Comprehensive Public Health Strategy Research Articles

Sequential Infection with Influenza A Virus Followed by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Leads to More Severe Disease and Encephalitis in a Mouse Model of COVID-19

COVID-19 is a spectrum of clinical symptoms in humans caused by infection with SARS-CoV-2. The coalescence of SARS-CoV-2 with seasonal respiratory viruses, particularly influenza viruses, is a global health concern. To understand this, transgenic mice expressing the human ACE2 receptor (K18-hACE2) were infected with influenza A virus (IAV) followed by SARS-CoV-2 and the host response and effect on virus biology was compared to K18-hACE2 mice infected with IAV or SARS-CoV-2 alone. The sequentially infected mice showed reduced SARS-CoV-2 RNA synthesis, yet exhibited more rapid weight loss, more severe lung damage and a prolongation of the innate response compared to the singly infected or control mice. Sequential infection also exacerbated the extrapulmonary encephalitic manifestations associated with SARS-CoV-2 infection. Conversely, prior infection with a commercially available, multivalent live-attenuated influenza vaccine (Fluenz Tetra) elicited the same reduction in SARS-CoV-2 RNA synthesis, albeit without the associated increase in disease severity. This suggests that the innate immune response stimulated by IAV inhibits SARS-CoV-2. Interestingly, infection with an attenuated, apathogenic influenza vaccine does not result in an aberrant immune response and enhanced disease severity. Taken together, the data suggest coinfection (‘twinfection’) is deleterious and mitigation steps should be instituted as part of the comprehensive public health and management strategy of COVID-19.

Narrative review on the spectrum of diseases prevalent among substance-addicted populations and their interconnected health dynamics

Substance addiction is a complex phenomenon characterized by the dysfunction of the brain's reward system and neuroplasticity, leading individuals to lose control over their behaviour. This review explores the diverse health implications of addiction, including its impact on liver diseases, cardiovascular conditions, respiratory issues, cancers, infectious diseases, gastrointestinal problems, and mental disorders. Heavy alcohol consumption, tobacco use, illicit drug abuse, and prescription drug misuse contribute significantly to these health burdens, affecting various organs and systems in the body. Respiratory issues arise from tobacco smoking, inhalation of illicit drugs, and volatile chemicals, causing chronic obstructive pulmonary disease, lung cancers, and bronchial asthma. Substance addiction is also linked to various cancers, particularly lung cancer from tobacco, oral cancers from tobacco and alcohol, and oesophageal cancers from alcohol and prescription drugs. Furthermore, addictive substances impair immunity, making individuals more susceptible to infectious diseases like pneumonia, tuberculosis, and HIV/AIDS, especially among injection drug users. The interconnected nature of substance addiction with mental health disorders, genetic factors, environmental influences, and social determinants underscores the need for comprehensive public health strategies. These strategies should encompass education, prevention programs, access to treatment and support services, harm reduction approaches, and destigmatization efforts to address substance addiction comprehensively and improve overall health outcomes for individuals and communities.

Exploring the Link: Health Insurance Coverage and Historical Substance Use Patterns Among U.S. Adults-A NHANES-Based Analysis.

This study analyzed the NHANES database (2016-2018), investigating substance use patterns among 6,108 U.S. adults (18-64 years), with a focus on health insurance, race/ethnicity, age, gender, and socioeconomic status. Among participants, 1,063 reported a history of substance use. A key finding was the correlation between health insurance coverage and substance use history; notably, 80% of those with a history of substance use were insured. Non-Hispanic Whites represented a significant proportion (76%) of substance users, exceeding their population representation. Age and gender differences were prominent, with older adults (50-64 years) comprising 41% of substance users, and males accounting for 61%. The study's reliance on self-reported substance use history from NHANES may introduce measurement bias. Such bias necessitates careful interpretation of the data, considering variations across demographic and socioeconomic variables. Logistic regression analysis revealed that lacking health insurance increased the odds of a history of substance use (OR = 1.43, p < .01). The interaction between insurance coverage and race/ethnicity was not significant. These findings underscore the multifaceted nature of substance use, highlighting the need for comprehensive public health strategies to address the diverse factors influencing substance use behaviors.

MENTAL HEALTH AND DIGITAL TECHNOLOGY: A PUBLIC HEALTH REVIEW OF CURRENT TRENDS AND RESPONSES

The intersection of mental health and digital technology has become a critical focus in the realm of public health. This paper provides a concise overview of the current trends and responses within this evolving landscape. The widespread integration of digital technology into daily life has both positive and negative implications for mental health. On one hand, digital platforms offer innovative tools for mental health support, including virtual therapy, mental health apps, and online communities. These resources enhance accessibility and reduce barriers to seeking help. Conversely, concerns have arisen regarding the adverse impact of excessive digital screen time, social media use, and cyberbullying on mental well-being. The paper explores the prevalence of digital mental health interventions, emphasizing the need for evidence-based practices and regulatory frameworks to ensure their efficacy and user safety. Additionally, it addresses the growing recognition of the digital divide and disparities in access to mental health resources, emphasizing the importance of inclusivity in digital mental health initiatives. Responses to these challenges involve collaborative efforts among mental health professionals, technology developers, policymakers, and public health practitioners. The paper highlights the importance of research in understanding the nuanced relationship between digital technology and mental health, informing the development of targeted interventions. Furthermore, it emphasizes the need for comprehensive public health strategies that prioritize digital literacy, mental health education, and the promotion of positive online behaviors. The paper underscores the multifaceted nature of the relationship between mental health and digital technology, calling for a holistic and collaborative approach to address the evolving challenges and opportunities in this dynamic landscape.&#x0D; Keywords: Mental health, Digital technologies, Public health, Trends, Review.

The Prevalence of Sexually Transmitted Infections and Subsequent Association with Exposure to Childhood Violence and Mental Health Outcomes for Adolescents and Young Adults in Zimbabwe

Sexually transmitted infections (STIs) represent a major public health concern for young people in developing nations, impacting approximately two-thirds of individuals below the age of 25. This study examined the prevalence and the association between self-reported STIs, childhood violence exposure, and mental health outcomes among adolescents and young adults (13-24 years old) in Zimbabwe. Secondary data from the 2017 Zimbabwe Violence Against Children and Youth Survey (n=8,715) was utilized. Data analysis was performed using chisquare to determine the prevalence estimates for bivariate. Seven logistic regression models were used to examine the significant association between independent variables and outcomes for multivariate. About 45.5% of adolescents and young adults with self-reported STIs were exposed to multiple forms of childhood violence, 49.8% reported lifetime suicide risk, and 44.9% reported moderate-to-severe mental distress in the past 30 days. Furthermore, logistic regression results indicated that adolescents and young adults with self-reported STI diagnoses were more likely to be exposed to multiple forms of childhood violence, including physical, emotional, and sexual violence, as well as mental distress in the past 30 days and lifetime suicide risk compared to those without STIs. Therefore, this study underscores the importance of implementing comprehensive public health strategies to protect the wellbeing of adolescents and young adults with STIs. Interventions should also prioritize raising awareness, destigmatizing STIs, implementing and strengthening violence prevention policies, and addressing mental health problems through community mental health treatment programs in Zimbabwe. Keywords: Childhood violence, Emotional violence, Exposure, Mental distress, Physical violence, Sexual violence, Sexually transmitted infections (STIs), Suicide risk, Zimbabwe.

Study of Prevalence of Oral Diseases in The Population of District Buner Khyber Pakhtunkhwa, Pakistan

Background: Oral diseases, prevalent globally, pose significant health challenges, especially in regions with limited healthcare resources. District Buner, in Khyber Pakhtunkhwa, Pakistan, is one such area where oral health has received minimal attention. The study of oral diseases in this region is crucial for understanding the health needs of its population and for implementing effective public health interventions. Objective: This study aimed to assess the prevalence and types of oral diseases in District Buner and to identify the major contributing factors to these conditions, thereby informing targeted healthcare strategies. Methods: A cross-sectional study was conducted from October 2019 to October 2020 in all tehsils of District Buner. Data collection was based on questionnaires administered to both dentists and patients. Approximately 20 to 25 dentists from various healthcare facilities, including government hospitals and private clinics, participated in the study. The questionnaires for dentists consisted of ten open-ended questions, while those for patients included fifteen close-ended questions. The sample size was 508 individuals, representing various age groups and genders. Data analysis involved descriptive and inferential statistical methods to determine prevalence rates and associations. Results: The study revealed that the most common oral diseases were dental caries (90%), gingivitis (63%), periodontitis (59%), pulpitis (43%), TMJ disorders (23%), and oral cancer (5%). Dental caries was notably prevalent across all age groups, with a higher incidence in children. Gingivitis was observed more in females, particularly during pregnancy. Periodontitis and gingivitis showed a greater prevalence in males, often associated with smoking. Pulpitis was more common in females, while TMJ disorders were evenly distributed among genders. Oral cancer was the least prevalent disease. Conclusion: The study underscores the critical need for improved oral health awareness and preventive care in District Buner. The high prevalence of various oral diseases, influenced by factors such as dietary habits, smoking, and gender-specific issues, calls for comprehensive public health strategies. These strategies should include education on oral hygiene, increased access to dental care, and integration of oral health into general healthcare services.

The impact of soil-transmitted helminths infection on growth impairment: systematic review and meta analysis

Human helminthiasis, particularly soil-transmitted helminth (STH) infections, is a prevalent health concern in Indonesia, especially among children, often resulting in growth disorders, notably stunting. To examine the link between STH infections and childhood stunting, we conducted a comprehensive review of literature spanning 2012-2023, encompassing 40 selected articles from databases like PubMed, Science Direct, and Google Scholar. Our analysis revealed a substantial association between STH infections and increased stunting risk in children, estimating a 44.407% rise in stunting risk due to STH infection. Stunting, a consequence of chronic malnutrition, profoundly affects a child's physical and cognitive development, with long-lasting repercussions on their future potential and quality of life. This study has significant implications. It underscores the urgent need for robust public health interventions targeting STH infections, especially in high-prevalence areas like Indonesia. Measures such as mass deworming campaigns, improved sanitation and hygiene practices, and health education can significantly alleviate the burden of STH infections and the resulting stunting. Moreover, the research emphasizes the intricate relationship between infectious diseases and malnutrition, highlighting the necessity for a holistic approach to child health. Addressing STH infections necessitates not only medical intervention but also efforts to enhance overall living conditions and nutritional status. Integrating these approaches into a comprehensive public health strategy can yield more effective and sustainable results in the fight against childhood stunting. In conclusion, this study underscores the paramount importance of addressing STH infections in the context of child growth and underscores the urgency of implementing effective public health interventions. This approach can enable children to reach their full physical and cognitive potential, ultimately contributing to the overall well-being and development of societies.

Abstract 19042: Statewide Burden of Ischemic Heart Disease Attributable to Dietary Risk Factors From 1990-2019 in United States: A Systematic and Comparative Benchmarking Study

Introduction: Ischemic Heart Disease (IHD) is the 1 st leading cause of deaths among all causalities in United states (US). However, there is a large statewide variation within the US due to IHD attributable to dietary risk factors. Comparable and consistent state-level burden of total IHD attributable to dietary risk factors have not been produced previously. Methods: Using Global Burden of Disease methodology, deaths, and disability adjusted life years (DALYs) due to IHD attributable to dietary risk factors were analyzed by age group, sex, year, and location across the US from 1990-2019. Results were presented in all age counts and age standardized rate per 100,000 person years. Results: The annual percentage of change (APC) in total DALYs increased by 32% for IHD attributable to a high sodium diet, followed by a 10% increase for a diet high in sugar-sweetened beverages and a 2% increase for a diet low in vegetables. In terms of total deaths, the highest APC increase was observed in Nevada (142%), followed by Alaska (98%) and Arizona (65%). Conversely, the District of Columbia and Nebraska had the lowest APC increases in total DALYs and deaths. Regarding age groups, the highest APC increase in the total number of deaths was seen in the 95+ year group (97%), followed by the 90-94 age (44%), 55-59 age (10%), and 50-54 age (3%). Conclusions: Statewide disparities of IHD attributable to dietary risk factors in the US is significant and calls for comprehensive public health strategies. By addressing the root causes and promoting healthier dietary habits, it is possible to reduce the burden of IHD, improve population health outcomes, and alleviate the strain on healthcare systems and the economy.

Pancreatic cancer challenge in 52 Asian countries: age-centric insights and the role of modifiable risk factors (1990-2019).

Pancreatic cancer is renowned for its elevated incidence and mortality rates on a global scale. The disease burden of pancreatic cancer is anticipated to increase, particularly in Asia, due to its vast and rapidly aging population. Data from the Global Burden of Disease 2019 were analyzed for pancreatic cancer burden across 52 countries in Asia, including the incidence, mortality, and disability-adjusted life years (DALY) for pancreatic cancer, with a focus on risk factors such as high body mass index (BMI), elevated fasting plasma glucose, and smoking. We applied the Estimated Annual Percentage Change, the Age-Period-Cohort model, and decomposition analysis to evaluate incidence trends and effects. From 1990 to 2019, both incidence and mortality rates of pancreatic cancer in Asia significantly increased, with an average annual standardized incidence rate change of 1.73%. Males consistently exhibited higher rates than females, with smoking as a key risk factor. Central Asia reported the highest rates, and South Asia the lowest. The incidence rose with age, peaking in those aged 70~74. The disease burden increased in all age groups, particularly in populations aged 55 and above, representing 84.41% of total cases in 2019, up from 79.01% in 1990. Pancreatic cancer ranked the fifth in incidence among six major gastrointestinal tumors but presented a significant growth rate of mortality and DALY. With the growing, aging population in Asia, the pancreatic cancer burden is projected to escalate, bringing a significant public health challenge. Hence, comprehensive public health strategies emphasizing early detection, risk modification, and optimized treatment of pancreatic cancer are imperative.

Geriatric syndromes, chronic inflammation, and advances in the management of frailty: A review with new insights.

As people age, geriatric syndromes characterized by frailty significantly impact both clinical practice and public health. Aging weakens people's immune functions, leading to chronic low-grade inflammation that ultimately contributes to the development of frailty. Effectively managing geriatric syndromes and frailty can help alleviate the economic burden of an aging population. This review delves into the intricate relationship among aging, infection-induced inflammation, chronic inflammation, and frailty. In addition, it analyzes various approaches and interventions to address frailty, such as smart rehabilitation programs and stem-cell treatments, offering promising solutions in this new era. Given the importance of this topic, further research into the mechanisms of frailty is crucial. Equally essential is the devising of relevant measures to delay its onset and the formulation of comprehensive clinical, research, and public health strategies to enhance the quality of life for elderly individuals.

Gait and falls in cerebral small vessel disease: a systematic review and meta-analysis.

Gait impairment contributes to falls and frailty. Some studies suggest that cerebral small vessel disease (CSVD) is associated with gait impairment in the general population. We systematically reviewed and meta-analysed the literature on associations of CSVD with gait impairment and falls. The protocol was published in PROSPERO (CRD42021246009). Searches of Medline, Cochrane and Embase databases were conducted on 30 March 2022. Cross-sectional and longitudinal studies of community-dwelling adults were included, reporting relationships between diagnosis or neuroimaging markers of CSVD and outcomes related to gait or falls. Partial correlation coefficients were calculated and pooled using a random-effects model for meta-analysis. The search retrieved 73 studies (53 cross-sectional; 20 longitudinal). Most studies reported an association between CSVD and gait impairments or falls risk: 7/7 studies on CSVD score or diagnosis, 53/67 studies on white matter hyperintensities (WMHs), 11/21 studies on lacunar infarcts, 6/15 studies on cerebral microbleeds and 1/5 studies on perivascular spaces. Meta-analysis of 13 studies found that higher WMH volume was mildly correlated with lower gait speed, in all studies (r = -0.23, 95% confidence interval: -0.33 to -0.14, P < 0.0001). However, there was significant heterogeneity between studies (I2 = 82.95%; tau2 = 0.02; Q = 79.37, P < 0.0001), which was unexplained by variation in age, sex, study quality or if the study adjusted for age. Findings suggest that CSVD severity is associated with gait impairment, history of falls and risk of future falls. Prevention of CSVD should be part of a comprehensive public health strategy to improve mobility and reduce risk of falls in later life.

Identifying and Evaluating the Socioeconomic Factors of COVID Vaccine Hesitancy Through an Integrated Multicriteria Decision Analysis Approach.

The governments have been facing the challenges to develop tailored strategies to decrease COVID vaccine hesitancy (CVH) and refusal and increase the acceptability and uptake to ensure the protection of public health. In Pakistan, it has been a great challenge for the government to increase the acceptability of the COVID vaccine. CVH has been a great hurdle to achieving this objective. The authors found it imperative to identify and evaluate the factors of CVH in Pakistan. For this purpose, the authors used an integrated multicriteria decision analysis method (MCDM) by combining Delphi and DEMATEL methods. The factors of CVH have been identified and finalized using the Delphi method. The experts' opinions were obtained to evaluate the factors. The DEMATEL method was used to find out the most critical factor(s) of CVH. Moreover, the cause/effect relationship was also developed to have a better understating of factors and their relationships. The analysis revealed "ineffective public awareness strategies" as the most critical factor of CVH followed by "misinformation and disinformation, conspiracy theories", and "acquired knowledge". The study also examined the cause-and-effect relationship between the prioritized factors. The government in Pakistan introduced successful efforts to deal with the COVID-19 pandemic, yet the government could do more to increase vaccine acceptance. For this purpose to serve effective scientific and evidence-based public awareness strategiesare needed to increase the acquired knowledge and deal with misinformation, disinformation, and conspiracy theories to increase vaccine acceptance. The government could sue the media, especially social media to increase vaccination. The findings of the study provide a detailed understanding of the CVH in Pakistan and develop a comprehensive public health strategy to deal with any health-related potential issues in the future.

Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis.

Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.

“It is always there in your face.” Australian young people discuss exposure to gambling activities and promotions.

The normalisation of gambling for young people is a growing public health challenge. Despite initiatives aimed at reducing young people's exposure to unhealthy products, there is still little understanding of how they may be exposed to gambling. Using social exposure theory, this study aimed to explore young people's observations of gambling products and promotions within their everyday environments. In-depth interviews were conducted with 54 young people (n ​= ​25 girls, n ​= ​29 boys, aged 11–17 years) in Australia. Convenience and then snowball and purposive recruitment strategies were used to ensure a range of gambling attitudes and experiences were represented. Data were interpreted using reflexive thematic analysis. Young people described seeing gambling in varied social environments such as their own homes; physical environments in their local communities – including at local shopping centres, post offices, and sporting matches; and through symbolic environments such as marketing in community settings, on traditional and social media platforms, and depictions of gambling in movies and television shows. This exposure contributed to the perception that gambling was a normal activity, often placed alongside non-gambling activities in everyday settings. Comprehensive evidence-based public health strategies are needed to protect young people from exposure to gambling activities and promotions. These should include legislation to restrict the marketing and availability of gambling products, and research-based public education designed to counter normalising messages about gambling.

Public knowledge of chronic kidney disease in Portugal: a quantitative approach

Abstract Background Chronic kidney disease (CKD) has increased progressively worldwide, however evidence on public awareness highlights gaps for a comprehensive public health strategy. This study aims to evaluate public knowledge and possible lack of awareness about CKD in Portugal. Methods Cross-sectional study conducted through community based online survey (n = 1209). It was applied the CKD Knowledge Questionnaire and a score was calculated from 24 items categorized in 5 dimensions. Bivariate analyses was performed using one-way ANOVA and independent T-tests, at a 5% significance level, to compare the effect of independent variable and score. Results A total of 1209 respondents with mean age 50 years (±15.1), 74.1% of female, 62.6% married or living with a partner, 55,7% at least university level. The mean (SD) public knowledge of CKD score was 14.30 (±3.4). The dimension “Functions of kidneys perform in the body” presented the lowest percentage of correct answers (48.9±19.5) while “Following are commonly used to determine health of the kidney” the highest percentage (71.3±22.4). Results of the bivariate analysis showed significant associations with gender (p &amp;lt; 0,001), marital status (p = 0,019), education (p &amp;lt; 0,001), high blood pressure (p = 0,020), personal history of kidney disease (p &amp;lt; 0,001), familiar history of kidney disease (p &amp;lt; 0,001), access to healthcare (p = 0,049), follow-up with a healthcare professional (p = 0,023), use of urgent care or hospital urgency (p = 0,020) and use of medical specialty appointments (p &amp;lt; 0,001). Conclusions People living in Portugal revealed a middle knowledge level. Knowledge higher scores were observed in female, people with higher level of education, with experience imposed by health condition (e.g., risk factors or history disease), and access to health services. Future health education focused on ‘Functions of kidneys perform in the body’ might be an important contribution to increase health literacy about CKD. Key messages • Social vulnerabilities may be associated with lower levels of public knowledge of Chronic Kidney Disease. • The evaluation of population’s knowledge about CKD is an important instrument for public health policy-making.

Sun Protection and Tanning Behaviors in Caregivers: Prevalence, Determinants, and Associations with Children's Behaviors.

The association between skin cancer and ultraviolet radiation (UVR) is well established, and sun protection behavior represents an important preventative measure. In children, caregivers play a key role in this regard. The subject of this study was threefold: whether caregivers of 1 to 11 year-old children are more likely to use sun protection measures compared to non-caregivers, whether considering oneself a role model is associated with sun protection behaviors, and whether their sun protection and risk behaviors are related to children’s behaviors. We used data from the 2020 wave of the National Cancer Aid Monitoring (NCAM) comprised of 4000 individuals (including 554 caregivers of at least one child aged 1–10 years) aged 16 to 65 years and living in Germany. Data were collected through telephone interviews between October and December 2020. No significant differences between caregivers and non-caregivers regarding sun protection and risk behaviors were identified (except tanning on vacation). In both groups, sun protection behaviors were deficient. Caregivers who considered themselves role models concerning sun safety were more likely to use sun protection measures (e.g., using sunscreen on the face: OR = 5.08, p < 0.001). In addition, caregivers’ sun protection behaviors were positively associated with children’s behaviors. Caregivers being highly protected against UVR were more likely to report the use of different measures by/in the child (mean = 4.03), compared to caregivers with medium (3.41) and low (2.97, p < 0.001) protection levels. However, we also found that caregivers’ risk behavior was associated with children’s reported risk behavior. For future prevention, it might be worth focusing on the aspect of caregivers serving as role models. A comprehensive public-health strategy is needed, including key figures such as pediatricians to prevent today’s children from developing skin cancer in later life.

Epidemiology of COVID-19 and effect of public health interventions, Chennai, India, March–October 2020: an analysis of COVID-19 surveillance system

ObjectivesTo describe the public health strategies and their effect in controlling the COVID-19 pandemic from March to October 2020 in Chennai, India.SettingChennai, a densely populated metropolitan city in Southern India,...

Study protocol for an evaluability assessment of an anti-human trafficking program

BackgroundHuman trafficking is a serious global challenge associated with a complex array of health inequities for individuals, families, and communities. Consequently, in addition to a conventional criminal justice approach, anti-trafficking scholars have increasingly called for a public health approach to address this global challenge. Such calls have emphasized that a comprehensive, robust, and social justice-informed public health strategy for anti-trafficking must include services to facilitate survivors’ HT exit and recovery, and to prevent their re-victimization. Fortunately, many community-based organizations and non-governmental organizations worldwide have heeded these calls and developed anti-trafficking programs for survivors. Unfortunately, despite the growing numbers of organizations providing anti-trafficking services, research concerning these programs’ effectiveness remains nascent overall, and even more scant when filtered through an equity focus.MethodsTo advance the field by developing guidance concerning how best to evaluate anti-human trafficking programs, an ongoing research project aims to conduct a mixed methods evaluability assessment of a prominent anti-trafficking program using a social justice framework. Guided by well-established evaluability assessment frameworks, the study activities include four sequential steps: (a) focusing the assessment, (b) developing the program theory and logic, (c) gathering feedback, and (d) applying the assessment findings. Activities will include qualitative interviews and focus groups, observations, and quantitative analysis of program data among others. Human subjects and ethical review for the evaluability assessment has been granted by the Office of Human Subjects Research at The University of North Carolina at Chapel Hill.DiscussionOnce completed, evaluability assessment results will provide evidence and products that have the potential to guide both evaluation research and service provision not only for the specific organization under study, but also for other anti-human trafficking programs worldwide. Findings will be developed into a variety of dissemination products tailored for both practice professionals and researchers. In the interim, this protocol manuscript offers research strategies and recommendations that can help inform the development of other studies in the developing field of anti-trafficking program evaluation research.

Infectious Diseases of Eastern Spotted Skunks (Spilogale putorius) within a One Health Framework

Owing to their omnivorous diet, den-site habits, foraging activities, mating behaviors, and other pertinent habitat-use and natural-history traits, Spilogale putorius (Eastern Spotted Skunk [ESS]) are exposed to a wide variety of pathogenic agents. Understanding the diversity of infectious diseases affecting ESS in conjunction with the role this species plays in the disease ecology of these pathogens is crucial not only for devising efficacious management strategies, but also in formulating comprehensive veterinary and public health strategies for combatting zoonotic diseases associated with this species. Herein I review the reported infectious diseases of ESS. I address the implications of these pathogens for current and future population health of the species with reference to the changing dynamics of ESS disease ecology, influenced by increasing habitat fragmentation, exposure to pathogens across the domestic–wildlife interface, fluctuating climatic patterns, antimicrobial-resistant pathogens, and the profusion of immunosuppressant chemicals throughout the environment. Employing a One Health framework to evaluate the role that ESS play in the disease ecology of zoonoses further highlights the interrelationships of ESS health to the health of humans, domestic animals, and other wildlife. The potential for ESS to serve as hosts, “dilutors”, and/or sentinels for zoonoses underscores their importance in public health and provides an opportunity to leverage their potential disease-mitigating attributes for the conservation of ESS aligned with their provision of ecosystem services.

Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: a population-based cross-sectional study

ObjectivesTo assess the prevalence of disabilities (vision, hearing, mobility, cognitive, self-care and communication) and non-communicable diseases (NCDs) among the elderly population in two districts in Telangana, India.DesignPopulation-based cross-sectional study using...