Integrated Public Health Research Articles

Guest Editorial: Integrating Public Health and Behavioral Science to Improve Population Health

Guest Editorial: Integrating Public Health and Behavioral Science to Improve Population Health

Health for all in India: A vision made possible through integrated Public Health and Community Medicine

Health for all in India: A vision made possible through integrated Public Health and Community Medicine

Advancing Black Men’s Type 2 Diabetes Healthcare Through Addressing Gender-centered Social Norms, Cognitive Scripts, and Manhood: An Integrated Public Health Approach for Reducing T2D Disparities

ABSTRACT In the United States, the burden of type 2 diabetes (T2D) health complications and outcomes is higher in Black men, and the diabetes disparities are escalating. Previous evidence-based research underscored the need to explore gender-specific experiences of chronic illness in social-cultural, historical, and clinical contexts. Our community-engaged qualitative study focused on learning from the live experiences of Black men (n = 15) in the Arkansas Delta area. Applying a narrative approach, we explored and learned from the participants about their perception of the consequences of T2D on manhood and the usefulness of T2D management instructions. Findings indicate that an integrated public health approach contextualizes social-cultural norms, cognitive scripts, and gender-centered expressions of manhood, a promising direction in T2D healthcare; social support is essential for emotional and physical help in continued T2D management; and connecting with Black men and their insights are vital to develop relevant and appropriate guidelines for T2D management care.

The comparative analysis of health care systems based on rating definition

The comparative analysis of effectiveness and efficiency of health care systems functioning causes a number of difficulties due to different indicators applied in countries as assessment tools, different data collection mechanisms and differences in nature and dimension of determining indicators. To ensure comparability of absolute values of various indicators and possibility to compare activities of single medical organizations and effectiveness of health care system of both various Subjects of the Russian Federation and health care system as a whole, it is possible to apply different rating techniques. The article presents comprehensive comparative analysis of activities of health care systems based on construction of rating using integral indicators of public health: indicators of key functioning of health systems (financial support and infrastructure development), total mortality from non-communicable diseases, probability of dying at the age of 30 to 70 years from any of cardiovascular diseases, cancer, diabetes or chronic respiratory diseases, universal health coverage index, life expectancy (at birth and at the age of 60). The comprehensive comparative analysis of results permitted to to conclude that the greatest financial costs for health care and best level of infrastructural support (beds and medical personnel) in countries with health insurance system. At that, according to ranking results and all selected integral public health indicators, health insurance system took the first place.

Integrating Public Health and Health Care - Protecting Health as a Team Sport.

Integrating Public Health and Health Care - Protecting Health as a Team Sport.

Brief Commentary: Using a Logic Model to Integrate Public Health Informatics Into Refinements of Public Health Surveillance System

The COVID-19 pandemic has been a watershed moment in public health surveillance, highlighting the crucial role of data-driven insights in informing health actions and policies. Revisiting key concepts— public health, epidemiology in public health practice, public health surveillance, and public health informatics—lays the foundation for understanding how these elements converge to create a robust public health surveillance system framework. Especially during the COVID-19 pandemic, this integration was exemplified by the WHO efforts in data dissemination and the subsequent global response. The role of public health informatics emerged as instrumental in this context, enhancing data collection, management, analysis, interpretation, and dissemination processes. A logic model for public health surveillance systems encapsulates the integration of these concepts. It outlines the inputs and outcomes and emphasizes the crucial actions and resources for effective system operation, including the imperative of training and capacity development.

CORRELATION OF FAMILY SUPPORT AND FAMILY RESILIENCE WITH DHF PREVENTION BEHAVIOR IN OLDER ADULTS

Background: The elderly are a vulnerable age group for Dengue Haemorrhagic Fever (DHF) with a high risk of death. Families must carry out their roles in efforts to prevent DHF in older adults. Purpose: This study aims to identify the correlation between family support and resilience with DHF prevention behavior. Methods: This study used a correlational design to detect a relationship between family support and resilience variables and DHF prevention behavior by older adults. The research location was at the Andalas Health Center in Padang, with 96 randomly recruited from seven elderly Integrated Public Health Centers. The instrument consisted of three closed-question questionnaires. Family support is identified through informational, reward, instrumental, and emotional indicators, while family resilience includes relationship communication, positive framing, and external resources. Data were analyzed using the Spearman Rho test. Results: Most respondents were older adults (73.96%) aged 60-65 (68.75%). The correlation test between family support and family resilience with DHF prevention behavior has a significant relationship (0.00). Testing the correlation partially on each indicator shows the highest level of correlation on the instrumental indicator (0.83). The correlation between family support and resilience was highest on emotional and communication-relationship indicators (0.71). Conclusion: Family support and resilience are correlated with DHF prevention behavior by the elderly. Emotional support from the family through communication appropriate to the older adults' age phase is needed to prevent DHF.

Integrating Public Health Ethics into Public Health Policymaking: Being in the Room Where It Happens.

This commentary takes up a challenge posed by Franklin Miller in a 2022 essay in Bioethics Forum. Dr. Miller queried whether bioethicists could be useful in public health policy contexts and while he refrained from issuing an ultimate opinion, did identify several challenges to such utility. The current piece responds to the challenges Dr. Miller identifies and argues that with appropriate training, public health ethicists can be of service in virtually any context in which public health policies are deliberated and decided.

Principles for effective management of scabies outbreaks

Background: The contagious skin infestation scabies, is caused by the mite <i>Sarcoptes scabiei</i> var. <i>hominis</i>. These microscopic organisms navigate under the skin surface to lay eggs, creating burrows that cause notable discomfort and itching and enable the maturation and subsequent proliferation of the mites. Spread to other hosts can occur through direct, often prolonged, skin-to-skin contact or indirectly through shared items such as clothing, bedding, or towels.Current Concepts: Management of a scabies outbreak encompasses several pivotal steps: accurate diagnosis, comprehensive treatment with topical scabicides to kill the mites, rigorous environmental control (including washing all possibly infested materials in hot water), meticulous contact tracing of all close contacts, administration of symptomatic relief through antihistamines and corticosteroids, and meticulous follow-up to verify successful treatment outcomes.Discussion and Conclusion: The prevention of further infestation and recurrent outbreaks is crucial, necessitating a holistic, integrative public health management approach. This approach involves consistent communication and public education about preventive measures and prompt treatment strategies to curtail widespread infestation, thereby safeguarding community health.

Correction: Integrating Public Health Expertise in Research: a Series of Workshops about Vector-Borne and Other Zoonotic Diseases

Correction: Integrating Public Health Expertise in Research: a Series of Workshops about Vector-Borne and Other Zoonotic Diseases

Integrating Public Health Expertise in Research: a Series of Workshops about Vector-Borne and Other Zoonotic Diseases

Research groups must understand the needs and requirements of the public health service to be able to develop tools and strategies for supporting it in risk assessment and risk communication. The zoonotic research consortia RoBoPub, Q-GAPS, TBENAGER and ZooBoCo used the format of workshops to include the expertise of the public health service system in their work. We present the results of three workshops that were held with representatives of the German public health service as part of the annual congress of the Federal Association of Physicians of German Public Health Departments in 2018, 2019 and 2022. Each workshop, held in a world-café format, lasted 90 minutes and had its own thematic focus. In the first workshop, information on the goals, problems, solutions and expectations of the public health service from the research consortia concerning exposure to rodent-borne infections during their occupational and leisure-time activities as well as the use of risk maps was collected. In the second and third workshops, participants developed risk communication strategies based on scenarios of outbreaks and identifications of new risk areas. Each workshop had more than 20 participants, of which at least half worked for local public health authorities. Foremost, participants expected practical, target group-specific material for risk communication from the research groups. According to the experience of most participants, direct contact with the affected groups was essential for risk communication. To raise awareness of the situation and establish contact with the relevant target groups, social media can complement traditional media, especially for hard-to-reach groups. However, their use should be considered and planned carefully. The workshop format was appropriate for integrating the public health expertise in the research activities. The expectations of the public health service on material for risk communication could be translated into a guideline, a risk management plan and pathogen descriptions by the research groups. When integrating the expertise of the public health authorities in their work, research groups should consider how to reach a suitable panel of representatives and how to keep the workload for those at an acceptably low level.

Healthier mind builds healthier nation under ABArK

Background: The State of Karnataka launched a scheme called “Arogya Karnataka” as a part of universal health coverage following the Karnataka Integrated Public Health Policy 2017 and Karnataka Vision 2025 document. With the goal of achieving universal health coverage (UHC), Karnataka, a national leader in healthcare, launched the Arogya Karnataka scheme in March 2018. It was later integrated with the government of India's national health protection scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB-PMJAY) to help with financial protection. Mental health, as defined by the World Health Organization (WHO), refers to “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. Methods: A cross-sectional analysis of data collected from the State Health Agency, Suvarna Arogya Suraksha Trust (SAST) portal. The study was conducted for a period 12 months from January to December 2022. Results: The study included 7292 mental disorder patients, majority of were male (70.95%), having age group of 31-45 years (45.41%), and belonged to the Below poverty line (BPL) (94.54%). Majority of cases were psychoactive substance use (64%) followed by Schizophrenia (22%) and Mental Retardation (14%). Conclusions: Ayushman Bharat –PM-JAY Arogya Karnataka (AB-PMJAY ArK) has potential to reduce the out of pocket expenditure, distress financing and reduce catastrophic health expenditure which will lead to significant impact on health indices.

Spending It Forward: Integrated Public Health Investments Are Vital to the Pandemic Response.

Spending It Forward: Integrated Public Health Investments Are Vital to the Pandemic Response.

Integrating Public Health Into Undergraduate Medicine in North America: A Systematic Review.

The coronavirus disease 2019 (COVID-19)pandemic has served as a stark reminder of the importance of foundational public health training for all physicians. However, the most effective way to incorporate these concepts into undergraduate medical education remains unclear. Here, we characterize the literature regarding the effectiveness of public health integration into undergraduate medical education in North America. We systematically searched MEDLINE, Embase, Cochrane Central, and Education Resources Information Center (ERIC) in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for North American peer-reviewed literature, published from 01/01/2000 to 30/08/2021, that described outcomes of integrating public health training within an undergraduate medical curriculum. Results were qualitatively synthesized into key themes. A total of 38 studies, involving interventions across 43 medical schools, were included. Studies reported on a combination of public (n=13), global (n=9), population (n=9), community (n=6), and epidemiological (n=1) health interventions, and either implemented one-off workshops, electives, or international experiences (n=19); a longitudinal theme or long-term enrichment pathway (n=14); or a case-based learning curriculum (n=8). The majority (81.5%, 31/38) of integrations were self-described as successful and, of studies reporting on feasibility, most (94.1%, 16/17) were indicated as feasible. The definition of what constituted such success, however, was unclear. Innovative examples included the use of simulation workshops and mobile-optimized media content. Key challenges were noted, however, in securing adequate funding and buy-in from administrative leadership. Robust community partnerships and iterative cycles of implementation of the intervention were critical factors to success. In summary, foundational public health components can be effectively integrated into medical school curricula and would benefit from adequate resourcing, innovation, community partnerships, and continuous improvement.

Anxious, Depressed, and Suicidal: Crisis Narratives in University Student Mental Health and the Need for a Balanced Approach to Student Wellness.

There is growing global awareness of the poor mental health of university students, as well as the need to improve students' access to services and expand the range of available evidence-based interventions. However, a crisis narrative is emerging, particularly in the wake of the COVID-19 pandemic, that runs the risk of positioning all students as potential patients in need of formal psychiatric interventions. Our aim in this commentary is to critically present the evidence that supports increased attention to student mental health, while also raising a concern that the crisis narrative may itself have unintended harmful consequences. We highlight some of the potential dangers of overtly medicalizing and thus pathologizing students' experiences of everyday distress, inadequacies of formal diagnostic categories, limitations of focusing narrowly on psychotherapeutic and psychiatric interventions, and the short-sightedness of downplaying key social determinants of students' distress. We argue for an integrative and balanced public health approach that draws on the rigor of psychiatric epidemiology and the advances that have been made to identify evidence-based interventions for students, while simultaneously being mindful of the shortcomings and potential dangers of working narrowly within the paradigm of diagnostic labels and psychotherapeutic interventions.

Nursing home crowding and its association with outbreak-associated respiratory infection in Ontario, Canada before the COVID-19 pandemic (2014–19): a retrospective cohort study

Studies conducted during the COVID-19 pandemic have shown that crowding in nursing homes is associated with high incidence of SARS-CoV-2 infections, but this effect has not been shown for other respiratory pathogens. We aimed to measure the association between crowding in nursing homes and outbreak-associated respiratory infection incidence and related mortality before the COVID-19 pandemic. We conducted a retrospective cohort study of nursing homes in Ontario, Canada. We identified, characterised, and selected nursing homes through the Ontario Ministry of Long-Term Care datasets. Nursing homes that were not funded by the Ontario Ministry of Long-Term Care and homes that closed before January, 2020 were excluded. Outcomes consisting of respiratory infection outbreaks were obtained from the Integrated Public Health Information System of Ontario. The crowding index equalled the mean number of residents per bedroom and bathroom. The primary outcomes were the incidence of outbreak-associated infections and mortality per 100 nursing home residents per year. We examined the incidence of infections and deaths as a function of the crowding index by use of negative binomial regression with adjustment for three home characteristics (ie, ownership, number of beds, and region) and nine mean resident characteristics (ie, age, female sex, dementia, diabetes, chronic heart failure, renal failure, cancer, chronic obstructive pulmonary disease, and activities of daily living score). Between Sept 1, 2014, and Aug 31, 2019, 5107 respiratory infection outbreaks in 588 nursing homes were recorded, of which 4921 (96·4%), involving 64 829 cases of respiratory infection and 1969 deaths, were included in this analysis. Nursing homes with a high crowding index had higher incidences of respiratory infection (26·4% vs 13·8%; adjusted rate ratio per one resident per room increase in crowding 1·89 [95% CI 1·64-2·17]) and mortality (0·8% vs 0·4%; 2·34 [1·88-2·92]) than did homes with a low crowding index. Respiratory infection and mortality rates were higher in nursing homes with high crowding index than in homes with low crowding index, and the association was consistent across various respiratory pathogens. Decreasing crowding is an important safety target beyond the COVID-19 pandemic to help to promote resident wellbeing and decrease the transmission of prevalent respiratory pathogens. None.

Integrating Public Health Research and Teaching With Social Justice Activism: Lessons From 80 Years of Practice.

In this commentary, we reflect on the lessons we have learned from our successes and failures in aligning the roles of scholars and activists. Our hope is to provide insights that can guide public health students, faculty, practitioners, and activists seeking to chart their professional, political, and personal futures in today's polarized and catastrophe-burdened world. Several experiences motivate us to write this commentary now. In the last few years, inspired in part by the new activism against systemic racism sparked by the murder of George Floyd and others, growing climate emergencies, the COVID pandemic, anti-immigrant politics, increasing anti-Asian acts of violence, gun bloodshed, attacks on the right to reproductive and sexual health, resurgence of interest in worker organizing, and the ongoing quest for lesbian, gay, bisexual, transgender, and intersex (LGBTQI+) rights, we are impressed by the number of young people engaged in activism to defend and expand their rights and show that another world is possible.

“Integrative Health System” beyond “Integrative Medicine”

One Nation, One Health System has many dimensions, and an inclusive Integrative Health System is one of the overarching and cross-cutting approaches to attain it. This paper discusses the imperatives for creating an Integrative Health System that incorporates AYUSH and Allopathic knowledge traditions. Since Integrative Health System is a term diversely understood and used, the need to conceptualize it and come to a shared understanding is highlighted. The paper brings insights and tools from a Health Systems perspective to suggest conceptualizing an Integrative Health System framework. It proposes that the IHS has three components— Integrative Medicine, Integrative Public Health, and an Integrative Health Care System. After discussing these components, the paper moves on to the Health Systems Research required for designing an Integrative Health Care System. The Complex Adaptive Systems approach is considered appropriate and explained. An illustration is provided from a study conducted to study the role and status of Ayush services and Local Health Traditions in the Public health system. Inferring conclusions from the study mentioned above and similar studies undertaken by the author, few illustrative inputs regarding Integrative Health Systems are provided, which would adequately support an ecosystem that allows interaction and dialogue between systems. It is postulated that this requires a shift in thinking from the dominant positivist paradigm to a critical holist paradigm.

64 Impact of Substance Use Navigators on Addiction Treatment and Outcomes for Emergency Department Patients in an Integrated Public Health System

64 Impact of Substance Use Navigators on Addiction Treatment and Outcomes for Emergency Department Patients in an Integrated Public Health System

EPH60 Real-World Data Dashboard Integrating Public Health & EHR Data for Identifying COVID-19 Vaccination Gaps in the US

EPH60 Real-World Data Dashboard Integrating Public Health & EHR Data for Identifying COVID-19 Vaccination Gaps in the US