Observed face mask use outside retail chain stores during the COVID-19 pandemic in two cities in the state of Idaho, USA

During the COVID-19 pandemic, public health authorities have encouraged the use of face masks to minimize transmission within the community. To assess mask wear during a COVID-19 surge and guide public health response efforts, including public messaging on mask recommendations, we compared observed mask use in the largest city in each of Idaho's 2 most populous counties, both without a current mask mandate. We recorded mask usage by every third person exiting stores of 5 retail chains in Boise and Nampa during November 8-December 5, 2021. Observations were conducted during three time periods (morning, afternoon, and evening) on weekday and weekend days. A multivariable model with city, retail chain, and city-chain interaction was used to assess mask wear differences by city for each chain. Of 3021 observed persons, 22.0% wore masks. In Boise, 31.3% (430/1376) of observed persons wore masks; in Nampa, 14.3% (236/1645) wore masks. Among all persons wearing masks, > 94% wore masks correctly; cloth and surgical masks were most common. By retail chain, observed individuals at Boise locations were 2.3-5.7 times as likely to wear masks than persons at respective Nampa locations. This study provided a rapid, nonconfrontational assessment of public use of mitigation measures in 2 Idaho cities during a COVID-19 surge.

Microbial and heavy metal contamination in herbal medicine: a prospective study in the central region of Saudi Arabia

INTRODUCTION

Herbal medicine is a medical system based on the utilization of plants or plant extracts for therapy. The continual increase in global consumption and the trade of herbal medicine has raised safety concerns in many regions. These concerns are mainly linked to microbial contamination, which could spread infections with multi-resistant bacteria in the community, and heavy metal contamination that may lead to cancers or internal organs' toxicity.

METHODS

This study was performed using an experimental design. A total of 47 samples, herbal medicine products sold in local stores in Qassim region, were used in the experiments. They were tested for bacterial contamination, alongside 32 samples for heavy metal analysis. Bacterial contamination was determined by the streak plate method and further processed to determine their antimicrobial susceptibility patterns using MicroScan WalkAway96 pulse; heavy metals were determined using a spectrometer instrument.

RESULTS

A total of 58 microorganisms were isolated. All samples were found to be contaminated with at least one organism except three samples. The majority of the isolated bacterial species were gram negative bacteria, such as Klebsiella spp., Pseudomonas spp. and E. coli., which could be of fecal origin and may lead to pneumonia, skin, or internal infections. Furthermore, most of the gram-positive bacteria were found to be multi-drug resistant. Moreover, for heavy metals, all samples had levels exceeding the regulatory limits.

CONCLUSION

This study demonstrated the presence of bacteria and heavy metals in samples of herbal medicines. Using these contaminated products may spread resistant infections, metal toxicities, or even cancers in the community.

Towards successful implementation of public health research into practice: Experiences and lessons learned from EDUCATE

Background

The English schools-based human papillomavirus (HPV) vaccination programme is routinely offered to all young people aged 12-13 years. The EDUCATE lesson was developed to overcome barriers to uptake related to unmet information needs by providing young people with information and answering questions they may have about the HPV vaccine. The resource comprises a PowerPoint presentation, interspersed with five short films and a guidance document for professionals delivering the lesson. Adopting public health research into practice is challenging and few papers describe the process. This paper reports the initial use of the EDUCATE resource in schools and the process involved in supporting wider implementation.

Study design

Implementation and knowledge mobilisation.

Methods

Five secondary schools supported implementation of the EDUCATE resource. Delivery took place during April and December 2022 and was observed in four schools, with feedback obtained from two school staff members and 15 young people. Alongside this, meetings were held with over 80 stakeholders with the aim of identifying possible policy levers to encourage use of the EDUCATE resource, and to enhance understanding of how wider scale and sustained impact can be achieved.

Results

Overall, the resource was positively received by school staff and young people engaged well during the lesson. As a result of the stakeholder networking activities, the research team worked with the Personal, Social, Health and Economic (PSHE) Association to adapt the materials to meet their Quality Assessment and incorporate elements, such as more interactive activities, requested during the implementation study.

Conclusion

The EDUCATE resource has the potential to change practice by enhancing information provision about the HPV vaccine in schools and supporting young people nationally to make informed decisions. Key learnings from the project include the importance of integrating input from target users at all stages of the research process, pragmatism in relation to evaluation research designs, and incentivising researchers to undertake translation activities through further funding and a greater focus on impact. Together, these can help facilitate the availability of public health resources and their adoption into 'real-world' practice.

Team effectiveness: epidemiologists' perception of collective performance during emergency response

BACKGROUND

To describe epidemiologists' experience of team dynamics and leadership during emergency response, and explore the utility of the Team Emergency Assessment Measure (TEAM) tool during future public health emergency responses. The TEAM tool included categories for leadership, teamwork, and task management.

METHODS

We conducted a cross-sectional survey between October 2019 and February 2020 with the global applied field epidemiology workforce. To validate the TEAM tool for our context, we used exploratory and confirmatory factor analysis.

RESULTS

We analysed 166 completed surveys. Respondents included national and international emergency responders with representation of all WHO regions. We were unable to validate the TEAM tool for use with epidemiology teams involved in emergency response, however descriptive analysis provided insight into epidemiology emergency response team performance. We found female responders were less satisfied with response leadership than male counterparts, and national responders were more satisfied across all survey categories compared to international responders.

CONCLUSION

Functional teams are a core attribute of effective public health emergency response. Our findings have shown a need for a greater focus on team performance. We recommend development of a fit-for-purpose performance management tool for teams responding to public health emergencies. The importance of building and supporting the development of the national workforce is another important finding of this study.

The Role of Physician Advocacy in Supporting Policy Change That Reduces Leaded Aviation Gasoline Emissions

BACKGROUND

Leaded aviation gasoline (AvGas) accounts for 70%, or 935,082 pounds, of total lead emissions in the United States and has been repeatedly linked to elevated blood lead levels (BLLs) in those living in the vicinity of airports using AvGas. The well-established link between lead exposure and adverse health outcomes provided a platform ripe for environmental health advocates and pediatric health experts to assist a local environmental health organization in addressing lead waste from a local airport, Montgomery-Gibbs Executive Airport (MYF).

METHOD

We detail the steps we took, as a physician clean-air advocacy group. We provide a qualitative analysis of our efforts in addressing leaded air pollution through targeted and creative environmental health advocacy through three main avenues: government, public awareness, and academia.

OBJECTIVES

Our actions were taken to ensure the City of San Diego installed an unleaded fuel tank at MYF to reduce leaded aviation gasoline usage and subsequently lead air pollution in the surrounding area.

DISCUSSION

Ultimately, the identified objective of an unleaded fuel tank was added to the San Diego City budget and scheduled for construction. We hope our actions can serve as a framework to provide concrete steps for clinicians and other advocates to enact change in their communities.

Public health community engagement with Asian populations in British Columbia during COVID-19: towards a culture-centered approach

OBJECTIVES

COVID-19 has posed significant challenges to those who endeavour to provide equitable public health information and services. We examine how community leaders, advocates, and public health communication specialists have approached community engagement among Asian immigrant and diaspora communities in British Columbia throughout the pandemic.

METHODS

Qualitative interviews with 27 participants working with Asian communities in a healthcare, community service, or public health setting, inductively coded and analyzed following the culture-centred approach to health communication, which focuses on intersections of structure, culture, and agency.

RESULTS

Participants detailed outreach efforts aimed at those who might not be reached by conventional public health communication strategies. Pre-existing structural barriers such as poverty, racial disparities, and inequitable employment conditions were cited as complicating Asian diaspora communities' experience of the pandemic. Such disparities exacerbated the challenges of language barriers, information overload, and rapidly shifting recommendations. Participants suggested building capacity within existing community service and public health outreach infrastructures, which were understood to be too lean to meet community needs, particularly in a pandemic setting.

CONCLUSION

A greater emphasis on collaboration is key to the provision of health services and information for these demographic groups. Setting priorities according to community need, in direct collaboration with community representatives, and further integrating pre-existing bonds of trust within communities into public health communication and engagement strategies would facilitate the provision of more equitable health information and services. This mode of engagement forgoes the conventional focus on individual behaviour change, and focuses instead on fostering community connections. Such an approach harmonizes with community support work, strengthening the capacity of community members to secure health during public health emergencies.

Exploration of barriers and facilitators to the implementation of the DREPADO randomized controlled trial: A qualitative study

PURPOSE

DREPADO is a randomized controlled trial (RCT) assessing the impact of a pediatric-adult transition program, on the health status of adolescents with sickle cell disease. Using a biopsychosocial approach with three main facets (educational, psychological and social interactions), it constitutes a complex transition program, which is quite difficult to implement. To facilitate the implementation of this complex program, the aim of this ancillary study is to explore barriers and facilitators at the early stages of this implementation.

METHODS

A qualitative study with semi-structured interviews was conducted, according to COREQ quality criteria, in patients with sickle cell disease who had already experienced the transition to adult care before DREPADO, and healthcare professionals working on the DREPADO RCT.

RESULTS

Semi-structured interviews were conducted with patients (n = 12) and healthcare professionals (n = 12) from November 2019 to May 2020. The main barriers identified by patients were time and implication required by this transition program. Healthcare professionals involved in the coordinating center mentioned changes in their working habits and also elements about the RCT regulatory procedures. Main facilitators reported by both patients and healthcare professionals were the positive perception of the transition program design, and especially the home setting for therapeutic education sessions.

CONCLUSION

This study led to the identification of main barriers and facilitators to the implementation of both the DREPADO intervention and RCT. These propositions could also be used to promote other complex public health interventions or/and other randomized controlled trials.

Epidemiology for public health practice: The application of spatial epidemiology

Spatial epidemiology is the description and analysis of geographic patterns and variations in disease risk factors, morbidity and mortality with respect to their distributions associated with demographic, socioeconomic, environmental, health behavior, and genetic risk factors, and time-varying changes. In the Letter to Editor, we had a brief description of the practice for the mortality and the space-time patterns of John Snow's map of cholera epidemic in London, United Kingdom in 1854. This map is one of the earliest public heath practices of developing and applying spatial epidemiology. In the early history, spatial epidemiology was predominantly applied in infectious disease and risk factor studies. However, since the recent decades, noncommunicable diseases have become the leading cause of death in both developing and developed countries, spatial epidemiology has been used in the study of noncommunicable disease. In the Letter, we addressed two examples that applied spatial epidemiology to cluster and identify stroke belt and diabetes belt across the states and counties in the United States. Similar to any other epidemiological study design and analysis approaches, spatial epidemiology has its limitations. We should keep in mind when applying spatial epidemiology in research and in public health practice.

Satisfaction of industrial health care managers regarding the work of industrial hygiene engineers: a cross-sectional study

BACKGRUOUND

A group health service is a system that delegates workplace health management to an entrusted institution. There have been various studies on group health services to date, but recent changes, such as an increase in foreign workers, are rapidly changing industry characteristics.

METHODS

Satisfaction was assessed using a 27-question survey distributed among 203 workplaces employing health professionals. The survey items consisted of general characteristics, comprehensive satisfaction, requirements for health professionals' work, and satisfaction with work environment management, ergonomic management, and healthcare management. Multiple regression and frequency analyses were performed.

RESULTS

The comprehensive satisfaction was 4.08 points on average, out of 5. The comprehensive satisfaction of health professionals in the industry was positively correlated with each factor. Hazardous materials and chemical management (material safety data sheets, MSDSs) were the most common requirements.

CONCLUSION

A low level of satisfaction with work environment management indicates high demand for healthcare management. The working environment should be improved by identifying characteristics of the workplace, examining harmful substances, inspecting equipment, and enhancing worker methods. The shorter the work experience of health professionals, the more dependent they are on group health services. The variables affecting comprehensive satisfaction were the period of work, healthcare management satisfaction, and work environment management satisfaction. Most of the requirements of health professionals in the workplace were practical improvement case presentations, MSDSs, and legal document management.

Abdominal volume index trajectories and risk of diabetes mellitus: Results from the China Health and Nutrition Survey

AIMS/INTRODUCTION

Abdominal obesity is a risk factor for developing diabetes mellitus, but trajectories of abdominal obesity over time and incident diabetes mellitus have not been considered. We derived trajectories of abdominal volume index (AVI) over 16 years of follow up, and examined the associations between AVI trajectories and risk of diabetes mellitus.

MATERIALS AND METHODS

Data were used from the China Health and Nutrition Survey, and 5,267 participants were enrolled to fit the trajectory of AVI by using latent class growth models. Multivariate logistic regression models explored the relationship between different AVI trajectories and risk of diabetes mellitus. In addition, we examined the slope of the AVI trajectories in relation to age to identify appropriate life course intervention opportunities for the prevention of diabetes mellitus.

RESULTS

Three trajectories were derived reflecting graded categories in the speed and slope of increase in AVI over time: slow, intermediate and fast increase group, respectively. After multivariate adjustment, the odds ratios for diabetes mellitus among those in the intermediate and fast increase groups were 1.81 (95% confidence interval 1.37-2.38, P < 0.001) and 2.80 (95% confidence interval 1.85-4.24, P < 0.001) respectively, relative to the slow increase group. The distribution of AVI slope in the slow increase group showed an inverted "U" shape, whereas the fast increase group presented a "U" shape.

CONCLUSIONS

AVI trajectory is associated with an increased risk of diabetes mellitus. These results provide new insights on the relationship between abdominal adiposity and diabetes mellitus, which in turn can help improve clinical and public health intervention for diabetes mellitus prevention.

Leadership, politics, and communication: challenges of the epidemiology workforce during emergency response

BACKGROUND

Improving the epidemiological response to emergencies requires an understanding of who the responders are, their role and skills, and the challenges they face during responses. In this paper, we explore the role of the epidemiologist and identify challenges they face during emergency response.

METHODS

We conducted a cross-sectional survey to learn more about epidemiologists who respond to public health emergencies. The online survey included open and closed-ended questions on challenges faced while responding, the roles of epidemiology responders, self-rating of skills, and support needed and received. We used purposive sampling to identify participants and a snowballing approach thereafter. We compared data by a number of characteristics, including national or international responder on their last response prior to the survey. We analysed the data using descriptive, content, and exploratory factor analysis.

RESULTS

We received 166 responses from individuals with experience in emergency response. The most frequently reported challenge was navigating the political dynamics of a response, which was more common for international responders than national. National responders experienced fewer challenges related to culture, language, and communication. Epidemiology responders reported a lack of response role clarity, limited knowledge sharing, and communication issues during emergency response. Sixty-seven percent of participants reported they needed support to do their job well; males who requested support were statistically more likely to receive it than females who asked.

CONCLUSIONS

Our study identified that national responders have additional strengths, such as better understanding of the local political environment, language, and culture, which may in turn support identification of local needs and priorities. Although this research was conducted prior to the COVID-19 pandemic, the results are even more relevant now. This research builds on emerging evidence on how to strengthen public health emergency response and provides a platform to begin a global conversation to address operational issues and the role of the international epidemiology responder.

Transdisciplinarity of India's master's level public health programmes: evidence from admission criteria of the programmes offered since 1995

INTRODUCTION

In the Indian subcontinent, Master's-level Public Health (MlPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MlPH admissibility criteria 1995 to 2021.

METHODS

Using a search strategy, we abstracted information available in the public domain on MlPH programmes and their admissibility criteria. We categorized the admission criteria based on specified disciplines into Health science, Non-health science and Non-health non-science categories. We described the MlPH programmes by location, type of institution, course duration, curriculum, pedagogical methods, specializations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for MlPH admission.

RESULTS

Overall, 76 Indian institutions (Medical colleges-21 and Non-medical coleges-55) offered 92 MlPH programmes (Private-58 and Public-34). We included 89 for review. These programmes represent a 51% increase (n = 47) from 2016 to 2021. They are mostly concentrated in 21 Indian provinces. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "3-year bachelor's degree in any discipline", "graduation from any Indian universities", and "graduation in any discipline". Among the health science disciplines, Modern medicine (n = 89; 100%), Occupational therapy (n = 57; 64%) is the least eligible. Among the non-health science disciplines, life sciences and behavioural sciences (n = 53; 59%) and non-health non-science disciplines, humanities and social sciences (n = 62; 72%) are the topmost eligible disciplines for admission in the MPH programmes.

CONCLUSION

Our review suggests that India's MlPH programmes are less transdisciplinary. Relatively, non-medical institutions offer admission to various academic disciplines than the medical institutions in their MlPH programmes. India's Master's level public health programmes could be more inclusive by opening to graduates from trans-disciplinary backgrounds.

[Future National Public Health Agency: an opportunity for the public health system in Spain]

The creation of a national centre for public health, with adequate resources, will make it possible to face the public health challenges of the present and the future in our country. To this end, the proposed state agency, should hold functions based on advanced public health organizational schemes, while linking with the sustainable development goals. The coordination of a national public health strategy built on a collaborative network of networks would also be essential, as developing an innovative, benchmarked and prioritised public health communication strategy, among other tasks. The lack of resources, the current relative disconnection of essential public health functions at the state level, and the inequity in their development of these functions at the regional and municipal levels, favour the development of the agency project as a network of networks. In this paper we give ideas for a process that seems decisive for Spanish public health in the 21st century.

Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US

In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected states (CO, CT, FL, MI, and VA), querying participants regarding substance use and overdose in their communities and institutions, and their preparedness to respond. We describe substance use and overdose patterns, as well as correlates of naloxone uptake, in public libraries. Participating library staff (N = 356) reported witnessing alcohol use (45%) and injection drug use (14%) in their libraries in the previous month. Across states surveyed, 12% of respondents reported at least one on-site overdose in the prior year, ranging from a low of 10% in MI to a high of 17% in FL. There was wide variation across states in naloxone uptake at libraries, ranging from 0% of represented libraries in FL to 33% in CO. Prior on-site overdose was associated with higher odds of naloxone uptake by the library (OR 2.5, 95% CI 1.1-5.7). Although 24% of respondents had attended a training regarding substance use in the prior year, over 90% of respondents wanted to receive additional training on the topic. Public health professionals should partner with public libraries to expand and strengthen substance use outreach and overdose prevention efforts.

Tackling the global health threat of arboviruses: An appraisal of the three holistic approaches to health

Background: The rapid circulation of arboviruses in the human population has been linked with changes in climatic, environmental, and socio-economic conditions. These changes are known to alter the transmission cycles of arboviruses involving the anthropophilic vectors and thus facilitate an extensive geographical distribution of medically important arboviral diseases, thereby posing a significant health threat. Using our current understanding and assessment of relevant literature, this review aimed to understand the underlying factors promoting the spread of arboviruses and how the three most renowned interdisciplinary and holistic approaches to health such as One Health, Eco-Health, and Planetary Health can be a panacea for control of arboviruses. Methods: A comprehensive structured search of relevant databases such as Medline, PubMed, WHO, Scopus, Science Direct, DOAJ, AJOL, and Google Scholar was conducted to identify recent articles on arboviruses and holistic approaches to health using the keywords including "arboviral diseases", "arbovirus vectors", "arboviral infections", "epidemiology of arboviruses", "holistic approaches", "One Health", "Eco-Health", and "Planetary Health". Results: Changes in climatic factors like temperature, humidity, and precipitation support the growth, breeding, and fecundity of arthropod vectors transmitting the arboviral diseases. Increased human migration and urbanization due to socio-economic factors play an important role in population increase leading to the rapid geographical distribution of arthropod vectors and transmission of arboviral diseases. Medical factors like misdiagnosis and misclassification also contribute to the spread of arboviruses. Conclusion: This review highlights two important findings: First, climatic, environmental, socio-economic, and medical factors influence the constant distributions of arthropod vectors. Second, either of the three holistic approaches or a combination of any two can be adopted on arboviral disease control. Our findings underline the need for holistic approaches as the best strategy to mitigating and controlling the emerging and reemerging arboviruses.

Indicators for dental appointment scheduling in primary health care: a national cross-sectional study

Background

Integrated dental services within the Health System, particularly at primary health care, are crucial to reverse the current impact of oral diseases, which are among the most prevalent diseases worldwide. However, the use of dental services is determined by complex phenomena related to the individual, the environment and practices in which care is offered. Therefore, factors associated with dental appointments scheduling can affect positively or negatively the use of dental services. The aim of the present study was to evaluate the indicators for dental appointment scheduling in Primary Health Care (PHC).

Methods

The present is a cross-sectional analytical study that used data from the external assessment of the third cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), carried out between 2017 and 2018, in Brazil. The final sample consisted of 85,231 patients and 22,475 Oral Health teams (OHTs). The outcome variable was the fact that the user sought for a dental appointment at the Primary Health Care Unit. A multilevel analysis was carried out to verify the association between individual variables (related to users) and contextual variables (related to the OHTs) in relation to the outcome.

Results

Only 58.1% of the users interviewed at these Primary Health Care Units seek the available dental care. The variables with the greatest effect on the outcome were the patient’s age up to 42 years old (OR = 2.03, 95% CI: 1.96–2.10), at individual level, and ‘oral health teams that assisted no more than a single family health team (FHT)’ (OR = 1.29, 95% CI: 1.23–1.36) at contextual level. Other variables were also associated with the outcome, but with a smaller effect size.

Conclusion

In conclusion, users’ age and work process of OHT were indicators for dental appointment scheduling. Our results suggest that when OHT put the National Oral Health Policy guidelines into practice, by assisting only one FHT, the chance for PHC users seeking dental appointments is higher than OHTs that assist more than one FHT. Regarding age, patients aged up to 42 years are more likely to seek an appointment with a dentist.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12319-x.

Application of a return of investment analysis for public health training by case study

BACKGROUND

Local health departments require assurance of competence of their workforce to prevent and mitigate outbreaks by supporting the implementation of evidence-based actions in clinical practice, medical procedures and infection control practices. Too often outdated policies or reduction in budgets prevent the appropriate training strategies or resources to recruit, retain or support this capability.

DESIGN AND METHODS

In this 2018 case study analysis, we coupled the Phillip's Return on Investment model with a standard financial proforma model to make a business case that investing in training, specifically the Certification in Infection Control (CIC), was worthwhile for cost reduction, improved knowledge, skills and abilities (KSA's) and improved employee retention.

RESULTS

Our model demonstrated that our initial investment (USD $1,840) was profitable based on the internal rate of return (IRR = 130%, Year. 5), payback period (0.71 years), Benefit Cost Ratio (BCR = 1.41) and Return of Investment (ROI = 41%), if an epidemiologist worked a minimum of 3 healthcare associated infection outbreaks per year. Data from 4 local epidemiologists demonstrated that the application of KSA's reduced investigation hours by 10%-25% for all types of outbreaks with payback periods of less than 6 months and positive ROIs for staff with retention greater than 1 year. Our model demonstrated that at the highest end of our investment costs (US $2940) with an investigation improve efficiency of 25%, the IRR was 85% after year 5 with a payback period of 1.13 years if the epidemiologist worked on 3 HAI outbreaks per year over the 5 years.

CONCLUSIONS

Our results validate the profitability of investment into the CIC for local epidemiologists if they could be retained longer than the payback period. The model provides a method for managers to leverage training opportunities for employee retention while ensuring competencies in the workforce.

Solving gender gaps in health, what else is missing?

In recent years, a great deal of attention has been paid to gender inequities in health. However, while we have a good body of evidence on the impact of gender on the health and vulnerability of women and men, we have not yet been able to generate sufficient evidence on effective interventions that can transform this situation or can influence public health policy making. Only a limited number of educational interventions on gender-sensitivity, gender bias in clinical practice and policies to tackle gender inequalities in health have been formulated, implemented and evaluated. Even in the current pandemic situation caused by SARS-CoV2, we have seen the lack of gender mainstreaming reflected in the global response. This happens even when we have tools that facilitate the formulation and implementation of actions to reduce gender inequities in health. We consider that the current initiatives organized to carry out advocacy activities on gender inequity in health to be very positive. In the same line of these initiatives, we propose that while academic and institutional research on gender and health remains essential, we need to shift the focus towards action. In order to move forward, we need public health researchers questioning what public health practice need to do to address gender inequities and shake structural and social power inequities in order to increase the gender equity in health.

A Systematic Review of the Social Network Strategy to Optimize HIV Testing in Key Populations to End the Epidemic in the United States

The United States (U.S.) has a plan to end the HIV epidemic by 2030. The plan’s first pillar prioritizes HIV testing. Social Network Strategy (SNS) is an intervention to reach persons not routinely testing for HIV. We conducted a systematic review of SNS to understand its implementation to optimize HIV testing in the U.S. among key populations. The eligibility criteria included peer-reviewed papers based in the U.S. and focused on HIV testing. We identified and thematically analyzed 14 articles to explore factors associated with successful implementation. Key themes included: (1) social network and recruiter characteristics; (2) strategies for and effectiveness of recruiting key populations; (3) use of and types of incentives; (4) trust, confidentiality, and stigma concerns; and (5) implementation plans and real-world guidance. Cohort studies indicated that SNS detects more incident HIV cases. Partnerships with health departments are critical to confirm new diagnoses, as are developing plans that support recruiters and staff. SNS is a promising strategy to optimize HIV testing among key populations.

The U.S. national biomonitoring network - Enhancing capability and capacity to assess human chemical exposures

BACKGROUND

With the increased use of biomonitoring in public health, biomonitoring networks are forming worldwide. The National Biomonitoring Network (NBN), created in 2018, is an interconnected system of U.S. government laboratories in collaboration with public health partners, to advance human biomonitoring science and practice. The NBN aims to harmonize biomonitoring data for use in routine public health practice.

METHODS

The NBN has taken a systems approach to provide high-quality biomonitoring data by establishing quality standards, mentoring nascent programs, and enhancing analytical capability and capacity through technical assistance. Guided by a multi-disciplinary Network Steering Committee (NSC), the NBN has developed an organizational framework, membership criteria, and guidance practices related to study design, quality management and analytical measurements. To facilitate the production of these resources, the NSC established interdisciplinary workgroups of subject matter experts.

RESULTS

To date, 20 state public health laboratories have joined the NBN. Differences in land-use practices, state and local laws and availability of resources resulted in considerable variability in the design and approach of NBN member biomonitoring programs. By contributing technical guidance, technical training, examples and templates for analytical and epidemiological practices and opportunities for collaboration and interaction, the NBN addressed some of these challenges. Important challenges remaining are to define minimum data variables for laboratory measurements, demographic and exposure information, and to identify an appropriate national repository for biomonitoring data.

CONCLUSION

The current NBN membership has greatly benefited from the resources, collaboration and engagement with other state and federal scientists. The NBN hopes to expand membership and increase interaction with biomonitoring networks internationally. While the objectives of biomonitoring networks around the world may differ, understanding their structures, advantages and limitations inform the NBN and provide opportunity for cross-network collaboration.

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community's needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent's capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

Development and implementation of a logic model: Occupational stress, physical activity, and sedentary behavior in the workplace

BACKGROUND

An increasing level of occupational stress is a major problem in the workplace that requires innovative approaches and strategies. An understudied research area pertains to the effects that physical activity performed during the workday have on occupational stress.

OBJECTIVE

To determine if and how an intervention that increases physical activity and reduces sedentary behavior affects workplace stress. The population of interest are employees at a large university medical center including supportive staff, healthcare professionals, physicians, and faculty members; the study design is longitudinal; the approach is the implementation of an innovative workplace program (i.e., the Booster Break).

METHODS

We present a logic model promoting physical activity and reducing sitting time during the workday as a feasible and practical strategy to cope with occupational stress.

RESULTS

The logic model approach emphasizes that funding, partnerships, and incentives are inputs to implementing program activities such as Booster Break sessions, weekly meetings, social support, and personal self-monitoring. Short-term outcomes were categorized as psychosocial, goal setting, organizational, and social; intermediate outcomes were behavioral and psychosocial; and long-term outcomes were health status and physiological status.

CONCLUSIONS

This study is the first known effort to outline a comprehensive intervention based on changing physical activity and sedentary behavior during the workday and the concomitant effects on occupational stress. The findings of this study can be used to develop and implement interventions at workplaces to target increases in physical activity, decreases in sedentary time, and improvements in overall employee health.

The match between what is prescribed and reasons for prescribing in exercise referral schemes: a mixed method study

Background

Exercise referral schemes (ERS) aim to tackle non-communicable disease (NCD) by increasing physical activity levels through prescribed exercise. However, there is a sparsity of knowledge upon what exercises are prescribed and if they are targeted towards tackling NCD.

Method

Mixed methods were employed. Quantitative data was extracted from exercise prescription cards of 50 participants and were assessed for frequency, intensity, type and time of prescribed exercise. Descriptive measures of aggregate data are expressed as median (range: minimum-maximum). Thematic analysis of semi-structured interviews generated qualitative data on exercise referral instructors’ experiences of prescribing exercise.

Results

Thirty-eight different types of exercise were prescribed. Median prescription was 4 (1–11) exercises per session, at a moderate intensity. Participants were prescribed a median of 35 (5–70) minutes of aerobic exercise per referral session. Exercise referral instructors prescribed exercise to improve activities of daily living, promote independence and autonomy of participants, rather than explicitly targeting the referral condition.

Conclusions

Knowledge that prescribed exercises are not explicitly targeted to the referral condition provides critical information in understanding the purpose of exercise prescription. Future evaluations of ERS should be mindful of this, that is, perceived outcomes might not match up to what is being prescribed within ERS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11094-z.

Barriers and activities to implementing or expanding influenza vaccination programs in low- and middle-income countries: A global survey

INTRODUCTION

Despite considerable global burden of influenza, few low- and middle-income countries (LMICs) have national influenza vaccination programs. This report provides a systematic assessment of barriers to and activities that support initiating or expanding influenza vaccination programs from the perspective of in-country public health officials.

METHODS

Public health officials in LMICs were sent a web-based survey to provide information on barriers and activities to initiating, expanding, or maintaining national influenza vaccination programs. The survey primarily included Likert-scale questions asking respondents to rank barriers and activities in five categories.

RESULTS

Of 109 eligible countries, 62% participated. Barriers to influenza vaccination programs included lack of data on cost-effectiveness of influenza vaccination programs (87%) and on influenza disease burden (84%), competing health priorities (80%), lack of public perceived risk from influenza (79%), need for better risk communication tools (77%), lack of financial support for influenza vaccine programs (75%), a requirement to use only WHO-prequalified vaccines (62%), and young children require two vaccine doses (60%). Activities for advancing influenza vaccination programs included educating healthcare workers (97%) and decision-makers (91%) on the benefits of influenza vaccination, better estimates of influenza disease burden (91%) and cost of influenza vaccination programs (89%), simplifying vaccine introduction by focusing on selected high-risk groups (82%), developing tools to prioritize target populations (80%), improving availability of influenza diagnostic testing (79%), and developing collaborations with neighboring countries for vaccine procurement (74%) and regulatory approval (73%). Responses varied by country region and income status.

CONCLUSIONS

Local governments and key international stakeholders can use the results of this survey to improve influenza vaccination programs in LMICs, which is a critical component of global pandemic preparedness for influenza and other pathogens such as coronaviruses. Additionally, strategies to improve global influenza vaccination coverage should be tailored to country income level and geographic location.

Shaping applied epidemiology workforce training to strengthen emergency response: a global survey of applied epidemiologists, 2019-2020

BACKGROUND

Rapid and effective emergency response to address health security relies on a competent and suitably trained local and international workforce. The COVID-19 pandemic has highlighted that the health security workforce needs to be well equipped to tackle current and future challenges. In this study, we explored whether training in applied epidemiology was meeting the current needs of the applied epidemiology workforce.

METHOD

We conducted a cross-sectional online survey that was available in English and French. We used purposive and snowballing sampling techniques to identify potential survey respondents. An online social media advertisement campaign was used to disseminate a REDCap survey link between October 2019 and February 2020 through field epidemiology networks. Survey questions included demographic details of participants, along with their technical background, level of formal education, topics studied during epidemiology training, and years of experience as an epidemiologist. We used Pearson Chi-squared (Chi2) to test the difference between categorical variables, and content analysis to evaluate responses to open-ended questions.

RESULTS

In total, 282 people responded to the survey. Participants had a range of formal public health and epidemiology training backgrounds. Respondents applied epidemiology experience spanned almost 30 years, across 64 countries. Overall, 74% (n = 210) were alumni of Field Epidemiology Training Programs (FETP). Basic outbreak and surveillance training was well reported by respondents, however training in specialised techniques related to emergency response, communication, and leadership was less common. FETP graduates reported higher levels of formal training in all survey topics.

CONCLUSION

It is critical for the health security workforce to be well-trained and equipped with skills needed to ensure a rapid and effective response to acute public health events. Leadership, communication, interpersonal skills, and specialist training in emergency response are lacking in current training models. Our study has demonstrated that applied epidemiology workforce training must evolve to remain relevant to current and future public health challenges.

Outbreak response operations during the US measles epidemic, 2017-19

BACKGROUND

To understand operational challenges involved with responding to US measles outbreaks in 2017-19 and identify applicable lessons in order to inform preparedness and response operations for future outbreaks, particularly with respect to specific operational barriers and recommendations for outbreak responses among insular communities.

METHODS

From August 2019 to January 2020, we conducted 11 telephone interviews with 18 participants representing state and local health departments and community health centers that responded to US measles outbreaks in 2017-19, with a focus on outbreaks among insular communities. We conducted qualitative, thematic coding to identify and characterize key operational challenges and lessons identified by the interviewees.

RESULTS

We categorized principal insights into 5 topic areas: scale of the response, vaccination operations, exclusion policies, community engagement, and countering anti-vaccine efforts. These topics address resource-intensive aspects of these outbreak responses, including personnel demands; guidance needed to support response operations and reduce transmission, such as excluding exposed or at-risk individuals from public spaces; operational challenges and barriers to vaccination and other response activities; and effectively engaging and educating affected populations, particularly with respect to insular and vulnerable communities.

CONCLUSIONS

Measles outbreak responses are resource intensive, which can quickly overwhelm existing public health capacities. Early and effective coordination with trusted leaders and organizations in affected communities, including to provide vaccination capacity and facilitate community engagement, can promote efficient response operations. The firsthand experiences of public health and healthcare personnel who responded to measles outbreaks, including among insular communities, provide evidence-based operational lessons that can inform future preparedness and response operations for outbreaks of highly transmissible diseases.

Conditions for successful interprofessional collaboration in integrated care - Lessons from a primary care setting in Denmark

INTRODUCTION

Increasing demand for interprofessional collaboration in health care settings has led to a greater focus on how conditions influence the success of interprofessional collaboration, but little is known about the magnitude of the interactions between different conditions. This paper aims to examine the relationships of intervention conditions and context conditions at the professional and organisational level and examine how they influence the staff's perceived success of the interprofessional collaboration.

METHODS

The study was conducted as a multilevel cross-sectional survey in March of 2019 in the second largest municipality in Denmark, Aarhus. The study population was all frontline-staff members and managers in nursing homes, home care units and health care units. The final sample consisted of 498 staff members and 27 managers. Confirmatory path analysis was used to analyse the data.

RESULTS

The results indicate that context conditions greatly influence intervention conditions at the professional and organisational level and that the professional and organisational levels moderately co-variate. Professional level context conditions have the biggest influence on staff's perceived success, partly because its influence is confounded by intervention conditions.

CONCLUSION

Practice and research in health care settings should re-focus their attention from a broad understanding of context as unchangeable and inconsequential, to understanding context as an important condition type for interprofessional collaboration that needs to be further understood and researched.

The experience of social distancing for families with children and adolescents during the coronavirus (COVID-19) pandemic in Uruguay: Difficulties and opportunities

The social distancing measures implemented to contain the coronavirus (COVID-19) pandemic worldwide have created a series of emotional and economic challenges. The aim of the present work was to explore the experiences of families with children and adolescents during the coronavirus (COVID-19) pandemic in Uruguay. An online study was conducted in March 2020 with 1725 parents with children under 18 years old. A series of closed and open-ended questions about their family life since the implementation of social distancing measures were asked, addressing the following topics: how they had felt, changes they had experienced in their daily life, children's daily routine, changes implemented in relation to child-care, changes they had perceived in children's eating patterns, changes in their relationship with their children, changes in their children's mood and behavior, and their reaction to those changes. Results showed that the coronavirus pandemic elicited negative feelings in the majority of participants, mainly related to worry, fear, anxiety and uncertainty. Social distancing measures caused a major disruption in daily habits, which were mostly attributed to changes in work-related activities and the closure of educational institutions. Changes in children's mood and behavior were perceived by the majority of the participants, who mainly referred to boredom, agitation and restlessness. Although some participants reported difficulties to cope with children's behavior during social distancing, others valued the opportunity of spending more time with their children. In terms of children's eating patterns, changes related to both an increase and a decrease in the consumption of healthy foods were observed. Results from the present work have relevant implications for public health policy and practice by highlighting the importance of providing emotional and psychological support to people during social distancing measures and providing insights for the design of communication campaigns and interventions.

Merging academy and healthcare in the Public Health training of medical students

Background

Public Health remains central to understand health and its determinants, and Public Health teams are essential for an integrated collaborative medical practice. However, current teaching of public health to medical students varies in the European Region though an investment in multidisciplinary workforce is recognised essential to deliver high quality public health services. A recent medical education curricula restructuring in the University of Porto Medical School resulted in the inclusion of a Public Health module linking academic teaching to field practice and provided the opportunity to make an initial appraisal of students’ perceptions.

Case study

We analysed final reports (n = 196), debriefing meetings notes (n = 2), and e-mails sent by students (n = 34) regarding the activities they observed or participated at, their contact with Public Health services’ teams, knowledge and critical appraisal, and opinion about the module. Students gained basic knowledge about how epidemiological surveillance, environmental health, health planning, and health promotion are performed in practice. They reported a better understanding of the roles and importance of Public Health services and its teams. Most considered that this module had an important role in their training. Some activities observed in the field lacked the needed standardisation to provide the students the feeling that core operations were experienced, which needs to be addressed in the future.

Conclusions

Public Health practice-based training within field institutions may bring a better understanding of the discipline and specialty for medical students. It may strengthen interconnectivity and coordination of healthcare agents, which may improve future medical practice with potential improvement of patient-centred care and in terms of public health response, and back their roles as health agents and decision-makers.

The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR): Unique 1.4 M patient Electronic Health Record cohort

BACKGROUND

The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR) study uses a novel Electronic Health Record (EHR) data approach as a tool to assess the epidemiology of known and new risk factors for type 2 diabetes mellitus (T2DM) and study how prevention interventions affect progression to and onset of T2DM. We created an electronic cohort of 1.4 million patients having had at least 4 encounters with a healthcare organization for at least 24-months; were aged ≥18 years in 2010; and had no diabetes (i.e., T1DM or T2DM) at cohort entry or in the 12 months following entry. EHR data came from patients at nine healthcare organizations across the U.S. between January 1, 2010-December 31, 2016.

RESULTS

Approximately 5.9% of the LEADR cohort (82,922 patients) developed T2DM, providing opportunities to explore longitudinal clinical care, medication use, risk factor trajectories, and diagnoses for these patients, compared with patients similarly matched prior to disease onset.

CONCLUSIONS

LEADR represents one of the largest EHR databases to have repurposed EHR data to examine patients' T2DM risk. This paper is first in a series demonstrating this novel approach to studying T2DM.

IMPLICATIONS

Chronic conditions that often take years to develop can be studied efficiently using EHR data in a retrospective design.

LEVEL OF EVIDENCE

While much is already known about T2DM risk, this EHR's cohort's 160 M data points for 1.4 M people over six years, provides opportunities to investigate new unique risk factors and evaluate research hypotheses where results could modify public health practice for preventing T2DM.

A quality improvement collaborative to increase human papillomavirus vaccination rates in local health department clinics

Human papillomavirus (HPV) vaccination rates are well below the Healthy People 2020 goal of 80%. Vaccinating in settings other than primary care, such as local health departments (LHDs), may help achieve higher HPV immunization rates. We tested the effect of a quality improvement (QI) collaborative to reduce missed opportunities (MOs) for HPV vaccine in LHDs. Between 2016 and 2019, we conducted four consecutive cohorts of a virtual QI collaborative at 24 LHDs across multiple states. Participants were trained on topics including how to provide an effective recommendation for HPV vaccine, strategies to reduce MOs, and motivational interviewing. Throughout the 6-month project implementation, LHDs tested strategies to reduce MOs through Plan-Do-Study-Act cycles, performed chart reviews to identify and characterize MOs, and received feedback reports to assess progress on MOs. HPV vaccination rates were assessed pre- and post-intervention. LHDs reduced MOs for HPV vaccine in all four cohorts with aggregated data showing a 25.3 percentage point reduction in MOs. Modified Poisson regression analysis found a 44% reduction in the relative risk of missing the opportunity for an HPV vaccine at a visit (RR = 0.56, 0.46-0.68, p < .001). This project shows that strategies effective in reducing MO for HPV vaccine in primary care settings are also effective in LHD settings. Training LHD staff on these strategies may help the U.S. approach national goals for HPV vaccine coverage.

[Reinventing a public health organization]

Las organizaciones más avanzadas son descentralizadas, colaborativas y adaptativas. Esto les proporciona una capacidad de gestión de las situaciones complejas. A estas organizaciones, Laloux las llama Teal. El objetivo de este manuscrito es describir el proceso de implementación del modelo de gestión Teal en la Agència de Salut Pública de Barcelona (ASPB). Existe una triple oportunidad para innovar en la ASPB: el cambio político hacia un gobierno progresista, la organización está en un momento de renovación masiva de su personal con un cambio generacional que facilita la comprensión del modelo Laloux, y las personas directivas tienen un bagaje técnico con una larga trayectoria en la organización, lo que las hace conocedoras de las capacidades de esta. El proceso se pone en marcha empezando con la implicación de un grupo reducido de personas (Grupo Llavor) para después ser ampliado (Grupo Planter). Además de discutir las bases del modelo Laloux, se forman seis grupos de trabajo (Cómo organizar reuniones más eficaces, Espacios físicos, Espacios de reflexión/confianza, Banco del tiempo, Jornada anual del personal de la ASPB y Espacio para escuchar la voz de las personas trabajadoras de la ASPB) y se organizan talleres informativos dirigidos a toda la organización, en los que participan 67 personas. En total, unas 120 personas de la organización han participado en actividades del Grupo Planter. El éxito de las primeras iniciativas deberá servir para que los valores y principios cultivados vayan traspasando las fronteras de los proyectos para convertirse en un estilo generalizado de gestión.

Patterns of prescription, hospitalizations and costs of herpes zoster in patients at risk, from a large Italian claims database

Purpose

This observational study aimed to investigate the incidence of herpes zoster (HZ) among at-risk subjects aged ≥50 years, characterize them and assess annual healthcare utilization and costs from the Italian National Health System (NHS) perspective.

Methods

Records of reimbursed drug prescriptions, hospitalizations and outpatient specialist care from the Fondazione ReS database were linked to identify patients aged ≥50 years at HZ risk (i.e. cardiovascular disease/chronic obstructive pulmonary disease/diabetes/immunosuppression, according to the Italian National Vaccine Prevention Plan - PNPV 2017-2019) in 2013. New HZ events (incidence per 1,000) were researched in 2 years, and subjects with HZ in the previous year were excluded. Antiviral and pain therapy consumptions, hospitalizations for HZ and costs paid by NHS were assessed annually.

Results

From 12,562,609 inhabitants in 2013, a total of 1,004,705 patients (18.5% aged ≥50 years) at risk without a previous event were selected. The 2-year incidence of HZ was 5.9 per 1,000 (mean age 74 ± 10 years; 54.3% female). Patients aged 80-89 (7.2 per 1,000), females (6.7 per 1,000) and immunosuppressed subjects (6.9 per 1,000) had the highest incidence rates. One year after the new HZ episode, 82.2% were treated with specific antivirals (79.3% brivudine), generating an annual average cost/treated of €106; 8.0% were hospitalized for HZ, with an average cost/hospitalized of €3,927; the overall mean cost/incident patient was €402.

Conclusions

This analysis provided HZ incidence in subjects aged ≥50 years considered at risk by the PNPV and its burden from the NHS perspective. Our findings can help health governance to improve clinical decisions and economic positioning concerning zoster vaccine plan.

Sarcopenia is associated with severe erectile dysfunction in older adults: a population-based cohort study

BACKGROUND/AIMS

Sarcopenia and erectile dysfunction (ED) are associated with poor health and quality of life in older men. We investigate the association between sarcopenia and severe ED in community-dwelling older men.

METHODS

We prospectively assessed sarcopenia and ED in 519, community-dwelling, older men (mean age, 74.0) in Pyeongchang, Korea, in 2016 to 2017. Sarcopenia was based on muscle mass, grip strength, and gait speed according to the Asian Working Group consensus algorithm. Severe ED was defined as 5-item International Index of Erectile Function questionnaire score under 8. Logistic regressions were used to study associations between incident severe ED and sarcopenia, after adjusting age, cardiovascular risk factors, depression, and polypharmacy.

RESULTS

The prevalence of severe ED was 52.4% and that of sarcopenia was 31.6%. At baseline, the prevalence of severe ED was higher in men with sarcopenia than in those without (73.2% vs. 42.8%; adjusted odds ratio [aOR], 1.89; 95% confidence interval [CI], 1.18 to 3.03; p = 0.008). Slow gait speed (aOR, 2.80; 95% CI, 1.18 to 6.62; p = 0.019) and decreased muscle mass (aOR, 2.54; 95% CI, 1.11 to 5.81; p = 0.027) were associated with the incidence of severe ED, while decreased grip strength (aOR, 0.76; 95% CI, 0.30 to 1.91; p = 0.564) was not.

CONCLUSION

Sarcopenia was associated with severe ED. Slow gait speed, and decreased muscle mass was independently associated with incident severe ED at 1 year. Further research is warranted to examine whether an intervention targeting these components can prevent severe ED.

Perceived utility and feasibility of pathogen genomics for public health practice: a survey among public health professionals working in the field of infectious diseases, Belgium, 2019

BACKGROUND

Pathogen genomics is increasingly being translated from the research setting into the activities of public health professionals operating at different levels. This survey aims to appraise the literacy level and gather the opinions of public health experts and allied professionals working in the field of infectious diseases in Belgium concerning the implementation of next-generation sequencing (NGS) in public health practice.

METHODS

In May 2019, Belgian public health and healthcare professionals were invited to complete an online survey containing eight main topics including background questions, general attitude towards pathogen genomics for public health practice and main concerns, genomic literacy, current and planned NGS activities, place of NGS in diagnostic microbiology pathways, data sharing obstacles, end-user requirements, and key drivers for the implementation of NGS. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic analysis was used to analyze free text responses. A multivariable logistic regression model was constructed to identify important predictors for a positive attitude towards the implementation of pathogen genomics in public health practice.

RESULTS

146 out of the 753 invited public health professionals completed the survey. 63% of respondents indicated that public health agencies should be using genomics to understand and control infectious diseases. Having a high level of expertise in the field of pathogen genomics was the strongest predictor of a positive attitude (OR = 4.04, 95% CI = 1.11 - 17.23). A significantly higher proportion of data providers indicated to have followed training in the field of pathogen genomics compared to data end-users (p < 0.001). Overall, 79% of participants expressed interest in receiving further training. Main concerns were related to the cost of sequencing technologies, data sharing, data integration, interdisciplinary working, and bioinformatics expertise.

CONCLUSIONS

Belgian health professionals expressed favorable views about implementation of pathogen genomics in their work activities related to infectious disease surveillance and control. They expressed the need for suitable training initiatives to strengthen their competences in the field. Their perception of the utility and feasibility of pathogen genomics for public health purposes will be a key driver for its further implementation.

Developing co-funded multi-sectoral partnerships for chronic disease prevention: a qualitative inquiry into federal governmental public health staff experience

Background

Multi-sectoral partnerships (MSPs) are frequently cited as a means by which governments can improve population health while leveraging the resources and expertise of the private and non-profit sectors. As part of their efforts in this area, the Public Health Agency of Canada (the Agency) introduced a novel funding programme requiring applicants to procure matched resources from private sources to support large-scale interventions for chronic disease prevention. The current literature on MSPs is limited in its applicability to this model of multi-sectoral engagement. The purpose of this study was to explore the experiences of Agency staff working with potential partners to develop programme applications, such that we might identify lessons from adopting this type of partnership approach.

Methods

Semi-structured interviews were conducted with the 12 staff working in the MSP programme. Interviews were recorded, transcribed and analysed using thematic analysis. Preliminary themes were used to inform follow up focus-groups sessions. A second round of analysis was conducted guided by a coding paradigm focused on understanding process.

Results

We identified “experiencing uncertainty” to be a central concept in participants’ accounts of the MSP process, related specifically to the MSP programme’s novel conditions, shifts that occurred in sectoral roles and demands for new capacities. In response, Agency staff employed strategies to clarify partner interests, build trust in inter-sectoral relationships, and support internal and partner capacity. Outcomes associated with this process include impacts on trust between the Agency and potential partners, a deeper understanding of other sectors, and programme adaptations and refinements to address challenges related to the programme model.

Conclusions

The co-funding model employed by the Agency is a potentially popular one for government bodies wanting to leverage funding from private sector sources. Our study identifies the potential challenges that can occur under this model. Some challenges are related to addressing material conditions related to partner capacity, whereas other challenges speak to deeper and more difficult to address concerns regarding trust and alignment of motivations and interests between partners. Future research exploring the challenges associated with specific models of MSP engagement is necessary to inform approaches to addressing complex problems through collaborative efforts.

Computed tomography surveillance helps tracking COVID-19 outbreak

Purpose

To reveal that a computed tomography surveillance program (CT-surveillance) could demonstrate the epidemiologic features of COVID-19 infection and simultaneously investigate the type and frequency of CT findings using clinical CT data.

Materials and methods

We targeted individuals with possible CT findings of viral pneumonia. Using an online questionnaire, we asked Japanese board-certified radiologists to register their patients’ information including patient age and sex, the CT examination date, the results of PCR test for COVID-19 infection, CT findings, and the postal code of the medical institution that performed the CT. We compared the diurnal patient number and the cumulative regional distribution map of registrations in CT-surveillance to those of the PCR-positive patient surveillance (PCR-surveillance).

Results

A total of 637 patients was registered from January 1 to April 17, 2020 for CT-surveillance. Their PCR test results were positive (n = 62.5–398%), negative (n = 8.9–57%), unknown (n = 26.2–167%), and other disease (n = 2.4–15%). An age peak at 60–69 years and male dominance were observed in CT-surveillance. The most common CT finding was bilaterally distributed ground-glass opacities. The diurnal number and the cumulative regional distribution map by CT-surveillance showed tendencies that were similar to those revealed by PCR-surveillance.

Conclusion

Using clinical CT data, CT-surveillance program delineated the epidemiologic features of COVID-19 infection.

Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities

OBJECTIVE

To identify the prevalence and associated factors with the performance of the Guthrie test, hearing, and red reflex screening tests in Brazil.

METHODS

This was a population-based, cross-sectional study that analyzed data on 5,231 children under 2 years of age participating in the National Health Survey of 2013. The study described the prevalence and Confidence Intervals (95% CI) of the three neonatal screening tests performed, in any period, and their association with the country's regions, skin color/ethnicity, private health insurance, and per capita household income. Logistic regression models were used, and odds ratios were calculated by incorporating sample weights.

RESULTS

The prevalence of Guthrie test screening in Brazil at any time of life was 96.5%, that of the newborn hearing screening was 65.8% and that of the red reflex screening test was 60.4%. The performance of the three screening tests was significantly higher among children whose mothers/guardians reported higher per capita household income, who lived in the South and Southeast regions, and who had private health insurance (p<0.001). There was no statistically significant difference regarding the performance of the tests according to skin color/ethnicity (p>0.05). The same inequalities were verified when the tests were performed during the recommended periods, with a strong socioeconomic gradient.

CONCLUSIONS

There are inequalities in the performance of neonatal screening tests in the country, and also in the performance of these tests during the periods established in the governmental guidelines. The guarantee of the performance of these tests in a universal and public health system, as in Brazil, should promote equity and access to the entire population.

Weight Status of Brazilian's Mother-Son Dyad after Maternal Bariatric Surgery

PURPOSE

Pregnant women who have undergone bariatric surgery must be followed to ensure healthy mother-child nutritional status. This study aimed to compare weight status of mother-child dyad after maternal bariatric surgery in public and private Brazilian healthcare system units.

MATERIALS AND METHODS

This retrospective matched case-control included 19 women who underwent Roux-en-Y gastric bypass surgery performed by the same private clinical surgical team and 19 age- and preoperative body mass index (BMI) matched patients from a public hospital. All 38 female patients reported a postoperative spontaneous pregnancy. The T test of independent samples and Pearson chi-square test were used to investigate inter-group differences.

RESULTS

Patients in the private system were more frequently married (94.7% versus 68.4%, p = 0.036) and had a higher educational level (94.7% versus 36.8%, p = 0.01 for tertiary education) but lower BMI, compared with those in the public system (pre-gestational = 25.7 ± 3.2 versus 28.5 ± 5.0 kg/m², p = 0.049; post-gestational = 24.6 ± 1.6 versus 29.0 ± 6.0 kg/m², p = 0.040). The interval from bariatric surgery to conception was shorter among public system patients (21.1 ± 13.9 versus 43.4 ± 31.2 months, p = 0.009). In both groups, almost 90% of children were born at full term and with adequate weights.

CONCLUSION

Despite differences in the characteristics of public and private systems, the mother-child dyads in both groups achieved satisfactory post-bariatric surgery gestation outcomes. The type of medical system does not appear to influence pregnancy outcomes or neonatal weight status conditions.

Census of economic evaluations in primary prevention 2014-2019: a scoping review protocol

BACKGROUND

A large proportion of the burden of disease is preventable, yet investment in health promotion and disease prevention programmes remains a small share of the total health budget in many countries. The perception that there is paucity of evidence on the cost-effectiveness of public health programmes is seen as a barrier to policy change. The aim of this scoping review is to conduct a census of economic evaluations in primary prevention in order to identify and map the existing evidence.

METHODS

This review is an update of a prior census and will include full economic evaluations of primary prevention programmes conducted in a community-based setting that were published between 2014 and 2019. The search of electronic databases (MEDLINE and Embase, and NHS-EED for 2014) will be supplemented by a search for grey literature in OpenGrey and a search of the reference lists of reviews of economic evaluations identified in our searches. Retrieved citations will be imported into Covidence® and independently screened in a two-stage process by two reviewers (abstracts and full papers). Any disagreements on the eligibility of a citation will be resolved by discussion with a third reviewer. Included studies will then be categorised by one independent reviewer according to a four-part typology covering the type of health promotion intervention, the risk factor being tackled, the setting in which the intervention took place and the population most affected by the intervention. New to this version of the census, we will also document whether or not the intervention sets out specifically to address inequalities in health.

DISCUSSION

This review will produce an annotated bibliography of all economic evaluations plus a report summarising the current scope and content of the economic evidence (highlighting where it is plentiful and where it is lacking) and describing any changes in the type of economic evidence available for the various categories of disease prevention programmes since the last census. This will allow us to identify where future evaluative efforts should be focused to enhance the economic evidence base regarding primary prevention interventions.

SYSTEMATIC REVIEW REGISTRATION

Registration is being sought concurrently.

Practitioner perspectives on building capacity for evidence-based public health in state health departments in the United States: a qualitative case study

BACKGROUND

Public health agencies are responsible for implementing effective, evidence-based public health programs and policies to reduce the burden of chronic diseases. Evidence-based public health can be facilitated by modifiable administrative evidence-based practices (A-EBPs) (e.g., workforce development, organizational climate), yet little is known about how practitioners view A-EBPs. Thus, the purpose of this qualitative study was to understand state health department practitioners' perceptions about how A-EBPs are implemented and what facilitators and barriers exist to using A-EBPs.

METHODS

Chronic disease prevention and health promotion program staff who were members of the National Association of Chronic Disease Directors were recruited to participate in telephone interviews using a snowball sampling technique. Interviews were transcribed verbatim, and transcripts were analyzed using a common codebook and the a priori method in NVivo.

RESULTS

Twenty seven interviews were conducted with practitioners in four states (5-8 interviews per state). All practitioners felt that their work unit culture is positive and that leadership encouraged and expected staff to use evidence-based processes. Participants discussed the provision of trainings and technical assistance as key to workforce development and how leaders communicate their expectations. Access to evidence, partnerships, and funding restrictions were the most commonly discussed barriers to the use of A-EBPs and EBDM.

CONCLUSIONS

Results of this study highlight practitioners' perspectives on promoting evidence-based public health in their departments. Findings can inform the development and refinement of resources to improve A-EBP use and organizational and leadership capacity of state health departments.

Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017

BACKGROUND

Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden.

METHODS

We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017.

RESULTS

Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3-161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0-1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9-82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1-71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries.

CONCLUSIONS

Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.

Caractériser l'environnement alimentaire d'une municipalité régionale de comté pour identifier les zones prioritaires d'intervention en matière de sécurité alimentaire

OBJECTIVES

Food security intervention is particularly complex in rural areas. The local stakeholders of the regional county municipality (RCM) of Portneuf wished to analyze the regional food supply in order to reduce food insecurity. The objective of this study was to characterize the RCM's food environment and to identify potential food deserts and priority intervention areas.

METHOD

We measured the quality of the food supply in the RCM's food stores, using four indicators: freshness, diversity, economic accessibility and relative availability. We mapped the distance between residences and the nearest food store with a favourable result for all four indices to locate potential food deserts. We then presented the mapping of the food environment to a group of local stakeholders and compared it to their own perception.

RESULTS

This study reveals three sectors that meet the criteria of a food desert in the RCM. Local actors did not perceive these sectors as food deserts, but thought they were at risk of becoming such in the future. We complemented the measures by taking into account the structuring impact of certain infrastructures as well as the temporal and seasonal accessibility of food stores in rural areas. Only one priority intervention area was suggested.

CONCLUSION

Presenting geographical analyses to local stakeholders improved the characterization of the studied food environment. The use of a mixed methodology has enabled the particularities of the rural environment to be better accounted for and has facilitated intersectoral mobilization around food insecurity at the regional level.

Status and potential of bacterial genomics for public health practice: a scoping review

Background

Next-generation sequencing (NGS) is increasingly being translated into routine public health practice, affecting the surveillance and control of many pathogens. The purpose of this scoping review is to identify and characterize the recent literature concerning the application of bacterial pathogen genomics for public health practice and to assess the added value, challenges, and needs related to its implementation from an epidemiologist’s perspective.

Methods

In this scoping review, a systematic PubMed search with forward and backward snowballing was performed to identify manuscripts in English published between January 2015 and September 2018. Included studies had to describe the application of NGS on bacterial isolates within a public health setting. The studied pathogen, year of publication, country, number of isolates, sampling fraction, setting, public health application, study aim, level of implementation, time orientation of the NGS analyses, and key findings were extracted from each study. Due to a large heterogeneity of settings, applications, pathogens, and study measurements, a descriptive narrative synthesis of the eligible studies was performed.

Results

Out of the 275 included articles, 164 were outbreak investigations, 70 focused on strategy-oriented surveillance, and 41 on control-oriented surveillance. Main applications included the use of whole-genome sequencing (WGS) data for (1) source tracing, (2) early outbreak detection, (3) unraveling transmission dynamics, (4) monitoring drug resistance, (5) detecting cross-border transmission events, (6) identifying the emergence of strains with enhanced virulence or zoonotic potential, and (7) assessing the impact of prevention and control programs. The superior resolution over conventional typing methods to infer transmission routes was reported as an added value, as well as the ability to simultaneously characterize the resistome and virulome of the studied pathogen. However, the full potential of pathogen genomics can only be reached through its integration with high-quality contextual data.

Conclusions

For several pathogens, it is time for a shift from proof-of-concept studies to routine use of WGS during outbreak investigations and surveillance activities. However, some implementation challenges from the epidemiologist’s perspective remain, such as data integration, quality of contextual data, sampling strategies, and meaningful interpretations. Interdisciplinary, inter-sectoral, and international collaborations are key for an appropriate genomics-informed surveillance.

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0930-2) contains supplementary material, which is available to authorized users.

Latent tuberculosis treatment completion rates from prescription drug administrative data

OBJECTIVE

In the province of Manitoba, Canada, given that latent tuberculosis infection (LTBI) treatment is provided at no cost to the patient, treatment completion rates should be optimal. The objective of this study was to estimate LTBI treatment completion using prescription drug administrative data and identify patient characteristics associated with completion.

METHODS

Prescription drug data (1999-2014) were used to identify individuals dispensed isoniazid (INH) or rifampin (RIF) monotherapy. Treatment completion was defined as being dispensed INH for ≥ 180 days (INH180) or ≥ 270 days (INH270) or RIF for ≥ 120 days (RIF120). Logistic regression models tested socio-demographic and comorbidity characteristics associated with treatment completion.

RESULTS

The study cohort comprised 4985 (90.4%) persons dispensed INH and 529 (9.6%) RIF. Overall treatment completion was 60.2% and improved from 43.1% in 1999-2003 to 67.3% in 2009-2014. INH180 showed the highest completion (63.8%) versus INH270 (40.4%) and RIF120 (27.0%). INH180 completion was higher among those aged 0-18 years (68.5%) compared with those aged 19+ (61.0%). Sex, geography, First Nations status, income quintile, and comorbidities were not associated with completion.

CONCLUSIONS

Benchmark 80% treatment completion rates were not achieved in Manitoba. Factors associated with non-completion were older age, INH270, and RIF120. Access to shorter LTBI treatments, such as rifapentine/INH, may improve treatment completion.

[Local public health services: a descriptive study of the municipalities of Catalonia in 2016]

OBJECTIVE

The health system in Spain rests mostly in the Autonomous Communities (similar to the states in the US). The public health activities of many local governments are little studied. The objective of this work was to bring knowledge about the public health activities of the municipalities, providing information obtained from a recent survey in Catalonia.

METHODS

Descriptive study based on a survey to public health officers in the 119 municipalities above 10,000 population in Catalonia, excluding the city of Barcelona. The survey was conducted between May and October 2016, with 103 municipalities (86.6%) reporting on their services in 2015, prior to the survey. Data were collected and descriptive analyses performed.

RESULTS

A consolidation of both political and professional public health structures of the municipalities was observed. Most frequent activities in health protection were related to legionella control, the control of urban pests and the management of complaints and requests by citizens. Most frequent activities in the field of health promotion were related to physical activity and health, prevention in tobacco and alcohol, food and nutrition. There were relatively few changes reported in public health structures and their officers, as well as in human resources.

CONCLUSIONS

In Catalonia, municipalities above 10,000 population have a remarkable level of activity in public health. Both the areas of health protection (with mandatory minimum services for local governments) and of health promotion show high levels of activity. The system seems stable regarding political changes and budget constraints. There are opportunities for improvement in the training of professionals and service accreditation. It would be desirable to find ways to improve coordination among these services.

Evidence use in equity focused health impact assessment: a realist evaluation

BACKGROUND

Equity-focused health impact assessment (EFHIA) can function as a framework and tool that supports users to collate data, information, and evidence related to health equity in order to identify and mitigate the impact of a current or proposed initiative on health inequities. Despite education efforts in both the clinical and public health settings, practitioners have found implementation and the use of evidence in completing equity focussed assessment tools to be challenging.

METHODS

We conducted a realist evaluation of evidence use in EFHIA in three phases: 1) developing propositions informed by a literature scan, existing theoretical frameworks, and stakeholder engagement; 2) data collection at four case study sites using online surveys, semi-structured interviews, document analysis, and observation; and 3) a realist analysis and identification of context-mechanism-outcome patterns and demi-regularities.

RESULTS

We identified limited use of academic evidence in EFHIA with two explanatory demi-regularities: 1) participants were unable to "identify with" academic sources, acknowledging that evidence based practice and use of academic literature was valued in their organization, but seen as less likely to provide answers needed for practice and 2) use of academic evidence was not associated with a perceived "positive return on investment" of participant energy and time. However, we found that knowledge brokering at the local site can facilitate evidence familiarity and manageability, increase user confidence in using evidence, and increase the likelihood of evidence use in future work.

CONCLUSIONS

The findings of this study provide a realist perspective on evidence use in practice, specifically for EFHIA. These findings can inform ongoing development and refinement of various knowledge translation interventions, particularly for practitioners delivering front-line public health services.

Applied Learning for Undergraduates: Integrating NCHEC Competencies and CEPH Public Health Domains in a Public Health Practice Course

To meet Council on Education for Public Health (CEPH) accreditation standards for a standalone undergraduate public health program, faculty at the University of North Carolina Wilmington conducted a matrix exercise to assess curricular alignment with the CEPH Domains of Public Health (PHDs) and the National Commission for Health Education Credentialing (NCHEC) competencies. Addressing gaps in the undergraduate public health program identified by the matrix exercise drove development of a new course, Public Health Practice. The course was designed to use real world experience to provide students with the tools and skills needed for the practice of public health. Written assignments such as a needs assessment and a logic model were used to simultaneously expose and prepare students to address real-life public health challenges and to introduce students to selected CEPH PHDs and NCHEC competencies. This integration of competencies and domains into a course curriculum may be of benefit to undergraduate public health programs seeking to develop courses with applied learning aligned with CEPH and NCHEC requirements.