Public Health Assessment Research Articles

Расчет и картографирование индекса общественного здоровья регионов России и стран мира в последнем кризисном десятилетии XX в.

The presented article is devoted to the development of a methodology for calculating the integral assessment of public health in relation to both countries of the world and regions of a single country using the example of Russia. The calculation was made on the basis of a universal system of maximally integrated indicators. When carrying out the research, the creation of a system of indicators is considered in order to achieve the greatest opportunities within the framework of rapid and visual analysis of the material. A classification of countries and regions of Russia is given according to the level of public health, both for individual years and over a certain period of time. Cartographic proceedings have been created to illustrate the situation that has developed both in a single year and the dynamics over a certain period of time, and primarily during periods of crisis. The integral index of public health has proven itself not only as a measure of the health of the territory’s population, but also turned out to be quite comprehensive to reflect the diversity of socio-economic processes in such a complex and contradictory time as the end of the 20th century. Analytical and synthetic cartographic proceedings also showed their effectiveness, showing the most interesting time frames for more detailed analysis, identifying areas that need the most closed attention. All this makes the presented methodology for calculating and mapping the required index effective from the point of view of searching for new scientific knowledge and indicates its ability to become a good tool for management decision makers with its further implementation in geographic information systems.

How History Informs FDA Tobacco Regulation: Retrospective Application of a Public Health Assessment Framework to 'Low Tar' Cigarettes

How History Informs FDA Tobacco Regulation: Retrospective Application of a Public Health Assessment Framework to 'Low Tar' Cigarettes

Calculation of the Public Health Index in the Regions of the Russian Federation

Introduction: The COVID-19 pandemic has demonstrated the need to improve methods of public health assessment and approaches to the development of a system for its monitoring in the Russian Federation. Public health represents a sociomedical resource of the society, deterioration of which has a negative effect on the potential of the society to resist emerging threats. Within a series of previous studies, the authors have developed a methodological approach to calculating the public health index, the monitoring of which will facilitate managerial decisions aimed at strengthening of the potential of public health. Objective: To test a methodological approach to calculating the public health index in the regions of the Russian Federation. Materials and methods: To estimate the public health index, we applied an original methodology specially developed with account for strategic goals outlined by the Russian President and provisions of the WHO Handbook for calculation and use of the Urban Health Index. It includes correlation assessment and standardization of parameters. The components of the public health index were selected in view of the requirements established by the presidential decree on preserving the population of the country, developing the human potential, and strengthening national defense capabilities. Results: We calculated Russian regional values of the public health index for the year 2019. The year selection was determined by the absence of significant biological challenges, currently posed by the COVID-19 pandemic, and the aftermath of the pension reform. The estimated mean of the public health index in the Russian Federation in 2019 was 0.238, with extremes established in the Yamalo-Nenets Autonomous Okrug (0.458) and the Kurgan Region (0.036). Conclusions: Public health monitoring involves tracking of achieved values of the public health index and its individual constituents as they allow judgment on the potential of the society to counteract external threats. Further research should be aimed at analyzing changes in the public health index in the regions of Russia during and after large-scale biological and social challenges. It seems expedient to consider the issue of creating a national information portal devoted to public health problems in the country.

Differences in wasting assessment through Middle-Upper Arm Circumference (MUAC) adjusted by sex, age and geographic origin for children aged 6-59 months: New reference based on anthropometric surveys from 22 low-and-middle-income countries.

The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal cut-off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut-off point. In addition, the creation of MUAC growth charts is presented for reference use. This study was carried out with a database developed by Action Against Hunger, composed, after the data pre-processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k-means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method. Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k-means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group. All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.

Deep learning modeling of public’s sentiments towards temporal evolution of COVID-19 transmission

Public sentiments towards global pandemics are important for public health assessment and disease control. This study develops a modularized deep learning framework to quantify public sentiments towards COVID-19, followed by leveraging the predicted sentiments to model and forecast the daily growth rate of confirmed COVID-19 cases globally, via a proposed G parameter. In the proposed framework, public sentiments are first modeled via a valence dimensional indicator, instead of discrete schemas, and are classified into 4 primary emotional categories: (a) neutral; (b) negative; (c) positive; (d) ambivalent, by using multiple word embedding models and classifiers for text sentiments analyses and classification. The trained model is subsequently applied to analyze large volumes (millions in quantity) of daily Tweets pertaining to COVID-19, ranging from 22 Jan 2020 to 10 May 2020. The results demonstrate that the global community gradually evokes both positive and negative sentiments towards COVID-19 over time compared to the dominant neural emotion at its inception. The predicted time-series sentiments are then leveraged to train a deep neural network (DNN) to model and forecast the G parameter by achieving the lowest possible mean absolute percentage error (MAPE) score of around 17.0% during the model’s testing step with the optimal model configuration.

Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize?

This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. State and local health departments. Nationally representative population of state and local governmental public health workers. Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response. For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered. A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.

Developing human biomonitoring as a 21st century toolbox within the European exposure science strategy 2020-2030.

Human biomonitoring (HBM) is a crucial approach for exposure assessment, as emphasised in the European Commission's Chemicals Strategy for Sustainability (CSS). HBM can help to improve chemical policies in five major key areas: (1) assessing internal and aggregate exposure in different target populations; 2) assessing exposure to chemicals across life stages; (3) assessing combined exposure to multiple chemicals (mixtures); (4) bridging regulatory silos on aggregate exposure; and (5) enhancing the effectiveness of risk management measures. In this strategy paper we propose a vision and a strategy for the use of HBM in chemical regulations and public health policy in Europe and beyond. We outline six strategic objectives and a roadmap to further strengthen HBM approaches and increase their implementation in the regulatory risk assessment of chemicals to enhance our understanding of exposure and health impacts, enabling timely and targeted policy interventions and risk management. These strategic objectives are: 1) further development of sampling strategies and sample preparation; 2) further development of chemical-analytical HBM methods; 3) improving harmonisation throughout the HBM research life cycle; 4) further development of quality control / quality assurance throughout the HBM research life cycle; 5) obtain sustained funding and reinforcement by legislation; and 6) extend target-specific communication with scientists, policymakers, citizens and other stakeholders. HBM approaches are essential in risk assessment to address scientific, regulatory and societal challenges. HBM requires full and strong support from the scientific and regulatory domain to reach its full potential in public and occupational health assessment and in regulatory decision-making.

Biodiesel Emissions: A State-of-the-Art Review on Health and Environmental Impacts

Biodiesel is an alternative source of fuel for various automotive applications. Because of the increasing demand for energy and the scarcity of fossil fuels, researchers have turned their attention to biodiesel production from various sources in recent years. The production of biofuels from organic materials and waste components allows for the use of these waste resources in transporting resources and people over long distances. As a result, developing sustainable measures for this aspect of life is critical, as knowledge of appropriate fuel sources, corresponding emissions, and health impacts will benefit the environment and public health assessment, which is currently lacking in the literature. This study investigates biodiesel’s composition and production process, in addition to biodiesel emissions and their associated health effects. Based on the existing literature, a detailed analysis of biodiesel production from vegetable oil crops and emissions was undertaken. This study also considered vegetable oil sources, such as food crops, which can have a substantial impact on the environment if suitable growing procedures are not followed. Incorporating biodegradable fuels as renewable and sustainable solutions decreases pollution to the environment. The effects of biodiesel exhaust gas and particulates on human health were also examined. According to epidemiologic studies, those who have been exposed to diesel exhaust have a 1.2–1.5 times higher risk of developing lung cancer than those who have not. In addition, for every 24 parts per billion increase in NO2 concentration, symptom prevalence increases 2.7-fold. Research also suggests that plain biodiesel combustion emissions are more damaging than petroleum diesel fuel combustion emissions. A comprehensive analysis of biodiesel production, emissions, and health implications would advance this field’s understanding.

Dual-mode detection and efficient annihilation of pathogenic bacteria based on the construction of a ratiometric electrochemiluminescent/electrochemical sensor

Sensitive, reliable, and selective detection of pathogenic bacteria is a key objective for the assessment of public health. Here, a ratiometric electrochemiluminescent/electrochemical (ECL/EC) sensor sensitized with a two-step signal amplification strategy was designed for the dual-mode detection of pathogenic bacteria. Target-induced releasing of multi-DNA strands, as the first-step amplification, transformed Staphylococcus aureus (S. aureus) into abundant intermediate DNA strands, which then hybridized with the block DNA (W). New splice sites were formed via hybridization of the releasing swing arm with EC indicator-labeled anchor DNA. With the introduction of nicking endonuclease, DNA walker was activated as the second-step amplification, yielding abundant single-stranded DNAs on the sensing interface. ECL emitter-labeled probe DNA was hybridized with the left DNAs, resulting in a significant increase in ECL/EC ratio value to achieve sensitive monitoring of S. aureus. Taking advantage of the two-step signal amplification strategy, this method exhibited a high sensitivity for S. aureus analysis with a low detection limit of 1 CFU/mL. Concurrently, this sensing strategy brought about satisfactory results for S. aureus assay when interfering bacterial strains and complex matrices appeared. Furthermore, aptamer encapsulated silver nanoclusters (aptamer-Ag NCs) exhibited striking bactericidal performance against S. aureus during the experiment, which opened a promising antifouling avenue to eliminate bacteria.

Anthropogenic Sewage Water Circuit as Vector for SARS-CoV-2 Viral ARN Transport and Public Health Assessment, Monitoring and Forecasting-Sibiu Metropolitan Area (Transylvania/Romania) Study Case.

Water is a risk factor for epidemics of waterborne diseases with effects on human health. In 2019, new viral pneumonia cases occurred in China and spread worldwide. The aim of this study was to assess the feasibility and accuracy of a wastewater-based epidemiological (WBE) monitoring tool in a SARS-CoV-2 hot spot (Sibiu City metropolitan area), namely to highlight the correlation between the number of infections on the days of sampling and the amount of viral RNA detected in wastewater. Wastewater samples were collected once a week, and viral RNA was extracted and quantified. In parallel, the daily number of SARS-CoV-2 infections was obtained from the local council. The correlation between the number of infections and viruses detected in sewage was measured by Pearson correlation coefficients. The results show the amount of viral RNA in the wastewater is directly correlated with the number of infections reported in the week up to the sampling day and also the number of infections reported for the sampling day. Moreover, correlation coefficients show the amount of viral RNA in wastewater increases in advance of the increase in reported infection cases. Therefore, WBE can be used as a tool for monitoring virus spread trends in human communities and can help anticipate the trend of this type of viral infection.

A psychometric assessment of the Military Suicide Attitudes Questionnaire (MSAQ)

Suicide rates remain high among military populations. Stigmatizing beliefs about suicide contribute to the problem of heightened suicide risk as a deterrent for help-seeking. Measurement of military suicide stigma is therefore an important gap in the literature as a necessity toward the development of military suicide prevention programming. This paper assessed the factor structure, reliability, and validity of the Military Suicide Attitudes Questionnaire (MSAQ). Study 1 featured secondary analysis of a suicide risk dataset from active duty treatment-seeking military personnel (N = 200). Study 2 was a secondary analysis of a statewide assessment of Army National Guard service members’ beliefs about mental health and suicide (N =1116). Factor analyses results collectively supported a four-factor Military Suicide Attitudes Questionnaire (MSAQ) structure: discomfort, unacceptability, support, and empathic views. Subscale reliabilities ranged from 0.77 to 0.83 across samples. Unacceptability and support displayed significant negative correlations with psychological distress. Men displayed more negative suicide-related beliefs compared to women counterparts. Discomfort and unacceptability beliefs displayed significant positive associations with perceived barriers to care. The final short version of the MSAQ is an efficient, multi-dimensional measure of military suicide-related beliefs. The instrument can be used for public health assessment and program evaluation in military settings.

Double burden of malnutrition among migrants and refugees in developed countries: A mixed-methods systematic review.

Migrants and refugees living in high income countries (HICs) have an increased risk of developing non-communicable diseases (NCDs) due to malnutrition at different stages over their life course. This systematic review aims to examine the double burden of malnutrition (DBM) among migrants and refugees in developed countries. This review was informed by the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Eligible studies were peer-reviewed observational studies that focused on the DBM in refugee or migrant populations; and were written in English with full texts available and accessible. A combination of keywords was used to search 8 electronic bibliographic databases including Ovid MEDLINE, EMBASE, PsycINFO, CINAHL, ProQuest, Scopus, PubMed, and web of science. There is a paucity of research into the DBM among migrants and refugees residing in HICs. Of a total of 2344 articles retrieved from eight databases, 5 studies met the inclusion criteria. All included studies showed the co-existence of some form of undernutrition and overnutrition within the same population. Overnutrition (overweight and obesity) in the studied populations ranged from 11.1% to 42% while undernutrition (stunting, wasting and underweight) ranged from 0.3% to 17%. Standard measures for anthropometry as determined by World Health Organization (WHO) were used for data collection in all included studies. A piloted form informed by the Cochrane Public Health Group Data Extraction and Assessment Template was used in the extraction of data from retrieved studies. Quality assessment of included studies was performed using the study assessment tools of the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and showed that all studies were of fair quality. Interventions that simultaneously target more than one form of malnutrition especially amongst migrant and refugee populations must be implemented for policy solutions to be effective. This review has been registered by the PROSPERO international prospective registry for systematic reviews, reference CRD42020192416.

The Future of Occupational and Environmental Medicine.

Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions.

Algorithm for Analyzing the Results of Laboratory Testing of Micro- and Macronutrient Composition of Milk

Introduction: The assessment of actual nutrition of the population, both at the individual and population level, strongly depends on the accuracy of data on the chemical composition of food products. Milk is an important component of a diet, and a precise estimation of micro- and macronutrients consumed with it is essential for public health assessment. Objective: To develop an algorithm for obtaining statistically accurate values of average concentrations and variability of basic micro- and macronutrients in milk. Materials and methods: To elaborate and check the algorithm, we used milk fat test results collected within the Federal Project on Public Health Strengthening by the laboratories of the Federal Service for Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) in the years 2020–2021. Results: Due to numerous missing and outlying values of milk composition testing, an appropriate adjustment of the algorithm was necessary. The best separating ability was demonstrated by the approach of dividing types of milk into clusters based on their fat and calcium content. The three clusters obtained included milk with a 2.5 % fat content and the average calcium concentration of 1,144 mg/L, milk with a 3.2 % fat content and the average calcium concentration of 1,180 mg/L, and milk with both fat contents and the mean calcium level of 597 mg/L. The algorithm was validated by checking the completeness of data on the fatty acid composition and a low variability of values. Conclusion: The developed algorithm has enabled us to obtain up-to-date information on the chemical composition of milk sold by food retailers in the Russian Federation. Low-calcium milk on the market is of special concern as its average consumption fails to satisfy human physiological needs. At the same time, the content of saturated fat was below 2.2 g/100 g in the cluster of milk types with the maximum fat content, thus raising no additional health concerns. Further studies should be aimed at determining the acceptable and correct stages of data preprocessing that maintain a balance between the obtained accuracy of values and their actual reproducibility.

Chronic kidney disease awareness among the general population: tool validation and knowledge assessment in a developing country

IntroductionGood knowledge and early identification of chronic kidney disease (CKD) can help in preventing disease progression in its early stages and reducing undesired outcomes. The aim of the current study was to assess the level of public knowledge about CKD, determine predictors of better knowledge, and to construct and validate a CKD knowledge scale for public health assessment and research use.MethodsA community-based cross-sectional study was conducted using an electronic self-administered questionnaire. All people living in Lebanon and being 18 years of age and above were considered eligible for recruitment. CKD knowledge was assessed by a 37-item scale that was constructed by principal component analysis and then validated. The score of the CKD knowledge scale was computed from the extracted factors. A multivariable binomial logistic regression model evaluated the sociodemographic and clinical predictors of the knowledge score.ResultsA total of 1308 participants were included. The scale items converged over 9 factors with Eigenvalue greater than 1 and explaining 53.26% of the total variance, and the total scale had a high Cronbach’s alpha of 0.804. All items of the scale significantly correlated with the full scale with correlation coefficients ranging from 0.082 to 0.558. The ROC curve analysis determined an optimal cutoff point of better knowledge at 47.5 with 70.6% sensitivity and 44.2% specificity. The CKD knowledge score had a median of 51.00 (IQR 47.00–55.00). Higher knowledge score was significantly associated with old age (ORa = 1.018, 95% CI 1.006–1.030, P = 0.003),, occupation (ORa = 3.919, 95% CI 2.107–7.288, P < 0.001), and recent renal function assessment (ORa = 2.314, 95% CI 1.532–3.495, P < 0.001). However, a lower knowledge score was significantly associated with lower level of education (ORa = 0.462, 95% CI 0.327–0.653, P < 0.001).ConclusionA reliable tool to assess public knowledge and awareness about CKD was developed and validated. The overall knowledge was good, however, important gaps in CKD awareness were detected in some areas and subpopulations. Therefore, public health stakeholders need to implement targeted CKD educational activities to minimize the disease burden.

A Radiological Emergency Health and Safety Plan for City Agencies Without First Response Responsibilities.

In New York City, the citywide radiological response plan charges 4 primary agencies with various roles and objectives: police, fire, health, and environmental protection. These agencies perform essential functions such as criminal investigation, life safety, public health, and environmental assessments. In the late phase of an incident where components of remediation and recovery have been initiated, other municipal agencies that had not previously planned to respond to a radiological incident may be expected to supply various levels of support. To prepare the personnel of these other agencies to respond to a radiological incident expeditiously, a Radiological Health and Safety Plan (RHASP), was developed as an appendix to an existing Citywide Health and Safety Plan. RHASP is designed for an agency-wide health physics program that provides 4 key components of radiation safety: (1) training to understand the hazard, (2) framework for a personnel radiation dose measurement program (dosimetry), (3) environmental surveillance of the site for worker and public protection, and (4) radioactive waste control. These components of RHASP are supported by 2 functions inherent in successful radiation safety programs: documentation and quality assurance of the collected radiation safety data. In this article, we discuss the components of RHASP and the potential challenges to its successful implementation.

Screening for infectious maternal morbidity - knowledge, attitudes and perceptions among healthcare providers and managers in Malawi: a qualitative study

BackgroundMaternal morbidity and mortality related to infection is an international public health concern, but detection and assessment is often difficult as part of routine maternity care in many low- and middle-income countries due to lack of easily accessible diagnostics. Front-line healthcare providers are key for the early identification and management of the unwell woman who may have infection. We sought to investigate the knowledge, attitudes, and perceptions of the use of screening tools to detect infectious maternal morbidity during and after pregnancy as part of routine antenatal and postnatal care. Enabling factors, barriers, and potential management options for the use of early warning scores were explored.MethodsKey informant interviews (n = 10) and two focus group discussions (n = 14) were conducted with healthcare providers and managers (total = 24) working in one large tertiary public hospital in Blantyre, Malawi. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes.ResultsMost healthcare providers are aware of the importance of the early detection of infection and would seek to better identify women with infection if resources were available to do so. In current practice, an early warning score was used in the high dependency unit only. Routine screening was not in place in the antenatal or postnatal departments. Barriers to implementing routine screening included lack of trained staff and time, lack of thermometers, and difficulties with the interpretation of the early warning scores. A locally adapted early warning screening tool was considered an enabler to implementing routine screening for infectious morbidity. Local ownership and clinical leadership were considered essential for successful and sustainable implementation for clinical change.ConclusionsAlthough healthcare providers considered infection during and after pregnancy and childbirth a danger sign and significant morbidity, standardised screening for infectious maternal morbidity was not part of routine antenatal or postnatal care. The establishment of such a service requires the availability of free and easy to access rapid diagnostic testing, training in interpretation of results, as well as affordable targeted treatment. The implementation of early warning scores and processes developed in high-income countries need careful consideration and validation when applied to women accessing care in low resource settings.

Public health and economic impact assessment of PM2.5 from open biomass burning over countries in mainland Southeast Asia during the smog episode

PM2.5 is considered the principal air pollutant caused by open biomass burning (OBB) in Mainland Southeast Asia (MSEA) and significant adverse health effects and economic burdens. The goals of this work are to conduct a literature review on relative measures of the effect associated with the exposure to OBB emission in MSEA, to analyze the impact of OBB emission on PM2.5 concentration in MSEA using the dispersion model, and to estimate the public health and economic impacts associated with the exposure to PM2.5 from OBB on regional and national scales using Environmental Benefits Mapping and Analysis Program during a smog episode. This work found that OBB was the largest emission source in MSEA, contributing 57% to the PM2.5 concentrations, with the substantial OBB impact was found in Northern Laos and Eastern Myanmar. As a result, the exposure to PM2.5 from OBB was estimated to contribute a substantial number of deaths regarding all-cause (78,276 cases - 95% CI: 62,915–92,629), respiratory disease (6,716 cases – 95% CI: 3,639–9,482), and cardiovascular disease (1,076 cases – 95% CI: 490-1,615). The economic impact was estimated at 23.28 billion (95% CI: 18.69–27.57), 1.90 billion (95% CI: 0.88–2.40), and 0.44 billion (95% CI: 0.20–0.67) USD, respectively. OBB emission caused the greatest public health and economic impact in Myanmar, while the smallest impact was found in Cambodia. Our study provides policymakers with quantitative estimates of the OBB impacts so that they can develop appropriate control measures at the regional and national levels in MSEA.

Risk factors for death and illness in dogs imported into the United States, 2010-2018.

CDC estimates 1 million dogs are imported into the United States annually. With the movement of large numbers of animals into the United States the risk of disease importation, especially emerging diseases, and animal welfare issues are of concern. Dogs that arrive to the United States ill or dead are investigated by public health authorities to ensure dogs are not infected with diseases of concern (such as rabies). We identified factors associated with illness and death in imported dogs and estimated the initial investigation cost to public health authorities. Dog importation data from the CDC’s Quarantine Activity Reporting System were reviewed from 2010 to 2018. The date of entry, country of origin, port of entry, transportation method and breed were extracted to examine factors associated with illness and death in dogs during international travel. Costs for public health investigations were estimated from data collected by the Bureau of Labor Statistics and Office of Personal Management. Death or illness was more likely to occur in brachycephalic breeds (aOR = 3.88, 95%CI 2.74–5.51). Transportation of dogs via cargo (aOR = 2.41, 95%CI 1.57–3.70) or as checked baggage (aOR = 5.74, 95%CI 3.65–9.03) were also associated with death or illness. On average, 19 dog illnesses or deaths were reported annually from 2010 to 2018. The estimated annual cost to public health authorities to conduct initial public health assessments ranged from $2,071 to $104,648. Current regulations do not provide adequate resources or mechanisms to monitor the rates of morbidity and mortality of imported dogs. There are growing attempts to assess animal welfare and communicable disease importation risks. However, because the responsibility for dogs’ health and wellbeing is overseen by multiple agencies it is challenging to coordinate implementation and enforcement measures. A joint federal agency approach to identify interventions that reduce dog morbidity and mortality during flights while continuing to protect US borders from public health and foreign animal disease threats could be beneficial.

Empirical Modeling of COVID-19 Evolution with High/Direct Impact on Public Health and Risk Assessment.

This report develops a conceivable mathematical model for the transmission and spread of COVID-19 in Romania. Understanding the early spread dynamics of the infection and evaluating the effectiveness of control measures in the first wave of infection is crucial for assessing and evaluating the potential for sustained transmission occurring in the second wave. The main aim of the study was to emphasize the impact of control measures and the rate of case detection in slowing the spread of the disease. Non pharmaceutical control interventions include government actions, public reactions, and other measures. The methodology consists of an empirical model, taking into consideration the generic framework of the Stockholm Environment Institute (SEI) Epidemic–Macroeconomic Model, and incorporates the effect of interventions through a multivalued parameter, a stepwise constant varying during different phases of the interventions designed to capture their impact on the model. The model is mathematically consistent and presents various simulation results using best-estimated parameter values. The model can be easily updated later in response to real-world alterations, for example, the easing of restrictions. We hope that our simulation results may guide local authorities to make timely, correct decisions for public health and risk assessment.