Public Health Framework Research Articles

Spatio-Temporal Investigations of Dengue Fever in Pakistan Through an HL7 Based Public Health Framework for Hotspot Analysis

The importance of a standard based interoperability framework is now widely recognized. In order to understand the challenges, feasibility and impact of outcomes of such architectures for public health improvement, it is important to implement and demonstrate the usefulness of data analytics based on pathway provided by the framework. This work provides an implementation details and results of transferring dengue data from source database to data analytical programs used by public health authorities. Dengue fever, a mosquito-borne disease that occurs in tropical and subtropical areas of the world, is considered to be a significant threat in both developing and the developed countries. This study investigates the spatio-temporal distribution of dengue in Pakistan from the years 2014-2017 and identify the most frequently affected hotspots of dengue across the the 3 provinces in the country using data mining, clustering and GIS based analysis of data. In addition, the identification of most vulnerable dengue locations has led to investigation into the potential environmental or geographical conditions that may have contributed to dengue prevalence in the area. These investigations present interesting results that shows positive correlation for temperature, humidity and population density with the dengue incidences. In addition, the results are able to identify disease hotspots over time windows that can be mapped to any spatio-temporal scales. The outcome of this research is crucial for optimal use of resources for combating dengue fever at a regional or national scale by identifying the hotspots. The hotspots identified can be use to create a sentinel surveillance network for a pandemic disease. In addition, the work serves as a useful reference for a comprehensive national level early warning and rapid disease outbreak detection framework for any disease of public health context.

Public Health from the Middle-Out: A New Analytical Perspective.

Obstacles to collaborative public health frameworks such as Health in All Policies continue to emerge. Partnership-based public health programs present opportunities to study how public servants and practitioners address these barriers in real time. To this end, we utilized “Middle-Out,” a socio-technical analytical approach that highlights the importance of Middle Actors-stakeholders positioned between policymakers and grassroots—to policy diffusion, innovation and collaboration in public health. We conducted participatory observation in administrative settings of Israel’s National Program to Promote Active, Healthy Lifestyle, 30 stakeholder interviews and document analysis. We examined two dimensions of impact from the Middle-Out: Directions of Influence—Middle-Up, Middle-Down and Sideways, and Modes of Influence—Enabling, Mediating and Aggregating. Through Middle-Out’s lens, our analysis transcends visible benchmarks such as legislation and macro-level resource-allocation, focusing, instead, on elusive administrative spaces within which Middle Actors shape policies, steer funding and facilitate continuity. Incorporating Middle-Out into public health’s conceptual toolbox, we conclude, can improve understanding of complex public health policy arenas, increase recognition of critical socio-technical changemakers and catalyze more effective design of policy tools and strategies that specifically harness Middle Actors’ strengths and qualities.

Impact of social violence and childhood adversities on pregnancy outcomes: a longitudinal study in Tunisia.

BackgroundAccumulating research suggests that exposure to intra-familial adversities are significant risk factors for adverse pregnancy outcomes. However, the relationship between social violence (peer violence, witnessing community violence and exposure to collective violence) and pregnancy outcomes has not been extensively investigated. Our study aims to examine the association between social Adverse Childhood Experiences (ACEs) and pregnancy outcomes and to explore the role of depression during pregnancy as a mediator of this association.MethodsWe performed a prospective follow-up study of pregnant women in five Primary Health care Centers (PHC) in the region of Monastir (Tunisia) from September 2015 to August 2016. Enrolled women were followed during the second trimester, third trimester of pregnancy and during the postnatal period. Exposure to violence was assessed retrospectively using the validated Arabic version of the World Health Organization (WHO) ACE questionnaire. The Self Reporting Questionnaire 20-Item (SRQ-20) was used as a screening tool for depression during pregnancy.ResultsWe recruited and followed a total of 593 women during the study period. Witnessing community violence was the most frequently reported social ACE among pregnant women (237; 40%), followed by peer violence (233; 39.3%). After adjustment for high risk pregnancies, environmental tobacco smoke, and intra-familial ACEs, the risk of premature birth was significantly associated with exposure to collective violence (P < 0.001) and witnessing community violence (P < 0.05). The risk of low birth weight was significantly associated with witnessing community violence (P < 0.001). In the mediation analysis, depression mediated significant proportions of the relationship between the cumulative number of ACEs and pregnancy outcomes.ConclusionsSocial ACEs may have a long-term effect on maternal reproductive health, as manifested by offspring that were of reduced birth weight and shorter gestational age. A public health framework based on the collaboration between pediatric, psychiatric obstetrical health professionals, education professionals and policy makers could be applied to ensure primary prevention of childhood adversities and pay attention to expected mothers with history of exposure to such adversities.

Regulation of Illegal Drugs – No Longer “What”?, but “How”?

The debate about the prohibition of drugs has taken a fundamental turn with the publication of ‘Regulation: The Responsible Control of Drugs’ by the Global Commission on Drug Policy. This edition of the journal publishes papers addressing how to regulate drugs, which informed the Global Commission report. These papers shift the discussion from what must be done, i.e. end prohibition, to how regulation can be implemented. These papers shift the discourse from a ‘drugs are the problem’ paradigm to ‘management of drugs is the problem’. Implications of regulation means: accepting that people should have controlled access, within a public health framework, to a range of psychoactive substances for non-medical use purposes highlighting of the incoherence of substance use management policy and regulation between legal and illegal substances blurring the dichotomy concept of medical and non-medical use supporting rigorous monitoring, evaluation, and research Consideration of implementing public interest–based regulated drug markets is gaining traction. This will not be without challenges, including pressure from profit-driven interests to weaken the public health orientation. Governments can be capable and competent when provided with technical support to regulate risky products, so should move from rigid adherence to the failed drug prohibition policy to regulation based on public health and human rights principles. This will help refocus on achieving the fundamental aim of the UN drug treaties – promotion of the health and welfare of humankind.

139. The Morbidity and Financial Burden of Infective Endocarditis in Persons Who Inject Drugs in the Deep South

BackgroundIn the context of the opioid epidemic, infective endocarditis (IE) poses an economic challenge in Alabama. The objective of this proposal is to analyze the outcomes and financial burden of IE in persons who inject drugs (PWID) at The University of Alabama at Birmingham (UAB) Hospital, the largest tertiary referral center in this rural, Southern state. We hypothesized that those with the most severe substance use disorder would be most costly.MethodsThis is a retrospective study of PWID receiving care for IE at UAB Hospital from October 1, 2016 to March 1, 2019. IE was defined by Infectious Diseases consultation. Clinical data were obtained from the electronic medical record (EMR). Deaths were obtained from both the EMR and the regional medical examiner. Hospital costs (direct costs, overall charges) were obtained from financial accounts. To stratify patients by severity of substance use disorder, we used a 9-item risk assessment for PWID (see table). We then evaluated the association between clinical factors and outcomes (death, cost) using parametric and nonparametric tests when appropriate. A P-value < 0.05 was considered significant.ResultsA total of 69 persons met criteria (Table 1). The average length of stay was 30.8 days. Thirty-four (52%) had documentation of antibiotic completion (in or outpatient). Seventeen received surgery: 16 with valve replacement and one device removal. Overall, 14 (20%) died over the study period. There was no significant association between antibiotic completion or 9-item risk and death. When stratified into low risk (<4 items) vs. high risk (≥5), there was no difference in overall direct costs, LOS, or whether patients received surgery.ConclusionPWID with IE at a hospital serving a rural, Southern population have a greater length of stay, discharges against advice, surgical interventions, and costs than other regions, relative to existing literature. The lack of association between 9-item risk and outcomes suggests that death and high costs are attributable to factors beyond substance use. Costs of providing care for this population are exorbitant and likely devastating for rural county hospitals within the context of the current public health and payment framework, including Medicaid non-expansion. Disclosures All authors: No reported disclosures.

Framing Community-Based Interventions for Gun Violence: A Review of the Literature.

Social workers are uniquely situated to lead community-based efforts to reduce gun violence, which has been identified as a prevalent and pressing public health concern. The current literature, however, has not addressed the frameworks guiding community-based interventions for gun violence. In the present article, a systematic literature review examines frameworks used to support community-based interventions for gun violence and to evaluate their outcomes. The search found 13 articles-unique to gun violence interventions-organized by the frameworks shaping perceptions of gun violence and community-based research. The review assessed frameworks based on their relationship to intervention stage and study outcomes. Findings suggest that these community-based gun violence interventions are shaped by systems, public health, and community mobilization frameworks. The article discusses frameworks found to be associated with successful community-based interventions and explains how the findings are relevant to future social work practice and research.

Leveraging a Public Health Framework and Community Advisory Board to Innovate Workplace Violence Intervention Strategies.

Even with extensive evidence documenting the incidence, risk factors, and negative outcomes of workplace violence (WPV) against emergency department (ED) employees, there is a lack of intervention strategies reported that could be subjected to a clinical trial in the ED setting. The purpose of this article is to report the outcomes of a novel process adapted from the Framework for Program Evaluation in Public Health for soliciting intervention strategies from a WPV Community Advisory Board (CAB) organized by the U.S. Occupational Safety and Health Administration's WPV prevention guidelines. Ten professionals comprising both practitioners and researchers from a variety of disciplines ultimately constituted the WPV CAB. In total, 127 strategies to address WPV in ED settings organized by the Occupational Safety and Health Administration's WPV guideline elements were recommended. The use of a CAB and the Framework was shown to be effective for generating WPV intervention strategies.

A Public Health Framework to Improve Population Health Through Health Care and Community Clinical Linkages: The ASTHO/CDC Heart Disease and Stroke Prevention Learning Collaborative

Thirty-one state and territorial public health agencies participated in a learning collaborative to improve diagnosis and management of hypertension in clinical and community settings. These health agencies implemented public health and clinical interventions in medical settings and health organizations using a logic model and rapid quality improvement process focused on a framework of 4 systems-change levers: 1) data-driven action, 2) clinical practice standardization, 3) clinical–community linkages, and 4) financing and policy. We provide examples of how public health agencies applied the systems-change framework in all 4 areas to assess and modify population-based interventions to improve control of hypertension. This learning collaborative approach illustrates the importance of public health in the prevention and control of chronic disease by supporting interventions that address community and clinical linkages to address medical risk factors associated with cardiovascular disease.

Cross-System Collaboration and Engagement of the Public Health Model to Promote the Well-Being of Children and Families

A public health model aimed at promoting children’s well-being by reducing risks in the environment and enhancing protection at the individual, family, and community levels is frequently recommended as a framework for implementing programs and policies in the nation’s child welfare, juvenile justice, mental and behavioral health, and education systems. Unfortunately, these systems of care are often inadequately equipped to advance a public health framework focused on preventive interventions and policies. This invited article addresses the need for system reform and calls for collaboration to advance prevention goals, underscoring the need to trade reactive, deficit-oriented strategies for those that are proactive, empowering, and strengths-based. Strategies to encourage social work practitioners and policymakers to become more involved in advancing prevention principles in systems of care are noted.

A framework for integrating young peers in recovery into adolescent substance use prevention and early intervention

Substance use among adolescents is associated with a range of negative outcomes and risk-taking behaviors. Identifying and intervening early is essential to reducing associated risks in adolescence and adulthood. New approaches are needed to equip youth-serving systems with tools to identify and respond to substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has emerged as a promising public health framework and there is a growing research interest in effective adaptations for its use with adolescents. However, healthcare settings, schools, and other community-based settings are slow to adapt SBIRT, citing gaps in knowledge and capacity to deliver evidence-based substance use prevention and early intervention. Further, these settings and the surrounding communities often lack the treatment and other prevention and recovery support resources needed for youth who screen as high-risk. Integrating young adult peers with personal lived experience of substance use recovery may meet this practical need. By drawing upon their shared experiences and skills developed in recovery, young adult peers can provide developmentally appropriate screening and intervention support to youth – while also providing urgently needed skills and time to under resourced settings. This article describes the value of young adult peer roles in expanding youth substance use prevention and early intervention, and features Project Amp as an example. Project Amp was designed as an extended, four-session brief intervention for low to moderate risk adolescents, delivered by trained young adult peers. Project Amp draws on best practices from peer recovery support and prevention and early intervention approaches such as SBIRT.

A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties

BackgroundInfant mental health has emerged as a unique area of practice and research distinguished from child and youth sub-specialties by its advocacy for a relational practice framework with an emphasis on parents/caregivers being integral to assessment, treatment, and prevention initiatives. A diverse array of initiatives offered across a broad spectrum of delivery methods is available to clinicians. However, to date, a large-scale mapping of the research evidence regarding these interventions has yet to be completed to help inform clinician’s decisions regarding the best approaches for their clients. To address this knowledge gap, this study aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0–5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes.MethodA scoping review methodology was used to conduct a large-scale mapping of the intervention research pertaining to infants and preschoolers (0–5) at risk for socio-emotional difficulties. We searched MEDLINE, PsycINFO, EMBASE, Web of Science, The Cochrane Library, CINAHL, LILACS, ProQuest Nursing & Allied Health Source, World Cat, and ClinicalTrials.gov, from inception to December 31, 2012. We extracted information regarding publication date, geographical location, study design, level of risk, population, key intervention mechanism, and outcome measures.ResultsWe identified 533 potential studies from 1233 title and abstracts after the first round of screening. Full text article review in the second round of screening resulted in a total of 162 included articles for the final analysis. Results indicated that over 50% of interventions evaluated were randomized controlled trials conducted in Westernized countries. Most studies could be subdivided by level of risk within a preventative public health framework including universal, selected, indicated, and direct treatment for children formally diagnosed with a mental disorder. Risk factors experienced by children and their families were heterogeneously defined and numerous outcome measures across included studies. The results of this study are limited to the last search date of 2012.ConclusionsKey intervention mechanisms spanned a range of approaches including parenting groups, dyadic, in-home, cognitive-behavioral therapy, and day care-based interventions. The findings are discussed in terms of implications for broad trends and gaps in research and policy for this population.

A Community Capitals Framework for Identifying Rural Adaptation in Maternal-Child Home Visiting.

To understand how maternal and child home-visiting programs are adapted, enhanced, and expanded to meet the unique needs of rural communities. We explored factors shaping the role of home visiting with data from a 2013-2015 statewide evaluation of Maternal, Infant, and Early Childhood Home Visiting-funded programs. Features unique to a rural experiences were mapped onto the Community Capitals Framework. Individual, semistructured interviews were conducted at 11 of 38 home-visiting sites across Pennsylvania. Program administrators, home visitors, and clients. Program adaptation. Our analysis represents 150 interviews with 11 program sites serving 14 counties. We document how rural home-visiting programs address community-wide limitations to maternal and child health by adapting program content to better meet the needs of families in rural areas. Data demonstrate how rural home-visiting program's provision of economic and social services reach beyond maternal child health care, building the capacity of individual families and the broader community. Home-visiting programs should be viewed as a vehicle for improving community well-being beyond health outcomes. These programs have become an integral part of our public health framework and should be leveraged as such.

Potencialidades e fragilidades da educação a distância no contexto da atenção básica

A educação a distância como estratégia para o incremento das ações de alimentação e nutrição na atenção primária no SUS é o tema central desse artigo, com o objetivo de avaliar o processo de educação a distância para a promoção da segurança alimentar e nutricional no contexto da atenção básica. Os dados foram gerados a partir da interação dos educandos e tutores, categorizados a partir do referencial de análise de conteúdo, os resultados a luz da teoria da Problematização e apoiada pelo arcabouço teórico da Saúde Coletiva. Categorias de análise destacam-se: O processo educacional e o educando em ambiente virtual; O papel do tutor na modalidade de EAD: Ações intersetoriais e territorialização. Concluiu-se que a educação a distância é uma tecnologia que promove mudanças, quando utilizada para aproximar teoria e prática, ressignificar o trabalho e empoderar o educando para ações de transformação na atenção básica

Analysis of medicinal plant and herbal medicine programs in the Unified Health System (SUS) from the territorial perspective

There has been significant growth in the number of municipal phytotherapy programs in the Unified Health System since the launch of the National Policy of Medicinal Plants in 2006. The aim of the research was to analyze how these programs are distributed throughout Brazil, how they express regional diversity and how land use can influence these programs and promote broad technical synergy (local knowledge and universal knowledge) and policy (strategy and actors) in the production, circulation, distribution and dispe sation of medicinal plants in the public health system. The analysis involved a theoretical framework of critical geography and public health, conceptual and thematic literature review, document analysis, survey of primary and secondary data along with extensive fieldwork. The results show that the growth of programs was accompanied by the choice of industrialized herbal medicines, spatially concentrated in the South and Southeast. Two phases were identified in this process: 1980-2008 characterized by horizontal actions linked to regional diversities; 2008 to the present characterized by verticalized actions on a national scale. The National Policy made it possible to increase the number of programs but did little to promote greater regional diversity.

The Global Burden of Disease of Zoonotic Parasitic Diseases: Top 5 Contenders for Priority Consideration.

With the rise of global migration, international trade, and global environmental challenges such as climate change, it is not surprising that the interactions between humans and other animals are shifting. Salient infectious diseases, such as malaria and HIV (which have high burdens of disease), attract sophisticated public health frameworks and funding from global/regional organisations, such as the WHO. This unfortunately detracts attention from the many emerging zoonoses that fall under the radar as neglected tropical diseases (NTDs). This review considers the available literature and the attribution of burden of disease to the most insidious NTDs and recommends which five are deserving of policy prioritisation. In line with WHO analyses of NTDs, intestinal nematode infections, leishmaniasis, schistosomiasis, and lymphatic filariasis should be prioritised, as well as the burden of disease of cryptosporidiosis, which is largely underestimated. Both monitoring and treatment/prevention control methods for cryptosporidiosis are suggested and explored.

Highly Selective Copper Ion Imprinted Clay/Polymer Nanocomposites Prepared by Visible Light Initiated Radical Photopolymerization.

There is an urgent demand worldwide for the development of highly selective adsorbents and sensors of heavy metal ions and other organic pollutants. Within these environmental and public health frameworks, we are combining the salient features of clays and chelatant polymers to design selective metal ion adsorbents. Towards this end, the ion imprinting approach has been used to develop a novel nanohybrid material for the selective separation of Cu2+ ions in an aqueous solution. The Cu2+-imprinted polymer/montmorillonite (IIP/Mt) and non-imprinted polymer/montmorillonite (NIP/Mt) nanocomposites were prepared by a radical photopolymerization process in visible light. The ion imprinting step was indeed important as the recognition of copper ions by IIP/Mt was significantly superior to that of NIP/Mt, i.e., the reference nanocomposite synthesized in the same way but in the absence of Cu2+ ions. The adsorption process as batch study was investigated under the experimental condition affecting same parameters such as contact time, concentration of metal ions, and pH. The adsorption capacity of Cu2+ ions is maximized at pH 5. Removal of Cu2+ ion achieved equilibrium within 15 min; the results obtained were found to be fitted by the pseudo-second-order kinetics model. The equilibrium process was well described by the Langmuir isothermal model and the maximum adsorption capacity was found to be 23.6 mg/g. This is the first report on the design of imprinted polymer nanocomposites using Type II radical initiators under visible light in the presence of clay intercalated with hydrogen donor diazonium. The method is original, simple and efficient; it opens up new horizons in the general domain of clay/polymer nanocomposites.

Public Health Workforce Self-Identified Training Needs by Jurisdiction and Job Type.

Context:Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills.Objective:The purpose of this article is to identify training needs among public health workers in specific job types and settings.Design and Participants:This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction.Results:Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need.Conclusions:Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks–like Public Health 3.0 and the Chief Health Strategist–are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.

“I Would Say It’s Almost Like a Crime Against, You Know, the Soul”: Building a Culture of Health in Low-Income Housing Communities Through Addressing Childhood Trauma

ABSTRACTThe purpose of this article is to examine parental perceptions of child maltreatment to inform services that target families living in low-income housing communities in Fresno, California, through focus group interviews. We identified three main themes across all focus group interviews that describe the child maltreatment among our participants: (a) acknowledging child maltreatment as a problem, and its negative consequences; (b) normalizing or justifying child maltreatment as part of growing up; and (c) seeing child maltreatment as intergenerational. Additionally, parents discussed types of help to address child maltreatment. We then propose a prevention model using a public health framework along with other policy recommendations that highlight the importance of culturally and linguistically appropriate services for diverse families living in low-income housing communities.

Cascade of Care approach to opioid crisis would incentivize MAT: Study

Adoption of a unified public health framework for the treatment of opioid use disorders (OUDs) would encourage more continuity of care and use of evidence‐based medication treatments to combat the crisis, suggest researchers with Columbia University and the New York State Psychiatric Institute. Moreover, they state in a newly published paper, the “Cascade of Care” framework they seek to advance could be used to improve accreditation standards they believe do not sufficiently address providers that do not use methadone, buprenorphine or injectable naltrexone in their treatment of opioid addiction.

Accomplishing Great Things Together: a Cross-State Synthesis of Essentials for Childhood Grantees’ Efforts to Prevent Child Maltreatment

The purpose of CDC’s Essentials for Childhood (EfC) initiative was to assure safe, stable, nurturing relationships and environments and prevent child maltreatment. SciMetrika supported the evaluation of this initiative by collecting, tracking, analyzing, and reporting data on Essentials for Childhood grantees’ efforts to implement the four primary goals of CDC’s Essentials for Childhood Framework using a collective impact approach. In this article, we report quantitative and qualitative findings from our analysis of data sources collected from funded states over the five-year period. Further, we describe key successes and barriers to implementing the EfC framework at the state level using the collective impact model. These lessons learned can be applied to other state-level initiatives looking to implement a public health framework to address a complex social issue.