National Public Health Programs Research Articles

Integrating Pharmacists into Public Health Initiatives: Challenges and Opportunities in India

Since most people can visit pharmacies easily and don't need an appointment, they are naturally regarded as the primary choice for healthcare professionals in society. Pharmacists have the potential to be an important link in the global healthcare system. Since not everyone is served by public health services, pharmacies and private healthcare providers can play a significant role in the healthcare system. This also applies to the nation of India, which is inhabited by almost 1.3 billion people. The majority of India's chemists, both in the public and commercial sectors, are underutilised resources despite their extensive presence. The purpose of this study was to assess the emphasis on patient care and public health in pharmacy education, as well as the participation of pharmacists in national public health programmes (NPHPs) in India. The aim of the research was to ascertain the extent to which pharmacist education may aid in this transition and the locations where pharmacists could participate more actively in national public health campaigns. The public health and patient care components of the pharmacy curriculum in India are being evaluated for the first time with this study. It will be helpful to statutory organisations and curriculum reform committees in India and other countries where the functions of chemists are expanding to include public health and patient care.

Cost and Cost-Effectiveness of the Mediterranean Diet: An Update of a Systematic Review.

It is well known that the Mediterranean diet (DM) is beneficial for health, as years of research globally have confirmed. The aim of this study was to update a previous systematic review that assessed the cost-effectiveness of adherence to the DM as a strategy for the prevention of degenerative diseases by evaluating the economic performance of this diet. The research approach utilized three electronic databases: PubMed, Scopus, and Web of Science. A comprehensive search was conducted to retrieve articles based on a PRISMA-compliant protocol registered in PROSPERO: CRD 42023493562. Data extraction and analysis were performed on all included studies. One thousand two hundred and eighty-two articles were retrieved, and once duplicates and irrelevant articles were removed, fifteen useful articles were reviewed. The studies indicated a clear link between dietary habits, health, and economic aspects related to dietary cost and health spending. Recognizing the significant health benefits associated with adopting DM and the potential savings on health care spending, it is important for national public health programs to consider policies that support this lifestyle.

RISK SCORE PREDICTION MODEL FOR DEMENTIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS : AN UPDATE SYSTEMATIC REVIEW

Background: Dementia is a substantial global health issue. Reduction in future numbers of dementia cases through effective preventive strategies could significantly affect the personal and socioeconomic burdens of dementia. WHO has recommended that countries urgently develop national public health programmes to reduce the impact of dementia. The aim: The aim of this study to show about risk score prediction model for dementia in patients with type 2 diabetes mellitus. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 67 articles, whereas the results of our search on SagePub get 210 articles, on Google Scholar 1350 articles. Records remove before screening are 667, so we get 960 articles fos screening. After we screened based on record exclude, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: RxDx-Dementia risk index to predict dementia in patients with type 2 diabetes and hypertension. The RxDx-Dementia risk index which incorporated diagnosis and prescription-based information in a single summary score performed better than diagnosis- or prescription-based comorbidity scores or its combinations. The RxDx-Dementia risk index can be used for prognostic purpose or to control confounding in epidemiological studies.

Public health priorities for the Gulf states.

The newly established Gulf Center for Disease Prevention and Control (Gulf CDC) has to identify priorities to tackle in the first 2years of operation. A rapid situational assessment involving a selected sample of national stakeholders, an objective study of the strengths and gaps in the national public health programmes and a study estimating the burden of the main disease/risk factors were carried out. The findings of an objective ranking survey, followed by consensus discussion in an in-person meeting for senior Gulf states' experts, were combined with the evidence available from the previous three studies to result in a short list of the most pressing priority topics for the Gulf CDC to tackle. Both communicable (lead priorities: antimicrobial resistance and immunisation) and non-communicable diseases (leads: cardiovascular disease, then cancer, diabetes, and mental health) are the consensus priorities. Also, the risks associated with non-communicable diseases (high BMI, blood sugar, high blood pressure) and unhealthy lifestyle (poor diet, low physical activity and tobacco use) were also highlighted as top priorities to tackle.

Generating Contextual Variables From Web-Based Data for Health Research: Tutorial on Web Scraping, Text Mining, and Spatial Overlay Analysis.

Contextual variables that capture the characteristics of delimited geographic or jurisdictional areas are vital for health and social research. However, obtaining data sets with contextual-level data can be challenging in the absence of monitoring systems or public census data. We describe and implement an 8-step method that combines web scraping, text mining, and spatial overlay analysis (WeTMS) to transform extensive text data from government websites into analyzable data sets containing contextual data for jurisdictional areas. This tutorial describes the method and provides resources for its application by health and social researchers. We used this method to create data sets of health assets aimed at enhancing older adults' social connections (eg, activities and resources such as walking groups and senior clubs) across the 374 health jurisdictions in Catalonia from 2015 to 2022. These assets are registered on a web-based government platform by local stakeholders from various health and nonhealth organizations as part of a national public health program. Steps 1 to 3 involved defining the variables of interest, identifying data sources, and using Python to extract information from 50,000 websites linked to the platform. Steps 4 to 6 comprised preprocessing the scraped text, defining new variables to classify health assets based on social connection constructs, analyzing word frequencies in titles and descriptions of the assets, creating topic-specific dictionaries, implementing a rule-based classifier in R, and verifying the results. Steps 7 and 8 integrate the spatial overlay analysis to determine the geographic location of each asset. We conducted a descriptive analysis of the data sets to report the characteristics of the assets identified and the patterns of asset registrations across areas. We identified and extracted data from 17,305 websites describing health assets. The titles and descriptions of the activities and resources contained 12,560 and 7301 unique words, respectively. After applying our classifier and spatial analysis algorithm, we generated 2 data sets containing 9546 health assets (5022 activities and 4524 resources) with the potential to enhance social connections among older adults. Stakeholders from 318 health jurisdictions registered identified assets on the platform between July 2015 and December 2022. The agreement rate between the classification algorithm and verified data sets ranged from 62.02% to 99.47% across variables. Leisure and skill development activities were the most prevalent (1844/5022, 36.72%). Leisure and cultural associations, such as social clubs for older adults, were the most common resources (878/4524, 19.41%). Health asset registration varied across areas, ranging between 0 and 263 activities and 0 and 265 resources. The sequential use of WeTMS offers a robust method for generating data sets containing contextual-level variables from internet text data. This study can guide health and social researchers in efficiently generating ready-to-analyze data sets containing contextual variables.

Knowledge, attitudes and behaviour of Egyptians towards antibiotic use in the community: can we do better?

BackgroundInfectious diseases are among the leading causes of death worldwide. This is concerning because of the increasing capacity of the pathogens to develop antibiotic resistance. Antibiotic overuse and misuse remain the main drivers of resistance development. In the USA and Europe, annual campaigns raise awareness of antibiotic misuse hazards and promote their judicial use. Similar efforts are lacking in Egypt. This study assessed the knowledge of the public in Alexandria, Egypt of antibiotic misuse risks and their habits towards antibiotic use, in addition to conducting a campaign to increase awareness of the safe use of antibiotics.MethodsA questionnaire assessing knowledge, attitudes and behaviour towards antibiotics was used to collect responses from study participants at various sports clubs in Alexandria in 2019. An awareness campaign to correct misconceptions and a post awareness survey followed.ResultsMost of the participants were well-educated (85%), in their middle age (51%) and took antibiotics last year (80%). 22% would take an antibiotic for common cold. This dropped to 7% following the awareness. There was a 1.6 time increase in participants who would start an antibiotic on a healthcare professional’s advice following the campaign. A 1.3 time increase in participants who would finish an antibiotic regimen was also observed. The campaign made all participants recognize that unwise antibiotic use is harmful to them or others; and 1.5 more participants would spread the word about antibiotic resistance. Despite learning of the risks of antibiotic use, there was no change in how often participants thought they should take antibiotics.ConclusionsAlthough awareness of antibiotic resistance is rising, some wrong perceptions hold fast. This highlights the need for patient and healthcare-tailored awareness sessions as part of a structured and national public health program directed to the Egyptian population.

2165. Surveillance of Severe Viral Respiratory Infections among Children Presenting to Hôpital Saint Damien in Haiti

Abstract Background Learning the burden and seasonality of respiratory viral infections in children in resource-limited settings is critical for hospital infection care and prevention and national public health programs. We built a prospective surveillance program of severe acute respiratory illness (SARI) in hospitalized children at Hôpital Saint Damien - Nos Petits Frères et Soeurs to gather local evidence and support informed clinical and policy decision-making. The COVID-19 pandemic erupted as we were launching our project, requiring the use of available point-of-care diagnostics. Methods Children < 18 years of age with cough, history of fever ≥ 38 C°, of < 10 days evolution, and requiring hospitalization were included in the study. We obtained a nasopharyngeal swab and collected demographic and clinical data for eligible patients. Samples were tested using antigen test on-site for influenza A (Flu A) and B (Flu B), respiratory syncytial virus (RSV), and SARS-CoV-2. Afterwards, all specimens (both negative and positive) were stored and shipped for molecular studies. Results We obtained and tested 167 samples from patients since April 30, 2021, through January 31, 2022. Single isolates were detected in 88 samples (53%), multiple isolates in 20 samples (12%), and no isolates in 59 samples (35%). Positive cases for RSV, Flu A, and Flu B peaked between November and January. Rhinovirus 1A (RhV) was detected throughout the study period, with peaks around August-September and was the most often detected viral isolate (49, 38%), followed by RSV (37, 29%). Co-infections were seen with RSV, Flu A, RhV, and SARS-CoV-2. Molecular studies detected 7 isolates of Flu A not detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. However, it failed to detect 2 isolates of Flu A detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. Conclusion Our study captured circulating respiratory viruses in children with SARI in Haiti during the COVID-19 pandemic. Preliminary data suggest an increase in respiratory viruses between August and January. Improving point-of-care diagnostics can better inform providers of the local epidemiology of respiratory viruses and support clinical decision-making, such as good use of antibiotics. However, we confirmed the sensitivity of molecular testing. Disclosures All Authors: No reported disclosures.

Informing the UK Muslim Community on Organ Donation: Evaluating the Effect of a National Public Health Programme by Health Professionals and Faith Leaders

There is a significant shortage of transplantable organs in the UK particularly from Black, Asian and Minority Ethnic (BAME) groups, of which Muslims make a large proportion. The British Islamic Medical Association (BIMA) held a nationwide series of community gatherings with the aim of describing the beliefs and attitudes to organ donation amongst British Muslims and evaluate the efficacy of a national public health programme on views and uncertainties regarding religious permissibility and willingness to register. Eight public forums were held across the UK between June 2019 and March 2020 by the British Islamic Medical Association (BIMA). A panel of experts consisting of health professionals and Imams discussed with audiences the procedures, experiences and Islamic ethico-legal rulings on organ donation. Attendees completed a self-administered questionnaire which captured demographic data along with opinions before and after the session regarding religious permissibility and willingness to register given permissibility. A total of 554 respondents across seven UK cities were included with a M:F ratio 1:1.1. Only 45 (8%) respondents were registered as organ donors. Amongst those not registered multiple justifications were detailed, foremost of which was religious uncertainty (73%). Pre-intervention results indicated 50% of respondents were unsure of the permissibility of organ donation in Islam. Of those initially unsure or against permissibility or willingness to register, 72% changed their opinion towards deeming it permissible and 60% towards a willingness to register indicating a significant change in opinion (p < 0.001). The effectiveness of our interventions suggests further education incorporating faith leaders alongside local healthcare professionals to address religious and cultural concerns can reduce uncertainty whilst improving organ donation rates among the Muslim community.

The Overdose Response Strategy: Reducing Drug Overdose Deaths Through Strategic Partnership Between Public Health and Public Safety.

Context:Public health and public safety collaborations can strengthen and improve efforts to address the worsening drug overdose crisis.Program:The Overdose Response Strategy is addressing this need through a national public health and public safety program designed to foster the cross-sector sharing of timely data, pertinent intelligence, and evidence-based and innovative strategies to prevent and respond to drug overdose.Implementation:Since 2015, the Overdose Response Strategy has been implemented by state-based public health and public safety teams who work together to prevent and respond to drug overdoses within and across sectors, states, and territories. The public health and public safety teams share data systems to inform rapid and effective community overdose prevention efforts; support immediate, evidence-based response efforts that can directly reduce overdose deaths; design and use promising strategies at the intersection of public health and public safety; and use effective and efficient primary prevention strategies that can reduce substance use and overdose long term. Implementation of the Overdose Response Strategy aligns with the US Centers for Disease Control and Prevention's Strategic Partnering Framework.Evaluation:The evaluation of the Overdose Response Strategy, which is currently underway, is based on 2 evaluation approaches: Collective Impact and Organizational Network Analysis. These approaches provide a way to look at the strength of the relationship between public health and public safety and the way the relationship is leveraged to advance program goals and objectives.Discussion:The Overdose Response Strategy serves as a strategic partnership model that can potentially be applied to other issues, such as gun violence, that may benefit from public health and public safety collaboration.

Levers of Change: How to Help Build the Public Health Workforce of the Future.

Public health leaders are working to rebuild the US public health workforce. Master of Public Health (MPH) programs have a stake in this, given their role in educating and training public health practitioners. Over the last 10 years, MPH programs have implemented changes to program structure, content, and approach, but workforce gaps persist. This study sought to explore the factors that inform and influence MPH program design and changes they make in order to elucidate how MPH programs may be further engaged to help address current and future public health workforce needs. Sequential mixed-methods study. US MPH programs accredited by the Council on Education for Public Health (CEPH), and applicants approved to seek accreditation. In total, 115 representatives representing at least 43% of the 215 accredited/applicant MPH programs in the United States. Factors that inform and influence programmatic and curricular changes within MPH programs. The shifts that MPH programs have made to program focus and the approaches used to support student competence development are influenced by individual, programmatic, institutional, and national factors, including faculty and staff background, access to resources, program team/faculty culture, access to resources, program placement, university priorities, and national policies. Most influential in catalyzing changes made by MPH programs between 2015 and 2020 were CEPH MPH accreditation standards, feedback from interested parties, learning best practices, university initiatives, and access to resources including funding and faculty. Identified factors served as facilitators and/or as barriers, depending on the context. There are multiple levers at different levels that may be utilized by national public health leaders, university administrators, and program constituents to effect change within MPH programs, helping them to be even better positioned to help address public health workforce needs of today and tomorrow.

Group B Streptococcus among Pregnant Women and Neonates in Saudi Arabia: A Systemic Review.

Sepsis caused by Group B Streptococcus (GBS) continues to cause mortality and morbidity in newborns, especially in developing countries. Bacterial sepsis in newborns varies nationally and even within countries. Developing countries have reported 34 deaths per 1000 live births compared to 5 in developed countries. This systemic review aimed to assess the prevalence of GBS colonization among pregnant women and the incidence of neonatal GBS sepsis in Saudi Arabia. A literature search of PubMed, MEDLINE Ovid, and Google Scholar was conducted. A total of 21 studies were found: 15 described maternal GBS colonization and 6 studies described neonatal GBS infections. The GBS colonization prevalence among pregnant women ranged from 2.1% to 32.8%. Inconsistencies in the reporting method for neonatal GBS infection rates were observed. Only two studies have the incidence of neonatal GBS as the primary outcome. No national multicenter studies exist on the GBS rates among neonates. Nationwide studies are warranted to assess the burden of GBS infections in neonates. These studies would guide appropriate GBS screening strategies during pregnancy for application in a national public health program.

Saudi pharmacy students' perceived knowledge and attitude on their role in public health services.

This study aimed to explore the preparedness of pharmacy students to actively participate in public health services by examining their attitude towards and knowledge about the national public health programmes (NPHPs). A cross-sectional study was conducted using an online questionnaire survey of the students in Unaizah College of Pharmacy (UCP) and College of Pharmacy Main Campus (CPMC), Qassim University, between October 2019 and February 2020. A total of 100 out of 125 students responded to the questionnaire at a response rate of 80%. While the majority (77%) of the participants agreed on the necessity for pharmacists to know about the NPHPs, 71% reported they did not learn about National Health Policy in their pharmacy curriculum. Also, a small number of pharmacy students, at 16%, believed that their current knowledge about the NPHPs was sufficient or very sufficient. Lastly, 81% of the participants felt that they had an important or very important role to play in the NPHPs. The majority of the participants expressed interest in more education on public health during their pharmacy education. Their interest supports the advancement of public health education to facilitate greater involvement of pharmacists in public health services.

Multiplex Serology for Measurement of IgG Antibodies Against Eleven Infectious Diseases in a National Serosurvey: Haiti 2014-2015.

BackgroundIntegrated surveillance for multiple diseases can be an efficient use of resources and advantageous for national public health programs. Detection of IgG antibodies typically indicates previous exposure to a pathogen but can potentially also serve to assess active infection status. Serological multiplex bead assays have recently been developed to simultaneously evaluate exposure to multiple antigenic targets. Haiti is an island nation in the Caribbean region with multiple endemic infectious diseases, many of which have a paucity of data for population-level prevalence or exposure.MethodsA nationwide serosurvey occurred in Haiti from December 2014 to February 2015. Filter paper blood samples (n = 4,438) were collected from participants in 117 locations and assayed for IgG antibodies on a multiplex bead assay containing 15 different antigens from 11 pathogens: Plasmodium falciparum, Toxoplasma gondii, lymphatic filariasis roundworms, Strongyloides stercoralis, chikungunya virus, dengue virus, Chlamydia trachomatis, Treponema pallidum, enterotoxigenic Escherichia coli, Entamoeba histolytica, and Cryptosporidium parvum.ResultsDifferent proportions of the Haiti study population were IgG seropositive to the different targets, with antigens from T. gondii, C. parvum, dengue virus, chikungunya virus, and C. trachomatis showing the highest rates of seroprevalence. Antibody responses to T. pallidum and lymphatic filariasis were the lowest, with <5% of all samples IgG seropositive to antigens from these pathogens. Clear trends of increasing seropositivity and IgG levels with age were seen for all antigens except those from chikungunya virus and E. histolytica. Parametric models were able to estimate the rate of seroconversion and IgG acquisition per year for residents of Haiti.ConclusionsMultiplex serological assays can provide a wealth of information about population exposure to different infectious diseases. This current Haitian study included IgG targets for arboviral, parasitic, and bacterial infectious diseases representing multiple different modes of host transmission. Some of these infectious diseases had a paucity or complete absence of published serological studies in Haiti. Clear trends of disease burden with respect to age and location in Haiti can be used by national programs and partners for follow-up studies, resource allocation, and intervention planning.

Assessment of the Current State of Pharmacovigilance System in Pakistan Using Indicator-Based Assessment Tool.

Objectives: Pakistan felt the need for an effective and robust pharmacovigilance (PV) system after one of the deadliest drug-related tragedies causing more than 300 deaths in 2012. The country set up its national PV center in 2015 and joined WHO’s Program for International Drug Monitoring (PIDM) in 2018 as a full member. The current study was aimed to evaluate the PV system’s functionality, identify the gaps, areas of improvement, and a strategy to lead a functional PV system in Pakistan. Methods: The descriptive cross-sectional study was conducted by providing an interviewer-administered questionnaire of the PV system across Pakistan by utilizing the Indicator based Pharmacovigilance assessment tool (IPAT). By a convenience sampling method 36 study participants were selected from the Drug Regulatory Authority of Pakistan (DRAP), drug administration of provincial health departments of 4 provinces and federally affiliated areas, 5 national public health programs, and 23 public and private hospitals. The assessment includes document review, interviews of the key informants by structured open-ended questions, and a review of websites of relevant organizations. Results: Drug Regulatory Authority of Pakistan (DRAP) with a national PV center received a 75% overall performance score on IPAT. To be regarded as “minimally functioning,” a country’s PV and drug safety system must meet all core indicators. DRAP scored 80.76% on the core indicators so cannot be deemed functional at this time. The only province with a regional PV center, Punjab, had scored 72.13% on relevant parameters. Despite receiving funding from the Global Fund, none of the National Public Health Programs (PHPs) have PV centers or associated activities. All hospitals except two private hospitals could not qualify the minimum requirements for functional PV. The absence of a legal framework for mandatory ADR reporting, lack of drug information center, budgetary constraints, no active surveillance activities, the nonexistence of pharmacovigilance risk assessment expert committee, and insufficient coordination among stakeholders were identified as major gaps. Conclusion: The results of the study reveal that Pakistan’s PV system is not fully functional at all levels. A two-phased strategy encompassing the non-financial and financial interventions is proposed to improve the PV systems at the national, provincial, PHPs, and hospitals levels.

Applying the EPIS framework to policy-level considerations: Tobacco cessation policy implementation among California Medicaid managed care plans.

In 2016, the California Department of Healthcare Services (DHCS) released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs. We assessed fidelity through semi-structured interviews with MCP health educators (N = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs. The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers' identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs. The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals. In 2016, the California Department of Healthcare Services (DHCS) in California released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs.

Posture correction as part of holistic health promotion in Hungarian schools.

The primary prevention program of the Hungarian Spine Society was launched in 1995 with two goals: 1. to achieve that all school-children take part regularly in effective posture correcting exercises as part of physical education; and 2. to achieve daily physical education for all school-children. With appropriate governmental legislation and parliamentary decision both goals were integrated into the National Public Health Program in 2001 and 2003 and later in the national educational laws and documents. From 2011 and 2012 holistic health promotion in schools with the goal to reach all children became also prescription for all schools in Hungary. Public health institutions and actors still have to do much: they have to give continuous professional help to the physical education teachers in their posture correcting work and to all teachers in their daily health promoting tasks. The article presents the details of the special posture correcting exercises, their distribution and prospective controlled studies, their place in the national education, the present situation and the further tasks. The article is supplemented by a short report about daily physical education and holistic health promotion in schools: how the prescription was achieved, the essence and the follow up of it, and what are the tasks for the helping public health actors.

PM2.5-associated burden of disease and its cost in 429 Iranian counties from 2016 to 2018

BACKGROUND AND AIM: Ambient fine particulate matter (PM2.5: particles with an aerodynamic diameter of ≤ 2.5 μm) causes a globally considerable disease burden. Little is known about the impacts of PM2.5 in all counties of Iran. We estimated the PM2.5-health burden, years of life lost (YLL) and economic impacts (based on the value of statistical life (VSL) and value of life year (VOLY)) of 429 Iranian counties during the period 2016-2018. METHODS: All-natural cause and cause-specific mortalities were assessed using the Environmental Benefits Mapping and Analysis Program (BenMAP-CE v1.5) based on the Global Exposure Mortality Model (GEMM) and integrated exposure-response (IER) functions. RESULTS:The annual mean population-weighted PM2.5 exposure concentrations across Iranian counties varied from 17.5 to 44.9, 16.8 to 58.2 and 19.4 to 66.1 μg m-3 in 2016, 2017 and 2018, respectively. The premature all-natural cause mortality attributed to long-term exposure to ambient PM2.5 in Iran was approximately 49300 (95% Confidence Interval (95% CI): 45400, 52000), 51000 (95% CI: 47000, 53500) and 49300 (95% CI: 45600, 51800) in 2016, 2017 and 2018, respectively. Furthermore, approximately 16% of all-natural cause mortality in adults (aged above 25 years) was attributed to PM2.5. The YLL attributable to PM2.5 exposures in Iran was approximately817000 (95% CI: 679000, 950000), 848000 (95% CI: 705500, 985000) and 827000 (95% CI: 687000, 961000) in 2016, 2017 and 2018. These YLL related to premature deaths were equivalent to the death of approximately 11 thousand children at birth. The economic loss in Iran due to the total estimated premature mortality attributable to ambient PM2.5 exposures was 20600 (95% CI: 19000, 21700), 21600 (95% CI: 20000, 23000) and 20300 (95% CI: 19000, 21300) million US$ from 2016 to 2018. CONCLUSIONS:Our findings provide a quantitative assessment of PM2.5 burden, assisting national evidence-based public health programs in Iran. KEYWORDS: Particulate matter, Long-term exposure, Outcomes, Mortality.

Psychosocial stress, sleep deprivation, and its impact on type II diabetes mellitus: Policies, guidelines, and initiatives from Malaysia.

Type II Diabetes Mellitus (T2DM) is a serious public health issue, affecting the global population, particularly those living in low‐ and middle‐income countries. Worldwide, the prevalence of T2DM ranges between 10.4% and 13.5%, depending on the domiciliary. T2DM negatively affects individuals' quality of life and causes high economic burden due to the increasing cost of treatment and management of the disease. Risk factors associated with T2DMs include aging, lifestyle or behavior, genetics, and important biopsychological aspects, which are psychological stress and sleep deprivation. By understanding the associations of psychological stress and sleep deprivation, which contribute to pathophysiology of T2DM, policies, programs, and guidelines were developed in Malaysia to combat the issue among population at large. This narrative review examines 19 national public health policies, programs, and guidelines from the past 20 years in Malaysia that aimed to mitigate the negative health effects of psychological stress, sleep deprivation, and T2DM, both from the government and non‐governmental organizations. Both psychological stress and sleep deprivation works independently or as combined effects in the pathophysiology of T2DM. Besides, in Malaysia, the government, in collaboration with non‐governmental organizations, have been developing and implementing policies, programs, and guidelines to combat mental health and T2DM issues, targeted to population at large. Integration of digital technology, such as usage of social media for health promotion and dissemination of public health messages to the community and good governance from government were deemed important in the effective implementation of health policies and guidelines, resulting in better health outcome.

Perspectives of different stakeholders on data use and management in public health emergencies in sub-Saharan Africa: a meeting report

During public health emergencies (PHEs), data are collected and generated from a variety of activities and sources, including but not limited to national public health programs, research and community-based activities. It is critical that these data are rapidly shared in order to facilitate the public health response, epidemic preparedness, as well as research during and after the epidemic. Nonetheless, collecting and sharing data during PHEs can be challenging, especially where there are limited resources for public health and research-related activities. In a symposium that brought together different stakeholders that were involved in the 2013-2016 Ebola outbreaks in West Africa, meeting attendees shared their perspectives on the values and management of data during PHEs in sub-Saharan Africa. Key factors that could inform and facilitate data management during PHEs in sub-Saharan Africa were discussed, including using data to inform policy decisions and healthcare; a coordinated data collection and management scheme; identifying incentives for data sharing; and equitable data governance mechanism that emphasise principles of reciprocity, transparency and accountability rather that trust between stakeholders or collaborators. Empirical studies are required to explore how these principles could inform best practices for data management and governance during PHE in sub-Saharan Africa.

Regional Consortia: A Framework for Public Health Laboratory Collaboration and Service Sharing.

Public health laboratories (PHLs) provide specialized testing services for programs focused on the prevention and control of communicable diseases, early detection of congenital disorders, testing for antimicrobial resistance, and identification of environmental contaminants, among other responsibilities. Although national public health programs and partners provide some funding support, training, and technical resources to PHLs, no dedicated funding is provided from federal programs to fully support comprehensive PHL services across the United States or the underlying infrastructure needed for PHLs to provide and ensure their core functions and capabilities. Public health laboratories have begun to rely on a "community of practice" approach to addressing various service needs by creating and formalizing regional consortia, which are organized groups of geographically clustered PHLs that share expertise, capacities, and capabilities to enhance PHL services. The number of states participating in these networks increased from 13 to 48 from 2015 to 2020, including participation by multiple local PHLs and a territorial PHL. These consortia have enabled strengthening of partnerships and collaboration among PHLs to address regional priorities and challenges. We explore the background and evolution of regional consortia, outline some of their practices and activities, review lessons learned from these successful collaborations, and discuss the positive effect they have on the national public health system.