Diverse experiences by active travel for carbon neutrality:A longitudinal study of residential context,daily travel and experience types

Two key goals for sustainable spatial planning are to promote low-carbon travel in daily life and to enhance human wellbeing through diverse human-environment interactions.Yet,the integration of these goals has been underexplored.This study investigates the potential for experiential diversity via active travel in different resi-dential contexts within the Gävle city-region,Sweden.Over 15 months,we collected spatiotemporal data from 165 participants,analyzing 4,362 reported experiences and 13,192 GPS-derived travel trajectories.Our analysis uncovered a significant spatial discrepancy:while the travelled distances to locations of positive experiences typ-ically ranged from 1.5 km to 5 km,active travel predominated only within 1.5 km.This discrepancy persisted across urban,suburban,and peripheral contexts.Although residents in different contexts reported the same types of experiences,urban dwellers travelled about 50%farther for nature experiences compared with other positive experiences,whereas peripheral dwellers travelled twice the distance for urbanicity experiences compared with other positive experiences.Consequently,urban residents mostly relied on active travel for urbanicity experiences and motorised travel for nature experiences,with the reverse trend observed among peripheral dwellers.These results illustrate the importance of spatial scale for promoting diverse positive experiences via active travel,re-gardless of residential context.Effective planning strategies may include enhancing environmental diversity near homes and developing infrastructure that favours active over motorised travel for short to moderate distances.

An Analysis of the Accounting Costs Associated with 20-Month DR TB Regimens in Maputo City, Mozambique

Introduction: Socioeconomic and demographic conditions in a country can influence tuberculosis incidence and mortality, with nearly 95% of tuberculosis-related deaths occurring in poorer countries. Mozambique is among the 30 countries with the highest TB burden. Objective: The study aimed to estimate the average direct medical cost of treating drug-resistant tuberculosis in 19 health centers in Maputo City, Mozambique. Methods: A retrospective analysis of direct medical costs was conducted on patients aged 18 and older who completed 20-month drug-resistant tuberculosis treatment regimens in Maputo City in 2019. Results: This analysis covered 140 patients who completed a 20-month treatment regimen, with 64.3% (78) being male and 35.7% (62) female. Approximately 50% of the participants were aged between 29 and 47. The average direct medical cost of DRTB treatment was $4789.43, reaching up to $6568.00, with a standard deviation of $753.26, including clinical interventions and treatment. Conclusion: The direct medical costs for a basic treatment package for a patient with drug-resistant TB in Mozambique equal 36 minimum wages. Developing alternative and innovative funding mechanisms and identifying ways to mitigate costs through the use of generic medicines would be beneficial.

Assessment of the Indirect Cost of Drug Resistant Tuberculosis Treatment to Patients in a High Burden, Low Income Setting in Mozambique

Introduction: Tuberculosis is closely linked to poverty, with patients facing significant indirect treatment costs. Treating drug-resistant tuberculosis further increases these expenses. Notably, there is a lack of published data on the indirect costs incurred by patients with drug-resistant tuberculosis in Mozambique. Objective: To assess the indirect costs, income reduction, and work productivity incurred by patients undergoing diagnosis and treatment for Drug-Resistant Tuberculosis (DRTB) in Mozambique during their TB treatment. Methods: As part of a comprehensive mixed-methods study conducted from January 2021 to April 2023, this research utilized a descriptive cross-sectional approach, incorporating both quantitative and qualitative methods. The primary goal was to evaluate the costs incurred by the national health system due to drug-resistant TB. Additionally, to explore the indirect costs experienced by patients and their families during treatment, semi-structured interviews were conducted with 27 individuals who had been undergoing treatment for over six months. Results: All survey participants unanimously reported a significant decline in labour productivity, with 70.3% experiencing a reduction in their monthly income. Before falling ill, the majority of respondents (33.3%) earned up to $76.92 monthly, representing the minimum earnings range, while 29.2% had a monthly income above $230.77, the maximum earnings range. Among those who experienced income loss, the majority (22.2%) reported a decrease of up to $76.92 per month, and 18.5% cited a loss exceeding $230.77 per month. Notably, patients with Drug-Resistant Tuberculosis (DRTB) have not incurred the direct costs of the disease, as these are covered by the government. Conclusion: The financial burden of treating Drug-Resistant Tuberculosis (DRTB), along with the income reduction it causes, is substantial. Implementing a patient-centred, multidisciplinary, and multisector approach, coupled with strong psychosocial support, can significantly reduce the catastrophic costs DRTB patients incur.

Characterization of two Achromobacter xylosoxidans isolates from patients with pertussis-like symptoms

Objective:To characterize two Achromobaeter xylosoxidans recovered from 2 patients diagnosed with pertussis during a Bordetella pertussis surveillance program.Methods:Nasopharyngeal swabs from 2 children under 1 year of age with clinical suspicion of pertussis were analyzed by culture and PCR.Results:Two Achromobaeter xylosoxidans A8,closely related to Bordetella spp.were recovered from 2 patients diagnosed of pertussis,both carrying the ptxA gene and IS418 the pertussis toxin encoding gene.Subsequently,antibiotic susceptibility was evaluated by disk-diffusion method and by PCR.Conclusions:Although more detailed studies are needed,the present data highlight the possibility that Achromobaeter xylosoxidans.closely related Bordetella pertussis microorganisms and not covered under the vaccine umbrella,might also result in cases of whooping cough.Thereby further surveillance is necessary to determine the extension and relevance of their pathogenic role in order to discriminate their real public health implication.

Accelerating the elimination of hepatitis C in Kuwait: An expert opinion

The hepatitis C virus(HCV)is estimated to affect 71 million people worldwide.In 2016,the World Health Organization adopted the first global health sector strategy to eliminate viral hepatitis as a public health threat by 2030.In December 2018,the European Association for the Study of the Liver,International Liver Foundation convened an expert panel to address the elimination of HCV in Kuwait.Several steps have already been taken to eliminate HCV in Kuwait,including free HCV treatment for Kuwait’s citizens,high blood safety standards,and the implementation of screening and awareness programs.The expert panel made several recommendations aimed at accelerating the elimination of HCV in Kuwait:The development of a national strategy and action plan to guide all HCV elimination activities;the formation of a coordination mechanism to support collaboration between hepatitis working committees;the prioritization of microelimination at primary,secondary or tertiary facilities,in prisons and rehabilitation centers;and ensuring the involvement of multiple stakeholders–including relevant civil society groups–in all activities.Enhanced screening and linkage to care should be prioritized in Kuwait,with the expansion of the prescriber base to primary healthcare providers and nurse practitioners to be considered.Raising awareness and educating people about HCV infection also remain essential to achieve the goal of HCV elimination.Lastly,a national HCV registry should be developed to help monitor the implementation of viral hepatitis plans and progress towards achieving national and international targets.

INMA-Sabadell队列中孕期双酚A及邻苯二甲酸酯暴露与胎儿发育的超声测量(续完)

暴露于ΣMWPm与任何胎儿大小或胎儿发育结局（见补充材料，表8）及所评估的出生结局（表2及补充材料表S7）都没有显著相关性。代谢物MnBP与12-20孕周HC增长降低有显著相关性（-4．88％；95％CI：-8．36，-1．36），且与EFW增长减低也有显著相关性（-4．32％；95％CI：-8．33，-0．27）（图3及补充材料表S8）。

INMA-Sabadell队列中孕期双酚A及邻苯二甲酸酯暴露与胎儿发育的超声测量(待续)

[背景]产前暴露于双酚A（BPA）及邻苯二甲酸酯会影响胎儿发育；然而该类研究很少，且得出的结果不一致。[目的]对一个西班牙出生队列中488对母婴进行研究，评估产前暴露于BPA及邻苯二甲酸酯是否与胎儿发育相关。[方法]检测第一和第三孕期两次尿液样本中BPA及8种邻苯二甲酸酯[4种邻苯二甲酸二（2-乙基己基）酯代谢物（DEHPm），邻苯二甲酸单卞酯（MBzP）以及3种低分子量邻苯二甲酸酯代谢物（LMWPm）]。另外，估计股骨长度（FL）、头围（HC）、腹围（AC）、双顶径（BPD）的生长曲线，估计孕期（12—20周，20～34周）的胎儿体重，并测量出生体重、出生长度、出生头围以及胎盘重量。[结果]总体上，结果并不支持孕期暴露于BPA或DEHPm与胎儿发育参数相关。产前MBzP暴露与20～34孕周的FL呈正相关，MBzP浓度每增加一倍，平均FL增加3．7％（95％CI：0．75，6．63％）。MBzP与男婴出生体重呈正相关（48g；95％CI：6，90），但在女婴中没有相关性（-27g；95％CI：-79，25）（交互作用P=0．04）。LMWPm邻苯二甲酸单丁酯（MnBP）与12—20孕周的HC呈负相关[平均HC降低了4．88％（95％CI：-8．36，-1．36％）]。[结论]本研究首次将暴露生物标志重复测量值与胎儿期多种发育参数相结合，发现暴露于BPA或邻苯二甲酸酯与胎儿发育不相关。邻苯二甲酸酯代谢物MBzP与MnBP与部分胎儿发育参数相关，但这些结果还需要重复验证。

Trihalomethane concentrations in tap water as determinant of bottled water use in the city of Barcelona

Bottled water consumption is increasing worldwide, despite its huge economic and environmental cost. We aim to describe personal and tap water quality determinants of bottled water use in the city of Barcelona. This cross-sectional study used data from the Health Survey of Barcelona in 2006（N = 5417 adults）. The use of bottled water to drink and to cook was evaluated in relation to age, gender, educational level, district and levels of trihalomethanes（THMs）, free chlorine, conductivity, chloride, sodium, p H, nitrate and aluminium in municipal tap water using Robust Poisson Regression. The prevalence of bottled water use to drink and cook was 53.9% and 6.7%, respectively. Chemical parameters in water had a large variability（interquartile range of THMs concentrations： 83.2–200.8 μg/L）and were correlated between them, except aluminium. Drinking bottled water increased with educational level, while cooking with bottled water was higher among men than among women and decreased with age. After adjusting by these personal determinants, a dose–response relationship was found between concentrations of all chemicals except aluminium in tap water and bottled water use. The highest association was found for THMs,with a Prevalence Ratio of 2.00（95%CI = 1.86, 2.15） for drinking bottled water and 2.80（95%CI = 1.72, 4.58） for cooking with bottled water, among those with 〉 150 μg/L vs. 〈 100 μg/L THMs in tap water. Conclusion： More than half of Barcelona residents regularly drank bottled water, and the main determinant was the chemical composition of tap water,particularly THM level.

Serum levels of the novel adipokine isthmin-1 are associated with obesity in pubertal boys

Objectives To evaluate whether there is an association between the serum levels of the novel insulin-like adipokine isthmin-1(ISM1)and obesity-related phenotypes in a population of Spanish children and to investigate the plausible molecular alterations behind the alteration of the serum levels of this protein in children with obesity.Methods The study population is a sub-cohort of the PUBMEP research project,consisting of a cross-sectional population of 119 pubertal children with overweight(17 boys,19 girls),obesity(20 boys,25 girls),and normal weight(17 boys,21 girls).All subjects were classified into experimental groups according to their sex,obesity,and insulin resistance(IR)status.They were counted anthropometry,glucose and lipid metabolism,inflammation and cardiovascular biomarkers as well as isthmin-1(ISM1)serum levels.This population was intended as a discovery population to elucidate the relationship between obesity and ISM1 levels in children.Furthermore,the study population had blood whole-genome DNA methylation examined,allowing deepening into the obesity–ISM1 molecular relationship.Results Higher serum ISM1 levels were observed in boys with obesity than in normal weight(P=0.004)and overweight(P=0.007)boys.ISM1 serum levels were positively associated with body mass index(BMI)Z-score(P=0.005)and fat mass(P=0.058)and negatively associated with myeloperoxidase(MPO)(P=0.043)in boys.Although we did not find associations between ISM1 serum levels and metabolic outcomes in girls,which may indicate a putative sexual dimorphism,fat mass was positively associated in all children,including boys and girls(P=0.011).DNA methylation levels in two-enhancer-related CpG sites of ISM1(cg03304641 and cg14269097)were associated with serum levels of ISM1 in children.Conclusions ISM1 is associated with obesity in boys at the pubertal stage,elucidating how this protein might be of special relevance as a new biomarker of obesity in children.Further studies including a longitudinal design during puberty are needed.

Carrion’s disease: an eradicable illness?

Carrion’s disease is a neglected tropical disease caused by Bartonella bacilliformis,a vector-borne pathogen restricted to the Andean valleys of Peru,Ecuador and Colombia.Carrion’s disease is a biphasic illness;in the acute phase the case-fatality rate can be as high as 88%,related to high parasitemia,arriving to almost all erythrocytes,and secondary bacterial infections close related with the development of transient immunosuppression in the earlier illness phases.In addition,there are an undefined number of asymptomatic carriers that are reservoirs of the etiological agent of Carrion’s disease in endemic areas,they make take into account due to they are the perpetuators of this disease.The actual scenario of Carrion’s disease,in which the illness is arriving to new areas,due to the expansion of the vector’s distribution,suggests that now may be a crucial time to design a strategy focusing on its elimination.

Adapt or perish:SARS-CoV-2 antibody escape variants defined by deletions in the Spike N-terminal Domain

In a recent report in Science,McCarthy et al.promptly observed a pattern of recurrent deletions in four discrete regions of the N-terminal Domain(NTD)of the Spike protein,which provide resistance to antibody neutralization,suggesting convergent evolution due to selective pressure and antigenic drift.

Gene expression changes in blood RNA after swimming in a chlorinated pool

Exposure to disinfection by-products（DBP） such as trihalomethanes（THM） in swimming pools has been linked to adverse health effects in humans, but their biological mechanisms are unclear. We evaluated short-term changes in blood gene expression of adult recreational swimmers after swimming in a chlorinated pool. Volunteers swam 40 min in an indoor chlorinated pool. Blood samples were drawn and four THM（chloroform,bromodichloromethane, dibromochloromethane and bromoform） were measured in exhaled breath before and after swimming. Intensity of physical activity was measured as metabolic equivalents（METs）. Gene expression in whole blood m RNA was evaluated using Illumina Human HT-12v3 Expression-Bead Chip. Linear mixed models were used to evaluate the relationship between gene expression changes and THM exposure. Thirty-seven before-after pairs were analyzed. The median increase from baseline to after swimming were： 0.7 to 2.3 for MET, and 1.4 to 7.1 μg/m^3 for exhaled total THM（sum of the four THM）.Exhaled THM increased on average 0.94 μg/m^3 per 1 MET. While 1643 probes were differentially expressed post-exposure. Of them, 189 were also associated with exhaled levels of individual/total THM or MET after False Discovery Rate. The observed associations with the exhaled THM were low to moderate（Log-fold change range：-0.17 to 0.15）. In conclusion, we identified short-term gene expression changes associated with swimming in a pool that were minor in magnitude and their biological meaning was unspecific. The high collinearity between exhaled THM levels and intensity of physical activity precluded mutually adjusted models with both covariates. These exploratory results should be validated in future studies.