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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 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.

In this study, predictive models are proposed to accurately estimate the confirmed cases and deaths due to of Corona virus 2019 (COVID-19) in Africa. The study proposed the predictive models to determine the spatial and temporal pattern of COVID 19 in Africa. The result of the study has shown that the spatial and temporal pattern of the pandemic is varying across in the study area. The result has shown that cubic model is best outperforming compared to the other six families of exponentials ( R 2 = 0.996 , F = 538.334 , D F 1 = 3 , D F 1 = 7 , b 1 = 13691.949 , b 2 = − 824.701 , b 1 = 12.956 ) . The adopted cubic algorithm is more robust in predicting the confirmed cases and deaths due to COVID 19. The cubic algorithm is more superior to the state of the art of the works based on the world health organization data. This also entails the best way to mitigate the expansion of COVID 19 is through persistent and strict self-isolation. This pandemic will sustain to grow up, and peak to the highest for which a strong care and public health interventions practically implemented. It is highly recommended for Africans must go beyond theory preparations implementations practically through the public interventions.

A significant increase in the number of coronavirus cases can easily be noticed in most of the countries around the world Inspite of the consistent preventive initiatives being taken to contain the spread of this virus, the unabated increase in the cases is both alarming and intriguing The role of mathematical models in predicting and estimating the spread of the virus, and identifying various preventive factors dependencies has been found important and effective in most of the previous pandemics like Severe Acute Respiratory Syndrome (SARS) 2003 In this research work, authors have proposed the Susceptible-Infectected-Removed (SIR) model variation in order to forecast the pattern of coronavirus disease (COVID-19) spread for the upcoming eight weeks in perspective of Saudi Arabia The study has been performed by using SIR model with a proposed simplification using average progression for further estimation of beta and gamma values for better curve fittings ratios The predictive results of this study clearly show that under the current public health interventions, there will be an increase in the COVID-19 cases in Saudi Arabia in the next four weeks Hence, a set of strong health primitives and precautionary measures are recommended in order to avoid and prevent the further spread of COVID-19 in Saudi Arabia

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.

The aim of this study is to determine suitability the quality of drinking water for human consumption. Monthly samples were taken from tow water treatment plants in Kut city with the aim of improving public health interventions. To assess drinking water quality, we measured fifteen parameters namely: temperature, pH, turbidity, TDS, TS, DO, BOD5, TH, SO4, NO3, PO4, Pb, Fe, Al and fecal coliform. All the water quality parameters are exceed maximum permissible limit values recommended by World Health Organization (2015) and Iraqi drinking water standards (417/2011), except pH, BOD5 and NO3. National Sanitation Foundation Index (NSF-WQI) were used for evaluate drinking water quality. The calculated value of NSF-WQI indicates that the drinking water quality in the city of Kut are medium category (NSF-WQI = 50–69) in all six site except KU3 and KA3 are classified as bad category (NSF-WQI = 25–49) in summer season, and that turbidity, Pb, Fe and fecal coliform are the main reason in deterioration of drinking water quality.

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.

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 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.

Dengue fever (DF) infection continues to present as a serious public health problem in Medan municipality, North Sumatera, Indonesia. The number of DF cases continuously increasing recently. However, space time clusters of DF have not been investigated yet. A study was undertaken to detect clusters of DF incidence during 2015-2018 in Medan. Spatial geo-reference was conducted to 151 village coordinates by geocoding each village’s offices. A retrospective space-time scan statistic analysis based on population data and monthly DF incidence was performed using SaTScan TM v9.4.4. Data of DF during 1 January 2015-31 December 2018 were analyzed using Poisson model to identify the villages at high risk of DF. The test of significance of the identified clusters of DF was based on comparing the likelihood ratio (LLR) against the null distribution obtained from Monte Carlo hypothesis testing. Total number of permutation was set to 999 and the significance level was set as 0.05. The highest LLR number was determined as the most likely cluster, while the rests were as the secondary clusters. This analysis identified 13 significant clusters. These DF clusters were initially spatially concentrated in the southwest and center of Medan and the last two years of study moved towards the northern part and identified in the last four months (September-December) of each year, which were the rainy seasons in the area. Most likely clusters were most frequently detected in the last three-year period of study in Anggrung village. Thirteen statistically significant DF clusters were identified in the 2015-2018 period. This may assist health authorities to improve the DF preventive strategies and develop public health interventions especially in the cluster’s area.

The Covid-19 pandemic has had enormous effects on health, wellbeing and economies worldwide. Governments have responded with rapid and sometimes radical public health interventions. As nations grapple with the question of how to regain normality without unnecessarily endangering lives or healthcare systems, some scientists have argued for policies to encourage or compel use of face coverings in community (non-clinical) settings, despite acknowledged gaps in the evidence base for the effectiveness of such a measure. This commentary has two objectives. First, in the face of strong arguments that face coverings are a commonsense intervention, with negligible downsides, that can only do good, we make the case for caution in changing policy. Many seemingly benign public health interventions have the potential to cause harm, and that harm is often socially differentiated. We present five arguments for caution in policy change. Second, we reflect on the wider implications of the increasingly overt approaches to policy advocacy taken by some scientists. Drawing from the theory of post-normal science, we argue that the science-policy interface in the case of face coverings has taken a surprisingly traditional form, falling short of interdisciplinary integration and failing to incorporate insights of the full range of relevant experts and affected stakeholders. We sketch a vision for an alternative, more mature, relationship between science and society that accepts uncertainty, embraces deliberation, and rises to the challenge of developing knowledge to improve public health.

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.

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.

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.

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.

The notion of “emerging infectious diseases” (EID) as a category of global health concerns was created in the 1990s to acknowledge that, although public health interventions, vaccines, and antibiotics since the late 19th century had given wealthier parts of the world control over most infectious diseases, the experience of Ebola and HIV/AIDS showed that new human diseases could still arise. “Emerging diseases” have clear histories, and the task the field of EID set itself has been to make those histories as short as possible—to catch emerging diseases as close to their origin as possible and snuff them out before they can become pandemics. In contrast, many of the known infectious diseases, those that were allegedly “conquered” by the rise of biomedicine in the late 19th and early 20th centuries and which (aside from smallpox) nonetheless still persist today, were assumed to have existed “since time immemorial.” Their histories had no specific time-depth, no documentable origins, and few discernible narrative arcs. The advent of a new field of research, palaeogenetics, has made possible an evolutionary perspective on pathogenic microorganisms, bringing hitherto unimaginable specificity to their documentable histories. Many origin stories, and nearly all globalization stories, fall within periods that historians and archaeologists study intensively. I argue that the diseases that have proved best suited to global expansion since the advent of the Holocene—those that became pandemics, like COVID-19—are those that have best exploited humans' global networks and behaviors in a given age. This recognition, in turn, gives the fields of both global health and history of medicine a new agenda.

Amid the current COVID-19 crisis, everyone has been called upon to offer assistance. What can historians contribute? One obvious approach is to draw on our knowledge of the history of epidemics and proclaim the lessons of history. But does history offer clear lessons? To make their expertise relevant, some historians assert that there are enduring patterns in how societies respond to all epidemics that can inform our experiences today. Others argue that there are informative analogies between specific past epidemics and our present crisis, for instance between COVID-19 and prior outbreaks of SARS or influenza. Both strategies can be pursued, but each must be done with care. It is certainly possible to map COVID-19 onto the classic dramatic structure of an epidemic, but we cannot yet know how it will end, a failure of prognostication that constrains the advice we can offer. It is likewise possible to draw on the history of medical therapeutics and public health interventions to identify the risks we face of both underuse and overuse of our remedies, but we cannot yet judge whether our current commitment to heroic social distancing is warranted. While historians can offer insight, we must temper our contributions with humility.

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.

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.

Summary statistics, often derived from simplified models of epidemic spread, inform public health policy in real time. The instantaneous reproduction number, Rt, is predominant among these statistics, measuring the average ability of an infection to multiply. However, Rt encodes no temporal information and is sensitive to modelling assumptions. Consequently, some have proposed the epidemic growth rate, rt, i.e., the rate of change of the log-transformed case incidence, as a more temporally meaningful and model-agnostic policy guide. We examine this assertion, identifying if and when estimates of rt are more informative than those of Rt. We assess their relative strengths both for learning about pathogen transmission mechanisms and for guiding public health interventions in real time.

The main goal of epidemic modelling is to support the epidemic management through forecasts and analyses of past developments. With this in mind a robust and intuitive SEIR (Susceptible, Exposed, Infectious, Recovered) type model has been developed, applied and verified during the multiple waves of the COVID-19 epidemics in Slovenia since March 2020. The model parameters were based on the general characteristics of the COVID-19 disease reported globally for the entire planet and refined with the aggregate data available mostly on a daily basis in Slovenia, as for example the number of confirmed cases, hospitalized patients, hospitalized patients in intensive care units and deceased. The Slovenian aggregate data was also used to estimate the degree of immunisation due to past infections and vaccination, which reduces the number of susceptible persons for the disease. Examples of the model application are presented to illustrate its robustness and intuitiveness in both the forecasts and analyses of past developments. The analyses of past developments provided specific estimates of modelling parameters for Slovenia and quantified the effects of pharmaceutical and non-pharmaceutical interventions and various events on the development of the epidemics as measured through the reproduction number R. This empirically obtained information was then applied in the forecasts. Accurate forecasts are a great support for decision makers and for hospitals to plan appropriate actions in advance. The inherent uncertainties in the model and data were quantified through intuitive sensitivity analyses represented as different scenarios. The observed accuracy of the forecasts was impressively good also in demanding conditions, when various complex processes influencing the spread of the disease were going on in parallel. This demonstrates the robustness and relevance of the proposed model.

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.

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.

The mental health of college students has become one of the top concerns in higher education. The number of students reporting psychological distress and seeking services has dramatically increased over the last two decades. Colleges are struggling to address longstanding mental health inequities such as those facing students of color (SOC) and transgender and gender diverse (TGGD) students. An accumulating body of research documents the scope of the problem and potential interventions. However, this literature has been siloed across a variety of academic fields and predominantly focused on individual student risk and protective factors while dedicating minimal attention to institutional opportunities for advancing mental health equity. This dissertation takes a socioecological approach and focuses on community, institutional, and policy-level factors to identify solutions that move beyond “fixing students” to help institutions become mental health promoting, not harming, environments. First, I conduct a multidisciplinary review of higher education interventions and policies shaping student mental health, with attention to multiple levels of influence (Study 1 | Chapter 2). This chapter provides the first comprehensive review of the evidence base pertaining to public health approaches to promote college student mental health, prevent mental health problems, and intervene with students who are already struggling. My scholarship lays crucial groundwork for a more evidence-informed approach to address the growing challenges of student mental health in higher education. Next, I advance research on two arenas of institutional practice—policing and TGGD-inclusive policies—relevant for enhancing mental health equity. Specifically, I use new data that I collected from 5379 students at a large Midwestern institution in partnership with the Healthy Minds Study to examine a) differing perceptions of and experiences with university police across race/ethnicity and gender identity and b) student perspectives on public safety policy-change opportunities to enhance mental health (Study 2 | Chapter 3). I take a novel intersectional approach that moves beyond binary conceptions of gender and considers the experiences of cisgender men, cisgender women, and TGGD students across multiple races/ethnicities. My results provide the first quantitative, representative understanding of student experiences with police at a large, public university. Findings reveal half of students reported encounters with police; with 24% experiencing unfair treatment. Attitudes about police presence were mixed, most students indicated one or more problems with campus police, and support for policy change was widespread. There were significant differences across race and gender. Last, I investigate the relationship between awareness and visibility of school TGGD-inclusion policies, psychosocial outcomes, and psychosocial inequities between TGGD and cisgender students using a survey that I designed and implemented at 28 institutions through the Healthy Minds Study (Study 3 | Chapter 4). This is the first research to examine the impact of higher education policy on psychosocial inequities between TGGD and cisgender students. I advance understanding of a novel and important construct: policy visibility. Multivariable results reveal higher visibility of inclusive nondiscrimination policies, gender inclusive restrooms, and pronoun options is associated with reduced psychosocial inequities for TGGD college students. The dissertation concludes with recommendations for colleges as we emerge from a global pandemic, which has further taxed student mental health. The culmination of the research suggests a more evidence-informed, policy-focused, equity-minded approach is needed to address the growing challenges of student mental health in higher education.

As the Latinx population in the U.S. continues to grow, public health interventions aimed at improving health care access for Latinx individuals are increasingly vital. DULCE (Developmental Understanding and Legal Collaboration for Everyone), a pediatric health intervention built around the Family Centered Care (FCC) model, is one promising intervention for tackling Latinx health disparities beginning at infancy. Drawing on qualitative interviews from Latinx DULCE participants, the current study explored how FCC transformed Latinx families’ pediatric health care experiences and how cultural barriers, such as immigration status, impacted engagement in overall services. The FCC model utilized in DULCE was able to bridge barriers to care and increase parental knowledge through the assignment of Family Specialists, who worked to assist parents in finding and enrolling in additional services outside and within the clinic. These one-on-one relationships resulted in more open and honest discussion of needs by Latinx parents and bolstered family's engagement in services, improving overall family health outcomes. Family Centered Care interventions may be a promising strategy for better assisting Latinx families and improving infant health outcomes, further mitigating Latinx health disparities across the lifespan.

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.

The emergence of COVID-19 requires new effective tools for epidemiological surveillance. Spatio-temporal disease mapping models, which allow dealing with small units of analysis, are a priority in this context. These models provide geographically detailed and temporally updated overviews of the current state of the pandemic, making public health interventions more effective. These models also allow estimating epidemiological indicators highly demanded for COVID-19 surveillance, such as the instantaneous reproduction number R t , even for small areas. In this paper, we propose a new spatio-temporal spline model particularly suited for COVID-19 surveillance, which allows estimating and monitoring R t for small areas. We illustrate our proposal on the study of the disease pandemic in two Spanish regions. As a result, we show how tourism flows have shaped the spatial distribution of the disease in these regions. In these case studies, we also develop new epidemiological tools to be used by regional public health services for small area surveillance.