National Public Health Research Articles

A Community Waterborne Salmonella Bovismorbificans Outbreak in Greece.

In August 2022, the Hellenic National Public Health Organisation was notified about a gastroenteritis outbreak in town A in Southern Greece. Investigations aimed to identify the source and implement control measures. Case definition categories were used in a 1:3 case-control study. Cases and controls were interviewed about various exposures. Cases' stool samples were cultured on agar plates and characterised by serotyping, antimicrobial susceptibility testing and Pulse Field Gel Electrophoresis (PFGE). Environmental investigations included tap water sampling for microbiological and chemical analysis in town A and inspection of the water supply system. We identified 33 cases (median age: 17 years). Tap water consumption was the only significant risk factor for gastroenteritis (OR = 5.46, 95% CI = 1.02-53.95). Salmonella (S.) Bovismorbificans isolated from eight stool and one tap water samples had identical PFGE profiles. No resistant isolates were identified. Residual chlorine levels were lower than the acceptable limits before and during the outbreak. We advised consumption of bottled water and adherence to strict hand hygiene rules until tap water was declared suitable for drinking. Epidemiological and molecular data revealed a waterborne S. Bovismorbificans outbreak in town A. We recommend local water safety authorities to ensure that residual chlorine levels comply with the legislation towards water safety planning, to mitigate risks.

Registered Nurses' Well-Being, Michigan, 2022.

Objectives. To examine nurses' well-being and identify individual and workplace factors associated with adverse outcomes. Methods. We administered an e-mail survey to registered nurses in Michigan in March 2022. Outcomes included the Oldenburg Burnout Inventory-Exhaustion scale, self-harm thoughts (yes/no), and overall wellness on a 0 to 10 visual analog scale. Covariates included practice environment, psychological safety, workplace abuse, staffing adequacy, stress coping strategies, and demographics. We examined associations between covariates and exhaustion, thoughts of self-harm (both via logistic regression), and overall wellness (via linear regression). Results. Among surveyed nurses, 93.63% reported significant exhaustion, 9.88% reported self-harm thoughts, and the mean (SD) overall wellness score was 6.2 (2.3). Factors associated with exhaustion included inadequate staffing, lower psychological safety, and younger age. Factors associated with self-harm thoughts included recent workplace physical abuse and younger age. Factors associated with higher wellness scores included employer support, favorable practice environments, higher job satisfaction, and positive coping strategies. Conclusions. Negative well-being outcomes were prevalent among registered nurses and were associated with correctable workplace deficits. Nurses' well-being is a national public health problem that warrants comprehensive interventions at individual, workplace, and community levels. (Am J Public Health. 2024;114(S2):S180-S188. https://doi.org/10.2105/AJPH.2023.307376).

Functional Simulation Exercise on Functionality of National Public Health Emergency Operations Centers in the African Region: Review of Strengths and Gaps.

National public health emergency operations centers (PHEOCs) serve as hubs for coordinating information and resources for effective emergency management. In the International Health Regulations (IHR 2005) Monitoring and Evaluation Framework, a simulation exercise is 1 of 4 components that can be used to test the functionality of a country's emergency response capabilities in a simulated situation. To test the functionality of PHEOCs in World Health Organization African Region member states, a regional functional exercise simulating an Ebola virus disease outbreak was conducted. The public health actions taken in response to the simulated outbreak were evaluated against the exercise objectives. Thematic analysis was conducted to summarize key strengths and areas for improvement. From December 6 to 7, 2022, more than 1,000 representatives from 36 of the 47 African Region member states participated in the exercise from their respective PHEOCs. Approximately 95% of the 461 participants polled agreed with the positive responses to the postexercise survey. More than half of the PHEOC participants were able to test their existing emergency preparedness and response plans and became familiar with the expected roles to be fulfilled during an event. Of the participants who responded to the survey, over 90% reported that the exercise helped them understand their roles during emergency management. The exercise met its objectives and provided an opportunity to test the functionality of PHEOCs using realistic scenarios, and it helped participants understand existing response systems and procedures. However, the exercise also revealed areas for improvement in terms of the timing and preparation of participants. We recommend conducting functional exercises at the regional and national levels at least once a year, early or midyear, to allow many stakeholders to take part in the exercise. Moreover, there is a need to train country-level evaluators and controllers in designing and conducting functional exercises.

The role of the Field Epidemiology Training Program in the public health emergency response: Sudan armed conflict 2023.

On April 15, 2023, the armed conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in Khartoum state, Sudan. This conflict was complicated by the preexisting complicated epidemiological situation and fragile health system in Sudan. This study endeavors to illuminate the pivotal role essayed by the Sudan FETP (SFETP) in enhancing the nation's public health response, particularly amidst the tumultuous backdrop of armed conflicts that have left their indelible mark on the region. Employing a blend of quantitative and qualitative methodologies, we investigated the SFETP's contributions to the public health response during the initial 4 months of the conflict (April-July 2023). Sixty-four SFETP residents and graduates were invited to participate, and data were gathered through semi-structured questionnaires. A total of 44 (69%) SFETP residents and graduates were included in this study. Out of 38 SFETPs present in the states, 32 have considerably contributed to the crisis response at state and locality levels. Three-quarters of them have played key leadership, planning, and management roles. In essence, 38% (n = 12) of them have contributed to public health surveillance, particularly in data management, reports, Early Warning Alert and Response System (EWAR) establishment, and epidemic investigation. SFETPs have made special contributions to crisis response at the community level. The involved SFETPs supported WASH interventions (n = 4), and almost one-third of them strengthened risk communication and community engagement (n = 9). Despite their physical presence at the subnational level, 27% of graduates were not deployed to the crisis emergency response. Notably, throughout this time, half of the total SFETPs were formally retained during this response. The study highlighted the importance of FETP engagement and support during public health crises. SFETP residents and graduates played diverse roles in the various levels of public health emergency response to the crisis. However. Strategies to improve the deployment and retention of FETP residents are necessary to ensure their availability during crises. Overall, FETP has proven to be an asset in public health crisis management in Sudan.

Public health consequences of armed conflict in Sudan in the face of global donor fatigue

AbstractSudan, a country located in northeastern Africa, is grappling with a profound health crisis resulting from the recent war that erupted on April 15, 2023. This conflict has inflicted significant damage on the country's health system, particularly through the destruction of healthcare infrastructure. Approximately 61% of health facilities have been destroyed, leaving only 16% operating optimally in Khartoum. Hospitals and clinics, vital for public health, have become targets of violence, exacerbating the challenges faced by the nation. The World Health Organization has noted the closure of roughly 16 hospitals since the start of the conflicts due to staff safety concerns as well as a shortage of hospital supplies, consumables, and medication. There has also been a gradual waning of donor support and resources allocated to address protracted crises and emergencies worldwide Sudan receives very little funding from donor organizations to maintain its healthcare system, which worsens the nation's general public health architecture. This makes the country vulnerable to serious challenges like disease outbreaks, starvation, infectious diseases, deteriorating health infrastructure, and mental health issues. To successfully reduce the severity of negative impacts on public health, the crisis must be ceased and facilities reopened. An emergency disease surveillance system for infectious diseases should be established, women and child health should be prioritized, and mental health awareness programs and services should be implemented. The global community must support the efforts to mitigate the devastating effects of this crisis. This article aims to highlight the critical impact of the recent war on Sudan's healthcare, advocating for urgent measures, including facility reopening, disease surveillance, and global support to mitigate devastating consequences.

Methodology for assessing regional health care in the context of control over functional focus and social orientation

Subject. The article investigates regional health care as an integral part of national public health. Objectives. We focus on substantiation of methods to assess public health achievements against social indicators reflecting its usefulness to society. Methods. The study employs general scientific methods of cognition, statistical analysis, systems and integrated approaches. Synthesis and logical generalization enabled to develop concluding summaries and formulate proposals for systematizing the assessment of the work of regional health authorities. Results. The study found that the result of regional and national health care functioning is reflected in the degree of achievement of goals, which are defined as positive changes in socio-demographic characteristics of the region and the country. Positive trends in the social aspect are associated with improvement in life quality, which depends on many factors, one of which is high-quality modern healthcare that meets public demand as needed and when required Conclusions. Comparing the indicators characterizing functional tasks with social goals, it is possible to conclude on the degree of their achievement. The study showed that it is necessary to focus on comprehensive assessment of groups of indicators combined according to the characteristics of particular tasks of health care functioning, as well as on systems approach, in which it is advisable to describe health systems to assess balance and sustainability.

Rethinking the World Health Organization's leadership of global health governance and the global health surveillance systems.

Global health governance is a strategic priority for the World Health Organization (WHO), and the public health surveillance system (PHSS) is a fundamental element of the global health governance structure to timely identify emerging diseases and guide global public health decisions and actions. This analysis explores the overall landscape of global health governance, with a specific focus on the PHSS to understand whether the existing governance landscape facilitates or undermines the WHO's ability to formulate and implement global health policies and initiatives. To achieve this, the existing evidence was reviewed, and synthesized with the experts' perspectives. It is reported that fragmentation is the main drawback of the global health governance landscape, necessitating reorganization and restructuring. The disintegration of PHSS at the global, regional and local levels is associated with a lack of leadership, misalignment with global health priorities, imbalance in coverage of surveillance systems, inadequate innovative technology and digitalization, and fragmented data and information systems. The fragmentation and disintegration of global health governance undermine the effectiveness of the WHO's global health strategic directions and programmes and hinder its ability to govern and guide the global, regional and national public health emergency response. Strategic rethinking of the WHO's governance is essential because strong governance and leadership lead to a robust, aligned and effective PHSS.

Evolving Disparities in Cannabis Use Among Youth by Demographics and Tobacco and Alcohol Use in the U.S.: 2013–2021

IntroductionThe current study investigated the prevalence of past 30-day cannabis use among US youth by cigarette use, alcohol use, demographics and state-of-residence cannabis legal status in 2021, and examined whether changes in prevalence were modified by these factors from 2013 to 2021. MethodsData were drawn from the 24 states that collected cannabis use data participating in the Youth Risk Behavior Surveillance System (YRBSS) from 2013-2021. Logistic regression analyses estimated past 30-day cannabis prevalence in 2021 and produced adjusted odds ratios (AOR) by current cigarette, alcohol, state-of-residence cannabis legal status. The same method was used with year as the exposure, adjusting for sex, race and ethnicity, to assess trends in prevalence from 2013 to 2021. ResultsIn 2021, cannabis use was more common among female (16.75% vs. 13.83%, AOR=1.26 (95% CI: 1.16, 1.37)), Non-Hispanic (NH) Black and Hispanic youth relative to NH White youth (17.19%, 16.14% vs. 14.60%; AOR=1.25 (95% CI: 1.12, 1.39); AOR=1.16 (95% CI: 1.04, 1.29)), respectively. Cannabis use was much more common among youth who reported any past 30-day cigarette or alcohol use (44.90% vs. 6.48%, AOR=11.80 (95% CI: 10.57, 13.18)). Declines in cannabis use were observed independent of state-level cannabis law from 2013 to 2021 and cannabis use prevalence did not differ significantly by state-of-residence cannabis legal status among the 24 participating states in 2021. ConclusionsPublic health officials should carefully consider the potential differential impact of expanding commercialization of cannabis and US state government endorsement of cannabis as a “wellness” product on youth, especially with regard to co-use with tobacco and alcohol. National and state-level public health education on cannabis use and youth-oriented prevention of cannabis uptake are long overdue.

P1108 Factors Associated with Delayed Diagnosis of Inflammatory Bowel Disease and Risk of Complications: Analysis of the Brazilian National Registry

Abstract Background The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) has established a national registry of inflammatory bowel disease (IBD). Timely diagnosis and treatment of the disease are crucial to mitigate the risk of complications in this patient population. Therefore, this study aimed to assess the variables associated with delayed diagnosis and the frequency of complications in IBD patients in Brazil. Methods A cohort study was conducted from August 2020 to August 2023. Data were obtained from medical records and patient consultations using the REDCap platform, with approvals from the ethics boards of participating institutions. Patients were categorized based on the time from symptom onset to diagnosis: < 1 year, 1 to 1 year 11 months, and ≥ 2 years. Socioeconomic and clinical data, such as disease extension, use of biological therapy, and complications like the need for surgery or hospitalization, were evaluated. Results The study included 2,436 patients, with 1,147 diagnosed with ulcerative colitis (UC) and 1,289 with Crohn's disease (CD). Of these, 62% were managed in public centers, and 38% in the private system. The age at diagnosis was 38 ± 15.5 years for UC and 33.7 ± 14.9 years for CD, with females predominating (64.5% for UC and 53.4% for CD). Among UC patients, disease extension included pancolitis (43.5%), left colitis (28.8%), and proctitis (27.7%). The time between symptom onset and diagnosis was longer in CD patients (p<0.001), as follows: < 1 year (UC 58.4% and CD 50.9%), 1 to 1 year 11 months (UC 22.3% and CD 21.1%), and ≥ 2 years (UC 19.3% and CD 28%). The shortest interval in UC patients was observed in private services (p<0.001), Southern and Northeastern regions of Brazil (p<0.001), and in patients without extraintestinal manifestations (EIM) (p=0.003). No differences were noted regarding disease extent, need for surgery, hospitalization, presence of cancer, or use of biological therapy. In CD patients, the shortest interval was observed in private services (p<0.001), the Southern region of Brazil (p<0.001), and was associated with a lower rate of hospitalization due to complications or disease activity (p=0.032). Among those who underwent surgery (35.6%), patients operated on in a public university hospital experienced a greater delay in diagnosis (p=0.014). No differences were observed regarding the presence of perianal disease, need for surgery, cancer, or use of biological therapy. Conclusion The window of opportunity is imperative to reduce complications, especially in CD. Further epidemiological studies are needed to shape national public health policies, emphasizing early diagnosis and appropriate treatment of IBD.

Cross trust: A decentralized MA-ABE mechanism for cross-border identity authentication

With an increasing demand for authenticated data exchange between jurisdictions, ensuring the privacy and security of data interactions is crucial for national security, public health, and economic vitality, becoming a fundamental national infrastructure. Current solutions can be categorized into two types: fully decentralized autonomous systems based on blockchains or centralized solutions that rely on authoritative centers such as certification authorities (CAs). In reality, a balance needs to be struck between guaranteed authority and privacy independence. A certain authority is needed as an authorization guarantee, and decentralization is required to ensure privacy and the independence of the authority. This paper proposes a novel scheme, CT-MA-ABE (Cross-Trust Multiple Authorization Attribute-Based Encryption), to address these issues by implementing MA-ABE for cross-border institutional authorization interactions, utilize blockchain certification authority (BCA) for credibility and encryption-based authorization to protect attribute data privacy. This solution integrates the role of 'notary' in cross-border interactions, addressing the supervision problem in fully decentralized approaches while also considering the trust issue in centralized systems. This paper also introduces the Universal Certificate Authority Pool (UCAP), an innovative hybrid federated authorization method, creatively utilizing the implied authorization conditions of attributes to create a flexible and transitive authorization mechanism based on attribute relationships and extensions, enhancing privacy protection and improving the speed of authorization matrix calculation. The successful deployment of the system between the legal jurisdictions in South China, Zhuhai and Macau as a critical infrastructure component for securing data interactions further demonstrates its effectiveness as a reliable and secure solution.

Brief Report: Determinants of Potential Sexual Activity Reduction in the Face of the Mpox Epidemic.

The current mpox epidemic is most prevalent among men-who-have-sex-with-men (MSM). Vaccination programs are being rolled-out to curb the epidemic. Behavioural measures have been called for as well, for example, by the WHO and national public health authorities to reduce the number of sexual partners and sexual activity. We investigated intentions and determinants among Dutch MSM to follow such behavioural measures. Early in July 2022, in the context of a dynamic ongoing epidemic, 394 MSM answered an online questionnaire investigating concepts such as perceived mpox risk, vaccination and behavioural change intentions and collecting socio-demographic and sexual behaviour information. The overall intentions to reduce number of partners and sexual activity were high, but only a minority had developed definite intentions. Determinant analysis revealed that dating/open relationship status was a positive predictor; vaccination intentions did not predict sexual behaviour change; those not on PrEP were more likely to change their sexual behaviour. Mpox infection concern was the main predictor for behaviour change intentions. Our results show that behavioural measures to avoid an mpox infection are present in majority of participants in our survey, but high intentions are held by a minority. Taking the historic complexity of behavioural change pleas among MSM into account sensitive, additional public health measures are necessary to reach and to inform MSM about potential benefits of sexual behaviour change.

Artificial intelligence in healthcare: combining deep learning and Bayesian optimization to forecast COVID-19 confirmed cases.

Healthcare is a topic of significant concern within the academic and business sectors. The COVID-19 pandemic has had a considerable effect on the health of people worldwide. The rapid increase in cases adversely affects a nation's economy, public health, and residents' social and personal well-being. Improving the precision of COVID-19 infection forecasts can aid in making informed decisions regarding interventions, given the pandemic's harmful impact on numerous aspects of human life, such as health and the economy. This study aims to predict the number of confirmed COVID-19 cases in Saudi Arabia using Bayesian optimization (BOA) and deep learning (DL) methods. Two methods were assessed for their efficacy in predicting the occurrence of positive cases of COVID-19. The research employed data from confirmed COVID-19 cases in Saudi Arabia (SA), the United Kingdom (UK), and Tunisia (TU) from 2020 to 2021. The findings from the BOA model indicate that accurately predicting the number of COVID-19 positive cases is difficult due to the BOA projections needing to align with the assumptions. Thus, a DL approach was utilized to enhance the precision of COVID-19 positive case prediction in South Africa. The DQN model performed better than the BOA model when assessing RMSE and MAPE values. The model operates on a local server infrastructure, where the trained policy is transmitted solely to DQN. DQN formulated a reward function to amplify the efficiency of the DQN algorithm. By examining the rate of change and duration of sleep in the test data, this function can enhance the DQN model's training. Based on simulation findings, it can decrease the DQN work cycle by roughly 28% and diminish data overhead by more than 50% on average.

The national public health institute: long missed agenda

The national public health institute: long missed agenda

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.

Despite public health emergency, OD deaths keep rising: Here are some solutions

In 2017, President Trump declared the opioid epidemic a national public health emergency (PHE), telling the nation that “we can be the generation that ends the opioid epidemic.”

Multinational collaboration in solving a European Salmonella Braenderup outbreak linked to imported melons, 2021.

A genomic cluster of Salmonella Braenderup ST22, a serovar of Salmonella enterica subsp. enterica which causes symptoms of gastrointestinal illness, was notified by Danish authorities to the European Centre for Disease Prevention and Control (ECDC) on 3 May 2021. By 6 July 2021, S. Braenderup outbreak cases (n=348) had been reported from 12 countries in the European Union/European Economic Area (EU/EEA) and the United Kingdom (UK), including 68 hospitalised cases. With support from affected EU/EEA countries, and in partnership with the European Food Safety Authority (EFSA), ECDC established an international outbreak investigation team to rapidly identify the source and prevent outbreak spread. Consumption information was shared with affected countries through a standard line list, revealing that 124 of 197 cases (63%) reported having eaten (any) melons within 7 days prior to disease onset. The speed and completeness of the investigation, which identified the outbreak vehicle as galia melons imported from Honduras in June 2021, was a direct result of extensive collaboration and information sharing between countries' national food safety and public health authorities. This article describes the outbreak and the benefits, successes, and challenges of multi-country collaboration for consideration in future large foodborne outbreaks across Europe.

Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study

BackgroundThe COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays. ObjectivesThis study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity. MethodsThis international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses. ResultsWe included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P < 0.001) and 7% (P < 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (−52%; P = 0.001), Central-South America (−33%; P < 0.001), and Asia (−29%; P < 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P < 0.001) and economic status (P < 0.001), higher COVID-19 incidence (P < 0.001), and more stringent public health restrictions (P < 0.001) experienced a greater reduction in TAVR activity. ConclusionsTAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.

Descriptive Review of Patents in Healthcare and Nursing: Based on Network Analysis

The significance of the healthcare industry has grown exponentially in recent years due to the impact of the fourth industrial revolution and the ongoing pandemic. Accordingly, this study aimed to examine domestic healthcare-related patents comprehensively. Big data analysis was used to present the trend and status of patents filed in nursing. The descriptive review was conducted based on Grant and Booth's descriptive review framework. Patents related to nursing was searched in the Korea Intellectual Property Rights Information Service between January 2016 to December 2020. Data analysis included descriptive statistics, phi-coefficient for correlations, and network analysis using the R program (version 4.2.2). Among 37,824 patents initially searched, 1,574 were selected based on the inclusion criteria. Nursing-related patents did not specify subjects, and many patents (41.4%) were related to treatment in the healthcare delivery phase. Furthermore, most patents (56.1%) were designed to increase effectiveness. The words frequently used in the titles of nursing-related patents were, in order, "artificial intelligence," "health management," and "medical information," and the main terms with high connection centrality were "artificial intelligence" and "therapeutic system." The industrialization of nursing is the best solution for developing the healthcare industry and national health promotion. Collaborations in education, research, and policy will help the nursing industry become a healthcare industry of the future. This will prime the enhancement of the national economy and public health.

Antibiotic Resistance Profile of &amp;lt;i&amp;gt;Salmonella&amp;lt;/i&amp;gt; Strains Isolated at the National Clinical Biology and Public Health Laboratory in Bangui, Central African Republic

Antibiotic Resistance Profile of &amp;lt;i&amp;gt;Salmonella&amp;lt;/i&amp;gt; Strains Isolated at the National Clinical Biology and Public Health Laboratory in Bangui, Central African Republic

Navigating the network: a narrative overview of AMR surveillance and data flow in the United States.

The antimicrobial resistance (AMR) surveillance landscape in the United States consists of a data flow that starts in the clinical setting and is maintained by a network of national and state public health laboratories. These organizations are well established, with robust methodologies to test and confirm antimicrobial susceptibility. Still, the bridge that guides the flow of data is often one directional and caught in a constant state of rush hour that can only be refined with improvements to infrastructure and automation in the data flow. Moreover, there is an absence of information in the literature explaining the processes clinical laboratories use to coalesce and share susceptibility test data for AMR surveillance, further complicated by variability in testing procedures. This knowledge gap limits our understanding of what is needed to improve and streamline data sharing from clinical to public health laboratories. Successful models of AMR surveillance display attributes like 2-way communication between clinical and public health laboratories, centralized databases, standardized data, and the use of electronic health records or data systems, highlighting areas of opportunity and improvement. This article explores the roles and processes of the organizations involved in AMR surveillance in the United States and identifies current knowledge gaps and opportunities to improve communication between them through standardization, communication, and modernization of data flow.