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Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms. [ABSTRACT FROM AUTHOR]

Suicide is a major global public health issue, and in recent years, there has been increasing recognition of the problem of physician suicide. This American College of Physicians policy paper examines, from the perspective of ethics, the issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention. Emphasizing the medical profession as a unique moral community characterized by ethical and professional commitments of service to patients, each other, and society, this paper offers guidance regarding physician suicide and the role of a healing community. The response to an individual physician suicide should be characterized by respect and concern for those who are grieving, the creation of a supportive environment for suicide loss survivors, and careful communication about the event. Because suicide is a complex problem, actions aimed at preventing suicide must occur at the individual, interpersonal, community, and societal levels. The medical community has an obligation to foster a culture that supports education, screening, and access to mental health treatment, beginning at the earliest stages of medical training. [ABSTRACT FROM AUTHOR]

Objectives: Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations., Methods: A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes., Results: Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce., Conclusion: Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms., (© 2023. The Author(s).)

Contamination rate of Ethiopian paper currency notes handled by various food handlers with Escherichia coli and antimicrobial susceptibility of the isolates was assessed. A total of 384 Ethiopian Birr (ETB) notes were randomly sampled from meat handlers at butchers, bread and the related food handlers at cafeteria, fruit and vegetables handlers at supermarket, and milk sellers both at open market and dairy station. Fifty control new currencies were also sampled from Commercial Bank of Ethiopia. Both surfaces of the currency were swabbed using wet sterile cotton. The swab was overnight incubated in buffered peptone water. A loop full was streaked on eosin methylene blue agar and followed by biochemical test on presumptive E. coli colonies. Randomly selected isolates were exposed to chloramphenicol (C-30 µg), neomycin (N-30 µg), oxytetracycline (OT-30 µg), polymyxin-B (PB-300 IU) and trimethoprim-sulfamethoxazole (SXT-1.25/23.75/µg) susceptibility using disc diffusion techniques. E. coli was not isolated from currency used as control. A total of 288 (75 %) currency notes were found carrying E. coli. E. coli prevalence was ranges from 67.2 % at open market milk sellers to 87.2 % at dairy station milk sellers; from 64.8 % on ETB 100 to 82.9 % on ETB 1. Differences were not observed in E. coli prevalence on currency notes from among almost all food handlers (P > 0.05). Susceptibility of tested isolates to each chloramphenicol, oxytetracycline and trimethoprim-sulfamethoxazole was 100 %, and to polymyxin-B was 97.3 %. High resistance (83.7 %) was observed to neomycin. The finding indicates, contaminated food can be a source of E. coli for further contamination of currency which again transfer through various foods ready for consumption. [ABSTRACT FROM AUTHOR]

Foodborne pathogens are a burden to the economy and a constant threat to public health. The ability to rapidly detect the presence of foodborne pathogens is a vital component of any strategy towards establishing a safe and secure food supply chain. Bacteriophages (phages) are viruses capable of infecting and replicating within bacteria in a strain-specific manner. The ubiquitous and selective nature of phages makes them ideal for the detection and biocontrol of bacteria. Therefore, the objective of this research was to develop and test a phage-based paper dipstick biosensor for the detection of various foodborne pathogens in food matrices. The first step was to identify the best method for immobilizing phages on paper such that their biological activity (infectivity) was preserved. It was found that piezoelectric inkjet printing resulted in lower loss of phage infectivity when compared with other printing methods (namely gravure and blade coating) and that ColorLok paper was ideally suited to create functional sensors. The phage-based bioactive papers developed with use of piezoelectric inkjet printing actively lysed their target bacteria and retained this antibacterial activity for up to 1 week when stored at room temperature and 80% relative humidity. These bioactive paper strips in combination with quantitative real-time PCR were used for quantitative determination of target bacteria in broth and food matrices. A phage dipstick was used to capture and infect Escherichia coli O157:H7, E. coli O45:H2, and Salmonella Newport in spinach, ground beef and chicken homogenates, respectively, and quantitative real-time PCR was used to detect the progeny phages. A detection limit of 10-50 colony-forming units per millilitre was demonstrated with a total assay time of 8 h, which was the duration of a typical work shift in an industrial setting. This detection method is rapid and cost-effective, and may potentially be applied to a broad range of bacterial foodborne pathogens. [ABSTRACT FROM AUTHOR]

The American College of Medical Toxicology and the National Association of Medical Examiners convened an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance. The panel finds the following: 1. A complete autopsy is necessary for optimal interpretation of toxicology results, which must also be considered in the context of the circumstances surrounding death, medical history, and scene findings. 2. A complete scene investigation extends to reconciliation of prescription information and pill counts. 3. Blood, urine, and vitreous humor, when available, should be retained in all cases. Blood from the femoral vein is preferable to blood from other sites. 4. A toxicological panel should be comprehensive and include opioid and benzodiazepine analytes, as well as other potent depressant, stimulant, and anti-depressant medications. 5. Interpretation of postmortem opioid concentrations requires correlation with medical history, scene investigation, and autopsy findings. 6. If death is attributed to any drug or combination of drugs (whether as cause or contributing factor), the certifier should list all the responsible substances by generic name in the autopsy report and on the death certificate. 7. The best classification for manner of death in deaths due to the misuse or abuse of opioids without any apparent intent of self-harm is 'accident.' Reserve 'undetermined' as the manner for the rare cases in which evidence exists to support more than one possible determination. [ABSTRACT FROM AUTHOR]

Bed bugs are pests of public health importance due to their relentless biting habits that can lead to allergies, secondary infections and mental health issues. When not feeding on human blood bed bugs aggregate in refuges close to human hosts. This aggregation behaviour could be exploited to lure bed bugs into traps for surveillance, treatment efficacy monitoring and mass trapping efforts, if the responsible cues are identified. The aim of this study was to identify and quantify the bed bug aggregation pheromone. Volatile chemicals were collected from bed bug-exposed papers, which are known to induce aggregation behaviour, by air entrainment. This extract was tested for behavioural and electrophysiological activity using a still-air olfactometer and electroantennography, respectively. Coupled gas chromatography-electroantennography (GC-EAG) was used to screen the extract and the GC-EAG-active chemicals, benzaldehyde, hexanal, (E)-2-octenal, octanal, nonanal, decanal, heptanal, (R,S)-1-octen-3-ol, 3-carene, β-phellandrene, (3E,5E)-octadien-2-one, (E)-2-nonenal, 2-decanone, dodecane, nonanoic acid, 2-(2-butoxyethoxy)ethyl acetate, (E)-2-undecanal and (S)-germacrene D, were identified by GC-mass spectrometry and quantified by GC. Synthetic blends, comprising 6, 16, and 18 compounds, at natural ratios, were then tested in the still-air olfactometer to determine behavioural activity. These aggregation chemicals can be manufactured into a lure that could be used to improve bed bug management. [ABSTRACT FROM AUTHOR]

In response to the imperatives of universal health coverage, structural factors that may hinder the effectiveness of increased spending in sub-Saharan Africa (SSA) need attention. This study assessed the mediating role of these factors in domestic general government health expenditure (DGGHE) effects to propose solutions for improving population health outcomes (PHO). The analysis used the Latent Growth Curve Mediation Model (LGCMM) approach within the structural equation model (SEM) framework for panel data from 42 SSA countries from 2015 to 2018. The findings were that malaria and female education formed a channel through which DGGHE imparted its effects on DALY in SSA, and these effects were achieved via the specific path from the DGGHE slope to the DALY slope, via malaria and female education slopes. However, the paper found no evidence of immunization coverage mediating the relationship between DGGHE and DALY in SSA. The paper concludes that structural factors affect the effectiveness of DGGHE on PHO, implying that governments should emphasize existing programs to fight against malaria and increase immunization coverage. Highlights: • Sub-Saharan Africa has many mediating factors acting as barriers to the effect of investments in health. • The Latent Growth Curve Mediation Model is used to assist the understanding of such factors. • The mediation effect (transmission mechanisms) of these factors must be understood for proper policymaking in favour of universal health coverage. [ABSTRACT FROM AUTHOR]

Poultry meat, an essential source of animal protein, requires stringent safety and quality measures to address public health concerns and growing international attention. This review examines both direct and indirect factors that compromise poultry meat quality in intensive farming systems. It highlights the integration of rapid and micro-testing with traditional methods to assess meat safety. The paper advocates for adopting probiotics, prebiotics, and plant extracts to improve poultry meat quality. [ABSTRACT FROM AUTHOR]

Plant diseases pose significant threats to agriculture, impacting both food safety and public health. Traditional plant disease detection systems are typically limited to recognizing disease categories included in the training dataset, rendering them ineffective against new disease types. Although out-of-distribution (OOD) detection methods have been proposed to address this issue, the impact of fine-tuning paradigms on these methods has been overlooked. This paper focuses on studying the impact of fine-tuning paradigms on the performance of detecting unknown plant diseases. Currently, fine-tuning on visual tasks is mainly divided into visual-based models and visual-language-based models. We first discuss the limitations of large-scale visual language models in this task: textual prompts are difficult to design. To avoid the side effects of textual prompts, we futher explore the effectiveness of purely visual pre-trained models for OOD detection in plant disease tasks. Specifically, we employed five publicly accessible datasets to establish benchmarks for open-set recognition, OOD detection, and few-shot learning in plant disease recognition. Additionally, we comprehensively compared various OOD detection methods, fine-tuning paradigms, and factors affecting OOD detection performance, such as sample quantity. The results show that visual prompt tuning outperforms fully fine-tuning and linear probe tuning in out-of-distribution detection performance, especially in the few-shot scenarios. Notably, the max-logit-based on visual prompt tuning achieves an AUROC score of 94.8 % in the 8-shot setting, which is nearly comparable to the method of fully fine-tuning on the full dataset (95.2 % ), which implies that an appropriate fine-tuning paradigm can directly improve OOD detection performance. Finally, we visualized the prediction distributions of different OOD detection methods and discussed the selection of thresholds. Overall, this work lays the foundation for unknown plant disease recognition, providing strong support for the security and reliability of plant disease recognition systems. We will release our code at https://github.com/JiuqingDong/PDOOD to further advance this field. [ABSTRACT FROM AUTHOR]

Watersheds are settings for health and well-being that have a great deal to offer the public health community due to the correspondence between the spatial form of the watershed unit and the importance to health and well-being of water. However, managing watersheds for human health and well-being requires the ability to move beyond typical reductionist approaches toward more holistic methods. Health and well-being are emergent properties of inter-related social and biophysical processes. This paper characterizes points of connection and integration between watershed management and public health and tests a new conceptual model, the Watershed Governance Prism, to determine the prevalence in peer-reviewed literature of different perspectives relating to watersheds and public health. We conducted an initial search of academic databases for papers that addressed the interface between watershed management (or governance) and public health themes. We then generated a sample of these papers and undertook a collaborative analysis informed by the Watershed Governance Prism. Our analysis found that although these manuscripts dealt with a range of biophysical and social determinants of health, there was a tendency for social factors and health outcomes to be framed as context only for these studies, rather than form the core of the relationships being investigated. At least one cluster of papers emerged from this analysis that represented a cohesive perspective on watershed governance and health; 'Perspective B' on the Watershed Governance Prism, 'water governance for ecosystems and well-being,' was dominant. Overall, the integration of watershed management/governance and public health is in its infancy. [ABSTRACT FROM AUTHOR]

Breast cancer is a major public health concern, and early detection and classification are essential for improving patient outcomes. However, breast tumors can be difficult to distinguish from benign tumors, leading to high false positive rates in screening. The reason is that both benign and malignant tumors have no consistent shape, are found at the same position, have variable sizes, and have high correlations. The ambiguity of the correlation challenges the computer-aided system, and the inconsistency of morphology challenges an expert in identifying and classifying what is positive and what is negative. Due to this, most of the time, breast cancer screen is prone to false positive rates. This research paper presents the introduction of a feature enhancement method into the Google inception network for breast cancer detection and classification. The proposed model preserves both local and global information, which is important for addressing the variability of breast tumor morphology and their complex correlations. A locally preserving projection transformation function is introduced to retain local information that might be lost in the intermediate output of the inception model. Additionally, transfer learning is used to improve the performance of the proposed model on limited datasets. The proposed model is evaluated on a dataset of ultrasound images and achieves an accuracy of 99.81%, recall of 96.48%, and sensitivity of 93.0%. These results demonstrate the effectiveness of the proposed method for breast cancer detection and classification. [ABSTRACT FROM AUTHOR]

The exposure of pregnant women and young children to environmental pollutants is an ongoing concern of state and local public health departments. Of primary concern is the exposure to lead in lead-based paints, methyl mercury in contaminated fish and cadmium present at mining sites. The feasibility, utility and methodology of using blood spot cards collected for new born health screening purposes was studied for use in conducting routine state-wide surveillance of blood lead, mercury and cadmium levels in infants. Homogeneity of different lots of blank filter paper was examined. Mass measurements (weights) of filter paper punches were taken across three different lots of filter paper. Statistical analysis of the data was performed using one-way ANOVA, which indicated no significant difference in the means of all three lots, but high variances were noted. The three metals were examined in three different lots of filter papers purchased from the manufacturer. The lots had measurable amounts of cadmium and lead, but not mercury. Lead spike values were observed for roughly about 7% of the blank samples, indicating heterogeneous distribution of this metal. Statistical analysis of the data was also performed using a two-way ANOVA calculation with Tukey's pairwise comparisons. The results found that total mean metal loadings across the three lots were different. The concentration of the metals can be different from each other and the concentration of any one metal can differ across lots. Stability at different concentrations of the heavy metals in blood spotted onto filter paper with time and storage conditions was examined. Results indicate acceptable performance for at least 8.5 months for lead (near CDC's concern level) and for mercury (near NRC's concern level). The filter paper and blood spots were analyzed for metals using an acid extraction, followed by analysis using an inductively coupled plasma mass spectrometer (ICP-MS). Blood spot cards were studied from four different states across the Rocky Mountain region. Internal blank punches adjacent to the blood spot and actual dried spot punches from the same card were analyzed simultaneously. The blank punch indicated the amount of contamination present in the blood spot sample. Statistical analysis of the data was performed using MANOVA followed by calculations for each metal separately. This method was found to be suitable for assessing maternal exposure to lead and mercury using residual newborn screening specimens. Additional research into the applicability for cadmium is needed. Because of the intrinsic problem of contamination from the skin surface of capillary blood samples or other internal or extraneous sources, automatic re-analysis of elevated results assures minimal false positives are reported.Journal of Exposure Science and Environmental Epidemiology (2009) 19, 298–316; doi:10.1038/jes.2008.19; published online 9 April 2008 [ABSTRACT FROM AUTHOR]

Background: The concept of Positive Health (PH) has gained increasing attention as a way of measuring individuals' ability to adapt in the face of contextual challenges. However, a suitable measurement instrument for PH that encompasses contextual factors has not yet been developed. This paper responds to this need by developing a Context-specific Positive Health (CPH) measurement instrument that aligns with the Capability Approach (CA). Methods: The measurement instrument was developed and tested among a representative sample of 1002 Dutch internet survey panel members with diverse sociodemographic backgrounds. The instrument was developed in two stages: a preparation phase consisting of focus groups and expert consultations, and a validation among a representative panel of Dutch citizens. The goal of the preparation phase, was to pilot test and refine previously proposed Positive Health questionnaires into an initial version of the CPHQ. The validation phase aimed to examine the initial CPHQ's factorial validity using Factor Analysis, and its concurrent validity using Multivariate Regression Analysis. Results: The developed questionnaire demonstrated adequate factorial and concurrent validity. Furthermore, it explicitly includes an assessment of resilience, this being a key component of PH. Conclusions: The introduced measurement tool, the CPHQ, comprises 11 dimensions that we have labeled as follows: relaxation, autonomy, fitness, perceived environmental safety, exclusion, social support, financial resources, political representation, health literacy, resilience, and enjoyment. In this article, we present four major contributions. Firstly, we embedded the measurement in a theoretical framework. Secondly, we focused the questionnaire on a key concept of Positive Health - the "ability to adapt." Thirdly, we addressed issues of health inequality by considering contextual factors. Finally, we facilitated the development of more understandable measurement items. [ABSTRACT FROM AUTHOR]

The prevention and treatment of leprosy is a public health and social issue of global concern. China has become the first country in the world to put forward a proposal on the elimination of the harm caused by leprosy. This paper briefly introduces the status of the spread of leprosy in China, and systematically reviews the evolution of policies and measures at different stages of the disease in China, from the serious epidemic of leprosy to the control of the infection, to the basic elimination, and to the elimination of the hazards. On this basis, five main lessons learned from the control and elimination of leprosy in China were also summarized. These provide the basis for promoting the complete global elimination of leprosy and preventing its re-transmission, thereby benefiting all those who still suffer from the scourge of leprosy. [ABSTRACT FROM AUTHOR]

Ensuring the rational and orderly circulation of medical supplies during a public health emergency is crucial to quickly containing the further spread of the epidemic and restoring the order of rescue and treatment. However, due to the shortage of medical supplies, there are challenges to rationalizing the allocation of critical medical supplies among multiple parties with conflicting interests. In this paper, a tripartite evolutionary game model is constructed to study the allocation of medical supplies in the rescue environment of public health emergencies under conditions of incomplete information. The game's players include Government-owned Nonprofit Organizations (GNPOs), hospitals, and the government. By analyzing the equilibrium of the tripartite evolutionary game, this paper makes an in-depth study on the optimal allocation strategy of medical supplies. The findings indicate that: (1) the hospital should reasonably increase its willingness to accept the allocation plan of medical supplies, which can help medical supplies allocate more scientifically. (2) The government should design a reasonable reward and punishment mechanism to ensure the rational and orderly circulation of medical supplies, which can reduce the interference of GNPOs and hospitals in the allocation process of medical supplies. (3) Higher authorities should strengthen the supervision of the government and the accountability for loose supervision. The findings of this research can guide the government in promoting better circulation of medical supplies during public health emergencies by formulating more reasonable allocation schemes of emergency medical supplies, as well as incentives and penalties. At the same time, for GNPOs with limited emergency medical supplies, the equal allocation of emergency supplies is not the optimal solution to improve the efficiency of emergency relief, and it is simpler to achieve the goal of maximizing social benefits by allocating limited emergency resources to the demand points that match the degree of urgency. For example, in Corona Virus Disease 2019, emergency medical supplies should be prioritized for allocation to government-designated fever hospitals that are have a greater need for medical supplies and greater treatment capacity. [ABSTRACT FROM AUTHOR]

Throughout the pandemic era, COVID-19 was one of the remarkable unexpected situations over the past few years, but with the decentralization and globalization of efforts and knowledge, a successful vaccine-based control strategy was efficiently designed and applied worldwide. On the other hand, excused confusion and hesitation have widely impacted public health. This paper aims to reduce COVID-19 vaccine hesitancy taking into consideration the patient's medical history. The dataset used in this study is the Vaccine Adverse Event Reporting System (VAERS) dataset which was created as a corporation between the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) to gather reported side effects that may be caused by PFIEZER, JANSSEN, and MODERNA vaccines. In this paper, a Deep Learning (DL) model has been developed to identify the relationship between a certain type of COVID-19 vaccine (i.e. PFIEZER, JANSSEN, and MODERNA) and the adverse reactions that may occur in vaccinated patients. The adverse reactions under study are the recovery condition, possibility to be hospitalized, and death status. In the first phase of the proposed model, the dataset has been pre-proceesed, while in the second phase, the Pigeon swarm optimization algorithm is used to optimally select the most promising features that affect the performance of the proposed model. The patient's status after vaccination dataset is grouped into three target classes (Death, Hospitalized, and Recovered). In the third phase, Recurrent Neural Network (RNN) is implemented for both each vaccine type and each target class. The results show that the proposed model gives the highest accuracy scores which are 96.031% for the Death target class in the case of PFIEZER vaccination. While in JANSSEN vaccination, the Hospitalized target class has shown the highest performance with an accuracy of 94.7%. Finally, the model has the best performance for the Recovered target class in MODERNA vaccination with an accuracy of 97.794%. Based on the accuracy and the Wilcoxon Signed Rank test, we can conclude that the proposed model is promising for identifying the relationship between the side effects of COVID-19 vaccines and the patient's status after vaccination. The study displayed that certain side effects were increased in patients according to the type of COVID-19 vaccines. Side effects related to CNS and hemopoietic systems demonstrated high values in all studied COVID-19 vaccines. In the frame of precision medicine, these findings can support the medical staff to select the best COVID-19 vaccine based on the medical history of the patient. [ABSTRACT FROM AUTHOR]

The article focuses on the research on the role of climate data in predicting malaria outbreaks in Botswana. Researchers was able to identify the malaria season which starts during the rainy season in the country. Their model could help them determine which areas will be hit hardest by the epidemic. This advance information could help curb the epidemics by implementing preventive action.

Recently, work on the natural resource curse thesis has extended to testing the effects of natural resources on public health. Focusing on the case of malaria, this paper examines the effects of the interaction between resource dependence and political institutions on malaria management. To be more specific, this work argues that in a resource-abundant state, democracy plays an active role in providing health goods to the general public and allocating government funds to public health. Democracies also combat corruption behaviors and diversify economies in a more effective way than their autocratic counterparts. By testing a series of interaction effects between natural resources and democracy, this paper finds a positive and robust effect of democracy on the reduction of malaria death rates in resource-rich states, based on data on malaria deaths during the period of 1990–2016. Resource-rich dictatorships demonstrated the worst performance in malaria control compared with resource-rich democracies and resource-poor democracies and dictatorships. This empirical evidence has policy implications for resource management, public health, and infectious disease control and prevention. [ABSTRACT FROM AUTHOR]

Objectives: To determine the feasibility of eliciting utilities with a standard gamble self-completion questionnaire that uses a single-item approach in melanoma patients. Methods: 150 patients with low-risk melanoma completed a paper standard gamble questionnaire. Six scenarios described the adjuvant treatment of high-risk melanoma with interferon alfa-2b with varied side effects. Patients were asked to directly state the maximum death risk they would accept to prevent these health states. Methods were the same as in a study by Kilbridge et al. (J Clin Oncol 19(3):812–823, 2021. https://doi.org/10.1200/JCO.2001.19.3.812), except that they used computerised interviews and an iterative risk variation (Ping–Pong method) to elicit utilities. Results: The rate of missing values in the standard gamble was 1.0%. The percentage of patients who misordered scenarios was very similar to the reference study (11.3% vs. 11.2%). Mean utilities were also similar with a maximum difference of 0.02 points, but median utilities were not (between 0.21 points below and 0.05 points above the reference study). Conclusions: One-item utility elicitation with questionnaires might be a feasible alternative to computerised face-to-face interviews to conduct a standard gamble in melanoma patients. [ABSTRACT FROM AUTHOR]

The study’s withdrawal from a preprint platform deals a blow to the anti-parasite drug’s chances as a COVID treatment, researchers say. [ABSTRACT FROM AUTHOR]

Health has been a focal point in sustainable development policies. Seventeen new goals of sustainable development contribute directly or indirectly to people's health. Particular emphasis should be laid on health, along with saving lives of poor people. This can be done by effectively creating healthier society for individuals around the world. Sustainable development goals perceive significance value—that is to concentrate on the needs of hindered groups, children, women, and the poorest of poor to attain sustainable development of human ambitions and to confirm a healthier life for all. This paper analyses the issues of public health and sustainable development from an ethical point of view. As ethics deals with what is good or bad, right or wrong, the paper examines the normative aspects of sustainable development with respect to public health. [ABSTRACT FROM AUTHOR]

Background: Previous studies have argued that the relationship between health expenditures and health outcomes is more significant among the poor than the non-poor. However, public spending alone does not improve health status. Quality of governance is considered not only as an important determinant of health outcomes but also of the efficiency of public expenditure on health. In low-income countries, barriers to quality service provision can be observed, which may explain the effects of health expenditures. Therefore, this paper aims to identify the relationship between health expenditures and maternal and child mortality in Madagascar and the potential bottlenecks in the flow of funds for maternal and child health. Methods: Using panel data, fixed and random effect models for the 22 regions of Madagascar over the period 2010 to 2017 were used. Then bottlenecks related to the flow of funds for maternal and child health were identified. Results: The results reveal that, on the one hand, funding for maternal health, mainly constituted by equipment endowments for health facilities, significantly contributes to the improvement of maternal health (-0.35; p-value = 0.00). On the other hand, child health financing, often realized through transfers of funds to the health system, does not affect children's health (0.22; p-value = 0.88). The bottleneck analysis illustrates that the transferred funds can suffer from delay or misappropriation and only few parts reach beneficiaries. Conclusions: Equipment endowments contributed more to health improvement and would be more effective than monetary financing. [ABSTRACT FROM AUTHOR]

Data-driven decision-making in modern healthcare underpins innovation and predictive analytics in public health and clinical research. Synthetic data has shown promise in finance and economics to improve risk assessment, portfolio optimization, and algorithmic trading. However, higher stakes, potential liabilities, and healthcare practitioner distrust make clinical use of synthetic data difficult. This paper explores the potential benefits and limitations of synthetic data in the healthcare analytics context. We begin with real-world healthcare applications of synthetic data that informs government policy, enhance data privacy, and augment datasets for predictive analytics. We then preview future applications of synthetic data in the emergent field of digital twin technology. We explore the issues of data quality and data bias in synthetic data, which can limit applicability across different applications in the clinical context, and privacy concerns stemming from data misuse and risk of re-identification. Finally, we evaluate the role of regulatory agencies in promoting transparency and accountability and propose strategies for risk mitigation such as Differential Privacy (DP) and a dataset chain of custody to maintain data integrity, traceability, and accountability. Synthetic data can improve healthcare, but measures to protect patient well-being and maintain ethical standards are key to promote responsible use. [ABSTRACT FROM AUTHOR]

The public health policy depends on the management, quality, and coverage aspects. However, the assessment analysis of spatial patterns and distribution of public health services is still a challenge. This paper attempts to analyze the availability and accessibility of public health facilities in the Muktsar district of Punjab at the village level. Spatial and attribute data for public health facilities have been used within the GIS platform to produce accurate measures of accessibility. The average nearest neighbor tool has been used for spatial patterns of services in the district. Near analysis tool has been used to calculate distances from demand points (populations) to providers (facilities). Apart from these, the ratios of public health facilities to population were calculated for the identification of underserved and over-served areas. The study advocates that the spatial pattern of public health facilities is significantly clustered (p value 0.000) with a Z-score of − 5.18. It has been found that urban areas of the Muktsar district were identified as having a higher density of health facilities, whereas villages located in the marginal parts have the lowest density of health facilities. When looking at the average distance from village centroids to health facilities, it varies considerably from village to village. Considerably less than 60 percent of the population living in 108 villages has access to public health facilities. Apart from these, 40 percent of the population living in 126 villages has the greatest increase in the distance while accessing these facilities. [ABSTRACT FROM AUTHOR]

Around 30–40 years ago, principles and methods were developed to conceptualise, assess and manage risk. These principles and methods are still, to a large extent, the foundation of the field. Over the past decade, many tools have been developed for risk analysis of water systems. Many advances have been made, both in the theoretical platform and in practical models and procedures. Various risk analysis approaches have been used to identify potential hazards, calculate the probability of accidents and assess the severity of consequences. The objective of this paper is to review these developments, focusing on the fundamental ideas and thinking behind them, considering their application at strategic, programmatic and operational levels of decision-making, in order to improve the understanding of stakeholders (researchers, regulators, etc.). To achieve this objective, scientific papers on risk analysis associated with water treatment systems were identified and reviewed, with particular focus on risk assessment methods (qualitative, semi-qualitative or quantitative, deterministic or probabilistic, etc.), tools (ETA, FTA, FMEA/FMECA, QMRA, HRA, Markov, etc.), applicability of these tools and results of case studies. A total of 141 references were selected on the basis of title sorting from databases as ScienceDirect, PubMed, Scopus, ISI Web of Science or SpringerLink, and a total of 68 articles were selected for full-text analysis. Main conclusions of this review and analysis efforts are as follows: (1) the scientific foundation of risk assessment and risk management is still an open issue; (2) principles, theories and base methods applicable to water supply systems are in continuous development, existing tools are suitable, and a growing number of applications are available and of great interest; and (3) risk analysis methodologies are in their journey to gain the necessary broad technical, community and political acceptance in the water treatment sector, and some gaps and opportunities have been included in the discussion. [ABSTRACT FROM AUTHOR]

Several attempts have been made by the global public health efforts and national governments to contain the spread and vulnerabilities to COVID-19. Evidence, however, shows a disproportionate upsurge in COVID-19 cases in correctional facilities such as prisons, particularly, in low- and middle-income countries (LMICs). The poor adherence to COVID-19 preventive protocols in these settings has raised a serious "moral panic" among the public. There are public health concerns about the most effective and state-of-the-art approach to tackling the continuous spread of the virus in prisons. This paper discusses the feasibility of depopulation and vaccination rollouts in combating COVID-19 in correctional facilities with a particular focus on African prisons. The paper proposes selective and strategic depopulation of prisoners, effective prioritization of vaccination among prisoners, and general sensitization of prisoners toward vaccine disbursement in this total institution. [ABSTRACT FROM AUTHOR]

This paper argues that machine learning (ML) and epidemiology are on collision course over causation. The discipline of epidemiology lays great emphasis on causation, while ML research does not. Some epidemiologists have proposed imposing what amounts to a causal constraint on ML in epidemiology, requiring it either to engage in causal inference or restrict itself to mere projection. We whittle down the issues to the question of whether causal knowledge is necessary for underwriting predictions about the outcomes of public health interventions. While there is great plausibility to the idea that it is, conviction that something is impossible does not by itself motivate a constraint to forbid trying. We disambiguate the possible motivations for such a constraint into definitional, metaphysical, epistemological, and pragmatic considerations and argue that “Proceed with caution” (rather than “Stop!”) is the outcome of each. We then argue that there are positive reasons to proceed, albeit cautiously. Causal inference enforces existing classification schema prior to the testing of associational claims (causal or otherwise), but associations and classification schema are more plausibly discovered (rather than tested or justified) in a back-and-forth process of gaining reflective equilibrium. ML instantiates this kind of process, we argue, and thus offers the welcome prospect of uncovering meaningful new concepts in epidemiology and public health—provided it is not causally constrained. [ABSTRACT FROM AUTHOR]

Halfway through the Sustainable Development Goal (SDG) period, there has been little research on the criteria for monitoring safely managed sanitation under SDG target 6.2. For reporting against SDGs, global indicators are necessarily limited and exclude many safety aspects from a public health perspective. Primary survey data from 31,784 households in seven countries in Asia and Africa were analysed, comparing estimates of safely managed on-site sanitation based on global indicators with five complementary indicators of safety: animal access to excreta, groundwater contamination, overdue emptying, entering containments to empty and inadequate protection during emptying. Application of additional criteria reduced the population with safely managed sanitation by 0.4–35% for specific indicators, with the largest impact due to the risk of groundwater contamination, animal access, and containments overdue for emptying. Combining these indicators across the service chain, excluding transport and treatment, found almost three-quarters of on-site systems currently assessed as safely managed with global indicators were considered unsafe based on complementary indicators. A more comprehensive assessment of safety of on-site sanitation can be achieved through these indicators, which could be integrated into national monitoring systems and used to inform sanitation investments that address local health-related risks. [ABSTRACT FROM AUTHOR]

Background: Reducing health outcomes disparities in Africa is a major concern for policymakers. Inter-country disparities in Africa is well documented. However, little is known about the accurate trajectory of these disparities over time. Thus, this paper investigates the convergence hypothesis in health outcomes in 40 African countries using data from the World Development Indicators. The study used panel data from 2000 to 2019. Method: The study employs a nonlinear time-varying factor model to test the convergence hypothesis on infant mortality rate, under-five mortality, and life expectancy at birth. Then, we use the marginal effects of the ordered logit regression model to investigate the factors that explain club memberships. Results: The findings showed the absence of overall convergence for the three variables of interest. However, we identified the presence of convergence clubs. Moreover, we observed substantial gaps between the estimated clubs. The marginal effect results reveal that real GDP per capita, population structure, urbanization, trade, access to basic sanitation, and external health expenditure are essential to club formation. In addition, DTP immunization and the general government health expenditure as a percentage of the general government expenditure (our Abuja Declaration instrument) also play a significant role in explaining the club membership. Conclusion: The findings suggest that policymakers should develop and implement targeted club-specific health policies. Furthermore, interventions to promote increased immunization, particularly among children, should be encouraged. Governments should also make substantial efforts to increase the share of their national budget allocated to the health sector by at least 15 percent. [ABSTRACT FROM AUTHOR]

Mercury (Hg) is a chemical of health concern worldwide that is now being acted upon through the Minamata Convention. Operationalizing the Convention and tracking its effectiveness requires empathy of the diversity and variation of mercury exposure and risk in populations worldwide. As part of the health plenary for the 15th International Conference on Mercury as a Global Pollutant (ICMGP), this review paper details how scientific understandings have evolved over time, from tragic poisoning events in the mid-twentieth century to important epidemiological studies in the late-twentieth century in the Seychelles and Faroe Islands, the Arctic and Amazon. Entering the twenty-first century, studies on diverse source-exposure scenarios (e.g., ASGM, amalgams, contaminated sites, cosmetics, electronic waste) from across global regions have expanded understandings and exemplified the need to consider socio-environmental variables and local contexts when conducting health studies. We conclude with perspectives on next steps for mercury health research in the post-Minamata Convention era. [ABSTRACT FROM AUTHOR]

Comments on the continuing need for the development of chemical sensors capable for pollution monitoring and control. Use of chemical sensors in a wide range of industries such as steel-making, heat treating, metal casting, glass, ceramic, pulp and paper, automotive, aerospace, utility and power; View by the author that major advances in these sensors are required in terms of simple structure, lower cost, selectivity, durability and reliability; Papers dealing with the resistive/semiconductive type sensor.

Incidence and prevalence rates of dengue have increased over the years, and the disease is quickly becoming cause for concern within the public health community. Globally, 128 countries and slightly under four billion people are at risk of contracting dengue. In Sri Lanka, more than half of dengue cases originate in Colombo, which in previous years, used a manual pen-and-paper data management system, which meant that it was not possible to obtain or provide up-to-date information about the severity and spread of dengue. In 2015, two versions of a mobile application called Mo-Buzz Dengue were developed and launched in Colombo, Sri Lanka in order to overcome the challenges of the traditional management system by capitalizing on the rising affordability and ubiquity of mobile phone technology. To keep up with the dynamic nature of disease outbreaks, real-time data need to be visualized in a manner which facilitates discerning and comprehending these patterns. Hence, we used health maps in Mo-Buzz to effectively present this information. The first version of Mo-Buzz was for public health inspectors (PHIs), digitized data management as well as provided educational materials. The second version of Mo-Buzz was a source of information for the general public, a crowdsourcing platform to provide information relating to dengue transmission, and for health authorities to alert users to dengue-specific developments in their area. This paper illustrates the design considerations of the Mo-Buzz disease surveillance system for the general public. A draft scaled-down version of the PHI system was used to obtain feedback and make incremental design enhancements. Additionally, similar health maps were evaluated in terms of capability and usability. These findings were applied to identify future enhancements to the health map of Mo-Buzz Dengue. [ABSTRACT FROM AUTHOR]

The COVID-19 global pandemic has significantly impacted every aspect of life all over the world. The United States is reported to have suffered more than 20% of the global casualties from this pandemic. It is imperative to investigate the growth dynamics of the disease in the US based on varying geographical and governmental factors that best manifest itself in each State of the Country. This paper utilizes a hybrid machine learning and continuum deformation-based approach for analyzing the stability and growth rate of the pandemic. To this end, principal stress values of the pandemic continuum body are obtained using Mohr's Circle method and overlapping, moving windows of data are analysed successively. This helps in finding the correlations between the growth rate and Governments' action/Public's reaction. Government actions include "state of emergency", "shelter at place", and "phase declarations". We also consider the vaccination rate milestones, which shows us the coordinated Governments' action/Public's reaction. Finally, a number of recommendations are made to the Governments and people for better management of future pandemics. [ABSTRACT FROM AUTHOR]

Whilst there is a rich body of literature linking globalization with economic disparities between rich and poor nations, there is very little situated understanding of causal links, if any, between globalization and health gaps between nations. Set against this background, this paper contributes to the empirical literature by investigating globalization as a channel of the health gap between countries in Organization for Economic Co-operation and Development (OECD) and Sub-Saharan Africa (SSA). Results from a dynamic panel data analysis show that globalization has statistically insignificant impact on the health gap between the OECD and SSA countries. Rather, economic and demographic structures, measured by the age dependency ratio (% of working-age population) and GDP per capita growth emerged as the main determinants of the health gap between SSA and OECD countries. The paper draws out some policy implications which may usefully impact programmes aimed at checking health inequities between developing and developed countries. [ABSTRACT FROM AUTHOR]

In recent years, the rapid advancement of digital technology has supported the growth of the digital economy. The transformation towards digitization in the public health sector serves as a key indicator of this economic shift. Understanding how the digital economy continuously improves the efficiency of public health services and its various pathways of influence has become increasingly important. It is essential to clarify the impact mechanism of the digital economy on public health services to optimize health expenditures and advance digital economic construction. This study investigates the impact of digital economic development on the efficiency of public health services from a novel perspective, considering social media usage and urban–rural healthcare disparities while constructing a comprehensive index of digital economic development. The findings indicate that the digital economy reduces the efficiency of public health services primarily through two transmission mechanisms: the promotion of social media usage and the widening urban–rural healthcare gap. Moreover, these impacts and transmission pathways exhibit spatial heterogeneity. This study unveils the intrinsic connection and mechanisms of interaction between digital economic development and the efficiency of public health services, providing a theoretical basis and reference for government policy formulation. However, it also prompts further considerations on achieving synergy and interaction between the digital economy and public health services. [ABSTRACT FROM AUTHOR]

The aim of the study is to investigate psychosocial factors that are associated with positive and negative coping with stress, as well as with worries about and perceived threat by COVID-19 to enable us to provide adequate support for oldest-old individuals. A paper–pencil-based survey assessed COVID-19 worries and perceived threat, depression, anxiety, somatization, social support, loneliness, resilience, positive and negative coping in a sample of n = 197 oldest-old individuals (78–100 years). Linear multivariate and binary logistic regression analyses were conducted. Individuals with high levels of resilience were more likely to feel self-efficient when coping with stress. High levels of depression, anxiety and loneliness were associated with feeling more helpless when coping with stress. However, oldest-old individuals who felt lonely also experienced situations where they felt competent in stress coping. Being male and experiencing high levels of social support was more likely associated with high levels of worries due to COVID-19. Increased age and higher levels of depression were associated with lower levels of perceived personal threat, whereas higher somatization scores were more likely associated with higher perceived personal threat. Findings suggest that mental health factors may shape the way oldest-old individuals cope with pandemic-related stress. Resilience might be an important factor to take into account when targeting an improvement in positive coping with stress. Oldest-old individuals who have higher levels of depression, anxiety and feel lonely may be supported by adapting their coping skill repertoire to reduce the feeling of helplessness when coping with stress. [ABSTRACT FROM AUTHOR]

The novel coronavirus pneumonia (COVID-19) outbreak that emerged in late 2019 has posed a severe threat to human health and social and economic development, and thus has become a major public health crisis affecting the world. The spread of COVID-19 in population and regions is a typical geographical process, which is worth discussing from the geographical perspective. This paper focuses on Shandong province, which has a high incidence, though the first Chinese confirmed case was reported from Hubei province. Based on the data of reported confirmed cases and the detailed information of cases collected manually, we used text analysis, mathematical statistics and spatial analysis to reveal the demographic characteristics of confirmed cases and the spatio-temporal evolution process of the epidemic, and to explore the comprehensive mechanism of epidemic evolution and prevention and control. The results show that: (1) the incidence rate of COVID-19 in Shandong is 0.76/100,000. The majority of confirmed cases are old and middle-aged people who are infected by the intra-province diffusion, followed by young and middle-aged people who are infected outside the province. (2) Up to February 5, the number of daily confirmed cases shows a trend of "rapid increase before slowing down", among which, the changes of age and gender are closely related to population migration, epidemic characteristics and intervention measures. (3) Affected by the regional economy and population, the spatial distribution of the confirmed cases is obviously unbalanced, with the cluster pattern of "high–low" and "low–high". (4) The evolution of the migration pattern, affected by the geographical location of Wuhan and Chinese traditional culture, is dominated by "cross-provincial" and "intra-provincial" direct flow, and generally shows the trend of "southwest → northeast". Finally, combined with the targeted countermeasures of "source-flow-sink", the comprehensive mechanism of COVID-19 epidemic evolution and prevention and control in Shandong is revealed. External and internal prevention and control measures are also figured out. [ABSTRACT FROM AUTHOR]

The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the 'program theory' of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous peoples are the first peoples of what is now called Canada. Canadians have benefitted from their largesse and contributions in a myriad of ways that remain unacknowledged. Indeed, ongoing colonization and systemic anti-Indigenous racism in all quarters of our society have had heinous impacts on their health and well-being. Despite this reality and multiple calls for redress, Indigenous health is still missing from the Core Competencies for Public Health in Canada, having obvious implications for public health training programs and subsequent practice. Our objective in this paper is to critically explore the reasons behind institutional apathy for reconciliation in Indigenous health., Methods: Interviews were conducted with 19 leaders in Canadian Graduate Public Health Programs (CGPHPs) at 15 universities to explore the extent to which CGPHPs engage with Canada's 2015 Truth and Reconciliation Commission's Calls to Action to address Indigenous health. We used thematic discourse analysis to illuminate the landscape and make recommendations., Results: Participants agree that Indigenous health is important, but our data reveal an uneven landscape for addressing the Calls to Action. Curriculum was limited though we noted modest positive change. On the whole, the non-Indigenous (white) professoriate still needs to educate themselves while not all see the need to do so. Many deflected responsibility. Yet anecdotally, there is desire among CGPHP students who are already unsettling themselves to see such competency in their training., Conclusion: It is a settler evasion to claim lack of expertise, to express a desire to limit the burden on Indigenous academics, and to stand on the sidelines of institutional inertia. Our findings are a call to CGPHPs to do better., (© 2021. The Author(s) under exclusive license to The Canadian Public Health Association.)

During and beyond the twentieth century, urbanization has represented a major demographic shift particularly in the developed world. The rapid urbanization experienced in the developing world brings increased mortality from lifestyle diseases such as cancer and cardiovascular disease. We set out to understand how urbanization has been measured in studies which examined chronic disease as an outcome. Following a pilot search of PUBMED, a full search strategy was developed to identify papers reporting the effect of urbanization in relation to chronic disease in the developing world. Full searches were conducted in MEDLINE, EMBASE, CINAHL, and GLOBAL HEALTH. Of the 868 titles identified in the initial search, nine studies met the final inclusion criteria. Five of these studies used demographic measures (such as population density) at an area level to measure urbanization. Four studies used more complicated summary measures of individual and area level data (such as distance from a city, occupation, home and land ownership) to define urbanization. The papers reviewed were limited by using simple area level summary measures (e.g., urban rural dichotomy) or having to rely on preexisting data at the individual level. Further work is needed to develop a measure of urbanization that treats urbanization as a process and which is sensitive enough to track changes in “urbanicity” and subsequent emergence of chronic disease risk factors and mortality. [ABSTRACT FROM AUTHOR]