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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 38498

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Dr. Elpidoforos S. Soteriades

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Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia 2252, Cyprus
Interests: public health; environmental health; firefighters’ health (cardiovascular diseases); infectious diseases; tobacco control (adolescent smoking); obesity; electronic health; occupational stress
* Address before 2021, Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates

Special Issue Information

Dear Colleagues,

Public Health is an umbrella term under which we usually include two main pillars, namely, prevention and treatment (healthcare services). Public health is defined as the art and science of all evidence-based organized efforts of the society aiming to protect and promote health, prevent disease, prolong life, and enhance the quality of life for the population as a whole. Public health, a contested field combining theory and practice, is guided by certain principles subject to global debate. Furthermore, Public Health cannot be appreciated without its values serving as the driving ethical force in policy decision-making. However, the recent pandemic elicited deep and widespread challenges against these public health principles and values, and there are serious concerns regarding the potential negative impact of the pandemic on these ideals.

In this proposed Special Issue of Medicina, we are expecting to scientifically discuss, review, and share the common knowledge gained through the concerted efforts to respond to the recent pandemic. We believe that it is of paramount importance to extract useful knowledge and experience from the past three years in order to design and implement successful examples of organized evidence-based approaches for public health preparedness while respecting and protecting the universal public health principles and values examined through the lenses of the recent pandemic and revalidated in the post-pandemic era.

Several research questions remain to be addressed since the post-pandemic era is now providing the opportunity for public health professionals, academics, researchers, and policymakers to review the appropriateness and effectiveness of control measures implemented during the pandemic and systematically assess different public health responses. What were the advances or setbacks for public health, and how can we integrate universal principles and values into our future public health preparedness?

The scope of the articles includes but is not limited to the following topics: public health, environmental health, prevention, health promotion, screening, monitoring, surveillance, public health principles and values, epidemic preparedness, as well as clinical, and laboratory aspects of public health measures for different population groups, communities and societies around the world.

We invite colleagues to share their knowledge and experience with original articles, reviews, mini-reviews, and opinion papers on "Public Health in the Post-pandemic Era” to support our future preparedness for public health practice grounded on its principles and values.

Dr. Elpidoforos Soteriades
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

public health
environmental health
prevention
health promotion
infectious disease epidemiology
public health screening
public health monitoring
epidemiological surveillance
public health principles
public health values
public health ethics
post-pandemic era
epidemic preparedness
COVID-19
evidence-based control measures
vaccine adverse effects
vaccine safety and effectiveness

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Published Papers (8 papers)

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Research

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13 pages, 1067 KiB

Open AccessArticle

The Effectiveness of a Specific Exercise Program in Alleviating Work-Related Neck and Upper Back Pain and Improving Mood State in Various Occupational Populations—A Randomized Controlled Trial

by Anastasia Beneka, Paraskevi Sakellari, Katerina Daskalaki, Paraskevi Malliou and Theodoros Konstantinidis

Medicina 2024, 60(12), 2002; https://doi.org/10.3390/medicina60122002 - 4 Dec 2024

Viewed by 546

Abstract

Background and Objectives: The COVID-19 pandemic brought significant challenges across governmental, industrial, and social systems. Additionally, numerous studies have reported a sharp increase in both mental health issues and musculoskeletal disorders worldwide. This study aimed to investigate whether a specific exercise program could alleviate neck and upper back pain symptoms and improve mood state among healthcare and office employees during the post-COVID-19 period. Materials and Methods: This was an unblinded (open label) randomized controlled trial (both the participants and the researchers knew which treatment or intervention was being administered). In total, 40 healthcare employees from a public hospital and 98 remote office employees, all of whom reported neck and upper back pain, were randomly assigned to an experimental (EG) and control group (CG). The experimental groups underwent the same exercise protocol, while their corresponding control groups underwent the assessments only. Pain assessment using the Visual Analogue Scale (VAS) and mood state using the Feeling Scale (FS) questionnaires of the participants were recorded at baseline (pre-intervention) and immediately following the exercise intervention period of 6 weeks (post-intervention). The intervention consisted of 18 exercise sessions conducted over a 6-week period, with remote office workers participating online and healthcare workers attending exercise sessions on site (at the hospital). Statistical analysis was performed using non-parametric Mann–Whitney and Wilcoxon tests, as appropriate. Results: Following the six-week intervention, the percentage of workers in the EG reporting pain decreased significantly (from 75% to 45% for healthcare workers and from 54% to 25% for office employees), whereas no change was observed for their corresponding control groups. Similarly, the mood state of the EGs significantly improved compared with the control groups, as measured between pre- and post-intervention sessions. Conclusions: The COVID-19 period exacerbated stress and musculoskeletal strain, particularly for workers in demanding occupational roles. To mitigate these effects, exercise programs that can be applied while at work should be implemented, as they are effective in enhancing mood and managing neck pain in employees with physical exertion. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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18 pages, 3626 KiB

Open AccessArticle

Design of an Epitope-Based Vaccine Against MERS-CoV

by Taghreed N. Almanaa

Medicina 2024, 60(10), 1632; https://doi.org/10.3390/medicina60101632 - 6 Oct 2024

Viewed by 790

Abstract

Background and Objectives: Middle East Respiratory Syndrome (MERS) is a viral respiratory illness caused by a coronavirus called Middle East respiratory syndrome. In the current study, immunoinformatics studies were applied to design an epitope-based vaccine construct against Middle East Respiratory Syndrome. Materials and Methods: In this study, epitopes base vaccine construct was designed against MERS using immunoinformatics approach. Results: In this approach, the targeted proteins were screened, and probable antigenic, non-allergenic, and good water-soluble epitopes were selected for vaccine construction. In vaccine construction, the selected epitopes were joined by GPGPG linkers, and a linear multi-epitope vaccine was constructed. The vaccine construct underwent a physiochemical property analysis. The 3D structure of the vaccine construct was predicted and subjected to refinement. After the refinement, the 3D model was subjected to a molecular docking analysis, TLRs (TLR-3 and TLR-9) were selected as receptors for vaccine construct, and the molecular docking analysis study determined that the vaccine construct has binding ability with the targeted receptor. Conclusions: The docking analysis also unveils that the vaccine construct can properly activate immune system against the target virus however experimental validation is needed to confirm the in silico findings further. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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Figure 1
A schematic diagram illustrating the construction and processing of a multi-epitope vaccine. This study begins with the selection of a MERS-specific spike protein from a biological database. Epitopes were then predicted from the query protein and prioritized using various machine learning classification models. The filtered epitopes were linked together to form a complete three-dimensional structure, which was subsequently subjected to immune simulations to predict the immune response against the vaccine construct. The resulting vaccine candidate, which demonstrated potential immune stimulation and structural stability, was further evaluated for performance through docking studies with known immune receptors. Full article ">Figure 2
This figure presents the sequence of the vaccine construct, where the adjuvant is highlighted in blue, the linkers are in yellow, and epitopes are not highlighted. Furthermore, the 3D structure of vaccine was modeled. This model explains a highly packed, completely modeled structure vaccine construct with multiple grooves, predicting the effective binding of immune receptors. Full article ">Figure 3
The wild-type (A) and mutated structure (B) of the vaccine construct. In the mutated vaccine structure, yellow represents di sulfide bonds. In both structures, white shows the loop, blue shows the sheet, and pink shows the ribbon secondary structure elements. Full article ">Figure 4
The Vaccine_TLR-3 complex. The red color represents the TLR-3 candidate, while green represents the vaccine. The figure shows that the vaccine is purely docked to the side domain of TLR-3, thus showing effective binding. Full article ">Figure 5
The Vaccine_TLR-9 complex, where the yellow color represents TLR-9, while the green color represents the vaccine candidate. The figure shows that the vaccine is purely docked to the middle region of TLR-9, thus showing effective binding. Full article ">Figure 6
Antibody and cytokine levels toward multi-epitope vaccine construct. (A) shows that upon the introduction of the vaccine antigen (black curve), starting from day 5, the adaptive immune response was highly activated. Large amounts of IgM and IgG, along with their subtypes, were produced in response to the vaccine candidate, which is a typical reaction when a foreign pathogen enters the body. (B) The results show cytokine production against the vaccine candidate. Large amounts of IFN-gamma along with other cytokines are produced, which clearly represent the robust activation of the immune system against the vaccine construct. Full article ">Figure 7
Immune simulation reports. Legend: Act = active, Intern = the internalized Ag, Pres II = presenting on MHC II, Dup = in the mitotic cycle, Anergic = anergic, Resting = not active. Full article ">Figure 8
Immune simulation reports. Legend: Act = active, Intern = the internalized Ag, Pres II = presenting on MHC II, Dup = in the mitotic cycle, Anergic = anergic, Resting = not active. Full article ">

17 pages, 1614 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study

by Giovanni Cangelosi, Stefano Mancin, Paola Pantanetti, Marco Sguanci, Sara Morales Palomares, Alessia De Luca, Federico Biondini, Francesco Tartaglia, Gaetano Ferrara and Fabio Petrelli

Medicina 2024, 60(10), 1624; https://doi.org/10.3390/medicina60101624 - 4 Oct 2024

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Abstract

Background and Objectives: In Italy, as in the rest of the world, government restrictions aimed at containing the spread of COVID-19 primarily imposed limitations on social relationships and personal behavior. This situation significantly affected the management of chronic illnesses, including type 2 diabetes (T2D). The objective was to evaluate the perceptions of patients with T2D regarding the quality of care received during the COVID-19 pandemic and the impact on dietary and physical activity behaviors. Materials and Methods: We conducted a retrospective cross-sectional survey. Data were collected from June to July 2023 using the convenience sampling of patients with T2D, and the Patient Assessment of Chronic Illness Care (PACIC) and Medi-Lite questionnaires were administered. Results: During the research period, out of the 130 subjects who met all enrollment criteria, 103 patients were included in this study (79.23%). The results of the administered questionnaires were heterogeneous. The average scores from the PACIC Questionnaire for each question displayed significant variability, indicating a range of experiences in the quality of care. In the Medi-Lite survey, fruit, cereals, and olive oil showed the highest adherence levels, with mean scores ranging from 2.58 (SD ± 1.18) for fruit to 1.89 (SD ± 0.34) for olive oil and 1.97 (SD ± 0.17) for cereals. Patients who reported increased food intake during the lockdown attributed it to having more time to prepare meals. Physical activity levels remained unchanged for 48 patients, decreased for 45 patients, and only 9 patients managed to exercise more during the COVID-19 restrictions. Conclusions: Healthcare systems must prioritize comprehensive care plans for T2D that address not only physical health, but also emotional and social well-being. Post-pandemic, promoting healthier lifestyles and empowering patients to manage their condition is crucial. A multidisciplinary and multidimensional approach could support the care of vulnerable individuals, such as patients with T2D, especially during crises like pandemics or other dramatic events. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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9 pages, 305 KiB

Open AccessArticle

Changes in the Success and Characteristics of Tobacco Dependence Treatment before and during the COVID-19 Pandemic: Clinical Sample Comparisons

by Lenka Stepankova, Kamila Zvolska, Alexandra Pankova, Jakub Rafl, Gleb Donin, Ales Tichopad and Eva Kralikova

Medicina 2024, 60(9), 1459; https://doi.org/10.3390/medicina60091459 - 6 Sep 2024

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Abstract

Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy use, and the success rate. The aim of our study was to compare the number of patients who entered tobacco dependence treatment programmes and evaluate the one-year success rate in patients three years before and three years after the COVID-19 pandemic. Materials and Methods: A single-site retrospective cohort study using data from patients treated at the Centre for Tobacco Dependence in Prague, Czech Republic, between 2017 and 2022 (n = 2039) was performed. The one-year abstinence rate was validated by measuring carbon monoxide in exhaled air (6 ppm cut-off). Patients were divided into two groups: the group for which treatment was initiated in 2017–2019 (i.e., before the COVID-19 pandemic, BC; n= 1221) and the group for which treatment was initiated in 2020–2022 (i.e., during the COVID-19 pandemic, DC; n = 818). Results: No significant differences in the success rate of tobacco dependence treatment were found between the two groups (BC group, 40.5% (494/1221) vs. DC group, 42.2% (345/818)) (χ² (1, N = 2.039) = 0.6, p = 0.440). Furthermore, differences were not found in sex, education level, age at first cigarette, the duration of pharmacotherapy use, or the number of in-person visits. In contrast, there was an increase in the number of telephone contacts between the groups (18.7% (SD = 17.5%) vs. 32.9% (SD = 18.2%), p < 0.001). Conclusions: The number of patients who started treatment during the COVID-19 pandemic decreased by one-third compared to that during the 3-year period before the pandemic. The overall treatment success rate did not change significantly even with the increase in the number of telephone visits with the therapist. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

9 pages, 1130 KiB

Open AccessArticle

Reports of Batch-Dependent Suspected Adverse Events of the BNT162b2 mRNA COVID-19 Vaccine: Comparison of Results from Denmark and Sweden

by Vibeke Manniche, Max Schmeling, Jonathan D. Gilthorpe and Peter Riis Hansen

Medicina 2024, 60(8), 1343; https://doi.org/10.3390/medicina60081343 - 19 Aug 2024

Viewed by 29812

Abstract

Background and Objective: An unexpected batch-dependent safety signal for the BNT162b2 mRNA COVID-19 vaccine was recently identified in a nationwide study from Denmark, but the generalizability of this finding is unknown. Therefore, we compared batch-dependent rates of suspected adverse events (SAEs) reported to national authorities in Denmark and Sweden. Materials and Methods: SAE and vaccine batch data were received from national authorities in Denmark and Sweden, and analyses of heterogeneity in the relationship between numbers of vaccine doses and SAEs per batch were performed, along with comparison of SAE rates and severities for batches that were shared between the two countries. Results: Significant batch-dependent heterogeneity was found in the number of SAEs per 1000 doses for both countries, with batches associated with high SAE rates detected in the early phase of the vaccination campaign and positive correlations observed between the two countries for the severity of SAEs from vaccine batches that they shared. Mild SAEs predominated in the batches used in the early part of the vaccination roll-out, where markedly higher SAE rates per 1000 doses in Denmark for the batches that were shared between the two countries suggested that a large proportion of these SAEs were under-reported in Sweden. Conclusions: The batch-dependent safety signal observed in Denmark and now confirmed in Sweden suggests that early commercial batches of BNT162b2 may have differed from those used later on, and these preliminary and hypothesis-generating results warrant further study. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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10 pages, 1016 KiB

Open AccessArticle

Anti-COVID-19 Vaccination Alters the Menstrual Cycle and Dose Accumulation Enhances the Effect

by Hospital Español de Pachuca Research Group, Roque D. Licona-Meníndez and Alberto N. Peón

Medicina 2024, 60(6), 956; https://doi.org/10.3390/medicina60060956 - 8 Jun 2024

Viewed by 2060

Abstract

Background and Objectives: New investigations have detected an enhanced probability for women to develop menstrual cycle alterations after anti-COVID-19 vaccination. Moreover, given that the protective immunity provided by anti-COVID-19 vaccination appears to wane quickly, booster vaccination has been recommended. Nonetheless, whether adverse events arise from such repeated immunization has not been studied. Materials and Methods: We studied the incidence of menstrual cycle alterations, the quantity of menstrual cycle alterations per subject, and of altered menstrual cycles in nonpregnant women of fertile age after anti-COVID-19 vaccination in a cohort of vaccinated female subjects by the means of a standardized questionary that was applied via telephone calls each month. Subjects that received up to four doses were studied for 6 months after each dose. We calculated the odds ratio for enhanced incidence, as well as quadratic functions for the tendencies. A sensitivity analysis excluding subjects taking hormonal birth control and those with polycystic ovary syndrome was performed. Results: Anti-COVID-19 vaccination enhanced the probability to develop menstrual cycle alterations (OR 1.52, CI at 95% 1.2–1.8, p < 0.0001) and, interestingly, such a tendency was enhanced when subjects received more doses (R² = 0.91). Furthermore, the same trends repeated for the quantity of alterations per subject, and of altered cycles. Such an effect was further demonstrated to be independent upon the vaccine brand being applied, the birth control status, and the diagnosis of polycystic ovary syndrome. Conclusions: Vaccination is the most cost-effective measure for primary prevention and is considered to be safe. Nonetheless, in this article, we show data that suggest that repeated vaccination of adult female subjects may lead to an enhanced incidence of menstrual cycle–related adverse events, quantity of alterations per subject, and altered cycles. We therefore think that the development of new vaccine formulations that produce longer-lasting immunity is of paramount importance to reduce the potential for dose accumulation–dependent enhanced risk. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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Review

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15 pages, 6995 KiB

Open AccessReview

The Influence of GLP1 on Body Weight and Glycemic Management in Patients with Diabetes—A Scientometric Investigation and Visualization Study

by Ileana Pantea, Angela Repanovici and Oana Andreescu

Medicina 2024, 60(11), 1761; https://doi.org/10.3390/medicina60111761 - 27 Oct 2024

Viewed by 996

Abstract

Diabetes medications can affect weight and cardiovascular health. Some medications can aid in weight management, while others may lead to weight gain. Patients must be monitored and receive appropriate care to manage weight and prevent cardiovascular complications. Despite advancements in diabetes treatments that can influence weight and cardiovascular outcomes, ongoing research is necessary in this intricate field. Long-term effects, individual variations, and combination therapies are still subjects of uncertainty and ongoing investigation. The major objective of the research is to evaluate the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on body weight in diabetic patients through a scientometric assessment. Methodology: Research data were gathered from the Web of Science Core Collection (WoSCC) database by searching for the keywords “Body Weight”, dulaglutide, and semaglutide, identifying 60 relevant articles in the field. While there are advantages in managing diseases in which the cardiovascular system is implicated, there are also clinical considerations for personalized medicine and shared decision-making. The scientometric analysis of the articles revealed important insights into how dulaglutide and semaglutide impact weight management and their potential benefits for managing cardiovascular diseases in individuals with diabetes. Conclusions: Semaglutide shows superior outcomes compared to other commercially available GLP-1RAs, particularly in improving blood sugar control, lowering body weight, and addressing other cardio-metabolic risk factors in individuals with type 2 diabetes (T2DM). The findings suggest that GLP-1 RAs have the potential to provide cardiovascular protection by influencing various physiological factors such as blood pressure, pulse rate, glycated hemoglobin (HbA1c) levels, and the urinary albumin-to-creatinine ratio (RAC). The development and validation of the 4GI model provides a sophisticated tool for evaluating the complex interactions involved in diabetes treatments, offering insights into the mechanisms of action of various medications. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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Classification of GLP-1 RAs. Full article ">Figure 2
The methodology’s key steps. Full article ">Figure 3
Visualization of clusters. Full article ">Figure 4
Research directions—results from the clusters analysis. Full article ">Figure 5
Visualization of cluster one. Full article ">Figure 6
Visualization of cluster two. Full article ">Figure 7
Visualization of cluster three. Full article ">Figure 8
Visualization of cluster four. Full article ">Figure 9
Visualization of cluster five. Full article ">Figure 10
Visualization of cluster six. Full article ">

16 pages, 1206 KiB

Open AccessReview

Potential Impacts of Prolonged Face Mask Use on Temporomandibular Joint Health as Neglected Lifestyle Repercussions of COVID-19 Pandemic—A Narrative Review

by Szymon Jozef Pietrzyk, Emilia Kielczynska, Martyna Kowalczyk, Mateusz Mazurek and Zygmunt Antoni Domagala

Medicina 2024, 60(9), 1468; https://doi.org/10.3390/medicina60091468 - 8 Sep 2024

Viewed by 1129

Abstract

Since December 2019, COVID-19 has rapidly spread worldwide, prompting the World Health Organization (WHO) to declare it a pandemic and advocate for the widespread use of face masks to mitigate transmission. In this review, we delve into the potential impact of prolonged face mask use on temporomandibular joint (TMJ) health, an area that has garnered limited attention amidst COVID-19 research. Research has revealed that improper mask fit and constant readjustment can lead to TMJ abnormalities. Similarly, there is a demonstrated correlation between continuous mask usage and an increased incidence of headaches, temporomandibular pain, and diminished quality of life. Many studies have highlighted discomfort in the preauricular area, headaches, TMJ noises, headache, jaw pain, and muscle fatigue, as well as dermatological disorders, which have been attributed to prolonged mask wear and its impact on TMJ health. Our study catalyzes future research endeavors, urging a deeper exploration of the implications of long-term mask wear, not only in the context of the COVID-19 pandemic but also among occupational groups regularly exposed to extended mask use. By unraveling the complexities of TMJ health in the face of evolving preventive measures, we aim to enhance our understanding of this issue and safeguard the well-being of mask-wearers worldwide. Full article

(This article belongs to the Special Issue Public Health in the Post-pandemic Era)

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