Surveillance Policy Research Articles

State Legislation Related to School Nutrition: Predictors of Bill Passage From 2010–2019

ObjectiveThis study aimed to discover the prevalence of school nutrition state legislation and to identify the correlates of enactment. Design, Setting, and ParticipantsAn online legislative database, Legiscan, was used to collect bills related to school nutrition from the US from 2010 to 2019. Bills were coded and compiled into a study database with state-level dietary variables (obesity prevalence, fruit, and vegetable intake, sugar-sweetened beverage consumption), community variables (percent White, poverty), and bill-characteristic variables (party affiliation in legislature, strength of language, party of governor, school gardens, vegetable intake, and other salient variables). Multivariable models were built to examine predictors of bill enactment. ResultsOf the 462 bills introduced, 38.7% (n = 156) were enacted. In a multivariable model, the strength of bill language, political party affiliation, implementation of school gardens, and vegetable intake were the variables associated with bill passage. Bills with strong language were less likely to be enacted (P <0.001). Bills introduced by Democrats were more likely to be enacted (P = 0.01). Conclusion and ImplicationThis study showed a better understanding of legislative support for child nutrition via policy surveillance of bills and their correlates of enactment. This information can be used to prioritize advocacy efforts and identify ways research can better inform policy.

Longitudinal Policy Surveillance of Private Insurance Hearing Aid Mandates in the United States: 1997-2022.

Objectives. To produce a database of private insurance hearing aid mandates in the United States and quantify the share of privately insured individuals covered by a mandate. Methods. We used health-related policy surveillance methods to create a database of private insurance hearing aid mandates through January 2023. We coded salient features of mandates and combined policy data with American Community Survey and Medicare Expenditure Panel Survey-Insurance Component data to estimate the share of privately insured US residents covered by a mandate from 2008 to 2022. Results. A total of 26 states and 1 territory had private insurance hearing aid mandates. We found variability for mandate exceptions, maximum age eligibility, allowable frequency of benefit use, and coverage amounts. Between 2008 and 2022 the proportion of privately insured youths (aged ≤ 18 years) living where there was a private insurance hearing aid mandate increased from 3.4% to 18.7% and the proportion of privately insured adults (19-64 years) increased from 0.3% to 4.6%. Conclusions. Hearing aid mandates cover a small share of US residents. Mandate exceptions in several states limit coverage, particularly for adults. Public Health Implications. A federal mandate would improve hearing aid access. States can also improve access by adopting exception-free mandates with limited utilization management and no age restrictions. (Am J Public Health. 2024;114(4):407-414. https://doi.org/10.2105/AJPH.2023.307551).

Antimicrobial resistance markers distribution in Staphylococcus aureus from Nsukka, Nigeria

BackgroundMultidrug resistance in Staphylococcus aureus continues to influence treatment complications in clinical settings globally. Multidrug-resistant-S. aureus (MDR-SA) is often genetically driven by resistance markers transferable in pathogenic strains. This study aimed to determine the distribution of resistance markers in clinical isolates of S. aureus in Nsukka, Nigeria.MethodsA total of 154 clinical samples were cultured on mannitol salt agar. Isolates were characterized using conventional cultural techniques and confirmed by PCR detection of S. aureus-specific nuc gene. Antibiotic resistance profiles of the isolates were determined against selected antibiotics using the disk-diffusion method, while screening for antibiotic resistance genes (Mec A, Erm A, Erm B, Erm C, Van A, and Van B) was by PCR.ResultsA total of 98 isolates were identified as S. aureus by conventional methods. Of these, 70 (71.43%) were confirmed by PCR. Phenotypically, the isolates exhibited high degrees of resistance to oxacillin (95.72%), erythromycin (81.63%), and ertapenem (78.57%) and 75.51% and 47.30% against methicillin and vancomycin, respectively. Multiple antibiotic resistance indexes of the isolates ranged from 0.3 to 1, and the most prevalent pattern of resistance was oxacillin-ertapenem-vancomycin-erythromycin-azithromycin-clarithromycin-ciprofloxacin- cefoxitin-amoxicillin-clavulanic acid. PCR screening confirmed the existence of various antibiotic resistance makers among the strains, with the most common resistance genes found in the isolates being Mec A (32.14%), Van A (21.43%), Van B (10.71%), Erm B (10.71%), and Erm C (17.86%). None possessed the Erm A gene.ConclusionThe study supports the need for necessary action, including rational drug use, continuous surveillance, and deployment of adequate preventive and curative policies and actions.

STUDY OF MULTIDRUG-RESISTANT GRAM-NEGATIVE BACILLI IN URINARY TRACT INFECTIONS AND THEIR ANTIBIOGRAM AT A TERTIARY CARE HOSPITAL

Objective: To study the frequency of multidrug-resistant Gram-negative bacilli in urinary tract infections and antibiotic susceptibility pattern of multidrug-resistant Gram-negative bacilli in urinary tract infections.&#x0D; Methods: This study was conducted on urine samples received at the Department of Microbiology, Andhra Medical College, for a period of six months from August 2022 to January 2023. During the study period, a total of 3361 urine samples were processed and conventional microbiological techniques were used to isolate uropathogens. Antibiotic susceptibility was tested by the Kirby-Bauer Disc diffusion method and interpreted according to Central Laboratory Standard Institute (CLSI) guidelines 2022. Multidrug-resistant bacilli in this study were defined as Gram-negative bacilli that were resistant to at least one agent in three or more antibiotic classes.&#x0D; Results: Out of 3361 urine samples received from outpatient and inpatient departments of our hospital, 858 samples were culture positive-839 were Gram-negative isolates and 19 were Gram-positive isolates. Mean age was 40-60 y. Urinary tract infections were more common in females than males. Among Gram-negative bacilli isolated, Escherichia coli was the most common organism isolated-435(50.69%), followed by Klebsiella species-232(27.03%), Acinetobacter species-105(12.25%), Pseudomonas species-55(6.41%), Proteus species-10(1.16%), Citrobacter species-2(0.23%). Among Gram-positive cocci, Staphylococci-17(1.98%) and Enterococci-2(0.23%) were isolated. Out of 858 isolates, 177 (20.62%) were identified as multidrug-resistant bacilli and all were resistant to the drug groups Cephalosporins, Carbapenems and Quinolones. Most of the Multidrug-resistant gram-negative bacilli were sensitive to Fosfomycin and Nitrofurantoin.&#x0D; Conclusion: Multidrug-resistant Gram-negative bacilli in urinary tract infections have become a major health problem. Assessment of Risk factors, Surveillance of Resistance patterns and policies for proper use of antibiotics are urgently needed.

The causes of bacterial bloodstream infections and antimicrobial resistance patterns in children attending a secondary care hospital in Bhaktapur, Nepal, 2017-2022: a retrospective study.

Data on antimicrobial resistance (AMR) among children in Nepal are limited. Here we have characterized the causes of bacterial bloodstream infections (BSIs), antimicrobial resistance patterns and the mechanisms of β-lactamase production in Enterobacterales among children attending outpatient and inpatient departments of a secondary care paediatric hospital in Nepal. We retrospectively collected demographic and clinical data of culture-proven bacterial BSIs between January 2017 and December 2022 among children <18 years attending a 50-bedded paediatric hospital. Stored isolates were subcultured for antimicrobial susceptibility testing against commonly used antimicrobials. Enterobacterales displaying non-susceptibility to β-lactams were phenotypically and genotypically investigated for ESBLs, plasmid-mediated AmpC (pAmpC) β-lactamases and carbapenemases. A total of 377 significant bacteria were isolated from 27 366 blood cultures. Among 91 neonates with a BSI, Klebsiella pneumoniae (n = 39, 42.4%), Pseudomonas aeruginosa (n = 15, 16.3%) and Acinetobacter baumannii complex (n = 13, 14.1%) were most common. In the non-neonates, 275/285 (96.5%) infections were community-acquired including Staphylococcus aureus (n = 89, 32.4%), Salmonella Typhi (n = 54, 19.6%) and Streptococcus pneumoniae (n = 32, 11.6%). Among the 98 S. aureus, 29 (29.6%) were methicillin-resistant Staphylococcus aureus. K. pneumoniae and Escherichia coli demonstrated non-susceptibility to extended-spectrum cephalosporins and carbapenems in both community and hospital-acquired cases. For E. coli and K. pneumoniae, blaCTX-M (45/46), blaEBC (7/10) and blaOXA-48 (5/6) were common among their respective groups. We determined significant levels of AMR among children attending a secondary care paediatric hospital with BSI in Nepal. Nationwide surveillance and implementation of antimicrobial stewardship policies are needed to combat the challenge imposed by AMR.

Infodemiology and infoveillance: framework for contagious exanthematous diseases, of childhood in Italy

ABSTRACT Background Contagious exanthematous diseases are becoming a major public health problem. The purpose of this study was to evaluate the potential epidemiological trend of four infectious exanthematous diseases in Italy through the searches on the internet. Methods We used the following Italian search term: ‘Sesta malattia’ (Sixth Disease, in English), ‘Eritema Infettivo’ (also knows ‘Quinta malattia’ in Italian; Fifth Disease in English), ‘Quarta malattia’ (Fourth Disease in English) and ‘Scarlattina’ (Scarlet fever in English). We overlapped Google Trends and Wikipedia data to perform a linear regression and correlation analysis. Statistical analyses were performed using the Spearman’s rank correlation coefficient (rho). The study period is between July 2015 and December 2022 Results The diseases considered have a seasonal trend and the search peaks between GT and Wikipedia overlap. A temporal correlation was observed between GT and Wikipedia search trends. Google Trends Internet search data showed strong correlation with Wikipedia with a rho statistically significant for Fifth disease (rho = 0.78), Fourth disease (rho = 0.76) and Scarlet-fever (rho = 0.77), moderate correlation for Sixth disease (rho = 0.32). Conclusions Infectious disease searches using Google and Wikipedia can be useful for public health surveillance and help policy makers implement prevention and information programs for the population, in addition to the fact that increases in searches could represent an early warning in the detection of outbreaks.

Perinatal and neonatal outcomes of high-risk asymptomatic women from a specialist preterm birth surveillance clinic

ObjectivesTo report the perinatal outcomes of high-risk asymptomatic women who attended a specialist preterm surveillance clinic (PSC) to undergo screening for spontaneous preterm birth (PTB) in Ireland. MethodsSingle center, retrospective cohort study of asymptomatic high risk women who attended the PSC between January 2019 and December 2022. A comprehensive database of all patients who attended the clinic during the study period was constructed and analyzed. Overall outcomes were reported, and stratified per the occurrence of preterm or term birth. Iatrogenic PTBs were included in the outcome data. ResultsFollowing exclusions for loss-to-follow-up, 762 cases were analyzed, constituting 2262 PSC visits. Of those, 183 women were prescribed progesterone (24.0 %), and 100 women underwent cervical cerclage (13.1 %) to prevent spontaneous PTB. Overall, 2.4 %, 6.2 % and 18.6 % of participants gave birth prior to 30 weeks, 34 weeks, and 37 weeks, respectively. The median gestational age at birth for the entire cohort was 38.6 weeks (inter-quartile range (IQR) 37.2–39.6 weeks).Women who delivered < 37 weeks were significantly more likely to be smokers (p = 0.030), have a previous spontaneous PTB (p = 0.016), have multiple pregnancies (p < 0.001), type 1 or 2 diabetes (p = 0.044), or have a previous full dilatation caesarean section birth (p = 0.024). Infants born prior to 37 weeks were more likely to have a lower median birthweight (2270 vs 3300 g, p < 0.001), be admitted to a neonatal intensive care unit (53.8 % vs 2.3 %, p < 0.001) or experience short-term morbidity, including respiratory support (38.0 % vs 1.6 %, p < 0.001). ConclusionsOver 80% of women deemed to be at high risk of PTB gave birth at term gestations following attendance at a PSC during pregnancy. Most women can be successfully managed without interventions, instead employing a policy of serial cervical surveillance, to identify those at greatest risk of PTB.

Implementasi Kebijakan Pengawasan Sungai Oleh Dinas Lingkungan Hidup Kabupaten Minahasa

This research aims to learn to analyze and describe the Implementation of Surveillance Policy by the Environmental Services of Minahasa District. The research method used is descriptive dermatative. The number of informants in this study is five. Data collection using observation, interview and documentation techniques. Data analysis through Data Reduction, Data Presentation and Conclusion Drawing. The results of the research show that the Programme of Action: the program of cleaning up the toubeke river is only carried out by the plumage and depletion. Here DLH contributes to the transportation of garbage. DLH provides fleet/facilitating vehicles and involves several officers. In 2023, he's already done twice a garbage cleaning program on the toubeke river. Executives: No special units have been assigned from the Environmental Services, adding that this lack of skilled personnel clearly constitutes an obstacle to enforcing supervisory functions. Results: From surveillance seen by DLH the toubeke river is still dirty These problems arise, among other things, because the laws made by the government are less stringent so that the people do not obey or do not perform as they ought to be as already laid down in the law.

P339 Dermatological evaluation of candidates with IBD for biological therapy - should it become part of the scheme during qualification?

Abstract Background Oncological anxiety associated with biological therapy is a common challenge in inflammatory bowel disease (IBD) and it have raised questions about the need for dermatological assessment of the skin before starting a biological therapy to exclude cutaneous malignancies. Methods The aim of the study was to assess the frequency of skin cancers in IBD patients before starting biological therapy. We conducted a retrospective, single-centre evaluation on the frequency of skin cancers. Results A group of patients with IBD who were referred for qualification for biological treatment consisted of n = 805 patients, out of which 348 (43.2%) were female and 457 (56.8%) were male. Average age of patients was 36.84 ± 12.49 years. During qualification for biological treatment dermatological skin assessment was performed and dermal lesions were found in 15.5% (125) patients, of which 9 (1.1%) were cutaneous malignancies. Only steroid dependance and resistance differentiated in a significant way between patients with and without dermal lesions. Dermal lesions group included lower proportion of patients with steroid dependence (84.6% vs 92.9% in group without dermal lesions) and higher proportion of patients with steroid resistance (13.6% vs 7.1% in groups of patients with no dermal lesions) (V = 0.09, CI95 [0.01;0.17], p = 0.022). Surprisingly, there was no effect of thiopurines on development of dermal lesions between group with and without dermal lesions 90.4% vs. 84.6%, MD = 0.06, CI95 [0.01;0.12], p = 0.118. In a multivariate logistic regression model only higher BMI (OR = 1.08, CI95 [1.02;1.14], p = 0.007) was identify as a risk factor for development a dermal lesions. Additionally, as many as 9 patients were diagnosed with cutaneous malignancies, including 4 basal cell carcinomas (BCC), 4 squamous cell carcinomas (SCC) and one MSC. Only 11.4% patients complied with our strict policy of skin surveillance every 6-8 months. Conclusion In this study, we observed dermal lesions in 15.5% of patients, of which 1% were cutaneous malignancies. The only risk factor for dermal lesions was higher BMI. The lack of effect of thiopurines on oncological risk may indicate the need to monitor the skin condition in every patient with IBD. It is also crucial to disseminate knowledge about the need for regular skin assessments among IBD patients.

Plaque Reduction Neutralization Test (PRNT) Accuracy in Evaluating Humoral Immune Response to SARS-CoV-2.

Massive vaccination positively impacted the SARS-CoV-2 pandemic, being a strategy to increase the titers of neutralizing antibodies (NAbs) in the population. Assessing NAb levels and understanding the kinetics of NAb responses is critical for evaluating immune protection. In this study, we optimized and validated a PRNT50 assay to assess 50% virus neutralization and evaluated its accuracy to measure NAbs to the original strain or variant of SARS-CoV-2. The optimal settings were selected, such as the cell (2 × 105 cells/well) and CMC (1.5%) concentrations and the viral input (~60 PFU/well) for PRNT-SARS-CoV-2 with cut-off point = 1.64 log5 based on the ROC curve (AUC = 0.999). The validated PRNT-SARS-CoV-2 assay presented high accuracy with an intraassay precision of 100% for testing samples with different NAb levels (low, medium, and high titers). The method displays high selectivity without cross-reactivity with dengue (DENV), measles (MV), zika (ZIKV), and yellow fever (YFV) viruses. In addition, the standardized PRNT-SARS-CoV-2 assay presented robustness when submitted to controlled variations. The validated PRNT assay was employed to test over 1000 specimens from subjects with positive or negative diagnoses for SARS-CoV-2 infection. Patients with severe COVID-19 exhibited higher levels of NAbs than those presenting mild symptoms for both the Wuhan strain and Omicron. In conclusion, this study provides a detailed description of an optimized and validated PRNT50 assay to monitor immune protection and to subsidize surveillance policies applied to epidemiologic studies of COVID-19.

Phenotypic antibiotic susceptibility profile of clinical Enterobacteriaceae isolates from Kaduna State, northwest Nigeria.

Background. The increasing resistance of clinical Enterobacteriaceae isolates to commonly prescribed antibiotics has been reported around the world. Data are generally lacking on the prevalence and antibiotic susceptibility profile of clinical Enterobacteriaceae isolates from Kaduna, northwest Nigeria. This study thus aimed to determine the diversity and antibiotic resistance profile of clinical Enterobacteriaceae isolates recovered from clinical specimens from patients admitted to two selected healthcare institutions in Kaduna. Methods. This was a prospective cross-sectional study conducted between September and December 2021. Non-duplicate clinical bacterial isolates recovered from various specimens were collected and identified using rapid biochemical identification kits. The susceptibility of identified Enterobacteriaceae to various antibiotics and phenotypic detection of carbapenemase enzymes were thereafter determined. The data were analysed and visualized using R software version 4.3.1. Results. Of the 500 bacterial isolates recovered from specimens collected for the purpose of clinical bacteriology diagnostics, 108 (21.6 %) were identified as Enterobacteriaceae, with Pantoea agglomerans (52, 48.1 %) and Klebsiella oxytoca (19, 17.6 %) being the most prevalent. The isolates exhibited high resistance to azithromycin (69 %) and ceftazidime (42 %), while exhibiting low resistance to amikacin (7 %) and imipenem (10 %). Among the carbapenem-resistant Enterobacteriaceae (CRE) isolates, a significant proportion (12/17, 70.6 %) tested positive for carbapenemase activity. Conclusion. This study reports a high prevalence of multidrug-resistant Enterobacteriaceae in Kaduna, northwest Nigeria. The emergence of pathogenic P. agglomerans and an alarmingly high prevalence of carbapenemase-producing CRE were also observed. The presence of carbapenemase producers in an area with low carbapenem usage and resistance rates raises significant concerns. Continuous surveillance and robust antibiotic stewardship policies are imperative to preserve the efficacy of carbapenems in this region.

Standing and Probabilistic Injury

Standing to sue often turns on questions of probability. For example, public law plaintiffs must show that they are likely to be affected by allegedly unlawful government surveillance or environmental policies, and consumers may wish to sue private defendants over false credit reporting or data breaches that may or may not cause them financial or reputational harm in the future. This Article offers a framework for resolving a wide range of these “probabilistic standing” issues. Our core claim is that courts and commentators ask too much of standing doctrine in probabilistic cases. First, scholars sometimes seek a unified theory of probabilistic standing to cover categories of cases that ask distinct questions, such as cases involving who is subject to a challenged action, on the one hand, and those involving whether a person subject to such an action is sufficiently likely to be harmed, on the other. Second, courts should not ask how probable elements of a plaintiff’s case must be in order to support standing, but rather who should decide whether a given probability is sufficient. Judges and parties struggle in litigation to assess the actual probability of occurrences, and Article III of the Constitution provides no standard for how probable an injury must be to support a lawsuit. Third, any doctrinal probability threshold for standing would encounter a related problem, which is that the probability of an injury depends significantly on how that injury is framed. Which harms “count” for standing is thus a vital question in assessing the probability of injury, but Article III is an unlikely place to look for answers. Within certain constraints, courts should look instead to the underlying substantive law to define the relevant injuries for standing purposes. Finally, we contend that many of the concerns associated with probabilistic claims are better addressed through the law of remedies and prudential elements of the timing doctrines (mootness and ripeness) than through the constitutional law of standing.

Space-time analysis of work-related musculoskeletal disorders in Brazil: an ecological study.

This study aimed to analyze the incidence of work-related musculoskeletal disorders (WMSD) in Brazil from 2007 to 2019, examining the spatial, temporal, and spatiotemporal patterns of their occurrence. An ecological time series study was conducted using spatial analysis techniques. WMSD morbidity data from 2007 to 2019 were collected from the Brazilian Information System for Notificable Diseases of the Brazilian Health Informatics Department. Incidence rates were standardized and smoothed using the local empirical Bayes' theorem. Time trends were analyzed by segmented linear regression. Spatial analysis was performed using Moran's univariate global (I) and local (LISA) indexes. The spatiotemporal scan statistic was used to identify high-risk spatiotemporal clusters for WMSD. A total of 93,387 cases of WMSD were recorded in Brazil. Temporal trends showed an increase in all regions except the Northeast, which remained stable. The incidence of WMSD showed a spatial dependence, with spatial and space-time clusters identified, especially in the Southeast region, overlapping the largest economic-industrial center of the country. The spatiotemporal clustering observed in one region suggests the highest level of industrial and economic development. Our findings highlight the need to implement intersectoral surveillance policies, inspect working conditions, and invest in the prevention and promotion of workers' health.

Data analytics in public health, A USA perspective: A review

The integration of data analytics into public health practices represents a transformative paradigm shift in the United States. This review provides a comprehensive analysis of the impact and implications of data analytics on public health strategies, with a focus on disease surveillance and health policy within the USA. In the context of disease surveillance, data analytics has emerged as a crucial tool for real-time monitoring and early detection of health threats. Leveraging diverse datasets, including electronic health records and social media, allows for swift identification of trends and anomalies, enabling proactive responses to potential outbreaks. Advanced analytics techniques, such as machine learning and predictive modeling, contribute to the precision of surveillance efforts, facilitating targeted interventions and resource allocation. Beyond disease surveillance, data analytics significantly influences health policy. Evidence-based policy formulation is enhanced through data-driven insights, providing policymakers with a foundation for understanding the impact of interventions and designing strategies that align with the unique needs of diverse populations. Resource allocation strategies are optimized, ensuring efficient use of limited resources by analyzing health outcomes, service utilization patterns, and cost-effectiveness. Continuous monitoring and evaluation of implemented health policies through data analytics enable policymakers to adapt strategies in response to evolving health challenges, fostering a dynamic and adaptive public health ecosystem. As the landscape of public health evolves, data analytics in the USA continues to play a central role in shaping strategies and policies. The study delves into the historical context, key components, applications, and success stories, providing valuable insights for policymakers, public health professionals, and researchers aiming to navigate the complexities of data-driven public health management.

POLICY SERIES: DOCTORAL PROGRAMS IN GERONTOLOGY: PROVIDING LEADERSHIP IN POLICY AND AGING

Abstract Advancements in education, medicine, wealth, technology, and population health have increased individual life expectancies. Healthy aging is not just a function of healthy genes, however; aging is modified by the broader context, which, in turn, creates opportunities and challenges that must be addressed by society. Lack of organized responses to population aging exacerbate social inequities based on workplace discrimination, displacement, and impoverishment, and contribute to public health inequalities pertaining to disease and disability, isolation, and vulnerability among older adults. Public policy offers one of the most effective ways to address inequities and inequalities such as these. This symposium spotlights four doctoral programs that prepare gerontologists who possess subject matter expertise in aging policy, conduct reliable policy surveillance and sourcing, execute empirical evaluations of policy formation and implementation, and offer well-informed contributions to policy makers who are most involved with supporting and protecting older adults. These well-established academic programs at the University of Massachusetts Boston (Edward Alan Miller, PhD), University of South Florida (Lyndsay Peterson, PhD), University of Southern California (Kathleen Wilbur, PhD), and Miami University (Jennifer M. Kinney, PhD) offer classroom education, research, and service-learning opportunities for students to acquire expertise in aging and public policy. Together, these programs provide models for training a generation of leaders in gerontology who can contribute productively to policy development and debates, illuminate structures and processes of policy making and implementation, and deploy analytic skills needed to evaluate policies relative to multiple and often competing interests.

INTERDISCIPLINARY MANAGEMENT OF OLDER ADULTS WITH HEARING LOSS: POLICY MATTERS

Abstract Hearing aids are an efficacious approach for treating hearing loss yet are underutilized in the US due to high out-of-pocket costs. Lack of hearing aid insurance coverage is one source of the breakdown in the interdisciplinary management of older adults with hearing loss, causing hesitation among primary care providers to refer patients to audiology for treatment. Recently, access and affordability of hearing aids for adults has gained traction, with several states mandating private insurance coverage of hearing aids. The purpose of this study was to understand state-level variability in private insurance hearing aid mandates and to quantify yearly averages of the share of privately insured adults aged &amp;lt;65. We conducted a longitudinal policy surveillance of state statutes for mandates through January 2023. Policy data were then combined with individual-level age, insurance, state, and year variables from American Community Survey and Medical Expenditure Panel Survey Insurance Component to estimate the share of privately-insured adults covered by a mandate from 2008-2022. We identified 25 states and 1 territory with effective private insurance hearing aid mandates. There was substantial variability in these mandates, including in exceptions, maximum age eligibility, allowable frequency of benefit use, and total coverage reimbursement amount. Between 2008-2022, we estimated that &amp;lt;10% of privately-insured adults lived in a state with coverage. We conclude that hearing aid mandates are covering a small but growing share of Americans. A federal mandate would be the fastest way to ensure access, but states can improve access by adopting exception-free mandates with limited utilization management.

Human Rights in the Era of Surveillance: Balancing Security and Privacy Concerns

In today's rapidly evolving digital landscape, the delicate equilibrium between security imperatives and the protection of individual privacy is under intense scrutiny. This abstract explores the multifaceted challenges posed by the proliferation of surveillance technologies and their impact on human rights. As governments and corporations harness the power of surveillance for security purposes, concerns over privacy violations, data breaches, and potential abuses of power have come to the forefront. This abstract delves into the evolving legal and ethical frameworks governing surveillance practices, highlighting key debates and global perspectives. It also examines the implications for fundamental human rights such as freedom of expression, privacy, and assembly. By examining case studies, emerging technologies, and international efforts to strike a balance between security and privacy, this abstract seeks to shed light on the complex dynamics of this contemporary issue and proposes potential avenues for reconciling these often conflicting interests. Ultimately, it calls for a thoughtful and inclusive dialogue that can guide the development of responsible surveillance policies that respect individual rights and uphold the principles of a free and democratic society.

INTEGRATING AI INTO HEALTH INFORMATICS FOR ENHANCED PUBLIC HEALTH IN AFRICA: A COMPREHENSIVE REVIEW

This study delves into the integration of Artificial Intelligence (AI) within the field of health informatics and its transformative effect on public health outcomes in Africa. It will cover how AI-driven solutions are being implemented to overcome challenges in disease surveillance, healthcare delivery, and public health policy. The paper aims to provide an in-depth analysis of current innovations, the effectiveness of these technological interventions, and their broader implications for health policy and management across the African continent. The integration of Artificial Intelligence (AI) into health informatics holds transformative potential for enhancing public health in Africa. This comprehensive review explores the multifaceted applications, challenges, and opportunities associated with the convergence of AI and health informatics on the African continent. The review encompasses various domains, including disease surveillance, diagnostics, treatment optimization, and public health management. Key themes addressed in the review include the adoption of AI-driven technologies in healthcare, the impact on disease detection and monitoring, and the potential for improving healthcare accessibility in resource-constrained settings. Moreover, the ethical considerations, regulatory challenges, and disparities in technology adoption across diverse African regions are examined, providing insights into the complexities of implementing AI in the African public health landscape. Through an in-depth analysis of current initiatives, case studies, and emerging trends, this review aims to contribute a comprehensive understanding of the opportunities and challenges associated with integrating AI into health informatics for the advancement of public health in Africa. Ultimately, this exploration seeks to inform policymakers, healthcare professionals, and researchers on the critical role AI can play in addressing public health challenges on the continent and fostering sustainable healthcare solutions.&#x0D; Keywords: Artificial Intelligence, Health Informatics, Health Management, Africa, Review, Disease Surveillance.

Changes in State Laws Related to Coverage for Substance Use Disorder Treatment Across Insurance Sectors, 2006-2020.

The authors assessed changes in state insurance laws related to coverage for substance use disorder treatment across public and private insurance sectors from 2006 through 2020 in all 50 U.S. states. Structured policy surveillance methods, including a coding protocol with duplicate coding and quality controls, were used to track changes in state laws during the 2006-2020 period. The legal database Westlaw was used to identify relevant statutes within each state's commercial insurance (large group, small group, and individual), state employee health benefits, and Medicaid codes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definition of substance use disorders, and enforcement and compliance. Scores were calculated to reflect the comprehensiveness of states' laws and to interpret changes in scores over time. Comprehensiveness scores across all sectors (on a 0-9 scale) increased, on average, from 1.47 in 2006 to 2.84 in 2020. In 2006, mean scores ranged from 0.47 (state employee sector) to 2.80 (large-group sector) and in 2020, from 1.22 (state employee) to 4.26 (large group). Comprehensiveness of state insurance laws in relation to substance use disorder treatment improved across all insurance sectors in 2006-2020. The State Substance Use Disorder Insurance Laws Database created in this study will aid future legal epidemiology studies in assessing the cumulative effects of parity-related insurance laws on outcomes of substance use disorder treatments.

The influence illegal fishing surveillance policies on marine fisheries business

Illegal fishing that occurs in Indonesian waters has the potential to harm the marine fisheries business. The government seeks to overcome losses due to illegal fishing through policies and surveillance programs through increasing the fleet of surveillance vessels, increasing operations by sea and air and utilizing information technology. Surveillance of illegal fishing is a public policy, in order to measure the impact and benefits of the policy, economic valuation is needed as a basis for stating that the policy is feasible and provides benefits presented in a value. This study aims to analyze the direct and indirect impact of illegal fishing Surveillance policies on the marine fisheries business. The research method uses producer surplus and analysis uses Extended Cost Benefit Analysis (ECBA). The results showed that the policy of increasing Surveillance provides positive benefits of Rp.1.8 trillion/year, so the policy is feasible. The policy has the potential to save economic and social losses, when the supervision conditions before the policy of increasing Surveillance of social and economic impacts obtained amounted to Rp.466.9 billion / year and after the policy increased Surveillance to Rp. 2.3 trillion / year. The policy of increasing supervision greatly affects the fisheries business at sea, namely the needs and supply of fish for raw materials for the fishery industry are met, increasing the productivity of catches, absorption of labor as fishermen on ships, sufficient fuel stocks and for the government, state revenues from PNBP and fisheries taxes increase.