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Background: Public health policies designed to influence individuals' infection-control behaviour are a tool for governments to help prevent the spread of disease. Findings on the impacts of policies are mixed and there is limited information on the effects of removing restrictions and how policies impact behavioural trends. Methods: We use low-acuity emergency department visits from 12 hospitals in New Brunswick, Canada, (January 2017 –October 2021) as a proxy for infection-control behaviour and provide insight into the effects of the COVID-19 virus on a population with a low prevalence of cases. Quasi-experimental techniques (event studies) are applied to estimate the magnitude and persistence of effects of specific events (e.g., policy changes), to control for COVID-19 cases and vaccines, and to explore how the effectiveness of policy changes during the pandemic as more policies are introduced. Results: Initial tightening of restrictions on March 11, 2020 reduced low-acuity emergency department visits by around 60% and reached a minimum after 30 days. Relaxing policies on social gatherings and personal services gradually increased low-acuity emergency department visits by approximately 50% after 44 days. No effects were found from policies lifting all restrictions, and reinstating a state of emergency on July 31, 2021, and September 24, 2021. Conclusion: These results suggest that policy interventions are less likely to be effective at influencing infection control behaviour with time and more policies introduced, and that tracking and publicly reporting case numbers can influence infection control behaviour. [ABSTRACT FROM AUTHOR]

Background: Group model building is a process of engaging stakeholders in a participatory modeling process to elicit their perceptions of a problem and explore concepts regarding the origin, contributing factors, and potential solutions or interventions to a complex issue. Recently, it has emerged as a novel method for tackling complex, long-standing public health issues that traditional intervention models and frameworks cannot fully address. However, the extent to which group model building has resulted in the adoption of evidence-based practices, interventions, and policies for public health remains largely unstudied. The goal of this systematic review was to examine the public health and healthcare applications of GMB in the literature and outline how it has been used to foster implementation and dissemination of evidence-based interventions. Methods: We searched PubMed, Web of Science, and other databases through August 2022 for studies related to public health or health care where GMB was cited as a main methodology. We did not eliminate studies based on language, location, or date of publication. Three reviewers independently extracted data on GMB session characteristics, model attributes, and dissemination formats and content. Results: Seventy-two studies were included in the final review. Majority of GMB activities were in the fields of nutrition (n = 19, 26.4%), health care administration (n = 15, 20.8%), and environmental health (n = 12, 16.7%), and were conducted in the United States (n = 29, 40.3%) and Australia (n = 7, 9.7%). Twenty-three (31.9%) studies reported that GMB influenced implementation through policy change, intervention development, and community action plans; less than a third reported dissemination of the model outside journal publication. GMB was reported to have increased insight, facilitated consensus, and fostered communication among stakeholders. Conclusions: GMB is associated with tangible benefits to participants, including increased community engagement and development of systems solutions. Transdisciplinary stakeholder involvement and more rigorous evaluation and dissemination of GMB activities are recommended. [ABSTRACT FROM AUTHOR]

Evidence suggests that treating sexually transmitted infections (STIs) amongst female sex workers (FSWs) is a cost-effective strategy to reduce the spread of HIV/AIDS. Senegal is the only African country where sex work is regulated by a public health policy which aims to monitor and routinely treat STIs. The law requires FSWs to be at least 21 years old, register with a health centre and the police, carry an up-to-date registration booklet, attend monthly health check-ups, and test negative for STIs. Despite health and legal benefits of registration, 80% of FSWs in Senegal are not registered. Hence, the potential health benefits of the policy have not materialised. To understand why FSWs do not want to register and to define policy changes that would increase the registration rate of FSWs in Senegal, we designed and implemented a discrete choice experiment (DCE) completed by 241 registered and 273 non-registered FSWs. Participants made choices between a series of hypothetical but realistic registration policy changes. Conditional logit models were used to analyse the DCE data. The results highlighted that confidentiality at the health facility was an important element, registered and non-registered FWs were respectively 26.0 percentage points (pp) and 22.1 pp more likely to prefer a policy that guaranteed confidentiality at the health centre. Similarly, both groups preferred a policy where their health record was only held at the health centre and not with the police. Several interventions to increase FSW registration rate and improve their wellbeing may be implemented without modifying the law. For example, the introduction of psychosocial support in the registration policy package, replacing the registration booklet by a QR code, the use of electronic medical files and the integration of FSWs routine visits with maternal health appointments to increase confidentiality have the potential to encourage registration of FSWs. [ABSTRACT FROM AUTHOR]

: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Qingyue Meng and colleagues illustrate progress towards UHC and its monitoring and evaluation in China. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Walaiporn Patcharanarumol and colleagues illustrate progress towards UHC and its monitoring and evaluation in Thailand. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Tanvir Mahmudul Huda and colleagues illustrate progress towards UHC and its monitoring and evaluation in Bangladesh. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Taavi Lai and colleagues illustrate progress towards UHC and its monitoring and evaluation in Estonia. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Background: Strongyloides stercoralis is a neglected soil-transmitted helminth (STH) that leads to significant morbidity in endemic populations. Infection with this helminth has recently been recognised by the World Health Organization (WHO) as a major global health problem to be addressed with ivermectin preventive chemotherapy, and therefore, there is now, the need to develop guidelines for strongyloidiasis control that can be implemented by endemic countries. This study aimed to evaluate the impact of ivermectin preventive chemotherapy (PC) on S. stercoralis prevalence in endemic areas to generate evidence that can inform global health policy. Methodology/Principal findings: This study was a systematic review and meta-analysis. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and LILACS for literature published between 1990 and 2022 and reporting prevalence of S. stercoralis before and after PC with ivermectin, administered either at school or at community level. The search strategy identified 933 records, eight of which were included in the meta-analysis. Data extraction and quality assessment were carried out by two authors. Meta-analysis of studies based on fecal testing demonstrated a significant reduction of S. stercoralis prevalence after PC: prevalence Risk Ratio (RR) 0.18 (95% CI 0.14–0.23), I2 = 0. A similar trend was observed in studies that used serology for diagnosis: RR 0.35 (95% CI 0.26–0.48), I2 = 4.25%. A sensitivity analysis was carried out for fecal tests where low quality studies were removed, confirming a post-intervention reduction in prevalence. The impact of PC could not be evaluated at different time points or comparing annual vs biannual administration due to insufficient data. Conclusions/Significance: Our findings demonstrate a significant decrease of S. stercoralis prevalence in areas where ivermectin PC has taken place, supporting the use of ivermectin PC in endemic areas. Author summary: Ivermectin is a broad-spectrum, anti-parasitic drug that has been administered for decades in the context of preventive chemotherapy programs for onchocerciasis and lymphatic filariasis elimination. Ivermectin is also effective against Strongyloides stercoralis, an intestinal worm causing significant morbidity in low-income countries in tropical and subtropical regions. The World Health Organization recently identified the need to develop guidelines to assist S. stercoralis control in endemic countries. We aimed to study the impact of ivermectin preventive chemotherapy on S. stercoralis prevalence to generate evidence that can inform global health policy. Therefore, we conducted a systematic review of the available literature, collecting data from studies where ivermectin was administered for control of S. stercoralis or other parasitic infections. The analysis demonstrated a reduction in the prevalence of S. stercoralis in areas where ivermectin was administered. These data may be useful for informing future public health policies. [ABSTRACT FROM AUTHOR]

Background: Chagas Disease (ChD) is a Neglected Tropical Disease (NTD) affecting 6 to 7 million people worldwide, mostly from Latin America. In Argentina, a national control program has been implemented since 1962, yet there are still an estimated 1.6 million infected individuals. Control programs were based almost exclusively on entomological surveillance and chemical control of households and were not continuous given a lack of coordination and resources. Argentina´s ChD program was originally vertical and centralized; later, it was partially and, in general, unsuccessfully transferred to the provinces. Herein, we describe the implementation of a control program for ChD with an ecohealth approach in rural settlements around the city of Añatuya, Santiago del Estero. Methods: The program included yearly household visits for entomological surveillance and control, health promotion workshops, and structural house improvements. Improved structures included internal and external walls and roofs, as well as the construction of water wells and latrines, and the organization and improvement of peri-domestic structures. Activities were carried out by specifically trained personnel except for house improvements, which were performed by the community, under technical guidance and provision of materials. Data was collected using standardized questionnaires for household characterization, entomological infestation status and chemical control activities. Results: This program was continuously implemented since 2005 with high community participation and adherence, incorporating 13 settlements and 502 households. During the surveillance phase, 4,193 domiciliary inspections were performed, and both the intra- and peri-domestic infestation rate were reduced from 17.9% to 0.2% (P < 0.01) and from 20.4% to 3%, respectively. Additionally, 399 households were structurally improved. Conclusion: The program is still ongoing and, after 14 years of implementation, has built social networks and collaboration between implementers and beneficiaries with a reduction of T. infestans infestation in the intra- and peri-domicile. This reduction, especially inside the household, has enabled access to diagnosis and treatment of the population, with minimal risk of re-infection. Author summary: Chagas disease (ChD) is caused by the parasite Trypanosoma cruzi, transmitted mainly through triatomine bugs of the Reduviidae family, genus Triatoma. These vectors are found in the Americas and T. infestans is the most common species in Southern Cone countries; closely tied to rural population that live in households with cracked walls and thatched roofs that serve as refuge for the bugs. Even though ChD can also be transmitted congenitally, through blood transfusions, or organ transplantation, among others, the main route of transmission is vectorial and programs for the prevention of this disease have traditionally focused on vector control through insecticide spraying. Argentina is the country with the greatest number ChD cases, and a national program of its control has been implemented since 1962, yet, due to a lack of sustainability, there are still 1.6 million infected individuals. Herein we describe a program that has been implemented since 2005 in rural areas from an endemic province of Argentina, Santiago del Estero, which worked together with the community, using an ecohealth approach, to monitor and control the vector and to improve the houses of the population to avoid the presence of the vector inside and prevent infection. The program achieved a reduction in triatomine infestation, especially in the domicile, therefore we hope it serves as an example to guide public health policy and enable diagnosis and treatment of ChD in endemic areas. [ABSTRACT FROM AUTHOR]

Recently, multi-regional clinical trials (MRCTs), which incorporate subjects from many countries/regions around the world under the same protocol, have been widely conducted by many global pharmaceutical companies. The objective of such trials is to accelerate the development process for a drug and shorten the drug’s approval time in key markets. Several statistical methods have been purposed for the design and evaluation of MRCTs, as well as for assessing the consistency of treatment effects across all regions with one primary endpoint. However, in some therapeutic areas (e.g., Alzheimer’s disease), the clinical efficacy of a new treatment may be characterized by a set of possibly correlated endpoints, known as multiple co-primary endpoints. In this paper, we focus on a specific region and establish three statistical criteria for evaluating consistency between the specific region and overall results in MRCTs with multiple co-primary endpoints. More specifically, two of those criteria are used to assess whether the treatment effect in the region of interest is as large as that of the other regions or of the regions overall, while the other criterion is used to assess the consistency of the treatment effect of the specific region achieving a pre-specified threshold. The sample size required for the region of interest can also be evaluated based on these three criteria. [ABSTRACT FROM AUTHOR]

Background: In recent decades, the social determinants of health (SDOH) has gained increasing prominence as a foundational concept for population and public health in academic literature and policy documents, internationally. However, alongside its widespread dissemination, and in light of multiple conceptual models, lists, and frameworks, some dilution and confusion is apparent. This scoping review represents an attempt to take stock of SDOH literature in the context of contemporary population and public health. Methods: We conducted a scoping review to synthesize and map SDOH literature, informed by the methods of Arksey and O’Malley (2005). We searched 5 academic and 3 grey literature databases for “social determinants of health” and “population health” or “public health” or “health promotion,” published 2004–2014. We also conducted a search on “inequity” or “inequality” or “disparity” or “social gradient” and “Canad*” to ensure that we captured articles where this language was used to discuss the SDOH. We included articles that discussed SDOH in depth, either explicitly or in implicit but nuanced ways. We hand-searched reference lists to further identify relevant articles. Findings: Our synthesis of 108 articles showed wide variation by study setting, target audience, and geographic scope, with most articles published in an academic setting, by Canadian authors, for policy-maker audiences. SDOH were communicated by authors as a list, model, or story; each with strengths and weaknesses. Thematic analysis identified one theme: health equity as an overarching and binding concept to the SDOH. Health equity was understood in different ways with implications for action on the SDOH. Conclusions: Among the vast SDOH literature, there is a need to identify and clearly articulate the essence and implications of the SDOH concept. We recommend that authors be intentional in their efforts to present and discuss SDOH to ensure that they speak to its foundational concept of health equity. [ABSTRACT FROM AUTHOR]

COVID-19 forecasting models have been critical in guiding decision-making on surveillance testing, social distancing, and vaccination requirements. Beyond influencing public health policies, an accurate COVID-19 forecasting model can impact community spread by enabling employers and university leaders to adapt worksite policies and practices to contain or mitigate outbreaks. While many such models have been developed for COVID-19 forecasting at the national, state, county, or city level, only a few models have been developed for workplaces and universities. Furthermore, COVID-19 forecasting models have rarely been validated against real COVID-19 case data. Here we present the systematic parameter fitting and validation of an agent-based compartment model for the forecasting of daily COVID-19 cases in single-site workplaces and universities with real-world data. Our approaches include manual fitting, where initial model parameters are chosen based on historical data, and automated fitting, where parameters are chosen based on candidate case trajectory simulations that result in best fit to prevalence estimation data. We use a 14-day fitting window and validate our approaches on 7- and 14-day testing windows with real COVID-19 case data from one employer. Our manual and automated fitting approaches accurately predicted COVID-19 case trends and outperformed the baseline model (no parameter fitting) across multiple scenarios, including a rising case trajectory (RMSLE values: 2.627 for baseline, 0.562 for manual fitting, 0.399 for automated fitting) and a decreasing case trajectory (RMSLE values: 1.155 for baseline, 0.537 for manual fitting, 0.778 for automated fitting). Our COVID-19 case forecasting model allows decision-makers at workplaces and universities to proactively respond to case trend forecasts, mitigate outbreaks, and promote safety. [ABSTRACT FROM AUTHOR]

COVID-19 and associated public health policies have significantly disrupted the lives of both adults and children. Experiences of COVID-positive adults are well described but less is known about the experiences of families of children who receive a positive diagnosis, and the impact of public health policies on this experience. This study aimed to develop a framework to understand the lived experience of families with a child testing positive for COVID-19. We applied a qualitative study design, using grounded theory. The study took place in Melbourne, Australia between July and December 2020, during the first major Australian COVID-19 wave. Parents of children 0–18 years tested at a walk-in clinic at a paediatric tertiary referral hospital were invited to participate. Two interviewers jointly undertook in-depth interviews with parents of children who tested positive. Interviews were transcribed and two analysts used an inductive, critical realist analysis approach with NVivo and a virtual whiteboard. Results are presented incorporating a stratified reality (empirical, actual, real). Families described seven sequential stages of the COVID-19 positive testing journey: COVID-19 close to home; time to be tested; waiting for the test result; receiving the result; dealing with the diagnosis; coping with isolation; and moving forward/looking back. Our findings highlight how public health policies and messages targeting the general (adult) public were experienced by families. We provide a framework that families move through when their child tests positive for COVID-19. Within each phase, we report unmet needs and identify strategies to improve future pandemic planning for parents and children. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has had broad impacts on individuals, families and communities which will continue to require multidimensional responses from service providers, program developers, and policy makers. Objectives: The purpose of this study was to use Life Course theory to understand and imagine public health and policy responses to the multiple and varied impacts of the COVID-19 pandemic on different groups. Methods: "The Cost of COVID-19" was a research study carried out in Kingston, Frontenac, Lennox and Addington counties in South Eastern Ontario, Canada, between June and December 2020. Data included 210 micronarrative stories collected from community members, and 31 in-depth interviews with health and social service providers. Data were analyzed using directed content analysis to explore the fit between data and the constructs of Life Course theory. Results: Social pathways were significantly disrupted by changes to education and employment, as well as changes to roles which further altered anticipated pathways. Transitions were by and large missed, creating a sense of loss. While some respondents articulated positive turning points, most of the turning points reported were negative, including fundamental changes to relationships, family structure, education, and employment with lifelong implications. Participants' trajectories varied based on principles including when they occurred in their lifespan, the amount of agency they felt or did not feel over circumstances, where they lived (rural versus urban), what else was going on in their lives at the time the pandemic struck, how their lives were connected with others, as well as how the pandemic impacted the lives of those dear to them. An additional principle, that of Culture, was felt to be missing from the Life Course theory as currently outlined. Conclusions: A Life Course analysis may improve our understanding of the multidimensional long-term impacts of the COVID-19 pandemic and associated public health countermeasures. This analysis could help us to anticipate services that will require development, training, and funding to support the recovery of those who have been particularly affected. Resources needed will include education, mental health and job creation supports, as well as programs that support the development of individual and community agency. [ABSTRACT FROM AUTHOR]

Population contact patterns fundamentally determine the spread of directly transmitted airborne pathogens such as SARS-CoV-2 and influenza. Reliable quantitative estimates of contact patterns are therefore critical to modeling and reducing the spread of directly transmitted infectious diseases and to assessing the effectiveness of interventions intended to limit risky contacts. While many countries have used surveys and contact diaries to collect national-level contact data, local-level estimates of age-specific contact patterns remain rare. Yet, these local-level data are critical since disease dynamics and public health policy typically vary by geography. To overcome this challenge, we introduce a flexible model that can estimate age-specific contact patterns at the subnational level by combining national-level interpersonal contact data with other locality-specific data sources using multilevel regression with poststratification (MRP). We estimate daily contact matrices for all 50 US states and Washington DC from April 2020 to May 2021 using national contact data from the US. Our results reveal important state-level heterogeneities in levels and trends of contacts across the US over the course of the COVID-19 pandemic, with implications for the spread of respiratory diseases. Author summary: Reliable quantitative estimates of contact patterns are in high demand because they are a critical input for modeling and reducing the spread of directly transmitted infectious diseases such as COVID-19 and influenza. But, while national-level contact data are available from surveys collected in many countries—including the United States—local-level estimates of age-specific contact patterns are almost never available. Yet these local-level contact patterns are crucial, since disease dynamics and public health policy vary by geography. Here, we introduce a new method for estimating levels and trends in local-level rates of disease-relevant contacts by combining information from national-level contact data and other locality-specific data sources. We illustrate our method by estimating novel state-level estimates of contact patterns in the US over the course of the COVID-19 pandemic. These estimates are an important resource for researchers and policymakers who wish to understand the state-level dynamics of the COVID-19 pandemic in the United States. The new methods we introduce are applicable to any directly transmitted infectious disease and can be applied in many different settings all over the world. [ABSTRACT FROM AUTHOR]

Background: Physicians' dual practice (simultaneous practice in both public and private sectors) may be challenging for achieving universal health coverage. The purpose of this review is to identify the types of available evidence in physicians' dual practice in Iran and define the research agenda for achieving universal health coverage (UHC). Methods: We conducted a scoping review of the literature using Arksey and O'Malley's approach. We searched Embase, PubMed, the Cochrane Library, Scopus, Web of Science core collection, as well as internal databases including the National Magazine Database (Magiran) and the Scientific Information Database (SID) until August 3, 2020. Studies published in Persian or English and investigating physicians' dual practice in the health system of Iran were included. Each step of the study was performed by two of the present researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) recommendations were used to conduct this study and report the findings. Results: Fourteen studies were included in the current review. The findings were categorized and synthesized into five themes including the forms of dual practice, the extent of dual practice, the motivators and factors affecting dual practice, the policy options, and the consequences of dual practice. There were limited evidence on the nature, types, and prevalence of this phenomenon for different provinces and medical specialties and on health policy options in Iran. There seems to be a methodological gap (a gap in the type of study and its method) in the subject area. Most studies have only used quantitative or qualitative study methods and based on the self-report of research samples in most of the included studies. Conclusions: More research is required at national level on the nature, types, and prevalence of this phenomenon, focusing on clarifying the root causes of this phenomenon and on the effects of dual practice on the indicators of accessibility to health services, especially for vulnerable populations, the quality of care provided, and equity, and on complex policy research on health policy options in Iran. The research questions proposed in the present study can help to bridge the knowledge gap in this area. Additional studies should address issues related to the quality of data collection in physicians' dual practice. [ABSTRACT FROM AUTHOR]

Background: Stillbirth and perinatal mortality issues continue to receive inadequate policy attention in Ghana despite government efforts maternal health care policy intervention over the years. The development has raised concerns as to whether Ghana can achieve the World Health Organization target of 12 per 1000 live births by the year 2030. Purpose: In this study, we compared stillbirth and perinatal mortality between two groups of women who registered and benefitted from Ghana's 'free' maternal health care policy and those who did not. We further explored the contextual factors of utilization of maternal health care under the 'free' policy to find explanation to the quantitative findings. Methods: The study adopted a mixed method approach, first using two rounds of Ghana Demographic and Health Survey data sets, 2008 and 2014 as baseline and end line respectively. We constructed outcome variables of stillbirth and perinatal mortality from the under 5 mortality variables (n = 487). We then analyzed for association using multiple logistics regression and checked for sensitivity and over dispersion using Poisson and negative binomial regression models, while adjusting for confounding. We also conducted 23 in-depth interviews and 8 focus group discussions for doctors, midwives and pregnant women and analyzed the contents of the transcripts thematically with verbatim quotes. Results: Stillbirth rate increased in 2014 by 2 per 1000 live births. On the other hand, perinatal mortality rate declined within the same period by 4 per 1000 live births. Newborns were 1.64 times more likely to be stillborn; aOR: 1.64; 95% [CI: 1.02, 2.65] and 2.04 times more likely to die before their 6th day of life; aOR: 2.04; 95% [CI: 1.28, 3.25] among the 'free' maternal health care policy group, compared to the no 'free' maternal health care policy group, and the differences were statistically significant, p< 0.041; p< 0.003, respectively. Routine medicines such as folic acid and multi-vitamins were intermittently in short supply forcing private purchase by pregnant women to augment their routine requirement. Also, pregnant women in labor took in local concoction as oxytocin, ostensibly to fast track the labor process and inadvertently leading to complications of uterine rapture thus, increasing the risk of stillbirths. Conclusion: Even though perinatal mortality rate declined overall in 2014, the proportion of stillbirth and perinatal death is declining slowly despite the 'free' policy intervention. Shortage of medicine commodities, inadequate monitoring of labor process coupled with pregnant women intake of traditional herbs, perhaps explains the current rate of stillbirth and perinatal death. [ABSTRACT FROM AUTHOR]

Believing in conspiracy theories is a major problem, especially in the face of a pandemic, as these constitute a significant obstacle to public health policies, like the use of masks and vaccination. Indeed, during the COVID-19 pandemic, several ungrounded explanations regarding the origin of the virus or the effects of vaccinations have been rising, leading to vaccination hesitancy or refusal which poses as a threat to public health. Recent studies have shown that in the core of conspiracy theories lies a moral evaluation component; one that triggers a moral reasoning which reinforces the conspiracy itself. To gain a better understanding of how conspiracy beliefs about COVID-19 affect public health containment behaviors and policy support via morality-relevant variables, we analysed comprehensive data from the International Collaboration on the Social & Moral Psychology (ICSMP) of COVID-19, consisting of 49.965 participants across 67 countries. We particularly explored the mediating role of two levels of morality: individual and group-based morality. Results show that believing in conspiracy theories reduces adoption of containment health-related behaviors and policy support of public health measures, but moral identity and morality-as-cooperation significantly mediate this relationship. This means that beliefs in conspiracy theories do not simply constitute antecedents of cognitive biases or failures, nor maladaptive behaviors based on personality traits, but are morally infused and should be dealt as such. Based on our findings, we further discuss the psychological, moral, and political implications of endorsement of conspiracy theories in the era of the pandemic. [ABSTRACT FROM AUTHOR]

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04–1.34; Québec: AdjRR = 1.69, 95%CI = 1.36–2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36–2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10–1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01–1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81–2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71–2.30; Québec: AdjRR = 1.16, 95%CI = 0.98–1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children. [ABSTRACT FROM AUTHOR]

Purpose: The aim of our investigation was to conduct a quantitative meta-analysis of the present world literature comparing the major surgical outcomes of penetrating keratoplasty (PKP) to lamellar procedures. Our goal is that clinicians, eye bank administrators, and health policy makers will be able to utilize this study in implementing decisions in regards to corneal transplantation. Methods: Pooled measures of association were with odds ratios and because of study heterogeneity, the pooled effects were assumed to follow a random effects model (DerSimonian-Laird). The comparisons were between 1) PKP’s and all lamellar procedures (anterior AND posterior) and then 2) between PKP’s and all anterior lamellar procedures and 3) PKP and all posterior lamellar procedures. Results: For PKP vs anterior lamellar procedures, the pooled odds ratio for rejection of PKP over lamellar keratoplasty (LK) was 3.56 (95% CI: 1.76-7.20) and for outright failure, the pooled odds ratio of PKP failure vs LK was 2.85 (95% CI: 0.84-9.66). For posterior lamellar procedures, the pooled odds ratio for rejection of PKP over LK was 1.52 (95% CI: 1.00-2.32). The pooled odds ratio for outright failure of PKP over posterior lamellar procedures was 2.09 (95% CI: 0.57-7.59). The follow up time was significantly longer for full transplants than for lamellar procedures. Conclusions: For both anterior and posterior lamellar procedures, the odds ratios comparing rejection of full transplants to lamellar procedures (both anterior and posterior individually) were significantly higher in the PKP group. For outright failure, the PKP group also had a higher risk of failure than the lamellar groups but this was not statistically significant in either instance (anterior or posterior). Some of the clinical differences benefitting lamellar procedures may at least be partly explained by follow up time differences between groups and this needs to be accounted for more rigorously in future studies. [ABSTRACT FROM AUTHOR]

Examinations of corporate power have demonstrated the practices and activities Unhealthy Commodity Industries (UCIs) employ to exert their power and influence on the public and health policy. The High in Fat Sugar and Salt (HFSS) product industry have exploited the online environment to market their products to young people. Regulating UCIs' marketing can limit the power of those industries and is argued to be one of the most appropriate policy responses to such marketing. However, there is minimal consideration of how stakeholders view regulation of online advertising of HFSS products to young people. This UK-focused study addressed this through a secondary analysis of focus groups with young people (n = 15), the primary analysis of focus groups with parents (n = 8), and interviews with professional stakeholders (n = 11). The findings indicated that participants' views on the regulation of online advertising of HFSS products were informed by how professional stakeholders exerted instrumental, structural and discursive power. Participants cited regulation as a means to re-negotiate problematic power dynamics to increase young people's and parents' autonomy over young people's diets, yet concern remained as to the impact regulation may have on individual autonomy. To garner increased public support for such regulatory policies, it may be beneficial for advocates to emphasise the empowering elements of those regulatory policies. Advocacy actors may wish to shift their framing of regulation from one that focuses on restricting industry practices, to one that centres on empowering individuals. [ABSTRACT FROM AUTHOR]

Background: Currently, in Canada, existing health administrative data and hospital-inputted portal systems are used to measure the wait times to receiving a procedure or therapy after a specialist visit. However, due to missing and inconsistent labelling, estimating the wait time prior to seeing a specialist physician requires costly manual coding to label primary care referral notes. Methods: In this work, we represent the notes using word-count vectors and develop a logistic regression machine learning model to automatically label the target specialist physician from a primary care referral note. These labels are not available in the administrative system. We also study the effects of note length (measured in number of tokens) and dataset size (measured in number of notes per target specialty) on model performance to help other researchers determine if such an approach may be feasible for them. We then calculate the wait time by linking the specialist type from a primary care referral to a full consultation visit held in Ontario, Canada health administrative data. Results: For many target specialties, we can reliably (F1Score ≥ 0.70) predict the target specialist type. Doing so enables the automated measurement of wait time from family physician referral to specialist physician visit. Of the six specialties with wait times estimated using both 2008 and 2015 data, two had a substantial increase (defined as a change such that the original value lay outside the 95% confidence interval) in both median and 75th percentile wait times, one had a substantial decrease in both median and 75th percentile wait times, and three has non-substantial increases. Conclusions: Automating these wait time measurements, which had previously been too time consuming and costly to evaluate at a population level, can be useful for health policy researchers studying the effects of policy decisions on patient access to care. [ABSTRACT FROM AUTHOR]

Background: The transmission networks of Plasmodium vivax characterize how the parasite transmits from one location to another, which are informative and insightful for public health policy makers to accurately predict the patterns of its geographical spread. However, such networks are not apparent from surveillance data because P. vivax transmission can be affected by many factors, such as the biological characteristics of mosquitoes and the mobility of human beings. Here, we pay special attention to the problem of how to infer the underlying transmission networks of P. vivax based on available tempo-spatial patterns of reported cases. Methodology: We first define a spatial transmission model, which involves representing both the heterogeneous transmission potential of P. vivax at individual locations and the mobility of infected populations among different locations. Based on the proposed transmission model, we further introduce a recurrent neural network model to infer the transmission networks from surveillance data. Specifically, in this model, we take into account multiple real-world factors, including the length of P. vivax incubation period, the impact of malaria control at different locations, and the total number of imported cases. Principal Findings: We implement our proposed models by focusing on the P. vivax transmission among 62 towns in Yunnan province, People's Republic China, which have been experiencing high malaria transmission in the past years. By conducting scenario analysis with respect to different numbers of imported cases, we can (i) infer the underlying P. vivax transmission networks, (ii) estimate the number of imported cases for each individual town, and (iii) quantify the roles of individual towns in the geographical spread of P. vivax. Conclusion: The demonstrated models have presented a general means for inferring the underlying transmission networks from surveillance data. The inferred networks will offer new insights into how to improve the predictability of P. vivax transmission. Author Summary: The transmission of Plasmodium vivax has induced enormous public health problems at the global level. Natural transmission of P. vivax depends on interactions between anopheles mosquitoes and human beings. There are two important factors that influence its geographical spread. First, different locations may have different risks of infection due to their heterogeneous environmental and demographical profiles. Second, human mobility may bring pathogens from high-transmission locations to low-transmission locations. In view of this, to effectively and efficiently control the geographical spread of P. vivax, it would be desirable for us to characterize how it transmits from one location to another. To achieve this, we first build a spatial transmission model to characterize both the heterogeneous infection risks at individual locations and the underlying mobility of infected populations. By doing so, we can further infer the underlying P. vivax transmission networks from tempo-spatial surveillance data by using a machine learning method (i.e., based on a recurrent neural network model). Our study offers new insights into malaria surveillance and control from the viewpoint of both system modeling and machine learning. [ABSTRACT FROM AUTHOR]

Background: A combined forecast from multiple models is typically more accurate than an individual forecast, but there are few examples of studies of combining in infectious disease forecasting. We investigated the accuracy of different ways of combining interval forecasts of weekly incident and cumulative coronavirus disease-2019 (COVID-19) mortality. Methods: We considered weekly interval forecasts, for 1- to 4-week prediction horizons, with out-of-sample periods of approximately 18 months ending on 8 January 2022, for multiple locations in the United States, using data from the COVID-19 Forecast Hub. Our comparison involved simple and more complex combining methods, including methods that involve trimming outliers or performance-based weights. Prediction accuracy was evaluated using interval scores, weighted interval scores, skill scores, ranks, and reliability diagrams. Results: The weighted inverse score and median combining methods performed best for forecasts of incident deaths. Overall, the leading inverse score method was 12% better than the mean benchmark method in forecasting the 95% interval and, considering all interval forecasts, the median was 7% better than the mean. Overall, the median was the most accurate method for forecasts of cumulative deaths. Compared to the mean, the median's accuracy was 65% better in forecasting the 95% interval, and 43% better considering all interval forecasts. For all combining methods except the median, combining forecasts from only compartmental models produced better forecasts than combining forecasts from all models. Conclusions: Combining forecasts can improve the contribution of probabilistic forecasting to health policy decision making during epidemics. The relative performance of combining methods depends on the extent of outliers and the type of models in the combination. The median combination has the advantage of being robust to outlying forecasts. Our results support the Hub's use of the median and we recommend further investigation into the use of weighted methods. [ABSTRACT FROM AUTHOR]

Female genital schistosomiasis (FGS) affects tens of millions of women and girls in sub-Saharan Africa, yet this inequitable threat is often overlooked by advocates in both the neglected tropical disease (NTD) and sexual and reproductive health and rights (SRHR) communities. FGS causes both acute infection and long-term sexual and reproductive health harm to marginalized women and girls, with gender, poverty, and rurality combining to invisibilize the disease. Human rights and gender imperatives can help to galvanize efforts to control and eliminate FGS, as they have for other NTDs. Specifically, international human rights obligations can frame state efforts to address FGS across healthcare settings, upstream social determinants of health, scientific research, and policy implementation. This article analyzes human rights–based approaches to FGS control and elimination efforts, outlining several areas for forward-looking reforms to health policy, programing, and practice. Building from the lessons learned in applying human rights–based approaches to advance progress on other NTDs, this analysis seeks to provide the NTD community with shared understanding around international legal obligations to engage SRHR advocates and draw heightened attention to FGS. Such human rights–based approaches to FGS control and elimination can help to reduce stigma and improve care for the millions of women and girls currently affected by this preventable disease. Author summary: Female genital schistosomiasis (FGS) affects over 56 million women and girls in sub-Saharan Africa alone, yet this inequitable threat is largely ignored by global health advocates, program managers, and policymakers. The lack of international attention undermines efforts to eliminate schistosomiasis globally. International human rights law can help to reverse this neglect and shape the role of the international community in supporting elimination of FGS as a public health problem, as has been done for other neglected tropical diseases (NTDs). This analysis provides the NTD community with shared language around international legal obligations to engage sexual and reproductive health and rights (SRHR) advocates and draw attention to this often overlooked condition. Working together, these two communities can reduce stigma and improve the health and well-being of the millions of marginalized women and girls affected by this preventable disease. [ABSTRACT FROM AUTHOR]

The WHO recommended intervention of Directly Observed Treatment, Short-course (DOTS) appears to have been less successful than expected in reducing the burden of TB in some high prevalence settings. One strategy for enhancing DOTS is incorporating active case-finding through screening contacts of TB patients as widely used in low-prevalence settings. Predictive models that incorporate population-level effects on transmission provide one means of predicting impacts of such interventions. We aim to identify all TB transmission modelling studies addressing contact tracing and to describe and critically assess their modelling assumptions, parameter choices and relevance to policy. We searched MEDLINE, SCOPUS, COMPENDEX, Google Scholar and Web of Science databases for relevant English language publications up to February 2012. Of the 1285 studies identified, only 5 studies met our inclusion criteria of models of TB transmission dynamics in human populations designed to incorporate contact tracing as an intervention. Detailed implementation of contact processes was only present in two studies, while only one study presented a model for a high prevalence, developing world setting. Some use of relevant data for parameter estimation was made in each study however validation of the predicted impact of interventions was not attempted in any of the studies. Despite a large body of literature on TB transmission modelling, few published studies incorporate contact tracing. There is considerable scope for future analyses to make better use of data and to apply individual based models to facilitate more realistic patterns of infectious contact. Combined with a focus on high burden settings this would greatly increase the potential for models to inform the use of contract tracing as a TB control policy. Our findings highlight the potential for collaborative work between clinicians, epidemiologists and modellers to gather data required to enhance model development and validation and hence better inform future public health policy. [ABSTRACT FROM AUTHOR]

France implemented a comprehensive smoke-free law in two phases: Phase 1 (February 2007) banned smoking in workplaces, shopping centres, airports, train stations, hospitals, and schools; Phase 2 (January 2008) banned smoking in hospitality venues (bars, restaurants, hotels, casinos, nightclubs). This paper evaluates France’s smoke-free law based on the International Tobacco Control Policy Evaluation Project in France (the ITC France Project), which conducted a cohort survey of approximately 1,500 smokers and 500 non-smokers before the implementation of the laws (Wave 1) and two waves after the implementation (Waves 2 and 3). Results show that the smoke-free law led to a very significant and near-total elimination of observed smoking in key venues such as bars (from 94–97% to 4%) and restaurants (from 60–71% to 2–3%) at Wave 2, which was sustained four years later (6–8% in bars; 1–2% in restaurants). The reduction in self-reported smoking by smoking respondents was nearly identical to the effects shown in observed smoking. Observed smoking in workplaces declined significantly after the law (from 41–48% to 18–20%), which continued to decline at Wave 3 (to 14–15%). Support for the smoke-free laws increased significantly after their implementation and continued to increase at Wave 3 (p<.001 among smokers for bars and restaurants; p<.001 among smokers and p = .003 for non-smokers for workplaces). The findings demonstrate that smoke-free policies that are implemented in ways consistent with the Guidelines for Article 8 of the WHO Framework Convention on Tobacco Control (WHO FCTC) lead to substantial and sustained reductions in indoor smoking while also leading to high levels of support by the public. Moreover, contrary to arguments by opponents of smoke-free laws, smoking in the home did not increase after the law was implemented and prevalence of smoke-free homes among smokers increased from 23.2% before the law to 37.2% 5 years after the law. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity (PA) typically declines throughout pregnancy. Low levels of PA are associated with excessive weight gain and subsequently increase risk of pre-eclampsia, gestational diabetes mellitus, hypertension disorders, delivery by caesarean section and stillbirth. Systematic reviews on PA during pregnancy have not explored the efficacy of behaviour change techniques or related theory in altering PA behaviour. This systematic review evaluated the content of PA interventions to reduce the decline of PA in pregnant women with a specific emphasis on the behaviour change techniques employed to elicit this change. Search and Review Methodology: Literature searches were conducted in eight databases. Strict inclusion and exclusion criteria were employed. Two reviewers independently evaluated each intervention using the behaviour change techniques (BCT) taxonomy to identify the specific behaviour change techniques employed. Two reviewers independently assessed the risk of bias using the guidelines from the Cochrane Collaboration. Overall quality was determined using the GRADE approach. Findings: A total of 1140 potentially eligible papers were identified from which 14 studies were selected for inclusion. Interventions included counselling (n = 6), structured exercise (n = 6) and education (n = 2). Common behaviour change techniques employed in these studies were goal setting and planning, feedback, repetition and substitution, shaping knowledge and comparison of behaviours. Regular face-to-face meetings were also commonly employed. PA change over time in intervention groups ranged from increases of 28% to decreases of 25%. In 8 out of 10 studies, which provided adequate data, participants in the intervention group were more physically active post intervention than controls. Conclusions and Implications: Physical activity interventions incorporating behaviour change techniques help reduce the decline in PA throughout pregnancy. Range of behaviour change techniques can be implemented to reduce this decline including goals and planning, shaping knowledge and comparison of outcomes. A lack of high quality interventions hampers conclusions of intervention effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: The paper describes the creation of a new scale to measure intimate partner violence (IPV) among gay and bisexual men. Methods: Seven focus group discussions were held with gay and bisexual men, focusing on defining intimate partner violence: 30 forms of IPV were identified. A venue-recruited sample of 912 gay and bisexual men was surveyed, examining definitional understanding and recent experiences of each of the 30 forms of IPV. Participants were also asked questions from the CDC definition of intimate partner violence and the short-form of the Conflicts Tactics Scale (CTS2S). Factor analysis of responses to the definitional questions was used to create the IPV-GBM scale, and the prevalence of intimate partner violence was compared with that identified by the CDC and CTS2S measures of intimate partner violence. Results: A 23-item scale, with 5 unique domains, was created, with strong internal reliability (Cronbach Alpha >.90). The IPV-GBM scale mirrored both the CDC and CTS2S definitions of intimate partner violence, but contained additional domains such as controlling violence, monitoring behaviors, emotional violence, and HIV-related violence. The new scale identified a significantly higher prevalence of IPV than either of the more commonly used measures. Conclusions: The results presented here provide encouraging evidence for a new, more accurate measure of intimate partner violence among gay and bisexual men in the U.S. [ABSTRACT FROM AUTHOR]

Background: The ‘three delays model’ attempts to explain delays in women accessing emergency obstetric care as the result of: 1) decision-making, 2) accessing services and 3) receipt of appropriate care once a health facility is reached. The third delay, although under-researched, is likely to be a source of considerable inequity in access to emergency obstetric care in developing countries. The aim of this systematic review was to identify and categorise specific facility-level barriers to the provision of evidence-based maternal health care in developing countries. Methods and Findings: Five electronic databases were systematically searched using a 4-way strategy that combined search terms related to: 1) maternal health care; 2) maternity units; 3) barriers, and 4) developing countries. Forty-three original research articles were eligible to be included in the review. Thirty-two barriers to the receipt of timely and appropriate obstetric care at the facility level were identified and categorised into six emerging themes (Drugs and equipment; Policy and guidelines; Human resources; Facility infrastructure; Patient-related and Referral-related). Two investigators independently recorded the frequency with which barriers relating to the third delay were reported in the literature. The most commonly cited barriers were inadequate training/skills mix (86%); drug procurement/logistics problems (65%); staff shortages (60%); lack of equipment (51%) and low staff motivation (44%). Conclusions: This review highlights how a focus on patient-side delays in the decision to seek care can conceal the fact that many health facilities in the developing world are still chronically under-resourced and unable to cope effectively with serious obstetric complications. We stress the importance of addressing supply-side barriers alongside demand-side factors if further reductions in maternal mortality are to be achieved. [ABSTRACT FROM AUTHOR]

Background: Peer review is the mainstay of editorial decision making for medical journals. There is a dearth of evaluations of journal peer review with regard to reliability and validity, particularly in the light of the wide variety of medical journals. Studies carried out so far indicate low agreement among reviewers. We present an analysis of the peer review process at a general medical journal, Deutsches Ärzteblatt International. Methodology/Principal Findings: 554 reviewer recommendations on 206 manuscripts submitted between 7/2008 and 12/2009 were analyzed: 7% recommended acceptance, 74% revision and 19% rejection. Concerning acceptance (with or without revision) versus rejection, there was a substantial agreement among reviewers (74.3% of pairs of recommendations) that was not reflected by Fleiss' or Cohen's kappa (<0.2). The agreement rate amounted to 84% for acceptance, but was only 31% for rejection. An alternative kappa-statistic, however, Gwet's kappa (AC1), indicated substantial agreement (0.63). Concordance between reviewer recommendation and editorial decision was almost perfect when reviewer recommendations were unanimous. The correlation of reviewer recommendations and citations as counted by Web of Science was low (partial correlation adjusted for year of publication: −0.03, n.s.). Conclusions/Significance: Although our figures are similar to those reported in the literature our conclusion differs from the widely held view that reviewer agreement is low: Based on overall agreement we consider the concordance among reviewers sufficient for the purposes of editorial decision making. We believe that various measures, such as positive and negative agreement or alternative Kappa values are superior to the application of Cohen's or Fleiss' Kappa in the analysis of nominal or ordinal level data regarding reviewer agreement. Also, reviewer recommendations seem to be a poor proxy for citations because, for example, manuscripts will be changed considerably during the revision process. [ABSTRACT FROM AUTHOR]

Background: Cause of death data are an essential source for public health planning, but their availability and quality are lacking in many parts of the world. Interviewing family and friends after a death has occurred (a procedure known as verbal autopsy) provides a source of data where deaths otherwise go unregistered; but sound methods for interpreting and analysing the ensuing data are essential. Two main approaches are commonly used: either physicians review individual interview material to arrive at probable cause of death, or probabilistic models process the data into likely cause(s). Here we compare and contrast these approaches as applied to a series of 6,153 deaths which occurred in a rural South African population from 1992 to 2005. We do not attempt to validate either approach in absolute terms. Methods and Findings: The InterVA probabilistic model was applied to a series of 6,153 deaths which had previously been reviewed by physicians. Physicians used a total of 250 cause-of-death codes, many of which occurred very rarely, while the model used 33. Cause-specific mortality fractions, overall and for population subgroups, were derived from the model's output, and the physician causes coded into comparable categories. The ten highest-ranking causes accounted for 83% and 88% of all deaths by physician interpretation and probabilistic modelling respectively, and eight of the highest ten causes were common to both approaches. Top-ranking causes of death were classified by population subgroup and period, as done previously for the physician-interpreted material. Uncertainty around the cause(s) of individual deaths was recognised as an important concept that should be reflected in overall analyses. One notably discrepant group involved pulmonary tuberculosis as a cause of death in adults aged over 65, and these cases are discussed in more detail, but the group only accounted for 3.5% of overall deaths. Conclusions: There were no differences between physician interpretation and probabilistic modelling that might have led to substantially different public health policy conclusions at the population level. Physician interpretation was more nuanced than the model, for example in identifying cancers at particular sites, but did not capture the uncertainty associated with individual cases. Probabilistic modelling was substantially cheaper and faster, and completely internally consistent. Both approaches characterised the rise of HIV-related mortality in this population during the period observed, and reached similar findings on other major causes of mortality. For many purposes probabilistic modelling appears to be the best available means of moving from data on deaths to public health actions. [ABSTRACT FROM AUTHOR]

An essay is presented on the prioritization tools which can be used for African maternal, neonatal, and child health care policy. It explores health care prioritization tools including Marginal Budgeting for Bottlenecks (MBB), Choosing Interventions that are Cost-Effective (WHO-CHOICE), and Lives Saved Tool (LiST). It tackles research prioritization tools including Council on Health Research for Development (COHRED), Essential National Health Research (ENHR), and Combined Approach Matrix (CAM).

The article discusses the effects of the selectivity of health system strengthening (HSS) strategies on the goal high-quality health systems in developing countries. It is stated that global health actors (GHAs) in the domain of HSS often use the terms global health initiative and global health partnership, which are ill defined. It notes that GHAs claim to support health systems but focus on disease-specific interventions. It also mentions the importance of an effective approach to HHS.

Proposes that an evidence-informed policy and practice pathway can help both public health researchers and policy actors navigate the use of evidence. Stages of progression involved in the pathway to evidence-informed policy and practice; Decision-making factors involved in the pathway; Values that are being underpinned in each stage; Fundamental to the transfer of evidence into policy and practice.

Introduction: Antimicrobial resistance (AMR) is considered one of the biggest health challenges of the 21st century. It has both social and economic consequences; therefore, timely review of public health policies that have been designed to manage AMR is essential. Brazil too has developed and implemented various polices for the prevention and control of AMR. However, till date, no study provides insights regarding the various public health policies or other programs implemented by Brazilian institutes. Objective: The objective is to define a scoping review protocol of policies that were developed to address prevention and control of antimicrobial resistance in Brazil, from a human health perspective. Method: This protocol has been registered in the Open Science Framework (DOI 10.17605/OSF.IO/EC9ZJ). Indexed literature in English, Spanish and Portuguese published till December 2020 in Lilacs, PubMed, Embase, and official websites of the Brazilian government will be reviewed. This review considers all studies identified through a comprehensive search of peer-reviewed and grey literature databases that have a reference for policies made for managing AMR in Brazil. The criteria for the scoping review will be set by two evaluators. A third evaluator will be consulted, if there is any disagreement between the two primary evaluators. A standardized form will be used for data extraction from the selected studies. The results will be presented in a tabular form with narrative abstracts related to the topics identified through the scoping review protocol. The PRISMA extension for Scoping Reviews tool will be used. [ABSTRACT FROM AUTHOR]

To assess the effects of consumer engagement in health care policy, research and services. We updated a review published in 2006 and 2009 and revised the previous search strategies for key databases (The Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; PsycINFO; CINAHL; Web of Science) up to February 2020. Selection criteria included randomised controlled trials assessing consumer engagement in developing health care policy, research, or health services. The International Association for Public Participation, Spectrum of Public Participation was used to identify, describe, compare and analyse consumer engagement. Outcome measures were effects on people; effects on the policy/research/health care services; or process outcomes. We included 23 randomised controlled trials with a moderate or high risk of bias, involving 136,265 participants. Most consumer engagement strategies adopted a consultative approach during the development phase of interventions, targeted to health services. Based on four large cluster-randomised controlled trials, there is evidence that consumer engagement in the development and delivery of health services to enhance the care of pregnant women results in a reduction in neonatal, but not maternal, mortality. From other trials, there is evidence that involving consumers in developing patient information material results in material that is more relevant, readable and understandable for patients, and can improve knowledge. Mixed effects are reported of consumer-engagement on the development and/or implementation of health professional training. There is some evidence that using consumer interviewers instead of staff in satisfaction surveys can have a small influence on the results. There is some evidence that consumers may have a role in identifying a broader range of health care priorities that are complementary to those from professionals. There is some evidence that consumer engagement in monitoring and evaluating health services may impact perceptions of patient safety or quality of life. There is growing evidence from randomised controlled trials of the effects of consumer engagement on the relevance and positive outcomes of health policy, research and services. Health care consumers, providers, researchers and funders should continue to employ evidence-informed consumer engagement in their jurisdictions, with embedded evaluation. Systematic review registration: PROSPERO CRD42018102595. [ABSTRACT FROM AUTHOR]

The effective reproduction number Rt is an epidemiological quantity that provides an instantaneous measure of transmission potential of an infectious disease. While dengue is an increasingly important vector-borne disease, few have used Rt as a measure to inform public health operations and policy for dengue. This study demonstrates the utility of Rt for real time dengue surveillance. Using nationally representative, geo-located dengue case data from Singapore over 2010–2020, we estimated Rt by modifying methods from Bayesian (EpiEstim) and filtering (EpiFilter) approaches, at both the national and local levels. We conducted model assessment of Rt from each proposed method and determined exogenous temporal and spatial drivers for Rt in relation to a wide range of environmental and anthropogenic factors. At the national level, both methods achieved satisfactory model performance (R2EpiEstim = 0.95, R2EpiFilter = 0.97), but disparities in performance were large at finer spatial scales when case counts are low (MASE EpiEstim = 1.23, MASEEpiFilter = 0.59). Impervious surfaces and vegetation with structure dominated by human management (without tree canopy) were positively associated with increased transmission intensity. Vegetation with structure dominated by human management (with tree canopy), on the other hand, was associated with lower dengue transmission intensity. We showed that dengue outbreaks were preceded by sustained periods of high transmissibility, demonstrating the potential of Rt as a dengue surveillance tool for detecting large rises in dengue cases. Real time estimation of Rt at the fine scale can assist public health agencies in identifying high transmission risk areas and facilitating localised outbreak preparedness and response. Author summary: The effective reproduction number Rt is an epidemiological quantity that provides an instantaneous measure of transmission potential of an infectious disease. While dengue is an increasingly important vector-borne disease, few have used Rt as a measure to inform public health operations and policy for dengue. This study demonstrates the utility of Rt for real time dengue surveillance. Using nationally representative, geo-located dengue case data from Singapore over 2010–2020, we estimated Rt by modifying methods from Bayesian (EpiEstim) and filtering (EpiFilter) approaches, at both the national and local levels. We conducted model assessment of Rt from each proposed method and determined exogenous temporal and spatial drivers for Rt in relation to a wide range of environmental and anthropogenic factors. At the national level, both methods achieved high accuracy, but disparities in performance were large at finer spatial scales when case counts are low. This study demonstrates the potential of Rt as a dengue surveillance tool for detecting large rises in dengue cases. Real time estimation of Rt at the fine scale can assist public health agencies in identifying high transmission risk areas and facilitating localised outbreak preparedness and response. [ABSTRACT FROM AUTHOR]

Background: Recognising the substantial political weight of the United Nations General Assembly (UNGA), a UN General Assembly special session (UNGASS) and high-level meetings (HLMs) have been pursued and held for 5 health-related topics thus far. They have focused on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS, 2001), non-communicable diseases (NCDs, 2011), antimicrobial resistance (AMR, 2016), tuberculosis (TB, 2018), and universal health coverage (UHC, 2019). This observational study presents a comprehensive analysis of the political and policy background that prompted the events, as well as an assessment of aims, approaches, and ultimate outcomes.Methods and Findings: We investigated relevant agencies' official documents, performed a literature search, and accessed international institutions' websites for the period 1990-2020. Knowledgeable diplomatic staff and experts provided additional information. Outcomes were evaluated from a United Nations perspective based on national and international commitments, and funding trends. Eliciting an effective governmental response through UNGASSs/HLMs is a challenge. However, increased international commitment was evident after the HIV/AIDS (2001), NCDs (2011), and AMR (2016) meetings. The more recent TB (2018) and UHC (2019) HLMs have received general endorsements internationally, although concrete commitments are not yet documented. Although attribution can only be hypothesized, financial investments for HIV/AIDS following the UNGASS were remarkable, whereas following HLMs for NCDs, AMR, and TB, the financial investments remained insufficient to face the burden of these threats. Thus far, the HIV/AIDS UNGASS was the only one followed by a level of commitment that has likely contributed to the reversal of the previous burden trend. Limitations of this study include its global perspective and aerial view that cannot discern the effects at the country level. Additionally, possible peculiarities that modified the response to the meetings were not looked at in detail. Finally, we assessed a small sample of events; thus, the list of strategic characteristics for success is not exhaustive.Conclusions: Overall, UNGASSs and HLMs have the potential to lay better foundations and boldly address key health challenges. However, to succeed, they need to (i) be backed by large consensus; (ii) engage UN authorities and high-level bodies; (iii) emphasise implications for international security and the world economy; (iv) be supported by the civil society, activists, and champions; and (v) produce a political declaration containing specific, measurable, achievable, relevant, and time-bound (SMART) targets. Therefore, to ensure impact on health challenges, in addition to working with the World Health Assembly and health ministries, engaging the higher political level represented by the UNGA and heads of state and government is critical. [ABSTRACT FROM AUTHOR]

Introduction: Public health policy and practice is strengthened by the application of quality evidence to decision making. However, there is limited understanding of how initiatives that support the generation and use of evidence in public health are operationalised. This study examines factors that support the internal functioning of a partnership, the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN). SiREN aims to build research and evaluation capacity and increase evidence-informed decision making in a public health context. Methods: This study was informed by systems concepts. It developed a causal loop diagram, a type of qualitative system model that illustrated the factors that influence the internal operation of SiREN. The causal loop diagram was developed through an iterative and participatory process with SiREN staff and management (n = 9) via in-depth semi-structured interviews (n = 4), workshops (n = 2), and meetings (n = 6). Results: Findings identified critical factors that affected the functioning of SiREN. Central to SiREN's ability to meet its aims was its capacity to adapt within a dynamic system. Adaptation was facilitated by the flow of knowledge between SiREN and system stakeholders and the expertise of the team. SiREN demonstrated credibility and capability, supporting development of new, and strengthening existing, partnerships. This improved SiREN's ability to be awarded new funding and enhanced its sustainability and growth. SiREN actively balanced divergent stakeholder interests to increase sustainability. Conclusion: The collaborative development of the diagram facilitated a shared understanding of SiREN. Adaptability was central to SiREN achieving its aims. Monitoring the ability of public health programs to adapt to the needs of the systems in which they work is important to evaluate effectiveness. The detailed analysis of the structure of SiREN and how this affects its operation provide practical insights for those interested in establishing a similar project. [ABSTRACT FROM AUTHOR]

Objectives: To exploit the features of digital PCR for implementing SARS-CoV-2 observational studies by reliably including the viral load factor expressed as copies/μL. Methods: A small cohort of 51 Covid-19 positive samples was assessed by both RT-qPCR and digital PCR assays. A linear regression model was built using a training subset, and its accuracy was assessed in the remaining evaluation subset. The model was then used to convert the stored cycle threshold values of a large dataset of 6208 diagnostic samples into copies/μL of SARS-CoV-2. The calculated viral load was used for a single cohort retrospective study. Finally, the cohort was randomly divided into a training set (n = 3095) and an evaluation set (n = 3113) to establish a logistic regression model for predicting case-fatality and to assess its accuracy. Results: The model for converting the Ct values into copies/μL was suitably accurate. The calculated viral load over time in the cohort of Covid-19 positive samples showed very low viral loads during the summer inter-epidemic waves in Italy. The calculated viral load along with gender and age allowed building a predictive model of case-fatality probability which showed high specificity (99.0%) and low sensitivity (21.7%) at the optimal threshold which varied by modifying the threshold (i.e. 75% sensitivity and 83.7% specificity). Alternative models including categorised cVL or raw cycle thresholds obtained by the same diagnostic method also gave the same performance. Conclusion: The modelling of the cycle threshold values using digital PCR had the potential of fostering studies addressing issues regarding Sars-CoV-2; furthermore, it may allow setting up predictive tools capable of early identifying those patients at high risk of case-fatality already at diagnosis, irrespective of the diagnostic RT-qPCR platform in use. Depending upon the epidemiological situation, public health authority policies/aims, the resources available and the thresholds used, adequate sensitivity could be achieved with acceptable low specificity. [ABSTRACT FROM AUTHOR]

Background: Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations. Methods: Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection. Results: Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors. Conclusions: Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations. [ABSTRACT FROM AUTHOR]

: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Gemini Mtei and colleagues illustrate progress towards UHC and its monitoring and evaluation in Tanzania. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

The proliferation of on-site betting shops has received enormous public attention, becoming one of the most alarming health policy issues in contemporary cities. However, there is little evidence on whether its growing presence nearby vulnerable populations produce social harm beyond its known adverse individual effects. This study provides new evidence on the negative societal effects of betting houses. Our research design takes advantage of a new wave of openings in Madrid (Spain), which created a sudden increase in the supply of on-site gambling. Using a differences-in-differences design, we find that new betting houses decline nearby high schools' educational performance, especially in public schools in less advantaged areas. This effect is neither trivial nor diminishing with time. This evidence suggests that betting houses increase inequality of educational opportunities. The ubiquity of betting houses around vulnerable populations in multiple regions drives us to think that these findings have relevant policy implications for many countries currently designing policies tackling the increase of problem gambling. [ABSTRACT FROM AUTHOR]

Background: Psychiatric disorders constitute a major public health concern that are associated with substantial health and socioeconomic burden. Psychiatric patients may be more vulnerable to high temperatures, which under current climate change projections will most likely increase the burden of this public health concern. Objective: This study investigated the short-term association between ambient temperature and mental health hospitalizations in Bern, Switzerland. Methods: Daily hospitalizations for mental disorders between 1973 and 2017 were collected from the University Hospital of Psychiatry and Psychotherapy in Bern. Population-weighted daily mean ambient temperatures were derived for the catchment area of the hospital from 2.3-km gridded weather maps. Conditional quasi-Poisson regression with distributed lag linear models were applied to assess the association up to three days after the exposure. Stratified analyses were conducted by age, sex, and subdiagnosis, and by subperiods (1973–1989 and 1990–2017). Additional subanalyses were performed to assess whether larger risks were found during the warm season or were due to heatwaves. Results: The study included a total number of 88,996 hospitalizations. Overall, the hospitalization risk increased linearly by 4.0% (95% CI 2.0%, 7.0%) for every 10°C increase in mean daily temperature. No evidence of a nonlinear association or larger risks during the warm season or heatwaves was found. Similar estimates were found across for all sex and age categories, and larger risks were found for hospitalizations related to developmental disorders (29.0%; 95% CI 9.0%, 54.0%), schizophrenia (10.0%; 95% CI 4.0%, 15.0%), and for the later rather than the earlier period (5.0%; 95% CI 2.0%, 8.0% vs. 2.0%; 95% CI -3.0%, 8.0%). Conclusions: Our findings suggest that increasing temperatures could negatively affect mental status in psychiatric patients. Specific public health policies are urgently needed to protect this vulnerable population from the effects of climate change. [ABSTRACT FROM AUTHOR]

Hospital Based Health Technology Assessment (HB-HTA) is a new policy implemented in Poland to allow for a more practical and contextualized assessment related to the use of specific medical procedures, devices, or equipment. It requires changes in governance relating to the healthcare sector. One of the forms of governance improvement is to involve society in the process of creating public services. This can be implemented, e.g., by applying the pragmatic model of public responsiveness. The aim of this research was to identify and analyze forces which will shape a dynamic process in determining the implementation of HB-HTA. The results obtained in the Gioia analysis led to the identification of the main forces driving and restraining the implementation of HB-HTA. The grouping and interpretation allowed for the twelve most important dimensions to be distinguished, which were recognized as conceptual categories necessary to build theories that describe the studied phenomenon. This study contributes to the development of the idea of responsiveness in public management theory and in health care services, and ultimately helps to better enable the adjustment of health services to the dynamically changing needs of Polish society. [ABSTRACT FROM AUTHOR]

Human T-cell lymphotropic viruses 1 and 2 (HTLV-1/2) are relatively common in Brazil but remain silent and neglected infections. HTLV-1 is associated with a range of diseases with high morbidity and mortality. There is no curative treatment for this lifelong infection, so measures to prevent transmission are essential. This narrative review discusses HTLV-1/2 transmission routes and measures to prevent its continuous dissemination. The public health policies that are currently implemented in Brazil to avoid HTLV-1/2 transmission are addressed, and further strategies are proposed. [ABSTRACT FROM AUTHOR]

Background: Public health policies and recommendations aim to be informed by the best available evidence. Evidence underpinning e-cigarettes policy recommendations has been necessarily limited due to the novelty of the technology and the lack of long-term epidemiological studies and trials. Some public health bodies have actively encouraged e-cigarette use whilst others have raised concerns over introducing new health risks and renormalising tobacco smoking. Using citation network analysis we investigated the author conflicts of interest and study funding statements within sources of evidence used by public health bodies when making recommendations about e-cigarette policy. Methods: We conducted citation network analysis of public health recommendation documents across four purposively selected diverse jurisdictions: WHO, UK, Australia, and USA. We extracted all citations from 15 public health recommendation documents, with more detailed data collected for influential citations (used in 3+ recommendation documents). We analysed the relationships between the sources of evidence used across jurisdictions using block modelling to determine if similar groups of documents were used across different jurisdictions. We assessed the frequency and nature of conflicts of interest. Results: 1700 unique citations were included across the 15 public health recommendation documents, with zero to 923 citations per document (median = 63, IQR = 7.5–132). The evidence base underpinning public health recommendations did not systematically differ across jurisdictions. Of the 1700 citations included, the majority were journal articles (n = 1179). Across 1081 journal articles published between 1998–2018, 200 declared a conflict of interest, 288 contained no mention of conflicts of interest, and 593 declared none. Conflicts of interest were reported with tobacco (3%; n = 37 journal articles of 1081), e-cigarette (7%; n = 72), and pharmaceutical companies (12%; n = 127), with such conflicts present even in the most recent years. There were 53 influential citations, the most common study type was basic science research without human subjects (e.g. examination of aerosols and e-liquids) (n = 18) followed by systematic review (n = 10); with randomised control trial being least common (n = 4). Network analysis identified clusters of highly-cited articles with a higher prevalence of conflicts of interest. Conclusion: Public health bodies across different jurisdictions drew upon similar sources of evidence, despite articulating different policy approaches to e-cigarettes. The evidence drawn upon, including the most influential evidence, contained substantial conflicts of interest (including relationships with e-cigarette and tobacco industries). Processes to explicitly manage conflicts of interest arising from the underlying evidence base may be required when developing public health recommendations. [ABSTRACT FROM AUTHOR]

How and why do people comply with protective behaviours during COVID-19? The emerging literature employs a variable-centered approach, typically using a narrow selection of constructs within a study. This study is the first to adopt a person-centred approach to identify complex patterns of compliance, and holistically examine underlying psychological differences, integrating multiple psychology paradigms and epidemiology. 1575 participants from Australia, US, UK, and Canada indicated their behaviours, attitudes, personality, cognitive/decision-making ability, resilience, adaptability, coping, political and cultural factors, and information consumption during the pandemic's first wave. Using Latent Profile Analysis, two broad groups were identified. The compliant group (90%) reported greater worries, and perceived protective measures as effective, whilst the non-compliant group (about 10%) perceived them as problematic. The non-compliant group were lower on agreeableness and cultural tightness-looseness, but more extraverted, and reactant. They utilised more maladaptive coping strategies, checked/trusted the news less, and used official sources less. Females showed greater compliance than males. By promoting greater appreciation of the complexity of behaviour during COVID-19, this research provides a critical platform to inform future studies, public health policy, and targeted behaviour change interventions during pandemics. The results also challenge age-related stereotypes and assumptions. [ABSTRACT FROM AUTHOR]

Pundits and academics across disciplines note that the human toll brought forth by the novel coronavirus (COVID-19) pandemic in the United States (U.S.) is fundamentally unequal for communities of color. Standing literature on public health posits that one of the chief predictors of racial disparity in health outcomes is a lack of institutional trust among minority communities. Furthermore, in our own county-level analysis from the U.S., we find that counties with higher percentages of Black and Hispanic residents have had vastly higher cumulative deaths from COVID-19. In light of this standing literature and our own analysis, it is critical to better understand how to mitigate or prevent these unequal outcomes for any future pandemic or public health emergency. Therefore, we assess the claim that raising institutional trust, primarily scientific trust, is key to mitigating these racial inequities. Leveraging a new, pre-pandemic measure of scientific trust, we find that trust in science, unlike trust in politicians or the media, significantly raises support for COVID-19 social distancing policies across racial lines. Our findings suggest that increasing scientific trust is essential to garnering support for public health policies that lessen the severity of the current, and potentially a future, pandemic. [ABSTRACT FROM AUTHOR]