Public Health Disciplines Research Articles

Counterfactual Graphical Models for Longitudinal Mediation Analysis With Unobserved Confounding

Questions concerning mediated causal effects are of great interest in psychology, cognitive science, medicine, social science, public health, and many other disciplines. For instance, about 60% of recent papers published in leading journals in social psychology contain at least one mediation test (Rucker, Preacher, Tormala, & Petty, 2011). Standard parametric approaches to mediation analysis employ regression models, and either the "difference method" (Judd & Kenny, 1981), more common in epidemiology, or the "product method" (Baron & Kenny, 1986), more common in the social sciences. In this article, we first discuss a known, but perhaps often unappreciated, fact that these parametric approaches are a special case of a general counterfactual framework for reasoning about causality first described by Neyman (1923) and Rubin (1924) and linked to causal graphical models by Robins (1986) and Pearl (2006). We then show a number of advantages of this framework. First, it makes the strong assumptions underlying mediation analysis explicit. Second, it avoids a number of problems present in the product and difference methods, such as biased estimates of effects in certain cases. Finally, we show the generality of this framework by proving a novel result which allows mediation analysis to be applied to longitudinal settings with unobserved confounders.

Health promotion: An integral discipline of public health

Health promotion is the process of enabling people to increase control over and to improve their health and is emerging as a critical domain of public health. Over the last two decades, the medical model of health care, with its reliance upon clinically oriented experts, has begun a subtle shift that highlights towards a participatory model of health promotion emphasizing healthful lifestyles and healthy communities. This health promotion movement demands public health professionals to create alliances with other disciplines which would ultimately strengthen a holistic model of health as envisaged by World Health Organization. Health promotion encompasses five key strategies with health communication and education as cornerstones. Although developed countries have incorporated health promotion activities as an integral component of their public health system and initiated health promotion education systematically, developing countries are yet to adopt the same. The present paper attempts to explore the importance of health promotion as a core discipline and tool in advancing public health education, research and practice. It further illustrates few health promotion models that have been adopted and practiced for community health development. The paper advocates for stronger recognition health promotion as an integral entity and incorporation of health promotion in all domains of public health.South East Asia J Public Health | Jan-June 2012 | Vol 2 Issue 1 | 3-7 DOI: http://dx.doi.org/10.3329/seajph.v2i1.15253

Race, Genetic Ancestry, and Health

Knowledge from human genetic research continuously challenges the notion that race and biology are inextricably linked, with implications across biomedical and public health disciplines. However, biomedical research continues to explore health and disease under a racial framework ignoring and at times confounding the identification of true biological and/or environmental risk factors. Within this article, we present a brief overview of the use of race in biomedical research and studies of human genome variation and how genetic ancestry may help us understand health disparities. We believe that the casual use of “race” to define groups in biomedical research has contributed to our limited understanding of complex disease etiology and risk factors driving health disparities.

Integrating Weight Bias Awareness and Mental Health Promotion Into Obesity Prevention Delivery: A Public Health Pilot Study

IntroductionPromoting healthy weight is a top priority in Canada. Recent federal guidelines call for sustained, multisectoral partnerships that address childhood obesity on multiple levels. Current healthy weight messaging does not fully acknowledge the influence of social determinants of health on weight.MethodsAn interactive workshop was developed and implemented by a team of academic researchers and health promoters from the psychology and public health disciplines to raise awareness about 1) weight bias and its negative effect on health, 2) ways to balance healthy weight messaging to prevent the triggering of weight and shape preoccupation, and 3) the incorporation of mental health promotion into healthy weight messaging. We conducted a full-day workshop with 342 Ontario public health promoters and administered a survey at preintervention, postintervention, and follow-up.ResultsParticipation in the full-day workshop led to significant decreases in antifat attitudes and the internalization of media stereotypes and to significant increases in self-efficacy to address weight bias. Participants reported that the training heightened their awareness of their own personal weight biases and the need to broaden their scope of healthy weight promotion to include mental health promotion. There was consensus that additional sessions are warranted to help translate knowledge into action. Buy-in and resource support at the organizational level was also seen as pivotal.ConclusionProfessional development training in the area of weight bias awareness is associated with decreases in antifat attitudes and the internalization of media stereotypes around thinness. Health promoters’ healthy weight messaging was improved by learning to avoid messages that trigger weight and shape preoccupation or unhealthful eating practices among children and youth. Participants also learned ways to integrate mental health promotion and resiliency-building into daily practice.

We screen newborns, don't we?: realizing the promise of public health genomics.

Genomics and public health have been uneasy bedfellows for some time. Most efforts to improve population health through genomic approaches have focused on the assessment of risks for common diseases, with the aim of tailoring interventions and screening.1 However, the improvement of population health through such an approach has remained elusive.2 Now, rapid progress in affordable, robust DNA sequencing offers a promising opportunity. By expanding the field’s focus from common to rare diseases, it may be possible to realize the promise of public health genomics by identifying those millions of individuals who unknowingly carry mutations that confer a dramatic predisposition to preventable diseases.

Survey of Instructors Teaching about Antimicrobial Resistance in the Veterinary Professional Curriculum in the United States

The objective of this study was to ascertain current teaching methods for antimicrobial resistance (AMR) in veterinary professional curricula and to find out what veterinary instructors consider to be prioritized subtopics related to AMR. The sampling frame was instructors in veterinary professional programs at US colleges of veterinary medicine who provide instruction about antibiotics or AMR in the disciplines of microbiology, pharmacology, public health, epidemiology, internal medicine, surgery, or related subjects. Identified instructors were invited to participate in an online survey of current teaching methods related to subtopics of AMR. From 1,207 invitations, 306 completed surveys were available for analysis (25% response rate) with the largest number of respondents stating their contact hours about antibiotics occur in the discipline of "medicine-food animal." The median contact time suggested for AMR in the core veterinary curriculum was 3-5 hours, and for antibiotics in general, 16-20 hours. Subtopics of AMR were prioritized based on respondents' indication that they use or would use various teaching tools. The most common teaching tool for all topics was projected text (i.e., slides or PowerPoint slides) and the least common were video clips, non-course Web sites, online modules, and laboratory experiments. Recommendations for identifying the priorities of AMR content coverage and learning outcomes are made.

Are we training our psychiatrists adequately as public mental health practitioners?

No abstract available.

Diversity in collaborative research communities: a multicultural, multidisciplinary thesis writing group in public health

Writing groups for doctoral students are generally agreed to provide valuable learning spaces for Ph.D. candidates. Here an academic developer and the eight members of a writing group formed in a Discipline of Public Health provide an account of their experiences of collaborating in a multicultural, multidisciplinary thesis writing group. We consider the benefits of belonging to such a group for Ph.D. students who are operating in a research climate in which disciplinary boundaries are blurring and where an increasing number of doctoral projects are interdisciplinary in nature; in which both academic staff and students come from enormously diverse cultural and language backgrounds; and in which teamwork, networking and collaboration are prized but not always proactively facilitated. We argue that doctoral writing groups comprising students from diverse cultural and disciplinary backgrounds can be of significant value for postgraduates who wish to collaborate on their own academic development to improve their research writing and communication skills; at the same time, such collaborative work effectively builds an inclusive, dynamic research community.

The Cardiovascular Benefits of Polyphenol Compounds

In comparison, polyphenols are one of the most diverse to most other groups of bioactive phytochemicals. Polyphenols can be found in a wide range of foods that are derived from plants. Polyphenols are made up of various subgroups, but it’s the phenolics, stillbenes, and flavonoids that engender positive impacts on cardiovascular health. These three phytochemical compounds can reduce cardiovascular conditions such as hypertension and coronary heart disease. Remarkably, polyphenols and its subgroups can be found ubiquitously in most human diets. As a result, many studies have effectively illustrated the positive impacts polyphenols can induce when processed by the human body. Furthermore, research efforts have shown that modern diets and more “traditional” diets have unknowingly promoted the consumption of foods rife with polyphenols. These findings are starting to be incorporated into the public health discipline as a more practical option for more sustainable nutritional interventions. In all, polyphenols can produce a myriad of positive developments on at the micro and macro level.

Environmental health citation patterns: mapping the literature 2008-2010.

This research seeks to understand the publication types and ages cited most often in environmental health literature and the most commonly cited journal titles. From the 43,896 items cited in Environmental Health Perspectives and the Journal of Environmental Health during 2008-2010, 2 random samples were drawn: First, 1,042 items representing all citations were analyzed with respect to publication type, age, and Internet link. Second, the cited journal name and citation age were recorded for 1,038 items culled from only citations to journal articles. All journal titles were classified into Bradford zones and assigned subject disciplines. Journal articles (n = 891, 85.5%) were the most heavily cited publication type. Cited items' publication years ranged from 1951 to 2010. Close to half (49.1%) of all cited items were published 5 or fewer years previous. Sixteen journal titles (3.9%) accounted for 32.5% of all cited journal articles. The 3 most common subject disciplines-"Public, Environmental & Occupational Health," "Environmental Sciences," and "Toxicology"-accounted for 21.6% of all unique journal titles and 45.3% of all citations. Environmental health citation patterns differ from other public health disciplines in terms of cited publication types, cited journals, and age of citations.

Use of GIS Mapping as a Public Health Tool-From Cholera to Cancer.

The field of medical geographic information systems (Medical GIS) has become extremely useful in understanding the bigger picture of public health. The discipline holds a substantial capacity to understand not only differences, but also similarities in population health all over the world. The main goal of marrying the disciplines of medical geography, public health and informatics is to understand how countless health issues impact populations, and the trends by which these populations are affected. From the 1990s to today, this practical approach has become a valued and progressive system in analyzing medical and epidemiological phenomena ranging from cholera to cancer. The instruments supporting this field include geographic information systems (GIS), disease surveillance, big data, and analytical approaches like the Geographical Analysis Machine (GAM), Dynamic Continuous Area Space Time Analysis (DYCAST), cellular automata, agent-based modeling, spatial statistics and self-organizing maps. The positive effects on disease mapping have proven to be tremendous as these instruments continue to have a great impact on the mission to improve worldwide health care. While traditional uses of GIS in public health are static and lacking real-time components, implementing a space-time animation in these instruments will be monumental as technology and data continue to grow.

Served or unserved? A site suitability analysis of social services in Atlanta, Georgia using Geographic Information Systems

Geographers, planners and public health officials are increasingly interested in working with community partners, organizations, and residents to engage in action oriented research designed to impact positive community change. One growing area of community-based research focuses on geographic examinations of aspects of social service accessibility. In this study, we work with multiple community partners in an urban area to examine the spatial distribution of social service providers. We also identify potential new locations for social service providers that can meet the unmet demands for such services. We utilize a Public Participation GIS framework to create shared community resources and research deliverables for our community partners. The results of our work help local providers, leaders, and community residents to visualize gaps and coverage in social services across urban space; draw attention to additional forces that shape access, i.e. public transportation, walkability, and zoning codes; and confirm the anecdotal evidence of poor accessibility presented by neighborhood leaders and residents. The work has practical and actionable implications for lower income urban communities and methodological implications for the disciplines of geography, public health and planning.

Convergence of Ecohealth and One Health

Interest and participation in EcoHealth and One Health approaches have grown considerably over the past decade. Clearly, the two approaches have many similarities and strive for similar outcomes, and collaboration between them holds great potential value. Convergence of the two approaches could avoid repetition, strengthening both communities yet still highlighting the unique attributes of each approach. In 2011 Margot Parkes, then President of the International Association for Ecology and Health (EcoHealth), called for critical reflection on directions for ecohealth as a transdisciplinary field positioned among converging efforts (Parkes 2012). Building on this, seventeen of us engaged in further discussion about the convergence between One Health and Ecohealth at the 4th biennial EcoHealth conference this past October. We represent veterinary medicine, public health, ecology and several other disciplines, geographic locations, and both Ecohealth and One Health experiences. We present our deliberations and insights on two questions: Where and how can the two concepts converge? What is their common ground and where can they live happily apart?

Development of a CONSORT extension for interventions in public health and related disciplines

BackgroundMany interventions in public health and related specialties are complex and challenging to assess. These interventions can have interacting components at several levels, with multiple and variable outcomes that require sophisticated assessments and analyses. Understanding randomised studies of these complex UPSCaLE (pUblic health, Psychology, Social work, CriminoLogy, and Education) interventions requires detailed reports of the interventions tested and methods used to assess them; however, reports of these trials often omit important information. Poor reporting hinders proper critical appraisal and synthesis of trials in systematic reviews, thereby impeding the effective transfer of research evidence to policy and practice decision-making. The CONSORT statement is a guideline for reporting randomised trials that has versions for reporting cluster, pragmatic, and non-pharmacological intervention trials. Despite improvements in reporting of these trials in medical disciplines, several studies have shown persistent deficiencies in the reporting quality of randomised studies of UPSCaLE interventions. Several researchers have suggested developing a new CONSORT extension for UPSCaLE interventions because of their unique and complex features, which is the objective of this multiphased project. MethodsThis project has five phases. The first phase, which has been completed, included scientific literature reviews to assess reporting guidelines for and the current reporting quality of publications of UPSCaLE intervention trials. The second phase will be a Delphi exercise to generate a prioritised list of possible items to include in the CONSORT extension. The third phase will be a formal consensus meeting to select reporting items to add to or modify for the CONSORT extension. The fourth phase is writing the guideline documents, including an explanation and elaboration document that provides detailed advice and examples of good reporting for each reporting standard. The final phase will consist of simultaneous publication of the guideline in many journals, guideline endorsement by journals and funding organisations, presentations at conferences and organisational meetings, and a dedicated website allowing feedback about the guideline. FindingsWe identified 14 reporting guidelines and five reporting quality assessment methods, yielding a total of 147 relevant reporting standards. Official CONSORT guidelines had better practices for development and dissemination of reporting guidelines, yet other reporting guidelines for empirical intervention research yielded 89 modified standards for UPSCaLE interventions not identified in CONSORT guidance. A systematic review of UPSCaLE intervention trials (n=239) showed that many key aspects of UPSCaLE intervention trials were often poorly reported. The Delphi exercise is set to begin in January, 2013. InterpretationA new CONSORT extension for UPSCaLE interventions could improve reporting of these trials. This extension could improve the critical appraisal of research and its use in evidence-based decision-making. We aim to enlist stakeholders in UPSCaLE intervention research in the development and dissemination of the guideline to reach the best-informed consensus on guideline content and to improve empirical intervention methods in public health science. FundingSG holds a linked University of Oxford Clarendon Fund-Green Templeton College Annual Fund Scholarship. The UK Economic and Social Research Council has indicated that it will fund the project's future phases. No other funding sources were provided for the research to date.

Continuing professional development for public health: An andragogical approach

The UK professional body for public health, the Faculty of Public Health (FPH), has a well-established approach towards continuing professional development (CPD) for its members and fellows. The FPH approach, initially designed for public health physicians, has evolved to meet CPD requirements of a workforce beyond that of public health medicine to what is now a multiprofessional public health workforce. Despite over 20 years of CPD activity in the field of public health, limited literature examines the underlying theoretical principles, or proposes the most effective approach to adopt. Public health CPD is a mandatory requirement for ongoing practice in many professional groups; it is therefore timely to examine theoretical principles and to propose the adoption of an andragogical approach to underpin CPD for all disciplines in public health. This paper concludes that adopting an andragogical approach to public health CPD, supported with critical reflective practice and undertaken in an ethical and moral framework, will equip practitioners to be ready to question practice, implement innovation and progress, and meet the challenges of a multiprofessional public health service.

Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men

George Mnatzaganian1 Philip Ryan1,2 Paul E Norman3 David C Davidson4 Janet E Hiller1,5 1School of Population Health and Clinical Practice, Discipline of Public Health, 2Data Management and Analysis Centre, The University of Adelaide, South Australia; 3School of Surgery, University of Western Australia, Western Australia; 4Royal Adelaide Hospital, South Australia; 5Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia

Frontiers in Osteoarthritis: Executive Summary of the Scientific Meeting

Osteoarthritis (OA) is the most common form of arthritis and represents the leading cause of disability in the USA. Importantly, with an aging population, the prevalence, impact, and economic consequences of OA will rise dramatically within the next decades. Although much has been learned concerning the factors that play a role in the initiation and progression of OA, this information has not been effectively translated into individual or public health strategies that have significantly altered the natural history of this disabling form of arthritis. While total joint arthroplasty is an effective treatment for the late stages of OA, no validated pharmacologic interventions exist for effectively eliminating pain and restoring function during disease progression. Although initially regarded as a disease of articular cartilage, numerous lines of investigation have established that OA represents an example of total “organ failure,” in which every component of the joint tissues, including the cartilage, synovium, periarticular bone, and connective tissues, is affected by the disease process. Given OA’s pleiotropic effects on joint tissues, the development of effective diagnostic, preventative, and treatment strategies requires a broad interdisciplinary approach that embraces multiple scientific and public health disciplines. This need formed the basis for the sponsorship of the “Osteoarthritis Summit: Frontiers in OA Research, Prevention, and Care” that was held at the Hospital for Special Surgery in New York in June, 2011, the results of which are published in this issue of the HSS Journal. The Osteoarthritis Summit brought together research scientists; clinicians caring for patients with OA; governmental officials responsible for aiding and directing research; representatives from major OA research societies and foundations; and members of the pharmaceutical, device, and insurance industries in a workshop setting (Fig. ​(Fig.1).1). The meeting was organized into a series of six sessions that included concise presentations from the meeting attendees. Each session focused on a specific aspect of OA, progressing from an overview of the clinician’s perspective and the classification and epidemiology of OA to a session on pathological and pathogenic processes in OA, including structural alterations and the onset and characterization of symptoms. The third session focused on the diagnosis and assessment of OA, while the fourth centered on strategies for OA prevention. The fifth and sixth sessions covered current treatments for OA and identified opportunities and priorities for development of future therapies and public health strategies. The formal presentations were followed by extended breakout sessions that provided an open forum for discussion of perspectives that addressed critical questions related to OA with the goal of reaching consensus on the current state of knowledge of OA research and the strategies for OA diagnosis, prevention, and treatment. Fig. 1 Participants of the Osteoarthritis Summit: Frontiers in OA Research, Prevention, and Care. Courtesy of Hospital for Special Surgery. Bottom row (left to right): Virginia Kraus, MD, PhD; Steven Goldring, MD; Timothy Wright, PhD; Linda Sandell, MD; Constance ...

Public Health Ethics Theory: Review and Path to Convergence

Public health ethics is a nascent field, emerging over the past decade as an applied field merging concepts of clinical and research ethics. Because the "patient" in public health is the population rather than the individual, existing principles might be weighted differently, or there might be different ethical principles to consider. This paper reviewed the evolution of public health ethics, the use of bioethics as its model, and the proposed frameworks for public health ethics through 2010. Review of 13 major public health ethics frameworks published over the past 15 years yields a wide variety of theoretical approaches, some similar foundational values, and a few similar operating principles. Coming to a consensus on the reach, purpose, and ends of public health is necessary if we are to agree on what ethical underpinnings drive us, what foundational values bring us to these underpinnings, and what operating principles practitioners must implement to make ethical decisions. If public health is distinct enough from clinical medicine to warrant its own set of ethical and philosophical underpinnings, then a decision must be made as to whether a single approach is warranted or we can tolerate a variety of equal but different perspectives.

Towards a Public Health Curriculum in Undergraduate Medicine

The need to adequately train medical professionals in public health has been recognised internationally. Despite this, public health curricula, particularly in undergraduate medicine, are poorly defined. This study explored the public health disciplines that newly qualified doctors in the United Kingdom (UK) should know. We developed a 31-item questionnaire covering public health subject areas and expected competencies that medical graduates should know. The questionnaire was then administered to a stratified sample of medically trained individuals across a number of postgraduate schools of public health in the UK. Following administration, a ranking list was developed by subject area and by competency. There was an 85% response rate (69/81). Subject areas ranked highest included epidemiology, health promotion and health protection. Sociology and the history of public health ranked lowest. Competencies perceived as important by the respondents included understanding health inequalities, empowering people about health issues and assessing the effectiveness of healthcare programmes. Our study identifies the expected public health subject areas and competencies that newly graduating medical students should know. They provide a context through which to begin addressing concerns over the disparity between these expectations and what is actually taught in medical school, highlighting the continuing need to reframe undergraduate public health education in the UK.

Biofortification: a global challenge program

A Global Challenge Program on Biofortification with proposed funding of US$90 million over 10 years has just been approved by the Consultative Group on International Agricultural Research (CGIAR). Program researchers in collaborating agricultural and public health (nutrition) disciplines will apply food systems strategies to deliver more nutritious staple crops to resource-poor consumers. Improved grain will be richer in iron, zinc, vitamin A, selenium, and iodine, as needed.