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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.

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.

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.

Immunization is among the most cost-effective public health interventions available and is estimated to have averted at least 37 million deaths between 2000 and 2019. Since the establishment of the Expanded Programme on Immunization in 1974, global vaccination coverage increased and the coverage gap between rich and poor countries decreased. Creation of Gavi, the Vaccine Alliance, in 2000 allowed the poorest countries in the world to benefit from new, life-saving vaccines and expand the breadth of protection against an increasing number of vaccine-preventable diseases. Despite this progress, inequities in access to and uptake of vaccines persist. Opportunities to realize the full potential of vaccines are within reach but require focused, tailored and committed action by Governments and immunization stakeholders. The Immunization Agenda 2030 provides a framework for action during the next decade to attain a world where everyone, everywhere, at every age fully benefits from vaccines for good health and well-being.

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.

Aim The aim of this study was to explore the use and future potential of realist approaches to research in nutrition and dietetics. Methods A targeted literature review was used to search key journals (n = 7) in nutrition and dietetics to identify existing research using a realist approach. A narrative synthesis was conducted to explore findings in relation to the research aim. Results Nine research papers (four realist evaluations, five realist reviews) describing seven nutrition interventions were found, which revealed the application of realist research in nutrition and dietetics has focused on public health interventions. Realist research provided a deeper, more nuanced understanding of varied outcomes including the role of context, and contributed to the development of theory about how and why interventions work. As a theory‐driven research method, realist research was able to assist in overcoming methodological shortcomings to contribute to meaningful, transferable findings. Conclusion The results highlight the potential contribution of the realist research in nutrition and dietetics to evaluate interventions and inform future practice.

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

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

Objective: This review aimed to understand the broader community’s attitudes toward ADHD, which could facilitate public health interventions to improve outcomes for individuals with ADHD. Methods: A standardized protocol identified peer-reviewed studies focusing on attitudes of broader community samples, published from January 2014 to February 2020 (inclusive). Results: A total of 1,318 articles were screened and 10 studies were included, examining attitudes of broader community samples from Australia, Sweden, Germany, Finland, Korea, Indonesia, and the United States. Findings revealed that broader community samples displayed varying degrees of ADHD-related knowledge, negative attitudes (that ADHD is over-diagnosed; that pharmacological treatment is not acceptable; that those with ADHD are more likely to exhibit poor behavior), and a desire for maintaining social distance from individuals with ADHD. Conclusion: Findings suggest that community attitudes are generally negative toward those with ADHD. Targeted mental health literacy could provide an important avenue for improving the broader community’s attitudes toward those with ADHD.

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.

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

We aimed to develop a core outcome set (COS) for systems-wide public health interventions seeking to promote early life health and wellbeing. Research was embedded within the existing systems-based intervention research programme ‘ActEarly’, located in two different areas with high rates of child poverty, Bradford (West Yorkshire) and the Borough of Tower Hamlets (London). 168 potential outcomes were derived from five local government outcome frameworks, a community-led survey and an ActEarly consortium workshop. Two rounds of a Delphi study (Round 1: 37 participants; Round 2: 56 participants) reduced the number of outcomes to 64. 199 members of the community then took part in consultations across ActEarly sites, resulting in a final COS for systems-based public health interventions of 40 outcomes. These were grouped into the domains of: Development & education (N = 6); Physical health & health behaviors (N = 6); Mental health (N = 5); Social environment (N = 4); Physical environment (N = 7); and Poverty & inequality (N = 7). This process has led to a COS with outcomes prioritized from the perspectives of local communities. It provides the means to increase standardization and guide the selection of outcome measures for systems-based evaluation of public health programmes and supports evaluation of individual interventions within system change approaches.

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.

We sought to determine whether a shortened version of the 12-item Household Water Insecurity Experiences (HWISE) Scale, which measures water insecurity equivalently in low- and middle-income countries (LMICs), is valid for broad use. Using data from 9,261 households in 25 LMICs, subsets of candidate items were evaluated on their predictive accuracy, criterion validity, and sensitivity–specificity. A subset with items assessing “worry,” “changing plans,” “limited drinking water,” and “inability to wash hands” because of problems with water (range: 0–12) were highly correlated with full HWISE Scale scores (correlation coefficient: 0.949–0.980) and introduced minimal additional error (root mean square error: 2.13–2.68). Criterion validity was demonstrated, and a cut point of ≥ 4 correctly classified more than 91% of households as water secure or insecure. The brief HWISE-4 can be used in LMICs to inform decisions about how to most effectively target resources and evaluate public health interventions.

Though faith community nurses (FCNs) serve many roles in churches and communities, little is known about their roles or effectiveness in public health interventions. This systematic review summarizes the literature on recent faith community nursing interventions, examining trends, evaluating rigor, and proposing future research directions. Articles were downloaded from PubMed and CINAHL, and 24 studies were included. Interventions addressed various health outcomes. The FCNs participated in research by recruiting participants, developing study measures, and implementing programs. Results reported mainly process evaluation and provided few outcomes. Better evaluation is needed to understand the effectiveness of FCNs in public health research.

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.

Highlights • Among SARS-CoV2 positive cases in Africa, the proportion of severe COVID-19 appears to be low. • Current epidemiological patterns in Africa could be due to several factors (e.g. lockdowns, young age structure, and host genetics). • Nonetheless, it is important to implement long-term strategies of prevention in Africa, as lockdowns ease and the nature of the SARS-CoV2 virus changes. • Using regionally-specific public health interventions, African countries can minimize the onward transmission of SARS-CoV2 even in the absence of a vaccine., To date, SARS-CoV-2 (the virus that causes COVID-19) has spread to almost every region of the world, infecting millions and resulting in the deaths of hundreds of thousands of people. Although it was predicted that Africa would suffer a massive loss of life, the number of COVID-19 cases has been relatively low across the continent. Researchers have speculated that a number of factors could be responsible for this pattern in Africa, including the extensive experience that countries have with infectious diseases and the young median age of their populations. However, it is still important for African countries to adopt aggressive and bold approaches against COVID-19, in case the nature of the pandemic changes. This short review will summarize the status of the outbreak in Africa and possible reasons for current trends, as well as discuss interventions aimed at preventing a rapid increase in the number of COVID-19 cases in the future.

Significance In contrast to predictions of conventional epidemic models, COVID-19 outbreak time series have highly asymmetric shapes, with cases and fatalities declining much more slowly than they rose. Here, we investigate how awareness-driven behavior modulates epidemic shape. We find that short-term awareness of fatalities leads to emergent plateaus, persistent shoulder-like dynamics, and lag-driven oscillations in an SEIR-like model. However, a joint analysis of fatalities and mobility data suggests that populations relaxed mobility restrictions prior to fatality peaks, in contrast to model predictions. We show that incorporating fatigue and long-term behavior change can explain this phenomenon, shed light on when post-peak dynamics are likely to lead to a resurgence of cases or to sustained declines, and inform public health campaigns to control COVID-19., The COVID-19 pandemic has caused more than 1,000,000 reported deaths globally, of which more than 200,000 have been reported in the United States as of October 1, 2020. Public health interventions have had significant impacts in reducing transmission and in averting even more deaths. Nonetheless, in many jurisdictions, the decline of cases and fatalities after apparent epidemic peaks has not been rapid. Instead, the asymmetric decline in cases appears, in most cases, to be consistent with plateau- or shoulder-like phenomena—a qualitative observation reinforced by a symmetry analysis of US state-level fatality data. Here we explore a model of fatality-driven awareness in which individual protective measures increase with death rates. In this model, fast increases to the peak are often followed by plateaus, shoulders, and lag-driven oscillations. The asymmetric shape of model-predicted incidence and fatality curves is consistent with observations from many jurisdictions. Yet, in contrast to model predictions, we find that population-level mobility metrics usually increased from low levels before fatalities reached an initial peak. We show that incorporating fatigue and long-term behavior change can reconcile the apparent premature relaxation of mobility reductions and help understand when post-peak dynamics are likely to lead to a resurgence of cases.

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.

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.

Highlights • We applied the SIR (susceptible–infected–removed) model with a breakpoint to allow for a change in transmission rate. • The model accurately estimated the trajectory of COVID-19 spread in South Korea. • The breakpoint may reflect potential effects of preventive strategies on transmission rates. • Counterfactual experiments illustrated potential impacts of the breakpoint on the spread of infection., Objectives Amid the global coronavirus disease 2019 (COVID-19) crisis, South Korea has been lauded for successfully preventing the spread of this infectious disease, which may be due to the aggressive implementation of preventive policies. This study was performed to evaluate the pattern of spread of COVID-19 in South Korea considering the potential impact of policy interventions on transmission rates. Methods A SIR (susceptible–infected–removed) model with a breakpoint that allows a change in transmission rate at an unknown point was established. Estimated trajectories of COVID-19 from SIR models with and without a breakpoint were compared. Results The proposed model with a break fitted the actual series of infection cases much better than the classic model. The estimated breakpoint was March 7, 2020 and the transmission rate dropped by 0.23 after the breakpoint. A counterfactual study based on our estimate indicated that the number of infected could have reached 2 500 000 compared to the peak of 8000 in the observed series. Conclusions It is critical to consider a change in the transmission rate to evaluate the trajectory of spread of COVID-19 in South Korea. Our estimation and counterfactual experiments indicate that public health interventions may play a role in determining the pattern of spread of infectious diseases.

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.

The substantial increase in the number of daily new cases infected with coronavirus around the world is alarming, and several researchers are currently using various mathematical and machine learning-based prediction models to estimate the future trend of this pandemic. In this work, we employed the Autoregressive Integrated Moving Average (ARIMA) model to forecast the expected daily number of COVID-19 cases in Saudi Arabia in the next four weeks. We first performed four different prediction models; Autoregressive Model, Moving Average, a combination of both (ARMA), and integrated ARMA (ARIMA), to determine the best model fit, and we found out that the ARIMA model outperformed the other models. The forecasting results showed that the trend in Saudi Arabia will continue growing and may reach up to 7668 new cases per day and over 127,129 cumulative daily cases in a matter of four weeks if stringent precautionary and control measures are not implemented to limit the spread of COVID-19. This indicates that the Umrah and Hajj Pilgrimages to the two holy cities of Mecca and Medina in Saudi Arabia that are supposedly scheduled to be performed by nearly 2 million Muslims in mid-July may be suspended. A set of extreme preventive and control measures are proposed in an effort to avoid such a situation.

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.

Background Eliminating Plasmodium vivax will require targeting the hidden liver-stage reservoir of hypnozoites. This necessitates new interventions balancing the benefit of reducing vivax transmission against the risk of over-treating some individuals with drugs which may induce haemolysis. By measuring antibodies to a panel of vivax antigens, a strategy of serological-testing-and-treatment (PvSeroTAT) can identify individuals with recent blood-stage infections who are likely to carry hypnozoites and target them for radical cure. This provides a potential solution to selectively treat the vivax reservoir with 8-aminoquinolines. Methods PvSeroTAT can identify likely hypnozoite carriers with ~80% sensitivity and specificity. Diagnostic test sensitivities and specificities ranging 50–100% were incorporated into a mathematical model of vivax transmission to explore how they affect the risks and benefits of different PvSeroTAT strategies involving hypnozoiticidal regimens. Risk was measured as the rate of overtreatment and benefit as reduction of community-level vivax transmission. Results Across a wide range of combinations of diagnostic sensitivity and specificity, PvSeroTAT was substantially more effective than bloodstage mass screen and treat strategies and only marginally less effective than mass drug administration. The key test characteristic determining of the benefit of PvSeroTAT strategies is diagnostic sensitivity, with higher values leading to more hypnozoite carriers effectively treated and greater reductions in vivax transmission. The key determinant of risk is diagnostic specificity: higher specificity ensures that a lower proportion of uninfected individuals are unnecessarily treated with primaquine. These relationships are maintained in both moderate and low transmission settings (qPCR prevalence 10% and 2%). Increased treatment efficacy and adherence can partially compensate for lower test performance. Multiple rounds of PvSeroTAT with a lower performing test may lead to similar or higher reductions in vivax transmission than fewer rounds with a higher performing test, albeit with higher rate of overtreatment. Conclusions At current performance, PvSeroTAT is predicted to be a safe and efficacious option for targeting the hypnozoite reservoir towards vivax elimination. P. vivax sero-diagnostic tests should aim for both high performance and ease of use in the field. The target product profiles informing such development should thus reflect the trade-offs between impact, overtreatment, and ease of programmatic implementation.

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.

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.

Preventive and modelling approaches to address the COVID-19 pandemic have been primarily based on the age or occupation, and often disregard the importance of heterogeneity in population contact structure and individual connectivity. To address this gap, we developed models based on Erdős-Rényi and a power law degree distribution that first incorporate the role of heterogeneity and connectivity and then can be expanded to make assumptions about demographic characteristics. Results demonstrate that variations in the number of connections of individuals within a population modify the impact of public health interventions such as lockdown or vaccination approaches. We conclude that the most effective strategy will vary depending on the underlying contact structure of individuals within a population and on timing of the interventions.Author summaryThe best strategy for public health interventions, such as lockdown or vaccination, depends on the contact structure of the population and the timing of the intervention. In general, for heterogeneous contact structures that mimic the COVID-19 spread, which is characterized by the presence of super spreaders, vaccinating the most connected individuals first was the most effective strategy to prevent infections and deaths, especially when coupled to serological tests. Models considering heterogeneity in human interactions need be used to identify the best potential vaccine prioritization strategies.

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.

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.

Ensuring the sustainability of school-based public health intervention activities remains a challenge. The Young and Active (Y&amp, A) intervention used peer-led workshops to promote movement and strengthen students’ sense of community in 16 Danish high schools. Peer mentors inspired first-year students to implement movement activities. To support sustainability, we applied a three-year stepwise implementation strategy using university students as peer mentors in year 1 and senior high school students in the following two years. This study explores the sustainability potential of Y&amp, A, focusing on school coordinators’ reflections on the intervention’s fit to their schools and the student-driven approach, and we assess the three-step implementation strategy. The study is based on telephone interviews with coordinators (n = 7) from schools that participated in all three years and participant observations of four workshops (a total of approximately 250 participating students). Results were generated through an abductive analysis. Seven schools continued the intervention throughout the three years and adapted it to fit their priorities. The student-driven approach was perceived to be valuable, but few student-driven activities were initiated. Teacher support seemed crucial to support students in starting up activities and acting as peer mentors in workshops. The three-step implementation strategy proved valuable due to the peer-approach and the possibility of gradual adaptation. In future similar initiatives, it is important to address how the adequate staff support of students can be facilitated.

We welcome this latest research on the impact of the Sure Start programme.12 The evidence shows that large scale, holistic public health interventions can be effective in improving children’s health.2 Sure Start substantially reduced hospital admissions for infections, injuries, and mental health problems. For those interested in “levelling up” there are clear lessons to be learnt from this research. The impacts of …

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

To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between ‘neighborhood risks and resources’ and ‘sense of community’ factors for each dietary outcome of interest. While high perceived neighborhood violence (p &lt, 0.001) and perceived community-level collective efficacy (p &lt, 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p &lt, 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p &lt, 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations.

Measuring and monitoring non-pharmaceutical interventions is important yet challenging due to the need to clearly define and encode non-pharmaceutical interventions, to collect geographically and socially representative data, and to accurately document the timing at which interventions are initiated and changed. These challenges highlight the importance of integrating and triangulating across multiple databases and the need to expand and fund the mandate for public health organizations to track interventions systematically.

Background To fight against COVID-19, many policymakers are wavering on stricter public health interventions. Examining the different strategies both in and out of China’s Hubei province, which contained the epidemic in late February 2020, could yield valuable guidance for the management of future pandemics. This study assessed the response process and estimated the time-varying effects of the Hubei control strategy. Analysis of these strategies provides insights for the design and implementation of future policy interventions. Methods We retrospectively compared the spread and control of COVID-19 between China’s Hubei (excluding Wuhan) and non-Hubei areas using data that includes case reports, human mobility, and public health interventions from 1 January to 29 February 2020. Static and dynamic risk assessment models were developed to statistically investigate the effects of the Hubei control strategy on the virus case growth after adjusting importation risk and policy response timing with the non-Hubei strategy as a control. Results The analysis detected much higher but differential importation risk in Hubei. The response timing largely coincided with the importation risk in non-Hubei areas, but Hubei areas showed an opposite pattern. Rather than a specific intervention assessment, a comprehensive comparison showed that the Hubei control strategy implemented severe interventions characterized by unprecedentedly strict and ‘monitored’ self-quarantine at home, while the non-Hubei strategy included physical distancing measures to reduce contact among individuals within or between populations. In contrast with the non-Hubei control strategy, the Hubei strategy showed a much higher, non-linear and gradually diminishing protective effect with at least 3 times fewer cases. Conclusions A risk-based control strategy was crucial to the design of an effective response to the COVID-19 outbreak. Our study demonstrates that the stricter Hubei strategy achieves a stronger controlling effect compared to other strategies. These findings highlight the health benefits and policy impacts of precise and differentiated strategies informed by constant monitoring of outbreak risk.

During the COVID-19 pandemic, the need for rapid legal interventions to protect public health has challenged standards of evidence generation and implementation. Investigators have generated high-quality evidence for drugs and vaccines at remarkable speed, but COVID-19 mitigation measures enforced by laws and regulations remain guided by the precautionary principle rather than by empirical evidence. This article discusses new concepts for embedded evidence generation for legal public health interventions in times of crisis.

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

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.

This article examines resuscitation practices in the second half of the eighteenth century, especially the new use of tobacco smoke enema machines on people who had been extracted from water with no signs of life. Drownings accounted for a small number and proportion of urban deaths, yet governments promoted resuscitation techniques at considerable expense in order to prevent such deaths. The visibility of drowning in religious, urban, and civic life encouraged engagement with new approaches. Analyzing the deployment of resuscitation practices illuminates three key features of premodern public health interventions: the focus of governments on the logistics of these interventions, the participation of physicians and surgeons at all levels of the professional hierarchy, and the importance of communication.