Objective Public life restrictions associated with the COVID-19 pandemic caused reductions in physical activity (PA) and decreases in mental and somatic health. Considering the interplay between these factors, we investigated the effects of digital home exercise (DHE) during government-enforced lockdowns. Methods A multicentre randomised controlled trial was performed allocating healthy individuals from nine countries (N=763; 523 female) to a DHE or an inactive control group. During the 4-week main intervention, DHE members engaged in live-streamed multicomponent home exercise. Subsequently, both groups had access to prerecorded workouts for an additional 4 weeks. Outcomes, assessed weekly, included PA level (Nordic Physical Activity Questionnaire-Short), anxiety (Generalized Anxiety Disorder Scale-7), mental well-being (WHO-5 Questionnaire), sleep quality (Medical Outcome Study Sleep Scale), pain/disability (Chronic Pain Grade Scale) and exercise motivation (Self-Concordance Scale). Mixed models were used for analysis. Results Live-streamed DHE consistently increased moderate PA (eg, week 1: 1.65 times more minutes per week, 95% CI 1.40 to 1.94) and vigorous PA (eg, week 1: 1.31 times more minutes per week, 95% CI 1.08 to 1.61), although the effects decreased over time. In addition, exercise motivation, sleep quality and anxiety were slightly higher for DHE in the 4-week live streaming period. The same applied to mental well-being (mean difference at week 4: +0.99, 95% CI 0.13 to 1.86), but an inverted trend was observed after live streaming was substituted by prerecorded exercise. Conclusions Live-streamed DHE represents an efficacious method to enhance PA and selected markers of health during pandemic-related public life restrictions. However, research on implementation is warranted to reduce dropout rates.
The objective. To assess the dynamics of the epidemic process of chronic hepatitis C (CHC) in Russia and the Northwest Federal Region for the period 2015–2020. Materials and methods. The article analyzes the data from the state statistical reporting of infectious diseases in the Russian Federation (RF), from the reference-center for the monitoring of viral hepatitis, from statistical tables compiled at Methodological and Research Center for Epidemiological Surveillance of Viral Hepatitis under Pasteur Institute of Epidemiology and Microbiology. The data from the Federal register of patients with viral hepatitis were used.Results. The epidemiological indicators for 2020 should be interpreted taking into account the implementation of anti-epidemic measures for COVID-19 in the context of a pandemic. In 2015–2019, CHC incidence in the RF decreased by 18% (from 38o⁄oooo to 30,9o⁄oooo). For 2020 — by 46% (up to 16,7o⁄oooo). The total number of people with CHC is increasing (in 2015 — 562 622 people, in 2019 — 635 372). There is no clear downward trend in the dynamics of changes in the mortality rate from causes associated with HCV in the RF and the Northwestern Federal Region. The impact of the pandemic on mortality in HCV infection remains to be assessed. In 2019 in Russia, only 8,6% of patients on the register are covered by treatment. In 2020, according to preliminary data, treatment coverage was less than 1% of the estimated number of people with HCV infection (3 million). СHC incidence in the Northwest Federal Region decreased by less than 15% (48o⁄oooo — in 2019, 56,2o⁄oooo — in 2015), for 2020 — by 41% (up to 28,2o⁄oooo). Incidence is 1,5 times higher than in the RF on average. The total number of people with СHC is increasing (in 2015 — 92 780, in 2020 — 106 052). Few people with viral hepatitis know about their diagnosis (35% HCV-infected persons). Government funding for treatment has increased, but only 3% is covered by therapy. In the Northwestern Federal Region, as in the RF, the WHO strategy targets have not been achieved by 2020. The sharp decline in basic epidemiological indicators for 2020 is most likely due to a decrease in the number of patients seeking outpatient care and screening during the implementation of anti-epidemic measures for COVID-19. ; Цель исследования: оценить динамику эпидемического процесса гепатита С в Российской Федерации и Северо-Западном федеральном округе за период 2015–2020 гг.Материалы и методы. Проведен ретроспективно-проспективный анализ государственной статистической отчетности инфекционной заболеваемости в Российской Федерации, данных референс-центра по мониторингу вирусных гепатитов, федерального регистра больных вирусными гепатитами, отчетов главных инфекционистов субъектов РФ, а также аналитических таблиц, разработанных специалистами Научно-методического центра ФБУН «СПб НИИ эпидемиологии и микробиологии имени Пастера» Роспотребнадзора.Результаты и их обсуждение. Эпидемиологические показатели 2020 г. следует интерпретировать с учетом осуществления противоэпидемических мероприятий по COVID-19 в условиях пандемии. Заболеваемость ХГС в РФ за 2015–2019 гг. снизилась на 18% (с 38o⁄oooo до 30,9o⁄oooo), за 2020 г.— на 46% (до 16,7o⁄oooo). Кумулятивное число пациентов увеличилось на 11,4%, достигнув в 2019 г. 635 372. В динамике изменения показателя смертности от причин, связанных с хроническим гепатитом С (ХГС), в РФ и СЗФО не наблюдается отчетливой тенденции к снижению. Влияние пандемии на летальность при HCV-инфекции еще предстоит оценить. В 2019 г. в России только 8,6% находящихся в регистре пациентов охвачено лечением. В 2020 г. по предварительным данным охват терапией составил менее 1% от оценочного числа людей с HCVинфекцией (3 млн). Заболеваемость ХГС в Северо-Западном федеральном округе в 2015–2019 гг. снизилась менее чем на 15% (48o⁄oooo — в 2019 г., 56,2o⁄oooo — в 2015 г.), за 2020 г.— на 41% (до 28,2o⁄oooo). Показатели превосходят среднефедеральные в 1,5 раза. Кумулятивное число лиц с ХГС увеличивается (в 2015 г.— 92 780 человек, в 2020 г.— 106 052). По оценочным данным, только около 35% инфицированных знают о своем заболевании. Государственное финансирование на лечение увеличилось, но терапией охвачено только около 3% пациентов, находящихся в регистре.Заключение. С учетом динамики базовых эпидемиологических показателей в Северо-Западном федеральном округе, как и в РФ, заявленные ВОЗ показатели не достигнуты к 2020 г. Резкое снижение базовых эпидемиологических показателей за 2020 г. вероятнее связано со снижением обращаемости пациентов за амбулаторной помощью и скринингового обследования в период осуществления противоэпидемических мероприятий по COVID-19.
BACKGROUND: For the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty. METHODS: Current knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI). RESULTS: Based on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts. CONCLUSION: Allergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose.
BACKGROUND: For the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty. METHODS: Current knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI). RESULTS: Based on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts. CONCLUSION: Allergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose.
BACKGROUND: Diabetes is a major threat to public health in the United States and worldwide. Understanding the role of environmental chemicals in the development or progression of diabetes is an emerging issue in environmental health. OBJECTIVE: We assessed the epidemiologic literature for evidence of associations between persistent organic pollutants (POPs) and type 2 diabetes. METHODS: Using a PubMed search and reference lists from relevant studies or review articles, we identified 72 epidemiological studies that investigated associations of persistent organic pollutants (POPs) with diabetes. We evaluated these studies for consistency, strengths and weaknesses of study design (including power and statistical methods), clinical diagnosis, exposure assessment, study population characteristics, and identification of data gaps and areas for future research. CONCLUSIONS: Heterogeneity of the studies precluded conducting a meta-analysis, but the overall evidence is sufficient for a positive association of some organochlorine POPs with type 2 diabetes. Collectively, these data are not sufficient to establish causality. Initial data mining revealed that the strongest positive correlation of diabetes with POPs occurred with organochlorine compounds, such as trans-nonachlor, dichlorodiphenyldichloroethylene (DDE), polychlorinated biphenyls (PCBs), and dioxins and dioxin-like chemicals. There is less indication of an association between other nonorganochlorine POPs, such as perfluoroalkyl acids and brominated compounds, and type 2 diabetes. Experimental data are needed to confirm the causality of these POPs, which will shed new light on the pathogenesis of diabetes. This new information should be considered by governmental bodies involved in the regulation of environmental contaminants.
INTRODUCTION: The European Medical Information Framework consortium has assembled electronic health record (EHR) databases for dementia research. We calculated dementia prevalence and incidence in 25 million persons from 2004 to 2012. METHODS: Six EHR databases (three primary care and three secondary care) from five countries were interrogated. Dementia was ascertained by consensus harmonization of clinical/diagnostic codes. Annual period prevalences and incidences by age and gender were calculated and meta-analyzed. RESULTS: The six databases contained 138,625 dementia cases. Age-specific prevalences were around 30% of published estimates from community samples and incidences were around 50%. Pooled prevalences had increased from 2004 to 2012 in all age groups but pooled incidences only after age 75 years. Associations with age and gender were stable over time. DISCUSSION: The European Medical Information Framework initiative supports EHR data on unprecedented number of people with dementia. Age-specific prevalences and incidences mirror estimates from community samples in pattern at levels that are lower but increasing over time. ; The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under European Medical Informatics Framework (EMIF) grant agreement no. 115372, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies' in kind contribution. R.S. and G.P. are partly funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
Much of Alzheimer disease (AD) research has been traditionally based on the use of animals, which have been extensively applied in an effort to both improve our understanding of the pathophysiological mechanisms of the disease and to test novel therapeutic approaches. However, decades of such research have not effectively translated into substantial therapeutic success for human patients. Here we critically discuss these issues in order to determine how existing human-based methods can be applied to study AD pathology and develop novel therapeutics. These methods, which include patient-derived cells, computational analysis and models, together with large-scale epidemiological studies represent novel and exciting tools to enhance and forward AD research. In particular, these methods are helping advance AD research by contributing multifactorial and multidimensional perspectives, especially considering the crucial role played by lifestyle risk factors in the determination of AD risk. In addition to research techniques, we also consider related pitfalls and flaws in the current research funding system. Conversely, we identify encouraging new trends in research and government policy. In light of these new research directions, we provide recommendations regarding prioritization of research funding. The goal of this document is to stimulate scientific and public discussion on the need to explore new avenues in AD research, considering outcome and ethics as core principles to reliably judge traditional research efforts and eventually undertake new research strategies.
Use of a multi-sensor approach can provide citizens with holistic insights into the air quality of their immediate surroundings and their personal exposure to urban stressors. Our work, as part of the ICARUS H2020 project, which included over 600 participants from seven European cities, discusses the data fusion and harmonization of a diverse set of multi-sensor data streams to provide a comprehensive and understandable report for participants. Harmonizing the data streams identified issues with the sensor devices and protocols, such as non-uniform timestamps, data gaps, difficult data retrieval from commercial devices, and coarse activity data logging. Our process of data fusion and harmonization allowed us to automate visualizations and reports, and consequently provide each participant with a detailed individualized report. Results showed that a key solution was to streamline the code and speed up the process, which necessitated certain compromises in visualizing the data. A thought-out process of data fusion and harmonization of a diverse set of multi-sensor data streams considerably improved the quality and quantity of distilled data that a research participant received. Though automation considerably accelerated the production of the reports, manual and structured double checks are strongly recommended. ; This work has received funding from the European Union's Horizon 2020 Programme for Research, Technological Development, and Demonstration, under grant agreement No. 690105 (Integrated Climate forcing and Air Pollution Reduction in Urban Systems (ICARUS)). This work reflects only the authors' views, and the European Commission is not responsible for any use that may be made of the information it contains. Funding was received from the Young Researchers Program and the P1-0143 program "Cycling of substances in the environment, mass balances, modelling of environmental processes and risk assessment", both funded by the Slovenian Research Agency. The authors thank RECETOX Research Infrastructure (No. ...
Using low-cost portable air quality (AQ) monitoring devices is a growing trend in personal exposure studies, enabling a higher spatio-temporal resolution and identifying acute exposure to high concentrations. Comprehension of the results by participants is not guaranteed in exposure studies. However, information on personal exposure is multiplex, which calls for participant involvement in information design to maximise communication output and comprehension. This study describes and proposes a model of a user-centred design (UCD) approach for preparing a final report for participants involved in a multi-sensor personal exposure monitoring study performed in seven cities within the EU Horizon 2020 ICARUS project. Using a combination of human-centred design (HCD), human-information interaction (HII) and design thinking approaches, we iteratively included participants in the framing and design of the final report. User needs were mapped using a survey (n = 82), and feedback on the draft report was obtained from a focus group (n = 5). User requirements were assessed and validated using a post-campaign survey (n = 31). The UCD research was conducted amongst participants in Ljubljana, Slovenia, and the results report was distributed among the participating cities across Europe. The feedback made it clear that the final report was well-received and helped participants better understand the influence of individual behaviours on personal exposure to air pollution. ; This work has received funding from the European Union's Horizon 2020 Programme for research technological development and demonstration under grant agreement No 690105 (Integrated Climate forcing and Air Pollution Reduction in Urban Systems (ICARUS)). This work reflects only the authors' views, and the European Commission is not responsible for any use that may be made of the information it contains. Funding was received from the Young Researchers Program and P1-0143 program "Cycling of substances in the environment, mass balances, modelling of environmental ...
Terrestrial, freshwater, and marine ecosystems are connected via multiple biophysical and ecological processes. Identifying and quantifying links among ecosystems is necessary for the uptake of integrated conservation actions across realms. Such actions are particularly important for species using habitats in more than one realm during their daily or life cycle. We reviewed information on the habitats of 2,408 species of European conservation concern and found that 30% of the species use habitats in multiple realms. Transportation and service corridors, which fragment species habitats, were identified as the most important threat impacting ∼70% of the species. We examined information on 1,567 European Union (EU) conservation projects funded over the past 25 years, to assess the adequacy of efforts toward the conservation of "multi-realm" species at a continental scale. We discovered that less than a third of multi-realm species benefited from projects that included conservation actions across multiple realms. To achieve the EU's conservation target of halting biodiversity loss by 2020 and effectively protect multi-realm species, integrated conservation efforts across realms should be reinforced by: (1) recognizing the need for integrated management at a policy level, (2) revising conservation funding priorities across realms, and (3) implementing integrated land-freshwater-sea conservation planning and management.
Frontmatter -- Contents -- Acknowledgments. -- Contributors -- Introduction -- One. Christian Attitudes toward Boundaries -- Two. The Value of Limited Loyalty -- Three. Toward a Liberal Theory of National Boundaries -- Four. Hard Borders, Compensation, and Classical Liberalism -- Five. Territorial Boundaries and Confucianism -- Six Boundaries of the Body and Body Politic in Early Confucian Thought -- Seven. International Law, Boundaries, and Imagination -- Eight. Territorial Sovereignty -- Nine Islamic Perspectives on Territorial Boundaries and Autonomy -- Ten. Religion and the Maintenance of Boundaries -- Eleven. Land and People -- Twelve. Contested Boundaries -- Thirteen. Territorial Boundaries -- Fourteen. Group Boundaries, Individual Barriers -- Fifteen. Boundaries, Ownership, and Autonomy -- Sixteen. In Defense of Reasonable Lines -- Seventeen. The Ethics of Boundaries -- Index
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To answer the question, "What are the best ways to communicate uncertainties to public audiences, at-risk communities, and stakeholders during public health emergency events?" we conducted a systematic review of published studies, grey literature, and media reports in English and other United Nations (UN) languages: Arabic, Chinese, French, Russian, and Spanish. Almost 11,500 titles and abstracts were scanned of which 46 data-based primary studies were selected, which were classified into four methodological streams: Quantitative-comparison groups; Quantitative-descriptive survey; Qualitative; and Mixed-method and case-study. Study characteristics (study method, country, emergency type, emergency phase, at-risk population) and study findings (in narrative form) were extracted from individual studies. The findings were synthesized within methodological streams and evaluated for certainty and confidence. These within-method findings were next synthesized across methodological streams to develop an overarching synthesis of findings. The findings showed that country coverage focused on high and middle-income countries in Asia, Europe, North America, and Oceania, and the event most covered was infectious disease followed by flood and earthquake. The findings also showed that uncertainty during public health emergency events is a multi-faceted concept with multiple components (e.g., event occurrence, personal and family safety, recovery efforts). There is universal agreement, with some exceptions, that communication to the public should include explicit information about event uncertainties, and this information must be consistent and presented in an easy to understand format. Additionally, uncertainty related to events requires a distinction between uncertainty information and uncertainty experience. At-risk populations experience event uncertainty in the context of many other uncertainties they are already experiencing in their lives due to poverty. Experts, policymakers, healthcare workers, and other stakeholders experience event uncertainty and misunderstand some uncertainty information (e.g., event probabilities) similar to the public. Media professionals provide event coverage under conditions of contradictory and inconsistent event information that can heighten uncertainty experience for all.
Mosquito control programs at seven urban sites in Kenya, Egypt, Israel, Costa Rica, and Trinidad are described and compared. Site-specific urban and disease characteristics, organizational diagrams, and strengths, weaknesses, obstacles and threats (SWOT) analysis tools are used to provide a descriptive assessment of each mosquito control program, and provide a comparison of the factors affecting mosquito abatement. The information for SWOT analysis is collected from surveys, focus group discussions, and personal communication. SWOT analysis identified various issues affecting the efficiency and sustainability of mosquito control operations. The main outcome of our work was the description and comparison of mosquito control operations within the context of each study site's biological, social, political, management, and economic conditions. The issues identified in this study ranged from lack of inter-sector collaboration to operational issues of mosquito control efforts. A lack of sustainable funding for mosquito control was a common problem for most sites. Many unique problems were also identified, which included lack of mosquito surveillance, lack of law enforcement, and negative consequences of human behavior. Identifying common virtues and shortcomings of mosquito control operations is useful in identifying "best practices" for mosquito control operations, thus leading to better control of mosquito biting and mosquito-borne disease transmission.
Governments have restricted public life during the COVID-19 pandemic, inter alia closing sports facilities and gyms. As regular exercise is essential for health, this study examined the effect of pandemic-related confinements on physical activity (PA) levels. A multinational survey was performed in 14 countries. Times spent in moderate-to-vigorous physical activity (MVPA) as well as in vigorous physical activity only (VPA) were assessed using the Nordic Physical Activity Questionnaire (short form). Data were obtained for leisure and occupational PA pre- and during restrictions. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). In total, n = 13,503 respondents (39 +/- 15 years, 59% females) were surveyed. Compared to pre-restrictions, overall self-reported PA declined by 41% (MVPA) and 42.2% (VPA). Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with WHO guidelines decreased from 80.9% (95% CI: 80.3-81.7) to 62.5% (95% CI: 61.6-63.3). Results suggest PA levels have substantially decreased globally during the COVID-19 pandemic. Key stakeholders should consider strategies to mitigate loss in PA in order to preserve health during the pandemic.
