as the pursuit of knowledge,cures and healing,an ethical study allows us to align our values and steer the technology towards an agreed goal.However,to appreciate the long-term consequents of a technology,those consequences must be considered in the context of a society already shaped by that technology.This paper identifies the technologies currently shaping society and considers the ethical,and social consequences of the medical metaverse and digital twin in that future society.

Data,digital worlds,and the avatarization of health care

Significant technological trends are impacting health care,from consumerisation,datafication,circular economy,and platformization of services.Web 3.0,or the Internet of Value,enables direct peer-to-peer value exchange,opening up new business models that will impact health care.Among the many technologies that will also be part of the healthcare transformation is artificial intelligence,which shocked the world with the debut of ChatGPT in 2022.This opinion piece will explore how AI underpins the health transformation and,far from being an enemy of health,is the critical friend health care has been waiting for.

The use of oral human immunodeficiency virus pre-exposure prophylaxis in pregnant and lactating women in sub-Saharan Africa:considerations,barriers,and recommendations

In sub-Saharan Africa(SSA),63%of new human immunodeficiency virus(HIV)infections in 2021 were among women,particularly adolescent girls,and young women.There is a high incidence of HIV among pregnant and lactating women(PLW)in SSA.It is estimated that the risk of HIV-acquisition during pregnancy and the postpartum period more than doubles.In this article,we discuss the safety and effectiveness of drugs used for oral HIV pre-exposure prophylaxis(PrEP),considerations for initiating PrEP in PLW,the barriers to initiating and adhering to PrEP among them and suggest recommendations to address these barriers.Tenofovir/emtricitabine,the most widely used combination in SSA,is safe,clinically effective,and cost-effective among PLW.Any PLW who requests PrEP and has no medical contraindications should receive it.PrEP users who are pregnant or lactating may experience barriers to starting and adhering for a variety of reasons,including personal,pill-related,and healthcare facility-related issues.To address the barriers,we recommend an increased provision of information on PrEP to the women and the communities,increasing and/or facilitating access to PrEP among the PLW,and developing strategies to increase adherence.

Charting the course:India's health expenditure projections for 2035

Objectives Understanding past trends and forecasting future changes in health spending is vital for planning and reducing reliance on out-of-pocket(OOP)expenses.The current study analyzed health expenditure patterns in India and forecasted future trends and patterns until 2035.Methods Data on health expenditure in India from 2000 to 2019 was collected from the Organisation for Economic Co-operation and Development(OECD)iLibrary and National Health Accounts 2019 databases.Gross domestic product(GDP)data from the World Bank was also utilized.Descriptive statistics analyzed the composition and pattern,while the exponential smoothing model forecasted future health expenditures.Results The findings revealed that expenditure made by OOP is the primary health financing source,followed by government and pre-paid private spending.The percentage of GDP allocated to total health expenditure remains stable,while the per capita health expenditure fluctuates.Variations in expenditure among states are observed,with Karnataka relying heavily on pre-paid private coverage.Future projections suggest a decline in per capita and total health expenditure as a share of GDP,with a slight increase in the government’s share.Pre-paid private expenditure per capita and OOP health expenditure as a share of the total is projected to remain relatively constant but still high in absolute terms.Conclusion The study highlights variations in health spending in India,characterized by high OOP spending,limited public coverage,and a need for investments,and reforms to improve healthcare access and equity.

Time trends and disparities of obesity and related national policies and programs in Nepal:a systematic review

Objective Overweight and obesity prevalence has increased in low-income countries.This study systematically reviewed the obesity trend,disparities,and prevention and control efforts in Nepal.Methods We searched PubMed and Google Scholar for articles and reports published between January 1,2004 and December 31,2022.Additional information on National policies and programs related to obesity prevention was retrieved from governmental websites and consultation with relevant experts.Overweight and obesity were defined using the World Health Organization body mass index cut points.Thirty-two studies and reports were included.Results Overall,overweight and obesity rates increased in all groups in Nepal although nationally representative data remained limited.The combined overweight and obesity(OW/OB)and obesity rates in women aged 15-49 years increased from 8.5%to 22.2%and from 0.9%to 5.1%between 2006 and 2016,respectively.OW/OB and obesity rates in men were 17.1%and 2.5%based on data from the 2016 Demographic and Health Survey.OW/OB rate in under-five children increased from 0.6%to 2.8%between 2006 and 2016.Obesity rates for school-age(5-9 years)boys and girls in 2016 were 2.4%and 2.8%,respectively,and were 1.1%and 1.4%for male and female adolescents aged 10-19 years,respectively.OW/OB prevalence was much higher among women,residents in urban areas and central provinces,and in higher socioeconomic status groups.Projected prevalence of OW/OB and obesity for 2030 in adults aged 15-49 was 44.7%and 8.3%,respectively,while it was 2.2%for OW/OB in preschool children.Policies and direct interventions that specifically focused on obesity prevention and control are limited.Conclusions OW/OB prevalence in Nepal has increased during the past 1.8 decades,disproportionately affecting population groups.Existing interventions mostly focused on undernutrition with some indirect implications for obesity prevention.In the future,Nepal needs to develop population-based programs for obesity prevention.

Knowledge and discriminatory attitudes towards HIV/AIDS among the women of reproductive age group of Pakistan using the Multiple Indicator Cluster Survey(MICS)

Background Human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)has become a major worldwide public health issue,with a focus on developing nations.Despite having a very low HIV prevalence,South Asia faces serious issues with stigma and false information because of a lack of awareness.This stigma highlights significant gaps in popular awareness while also sustaining unfavorable attitudes towards those living with HIV/AIDS.Pakistan is ranked second in South Asia for the rapidly increasing AIDS epidemic.Thorough information and optimistic outlooks are essential for successful HIV/AIDS prevention,control,and treatment.But false beliefs about how HIV/AIDS spreads lead to negative perceptions,which highlights the need to look into how women’s knowledge and attitudes about HIV/AIDS in Pakistan are influenced by sociodemographic traits and autonomy.Methods The purpose of this study is to evaluate Pakistani women’s discriminatory attitudes and level of awareness on HIV/AIDS.This study used data(the women in reproductive age 15-49 years’dataset)from the Pakistan Multiple Indicator Cluster Survey to conduct an analytical cross-sectional analysis.To represent the respondents’attitudes and knowledge towards people living with HIV(PLHIV),two composite variables were developed and composite scored.Binary logistics regression was used to identify predictor variables and chi-square was used for bivariate analysis.Results The findings reveal that almost 90%of Pakistani women have poor knowledge and attitude with HIV/AIDS.In Punjab,72.8%of rural residents have low knowledge,whereas only 20.6%of young individuals(15-<25 years old)show the least amount of ignorance.Education is shown to be crucial,and“Higher”education is associated with superior knowledge.Urban dwellers in Khyber Pakhtunkhwa typically have more expertise.Knowledge of HIV is positively correlated with education;those with higher education levels know a lot more(odds ratio[OR]=5.419).Similarly,quintiles with greater incomes show a higher likelihood of knowing about HIV(OR=6.745).The study identifies age,wealth index,place of residence,educational attainment,and exposure to contemporary media as significant predictors influencing HIV knowledge and attitudes among women in these provinces.Conclusion The majority of respondents had negative opinions regarding the virus,and the majority of women in the study knew very little about HIV.Individuals who live in metropolitan areas,have higher incomes,are better educated,are exposed to contemporary media,and are generally more aware of HIV and have more positive attitudes towards HIV/AIDS,or PLHIV.The study found that,in comparison to those living in urban environments,those from rural areas with low socioeconomic level have a negative attitude and inadequate understanding.

Epidemiology and control of monkeypox outbreak in Houston,Texas

Background:In the 2022-2023 global outbreak,the United States and state of Texas recorded a total of 31,277 and 3,085 confirmed monkeypox(Mpox)cases respectively as of November 2023.This study aims to investigate the demographic characteristics and risk factors of Mpox outbreak in Houston and document the epidemiologic control measures implemented with their outcomes.Methods:Houston Health Department received reports of suspected Mpox cases via electronic case reports and laboratory reports from healthcare providers within Houston.These were then investigated and reclassified as either positive or negative using DNA polymerase chain reaction tests.All the reported cases received between May 2022 and January 2023 were included in this study using convenient sampling methods.Descriptive statistics using frequency distribution was used to analyze the sociodemographic,clinical features and travel history of the cases.A two-sided Chi-squared test was used to determine association between Mpox test results and risk factors with significant level set at P<0.05.Other infection control measures such as community engagement,health education,tracking and contact tracing,vaccination,referrals and laboratory sample logistics support were implemented by the health department.Results:Out of the total of 1,625 suspected persons investigated for Mpox,724(44.6%)tested positive.Among the 724 confirmed cases,male was 700(96.7%),females 20(2.8%),transgender male 1(0.1%),transgender female 3(0.4%).Age groups 30-39 years constituted 43.6%,18-29 years 27.4%,40-49 years 18.2%,50-59 years was 8%.Race distribution of positive cases was Whites 43.4%,African American 38.7%,Asian 1.4%.Risk factors with P<0.05 included male gender,age groups 30-39 years and 40-49 years,travel history to Mpox endemic areas,recent sexual contact with known or suspected Mpox cases,human immunodeficiency virus seropositivity.Identifying as gay and bisexual were also statistically significant risk factors for Mpox infection.Conclusion:The timely implementation of primary and secondary prevention measures targeted at the most at-risk populations was very effective at curtailing the spread of Mpox infection within the city of Houston.

Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Alcohol and illicit drugs:prevalence of alcohol and illicit drug use and their predictors in young people from Argentina,Bulgaria,Chile and Romania

Background:Alcohol and illicit drugs(AID)continue to be a major global health concern.Although preventable,AID is linked to millions of deaths annually worldwide.The situation is particularly grave for young people,with AID being a major direct risk factor for disability-adjusted youth life-years lost and death.It further contributes to assaults,road crashes,accidental poisoning,and suicide,leading to long-term issues and public health concerns.Objective:This study aimed at disclosing current AID prevalence data for Argentinian,Bulgarian,Chilean and Romanian youth.It shed light on the predictors of AID in young people from those countries.Method:The study used an online survey to gather data from people aged 18 to 25(n=1,297).The survey was underpinned by the theory of planned behaviour(TPB).Predictors were investigated separately for drinking alcohol and using illicit drugs.Results:Our data revealed that across the four target countries,49%to 90%of the participants drank alcohol,and 8%to 35%used illicit drugs in the past three months.Between 20%and 91%of them intended to drink,and between 8%and 31%intended to use illicit drugs in the following three months.Our TPB model predicted statistically significant(P<0.001)amounts of variance in drinking alcohol(between 61%and 72%)and using illicit drugs(between 20.3%and 74.4%).Intention was consistent in significantly predicting both behaviours.Evidence around the predictive validity of self-efficacy,age and gender was mixed across the investigated countries.Conclusion:This research provided an update on the scarce AID epidemiological data.It also supplied evidence about what theoretically-informed measures might be useful targets of interventions in the case of Argentina,Bulgaria,Chile and Romania.This new knowledge of understanding substance abuse determinants and prevalence may help researchers and practitioners better meet young people's health prevention needs.

Workplace harassment faced by female Nepalese migrants working aboard

Background:Nepal has a long history of labour migration over the years.Migrants can experience a range of problems in their destination countries,and women are more at risk than men.This paper is the first to explore the problems faced by Nepalese women migrants while working abroad.Methods:This study was conducted among 1,889 women who were registered as migrant returnees at an organisation called Pourakhi Nepal.The study extracted and analysed data from a non-governmental organisation that supports returning female migrant workers in Nepal.Results:Around half(43.1%)of the women were 35 or older,30.9%were illiterate,and 63.6%were in their first overseas job.More than one-third(38.5%)had self-reported workplace harassment.Physical violence was the most prevalent(68%),followed by verbal abuse(37.5%),mental stress(29.7%),and sexual abuse(14.1%).Women who were illiterate(adjusted odds ratio[AOR]1.25,95%confidence interval[CI):1.01 to 1.55),unmarried(AOR 1.27,95%CI:1.05 to 1.56),worked abroad twice or more(AOR 1.35,95%CI:1.10 to 1.66),changed their place of work(AOR 2.38,95%CI:1.42 to 4.01),lived without documents(AOR 1.24,95%CI:1.03 to 1.50),worked as domestics(AOR 3.56,95%CI:2.03 to 6.23),worked in other than Gulf Cooperation Council countries(AOR 1.45,95%CI:1.06 to 1.99),women who did not have a fixed salary(AOR 1.64,95%CI:1.28 to 2.10)and did not receive salary(AOR 3.71,95%CI:2.88 to 4.77)were more likely to be harassed at work.Conclusion:Our findings suggest that the host governments should introduce and enforce policies protecting women in the workplace.Migrant women should be provided with better information about health risks and hazards as well as how to improve preventive measures in destination countries to reduce workplace harassment.

Mobile health interventions for improving maternal and child health outcomes in South Africa:a systematic review

Background:Maternal and child health(MCH)remains a significant public health concern globally despite previous efforts made to improve MCH services.Initiatives such as antenatal care,postnatal care services exclusive breastfeeding,child vaccination and supplements have been rolled out to improve MCH outcomes.However,inadequate maternal healthcare,socioeconomic factors,obstetric haemorrhaging,complications of hypertension during pregnancy,lack of maternal information,poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates,especially in resource-constrained areas in many sub-Saharan African countries including South Africa.Objective:This study aimed to review mobile health(mHealth)interventions deployed to improve maternal and child health outcomes.Methods:The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable,prominent electronic databases(Google Scholar,Scopus,PubMed,Embase,CINAHL,Web of Science,etc.).A total of 26 papers were selected and analyzed.Results:The findings revealed several mHealth interventions such as MomConnect,Mobile Alliance for Maternal Action,NurseConnect,ChildConnect,CommCare,Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services.However,inadequate digital infrastructure,digital divide,resistance to change,inadequate funding,language barriers,short message service and data costs,lack of digital skills and support,compatibility,scalability and interoperability issues,legislative and policy compliance,lack of mHealth awareness,data security and privacy concerns hinder uptake and utilisation of mHealth interventions.There is a need to scale up and sustain mHealth interventions and update existing regulatory framework,policies and strategies.Conclusion:mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services.Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues.

Combating obesity in Southeast Asia countries:current status and the way forward

Obesity is gaining prominence as a serious public health challenge in the Southeast Asia(SEA)region,with an alarming rate of increase in its prevalence.Countries in the region have shown commitment to curbing the rise of obesity by establishing policies,strategies,and action plans.This paper summarises the current situation and strategies undertaken to combat obesity and related chronic diseases.Although a range of policies and strate-gies have been developed,including national nutrition action plans,community intervention programmes,fiscal measures,nutrition labelling to promote healthier choices,countries in the region are struggling to make signifi-cant progress toward halting the scourge of obesity.It is imperative to strengthen existing health systems with a paradigm shift from a focus on"sick care"to and enhancing nutrition initiatives to support obesity prevention.A comprehensive and coordinated approach is essential,one that emphasises high-level coordination across all lev-els of government and multiple sectors,and a unified plan rather than fragmented initiatives.For strategies to be effective and sustainable,they must address the fundamental environmental determinants of poor dietary choices and nutritional inequalities.A more holistic approach is clearly needed to improve the entire food environment,which in SEA countries must include the multitude of eating places where large segments of the population"eat out"everyday to meet their energy and nutrient needs.There is a recognised need for more comprehensive measures to promote healthy eating among school children and ensure a supportive environment for lifelong healthy habits.This paper calls for a whole-of-government,whole-of-society approach that combines changes to the fundamental food environment and accompanied by systematic monitoring and surveillance systems to achieve long-lasting health outcomes.

Shared decision making in rural general practices:a qualitative exploration of older rural South Australians'perceived involvement in clinical consultations with doctors

Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.

Social prescribing in the metaverse:a new frontier for primary care practice

The advent of immersive technologies such as the metaverse,extended reality,artificial intelligence,and blockchain offers novel possibilities to transform healthcare services.These innovations coincide with clinicians'aspirations to deliver more comprehensive,patient-centered care tailored to individuals singular needs and preferences.Integration of these emerging tools may confer opportunities for providers to engage patients through new modalities and expand their role.However,responsible implementation necessitates deliberation of ethical implications and steadfast adherence to foundational principles of compassion and interpersonal connection underpinning the profession.While the metaverse introduces new channels for social prescribing,this perspective advocates that its ultimate purpose should be strengthening,not supplanting,human relationships.We propose an ethical framework centered on respect for patients'dignity to guide integration of metaverse platforms into medical practice.This framework serves both to harness their potential benefits and mitigate risks of dehumanization or uncompassionate care.Our analysis maps the developing topology of metaverse-enabled care while upholding moral imperatives for medicine to promote healing relationships and human flourishing.

Community-led total sanitation(CLTS)implementation in West Mamprusi Municipal Assembly in Ghana.What do communities think eleven years on?

Objective Access to improved sanitation is a fundamental human right and an important aspect of Public Health.However,an estimated thousands of people in Ghana especially,the West Mamprusi Municipal Assembly(WMMA)still have no access to adequate toilet facilities.This has brought untold health repercussions to the inhabitants,the community,and the environment at large.To address this menace,the community-led total sanitation(CLTS)was implemented.This study aimed to assess communities’perspectives on the implementation of CLTS and to understand the factors influencing its success and failures.Methods A mixed-method approach involving sequential qualitative and quantitative methods was employed in this study.Participants for the quantitative study were randomly selected and surveyed using questionnaires.The qualitative study employed focus group discussion involving purposively sampled participants including assembly members,opinion leaders,and assembly staff.Results The CLTS program in WMMA realized an apparent use of construction and proper use of household latrines leading to a reduction of open defecation free(ODF)and two communities achieving sanitized status in the history of the study area,enabling the training of latrine artisans and natural leaders to facilitate the CLTS expansion and sustainability,improved sanitation and hygiene,strengthened the enforcement of community rules and regulations and many others.Conclusion The CLTS program has received more widespread acceptance in the study area than the previous government policy of constructing public toilets,which was greeted with massive failures due to poor implementation.To ensure that gains achieved through CLTS implementation are sustained longer,it is recommended that chiefs and opinion leaders should be involved in the CLTS programs to ensure checks and enforcement.The entrenchment of bylaws and more education to address enduring myths and misconceptions will sustain the program.Subsidies in the form of sanitation loans for latrine construction materials by the government and supporting non-governmental organizations(NGOs)will be paramount in sustaining ODF.

Individual alcohol consumption by the population of Russia versus regional living conditions

Background:There are substantial regional differences in drinking alcohol in Russia,both at the population and individual levels.However,the causes of these differences have not been studied yet.Objective:The goal of our study was to examine the effect of regional living conditions on individual alcohol consumption by the population of Russia.Methods:For the analysis,we used data from a cross-sectional epidemiological study conducted in 2013-2014.The final analytical sample included 18,130 people aged 25-64 years.We conducted the interviews face to face,based on which any drinking in the last year,as well as alcohol abuse,were considered as a response.Alcohol abuse was recorded when the respondent consumed 5.75 or more grams of pure ethanol per day(75th percentile of average daily alcohol consumption among alcohol drinkers).The assessment of the regional living conditions was accomplished via integral indexing,which was previously performed based on publicly available data for 2010-2014.Associations were assessed using generalized scoring equations with unchanging standard errors.The associations were expressed by odds ratios(OR)and 95%confidence intervals(C).Results:Deterioration of social conditions and increase in demographic depression in the region of residence increased the odds of any drinking(OR 1.51,95%CI:1.33 to 1.72,P<0.001 and OR 1.22,95%CI:1.05 to 1.41,P=0.oo9,respectively).The odds of alcohol abuse increased with the deterioration of social living conditions and the growth of the industrial development in the region:OR 1.35,95%CI:1.14 to 1.59,P<0.001 and OR 1.16,95%CI:1.05 to 1.28,P=0.002,respectively.Conclusion:Our analysis allowed assessing the impact of the regional living conditions on individual drinking alcohol in the population of Russia.

Building a transdisciplinary science of One Health with a global vision

One Health has been recognized as a cost-effectiveness approach that intricate connections between human health,animal health,and ecosystem health.This holistic perspective is crucial for addressing complex health challenges that arise at the intersection of these domains,such as emerging infectious diseases,antimicrobial resistance,food safety&food security,and environmental degradation.The beneficiaries of the One Health ap-proach have been demonstrated by many case studies worldwide,and summarized by The World Bank that not only support poverty alleviation in developing countries,but also can reduce pandemic risk globally.It is essential for us to understand the means of promoting the initiatives in building the transdisciplinary science of One Health that requires a global vision with integration of various disciplines,stakeholders,and resources.Therefore,we introduce the role of the transdisciplinary science of One Health,and the key steps and strategies necessary to implement One Health approach in the real world.We also propose three research priorities,including empha-sizing climate change and health,enhancing global health security,and promoting equity and inclusivity which is crucial for the success of One Health initiatives.Hence,building a transdisciplinary science of One Health will not only improve holistic health between human,animal,and environmental domains,but also contribute to the global health security and sustainable development.

Implementation of an international medical student pen-pal club:survey outcomes of perceptions in cultural competency and global health

Background:Pen-pal clubs(PPC)are used worldwide for students to learn about different cultures and other skillsets without the need for travel.Many medical students are interested in global health opportunities abroad but costs,scheduling,and other barriers allow few to participate in such experiences.It is important that medical students have nuanced global medical perspectives and can contribute to the global medical community.Objective:The purpose of this study is to demonstrate that an international medical student PPC improves medical students'perspectives of cultural competency and global health engagement.Methods:In 2021,a novel medical student PPC was established that began between an American and Japanese medical school.Following a shareholders meeting,it was decided that the number of medical schools involved globally be expanded through previous institutional affiliations and online presences.In total,the club connected 50 American medical students and 52 medical students from 17 high-and middle-income countries.The primary form of communication was online;pen-pals were encouraged to communicate monthly using provided topics,although frequency and way of communication was their discretion.In February 2022,American PPC members were emailed a qualitative survey to assess the PPC's impact.Results:The survey was completed by 42%of American PPC members,95%of which were 22-26 years.Participants were preclinical medical students,60%whom were female and the majority either white(47%)or Asian(43%).Overall,the PPC positively influenced American medical students'perception of global medicine,medical education,and their cultural competency after joining the PPC compared to prior(P=0.004).Conclusion:PPCs encourage medical students to think from a global perspective and foster open-mindedness within varying social and cultural contexts.Having a global communication platform for students during medical school education may be an additional way to train aspiring global leaders.