Government Health Agencies Research Articles

Network relationships of U.S. government health agencies in relation to the Covid-19 pandemic

Introduction. Government institutes, such as the Centers for Disease Control and Prevention and the US Department of Health and Human Services, play important but different roles dealing with COVID-19 in the USA. Method. This study used NodeXL between June 7 and June 8 to visualise the social networks of the Centers and the Department by collecting 5,166 (the Centers) and 2,940 tweets (the Department). Analysis. Examined the characteristics of centrality of the two networks and used cluster analysis to identify communication groups. Results. Findings confirmed that the Centers demonstrate characteristics of people-based online networks, whereas the Department appears as an institutes-based online networks. Second, offline social networks play an essential role in online social networks. Third, the Centers had a greater impact on the networks in the Department network than the effect the Department had on the Centers. Fourth, some key players, such as the World Health Organization, play a pivotal role in both networks. Conclusions. Governments should explore the different types of health information of government institutes to effectively cope with the COVID-19 pandemic.

Pattern of substance or drug abuse in cases reported by chemical examiner laboratory, Punjab, India

Punjab in the northern part of India has been facing a drug or substance abuse (mainly of heroin, commonly known as chitta in Punjab) in recent years, resulting in considerable harm both to the individual and to the society. Drug abuse refers to the inappropriate (e.g., using chemicals that are never intended to be put into the body like glue sniffing), usually excessive and self-administration of a drug, any other chemical or illegal substance to affect the mind and body for a non-medical purpose. The geographical location of Punjab also contributes to the increasing problem of drug abuse. Drug abuse is also associated with crime. The analysis of available data was conducted from January to September 2018. During this period, 82 viscera cases were received by Chemical Examiner Laboratory (CEL) with a history of suspected drug abuse/drug overdose. After analysis by seven analysts, morphine, a metabolite of diacetylmorphine (the active ingredient of heroin), was found to be the most common drug. These statistics can be helpful for the government and various public health agencies to identify emerging trends of drug abuse in the state so that they can better target prevention measures.

Epidemiology of Squamous Cell Carcinoma in Response to Different Hazardous Chewing Causes in Lahore, Pakistan-a Unicenter study

Oral squamous cell carcinoma (OSCC) being the world’s most prevailing and frightening cancerousdisorder lacks the sufficient data in Pakistan despite of its higher magnitude and prevalence. Objective:This study was specifically designed and conducted with the aim to identify the frequency of this disorderalong with causative factors in past three years in a tertiary care hospital of Lahore, Pakistan. Methods:Epidemiological study was conducted using retrospective randomized method and all pre-requisites werefilled. The clinical profiles of patients were collected from Maxillofacial and Oral Surgery Department ofPathology, Mayo Hospital Lahore. Patients who had undergone treatment for OSCC were contacted andinterviewed for information about demographic regions, previous history of malignancy, disease onset,chewing habits, exposure to pesticides, industrial exposure to metals etc. and all particulars were not andcompiled on questionnaire. Results: A total of 54 patients from different districts of Punjab participatedin the study. Percentages for each possible causative chewing habit were calculated and 87.50 % ofpopulation was found addicted to different habits. Genetic factor might have contributed in remaining fordevelopment of OSCC. Conclusions: Informative data provided in this study will be helpful to be used bythe government and private health agencies while designing and planning management of oral healthproblems and allocating health budgets in focusing this issue.

Local Health Departments' Spending on the Foundational Capabilities

Improving our nation's public health system requires a detailed understanding of public health expenditures and related revenue sources, yet no comprehensive data source exists that contains such information for governmental health agencies at all levels. Using pilot study data of a standardized financial accounting framework for public health agencies-in the form of a uniform chart of accounts crosswalk-this article presents local health departments' (LHDs') expenditures on the foundational capabilities, that is, crosscutting skills and capacities needed to support all of an LHD's programs and activities. Among 16 sample LHDs from 4 states, per capita foundational capabilities spending ranged from $1.10 to $26.19, with a median of $7.67. Larger LHDs and LHDs with greater financial resources spent more per capita, as did accredited LHDs. Future work using data from a larger sample of LHDs is needed to examine agency and community-level characteristics associated with adequate funding for the foundational capabilities.

An integrated fog and Artificial Intelligence smart health framework to predict and prevent COVID-19

Nowadays, COVID-19 is spreading at a rapid rate in almost all the continents of the world. It has already affected many people who are further spreading it day by day. Hence, it is the most essential to alert nearby people to be aware of it due to its communicable behavior. Till May 2020, no vaccine is available for the treatment of this COVID-19, but the existing technologies can be used to minimize its effect. Cloud/fog computing could be used to monitor and control this rapidly spreading infection in a cost-effective and time-saving manner. To strengthen COVID-19 patient prediction, Artificial Intelligence(AI) can be integrated with cloud/fog computing for practical solutions. In this paper, fog assisted the internet of things based quality of service framework is presented to prevent and protect from COVID-19. It provides real-time processing of users’ health data to predict the COVID-19 infection by observing their symptoms and immediately generates an emergency alert, medical reports, and significant precautions to the user, their guardian as well as doctors/experts. It collects sensitive information from the hospitals/quarantine shelters through the patient IoT devices for taking necessary actions/decisions. Further, it generates an alert message to the government health agencies for controlling the outbreak of chronic illness and for tanking quick and timely actions.

Utilisation of evidence from Thailand\u2019s National Health Examination Survey in policy development: finding the weakest link

BackgroundHealth surveillance and survey data are helpful in evidence-informed policy decisions. This study is part of an evaluation of the National Health Examination Survey (NHES) programme in Thailand. This paper focuses on the obstacles in the translation of survey information into policies at a national level.MethodsIn-depth interviews with relevant individuals and representatives of institutes were carried out for the data collection. A total of 26 focal informants included executives and staff of NHES funders, government health agencies, civil society organisations, health experts, NHES programme managers and researchers in the survey network.ResultsUtilisation of NHES data in policy-making is limited for many reasons. Despite the potential users’ positive views on the technical integrity of experts and practitioners involved in the NHES, the strength of employing health examinations in the data collection is not well recognised. Meanwhile, alternative health surveillance platforms that offer similar information on a shorter timescale are preferable in policy monitoring and evaluation. In sum, the lack of governance of Thailand’s health surveillance system is identified as a key element hindering the translation of health surveys, including the NHES, into policies.ConclusionDespite an adequate capacity to conduct population health surveys, the lack of governance structure and function has resulted in a fragmented health monitoring system. Large and small survey projects are conducted and funded by different institutes without common policy direction and alignment mechanisms for prioritising survey topics, collective planning and capacity-building programmes for survey practitioners and users. Lessons drawn from Thailand’s NHES can be helpful for policy-makers in other low- and middle-income countries, as effective governance for evidence generation and utilisation is necessary in all contexts, regardless of income level and available resources.

Americans' Trust in Health Information Sources: Trends and Sociodemographic Predictors.

To assess the public's trust in health information sources (ie, government health agencies, doctors, family/friends, charitable organizations, and religious leaders/organizations) from 2005 to 2015 and identify sociodemographics factors associated with high trust. Cross-sectional. Health Information National Trends Survey, a US nationally representative publicly available data on health-related knowledge, behaviors, and attitudes. Data included 5 iterations (2005-2015) of US adults (2005: N = 5586, 2008: N = 7764, 2011: N = 3959, 2013: N = 3185, and 2015: N = 3738). Outcome variables were high trust in health information sources and independent variables were sociodemographics. A descriptive analysis was conducted to track changes in trust over the past decade. The χ2 and multivariable logistic regression were conducted to assess sociodemographic associations in 2015. Trust in health information across all sources remained stable from 2005 to 2015. Doctors were the most trusted source, followed by government health agencies. Sociodemographics were independently associated with trust. For example, non-Hispanic blacks were more likely to trust charitable organizations (odds ratio [OR] = 2.32, confidence interval [CI] = 1.42-3.79) and religious leaders/organizations (OR = 3.57, CI = 1.20-10.57) compared to non-Hispanic whites. In addition, those with less than high school education (OR = 2.44, CI = 1.32-4.52) were more likely than college graduates to report trust in religious leaders/organizations. Although there are analytic limitations to the specific time periods, the findings demonstrate that public health communication practitioners must consider the role of source credibility among priority populations when disseminating and promoting information.

Recruitment of men to a multi-centre diabetes prevention trial: an evaluation of traditional and online promotional strategies

BackgroundEffective interventions are required to prevent the current rapid increase in the prevalence of Type 2 diabetes. Clinical trials of large-scale interventions to prevent Type 2 diabetes are essential but recruitment is challenging and expensive, and there are limited data regarding the most cost-effective and efficient approaches to recruitment. This paper aims to evaluate the cost and effectiveness of a range of promotional strategies used to recruit men to a large Type 2 diabetes prevention trial.MethodsAn observational study was conducted nested within the Testosterone for the Prevention of Type 2 Diabetes (T4DM) study, a large, multi-centre randomised controlled trial (RCT) of testosterone treatment for the prevention of Type 2 diabetes in men aged 50–74 years at high risk of developing diabetes. Study participation was promoted via mainstream media—television, newspaper and radio; direct marketing using mass mail-outs, publicly displayed posters and attendance at local events; digital platforms, including Facebook and Google; and online promotions by community organisations and businesses. For each strategy, the resulting number of participants and the direct cost involved were recorded. The staff effort required for each strategy was estimated based on feedback from staff.ResultsOf 19,022 men screened for the study, 1007 (5%) were enrolled. The most effective recruitment strategies were targeted radio advertising (accounting for 42% of participants), television news coverage (20%) and mass mail-outs (17%). Other strategies, including radio news, publicly displayed posters, attendance at local events, newspaper advertising, online promotions and Google and Facebook advertising, each accounted for no more than 4% of enrolled participants. Recruitment promotions cost an average of AU$594 per randomised participant. The most cost-effective paid strategy was mass mail-outs by a government health agency (AU$745 per participant). Other paid strategies were more expensive: mail-out by general practitioners (GPs) (AU$1104 per participant), radio advertising (AU$1081) and newspaper advertising (AU$1941).ConclusionRadio advertising, television news coverage and mass mail-outs by a government health agency were the most effective recruitment strategies. Close monitoring of recruitment outcomes and ongoing enhancement of recruitment activities played a central role in recruitment to this RCT.Trial registrationANZCTR, ID: ACTRN12612000287831. Registered on 12 March 2012.

A Deterministic Model Of HIV Transmission Between Two Closed Patches Incorporating The Monod Equation

Among other factors, migration has significantly contributed to the spread of HIV. Recent studies have revealed that new infections occur along major transport corridors and truck-drivers have overall higher prevalence rates of HIV and sexually transmitted infections than non-truck drivers’ counterparts. Therefore, there exist a link between population mobility and HIV infection, as populations along transport corridors remain substantial contributors of new infections. This research work documents a deterministic model of the dynamics of HIV transmission between two closed patches that incorporates the Monod equation in migration with truck drivers being the agents of HIV transmission. Migration is considered as a social determinant to health and have a significant impact on health‐related vulnerabilities and access to services. We assumed that susceptible individuals become infected via sexual intercourse with HIV infected truck drivers and all the infected individuals ultimately developed AIDS exponentially. The model also assumed that the patches have different infection and susceptibility rates. The patches basic reproduction number, was determined using the Next Generation Matrix. The results revealed that should be kept below unity to eradicate the transmission of the virus. The Disease-Free Equilibrium Point was obtained based on the signs of the Eigen values of the Jacobian matrix. In the absence, the Disease-Free Equilibrium Point is both Locally Asymptotically and Globally Asymptotically Stable. It was further proved that the model did not display Endemic Equilibrium Point under a special property for epidemic models. The model findings are vital in guiding health practitioners, governmental and non-governmental health agencies in the development of effective mitigation strategies to reduce the spread of HIV. KEY WORDS : HIV/AIDS, Migration, Monod function, Basic reproduction number, Stability Analysis, Equilibria Points. DOI : 10.7176/MTM/9-6-03 Publication date : June 30 th 2019

Trust in national health information sources in the United States: comparing predictors and levels of trust across three health domains.

Public trust in traditional sources of health information is essential for public health agencies and organizations to perform necessary public health functions. Little research has examined levels and predictors of trust in government health agencies and national health organizations. Additionally, few studies have simultaneously analyzed trust in multiple health topics. The major aim of this study was to compare levels and factors associated with trust in national health sources across three health topics: information about tobacco, electronic cigarettes, and general health. Data from two cycles of the National Cancer Institute's Health Information National Trends Survey collected in 2015 and 2017 were merged and analyzed for this study (n = 5,474). A series of weighted multivariable logistic regression models calculated odds of high trust in government health agencies and health organizations for each health topic. More respondents reported high trust in health organizations than for government health agencies across all topics. More participants reported high trust in these sources tobacco information, as compared to general health or e-cigarette information. Logistic models found that those higher in information seeking confidence were more likely to report high trust across all models. Other demographic variables were inconsistent predictors of trust across topics. This study highlights inconsistent sociodemographic predictors of trust across multiple health topics and national health sources. Researchers, practitioners, and policymakers should consider the unique context of specific health topics in health promotion campaigns, partner with existing community-based organizations, and encourage and enable health information seeking.

Evaluating smog awareness and preventive practices among Pakistani general population: a cross-sectional survey

ABSTRACTSmog pollution is one of the serious public health concerns worldwide. This study aimed to evaluate the awareness and preventive practices of smog among general population belonging to one of the industrialized cities (Lahore) of Pakistan. A cross-sectional survey was carried out among 607 individuals using a 46-item self-administered questionnaire. Data was analyzed using SPSS (version 20.0). The overall adequate knowledge was 74% (n = 449). Majority of individuals having Science qualifications (89.4%) exhibited adequate knowledge of smog as compared to those with Arts qualifications (OR; 4.73, p-value < 0.001). Significant associations were observed between the practice and family income (OR; 1.710, p-value = 0.004), educational group (OR; 1.648, p-value = 0.011), employment status (OR; 0.371, p-value < 0.001) and smoking history (OR; 0.260, p-value < 0.001). Respondents having good family income were following several preventive measures to avoid interaction with smog pollution. Government and environmental health agencies in Pakistan should take steps to improve the awareness and preventive practices of masses particularly of those with non-science qualification and low income to avoid adverse outcomes associated with smog pollution.Abbreviations: CDGL: City District Government of Lahore; WHO: World Health Organization; EPA: Environmental Protection Agency; USA: United States of America; SPSS: Statistical Program for Social Sciences

Seeking Formula for Misinformation Treatment in Public Health Crises: The Effects of Corrective Information Type and Source

ABSTRACTAn increasing lack of information truthfulness has become a fundamental challenge to communications. Insights into how to debunk this type of misinformation can especially be crucial for public health crises. To identify corrective information strategies that increase awareness and trigger actions during infectious disease outbreaks, an online experiment (N = 700) was conducted, using a U.S. sample. After initial misinformation exposure, participants’ exposure to corrective information type (simple rebuttal vs. factual elaboration) and source (government health agency vs. news media vs. social peer) was varied, including a control group without corrective information. Results show that, if corrective information is present rather than absent, incorrect beliefs based on misinformation are debunked and the exposure to factual elaboration, compared to simple rebuttal, stimulates intentions to take protective actions. Moreover, government agency and news media sources are found to be more successful in improving belief accuracy compared to social peers. The observed mediating role of crisis emotions reveals the mechanism underlying the effects of corrective information. The findings contribute to misinformation research by providing a formula for correcting the increasing spread of misinformation in times of crisis.

Prevalence of Asymptomatic and Sub-Microscopic Malaria Infection During Non-Transmission Season: A Community Based Cross-Sectional Study in Districts of North-Eastern Region, India

Background: Malaria elimination requires targeting asymptomatic sub-microscopic malaria which largely remained undetected hidden reservoir of infection to sustain malaria transmission. The pre-requisite of malaria elimination programme requires early screening, prompt detection and complete treatment of asymptomatic/ sub-microscopic infection. Thus, the present study was aimed to estimate the prevalence of asymptomatic and sub-microscopic malaria burden in high and low endemic regions in North east India by comparing the sensitivity of diagnostic tools utilized by Government Health Agencies with the molecular technique. Methods: The mass blood surveys were conducted in high and low malaria-endemic areas of two north-eastern districts of India using a probability proportion to size method. All available individuals were screened for malaria irrespective of any clinical sign and symptoms. Finger prick blood was collected for on-spot diagnosis using rapid diagnostic test kit (RDK), thick and thin blood smear for light microscopy and dried blood spot on filter paper for molecular diagnosis. History of fever and other clinical signs and symptoms related to malaria were recorded along with measuring axillary body temperature. Findings: A total of 9118 participants were screened that showed overall malaria prevalence was 6·5%, 2·2% and 11·1% when tested with RDK, microscopy and PCR respectively. Among asymptomatic, malaria prevalence was found to be 6·0%, 1·9% and 11·0% using RDK, microscopy and PCR respectively. In addition, a significant proportion of malaria positive patients were asymptomatic ~82% (using microscopy)–85% (using PCR). The prevalence of sub-microscopic malaria was 57·3%, of which 88·9% were asymptomatic. The geographic differences and age-wise dispersion was observed for the likelihood of malaria infection, the prevalence of asymptomatic and sub-microscopic malaria. Of 8228 participants who underwent haemoglobin testing, 55·2% were anaemic, of which 24·9% were mild, 28·8% moderate and 1·6% were severely anaemic. The diagnostic accuracy of microscopy was lesser than RDK in comparison to PCR, and further much lesser in low compared to high malaria-endemic areas. Interpretation: The result suggests that there is a need to deploy molecular tools even when microscopy/ RDK malaria results indicate low prevalence, to curtail undetected infectious reservoir and accelerate malaria elimination programme. Funding Statement: The study was funded by the Indian Council of Medical Research, New Delhi, India. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institution Ethics Committee of National Institute of Malaria Research (Ref. No.# ECR/NIMR/EC/2015/490).

Smartphone-Based Diagnosis of Parasitic Infections With Colorimetric Assays in Centrifuge Tubes

A smartphone-based platform for the diagnosis of parasitic infections has been developed, tested and validated. The system is capable of making automatic and accurate analysis of millimetric colorimetric arrays in centrifuge collection tubes, which are well established tools used in clinical analysis. To that end, an Android-based software application has been developed, making use of the smartphone rear camera, enabling precise image processing of the colorimetric spot arrays. A low-cost plastic accessory has been developed using 3D-printing to provide controlled illumination, fixed sample positioning and cell phone attachment. The platform was then tested repeatedly for its size detection, edge blurriness and colour detection capabilities. A minimum spot radius of $175~\mu \text{m}$ is detectable when using the developed app, with a tolerance of 15%, corresponding to 0.25% of the area where the spot array is printed. Spot edge definition has been studied up to 40% of blurriness, resulting in a low average percentage error of 1.24%. Colour detection follows the well-known Gamma correction function. Finally, the whole platform was tested and validated using real DNA to analyse for accurate discrimination of Trypanosomatid species, which are responsible for devastating diseases in humans and livestock. The smartphone-based platform can be further extended to other clinical analysis. Its simplicity and reliable performance mean it can be used in remote, limited-resource settings by relatively unskilled technicians/nurses, where diagnostic laboratories are sparsely distributed. The results can however be sent easily via the smartphone to medical experts as well as government health agencies.

A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention.

Youth exposure to trauma is a significant public health problem in the United States, particularly in urban areas. Although trauma-informed care (TIC) training of service providers to address this challenge is increasing nationwide, we lack empirical evidence regarding the feasibility and acceptability of cross-organizational TIC training, including perspectives of training participants. The purpose of our study was to evaluate participating service providers' self-reported changes in knowledge about trauma, attitudes toward traumatized individuals, and beliefs in their capacity to provide referrals to trauma services after completion of the TIC intervention. Intervention participants represented a range of service sectors, including government health and education agencies, social services, law enforcement, as well as nonprofits. Participants completed a pre-post quantitative survey assessing TIC-related knowledge, attitudes, and beliefs (N = 88). A subset of participants was interviewed using a semistructured interview format (n = 16). Mixed methods were used to evaluate the intervention's impact on participants' knowledge about trauma and to understand participants' experience in the training. Quantitative results revealed significant improvements in TIC-related knowledge and attitudes. Five themes emerged from qualitative analysis of interviews: the intervention provided a framework for understanding TIC; useful lessons were learned from other participants; there was a need for outreach to upper-level management; real-life applicability was lacking; and guidance regarding next steps was wanting. Study findings suggest the training may be a starting point for enhancing service providers' capacity to address traumatized youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Modeling Mortality Rates Using Heligman-Pollard and Lee-Carter in Nigeria

In recent years the need for accurate mortality statistics has been emphasized by researchers in planning, analyzing, monitoring and projection of health situations in the country. It helps the government and other health agencies initiate various programs that can improve life expectancy especially in developing countries like Nigeria. Given the impact of mortality rates on the population size, structure, social security system, life insurance and pension (from actuarial point of view) there is need to understand how mortality patterns change with time. According to past studies the Heligman-Pollard (Henceforth HP) model and Lee-Carter (Henceforth LC) model have been widely accepted and use by researchers in forecasting future mortality. In this study both models were applied to Nigerian data with the objective to investigate the accuracy of their performances by comparing their assumptions. The LC model parameters were estimated based on the singular value decomposition technique (SVD), while HP model parameters were estimated using nonlinear least squares method. Autoregressive Integrated Moving Average (ARIMA) procedure was applied to acquire to forecasted parameters for both models. To investigate the accuracy of the estimation, the forecasted results were compared based on the mean absolute percentage error (MAPE). The results indicate that both models provide better results for female population. However, for the elderly female population, HP model seems to overestimate to the mortality rates while LC model seems to underestimate to the mortality rates. Although the HP model does not seem to follow the pattern of the actual mortality rates, after further analysis was carried out it was discovered that the HP model gave a better forecast than the Lee-Carter model. Based on the HP model the forecasted probabilities of death were used to construct an abridged life table for males and females and the life expectancy at e0 and e75 were obtained. From our results we see that males experience higher life expectancy than females due to the mortality rates experienced by both sexes. Given the level of mortality rate especially in developing countries like Nigeria, the study therefore recommends the need for a vital registration system that could continuously and reliably collect information because it is well known that incomplete data affect the performance of a model to forecast. To ascertain level and pattern of mortality rate especially in adult, parameterization model especially the HP model should be considered because of it lesser errors, with the view of achieving a robust forecasting model that could improve the understanding of the pattern of general mortality rate and how it affects life expectancy level in the country.

Barriers to HIV care among Francophone African, Caribbean and Black immigrant people living with HIV in Canada: a protocol for a scoping systematic review

IntroductionLanguage is a social determinant of health. Addressing social determinants of health is paramount to successful progression along the HIV-care continuum. Canada is a bilingual country with French and English...

Determinants of Youth Engagement with Health Information on Social Media Platforms in United Arab Emirates

Since most social media platforms are accessible anytime and anywhere where Internet connections and smartphones are available, the invisibility of the reader raises questions about accuracy, appropriateness and comprehensibility of social media communication. This purposive sampling study of 120 participants aged 18 - 35 year in UAE was conducted between September and December 2017, and explored commonly used social media platforms, frequency of use of social media for accessing health related information, and approaches for assessing the trustworthiness of health information. Results indicate that Whats App (95%), Instagram (87%) and Youtube (82%) were the most commonly used social media platforms among respondents. Majority of respondents (81%) indicated that they regularly access social media to get health-associated information. About 55% of respondents with non-chronic health status relied on unsolicited messages to obtain health-related information. Doctors’ health blogs (21%) and social media sites of international healthcare organizations (20%) constitute the most trusted source of health information among respondents, with UAE government health agencies’ social media accounts trusted by 15% of respondents. Cardiovascular diseases, diabetes and hypertension were the most commonly searched topics on social media (29%), followed by nutrition (20%) and skin care (16%). Majority of respondents (41%) rely on reliability of Google search results, 22% check for health information only from “reliable” social media sites, while 8% utilize “logic” to ascertain reliability of health information. Utilizing popular social media platforms for posting reader-friendly health information will achieve high coverage. Improving youth digital literacy will facilitate easier access to trustworthy information on the internet.

Medication errors in community pharmacies: The need for commitment, transparency, and research.

Medication errors place a serious medical and economic burden on the United States (U.S.) healthcare system. Since 1975, government health agencies and non-profit organizations in the U.S., such as the Agency for Healthcare Research and Quality (AHRQ), the Institute of Medicine (IOM), and the Joint Commission, have undertaken initiatives intended to reduce medication errors, and there has been noteworthy progress in inpatient settings. However, there have been fewer advances in settings outside the hospital such as community pharmacies, where 4 billion prescriptions were dispensed to patients in 2017. There are limited information and research on community pharmacies' involvement in reducing and preventing medication errors. Most published studies on medication errors in community pharmacy settings are cross-sectional in design and often limited by geography, such that each study describes a single geographic region, i.e., one or a few practices in a single city or state within the U.S. An attempt to gain additional insight on how medication errors are managed was met with the inability of many pharmacy corporations to provide meaningful information. In order to reduce medication errors, improvement strategies such as transparency and bi-directional communication between pharmacists and patients are needed. Pharmacists are required by law to counsel patients, and research has shown that counseling can assist with detecting medication errors. Community pharmacies play a significant role in the U.S. healthcare system, but their efforts to reduce medication errors are not well known. By improving transparency in quality assurance processes and promoting patient engagement to improve patient safety, community pharmacies have the potential to play a more active role in reducing medication errors and safeguarding patients from harm.

Dynamics of Health Agency Response and Public Engagement in Public Health Emergency: A Case Study of CDC Tweeting Patterns During the 2016 Zika Epidemic

BackgroundSocial media have been increasingly adopted by health agencies to disseminate information, interact with the public, and understand public opinion. Among them, the Centers for Disease Control and Prevention (CDC) is one of the first US government health agencies to adopt social media during health emergencies and crisis. It had been active on Twitter during the 2016 Zika epidemic that caused 5168 domestic noncongenital cases in the United States.ObjectiveThe aim of this study was to quantify the temporal variabilities in CDC’s tweeting activities throughout the Zika epidemic, public engagement defined as retweeting and replying, and Zika case counts. It then compares the patterns of these 3 datasets to identify possible discrepancy among domestic Zika case counts, CDC’s response on Twitter, and public engagement in this topic.MethodsAll of the CDC-initiated tweets published in 2016 with corresponding retweets and replies were collected from 67 CDC–associated Twitter accounts. Both univariate and multivariate time series analyses were performed in each quarter of 2016 for domestic Zika case counts, CDC tweeting activities, and public engagement in the CDC-initiated tweets.ResultsCDC sent out >84.0% (5130/6104) of its Zika tweets in the first quarter of 2016 when Zika case counts were low in the 50 US states and territories (only 560/5168, 10.8% cases and 662/38,885, 1.70% cases, respectively). While Zika case counts increased dramatically in the second and third quarters, CDC efforts on Twitter substantially decreased. The time series of public engagement in the CDC-initiated tweets generally differed among quarters and from that of original CDC tweets based on autoregressive integrated moving average model results. Both original CDC tweets and public engagement had the highest mutual information with Zika case counts in the second quarter. Furthermore, public engagement in the original CDC tweets was substantially correlated with and preceded actual Zika case counts.ConclusionsConsiderable discrepancies existed among CDC’s original tweets regarding Zika, public engagement in these tweets, and actual Zika epidemic. The patterns of these discrepancies also varied between different quarters in 2016. CDC was much more active in the early warning of Zika, especially in the first quarter of 2016. Public engagement in CDC’s original tweets served as a more prominent predictor of actual Zika epidemic than the number of CDC’s original tweets later in the year.