National Public Health Research Articles

Infection Prevention and Control in Correctional Settings.

Correctional facilities house millions of residents in communities throughout the United States. Such congregate settings are critical for national infection prevention and control (IPC) efforts. Carceral settings can be sites where infectious diseases are detected in patient populations who may not otherwise have access to health care services, and as highlighted by the COVID-19 pandemic, where outbreaks of infectious diseases may result in spread to residents, correctional staff, and the community at large. Correctional IPC, while sharing commonalities with IPC in other settings, is unique programmatically and operationally. In this article, we identify common challenges with correctional IPC program implementation and recommend action steps for advancing correctional IPC as a national public health priority.

Інформаційно-комунікаційні технології у стратегії розвитку національної системи громадського здоров’я України

Goal of study: to identify the key directions in the development strategy of transformative changes in the information and communication support of the national public health system of Ukraine. Object and methods of study: the analysis of scientific literature and regulatory documents at both the national and global levels concerning the prospects of digitizing information and communication technologies in the public health system and strategy for transformative processes in the modernization of the healthcare sector. Results: based on the generalization of the scientific literature and legal acts of the national and international levels, the main directions of the strategic development of the national public health system of Ukraine in the reconstruction period until 2030 have been determined. The features of the challenges of the global situation in the country as a result of the large-scale military aggression of the Russian Federation, the experience gained by the public health system of Ukraine in the fight against the epidemic of COVID-19 established the role and significance of the digital information and communication system for preserving the life and health of the population, the security of the country in general, the development of urgent and long-term measures to ensure sanitary and epidemic well-being. Conclusions: the information base of Ukraine’s public health system is a state information resource maintained by the main expert institution in the field and replenished in accordance with the Procedure established by the Cabinet of Ministers of Ukraine, serving as the central information repository for the registry of the population's health status, sanitary-epidemiological well-being and indicators of the living environment in the country. Identifying and assessing health risk factors, developing immediate and long-term measures for preventing and eliminating harmful determinants of the health, informing the public, and forecasting a safe situation are integral operational functions of the public health system, as stipulated by the Law of Ukraine «On the Public Health System». The role and significance of the digital development of the public health information system should be clearly defined in the Concept of Informatization of the Healthcare System of Ukraine No. 1671-r dated December 28, 2020.

Perspectives of rural farming households on home gardens as an agroforestry for food security: a qualitative study in Indonesia

In developing countries, rural farmers contribute significantly to food production, but their households are still vulnerable to poverty, food insecurity, and malnutrition. Food security is a concept that refers to the ability of a country or region to ensure the availability, accessibility, and utilization of sufficient and nutritious food for its entire population, both in normal situations and under crisis conditions such as natural disasters or political instability. Food security is critical as it is directly related to national security, public health, and sustainable development. To improve food security, governments and international agencies often focus on policies such as increased food production, diversification of food sources, sustainable management of natural resources, and food assistance programs for vulnerable populations. The practice of agroforestry in home gardens offers a variety of readily available, cost-effective, and nutritious food options, which plays a significant role in enhancing the food security of agricultural families. Agroforestry, an integrated land management system combining food crops, trees, and sometimes livestock, offers a potential solution to improve food security. By growing various crops, farmers are not solely dependent on a single source of food, which reduces the risk of crop failure. Agroforestry systems increase resilience to climate change by reducing the impact of natural disasters, such as floods and droughts. Trees can act as wind barriers, reduce soil erosion, and aid in water conservation. This qualitative research with a systematic exploratory approach and grounded analysis examines how agroforestry contributes to farmers' food security by conducting in-depth interviews with farmers in North Luwu, Indonesia. The study identified home garden categories of agroforestry and then evaluated the role of agroforestry food production in terms of securing the food needs of households. The study discovered that restructure food bolsters across various income brackets by promoting healthier eating habits. Additionally, food production enhances the sustainability of food supplies for households and the health and prosperity of agriculturalists. The primary obstacles to producing food at the household level were identified as secure access to appropriate land and the possession of adequate farming expertise. Key words: agroforestry, farmer, rural, food security, household, home garden, Indonesia

A closer look at Cuba’s public health model that prioritizes population health

As the largest Caribbean island, Cuba is known for its picturesque Havana boardwalk, musical rhythms, and tropical climate. A closer look at the national public health model that integrates care for Cuban citizens, however, is fundamental to learn and adapt lessons learned and best practices to bridge knowledge-practice gaps within global health systems. In this visual essay, the author explores connections between photography and community health, illustrating an invaluable story about a primary care workforce, supported by the health system infrastructure, dedicated to achieve high-quality community health for citizens. She shares photographs coupled with narrative elements to showcase the population health model of Cuba, one Latin America and Caribbean country that has received international recognition for achieving universal health care to residents. She weaves words and images to portray her experiences of completing clinical rotations in tuberculosis prevention and control at the ‘Pedro Kourí’ Tropical Medicine Institute and surrounding public health institutions in the capital city of Havana.

COVID-19 VACCINE UPTAKE AMONG OPULENT VS SLUMS OF URBAN SETTING IN KARACHI, PAKISTAN

Background: COVID-19 vaccine effectiveness and acceptability are critical for a number of important outcomes, including symptomatic COVID-19, severe illnesses, and COVID-19-related mortality. Aim: To assess the immunization status regarding age, gender, and living standards and the reason for non-compliance to the Covid-19 vaccine among people of urban opulent and slums areas of a single city, i.e., Karachi, Pakistan. Method: This cross-sectional study was conducted from December 2022 to January 2023 in Karachi, Pakistan. Data were collected through social media websites, including WhatsApp and Facebook, telephonic interviews from opulent urban areas, and direct contact during the visit to primary health care clinics in urban slum areas. STATA software was used for data analysis. Result: Of 1265 respondents from slums and opulent areas, 15.8% were non-vaccinated slums, whereas 14.16% belonged to opulent areas needing vaccination with adjusted OR 95% is 0.74(0.41-0.95). Of 1265 respondents, 825(65%) were females, and 440 (34.7%) were male. The vaccine compliance among females was 49%, and 32% among male respondents with adjusted OR 95% 1.84(1.12-3.03). Only 6% of the slums area were vaccinated with the required shots of vaccine (2 doses and one booster) compared to opulent areas, i.e., 20%. Conclusion: Our research at the population level adds to the knowledge we now have from patient data and demonstrates how aggregated data from fully functioning epidemic surveillance and monitoring may provide information about the possible effects of extended COVID on national and international public health.

Hygienic aspects of general medicine ward operation: problems and solutions

The existing problems in the field of healthcare and prevention create new challenges and difficulties in various parts of the national public health system. Today, there is an effective set of new sanitary rules and regulations important for competent organization and stable functioning of general medicine wards. In 2023, this set is SanPiN 2.1.3678-20, developed to ensure safe and effective work in medical facilities. There are special bodies tasked with controlling compliance with the standards, including Rospotrebnadzor. The COVID-19 pandemic revealed a number of problems in the organization of work of inpatient departments, which required revision of the ways of rendering medical assistance. This article considers current sanitary and hygienic aspects of organization of operations at a general medicine ward, as well as the approaches to infection prevention in the context of medical care.

Early suppression policies protected pregnant women from COVID-19 in 2020: A population-based surveillance from the Nordic countries.

The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.

Cardiovascular Health, Lifestyle Factors, and Social Determinants in Asian Subpopulations in the United States

Asian Americans are often aggregated in national public health surveillance efforts, which may conceal important differences in the health status of subgroups that are included in this highly diverse population. Little is known about how cardiovascular health varies across Asian subpopulations and the extent to which lifestyle and social risk factors contribute to any observed differences. This national study used data from the National Health Interview Survey to evaluate the burden of cardiovascular risk factors (hypertension, hyperlipidemia, diabetes mellitus) and cardiovascular diseases (heart attack, coronary heart disease, angina, stroke) across Asian groups (Chinese, Asian Indian, Filipino, Other Asian), and determine whether differences are related to lifestyle factors and/or social determinants of health. The weighted study population included 13,592,178 Asian adults. Filipino adults were more likely to have hypertension than Chinese adults (29.4% vs 15.4%; adjusted odds ratio [OR] 2.40, 95% confidence interval [1.91 to 3.02]), as were Asian Indians (15.7%; OR 1.59 [1.25 to 2.02]). These patterns were similar for hyperlipidemia and diabetes mellitus. For cardiovascular diseases, Filipino adults were significantly more likely to have coronary heart disease (4.2% vs 1.9%; OR 2.19 [1.32 to 3.56]), heart attack (2.6% vs 0.9%; OR 2.79 [1.44 to 5.41]), angina (1.8% vs 0.9%; OR 2.15 [1.06 to 4.32]), and stroke (2.1% vs 0.8%; OR 2.54 [1.42 to 4.55]) compared with Chinese adults, whereas there were no differences compared with Asian Indian adults. Adjustments for lifestyle factors and social determinants completely attenuated differences in coronary heart disease, heart attack, and angina among subpopulations. In conclusion, these findings demonstrate that cardiovascular risk factors and diseases vary significantly across Asian subpopulations, with Filipino adults experiencing the highest burden and Chinese adults the lowest, and that differences in cardiovascular disease are largely attenuated after adjustment for lifestyle and social determinants.

Human respiratory syncytial virus subgroups A and B outbreak in a kindergarten in Zhejiang Province, China, 2023.

In May-June 2023, an unprecedented outbreak of human respiratory syncytial virus (HRSV) infections occurred in a kindergarten, Zhejiang Province, China. National, provincial, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We interviewed patients with the respiratory symptoms by questionnaire. Respiratory samples were screened for six respiratory pathogens by real-time quantitative polymerase chain reaction (RT-PCR). The confirmed cases were further sequenced of G gene to confirm the HRSV genotype. A phylogenetic tree was reconstructed by maximum likelihood method. Of the 103 children in the kindergarten, 45 were classified as suspected cases, and 25 cases were confirmed by RT-PCR. All confirmed cases were identified from half of classes. 36% (9/25) were admitted to hospital, none died. The attack rate was 53.19%. The median ages of suspected and confirmed cases were 32.7 months and 35.8 months, respectively. Nine of 27 confirmed cases lived in one community. Only two-family clusters among 88 household contacts were HRSV positive. A total of 18 of the G gene were obtained from the confirmed cases. Phylogenetic analyses revealed that 16 of the sequences belonged to the HRSV B/BA9 genotype, and the other 2 sequences belonged to the HRSV A/ON1 genotype. The school were closed on June 9 and the outbreak ended on June 15. These findings suggest the need for an increased awareness of HRSV coinfections outbreak in the kindergarten, when HRSV resurges in the community after COVID-19 pandemic.

On the Evidence of Things Not Seen: A Systems-Driven Analysis of LifeSkills Training, University and Tobacco Industry Efforts in School-Based Drug Prevention

ABSTRACT Background Despite recent declines, youth nicotine vaping remains seen by experts as a national public health epidemic. Few, if any, researchers have examined how related high-profile and school-based prevention programs such as LifeSkills Training (LST) are further disseminated with cooperation from research-to-practice entities as well as the tobacco industry. Purpose Provides a systems-driven documentary analysis of efforts pertaining to prevention entities at the University of Colorado, Boulder, as well as LST, and the tobacco industry. Methods Employs focused synthesis data collection with constant comparative analyses. Results Likely previously unseen and related to LST, is the degree to which prevention entities with a public mission appear to cooperate among themselves and with the tobacco industry as part of a longstanding, if not elaborate, school-based drug prevention social system characterized by patterned evidence of opaque or furtive representations and/or activities. Discussion Along with limitations, summarizes a research-to-practice social system likely compromising school-based prevention and, in turn, the health of the young people they serve. Theorizes a symbolic politics explanatory mechanism while providing recommendations toward transparency for more informed school-based prevention decision-making. Translation to Health Education Practice Emphasizes the National Commission for Health Education Credentialing Inc. (NCHEC) critical thinking and program evaluation competencies.

Measuring the Coverage of the HL7® FHIR® Standard in Supporting Data Acquisition for 3 Public Health Registries

With the increasing need for timely submission of data to state and national public health registries, current manual approaches to data acquisition and submission are insufficient. In clinical practice, federal regulations are now mandating the use of data messaging standards, i.e., the Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard, to facilitate the electronic exchange of clinical (patient) data. In both research and public health practice, we can also leverage FHIR® ‒ and the infrastructure already in place for supporting exchange of clinical practice data ‒ to enable seamless exchange between the electronic medical record and public health registries. That said, in order to understand the current utility of FHIR® for supporting the public health use case, we must first measure the extent to which the standard resources map to the required registry data elements. Thus, using a systematic mapping approach, we evaluated the level of completeness of the FHIR® standard to support data collection for three public health registries (Trauma, Stroke, and National Surgical Quality Improvement Program). On average, approximately 80% of data elements were available in FHIR® (71%, 77%, and 92%, respectively; inter-annotator agreement rates: 82%, 78%, and 72%, respectively). This tells us that there is the potential for significant automation to support EHR-to-Registry data exchange, which will reduce the amount of manual, error-prone processes and ensure higher data quality. Further, identification of the remaining 20% of data elements that are “not mapped” will enable us to improve the standard and develop profiles that will better fit the registry data model.

Training Senior Companion Volunteers to Identify and Report Adult Abuse, Neglect, and Exploitation.

Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. Evaluation consisted of surveys distributed prior to and at the conclusion of the training. A total of 302 volunteers were trained with a survey response rate of 76%. While there was significant knowledge improvement in one of the five knowledge items (p < .000, all other ps ≥ .065), volunteers' subjective rating of their knowledge on abuse significantly improved (p = .029). Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.

Integrated physical and mental management for China's elderly: insights from Long-gang District, Shenzhen.

China is in a period of rapid population aging. The total population of the elderly aged 60 and above in mainland China was 264 million in 2020, and is the country with the largest elderly population in the world, which is home to 1/5 of the world's older people. The urgency of actively coping with the aging population has never been greater, and China has raised it to the height of national strategy. To this end, China has issued several plans and projects on aging work. Many of them include multiple overlapping components. The management of physical illness and mental illness in the elderly is over-differentiated and segmented. However, it is common for older adults with complex health problems. The body and mind are inherently integrated and interact with each other, and should not be separated. There is an urgent need for integrated healthcare services for the physical and mental health of the elderly population. The national basic public health services play an important role in early detection and awareness of health problems for the elderly in community health services. This paper introduces the elderly health management services, one of the national basic public health projects, and the psychological care project for the elderly in Shenzhen, Guangdong Province, China. Taking Long-gang District's exploration of the joint management of physical and mental health of the elderly as an example, this review discusses the difficulties of the elderly health work, and the feasibility of integrating the elderly mental health and physical health in medical care. We outlook to build an integrated platform for physical and mental health of the elderly in China. Focus on the needs of older population, strengthen community health services, build a integrative team, fully publicize and improve health literacy of the elderly, link up and down and work together, improve coordination between providers of medical care and social services. It is of great significance to construct a strong public health system for the elderly and promote the realization of the grand goal of Healthy China.

Common mutation analysis of beta-thalassemia carriers by amplification refractory mutation system-polymerase chain reaction in cases diagnosed by capillary zone electrophoresis at National Public Health Laboratory, Nepal

Abstract BACKGROUND: Beta (β)-thalassemia is a globally prevalent genetic disorder with over 350 known mutations in the β-globin gene. Intervening-sequence (IVS) 1–5 (G→C), 619 bp deletion, IVS 1–1 (G →T), C-15 (G→A), frameshift (FS) 41/42 (−CTTT), FS 8/9 (+G), codon 19, A-G, and codon 17 (A→T) are some common mutations in β-thalassemia. This study aimed to identify and analyze the common mutation by amplification refractory mutation system polymerase chain reaction in β-thalassemia carriers diagnosed by capillary zone electrophoresis (CZE) at National Public Health Laboratory. MATERIALS AND METHODS: On the basis of archived data, the CZE performed on 781 samples between June 2019 and July 2022 was analyzed. Without regard to age, gender, race, or address, 121 samples were ultimately selected for mutation analysis during this time because they were identified as positive for the β-thalassemia traits based on high HbA2 levels of more than 3.5%. RESULTS: IVS 1–5 (G→C) was the most common mutation followed by 619 bp deletion. Five mutations namely IVS 1–5 (G→C), 619 bp deletion, FS 41/42 (−TTCT), FS 8/9 (+G), and codon 15 (G→A) accounted for 84.3% of cases. A single mutation was seen in 87 cases (71.9%), more than one mutation in 15 cases (12.4%) whereas 19 cases (15.7%) did not show any of the mutations tested. CONCLUSION: IVS 1–5 (G-C) is the most prevalent mutation in Southeast Asian nations, with the 619 bp deletion predominant in the Tharu community. Further research is needed to understand diverse ethnic groups and regions, enabling prenatal diagnostics and genetic counseling for β-thalassemia prevention.

Research on Factors that Influence the Employment of Foreigners in China

In the era of global economic integration and a rapidly changing international workforce, China has witnessed a significant increase in the number of foreign workers, especially since its accession to the WTO. This influx has disrupted China's labor market equilibrium and raised substantial challenges related to national sovereignty, security, social order, and public health. The Chinese legislative landscape grapples with various issues, such as delays in legislation, unclear regulatory boundaries, gaps in emerging sectors, lenient penalties for illegal employment, and inadequate coordination among law enforcement agencies. This paper holds both theoretical and practical importance as it aims to tackle these problems, proposing potential solutions to issues arising from the illicit employment of foreigners. Drawing insights from global legislative practices and emphasizing the safeguarding of domestic labor, this paper seeks to establish a comprehensive legislative framework for foreign employment in China, including provisions for exceptions to equal treatment. Additionally, it advocates for stricter employer accountability and penalties for illegal employment, highlighting the urgent need for improved cooperation and efficiency among law enforcement agencies. Beyond addressing domestic challenges, this paper also promotes international cooperation in foreign labor management, aligning with evolving global standards and continuously enhancing China's legal framework.

Assessment of the yellow fever outbreak in Angola from December 2015 through December 2016: A retrospective study.

The acute tropical infectious disease known as yellow fever (YF) is caused by an arbovirus and is characterized by fever, jaundice, hemorrhage, headache, muscle pain, nausea, vomiting, and fatigue. Angola experienced a yellow fever virus (YFV) outbreak that was documented in December 2015. However, little is known about the outcome of this outbreak. We aimed to demonstrate epidemic features and lessons learned during the YF epidemic in Angola. A total of 4618 blood samples from suspected YF cases were sent to the Instituto Nacional de Investigação em Saúde (INIS), a national referral and public health laboratory, between December 5, 2015, and December 23, 2016. Sample analyses were conducted using enzyme-linked immunosorbent assay (ELISA) and reverse transcription polymerase chain reaction (RT-PCR) assays. Blood samples were sent from 16 out of the 18 provinces of Angola. We detected 884 (19.1%) cases that were positive for ELISA, which were confirmed by RT-PCR assay. Considering the positive cases, the incidence among male patients was around three times higher (n = 223; 10.9%) than in female patients (n = 59; 2.6%) in the 20-29 age group, followed by the age group 10-19 with n = 211 (6.8%) in males versus n = 108 (3.3%) in females; and the age group 30-39 had n = 68 (4.8%) in males versus n = 28 (1.8%) in females. The other groups had an incidence below 3.0%. The case fatality ratio for YF was in young adults in the age group 20-29 with n = 39 cases, followed by the age group 10-19 with n = 16 cases, and finally the age group 0-9 with n = 13 cases. The other age groups had several deaths by YF below 10 cases. This study demonstrates features of the YF epidemic that occurred in Angola. Also, it demonstrates that YF causes deaths in young people but is preventable by high vaccine coverage. Thus, public health laboratory surveillance must be strengthened to reduce the possibility of emerging and re-emerging human infections.

Acceptability of built environment interventions to improve healthy eating and physical activity among city dwellers in Saskatchewan, Canada: THEPA findings from a local context

ABSTRACT Obesity and related chronic conditions present significant challenges in both national and global public health. Modifying the built environment stands as a population-level strategy to foster healthier behaviours and alleviate the burden of chronic diseases. The success of such interventions, however, hinges on their public acceptability, an aspect often overlooked. This study aimed to evaluate the level of public acceptability concerning diverse built environment interventions promoting healthy eating and physical activity within two major Canadian cities. We conducted an analysis of data gathered from 2,133 participants through a pan-Canadian survey, employing multilevel logistic regression. Interventions were categorized using the Nuffield Council on Bioethics’ ‘intervention ladder’, graded by their level of intrusiveness. Overall, individuals were more agreeable to implementing the least intrusive interventions in both food and physical activity domains. However, public support varied based on the type of intervention within and across different levels of intrusiveness. Notably, individuals self-identifying as women, Indigenous, or born outside of Canada demonstrated a higher likelihood of accepting interventions across all levels. The connection between neighborhood attributes and acceptability remained inconclusive. These locally pertinent findings carry practical implications for selecting, designing and implementing built environment interventions.

The opioid public health crisis in Texas: Characterizing real-world healthcare resource utilization and economic burden in different clinical settings.

Given the national opioid public health crisis, this study aimed to characterize the real-world healthcare resource utilization pattern and to quantify the economic burden associated with opioid misuse in Texas. A retrospective cross-sectional study was conducted using Texas state-wide Inpatient, Outpatient, and Emergency Department (ED) administrative data. International Classification of Diseases, 10th Revision (ICD-10-CM) codes related to opioid abuse, adverse effects, dependence, and poisoning identified opioid-related clinical encounters. High-sensitivity and high-specificity definition criteria were used to capture the range of opioid-related clinical encounters. Descriptive statistics were applied to evaluate the resource utilization and economic burden in different clinical settings and by different types of opioid misuse. Multivariable logistic regression models were applied to identify the association with patients' characteristics. The high-sensitivity definition identified three to six times more opioid-related clinical encounters related as compared to the high-specificity definition (31,901 vs 10,423 outpatient visits and 47,021 vs 7,444 inpatient visits). A greater proportion of these patients were aged 18-44, White, non-Hispanic, living in metro areas, and uninsured as compared to all-cause visits. EDs were heavily utilized with the outpatient visits predominantly through the ED (>90 percent) and between 49 and 78 percent of inpatient hospitalizations admitted through ED. The multivariable association between patient characteristics and opioid-related clinical encounters varied with clinical settings and the two definitions. High-sensitivity opioid-related clinical encounters were generally associated with higher charges as compared to high-specificity encounters. The total healthcare charge related to opioid misuse in 2016 was estimated to be USD 0.27 billion using the high-specificity definition and USD 2.6 billion using the high-sensitivity definition. Findings indicate opioid-related clinical encounters impose significant clinical and economic burdens in Texas. Study findings can help healthcare policymakers, professionals, and clinicians better classify opioid use disorder as a major but underreported condition in Texas.

Social integration and utilization of national basic public health services among China's internal migrants with chronic diseases: A structural equation modelling approach

Internal migrants with chronic diseases (IMCDs) are a specific subgroup of the internal migrants, but few studies have focused on health service utilization among this group. Social integration is an essential element in the maintenance of health and well-being in migrants. However, the measurement of social integration remains inconsistent. This study aimed to measure social integration more comprehensively and evaluate the association between social integration and National Basic Public Health Services (NBPHS) utilization among IMCDs in China, thereby providing theoretical support for health promotion among IMCDs. The data of this study were obtained from the China Migrants Dynamic Survey (CMDS) in 2017. A total of 9272 internal migrants who self-reported hypertension and/or type 2 diabetes were included in the analysis. Four factors were extracted through exploratory factor analysis to measure the social integration of IMCDs: psychological identity, community involvement, social security, and sociocultural adaptation. The results show the IMCDs underutilized NBPHS, with 26.80 % stating that they have not used any of the services in the NBPHS. We confirmed the positive association between social integration and NBPHS use among IMCDs. The social integration of IMCDs in developed regions was relatively worse than in developing regions, further exacerbating the underutilization of NBPHS in developed regions. Therefore, targeted government measures and supportive policies are necessary, especially in developed regions, to encourage IMCDs to participate in social organizations and community activities and stimulate their active participation in the NBPHS.

Respiratory syncytial virus immunoprophylaxis: Novel opportunities and a call for equity.

With the approval of the first vaccines against respiratory syncytial virus (RSV) and a novel RSV-neutralizing antibody, 2023 has been perceived as a game-changing year in preventing severe outcomes of RSV infections in infants and the elderly. However, the costs of these pharmaceuticals are high, while RSV disproportionately impacts populations of low-to-middle-income regions, which may continue to suffer from a lack of pharmaceutical measures for RSV prevention under health and socioeconomic disparities. This paper presents an overview of the characteristics, clinical results, and approval status of various RSV vaccines and anti-RSV antibodies. It posits that wealthy nations cannot monopolize RSV immunoprophylaxis and should work jointly to make it available to lower-income countries. An approach toward RSV immunoprophylaxis equity based on five points is offered: (1) integration of RSV vaccines and antibodies into the existing global humanitarian distribution systems, (2) using affordable RSV vaccine pricing models, (3) enforcing equity as a part of national and global public health strategy, (4) implementing equitable allocation frameworks for RSV immunoprophylaxis, and (5) promoting local manufacturing. Such a plan needs to be put into action as soon as possible to avoid delays in serving the populations with the highest needs related to RSV burden.