Health Advisory Research Articles

Mercury in Dried Market Fish of Hong Kong and San Francisco: Human Health Implications

Asian, Asian Pacific Islanders, and Asian American residents of San Francisco have higher exposure to mercury and the associated health risks associated with methylmercury toxicity from fish consumption than other demographics across the United States. Due to their higher annual fish consumption, Hong Kong Chinese residents have elevated risks to methylmercury exposure. Objectives: We investigate samples of dried market fish from San Francisco and from Hong Kong as potential sources of mercury contamination in fish commonly consumed by Asian and Asian American residents. Methods: We analyze 81 samples of dried market fish from San Francisco and Hong Kong for mercury concentration using Inductively Coupled Plasma Emission Spectrograph and Processing Cold Vapor Atomic Fluorescence Spectrometry. We binned into market categories, trophic level, and habitat type for statistical analysis. Results: No significant difference was observed in the mercury levels of samples between San Francisco and Hong Kong (p-value = 0.47). Dried samples did show higher rates of mercury than wet samples reported by the FDA. Data from dried market fish samples also show evidence of bioaccumulation: the concentration of toxins in higher trophic levels of fish (p-value < 0.01). Eliminating apex predators, nearly all samples of fish from both locations and from lower trophic levels had levels below the lowest health advisory thresholds of 0.5 ppm methylmercury by weight. Discussion: Dried fish samples from markets in San Francisco and Hong Kong showed mercury levels with the potential to exceed guidelines set by the EPA and the EFSA, but consumption rates are lacking to know if this threshold is actually being exceeded by consumers. We make recommendations regarding the health risks of dried market fish and of consuming or avoiding fish from certain trophic groups.

The CNA Crisis: Turning Ideas Into Action

The CNA Crisis: Turning Ideas Into Action

Knowledge, Attitudes, and Practice Toward Prevention of COVID-19 Among Jimma Town Residents: A Community-Based Cross-Sectional Study.

BackgroundCoronavirus disease (COVID-19) was first reported by the World Health Organization on 31 December 2019, and later, it was declared a global pandemic on 12 March 2020. To date, it is a great challenge to the world including Ethiopia. Therefore, to attain effective prevention and control of the COVID-19 pandemic, improving the knowledge, attitude, and practices of the community is necessary.ObjectiveTo assess, knowledge, attitudes, and practice, and associated factors of COVID-19 among Jimma Town residents.MethodsA community-based cross-sectional study was conducted among 1,500 Jimma town residents from May through June 2020. Adults aged ≥18 years were included in the study. Data were collected using a structured questionnaire that was adopted from different literature. A face-to-face interview was implemented to collect data. Analysis was done by using SPSS version 22. p < 0.05 was used to declare statistical significance.ResultA total of 1,500 participants were enrolled in the study. The majority of the respondents were female (59.3%). About 841 (56.1%) of the participants had knowledge about COVID-19. Educational status, household wealth index, and employment showed association with knowledge of COVID-19. Government-owned television (37.3%) was the primary source of information about COVID-19 in the Jimma population. Only 46.6% of respondents had good attitudes toward the COVID-19 pandemic and about 638 (42.5%) of the study participants had good practice toward COVID-19. The mean practice score was 1.98 (± 0.319). Study participants who were residing in the outskirts of the town were 0.37 less likely to apply good practice regarding COVID-19 prevention measures than those around the center of the town. Whereas, households with a family size of four to five individuals were 1.4 times more likely to show good practice against COVID-19 compared to households with ≤3 individuals (AOR: 1.41; CI: 1.05, 1.91).ConclusionJimma town community has low knowledge, attitude, and practice regarding COVID-19. Knowledge, attitude, and practice scores regarding COVID-19 are significantly related to educational status, being self-employed, occupation, marital status, residence, family size, and household relative wealth index. Preventive health advisories to upraise knowledge, attitude, and practice are crucial to prevent and control COVID-19.

Increasing the Awareness of Health Risks from Lead-Contaminated Game Meat Among International and National Human Health Organizations

Lead bullets and gunshot frequently fragment on impact in game animals and the resulting lead particles are bioavailable. Dietary exposure to this lead source can present health risks to vulnerable groups including young children and frequent consumers such as hunters, subsistence indigenous communities, and recipients of game meat from food banks. Many of the frequent game meat consumers in the European Union (EU) are likely to be drawn from the 13.8 million people, including 1.1 million young children, belonging to hunters’ households. It is estimated that 10 million people are potentially at risk in the USA. National food and health advisories and regulatory considerations appear confined to Europe. Despite the European Commission requesting restrictions on lead ammunition, the World Health Organization (WHO), the Food and Agricultural Organization of the UN (FAO), the UN Children’s Fund (UNICEF), and individual countries have not adequately recognized this lead source nor developed mitigation measures. In contrast, several agreements administered by the UN Environment Programme (UNEP), have well-developed risk reduction strategies for lead ammunition exposure of wildlife. These agencies could play a leadership role, stimulating appropriate international accords and national regulatory changes requiring the use of non-lead ammunition. Establishing a maximum allowable level of lead in game meat under FAO/WHO Codex Alimentarius and EU Regulation 1881/2006, and harmonizing inter-agency human and environmental health approaches would be an important start.

Compliance to Public Health Advisory amid COVID-19 Scare: The Communication Conundrum and Public Health Ethics

Discussion of ethics in the public health arena has primarily focused on the practices of public health doctors and professionals. The community could not get the required attention in terms of their role in compliance with the communication in the form of public health advisory in times of public health crisis. Even though public health is the societal approach to protecting and promoting health, ethics in public health have prioritised behaviours of and moral dilemmas faced by public health professionals only. Leaving out the community’s responsibility makes the entire gamut of public health efforts incomplete and deficient. Amid the COVID-19 pandemic, non-compliance to the public health advisory raised an important aspect of expectation of ethical behaviour by the community and what could facilitate and hinder compliance of ethical behaviour ensuring the safety of self and others. Public health ought to consider the community as not only an important but also responsible stakeholder in its pursuit of promotion of health and prevention of disease.

2022: A Year to Prepare for Compliance Requirements

Key TakeawaysIn 2022, the US Environmental Protection Agency (EPA) is engaging in several regulatory activities that will affect the regulatory compliance of US water systems.Being familiar with the changes in regulations will help US water systems prepare for any changes they should make in their own operations.Areas being addressed this year by EPA include, among others, infrastructure, emerging contaminants, lead service lines, per‐ and polyfluoroalkyl substances, health advisories, affordability, and cybersecurity.

Towards a participatory approach to risk communication: the case of contaminants and Inuit health

Indigenous populations residing in the Arctic commonly rely on country foods for nutritional, spiritual and cultural benefits. However, some food sources have become contaminated with heavy metals or persistent organic pollutants. As a result of these contaminants, it is critical that risk communicators develop effective and culturally appropriate health messages about the risks and benefits of eating country foods. To address this challenge in the Canadian Inuit region of Nunavik, a working group was formed to advance risk management, determine health advisories, and communicate recommendations about local country foods. The Nunavik Child Development Study (NCDS) Communications Working Group included local hunters, educators, health care professionals, researchers, and communicators, among others. In-depth interviews with members of the NCDS Communications Working Group were completed to provide insight into the risk management approach and how communication messages and materials were developed and delivered. Study results reveal the importance of including members of the Inuit population affected by the risk in the design and dissemination of communication material. In addition, researchers and healthcare professionals were able to: (1) access important local knowledge; (2) better understand the perceptions of the populations; and (3) assess behaviors that contributed to contaminant exposure. By incorporating multiple perspectives and including members of the population in the affected region in the decision-making process, there was greater consensus in risk management and communication design. We discuss the benefits and challenges of utilizing an approach that includes participatory elements, and how lessons from this case can contribute to participatory risk communication literature more broadly. This study ultimately provides insight into how using elements of a participatory approaches to risk management and communication – that considers different experiences, knowledges, and skills – can result in potentially more culturally relevant health advisories and risk communication campaigns.

Acute Compartment Syndrome in the Setting of Weight Loss Supplements and Exercise-Induced Rhabdomyolysis.

The growing prevalence of obesity in the USA has resulted in increased consumption of weight loss products that promote fat metabolism. Dietary supplements used for weight loss contain a wide variety of ingredients but the amount of scientific information available on these ingredients varies considerably. Such supplements have documented and undocumented adverse effects. Although the FDA frequently issues health advisories, the health consequences of consuming supplements are often overlooked by the general public. A common supplement used for weight loss is Hydroxycut. The ingredients used in the different forms of Hydroxycut products vary but generally include caffeine and green tea extract, which are responsible for a wide range of adverse effects. We present the case of 41-year-old man with a medical history of polysubstance abuse who developed acute compartment syndrome in the setting of rhabdomyolysis from prolonged immobilisation and the use of Hydroxycut. This case demonstrates the possible adverse effects of consuming weight loss herbal supplements like Hydroxycut. Healthcare professionals and consumers are encouraged to report serious adverse events or product quality problems with the use of these supplements to the FDA’s MedWatch adverse event reporting program.LEARNING POINTSThe weight loss supplement Hydroxycut is sold in various formulations whose side effect profiles are not fully known; the latest formulation has a very high concentration of caffeine which increases the risk of rhabdomyolysis.Although uncommon, exercise-induced rhabdomyolysis can cause compartment syndrome, especially in the setting of concurrent use of weight loss supplements.High clinical suspicion, prompt diagnosis and early treatment are key to preventing complications from compartment syndrome.

Find and Replace: R&amp;D Investment Following the Erosion of Existing Products

How do innovative firms react when existing products experience negative shocks? We explore this question with detailed project-level data from drug development firms. Using the Food and Drug Administration public health advisories as idiosyncratic negative shocks to approved drugs, we examine how drug makers react through investment decisions. Following these shocks, affected firms increase research and development (R&amp;D) expenditures, driven by a higher likelihood of acquiring external innovations rather than developing novel projects internally. Such acquisition activities are concentrated in firms with weak research pipelines. We also find that competing developers move resources away from the affected therapeutic areas. Our results show how investments in specialized commercialization capital create path dependencies and alter the direction of R&amp;D investments. This paper was accepted by Ashish Arora, entrepreneurship and innovation.

Modeling PFAS Removal Using Granular Activated Carbon for Full-Scale System Design.

Per- and polyfluoroalkyl substances (PFAS) are increasingly of interest to drinking water utilities due to state regulations, the release of federal and state health advisories, and public concern. Pilot-scale data were fitted for 16 PFAS species and five commercial-activated carbons using an open-source pore and surface diffusion model that includes an automated parameter-fitting tool. The estimated model parameters are presented, and an uncertainty analysis was evaluated considering the expected temporal variability of influent concentrations. Expected treatment performance differed between two seasons in the pilot phase for the same carbon, which was not captured by modeled uncertainty. However, modeling results can support a utility's decision to choose activated carbon, and make design and operational decisions that can address changing water production rates and treatment goals. For the utility that undertook this pilot study and their desired treatment goals, granular activated carbon (GAC) was found to be an effective treatment technology for PFAS removal.

Oral health care of hospitalized elderly in a Southern Brazilian public hospital

Oral health care plays a part in the integral recovery of hospitalized older people. Based on that, this study characterized the oral health care of hospitalized older people in a Brazilian public hospital. Through application of questionnaires, this cross-sectional study assessed oral health care practice by hospital nursing staff (n=31), companions (n=134) and hospitalized older people (n=200) of a public hospital in Southern Brazil. Clinical examination was conducted by two previously calibrated examiners to screen the oral health condition of the patients, considering the presence of cavitated lesions, residual roots, visible biofilm, calculus, gum inflammation and bleeding. Data were analysed descriptively. Nursing staff limits oral health assessment to surgical procedures; 55% of nurses and 58% of companions do not supervise the oral hygiene, but 81% and 96%, respectively, claim to perform oral hygiene of elderly with difficulties to do so. The elderly (51%) claimed to brush their teeth 3x/day or more; yet, their oral health was characterized by the presence of visible biofilm, calculus, gingival inflammation and bleeding and decayed teeth. Oral health advisory or assessment is not part of the hospital routine. Companions and hospital nursing staff are willing to receive oral health care information. Poor oral health was observed in hospitalized older people, which would probably be enhanced by an interdisciplinary educational approach towards oral health care to older patients.

Meta-Analyses Do Not Establish Improved Mortality With Ivermectin Use in COVID-19

Meta-Analyses Do Not Establish Improved Mortality With Ivermectin Use in COVID-19

Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021

During October 2019, the West Virginia Bureau for Public Health (WVBPH) noted that an increasing number of persons who inject drugs (PWID) in Kanawha County received a diagnosis of HIV. The number of HIV diagnoses among PWID increased from less than five annually during 2016-2018 to 11 during January-October 2019 (Figure). Kanawha County (with an approximate population of 180,000*) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016,† and the county is located near Cabell County, which experienced an HIV outbreak among PWID during 2018-2019 (1,2). In response to the increase in HIV diagnoses among PWID in 2019, WVBPH released a Health Advisory§; and WVBPH and Kanawha-Charleston Health Department (KCHD) convened an HIV task force, conducted care coordination meetings, received CDC remote assistance to support response activities, and expanded HIV testing and outreach.

Leveraging Collective Impact to Address Structural Racism in Buncombe County, North Carolina.

Buncombe County, North Carolina, was recognized in 2014 as a Robert Wood Johnson Foundation Culture of Health Prize Winner for its work fostering collaboration and partnership to address community health needs. As part of this work, Buncombe County Health and Human Services (HHS) convened a cross-sector Public Health Advisory Council that supported community-based initiatives and ensured that community members were involved in identifying and implementing solutions to issues such as poverty and child well-being. Leveraging existing relationships and past efforts, Buncombe County has continued to build collaborative networks for systems change using a collective impact framework. Bringing together partners across sectors, including the faith community, Black fraternities and sororities, community health workers, consulates, and others, Buncombe County HHS is supporting efforts to train and equip community members to lead health promotion efforts and community conversations on historical trauma and racial healing; engage community members in the policymaking process through town halls; and archive the community's pandemic journey through storytelling. The collective impact framework has shaped an environment that supports community change by centering community aspirations and values. This environment informed recent declarations by Buncombe County HHS and the Board of Commissioners that racism is a public health crisis, as well as a resolution by the city of Asheville supporting community reparations. This article explores how the collective impact framework has been used in Buncombe County to engage and continually invest in communities of color and reviews steps taken to develop and implement an equity action plan to address structural racism.

Key Insights Into Schizophrenia Misdiagnosis and the Use of Antipsychotics

Key Insights Into Schizophrenia Misdiagnosis and the Use of Antipsychotics

Synthetic Biology Construct of Ebola Virus in Bacteria Surrogate Is Stable and Safe for Rapid Detection Studies in a BSL-2 Laboratory Setting

Rapid detection of virulent pathogens during an outbreak is critical for public health advisories and control of the disease in a population. While many molecular techniques for point of care and clinical diagnosis abound, the US experience with the COVID-19 testing in the early stages of the pandemic underscores the critical importance of determining the appropriate target gene(s) with in-built controls that reliably detect pathogens with high sensitivity and specificity. Assays and research for diagnostics and therapy could be slowed during an epidemic because access to the required BSL-3 and BSL-4 laboratories are limited. So, during the 2014 West Africa Ebola outbreak, we tested the hypothesis that using synthetic cDNA of Ebolavirus in a bacteria surrogate (fit for all lab settings), would remain unmutated and safe after several generations, serving as an effective positive control in research settings, self test and point-of-care detection platforms. Primers were designed for the detection and quantification of the nucleoprotein (NP) gene of the 2014 Makona Ebola strain (KR781608.1, 733 - 1332 bp). To test the stability of artificially inserted translation arrest in the Orf of the model gene, it was edited to include three STOP codons in the RNA transcript using SNAP GENE. The segment was then spliced into a high copy number plasmid, cloned into One ShotTM TOP10 Escherichia coli (Invitrogen), and tested for stability and safety by periodic subculture, extraction and sequencing. Unlike COVID-19, rapid detection of blood-borne etiologies like Ebola requires optimized protocols for blood matrix. Using real-time PCR and newly designed primer pairs, the EBOV surrogate was detected and enumerated in human blood and regular broth and buffers. Based on aligned sequence analysis, the EBOV synthetic NP gene was stable (>99.9999% similarity coefficient) for at least 3 months. Detection sensitivity in broth and blood was at least 100 cells/ml or about 5.8 × 103 to 7.3 × 103 virion equivalents per ml. While the developments of transcription-and-replication-competent virus like particles (trVLP) have made it possible to study the infection and replication cycles of virulent pathogens in BSL-2 laboratories, the simplicity of our model and the reproducibility of detection and enumeration show the utility of synthetic bio-components as positive controls for point of care diagnostic tools. The inserted stop codons remained intact after many generations, suggesting that expressed virulent proteins can be easily silenced in synthetic biology models for research in BSL-1 and 2 and a wide range of pathogens. Synthetic bio-components can thereby aid further research by reducing costs and improving safety for workers and stakeholders.

MHW looks back at some of the news, issues impacting the MH field in 2021

The year 2021 proved again to be a year like no other, particularly with the ongoing COVID‐19 pandemic further fueled by the omicron variant. Alarming increases in anxiety, depression and stress have been reported for adults around the country, with the Centers for Disease Control and Prevention (CDC) noting that more than 40% of adults are struggling. Children and teens are experiencing mental health crises, so much so that a national emergency was declared, followed by a federal public health advisory.

Elementary Schools' Response to Student Wellness Needs during the COVID-19 Shutdown: A Qualitative Exploration Using the R = MC2 Readiness Heuristic.

During spring of 2020, the COVID-19 pandemic and accompanying public health advisories forced K-12 schools throughout the United States to suspend in-person instruction. School personnel rapidly transitioned to remote provision of academic instruction and wellness services such as school meals and counseling services. The aim of this study was to investigate how schools responded to the transition to remote supports, including assessment of what readiness characteristics schools leveraged or developed to facilitate those transitions. Semi-structured interviews informed by school wellness implementation literature were conducted in the spring of 2020. Personnel (n = 50) from 39 urban and rural elementary schools nationwide participated. The readiness = motivation capacity2 (R = MC2) heuristic, developed by Scaccia and colleagues, guided coding to determine themes related to schools’ readiness to support student wellness in innovative ways during the pandemic closure. Two distinct code sets emerged, defined according to the R = MC2 heuristic (1) Innovations: roles that schools took on during the pandemic response, and (2) Readiness: factors influencing schools’ motivation and capacity to carry out those roles. Schools demonstrated unprecedented capacity and motivation to provide crucial wellness support to students and families early in the COVID-19 pandemic. These efforts can inform future resource allocation and new strategies to implement school wellness practices when schools resume normal operations.

Case Study - Candida auris in Skilled Nursing Facility

Candida Auris (C. auris), is a multidrug-resistant organism, first described in Japan 2009, and now a serious, emerging global health threat1. C. auris pathogen can potentiate morbidity and mortality, i.e. lifelong contact precaution isolation, intravenous antifungal treatment, hospitalization and mortality rate of 30-60%1. Los Angeles County (LAC) developed 15 new cases in May 2020, and 73 cases in July 2020, amidst COVID-19 pandemic2. A 88 year old Black female had a positive skin test for C. auris by LAC Department of Public Health (DPH) during skilled nursing facility (SNF) admission for hip fracture in September 2020. Patient’s risk factors for C. auris included: age, kidney transplantation (1998) immunosuppression on tacrolimus, fungal infection on fluconazole, drug-drug interaction between tacrolimus-fluconazole including nephrotoxicity and neurotoxicity, malnutrition, bedbound, Stage 4 sacrococcyx pressure ulcer, osteomyelitis on broad-spectrum antibiotics, chronic indwelling catheter, and healthcare setting. Our multimorbid and frail patient remained asymptomatic with C. auris under an interdisciplinary team approach, including geriatricians, infectious disease, pharmacists, SNF team and local DPH. Our patient’s psychosocial isolation and family distress with local DPH guidelines for COVID-19 SNF visitation restrictions were compounded by multifaceted coordination of patient-centered care between SNF team and specialists via telehealth. Further research in the prevention, detection, and management of C. auris is warranted to protect our vulnerable SNF residents. 1. Centers for Disease Control and Prevention. (2020). Tracking Candida auris. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html 2. Los Angeles County Health Alert Network. (2020). CDPH Health Advisory: Resurgence of Candida auris in Healthcare Facilities in the Setting of COVID-19. http://publichealth.lacounty.gov/eprp/lahan/alerts/CAHANCauris082020.pdf

Bill would fund hiring of school counselors, social workers, psychologists

Less than a week after the U.S. surgeon general's issuance of a public health advisory to provide recommendations on addressing mental health challenges confronting children, adolescents and young adults (see MHW, Dec. 13), Senate lawmakers have introduced what observers say may provide some solution: legislation to boost the availability of mental health resources and investments in more mental health providers in public schools.