Part Of Public Health Policy Research Articles

Current Vaccine and Efficacy of COVID-19 in Latin America: Challenges and need for updated public health policy

In Latin America, the COVID-19 pandemic, which initially surged and is now a constant presence, has brought about significant health challenges due to disparities and differences in regional responses. Vaccination is not only a necessity but also a responsibility as the primary tool for prevention. However, its implementation has not been consistent across countries, leading to various challenges such as global demand, initial high costs, infrastructure limitations for distribution, public hesitance, and misinformation. Other issues, like vaccine efficacy in immunocompromised patients and the use of different vaccines, were initially questioned but are now regarded as strategies to protect patients. This region, with its unique traditions, also faces several risk factors including vaccine supply shortages, lack of vaccine manufacturing, overcrowded cities, and an increasing migrant population that adds to the vulnerability of the people, challenging countries to strive for equity in prevention strategies. It is important to address individual strategies in communities to increase vaccine uptake as part of public health policy, and collaboration between countries should be encouraged to reach more people. This review will provide information about the COVID-19 vaccines available in the region, their characteristics and composition, their use across countries, and the reported effectiveness in the general population and among those with weakened immune systems.

Knowledge, Propensity and Hesitancy among Pregnant Women in the Post-Pandemic Phase Regarding COVID-19 Vaccination: A Prevalence Survey in Southern Italy

The vaccination of pregnant women against influenza and COVID-19 may reduce the risk of severe illness in both the women of this population and their babies. Although the risks of non-vaccination are more serious than the side effects, maternal immunization is still the least-used method of prevention due to a lack of information leading to concerns about the safety and efficacy of vaccines, resulting in a low prevalence rate among pregnant individuals. Our study investigates vaccination coverage and the knowledge, attitudes and perceptions of COVID-19 in pregnant women at a university hospital. A questionnaire was created with the following three scores: a vaccination propensity score, a knowledge score and a hesitancy score. The first observation in the results was the very low number of immunized women (only 4.7% received their first dose). The main barrier towards vaccination was found to be fear of adverse events. We noticed a low percentage of influenza and diphtheria tetanus pertussis vaccination compared to other studies. Vaccination propensity was higher when healthcare workers educated their patients. As immunization is a crucial part of public health policy, measuring coverage to identify gaps and monitor trends, especially for individuals considered at high risk, and developing new strategies in order to increase awareness of vaccination during pregnancy is particularly timely and relevant.

Sexual and reproductive health in the triple border: a gender issue

Sexual and reproductive health became part of public health policies as a specific point of discussion and raised numerous problems in relation to gender, which has the concept of building theoretical responses, policies and interventions that can be used to counteract the inequalities of diverse orders sustained from the naturalized differences between men and women. The objective of this study was to raise awareness of the problems faced by women in front of health services in a border region with the theme of sexual and reproductive health. The study is an integrative review, with online search of the LILACS (6,148), BVS (1,880), PUBMED (3,378) and Scielo (1797) databases, using the following descriptive terms: “Health on the Frontier”, Sexual and Reproductive Health ”, “gender”, “female”, “woman”, Primary Health Care”. A greater vulnerability was identified in women regarding sexual and reproductive health as impacts on health care that tend to accompany maternal care, with emphasis on the fact that thousands of Brazilian women die annually due to unsafe abortion practices,

Breastfeeding support provided by lactation consultants in high-income countries for improved breastfeeding rates, self-efficacy, and infant growth: a systematic review and meta-analysis protocol

BackgroundIt is well established that breast milk offers numerous health benefits for mother and child. Mothers are recommended to exclusively breastfeed their child until 6 months of age, with continued breastfeeding up to 1–2 years of age or beyond. Yet, these recommendations are met less than half of the time in high-income countries. Lactation consultants specialize in supporting mothers with breastfeeding and are a promising approach to improving breastfeeding rates. For lactation consultant interventions to be implemented widely as part of public health policy, a better understanding of their effect on breastfeeding rates and important health outcomes is needed.MethodsThe overall aim of this systematic review is to evaluate the effect of lactation consultant interventions provided to women, compared to usual care, on breastfeeding rates (primary outcome), maternal breastfeeding self-efficacy, and infant growth. A search strategy has been developed to identify randomized controlled trials published in any language between 1985 and April 2023 in CENTRAL, MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science. We will also perform a search of the grey literature and reference lists of relevant studies and reviews. Two reviewers will independently extract data on study design, baseline characteristics, details of the interventions employed, and primary and secondary outcomes using a pre-piloted standardized data extraction form. Risk of bias and quality of evidence assessment will be done independently and in duplicate using the Cochrane Risk of Bias tool and GRADE approach, respectively. Where possible, meta-analysis using random-effects models will be performed, otherwise a qualitative summary will be provided. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.DiscussionThis review will fill an important gap in the lactation support literature. The findings will be of importance to policymakers who seek to implement interventions to improve breastfeeding rates.Trial registrationThis review has been registered in the PROSPERO database (ID: CRD42022326597).

Modeling a traffic light warning system for acute respiratory infections

The high morbidity of acute respiratory infections constitutes a crucial global health burden. In particular, for SARS-CoV-2, non-pharmaceutical intervention geared to enforce social distancing policies, vaccination, and treatments will remain an essential part of public health policies to mitigate and control disease outbreaks. However, the implementation of mitigation measures directed to increase social distancing when the risk of contagion is a complex enterprise because of the impact of NPI on beliefs, political views, economic issues, and, in general, public perception. The way of implementing these mitigation policies studied in this work is the so-called traffic-light monitoring system that attempts to regulate the application of measures that include restrictions on mobility and the size of meetings, among other non-pharmaceutical strategies. Balanced enforcement and relaxation of measures guided through a traffic-light system that considers public risk perception and economic costs may improve the public health benefit of the policies while reducing their cost. We derive a model for the epidemiological traffic-light policies based on the best response for trigger measures driven by the risk perception of people, instantaneous reproduction number, and the prevalence of a hypothetical acute respiratory infection. With numerical experiments, we evaluate and identify the role of appreciation from a hypothetical controller that could opt for protocols aligned with the cost due to the burden of the underlying disease and the economic cost of implementing measures. As the world faces new acute respiratory outbreaks, our results provide a methodology to evaluate and develop traffic light policies resulting from a delicate balance between health benefits and economic implications.

Frequency of social participation by types and functional decline: A six-year longitudinal study

Social participation is effective for preventing functional decline in older people. However, researchers have not fully explored how different frequencies of social participation by type. We aimed to clarify the relationship between the frequency of social participation by type and functional decline. We used data from the Japan Gerontological Evaluation Study, which consists of individuals aged 65 years and older who were not eligible to receive public long-term-care insurance benefits. From 13 municipalities, 51,968 respondents who met the criteria were included in the analysis. We used a sex-stratified Cox proportional hazards model. The outcome was the new incidence of functional decline during a six-year follow-up, and the exposure was the frequency of social participation of one of the following six types: sports, hobbies, volunteering, neighborhood, senior clubs, and industry groups. The frequency was categorized as “never,” “a few times a year,” “once or twice a month,” and “once a week or more.” We set non-participation in each activity as the reference, and we adjusted for 12 potential confounders (i.e., sociodemographic and health-related factors). After we adjusted for confounders, participation in sports and hobbies once or twice a month, once a week or more was protectively associated with functional decline. We found a similar association for participation in neighborhood a few times a year. Our findings demonstrate the importance of considering the effects of different types and frequencies of activities when promoting social participation among older people as part of public health policies.

Babies before bottom lines: A call for Australia to end exploitative marketing of commercial milk formula at home and abroad

Babies before bottom lines: A call for Australia to end exploitative marketing of commercial milk formula at home and abroad

Multidirectional dynamic model for the spread of extended-spectrum-β-lactamase-producing Escherichia coli in the Netherlands

Extended-spectrum-β-lactamase-producing Escherichia coli (ESBL-EC) is a major public health concern. A better understanding of the dynamics of ESBL-EC transmission is required for effective prevention and control. We present here a multidirectional dynamic risk model for ESBL-EC transmission between broiler flocks, broiler farmers, and the open community, parameterized for the Netherlands. A discrete-time model was used to describe the transmission of ESBL-EC within and between populations including modeling the flock-to-human transmission via food consumption due to contamination at the slaughterhouse and/or during food preparation. The ESBL-EC prevalence reached an equilibrium prevalence of 0.65%, 24.7%, and 15.9% in the open community, farmers, and broiler flocks, respectively. The colonization of the open community could primarily be attributed to the open community itself (62%), followed by vegetable consumption (29.5%), and contact with farmers (8.5%). Model results were most sensitive to the estimated colonization and decolonization rate for humans. What-if analysis to explore the effect of interventions in the food production chain (i.e. from farm to fork) on the ESBL-EC prevalence in the open community indicated that interventions aimed at reducing the spread of ESBL-EC within broiler flocks were most effective. Interventions in the consumer phase (reduced cross-contamination in the kitchen, and reduced chicken meat consumption) resulted in a slightly lower ESBL-EC prevalence in the open community. Reducing cross-contamination at the slaughterhouse or reducing the proportion of broiler flocks with high antimicrobial use hardly had any effect on the prevalence in the open community. These results illustrate the relevance of the model for supporting the development of antimicrobial resistance risk mitigation strategies as part of public health policy making.

Medical Review and Analysis of Canned Food Production Safety

Summary Food safety is an essential and integral part of public health policies in developed countries. Canned foods play a significant role in modern human nutrition. Improving the safety of internal control in production is additional prevention of the potential risks of consuming contaminated food. The present study aims to perform a health assessment and medical analysis of the Internal Control System and a canning company’s Hazard Analysis and Critical Control Points (HACCP) plan. Our study also aimed to find potential mechanisms to increase the safety in producing this type of ready-to-eat foods and possible new approaches in avoiding and managing risks. An audit algorithm was developed to analyze the existing food safety systems in the enterprise to achieve the study’s goal. The algorithm was based on the Codex Alimentarius methodology, presented in the document “Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System. A medical analysis of the Internal Control System was performed, based on the prerequisite programs, technical documentation, and the company’s HACCP-plan. The analysis of the documentation and the critical remarks made can provide more reliable conditions for producing products safe for consumers’ health. The proposed corrections in the Good Hygiene Practices (GHP), the Good Manufacturing Practices (GMP), and the HACCP plan, mainly through adequately naming authentic hazards of a biological nature, are the basis for more professional verification of the processes and ensuring food safety.

Nature-Based Citizen Science as a Mechanism to Improve Human Health in Urban Areas.

The world is becoming increasingly urbanised, impacting human interactions with natural environments (NEs). NEs take a number of forms, ranging from pristine, modified, to built NEs, which are common in many urban areas. NEs may include nature-based solutions, such as introducing nature elements and biological processes into cities that are used to solve problems created by urbanisation. Whilst urbanisation has negative impacts on human health, impacting mental and physical wellbeing through a number of mechanisms, exposure to NEs may improve human health and wellbeing. Here, we review the mechanisms by which health can be improved by exposure to NEs, as explained by Stress Reduction Theory, Attention Restoration Theory, and the ‘Old Friends’/biodiversity hypothesis. Such exposures may have physiological and immunological benefits, mediated through endocrine pathways and altered microbiota. Citizen Science, which often causes exposure to NEs and social activity, is being increasingly used to not only collect scientific data but also to engage individuals and communities. Despite being a named component of scientific and environmental strategies of governments, to our knowledge, the intrinsic health benefits of Citizen Science in NEs do not form part of public health policy. We contend that Citizen Science programs that facilitate exposure to NEs in urban areas may represent an important public health policy advance.

Tweeting about twenty: an analysis of interest, public sentiments and opinion about 20mph speed restrictions in two UK cities

BackgroundTwenty miles per hour (20mph) speed limits (equivalent to roughly 30kmh) have become part of public health policies to reduce urban road collisions and casualties, especially in Western countries. Public opinion plays a crucial role in opposition to and acceptance of policies that are advocated for improving public health. Twenty miles per hour speed limit policies were implemented in Edinburgh and Belfast from 2016 to 2018. In this paper, we extract public opinion and sentiments expressed about the new 20mph speed limits in those cities using publicly available Twitter data.MethodsWe analysed public sentiments from Twitter data and classified the public comments in plain English into the categories ‘positive’, ‘neutral’, and ‘negative’. We also explored the frequency and sources of the tweets.ResultsThe total volume of tweets was higher for Edinburgh than for Belfast, but the volume of tweets followed a similar pattern, peaking around 2016, which is when the schemes were implemented. Overall, the tone of the tweets was positive or neutral towards the implementation of the speed limit policies. This finding was surprising as there is a perception among policymakers that there would have been public backlash against these sorts of policy changes. The commonly used hashtags focused largely on road safety and other potential benefits, for example to air pollution.ConclusionsOverall, public attitudes towards the policies were positive, thus policymakers should be less anxious about potential public backlash when considering the scale-up of 20mph speed restrictions.

Seismic noise variability as an indicator of urban mobility during the COVID-19 pandemic in the Santiago metropolitan region, Chile

Abstract. On 3 March 2020, the first case of COVID-19 was confirmed in Chile. Since then, the Ministry of Health has imposed mobility restrictions, a global policy implemented to mitigate the propagation of the virus. The national seismic network operating throughout Chile provides an opportunity to monitor the ambient seismic noise (ASN) and determine the effectiveness of public policies imposed to reduce urban mobility in the major cities. Herein, we analyse temporal variations in high-frequency ASN recorded by broadband and strong-motion instruments deployed throughout the main cities of Chile. We focus on the capital, Santiago, a city with more than 7 million inhabitants because it is seismically well instrumented and has high levels of urban mobility due to worker commutes inside the region. We observed strong similarities between anthropogenic seismic noise and human mobility indicators, as shown in the difference between urban and rural amplitudes, long-term variations, and variability due to the COVID-19 outbreak. The same results are observed in other cities such as Iquique, La Serena, and Concepción. Our findings suggest that the initially implemented public health policies and the early end to confinement in mid-April 2020 in the metropolitan region caused an increase in mobility and virus transmission, where the peak in anthropogenic seismic noise coincides with the peak of the effective reproductive number from confirmed positive cases of COVID-19. These results confirm that seismic networks are capable of recording the urban mobility of population within cities, and we show that continuous monitoring of ASN can quantify urban mobility. Finally, we suggest that real-time changes in ASN amplitudes should be considered part of public health policy in further protocols in Santiago and other high-density cities of the world, as has been useful during the recent pandemic.

New obstacles and widening gaps: A qualitative study of the effects of the COVID-19 pandemic on U.S. adults with disabilities

BackgroundPrior research has demonstrated that the needs of the disability community have not been met during public health emergencies. The COVID-19 pandemic has exacerbated existing inequities for many populations including people with disabilities, and data is needed to develop inclusive public health response policies. ObjectiveTo identify how COVID-19 has uniquely impacted the lives of adults with disabilities. Methods38 participants were recruited through disability advocacy groups and social media. Semi-structured virtual focus groups were conducted with adults (≥18 years) who self-identified as having a disability. Focus groups were conducted for each of six disability sub-groups: vision, hearing, mobility and physical, mental health, cognitive, intellectual, and developmental, and chronic illness. Using inductive coding, major themes were identified and compared across the disability sub-groups. ResultsThree major themes and thirteen sub-themes were identified from the focus groups. The three major themes comprised: new problems created by the pandemic, obstacles in daily life that were exacerbated by the pandemic, and broader changes to accessibility and disability identity. Sub-themes such as difficulty with COVID-19 testing and regular medical care were reported by participants of all disability sub-groups, while other sub-themes like direct care needs and medical rationing were reported by participants from a subset of the disability sub-groups. ConclusionsThese results indicate how the COVID-19 pandemic unequally impacts disabled people. The participants indicated that to fully address their needs, disability perspectives must be included in the public health pandemic response. As new research shows that COVID-19 can cause long-term disability, the urgency to ensure the disability community is part of public health policies will increase.

Exploring influences on evaluation practice: a case study of a national physical activity programme

BackgroundInterventions to improve physical activity behaviour are a core part of public health policy and practice. It is essential that we evaluate these interventions and use the evidence to inform decisions to improve population health. Evaluation of ‘real-world’ interventions provide an opportunity to generate practice-relevant evidence, however these interventions are difficult to evaluate. Various guidelines have been developed to facilitate evaluation, but evidence about their effectiveness in practice is limited. To explore influences on evaluation practice in an applied context, we conducted a case study of Sport England’s ‘Get Healthy Get Active’ (GHGA) programme. This was a national programme that funded 33 projects that were delivered and evaluated across England. The programme was chosen as it was designed to generate evidence on the role of sport in increasing physical activity and improving health. The study aimed to explore and appraise whether strategies intended to facilitate project evaluation, including funder requirements to use a standardised evaluation framework and specific data collection methods, were effective in generating evidence that enabled the programme to meet its aims.MethodsWe applied a collective case study design involving 35 semi-structured interviews, and documentary analysis of multiple sources of evidence from 23 physical activity projects funded by GHGA. We applied thematic and framework analysis. We developed a logic model and mapped actual outcomes against intended outcomes. A narrative synthesis is provided. We discuss implications for the effective commissioning and evaluation of public health interventions.ResultsWe identified five main themes of influences on evaluation practices that can act as barriers and facilitators to good practice: programme and project design; evaluation design; partnerships; resources; and organisational structures and systems. These influences are context-specific and operate through a complex set of interactions.ConclusionDeveloping a better understanding of how influences on evaluation practice can act as facilitators or barriers is vital to help close current gaps in the evidence-based practice cycle. Critically, organisational structures and systems are needed to facilitate collaborative decision making; integration of projects and evaluation across partners organisations; transfer of knowldege and insights between stakeholders; and more rapid feedback and dissemination.

Satisfação dos Usuários Atendidos pela Farmácia Básica do Sus no Município de Agudo – RS

Neste estudo, analisou-se o grau de satisfação dos usuários do Programa de Assistência Farmacêutica, como parte da Política Pública na área de Saúde, na qual o medicamento é o insumo essencial e está no centro de um conjunto de ações voltadas para a promoção, proteção e recuperação da saúde humana, que prevê o acesso da população aos medicamentos necessários para o controle de suas enfermidades. O programa abrange o processo, desde o desenvolvimento do medicamento, até sua distribuição e consumo pelo indivíduo atendido. Assim, é de suma importância conhecer o processo antes de procederem-se as análises quanto à situação encontrada. Para tanto, realizou-se um estudo de caso, mediante pesquisa descritiva e qualitativa, sendo analisados os pontos positivos e negativos do serviço prestado no município de Agudo no Rio Grande do Sul. Selecionaram-se 134 pessoas que acessam o referido programa por amostragem aleatória simples, as quais responderam ao questionário formulado. Utilizou-se a escala de cinco pontos de Rensis Likert. Buscou-se identificar por meio da opinião dos participantes, o grau de satisfação em relação ao atendimento prestado pela farmácia do SUS nesta localidade. Verificou-se que a maioria dos usuários se encontra satisfeita quanto aos serviços da farmácia e constatou-se que há descontentamento no que se refere à disponibilidade de medicamentos e ao empenho dos funcionários na resolução desse problema.

Mercury Levels and Risk Implications Through Fish Consumption on the Sinaloa Coasts (Gulf of California, Northwest Mexico).

Fish consumption is the major source of mercury to humans. Fetuses and children are the most sensitive groups of populations to the effects of mercury. Consequently, fish consumption by pregnant women, children, and women of childbearing age is of concern because of the effects of mercury exposure on human health. To assess mercury exposure in a population in northwest Mexico, the allowed daily consumption of fish (which indicates the maximum daily amount of fish that can be consumed without causing adverse noncarcinogenic effects) was calculated for the general population (GP) and fishing-related population (FRP). The studied groups for both sectors of the population were children A (3-10 years old), children B (11-15 years old), women of childbearing age (16-40 years old), and the rest of the population (men ≥16 years old, and women ≥41 years old). Mercury content in canned and frozen tuna, smoked marlin, tilapia, Pacific sierra, dolphinfish, and bullseye puffer ranged from 0.01 to 0.23 μg/gwet weight; none of the values were above the limit set by Mexico. Regarding mercury concentrations and rates of fish consumption, the GP consumes 1.7-2.7 times the allowed daily consumption, and the FRP consumes 1.6-3.9 that limit. The risk analysis showed the children A and B groups from the GP and adults of FRP to be the highest percentage of the population at risk (approximately 35%). These results highlight the need for adequate strategies that consider mercury exposure as part of public health policies associated with fish consumption in Mexico.

Global oral health in the framework of the Global Charter for the Public's Health.

Oral diseases are a neglected epidemic affecting all ages globally and can substantially impact overall health and well-being. Even though most oral diseases are preventable and share major risk factors with other non-communicable diseases, integration of oral health into public health systems is still limited in both clinical and health policy perspectives. This Viewpoint aims to highlight oral health from a global health perspective, calling for all public health leaders to advocate for oral health of all. We strongly recommend oral health as an essential part of public health policy and oral health-related activities to be aligned with the Global Charter for the Public's Health Framework.

Addressing violent extremism as public health policy and practice

ABSTRACTAddressing violent extremism could potentially benefit from new initiatives that extend beyond criminal justice and are a part of public health policy and practice. This claim is based on knowledge from prior countering violent extremism (CVE) research and on immersion with communities, practitioners, and policymakers. This knowledge indicates that to date law enforcement-centered initiatives have not generated targeted evidence-based prevention or intervention initiatives, and they have had the unintended consequence of provoking community resistance. The Center for Disease Control’s Ten Essential Public Health Services is proposed as a new conceptual framework for a public health approach to addressing violent extremism which aims for policy and practice shifts. The public health approach offers opportunities for multi-purpose programming, avoiding stigma, and leveraging existing public health resources. Such shifts are illustrated by discussing the CVE program being further developed in Los Angeles, California, based in part upon the public health model.

How do health behaviours relate to dietary practice patterns among Japanese adults?

To identify dietary practice patterns for Japanese adults and investigate the links between health behaviours and these patterns. A random sample, stratified according to area, sex, and age, of 4570 adults aged 20-80 years completed a survey conducted in 2011 in a city, in Yamagata Prefecture, Northeast Japan. Cluster analysis of 16 dietary practice items revealed four patterns labelled as: low fat, sugar, or salt; emphasis on nutrition; regular breakfast and staples; and meals not snacks. Findings from multiple linear regression analyses showed that those not engaged in habitual physical exercise had lower scores on low fat, sugar, or salt (beta coefficient -0.22: 95% confidence intervals -0.30, -0.14); emphasis on nutrition (-0.17: -0.25, -0.09); meals not snacks; (-0.38: -0.46, -0.3) that other participants. Current smokers had lower scores than never smokers on low fat, sugar, or salt (-0.23: -0.32, -0.14); emphasis on nutrition (-0.28: -0.37, -0.19); regular breakfast and staples (-0.42: -0.51, -0.33) patterns. Compared with nondrinkers, those who had reduced their consumption of alcohol had higher scores on low fat, sugar, or salt (0.19: 0.09, 0.29) and emphasis on nutrition (0.17: 0.07, 0.27). These relationships were adjusted for other dietary practice patterns, sociodemographic factors, body mass index, and the presence of major illness or pain. Findings support an integrated and targeted approach as part of public health policy by considering links between dietary practices and other health behaviours, such as habitual exercise and smoking behaviour that may facilitate changes in dietary practices.

‘Give people work, and the blood pressure will sink’: lay engagement with cardiovascular risk factors in North Karelia in the 1970s

In high-income countries such as Finland, personal healthcare is organised around the management of lifestyle risks and minimisation of such risks forms a key part of public health policy. While the scientific development of the lifestyle risk model has been thoroughly studied, there has been less research on the history of popular experiences of the model. In this article, I examine lay people’s response to a pioneering heart disease prevention programme in north-eastern Finland in the 1970s, the North Karelia Project, which promoted the lifestyle risk model. I use archival data from early 1970s that recorded the project interactions with the local population and their reactions to the project. I show that although local residents in North Karelia responded positively to the project, they did not necessarily subscribe to its preventive and risk minimising objectives. In an area of limited health resources, the project provided local residents with access to medical expertise. Local reactions indicated a clash of a cultural notion of illness embedded in the social life-world of Karelians with a specific rationality of government emphasising individual responsibility vis-à-vis heart conditions. Local residents who were critical of the public health risk model tended to minimise the role of lifestyle risk factors in cardiovascular disease causation or subsumed these factors into a more encompassing explanation that stressed the effects of the on-going structural social change in the area, highlighting the sense of loss caused by the waning of traditional small farm existence and their anxiety about the resulting economic and social insecurity.