Public Health Information Research Articles

Comparing E-Cigarettes and Traditional Cigarettes in Relation to Myocardial Infarction, Arrhythmias, and Sudden Cardiac Death: A Systematic Review and Meta-Analysis.

The use of electronic cigarettes (e-cigarettes) as a perceived safer alternative to traditional cigarettes has grown rapidly. However, the cardiovascular risks associated with e-cigarettes compared to regular cigarettes remain unclear. To systematically review and compare the cardiovascular outcomes of e-cigarette use versus traditional cigarette use, focusing on the risks of myocardial infarction, arrhythmias, and sudden death. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Peer-reviewed studies published in English were included if they reported cardiovascular outcomes related to e-cigarette or traditional cigarette use. A total of 20 studies were included, covering observational and interventional studies focusing on heart rate variability, myocardial infarction, arrhythmias, and sudden cardiac events. The quality of the evidence was assessed using the GRADE criteria, and data were extracted and analyzed based on the PICOS (Population, Interventions, Comparisons, Outcomes, and Study designs) framework. The systematic review found that both e-cigarettes and traditional cigarettes pose significant cardiovascular risks, with traditional cigarettes linked to a higher incidence of myocardial infarction, arrhythmias, and sudden cardiac death. E-cigarette users also face increased risks of arrhythmias and myocardial infarction compared to non-smokers, primarily due to the constituents of aerosolized e-liquid, including nicotine and flavorings, which contribute to adverse cardiac effects. Regular e-cigarette use, particularly in combination with traditional cigarette use, was associated with a heightened risk of myocardial infarction. Studies also reported heart function abnormalities, such as systolic and diastolic dysfunction, and reduced ejection fractions. Additionally, changes in heart rate variability, heart rate, and blood pressure were observed, indicating both acute and chronic effects of e-cigarettes on cardiovascular autonomic regulation. While e-cigarettes may present a lower cardiovascular risk compared to traditional cigarettes, they are not without harm. Both products are linked to increased risks of myocardial infarction and arrhythmias, though traditional cigarettes pose a higher overall threat. Given the limitations in the current evidence base, particularly concerning the long-term effects of e-cigarette use, further research is needed to clarify these cardiovascular risks and inform public health guidelines.

Lessons Learned from the Zika Virus Epidemics: A Mounting Demand for Adopting Public Health Informatics Tools and Technologies for Epidemiological Surveillance and Outbreak Containment

Lessons Learned from the Zika Virus Epidemics: A Mounting Demand for Adopting Public Health Informatics Tools and Technologies for Epidemiological Surveillance and Outbreak Containment

Neuropsychological and Health Literacy Correlates of Science Knowledge Among Older and Younger Healthy Adults.

Science knowledge refers to the depth and breadth of facts acquired within the life, social, and earth sciences, and it has implications for both public and personal health. Drawing from cognitive aging theory, we examine whether levels of science knowledge are associated with age, neuropsychological functioning, and personal health literacy. Fifty-two younger and fifty older healthy adults completed our telephone-based study that included a commonly used test of science knowledge, as well as measures of neuropsychological functioning, health literacy, and relevant descriptives (e.g., mood). Adjusting for other demographics and neuropsychological functioning, older adults had significantly lower science knowledge test scores than younger adults. In the full sample, lower science knowledge showed medium-to-large associations with episodic memory, executive functions, and health literacy, independent of years of education. These results suggest that older adults' science knowledge falls slightly below that of their younger counterparts and is independently associated with higher order neuropsychological functions and aspects of personal health, which may have implications for accessing, understanding, and using relevant public health information across the lifespan.

Mapping the genetic landscape of treatable inherited metabolic disorders in a large Middle Eastern biobank

PurposeTo date, approximately 1400 inherited metabolic disorders (IMDs) have been described, some of which are treatable. It is estimated that 2% to 3% of live births worldwide are affected by treatable IMDs. Roughly 80% of IMDs are autosomal recessive, leading to a potentially higher incidence in regions with high consanguinity. MethodologyThe study utilized genome sequencing data from 14,060 adult Qatari participants who were recruited by the Qatar Biobank and sequenced by the Qatar Genome Program. The genome sequencing data were analyzed for 125 nuclear genes known to be associated with 115 treatable IMDs. ResultsOur study identified 253 pathogenic/likely pathogenic single-nucleotide variations associated with 69 treatable IMDs, including 211 known and 42 novel predicted loss-of-function variants. We estimated that approximately 1 in 13 unrelated individuals (8%) carry a heterozygous pathogenic variant for at least 1 of 46 treatable IMDs. Notably, phenylketonuria/hyperphenylalaninemia and homocystinuria had among the highest carrier frequencies (1 in 68 and 1 in 85, respectively). ConclusionPopulation-based studies of treatable IMDs, particularly in globally under-studied populations, can identify high-frequency alleles segregating in the community and inform public health policies, including carrier and newborn screening.

Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations.

The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health. Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development.

The impact of climate variation on the spread of Shiga toxin-producing E. coli.

Shiga toxin-producing Escherichia coli (STEC) is influenced by seasonality, but there is limited understanding of how specific climatic variables contribute to disease spread. This information aids in understanding disease transmission dynamics and could potentially inform public health modeling. This retrospective cohort study analyzed public health data from Ontario, Canada, between 2012 and 2021, along with historical climate data from Environment Canada. We employed Seasonal Autoregressive Integrated Moving Average (S-ARIMA) models to assess how temperature and precipitation impact the incidence of STEC infections, measured per 10,000,000 population. The study included 1658 confirmed STEC cases. A significant correlation was found between STEC incidence and climatic variables. Each degree Celsius increase in maximum temperature was associated with a rise of 3 STEC cases per 10,000,000 population (Centers for Disease Control and Prevention (2024)). Additionally, each millimeter of increased precipitation correlated with an increase of 1.1 cases per 10,000,000 population. The findings demonstrate a significant impact of temperature and precipitation on STEC transmission, highlighting the importance of integrating meteorological data into public health surveillance. This integration may help inform public health responses and support healthcare systems in planning for future outbreaks. Further studies are needed to refine predictive models and develop effective early warning systems for clinical settings.

Causal analyses in longitudinal observational studies in oral health: A scoping review.

Causal analysis including causal inference and causal mediation is pivotal to inform effective interventions. In modern epidemilogy, causal analysis involves four key steps: formulating causal questions, employing directed acyclic graphs (DAGs), conducting data management and selecting statistical strategies. Our objective was to conduct a scoping review to assess how longitudinal observational studies (LOSs) in dental field have integrated these four steps to contribute leverage evidence that inform oral public health interventions. LOSs focusing on determinants of dental caries published from 2012 to 2024 were systematically retrieved from five major databases. The Joanna Briggs Institute-scoping review guidance and the Covidence application were employed to identify eligible LOSs for being reviewed. Out of the 85 eligible LOSs, none formulated causal hypothesis by applying 'what if' question or investigated mediation across three levels of the determinants of oral health. A minority (18 studies, ~21.2%) employed DAGs to visualise relationships among study variables, while only one third (33 studies, ~39%) clearly defined confounders. The majority (64 studies, ~75%) incorporated a time-varying feature of their data, yet only a few (11 studies) fully leveraged this advanced aspect. Among these studies that fully utilised time-varying data, more than half encountered challenges in employing robust statistics to address confounders arising from such data dynamics. Dental LOSs have, to date, mostly focused on investigating associations over causality, often neglecting the four-step causal analysis and not fully utilising time-varying data. Researchers necessitate to shift their focus to causal inference and prioritise building capacity in causal analysis with a consistent four-step approach to advance the field. Studies exploring mechanisms linking determinants of dental caries across levels and leveraging time-varying data are strongly encouraged.

Unbiased care, unequal outcomes: a nursing telehealth intervention reveals systematic inequities in COVID-19 care delivery

BackgroundThe Covid Connected Care Center (C4), a low-barrier telephone nurse hotline, was developed at an academic medical center to increase access to healthcare information and services across the state of Oregon, including to those without a usual source of care. Other studies have demonstrated that telephone triage services can positively influence health behaviors, but it is not known how this effect is maintained across racial/ethnic groups. The objective of this study was to show that the C4 reached throughout the state of Oregon, was valuable to callers, and that recommendations given affected callers’ subsequent health-related behaviors.MethodsThis mixed-methods study, informed by the RE-AIM (Reach, Effectiveness, Addoption, Implementation and Maintenance) framework, assessed caller demographics and clinical care from March 30 2020 until September 8, 2021. Descriptive statistics, multivariable risk models and Zou’s modified Poisson modeling were applied to electronic health record and call system data; An inductive approach was used for patient and staff experience surveys and semi-structured interviews. Approval was obtained from the OHSU Institutional Review Board (Study 00021413).Results145,537 telephone calls and 92,100 text-based contacts (61% and 39%, respectively) were included. Callers tended to not have a usual source of primary care and utilized recommended services. Emergency department utilization was minimal (1.5%). Racial or ethnic disparities were not detected in the recommendations, but Black (RR 0.92, CI 0.86–0.98) and Multiracial (RR 0.90 CI 0.81–0.99) callers were less likely than non-Hispanic white callers to receive a COVID-19 test. Participants in the post-call survey (n = 50) would recommend this service to friends or family. Interviews with callers (n = 9) revealed this was because they valued assistance translating general recommendations into a personalized care plan. C4 staff interviewed (n = 9) valued the opportunity to serve the public. The C4 was a trusted resource to the public and reached the intended audiences. However, disparities in access to COVID-19 testing persisted.ConclusionsNursing triage hotlines can guide caller behavior and be an effective part of a robust public health information infrastructure.

Emerging Omicron Subvariants EG.5 and BA.2.86: Implications for COVID-19 Immunity and Surveillance

The SARS-CoV-2 virus, responsible for the COVID-19 pandemic, has continuously evolved since its emergence. Among its variants, the Omicron lineage has become globally dominant, displaying a diverse range of sublineages. Two significant sub lineages within Omicron are EG.5 and BA.2.8, which have gained attention due to their unique characteristics and potential implications. EG.5 is characterized by a constellation of mutations, including N501Y, L452R, and D614G. Similarly, BA.2.8 carries the L452Q and P681R mutations, which enhance its ability to evade antibodies elicited by prior infection or vaccination. Similar to those in the EG.5, the clinical severity and impact of BA.2.8 on public health measures are still being assessed. These sublineages, with their unique genetic profiles and transmissibility characteristics, pose challenges to virulence response efforts. Continued surveillance, genomic sequencing, and research are essential to understand their behavior, assess their impact, and inform public health strategies accordingly. By a comprehensive synthesis of the literature, genomic data, and epidemiological insights, this study provides an analysis of Omicron mutations’ transmission dynamics, and clinical implications associated with these variants. The significance of variant surveillance in informing public health responses to the COVID-19 pandemic is underscored, highlighting the critical role of genomic sequencing in tracking viral evolution and guiding interventions. This manuscript aimed to elucidate the mechanisms underlying variant emergence, assess vaccine effectiveness against emerging strains, and explore the broader implications for global public health. This study provides insights into vaccine-induced immunity and the potential impact of variants on vaccine efficacy. Overall, this communication aims to inform public health practitioners, policymakers, and researchers engaged in the battle against COVID-19, offering actionable insights to mitigate the spread of the virus and improve pandemic response strategies.

Knowledge, Attitudes, and Practices in Bungkulan Buleleng Village Communities Related to the Implementation of COVID-19 Vaccination

Background: The contribution of the community through their knowledge, attitudes, and practices are essential to control COVID-19 through vaccination.Objectives: This study aims to analyze the relationship between knowledge, attitudes, and practices of the community related to implementing the COVID-19 vaccine.Methods: This observational study with a cross-sectional design was carried out from June to July 2023. Samples of 155 respondents were obtained through convenience sampling. Inclusion criteria include the community domiciled in Bungkulan Village, aged ≥18 years, and is willing to be involved in research, while respondents who didn’t fill in the complete questionnaire are excluded from research. Data was collected using self-developed offline questionnaire. The relationship of knowledge, attitudes, and practices was analyzed by multiple linier regression and Spearman-rho test (95% CI).Results: Findings showed that the majority of respondents were aged 25-29 years old (30.32%), male (76.13%), graduated from high school (65.16%), worked (89.68%), didn’t experience comorbidities (96.13%) and AESI (87.10%), lack of knowledge (53.29 ± 23.24) but has a good attitude (75.18 ± 11.55) and practices (84.06 ± 16.17) related to the implementation of the COVID-19 vaccination. There is a significant relationship between knowledge with attitudes (r = 0.352; p = <0.001) and attitudes with practices (r = 0.257; p = <0.001), also knowledge and attitudes simultaneously influence the practice of Covid-19 vaccination (p=<0.001).Conclusion: A person's attitudes and practices in a positive direction tend to begin with good knowledge. Strong sources of public health information and communication are necessary to develop good knowledge.

Human echinococcosis incidence in Canada: A retrospective descriptive study using administrative hospital and ambulatory visit data, 2000-2020.

Echinococcosis is a zoonotic disease caused by the ingestion of tapeworm eggs shed by canids. The potential recent establishment of a more virulent European-type strain may be impacting human echinococcosis in Canada, yet information is limited. Administrative hospital and ambulatory visit data were used to provide a baseline of human echinococcosis cases in Canada between 2000-2020. Canadian Institute of Health Information's Discharge Abstract Database, Hospital Morbidity Database and National Ambulatory Care Reporting System were combined to identify cases. Risk ratios (RR) by demographic factors and cumulative incidences (CIN) over place and time were calculated. A total of 806 echinococcosis cases were identified in Canada between 2000-2020, for a mean annual CIN of 1.3 cases per million population. Over the two decades, the mean annual CIN of cases increased nationally (1.3-1.4 cases per million), in the Northwest Territories (6.3-9.1 cases per million), in Alberta (1.5-2.4 cases per million) and in the Atlantic provinces (0.2-0.6 cases per million). Those from the Territories had the highest risk of echinococcosis (RR 17.1; 95% confidence interval: 8.7-33.7). Though explanations are multifactorial, the new European-type strain may have a role in the small absolute increase in echinococcosis CIN in Canada observed over the study period. The CIN is likely underestimated and the validity of administrative data for analyzing zoonoses warrants investigation. Though this study contributes important awareness and a baseline, improved data are needed to clarify the effects of the new strain and inform public health response.

A Comparative Analysis of Drinking Water Provision and Hepatitis A Incidence in Uzbekistan in 2010-2023.

Objective This study aims to analyze the relationship between access to safe drinking water and the incidence of hepatitis A in Uzbekistan from 2010 to 2023to inform public health strategies for disease prevention. Methods We utilized hepatitis A incidence data from the Sanitary and Epidemiological Well-Being and Public Health Authority and drinking water provision data from the Government Statistics Agency of Uzbekistan. A linear regression analysis was performed using R 4.3.2 to investigate the correlation between these variables. The study examined hepatitis A cases per 100,000 population and the percentage of households with access to safe drinking water. Results Hepatitis A incidence fluctuated significantly over the study period, with a notable spike to 162 cases per 100,000 population in 2023, despite relatively stable access to safe drinking water (ranging from 67.4% to 77% of households). The analysis revealed a complex relationship between water access and hepatitis A incidence. The linear regression coefficient was 3.89 (adjusted R-squared: 0.3021, P-value: 0.02), indicating that each growing percent of water supply is raising the incidence of hepatitis 3.89 cases of hepatitis infection. Conclusion The reverse effect of water supply percentage and the incidence of hepatitis A incidence in Uzbekistan suggests that other factors play significant roles in disease transmission. These may include sanitation practices, hygiene behaviors, and vaccination coverage. The findings emphasize the need for a multifaceted approach to hepatitis A prevention, incorporating improved water infrastructure, enhanced sanitation, public education, and comprehensive vaccination programs. Further research is needed to identify specific determinants of hepatitis A transmission in Uzbekistan to guide targeted interventions and public health policies.

Whether COVID-19 Affected Hospital Death Rate in Split - Dalmatia County, Croatia

The main aim of this study was to examine whether the COVID-19 pandemic affected hospital death rate. A cross-sectional comparative study using two different periods, pre-COVID-19 (March 2019 to February 2020) and the COVID-19 era (March 2020 to February 2021) was employed to explore the possibilities of COVID-19 influencing hospital death rate in Split and Dalmatian County, Croatia. Data from the National Public Health Information System was used in this research. The indicators were statistically analyzed. The study showed that in the COVID-19 era, there was a significantly higher hospital death rate in comparison to the pre-COVID-19 era (z=-14.084; p<0.001), mainly due to the significant increase in hospital death rate from respiratory diseases. The Intensive Care Unit and the Infectious Diseases Department showed a significantly higher hospital death rate among hospital department. Among deaths with confirmed COVID-19, deaths from respiratory diseases were significantly more positive (z=23.975, p<0.001). The results of the study showed that COVID-19 had an impact on hospital death rate in Split-Dalmatia County. Given that the study analysed the first year of the pandemic, additional research will be needed over a wider period to get a more detailed insight of the impact of COVID-19 on hospital death rate in Croatia, as well as in other regions.

Influence of social media on health-related decision-making among adults attending an outpatient department of a tertiary care centre in India: A cross-sectional analytical study.

Background Social media platforms, especially Facebook and WhatsApp, can spread public health information effectively. We aimed to estimate the influence of health-related messages circulated through these social media platforms on health-related decision-making and its associated factors. Methods We did a cross-sectional analytical study among adults (aged >18 years) who visited the outpatient department of a tertiary care hospital in suburban West Bengal, during July-September 2021. A structured questionnaire was used regarding receiving health-related messages on social media and the subsequent effect on health-related decision-making in the past year. Results A total of 673 individuals participated in the study. Their mean (SD) age was 34.4 (10.2) years and 56.8% (382) were men, 50.8% (342) were graduates, 63.6% (428) were from rural areas and 82.9% (558) were active users of more than one social media platform. A total of 474 (70.4%; 95% CI 67.0-73.9) study participants reported health-related decision-making based on social media messages, whereas 44.7% (301) reported checking the authenticity of forwarded messages or posts or updates with healthcare professionals before making a decision. On adjusted analysis, participants who had secondary education (adjusted prevalence ratio [aPR] 1.40; 95% CI 1.01-1.94), used both the media (aPR 1.31; 95% CI 1.09-1.58) and checked the authenticity of the messages with a healthcare professional (aPR 1.52, 95% CI 1.38-1.68) were significantly more influenced by the messages, posts or updates received on social media platforms. Conclusion WhatsApp forwards or updates and Facebook posts or updates influence health-related decision-making among the Indian adult population.

Linking Maternal and Child Health Data to Enhance Public Health Surveillance and Implement Sustainable Interventions.

Our initiative aims to enhance the public health informatics infrastructure for surveillance of maternal and child health (MCH) using data captured from electronic health records (EHRs), public health information systems, and administrative health data. Our work includes development, validation, and application of linkage algorithms across records for mothers and children; integration of data across myriad sources; design of routine surveillance reports; and design of longitudinal studies to examine determinants and outcomes in MCH populations. Our work is conducted in partnership with governmental public health agencies, health care providers, academic institutions, and community-based organizations. Future work will build on the enhanced informatics infrastructure to draw from additional public health data sources and/or expand surveillance efforts to include prioritized MCH outcomes. We will further translate knowledge gained from surveillance into action, working with our partners to improve and sustain better MCH equitably in our population.

An observational cohort study to investigate the impact of dolutegravir in pregnancy and its obesogenic effects on the metabolic health of women living with HIV and their children: Study protocol.

Dolutegravir (DTG)-based antiretroviral therapy is the World Health Organization's preferred first-line regimen for all persons with HIV, including pregnant women. While DTG has been implicated as an obesogen associated with greater weight gain compared to other antiretrovirals, there is a paucity of data in pregnant women and their children. The Obesogenic oRigins of maternal and Child metabolic health Involving Dolutegravir (ORCHID) study is investigating associations between DTG, weight gain, and metabolic outcomes in the context of HIV. ORCHID is a prospective observational study taking place in Cape Town, South Africa (NCT04991402). A total of 1920 pregnant women with and without HIV infection are being followed from ≤18 weeks gestational age to 24 months postpartum with their children. Participants attend eleven study visits: 3 antenatal, delivery, and 7 postnatal visits. Several embedded sub-studies address specific scientific aims. Primary outcome measurements in mothers include anthropometry, blood pressure, body composition, dysglycemia, insulin resistance (IR), and dyslipidemia. Other maternal measures include demographics, resting energy expenditure, viral load, physical activity, dietary intake, hepatic steatosis, and repository specimens. Sub-study measurements include markers of adipose inflammation, gut integrity, and satiety/hunger, subcutaneous adipose tissue morphology and mitochondrial function, and metabolomics. Primary outcome measurements in children include anthropometry, adipose tissue mass, dysglycemia, IR, and dyslipidemia. Other variables include fetal growth, birth outcomes, medical/breastfeeding history, caloric intake, neurodevelopment, and repository specimens. Sub-study measurements include metabolites/lipid subspecies in umbilical cord blood, as well as breast milk composition and DTG exposure. ORCHID will play a pivotal role in defining obesogenic mechanisms and clinical consequences of DTG use in pregnancy in women with HIV and their children. It will provide insights into metabolic disease risk reduction in the context of HIV/DTG, identify intervention targets, and inform public health approaches to diminish chronic metabolic co-morbidities for women and children.

Longitudinal assessment of the impact of COVID-19 infection on mask-wearing behaviors

BackgroundWearing a mask was a crucial component in slowing the COVID-19 pandemic. However, little is known about the intersectionality between mask usage, risk perception, and infection. The purpose of this study was to investigate whether risk perceptions and masking behaviors are associated with contracting SARS-CoV-2 and how contracting SARS-CoV-2 subsequently changes masking behaviors in specific situations.MethodsThis cohort study utilized survey data from the UC San Diego ZAP COVID-19 study (n = 1,230) to evaluate the risk of contracting SARS-CoV-2 in relation to baseline risk perceptions and masking behaviors in various situations and how contracting SARS-CoV-2 affects subsequent masking behavior.ResultsWe found that more consistent self-reported mask use in indoor public spaces (p = 0.03) and in other people’s houses (p = 0.002) was associated with remaining free of SARS-CoV-2 infection. We also found that contracting SARS-CoV-2 was associated with a subsequent increase in mask use in other people’s houses (p = 0.01).ConclusionsOur findings suggest that consistent mask use is correlated with decreased infection and that contracting SARS-CoV-2 may modify mask use behaviors in high-risk situations. These findings may help inform future public health messaging for infectious disease prevention.Trial registrationThis study has not been previously registered as it is an observational study. There was no pre-registration of the analytic plan for the present study.

A model of academic-practice collaboration for facilitating informatics capacity and building a learning health system framework in public health.

The data modernization initiative (DMI) is a multi-year, multi-billion-dollar endeavor toward a robust public health information infrastructure. The various DMI projects (interoperability, analytics, workforce, governance) present an opportunity for a learning health system (LHS) framework in public health. The objective is to share an academic-practice partnership model between the University of Minnesota (UMN) and the Minnesota Department of Health (MDH) in advancing public health informatics (PHI) and its relationship to an LHS model. The UMN-MDH partnership was conceptualized in 2018 as a 1-year pilot with annual renewals through a time/cost-sharing faculty position with PHI expertise. The partnership focus was decided based on MDH's needs and mutual interests, with the core collaborating faculty (SR) being an embedded researcher at MDH. Responsibilities included supporting electronic case reporting (eCR), interoperability projects, and assisting MDH staff with PHI presentations/publications. The partnership has expanded to PHI workforce development through a national grant and now includes an interest in applying the LHS framework to MDH-DMI work. The MDH-DMI team has embarked upon 13 projects for assessment through an LHS approach: systems interoperability projects between MDH and healthcare/local public health (n = 6); systems modernization for MDH programs (n = 5); informatics workforce development (n = 1); and program governance (n = 1). Each project has been evaluated and/or has current/future assessment plans to synthesize learnings and create a feedback loop for iterative improvement. The partnership has been mutually beneficial as it met agreed upon metrics across both institutions. The program's productivity is showcased with shared authorship in 10 peer-reviewed proceedings/publications, 22 presentations and 16 posters across local/national conferences. The current case report of the UMN-MDH partnership is a relatively recent exemplar to support tangible LHS demonstration in public health. Building LHS momentum at MDH and other public health entities will require LHS champion(s) and continued academic collaboration.

SARS-CoV-2 seroprevalence in people living with HIV in South Sudan

ObjectivesThe burden of SARS-CoV-2 infection in people living with HIV (PLHIV) in South Sudan is unknown. MethodsWe conducted a cross-sectional seroprevalence survey of SARS-CoV-2 immunoglobulin (Ig) G antibodies and other diseases of public health importance (strongyloidiasis, toxoplasmosis) in PLHIV in South Sudan during April 1, 2020-April 30, 2022. We used a multiplex SARS-CoV-2 immunoassay to detect IgG antibodies targeting the SARS-CoV-2 spike, receptor binding domain, and nucelocapsid (N) proteins, and antigens for other pathogens (Strongyloides stercoralis and Toxoplasma gondii). ResultsAmong 3518 samples tested, seroprevalence of IgG antibodies to SARS-CoV-2 spike protein and receptor binding domain 591 and nucleocapsid ranged from 1.4% (95% confidence interval [CI]: 0.9-2.1%) in April-June 2020 to 53.3% (95% CI: 49.5-57.1%) in January-March 2022. The prevalence of S. stercoralis IgG ranged between 27.3% (95% CI: 23.4-31.5%) in October-December 2021 and 47.2% (95% CI: 37.8-56.8%) in July-September 2021, and, for T. gondii IgG, prevalence ranged from 15.5% (95% CI: 13.3-17.9%) in April-June 2020 to 36.2% (95% CI: 27.4-46.2%) July-September 2021. ConclusionsBy early 2022, PLHIV in South Sudan had high rates of SARS-CoV-2 seropositivity. Surveillance of diseases of global health concern in PLHIV is crucial to estimate population-level exposure and inform public health responses.

Evaluating barriers to reaching women with public health information in remote communities in Mali

Telecommunications offers an alternative or supplement to community-based interventions as a means of extending healthcare services and improving health outcomes in remote settings but can fail to reach target communities and achieve the desired impact if barriers to access are not overcome. We conducted seven focus group discussions and 26 interviews with community health workers, community leaders, and female members of the public who declared that they had or had not previously accessed free audio health messages provided via a mobile platform in two rural communities of Mali, Koulikoro and Bougouni. A content analysis showed that participants accessed and trusted health information from a range of sources, including radio, telephone and television, as well as town criers, local relays and community health centres. Barriers to access faced by women included economic factors, lack of network or electricity, and social factors such as illiteracy, cultural restrictions and being unaware of mobile communication. Through analysis and interpretation of the participants’ responses, we have made recommendations for future campaigns for the dissemination of health-related information for women in remote settings.