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Objectives: The exact characteristics of a coronavirus disease 2019 (COVID-19) outbreak that trigger public health interventions are poorly defined. The aim of this study was to assess the critical timing and extent of public health interventions to contain COVID-19 outbreaks in Australia. Methods: A practical model was developed using existing epidemic data in Australia. The effective combinations of public health interventions and the critical number of daily cases for intervention commencement under various scenarios of changes in transmissibility of new variants and vaccination coverage were quantified. Results: In the past COVID-19 outbreaks in four Australian states, the number of reported cases on the day that interventions commenced strongly predicted the size and duration of the outbreaks. In the early phase of an outbreak, containing a wildtype-dominant epidemic to a low level (≤10 cases/day) would require effective combinations of social distancing and face mask use interventions to be commenced before the number of daily reported cases reaches six. Containing an Alpha-dominant epidemic would require more stringent interventions that commence earlier. For the Delta variant, public health interventions alone would not contain the epidemic unless the vaccination coverage was ≥70%. Conclusions: This study highlights the importance of early and decisive action in the initial phase of an outbreak. Vaccination is essential for containing variants.

Data on dietary calcium and vitamin D intake from Latin America are scarce. We explored the main correlates and dietary sources of calcium and vitamin D in a probabilistic, population-based sample from Colombia. We studied 1554 participants aged 18–75 from five different geographical regions. Dietary intake was assessed by employing a 157-item semi-quantitative food frequency questionnaire and national and international food composition tables. Daily vitamin D intake decreased with increasing age, from 230 IU/day in the 18–39 age group to 184 IU/day in the 60–75 age group (P -trend < 0.001). Vitamin D intake was positively associated with socioeconomic status (SES) (196 IU/day in lowest vs 234 in highest SES, P-trend < 0.001), and with educational level (176 IU/day in lowest vs 226 in highest education level, P-trend < 0.001). Daily calcium intake also decreased with age, from 1376 mg/day in the 18–39 age group to 1120 mg/day in the 60–75 age group (P -trend < 0.001). Calcium intake was lowest among participants with only elementary education, but the absolute difference in calcium intake between extreme education categories was smaller than for vitamin D (1107 vs 1274 mg/day, P-trend = 0.023). Daily calcium intake did not correlate with SES (P -trend = 0.74). Eggs were the main source of overall vitamin D, albeit their contribution decreased with increasing age. Dairy products contributed at least 48% of dietary calcium in all subgroups, mostly from cheese-containing traditional foods. SES and education were the key correlates of vitamin D and calcium intake. These findings may contribute to shape public health interventions in Latin American countries.

This essay explores the amazing phenomenon that in Europe since ca. 1700 most diseases have shown a pattern of 'rise-and-fall'. It argues that the rise of so many diseases indicates that their ultimate cause is not to be sought within the body, but in the interaction between humans and their environment. In their tireless pursuit of a better life, Europeans have constantly engaged in new activities which exposed them to new health risks, at a pace that evolution could not keep up with. Fortunately, most diseases have also declined again, mainly as a result of human interventions, in the form of public health interventions or improvements in medical care. The virtually continuous succession of diseases starting to fall in the 18th, 19th and 20th centuries suggests that the concept of an “epidemiological transition” has limited usefulness.

Background During the COVID-19 pandemic, there have been an increasing number of emergency department visits for behavioral health reasons, even as overall emergency department volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high-intensity care for severely ill patients who are likely to be homeless and underserved. Objective We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States. Methods Changes in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020. Results The pandemic's impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance. Conclusions There has been a decrease in volume at these services after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.

espanolObjetivo. Conocer la magnitud del consumo excesivo de alcohol (CEA) y su asociacion con los factores individuales, familiares y sociales entre agosto y noviembre de 2020 en Mexico. Material y metodos. Con base en los datos de la Encuesta Nacional de Salud y Nutricion 2020 sobre Covid-19, se analizaron 8 595 adultos mayores de 20 anos. Se estimaron modelos de regresion logistica estratificados por sexo y se obtuvieron razones de momios (RM) con intervalos de confianza al 95% (IC95%). Resultados. El CEA fue de 40.43%; hombres 56.49% y mujeres 25.70%. Los principales factores asociados fueron ser hombre (RM=3.66; IC95%: 3.22,4.12), edad de 20 a 29 anos (RM=3.65; IC95%: 2.89,4.63), salir a trabajar durante la pandemia (RM=1.56; IC95%: 1.33,1.81) y tener dos o mas escolares en el hogar (RM=1.20; IC95%: 1.03,1.39). Conclusiones. En Mexico, el patron de CEA es prevalente; por su naturaleza de riesgo y su amplia distribucion poblacional, es prioritario implementar intervenciones preventivas individuales y de salud publica EnglishObjective. Estimate the magnitude of binge drinking and its association with individual, family, and social factors between August to November 2020 in Mexico. Materials and methods. Based on thedata from National Health and Nutrition Survey 2020 Covid-19, 8 595 adults over 20 years old were analyzed. Stratified logistic regression models by sex were estimated obtaining odds ratio (OR) with 95% confidence intervals (95%CI). Results. The binge drinking reported was 40.43%; in men 56.49% and in women 25.70%. The main associated factors were being a man (OR=3.66; 95%CI: 3.22,4.17), age 20 to 29 years (OR=3.56; 95%CI: 2.89,4.63), going to work during the pandemic (OR=1.56; 95%CI: 1.33,1.81), and having two or more people of school children (OR=1.20; 95%CI: 1.03,1.39). Conclusions. The binge drinking pattern in Mexico is prevalent; due to the risky nature and the wide population distribution, it is a priority to implement individual preventive and public health interventions

The postpartum period, also known as the puerperium and the "fourth trimester," refers to the time after delivery when maternal physiologic changes related to pregnancy return to the non-pregnant state. From the day of delivery to six-eight weeks after delivery is termed as the fourth trimester. A few days after birth, the mother’s breast will swell with milk and become tender swollen, firm, and painful breasts. If the breasts are severely engorged, they are very swollen, hard, shiny, warm, and slightly lumpy to the touch. This is called engorgement. Breast care is necessary postnatally since this will avoid complications such as mastitis – infection caused due to trapped milk. Post natal education on breast care is much needed for all mothers. Mastitis, for example, is an infection that causes inflammation of the breast tissue. It’s most commonly caused by milk trapped in the breast. Untreated mastitis can lead to complications such as a collection of pus in the clogged milk ducts. Often, even well educated women seem to know very less about breast care post childbirth. Hence the present study was framed to assess on how much knowledge the new mothers possess about breast care (sample size: 60). From the results obtained we conclude that all the new mothers post the awareness rendered about breast care acquired good or adequate knowledge regarding the same when compared to pre-test. This emphasizes the need for public health interventions and awareness programs to educate as well as minimize the related complications.

OBJECTIVE: There is a scarcity of data on the impact of the pandemic in farmers. METHODS: Cross-sectional survey of certified organic producers through a 28-item self-reported paper or electronic survey. Analysis included descriptive statistics, Cronbach α to measure the internal consistency of a six-item prevention scale, and correlation and regression analyses. RESULTS: A total of 344 records were computed. Infection rate among producers was 6.4%. Sex and farm size were the most statistically significant predictors of prevention behaviors. Women reported more use of prevention methods (s = 0.333, P 

This study sought to identify the spatial, temporal, and spatiotemporal clusters of COVID-19 cases in 366 cities in mainland China with the highest risks and to explore the possible influencing factors of imported risks and environmental factors on the spatiotemporal aggregation, which would be useful to the design and implementation of critical preventative measures. The retrospective analysis of temporal, spatial, and spatiotemporal clustering of COVID-19 during the period (January 15 to February 25, 2020) was based on Kulldorff’s time-space scanning statistics using the discrete Poisson probability model, and then the logistic regression model was used to evaluate the impact of imported risk and environmental factors on spatiotemporal aggregation. We found that the spatial distribution of COVID-19 cases was nonrandom; the Moran’s I value ranged from 0.017 to 0.453 (P < 0.001). One most likely cluster and three secondary likely clusters were discovered in spatial cluster analysis. The period from February 2 to February 9, 2020, was identified as the most likely cluster in the temporal cluster analysis. One most likely cluster and seven secondary likely clusters were discovered in spatiotemporal cluster analysis. Imported risk, humidity, and inhalable particulate matter PM2.5 had a significant impact on temporal and spatial accumulation, and temperature and PM10 had a low correlation with the spatiotemporal aggregation of COVID-19. The information is useful for health departments to develop a better prevention strategy and potentially increase the effectiveness of public health interventions.

Purpose Young adults have the highest cumulative incidence of COVID-19 infection in the country. Using March 2021 Household Pulse Survey data, an ongoing, cross-sectional nationally representative survey, we examined U.S. young adult intention to accept COVID-19 vaccines. Methods Young adult (ages 18–25 years) Household Pulse Survey participants were queried on intention to receive a COVID-19 vaccine and related perspectives (N = 5,082). Results Most unvaccinated respondents (76%) indicated an intention to become vaccinated. The most frequently cited reasons for potentially rejecting vaccination included desire to wait and see if the vaccine is safe (56%); concerns over side effects (53%); and believing others are in greater need of the vaccine (44%). Conclusions With 24% of young adults hesitant to accept a COVID-19 vaccine, public health interventions should target reasons for hesitancy, address concerns about safety and side effects, and underscore the importance of vaccinations for this population.

Despite its generally decreasing trend in incidence, gastric cancer remains the fifth-most common cancer worldwide. Gastric cancer has substantially declined over the past century, thanks to decreases in risk factors such as Helicobacter pylori infection, tobacco smoking, and salt-preserved food intake. These decreases have resulted from natural interventions and population-based intervention strategies. H pylori eradication for infected patients has potential as a prevention strategy for those at high risk, but warrants a longer follow-up period. The ongoing increase in obesity prevalence may cause an increase in cardia gastric cancer, especially in Western populations, and should be carefully monitored.

Purpose Prior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups. Methods Weighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012–2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups. Results The prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4–34.9) in 2012 to 44% (95% CI 43.2–44.7) in 2018 (OR for trend = 1.07, P for trend

In 2019, the American Academy of Ophthalmology (AAO) created the Task Force on Myopia in recognition of the substantial global increases in myopia prevalence and its associated complications. The Task Force, led by Richard L. Abbott, MD, and Donald Tan, MD, comprised recognized experts in myopia prevention and treatment, public health experts from around the world, and organization representatives from the American Academy of Family Physicians, American Academy of Optometry, and American Academy of Pediatrics. The Academy's Board of Trustees believes that myopia is a high-priority cause of visual impairment, warranting a timely evaluation and synthesis of the scientific literature and formulation of an action plan to address the issue from different perspectives. This includes education of physicians and other health care providers, patients and their families, schools, and local and national public health agencies; defining health policies to ameliorate patients' access to appropriate therapy and to promote effective public health interventions; and fostering promising avenues of research.

Recent studies have identified notable disparities in SARS-CoV-2 infection risk among ethnic minorities. We evaluated SARS-CoV-2 test results from individuals presenting for testing in Los Angeles between June and December, 2020. We calculated prevalence ratios for various employment categories. Among 518,914 test results, of which 295,295 (56.9%) were from individuals reporting Hispanic ethnicity, SARS-CoV-2 positivity was 16.5% among Hispanic individuals compared to 5.0% among non-Hispanic individuals (p-value

Aim Many people delay presenting to health services with cancer symptoms due to lack of awareness, particularly in areas of high socio-economic deprivation. A three-year community-based intervention was launched in Northwest England to improve public awareness of cancer symptoms. In this study, we aimed to evaluate this intervention by exploring the views of those involved in its management and delivery. Methods Ten semi-structured interviews were conducted with volunteers as well as members of the project management and steering group. Interviews were analysed qualitatively using thematic analysis. Results Participants felt they succeeded in raising awareness, influencing behaviour, connecting with local communities and engaging with vulnerable people. Participants perceived some weaknesses in the delivery of the intervention, including limited engagement of stakeholders, particularly general practitioners (GPs), and socially excluded groups. Conclusions Future public health interventions should pay particular attention to engagement of socially excluded individuals who do not interact with community events or groups, and to the engagement of stakeholders in early planning stages of the intervention. This should involve a specific GP engagement plan.

Health care decisions in many low-income countries often require a close political agency relationship between healthcare decision makers and constituents. This is especially the case for maternal and child care as well as preventative interventions when resources are scarce. This article examines the effect of the introduction of the National Rural Health Mission in India, introducing Village Health, Sanitation and Nutrition Committees (VHSNC), a self-governance mechanism to strengthen the political agency in village health care decision making. We study the effect of exposure to VHSNC on both maternal and preventative child health care. We find that exposure to VHSNC's increase the utilization of several maternal health care services, but does not systematically increase the uptake of preventive health care. The effect of VHSNC is more intense in larger villages and areas closer to district headquarters, and is driven by an increase in the utilization of the public healthcare network.

Can exhibitions of artifacts from the tobacco industry, its allies and critics, act as a public health intervention? The University of Alabama Center for the Study of Tobacco and Society is a curatorial and research center dedicated to the creation of exhibitions on the tobacco industry and its allies, the marketing of cigarettes and other tobacco products, and the efforts to counteract the use and promotion of cigarettes throughout the 20th century to the present day (Blum, 1994, p. 8). Physical and digital exhibitions provide social and historical context to increase public understanding of a deadly product which, according to the Centers for Disease Control and Prevention, kills 1,300 Americans a day. University of Alabama Center for the Study of Tobacco and Society collects “communication artifacts” of the tobacco industry, from ubiquitous advertisements to subtler promotional efforts such as financial support for museums and other cultural institutions. This summary of the center’s work spotlights archives, curated and made public through exhibitions.

For systematic reviews to have an impact on public health, they must report outcomes that are important for decision-making. Systematic reviews of public health interventions, however, have a range of potential end users, and identifying and prioritizing the most important and relevant outcomes represents a considerable challenge. In this commentary, we describe potentially useful approaches that systematic review teams can use to identify review outcomes to best inform public health decision-making. Specifically, we discuss the importance of stakeholder engagement, the use of logic models, consideration of core outcome sets, reviews of the literature on end users’ needs and preferences, and the use of decision-making frameworks in the selection and prioritization of outcomes included in reviews. The selection of review outcomes is a critical step in the production of public health reviews that are relevant to those who use them. Utilizing the suggested strategies may help the review teams better achieve this.

Introduction: We aimed to examine how public health policies influenced the dynamics of coronavirus disease 2019 (COVID-19) time-varying reproductive number (R t ) in South Carolina from February 26, 2020, to January 1, 2021. Methods: COVID-19 case series (March 6, 2020, to January 10, 2021) were shifted by 9 d to approximate the infection date. We analyzed the effects of state and county policies on R t using EpiEstim. We performed linear regression to evaluate if per-capita cumulative case count varies across counties with different population size. Results: R t shifted from 2-3 in March to R t rose over the summer and stayed between 1.4 and 0.7. The introduction of statewide mask mandates was associated with a decline in R t (−15.3%; 95% CrI, −13.6%, −16.8%), and school re-opening, an increase by 12.3% (95% CrI, 10.1%, 14.4%). Less densely populated counties had higher attack rates (P < 0.0001). Conclusions: The R t dynamics over time indicated that public health interventions substantially slowed COVID-19 transmission in South Carolina, while their relaxation may have promoted further transmission. Policies encouraging people to stay home, such as closing nonessential businesses, were associated with R t reduction, while policies that encouraged more movement, such as re-opening schools, were associated with R t increase.

BackgroundAs the epidemic of COVID-19 is gradually controlled in China, a summary of epidemiological characteristics and interventions may help control its global spread.MethodsData for COVID-19 cases in Hubei Province (capital, Wuhan) was extracted until 7 March 2020. The spatiotemporal distribution of the epidemic in four periods (before 10 January, 10–22 January, 23 January–6 February and 7 February–7 March) was evaluated, and the impacts of interventions were observed.ResultsAmong 67 706 COVID-19 cases, 52 111 (76.97%) were aged 30–69 years old, and 34 680 (51.22%) were women. The average daily attack rates (95% CI) were 0.5 (0.3 to 0.7), 14.2 (13.2 to 15.1), 45.7 (44.0 to 47.5) and 8.6 (7.8 to 9.3) cases per 106 people in four periods, and the harmonic means (95% CI) of doubling times were 4.28 (4.01 to 4.55), 3.87 (3.78 to 3.98), 5.40 (4.83 to 6.05) and 45.56 (39.70 to 52.80) days. Compared with the first period, daily attack rates rose rapidly in the second period. In the third period, 14 days after 23 January, the daily average attack rate in and outside Wuhan declined by 33.8% and 48.0%; the doubling times increased by 95.0% and 133.2%. In the four periods, 14 days after 7 February, the daily average attack rate in and outside Wuhan decreased by 79.1% and 95.2%; the doubling times increased by 79.2% and 152.0%.ConclusionsThe public health interventions were associated with a reduction in COVID-19 cases in Hubei Province, especially in districts outside of Wuhan.

Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time

Background The New Zealand government instituted escalating public health interventions to prevent the spread of COVID‐19. There was concern this would affect health seeking behaviour leading to delayed presentation and worse outcomes. The aim of this study was to examine the effects of these interventions on rate and severity of acute general surgical admissions in Northland, New Zealand. Methods A retrospective comparative cohort study was performed. Two cohorts were identified: 28 February to 8 June 2020 and same period in 2019. Data for surgical admissions and operations and emergency department (ED) presentation were obtained from the hospital data warehouse. Three index diagnoses were assessed for severity. Results There were 650 acute general surgical admissions in 2019 and 627 in 2020 (P 0.353). Operations were performed in 226 and 224 patients respectively (P 0.829). ED presentations decreased from 11 398 to 8743 (P, The aim of this study was to examine the effects of public health interventions aimed at eliminating COVID‐19 from New Zealand on rate and severity of acute general surgical admissions in Northland, New Zealand.

The COVID-19 pandemic resulted in 5 consecutive Movement Control Orders (MCOs) in Malaysia in an attempt to flatten the epidemiological curve, with a reduction of cases. This study aims to use statistical analysis to assess whether the decisive public health interventions in the MCO were efficacious. Three statistical tests were employed: Mann-Kendall trend analysis; one way between groups ANOVA; and Pearson correlation test. Results demonstrated significant differences between the second block, MCO 3-5, compared to MCO 1-2. Johor and Selangor states experienced significant increase in early MCO, whereas Sarawak and Selangor states experienced significant decrease by MCO 3-5. The northern border states of Kedah, Perlis and Kelantan, had caseloads stabilised to zero by MCO 4/MCO 5. This study demonstrates that the MCO was effective within the target of twice the two-week incubation period of COVID-19, with cases from community transmission and importation through the air and southern land borders. Selangor and Sarawak had higher cases in early MCO due to situational factors. In conclusion, MCO has been efficacious, with different states attaining different levels of case reduction due to individualised reasons.

Background The prevalence of children with elevated weight or obesity is concerning for public health due to associated comorbidities. This study investigates associations between parental adiposity, physical activity (PA), fruit and vegetable consumption, and child adiposity and moderation by both child and parent gender. Methods Cross-sectional nationally representative data from the New Zealand Health Survey were pooled for the years 2013/14-2016/17. Parent and child surveys were matched resulting in 13,039 child (2-14 years) and parent (15-70 years) dyads. Parent and child, height (cm), weight (kg) and waist circumference (WC) were measured objectively. Height and weight were used to calculate BMI. Linear regression, accounting for clustered samples (b [95% CI]) investigated associations between parental characteristics and child BMI z-score and WC. Interactions and stratification were used to investigate effect moderation by parent gender, child gender, and parent adiposity. Results Parental PA and fruit and vegetable consumption were unrelated to child adiposity. Overall, higher parent BMI was related to a higher child BMI z-score (b = 0.047 [0.042, 0.052]) and higher parental WC was related to a higher child WC (0.15 [0.12, 0.17]). A three-way interaction revealed no moderation by parent gender, child gender, and parent BMI for child BMI z-score ((b = 0.005 [-0.017, 0.027], p = 0.318). However, a three-way interaction revealed moderation by parent gender, child gender, and parent WC for child WC (b = 0.13 [0.05, 0.22]). The slightly stronger associations were seen between father-son WC (b = 0.20 [0.15, 0.24]) and mother-daughter WC (b = 0.19 [0.15, 0.22]). Conclusions The findings are highly relevant for those wishing to understand the complex relationships between child-parent obesity factors. Findings suggest that family environments should be a key target for obesity intervention efforts and show how future public health interventions should be differentiated to account for both maternal and paternal influences on child adiposity.

Background Public health surveillance requires historical baselines to identify unusual activity. However, these baselines require adjustment after public health interventions. We describe an example of such an adjustment after the introduction of rotavirus vaccine in England in July 2013. Methods We retrospectively measured the magnitude of differences between baselines and observed counts (residuals) before and after the introduction of a public health intervention, the introduction of a rotavirus vaccine in July 2013. We considered gastroenteritis, diarrhea, and vomiting to be indicators for national syndromic surveillance, including telephone calls to a telehealth system, emergency department visits, and unscheduled consultations with general practitioners. The start of the preintervention period varied depending on the availability of surveillance data: June 2005 for telehealth, November 2009 for emergency departments, and July 2010 for general practitioner data. The postintervention period was July 2013 to the second quarter of 2016. We then determined whether baselines incorporating a step-change reduction or a change in seasonality resulted in more accurate models of activity. Results Residuals in the unadjusted baseline models increased by 42%-198% from preintervention to postintervention. Increases in residuals for vomiting indicators were 19%-44% higher than for diarrhea. Both step-change and seasonality adjustments improved the surveillance models; we found the greatest reduction in residuals in seasonally adjusted models (4%-75%). Conclusion Our results demonstrated the importance of adjusting surveillance baselines after public health interventions, particularly accounting for changes in seasonality. Adjusted baselines produced more representative expected values than did unadjusted baselines, resulting in fewer false alarms and a greater likelihood of detecting public health threats.

Argentina was able to anticipate public health interventions in order to flatten the contagion curve of CoViD-19. Eighty-three surgeons answered an online survey to assess the impact of the pandemic on bariatric surgery (BS) in Argentina. Most of them showed a high economic dependence on BS. Near 90% of health institutions were on phase 0 or I. While 90% still performed other laparoscopic surgeries, BS was suspended. In many surgeries for nonsuspected CoViD-19 patients, high personnel protection resources were applied. Ninety-five percent offered virtual consults. Most surgeons would not change usual algorithms or techniques. To restart BS a scientific society recommendation was expected, including patient selection criteria. The opinions gathered by this survey were taken into account to elaborate official recommendations for restarting elective BS.

Objective To evaluate the association of weather, seasons, months and holidays on the frequency and pattern of pediatric facial fractures. Methods Retrospective review of pediatric patients treated for facial fractures at two Level I trauma centers in a midsize Midwestern US city over a 5‐year period. Patients were included only if presentation was within 3 hours of inciting trauma, transfers from other facilities were excluded. Demographic characteristics, fracture patterns, operative interventions, weather data, and local public school schedules were acquired and associations were analyzed with unpaired t tests, χ2, multivariate and binomial regression model analyses. Results Two hundred and sixty patients were included. The average age (SD) was 11.8 (5.0) years, with 173 males and 87 females. The highest distribution of presentations occurred in the summer season (35.0%), on weekends and holidays (58.1%), and when the weather was described as clear (48.5%). The most common mechanisms of injury were motor vehicle collisions (25.8%), followed by sports—(21.5%) and assault—(16.5%) related injuries. Mechanisms were significantly associated with certain fracture patterns. Older age was associated with fewer orbital fractures (P, A retrospective review of 260 pediatric facial trauma patients found an association between the incidence of facial fractures and warmer weather, clear skies, weekends or holidays, and mechanism of injury. Older age is associated with operative intervention. These results can be used to guide public health interventions, policymaking, and facial trauma resource allocation.

Locked-up and unloaded firearm storage is a tenet of injury prevention campaigns to decrease children’s access to firearms. This study cohort describes the reported presence of, storage mechanisms for, and children’s perceived access to firearms. Parent-child dyads (n = 297) were recruited from pediatric emergency departments in Atlanta, GA. Gun owners were 25% of cohort; 53% reported storing some firearms insecurely. Gun owners were more likely to believe their child could access a firearm versus non–gun owners (11% vs 3%). Children of gun owners versus non-gun owners indicated increased ability to acquire a gun (14% vs 4%). Fifty-nine percent of children could not identify a real versus toy gun in a picture. This study highlights a plurality of parents storing firearms insecurely with a significant portion of children reporting gun access and demonstrating inability to recognize actual guns. This disconnect points to the importance of public health interventions to decrease access to firearms in this vulnerable population.

Purpose of review To offer healthcare providers current, evidence-based approaches for addressing vaccine hesitancy to increase vaccine coverage and reduce the frequency of vaccine-preventable disease outbreaks. Recent findings Vaccine hesitancy is a growing problem with profound societal, economic, and medical consequences. Understanding the complexity of vaccine hesitancy can inform approaches to increasing vaccine uptake on both the individual and population levels. Notably, pediatricians play a critical role in increasing vaccine uptake due to their relationships with families. This doctor-patient relationship establishes trust and allows evidence-based intervention strategies to be effective in the office. Understanding potential solutions outside the office, such as media campaigns and policy changes, also provide insight into vaccine hesitancy and potential directions for future research. While pediatricians' attempts in the clinic to increase coverage remain crucial, vaccine hesitancy remains a formidable public health problem that requires attention on both the micro and macro levels to be addressed successfully. Summary Providers have an opportunity to increase both confidence in and uptake of vaccines. Public health interventions would effectively complement strategies in the clinic to increase overall coverage.

Daily oral pre-exposure prophylaxis is an effective strategy for HIV prevention; yet, uptake has been lower than anticipated. This study explores the factors that influenced current users' decisions to initiate PrEP in Western New York. Qualitative data from 41 semi-structured interviews were thematically analyzed. Participants' decision to initiate PrEP was based on individual, interpersonal and structural factors. PrEP users initiated when there was an increase in knowledge, risk perception, sexual health communication, and PrEP access. Findings suggest for PrEP to maximize its HIV prevention potential, public health interventions that utilize a multi-level approach may be most impactful to increase uptake.

While Okinawa has been facing outbreak of the coronavirus disease 2019 (COVID‐19) pandemic, healthcare collapse should be prevented by sufficient supply of ventilators for caring the rapidly growing number of critically ill patients with COVID‐19. We estimated the number of invasive and noninvasive ventilators that would be required in Okinawa at the peak of the COVID‐19 outbreak based on recent data of COVID‐19 cases in Okinawa and data on the proportion of patients with COVID‐19 in the ICU requiring ventilation. Based on our results using the current supply of all ventilators, demand for ventilators could be prepared for patients with COVID‐19 who would require it and demand for noninvasive ventilators could also be prepared for those with COVID‐19 who would require it. The higher supply over the demand would be achieved by flattening the epidemic curve by implementing public health interventions to delay and suppress the epidemic peak in Okinawa., Demand for ventilators could be prepared for patients with COVID‐19 who would require it and demand for noninvasive ventilators could also be prepared for those with COVID‐19 who would require it. The higher supply over the demand would be achieved by flattening the epidemic curve by implementing public health interventions to delay and suppress the epidemic peak in Okinawa.

Objective:Despite a reduction in maternal mortality in recent years, a high rate of anaemia and other nutrient inadequacies during pregnancy pose a serious threat to mothers and their children in the Global South. Using the framework of the WHO–Commission on Social Determinants of Health, this study examines the socioeconomic, programmatic and contextual factors associated with the consumption of iron and folic acid (IFA) tablets/syrup for at least 100 d (IFA100) and receiving supplementary food (SF) by pregnant women in India.Design:We analysed a nationally representative cross-sectional survey of over 190 898 ever-married women aged 15–49 years who were interviewed as part of the National Family Health Survey (NFHS) conducted during 2015–16, who had at least one live birth preceding 5 years of the survey.Setting:All twenty-nine states and seven union territories of India.Participants:Ever-married women aged 15–49 years.Results:Less than one-third of women were found to be consuming IFA100, and a little over half received SF during their last pregnancy. The consumption of IFA100 was likely to improve with women’s education, household wealth, early and more prenatal visits, and in a community with high pregnancy registration. Higher parity, early and more prenatal visits, contact with community health workers during pregnancy, belonging to a poor household and living in an aggregated poor community and rural area positively determine whether a woman might receive SF during pregnancy.Conclusions:Continuous monitoring and evaluation of provisioning IFA and SF in targeted groups and communities is a key to expanding the coverage and reducing the burden of undernutrition during pregnancy.

Objective:To identify correlates and underlying beliefs regarding the adolescents’ intention to abstain from consuming sugar-sweetened beverages (SSB) and the consumption of ≤1 daily portion of SSB.Design:Correlational study.Setting:Region of Chaudière-Appalaches in the province of Quebec, Canada.Participants:311 adolescents aged 13–18 years completed a self-administrated online questionnaire based on the Reasoned Action Approach. Frequency and quantity of different types of SSB within the past month were measured.Results:Total mean SSB intake was 882·6 ml/d (654·0 kJ/d ). Only 11·3 % abstained from SSB within the last month. Intention to abstain from SSB was explained by identification as SSB abstainers (β = 0·47), perceived norm (β = 0·32), attitude (β = 0·30), age 13–14 years (β = –0·27) and perception of the school environment (β = 0·14), which explained 66 % of the variance. Consumption of ≤1 daily portion of SSB was explained by the intention to abstain (OR = 1·55; 95 % CI 1·14, 2·11), perceived behavioural control to abstain (OR = 1·80; 95 % CI 1·29, 2·52), sex (girls v. boys: OR = 2·34; 95 % CI 1·37, 3·98) and socio-economic status (advantaged v. disadvantaged school: OR = 2·08; 95 % CI 1·21, 3·56). Underlying beliefs (i.e. more energy, decreased risk of addiction and friends’ approval) associated with intention as well as perceived barriers (e.g. access to SSB, after an activity that makes you thirsty), and facilitating factors (e.g. access to water) linked to SSB consumption were identified.Conclusions:The results can inform public health interventions to decrease SSB consumption and their associated health problems among adolescents.

Cervical cancer screening is considered one of the most significant public health interventions that can reduce not only the incidence, but also the mortality of the disease. One of the most important factors for screening effectiveness is coverage defined as the number of women tested within a recommended interval. In the first years of the cervical screening, the participation rate in National Screening Program in Romania was 14.2% with slight difference in different region of the country. In the northeastern part of the country, in the first four years of the program, the rate was 16.9% with an alarmingly continuous decrease. Thus, increasing the rate of uptake of cervical screening is essential. The policy-makers should take new measures to increase women's participation in this screening program. The objective of this paper was to review situation of the screening program and to identify gaps and needs in the system and to bring or suggest solution.

BackgroundDisparities in multimorbidity prevalence indicate health inequalities. This study sought to determine if gaps in multimorbidity prevalence by race and ethnicity are decreasing over time.Methods and findingsSerial cross-sectional analysis of the National Health Interview Survey from years 1999 to 2018. The study included individuals ≥18 years old, categorized by self-reported race, ethnicity, age, and income. The main outcomes were temporal trends in multimorbidity prevalence based on the self-reported presence of ≥2 of 9 chronic conditions. The study sample included 596,355 individuals (4.7% Asian, 11.8% Black, 13.8% Latino/Hispanic, and 69.7% White). In 1999, the estimated prevalence of multimorbidity was 5.9% among Asian, 17.4% among Black, 10.7% among Latino/Hispanic, and 13.5% among White individuals. Prevalence increased for all racial/ethnic groups during the study period (PConclusionsFrom 1999 to 2018, a period of increasing multimorbidity prevalence for all the groups studied, there has not been any significant progress in eliminating disparities between Black and White people. The disparity began among young adults. Public health interventions that prevent the onset of chronic conditions in early life may be needed to eliminate these disparities.

To investigate a superspreading event at a fitness center in Hong Kong, China, we used genomic sequencing to analyze 102 reverse transcription PCR–confirmed cases of severe acute respiratory syndrome coronavirus 2 infection. Our finding highlights the risk for virus transmission in confined spaces with poor ventilation and limited public health interventions.

Background Various public health interventions have been implemented against the COVID‐19 pandemic. We investigated herein changes in pediatric emergency healthcare utilization during the current pandemic. Methods Based on data on outpatient healthcare visits to one pediatric emergency department in Tokyo, Japan, the descriptive, cross‐sectional study compared the number of emergency department visits between 2020 and the previous three years. Data were extracted from the electronic triage reporting system. The primary outcome was the number of emergency department visits. The characteristics of patients by age group were also investigated. Results A 40.6% reduction in pediatric emergency healthcare utilization was observed during the study period, with the greatest decrease occurring in the number of visits for fever. However, while the number of patients with a complaint with an exogenous cause decreased, the proportion of these patients increased. Although social activities in the greater community have now almost normalized, and only a slight increase in the number of patients with fever has been reported, the number of emergency department visits remains lower than in previous years as of this writing. Conclusions Public health interventions led to a reduction in emergency department visits, thereby allowing time to redistribute health care resources.

In recent years, reports of lead contamination have dramatically increased in Georgia. Given concerns about the exposure of children to lead (Pb), the National Multiple Indicator Cluster Survey (MICS-2018) included a blood sampling component. The results showed that 41% of the children that participated had blood Pb levels (BLL) ≥ 5 µg/dL and that BLL in children living in Western Georgia were higher than those in Eastern regions. In response to these findings, NCDC implemented written and verbal advice to the families of children who participated in the MICS-2018 on how to reduce Pb exposure. From August 2019 onwards, the state program of clinical follow-up was implemented. The design of this study was a longitudinal study. The intervention of interest was the public health advice and medical follow-up, and the outcome was defined as the difference in BLL between the MICS-2018 survey and the state program follow-up. We observed a significant overall reduction in median BLL between MICS-2018 and state program follow-up in both August 2019 and the latest results (until December 2019). However, we did not observe any significant further reduction between August and the most recent BLL results. In the Georgian setting, written and verbal communication targeting individual households, alongside home visits to the most exposed, effectively reduced BLL in children.

Malaria remains a global health priority, with substantial resources devoted to control and intervention since the causative parasite was first identified in 1880. Major advances have been made in discovery and translational research activities aimed at prevention, treatment and control. Laboratory-based, clinical, and field-based studies complement public health approaches. Australian scientists have played important roles, developing and applying innovative approaches, novel research tools and cutting-edge technologies in animal and human models of disease, as well as in disease-endemic settings. This article will provide an insight into 50 years of Australian efforts to discover mechanisms and targets of immunity and pathogenesis; develop new diagnostics, drugs, vaccines, and therapeutics; and assess new public health interventions and control measures in malaria-endemic settings.

The use of biomarkers to measure immune responses in serum is crucial for understanding population-level exposure and susceptibility to human pathogens. Advances in sample collection, multiplex testing, and computational modeling are transforming serosurveillance into a powerful tool for public health program design and response to infectious threats. In July 2018, 70 scientists from 20 countries met to perform a landscape analysis of approaches that support an integrated serosurveillance platform, including the consideration of issues for successful implementation. Here, we summarize the group’s insights and proposed roadmap for implementation, including objectives, technical requirements, ethical issues, logistical considerations, and monitoring and evaluation.

Aim: The aim of this study was to analyze the changes in incidence of notifiable infectious diseases in China under the prevention and control measures of COVID-19.Methods: Using descriptive epidemiological methods, data were collected from the official website of the Health Commission of the People's Republic of China, and the prevalence characteristics of notifiable infectious diseases in the country in 2020 were analyzed and compared with the historical data in 2019. Monthly reporting data on influenza and tuberculosis from 2015 to 2019 were also collected.Results: Except for COVID-19, the total number of notifiable infectious diseases cases in 2020 was 6,366,176, a decrease of 41.38% year-on-year compared with 2019. Category B and C notifiable infectious diseases decreased by 14.84 and 54.98% year-on-year, respectively (P < 0.01). The top three incidence rates were influenza (87.63 cases/100,000), hepatitis B (81.36 cases/100,000) and other infectious diarrhea (76.33 cases/100,000). Three types of diseases with the largest decline were influenza (−2,280,502 cases), hand-foot-mouth disease (−1,174,588 cases), and other infectious diarrhea diseases (−275,746 cases). Compared with 2019, respiratory infectious diseases were reported to be in the largest decline in 2020, followed by intestinal infectious diseases, blood-borne and sexually transmitted diseases, natural foci, and insect-borne infectious diseases. The monthly reported incidences of influenza and tuberculosis in 2020 were lower than the average of the previous 5 years.Conclusion: In 2020, the incidence of most notifiable infectious diseases in China showed a downward trend, non-pharmaceutical interventions (NPIs)such as the wearing of masks, frequent hand-washing, more ventilation, less gathering, etc, played an positive role in the prevention and control of respiratory and intestinal infectious diseases. The various public health intervention strategies and measures adopted by China to contain COVID-19 can provide a reference for the prevention and control of infectious diseases in other countries.

BACKGROUND AND OBJECTIVES Canada legalized nonmedical cannabis possession and sale in October 2018. In the United States, state legalization has been tied to an increase in cannabis-related emergency department (ED) visits; however, little research exists on provincial changes in pediatric visits after nationwide legislation. We compared pre- and postlegalization trends in pediatric cannabis-related ED visits and presentation patterns in urban Alberta EDs. METHODS Retrospective National Ambulatory Care Reporting System data were queried for urban Alberta cannabis-related ED visits among patients aged RESULTS Pediatric visit volume did not change postlegalization when accounting for preexisting volume trends. Unintentional ingestions increased in children (IRR: 1.77, 95% confidence interval [CI]: 1.42 to 2.20 and RR: 1.24, 95% CI: 1.05 to 1.47, respectively) and older adolescents (IRR: 1.36, 95% CI: 1.07 to 1.71 and RR: 1.48, 95% CI: 1.21 to 1.81, respectively). Presentation patterns remained similar, although older adolescent co-ingestant use decreased (RR: 0.77, 95% CI: 0.67 to 0.88), whereas hyperemesis cases increased (RR: 1.64, 95% CI: 1.13 to 2.37). CONCLUSIONS Cannabis legalization has increased child and older adolescent unintentional cannabis ingestions, increasing child cannabis-related ED visits. Changes highlight need for public health interventions targeting pediatric exposures.

COVID-19 has been causing negative impacts on various sectors in Sri Lanka as a result of the public health interventions that government had to implement in order to reduce the spreading of the disease. Equivalent work carried out in this context is outdated and close to ideal models. This research is carried out in a crucial time which the daily deaths are rapidly increasing which arise the requirement for an accurate and practical model to predict the mortality in order to take decisions regarding public health interventions. This paper presents a mathematical epidemiological model called SEQIJRDS to predict on COVID-19. The model has been validated for the COVID 19 pandemic in Sri Lanka. The results show that the model outstands many of the state-of-the-art SEIR epidemiological models such as Imperial, IHME once properly parameterized. At the end; this work recommends public health interventions at this crucial time to save people's lives based on the predictions of the proposed model. Specifically, 3 recommendations called minimal, sub-optimal and optimal recommendations are provided for public health interventions.

It is known that the COVID-19 spread mainly from having close contact with people who have histories of exposure to the novel Corona virus (2019-nCoV or SARS-CoV-2). Though some countries have succeeded in developing the vaccine, its arrival remains a challenge in most countries like the Philippines. For this purpose, strict health protocols and contact tracing remain to be the principal public health interventions and preventive measures to limit the spread of COVID-19. With the number of available contact tracing applications that use Bluetooth and GPS technologies, this study focused on the development and pilot testing of GoTrace, a web-based contact tracing application that uses Quick Response (QR) codes. GoTrace integrates the collection of daily health surveys and location tracking data of the end-users on a digital and web platform to generate real-time, accurate, and reliable contact tracing reports. With the positive feedback of the participants during the pilot testing, GoTrace will offer a promising mobile contact tracing technology that can be adopted in various environments through its dynamic, flexible, and user-friendly architecture.

Vaccine hesitancy has increased, which has an effect on vaccine uptake. The aim of our study was to investigate childhood vaccination coverage in Western Greece and identify factors affecting it. We also aimed to assess trends in childhood vaccination coverage nationwide. A cross-sectional study was conducted (2016-2019) in all the primary schools in Patras, the third largest city in the country. Data collection was undertaken using child vaccination booklets and questionnaires on socio-demographics. Multiple regression analyses were performed to evaluate relevant associations. We also performed a systematic review of published data on childhood vaccination coverage in Greece during the last two decades. Data for 1657 children was collected and 371 questionnaires were returned. High vaccination coverage (>90%) was observed for the majority of the vaccines. For the pneumococcal conjugate vaccine (PCV), coverage with four doses, as recommended at the time of study, was suboptimal (39.2%). For human papillomavirus vaccines and the meningococcal serogroup B vaccine, full vaccination coverage was 2.6% and 6.5%, respectively. No association with socio-demographics was found for vaccines with high coverage. For PCV the number of doses given was related to Greek nationality (β = 0.185, p

Our Australian hospital tested almost 22 000 symptomatic people over 11 weeks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a multiplex polymerase chain reaction (PCR) assay. Following travel bans and physical distancing, SARS-CoV-2 and other respiratory viruses diagnoses fell dramatically. Increasing rhinovirus diagnoses as social control measures were relaxed may indirectly indicate an elevated risk of coronavirus disease 2019 (COVID-19) resurgence.

We implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of patients undergoing surgical procedures as a means to conserve personal protective equipment (PPE). The rate of asymptomatic coronavirus disease 2019 (COVID-19) was

Mathematical modelling can be useful for predicting how infectious diseases progress, enabling us to show the likely outcome of an epidemic and help inform public health interventions. Different modelling techniques have been used to predict and simulate the spread of COVID-19, but they have not always been useful for epidemiologists and decision-makers. To improve the reliability of the modelling results, it is very important to critically evaluate the data used and to check whether or not due regard has been paid to the different ways in which the disease spreads through the population. As building an epidemiological model that is reliable enough and suits the current epidemiological situation within a country or region, certain criteria must be met in the modelling process. It might be necessary to use a combination of two or more different types of models in order to cover all aspects of epidemic modelling. If we want epidemiological models to be a useful tool in combating the epidemic, we need to engage experts from epidemiology, data science and statistics.Matematično modeliranje je lahko koristno za napovedovanje razvoja nalezljivih bolezni, saj s prikazom možnih izidov epidemije pomaga oblikovati javnozdravstvene ukrepe. Za napovedovanje in simulacijo širjenja v času epidemije COVID-19 so bile uporabljene različne tehnike modeliranja, vendar vse niso bile vedno koristne za epidemiologe in odločevalce. Da bi bili rezultati modeliranja zanesljivejši, je zelo pomembno kritično ovrednotiti uporabljene podatke ter preveriti, ali so bili upoštevani različni načini širjenja bolezni v populaciji ali ne. Izdelava dobrega epidemiološkega modela, ki je dovolj zanesljiv in ustreza trenutnim epidemiološkim razmeram v državi ali regiji, je zahtevna, zato je treba pri modeliranju slediti določenim kriterijem. Smiselno bi bilo tudi kombinirati dve različni vrsti modelov. Modeliranje bi bilo tako zanesljivejše, saj bi upoštevalo različne predpostavke. Če želimo, da bodo epidemiološki modeli koristno orodje v boju proti epidemiji, morajo pri modeliranju sodelovati strokovnjaki z različnih področij, predvsem epidemiologije, podatkovne znanosti in statistike.

Policy Points US maternal mortality rates (MMRs) display considerable racial disparities and exceed those of other developed countries. While worldwide MMRs have dropped sharply since the 1990s, the US MMR appears to be rising. We provide strong evidence of the effectiveness of pregnancy-related public health spending on improvements in maternal health. Using longitudinal data from Florida counties, we found that spending on public health significantly reduced the MMR among black mothers and narrowed black-white outcome disparities. Each 10% increase in pregnancy-related public health expenditures was associated with a 13.5% decline in MMR among blacks and a 20.0% reduction in black-white disparities. Context Maternal mortality rates in the United States exceed those of other developed countries. Moreover, these rates show considerable racial disparities, in which black mothers are at three to four times the risk compared with their white counterparts. With more than half of all maternal deaths deemed to be preventable, public health interventions have the potential to improve maternal health along with other pregnancy outcomes. This rigorous longitudinal study examines the impact of a package of pregnancy-related public health programs on maternal mortality rates. Methods We analyzed administrative data on pregnancy-related public health expenditures, maternal mortality rates, and sociodemographic factors from all 67 Florida counties between 2001 and 2014. Florida provides consistent counts of maternal deaths for the entire period of this analysis. We estimated both fixed-effects ordinary least squares regressions (OLS) and generalized method of moments (GMM) models. GMM enabled us to identify the impact of public health expenditures on maternal mortality rates while also addressing both potential endogeneity and serial correlation problems. We also provide a series of robustness and falsification tests. Findings Overall, a 10% increase in targeted public health expenditures led to a weakly significant decline in overall maternal mortality rates of 3.9%. The estimated effect for white mothers was not statistically significant. However, we found statistically significant improvements for black mothers. Specifically, a 10% increase in pregnancy-related public health spending led to a 13.5% decline in maternal mortality rates among black mothers and a 20.0% reduction in the black-white maternal mortality gap. Conclusions Our analysis provides strong evidence of the effectiveness of public health programs in reducing maternal mortality rates and addressing racial disparities.