Local Public Health Authorities Research Articles

Framing the wider determinants of health: Reflections and learning from a knowledge mobilisation exercise with an English local authority

BackgroundHealth inequalities remain a persistent problem in the UK. One contributing factor may be how health inequalities are framed in professional and public debate. Dominant understandings of health focus on the individual, personal choice, lifestyle and (un)healthy behaviour. This project sought to reframe health inequalities as a ‘systemic’ or structural problem using extant guidance. This was intended to support the work of a local authority in England working to address health inequalities. Project designAn academic-practitioner participatory knowledge mobilisation exercise with a local authority public health team using recent guidance and reflective feedback and the iterative development of actionable tools. There were four discrete stages to the exercise. MethodsTwo on-line and one face-to-face participatory, deliberative workshops designed to co-create reframed public health challenges and solutions based on team portfolios. Iterative feedback provided by the researcher to support the development of actionable tools. ResultsSix topic areas were developed with a systemic framing: 1. Food insecurity, 2. Obesity, 3. Prostate cancer among Black men, 4. Cost of living, 5. Mental health, suicide prevention and Gypsy, Roma, Traveller communities, 6. Healthy streets. Reflections from the process revealed some perceived advantages of engaging in a systemic framing of the wider determinants of health, some limitations and issues to consider in a local setting. Benefits included: Clarity in a complex field; structured thinking about what to communicate and how; eliminated jargon; could be made locally relevant. Challenges included: Sustaining a consistent framing; maintaining the technique; knowing if was making a difference; slipping back into dominant (individualised) framings, especially in free-flowing discussion. ConclusionsThe process of reframing the wider determinants of health using recent guidance in a local authority setting was broadly helpful in developing coherence and consistency across the public health team. There were challenges to adopting the approach and evaluation of its impact locally would be beneficial.

Technical Review: Key concepts of health database management for public health workforce development in resource-limited settings

The academic and professional technology communities recognize that data science and big data management are essential methods for handling and using data in modern society for decision-making that ultimately leads to societal improvements. These insights are applicable to the world-wide practice of public health. The purpose of this technical review is to provide the public health decision-maker with an overview of key concepts of health database management to help guide additional individual or workforce development in order to support public health practice. This discussion is organized with the following subheading: Definition: Health Data Management; Data Preparation Actions; Basic SQL Commands in Microsoft Access; and Basic Data Management Procedures. Public health workforce development efforts that include discussion and skill-building activities dealing with issues and topics in health data management could contribute to developing the public health competencies of all public health professionals, including those in resource-limited settings, for the benefit of reporting disease outbreaks and other health outcomes of interest to local public health authorities.

Public health intelligence challenges for local public health authorities responding to disease outbreaks: a mixed-methods systematic review protocol.

Information management capacity is crucial for controlling risks from health emergencies. But little is known about how sub-national public health bodies overcome public health intelligence challenges when responding to disease outbreaks. This paper describes a protocol for a mixed-methods systematic review to fill this knowledge gap. In addition to describing the evidence base and characterising public health intelligence responses, it will explore reported facilitators and barriers to response. Research on sub-national Public Health Intelligence disease outbreak responses will be synthesised. The review will be limited to articles published in English, during or after 2019. Key electronic databases will be searched for peer-reviewed, primary research studies. Two reviewers will independently screen articles for relevance. Articles that refer to a public health intelligence response to a propagated disease outbreak by a sub-national Public Health Authority will be included. Quality assessment of included articles will be undertaken using published tools. Data integration will be by the Pillar Integration Process (PIP). This review will describe and synthesise the recent literature on sub-national Public Health Authorities' responses to propagated disease outbreaks. The systematic design will limit bias and the inclusion of data from quantitative, qualitative and mixed-methods studies will ensure relevant evidence is considered regardless of the methodology used to produce it. The review is part of a larger research project which aims to explore the role of sub-national public health intelligence during the COVID-19 pandemic and investigate how public health intelligence preparedness could be improved in the future. This could provide information to support the development of training, preparedness indicators and/or ways of implementing directives. CRD42022308042 (08/02/2022).

Environmental Public Health practice: designing and delivering a locally desirable service

ObjectivesWe reviewed environmental public health practice at a local level (roles, responsibilities, interaction with partner agencies) to establish what and how an integrated approach to the service, as found in Cheshire and Merseyside, North West England, should be delivered, if at all, and at what footprint. Study designMixed methods approach. MethodsWe triangulated: qualitative interviews with relevant professionals to gain an in-depth understanding of their interest and vision for any health protection input to health risks and outcomes from environmental issues; an electronic questionnaire assessing experience, interest, vision and comfort zones of a wider range of professionals involved in environmental health issues; a half-day workshop to review study findings and agree ways forward. ResultsStakeholders value their local health protection team’s input, but environmental public-health knowledge and skills also exist in local authority teams. Regional health protection teams can provide environmental public-health expertise to local partners and agencies. They harness national input and evidence with local frontline professionals practice, enabling locally grounded approaches, integrating science into local contexts, to answer difficult, often incorrigible, problems. ConclusionsSpecialist leadership by experienced Consultants in Health Protection is of value to local authority public health and environmental teams and should be based on a footprint that is appropriate to enhance local relationships without compromising available expert knowledge and skills.

Surveillance for Ixodes scapularis and Ixodes pacificus ticks and their associated pathogens in Canada, 2020.

Ixodes scapularis and Ixodes pacificus ticks are the principal vectors of the agent of Lyme disease and several other tick-borne diseases in Canada. Tick surveillance data can be used to identify local tick-borne disease risk areas and direct public health interventions. The objective of this article is to describe the seasonal and spatial characteristics of the main Lyme disease vectors in Canada, and the tick-borne pathogens they carry, using passive and active surveillance data from 2020. Passive and active surveillance data were compiled from the National Microbiology Laboratory Branch (Public Health Agency of Canada), provincial and local public health authorities, and eTick (an online, image-based platform). Seasonal and spatial analyses of ticks and their associated pathogens are presented, including infection prevalence estimates. In passive surveillance, I. scapularis (n=7,534) were submitted from all provinces except Manitoba and British Columbia, while I. pacificus (n=718) were submitted only from British Columbia. No ticks were submitted from the Territories. The seasonal distribution of I. scapularis submissions was bimodal, but unimodal for I. pacificus. Four tick-borne pathogens were identified in I. scapularis (Borrelia burgdorferi, Anaplasma phagocytophilum, Babesia microti and Borrelia miyamotoi) and one in I. pacificus (B. miyamotoi). In active surveillance, I. scapularis (n=688) were collected in Ontario, Québec and New Brunswick. Five tick-borne pathogens were identified: B. burgdorferi, A. phagocytophilum, B. microti, B. miyamotoi and Powassan virus. This article provides a snapshot of the distribution of I. scapularis and I. pacificus and their associated human pathogens in Canada in 2020, which can help assess the risk of exposure to tick-borne pathogens in different provinces.

Linking Public Health Monitoring to Dialogue-based Decision-making During the COVID-19 Pandemic: Experiences from a Participatory Pilot in the Netherlands

Introduction:In the Netherlands, a nationally coordinated research program has been initiated to monitor the immediate and long-term public health impact of the COVID-19 pandemic. This contribution describes the design and early results of a continuous dialectic process to involve national and local public health authorities and professionals in monitor-driven decision-making to anticipate the health impact of viral infections and mitigation measures.Method:An ongoing series of dialogue sessions was organized upon the release of quarterly and annual results of the monitoring program. Apart from supporting public health decision-making, the stepwise dialectic process aimed to ensure multi-sectoral learning and co-creation and nurture a sense of ownership among stakeholders from policy, practice and science. National and regional public health authorities served as hub coordinators and participated in determining and approaching relevant stakeholders. Whenever considered relevant, new stakeholders were invited to participate.Results:In the first year, three dialogue sessions were organized, with an emphasis on youth and young adults. Representatives from ministries, municipalities, health organizations, experiential experts and knowledge institutes attended the sessions. Based on the exchange, policy recommendations were formulated and shared among participants. The themes prioritized included mental health issues, overburdened healthcare services, involvement of vulnerable groups in policy development and understanding the complex myriad of risk factors. Moreover, several factors were identified that might facilitate or hinder the implementation and uptake of monitoring findings.Conclusion:The dissemination and discussion of monitoring data proved to be of added value in developing evidence-informed solutions and areas of attention for future monitoring, including the need to track progress of local and national implementation of recommendations. More broadly, the methodology piloted during the program requires further testing as a community engagement strategy and might be meaningful in other crises or problem contexts as well.

Tick-borne encephalitis virus IgG antibody surveillance: vaccination- and infection-induced seroprevalences, south-western Germany, 2021.

BackgroundThe exact epidemiology of tick-borne encephalitis virus (TBEV) infections is unknown because many TBEV infections have an influenza-like or asymptomatic course. Surveillance data are based on patients with any (predominantly neurological) symptoms that prompted diagnostic testing. Infection- and vaccine-induced antibodies against TBEV can be distinguished using an NS1IgG ELISA.AimIn a seroprevalence study we aimed to investigate TBEV antibody prevalence, incidences, manifestation indices and potential protection rates in a highly endemic district in south-western Germany.MethodsWe analysed 2,220 samples from healthy blood donors collected between May and September 2021. The reported number of TBEV infections was provided on a sub-district level by the local public health authorities. Blood samples were first screened using a TBEVIgG ELISA. In a second step, all positive samples were further analysed with a recently established NS1IgG ELISA. The presence of specific antibodies against TBEV (excluding cross-reacting antibodies against other flaviviruses) was confirmed by testing screening-positive samples with a microneutralisation assay.ResultsOf 2,220 included samples, 1,257 (57%) tested positive by TBEVIgG ELISA and 125 tested positive for infection-induced TBEV NS1 antibodies, resulting in a TBEV NS1IgG seroprevalence at 5.6% in our population. The yearly incidence based on the NS1 ELISA findings resulted in 283 cases per 100,000 inhabitants.ConclusionUsing the TBEV NS1IgG assay, we confirmed a manifestation index of ca 2% and a high incidence of predominantly silent TBEV infections (> 250/100,000/year), which exceeds the incidence of notified cases (4.7/100,000/year) considerably.

Geo-visualization of Sarawak COVID-19 Publicly Available Data Employing Open-source Geospatial Software

The state government of Sarawak with the help of the Sarawak Disaster Management Committee (SDMC) has continuously made the updated information on the state COVID-19 situation and its ensuing control measures available to general public in the form of daily press statements. However, these statements are merely providing textual information on daily basis though the data are in fact rich in temporal and spatial properties. Since the onset of COVID-19 pandemic, spatiotemporal analysis becomes the key element to better understand the spread of COVID-19 in various spatial levels worldwide. Hence, there is an urgent need to convert this textual information into more valuable insights by applying geo-visualization techniques and geospatial statistics. The paper demonstrates the prospect of retrieving geospatial data from publicly available document to locate, map and analyze the spread of COVID-19 up to division level of Sarawak. Specifically, map visualization and geospatial statistical analysis are performed for the list of exposed locations, which are indeed locations visited by COVID-19 patients prior to being tested positive in Kuching division, using open-source geospatial software QGIS. It is found that these exposed locations concentrate on the build-up areas in the division and are in south-west to north-east direction of the center of Kuching in September and October 2021. Despite the number of exposed locations published is relatively small compared to the number of confirmed cases reported, both are nearly strongly correlated. The insights gained from such geospatial analysis may assist the local public health authorities to impose applicable disease control interventions at division level.

Investigation and response to a large outbreak of leptospirosis in field workers in Lower Saxony, Germany.

Between June and August 2014, 45 cases of leptospirosis were notified among workers on two strawberry farms in North-West Germany. We describe the characteristics of the outbreak and the actions taken to prevent further cases. The activities of the local, federal and national public health and veterinary authorities included collection of case data, laboratory testing of human specimens and of small mammals trapped on the fields, investigation of weather data, as well as information provided to farmers, field workers, physicians and to the authorities in Poland and Romania. Of the 45 identified cases (median age 22, 60% male), 47% were hospitalized. Characteristic symptoms were fever ≥38.5°C, generalized muscle pain and an increase in renal or liver enzymes. Thirteen cases were laboratory confirmed by serological and/or molecular methods. ELISA tests for Leptospira IgG and IgM-antibodies were positive in those samples taken >5 days after hospitalization. The probable causative agent was identified as Leptospira kirschneri serovar Grippotyphosa. Leptospira-specific DNA was found in kidneys of 67% of 64 trapped small mammals and was further identified as Leptospira kirschneri multi locus sequence type 110. During the estimated time period of human infections, the affected region faced warm weather with heavy rainfalls. The results of this investigation are in accordance with the theory of a chain of infection from mice to field workers during warm and humid weather. In 2015, a campaign was initiated to inform physicians, farmers and workers to enhance prevention measures, such as the use of personal protective equipment and early consultation of physicians in case of illness. Since then, no further outbreak occurred.

Adopting a Statistical, Mechanistic, Integrated Surveillance, Thermal Biology, and Holistic (SMITH) Approach for Arbovirus Control in a Changing Climate: A Review of Evidence

Arbovirus control depends on accurate projections of likely changes in the arthropod vector species, essential to inform local and global public health authorities. According to the WHO Assembly and the Global Vector Control Response (GVCR), by 2030, the burden of vector-borne diseases, particularly arbovirus infections, is expected to be greatly decreased. However, anthropogenic drivers, including climate change, insecticide resistance, and a lack of operational local databases for risk management of emerging and re-emerging arboviruses, hinders effective implementation plans. This article presents a statistical, mechanistic, integrated surveillance, thermal biology, and holistic framework (termed SMITH) to discuss how temperature variations affect the biological transmission, replication, extrinsic incubation period, nutritional behavior, distribution, and survival (TRENDS) of arboviruses. Future transdisciplinary research that involves knowledge translation between local and global communities is required for early detection and risk management of the growing threat posed by arboviruses for human, animal, and planetary health.

식민지기 醫生을 둘러싼 식민권력의 통치 기술과 전략

This article aims to understand the characteristics of Japanese colonial rule by examining the governing strategy and technologies of colonial power to subsume Uisaeng under the modern medical system during the Japanese colonial period. To that end, this article urg es to recog nize colonial power as disciplinary power, which reproduces ruling orders through strategy and technologies of inhumane and constant surveillance and control instead of personal and violent power. Moreover, this study examines Uisaeng, the oriental medical doctors in charge of low-level administration and medical care in the modern medical system, to investigate how Japanese colonial power used the new disciplinary power to rule their colony. Also, with criticism of Gyeongseong-centric disparity in the study of Uisaeng , this study seeks to reproduces the differences among regions. As the oriental medical doctors, Uisaeng was heterogeneous to be subsumed under the Western-centric modern medical system. However, due to poor medical conditions, the colonial power attempted to utilize Uisaeng. Accordingly, colonial power recreated them as modern medical practitioners by selecting, educating, evaluating, and censoring them. Meanwhile, diverse strategies to use and mobilize Uisaeng were implemented depending on regional circumstances as local public health authorities gained more autonomy due to the reorg anized local system in the 1920’s.

Effects of large temperature change lasting for several days on cardiovascular disease hospital admissions among farmers in China’s Western villages

ABSTRACT Global climate change has resulted in an increase in the frequency, intensity, and duration of extreme events. However, we know very little about the associations between large temperature changes lasting for several days (LTCD) and CVD, particularly in less-developed, rural areas. We collected daily data on cardiovascular-related diseases and weather conditions from 119 villages in seven counties between 2010 and 2016. A distributed lag non-linear model was used to investigate the association between LTCD and relative risk (RR) of hospital admissions for CVD. Analyses were stratified by the duration and intensity of LTCD, age, and sex. The RR of CVD increases with the intensity and duration of LTCD. Men and young people were more vulnerable to LTCD of longer duration and higher intensity than women and old. Our findings may help local public health authorities develop adaptive preventive strategies targeting inhabitants of villages.

Epidemiological investigation of a case of malaria in a non-endemic area, Campo de Gibraltar, Cadiz, Spain, January 2022

We describe a non-imported malaria case reported in January 2022 in Campo de Gibraltar and the investigations by local public health authorities to identify the transmission mechanism and subsequent measures to prevent local transmission. Vector transmission, parenteral transmission, airport malaria, and imported malaria were ruled out. No clear mechanism of transmission was identified. The most probable cause was a hospital-acquired infection since the case was admitted to hospital at the same time as a case of imported Plasmodium falciparum malaria.

Public health intelligence challenges for local public health authorities responding to disease outbreaks: a mixed-methods systematic review protocol

Background Information management capacity is crucial for controlling risks from health emergencies. But little is known about how sub-national public health bodies overcome public health intelligence challenges when responding to disease outbreaks. This paper describes a protocol for a mixed-methods systematic review to fill this knowledge gap. In addition to describing the evidence base and characterising public health intelligence responses, it will explore reported facilitators and barriers to response. Methods Research on sub-national Public Health Intelligence disease outbreak responses will be synthesised. The review will be limited to articles published in English, during or after 2019. Key electronic databases will be searched for peer-reviewed research articles of all study designs. Two reviewers will independently screen articles for relevance. Articles that refer to a Public Health Intelligence response to a propagated disease outbreak by a sub-national Public Health Authority will be included. Quality assessment of included articles will be undertaken using tools appropriate for the study design. An integrated synthesis will be performed. Discussion This review will describe and synthesise the recent literature on sub-national Public Health Authorities’ responses to propagated disease outbreaks. The systematic design will limit bias and the inclusion of data from quantitative, qualitative and mixed-methods studies will ensure relevant evidence is considered regardless of the methodology used to produce it. The review is part of a larger research project which aims to explore the role of sub-national public health intelligence during the COVID-19 pandemic and investigate how public health intelligence preparedness could be improved in the future. This could provide information to support the development of training, preparedness indicators and/or ways of implementing directives. PROSPERO registration CRD42022308042 (08/02/2022)

What do public health professionals think their role is in tackling the climate and ecological emergency? A qualitative study

BackgroundThe climate and ecological emergency is the single biggest health threat facing humanity. However, it is not universally seen as a priority for public health. It is not clear to what extent public health professionals are involved in working on the climate and ecological emergency. This research aimed to establish what senior public health professionals working in English local authorities perceive their role is, what activities they are involved in, whether climate and environmental issues are a core component of public health, and to identify barriers to action. MethodsSemi-structured interviews were done with a purposive sample of 15 local authority public health consultants and directors of public health in England using a predefined and piloted topic guide over a Zoom session. Participants were recruited via national public health bodies, social media, or snowballing. Thematic content analysis was used to identify codes and key themes. Ethical exemption was obtained from the University of Manchester. FindingsSome public health professionals have started work on climate change and others were unclear about the role of public health. Key activities included establishing governance structures, bringing together stakeholders, making the case for health co-benefits of climate action, and advocating for reducing inequalities while reducing carbon emissions. Barriers to action included shortage of financial resources, communication tools and capacity, little sharing of best practice, scarcity of local expertise, and conflict between the need for action on climate change and other urgent public health issues. InterpretationPublic health professionals increasingly work on climate change, but practice would be strengthened by improved intelligence, more resources, and support networks. This new qualitative data can inform the development of the role of public health professionals in climate change and the ecological emergency. However, a limitation on the study was that only able to engage public health consultants who considered the climate and ecological crisis as important for public health, so it remains unclear in how far our findings represent the views of the larger public health community. FundingNone.

Risk Assessment of Arbaeen Mass Gathering in the Covid-19 Pandemic.

IntroductionArbaeen is a religious ceremony held annually with the participation of a large number of pilgrims. During the pandemic of Covid-19, a mass gathering of Arbaeen pilgrims can strengthen the transmission of this disease and put more pressure on the health care system of countries. The aim of the study is to evaluate the risk of Arbaeen ceremony in the Covid-19 pandemic in 2021.Materials and methodsA mixed method was performed to perform the study using qualitative and quantitative methods. A national risk assessment tool was used that consisted of hazard identification and assessment, scenario development, exposure assessment, vulnerability assessment and risk estimation. The national risk assessment tool was completed through a focused group discussion and the opinions of 20 representatives of the health system and the level of risks were estimated. Data were collected, analyzed, and integrated by the research team.ResultsBased on the results of risk matrix analysis, factors such as the increase in the number of new cases of COVID-19, the probability of exposure to a new variant of COVID-19, the probability of arrival of a new variant of COVID-19 to the country, the probability of increasing referrals to healthcare facilities (score 16), the probability of getting respiratory diseases, and the environmental contamination (score 12) occupied the red area of the matrix and were found to have the highest risk (unbearable risk), that needs immediate action.ConclusionPreparing for a mass gathering such as Arbaeen is very important in order to reduce the risk of communicable disease, and the first step in improving preparedness is risk assessment and its continuity in the various stages of the ceremony. Therefore, policy makers and planners of such events should conduct risk assessments with the participation of local and national public health authorities regularly.

The integrated GOR-COVID-19 health monitor: research-informed policy-making through dialogue

Abstract Introduction Like in many other countries, the COVID-19 pandemic and the government restrictions introduced to contain the spread of the virus had major consequences for the health and wellbeing of the population in the Netherlands. To monitor the short and long-term public health impact, a nationally coordinated research program was initiated with the intention to guide decision-making by local and national public health authorities. This contribution presents the process to establish a continuous dialogue with end-users of information to add focus to the monitor, make sense of the findings and formulate policy recommendation and practical guidance, both at the national and regional level. Methods To facilitate the translation and dissemination of research results among policy makers, practitioners and scientists, an ongoing series of dialogue sessions is organized during the monitoring program. Apart from the objective of evidence-informed public health decision-making, the dialectic process seeks to ensure multi-sectoral learning and co-creation and contribute to a broad sense of ownership among stakeholders. National and regional health participants serve as hub coordinators. New stakeholders are invited and will be actively approached wherever considered relevant. Results At the EUPHA conference experiences with organizing the dialogue in app. the first two years of the program will be presented together with preliminary results and a reflection on factors that helped or hindered the implementation and uptake of findings. Discussion Monitoring data collected using robust methods and analyzed in such a way that vulnerability factors are carefully considered, is invaluable for decision-making. However, in order to effectively serve as guidance to public health policy, whether in the context of the COVID-19 pandemic or in non-crisis situations, a constructive, ongoing exchange between end-users of the information needs to be facilitated.

Building capacity for mental health resilience – local impact of the UK Better Mental Health Fund

Abstract Background COVID-19 as a public mental health emergency has exacerbated existing mental health inequalities. The UK government invited local authorities with areas of high deprivation to apply for a year of funding, in order to address the mental health impacts of COVID-19 and incentivize investment in prevention and promotion interventions for better mental health. South Tyneside Council in North East England made a successful bid to the Better Mental Health Fund (BMHF), and distributed grants to 7 organisations delivering 13 programs. A qualitative evaluation of these programs aimed to answer the following questions: 1. How were the funded programs implemented? 2. What difference did they make to local beneficiaries? 3. How might these programs and their impacts be sustained into the future? 4. Has the BMHF led to any wider impacts on organisations and local communities? Methods In-depth interviews with individuals, pairs and groups were conducted online or in person with service providers and beneficiaries. Non-verbatim transcripts were made from recordings, checked with verbatim transcripts from Teams and Zoom, and analyzed thematically to generate a coding frame. Throughout the analysis, comparisons were made between organizations and programs. Results Fifteen interviews involving 22 participants lasting up to an hour each were conducted. The main themes identified as impactful were 1) community approaches based on supportive and good relationships between the local authority public health lead and participating organizations (mainly voluntary agencies), enabling 2) capacity-building for mental health resilience and 3) community empowerment. This was despite the short turnaround of the grant application process, limited time to deliver on targets, and anxieties about future sustainability. Conclusions Short-term funding can build capacity in mental health resilience in deprived areas if administered by public health leaders who relate well with provider organizations. Key messages • Public health leaders who relate well with provider organizations are key drivers of community health promotion strategies that include mental health capacity building. • Qualitative methods used in evaluations can inform public health commissioning by capturing the benefits and challenges of short-term funding for interventions promoting community mental health.

Examining the influences on the use of behavioural science within UK local authority public health: Qualitative thematic analysis and deductive mapping to the COM-B model and Theoretical Domains Framework.

Behavioural science and its contribution towards improving public health is receiving increased recognition. Yet, the translation of these insights into public health practice is under-researched. This study explored the factors influencing the use of behavioural science within public health at a local authority level. Fourteen local authority staff (n = 13 female) in the south of England participated in semi-structured interviews, which were analysed inductively to identify key themes. These were later mapped deductively to the COM-B model and Theoretical Domains Framework. Nine themes were identified as factors that influence the use of behavioural science in local authority public health: (1) "Limited past experience," (2) "Narrow understanding," (3) "Perceived value of behavioural science," (4) "Translational gap from theory-to-practice," (5) "No protected time," (6) "Old ways of working," (7) "Political influence and organisational culture," (8) "Relationships with key stakeholders," (9) "Access to behavioural science resources". Deductive mapping of these themes revealed that five of the COM constructs (excluding Physical Capability) and eleven of the TDF domains influenced behavioural science use, with "Social influences" and "Knowledge" being the most prominent. Use of behavioural science within local authority public health practice is limited and inconsistent. For it to be successfully implemented, there must be an understanding of its role and value, alongside strategies to overcome a translational gap from theory to practice. Public health teams would benefit from protected time to enable application and strategies to break old habits of using a common-sense approach. System-wide buy-in, particularly related to senior leadership and system partners is needed, which would benefit from organisational and political culture change. Training opportunities, practical resources and expert in-house support should be considered a priority across public health teams.

Exposure assessment of per- and polyfluoroalkyl substances (PFAS) and disinfection by-products (DBPs) in drinking water during pregnancy

BACKGROUND AND AIM: Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and disinfection by-products (DBPs) have been linked to multiple adverse birth outcomes in epidemiological studies. The aim of this study was to comprehensively assess exposure to these chemicals in drinking water during pregnancy in the Barcelona Life Study Cohort (BiSC). METHODS: A total of 1086 pregnant women living in the Barcelona Metropolitan area were recruited at the first trimester of pregnancy and followed by surveys until delivery (2018-2021). Water ingestion habits were ascertained at the first and third trimesters through questionnaires. Tap water samples were collected in a subset (N=105) during the 3rd trimester to analyze 35 PFAS. Routinely monitored DBPs (trihalomethanes, THMs) were obtained from the local public health authority for the pregnancy period (N=183). PFAS and DBPs concentrations were modelled based on geolocation and temporal variation to predict concentrations in the residential water supply of each participant from conception until delivery. RESULTS: 5/35 PFAS were detected, namely perfluoropentanoic acid (PFPeA), perfluorohexanoic acid (PFHxA), perfluoroheptanoic acid (PFHpA), perfluorobutane sulfonic acid, (PFBS), and perfluorooctane sulfonic acid (PFOS), at median (Interquartile range; IQR) concentrations (ng/L), respectively, of 5.7(4.3-8.3), 12.0(10.5-12.0), 3.4(2.5-4.7), 8.3(7.2-10.5), and 13.0(11.8-14.0). Median (IQR) concentrations (μg/L) of THMs were 18.6(7.3-27.6) for chloroform, 9.4(5.6-12.4) for dibromochloromethane, 6.4(2.9-10.3) for bromodichloromethane, and 26.1(16.2-36.0) for bromoform. Drinking water consumed at home was bottled (64.8%), filtered (22.9%), and tap water (12.3%). Water used for cooking was from tap (78.4%), filtered (15.7%), and bottled water (0.6%). Individual exposure estimates by trimester and for the whole pregnancy will be calculated using residential levels multiplied by amount and type of water consumed. CONCLUSIONS: The study population is exposed to relatively low concentrations of PFAS in drinking water, and THMs have a significant component of brominated species. KEYWORDS: drinking water; PFAS; disinfection byproducts; exposure assessment.