Public Health

The main objective of the working paper series of the IIMA is to help faculty members, research staff and doctoral students to speedily share their research findings with professional colleagues and test their research findings at the pre-publication stage. IIMA is committed to maintain academic freedom. The opinion(s), view(s) and conclusion(s) expressed in the working paper are those of the authors and not that of IIMA.

This qualitative research aimed to explain working of outstanding nurses in Khon Kaen province, Thailand. The participants were a total of 7 outstanding nurses, community leaders, health volunteers, health care personal and local organization officers in the communities. Data were collected by using in-depth interview, focus groups, and participant observation. Content analysis was used for data analysis. It was found that working of outstanding nurses were working with happiness, inspiring outstanding nurses to work in the communities, and socialized new health generation. The work in regard with happiness was composed of 6 components; 1) Effective early detection & basic medical care, 2) promoting individual, family and community participation, 3) setting up community learning curriculum, 4) effective home visits, and 5) arranging an accessible and prompt referral system. Factors affecting happiness from work were 1) primary care policy 2) hometown workplace, 3) nursing knowledge,...

This was a survey research conducted in Northestern Thailand during 2009-2010 and designed to evaluate the success of a health education program by comparing levels of health knowledge in the community before and after the launching of a Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme. The survey questionnaire included items about demographic characteristics and health knowledge. The participants were 1,015 members of various communities, who were randomly selected to be included in the survey before launching the intervention, and 1,030 members of the same communities randomly selected to be included in the survey after the intervention was completed. The demographic characteristics of both groups were similar. Overall knowledge and knowledge of all the diseases, except lung and cervical cancer, were significantly higher after the intervention. In conclusion, a Volunteer-based Community Health Programme has advantages for areas where the numbers of health personnel are limited. The use of trained community health volunteers may be one of the best sustainable alternative means for the transfer of health knowledge.

Human behavior, social networks, and the civil infrastructures are closely intertwined. Understanding their co-evolution is critical for designing public policies and decision support for disaster planning. For example, human behaviors and day to day activities of individuals create dense social interactions that are characteristic of modern urban societies. These dense social networks provide a perfect fabric for fast, uncontrolled disease propagation. Conversely, people's behavior in response to public policies and their perception of how the crisis is unfolding as a result of disease outbreak can dramatically alter the normally stable social interactions. Effective planning and response strategies must take these complicated interactions into account. In this chapter, we describe a computer simulation based approach to study these issues using public health and computational epidemiology as an illustrative example. We also formulate game-theoretic and stochastic optimization problems that capture many of the problems that we study empirically.

The primary infection of Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV) and Herpes simplex virus (HSV) abbreviated as TORCH has remained a major problem in the women of childbearing age in Nepal. The main objective of this study was to determine the seroprevalence of TORCH infections among the women of childbearing age visiting the National Public Health laboratory (NPHL), Teku, Kathmandu. A total of 314 blood samples were collected and tested for TORCH infections by Chemiluminescent Immunoassay (CLIA). Of the total 314 patients, different patterns were observed in the requested test series. Highest number of patients (243) requested for CMV IgM test while only 195 requested for the same for Rubella. The IgM seroprevalence rates were 4.20% (9/214) for Toxoplasma gondii, 5.12% (10/195) for Rubella, 4.91% (12/244) for Cytomegalovirus and 5.56% (13/234) for Herpes Simplex virus. Significant portion of the test exhibited the equivocal result making this latest technology furthe...

The study, Local Wisdom and Culture-based Health Tourism in Rayong Province aims to develop a model of local wisdom and culturebased health tourism in Ranong Province through a qualitative study for Ban Hat Som Pan Community, Ranong Province, because of suitable potential for connecting with other health tourism routes in Ranong Province. Data were collected from relevant persons in health and cultural tourism as well as local stakeholders through in-depth and group interviews (four groups: public and private persons relevant to health tourism; experts; local leaders and wise people; and Thai and foreign tourists). The data was put through a content analysis process and triangulation to verify data reliability. The study found that Ban Hat Som Pan Community had natural tourist attractions that facilitated health tourism route creation, as well as health-promoting local wisdom that could be included in the health tourism route. Furthermore, the community cooperations with private and public agencies to connect to the larger tourism route in Ranong Province, diversifying the tourism route as the health route could start from the community and then cover other attractions. The identity of community tourism such as the "Shape Ore, Sift Ore, Soak Ore" was developed alongside the three main activities developed by this study, consisting of 1. Make -Eat, Delicious Medicine through health-promoting local food wisdom and cooking for visitors; 2. Make -Beauty, as the use of local herbs in a traditional cosmetic or skin care spa; 3. Make -Body, as a relaxing or therapeutic massage using locally-produced herbal oil and spring bath to promote health holistically. Along this route, the tourists will be able to spend time traveling and engaging in activities with the locals for recreation and health promotion along the guideline of health tourism.

Background:Emerging evidence describes impacts of the COVID-19 pandemic upon people living with dementia and their informal carers, however without evidence-based global comparisons to date. The aim of this international study was to explore and compare the impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries.Methods:People with dementia and informal carers from the UK, Australia, Italy, India, and Poland participated in remote semi-structured interviews. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using thematic analysis, then combined across sites.Results:Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and is...

Resumo O uso intensivo de agrotóxicos na agricultura está associado a externalidades negativas, que afetam o meio ambiente e a saúde pública. Sabe-se que o número de registros é menor que os de intoxicações por pesticidas, ocorrendo subnotificações. Com o objetivo de compreender esse evento, analisou-se os dados de dois sistemas de informação de notificações e agravos à saúde e realizou-se estudo de caso com profissionais da 5ª Regional de Saúde e da rede de saúde de um município do Paraná. Confirmou-se que ocorrem as subnotificações nos sistemas de informações, a inconsistência de dados e a falta de comunicação entre eles, dificultando a compreensão da realidade das intoxicações. No estudo de caso identificou-se a ocorrência de subnotificação prévia: quando muitos trabalhadores não procuram os sistemas de saúde; as capacitações dos profissionais são insuficientes e neutralizadas pela grande rotatividade, especialmente de médicos; o diagnóstico, a conduta e o tratamento das intoxica...

The study aimed to analyze the prevention of the actions of HIV and health promotion in the context of AIDS developed by the Strategy Family Health (ESF) in João Pessoa-PB. This search is a descriptive study with qualitative approach, performed with 16 nurses working in the ESF, using a semi-structured interview guide and followed the steps of content analysis. Nurses work in the context of AIDS with actions in health education and care contexts, additionally ease and difficulties in these experiences for these actions are implemented successfully. It was concluded that the actions aimed at prevention of HIV and health promotion in the context of AIDS are present in the activities of professional nurses who are working in the ESF, however not constitute everyday actions and pre-established, happening mostly in special moments and the demands during nursing visits. Palavras-chave: HIV. AIDS. Prevention.

The evolution of pharmacy practice in the last 15 years has created expanded public health access. Community pharmacies now provide a range of public health services with promising improvements in health access and outcomes. The observed practice changes call our attention to systemic issues that remain in need of collective attention. As we strengthen our intersectoral public health system, we must focus on the pharmacy-public health partnership and establish collaborative policy and research agendas to guide this system change for maximum public health impact. Our collective effort to assure the health of communities depends upon our seeing opportunities across systems and sectors, and upon our success in shifting the policy environment to allow health system flexibility. introduCtion Community pharmacies are independent, chain, or supermarket pharmacies that directly serve the general public. A systemic change has occurred in community pharmacy practice during the past 20 years. The once segregated druggist with limited public health engagement in times of epidemics or national initiatives 1 has morphed into a medications evaluator, health educator, immunizer, and health-care partner. These changes have helped clarify and institutionalize the expression of pharmacy-based public health. The practice of pharmacy as we know it in modern times dates back to the 18th century. The role of the pharmacist evolved in response to the ever-changing health environment. For example, the apothecary became a temporary vaccine distributor in the 1800s in response to smallpox efforts. 1 Fast-forward to the 20th century, and pharmacists expanded their clinical role to serve within the Indian Health Service and the Bureau of Prisons. The mid-1990s witnessed the emergence of the pharmacist immunizer and vaccine advocate. Today, community pharmacists provide many services in addition to drug dispensing: medication therapy management; 6-8 immunizations for children

Background Efforts to eliminate hepatitis C are hampered by the inability to reach communities with screening opportunities, especially people who use drugs. Purpose To evaluate the feasibility and impact of a community-based hepatitis C screening program for people who use drugs in Arizona. Methods This study is a secondary analysis of hepatitis C screening and participant survey data gathered from July 18, 2019 through March 23, 2020. The primary outcome measure was a reactive HCV test. The survey measured demographics in an open-ended manner, presenting an array of response options allowing participants to self-define their identities. The analysis was conducted in 2021. Results The sample included 541 people from 12 of Arizona’s 15 counties. Over half of the sample (50.8%) reported ever injecting drugs and 21% of the participants were reactive for HCV. Conclusions Community-based HCV screening among people who use drugs by harm reduction organizations will significantly assist p...

To increase COVID-19 vaccine uptake in resistant populations, such as Republicans, focus groups suggest that it is best to de-politicize the issue by sharing five facts from a public health expert. Yet polls suggest that Trump voters trust former President Donald Trump for medical advice more than they trust experts. We conducted an online, randomized, national experiment among 387 non-vaccinated Trump voters, using two brief audiovisual artifacts from Spring 2021, either facts delivered by an expert versus political claims delivered by President Trump. Relative to the control group, Trump voters who viewed the video of Trump endorsing the vaccine were 85% more likely to answer “yes” as opposed to “no” in their intention to get fully vaccinated (RRR = 1.85, 95% CI 1.01 to 3.40; P = .048). There were no significant differences between those hearing the public health expert excerpt and the control group (for “yes” relative to “no” RRR = 1.14, 95% CI 0.61 to 2.12; P = .68). These findi...

Background: Vaccination literature highlights programmatic and ethical pertinence of ‘community engagement’ in ensuring efficacious vaccines becoming effective vaccinations. However, lack of consensual definition of community engagement, recurring evidence of community backlashes especially during vaccine introductions, and paucity of literature on community engagement’s effectiveness in achieving vaccination outcomes is problematic because assuming a shared understanding of community engagement will only lead to erroneous assumptions about its value, or lack thereof. This study examines conceptualization of community engagement by vaccine decisionmakers in India and efforts to foster it during the Decade of Vaccines.Methods: Elite interviews were carried out (December 2017 to February 2018) with 25 national-level vaccine decisionmakers in India. Study participants included policymakers, immunization program heads, and vaccine technical committee leads representing Government, inter...

Background: Evidence-based policy communication (EBPC) is an important, emerging focus in public health research. However, we have yet to understand public health workforce ability to develop and/or use it. The study objective was to characterize capacity to develop and use EBPC and identify cooperative learning and development opportunities using the case of Human papillomavirus (HPV). Methods: Vygotsky's Zone of Proximal Development (ZPD) informed guided interviews with 27 advocates in Indiana from government, industry, research, state associations and individuals. Participants focused on HPV, cancer, women's health, school health and minority health. Results: Capacity to develop and use EBPC was reported to develop through cooperative learning opportunities on the job or in advocacy focused coalitions. Coalition learning appeared to translate across health topics. Notably, policy experience did not assure understanding or use of EBPC. Conclusions: The ZPD framework can inform workforce EBPC interventions by focusing on actual development, potential development and factors for learning and development in the ZPD. Future studies should further clarify and evaluate emerging indicators in additional public health policy areas with a larger sample.

The evolution of pharmacy practice in the last 15 years has created expanded public health access. Community pharmacies now provide a range of public health services with promising improvements in health access and outcomes. The observed practice changes call our attention to systemic issues that remain in need of collective attention. As we strengthen our intersectoral public health system, we must focus on the pharmacy-public health partnership and establish collaborative policy and research agendas to guide this system change for maximum public health impact. Our collective effort to assure the health of communities depends upon our seeing opportunities across systems and sectors, and upon our success in shifting the policy environment to allow health system flexibility.

A national system of voluntary public health accreditation for state, local, and tribal health departments (local health departments [LHDs]) is part of a movement that aims to improve public health performance with ultimate impact on population health outcomes. Indiana is a good setting for the study of LHD accreditation adoption because several LHDs reported de-adopting accreditation in a recent statewide survey and because 71% of Indiana counties serve populations of 50 000 or less. A systematic method of analyzing qualitative data based on the Performance Improvement Model framework to expand our understanding of de-adoption of public health accreditation. In 2015, we conducted a key informant interview study of the 3 LHDs that decided to delay their engagement in the accreditation based on findings from an Indiana survey on LHD accreditation adoption. The study is an exploration of LHD accreditation de-adoption and of the contributions made to its understanding by the Performanc...

Background-Intimate partner violence (IPV) research has primarily focused on heterosexual couples, but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. Methods-MSM over the age of 16 were recruited through three MSM-focused websites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-

Reducing cervical cancer disparities in the U.S. requires intentional focus on structural barriers such as systems and policy which impact access to human papillomavirus (HPV) vaccination, cervical cancer screening and treatment. Such changes are difficult and often politicized. State comprehensive cancer control (CCC) plans are vehicles that, if designed well, can help build collective focus on structural changes. Study objectives were to identify the prioritization of cervical cancer in state CCC plans, the conceptualization of HPV within these plans, and the focus of plans on structural changes to reduce cervical cancer disparities. Data were gathered by systematic content analysis of CCC plans from 50 states and the District of Columbia from February-June 2014 for evidence of cervical cancer prioritization, conceptualization of HPV, and focus on structural barriers to cervical cancer vaccination, screening or treatment. Findings indicate that prioritization of cervical cancer wi...

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or information, and consultation about the test results in order to provide post diagnosis support and facilitate linkage to care. Las actitudes de los farmacéuticos sobre el over-the-counter (OTC) venta de las pruebas rápidas del VIH en farmacias se exploró a través de entrevistas entre los 17 farmacéuticos comunitarios con licencia en un estado del Midwestern en Estados Unidos, moderado incidencia del VIH entre Mayo y Septiembre de 2012. Los participantes reconocieron que OTC pruebas rápidas de VIH aumentaría el número de personas que conocen su estado serológico. Las preocupaciones incluyen la vinculación con cuidado y consulta los resultados para los que el resultado es VIH-positivo. Point of sale de venta fue identificado como una oportunidad de consulta sobre la prueba y establecer una relación para un discussion futuro sobre los resultados y la vinculación a la atención. Los farmacéuticos podría ofrecer consulta inicial de prueba o información y consulta sobre los resultados de la prueba con el fin de ofrecer apoyo después de diagnóstico y facilitar la vinculación a la atención.

La leucemia aguda es el cancer mas frecuente de la edad pediatrica. Como toda enfermedad con etiologia multifactorial, su manejo integral impone la identificacion, evaluacion y modificacion de factores de riesgos geneticos y ambientales, por lo que se requiere de la adecuada proyeccion del asesoramiento genetico. El objetivo que nos proponemos es presentar una propuesta de asesoramiento genetico para pacientes, familiares e individuos con riesgo de leucemia aguda infantil en Pinar del Rio que tiene como base un esquema, que pueda utilizarse como guia para asesores, basado en los resultados de estudios epidemiologicos y de interaccion genoma-ambiente desarrollados en el territorio, teniendo en cuenta el enfoque preventivo-comunitario. La propuesta tiene en cuenta los componentes practicos, eticos y psicologicos que sostienen todo proceso de asesoramiento genetico. Se fundamenta en los principios basicos de diagnostico, estimacion de riesgo y comunicacion y orienta las acciones de pre...

Aims: One of the ways to manage the current coronavirus disease 2019 (COVID-19) pandemic is monitoring of public knowledge, risk perceptions, adherence to preventive measures and preparedness behaviors. This is of utmost importance in resource limited countries. This study determined the knowledge and perception about COVID-19; adherence to COVID-19 preventive measures; as well as predictors of self-perceived risk of contracting COVID-19 among Nigerian adults.Methods: A cross-sectional study was conducted among Nigerian adults ≥ 18 years using an online survey. Participants were recruited using the authors’ social networks. Data was analysed using descriptive and inferential statistics at 5% level of statistical significance.Results: Generally, a high proportion of respondents had correct knowledge about COVID-19. However, only about half (49.8% and 49.9%) had correct knowledge that obesity was a risk factor for COVID-19 and that antibiotics cannot be used to treat COVID-19. Most (8...

Sexually transmitted infections are among the most important public health challenges, a significant burden for the healthcare system and a considerable factor reducing quality of life. Beyond their immediate acute effects, SPIs may have long term consequences that could impair both male and female health, especially in reproductive age. This article presents the epidemiological situation and trends in sexually transmitted infections in Europe and Croatia. It also presents the prevalence of genitourinary infections and hospital burden. The most common SPI complications are described, i.e. pelvic inflammatory diseases in Croatia, incidence and registration of spontaneous miscarriages, and trends in the cervical cancer incidence. Following the guidelines of the World Health Organization , programs and activities to promote and improve safe sexual behavior and reproductive health are suggested.

Sexually transmitted infections are among the most important public health challenges, a significant burden for the healthcare system and a considerable factor reducing quality of life. Beyond their immediate acute effects, SPIs may have long term consequences that could impair both male and female health, especially in reproductive age. This article presents the epidemiological situation and trends in sexually transmitted infections in Europe and Croatia. It also presents the prevalence of genitourinary infections and hospital burden. The most common SPI complications are described, i.e. pelvic inflammatory diseases in Croatia, incidence and registration of spontaneous miscarriages, and trends in the cervical cancer incidence. Following the guidelines of the World Health Organization, programs and activities to promote and improve safe sexual behavior and reproductive health are suggested.

Infections and other respiratory diseases are still the most common diseases in the general population and they also account for a high number of deaths in newborns and elderly patients. Almost 3.9 million people in the world died due to respiratory infections in 2002. In Croatia, 2895 people died due to respiratory diseases in 2004, while pneumonia is among ten leading causes of death in both genders. In Croatia, more than 50000 people are admitted every year to hospitals for treatment of respiratory diseases, while primary care units record more than 2.4 million of respiratory diagnoses. Their global spread and high contagiousness interfere with their prevention. However, prevention, education and promotion of public health policy are of crucial importance to combat the complications and consequences.

Sexual behaviour in adolescence is a sensitive issue and has possible immediate and long term medical and psychical consequences. The aim of the study was to examine whether early sexual intercourse varies by gender and how is associated with unhealthy behaviour and factors of psycho-social well-being. 773 boys and 857 girls of 15.5 years old, included in a representative national school-based survey, conducted in Croatia in 2006, were invited to fill in anonymous questionnaires. Sexual experience before the age of 16 years was reported by 28.6% of the boys and 16.5% of the girls. Early sexual experience in boys was associated with smoking, drinking of alcohol, marijuana taking, physical fighting, and bullying other The odds ratio was highest for smoking. (OR:8. 1; CI:5.4-12. 1). For girls the same variables were associated with the early sexual intercourse, marijuana use being the strongest independent predictor (OR:8.0; CI:5.0-12.6). While controlled for other behaviours, daily sm...

Aim To compare body image and weight control behavior among adolescents in Lithuania, Croatia, and the United States (US), the countries with striking contrasts in the prevalence of overweight among adolescents. The study was carried out according to the methodology of the Health Behavior in School-aged Children collaborative survey. Nationally-representative samples of students, aged 13 and 15, were surveyed in Lithuania (3778 respondents), Croatia (2946 respondents), and the US (3546 respondents) in the 2001/2002 school year. Results In all three countries, girls perceived themselves as being "too fat" more frequently than boys (37.0% vs 19.7%, P<0.001, z test). The prevalence of this perception increased with age among girls (32.7% vs 41.1%, P<0.001, z test) and decreased among boys (21.4% vs 17.9%, P = 0.005, z test). Lithuanian adolescents were least likely to perceive themselves as "too fat;" this perception was significantly more frequent in Croatia and the US (24.2%, 27.5%, and 34.3%, respectively; P<0.001, χ 2 test). With the exception of 15-year-old Lithuanian boys, in all respondents the proportion of adolescents with body mass index (BMI) ≥85th percentile who perceived themselves as "too fat" was significantly higher (up to 3.13 times among 15-year-old US girls) than the proportion of adolescents with BMI ≤15th percentile who perceived themselves as "too thin." The highest proportion of overweight boys and girls on a diet or doing something else to lose weight was found in the US. Boys in Lithuania were most likely to be satisfied with their weight regardless of their weight status. Perceived body image and weight control behavior differ among adolescents in Lithuania, Croatia, and the US. Cross-cultural, age, and sex influences moderate body image and weight control behavior in underweight and overweight adolescents.

T he present study aims at analyzing scientific works published in periodicals indexed in electronic databases about the importance of a social support network to the donation of human milk through the partnership between Brazilian Human Milk Banks and the Military Firefighters Corps for receivers of human milk, counting from the network's first registered existence in Brazil until the year of 2015, and considering its social effects in the country and perhaps abroad. Methodology: The study is a critical review of the electronic scientific literature, searched from December 2014 to February 2015. Results: 110.098 works were found, then selected and later recovered after thoroughly meeting all the inclusion and exclusion criteria. A total of 25 scientific publications were recovered and read in full: 6 articles, 1 doctoral thesis, 8 master's dissertation, 5 latu sensu post-graduation studies, 3 monographs and 2 undergraduate dissertations. Conclusion: From the scientific evidence and also from the practical experience of the Brazilian Network of Human Milk Banks, built and consolidated in the last two decades, Brazil currently represents a role model to be followed by other countries regarding human milk donation.

There is a general fear and anxiety surrounding adolescent sexuality. The question is why? Must we fear adolescent sexuality? This question, the title of the following article, is one that Amy Schalet, PhD, has spent the past decade investigating. It has culminated in a masterful doctoral thesis and a book to be published by the University of Chicago Press in 2006. More specifically, Dr. Schalet has asked how is it that 2 countries similar in terms of wealth, education, and reproductive technologies have had the highest and lowest rates of teen pregnancy, respectively, in the Western world. The countries, of course, are the United States and the Netherlands, and the answer has surely been illuminated by her sociological inquiry into the construction of adolescence and sexuality within the white, moderately religious or secular middle class of the 2 countries--the sector of the population that in both countries has a dominant influence on healthcare, education, politics, and the media. In a series of articles for Medscape General Medicine, Dr. Schalet will discuss the results of her research. In this first article she shows us that the construction of adolescent sexuality is an active process of dramatization in one society and normalization in the other. Ultimately, the results of her research suggest a course of action for the American healthcare profession as it regards adolescent healthcare. We invite and encourage you to comment. Send email to

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the &quot;tier 1&quot; funding of the Office of Adolescent Health&#39;s Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as &quot;evidence-based&quot; interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually tra...

Background & objectives: Dengue caused by dengue virus (DENV) is the most widespread arbovirosis in the world. Around 100 million people are infected annually, causing a high economic burden for public health, especially in low-and middle-income countries. Herein, we investigate the sociodemographic characteristics and risk factors related to DENV infection among individuals from Luanda, the capital city of Angola. Methods: This was a cross-sectional study carried out with 507 individuals screened for DENV in Luanda, between April to December 2021. Results: Overall, the DENV infection was 2.4%. The DENV positivity rate reduced with increasing age (41.7% in individuals under 20 years to 33.3% in individuals over 30 years). A lower risk of infection (OR: 0.64, p=0.507) in individuals aged over 40 years. DENV infection rate was higher among females, presenting 1.54 times more chances (CI: 0.48 -4.91, p=0.468). All cases of DENV infection were from individuals living in urbanized regions. No statistically signi cant differences were observed between DENV with age group, gender, or residential area (p>0.05). Interpretation & conclusion: Our ndings emphasize the need to implement programs or activities focused on the targeted prevention of infections transmitted by mosquito bites, early identi cation of signs and symptoms and effective treatment, especially in regions with high population density. The creation of programs for the surveillance of non-malarial febrile syndromes is crucial. In addition, further studies on risk factors for DENV infection should be carried out, especially in regions of Angola with high population density.

Objectives. We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity. Methods. We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models. Results. Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups. Conclusions. The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified. (Am

Objectives. We describe the epidemiology of smoking behaviors in a national young adult sample and identify common and unique demographic, social, and psychological correlates of daily smoking and lifetime and current nicotine dependence by race/ethnicity. Methods. Data are from the National Longitudinal Survey of Adolescent Health, wave III. Dependence was measured by the Revised Fagerström Test for Nicotine Dependence. Logistic regressions were estimated. Results. Hispanic ethnicity, low education, parental and peer smoking, novelty seeking, early age of smoking onset, and pleasurable initial smoking experiences are significantly correlated with daily smoking and lifetime nicotine dependence. Depressive symptoms are uniquely associated with lifetime and current dependence. Few factors are highly associated with current dependence. Initial sensitivity to smoking has a significantly greater impact on daily smoking than on dependence. Correlates of smoking behaviors are mostly common across racial/ ethnic groups, although parental and peer smoking are significant for Whites and Hispanics but not for African Americans. Conclusions. There are more common than unique correlates of each smoking stage and across racial/ethnic groups. Primary prevention and interventions addressing the factors tested could be uniform for most chronic smokers irrespective of dependence status and race/ethnicity. (Am

Following publication of the original article [1], the authors identified that an incorrect version of Fig. was published. The incorrect (Fig. ) and correct (Fig. ) version of Fig. are published in this correction article. The original article has been updated.

Background Baby-friendly workplace is an effective evidence based initiative developed by the World Health Organization to protect and support maternal knowledge, beliefs, and confidence in infant and young child feeding practices. However, studies that show the effect of the baby-friendly workplace initiative on the nutritional status of infant and young children are not available in Ethiopia. Therefore, this study aimed to assess the nutritional status among baby friendly initiatives service utlizers and non utlizers children age 6-24 months in public health facilities of Southern Ethiopia. We conducted a comparative cross-sectional study from 1 to 30 June 2022 among 220 mothers with children aged 6-24 months. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into Epidata Software version 4.2 and then exported to IBM SPSS version 26 software for analysis. Chi-square and Fisher exact test were used to assess the differences between users and non-users of the baby friendly workplace initiative. Logistic regression model was used to determine the association between dependent and independent variables. Adjusted odds ratio (AOR) with a 95% confidence interval was computed. P-values < 0.05 at a 95% confidence level were considered statistically significant. The mean (SD) scores of weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) were -0.38 (1.34),-0.17(2.62) and-0.35 (1.84) respectively. After adjusting for covariates, children aged 6-24 months who did not use baby friendly workplace initiatives were 2.26 times more likely to have stunting compared to the users of baby friendly workplace initiative (AOR 2.26, 95% CI: 1.05, 4.88). However, both wasting (AOR: 0.42; 95% CI:0.13, 1.37) and underweight (AOR: 1.09; 95% CI: 0.45, 2.60) were not significantly associated with the use of baby friendly workplace initiatives. The use of baby friendly work place initiatives was successful in improving nutritional status, specifically chronic malnutrition in children. Strengthening and scaling up the baby friendly work place initiative program has the

PurposeThe purpose of this paper is to explore how the health ministries of Turkey and Slovenia use Twitter as government agencies obliged to communicate with the public.Design/methodology/approachThis study employed a content analysis methodology to examine how Turkish (TR) and Slovenian (SLO) health ministries use Twitter for informing and encouraging behavior change in the public. A total of 662 “tweets” were analyzed. Drawing on prior studies, a coding scheme was developed and employed, and χ2 and t-tests were conducted for data analysis. Additionally, this study aimed at effecting a content analysis according to the “four models” method of Grunig and Hunt regarding efforts made to build communication with the public.FindingsThis study uncovered that the TR and SLO health ministries did not utilize two-way communication principles for Twitter communication, and their frequency of Twitter use is inadequate.Research limitations/implicationsThe sampled tweets were selected by using...

Background: An estimated one in five drivers will be over 65 by 2030. Compared with their younger counterparts, older adults are more likely to experience health and functional impairments, including cognitive dysfunction, which may interfere with their ability to drive safely. Law enforcement officers, as part of the public safety community, need help in developing the necessary skills to identify and manage these medically affected drivers. Methods: To address this need, in partnership with the California Highway Patrol (CHP), Training, Research and Education for Driving Safety (TREDS) at the University of California, San Diego, developed a certified two-hour training curriculum. To complement the training, the TREDS team also developed a roadside screening tool to assess for disorientation related to person, place, and time. The tool was developed, validated with a sample of persons with dementia compared to cognitively normal controls, and deployed in the training. A total of 2,018 police officers received instruction at 103 training sessions. Results: At baseline, prior to training, only 26 % of officers had reported drivers to the Department of Motor Vehicles in the previous 6 months. After training, 96 % stated they were likely to use their standard reporting forms, and 90 % reported they were likely to use the roadside screening tool. Conclusions: The certified training and tool were well received and resulted in changes to knowledge, attitudes, and intention to incorporate their new knowledge and tools into roadside screening.

Primary care-based approaches to address concurrent obesity and cardiovascular disease risk factors (CVDRFs) that begin with a high intensity intervention that is subsequently decreased (i.e., stepped-down) if weight loss is achieved have not been rigorously examined. Our study is a 20-month, single-blind randomized controlled trial at five primary care clinics in San Diego, CA, in 2013, where 262 obese adults (aged 25-70 years; 32.1% male; 59.2% white) with at least one CVDRF were enrolled into planned care for obesity and risk reduction (PCORR) using a stepped-down approach or enhanced usual care (EUC). All patients received physician recommendations for weight loss and CVDRFs. EUC patients (n = 132) received an individual session with a health educator every 4 months. PCORR patients (n = 130) received individual and group sessions (in-person, mail, telephone, and email) in three steps, characterized by less contact if success was achieved. At 20 months, 40.7%, 23.8%, and 15.4% of...

An estimated one in five drivers will be over 65 by 2030. Compared with their younger counterparts, older adults are more likely to experience health and functional impairments, including cognitive dysfunction, which may interfere with their ability to drive safely. Law enforcement officers, as part of the public safety community, need help in developing the necessary skills to identify and manage these medically affected drivers. To address this need, in partnership with the California Highway Patrol (CHP), Training, Research and Education for Driving Safety (TREDS) at the University of California, San Diego, developed a certified two-hour training curriculum. To complement the training, the TREDS team also developed a roadside screening tool to assess for disorientation related to person, place, and time. The tool was developed, validated with a sample of persons with dementia compared to cognitively normal controls, and deployed in the training. A total of 2,018 police officers r...

Background This study describes the barriers to effective and timely LTBI treatment encountered in a research study on INH adherence in Latino adolescents. Method Participant study logs were reviewed, results of continuing medical education pretests for medical providers were examined, and participating medical facilities were contacted in order to construct a profile of multilevel barriers to LTBI treatment. Results A total of 285 TST positive Latino (96%) high school students were recruited into the trial. We encountered a lack of understanding of the gravity of tuberculosis infection among both the public and providers of health care. Parents and adolescents cited competing priorities, transportation problems and financial constraints as reasons for non-compliance. Discussion Improved education of the public and physicians is needed regarding the gravity of the disease and the value of treatment, as well as public and financial support for LTBI treatment by both the government and the medical community.

Refugees experience a threefold challenge to their health and well-being: 1) psychiatric disorders precipitated by the refugee experience, 2) infectious and parasitic diseases endemic to countries of origin, and 3) chronic diseases endemic to host countries. This paper documents the “journey to wellness” in which these challenges are faced in stages by the refugees themselves and by the array of

To examine the risk of mortality associated with interruptions to the continuity of methadone maintenance treatment (MMT), including transfers between services, in opioid-dependent individuals attending specialist addiction services. Design Retrospective cohort study using addiction services and primary care dispensing records, the National Methadone Register and National Drug-Related Death Index (NDRDI). Setting Geographically defined population in Dublin, Ireland. Participants A total of 2899 people prescribed and dispensed methadone in specialist addiction services between January 2010 and December 2015. There were five exposure groups: weeks 1-4 following transfer between treatment providers; weeks 1-4 out of treatment; weeks 5-52 out of treatment; weeks 1-4 of treatment initiation; and weeks 5+ of continuous treatment (reference category). Measurements Primary outcome: drug-related poisoning (DRP) deaths. Secondary outcome: all-cause mortality (ACM). Mortality rates calculated by dividing number of deaths (DRP; ACM) in exposure groups by person-years exposure. Unadjusted and adjusted Poisson regression (covariates age, sex, incarceration, methadone dose and comorbidities) estimated differences in mortality rates. Findings There were 154 ACM deaths, 55 (35.7%) identified as DRP deaths. No deaths were observed in the first month following transfer between treatment providers. The risk of DRP mortality was highest in weeks 1-4 out of treatment [adjusted relative risk (aRR = 4.04, 95% confidence interval (CI) = 1.43-11.43, P = 0.009] and weeks 1-4 of treatment initiation (ARR = 3.4, 95% CI = 1.2-9.64, P = 0.02). Similarly, risk of ACM was highest in weeks 1-4 out of treatment (ARR = 11.78, 95% CI = 7.73-17.94, P < 0.001), weeks 1-4 of treatment initiation (aRR = 5.11, 95% CI = 2.95-8.83, P < 0.001) and weeks 5-52 off treatment (aRR = 2.04, 95% CI = 1.2-3.47, P = 0.009). Conclusions Interruptions to the continuity of methadone maintenance treatment by treatment provider do not appear to be periods of risk for drug-related poisoning or all-cause mortality deaths. Risk of drug related poisoning and all-cause mortality deaths appears to be greatest during the first 4 weeks of treatment initiation/re-initiation and after treatment cessation.

Background: The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Methods: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Results: Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. Conclusions: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross-departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID. HIV • Hepatitis C • COVID-19 • People who inject drugs (PWID) • Treatment • Prevention • Services • Epidemiology • Social determinants • Outbreaks • Homelessness • Overdose La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011-2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

The problematic use of psychoactive substances has adverse consequences for people's lives and requires on-going investigation of experiences of onset, course and resolution in order to better inform theoretical understanding, particularly with regard to the use of club drugs and novel psychoactive substances. In turn, this may influence treatment approaches. GHB/GBL, frequently termed 'G', is one such substance, with problematic use resulting in increased presentations at A&E departments and at substance dependence clinics across Europe. The aim of the present study was to explore problematic G use as experienced by people who had presented for treatment, in Ireland, using interpretative phenomenological analysis (IPA). IPA was selected in recognition of the lack of previous research on the experience of problematic use of G and in the context of an evolving understanding of what constitutes problematic substance use. A purposive and homogenous sample of seven people, five gay males and two straight females, who had presented for treatment for 'G' substance use disorder to a community-based