EPIDEMIOLOGY OF CHEMICAL CRISIS, PUBLIC HEALTH IMPACT, SPECIFIC MEDICAL COUNTERMEASURES AND EDUCATION

Policies in place throughout the world: action by the European Union

Background: The public health services project of the South-eastern Europe health network has undertaken an evaluation of public health services in its nine member countries. The purpose of the evaluation of public health services provision in the South-eastern European (SEE) countries is to understand where these countries now stand in public health, the institutional, organisational, legislative and service delivery developments that are taking place and to identify strengths and weaknesses in their public health systems and services in order to inform decision making about investment and future reform. Methods: The evaluation was orientated around “essential public health operations” that are deemed to form the core of public health activities and services and to be indispensable to the delivery of modern public health services in any country. The evaluation analysed these activities and services within the structure of the health system functions of stewardship, resource generation, financing and service delivery, as developed by WHO. Results: The results demonstrate a mixed picture of strengths and weaknesses within the context of significant social, economic and political challenges in the region. Among the many visible and significant strengths in public health services in the region are well developed networks of public health institutes with well defined surveillance systems, highly experienced and well educated public health professionals as well as many positive examples of service delivery. But there are also many concerns and challenges, not the least of which is political focus, direction and support for modern public health services, as well as funding. Collaboration and partnership among sectors is weak and information and communication systems are inadequate and not sufficiently integrated. Conclusions: Having emphasized the main weak and challengeable points in the Public Health systems and services in the SEE countries, the evaluation is also a first step to defining a way forward in the SEE countries to ensure that the turmoil of ‘transition’ is only a prelude to the comprehensive modernisation of public health services.

The Japanese government launched a project to facilitate collaboration between public health services and occupational health services with the aim of promoting overall health and wellbeing. However, collaboration at the practitioner level, including professionals who develop health support activities, has not yet been achieved. This study was conducted to clarify the actual state of collaboration between public health services and occupational health nurses as well as the factors related to their experiences with such collaboration. It also aimed to gather suggestions for promoting collaboration between occupational health nurses and public health and occupational health services. A self-administered questionnaire-based survey was conducted in 2017, targeting 2,574 occupational health nurses belonging to the Japan Society for Occupational Health. Survey items included basic attributes, recognition of the need for collaboration and the reasons behind it, whether or not they had collaboration experience, and self-study and learning experiences. Of the 756 nurses surveyed, 34.0% had experience collaborating with public health services and 80.8% felt such collaboration was necessary. Experience of collaboration was related to the number of years of experience as an occupational health nurse, experience reading guidelines and participating in workshops and study groups organized by public health services, opportunities to receive guidance, and recognition of the need for collaboration. Because only a few respondents had experience collaborating with public health services and some did not even recognize the need for such collaboration, it was deduced that occupational nurses might have few opportunities to collaborate with public health services and may find it difficult to recognize the need for such collaboration. This finding suggests that occupational nurses may be able to promote collaboration with public health services by reinforcing learning from life events. A mechanism should be created to obtain information on public health services. Furthermore, opportunities can be provided for those with experience in collaboration to communicate with those with no experience through specific examples of such teamwork.

Biological weapons are not just topics for contemporary novelists but found their way into classical literature long ago. Shakespeare has Hamlet's father's ghost describe, ‘Upon my secure hour thy uncle stole, with juice of cursed hebona in a vial, and in the porches of my ears did pour the leprous distillment.’ (Act 1, Scene 5) Indeed, neither the act nor the accusation is new. Jews in Europe were accused of poisoning wells to cause plague in the Middle Ages. Japanese planes in World War II dropped plague‐infested fleas over Chinese cities and villages. Murder or terrorism with biological or chemical agents is not a far‐fetched scenario—it has been used before. Criminal cases in the USA include various uses of biological agents in the last decades. The Rajneesh Foundation used Salmonella bacteria in 1984 to poison ten restaurant salad bars in the city of The Dalles, OR, hoping it would influence an election in its favour. A separatist group calling itself ‘Republic of Texas’ used Botulinum , HIV and rabies in 1998 and 1999 to threaten judges. Three members were later charged with conspiracy to use weapons of mass destruction and the eldest, Johnnie Wise, was sentenced to 24 years in prison. In 1977, Diane Thompson, a nurse from Texas, was sentenced to 20 years for intentionally contaminating doughnuts with Shigella dysenteriae in order to achieve personal revenge. > In 1998 and 1999, a separatist group from Texas used Botulinum, HIV and rabies to threaten judges The particular risk of biological agents, when used as weapons, is their extreme uncontrollableness. An infectious agent can easily spread from the original victim to relatives or colleagues. Particularly at risk are the medical personnel who treat victims without knowing what kind of infection they are dealing with. More unpredictable are the number of people and …

There is no clear explanation for the extraordinary rebound in China's population mortality over the past decade. This paper utilizes panel data from 31 Chinese provinces from 2010 to 2020 to determine the distinct impacts of public sports services (PSS), public health services (PMS), and their interaction on population mortality. Empirical results show that public sports services significantly reduce mortality. Every unit increase in public sports services reduces mortality by about 2.3%. It is characterized by delayed realization. Public health services were surprisingly associated with a rebound in mortality. Further studies found strong health effect from interaction of public sports and health services. The effect was significantly strengthened in areas with fewer extreme temperatures or developed economy. The findings have important policy implications for the high-quality development of public sports and health services. It also emphasizes integration of sports and medicine and mitigates health risks associated with extreme temperatures.

Disaster medicine and the emergency medicine resident

BackgroundIn Vietnam and many developing countries, private healthcare is increasingly being leveraged by governments to complement public services and increase health service access and utilisation. Extensive understanding of patterns of utilisation of private over public health services, and the rationale for such consumer decisions, is important to ensure and promote safe, affordable and patient-centred care in the two sectors. Few studies within the Southeast Asian Region have explored how private and public providers interact (via social networks, marketing, and direct contact) with consumers to affect their service choices. This study investigates providers’ views on social factors associated with the use of private over public health services in Vietnam.MethodA thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics.ResultsMultiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients’ needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients’ demands rather than medical needs, as well as the significant technical requirements for quality and safety.ConclusionsThis study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector.

Ensuring Safe Food for Infants: The Importance of an Integrated Approach to Monitor and Reduce the Risks of Biological, Chemical, and Physical Hazards

The Global Terrorism Database (GTD) is an open-source database on terrorist incidents around the world since 1970, and it is maintained by the National Consortium for the Study of Terrorism and Responses to Terrorism (START; College Park, Maryland USA), a US Department of Homeland Security Center of Excellence. The consortium reviews media reports to determine if an event meets eligibility to be categorized as a terrorism incident for entry into the database. The objective of this study was to characterize chemical terrorism incidents reported to the GTD and understand more about the kinds of chemical agents used, the associated morbidity and mortality, the geography of incidents, and the intended targets. Chemical terrorism incidents from 1970 through 2015 were analyzed by chemical agent category, injury and fatality, geographic region, and target. During the study period, 156,772 terrorism incidents were reported to the GTD, of which 292 (0.19%) met the inclusion criteria for analysis as a chemical terrorism incident. The reported chemical agent categories were: unknown chemical (30.5%); corrosives (23.3%); tear gas/mace (12.3%); unspecified gas (11.6%); cyanide (8.2%); pesticides (5.5%); metals (6.5%); and nerve gas (2.1%). On average, chemical terrorism incidents resulted in 51 injuries (mean range across agents: 2.5-1,622.0) and seven deaths (mean range across agents: 0.0-224.3) per incident. Nerve gas incidents (2.1%) had the highest mean number of injuries (n = 1,622) and fatalities (n = 224) per incident. The highest number of chemical terrorism incidents occurred in South Asia (29.5%), Western Europe (16.8%), and Middle East/North Africa (13.0%). The most common targets were private citizens (19.5%), of which groups of women (22.8%) were often the specific target. Incidents targeting educational institutions often specifically targeted female students or teachers (58.1%). Chemical terrorism incidents rarely occur; however, the use of certain chemical terrorism agents, for example nerve gas, can cause large mass-causality events that can kill or injure thousands with a single use. Certain regions of the world had higher frequency of chemical terrorism events overall, and also varied in their frequencies of the specific chemical terrorism agent used. Data suggest that morbidity and mortality vary by chemical category and by region. Results may be helpful in developing and optimizing regional chemical terrorism preparedness activities.

Chemical incidents

BackgroundThe integration of public health services into primary health care has been advocated and practiced worldwide for better management of preventable diseases. Health policy makers in China have started the reforms to better integrate public health services and clinical services, but public health services in China still remained neglected in primary health system. This study aimed to explore the input of Chinese primary health workers on delivering public health services and its association with their intrinsic working motivation in China.MethodsData were collected from a cross-sectional survey conducted in 2019. Participants in this survey included 803 primary health workers in 75 primary health institutions in China. Questions about the input on clinical and public health services delivery and intrinsic working motivation were asked. A multiple linear regression model was adopted to investigate the correlation between intrinsic working motivation and the time input on public health service. The robustness of this model was checked with a generalized linear model.ResultsIntrinsic motivation was found to have negative association with health workers’ input on public health (β: -1.01, p < 0.05), with the robustness checked with a generalized linear model. The significance of this association differed in the group of urban community health centers and rural township health center. Other factors that had significant relationship with the input on public health services include the being nurses instead of doctors (p < 0.01), being a member of family doctor team (p < 0.01), recognition on relative importance of clinical services (p < 0.01), and perception on better exterior support (p < 0.01).ConclusionWith higher intrinsic working motivation, primary health workers tended to spend less time on public health services. It reflected that doctors and nurses in primary healthcare institutions still perceived clinical treatment services as their main work responsibility and source of career recognition. Organizational level supports and system level policies should guide the primary health workers to increase their awareness on the importance of public health services and to cultivate their internal interests on public health services, in order to ensure sustainable input and performance improvement on public health services in primary health system in China.

Improvement of pathology in sub-Saharan Africa

This study examined the relationship of age and gender with risk of arrest among adolescents and young adults who were intensive adolescent users of public mental health services. Data were obtained from the Massachusetts Department of Mental Health (DMH) and juvenile and criminal courts. Participants were youths receiving DMH adolescent case management services sometime in 1994-1996 who were born between 1976 and 1979 (781 males and 738 females). They were cross-matched to document arrests between age seven and 25. The study examined age at first arrest, age-specific risk, and the relationship between arrest history and arrest risk by gender and age. Most males (69%) and almost half the females (46%) were arrested by age 25. First arrest was most common before age 18. As in the general population, males' arrest patterns were more concerning than those of females, although patterns were of concern in both groups. Most female arrestees had multiple arrests, many as adults. No gender differences were observed for several factors, including risk of first arrest over age 18. Risk was far greater for those arrested in the previous year than for those never arrested. Findings justify concerns of public mental health systems regarding justice system involvement of adolescent clients. Risk of first arrest was significant from early adolescence through age 24, indicating a need for arrest prevention into young adulthood. The heightened arrest risk at all ages among those who were recently arrested demarcates a population in need of immediate intervention.

The 53rd scientific congress of the Federal association of physicians and dentists in the public health services addressed the interdependence of migration and health under the motto "health unlimited" in May, 2003. Manifold interactions between migration and health contribute to the public health services' everyday experiences. Immigrants often encounter manifold obstacles to their access to health services in Germany. These barriers are often of communicative or administrative nature. The system of public health administration and services has, by its very nature, opportunities and assignment a special obligation to support the immigrant population. The public health services will increasingly become guarantors of equal health opportunities in times of cumulative migration and social inequalities. In cooperation with the German Federal Commissioner for Migration, Refugees and Integration the German Federal Working Group on Migration and Public Health acts as facilitator and advocate for health of immigrants to Germany since 1994. A very close co-operation with the public health services and an interdisciplinary, intercultural, population-oriented and health-promoting approach are core elements of the working group that is lobbying the health of a multinational population within the borders of Germany.

Illuminating a Practical Solution to Clothing Protection from Mustard Gas