Development Of Public Health Policies Research Articles

COVID-19 mitigation behaviors among English-Speaking Hmong Americans

BackgroundCOVID-19 mitigation strategies such as masking, social distancing, avoiding group gatherings, and vaccination uptake are crucial interventions to preventing the spread of COVID-19. At present, COVID-19 data are aggregated and fail to identify subgroup variation in Asian American communities such as Hmong Americans. To understand the acceptance, adoption, and adherence to COVID-19 mitigation behaviors, an investigation of Hmong Americans’ contextual and personal characteristics was conducted.MethodsThis study aims to describe COVID-19 mitigation behaviors among Hmong Americans and the contextual and personal characteristics that influence these behaviors. A cross-sectional online survey was conducted from April 8 till June 1, 2021, with Hmong Americans aged 18 and over. Descriptive statistics were used to summarize the overall characteristics and COVID-19 related behaviors of Hmong Americans. Chi-square and Fisher’s Exact Test were computed to describe COVID-19 mitigation behaviors by gender and generational status (a marker of acculturation).ResultsThe sample included 507 participants who completed the survey. A majority of the Hmong American participants in our study reported masking (449/505, 88.9%), social distancing (270/496, 55.3%), avoiding group gatherings (345/505, 68.3%), avoiding public spaces (366/506, 72.3%), and obtaining the COVID-19 vaccination (350/506, 69.2%) to stay safe from COVID-19. Women were more likely to socially distance (P = .005), and avoid family (P = .005), and social gatherings (P = .009) compared to men. Social influence patterns related to mitigation behaviors varied by sex. Men were more likely compared to women to be influenced by Hmong community leaders to participate in family and group gatherings (P = .026), masking (P = .029), social distancing (P = .022), and vaccination uptake (P = .037), whereas healthcare providers and government officials were social influencers for social distancing and masking for women. Patterns of social distancing and group gatherings were also influenced by generational status.ConclusionContextual and personal characteristics influence COVID-19 mitigation behaviors among English speaking Hmong Americans. These findings have implications for identifying and implementing culturally appropriate health messages, future public health interventions, policy development, and ongoing research with this population.

Deliberative dialogue on euthanasia in girls, boys and adolescents. Prequel to the Cabildo Ciudadano (Citizen Council) carried out in Colombia.

To date, there is a lack of published information on the utilization of the Deliberative dialogue methodology and the right to a dignified death in minors under 18 years of age in Colombia and Latin America. To examine the issue of children and adolescents' entitlement to a dignified death, including the criteria for exclusion, and to formulate a comprehensive plan for pediatric palliative care. A public policy document will be created with the aim of supporting the implementation of Resolution 825/2018. Participatory Action Research utilizing a Deliberative dialogue methods that has been adapted based on feminist epistemological principles. The outcome of the exercise was the production of a document containing Public Policy recommendations regarding euthanasia in minors and its submission to the Ministry of Health and Social Protection of Colombia a few days prior to the release of the Resolution regulating the right to a dignified death for this population. Additionally, the conclusions of this event enabled the creation of a guide for the implementation of (Cabildos Ciudadanos) Citizen Council, in which girls, boys, and adolescents are included, trans-disciplinarity is encouraged, and feminist epistemological foundations are explored. The deliberative dialogue method may serve as a cost-efficient alternative to replace or complement participatory approaches utilized in the development of public health guidelines and policies.

Self-reported reasons for opioid and analgesic misuse among participants without cancer in the United States

ABSTRACT Background This study examined opioid and analgesic misuse, and associated reasons for misuse, among participants without cancer in the United States. Methods We extracted data from three distinct waves of the National Survey on Drug Use and Health (NSDUH, 2017–2019). Using weighted multivariable logistic regression models, we examined the associations between misuse and its reasons. Results Among individuals without cancer who misused pain relievers, the top three reasons for misuse were to relieve physical pain (62.6%), to get high (29.2%), or to relax (28.9%). For compound analgesics, the top three reasons for misuse were similar: relieving physical pain (67.9%), getting high (22.1%), and relaxation (25.6%). Compared to participants who misused opioids, respondents using compound analgesics and other pain relievers had lowers odds of using pain relievers for getting high (all p < .05). Conclusion Understanding the underlying reasons for opioid and analgesic misuse can inform development of public health policy and help in determining best practices for prescription and monitoring programs.

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review.

The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0-18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people.

Associations between residential environmental health and sleep quality: Potential mechanisms

BackgroundSleep quality is an important dimension of sleep health. There are few studies on the relationship between residential environment and sleep quality in China. We validated the connection between them and explored the moderating role of spatial-geographic characteristics and the role of emotional stress and somatic function as mediators. MethodsUsing survey data collected by the Chinese General Social Survey in 2021, 2717 respondents were included in the analysis. First, OLS regression was used for baseline analysis. Second, a generalized ordered logit model was used to analyze the more precise correlations between residential environmental health and sleep quality. Finally, the mediating role of emotional stress and somatic function was explored using the KHB method. ResultsIn the baseline analysis, both the positive correlations of residential natural environmental health and residential health resources on people's sleep quality were tested. Further analysis revealed that the correlation of natural environmental health was more about protecting people from poor sleep quality (having “good” and “very good” sleep quality). The residential health resources correlated with whether people reported very good sleep quality. Regional development disparities played a negative moderating role in the relationship between residential health resources and sleep quality. Also, the mediating role of emotional stress and somatic function were supported, and the mediating role of somatic function was higher in proportion. ConclusionSleep quality was positively correlated with residential environmental health; the economic development gap between regions played a moderating role; and the correlation was generated by people's emotional stress and somatic function. In the development of public health policy, it is necessary to actively address various environmental issues, provide convenient health facilities in living spaces, and bolster the policy inclinations of less developed areas.

Household Dietary Diversity among the Ethnic Minority Groups in the Mekong Delta: Evidence for the Development of Public Health and Nutrition Policy in Vietnam.

Poor household dietary diversity has been linked to malnutrition in individuals, households, and cumulatively in populations. High rates of malnutrition among Khmer ethnic children aged five years and younger have been reported in Tri Ton district, Vietnam. This paper aims to further investigate household dietary diversity and associated factors among Khmer ethnic minority populations in Vietnam. A cross sectional study was conducted from October 2018 to April 2019 in Tri Ton District, An Giang Province. By employing a multistage sampling technique, a total of 402 (99.8% response rate) participants were interviewed to measure household dietary diversity using a structured and validated questionnaire developed by FAO. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with household dietary diversity. The results showed that the prevalence of low, medium and high dietary diversity scores were 21.4%, 70.4% and 8.2%, respectively. Male-headed households, literacy level, household income, exposure to mass media on nutrition and health information, and frequency of eating were positively associated with household dietary diversity (p &lt; 0.05). However, owning a vegetable and rice farm was not statistically related to households' dietary diversification. The paper concludes that the magnitude of household diversified dietary intakes was essentially low to medium in participants' households. These findings have provided evidence to inform the development of the National Nutrition Strategy-2021-2030 in Vietnam, to be revised in 2045. This national strategy proposes appropriate interventions, programs and policies to improve socioeconomic status in ethnic groups and in mountainous areas to enhance populations' health and well-being including controlling childhood malnutrition. In order to improve population health and wellbeing in Tri Ton District, further actions to address effective dietary practices including strengthening nutrition and health communication about the need to improve household dietary diversity to high levels are recommended.

Temperature-related mortality in China from specific injury

Injury poses heavy burden on public health, accounting for nearly 8% of all deaths globally, but little evidence on the role of climate change on injury exists. We collect data during 2013-2019 in six provinces of China to examine the effects of temperature on injury mortality, and to project future mortality burden attributable to temperature change driven by climate change based on the assumption of constant injury mortality and population scenario. The results show that a 0.50% (95% confident interval (CI): 0.13%–0.88%) increase of injury mortality risk for each 1 °C rise in daily temperature, with higher risk for intentional injury (1.13%, 0.55%–1.71%) than that for unintentional injury (0.40%, 0.04%–0.77%). Compared to the 2010s, total injury deaths attributable to temperature change in China would increase 156,586 (37,654–272,316) in the 2090 s under representative concentration pathways 8.5 scenario with the highest for transport injury (64,764, 8,517–115,743). Populations living in Western China, people aged 15–69 years, and male may suffer more injury mortality burden from increased temperature caused by climate change. Our findings may be informative for public health policy development to effectively adapt to climate change.

Desigualdades na cobertura vacinal infantil: potenciais lições do caso da Guiné-Bissau

Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast, inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.

A retrospective multicenter study of oral and maxillofacial lesions in older people.

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Prevalence and Determinants of Multiple Forms of Malnutrition among Adults with Different Body Mass Index: A Population-Based Survey in the Philippines.

The multiple forms of malnutrition, including overnutrition, undernutrition, and diet-related noncommunicable diseases, are emerging crises in Asian countries. Past studies have focused more on malnutrition among overweight/obese individuals; however, limited research has examined chronic energy-deficient adults. Therefore, this study is aimed at investigating the prevalence and determinants of different forms of malnutrition among adults with different body mass index, using the Philippines as an example. Findings from this study will guide the development and implementation of public health nutrition programs and policies. A representative dataset from the 2013 Philippine National Nutrition Survey was used in the study. Adults aged ≥20 years (n = 16,826) were included in the analysis after excluding those with missing values. Six phenotypes of malnutrition were assessed, including three in overweight/obese adults (overweight/obese with metabolic syndrome; those with micronutrient deficiency-anemia, vitamin A deficiency, and iodine insufficiency; and those with both metabolic syndrome and micronutrient deficiency) and three in chronic energy-deficient (CED) adults (CED with either metabolic syndrome or micronutrient deficiency and with both metabolic syndrome and micronutrient deficiency). Sociodemographic and lifestyle factors were examined as the determinants of different forms of malnutrition, and multinomial logistic regression analyses were performed. The prevalence of the six phenotypes of malnutrition ranged from 0.4% to 10.2%, where overweight/obese with metabolic syndrome was the most predominant type. The multinomial logistic regression models indicated that older age was the major risk factor across all phenotypes. Sex was associated with the outcomes in the overweight/obesity group, whereas employment status was correlated with CED adults. Furthermore, higher educational levels, being married, living in affluent households, and not smoking were protective factors for conditions related to CED but not overweight/obese individuals. Malnutrition in all its forms is a significant public health concern that must be understood and addressed. Policymakers should implement appropriate intervention programs to control these nutritional problems considering the specific risk factors for the adult population.

DOWNLOAD PDF DOWNLOAD XML THE IMPACT OF PUBLIC HEALTH POLICIES ON ALLEVIATING MENSTRUAL POVERTY: A REVIEW OF LITERATURE AND POLICY RECOMMENDATIONS

Menstrual poverty, a profound public health issue wherein females grapple with obstacles in acquiring menstrual materials, sanitation amenities, and pertinent instruction, has become a global concern. Particularly in regions of resource scarcity and nations with lower income, this predicament gravely impacts women’s quotidian lives, economic status, and psychosocial health. The present study delves into the impact and potential of public health policies in addressing menstrual poverty, underscoring the necessity of comprehensive menstrual health education, provision of free or affordable sanitary products, and consideration of specific environments and diverse population requirements in this process. While external influences, such as economic crises and public health incidents, may affect menstrual poverty, this paper delineates, via literature review, the pivotal role public health policies play in ameliorating menstrual poverty. Such policies not only facilitate the elevation of women’s mental health and social equity but also offer tangible strategies, like infrastructure enhancement, especially in resource-deprived locales. Nonetheless, the study also highlights several constraints and challenges, including cultural and societal impediments, fiscal restrictions, and others necessitating more in-depth exploration and solutions in future research and policy formulation. On balance, this investigation offers fresh perspectives and evidence for public health policy development, significantly aiding in the amelioration of menstrual poverty in low-income countries, thus yielding beneficial insights for promoting menstrual equity and enhancing the welfare of all individuals experiencing menstruation.

A Time Series Study for Effects of PM10 on Coronary Heart Disease in Ganzhou, China.

Objective: To investigate the effect of PM10 exposure in low concentration areas on the daily hospitalized patients with coronary heart disease. Methods: Daily air quality monitoring data, meteorological monitoring data and daily hospitalization data of coronary heart disease during 2019−2021 in Ganzhou, China were collected. Generalized additive model and distributed lag nonlinear model were used to evaluate the association between environmental PM10 and daily hospital visits for coronary heart disease. Stratified by sex and age to see their potential impact on this association. Results: PM10 exposure was correlated with an increased risk of hospitalization in coronary heart disease patients. Single-pollutant model analysis shows that at the day of lag1, for every 10 µg/m3 increase in PM10, the risk of coronary heart disease hospitalization increased by 1.69% (95%CI 0.39~3.00%); Subgroup analysis showed that females and older adults (>65 years) were more sensitive to PM10 exposure. In addition, in the dual-pollutant model, by adjusting other pollutants (including SO2, CO and O3), it was found that the relationship between PM10 exposure and coronary heart disease hospitalization was robust. And with changing the model’s degree of freedom was still robust. Conclusion: Short-term exposure to low concentrations of PM10 is associated with hospitalization for coronary heart disease. These results are important for local environmental public health policy development, so as to protect vulnerable populations.

Policy for temporary crisis or sustained structural change in an age of disasters, crises, and pandemics

This paper employs cases to discuss the impact of information, disinformation, and the evolution of scientific data as part of public health policy development in the COVID- 19 pandemic. The two areas of policy development center on (1) risk and public health precautions (e.g., mask mandates, cleaning protocols, and social distancing) and (2) risk and economic/travel policy (e.g., regional economic shutdown, travel restrictions, border closures). Key to the analysis is the understanding of social risk production and public trust in institutions and individuals within those institutions that craft emergency, interim, and long-lasting public policy. The paper concludes with recommendations for enhancing public trust in government institutions and the management of risks during times of disasters, crises, and pandemics.

Human microbiota drives hospital-associated antimicrobial resistance dissemination in the urban environment and mirrors patient case rates

BackgroundThe microbial community composition of urban environments is primarily determined by human activity. The use of metagenomics to explore how microbial communities are shaped in a city provides a novel input that can improve decisions on public health measures, architectural design, and urban resilience. Of note, the sewage system in a city acts as a complex reservoir of bacteria, pharmaceuticals, and antimicrobial resistant (AMR) genes that can be an important source of epidemiological information. Hospital effluents are rich in patient-derived bacteria and can thus readily become a birthplace and hotspot reservoir for antibiotic resistant pathogens which are eventually incorporated into the environment. Yet, the scope to which nosocomial outbreaks impact the urban environment is still poorly understood.ResultsIn this work, we extensively show that different urban waters from creeks, beaches, sewage spillways and collector pipes enclose discrete microbial communities that are characterized by a differential degree of contamination and admixture with human-derived bacteria. The abundance of human bacteria correlates with the abundance of AMR genes in the environment, with beta-lactamases being the top-contributing class to distinguish low vs. highly-impacted urban environments. Indeed, the abundance of beta-lactamase resistance and carbapenem resistance determinants in the urban environment significantly increased in a 1-year period. This was in line with a pronounced increase of nosocomial carbapenem-resistant infections reported during the same period that was mainly driven by an outbreak-causing, carbapenemase-producing Klebsiella pneumoniae (KPC) ST-11 strain. Genome-resolved metagenomics of urban waters before and after this outbreak, coupled with high-resolution whole-genome sequencing, confirmed the dissemination of the ST-11 strain and a novel KPC megaplasmid from the hospital to the urban environment. City-wide analysis showed that geospatial dissemination of the KPC megaplasmid in the urban environment inversely depended on the sewage system infrastructure.ConclusionsWe show how urban metagenomics and outbreak genomic surveillance can be coupled to generate relevant information for infection control, antibiotic stewardship, and pathogen epidemiology. Our results highlight the need to better characterize and understand how human-derived bacteria and antimicrobial resistance disseminate in the urban environment to incorporate this information in the development of effluent treatment infrastructure and public health policies.2A5ZQFmXmKxDXginhFNeyTVideo

‘To be had for a Pesthouse for the use of this parish’: plague pesthouses in early Stuart London, c. 1600–1650

AbstractThe use of the pesthouse in early modern England has received limited attention by scholars, in particular, how it was used in London. The study of the pesthouse tells us about the nature of parochial government in the capital, the early development of public health policies and the relationship between national and civic authorities and the suburban parishes, where plague was a long-term problem and intersected forcefully with poverty. This article explores how suburban parishes used the pesthouse in their repertoire of response to plague between c. 1600 and 1650, which is situated in the context of experiments with the pesthouse in England's provincial towns and cities. The article considers the development of the City of London's pesthouse in St Giles Cripplegate, its limited use by suburban parishes under the City's jurisdiction, and the establishment of a local pesthouse by some suburban parishes beyond the jurisdiction of the City.

Prevalence and factors associated with food insecurity in southern Mozambique

Abstract Background Food insecurity (FI) is one of the major causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how it’s related to negative health outcomes is unknown. This study aimed to investigate the prevalence of FI as well as the factors associated with FI in southern Mozambique. Methods Preliminary data from 301 household heads residing in suburb and peri-urban districts of Maputo were analysed in a cross-sectional design. Accordingly, FI was assessed using the 8-items of the United States Department of Agriculture Household Food Security Survey Module, and its association with various factors was determined through multiple regression models. Results The prevalence of FI was 62.8% (23.6% of households had mild FI, 16.6% had moderate FI, 22.6% had severe FI). Based on multiple regression models, 10 variables (out of 11) were relevant drivers of FI and reached statistical significance (p-value&amp;lt;0.05) with focus on food diversity, climate change, illnesses, household income, number of meals, type of work, household size. Conclusions These preliminary findings suggest the need for decent work and job creation. In addition, food diversity, climate change and some relevant diseases should be taken into account in the development of public health policies designed to alleviate household food insecurity in Mozambique. Key messages • Food insecurity in Mozambique calls for joint efforts from government, private sector, international institutions and communities. • The basic food basket for the most vulnerable groups is encouraged as a short-term solution.

Making the case for the governance of (digital public) health futures

Abstract Digital and data tools are fundamentally changing approaches to health and the design of health systems, but governance models have neither followed nor kept up with the pace of innovation. In response to this challenge, The Lancet &amp; Financial Times Commission on Governing health futures 2030: Growing up in a digital world explores the convergence of digital health, artificial intelligence, and other frontier technologies with universal health coverage to support attaining the SDG 3. Children and young people are crucial groups requiring particular attention to ensure that no one is left behind in achieving universal health coverage and SDG 3 amidst the digital transformation in health. Today, there are 1.8 billion people between the ages of 10 and 24 - the largest youth population in history - 90 percent of whom live in developing countries. This cohort represents an unprecedented powerhouse of human potential and digital engagement that could transform health to reach sustainable development goals. This presentation introduces several key findings from the Commission's report which pertain to the governance of (digital public) health futures amidst digital transformations in health. It will highlight how human-centred approaches to health are vital to navigating the digital transformations and maximising their benefits for population health and well-being. Further, it will provide an action plan for meaningful youth engagement in the design, development, implementation, and evaluation of digital public health policies, programmes, and services.

Use of traditional and complementary medicine for COVID 19 prophylaxis among healthcare professionals and students in Jordan: A cross-sectional study

IntroductionThere is inadequate evidence to recommend the use of any traditional and complementary medicine (T&CM) methods such as vitamin, mineral, herbal or other dietary supplements to prevent or treat COVID 19. Members of the medical team are particularly at risk of exposure to high viral load of coronavirus. They have also the best access to professional information regarding disease treatment and prophylaxis and disseminate such knowledge.The aim of the study was to assess the prevalence of use of T&CM for the prophylaxis of COVID 19 among the healthcare professionals and students in Jordan, along with the most common types and the factors associated with T&CM use.MethodologyA cross-sectional study of T&CM use was conducted in Jordan using a snowball sampling method to distribute Google Forms and to enrol participants during coronavirus outbreak between June 10, 2021, and August 28, 2021. The study included healthcare professionals or students who consented to participate in the survey. The survey excluded those participants who had filled the questionnaire at least once or were pregnant/breast-feeding at the time of the study. The questionnaire consisted of 29 items, including screening, checkbox, dichotomous, matrix and open-ended questions.ResultsThe response rate was 97.1%. Out of 560 study respondents, 359 (64.1%) reported using T&CM for COVID 19 prevention. Vitamins and nutrients were consumed by almost half (48.4%) of study participants, while nonpharmacological methods and herbal remedies were consumed by 35.2% and 25.2%, respectively. The most common source of information regarding T&CM use for COVID 19 prophylaxis included scientific publications (59.5%), followed by disease treatment guidelines (38.0%) and social media (32.3%). Adverse effects were reported by 8.5% and possible adverse effects were reported by another 8.5% of participants. The T&CM use was associated with working in contact with COVID 19 patients (OR: 1.625 (95% CI 1.047–2.523) (P = 0.03) and having a colleague as a source of information (OR: 1.720 (95% CI 1.026–2.883) (P = 0.04).ConclusionsThe prevalence of T&CM use for COVID 19 prevention among healthcare professionals and students in Jordan is high, with a significant proportion of participants reporting adverse effects. There is an urgent need for further research toward efficacy and safety of T&CM in COVID 19 prophylaxis as well as development of appropriate public health policy on this issue specific to each country.

Seasonal variability, predictive modeling and health risks of N-nitrosamines in drinking water of Shanghai

The prevalence of carcinogenic N-nitrosamines in drinking water is of significant concern. In the present study, eight N-nitrosamines from three representative drinking water treatment plants (DWTPs) in Shanghai, China were monitored for an entire year to evaluate their seasonal variability, probabilistic cancer risk and the resulting disease burden. The possibility of employing routinely monitored water quality parameters as predictors of N-nitrosamines was also examined. The results showed that the Taipu River-fed reservoir suffered more serious N-nitrosamine contamination than the Yangtze River-fed reservoirs. Winter witnessed higher levels of N-nitrosamines in both source and finished water. N-nitrosamine concentrations increased from source water to finished water in autumn or winter, but no spatial variations were observed in summer. The total lifetime cancer risk (LCR) posed by N-nitrosamines in finished water was within the acceptable range (1.00 × 10−6 to 1.00 × 10−4), with N-nitrosodimethylamine (NDMA) and N-nitrosodiethylamine (NDEA) being the main contributors. Winter and autumn were found to have higher total LCR values. The average individual disability-adjusted life years (DALYs) lost was 4.43 × 10−6 per person-year (ppy), exceeding the reference risk level (1.00 × 10−6 ppy). Liver cancer accounted for 97.1 % of the total disease burden, while bladder and esophagus cancers made a little contribution (2.9 %). A multiple regression model was developed to estimate the total N-nitrosamines in finished water as a function of water quality parameters, and the R2 value was 0.735. This study not only provides fundamental data for public health policy development, but also reveals the necessity to incorporate a seasonal control strategy in DWTPs to minimize the associated health risks induced by N-nitrosamines.

S547 Rising Inpatient Utilization and Costs of Cannabis Hyperemesis Syndrome Hospitalizations in Massachusetts Following Cannabis Legalization

Introduction: As cannabis legalization has become widespread, we sought to describe the demographics, inpatient utilization, and cost of services among patients hospitalized for cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts. Methods: We performed a retrospective cohort study of patients admitted to Tufts Medical Center in Boston, Massachusetts (MA) with CHS pre- and post-Dec 15, 2016, the date of cannabis legalization in MA. We examined the demographic and clinical characteristics of admitted patients as well as utilization of hospital services including length of stay, laboratory services, antiemetic drugs, intravenous fluids, endoscopies, imaging, gastroenterology consulting services and intensive care requirements both pre- and post- legalization. We also estimated inpatient cost pre- and post- legalization. Results: We identified 63 patients admitted between 2012-2020 with CHS across 72 hospitalizations, with more admissions post-legalization (n=57) than pre-legalization (n=15). Patient demographics were similar pre- and post- cannabis legalization, with a mean age of 33, 52% identifying as female, and the majority smoking cannabis as the primary route of administration. Utilization of hospital resources increased post-legalization for CHS, with increased length of stay (3 days vs 1 day, p< .005) and increased anti-emetic use (3 days vs 1 day, p< 0.05) compared to pre-legalization, with multivariate linear regression confirming that post-legalization admissions were independently associated with increased length of stay (B=5.35, p< 0.05). The mean cost of hospitalization per patient post-legalization was significantly higher than for pre-legalization ($18,714 vs $7,460, p< .0005), with intravenous fluid administration and endoscopy costs significantly increased post-legalization (p< 0.05). On multivariate linear regression, hospitalization for CHS during post-legalization significantly predicted increased costs (B=10,131.25, p< 0.05). (Table) Conclusion: In the post-legalization era of cannabis in Massachusetts, we found increased hospitalizations due to CHS, with a concomitant increase length of hospital stay and total cost per patient. As cannabis use increases, the recognition, measurement, and cost of the deleterious effects are necessary to incorporate into future practice strategies and public health policy development. Table 1. - Demographics Pre-legalization (n=12 patients) Post-legalization(n=51patients) p-value Number of hospital admissions 15 57 NA Female gender n, (frequency) 4 (33.3) 29 (50.9) 0.25 Age mean, (st dev) 35.5 (11.5) 32.9 (13.5) 0.32 Cannabis type used n, (frequency) Smoking 6 (50.0) 31 (60.8) 0.53 Vaping 0 2 (3.9) - Edibles 0 2 (3.9) - More than one type 0 1 (2.0) - Not reported 6 (50.0) 15 (29.4) - Cannabis use frequency n, (frequency) Less than daily 0 9 (17.6) 0.19 At least daily 3 (25.0) 24 (47.1) 0.21 Multiple times daily 3 (25.0) 8 (15.7) 0.42 Unknown 6 (50.0) 10 (19.6) - Utilization of Services Pre-legalization (n=15 hospitalizations) Post-legalization (n=57 hospitalizations) p-val Length of inpatient stay, days median, (IQR) 1.0 (1.0-2.0) 3.0 (1.0-4.0) < 0.005 Cannabis urine screen positivity n, (frequency) 10 (66.7) 37 (64.9) 1.0 Cannabis urine screen not performed n, (frequency) 4 (26.7) 16 (28.1) 1.0 Basic metabolic panel, days median, (IQR) 2 (1.0-2.8) 2.0 (0.25-3.0) 0.79 Antiemetics, days median, (IQR) 1.0 (1.0-2.5) 3.0 (2.0-4.0) < 0.05 Intravenous fluids, days median, (IQR) 1.0 (1.0-2.0) 1.0 (1.0-2.0) 0.32 Endoscopies performed n, (frequency) 3.0 (20.0) 14.0 (24.5) 1.00 Imaging studies performed n, (frequency) 12.0 (80.0) 43.0 (75.4) 1.00 GI consults n, (frequency) 5.0 (33.3) 26.0 (45.6) 0.57 ICU-level care needed days median, (IQR) 0.0 9.0 (15.8) 0.19 Cost of Services Pre-legalization (n=15 hospitalizations) Post-legalization (n=57 hospitalizations) p-value Mean inpatient charge $7460 $18,714 < 0.0005 IVF charges, mean $551 $745 < 0.05 Endoscopy charges, mean $1512 $2360 < 0.05