Search

Background: Vietnam implemented various public health interventions such as contact tracing and testing, mandatory quarantine, and lockdowns in response to coronavirus disease 2019 (COVID-19). However, the effects of these measures on the epidemic remain unclear. Methods: This article describes the public health interventions in relation to COVID-19 incidence. Maximum likelihood estimations were used to assess containment delays (time between symptom onset and start of isolation) and multivariable regression was employed to identify associated factors between interventions and COVID-19 incidence. The effective reproductive numbers (Rt) were calculated based on transmission pairs. Results: Interventions were introduced periodically in response to the epidemic. Overall, 817 (55.4%) among 1474 COVID-19 cases were imported. Based on a serial interval of 8.72 ± 5.65 days, it was estimated that Rt decreased to below 1 (lowest at 0.02, 95% CI 0–0.12) during periods of strict border control and contact tracing, and increased ahead of new clusters. The main method to detect cases shifted over time from passive notification to active case-finding at immigration or in lockdown areas, with containment delays showing significant differences between modes of case detection. Conclusions: A combination of early, strict, and consistently implemented interventions is crucial to control COVID-19. Low-middle income countries with limited capacity can contain COVID-19 successfully using non-pharmaceutical interventions.

Background On April 17, 2020, the State of New York (NY) implemented an Executive Order that requires all people in NY to wear a face mask or covering in public settings where social distancing cannot be maintained. Although the Centers for Disease Control and Prevention recommended face mask use by the general public, there is a lack of evidence on the effect of face mask policies on the spread of COVID-19 at the state level. Objective To assess the impact of the Executive Order on face mask use on COVID-19 cases and mortality in NY. Design A comparative interrupted time series analysis was used to assess the impact of the Executive Order in NY with Massachusetts (MA) as a comparison state. Participants We analyzed data on COVID-19 in NY and MA from March 25 to May 6, 2020. Intervention The Executive Order on face mask use in NY. Main Measures Daily numbers of COVID-19 confirmed cases and deaths. Key Results The average daily number of confirmed cases in NY decreased from 8549 to 5085 after the Executive Order took effect, with a trend change of 341 (95% CI, 187–496) cases per day. The average daily number of deaths decreased from 521 to 384 during the same two time periods, with a trend change of 52 (95% CI, 44–60) deaths per day. Compared to MA, the decreasing trend in NY was significantly greater for both daily numbers of confirmed cases (P = 0.003) and deaths (P < 0.001). Conclusions The Executive Order on face mask use in NY led to a significant decrease in both daily numbers of COVID-19 confirmed cases and deaths. Findings from this study provide important evidence to support state-level policies that require face mask use by the general public. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-020-06476-9.

Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. We conducted a 2-year cluster randomized trial in Peru by assigning 23 villages to 1 of 3 geographically targeted intervention approaches. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. In ring treatment (RT), participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment (MT), participants received niclosamide treatment every 6 months regardless of location. In each approach, half the villages received targeted or mass oxfendazole for pigs (6 total study arms). We noted significant reductions in seroincidence among pigs in all approaches (67.1% decrease in RS, 69.3% in RT, 64.7% in MT; p

Highlights • Hong Kong reported more than 1000 COVID-19 cases between January and May 2020. • The COVID-19 epidemic in Hong Kong was featured by several waves of imported cases followed by limited local transmissions. • A series of public health intervention have been implemented in Hong Kong in response to the local and overseas disease situations. • The multi-pronged strategy of border control, social distancing, enhanced surveillance and contact tracing resulted in the successful prevention of community-wide outbreak and containment of the epidemic in Hong Kong., Background Hong Kong, a Special Administrative Region of China, recorded its first confirmed Coronavirus disease 2019 (COVID-19) case on 23 January 2020. We reviewed the case epidemiology and the various public health measures implemented from January to May 2020. Method We described and compared the epidemiological and clinical characteristics of the cases recorded in different phases of the epidemic and reviewed the effectiveness of the public health measures implemented using the changes in the daily number of confirmed cases and the interval from symptom onset to hospital admission. Results Between January and May 2020, 1084 confirmed COVID-19 cases were reported, about 70% of which had travel history during the incubation period. The case fatality ratio was 0.4%. The local epidemic progressed through four phases: (i) preparedness and imported infection from mainland China, (ii) local transmission, (iii) imported infection from overseas countries associated with local transmission, and (iv) controlled imported infection with limited local transmission, with an eventual reduction of daily case number and minimization of onset-to-admission interval. Various public health measures, including enhanced surveillance, border control and social distancing, were introduced in phases in response to the prevailing local and global situations. Discussion Hong Kong’s overall containment strategy has led to a stabilization of number of cases and absence of community-wide outbreak in the 4.5 months since the reporting of the first case. Hong Kong’s strategy of containment might serve as an example for future planning of preparedness and response against novel infectious agents.

Background Due to the success of immunization, most of young people have little experience with vaccine preventable diseases. This inexperience may increase vaccine hesitancy in this population subgroup which can potentially jeopardize population vaccination coverage. Understanding young peoples' attitudes towards vaccination is important for vaccination uptake. The aim of this study was to evaluate attitudes towards vaccination among Croatian high school students. Methods This online cross-sectional questionnaire study was conducted during the January 2021 to April 2021 in convenient sample of high school students from north-western part of Croatia. Vaccination Attitudes Examination scale (VAX) was used to assess antivaccination attitudes in study population. Results The study included 1012 high school students; 29.2% males and 70.8% females; median age 17.0 (interquartile range (IQR) 17.0 - 18.0) years. Overall value of the VAX score in study sample was 50.4±11.1. Female students had more negative attitudes towards vaccination in comparison to male students (P = 0.001). When analysing differences between female and male students according to the VAX scale subcategories the study revealed that female students demonstrated more worries over unforeseen future effects of the vaccination (P < 0.001) while there were no differences between females and males according to the mistrust of vaccine benefits, concerns about commercial profit and preference for natural immunity (P = 0.155, P = 0.157 and P = 0.142, respectively). Conclusions The study revealed rather high antivaccination attitudes among Croatian high school students as measured by VAX score. Further studies are needed to better understand factors that influence such attitudes in study population because programs directed towards changing antivaccination attitudes in order to be efficient need to successfully tackle all of those factors. Key messages Public health interventions directed towards suppression of antivaccination movement should more involve younger population subgroups, such as elementary and high school students. Positive attitudes towards vaccination in younger population subgroups are one of the crucial preconditions for adequate vaccination coverage.

Background Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. Methods This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants’ compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. Discussion The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February–May 2019), a total of 91 children participated in the trial while for the second study period (February–May 2020), another 120 children completed data collection. Recruitment for the third study period (February–May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. Trial registration ClinicalTrials.gov: NCT03503812, April 20, 2018.

Highlights • Rt can be used to closely monitor the non-pharmaceutical interventions (NPI) of COVID-19 epidemic. • Generally, the activity of the epidemic in Oman. • Other factors, like the return of overseas students, have increased the epidemic activity. • Responses to NPI is different between migrants and natives., Background COVID-19’s emergence carries with it many uncertainties and challenges, one of which is epidemic management strategies. Oman has implemented non-pharmaceutical interventions (NPIs) to mitigate the impact of COVID-19. However, responses to NPIs may be different across different populations in a country with a large number of migrants like Oman. This study investigates the different responses to NPIs assessing the use of time-varying reproduction number (Rt) to monitor it. Methods Polymerase chain reaction (PCR) laboratory-confirmed COVID-19 data from Oman was used from February 24th to June 3rd, 2020 and included demographic and epidemiological information. Data were arranged into pairs of infector–infectee, and two main libraries of R software were used to estimate reproductive number (Rt). Rt was calculated for both Omanis and non-Omanis. Findings A total of 13,538 cases were included, 44·9% of which were Omanis. Among all, we identified 2769 infector–infectee pairs to calculate Rt. There was a sharp drop in Rt from 3·7, (95% confidence interval [CI] 2·8-4·6) mid-March to 1·4 (95% CI 1·2–1·7) in late March in response to NPIs. Then Rt decreased to 1·2 (95% CI 1·1–1·3) late April when it rose, corresponding to the easing up of NPIs. Comparing the two groups, the response to major public health controls was more evident in Omanis in reducing the Rt to 1·09 (95% CI 0·84–1·3) at the end of March. Interpretation Use of real-time estimation of Rt has allowed us to follow the effect of NPIs. The migrant population responds differently than the Omani population.

The success of public health measures for controlling the coronavirus disease 2019 (COVID-19) pandemic relies on population compliance. We analyzed compliance with social distancing and its associations with mental health. The Hong Kong COVID-19 Health Information Survey was conducted from 9&ndash, 23 April 2020 on 1501 adults randomly sampled for landline telephone interviews (n = 500) and online surveys (n = 1001). Compliance with social distancing and staying-at-home, stress (Perceived Stress Scale-4), anxiety (General Anxiety Disorders-2), and depressive symptoms (Patient Health Questionnaire-2) were collected. The associations between mental health symptoms and compliance were examined by multivariable regression models. Of the 1501 respondents (52.5% female, 72.3% aged 18&ndash, 59 years), 74.2%, 72.7%, and 59.7% reported avoiding going out, going to crowded places, and attending social gatherings of more than four people, respectively. Most respondents had stayed-at-home for at least four of the past seven days (58.4%, mean 4.12, Standard Deviation 2.05). Adoption, perceived effectiveness, and perceived compliance with social distancing were associated with lower stress levels and less anxiety and depressive symptoms (all p &lt, 0.01). However, more days stayed-at-home were associated with more depressive symptoms (adjusted Odds Ratio 1.09, 95%Confidence Interval 1.00, 1.18). The long-term psychological impact in relation to social distancing and staying-at-home requires further investigation.

Background Non-pharmaceutical interventions (NPIs) are used to reduce transmission of SARS coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). However, empirical evidence of the effectiveness of specific NPIs has been inconsistent. We assessed the effectiveness of NPIs around internal containment and closure, international travel restrictions, economic measures, and health system actions on SARS-CoV-2 transmission in 130 countries and territories. Methods We used panel (longitudinal) regression to estimate the effectiveness of 13 categories of NPIs in reducing SARS-CoV-2 transmission using data from January to June 2020. First, we examined the temporal association between NPIs using hierarchical cluster analyses. We then regressed the time-varying reproduction number (Rt) of COVID-19 against different NPIs. We examined different model specifications to account for the temporal lag between NPIs and changes in Rt, levels of NPI intensity, time-varying changes in NPI effect, and variable selection criteria. Results were interpreted taking into account both the range of model specifications and temporal clustering of NPIs. Results There was strong evidence for an association between two NPIs (school closure, internal movement restrictions) and reduced Rt. Another three NPIs (workplace closure, income support, and debt/contract relief) had strong evidence of effectiveness when ignoring their level of intensity, while two NPIs (public events cancellation, restriction on gatherings) had strong evidence of their effectiveness only when evaluating their implementation at maximum capacity (e.g. restrictions on 1000+ people gathering were not effective, restrictions on Conclusion Understanding the impact that specific NPIs have had on SARS-CoV-2 transmission is complicated by temporal clustering, time-dependent variation in effects, and differences in NPI intensity. However, the effectiveness of school closure and internal movement restrictions appears robust across different model specifications, with some evidence that other NPIs may also be effective under particular conditions. This provides empirical evidence for the potential effectiveness of many, although not all, actions policy-makers are taking to respond to the COVID-19 pandemic.

Background: Iodine deficiency is the most common cause of preventable brain harm and cognitive impairment in children. Portuguese women of childbearing age, pregnant women and their progeny were shown to have inadequate iodine intake. Consequently, the Portuguese Health Authorities have recommended a daily supplementation with 150-200 µg iodine in preconception, pregnancy, and lactation. The IodineMinho study intends to evaluate whether (i) this recommendation impacted on the prevalence of iodine deficiency in pregnant women from the Minho region of Portugal, (ii) the time of initiation of iodine supplementation (if any) influences the serum levels of thyroid hormones at several intervals during pregnancy and (iii) there are serum thyroid-hormone parameters in the 1st trimester of pregnancy that predict psychomotor development of the child at 18 months of age. Methods: Most Portuguese women are followed throughout pregnancy in community Family Health Units, where family physicians may choose to follow the National recommendation or other, concerning iodine sufficiency. This study will recruit women (N = 304) who intend to become pregnant or are already pregnant from 10 representative Units. Physician's approach and prescriptions, sociodemographic, nutrition and clinical information will be obtained at baseline and throughout pregnancy. To evaluate endocrine function, blood and urine samples will be collected at recruitment, once in each trimester of pregnancy, at delivery and 3 months after delivery. Breastmilk samples will be collected for iodine and energy content analysis. Children will be evaluated for psychomotor development at 18 months. Maternal thyroid volume will be evaluated by ultrasound scan at baseline, in the 3rd trimester and at 3 months after delivery. Discussion: Iodine deficiency early during development precludes children from achieving full intellectual capabilities. This protocol describes a study that is innovative and unique in its detailed and comprehensive evaluation of maternal and child endocrine and psychomotor parameters. By evaluating the effectiveness of the iodine supplementation recommendation, it will contribute to the public health systems' efforts to provide excellence in maternal and infant care. Trial registration: ClinicalTrials.gov, NCT04288531 . Registered 28 February 2020-Retrospectively registered. Specific funding for this study is pending. The launching phase of this study was supported by National funds, through the Foundation for Science and Technology (FCT) - project UIDB/50026/2020 and UIDP/50026/2020; by the projects NORTE-01-0145-FEDER-000013, NORTE-01-0145-FEDER-000023 and NORTE-01-0246-FEDER-000012, supported by Norte Portugal Regional Operational Program (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). info:eu-repo/semantics/publishedVersion

Background: Dengue is a major emerging infectious disease, endemic throughout the tropics and subtropics, with approximately 2.5 billion people at risk globally. Active (AS) and passive surveillance (PS), when combined, can improve our understanding of dengue’s complex disease dynamics to guide effective, targeted public health interventions. The objective of this study was to compare findings from the Ministry of Health (MoH) PS to a prospective AS arbovirus research study in Machala, Ecuador in 2014 and 2015[P1] . Methods: Dengue cases in the PS system were compared to laboratory confirmed acute dengue illness cases that entered the AS study during the study period. Variables of interest included age, class, and sex. Outbreak detection curves by epidemiologic week, overall cumulative incidence and age-specific incidence proportions were calculated. Descriptive statistics were tabulated for all variables of interest. Chi-square tests were performed to compare demographic characteristics between the AS and PS data sets in 2014 and 2015. Results: 177 and 245 cases were identified from 1/1/2014 to 12/31/2015 by PS and AS, respectively; nine cases appeared in both systems. AS identified a greater number of laboratory-confirmed cases in 2014, accounting for more than 60% of dengue cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue cases in the region. Peak transmission time, as noted by AS and PS was similar in 2014 whereas earlier detection was observed by AS in 2015.Younger patients were more frequently identified by PS, while older patients were identified more frequently by AS. The cumulative incidence proportion for laboratory confirmed dengue illness reported via PS to the MoH was 4.12 cases per 10,000 residents in 2014, and 2.21 cases per 10,000 residents in 2015.Conclusions: Each surveillance system captured distinct demographic subgroups within the Machala population, possibly due to differences in healthcare seeking behaviors, access to care, emerging threats of other viruses transmitted by the same mosquito vector and/or differences in clinical presentation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously under diagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of timely public health interventions.

The outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China, in December 2019. As of 17 April 2020, more than 2 million cases of COVID-19 have been reported worldwide. Northern Italy is one of the world&rsquo, s centers of active coronavirus cases. In this study, we predicted the spread of COVID-19 and its burden on hospital care under different conditions of social distancing in Lombardy and Emilia-Romagna, the two regions of Italy most affected by the epidemic. To do this, we used a Susceptible-Exposed-Infectious-Recovered (SEIR) deterministic model, which encompasses compartments relevant to public health interventions such as quarantine. A new compartment L was added to the model for isolated infected population, i.e., individuals tested positives that do not need hospital care. We found that in Lombardy restrictive containment measures should be prolonged at least until early July to avoid a resurgence of hospitalizations, on the other hand, in Emilia-Romagna the number of hospitalized cases could be kept under a reasonable amount with a higher contact rate. Our results suggest that territory-specific forecasts under different scenarios are crucial to enhance or take new containment measures during the epidemic.

Background Experimentation with new behaviours during adolescence is normal. However, engagement in two or more risk behaviours, termed multiple risk behaviours is associated with socioeconomic disadvantage and poor health and social outcomes. Evidence of how adolescents cluster based on their risk behaviours is mixed. Methods Latent Class Analysis was used to study patterns of engagement in 10 self-reported risk behaviours (including substance use, self-harm and sexual health) from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort at ages 15–16 years. Data was available for 6556 adolescents. Associations between risk profile and sex were explored. Results A 3-class model for both females and males was deemed to have acceptable fit. Whilst we found evidence of a sex difference in the risk behaviours reported within each class, the sex-specific results were very similar in many respects. For instance, the prevalence of membership of the high-risk class was 8.5% for males and 8.7% for females and both groups had an average of 5.9 behaviours. However, the classes were both statistically dubious, with class separation (entropy) being poor as well as conceptually problematic, because the resulting classes did not provide distinct profiles and varied only by quantity of risk-behaviours. Conclusion Clusters of adolescents were not characterised by distinct risk behaviour profiles, and provide no additional insight for intervention strategies. Given this is a more complicated, software-specific method, we conclude that an equally effective, but more readily replicable approach is to use a count of the number of risk behaviours.

Digital contact tracing is a promising digital public health intervention to manage epidemics. However, in order to reach its full potential, the technology has to be widely adopted and used. During the SARS-CoV-2 pandemic, this has not necessarily been the case. We review the literature with a focus on how participation in digital contact tracing could be fostered and provide policy recommendations on how to increase its adoption and usage as well as recommendations for further research.

Background The YAM DAABO study (“your choice” in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents. Methods Based on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach – a research workshop gathering service providers, members of both country research teams, and the WHO coordination team. Results As barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners. Conclusions Our research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women’s right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries. Trial registration Retrospectively registered in the Pan African Clinical Trials Registry (PACTR201609001784334, 27 September 2016). Electronic supplementary material The online version of this article (10.1186/s12905-018-0573-5) contains supplementary material, which is available to authorized users.

Lifestyle and dietary changes have led to rise in noncommunicable diseases such as diabetes, obesity, and cardiovascular disorders, accounting for increased mortality and morbidity in many parts of the world including developing countries. Obesity has doubled since 1980s and continues to be a growing problem of our times. Public health policies to address obesity are evolving in connection with dynamically changing human behaviors and complex interactions with the environment. However, designing and testing of new interventions are expensive and time-consuming. Computational simulations to model interventions offer useful tools to compare the effectiveness of potential interventions. In this article, we discuss a popular computational approach, agent-based modeling (ABM), to address the global challenge of childhood obesity through modeling of different interventions as described in the literature.

Background: A novel coronavirus disease (COVID-19) outbreak due to the severe respiratory syndrome coronavirus (SARS-CoV-2) infection occurred in China in late December 2019. Facemask wearing with proper hand hygiene is considered an effective measure to prevent SARS-CoV-2 transmission, but facemask wearing has become a social concern due to the global facemask shortage. China is the major facemask producer in the world, contributing to 50% of global production. However, a universal facemask wearing policy would put an enormous burden on the facemask supply. Methods: We performed a policy review concerning facemasks using government websites and mathematical modelling shortage analyses based on data obtained from the National Health Commission (NHC), the Ministry of Industry and Information Technology (MIIT), the Centre for Disease Control and Prevention (CDC), and General Administration of Customs (GAC) of the People's Republic of China. Three scenarios with respect to wearing facemasks were considered: (1) a universal facemask wearing policy implementation in all regions of mainland China; (2) a universal facemask wearing policy implementation only in the epicentre (Hubei province, China); and (3) no implementation of a universal facemask wearing policy. Findings: Regardless of different universal facemask wearing policy scenarios, facemask shortage would occur but eventually end during our prediction period (from 20 Jan 2020 to 30 Jun 2020). The duration of the facemask shortage described in the scenarios of a country-wide universal facemask wearing policy, a universal facemask wearing policy in the epicentre, and no universal facemask wearing policy were 132, seven, and four days, respectively. During the prediction period, the largest daily facemask shortages were predicted to be 589·5, 49·3, and 37·5 million in each of the three scenarios, respectively. In any scenario, an N95 mask shortage was predicted to occur on 24 January 2020 with a daily facemask shortage of 2·2 million. Interpretation: Implementing a universal facemask wearing policy in the whole of China could lead to severe facemask shortage. Without effective public communication, a universal facemask wearing policy could result in societal panic and subsequently, increase the nationwide and worldwide demand for facemasks. These increased demands could cause a facemask shortage for healthcare workers and reduce the effectiveness of outbreak control in the affected regions, eventually leading to a pandemic. To fight novel infectious disease outbreaks, such as COVID-19, governments should monitor domestic facemask supplies and give priority to healthcare workers. The risk of asymptomatic transmission and facemask shortages should be carefully evaluated before introducing a universal facemask wearing policy in high-risk regions. Public health measures aimed at improving hand hygiene and effective public communication should be considered along with the facemask policy. Keyword: Novel coronavirus-infected pneumonia, COVID-19, SARS-CoV-2, Facemask shortage, Public health intervention, Universal facemask wearing policy

Background Heat wave early warning systems help alert decision-makers and the public to prepare for hot weather and implement preventive actions to protect health. Prior to harmonization, public health units across Ontario either used independent systems with varying methodologies for triggering and issuing public heat warnings or did not use any system. The federal government also issued heat warnings based on different criteria. During heat events, adjacent public health units in Ontario and the federal government would routinely call heat warnings at different times with separate public messages, leading to confusion. This article describes the collaborative process and key steps in developing a harmonized Heat Warning and Information System (HWIS) for Ontario. Setting Public health units across Ontario, Canada, collaborated with the federal and provincial government to develop the harmonized HWIS for Ontario. Intervention In 2011, stakeholders identified the need to develop a harmonized system across Ontario to improve heat warning services, warning criteria, and health messaging. Through a 5-year process facilitated by a non-governmental organization, the three levels of government collaborated to establish the Ontario HWIS. Outcomes The province-wide HWIS was implemented in 2016 with the Ontario Ministry of Health and Long-Term Care’s release of the harmonized HWIS Standard Operating Practice, which outlined the notification and warning process. Implications The lessons learned could help spur action in other provinces and jurisdictions internationally in the development of similar health evidence-based warning systems, including in particular those for protecting public health during extreme heat events.

In Qatar, tobacco is the leading preventable cause of death and disease. Telephone-based interventions for smoking are cost-effective and scalable interventions that are effective in promoting smoking behavior change. While many countries have implemented these services within their tobacco control programs, there is a distinct dearth of a telephone-based smoking cessation intervention that is adapted and tailored to meet the needs of people who smoke in Qatar. This study presents the protocol of a primary health care center integrated smoking quitline program in Qatar. Participants will be recruited from seven smoking clinics (recruitment sites). Trained clinic staff will provide brief advice on quitting followed by a referral to the quitline. Eligible participants (male smokers over 18 years of age) will complete baseline questionnaires and receive five weekly proactive counseling calls, an end-of-treatment assessment (approx. 1 week after Session 5), and 1- and 3-month follow-up assessments. The main aim of this study is to assess the feasibility and acceptability, which include the recruitment and retention rate, compliance to pharmacotherapy, and participant satisfaction. This is the first study to integrate an evidence-based smoking cessation intervention delivered via telephone within the healthcare system in Qatar. If effective, results can inform the development of a large-scale telephone-based program that widely reaches users of tobacco in Qatar as well as in the Middle East.

OBJECTIVES: To invite and support managers of child care centres to measure radon concentrations in their buildings. Their ability to carry out a measurement protocol and communication plan was also evaluated as well as the intention of parents and educators to test for radon at home. PARTICIPANTS: Managers, parents and educators of child care centres. SETTING: 36 child care centres located in two priority investigation areas in Quebec. INTERVENTION: A kit containing radon detectors with installation and recovery instructions was shipped by mail in addition to factsheets intended for parents and educators. Site visits and phone calls were also conducted with a sample of child care centres and participants. OUTCOMES: The instructions related to detector installation were generally well respected. Afterward, more than half (18) of the 34 parents and educators interviewed said that they had been directly informed of this radon testing by managers or other educators, and not by the factsheet provided. This radon measurement intervention was considered very relevant by 91% of them and a quarter (26%) expressed their intention to test for radon at home, while 6% had already done so. Two child care centres (5.5%) had at least one measurement above the Canadian guideline level of 200 Bq/m 3 . CONCLUSION: This intervention has demonstrated the ability of child care centre managers to carry out this type of autonomous procedure, which can be centralized to minimize costs. This type of intervention may influence parents to become more familiar with this contaminant and measure their family’s exposure at home.

OBJECTIVES: To provide opportunities for intergenerational knowledge sharing for healthy lifestyles; to facilitate youth and Elder mentorship; and to increase the self-esteem of youth by celebrating identity, cultural practices and community connection through the creation and sharing of digital stories. PARTICIPANTS: A youth research team (8 youth) aged 13–25, youth participants (60 core participants and 170 workshop participants) and Elders (14) from First Nations communities. SETTING: The project was conducted with participants from several communities on Vancouver Island through on-site workshops and presentations. INTERVENTION: Youth and Elders were invited to a 3-day digital story workshop consisting of knowledge-sharing sessions by Elders and digital story training by the youth research team. Workshop attendees returned to their communities to develop stories. The group re-convened at the university to create digital stories focused on community connections, family histories and healthy lifestyles. During the following year the research team delivered instructional sessions in communities on the digital story process. OUTCOMES: The youth involved reported increased pride in community as well as new or enhanced relationships with Elders. CONCLUSIONS: The digital stories method facilitated intergenerational interactions and engaged community members in creating a digital representation of healthy lifestyles. The process itself is an intervention, as it affords critical reflection on historical, cultural and spiritual ideas of health and what it means to be healthy in an Aboriginal community. It is a particularly relevant health promotion tool in First Nations communities with strong oral history traditions.

ObjectivesTo quantify population-level health and economic consequences of sick leave among workers with influenza symptoms.InterventionsCompared with current sick leave practice (baseline), we evaluated the health and cost consequences of: (1) increasing the proportion of workers on sick leave from 65% (baseline) to 80% or 90%; (2) shortening the maximum duration from symptom onset to sick leave from 4 days (baseline) to 2 days, 1.5 days, 1 day and 0.5 days; and (3) combinations of 1 and 2.MethodsA dynamic compartmental influenza model was developed using Norwegian population data and survey data on employee sick leave practices. The sick leave interventions were simulated under 12 different seasonal epidemic and 36 different pandemic influenza scenarios. These scenarios varied in terms of transmissibility, the proportion of symptomatic cases and illness severity (risk of primary care consultations, hospitalisations and deaths). Using probabilistic sensitivity analyses, a net health benefit approach was adopted to assess the cost-effectiveness of the interventions from a societal perspective.ResultsCompared with current sick leave practice, sick leave interventions were cost-effective for 31 (65%) of the pandemic scenarios, and 11 (92%) of the seasonal scenarios. Economic benefits from sick leave interventions were greatest for scenarios with low transmissibility, high symptomatic proportions and high illness severity. Overall, the health and economic benefits were greatest for the intervention involving 90% of sick workers taking sick leave within one-half day of symptoms. Depending on the influenza scenario, this intervention resulted in a 44.4%–99.7% reduction in the attack rate. Interventions involving sick leave onset beginning 2 days or later, after the onset of symptoms, resulted in economic losses.ConclusionsPrompt sick leave onset and a high proportion of sick leave among workers with influenza symptoms may be cost-effective, particularly during influenza epidemics and pandemics with low transmissibility or high morbidity.

The Cold Weather Plan (CWP) in England was introduced to prevent the adverse health effects of cold weather, however, its impact is currently unknown. This study characterizes cold-related mortality and fuel poverty at STP (Sustainability and Transformation Partnership) level, and assesses changes in cold risk since the introduction of the CWP. Time series regression was used to estimate mortality risk for up to 28 days following exposure. Area level fuel poverty was used to indicate mitigation against cold exposure and mapped alongside area level risk. We found STP variations in mortality risk, ranging from 1.74, 1.44–2.09 (relative risk (RR), 95% CI) in Somerset, to 1.19, 1.01–1.40 in Cambridge and Peterborough. Following the introduction of the CWP, national-level mortality risk declined significantly in those aged 0–64 (1.34, 1.23–1.45, to 1.09, 1.00–1.19), but increased significantly among those aged 75+ (1.36, 1.28–1.44, to 1.58, 1.47–1.70) and for respiratory conditions (1.78, 1.56–2.02, to 2.4, 2.10–2.79). We show how spatial variation in cold mortality risk has increased since the introduction of the CWP, which may reflect differences in implementation of the plan. Combining risk with fuel poverty information identifies 14 STPs with the greatest need to address the cold effect, and that would gain most from enhanced CWP activity or additional intervention measures.

To increase teenagers’ nutrition knowledge is an important target and has the potential to improve their dietary habits and lifestyle while reducing incidences of obesity-related non-communicable diseases throughout the whole lifespan. This study protocol presents the general approach and details of an assessment of nutritional knowledge, attitudes toward nutrition, diet quality, lifestyle and body composition that have been used to comprehensively evaluate the cross-behavioral patterns covering dietary and lifestyle behaviors in Polish teenagers. The study was designed in two paths as: a cross-sectional study (covering 1569 students) and an education-based intervention study (464 students) with a 9-month follow-up. We describe a short form of the food frequency questionnaire (SF-FFQ4PolishChildren) used to collect data and details of diet-related and lifestyle-related education program, which was developed and implemented by academic researchers involved in the study. We also describe details of the data development and statistical analysis, including multidimensional methods of clustering variables to identify cross-behavioral patterns covering diet and lifestyle. The results of the study will provide evidence-based support for preventive health care to promote normal growth and development of young population and reduce the risk of diet-related diseases in adulthood, by early shaping of adequate dietary and lifestyle behaviors. In the future, well-tailored education programs addressed to teenagers can be created as an important public health action, based on our results.

OBJECTIVES: To assess potential inequitable impacts of a proposed Teen Triple P Positive Parenting Program (Teen PPP) in Manitoba to achieve equity of access and outcomes for families of diverse backgrounds; recommend (if required) alternative actions to promote greater equity of access and outcomes for families participating in Teen PPP; and evaluate the influence of recommendations on implementation of the proposed program. INTERVENTION: An equity-focused health impact assessment (EfHIA) of the proposed Teen PPP was conducted, using a standard EfHIA framework. Methods used to assess potential Teen PPP impacts included: a literature review, key informant interviews and 14 community consultations. Evidence was analyzed, summarized and presented to the project Steering Committee (SC), along with draft recommendations for ensuring that equity is considered in Teen PPP planning and rollout. OUTCOMES: The SC prioritized 12 possible inequitable impacts of Teen PPP with potential to prevent certain parents/caregivers either from accessing the proposed program or benefitting adequately from the program, causing them to drop out prematurely. Recommendations for avoiding these impacts were finalized by the SC and presented to provincial government officials responsible for the proposed program. Follow-up interviews with these individuals indicated that the recommendations were well received and raised equity-related issues that will be considered in future program planning decisions. CONCLUSION: EfHIA is a proven planning tool for ensuring that health equity is considered in all policies, which is one of the necessary conditions for reducing inequities and closing the health equity gap throughout Canada within a generation.

OBJECTIVE: To test the feasibility, acceptability and preliminary impact of Parents and Tots Together (PTT), a family-based obesity prevention intervention, in Canada. PARTICIPANTS: Canadian parents of preschoolers (aged 2–5 years). SETTING: Ontario Early Years centres in southwestern Ontario. INTERVENTION: A pilot randomized controlled trial involving 48 parents who received either the PTT intervention ( n = 27) or an attention-matched control home safety intervention ( n = 21). To evaluate the feasibility of PTT, we assessed participant retention and outcome evaluation completion rates. To evaluate acceptability, we assessed program attendance and parents’ responses to program satisfaction surveys. To evaluate preliminary impact, we assessed children’s body mass index (BMI) at baseline, after intervention (end of 9-week intervention) and at 9-month follow-up. As well, at each time point, parents completed surveys assessing stress and self-efficacy related to parenting, children’s sleep, activity, TV viewing and diet. OUTCOMES: Retention rates were high in the intervention (93%) and control (84%) study arms, and 87% of parents reported that they would highly recommend PTT to a friend. At 9-month follow-up, intervention parents reported lower parenting stress ( β ＾ = 15.83, 95% confidence interval [CI] -29.57, -2.07, p = 0.02) and greater self-efficacy in managing their child’s behaviour ( β ＾ = 0.16, 95% CI 0.002, 0.33, p = 0.05) than control parents. PTT had minimal influence on children’s weight-related behaviours and BMI. CONCLUSIONS: The results suggest that PTT can feasibly be implemented and tested in the Canadian context. Preliminary impact results suggest that the program may be effective in changing general parenting; however, program content should be modified to adequately address children’s weight-related behaviours.

Introduction Sierra Leone experienced an unprecedented Ebola virus disease (EVD) outbreak in all its districts. Koinadugu District was the last to report an EVD case. Several outbreak response strategies were implemented. As part of lessons learnt, we conducted an observational study to describe the transmission chain in the district and the impact of the control measures implemented to contain the outbreak. Methods We reconstructed the transmission chain, positioning both confirmed and probable cases, described the distribution of the EVD confirmed cases in the context of the routes of transmission (Community, Funeral or Health facility setting) and assessed the impact of control measures using the surveillance data collected during the outbreak. Results All 142 confirmed and probable EVD cases registered were fully resolved in the transmission chain. 72.5% of all the EVD cases in the district were exposed in the community, 26.1% exposed during funerals, and 1.4% exposed in the health facility setting. Health-care workers contributed little to the EVD outbreak. 71.1% of EVD transmission occurred among family members. Female EVD cases generated more secondary cases than their male counterparts (P = 0.03). With removal of EVD cases from the community and admission to the community care center (CCC), the EVD transmission in the community decreased to substantially lower rates. In addition, transmission due to exposure in health facilities was further reduced with the implementation of full infection and prevention controls. Conclusion This study details the transmission chain of EVD in a rural district setting and the public health interventions implemented to successfully limit the outbreak to just one of 11 chiefdoms. Heightened community-based surveillance for early case detection, swift isolation of suspect cases, efficient contact tracing and monitoring, and good infection prevention and control measures in health facilities were highly effective in limiting transmission and, eventually, breaking the transmission chain. CCCs were also instrumental in achieving early isolation and basic care for suspect cases, while ensuring that their family members who were close contacts remained in the community for easy contact tracing and monitoring. These were very useful lessons learnt that would inform the management of future outbreaks.

OBJECTIVE: The Influenza Prevention Policy (“the Policy”) aims to increase seasonal influenza vaccination coverage among British Columbia (BC) health care workers (HCWs). PARTICIPANTS: HCWs who work in publicly funded facilities and attend patient care areas. SETTING: The Policy was announced in August 2012 and took effect province-wide during the 2012/13 flu season. INTERVENTION: BC HCWs are required to receive seasonal influenza vaccination by the start of the flu season (December 1) or wear a mask while at work until the flu season ends (March 30). Vaccinated HCWs need to wear a green dot on their identification tag. HCWs are expected to report noncompliant coworkers. As initially proposed, continued noncompliance with the Policy could result in termination of employment (ultimately this component was put in abeyance). OUTCOME: For the 2012/13 flu season, 74% of HCWs (35,889/48,818) at acute care facilities received influenza vaccination compared with 40% (23,375/58,212) in 2011/12 (difference in proportion=0.33, 95% confidence interval [CI]: 0.33-0.34, p

OBJECTIVES: We describe the development of the first community-based opioid overdose prevention and response program with naloxone distribution offered by a public health unit in Canada (Prevent Overdose in Toronto, POINT). PARTICIPANTS: The target population is people who use opioids by any route, throughout the City of Toronto. SETTING: The POINT program is operated by the needle exchange program at Toronto Public Health (The Works) and offered at over 40 partner agency sites throughout Toronto. INTERVENTION: POINT is a comprehensive program of overdose prevention and response training, including naloxone dispensing. Clients are instructed by public health staff on overdose risk factors, recognizing signs and symptoms of overdose, calling 911, naloxone administration, stimulation and chest compressions, and post-overdose care. Training is offered to clients one-on-one or in small groups. Clients receive a naloxone kit including two 1 mL ampoules of naloxone hydrochloride (0.4 mg/mL) and are advised to return to The Works for a refill and debriefing if the naloxone kit is used. OUTCOMES: In the first 8 months of the program, 209 clients were trained. Clients have reported 17 administrations of naloxone, and all overdose victims have reportedly survived. Client demand for POINT training has been high, and Toronto Public Health has expanded its capacity to provide training. Overall, reception to the program has been overwhelmingly positive. CONCLUSION: We are encouraged by the initial development and implementation experience with the naloxone program and its potential to save lives in Toronto. We have planned short-, intermediate-, and long-term process and outcome evaluations.

Background: Organophosphate poisoning is a major public health problem in South Africa. Individuals get exposed to organophosphate in both the domestic and industrial spheres. Method: A cross-sectional study was conducted using retrospective, secondary data of organophosphate poisoning cases over a 3-year period, reported at the Tshwane District surveillance office. Data were analysed using Microsoft Excel, and Epi Info version 7 was used for descriptive statistics. Results: A total of 207 cases were reported with ages ranging from 10 months to 59 years. Most of the cases were men (58.9%). Intentional poisoning accounted for 51% of cases. Unintentional poisoning accounted for 21.7% of cases, and 26.5% of cases had unknown circumstances of poisoning. A significant number (50.2%) of intentional poisonings were suicide related. Nonsuicidal cases accounted for 47.4% of cases, and deliberate unlawful poisoning accounted for 2.4% of cases. The mortality rate for the whole group was 3.4%. Conclusions: Improvement in data collection on organophosphate poisoning is essential to properly measure the burden of the problem. More effective regulatory controls for pesticide use are needed in South Africa.

OBJECTIVE: The objective of the Children’s Oral Health Initiative (COHI) is to increase access to preventive oral health services provided to First Nations and Inuit (FN/I) children living on federal reserves and in remote communities. PARTICIPANTS: COHI targets preschool children; 5–7-year-olds; pregnant women; and parents/caregivers in FN/I communities. SETTING: The program was piloted in 2004 by Health Canada and is potentially available to all FN/I communities. However, the community must consent to the program’s implementation and agree to support a community member to be trained as a COHI aide. INTERVENTION: Dental therapists and hygienists screen eligible children, apply fluoride varnish and sealants to children’s teeth, and stabilize active dental caries with glass ionomer. An innovation was the development of a community oral health worker, the COHI Aide. The COHI Aide is a community member who serves as an advocate for preventive oral health in the community and provides instruction to children, parent/caregivers and expectant mothers in preventing dental caries. RESULTS: COHI was piloted in 41 communities in 2004. By 2014, the program had expanded to 320 FN/I communities, which represents 55% of all eligible FN/I communities. In 2012, 23,085 children had received COHI preventive oral health services. CONCLUSION: The results demonstrate COHI’s success as a preventive oral health care delivery model in remote communities. Implementation and delivery of preventive oral health services has been enhanced by the sustained presence of a community-based COHI Aide.

OBJECTIVE: Our objective was to determine the effectiveness of an intervention, the Immunization Reminders Project, in terms of a) improving vaccination coverage rates for measles, mumps and rubella (MMR) among 2-year-olds and b) ameliorating geographical disparities in early childhood immunization coverage. TARGET POPULLATION: All 14-month-old and 20-month-old children in Saskatoon Health Region who were overdue for their immunizations. SETTING: Saskatoon Health Region (SHR). INTERVENTION: The intervention involved calling the parents/caregivers of the children in the target population with a reminder about immunizations. After five telephone calls and if the parent/caregiver could not be reached, a letter was mailed to the last known address. If there was no response to the letter, a reminder home visit was attempted for families residing in the low-income neighbourhoods in Saskatoon. Since January 2009, all reminders for families not residing in the low-income neighbourhoods in Saskatoon are made through mailed letters. OUTCOMES: After the introduction of the Immunization Reminders Project, coverage rates among 2-year-olds for MMR increased significantly overall and in most geographical areas examined. Disparities between geographical subgroups appeared to be declining, but not significantly. COMCLUSION: A universal approach to early childhood immunization can likely contribute to increases in coverage rates, but there is still room for improvement in SHR. These findings have prompted additional practice and policy changes.

Objectives: International agencies are required to adapt, pilot and then evaluate the effectiveness of the Nurse-Family Partnership (NFP) prior to broad implementation of this public health intervention. The objectives of this qualitative case study were to: 1) determine whether the NFP can be implemented in Canada with fidelity to the US model, and 2) identify the adaptations required to increase the acceptability of the intervention for service providers and families. Participants: 108 low-income, first-time mothers in Hamilton, Ontario, received the NFP intervention. In-depth interviews were conducted with NFP clients (n=38), family members (n=14) and community professionals (n=24). Setting: Hamilton, Ontario. Intervention and Data Collection: An intensive nurse home visitation program delivered to women starting early in pregnancy and continuing until the child was two years old. Processes to adapt and implement the NFP were explored across seven focus groups with public health nurses and managers. Eighty documents were reviewed to identify implementation challenges. Data were analyzed using directed content analysis. Outcomes: The NFP model elements are acceptable to Canadian health care providers, public health nurses and families receiving the intervention. The primary adaptation required was to reduce nurse caseloads from 25 to 20 active clients. Recommendations for adapting and implementing all model elements are described. Conclusion: The NFP model requires minor adaptations to increase the acceptability of the intervention to Canadian stakeholders. A consistent approach to adapting the NFP program in Canada is necessary as provincial jurisdictions commit themselves to supporting an experimental evaluation of the effectiveness of the NFP.

Objective: To evaluate the implementation of Ontario’s publicly-funded, school-based HPV immunization program through a process evaluation. Participants: The immunization program targets grade 8 females. Ontario vaccine-preventable disease managers were the key informants for this evaluation. Setting: Ontario, Canada. Intervention: Ontario’s Public Health Units (HUs) are responsible for the local implementation of the immunization program. The process evaluation involved a telephone-based, semi-structured questionnaire which included questions on stakeholder engagement; school and school board participation; communication strategies; and processes for obtaining informed consent. Outcomes: All 36 HUs participated; 16 (44%) reported difficulties receiving agreement from local school boards to administer HPV vaccine in schools. Two Catholic school boards have not permitted HPV vaccine clinics in their schools: 1 only during the first year and 1 in the second and third years. All HUs request parental consent for students to receive the HPV vaccine and 5/36 also request or encourage student consent; 14 HUs indicated they would immunize a grade 8 girl at a school clinic, in the absence of parental consent, if the student requested immunization and was judged capable of providing informed consent. Conclusion: Many HUs reported challenges in receiving support from local school boards. Despite this, vaccine clinics have been offered in all but 2 public school boards since 2007. All HUs request parental consent before HPV immunization at school-based clinics; 39% would consider immunizing in absence of parental consent. The results of this process evaluation will inform the HPV immunization program evaluation that is currently underway in Ontario. Key words: Human papillomavirus vaccines; school health services; adolescent health services; public health practice; vaccination

Lowering the global disease burden of preventable disease has been addressed in part by the distribution of health products and behavior change campaigns in low-income countries. Realizing a health impact requires adoption by participants, and the topic of program uptake and sustained adoption has been studied extensively, although an ecological context is largely missing from existing work. This study characterizes self-reported and observed adoption of improved cookstoves and point-of-use water filters among nearly 80,000 households in Rwanda using demographic and programmatic variables from implementer surveys and integration of geospatial and temporal data based on differentiated recipient location. The odds of stove or filter adoption were analyzed using Generalized Estimating Equation logistic regression modeling. Administrative district, rural residency, elevation, social networks, socioeconomic category, family composition, education delivery, technological factors, and use of the accompanying technology in the combined intervention were significantly associated with the odds of adoption of either the stove or filter. Population density, precipitation, anisotropic travel time to services, and timing of the health campaign largely showed no significant relationship with adoption. This research promotes the inclusion of geospatial and temporal data in designing and evaluating other public health interventions by successfully leveraging an ecological explanation of adoption decisions.

Objective: To create a mass media campaign that endeavours to a) denormalize tobacco use among youth aged 12-18, b) empower youth to stay tobacco product free, and c) increase awareness of the dangers of tobacco use, while using positive messaging. Participants: Target age group was youth between the ages of 12 and 18 years. Setting: The mass media campaign was developed, implemented, and evaluated within the city of Calgary. Intervention: The mass media campaign consisted of posters for schools and other venues frequented by youth (e.g., community centres, libraries, fitness centres, restaurants, movie theatres), posters for transit (e.g., bus shelters, LRT shelters, back of bus) print advertisements, television/radio public service announcements, an interactive community website for youth, a media launch event, promotional items, and organizational efforts to cross-promote the campaign. The creative concept was based on intercept interviews, focus group testing, and other research conducted by the campaign's creative team and youth volunteers in order to identify the key elements of this campaign. Outcomes: A total of 149 students completed both a baseline and follow-up survey to evaluate the marketing activities of the campaign. A total of 27 youth participated in prototype testing to compare this positive-messaging campaign with negative-toned tobacco reduction campaigns. Six stakeholders/partners participated in stakeholder interviews to assess their thoughts and learnings regarding the campaign process. Conclusion: The evaluation respondents viewed the campaign positively and showed strong recall of the messaging. Key words: Social marketing; youth; tobacco reduction Resume Objectif : Creer une campagne dans les medias afin de a) denormaliser le tabagisme chez les jeunes de 12 a 18 ans, b) outiller les jeunes pour qu'ils sachent eviter les produits du tabac et c) sensibiliser le public aux dangers du tabagisme en utilisant des messages positifs. Participants : Nous avons cible les jeunes de 12 a 18 ans. Lieu : La campagne dans les medias a ete creee, mise en œuvre et evaluee a Calgary. Intervention : La campagne englobait des affiches dans les ecoles et autres lieux frequentes par les jeunes (centres communautaires, bibliotheques, centres de conditionnement physique, restaurants, cinemas), des affiches dans les transports en commun (abribus, abris du train leger sur rail, arriere des autobus), de la publicite imprimee, des communiques a la television et a la radio, un site Web communautaire interactif pour les jeunes, un lancement mediatise, des articles promotionnels et des efforts d'autopublicite intermedia. Le concept creatif a ete mis au point a partir d'entrevues sur place, d'un sondage aupres de groupes cibles et de recherches menees par les createurs de la campagne et par de jeunes benevoles pour definir les principaux messages. Resultats : En tout, 149 eleves ont repondu au sondage de base et au sondage de suivi pour evaluer les activites de marketing de la campagne. Vingt-sept jeunes ont participe a un essai du prototype de la campagne, dont le ton positif a ete compare a celui des campagnes de reduction du tabagisme au ton negatif. Six parties prenantes/partenaires ont accorde des entrevues pour faire part de leurs reflexions et des enseignements qu'ils ont tires du deroulement de la campagne. Conclusion : Selon les repondants aux sondages, la campagne a ete bien accueillie, et ses messages ont ete bien retenus. Mots cles : marketing social; jeunes; reduction du tabagisme

Background Public health interventions are complex by nature, and their evaluation requires unpacking their intervention logic and their interactions with open social systems. By focusing on the interrelationships between context, mechanism, and outcome, Pawson and Tilley’s realist approach appears a promising innovation for public health-related evaluation works. However, and as expected of any methodological innovation, this approach is being constructed gradually by answering the multiple challenges to its operationalization that fall in its path. One of these challenges, users of this approach agree on, is the necessity of clarifying its key concept of mechanism. Method We first collected the definitions of mechanism from published works of Pawson and colleagues. Secondly, a scoping review was conducted to identify the ones quoted by users of the realist approach for evaluating public health interventions (1997–2012). We then appraised the clarity and precision of this concept against the three dimensions defined by Daigneault and Jacobs “term, sense and referent.” Results Of the 2344 documents identified in the scoping review, 49 documents were included. Term: Users of the realist approach use adjectives qualifying the term mechanism that were not specifically endorsed by Pawson and colleagues. Sense: None of the attributes stated by Pawson and colleagues has been listed in all of the documents analyzed, and some contributions clarified its attributes. Referent: The concept of mechanism within a realist approach can be ascribed to theory-based evaluation, complex social interventions, and critical realism. Conclusion This review led us to reconsider the concept of mechanism within the realist approach by confronting the theoretical stance of its proponents to the practical one of its users. This resulted in a clearer, more precise definition of the concept of mechanism which may in turn trigger further improvements in the way the realist approach is applied in evaluative practice in public health and potentially beyond. A mechanism is hidden but real, is an element of reasoning and reactions of agents in regard to the resources available in a given context to bring about changes through the implementation of an intervention, and evolves within an open space-time and social system of relationships. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0345-7) contains supplementary material, which is available to authorized users.

OBJECTIVES: We describe the processes used in SCOPE, a community-based participatory research (CBPR) initiative, to achieve multisectoral engagement and collective action to prevent childhood obesity. PARTICIPANTS: SCOPE engages representatives from various sectors (local government, health, schools, recreation, local media, early childhood, community services) who influence the environments in which children live, learn and play. SETTING: SCOPE has been implemented in three communities in British Columbia (BC). INTERVENTION: SCOPE (www.live5210.ca) is a multi-setting, multi-component initiative designed to enhance a community’s capacity to create and deliver localized solutions to promote healthy weights among children. SCOPE, in partnership with a local organization, engages multiple stakeholders who plan and implement actions framed by a common evidence-based health message (‘Live 5-2-1-0’). SCOPE’s central team in Vancouver, BC facilitates alignment with provincial initiatives, knowledge translation and exchange (KTE) within and across communities, and the collection, analysis and reporting of shared data. OUTCOMES: Best practice processes that have emerged from SCOPE’s experience align with the principles of CBPR and the five conditions of Collective Impact – a common agenda, mutually reinforcing action, continuous communication, a backbone organization and shared measurement. SCOPE has achieved sustainable practice change framed by a common agenda (‘Live 5-2-1-0’) leading to mutually reinforcing cross-sectoral action. CONCLUSION: A multi-pronged community-led childhood obesity prevention initiative can be achieved using CBPR principles and attending to the conditions for achieving collective impact.

OBJECTIVES: In order to improve healthy behaviours among rural children in their early years, a physical activity and healthy eating intervention (Healthy Start – Depart Sante) was implemented in rural childcare centres throughout Saskatchewan. The objective of the current study was to evaluate the impact of a multimodal physical activity and healthy eating intervention on educators’ provision of opportunities for children to improve their physical activity levels, fundamental movement skills and healthy eating behaviours. SETTINGS: Six childcare centres (three Francophone and three Anglophone) located in five different rural and semi-rural communities in Saskatchewan participated in this intervention. PARTICIPANTS: A total of 69 children with a mean age of 4 years 9 months, and 19 female early childhood educators. INTERVENTION: Guided by an ecological framework, we implemented a population health controlled intervention, using a wait list control design (48 weeks delayed intervention), and evaluated its impact in rural childcare centres. Mixed methods were employed to determine the effectiveness of the intervention. OUTCOMES: Overall, educators felt that the intervention supported the provision of physical activity and healthy eating opportunities for children. Increases in children’s physical activity levels were reported following the intervention. CONCLUSION: The lessons learned in this study can be used to improve the Healthy Start – Depart Sante intervention so that its implementation can be effectively expanded to childcare centres within and outside Saskatchewan, in turn, supporting the healthy development of early years (0–5) children in the province and beyond.

OBJECTIVE: Despite the high prevalence of mental illnesses and addictions, treatment rates remain low. In April 2010, a regional mass media campaign was implemented to increase awareness of mental health services in central Toronto, Canada. We studied the impact of this campaign on rates of psychiatric emergency department (PED) visits among all hospital emergency departments (EDs) located in Toronto. DESIGN: Monthly PED visit totals were obtained for all Toronto EDs from April 1, 2007 to March 31, 2012 ( n = 148,704). The campaign’s impact on visit rates was measured using interrupted time series analysis and a difference-in-difference estimator. We conducted pre- and post-campaign analyses to examine whether volume increases were explained by specific diagnostic categories and/or new presentations (new patients with no prior PED visits), and to examine geographic trends. RESULTS: The campaign was associated with an increased volume of PED visits at downtown hospitals (Centre for Addiction and Mental Health, an increase of 7.6 visits/month [ p < 0.0001]; University Health Network, 5.8 visits/month [ p < 0.0001]; St. Michael’s Hospital, 4.2 visits/month [ p < 0.0001]; and Mount Sinai Hospital, 3.2 visits/month [ p < 0.0001]) but not in hospitals located outside of the downtown area. Neither new patient visits nor specific diagnostic categories disproportionately accounted for the overall observed increases. Following the campaign, patients travelled greater distances to receive ED services. CONCLUSIONS: Mass media campaigns promoting mental health and psychiatric services can affect health care-seeking behaviour and utilization. Our findings have implications for system-level service planning, which should anticipate volume increases when public mental health campaigns are being considered.

OBJECTIVE: To establish a comprehensive, community-based program to improve and sustain self-management support for individuals with chronic diseases and complement office-based strategies to support behaviour change. PARTICIPANTS: Health service delivery organizations. SETTING: The Champlain Local Health Integration Network (LHIN), a health district in Eastern Ontario. INTERVENTION: We created Living Healthy Champlain (LHC), a regional organization providing peer leader training and coordination for the group Stanford Chronic Disease Self-Management Program (CDSMP); skills training and mentorship in behaviour change approaches for health care providers; and support to organizations to integrate self-management support into routine practice. We used the RE-AIM framework to evaluate the overall program’s impact by exploring its reach, effectiveness, adoption, implementation and maintenance. OUTCOME: A total of 232 Stanford CDSMP sessions (63 during the pilot project and 169 post-pilot) have been held at 127 locations in 24 cities across the Champlain LHIN, reaching approximately 4,000 patients. The effectiveness of the service was established through ongoing evidence reviews, a focus group and a pre-post utilization study of the pilot. LHC trained over 300 peer volunteers to provide the Stanford CDSMP sessions, 98 of whom continue to actively host workshops. An additional 1,327 providers have been trained in other models of self-management support, such as Health Coaching and Motivational Interviewing. Over the study period, LHC grew from a small pilot project to a regional initiative with sustainable provincial funding and was adopted by the province as a model for similar service delivery across Ontario. CONCLUSION: A community-based self-management program working in partnership with primary care can be effectively and broadly implemented in support of patients living with chronic conditions.

objectif : YouthBet.net (www.youthbet.net), un site Web interactif et multimedia fonde sur une demarche de sante publique, a pour but de prevenir les problemes de jeu chez les jeunes. Participants : YouthBet.net est concu par et pour les jeunes. Un groupe de travail de jeunes a passe plusieurs mois a concevoir le style du site pour qu'il plaise aux jeunes de 10 a 19 ans. En tout, 34 jeunes de la region du Grand Toronto ont participe aux trois premieres phases de validation de la convivialite du site par la methode de capture d'images video des interactions site-utilisateurs. Lieu : la zone urbaine de Toronto Intervention : A l'aide de diverses strategies de sante publique (promotion de la sante, reduction des mefaits, prevention des problemes), YouthBet.net presente des jeux, de l'information et des ressources de depannage pour prevenir les mefaits des jeux de hasard et aider les jeunes a s'en premunir. Resultats: Les jeunes participants ont dit apprecier la presentation interactive de l'information sur les jeux de hasard (par le biais de jeux et de devinettes realistes), en mentionnant souvent que YouthBet.net serait un outil amusant et educatif pour les enseignants en milieu scolaire. Les participants n'ont eu aucun mal a parcourir le site, a y trouver des renseignements et a jouer aux jeux. De plus, tous les jeunes ont dit qu'ils reviendraient sur le site et qu'ils le recommanderaient a un ami aux prises avec un probleme de jeu. Conclusion: YouthBet.net est l'un des premiers sites Web « tout-en-un » concus pour les jeunes qui s'adonnent a des jeux de hasard. Les resultats de notre etude seront utiles pour de futurs projets de promotion de la sante, de reduction des mefaits et de prevention des problemes de jeu menes aupres des jeunes en faisant appel a la technologie Internet.

Summary This review examines the literature, including literature in Chinese, on the effectiveness of handwashing as an intervention against severe acute respiratory syndrome (SARS) transmission. Nine of 10 epidemiological studies reviewed showed that handwashing was protective against SARS when comparing infected cases and non‐infected controls in univariate analysis, but only in three studies was this result statistically significant in multivariate analysis. There is reason to believe that this is because most of the studies were too small. The evidence for the effectiveness of handwashing as a measure against SARS transmission in health care and community settings is suggestive, but not conclusive.

Urban Aboriginal peoples are at higher risk to a variety of chronic diseases, compared with other Canadians. Social determinants of health, socio-ecological approaches to health, and life course perspectives can identify some of the various factors that contribute to this excess risk. The complexity of these factors suggests that an effective strategy for reducing this risk might be to focus on improving the capacity of the local public health system that serves Aboriginal people and families, rather than on interventions aimed solely at individual health behaviour change. This article uses the Healthy Weights Connection intervention as an example of one of several systems-focussed and collaborative approaches to improving the health of urban Aboriginal people. Despite their potential utility, we suggest that there are unique considerations for implementing and evaluating such interventions in an urban Aboriginal context.

OBJECTIVES: To 1) create a space where men who have sex with men (MSM) feel comfortable accessing sexually transmitted infection/human immunodeficiency virus (STI/HIV) testing, and 2) reduce STI/HIV incidence. PARTICIPANTS: Gay men in Ottawa and its surrounding regions. SETTING: A preponderance of diagnoses of sexually transmitted infections and HIV continue to occur among MSM. Meanwhile, other literature identifies that many MSM are reluctant to access STI/HIV testing services or to disclose their sexual practices to primary care practitioners. INTERVENTION: In Ottawa, in an effort to surmount these issues and decrease STI/HIV incidence among MSM, the local public health unit in collaboration with community partners created “GayZone”, a three-hour-per-week STI/HIV testing and STI treatment clinic for gay men. In this paper, we report on the uptake and STI/HIV diagnosis outcomes for this clinic from January 2010 through December 2013. OUTCOMES: GayZone is a well-utilized clinic that yields a number of STI/HIV diagnoses per year. Overall, the positivity rates of the STI/HIV tests at this clinic are above-average, although lower than what might be expected by local epidemiological data. While the results of this clinic validate anonymous HIV testing, they bring into question the utility of pharyngeal swabs to test for gonorrhea and chlamydia. CONCLUSION: The results of our study demonstrate the utility of a gay men’s STI/HIV testing clinic and highlight some areas for improvement. Public health practitioners, frontline clinicians, and community workers in other regions who wish to implement such an STI/HIV clinic would do well to consider our results beforehand.

OBJECTIVES: The FRESH (Food Resources and Education for Student Health) peer nutrition education program engages undergraduate and graduate students in experiential learning to improve the campus food and nutrition environment and promote healthy behaviours among university students. TARGET POPULATION: University students in general, and graduate and undergraduate food and nutrition students as program designers and peer educators, respectively. SETTING: Large university campus in southwestern Ontario. INTERVENTION: A peer nutrition education program, utilizing multiple population strategies and intersectoral partnerships, was created by and for university students with faculty and food service personnel as mentors. The population health strategies employed were building awareness and program branding; developing personal skills through peer nutrition education and hands-on cooking demonstrations; and creating supportive environments through incentive programs for fruit and dairy as well as point-of-purchase menu labelling. OUTCOMES: The program has reached students, staff and faculty through over 60 interactive FRESH displays and education sessions. Website and social media have also had a significant reach with over 4,000 website visits and 277 Facebook “likes”. FRESH has also improved the food environment for over 5,000 students in residence, e.g., 1,931 FRESH Fruit/Dairy Cards have been returned for free fruit/milk cartons. Graduate students in Foods and Nutrition continue to participate every year (cumulative n=60) in ongoing program development. Peer educators have developed enhanced leadership, public speaking and group facilitation skills, and the ability to creatively apply what they have learned in the classroom to new contexts. CONCLUSION: Increased nutrition knowledge and an improved food environment could, over the long term, support improved university student health.

OBJECTIVES: Body checking is a significant risk factor for injury, including concussion, in youth ice hockey. Recent evidence regarding injury rates in youth leagues prompted USA Hockey to institute a national policy change in 2011 that increased the age of body checking introduction from 11-12 years old (Pee Wee) to 13-14 years old (Bantam). Body checking policy was more controversial in Canada, and research evidence alone was insufficient to drive change. The purpose of this paper is to provide an example of one of the knowledge exchange processes that occurred between researchers and community stakeholders, leading up to a national policy change in 2013.PARTICIPANTS: There were 28 stakeholder attendees, representing the research community, youth hockey organizations, and child health advocacy groups.SETTING: A one-day meeting held in Whistler, British Columbia, in April 2013.INTERVENTION: Researchers and stakeholders presented current perspectives on evidence and policy change, and discussion focused on an a priori set of questions designed to elicit facilitators and barriers to policy change.OUTCOMES: Three major factors that can drive policy change in the sport safety context were identified: the need for decision-making leadership, the importance of knowledge translation, and the role of sport culture as a barrier to change.CONCLUSION: There is a critical need for researcher and stakeholder partnership in facilitating ongoing policy discussion and informing evidence-based policy change in sport and recreation injury prevention.

Sze Lin Yoong1,2, Luke Wolfenden1,2,3, Tara Clinton-McHarg3, Elizabeth Waters4, Tahna L. Pettman4, Emily Steele4, John Wiggers1,2,3 School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia Priority Research Centre for Health Behaviour (PRCHB), University of Newcastle, Callaghan, NSW 2308, Australia Hunter New England Population Health, NSW Health, Wallsend, NSW 2287, Australia Cochrane Public Health Group, Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia Address correspondence to Sze Lin Yoong, E-mail: serene.yoong@hnehealth.nsw.gov.au

Background: As alcohol-related health problems continue to rise, the attention of policy-makers is increasingly turning to Screening and Brief Intervention (SBI) programmes. The effectiveness of such programmes in primary healthcare is well evidenced, but very few cost-effectiveness analyses have been conducted and none which specifically consider the Italian context. Methods: The Sheffield Alcohol Policy Model has been used to model the cost-effectiveness of government pricing and public health policies in several countries including England. This study adapts the model using Italian data to evaluate a programme of screening and brief interventions in Italy. Results are reported as Incremental Cost-Effectiveness Ratios (ICERs) of SBI programmes versus a ‘do-nothing’ scenario. Results: Model results show such programmes to be highly cost-effective, with estimated ICERs of €550/Quality Adjusted Life Year (QALY) gained for a programme of SBI at next GP registration and €590/QALY for SBI at next GP consultation. A range of sensitivity analyses suggest these results are robust under all but the most pessimistic assumptions. Conclusions: This study provides strong support for the promotion of a policy of screening and brief interventions throughout Italy, although policy makers should be aware of the resource implications of different implementation options. Keywords: Public health interventions, Alcohol, Primary care, Cost-effectiveness

OBJECTIVE: The Chronic Disease Research Fellowship Program (RFP) aims to build the research capacity of recent medical graduates to support the development of chronic disease control strategies. SETTING: Guatemala is undergoing an epidemiologic transition. However, given the way universities and the health care system are structured, it lacks an environment that fosters research careers and generates the required knowledge to implement sound public health policies and clinical strategies. The RFP was implemented at the Cardiovascular Unit of Guatemala. INTERVENTION: This 4-year Program recruited two one-year fellows and provided funding to define a research topic, write a protocol and implement the research. Strong emphasis is placed on developing skills in knowledge translation and exchange to bridge the “know–do” gap. Close mentoring relationships between the Principal Investigator and former and current fellows are fostered through the Program. OUTCOMES: The mentoring Program has generated strategic data to support the implementation of sound chronic disease control strategies, mainly related to tobacco control. Results have been presented nationally and internationally. Research training has included principles of biostatistics and epidemiology, and a journal club. The Program is increasingly generating interest among medical graduates to pursue further research training abroad and is building local research capacity. Fellows and research assistants have created a research network in Guatemala and abroad. The main obstacle the Program faces is ensuring long-term sustainability. CONCLUSIONS: A mentoring program can lead to an increase in research interest and capacity in a low-income country with little research infrastructure.