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Objective To examine the adherence to the Mediterranean diet in the adult general population of Cyprus and assess its relationship with multi-morbidity. Design A representative sample of the adult population of Cyprus was selected in 2018-2019 using stratified sampling. Demographics, Mediterranean diet, smoking, and physical activity, as well as the presence of chronic, clinical, and mental conditions were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision (ICD-10). Setting The five government-controlled municipalities of the Republic of Cyprus. Participants A total of 1140 Cypriot men and women over 18-year old. Results The average Mediterranean Diet score was 15.5 ± 4.0 with males and residents of rural regions being more adherent to the Mediterranean Diet compared to females and residents of urban regions respectively (p<0.05). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity compared to the lower tertile and this result was statistically significant even after adjusting for age, gender, smoking habits, and physical activity (OR= 0.68, 95% CI: 0.46, 0.99). Conclusions The study provides evidence of the adherence to Mediterranean diet in Cypriot population and its association with multi-morbidity. Adherence to the Mediterranean diet was associated with lower risk of multi-morbidity. Future research would attempt to replicate such results that could add solid pieces of evidence towards meeting some criteria of causality and severity tests, hence prevention programs and practice guidelines in Cyprus and elsewhere should take into account those beneficial effects.

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in μg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries. ; ISSN:0804-4643 ; ISSN:1479-683X

Background: Guyana experiences health challenges related to both communicable and non-communicable diseases. Cardiovascular disease (CVD) is the most common non-communicable disease in Guyana. The main causes of the increased prevalence of non-communicable diseases are modifiable risk factors (e.g. obesity, hypertension, elevated cholesterol, unhealthy dietary patterns) and non-modifiable risk factors (e.g. age and genetics).Objective: The aim of this review is to understand CVD and risk factor data, in the context of ethnicity in Guyana.Methods: A review of the published literature as well as government and international health agency reports was conducted. All publications from 2002–2018 describing CVD and related risk factors in Guyana were screened and extracted.Findings: The population of Guyana is comprised of six ethnic groups, of which East Indian (39.8%) and African (29.3%) are the majority. CVD accounts for 526 deaths per 100,000 individuals per year. Among Indo-Guyanese and Afro-Guyanese, CVD is the primary cause of death affecting 32.6% and 22.7% of the populations, respectively. Within the Indo-Guyanese and Afro-Guyanese communities there is a high prevalence of hypertension and diabetes among individuals over the age of 50. There is a lack of available data describing ethnic disparities in CVD and related risk factors such as obesity, smoking, alcohol, physical activity and diet in Guyana.Conclusions: Important knowledge gaps remain in understanding the ethnic disparities of CVD and related risk factors in Guyana. Future research should focus on high risk populations and implement widespread screening and treatment strategies of common risk factors such as hypertension, diabetes, and elevated cholesterol to curb the epidemic of CVD in Guyana.

Dans les communautés riveraines des sites d'exploitation minière, les trente dernières années sont marquées par l'impact de l'exploitation exponentielle industrielle et artisanale des ressources minières. Ces impacts se manifestent sur le cadre social, économique et environnemental des populations riveraines des sites d'exploitation minières. Pour atténuer les conséquences désastreuses des activités minières, des incohérences des politiques publiques de développement qui s'en suivent dans un contexte fortement marqué par les catastrophes naturelles et les risques territoriaux, les approches développement territorial et la gestion des risques s'avèrent des démarches à implémenter dans les politiques nationales de développement local en vue de renforcer la décentralisation. A l'aune de ce contexte dominé par les catastrophes naturelles et les risques territoriaux enregistrés dans les communautés impactées par l'activité minière en général, le concept de gestion des risques se révèle une démarche qui condition l'avenir des infrastructures de base des territoires. Le retard observer dans la mise en place de l'approche gestion des risques par l'Etat dans les politiques territoriales et l'application de son contenu par les communautés et les compagnies minières constitue l'une des sources des risques territoriaux dont les populations, les élus locaux et les organisations de la société civile font face dans les domaines essentiels de développement. Abstract: In decentralized territorial communities, especially in communities bordering mining sites. In these communities, the last thirty years have been marked by the impact of industrial and artisanal exploitation of mineral resources. These impacts are manifested on the social, economic and environmental framework of the populations living near these mining sites. To mitigate the disastrous consequences of the mining activities, inconsistencies with public development policies in a context strongly marked by natural disasters and territorial risks, territorial ...

In 2007, after Hamas' takeover of the Gaza Strip, the area was subjected to an Israeli land siege, complemented in 2009 by a sea blockade. Since then, the already-dire living conditions in the Strip have declined consistently and the area's dependence on external aid has grown. Yet, there is no end in sight for either the siege or the blockade, or – by extension – for the inhumane circumstances of the Strip's population. This essay examines the duties of a military power in imposing what is effectively a years-long confinement of people and outlines a general argument for expanding the obligations of a party that imposes a prolonged siege or blockade. I consider these obligations in light of three potentially relevant legal frameworks: the law of occupation; international humanitarian law; and human rights law. In this essay, I argue that, although Gaza is no longer occupied, Israel, in exercising prolonged siege and blockade, must respect a set of obligations that encompass much more than simply not starving the besieged population or not cutting off their water supply. Paying attention only to the basic, biological needs of the besieged population ignores their human dignity because it reduces – in the eyes of the blockader – human existence to the intake of food and water. The essay concludes that the law should be interpreted as demanding that the besieger respect a wider scope of rights – including, among others, the right to enter and exit the besieged area – and, while it may limit such rights, such limitations must be compatible with the requirements of proportionality, taking into account the human toll caused by the extraordinary yet long-term situation.

Background: Combining National Quality Registries (NQRs) with existing National Health Registries (NHRs) might make it possible to get a wider picture of older adults health situation. The aim was to examine the feasibility of aggregating data across different NQRs and existing NHRs to explore the possibility to investigate trajectories and patterns of disease and care, specifically for the most ill older adults. Method: A Swedish twin population (N = 44,816) was linked to nine NQRs and four NHRs. A descriptive mixed-method study was performed. A manifest content analysis identified which health parameters were collected from each NQR. Factor analysis identified patterns in representation across NQRs. Two case studies illustrated individual trajectories of care by using NQRs and NHRs. Results: About 36% of the population was registered in one or more NQRs. NQRs included 1849 variables that were sorted into 13 categories with extensive overlap across the NQRs. Health and function variables were identified, but few social or cognitive variables. Even though most individuals demonstrated unique patterns of multi-morbidities, factor analysis identified three clusters of representation in the NQRs with sufficient sample sizes for future investigations. The two cases illustrated the possibility of following patterns of disease and trajectories of care. Conclusions: NQRs seem to be a significant source for collecting data about a population that may be underrepresented in most research on aging because of their age and poor health. However, NQRs are primarily disease related, and further development of the registries to maximize coverage and utility is needed. ; CC BY 4.0 Published online: 13 June 2020

PURPOSE: To examine the impact of new controlled drugs legislation introduced in May 2017 on benzodiazepine receptor agonist (BZRA) prescribing in Ireland. METHODS: A repeated cross-sectional analysis was conducted using publically available monthly pharmacy claims data from the General Medical Services (GMS) database. The study population comprised all GMS-eligible individuals aged ≥ 16 years from January 2016 to September 2019. Monthly prevalence rates of individuals receiving BZRA prescriptions per 10,000 eligible population were calculated and trends examined over time. Segmented linear regression of prevalence rates was used to examine changes before and after introduction of the legislation stratified by gender and age groups. Regression coefficients (β) and 95% confidence intervals (CIs) for monthly change were calculated. RESULTS: Pre-legislation (January 2016 to April 2017), there was a significant monthly decline in benzodiazepine prevalence rate (β = − 1.18; 95% CI − 1.84, − 0.51; p < 0.001) but no significant change in Z-drug prescribing. Post-legislation (May 2017 to September 2019), increases in prevalence rates were observed for benzodiazepines (β = 1.04; 95% CI 0.17, 1.92; p = 0.021) and Z-drugs (β = 1.04; 95% CI 0.26, 1.83; p = 0.010). Post-legislation trends showed increases in BZRA prevalence rates among the youngest subgroup (16–44 years), with variable changes in the middle-aged subgroup (45–64 years) and no changes in the oldest subgroup (≥ 65 years). CONCLUSIONS: This study indicates that introduction of new legislation had limited impact on BZRA prescribing on the main public health scheme in Ireland. Interventions targeting specific population subgroups may be required to achieve sustained reductions in prescribing. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00228-020-03063-z.

The tempo-spatial patterns of Covid-19 infections are a result of nested personal, societal, and political decisions that involve complicated epidemiological dynamics across overlapping spatial scales. High infection "hotspots" interspersed within regions where infections remained sporadic were ubiquitous early in the outbreak, but the spatial signature of the infection evolved to affect most regions equally, albeit with distinct temporal patterns. The sparseness of Covid-19 infections in the United States was analyzed at scales spanning from 10 to 2,600 km (county to continental scale). Spatial evolution of Covid-19 cases in the United States followed multifractal scaling. A rapid increase in the spatial correlation was identified early in the outbreak (March to April). Then, the increase continued at a slower rate and approached the spatial correlation of human population. Instead of adopting agent-based models that require tracking of individuals, a kernel-modulated approach is developed to characterize the dynamic spreading of disease in a multifractal distributed susceptible population. Multiphase Covid-19 epidemics were reasonably reproduced by the proposed kernel-modulated susceptible–infectious–recovered (SIR) model. The work explained the fact that while the reproduction number was reduced due to nonpharmaceutical interventions (e.g., masks, social distancing, etc.), subsequent multiple epidemic waves still occurred; this was due to an increase in susceptible population flow following a relaxation of travel restrictions and corollary stay-at-home orders. This study provides an original interpretation of Covid-19 spread together with a pragmatic approach that can be imminently used to capture the spatial intermittency at all epidemiologically relevant scales while preserving the "disordered" spatial pattern of infectious cases.

The COVID-19 pandemic has negatively impacted on the health and wellbeing of populations directly through infection, as well as through serious societal and economic consequences such as unemployment and underemployment. The consequences could be even more severe for those more vulnerable to the disease, such as the elderly and those with underlying health conditions. Indeed, there is evidence that such vulnerable populations are disproportionately affected in terms of both, their health and the socioeconomic impact. The aim of our study was to determine whether occupational health (OH) professionals thought that the COVID-19 pandemic might further disadvantage any particular group(s) of vulnerable workers globally, and if so, which group(s). A cross-sectional study was carried out with a sample of OH professionals by means of an online questionnaire which was shared via email within the ICOH (International Commission for Occupational Health) community. Data was collected over a period of two weeks in May 2020 and 165 responses from 52 countries were received. In this paper, the responses relating to questions about vulnerable workers are reported and discussed. Globally, our responders felt that those in less secure jobs (precarious employment (79%) and informal work (69%)), or unemployed (63%), were the most at risk of further disadvantage from this pandemic. The majority felt that their governments could act to mitigate these effects. There were suggestions of short-term alleviation such as financial and social support, as well as calls for fundamental reviews of the underlying inequalities that leave populations so vulnerable to a crisis such as COVID-19.

Introduction: The psychological effects of military service and lifestyle are not confined to individual service members, as there are also potential consequences for the mental health and well-being of military family members. Adult children and intimate partners of ex-service members can share this risk but may be overlooked both as potential research populations and in the planning of policy and outreach/treatment programs. This systematic review aimed to identify the psychological health outcomes of partners and adult children of ex-service members in Five Eyes alliance countries: Australia, Canada, New Zealand, United Kingdom, and the United States. Methods: Search protocols were used in aggregate databases and related journals for peer-reviewed literature. A total of 24 studies met inclusion criteria (N = 18 quantitative, N = 6 qualitative). Quantitative studies were summarized by narrative synthesis and qualitative data was analyzed using a descriptive-interpretive approach. Results: Intimate partners had higher prevalence rates of anxiety, depression, and posttraumatic stress disorder (PTSD) than population norms and were more likely to suffer distress because of the Veteran's mental health issues. Adult children were at increased risk for anxiety, depression, alcohol/substance misuse, and PTSD compared to population norms. Four themes were identified from the qualitative data: personal feelings and internal emotions, Veteran-oriented, help and support, and acting as a unit. Discussion: There are substantial gaps in the literature regarding the mental health and well-being of intimate partners and adult children of ex-service members in Five Eyes alliance countries. Future research is needed to address psychological outcomes among families after leaving the military.

Hyperarid, arid, semiarid, and dry subhumid areas cover approximately 41% of the global land area. The human population in drylands, currently estimated at 2.7 billion, faces limited access to sufficient, affordable, and nutritious food. We discuss the interlinkages among water security, environmental security, energy security, economic security, health security, and food security governance, and how they affect food security in drylands. Reliable and adequate water supply, and the prevention of water contamination, increase the potential for ample food, fodder, and fiber production. Protecting woodlands and rangelands increases food security by buffering the slow onset effects of climate change, including biodiversity loss, desertification, salinization, and land degradation. The protection of natural lands is expected to decrease environmental contamination, and simultaneously, reduce the transfer of diseases from wildlife to humans. Biofuel production and hydroelectric power plants increase energy security but generate land-use conflicts, deforestation, and ecosystem degradation. Economic security generally positively correlates with food security. However, economic growth often degrades the environment, changes tenure rights over natural resources, and stimulates migration to urban areas, resulting in lower food and health security. Moreover, civil unrest, political instability, and armed conflicts disrupt local economies in drylands. Maintaining food security is crucial for health security; conversely, malnourished populations and unresponsive health systems decrease economic security, and adversely affect environmental, energy, and food security. Climate change is expected to deteriorate health security by spreading vector-borne diseases. Effective governance and timely interventions can substantially shorten periods of food insecurity, lower their intensities, and accelerate recovery from inevitable crises, and are therefore crucial in preventing humanitarian crises. Since global drylands population will ...

The medicine development process is complex and requires time and effort to ensure safety, efficacy and quality. In paediatrics, this process is even more challenging, as it involves a subgroup of the population that already faces a considerable gap in the clinical evaluation of medicines and devices compared to the adult population. Moreover, access to therapies is heavily influenced by national health technology assessment (HTA) recommendations, which often form the basis for pricing and reimbursement decisions that affect the effective availability of treatments within the national health systems. Yet performing an HTA to assess the relative effectiveness and cost-effectiveness of a new children's treatment has several non-trivial implications, creating a critical issue for the paediatric population. In addition, the advent of innovative health technologies for children emphasises the need to empower the role of HTAs in paediatrics. This article aims at describing the most relevant elements of the drug development process in the paediatric field by focusing on the HTA assessment. Particular attention will be paid to the factors that influence market access for new paediatric medicines and patients' access to treatment. The paper will also highlight some central methodological challenges in conducting HTA in the paediatric field. Finally, the article will provide insight into how initiatives, such as conect4children, may subsequently reinforce HTA awareness in the paediatric community and strengthen collaborations through network mechanisms. ; This c4c project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777389. The Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA.

En décembre en 2019, le premier cas de COVID-19 est détecté en Chine. Le nombre de cas augmentant rapidement sur le plan international, l'OMS donne à la COVID-19 le statut de pandémie en mars 2020 et le Conseil Fédéral Suisse instaure un semi-confinement dès le 13 mars 2020. Dès lors, les services de santé suisses ont été contraints de se réorganiser et d'augmenter leur capacité pour prendre en charge les patient·e·s COVID-19. En parallèle, le gouvernement a émis des recommandations afin de protéger les personnes vulnérables et d'éviter la surcharge des hôpitaux. Ces recommandations sont basées sur le respect de règles de distanciation sociale et de gestes barrières (p.ex. : l'hygiène des mains et le port du masque), et ont été accompagnées de mesures exceptionnelles telles que la fermeture ponctuelle des restaurants, des commerces, des espaces culturels et sportifs, la généralisation du télétravail, etc. L'adhésion de la population à ces mesures, qui ont pu être parfois contraignantes, dépend des représentations et de la compréhension qu'elle a de la maladie : quelles sont ses origines, son mode de propagation, les stratégies efficaces pour s'en protéger, les enjeux sanitaires, etc. Connaître ces représentations et la façon dont la population appréhende la maladie et ses enjeux est dès lors crucial pour adapter la communication et les politiques publiques et, ainsi, lutter efficacement contre la propagation du virus. Dans ce but, nous avons réalisé une étude par questionnaire auprès d'un échantillon de la population adulte de trois cantons suisses : Genève, Vaud et Fribourg. Nous présentons, dans ce document, les principaux résultats en fonction de l'âge et du genre des répondant·e·s.

States, in their conflicts with militant groups embedded in civilian populations, often resort to policies of collective punishment to erode civilian support for the militants. We attempt to evaluate the efficacy of such policies in the context of the Gaza Strip, where Israel's blockade and military interventions, purportedly intended to erode support for Hamas, have inflicted hardship on the civilian population. We combine Palestinian public opinion data, Palestinian labor force surveys, and Palestinian fatalities data, to understand the relationship between exposure to Israeli policies and Palestinian support for militant factions. Our baseline strategy is a difference-in-differences specification that compares the gap in public opinion between the Gaza Strip and the West Bank during periods of intense punishment with the gap during periods when punishment is eased. Consistent with previous research, we find that Palestinian fatalities are associated with Palestinian support for more militant political factions. The effect is short-lived, however, dissipating after merely one quarter. Moreover the blockade of Gaza itself appears to be only weakly associated with support for militant factions. Overall, we find little evidence to suggest that Israeli security policies towards the Gaza Strip have any substantial lasting effect on Gazan support for militant factions, neither deterring nor provoking them relative to their West Bank counterparts. Our findings therefore call into question the logic of Israel's continued security policies towards Gaza, while also raising the possibility more generally that populations violently targeted by state actors may exhibit greater inertia in their support for militancy (or lack thereof) than is typically theorized in standard models of deterrence.

In response to the COVID-19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre-existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID-19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives.