Public Health Context Research Articles

Integrating Liberal Arts Learning Outcomes in the Development and Implementation of a Multisection Undergraduate Public Health Capstone Course

As demand increases for well-trained public health professionals, academic leaders of universities and colleges must tailor their curricula to prepare students to be ready for the public health workplace, while also providing critical thinking and awareness skills through a liberal arts course context. Temple University’s undergraduate public health program has created a capstone experience that bridges these two priorities. Using public health community-based program planning and evaluation as its content, this two-semester (32 weeks) writing-intensive course provides training for students in writing a grant proposal, including conducting a needs assessment, devising evaluable program goals and objectives, creating an intervention and planning its implementation and evaluation, and developing budgeting and marketing plans. Students also complete related assignments that help develop the critical thinking skills they need to understand the context of public health within the larger society. Utilizing the LEAP Essential Learning Outcomes, we infuse integrative, interdisciplinary, and applied knowledge with the concept of civic responsibility as pathways for ensuring learning, while still providing concrete skills related to public health practice. We discuss how the course is implemented and how public health practice and liberal arts learning objectives are emphasized to ensure an “educated citizenry.” Universities and colleges that offer an undergraduate degree in public health can use this framework to implement a capstone experience that bridges both public health and liberal arts skills.

Air pollution, deprivation and health: understanding relationships to add value to local air quality management policy and practice in Wales, UK.

Air pollution exposure reduces life expectancy. Air pollution, deprivation and poor-health status combinations can create increased and disproportionate disease burdens. Problems and solutions are rarely considered in a broad public health context, but doing so can add value to air quality management efforts by reducing air pollution risks, impacts and inequalities. An ecological study assessed small-area associations between air pollution (nitrogen dioxide and particulate matter), deprivation status and health outcomes in Wales, UK. Air pollution concentrations were highest in 'most' deprived areas. When considered separately, deprivation-health associations were stronger than air pollution-health associations. Considered simultaneously, air pollution added to deprivation-health associations; interactions between air pollution and deprivation modified and strengthened associations with all-cause and respiratory disease mortality, especially in 'most' deprived areas where most-vulnerable people lived and where health needs were greatest. There is a need to reduce air pollution-related risks for all. However, it is also the case that greater health gains can result from considering local air pollution problems and solutions in the context of wider health-determinants and acting on a better understanding of relationships. Informed and co-ordinated air pollution mitigation and public health action in high deprivation and pollution areas can reduce risks and inequalities. To achieve this, greater public health integration and collaboration in local air quality management policy and practice is needed.

Desenvolvimento de Biossimilares no Brasil

Este artigo apresenta uma breve visão do advento da indústria de biossimilares no Brasil e no mundo. Os biossimilares são medicamentos originários de proteínas terapêuticas ou biológicas, cujas patentes estão expiradas ou em expiração. Analogamente à indústria farmacêutica de genéricos, a expiração das patentes dos medicamentos biológicos condiciona o surgimento de um novo segmento na indústria farmacêutica. Seu advento enseja a transposição de inúmeras barreiras, não somente regulatórias, de propriedade intelectual, bem como de processos e domínio da expertise tecnológica. Esse nível de complexidade impõe às novas empresas que assumam a produção de biossimilares, o mesmo patamar estratégico das empresas originadoras ou detentoras das patentes. A importância dos biossimilares se deve no contexto de saúde pública, aos altos custos dos biológicos originadores. Como a incidência de doenças crônico-degenerativas dominará o cenário dos sistemas de saúde, devido ao envelhecimento da população, a emergência dos biossimilares acarretará reduções substanciais de custos.

Comorbidities and factors associated with central nervous system infections and death in non-perinatal listeriosis: a clinical case series.

BackgroundListeriosis is a rare disease caused by the bacterium Listeria monocytogenes and mainly affects at risk people. Listeriosis can lead to sepsis, central nervous system (CNS) infections and death. The objectives of this study were to describe and quantify comorbidities and neurological sequelae underlying non-perinatal listeriosis cases and to describe the factors associated with death and CNS infections in non-perinatal listeriosis.MethodsWe retrospectively collected clinical data through computerized, paper or microfilmed medical records in two Belgian university hospitals. Logistic regression models and likelihood ratio tests allowed identifying factors associated with death and CNS infections.ResultsSixty-four cases of non-perinatal listeriosis were included in the clinical case series and 84 % were affected by at least one comorbid condition. The main comorbidities were cancer, renal and severe cardio-vascular diseases. Twenty-nine patients (45 %) suffered from a CNS infection and 14 patients (22 %) died during hospitalization, among whom six (43 %) had a CNS involvement. Among surviving patients, eleven suffered from neurological sequelae (22 %) at hospital discharge; all had CNS infection. Five of these patients (45 %) still suffered of their neurological sequelae after a median follow-up of one year (range: 0.08–19). The factor associated with death during the hospitalization was the presence of a severe cardiovascular disease (OR = 4.72, p = 0.015). Two factors inversely related with CNS infections were antibiotic monotherapy (OR = 0.28, p = 0.04) and the presence of renal disease (OR = 0.18, p = 0.02).ConclusionsIn a public health context these results could be a starting point for future burden of listeriosis studies taking into account comorbidity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1602-3) contains supplementary material, which is available to authorized users.

QualisSUS-Redes e as proposições do Banco Mundial: problematizações críticas

O presente artigo tem por objetivo apresentar problematizações críticas acerca do QualiSUs-Redes - programa do Ministério da Saúde financiado pelo Banco Mundial. Através de uma pesquisa junto aos documentos que subsidiam o programa e às referências teóricas que tratam do mesmo, foi realizada uma apreciação das principais propostas do Programa. O estudo demonstrou que, apesar do QualiSUS-Redes ter em sua composição direcionamentos que buscam avanços na qualificação dos serviços públicos de saúde, é necessário problematizar o alinhamento aos ditames do Banco Mundial, em um contexto de ataque às políticas públicas de saúde, para desmistificar os fundamentos políticos e econômicos dos programas governamentais.

Carbapenem-resistant Gram-negative bacteria - analysis of the data obtained through a mandatory reporting system in the Rhine-Main region, Germany, 2012-2015.

Background: Multidrug-resistant Gram-negative bacteria (MRGN) and the infections they cause are a serious threat and a challenge to the healthcare system. This particularly applies to carbapenem-resistant Gram-negative bacteria (CRGN). Currently, the introduction of a nationwide mandatory notification system for CRGN in Germany is under consideration. Against this background, this paper presents an analysis of the mandatory reporting system for CRGN in effect since November 2011 in the federal state of Hesse (Germany). Materials and methods: All carbapenem-resistant Gram-negative bacteria and the detected carbapenemases reported to the public health department of the city of Frankfurt am Main, Hesse, Germany, on the basis of the mandatory notification system were analyzed.Results: 827 CRGN cases were reported to the public health department of Frankfurt/Main between April 2012 and December 2015. The following bacterial species were reported: Pseudomonas spp. (n=268), Acinetobacter spp. (n=183), Klebsiella spp. (n=195), Enterobacter spp. (n=77), Escherichia coli (n=75) and others (n=29). Between 2012 and 2015, a reduction of the CRGN reports was noticed, mainly due to changes in the reporting of Pseudomonas spp. Between 2012 and 2015, the total number of notifications decreased slightly, although the number of reported CRGN in screening samples increased, thus giving no indication of a decreased testing frequency. For 10.5% of the patients, the place of residence was not Germany, 18.0% of the patients had previously stayed in hospitals abroad, often in countries with a high CRGN prevalence. CRGN bacteria were reported from all of Frankfurt’s hospitals, and 3.9% were reported from out-patient care facilities. Carbapenemases were detected and reported in 251 CRGN bacteria, including 73 OXA-48, 76 OXA-23, 56 NDM subtypes, and 21 KPC subtypes. There have been no major epidemiological signs of outbreak scenarios.Discussion: CRGN bacteria are already widespread in patients from hospitals and out-patient care facilities. Clearly, infection control measurements should therefore not only include hospital patients but also those receiving out-patient care. Screening strategies focused on patients from foreign countries with high MRGN prevalence is not sufficient, as only 10.5% of MRGN patients resided in those countries, and only 18% of the patients had been previously treated in a foreign hospital. In a public health context, infection control measures should therefore encompass broader screening strategies.

El tratamiento psicológico de la tricotolomanía: un estudio de caso

This paper presents a clinical case of trichotillomania, thus aims to present in detail the procedure followed in a public health context, using cognitive-behavioral techniques, in order to deepen the knowledge of the efficacy of these treatment procedures and demonstrate the feasibility of their use. The results obtained showed significant improvements in different clinical aspects: first, the hair pulling behavior disappeared completely; moreover, anxiety diminished significantly and mood normalized. This allows us to conclude that the intervention was successful.

REIMBURSEMENT OF CELL-BASED REGENERATIVE THERAPY IN THE UK AND FRANCE.

Cell-based regenerative therapies are presented as being able to cure the diseases of the twenty-first century, especially those coming from the degeneration of the aging human body. But their specific nature based on biological materials raises particular challenging issues on how regulation should frame biomedical innovation for society's benefit regarding public health. The European Union (EU) supports the development of cell-based regenerative therapies that are medicinal products with a specific regulation providing their wide access to the European market for European patients. However, once these medicinal products have obtained a European marketing authorisation, they are still far away from being fully accessible to European patients in all EU Member States. Whereas there is much written on the EU regulatory system for new biotechnologies, there is no systematic legal study comparing the insurance provisions in two EU countries. Focussing on the situation in the UK and France that are based on two different healthcare systems, this paper is based on a comparative methodological approach. It raises the question of regulatory reimbursement mechanisms that determine access to innovative treatments and their consequences for social protection systems in the general context of public health. After having compared the French and English regulations of cell-based regenerative therapy regarding pricing and reimbursement, this papers analyses how England and France are addressing two main challenges of cell-based regenerative therapy, to take into account their long-term benefit through their potential curative nature and their high upfront cost, towards their adoption within the English and French healthcare systems. It concludes that England and France have different general legal frameworks that are not specific to the reimbursement of cell-based regenerative therapy, although their two current and respective trends would bring more convergence between the two systems while addressing the main challenges for the reimbursement of these therapies. Nevertheless, despite their current differences, neither the English nor the French national healthcare system has yet approved the reimbursement of cell-based regenerative therapies. The paper highlights where both systems could be learning from each others' experiences to favour the adoption of cell-based regenerative therapies through the adaptation of their reimbursement methodologies. It also emphasises the gap between market access and patients' access, and it calls for research and discussions through reflexive agencies such as the Regenerative Medicine Expert Group in the UK.

Supporting successful implementation of public health interventions: protocol for a realist synthesis.

BackgroundThere is a growing emphasis in public health on the importance of evidence-based interventions to improve population health and reduce health inequities. Equally important is the need for knowledge about how to implement these interventions successfully. Yet, a gap remains between the development of evidence-based public health interventions and their successful implementation. Conventional systematic reviews have been conducted on effective implementation in health care, but few in public health, so their relevance to public health is unclear. In most reviews, stringent inclusion criteria have excluded entire bodies of evidence that may be relevant for policy makers, program planners, and practitioners to understand implementation in the unique public health context. Realist synthesis is a theory-driven methodology that draws on diverse data from different study designs to explain how and why observed outcomes occur in different contexts and thus may be more appropriate for public health.MethodsThis paper presents a realist review protocol to answer the research question: Why are some public health interventions successfully implemented and others not? Based on a review of implementation theories and frameworks, we developed an initial program theory, adapted for public health from the Consolidated Framework for Implementation Research, to explain the implementation outcomes of public health interventions within particular contexts. This will guide us through the review process, which comprises eight iterative steps based on established realist review guidelines and quality standards. We aim to refine this initial theory into a ‘final’ realist program theory that explains important context-mechanism-outcome configurations in the successful implementation of public health interventions.DiscussionDeveloping new public health interventions is costly and policy windows that support their implementation can be short lived. Ineffective implementation wastes scarce resources and is neither affordable nor sustainable. Public health interventions that are not implemented will not have their intended effects on improving population health and promoting health equity. This synthesis will provide evidence to support effective implementation of public health interventions taking into account the variable context of interventions. A series of knowledge translation products specific to the needs of knowledge users will be developed to provide implementation support.Systematic review registrationPROSPERO CRD42015030052Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0229-1) contains supplementary material, which is available to authorized users.

Group work in the public health context: A proposal for training in psychology.

The entry of psychologists into the public health sector in Brazil is usually connected to a traditional clinical model, and, thus, marked by a lack of training for group work. A reflection on the training of psychologists for group work is essential. Aiming at contributing to this theme, the objective of this article is to discuss the training for group work in the public health sector. In particular, we aim to introduce a proposal for training in psychology in a Brazilian public university, covering a theoretical-practical module, as well as basic and professionalizing internship programmes.

Considerations for Public Health Organizations Attempting to Implement a Social Media Presence: A Qualitative Study.

BackgroundIn the past decade, social media has become an integral part of our everyday lives, but research on how this tool is used by public health workers and organizations is still developing. Budget cuts and staff reduction in county departments have required employees to take on more responsibilities. These reductions have caused a reduction in the time for training or collaborating with others in the field. To make up for the loss, many employees are seeking collaboration through social media sites but are unable to do so because state departments block these Internet sites.ObjectiveThis study sought to highlight the key considerations and decision-making process for a public health organization deciding whether to implement a social media presence for their organization.MethodsUsing 3 structured interviews, 15 stakeholders were questioned on their personal experience with social media, experience within the context of public health, and their thoughts on implementation for their center. Interviews were coded using constant comparative qualitative methods.ResultsThe following themes emerged from the interviews: (1) personal experience with technology and social networking sites, (2) use of social networking sites in public health, (3) use of social networking sites in work environments, (4) social networking sites access, (5) ways the Rural South Public Health Training Center could use social networking sites, and (6) perceived outcomes of social networking site usage for the Rural South Public Health Training Center (positive and negative).ConclusionsThe collective voice of the center showed a positive perceived perception of social media implementation, with the benefits outweighing the risks. Despite the benefits, there is a cautious skepticism of the importance of social networking site use.

An improved cumulative sum‐based procedure for prospective disease surveillance for count data in multiple regions

We present an improved procedure for detecting outbreaks in multiple spatial regions using count data. We combine well-known methods for disease surveillance with recent developments from other areas to provide a more powerful procedure that is still relatively simple and fast to implement. Disease counts from neighboring regions are aggregated to compute a Poisson cumulative sum statistic for each region of interest. Instead of controlling the average run length criterion in the monitoring process, we instead utilize the FDR, which is more appropriate in a public health context. Additionally, p-values are used to make decisions instead of traditional critical values. The use of the FDR and p-values in testing allows us to utilize recently developed multiple testing methodologies, greatly increasing the power of this procedure. This is verified using a simulation experiment. The simplicity and rapid detection ability of this procedure make it useful in disease surveillance settings. The procedure is successfully applied in detecting the 2011 Salmonella Newport outbreak in 16 German federal states. Copyright © 2016 John Wiley & Sons, Ltd.

Application of GIS technology in public health: successes and challenges.

The uptake and acceptance of Geographic Information Systems (GIS) technology has increased since the early 1990s and public health applications are rapidly expanding. In this paper, we summarize the common uses of GIS technology in the public health sector, emphasizing applications related to mapping and understanding of parasitic diseases. We also present some of the success stories, and discuss the challenges that still prevent a full scope application of GIS technology in the public health context. Geographical analysis has allowed researchers to interlink health, population and environmental data, thus enabling them to evaluate and quantify relationships between health-related variables and environmental risk factors at different geographical scales. The ability to access, share and utilize satellite and remote-sensing data has made possible even wider understanding of disease processes and of their links to the environment, an important consideration in the study of parasitic diseases. For example, disease prevention and control strategies resulting from investigations conducted in a GIS environment have been applied in many areas, particularly in Africa. However, there remain several challenges to a more widespread use of GIS technology, such as: limited access to GIS infrastructure, inadequate technical and analytical skills, and uneven data availability. Opportunities exist for international collaboration to address these limitations through knowledge sharing and governance.

A public health commissioner's approach to 0–5 services

Viriginia Pearson considers the importance of children's health and wellbeing in a public health context, and why health visitors should grasp the opportunities that present as a result of the transfer of commissioning responsibilities.

Multi-laboratory survey of qPCR enterococci analysis method performance in U.S. coastal and inland surface waters

Quantitative polymerase chain reaction (qPCR) has become a frequently used technique for quantifying enterococci in recreational surface waters, but there are several methodological options. Here we evaluated how three method permutations, type of mastermix, sample extract dilution and use of controls in results calculation, affect method reliability among multiple laboratories with respect to sample interference. Multiple samples from each of 22 sites representing an array of habitat types were analyzed using EPA Method 1611 and 1609 reagents with full strength and five-fold diluted extracts. The presence of interference was assessed three ways: using sample processing and PCR amplifications controls; consistency of results across extract dilutions; and relative recovery of target genes from spiked enterococci in water sample compared to control matrices with acceptable recovery defined as 50 to 200%. Method 1609, which is based on an environmental mastermix, was found to be superior to Method 1611, which is based on a universal mastermix. Method 1611 had over a 40% control assay failure rate with undiluted extracts and a 6% failure rate with diluted extracts. Method 1609 failed in only 11% and 3% of undiluted and diluted extracts analyses. Use of sample processing control assay results in the delta–delta Ct method for calculating relative target gene recoveries increased the number of acceptable recovery results. Delta–delta tended to bias recoveries from apparent partially inhibitory samples on the high side which could help in avoiding potential underestimates of enterococci — an important consideration in a public health context. Control assay and delta–delta recovery results were largely consistent across the range of habitats sampled, and among laboratories. The methodological option that best balanced acceptable estimated target gene recoveries with method sensitivity and avoidance of underestimated enterococci densities was Method 1609 without extract dilution and using the delta–delta calculation method. The applicability of this method can be extended by the analysis of diluted extracts to sites where interference is indicated but, particularly in these instances, should be confirmed by augmenting the control assays with analyses for target gene recoveries from spiked target organisms.

Systematic review on Endolimax nana: A less well studied intestinal ameba.

Of the so-called nonpathogenic intestinal protozoa, Endolimax nana belongs to the ones least well described. Most data on E. nana have emerged from general surveys of intestinal parasites in selected cohorts and mostly in the absence of any particular focus on Endolimax. Hence, the genus of Endolimax remains largely unexplored in terms of morphology, taxonomy, genetic diversity, host specificity, and epidemiology. In this review, we seek to provide an overview of the work that has been performed on the parasite since the genus Endolimax was described by Kuenen and Swellengrebel in 1917 and suggest activities that may pave the way for a better understanding of E. nana in a clinical and public health context.

Acute hepatitis B virus infection or acute exacerbation of chronic hepatitis B infection: the differential serological diagnosis.

Acute exacerbations of chronic hepatitis B are common, and may even be the first presentation of hepatitis B virus (HBV) infection. Sometimes, patients involved in these scenarios may have mistaken diagnosis of acute hepatitis B. The reason for the confusion is that the two forms of infection manifestation resemble remarkably in clinical, biochemical, and serological features, such as apparent rapid onset of severe disease, advanced grades of encephalopathy, high aminotransferases and prolonged international normalized ratios (INRs), as well as positivity for HBsAg and for IgM anti-HBc antibodies and DNA detection. Therefore, these two entities cannot be distinguished easily without historical information of HBV-associated chronic infection or recent HBV exposure, information that is often inaccurate. Considering the different prognoses, treatment strategies, and the epidemiological impact in the public health context, the correct diagnosis is extremely important. Despite the lack of effective and reliable tests to differentiate between acute infection and acute exacerbation of chronic HBV infection, the expression and kinetic evaluation of viral markers present in the circulation of individuals infected, the observation of physical-chemical properties of specific antibodies, and the combination of these findings represent some strategies in serology that could assist in differentiating between the two entities, or at least in the guidance for the correct diagnosis.

Measuring the contributions of prevention and treatment of illness to changing life expectancy with avoidable mortality as the outcome indicator: how to deal with new diseases

BackgroundAvoidable mortality is an important outcome indicator of the effectiveness of health care. It is commonly used to quantify the contribution of health care to changes in life expectancy among people dying prematurely. This method assumes that the only determinants of avoidable mortality are those of health care, which can be separated into prevention and treatment contributions. However, there might be other determinants. If so, the apportionment into prevention or treatment gives an erroneous picture; this occurs when a new disease manifests itself, and mortality increases. We illustrate this by examining the history of HIV infection since its emergence as a new disease, and propose an alternative method for dealing with this anomaly. MethodsWe tried to examine what might have happened to premature mortality in England and Wales during 1980–2010 if there had been no means of preventing or treating HIV infection. We hoped to compare that scenario with what actually happened. The difference in mortality from HIV infection between the two scenarios would then have to be apportioned to prevention and treatment. However, because this scenario is unobservable, the case of South Africa, which allocated far fewer resources for prevention, was used as counterfactual. FindingsWith the existing methodology, prevention and treatment of HIV were estimated to have a negative contribution of 0·3% to the 2·02 years gained in life expectancy during 1980–94 and a positive contribution of 0·2% to the 1·62 years gained during 1994–2010. A negative contribution makes sense only when health care is failing. A comparison of what could have happened in life expectancy (a decline of 1·84 years) under lower levels of HIV prevention and what actually happened (the increase of 1·62 years) can be used to estimate the effect of the combination of prevention and treatment of HIV. This led to a positive and significantly larger estimate of a 73% contribution of HIV control to the decline in premature mortality. InterpretationExisting methodology of apportioning changes in life expectancy into prevention and treatment effects cannot deal with situations that result in increased mortality, particularly in the public health context where the effect can be large. FundingNone.

Organisational factors affecting policy and programme decision making in a public health policy environment

Organisational factors can affect the success of interventions aimed at increasing research use. Research is needed to identify organisational factors affecting research use in specific public health policy contexts. Qualitative interviews with decision makers from a specific public health context identified a range of organisational factors that affected policy and programme decision making. Interestingly, factors affecting decision making generally were comparable to factors that affect research use specifically, highlighting the complexity of policy and programme decision making. Results revealed a window of opportunity to frame increased research use as part of broader organisational change aimed at improving policy and programme development and outcome measurement.

Smoking, vaping and public health: Time to be creative.

The development of policies on vaping in health care organizations (HCOs) needs to be based on a solid understanding of science and a recognition of individual rights. It should also be seen in the broader public health context of innovative alternative nicotine delivery systems playing a key role in ending the immense devastation of combustible cigarettes. Opposition to vaping based on inaccurate and incomplete information, or fear of unlikely and avoidable hypothetical unintended consequences, will invariably cause great harm to individuals, impede rather than assist the attainment of public health objectives, and unnecessarily prolong the epidemic of cigarette-caused diseases.