Public Health Advice Research Articles

Screen time and social media exposure in children and adolescents - the landscape

Abstract Dr. Cecilia Elias is a Public Health Consultant, collaborating with the Infant, Youth, Sexual and Reproductive Health Division at the Health Directorate General, in Lisbon, Portugal. Following on from John’s introduction, Cecilia will dig deeper into the impacts of the omnipresence of social media and phones in modern society. She will provide an overview of the harms and benefits for today’s youth. She will highlight data for example on impaired development of language, cognitive and social skills from screen exposure at young ages, and increased rates of depression, anxiety, self-harm, and school refusal among adolescents with problematic social media usage, including examples of significant outcomes. Exposure to disturbing and harmful content on social media platforms like TikTok and Instagram will be covered also.

The UK’s pandemic preparedness and early response to the COVID-19 pandemic

ABSTRACT This article focuses on the UK’s pre-COVID 19 pandemic preparedness and its early response to the COVID-19 pandemic (January ‘20 – March ‘20). The aim of this article is to explain the high excess mortality the UK experienced compared to many of its international and European peers in the first wave, which is contrary to the country’s high ranking in pre-COVID-19 preparedness rankings. The article assesses the various components of pre-COVID-19 pandemic preparedness such as pandemic strategy, exercises, and stockpiles, and it covers government decision making processes on the early response, including questions around post-travel quarantining, test and trace, and mobility restrictions. The article concludes that there were important deficiencies in the UK's pandemic preparedness and early response in the COVID-19 pandemic. These include the centrality of the ‘inevitability of spread’-assumption underpinning the UK’s pandemic planning pre-COVID, the insufficient implementation of pandemic exercise recommendations, the lack of early and ‘live learning’ from other countries’ experiences, the lack of adoption of public health advice of the World Health Organisation early on, the late implementation of internal mobility restrictions, the lack of timely consideration of alternative early pandemic response models, and fragilities in the SAGE/governmental interplay.

Pengaruh Effleurage Massage dan Teknik Relaksasi Nafas dalam terhadap Nyeri Punggung Bawah Ibu Hamil Trimester III

Lower back pain is a common complaint among pregnant women in the third trimester. It is estimated that approximately 70% of pregnant women experience some form of back pain during pregnancy, childbirth, or postpartum. Non-pharmacological therapies such as deep breathing relaxation techniques and effleurage massage therapy can effectively reduce pain levels in these women. This study employs a quantitative approach using a quasi-experimental research method and employs purposive sampling with a sample size of 37 participants. Data analysis includes both univariate and bivariate analyses. Most respondents (64.9%) were aged between 20 and 35 years old. Additionally, the majority (64.9%) were experiencing their first pregnancy. All respondents (100%) were confirmed to have no comorbidities. Furthermore, 73% of the participants had tertiary education (Diploma, Bachelor's, Master's, or Doctorate degrees), and 62.2% continued working during pregnancy. The results of the Wilcoxon test indicated a significant effect (p = 0.000 < 0.05), confirming that effleurage massage and deep breathing relaxation techniques effectively reduce lower back pain in pregnant women. This reduction is attributed to the stimulation of tactile fibers in the skin by effleurage massage, which inhibits pain signals. In conclusion, the findings suggest that implementing effleurage massage and deep breathing relaxation techniques is beneficial for alleviating lower back pain in pregnant women. Public health advice advocates for the application of these techniques to manage such pain effectively.

Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis

ObjectiveReductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children’s health. The reasons for these changes are not well described. This...

Shame-Sensitive Public Health.

In this article, we argue that shaming interventions and messages during Covid-19 have drawn the relationship between public health and shame into a heightened state of contention, offering us a valuable opportunity to reconsider shame as a desired outcome of public health work, and to push back against the logics of individual responsibility and blame for illness and disease on which it sits. We begin by defining shame and demonstrating how it is conceptually and practically distinct from stigma. We then set out evidence on the consequences of shame for social and relational health outcomes and assess the past and present dimensions of shame in the context of the Covid-19 pandemic, primarily through a corpus of international news stories on the shaming of people perceived to have transgressed public health directions or advice. Following a brief note on shame (and policymaking) in a cultural context, we turn to the concept and practice of 'shame-sensitivity' in order to theorise a set of practical and adaptable principles that could be used to assist policymakers in short- and medium-term decision-making on urgent, tenacious, and emerging issues within public health. Finally, we consider the longer consequences of pandemic shame, making a wider case for the acknowledgement of the emotion as a key determinant of health.

Two years of innovative dermatological care: the first public health consultation service for the transgender and gender diverse community in Argentina

BackgroundThe LGBTQI + community encounters distinct healthcare challenges due to discrimination and inadequate understanding of their needs. Dermatologists play a crucial role in addressing this by fostering inclusiveness, recognizing individual concerns, and adopting tailored approaches, thereby promoting a more equitable healthcare system. ObjectiveTo address the need for an inclusive healthcare space, the authors established the first dermatological practice exclusively for transgender and non-binary patients. This article presents a comprehensive two-year experience in a public hospital. MethodsThe authors conducted a retrospective and descriptive study, analyzing the medical records of 114 patients evaluated at a specialized dermatological practice between June 2021 and May 2023. Key variables assessed included self-identified gender, age, residence, access to private healthcare, human immunodeficiency virus status, hormonal treatment, surgical interventions, consultation motives, employment stability, and family support during gender expression transition. ResultsThe present study included 114 patients, 49.1% trans men, 39.5% trans women, and 8.8% non-binary individuals. Trans men, on average younger than trans women (p < 0.001), predominantly sought care for body modification-related concerns, particularly acne and androgenetic alopecia. In contrast, trans women exhibited a more diverse range of consultation motives typically unrelated to hormonal or surgical procedures. Study limitationsThis study is retrospective and limited in geographic scope. Additionally, the patient population lacked diversity in terms of Black ethnicity. ConclusionsThe pioneering dermatological practice for transgender and non-binary patients exemplifies healthcare equity and cultural competence. Effective LGBTQI + healthcare requires addressing unique dermatological concerns while fostering inclusiveness and continuous learning within the medical community.

Smoking and vaping alter genes related to mechanisms of SARS-CoV-2 susceptibility and severity: a systematic review and meta-analysis.

Evidence for the impact of smoking on coronavirus disease 2019 (COVID-19) is contradictory, and there is little research on vaping. Here we provide greater clarity on mechanisms perturbed by tobacco cigarette, electronic cigarette and nicotine exposures that may impact the risks of infection and/or disease severity. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the Ovid and Web of Science databases were searched. Study design and exposure-induced gene expression changes were extracted. Each study was quality assessed and higher confidence scores were assigned to genes consistently changed across multiple studies following the same exposure. These genes were used to explore pathways significantly altered following exposure. 125 studies provided data on 480 genes altered by exposure to tobacco cigarettes, e-cigarettes, nicotine or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Genes involved in both SARS-CoV-2 viral-entry and inflammation were changed following exposure. Pathway analysis revealed that many of those genes with high confidence scores are involved in common cellular processes relating to hyperinflammatory immune responses. Exposure to tobacco cigarettes, e-cigarettes or nicotine may therefore impact initial host-pathogen interactions and disease severity. Smokers and vapers of e-cigarettes with nicotine could potentially be at increased risk of SARS-CoV-2 infection, associated cytokine storm, and acute respiratory distress syndrome. However, further research is required, particularly on e-cigarettes, to determine the biological mechanisms involved in perturbation of viral-entry genes and host-pathogen interactions and subsequent responses within the respiratory tract. This will improve our physiological understanding of the impact of smoking and vaping on COVID-19, informing public health advice and providing improved guidance for management of SARS-CoV-2 and other respiratory viruses.

All hands on deck during the COVID-19 pandemic. Maintaining face-to-face medical education and clinical placements.

Medical students must have robust educational experiences, graduate and commence timely employment. Here, we describe how the Royal College of Surgeons in Ireland (RCSI) delivered clinical placements in medical programmes over the first three waves of the COVID-19 pandemic in Ireland, including a student-centred, holistic approach to students' educational, social and health needs with strong student involvement, re-organising the university's primary care team, developing COVID-19 PCR testing on site and re-focusing communications and student services. This resulted in re-arranging the students into learning communities, and students and staff electronically recorded their COVID-19 symptom status daily. In-person observed structured clinical examination and other clinical exams progressed. No lockdown of any campus occurred. Over the two senior years, 693 students completed 15,000 weeks of clinical and experiential learning across 104 sites, similar to previous years, including anatomy practicals, procedural skills training, simulated ward rounds and patient encounters, case-based presentations and small group tutorials. The compliance rate with the daily symptom tracker was 91%. The percentage response rate and the number of students providing feedback from October 2020 to April 2021 was as high as 50%. The overall response rate was 33%. By mid-May, 93-95% of students in the two senior years had had at least one dose of the SARS-CoV-2 vaccine, with 99% fully vaccinated by the start of the next academic year in autumn 2021. Over the period of testing for SARS-CoV-2, just over 22,000 samples were processed, of which 0.79% were positive; no medical student acquired COVID-19 or was associated with nosocomial transmission. The total investment by the RCSI in Dublin, was €9.3m (€1.2 in capital expenditure and €8.1 in operational expenses). Continuing face-to-face clinical placements during a pandemic was possible through a multi-model approach that prioritised two-way communication, compliance with national public health advice and student screening.

The palliative care experience in Irish nursing homes during the COVID-19 pandemic: a survey of residents, family, and staff

BackgroundNursing homes and other long-term care services account for a disparate share of COVID-19 cases and casualties worldwide. During COVID-19 there is a distinct need to preserve a holistic view of the wellbeing of residents of nursing homes, be mindful of their rights as citizens, and to be aware of protecting residents from infection. The delivery of health and social care throughout a pandemic must remain person-centred and adhere to a human rights-based approach.MethodsThis study aimed to capture nursing home residents, their families and staff’s perspective of the nursing homes residents experience, approaches of staff and the nursing home environment. An online survey was distributed via stakeholder networks and online platforms across Ireland. This study was performed and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).Results25 residents, 42 family members and 51 staff completed the survey (n = 118). Across the domains measured all but one aspect scored above 50% (residents get up and go to bed when they want 41.5%) with the highest score of 89.1% scored for the nursing home is comfortable and well-kept. Results highlight evidence of positive experiences and endeavours to preserve social connections, residents were in a safe place cared for by staff who did their best in a difficult position and who went above and beyond their duty of care. However, some families reported poor communication, no internet connections, not enough phones or tablets, and that staff were busy and unable at times to assist residents who needed help using phones/tablets.ConclusionThis study highlights the importance of human rights and how they ought to inform and shape the advancement of public health advice and policy documents. Overall, nursing home residents, their families and staff reported favourably on the study measures. However, issues pertaining to communication are essential and there is a need to address issues such as the provision of accurate timely information, communication infrastructure and resources, and inconsistencies in communications. Of note is that while healthcare professionals have a duty to uphold the rights of nursing home residents, they themselves have human rights which must also be protected and supported.

Informed, but uncertain: managing transmission risk and isolation in the 2022 mpox outbreak among gay and bisexual men in Australia

In 2022, a global outbreak of mpox (formerly ‘monkeypox’) emerged in non-endemic countries, including Australia, predominantly affecting gay, bisexual and other men who have sex with men. Public health advice on transmission and isolation emerged rapidly from different sources, sometimes conflicting and producing uncertainty. Using the concept of ‘counterpublic health’, which acknowledges the incorporation of official science and experiences of affected communities into embodied practice, this paper investigates how people affected by mpox in Australia managed risk of transmission and navigated self-isolation. In-depth interviews were conducted with 16 people: 13 people diagnosed with mpox and three close contacts. All participants were cisgender gay and bisexual men living in Australia. Participants thought critically about public health advice, often finding it restrictive and unresponsive to the needs of people with mpox. Participants’ decisions about reducing mpox risk and isolating often drew on experiences with other infections (i.e. HIV; COVID-19) and were made collaboratively with the people closest to them (e.g. partners, friends, family) to sustain relationships. Future public health responses to infectious disease outbreaks would benefit from identifying more opportunities to formalise and embed mechanisms to obtain feedback from affected communities so as to inform responses.

Associations between adverse childhood experiences and trust in health and other information from public services, professionals and wider sources: national cross sectional survey

IntroductionTrust in health and other systems can affect uptake of public health advice and engagement with health services. Individuals who had adverse childhood experiences (ACEs) are more likely to experience...

A Longitudinal Investigation of Lower-Risk Gambling Limits in the Canadian National Study.

Recent years have seen increased attention given to identifying and describing the levels of gambling participation that confer a risk of harm in order to generate public health advice regarding lower-risk gambling. However, most of the existing literature has failed to explicitly assess these limits in a prospective manner. The purpose of this study is to employ a methodology consistent with prior investigations to evaluate the level of gambling participation associated with an increased risk of future gambling-related harm. Using data from the Alberta Gambling Research Institute's National Project Online Panel Survey, risk ratios and Receiver Operating Characteristic (ROC) analyses were used to determine the relative risk of gambling-related harm associated with participating in a greater number of gambling formats, gambling more days per month, and spending a greater proportion of income gambling. Prospective lower-risk limits were largely consistent with those identified in previous cross-sectional analyses (e.g., no more than two gambling formats, no more than once a week), with the exception that higher limits were found for the percent of household income spent gambling (3.4-6.4% vs. 1%). We advise that future research on lower-risk gambling limits consider the use of more granular assessment instruments and prospective methods to more closely evaluate the association between gambling participation and gambling harm.

To stay or not to stay at home? The unintended consequences of public health advice for older adults in the context of Covid-19 and urban heat

Stay-at-home advice is one of the most widespread public health solutions to various health risks, including Covid-19 and heat stress. Authorities often direct this recommendation to adults above 65 years old, a group particularly vulnerable to multiple risks. While this advice aims to save lives, when prolonged it also comes with various negative unintended consequences. It increases older adults’ isolation and loneliness, which negatively affects their mental and physical health, as well as their wellbeing and quality of life.This article builds on the findings from two European projects that studied, respectively, Covid-19 responses and adaptation to urban heat. First, we analyze the data from semi-structured interviews about Covid-19 responses and their consequences conducted with local experts in Vienna, Austria, in 2021–22. Second, we analyze the data from focus groups on experiencing and adapting to urban heat conducted with older adults in Warsaw, Poland, in 2021.This article demonstrates why stay-at-home advice might be problematic for older adults who live alone and how it leads to their increased isolation and loneliness when it stops being a short-term measure and becomes a prolonged experience. We examine differences and similarities between the two cases to discuss the shortcomings in care for older and frail people. We argue that public health recommendations should consider the issues of temporality, sociality and inequality when re-implementing the stay-at-home advice in the future. We also demonstrate that measures focusing on community wellbeing, instead of thinking only in terms of individual health and responsibility, might be a way to address those issues.

Media coverage and pandemic behavior: Evidence from Sweden.

We study the effect of media coverage on individual behavior during a public health crisis. For this purpose, we collect a unique dataset of 200,000 newspaper articles about the Covid-19 pandemic from Sweden-one of the few countries that did not impose lockdowns or curfews. We show that mentions of Covid-19 significantly lowered the number of visits to workplaces and retail and recreation areas, while increasing the duration of stays in residential locations. Using two different identification strategies, we show that these effects are causal. The impacts are largest when Covid-19 news stories are more locally relevant, more visible and more factual. We find larger behavioral effects for articles that reference crisis managers (as opposed to medical experts) and contain explicit public health advice. These results have wider implications for the design of public communications and the value of the local media.

Trust in COVID-19 information sources and vaccination status: Exploring social inequalities and differences within the four United Kingdom nations using a representative survey.

To explore how the use of, and trust in, different sources of advice and information on COVID-19 differed across the four UK nations and between different sociodemographic groups and their associations with COVID-19 vaccination status. We used a UK-wide representative survey conducted in July 2021, which included data on uptake of COVID-19 vaccination, trust in information sources, use of sources and geographical and sociodemographic variables. We used multivariate logistic regression to identify factors associated with completed or planned COVID-19 vaccination. Trust in the NHS, followed by trust in scientists, were the strongest predictors of vaccination intention. NHS websites were the most used (56% across the UK); only the Scottish government website had a higher level of reported use (58%). Using either source was associated with a positive vaccination status as were use of the GP and television as sources of advice. Use of social media, family and friends, and 'none' of the sources enquired about, were all linked to a lower likelihood of being or intending to get vaccinated. Compared to those in England, respondents in other UK nations were less likely to trust the central UK government for advice on COVID-19. There was considerable variation by age in trust and use of some, but not all, sources of advice, with predicted probabilities ranging from 35% among the youngest age group to 62% among those aged 65years or older. There were also significant differences by annual household income and by occupational class for trust in government, with higher incomes correlating with greater likelihood of trust. This study demonstrates high levels of trust in the key sources of public health advice and there was a positive association between using official sources of advice and vaccination intentions, even in the context of overall high vaccination rates. Our findings highlight the need for the UK and devolved governments to value the importance of public trust in the health system and take appropriate measures to avoid undermining such trust.

Challenges and Resilience in the Lives of Refugees Now Residing in the United States: A Health and Well-Being Perspective

Abstract Objective This article explores the health-related challenges for refugees now residing in the United States and highlights strategies for building resilience in this vulnerable population. Methods This is a descriptive study identifying six common challenges refugees face when relocating from their country to another country. Results Refugees in the United States face many challenges, including language barriers, access to quality education, discrimination based on cultural and religious differences, and inadequate healthcare access. Child refugees, constituting a significant portion of the refugee population, face distinct challenges compared to adults. Many refugees grapple with psychological trauma and access to proper healthcare. Conclusion Refugees face many challenges when transitioning to a new country, including losing community, familial support, safety, and cultural norms. To address these challenges in the United States, advocates, and public health advisors must actively engage with refugees to assess their needs and build resilient communities. Proactive outreach tailored to refugees’ vulnerabilities is crucial to ensuring their well-being and successful integration into their new homes.

Role of public health professionals in the climate and ecological crisis: a qualitative study

BackgroundThe climate and ecological emergency is the single biggest health threat facing humanity, yet it is not clear to what extent the public health workforce have been involved in work...

How to increase COVID-19 vaccination among a population with persistently suboptimal vaccine uptake? Evidence from the North Macedonia mobile vaccination and public health advice caravan

Over three years since the first COVID-19 vaccine was approved, many countries still have suboptimal vaccination rates despite holding great amounts of vaccines. Overall, there is little evidence on which policies are more effective to encourage vaccination, particularly in countries where a large share of the population remains unvaccinated. In this study, we examine the effectiveness of a community-based intervention carried out in March 2022 in North Macedonia, a country with a large and persistent share of the population that remains unvaccinated. The intervention, spearheaded by the Ministry of Health and supported by the World Health Organization and UNICEF, consisted of a mobile caravan offering vaccination and public health advice to different locations across the country on different days. Results from our staggered difference-in-difference model show that the mobile vaccination caravan increased daily vaccination rates by 7.7 vaccines per 100,000 inhabitants during the three weeks after the day of the caravan visit. This corresponds to a 35 % increase with respect to pre-intervention vaccination rates. We estimate a cost-effectiveness of 25.4 US dollars (USD) per additional vaccination induced. These results point to mobile caravan vaccines as an effective and cost-effective strategy to increase COVID-19 vaccination rates, even in a context of persistently suboptimal uptake.

The relative effectiveness of three and four doses of COVID-19 vaccine in Victoria, Australia: A data linkage study

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic led to extensive vaccination campaigns worldwide, including in Australia. Immunity waning and the emergence of new viral variants pose challenges to the effectiveness of vaccines. Our study aimed to assess the relative effectiveness (rVE) of 3 and 4 compared with 2 doses of COVID-19 vaccine. The study focuses on the Victorian population, a majority of whom had no prior exposure to the virus before vaccination. MethodsWe used routinely collected data for the state of Victoria, Australia, to assess rVE during an Omicron-dominant period, 1 June 2022 to 1 March 2023. Immunisation, notifications, hospitalisations and mortality data for residents aged 65 years and older were linked for analysis. Cox proportional hazard regression was used to estimate the rVE against COVID-19 hospitalisation or death, accounting for key confounders with vaccination as a time-varying covariate. ResultsIn 1,070,113 people 65 years or older who had received their second dose, a third and fourth dose of a COVID-19 vaccine significantly reduced the hazard of hospitalisation or death compared to two doses. rVE was highest within two weeks from administration at 40 % (95 % CI: 0 % to 64 %) and 66 % (95 % CI: 60 % to 71 %) for a third and fourth dose, respectively. Additional protection conferred by third and fourth doses waned over time from administration. ConclusionsOur findings underscore the need for additional vaccine doses and updated vaccine strategies. These findings have implications for public health advice and COVID-19 vaccine strategies. Further research and monitoring of vaccine effectiveness in real-world settings are warranted to inform ongoing pandemic response efforts.

Pregnant women’s experiences of extreme exposure to bushfire associated smoke: a qualitative study

In 2019/2020, multiple bushfires burned across south-east Australia converging into unprecedented megafires that burned 5.8 million hectares. From October 2019–February 2020, 80% of Australians were affected by smoke from these fires, exposing them to dramatic increases of PM2.5 in the air at an average level of ∼70 μg m3 per day, well above the World Health Organisation recommendation of ∼10 μg m3. Maternal exposure to PM2.5 has been associated with negative birth outcomes and an increased rate of birth defects, yet there is a dearth of literature regarding how pregnant women deal with exposure to bushfire smoke. The aim of this study was thus to investigate how pregnant and postpartum women experienced severe bushfire smoke associated with the 2019–2020 bushfires in south-east Australia and the strategies they used to mitigate exposure to smoke for themselves and their unborn or newborn children. Forty-three women who were exposed to fire and/or smoke from the 2019–2020 bushfires participated in one-on-one semi-structured interviews via phone or videoconference. These women were selected purposively from a larger group of women who had elected to be interviewed. After interview, data were transcribed and thematically analysed using the four phases of disaster response (prevention, preparedness, response, recovery) as a frame. Overall, our results indicated that public health advice failed to meet the unique needs of this group. While many protected their properties appropriately and were reasonably well prepared for evacuation, they were unprepared for the disruption to vital services including power and communications. Women exposed to smoke inundation were unprepared for this outcome and self-initiated a variety of strategies. The support of community was also key to recovery. There is a clear need for specific recognition of the needs of pregnant women across all phases of disaster response, incorporating public health messaging, peer support, and access to resources.