Local Health Officials Research Articles

Promoting Smoking Cessation Among Lesbian and Bisexual Women: Lessons Learned From a Location-Based Media Campaign in Western North Carolina.

Despite well-documented inequities in tobacco use for lesbian, gay, bisexual, and transgender populations, there is little practical guidance for local public health officials on developing and implementing media campaigns that prioritize lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. In this practice note article, we describe the development and lessons learned from a location-based media campaign to promote tobacco use cessation and raise awareness of QuitlineNC among lesbian and bisexual women in Western North Carolina. The campaign used a digital approach based on cell phone locations and marketing profiles to deliver messages across 4 years (2018-2021). Considerations for practitioners include how our project required messaging adaptation to meet Google's restrictions against using the word "yours" and the importance of addressing privacy protection concerns with state officials to enable collection of outcome evaluation measures via a conversion pixel (code for capturing metrics).

Local public health officials and COVID-19: evidence from China

PurposeDid Chinese cities whose public health departments are headed by medical professionals fare better in fighting coronavirus disease 2019 (COVID-19)?Design/methodology/approachThe authors collected the professional background of the directors of the public health departments of 350 Chinese cities, which include 87% of the Chinese population. Excluding Wuhan, the epicenter of COVID-19, the authors analyzed the infection rates and death rates from COVID-19 between 131 Chinese cities whose public health departments are led by medical professionals and 218 cities whose public health departments are led by nonprofessionals. The authors employed a multivariate regression controlling for the number of people that traveled from Wuhan to each city, the local economic development and the number of hospital beds.FindingsChinese cities whose public health departments are led by medical professionals had 21 fewer confirmed cases per 10 million as of January 31, 2020 [95% CI, −40 to −3], 58 fewer cases per 10 million in the next 10 days [95% CI, −116 to 0], similar new cases between February 11 and February 20, 2020, and 3 fewer deaths per 10 million as of February 20, 2020 [95% CI, −7 to 0].Research limitations/implicationsAssociation could not make a strong causal claim.Practical implicationsLocal public health authorities are critical for combating a pandemic. The authors found that Chinese cities whose public health departments are headed by medical professionals were associated with lower infection rates and fewer death rates from COVID-19. The results were significant only at the start of the outbreak. This study’s results suggest that to better combat a pandemic, local public health authorities should be led by competent people who have a medical background.Originality/valueThe authors provide the first empirical evidence about the association between a local public health head's competence and the infection rate and death rate of COVID-19. The authors’ manually collected data also show that only 38% of the heads of the public health departments of Chinese cities have a medical background.

Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

BackgroundThe Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement.MethodsTrainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities.ResultsTrainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future.ConclusionsThis study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention.

Prospective spatial-temporal clusters of COVID-19 in local communities: case study of Kansas City, Missouri, United States.

Kansas City, Missouri, became one of the major United States hotspots for COVID-19 due to an increase in the rate of positive COVID-19 test results. Despite the large numbers of positive cases in Kansas City, MO, the spatial-temporal analysis of data has been less investigated. However, it is critical to detect emerging clusters of COVID-19 and enforce control and preventive policies within those clusters. We conducted a prospective Poisson spatial-temporal analysis of Kansas City, MO data to detect significant space-time clusters of COVID-19 positive cases at the zip code level in Kansas City, MO. The analysis focused on daily infected cases in four equal periods of 3 months. We detected temporal patterns of emerging and re-emerging space-time clusters between March 2020 and February 2021. Three statistically significant clusters emerged in the first period, mainly concentrated in downtown. It increased to seven clusters in the second period, spreading across a broader region in downtown and north of Kansas City. In the third period, nine clusters covered large areas of north and downtown Kansas City, MO. Ten clusters were present in the last period, further extending the infection along the State Line Road. The statistical results were communicated with local health officials and provided the necessary guidance for decision-making and allocating resources (e.g., vaccines and testing sites). As more data become available, statistical clustering can be used as a COVID-19 surveillance tool to measure the effects of vaccination.

The social determinants of health influencing obesity for the aged in the Pakpoon community context: A qualitative study

ObjectiveThis study aimed to describe the social determinants of health influencing obesity for the aged in a community context and based on the perspectives of various stakeholders. MethodsThis was qualitative content analysis study using data from the focus group, individual in-depth interview, and observation. The study population was domiciled in Pakpoon Village, Mung District, Nakhon Si Thammarat Province, a tight-knit settlement typical of most retirement communities. Data were collected through two focus group discussions, direct observation, and in-depth interviews with 19 participants. Respondents represented key community groups: local nurses and public health officers, elderly residents, family caregivers (family members), and village health volunteers. ResultsThe participants shared similar perspectives about the social determinants of health influencing obesity in the aged, which spanned three themes. These were: 1) neighborhood food environment (easy access to unhealthy food, no choice to recruit healthy food); 2) social networks influencing obesity (family affects food choices and prohibitions on exercise; belief, and socially imposed body image perceptions contributing to obesity in the aged); and 3) knowledge, attitudes, and beliefs behind lifestyle choices that cause obesity in the elderly (lack of awareness, personal attitudes, job and familial duties as barriers to engaging in physical activities; over-consumption behaviors lead to obesity in older people). ConclusionThese three themes were the root causes of obesity in the elderly in Pakpoon’s retirement community. This finding suggests that policymakers and nurses can create healthy environments, both to treat and prevent obesity, by raising awareness in younger generations, providing aging the provision of healthy food choices for older adults, encouraging health care professionals to share knowledge, and by modifying the attitudes and beliefs of both caregivers and older adults.

School-Based Health Services in Virginia and the COVID-19 Pandemic.

ABSTRACTBACKGROUNDSchools have a long history of delivering health services, but it is unclear how the COVID‐19 pandemic may have disrupted this. This study examined changes in school‐based health services and student needs before and during the pandemic and the factors important for delivering school‐based health services.METHODSA web‐based survey regarding the impact of the pandemic on school‐based health services was distributed via email to all 1178 Virginia public elementary schools during May 2021.RESULTSResponding schools (N = 767, response rate = 65%) reported providing fewer school‐based health services during the 2020‐2021 school year than before the pandemic, with the largest declines reported for dental screenings (51% vs 15%) and dental services (40% vs 12%). Reports show that mental health was a top concern for students increased from 15% before the pandemic to 27% (P < .001). Support from families and school staff were identified by most respondents (86% and 83%, respectively) as very important for the delivery of school‐based health services.CONCLUSIONSSchools reported delivering fewer health services to students during the 2020‐2021 school year and heightened concern about students' mental health. Understanding what schools need to deliver health services can assist state and local education and health officials and promote child health.

Patients' and Providers' Views on Optimal Evidence-Based and Scalable Interventions for Individuals at High Risk of HIV Treatment Failure: Sequential Explorations Among Key Stakeholders in Cape Town, South Africa.

To support translation of evidence-based interventions into practice for HIV patients at high risk of treatment failure, we conducted qualitative research in Cape Town, South Africa. After local health officials vetted interventions as potentially scalable, we held 41 in-depth interviews with patients with elevated viral load or a 3-month treatment gap at community clinics, followed by focus group discussions (FGDs) with 20 providers (physicians/nurses, counselors, and community health care workers). Interviews queried treatment barriers, solutions, and specific intervention options, including motivational text messages, data-informed counseling, individual counseling, peer support groups, check-in texts, and treatment buddies. Based on patients' preferences, motivational texts and treatment buddies were removed from consideration in subsequent FGDs. Patients most preferred peer support groups and check-in texts while individual counseling garnered the broadest support among providers. Check-in texts, peer support groups, and data-informed counseling were also endorsed by provider sub-groups. These strategies warrant attention for scale-up in South Africa and other resource-constrained settings.

Effects of tick surveillance education on knowledge, attitudes, and practices of local health department employees

BackgroundThe number of cases of tick-borne diseases in humans is increasing rapidly within Illinois. The responsibility for increased surveillance of tick-borne disease cases and tick vectors is being placed on local health departments throughout the United States, but they often lack the funding, time, and/or training needed to perform said surveillance. The aims of this study were to develop, deliver, and determine the effectiveness of tick surveillance training workshops for local health department employees within Illinois.MethodsWe developed and delivered in-person training at local health department offices in each of six Illinois Department of Public Health Environmental Health Regions between April–May of 2019. Pre-, post-, and six-month follow-up questionnaires on knowledge, attitudes, and practices with regards to tick surveillance were administered to training participants. Paired student’s t-test or Wilcoxon signed-rank test were used to compare knowledge, attitudes, and practices scores between questionnaires with Cohen’s d being used to calculate effect sizes associated with t-tests. McNemar’s and McNemar-Bowker tests were used to evaluate individual questions. Spearman’s rank correlation was used to evaluate the relationship between knowledge, attitudes, and practices at pre-, post-, and six-month follow-up.ResultsSeventy-six employees from 40 local health departments that represent 44% (45/102) of Illinois counties attended at least one training workshop. Of these attendees, 81.5% (62/76) participated in at least one survey, 79% (60/76) in the in-person pre-training survey, 74% (56/76) in the in-person post-training survey, and 22% (17/76) in the online six-month follow-up survey. The average knowledge score was significantly increased by 8.21 (95% CI:7.28–9.14) points from pre-training to post-training. The average overall attitude score significantly increased by 5.29 (95% CI: 3.91–6.66) points from pre- to post-training. There were no significant differences in practice scores.ConclusionsOur study found the training was effective in increasing the knowledge of ticks, tick-borne diseases, and surveillance as well as promoting positive attitudes related to surveillance. While the training, by itself, was not associated with increases in surveillance practices, we were able to empower local public health officials with the knowledge and positive attitudes needed to enact change.

Analysis of a tuberculosis outbreak in an office: Hokkaido, Japan, 2019-2020.

In August 2018, a male worker (Pt1) in an office was diagnosed with smear-positive pulmonary tuberculosis (TB). This study aims to characterize the cases found in the TB outbreak in the office. The risks of TB disease or infection were compared among the staff members by seating locations. A total of 116 current and ex-staff members were investigated, among whom 13 patients with active TB, including Pt1, and 20 with latent TB infection were found by the end of 2020. One-third of the seating groups located at one end of the office that Pt1 belonged to had the highest risk of TB disease (30.8%, 95% confidence interval [CI]: 14.3%-51.8%) and infection (61.5%, 95% CI: 40.6%-79.8%) with a high relative risk of TB infection (6.2, 95% CI: 2.0-18.8) compared to another one-third of the seating groups at the other end of the office that had the lowest risk of active TB (0%, 95% CI: 0%-11.6%) and TB infection (10.0%, 95% CI: 2.1%-26.5%). The seating groups that Pt1 belonged to had the highest risk of TB disease and infection because the staff members in the groups were exposed to the air containing TB bacilli from Pt1. Local health offices should initiate active case finding using chest X-rays as soon as they are notified of a sputum smear-positive TB case if the delay of the diagnosis is longer than three months.

I'm not throwing away my shot: increasing covid-19 vaccine confidence and decreasing disinformation within campus communities through student advocacy

For the past two years, COVID-19 has held the world's attention. It's been challenging to get the world's citizens to reach herd immunity due to a lack of vaccine confidence. Although vaccines have been a very successful part of public health in recent and past decades, there has been much debate about the COVID-19 vaccine. Strategies must be implemented to address vaccine confidence and decrease disinformation as this can be extremely helpful in preventing infections and reducing the likelihood of transmission. Student advocacy may be helpful in restoring trust within the campus community. The study used a cross-sectional, descriptive design. The non-random sample included 85 students, faculty, and staff on the campus of a university in a southeastern state. Participants were recruited via flyers, at COVID-19 campus events, and by word of mouth. The Center for Control and Disease Prevention (CDC) Vaccine Confidence Survey Question Bank was used to measure vaccine confidence at baseline. The intervention consisted of exposing the campus community to factual COVID-19 through educational flyers, town hall meetings, TikTok® and other social media platforms. Upon completion of the study, the grant team created a video of their experiences with the vaccine, which was streamed to the campus community. Data were analyzed using descriptive statistics, frequencies and independent t-tests. Participants' ages ranged from 20-55 (M = 30; SD = 12.1), were mostly female (64.7%), and white (52.9%). More than three-fourths of the samples (76.4%) were students. Only 17.4% of the sample had a previous diagnosis of COVID-19. Nurses and local health officials were the most trusted sources of vaccine information. Due to being a state institution, we were not at liberty to discuss the vaccination status of the participants. However, many felt that people at their work or school (58.9%) or family or friends (64.7%) would not get the vaccine. The findings of this study support the need for innovative strategies to deliver factual COVID-19 vaccine information to the campus community. Most of the participants did practice social distancing and other preventative behaviors, but more than half felt that they had received inaccurate information about the vaccine or were not sure where to receive accurate information from. There is no single intervention to restore campus community confidence, but student advocacy was helpful in starting a discussion about COVID-19 vaccines and collecting necessary data to determine support for effective strategies.

The effects of COVID-19 pandemic social isolation on the mental and physical health of the general population

During the early part of 2020, the COVID-19 pandemic began, and continues to affect the lives of millions of people spanning the globe. During the pandemic, local and national governments throughout the world sought to limit the spread of the SARS-CoV-2 virus, which causes the disease known as COVID-19, through the use of mandated lockdowns and social distancing measures. The effects that these unprecedented and hastily implemented measures have had on the mental and physical health of the general population, continues to be an area of intense study. We attempted to measure these effects through an anonymous Google forms survey. A majority of survey respondents lived on Long Island, NY during the period of social isolation. The survey, conducted during April and May of 2020, focused on changes in physical and mental health across various age groups and between sexes. The results of the survey reveal some negative impacts to physical health across all demographic groups, such as decreased physical activity and worsened perceived sleep quality. The survey also reveals significant increases in depressive symptoms and feelings of loneliness across all groups following the period of social isolation, with more significant increases occurring in younger age groups and amongst women. This study illustrates that the social isolation resulting from the COVID-19 lockdowns had negative effects on both the physical and mental health of the general population and provides valuable information that may be used to assist local and national health officials with post- pandemic mental health responses in the future.

Spatial diffusion of Omicron in Texas: Predictable or Random?

The impacts of Covid-19 on society and the environment have now, three years from its first appearance, ballooned across the scientific literature. But our knowledge of where it originated, and why it spread as it did, has advanced much more slowly. Models of spatial diffusion at national level have been applied to past pandemics with some success, but not yet to Covid-19. One exception is a study of the spread of the original strain of Covid-19 in Texas between March and September 2020. This spread adhered to spatial diffusion theory: first hierarchical, that is into metropolitan areas in proportion to their population sizes; later contagious, that is into adjacent towns based on their proximity to metropolitan areas to which they were tributary; and finally hierarchical once more, into the most isolated towns based on their urban/ rural status. This process took six months. By contrast, the Omicron variant, in less than two months (December 2021 and January 2022), reached case levels three times those of the original Covid surges. The current study focuses on how Omicron diffused across Texas over the period November to February 2021-22. Daily case numbers for Covid-19 were available for all 254 counties from the Texas Department of State Health Services over this period, and the Omicron variant was identifiable from these data. This analysis will reveal whether the Omicron spread across the counties of Texas was predictable, partially predictable, or unpredictable, based on county population, distance to their regional metro, or the gravity concept (the ratio between the two). These insights will be of value if other such variants appear on the horizon for the US and Texas, enabling local health officials to anticipate the onset in their communities.

Dietary Recommendation for Survival During COVID-19

Corona viruses are a large family of viruses that exist in many different species of animals including camels, bovine animals, and bats. The new strain of corona virus identified as the cause of outbreaks of respiratory disease in people first detected in Wuhan, China, was COVID-19.WHO has published a new guide on how to eat healthily during the COVID-19 COVID pandemic and self-quarantine.The guideline contains valuable information about nutrition to help keep the immune system strong. It also has tips for a diet that supports good health while advised to stay at home and may have less opportunity to consume fresh foods and be physically active.The FDA continues important research to protect public health during the COVID-19 pandemic along with other federal, state , and local agencies and public health officials around the country [1,2,3].

Metabolic Profile of Female Student in Senior High School of Metro City, Lampung, Indonesia

Adolescent girls are a crucial period in a woman's life. Health and nutritional status during adolescence are important for physical maturity, according to data from Riskesdas (2018) Metro City has a prevalence of very thin 1.2%, underweight 8.9%, normal 88.5, and obese 1.4%. is basic research that produces new theories, methods, or policy principles that are used for scientific development, namely the description of the Metabolic Profile of Young Women Against the Menstrual Cycle at SMA Negeri Metro City. The type of quantitative research with a quantitative research design with a descriptive approach to the population in this study were young women at Senior high school public Metro City. The instruments used in this study were questionnaires and Anthropometric (BMI) examination tools, Hb, Lipid Profile (Triglycerides, HDL, LDL and cholesterol) and GDS, data analysis in this study was a Univariate test. The results showed that there were 28 (18.5%) adolescents with low HB less than 12 g/dL, 25 (16.6%) adolescents with high cholesterol less than 200 mg/dL, 25 (16.6%) adolescents with metabolic status. skinny (-3 SD for SD less than-2) as many as 51 (33.8%), teenagers with less energy as much as 65 (43.0%), lack of fat as much as 55 (36.4%) lacking protein as much as 5 (33.8 %), and less carbohydrates as much as 26 (17.2%), it is hoped that the school will cooperate with the local Health Office and local health centres to provide counselling about anemia and obesity in order to reduce the prevalence of anemia in adolescent girls and its incidence. obesity and it is necessary to educate adolescents about obesity prevention for reproductive health.

Asthma Among Adults and Children by Urban-Rural Classification Scheme, United States, 2016-2018.

Although data on the prevalence of current asthma among adults and children are available at national, regional, and state levels, such data are limited at the substate level (eg, urban-rural classification and county). We examined the prevalence of current asthma in adults and children across 6 levels of urban-rural classification in each state. We estimated current asthma prevalence among adults for urban-rural categories in the 50 states and the District of Columbia and among children for urban-rural categories in 27 states by analyzing 2016-2018 Behavioral Risk Factor Surveillance System survey data. We used the 2013 National Center for Health Statistics 6-level urban-rural classification scheme to define urban-rural status of counties. During 2016-2018, the current asthma prevalence among US adults in medium metropolitan (9.5%), small metropolitan (9.5%), micropolitan (10.0%), and noncore (9.6%) areas was higher than the asthma prevalence in large central metropolitan (8.6%) and large fringe metropolitan (8.7%) areas. Current asthma prevalence in adults differed significantly among the 6 levels of urban-rural categories in 19 states. In addition, the prevalence of current asthma in adults was significantly higher in the Northeast (9.9%) than in the South (8.7%) and the West (8.8%). The current asthma prevalence in children differed significantly by urban-rural categories in 7 of 27 states. For these 7 states, the prevalence of asthma in children was higher in large central metropolitan areas than in micropolitan or noncore areas, except for Oregon, in which the prevalence in the large central metropolitan area was the lowest. Knowledge about county-level current asthma prevalence in adults and children may aid state and local policy makers and public health officers in establishing effective asthma control programs and targeted resource allocation.

Enhancing U.S. Local, State, and Federal Preparedness Through Simulated Interactive Tabletop Exercises of a Mock Antibiotic-Resistant Gonorrhea Outbreak, 2018-2019.

Responding effectively to outbreaks of antibiotic-resistant gonorrhea (ARGC) in the future will likely prove challenging. Tabletop exercises (TTXs) may assist local, state, and federal public health officials evaluate existing ARGC outbreak response plans, strengthen preparedness and response effectiveness, and identify critical gaps to address before an outbreak. In 2018 to 2019, Centers for Disease Control and Prevention (CDC) collaborated with state partners to develop and implement TTXs to simulate a public health emergency involving an ARGC outbreak. Before the TTXs, 2 state-local health department pairs developed ARGC outbreak response plans. During each 1-day exercise (in Indiana and Illinois), participants discussed roles, clinical management, public health response, and communication based on predeveloped response plans. Observers identified outbreak response strengths and gaps, and participants completed feedback forms. Forty-one (Illinois) and 48 people (Indiana) participated in each TTX, including sexually transmitted disease clinical staff, laboratorians, public health infectious disease program staff, and CDC observers. Strengths and gaps varied by jurisdiction, but identified gaps included: (1) local access to gonorrhea culture and timely antimicrobial susceptibility testing, (2) protocols for clinical management of suspected treatment failures, (3) communication plans, and (4) clarity regarding state and local responsibilities. The CDC observers identified opportunities to provide national-level technical assistance, foster local antimicrobial susceptibility testing, and develop further response guidance. Tabletop exercises summary reports were used to guide modifications to local response plans to address gaps. The TTXs allowed participants to practice responding to a simulated public health emergency and may have enhanced local response capacity. Centers for Disease Control and Prevention made TTX implementation materials publicly available.

Heterogeneity and Interoperability in Local Public Health Information Systems.

Heterogeneity and Interoperability in Local Public Health Information Systems.

Urban resilience: assessing climate vulnerabilities and risk perceptions in the city of Haifa, Israel

BACKGROUND AND AIM: Extreme climate events (wildfires, floods, heatwaves, cold spells) are becoming more frequent in the Mediterranean, but adaptation levels remain low. The city of Haifa in northern Israel is prone to extreme climate events. Focusing on Haifa, we aim to 1) conduct a spatial analysis of climate and health vulnerabilities, 2) examine local officials’ risk perceptions of different extreme events, and 3) assess the public's perceived risk and resilience METHODS: Mixed-METHODS: 1) spatial mapping of vulnerability indicators including socio-economic status, recipients of welfare allowances, temperature, sensitivity to floods and wildfires, proximity to hospitals. 2) qualitative analysis of 30 in-depth interviews with local government health and welfare officials, and 3) a survey of climate risk perceptions and resilience among a representative sample of 550 residents. RESULTS:Social and climatic vulnerabilities are correlated, so that downtown neighborhoods are characterized by poorer socio-economic, health and welfare conditions, and higher summer temperatures. Hospitals are prepared for emergencies, but not for extreme climate events, and there are no national budget or guidelines for climate adaptation at the city level or in hospitals. Correspondingly, risk perceptions of climate change among health and welfare officials remain low. Public perceptions of danger (2.64±0.82), community resilience (2.96±0.76) and national resilience (3.28±0.84) are moderate (1-5 scale), and correlated with ethnicity and age. Residents of neighborhoods with poorer socio-economic conditions report higher community resilience compared to others. CONCLUSIONS:Haifa is a geographically and socially diverse city, with multiple vulnerabilities to climate change. However, climate risk perceptions remain low among health and welfare officials and among residents. Good preparedness for events that had been experienced in the past including war and wildfire, provides a good infrastructure for climate change awareness and adaptation. The city should develop and implement an adaptation plan that will address the vulnerabilities of different populations and neighborhoods, and enhance urban resilience. KEYWORDS: Adaptation, climate change, public policy, risk perceptions, urban resilience, vulnerability assessment.

A clinical epidemiological onsite study of a massive outbreak of Scombroid fish poisoning after consumption of yellowtail kingfish in northern Chile

Scombroid fish poisoning (SFP) is an acute illness caused by the consumption of poorly preserved fish containing high levels of histamine. Symptoms develop within 1-2 h, with gastrointestinal, dermatologic, and cardiopulmonary manifestations. The diagnosis relies exclusively on the clinical picture. To describe an onsite clinical-epidemiological study of a massive outbreak of SFP occurring in Chile. Descriptive study of an outbreak occurring in a closed Convention Center after lunch with Chilean Palometa or Seriola lalandi (Yellowtail kingfish). An Onsite questionnaire was answered by all attendants within 24 h. Local health officials supervised the place with a second survey and sample recollection of suspected fish. Eighty-three adults attended the event, of which 81 ate fish. Mean age: 58.5 years old, 82.7% women. The symptomatic attack rate of people eating suspected poisoned fish was 79% (64 out of 81 participants). Most common symptoms included: diarrhea (68%); headache (64%); flushing (64%) and diffuse redness (56%). Mean incubation period: 77 min (30-240 min). 98.4% of patients recovered within 10 h. Ten patients were referred to the emergency room, but none were admitted. There was a presumption of loss of refrigeration in the handling of fish, and confirmation of SFP by clinical basis, incubation period and attack rate. Fish was the only food item associated with illness (Odds ratio: 19, p = 0.014; Fisher two tails). This is one of the 5 largest outbreaks of SFP with fresh fish, ever reported in the literature. The clinical picture and rapid onset of symptoms made it possible to suspect SFP allowing timely management of patients. It is relevant to spread the knowledge about this underdiagnosed and underreported syndrome.

Acceptability of Adolescent COVID-19 Vaccination Among Adolescents and Parents of Adolescents - United States, April 15-23, 2021.

On May 10, 2021, the Food and Drug Administration (FDA) expanded its Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine to include adolescents aged 12-15 years; this authorization was followed by interim recommendations from the Advisory Committee on Immunization Practices (ACIP) for the vaccine among this age group (1). Using data from nonprobability-based Internet panel surveys administered by the Healthcare and Public Perceptions of Immunizations (HaPPI) Survey Collaborative, the acceptability of adolescent COVID-19 vaccination and self-reported factors increasing vaccination intent were assessed among independently recruited samples of 985 adolescents aged 13-17 years and 1,022 parents and guardians (parents) of adolescents aged 12-17 years during April 15-April 23, 2021, prior to vaccine authorization for this age group. Approximately one quarter (27.6%) of parents whose adolescents were already vaccine-eligible (i.e., aged 16-17 years) reported their adolescent had received ≥1 COVID-19 vaccine dose, similar to the proportion reported by vaccine-eligible adolescents aged 16-17 years (26.1%). However, vaccine receipt reported by parents of adolescents differed across demographic groups; parents identifying as female or Hispanic, or who had an education lower than a bachelor's degree reported the lowest adolescent COVID-19 vaccination receipt. Among parents of unvaccinated adolescents aged 12-17 years, 55.5% reported they would "definitely" or "probably" have their adolescent receive a COVID-19 vaccination. Among unvaccinated adolescents aged 13-17 years, 51.7% reported they would "definitely" or "probably" receive a COVID-19 vaccination. Obtaining more information about adolescent COVID-19 vaccine safety and efficacy, as well as school COVID-19 vaccination requirements, were the most commonly reported factors that would increase vaccination intentions among both parents and adolescents. Federal, state, and local health officials and primary care professionals were the most trusted sources of COVID-19 vaccine information among both groups. Efforts focusing on clearly communicating to the public the benefits and safety of COVID-19 vaccination for adolescents, particularly by health care professionals, could help increase confidence in adolescent COVID-19 vaccine and vaccination coverage.