National Public Health Research Articles

Do Generative Artificial Intelligence Company Strategies of ‘Moving Fast and Breaking Things’ in Civil Society Cancel Their Social Licence to Operate? A Nurse’s Evaluation of Chatbot Impacts

A rapid expansion of the computer technology industry, particularly in the field of artificial intelligence, has ignited a global concern that warrants our immediate action. As nurses, our professional values frameworks compel us to protect public health and address national and global health issues. When industry activities adversely affect the social wellbeing of civil society and social institutions, it is important to evaluate them against their industry’s ‘social license to operate, which is a measure of public trust, credibility, and the legitimacy of their industrial and corporate citizenship status. The central question is, do computer technology companies continue to have a social license to operate in civil society? Nurses are encouraged to evaluate the computer technology industry’s recent ‘generative artificial intelligence’ chatbot activities against its tacit undertaking to be good corporate citizens in return for social acceptance of their operations and behaviour. An evidence-based overview of chatbot impacts on societies, environmental sustainability and human rights provide a basis for evaluation. Basic computer technology terminology and relevant concepts are explained. This article is a direct call to action for clinical nurses and those involved in research, education, management, and policy. We have a duty to critically assess the claims made by chatbot technology vendors in both practice and social contexts. If these vendors integrate chatbot technologies with existing machine learning used in nursing and healthcare technologies it could result in detrimental effects beyond user control. By influencing decisions on technology adoption, we can ensure the implementation of safeguards, protect patient safety and social well-being, and uphold the integrity of nursing values. A closing discussion of impacts of computer industry trust deficits on healthcare and research reflects the author’s concerns and conclusions about the central question. Readers may draw other conclusions and perhaps use the issues and evidence presented here to stimulate further investigations.

Examining the factors that impact the severity of cyberattacks on critical infrastructures

In light of the rising threats of cyberattacks on critical infrastructures, cybersecurity has become a high priority for government agencies worldwide. In particular, the severity of cyberattacks could lead to devastating consequences for national security, economic growth, and public health and safety. While earlier studies have examined several factors related to detecting, preventing, and predicting cyberattacks on critical infrastructures, they have largely neglected to consider the severity aspect of these attacks. This study aims to bridge this research gap by examining the factors that influence the severity of cyberattacks on critical infrastructures. To achieve this, we analyze 897 reported attacks on critical infrastructures to examine the impact of incident type, ransomware, zero-day vulnerability, attacker type, conflict type, initial access vector, and the number of targeted countries on the severity of these cyberattacks. The results show that cyberattacks employing ransomware and initiated by nation-state actors have the most impact on severity. On the contrary, cyberattacks that include data theft, disruption, hijacking with or without misuse, involve multiple types of conflict, and target the energy and finance sectors have the least impact on the severity of attacks. To gain further insight into these results, we perform sub-analyses on the metrics that makeup severity. Findings show that cyberattacks on the health sector are more vulnerable to data theft of sensitive information compared to other sectors. Also, nation-state-led attacks are more likely to involve data theft of sensitive information and long-term disruptions. Finally, as years progress, the results generally indicate a decreasing likelihood of attacks involving data theft of sensitive information and hijacking with misuse.

Whether COVID-19 Affected Hospital Death Rate in Split - Dalmatia County, Croatia

The main aim of this study was to examine whether the COVID-19 pandemic affected hospital death rate. A cross-sectional comparative study using two different periods, pre-COVID-19 (March 2019 to February 2020) and the COVID-19 era (March 2020 to February 2021) was employed to explore the possibilities of COVID-19 influencing hospital death rate in Split and Dalmatian County, Croatia. Data from the National Public Health Information System was used in this research. The indicators were statistically analyzed. The study showed that in the COVID-19 era, there was a significantly higher hospital death rate in comparison to the pre-COVID-19 era (z=-14.084; p<0.001), mainly due to the significant increase in hospital death rate from respiratory diseases. The Intensive Care Unit and the Infectious Diseases Department showed a significantly higher hospital death rate among hospital department. Among deaths with confirmed COVID-19, deaths from respiratory diseases were significantly more positive (z=23.975, p<0.001). The results of the study showed that COVID-19 had an impact on hospital death rate in Split-Dalmatia County. Given that the study analysed the first year of the pandemic, additional research will be needed over a wider period to get a more detailed insight of the impact of COVID-19 on hospital death rate in Croatia, as well as in other regions.

Future worldwide coronavirus disease 2019 epidemic predictions by Gaidai multivariate risk evaluation method.

Accurate estimation of pandemic likelihood in every US state of interest and at any time. Coronavirus disease 2019 (COVID-19) is an infectious illness with a high potential for global dissemination and low rates of fatality and morbidity, placing some strains on national public health systems. This research intends to benchmark a novel technique, that enables hazard assessment, based on available clinical data, and dynamically observed patient numbers while taking into account pertinent territorial and temporal mapping. Multicentre, population-based, and biostatistical strategies have been utilized to process raw/unfiltered medical survey data. The expansion of extreme value statistics from the univariate to the bivariate situation meets with numerous challenges. First, the univariate extreme value types theorem cannot be directly extended to the bivariate (2D) case,-not to mention challenges with system dimensionality higher than 2D. Assessing outbreak risks of future outbreaks in any nation/region of interest. Existing bio-statistical approaches do not always have the benefits of effectively handling large regional dimensionality and cross-correlation between various regional observations. These methods deal with temporal observations of multi-regional phenomena. Apply contemporary, novel statistical/reliability techniques directly to raw/unfiltered clinical data. The current study outlines a novel bio-system hazard assessment technique that is particularly suited for multi-regional environmental, bio, and public health systems, observed over a representative period. With the use of the Gaidai multivariate hazard assessment approach, epidemic outbreak spatiotemporal risks may be properly assessed. Based on raw/unfiltered clinical survey data, the Gaidai multivariate hazard assessment approach may be applied to a variety of public health applications. The study's primary finding was an assessment of the risks of epidemic outbreaks, along with a matching confidence range. Future global COVID-19/severe acute respiratory syndrome coronavirus 2 (SARS-COV2) epidemic risks have been examined in the current study; however, COVID-19/SARS-COV2 infection transmission mechanisms have not been discussed.

Clinical and biobehavioral phenotypic assessments and data harmonization for the RE-JOIN research consortium: Recommendations for common data element selection

BackgroundThe Restoring Joint Health and Function to Reduce Pain (RE-JOIN) Consortium is part of the Helping to End Addiction Long-term® (HEAL) Initiative. HEAL is an ambitious, NIH-wide initiative to speed scientific solutions to stem the national opioid public health crisis. The RE-JOIN consortium’s over-arching goal is to define how chronic joint pain-mediating neurons innervate different articular and peri-articular tissues, with a focus on the knee and temporomandibular joints (TMJ) across species employing the latest neuroscience approaches. The aim of this manuscript is to elucidate the human data gathered by the RE-JOIN consortium, as well as to expound upon its underlying rationale and the methodologies and protocols for harmonization and standardization that have been instituted by the RE-JOIN Consortium. MethodsThe consortium-wide human models working subgroup established the RE-JOIN minimal harmonized data elements that will be collected across all human studies and set the stage to develop parallel pre-clinical data collection standards. Data harmonization considerations included requirements from the HEAL program and recommendations from the consortium’s researchers and experts on informatics, knowledge management, and data curation. ResultsMultidisciplinary experts − including preclinical and clinical researchers, with both clinician-scientists- developed the RE-JOIN’s Minimal Human Data Standard with required domains and outcome measures to be collected across projects and institutions. The RE-JOIN minimal data standard will include HEAL Common Data Elements (CDEs) (e.g., standardized demographics, general pain, psychosocial and functional measures), and RE-JOIN common data elements (R-CDE) (i.e., both general and joint-specific standardized and clinically important self-reported pain and function measures, as well as pressure pain thresholds part of quantitative sensory testing). In addition, discretionary, site-specific measures will be collected by individual institutions (e.g., expanded quantitative sensory testing and gait biomechanical assessments), specific to the knee or TMJ. Research teams will submit datasets of standardized metadata to the RE-JOIN Data Coordinating Center (DCG) via a secure cloud-based central data repository and computing infrastructure for researchers to share and conduct analyses on data collected by or acquired for RE-JOIN. RE-JOIN datasets will have protected health information (PHI) removed and be publicly available on the SPARC portal and accessible through the HEAL Data Ecosystem. ConclusionData Harmonization efforts provide the multidisciplinary consortium with an opportunity to effectively collaborate across decentralized research teams, and data standardization sets the framework for efficient future analyses of RE-JOIN data collected by the consortium. The harmonized phenotypic information obtained will significantly enhance our understanding of the neurobiology of the pain-pathology relationships in humans, providing valuable insights for comparison with pre-clinical models.

Effects of Resource Sharing Networks on Community Anti-Drug Coalitions’ Outcomes: A Social Network Analysis

Substance use-related problems continue to be a national public health crisis despite years of prevention efforts. Community anti-drug coalitions are well positioned to address substance use at local levels. Coalitions often rely on their members to connect to resources they need to address community issues and plan for sustainability over time. Such capacity building occurs through voluntary cooperation among members, making it essential to understand the role network connections play. This study sought to determine whether structural characteristics of coalitions’ resource sharing networks impact members’ perceptions of community improvement and coalition sustainability. Surveys at two timepoints collected data from 68 coalitions in Pennsylvania and Missouri on members’ connections or ties to share information, personnel, money, or other types of collaboration. Analyses examined how coalition-level measurements of sectoral diversity, density, and resource sharing centralization, respectively, were associated with members’ perceptions of community improvement, sustainability planning, and coalition sustainability. Sectoral diversity and centralization were unrelated to study outcomes. Density was also unrelated with perceived community improvement and sustainability planning. However, two facets of cooperative density were positively associated with perceived coalition sustainability: the density of ties to share information and the density of multiple types of collaborative ties. This study suggests that both information and other collaborative ties foster perceived coalition sustainability, although not community improvement.

Regional features of sensitization to various allergens in children with allergic diseases, taking into account the formed exposome.

Background. According to statistical data from the WHO and a number of researchers, up to 40% of the world's population. Assessing the impact of the exposome in the population of the Russian Federation is a crucial issue of national public health care, the solution of which will provide a personalised approach to the treatment and prevention of allergic diseases in the local population. The aim of this study was to evaluate the sensitisation profile in children with allergic diseases from different regions of Russia. Methods. The study included sick children with allergic manifestations from different regions of the Russian Federation. A separate group consisted of children from the Far North regions from 2 to 12 years of age. The concentration of total IgE and allergen-specific immunoglobulins in blood was determined retrospectively on the basis of analyses of results obtained in CDCs performing immunoblotting tests using the Allergy-Q test system. Results. It was found that in more than 60% of cases allergic reactions are represented by combined manifestations. Allergic rhinitis took the second place, up to 65.32% of cases. Atopic dermatitis in the structure of allergic diseases took the third place, which was about 22,06%. The diagnosis of allergic conjunctivitis in our study was established in 15.38% of cases. Less than 5% in the structure of allergies was occupied by urticaria. In the group of household allergens the first place is occupied by cat, then dog and already then house dust. Among respiratory allergens, birch and/or other trees, weeds and mugwort are the leaders. Food sensitisation in children is mainly to milk, egg, fish and seafood. Conclusion. The peculiarities of sensitisation revealed in different regions are easily explained by the formed exposomes. The obtained data can be used to develop measures of prevention, diagnosis and treatment of allergic diseases.

Comparison of Different Reverse Transcriptase-Polymerase Chain Reaction-Based Methods for Wastewater Surveillance of SARS-CoV-2: Exploratory Study.

Many countries have applied the wastewater surveillance of the COVID-19 pandemic to their national public health monitoring measures. The most used methods for detecting SARS-CoV-2 in wastewater are quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) and reverse transcriptase-droplet digital polymerase chain reaction (RT-ddPCR). Previous comparison studies have produced conflicting results, thus more research on the subject is required. This study aims to compare RT-qPCR and RT-ddPCR for detecting SARS-CoV-2 in wastewater. It also aimed to investigate the effect of changes in the analytical pipeline, including the RNA extraction kit, RT-PCR kit, and target gene assay, on the results. Another aim was to find a detection method for low-resource settings. We compared 2 RT-qPCR kits, TaqMan RT-qPCR and QuantiTect RT-qPCR, and RT-ddPCR based on sensitivity, positivity rates, variability, and correlation of SARS-CoV-2 gene copy numbers in wastewater to the incidence of COVID-19. Furthermore, we compared 2 RNA extraction methods, column- and magnetic-bead-based. In addition, we assessed 2 target gene assays for RT-qPCR, N1 and N2, and 2 target gene assays for ddPCR N1 and E. Reverse transcription strand invasion-based amplification (RT-SIBA) was used to detect SARS-CoV-2 from wastewater qualitatively. Our results indicated that the most sensitive method to detect SARS-CoV-2 in wastewater was RT-ddPCR. It had the highest positivity rate (26/30), and its limit of detection was the lowest (0.06 gene copies/µL). However, we obtained the best correlation between COVID-19 incidence and SARS-CoV-2 gene copy number in wastewater using TaqMan RT-qPCR (correlation coefficient [CC]=0.697, P<.001). We found a significant difference in sensitivity between the TaqMan RT-qPCR kit and the QuantiTect RT-qPCR kit, the first having a significantly lower limit of detection and a higher positivity rate than the latter. Furthermore, the N1 target gene assay was the most sensitive for both RT-qPCR kits, while no significant difference was found between the gene targets using RT-ddPCR. In addition, the use of different RNA extraction kits affected the result when the TaqMan RT-qPCR kit was used. RT-SIBA was able to detect SARS-CoV-2 RNA in wastewater. As our study, as well as most of the previous studies, has shown RT-ddPCR to be more sensitive than RT-qPCR, its use in the wastewater surveillance of SARS-CoV-2 should be considered, especially if the amount of SARS-CoV-2 circulating in the population was low. All the analysis steps must be optimized for wastewater surveillance as our study showed that all the analysis steps including the compatibility of the RNA extraction, the RT-PCR kit, and the target gene assay influence the results. In addition, our study showed that RT-SIBA could be used to detect SARS-CoV-2 in wastewater if a qualitative result is sufficient.

Practices of Trans-National Corporations: The Need to Change Global Economic and Political Norms; Comment on "National Public Health Surveillance of Corporations in Key Unhealthy Commodity Industries – A Scoping Review and Framework Synthesis"

Trans-national corporations (TNCs) are recognised as having an adverse impact on public health through the marketing and sale of unhealthy products. In addition to this some of their practices affect health, including taxation avoidance, lobbying politicians to gain favourable legislative and regulatory environments for their operations, and failure to abide by occupational health and safety standards. We argue that while considering the individual practices of commercial actors is crucial the true public health harms are only evident when the synergistic impacts of the practices are considered. We also note that the practices are supported by a global economic and political system which operates in the favour of commercial actors rather than the health of people and the planet. Consequently there needs to be a norm change by which norms and power are shifted away from commercial interests and externalities of commercial practices are no longer outsourced to the public purse.

Heterogeneity in public health service utilization and its relationship with social integration among older adult migrants in China: a latent class analysis.

The older adult migrant population in China is on the rise, which presents challenges for the national public health service system. However, the heterogeneity of public health service utilization and its relationship with social integration among the older adult migrant population remains unclear. This study aims to explore the heterogeneity the public health service utilization and how it relates to their social integration. A total of 6,178 older adult migrants from the China Migrants Dynamic Survey (CMDS) in 2017 were included in this study. Exploratory factor analysis was used to categorize social integration into four dimensions. Latent class analysis (LCA) was used to identify different sub-groups of public health service utilization. ANOVA and multivariate logistic regression were used to determine the characteristics of different sub-groups. Three potential classes of public health service utilization were identified: low utilization of basic public health services class (N = 3,264,52.756%), medium utilization of basic public health services class (N = 1,743,28.172%), and high utilization of basic public health services class (N = 1,180,19.072%). Gender, education, extent of mobility, and move alone or not, flow time were all predictors of the class of public health service utilization. There were significant differences in social integration across potential categories (p<0.0001). The utilization of public health services of the older adult migrants is affected by many aspects. Social integration deserves attention as a significant influencing factor in the utilization of public health services. The government should pay attention to the characteristics of the older adult migrants and formulate relevant policies in a targeted manner in order to improve the utilization of public health services of the older adult migrants.

Age-Related Blood Pressure Gradients Are Associated With Blood Pressure Control and Global Population Outcomes.

The strong relationship between blood pressure (BP) and age is well known. Limited evidence suggests that a steeper age-BP slope may be associated with an increased risk of adverse outcomes. The May Measurement Month campaign enables an investigation of geographic, socioeconomic, and sex differences in age-related BP gradients and their association with public-health outcomes. Cross-sectional, annual global BP May Measurement Month screening data were analyzed. Average systolic BP and age-related BP slopes across different age groups were calculated to assess regional, socioeconomic, and sex-stratified variations. The association of BP slopes derived from adjusted linear regression models with country-level health metrics was investigated. Age-related systolic BP gradients differed distinctly across global geographic regions, income levels, and between sexes. The steepest age gradients of BP were observed in populations from Africa and Europe. Women had lower BP levels than men at younger ages (20s and 30s) but subsequently experienced more pronounced age-related BP gradients. Geographically divergent age-related BP gradients were significantly associated with major national public health indicators. Globally, steeper age-related BP slopes were associated with poor BP control, increased disability-adjusted life years, and death rates. A steeper population age-BP slope of 1 mm Hg per 10 years was associated with a decrease in life expectancy of 3.3 years in this population (95% CI, -5.1 to -1.4; P=0.0007). Age-related BP gradients vary considerably across global populations and are associated with variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of adverse BP gradients to improve health outcomes.

Toward better pandemic governance and preparedness: South Korea’s whole-of-nation approach to COVID-19

BackgroundThe profound impact of coronavirus disease (COVID-19) has led to an increased demand for sustainable pandemic governance practices. This study explored emerging hybrid governance practices that provide robust evidence on how to address the complex challenges of pandemics effectively. South Korea, which was severely affected by COVID-19, has implemented a novel governance approach using a whole-of-nation (WoN) model. This hybrid pandemic governance approach, which integrates both whole-of-government and whole-of-society approaches, has enabled synergistic and cohesive multi-sectoral coordination among all stakeholders (public authorities, private enterprises, and civil society) to address multifaceted challenges collectively and strengthen their resilience capacity. This study investigated South Korea’s WoN practices and their embedded context and identified key governance enablers facilitating this approach.MethodsThis study employed a case study design based on an extensive analysis of policy and program documents, drawing on South Korea’s publicly available data from January 1, 2020 to March 30, 2023. It assessed six system-level collaborative pandemic governance practices and key enablers, all of which were intended to fortify the country’s pandemic response.ResultsThe primary areas of the country’s WoN governance practices for COVID-19 control were (i) whole-of-government policy-making and response, (ii) COVID-19 testing system, (iii) digital surveillance of COVID-19, (iv) COVID-19 triage and treatment system, (v) domestic vaccine production, and (vi) community engagement. Key governance enablers for implementing the WoN model were establishing a legal foundation, ensuring decisive and strong governance and leadership, increasing public investment, applying a whole-of-health approach with augmented investment in public health, enhancing crisis communication, and mobilizing local leaders and civil society organizations in the national public health response.ConclusionsIn exploring innovative approaches to pandemic governance for increased efficacy, responsiveness, and impact, the WoN approach emerged as highly relevant. This example of emerging practice allows policy-makers to re-evaluate their governance strategies and initiatives to improve multi-agency partnerships across the country in their pandemic-preparedness planning.

Examining School Nurses' Knowledge and Confidence Related to Their Intention to Screen for and Report Child Sexual Abuse: A Descriptive Cross-Sectional Study.

Child sexual abuse (CSA) is a preventable national public health problem that results in adverse health consequences. Research suggests youth experiencing CSA are often of school age. Screening for early detection of health issues is integral to school nurse (SN) practice. Still, there is little evidence that routine screening when CSA is suspected is occurring in schools, despite recommendations that it should be. Lack of confidence and knowledge related to screening and reporting for CSA contribute to a SN's missed opportunity for early intervention. The aim of this study was to describe SNs' knowledge and self-efficacy associated with screening for and reporting suspected CSA in school settings. A descriptive cross-sectional survey design was employed. The Child Abuse Report Intention Scale was sent to over 2,000 members of the National Association of School Nurses. Among SN respondents (N = 123), the main findings showed almost half reported being concerned a youth was experiencing CSA but may have missed identifying it. Self-efficacy and professional responsibility were predictors of SNs' intention to screen as well as knowledge about obvious and serious signs of abuse were predictors of SNs' intention to report in this sample. An educational partnership between forensic nurse examiners and SNs can facilitate improving SNs' knowledge about nonspecific physical and behavioral indicators of abuse that are not overtly obvious. The development of a screening tool specific for use by SNs can empower their confidence to screen by providing a resource for them to use as a guide when they are uncertain about the evidence.

Piecing together Pakistan's health system and global health security.

Pakistan's health system has a critical role to play in global health security, however, it faces numerous structural and systemic challenges while contributing to international health efforts. Understanding the dynamics of health system is essential for developing effective strategies to prevent, detect, and respond to health emergencies, ensuring regional stability, and the overall global health security This paper documents the strengths and weaknesses of Pakistan's health systems, the impact of the COVID-19 pandemic, challenges such as funding constraints and fragmented healthcare delivery, threats including antimicrobial resistance, and the importance of international collaboration. Anti-microbial particularly multi-drug resistance, food safety in emergencies, surge capacity of the frontline workforce, patient safety at the health care facilities to curtail healthcare associated infections, and strengthening the points of entry are still the areas that need special attention. To optimise the system's performance, governance and accountability mechanisms are necessary to be put in place under the auspices of national public health agency. Pakistan has the potential to transform its health system by addressing these critical areas and improve its preparedness and readiness for any future health emergency of this scale.

Sexual Orientation Differences in Age of First Treatment for a Mental Health Diagnosis: A Population-Based Study of Childhood and Adolescence

The aim of the current study was to identify the age at which sexual orientation disparity in mental health diagnoses can be first identified, as well as gender and sexual identity subgroup differences in such treatment, in a population-based sample. Young people aged 16 to 25 (N= 10,365) participating in the probability-based Swedish National Public Health Survey in 2018 were included. This sample was linked to physician-assessed mental health care treatment history data starting when all participants were 8 years old using national health care registries. Participants reporting a sexual minority identity in adolescence and young adulthood were more than 3 times as likely to have been treated for an internalizing disorder diagnosis (eg, depression, anxiety) and more than twice as likely to have been treated for a neurodevelopmental disorder diagnosis during childhood than participants reporting a heterosexual identity. Sexual minority participants overall and women in particular were more likely to have been treated for an internalizing disorder diagnosis at an early age compared with heterosexual participants, with this disparity starting at age 13. The sexual orientation disparity in likelihood of treatment for a neurodevelopmental disorder diagnosis was particularly elevated among bisexual/pansexual women with this disparity starting in early/middle adolescence. This population-based study linked to physician-assessed mental health diagnoses during childhood and adolescence identifies the age at which sexual orientation differences in treatment for common mental disorders emerge. The early emergence of this disparity suggests a potential benefit of interventions that facilitate social belonging for all youth.

Re-Emerging, Under-Recognized Zoonotic, and Neglected Tropical Diseases in Hawai'i.

Hawai'i, the United States' most western geographic state in the Pacific, lies between the North and South American continents and the Indo-Pacific regions, including Japan. The tropical environmental conditions of the Hawaiian Islands provide favorable ecosystems for various infectious pathogens, their vectors, and reservoirs. This creates an environment conducive to the transmission of zoonotic diseases affecting both humans and animals. Hawai'i has experienced an increase in dengue, leptospirosis, and murine typhus outbreaks. Furthermore, toxoplasmosis and neuroangiostrongyliasis cases remain prevalent throughout the state, and the putative presence of autochthonous Zika cases identified in a retrospective study may be of national public health concern. Understanding the factors that affect the transmission and distribution of zoonoses is necessary to identify at-risk locations and populations. The One Health approach seeks to understand, report, and interpret these factors and requires collaboration between private and governmental institutions. One Health should focus on neglected tropical diseases (NTD) and prioritize development of interventions to control and prevent the transmission of diseases that spread between animals and humans. This review focuses on the epidemiological and clinical characteristics of under-recognized zoonotic and NTD affecting Hawai'i, including leptospirosis, murine typhus, neuroangiostrongyliasis, toxoplasmosis, dengue, and Zika.

Managing Lymphedema Induced by Lymphatic Filariasis: Implementing and Improving Care at the Individual and Programmatic Levels.

Providing and improving the care of patients suffering from lymphedema remains an essential goal for the clinical management of populations affected by lymphatic filariasis. Although the Essential Package of Care (EPC) recommended by the WHO leads to important positive benefits for many of these lymphedema patients, it is important to continue to address the challenges that remain both in quantifying these effects and in ensuring optimal care. This report, based on the authors' scientific and field experience, focuses on the impact and significance of lymphedema, its clinical presentation, current treatment approaches, and the importance of lymphedema care to the Global Program to Eliminate Lymphatic Filariasis. It emphasizes specific practical issues related to managing lymphedema, such as the importance of beginning treatment in the condition's early stages and the development of effective approaches to assess patients' progress toward improving both their clinical status and their overall quality of life. Priorities for research are also examined, particularly the need for tools to identify patients and to assess disease burden in endemic communities, the creation of EPC accessibility to as many patients as possible (i.e., targeting 100% "geographic coverage" of care), and the empowerment of patients to ensure the sustainability, and ultimately the provision of care from sectors of the national public health systems of endemic countries.

Lessons from the COVID-19 pandemic for ventilation and indoor air quality.

The rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the beginning of 2020 presented the world with its greatest health challenge in decades. It soon became clear that governments were unprepared to respond appropriately to this crisis. National and international public health authorities were confused about the transmission routes of the virus and the control measures required to protect against it. In particular, the need to reduce the risk of infection through sufficient and effective ventilation of indoor spaces was given little attention. In this review, we discuss insights and key lessons learned from the COVID-19 pandemic regarding the role of ventilation as an effective means against airborne transmission of pathogens and, more broadly, for supporting good indoor air quality.

Design and Implementation of a Course to Meet the Demand for a Skilled Public Health Workforce to Address the Needs of People With Disabilities

People with disabilities experience a higher burden of chronic diseases compared to people with no disabilities. To emphasize the importance of addressing health-related disparities affecting this population, multiple objectives of Healthy People 2030 focus on people with disabilities. Accomplishing these objectives requires a culturally competent public health workforce knowledgeable about the health issues and health-related factors affecting people with disabilities and evidence-based public health strategies for effective interventions. To prepare future public health professionals to be a part of efforts of diversity, equity, and inclusion, we developed and implemented a course on disability which was offered as an upper-level elective to students pursuing undergraduate training in public health. We structured the course around selected objectives of Healthy People 2030 and evidence-based strategies mapped to these objectives. The course framework allows for the development of proficiency and competency in these areas through learning about the basic disability-related terms, health issues, health-related behaviors, and social determinants of health affecting people with disabilities. We also aligned the course with the specific accreditation criteria outlined by the Council on Education for Public Health and disability competencies. There is an urgent need for future public health professionals to understand the challenges experienced by people with disabilities and be able to address them. Designing and implementing courses meeting the accreditation criteria and aligned with the national public health objectives could help strengthen the appropriate knowledge and skills of the future public health workforce.

Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program

BackgroundThe rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors.MethodsConducted from April to November 2020 in Huai’an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables.ResultsHigher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels.ConclusionsThis study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.