Evidence-based Public Health Research Articles

Evaluation of implementation of evidence-based public health training in sub-Saharan Africa.

The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) developed and offered a course on evidence-based public health (EBPH) in five sub-Saharan African (SSA) countries to enhance individual and institutional capacity. This study aims to assess, compare and learn from implementing the CEBHA+ EBPH course using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Practical, Robust, Implementation and Sustainability Model (PRISM). This study involved CEHBA+ partner universities in five countries in SSA. We developed a framework that draws on signalling questions for RE-AIM and PRISM dimensions. Country teams reflected on, discussed and mapped unique experiences. Using this framework, we then elicited common themes across countries and distilled country-specific experiences through virtual discussions. Across countries, 130 public health practitioners, researchers and students completed the course (Reach). The course increased EBPH knowledge and skills and the capacity to teach EBPH and resulted in immediate opportunities for applying skills (Effectiveness). Hybrid offering in two countries presented challenges regarding Internet connectivity and hybrid discussions. Facilitators had previous training in teaching EBPH. While learning material was the same across countries, the content was adapted to represent local public health priorities (Implementation, Adoption). Course materials have informed other related training leading to spin-offs (Maintenance). Institutionalisation is dependent on external funding. Strengthening EBPH capacity across contexts is feasible. Curricula containing both core and contextualised elements create an authentic learning environment. Formal evaluations should be embedded within capacity-strengthening initiatives. This is the first study evaluating EBPH training in SSA using an implementation science lens, offering learning about context-relevant adaptations that assist with plans for sustainability and scale.

Alcohol Consumption and Cancer Risk: A Meta-Analysis and Systematic Review in Germany

Background: Alcohol consumption is a prevalent behavior in Germany, deeply rooted in cultural traditions and societal norms. The relationship between alcohol consumption and cancer risk has been extensively studied globally, with evidence suggesting a positive association. However, the nuances of this association within the German population remain to be fully elucidated, considering the diverse patterns of alcohol consumption and regional variations in cancer incidence. Methods: This protocol outlines the methodology for a systematic review and meta-analysis aimed at examining the association between alcohol consumption and cancer risk in Germany. A comprehensive search strategy will be employed to identify relevant studies published until 2024. Inclusion criteria will encompass observational studies reporting on alcohol consumption levels and cancer incidence or mortality outcomes among adults in Germany. Data extraction, quality assessment, and statistical analyses will be conducted following established guidelines, including subgroup analyses based on alcohol type, consumption level, and cancer type. Results: The anticipated results will include a synthesis of the literature on alcohol consumption and cancer risk in Germany. The protocol expects to identify a substantial number of studies meeting the inclusion criteria, providing a robust dataset for meta-analysis. The meta-analysis will explore the association between alcohol consumption and overall cancer risk, as well as conduct subgroup analyses to investigate differential associations with specific cancer types based on alcohol type and consumption level. Conclusion: This protocol outlines a systematic approach to examining the association between alcohol consumption and cancer risk in Germany. The anticipated results will contribute to a better understanding of this relationship within the German population, informing evidence-based public health interventions and policy initiatives aimed at reducing the burden of alcohol-related cancers.

Equipping the Public Health Workforce of the Future: Evaluation of an Evidence-Based Public Health Training Delivered Through Academic-Health Department Partnerships.

Maintaining a skilled public health workforce is essential but challenging given high turnover and that few staff hold a public health degree. Situating workforce development within existing structures leverages the strengths of different organizations and can build relationships to address public health challenges and health equity. We implemented and evaluated an innovative, sustainable model to deliver an established evidence-based public health (EBPH) training collaboratively among Prevention Research Centers (PRC), local and state health departments, and Public Health Training Centers (PHTC). Quantitative data: quasi-experimental, 1-group pre-post. Qualitative data: cross-sectional. Data were collected between December 2021 and August 2022. Four US sites, each a partnership between a PRC, local or state health department, and a PHTC. Governmental public health staff and representatives from other organizations that implement public health programs in practice settings. Course participants completed a pre- and postcourse survey self-rating 14 skills on a 5-point Likert scale. Differences were analyzed using mixed effects linear models. In-depth interviews (n=15) were conducted with course faculty and partners to understand: (1) resources contributed, (2) barriers and facilitators, (3) benefits and challenges, and (4) resources needed to sustain this model. Interviews were transcribed verbatim, and a thematic analysis identified themes. Statistically significant increases in all skills were observed from pre- to postcourse (n=241 at post, 90% response). The skills with the largest increases were understanding economic evaluation enough to inform decision-making (mean change=1.22, standard error [SE]=0.05) and developing an action plan (mean change=1.07, SE=0.07). Facilitators to delivering the course included having a shared goal of workforce development, existing course curricula, and dedicated funding for delivering the course. Collaborative delivery of the EBPH training can ameliorate the effects of high staff turnover, strengthen academic-practice relationships, and promote population-wide health and health equity.

Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence

Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown. In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143). We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes. Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes. Epilepsy Research Institute UK.

Rise in Serum 25-Hydroxyvitamin D Levels during the COVID-19 Pandemic.

With the emergence of the COVID-19 pandemic, the absence of established evidence-based treatment protocols led healthcare professionals and the public to explore experimental treatments, including high doses of vitamin D supplements. This study aimed to assess changes in serum 25-hydroxyvitamin D levels during the pandemic, employing a retrospective cohort analysis of data from Charleston Area Medical Center (CAMC). The study analyzed serum 25-hydroxyvitamin D levels in a cohort of 35,556 patients treated at CAMC in 2019, a representative pre-pandemic period, to 2021, a representative pandemic period. Our findings revealed a significant increase in mean serum 25-hydroxyvitamin D levels as compared with 2019 (37 ± 21 vs. 31 ± 15 ng/mL, p ≤ 0.001). Additionally, in 2021, there were significantly more patients exhibiting serum levels in the highest quintiles, specifically >100 ng/mL (1.6% vs. 0.2%), 75-100 ng/mL (4.6% vs. 1.2%), and 50-75 ng/mL (16.0% vs. 8.4%), p ≤ 0.001. This upsurge suggests increased intake of vitamin D supplements, potentially fueled by widespread discussions that were taking place largely on the internet regarding the efficacy of vitamin D against COVID-19. Our findings underscore the critical need for evidence-based public health messaging, especially during health crises, to prevent unnecessary health risks and ensure patient safety.

Understanding Knowledge Mobilisation between Community Champions and Parents: Evidence from a Community-Based Programme to Support Parents with Young Children.

Community champions have been employed across various settings to disseminate evidence-based public health information. The Building Babies' Brains programme trains champions to work with parents in communities, equipping them with child development knowledge and parental engagement strategies. We explored what makes community champions effective in distributing information to parents, including how the champion-parent relationship and champions' personal characteristics affect information dissemination. Champions included both peers and professionals working with parents in target communities. We administered an online survey (n = 53) and follow-up interviews (n = 14) with champions, with representation from across all training cohorts. We conducted a realist-informed reflexive thematic analysis to generate themes in the data and highlight the contexts, mechanisms, and outcome patterns identified. We observed 15 Context-Mechanism-Outcome configurations across five themes: information sharing opportunities, information relevance, the nature of the champion-parent relationship, interaction expectations, and champion confidence. Our programme theory for how the community champion approach works identified that peer champions focused more on building rapport, modelling behaviours, and being a trusted community resource than direct information transfer. Professional champions, in contrast, showed greater expertise and confidence in discussing parenting practices directly. For both groups, traits such as friendliness and the ability to establish a trusting relationship enhanced effectiveness. This research identifies the impacts of champion role, characteristics, and the champion-parent relationship on the effectiveness of knowledge mobilisation in this context, with implications for training and recruitment of champions. Those using a champion model in comparable settings should ensure that champions have the necessary knowledge, skills, and confidence to engage parents and share information effectively.

Infectious disease surveillance needs for the United States: lessons from Covid-19.

The COVID-19 pandemic has highlighted the need to upgrade systems for infectious disease surveillance and forecasting and modeling of the spread of infection, both of which inform evidence-based public health guidance and policies. Here, we discuss requirements for an effective surveillance system to support decision making during a pandemic, drawing on the lessons of COVID-19 in the U.S., while looking to jurisdictions in the U.S. and beyond to learn lessons about the value of specific data types. In this report, we define the range of decisions for which surveillance data are required, the data elements needed to inform these decisions and to calibrate inputs and outputs of transmission-dynamic models, and the types of data needed to inform decisions by state, territorial, local, and tribal health authorities. We define actions needed to ensure that such data will be available and consider the contribution of such efforts to improving health equity.

Building Partnerships Out of Barriers: Lessons Learned From Partnerships Between Centers for Independent Living and Health Departments During the COVID-19 Pandemic.

People with disabilities were left behind in the beginning of the COVID-19 vaccination rollout. More work needs to be done to connect people with disabilities to public health initiatives. Centers for Independent Living (CILs) are an important and under-utilized community partner for health departments and should be engaged as a trusted source when working to reach people with disabilities and improve access to public health programs and services. The National Foundation for the Centers for Disease Control and Prevention (CDC Foundation), through funding from the CDC, launched the Leveraging CILs to Increase Vaccine Access for People with Disabilities project. The primary goal was to increase accessibility of the COVID-19 vaccination among people with disabilities through (1) outreach and education, (2) service linkage and barrier removal through increasing accessible, (3) widespread education about the vaccine, and (4) improved partnerships between disability-led organizations and local health care providers. A grant program resulted in 39 awards distributed to CILs across the United States totaling $2 955 294.00 between November 2021 and March 2023. The project successfully resulted in reported improvements in partnerships between funded CILs and local health providers and a reported reduction in barriers to accessing vaccinations faced by people with disabilities. A suite of resources was also created to address targeted needs identified throughout partner implementation. Successful outreach to the targeted population resulted in 27 044 consumers being directly reached by CILs and 3 675 655 people reached through communication and outreach activities. Catalytic funding to disability-led organizations during public health emergency response and including people with disabilities as subject matter experts in program design can successfully strengthen access to care via trust building, message dissemination, and partnership. Building the capacity of community-based and consumer-led partners to implement evidence-based public health programming can provide a foundation for improved care for people with disabilities, particularly during an emergency response.

Exploring Bioactive Compounds in Underutilized Fruit Crops of Arid and Semi-Arid Regions: A Comprehensive Review

Exploring the bioactive compounds in underutilized fruit crops of arid regions reveals a wealth of phytochemicals, including polyphenols, vitamins, polyunsaturated fatty acids, amino acids, and carotenoids. These compounds exhibit significant health benefits, evidenced through both in vitro and in vivo studies, demonstrating antioxidant, anti-inflammatory, antimicrobial, hypolipidemic and neuroactive properties. This review delves into the bioactive compounds found in fruits of arid and semi-arid regions, highlighting their phytochemical compositions and their potential in preventing chronic diseases, thereby enhancing human health. Underutilized fruit crops, typically grown and consumed locally rather than being commercially cultivated or widely traded, offer several advantages. They are easier to grow, more resilient to climate change, and exceptionally rich in phytochemicals with medicinal properties. These fruits, such as Indian jujube, Indian gooseberry, bael, and tamarind, among others, are valuable for their high nutritional content and potential to meet the dietary needs of rural populations in arid regions. Local knowledge attests to their nutritional and medicinal benefits, necessitating rigorous study for conservation and nutritional characterization to broaden future food options and enhance functional and nutritional values. This review outlines the ethnobotany, medicinal and nutritional values, biodiversity conservation, and utilization strategies for significant underutilized fruit crops from arid and semi-arid regions. These fruits are rich in diverse phytochemical compounds like flavonoids, tannins, terpenoids, saponins, glycosides, and alkaloids, which are utilized to treat various health conditions in humans and livestock. Their extracts demonstrate a range of activities, including antipyretic, analgesic, anti-inflammatory, anticancer, antimicrobial, antiplasmodial and antinociceptive effects. Highlighting the current research on the nutritional profiling, chemical composition, and potential applications of these fruits, this chapter addresses the knowledge gap concerning the health benefits of consuming arid and semi-arid fruits. This is particularly relevant given the growing interest in "superfoods" and the need for evidence-based public health guidelines to inform consumers about the benefits of polyphenol-rich plant foods in preventing chronic diseases such as cardiovascular disease and cancer.

Developing a gender affirming health response for trans and gender diverse Australians: a qualitative study

Introduction As trans and gender diverse populations experience disproportionately higher rates of discrimination, violence, mental health challenges, unemployment, and financial hardship, it is important to develop an evidence-based public health response for trans and gender diverse people seeking gender-affirming surgery (GAS). Resourcing and pathways for access vary across Australian states, with little research exploring the experiences of trans and gender-diverse people seeking GAS in Australia. Methods In-depth semi-structured interviews (N = 9) were conducted with three trans and gender diverse individuals, and six key representatives from community organizations (of which five identified as trans or gender diverse) in Queensland, Australia. Braun and Clarke’s reflexive thematic analysis was employed to analyze interview data. Results Interviews explored experiences with and attitudes toward existing models of gender-affirming care, barriers to the provision of GAS, and opportunities for developing and implementing a publicly funded gender-affirming model in Australia. Findings indicate individual, societal, and structural barriers prohibit access to GAS, with opportunities identified to improve health and wellbeing outcomes for trans and gender diverse people in Australia. Conclusions Findings are relevant to both future research and informing clinical policy, to establish appropriate and accessible pathways to GAS in Australia. Further research is required to inform the development of a publicly-funded model within the Australian context. Exploration of health economics and health service optimization would facilitate better understanding of individual trajectories and health outcomes within Australia, and ensure that any reform applies a person-centered approach to care

Temporal trends in population attributable fractions of modifiable risk factors for dementia: a time-series study of the English Longitudinal Study of Ageing (2004–2019)

BackgroundInterest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England.MethodsWe used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES).ResultsThe overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased.ConclusionsIn England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Distilling the Fundamentals of Evidence-Based Public Health Policy.

Public health policy interventions are associated with many important public health achievements. To provide public health practitioners and decision makers with practical approaches for examining and employing evidence-based public health (EBPH) policy interventions, we describe the characteristics and benefits that distinguish EBPH policy interventions from programmatic interventions. These characteristics include focusing on health at a population level, focusing on upstream drivers of health, and involving less individual action than programmatic interventions. The benefits of EBPH policy interventions include more sustained effects on health than many programs and an enhanced ability to address health inequities. Early childhood education and universal preschool provide a case example that illustrates the distinction between EBPH policy and programmatic interventions. This review serves as the foundation for 3 concepts that support the effective use of public health policy interventions: applying core component thinking to understand the population health effects of EBPH policy interventions; understanding the influence of existing policies, policy supports, and the context in which a particular policy is implemented on the effectiveness of that policy; and employing a systems thinking approach to identify leverage points where policy implementation can have a meaningful effect.

Recommended Strategies to Prioritize Evidence-Based Public Health Authority.

Recommended Strategies to Prioritize Evidence-Based Public Health Authority.

Nurses’ Perception on Evidence Based Practice in Tertiary Hospital of Nepal: A Quantitative Cross-sectional Study

Background: The evidence-based practice movement has spread globally, prompting calls for evidence-based policymaking and public health. Health care being the dynamic discipline with research, is, intended to improve practice through evidence-based novel approaches. As evidence based practice (EBP) among nurses is essential for improving the quality of care, fewer pieces of evidence are available in Nepal. This study aimed to assess the perception of evidence-based practice among nurses of a tertiary hospital in Nepal. Methods: We conducted a quantitative cross-sectional study among the 100 nurses of Bir Hospital in Kathmandu. The self-administered questionnaires were applied using the survey instrument by Upton and Upton. A purposive sampling technique was employed. We calculated the mean score to assess the nurses’ perceptions in the three sub-scales of knowledge, attitude, and use of evidence-based practice. Bivariate analysis was performed to examine the relationship between subscales. Results: The majority (89.0%) of nurses did not receive training on evidence-based practices. The mean score of knowledge on EBP was 4.47±1.11, the mean score of attitude on EBP was 4.45±1.06, and the mean score of EBP use was 4.18±1.42. EBP knowledge, attitude, and use were not significantly associated with the selected demographic variables (age, work experience, EBP training and marital status). Conclusion: Nurses’ perceptions of evidence-based practice were moderate. The implementation of EBP use needs to be strengthened among the nurses. Nurses need to be more involved in the implementation of EBP. To incorporate evidence in practice, nurses require training and support from high authorities.

Passive and low-energy strategies to improve sleep thermal comfort and energy resilience during heat waves and cold snaps

Sleep is a pillar of human health and wellbeing. In high- and middle-income countries, there is a great reliance on heating, ventilation, and air conditioning systems (HVAC) to control the interior thermal environment in the bedroom. However, these systems are expensive to buy, maintain, and operate while being energy and environmentally intensive—problems that may increase due to climate change. Easily-accessible passive and low-energy strategies, such as fans and electrical heated blankets, address these challenges but their comparative effectiveness for providing comfort in sleep environments has not been studied. We used a thermal manikin to experimentally show that many passive and low-energy strategies are highly effective in supplementing or replacing HVAC systems during sleep. Using passive strategies in combination with low-energy strategies that elevate air movement like ceiling or pedestal fans enhances the cooling effect by three times compared to using fans alone. We extrapolated our experimental findings to estimate heating and cooling effects in two historical case studies: the 2015 Pakistan heat wave and the 2021 Texas power crisis. Passive and low-energy strategies reduced sleep-time heat or cold exposure by 69–91%. The low-energy strategies we tested require one to two orders of magnitude less energy than HVAC systems, and the passive strategies require no energy input. These strategies can also help reduce peak load surges and total energy demand in extreme temperature events. This reduces the need for utility load shedding, which can put individuals at risk of hazardous heat or cold exposure. Our results may serve as a starting point for evidence-based public health guidelines on how individuals can sleep better during heat waves and cold snaps without relying on HVAC.

Advancing Evidence-Based Public Health Policy: How Core Component Thinking Can Illuminate the Multilevel Nature of Public Health Policy.

A growing body of literature uses the concept of core components to better understand small-scale programmatic interventions. Instead of interventions being viewed as unitary "black boxes," interventions are viewed as configurations of core components, which are the parts of interventions that carry their causal potential and therefore need to be reproduced with fidelity to produce the intended effect. To date, the concept of core components has not been as widely applied to public health policy interventions as it has to programmatic interventions. The purpose of this topical review is to familiarize public health practitioners and policy makers with the concept of core components as applied to public health policy interventions. Raising the profile of core component thinking can foster mindful adaptation and implementation of public health policy interventions while encouraging further research to enhance the supporting evidence base. We present 3 types of multilevel interactions in which the core components of a public health policy intervention produce effects at the population level by (1) seeking to directly affect individual behavior, (2) facilitating adoption of programmatic interventions by intermediaries, and (3) encouraging intermediaries to take action that can shape changes in upstream drivers of population health. Changing the unit of analysis from whole policies to core components can provide a basis for understanding how policies work and for facilitating novel evidence-generating strategies and rapid evidence reviews that can inform future adaptation efforts.

Leveraging systems science and design thinking to advance implementation science: moving toward a solution-oriented paradigm.

Many public health challenges are characterized by complexity that reflects the dynamic systems in which they occur. Such systems involve multiple interdependent factors, actors, and sectors that influence health, and are a primary driver of challenges of insufficient implementation, sustainment, and scale of evidence-based public health interventions. Implementation science frameworks have been developed to help embed evidence-based interventions in diverse settings and identify key factors that facilitate or hinder implementation. These frameworks are largely static in that they do not explain the nature and dynamics of interrelationships among the identified determinants, nor how those determinants might change over time. Furthermore, most implementation science frameworks are top-down, deterministic, and linear, leaving critical gaps in understanding of both how to intervene on determinants of successful implementation and how to scale evidence-based solutions. Design thinking and systems science offer methods for transforming this problem-oriented paradigm into one that is solution-oriented. This article describes these two approaches and how they can be integrated into implementation science strategies to promote implementation, sustainment, and scaling of public health innovation, ultimately resulting in transformative systems changes that improve population health.

Beach day or deadly heatwave? Content analysis of media images from the 2021 Heat Dome in Canada

AbstractDuring extreme heat events (EHEs) the public often learns about health protective actions through the media. Visual news coverage can act as a powerful tool to help convey complex health protective actions to the public. Despite the importance of images in helping the public understand the risk, there has been no systematic analysis to assess what images have been used by media outlets in Canada during EHEs. This paper helps to fill that gap by analyzing how the Canadian media visually communicated the risks of extreme heat to the public during the unprecedented 2021 Heat Dome. A review of thousands of online news media articles published about the 2021 Heat Dome in Canada was conducted on five subscription news databases. Overall, 845 images were coded to identify denotative, connotative, and ideological content. Only 16% of these published images implied that heat was dangerous, of which only 40% depicted people, and 46% implied human suffering. Our findings demonstrate that the majority of images used in Canadian news coverage on the 2021 Heat Dome are incompatible with, and frequently contradict, evidence-based heat protective actions. Governments, public health agencies, and other stakeholders engaged in distributing heat preparedness messaging (e.g., journalists) should prioritize improving the images of extreme heat in news coverage to align with evidence-based public health messages. With rising global temperatures due to climate change and the associated increases in the frequency and intensity of extreme heat events, prioritizing these actions is critically important to offset the threat posed to public health.

Understanding Vaccine Hesitancy Dynamics: Insights from Northern Mindanao, Philippines

Background & Aim: Amidst the ongoing COVID-19 pandemic, vaccine hesitancy persists, especially within specific demographics. This study delved into vaccine hesitancy among Northern Mindanao, Philippines, residents aged 20 to 64, aiming to understand factors shaping vaccination decisions. Employing the Health Belief Model, the research sought to dispel misconceptions and bolster vaccine uptake through evidence-based public health education and improved communication strategies. By examining socio-demographic variables like age, gender, education, religion, and vaccination status, the study informed targeted interventions for enhancing vaccine acceptance and bolstering community health outcomes. Methods: This study employed a quantitative, descriptive-correlational design and analyzed vaccine hesitancy factors among Northern Mindanao, Philippines residents aged 20 to 64. Stratified sampling ensured representative inclusion across age groups, with a sample size of 372 respondents. Statistical analyses, including F-tests and ANOVA, assessed hesitancy differences, while stringent adherence to data privacy regulations safeguarded participant confidentiality. Results: Among respondents, those aged 51 to 69 exhibited the highest vaccine hesitancy levels, particularly regarding uncertainty and knowledge about COVID-19 vaccines. However, no significant relationship was found between hesitancy levels and age or gender. Conversely, significant disparities in hesitancy were observed concerning educational attainment, religion, and vaccination status. Conclusion: While age, gender, education, and religion are associated with varying levels of COVID-19 vaccine hesitancy, none singularly determine hesitancy. Enhanced education and knowledge about vaccines correlate with decreased hesitancy, emphasizing the necessity of targeted education initiatives. However, significant hesitancy disparities based on vaccination status underscore the ongoing challenge of addressing hesitancy despite reassurances about vaccine safety. Recommendation: Implementing tailored educational programs that address specific concerns related to demographic factors is recommended as a crucial strategy for reducing COVID-19 vaccine hesitancy

Dysnatremia in a changing climate: A global systematic review of the association between serum sodium and ambient temperature.

Both hyponatremia and hypernatremia have been reported to occur more frequently with higher ambient temperatures, although the underlying mechanisms are not well understood. Global temperatures are rising due to climate change, which may impact the incidence of dysnatremia worldwide. We aimed to identify, collate and critically appraise studies analyzing the relationship between climate measures (outdoor temperature, humidity) and serum sodium concentrations. Systematic review, reported in accordance with PRISMA guidelines. MEDLINE and Embase were searched with relevant key terms. Studies assessing the effect on serum sodium measurement of elevated temperature or humidity versus a comparator were included. Of 1466 potentially relevant studies, 34 met inclusion criteria, originating from 23 countries spanning all inhabited continents. The majority (30 of 34, 88%) reported a significant association between outdoor temperature and dysnatremia, predominantly lower serum sodium with increased ambient temperature. Humidity had a less consistent effect. Individuals aged above 65 years, children, those taking diuretics and antidepressants, those with chronic renal impairment or those undertaking physical exertion had increased vulnerability to heat-associated dysnatremia. The risk of bias was assessed to be high in all but four studies. Higher ambient temperature is consistently associated with an increased incidence of hyponatremia. We infer that hyponatremia presentations are likely to rise with increasing global temperatures and the frequency of extreme heat events secondary to climate change. Evidence-based public health messages, clinician education and reduction in fossil fuel consumption are necessary to reduce the expected burden on healthcare services worldwide.