Health Advisory Research Articles

Priority Indicators for Adolescent Health Measurement – Recommendations From the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group

PurposeThis article describes the selection of priority indicators for adolescent (10–19 years) health measurement proposed by the Global Action for Measurement of Adolescent health advisory group and partners, building on previous work identifying 33 core measurement areas and mapping 413 indicators across these areas. MethodsThe indicator selection process considered inputs from a broad range of stakeholders through a structured four-step approach: (1) definition of selection criteria and indicator scoring; (2) development of a draft list of indicators with metadata; (3) collection of public feedback through a survey; and (4) review of the feedback and finalization of the indicator list. As a part of the process, measurement gaps were also identified. ResultsFifty-two priority indicators were identified, including 36 core indicators considered to be most important for measuring the health of all adolescents, one alternative indicator for settings where measuring the core indicator is not feasible, and 15 additional indicators for settings where further detail on a topic would add value. Of these indicators, 17 (33%) measure health behaviors and risks, 16 (31%) health outcomes and conditions, eight (15%) health determinants, five (10%) systems performance and interventions, four (8%) policies, programmes, laws, and two (4%) subjective well-being. DiscussionA consensus list of priority indicators with metadata covering the most important health issues for adolescents was developed with structured inputs from a broad range of stakeholders. This list will now be pilot tested to assess the feasibility of indicator data collection to inform global, regional, national, and sub-national monitoring.

Trends in Acute Hepatitis of Unspecified Etiology and Adenovirus Stool Testing Results in Children - United States, 2017-2022.

In November 2021, CDC was notified of a cluster of previously healthy children with hepatitis of unknown etiology evaluated at a single U.S. hospital (1). On April 21, 2022, following an investigation of this cluster and reports of similar cases in Europe (2,3), a health advisory* was issued requesting U.S. providers to report pediatric cases† of hepatitis of unknown etiology to public health authorities. In the United States and Europe, many of these patients have also received positive adenovirus test results (1,3). Typed specimens have indicated adenovirus type 41, which typically causes gastroenteritis (1,3). Although adenovirus hepatitis has been reported in immunocompromised persons, adenovirus is not a recognized cause of hepatitis in healthy children (4). Because neither acute hepatitis of unknown etiology nor adenovirus type 41 is reportable in the United States, it is unclear whether either has recently increased above historical levels. Data from four sources were analyzed to assess trends in hepatitis-associated emergency department (ED) visits and hospitalizations, liver transplants, and adenovirus stool testing results among children in the United States. Because of potential changes in health care-seeking behavior during 2020-2021, data from October 2021-March 2022 were compared with a pre-COVID-19 pandemic baseline. These data do not suggest an increase in pediatric hepatitis or adenovirus types 40/41 above baseline levels. Pediatric hepatitis is rare, and the relatively low weekly and monthly counts of associated outcomes limit the ability to interpret small changes in incidence. Ongoing assessment of trends, in addition to enhanced epidemiologic investigations, will help contextualize reported cases of acute hepatitis of unknown etiology in U.S. children.

Monkeypox Outbreak - Nine States, May 2022.

On May 17, 2022, the Massachusetts Department of Public Health (MDPH) Laboratory Response Network (LRN) laboratory confirmed the presence of orthopoxvirus DNA via real-time polymerase chain reaction (PCR) from lesion swabs obtained from a Massachusetts resident. Orthopoxviruses include Monkeypox virus, the causative agent of monkeypox. Subsequent real-time PCR testing at CDC on May 18 confirmed that the patient was infected with the West African clade of Monkeypox virus. Since then, confirmed cases* have been reported by nine states. In addition, 28 countries and territories,† none of which has endemic monkeypox, have reported laboratory-confirmed cases. On May 17, CDC, in coordination with state and local jurisdictions, initiated an emergency response to identify, monitor, and investigate additional monkeypox cases in the United States. This response has included releasing a Health Alert Network (HAN) Health Advisory, developing interim public health and clinical recommendations, releasing guidance for LRN testing, hosting clinician and public health partner outreach calls, disseminating health communication messages to the public, developing protocols for use and release of medical countermeasures, and facilitating delivery of vaccine postexposure prophylaxis (PEP) and antivirals that have been stockpiled by the U.S. government for preparedness and response purposes. On May 19, a call center was established to provide guidance to states for the evaluation of possible cases of monkeypox, including recommendations for clinical diagnosis and orthopoxvirus testing. The call center also gathers information about possible cases to identify interjurisdictional linkages. As of May 31, this investigation has identified 17§ cases in the United States; most cases (16) were diagnosed in persons who identify as gay, bisexual, or men who have sex with men (MSM). Ongoing investigation suggests person-to-person community transmission, and CDC urges health departments, clinicians, and the public to remain vigilant, institute appropriate infection prevention and control measures, and notify public health authorities of suspected cases to reduce disease spread. Public health authorities are identifying cases and conducting investigations to determine possible sources and prevent further spread. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.¶.

American Chemistry Council comments on US legislation on PFAS and other chemicals, and provides evidence most commercial fluoropolymers are safe for humans and the environment

ACC reacts to EPA New Chemicals Program, SEC Climate Disclosure Proposal and EPA Health Advisories for PFAS, and provides evidence most commercial fluoropolymers are of low concern

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.