Public Health Management Research Articles

Seroprevalence of Visceral Leishmaniasis in Children Up To 12 Years Old of Rural Areas from Kermanshah Province, Western Part of Iran.

After the earthquake in 2017 a few new cases of visceral leishmaniasis (VL) were reported from SarPol-e-Zahab district of Kermanshah Province, western part of Iran. This study was conducted to determine the seroprevalence in Kermanshah Province. This descriptive cross-sectional study was conducted on children up to 12 years of age from SarPol-e-Zahab County, Kermanshah Province, western part of Iran in 2021. For each individual, a questionnaire including age, sex, clinical features, history of the disease, and contact with canines as reservoir hosts of VL were completed, separately. To determine VL seroprevalence, blood samples were collected from the children and after centrifugation, the sera samples were separated and tested using Direct Agglutination Test (DAT) for detection of anti-L. infantum antibodies. Statistical analyses were performed using SPSS16. Totally, 13 persons were seropositive; 7 samples with titer 1:800, 3 samples had 1:1600, 2 samples had 1:3200 and 1 sample had 1:6400. None of the seropositive cases had a history of kala-azar. There was no significant difference between males and females at titers of anti-Leishmania specific antibodies. L. infantum infection is being circulated with low prevalence in children up to 12 years old from SarPol-e-Zahab County but it is necessary that the surveillance system is regularly monitored among physicians and public health managers in the studied areas.

Detection of DENV-2 and ZIKV coinfection in southeastern Brazil by serum and urine testing.

Aedes aegypti mosquito-borne diseases have a significant impact on public health in Brazil. In this study, we investigated the presence of the Zika virus (ZIKV) and dengue virus (DENV) in serum and urine samples from symptomatic participants who attended an Emergency Care Unit located in a city in the northwestern region of São Paulo between February 2018 and April 2019. Serum and urine samples were collected from participants suspected of having arbovirus infection. After the extraction of viral RNA, viral detection was performed by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) (One-Step RT-qPCR). A total of 305 participants participated in this study. A total of 283 blood and 270 urine samples were collected. Of 305 patients, 36.4% (111/305) were positive for ZIKV, 43.3% (132/305) for DENV2, and 0.3% (1/305) for DENV1. Coinfection with ZIKV/DENV2 was observed in 13.1% of participants. If only serum samples were used, ZIKV detection would have decreased to 23.3% (71/305). Of all the participants included in the study, only one was suspected of having ZIKV infection based on clinical diagnosis, and the remaining participants were suspected of having DENV. By testing serum and urine samples, we increased the detection of both viruses and detected considerable levels of ZIKV and DENV-2 coinfection when compared to other studies. Additionally, we detected an unnoticed ZIKV outbreak in the city. These findings highlight the importance of the molecular diagnosis of arboviruses to aid public health surveillance and management strategies.

Advances in the application of molecular diagnostic techniques for the detection of infectious disease pathogens (Review).

Infectious diseases are a major global cause of morbidity and mortality, seriously affecting public health and socioeconomic stability. Since infectious diseases can be caused by a wide variety of pathogens with similar clinical manifestations and symptoms that are difficult to accurately distinguish, selecting the appropriate diagnostic techniques for the rapid identification of pathogens is crucial for clinical disease diagnosis and public health management. However, traditional diagnostic techniques have low detection rates, long detection times and limited automation, which means that they do not meet the requirements for rapid diagnosis. Recent years have seen continuous developments in molecular detection technology, which has a higher sensitivity and specificity, shorter detection time and increased automation, and performs an important role in the early and rapid detection of infectious disease pathogens. The present study summarizes recent progress in molecular diagnostic technologies such as PCR, isothermal amplification, gene chips and high‑throughput sequencing for the detection of infectious disease pathogens, and compares the technical principles, advantages and disadvantages, applicability and costs of these diagnostic techniques.

Considering community care in public health responses: A national study regarding palliative care during a prolonged coronavirus disease 2019 lockdown

ObjectiveTo describe changes in palliative care characteristics, utilisation and outcomes in Victoria during a period of enhanced public health management and a prolonged lockdown due to coronavirus disease 2019. MethodsA national retrospective cohort study with palliative care service setting comparisons in Victoria and other mainland states was conducted. ResultsAnalysis of 48 non-Victorian services (n=53,428 patients) and 20 Victorian services (n=31,125 patients) showed that for community services, patient volume, average length of stay, functional dependency and the proportion of admissions in a deteriorating phase increased during the lockdown in Victoria, yet little changed in comparator states. Regarding inpatient services, the management of family/carer problems remained constant in comparator states, yet substantial fluctuations in outcomes in Victoria were observed. ConclusionsAs health systems adapt to changing circumstances during the pandemic, the ability to upscale community services is critical. Addressing the implications of shifting inpatient care to the community needs attention. Implications for public healthOur study highlights the need to ensure community care providers are adequately considered within public health management responses. ‘Joined up’ policy and implementation across care settings are essential, especially as major barriers to infection control and increased utilisation may be evident in the community during the coronavirus disease 2019 pandemic.

Problems of conceptualization of administrative and legal regulation in the healthcare sector of the Republic of Kazakhstan

The study analyzed social relations in the field of medical activity, problems of their legal regulation during various periods of formation of these relations. The subject of the study is the source and regulatory frame work of health care of the Republic of Kazakhstan. The study of the problem was carried out on the basis of an analysis of the historical retrospective of the development of medical law in Kazakhstan from 1913 to the present day, there was given a description and assessment of the main trends in the development of medical law, determined prospects for the development of this branch of law. Based on the study of the phenomenon of health care, the generalization of the theory and practice of international legal and state-legal impact on public relations in the field of health care, an attempt was made to identify and conceptually substantiate the legal foundations for the organization and implementation of legal regulation of the health care system in the Republic of Kazakhstan. The article formulates provisions that develop modern ideas about the essence of legal regulation of the health care system. Special attention is paid to the study of the general and political and legal aspects of the formation and development of the health care system, its place and role in the life of society and functional manifestations in the real state-legal reality of the Republic of Kazakhstan. Modern ideas about the problems of public health management are based on the need to solve the problem of improving the state's capacity in the field of public health.

Progress of polymer-based strategies in fungal disease management: Designed for different roles.

Fungal diseases have posed a great challenge to global health, but have fewer solutions compared to bacterial and viral infections. Development and application of new treatment modalities for fungi are limited by their inherent essential properties as eukaryotes. The microorganism identification and drug sensitivity analyze are limited by their proliferation rates. Moreover, there are currently no vaccines for prevention. Polymer science and related interdisciplinary technologies have revolutionized the field of fungal disease management. To date, numerous advanced polymer-based systems have been developed for management of fungal diseases, including prevention, diagnosis, treatment and monitoring. In this review, we provide an overview of current needs and advances in polymer-based strategies against fungal diseases. We high light various treatment modalities. Delivery systems of antifungal drugs, systems based on polymers' innate antifungal activities, and photodynamic therapies each follow their own mechanisms and unique design clues. We also discuss various prevention strategies including immunization and antifungal medical devices, and further describe point-of-care testing platforms as futuristic diagnostic and monitoring tools. The broad application of polymer-based strategies for both public and personal health management is prospected and integrated systems have become a promising direction. However, there is a gap between experimental studies and clinical translation. In future, well-designed in vivo trials should be conducted to reveal the underlying mechanisms and explore the efficacy as well as biosafety of polymer-based products.

The Role of Chinese Medicine in Chronic Diseases

The course of chronic disease is long and the etiology is complex. With the development of society, the occurrence of chronic disease is gradually becoming younger and the incidence is getting higher and higher. At present, the prevention and control of chronic diseases are mainly palliatives, intervention lags behind other disadvantages. Society is paying more and more attention to the prevention and control of chronic diseases. Due to various factors, the quality of life of many chronic disease patients is significantly different. TCM has diversified ways, precise diagnosis, and treatment of syndrome differentiation thought and means of diagnosis and treatment, TCM technology and operability, has a unique role in health management, health care, and other aspects so TCM has an important significance in the prevention and control of chronic diseases. From the Angle of TCM prevention of chronic diseases, this paper expounds on the theory of TCM prevention of chronic diseases, the key points of attention, and the methods of TCM treatment of chronic diseases. It can be concluded from the literature that the combination of evidence-based treatment of TCM and modern medical technology can improve the condition of patients to some extent. If the theory of "treatment before treatment" of TCM is applied to public health management.

The Economic Crisis (2008-2019) and Health Care in Zimbabwe: A Structured Literature Review

Background: The multi-prolonged nature and severity of the economic crisis (2008-2019) in Zimbabwe provided a distinct prospect to analyse the impact of economic crisis on the healthcare system. According to the System Model, the possible effect on health infrastructure, material resources, human resources, and financial resources is relevant. Aim: The structured literature review aimed to conduct an analysis of available evidence referring to the impact of economic crisis on health care in Zimbabwe between 2008 and 2019. Methods: A search of publications in English with inclusion criteria of timeframe between January, 2008 and December, 2019 that referred to the effect or impact of the economic crisis on health care was conducted utilising databases, such as Google Scholar, EBSCOhost, Pubmed, and UNISA repository. A thematic analysis for data extraction and synthesis was carried out. Exclusion criteria referred to irrelevance to the objectives and inappropriateness. Results: A total of 87 research publications were identified on various databases for analyses, 75 were excluded at different stages of screening, and 12 were included in the study. The thematic analysis, conducted according to the steps explained by Tesch (in Creswell 2014), revealed economic effects on health care in four themes: public health infrastructure, health workers, medical drugs, and public health expenditure and management, which were affected by an economic crisis. Conclusion: The effects of the economic crisis were evident in terms of negative changes in the healthcare delivery system, including a reduction in medical drug supply, loss of human resources, reduced financial resources, and an increase in the disease burden.

A citizen science approach to investigate the distribution, abundance, and pathogen infection of vector ticks through active surveillance

Tick-borne disease poses a growing public health burden in the United States and understanding the patterns of presence and density of infected vector ticks is key to developing and implementing effective public health management strategies. Citizen science has emerged as a highly effective means to generate data sets on the geographical distribution of tick species. But to date, nearly all citizen science studies of ticks are ‘passive surveillance’ programs in which researchers accept reports of ticks, together with either physical specimens or digital images, found opportunistically on people, pets, and livestock from community members for species identification and in some cases also tick-borne pathogen detection. These studies are limited because data are not collected systematically, making comparisons among locations and over time challenging, and introducing considerable reporting bias. In this study, we engaged citizen scientists in ‘active surveillance’ of host-seeking ticks, training volunteers to actively collect ticks on their woodland properties in an emergent region of tick-borne disease in the state of Maine, USA. We developed volunteer recruitment strategies, materials to train volunteers in data collection methods, field data collection protocols based on techniques used by professional scientists, and a variety of incentives to promote volunteer retention and satisfaction with their experiences, and we communicated research findings to participants. A total of 125 volunteers in 2020 and 181 volunteers in 2021 collected 7,246 ticks in southern and coastal Maine, including the American dog tick (Dermacentor variabilis, 4,023 specimens), the blacklegged tick (Ixodes scapularis, 3,092 specimens), and the rabbit tick (Haemaphysalis leporispalustris, 102 specimens). We demonstrated the feasibility of citizen scientists collecting ticks using active surveillance methods and found that volunteers were motivated to participate largely by their interest in the scientific problem and a desire to learn about ticks on their properties.

Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations - United States, 2023.

Chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality. Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality. Effective vaccines to prevent hepatitis B are available. This report updates and expands CDC's previously published Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection (MMWR Recomm Rep 2008;57[No. RR-8]) regarding screening for HBV infection in the United States. New recommendations include hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years. The report also expands risk-based testing recommendations to include the following populations, activities, exposures, or conditions associated with increased risk for HBV infection: persons incarcerated or formerly incarcerated in a jail, prison, or other detention setting; persons with a history of sexually transmitted infections or multiple sex partners; and persons with a history of hepatitis C virus infection. In addition, to provide increased access to testing, anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.

Whole-Genome Analysis of Antimicrobial-Resistant Salmonella enterica Isolated from Duck Carcasses in Hanoi, Vietnam.

Salmonella enterica is one of the most dangerous foodborne pathogens listed by the World Health Organization. In this study, whole-duck samples were collected at wet markets in five districts in Hanoi, Vietnam, in October 2019 to assess their Salmonella infection rates and evaluate the susceptibility of the isolated strains to antibiotics currently used in the prophylaxis and treatment of Salmonella infection. Based on the antibiotic resistance profiles, eight multidrug resistance strains were whole-genome-sequenced, and their antibiotic resistance genes, genotypes, multi-locus sequence-based typing (MLST), virulence factors, and plasmids were analyzed. The results of the antibiotic susceptibility test indicate that phenotypic resistance to tetracycline and cefazolin was the most common (82.4%, 28/34 samples). However, all isolates were susceptible to cefoxitin and meropenem. Among the eight sequenced strains, we identified 43 genes associated with resistance to multiple classes of antibiotics such as aminoglycoside, beta-lactam, chloramphenicol, lincosamide, quinolone, and tetracycline. Notably, all strains carried the blaCTX-M-55 gene, which confers resistance to third-generation antibiotics including cefotaxime, cefoperazone, ceftizoxime, and ceftazidime, as well as resistance genes of other broad-spectrum antibiotics used in clinical treatment such as gentamicin, tetracycline, chloramphenicol, and ampicillin. Forty-three different antibiotic resistance genes were predicted to be present in the isolated Salmonella strains' genomes. In addition, three plasmids were predicted in two strains, 43_S11 and 60_S17. The sequenced genomes also indicated that all strains carried SPI-1, SPI-2, and SPI-3. These SPIs are composed of antimicrobial resistance gene clusters and thus represent a potential threat to public health management. Taken together, this study highlights the extent of multidrug-resistant Salmonella contamination in duck meat in Vietnam.

Pollution and risk assessment of potentially toxic elements in soils from industrial and mining sites across China

Potentially toxic elements in soils (SPTEs) from industrial and mining sites (IMSs) often cause public health issues. However, previous studies have either focused on SPTEs in agricultural or urban areas, or in a single or few IMSs. A systematic assessment of the pollution and risk levels of SPTEs from IMS at the national scale is lacking. Here, we obtained SPTE (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn) concentrations from IMSs across China based on 188 peer-reviewed articles published between 2004 and 2022 and quantified their pollution and risk levels using the pollution index and risk assessment model, respectively. The results indicated that the average concentrations of the eight SPTEs were 4.42–270.50 times the corresponding background values, and 19.58% of As, 14.39% of Zn, 12.79% of Pb, and 8.03% of Cd exceeded the corresponding soil risk screening values in these IMSs. In addition, 27.13% of the examined IMS had one or more SPTE pollution, mainly distributed in the southwest and south central China. On the examined IMSs, 81.91% had moderate or severe ecological risks, which were mainly caused by Cd, Hg, As, and Pb; 23.40% showed non-carcinogenic risk and 11.70% demonstrated carcinogenic risk. The primary exposure pathways of the former were ingestion and inhalation, while that for the latter was ingestion. A Monte Carlo simulation also confirmed the health risk assessment results. As, Cd, Hg, and Pb were identified as priority control SPTEs, and Hunan, Guangxi, Guangdong, Yunnan, and Guizhou were selected as the key control provinces. Our results provide valuable information for public health and soil environment management in China.

Applying an ecosystem services framework on nature and mental health to recreational blue space visits across 18 countries

The effects of ‘nature’ on mental health and subjective well-being have yet to be consistently integrated into ecosystem service models and frameworks. To address this gap, we used data on subjective mental well-being from an 18-country survey to test a conceptual model integrating mental health with ecosystem services, initially proposed by Bratman et al. We analysed a range of individual and contextual factors in the context of 14,998 recreational visits to blue spaces, outdoor environments which prominently feature water. Consistent with the conceptual model, subjective mental well-being outcomes were dependent upon on a complex interplay of environmental type and quality, visit characteristics, and individual factors. These results have implications for public health and environmental management, as they may help identify the bluespace locations, environmental features, and key activities, that are most likely to impact well-being, but also potentially affect recreational demand on fragile aquatic ecosystems.

Artificial intelligence-based tools applied to pathological diagnosis of microbiological diseases.

Infectious diseases still threaten the global community, especially in resource-limited countries. An accurate diagnosis is paramount to proper patient and public health management. Identification of many microbes still relies on manual microscopic examination, a time-consuming process requiring skilled staff. Thus, artificial intelligence (AI) has been exploited for identification of microorganisms. A systematic search was carried out using electronic databases looking for studies dealing with the application of AI to pathology microbiology specimens. Of 4596 retrieved articles, 110 were included. The main applications of AI regarded malaria (54 studies), bacteria (28), nematodes (14), and other protozoa (11). Most publications examined cytological material (95, 86%), mainly analyzing images acquired through microscope cameras (65, 59%) or coupled with smartphones (16, 15%). Various deep-learning strategies were used for the analysis of digital images, achieving highly satisfactory results. The published evidence suggests that AI can be reliably utilized for assisting pathologists in the detection of microorganisms. Further technologic improvement and availability of datasets for training AI-based algorithms would help expand this field and widen its adoption, especially for developing countries.

Management and Leadership Development in Healthcare Professionals

leadership; Nepal; public health; training activities.

Emergency management pandemic planning: An analysis of state emergency plans.

Conventional wisdom holds that pre-event planning is a key factor in effective disaster response. In assessing the response to the Coronavirus Disease 2019 (COVID-19) pandemic, it is necessary to evaluate the extent to which emergency management agencies were prepared to respond to a pandemic, particularly given the unusual nature of this event, ie, scope, scale, and length of response. While emergency management agencies at every level of government have been involved in the COVID-19 response, state-level governments have taken on a prominent and atypical lead-ership role. This study assesses the extent and role that emergency management agencies planned for a pandemic scenario. Understanding the extent to which state-level emergency management agencies planned for an event like the COVID-19 pandemic and what they anticipated their roles to provide insight for future revisions in pandemic planning. This study addresses two related research questions: RQ 1: To what extent did state-level emergency management agencies account for a pandemic in emergency management response plans prior to COVID-19? RQ 2: What was the planned role of state-level emergency management agencies in the response to a pandemic? An analysis of state-level emergency management plans found that, although all states with available emergency management response plans included pandemics, there was significant variation in the extent of the inclusion, and the role prescribed for emergency management. Public health and emergency management response plans were congruent with respect to the planned role of emergency management.

Promotion of healthy nutrition in primary and secondary cardiovascular disease prevention: a clinical consensus statement from the European Association of Preventive Cardiology.

Poor dietary habits are common and lead to significant morbidity and mortality. However, addressing and improving nutrition in various cardiovascular settings remain sub-optimal. This paper discusses practical approaches to how nutritional counselling and promotion could be undertaken in primary care, cardiac rehabilitation, sports medicine, paediatric cardiology, and public health. Nutrition assessment in primary care could improve dietary patterns and use of e-technology is likely to revolutionize this. However, despite technological improvements, the use of smartphone apps to assist with healthier nutrition remains to be thoroughly evaluated. Cardiac rehabilitation programmes should provide individual nutritional plans adapted to the clinical characteristics of the patients and include their families in the dietary management. Nutrition for athletes depends on the sport and the individual and preference should be given to healthy foods, rather than nutritional supplements. Nutritional counselling is also very important in the management of children with familial hypercholesterolaemia and congenital heart disease. Finally, policies taxing unhealthy foods and promoting healthy eating at the population or workplace level could be effective for prevention of cardiovascular diseases. Within each setting, gaps in knowledge are provided. This clinical consensus statement contextualizes the clinician's role in nutrition management in primary care, cardiac rehabilitation, sports medicine, and public health, providing practical examples of how this could be achieved.

Variability in Media Content of Public Health Outbreak Coverage: A Crisis Communication Approach

ABSTRACT This study investigated the stage-specific nature of media coverage of a large-scale dengue outbreak in Bangladesh. We employed the three-stage model of crisis communication and the extended parallel process model as an integrated theoretical framework. A content analysis of two years (2019–2020) of media coverage (N = 615) showed that the number of dengue-related threat messages was significantly higher during the precrisis and crisis response stages than the postcrisis recovery stage. By delivering higher threat messages during the early phase, the media successfully alerted their audience about the forthcoming dengue crisis. During the crisis stage, when people are expected to engage with the crisis responses, efficacy messages are critical, along with threat messages. However, the number of efficacy messages was relatively low across the stages. Coverage of efficacy messages was not significantly different across the crisis stages. The findings also revealed significant relationships with the nature of media coverage and source types and story types. Findings have implications for public health crisis communication and management.

Au–Fe3O4 nanozyme coupled with CRISPR-Cas12a for sensitive and visual antibiotic resistance diagnosing

The accumulation and spread of antibiotic resistance bacteria (ARB) in the environment may accelerate the formation of superbugs and seriously threaten the health of all living beings. The timeliness and accurate diagnosing of antibiotic resistance is essential to controlling the propagation of superbugs in the environment and formulating effective public health management programs. Herein, we developed a speedy, sensitive, accurate, and user-friendly colorimetric assay for antibiotic resistance, via a synergistic combination of the peroxidase-like property of the Au–Fe3O4 nanozyme and the specific gene identification capability of the CRISPR-Cas12a. Once the CRISPR-Cas12a system recognizes a target resistance gene, it activates its trans-cleavage activity and subsequently releases the Au–Fe3O4 nanozymes, which oxidizes the 3,3,5,5-tetramethylbenzidine (TMB) with color change from transparent to blue. The diagnosing signals could be captured and analyzed by a smartphone. This method detected kanamycin-resistance genes, ampicillin-resistance genes, and chloramphenicol-resistance genes by simple operation steps with high sensitivity (<0.1 CFU μL−1) and speediness (<1 h). This approach may prove easy for the accurate and sensitive diagnosis of the ARGs or ARB in the field, thus surveilling and controlling the microbial water quality flexibly and efficiently.

Challenges of implementation of the preventive chemotherapy neglected tropical diseases programme in Ghana.

The Neglected Tropical Diseases programme since its implementation has improved the lives of many in the tropical and sub-tropical areas. Though witnessed many successes, the programme is continually facing challenges thus, preventing the attainment of various objectives. This study seeks to assess the challenges of implementation of the neglected tropical diseases programme in Ghana. The thematic analysis approach was used to analyze qualitative data collected from 18 key public health managers selected through purposive and snowballing procedures from the national, regional and district levels of Ghana Health Service. Data collection was done through in-depth interviews using semi-structured interview guides in line with the objective of the study. The Neglected Tropical Diseases Programme though received funding from external sources, faces multiple challenges which cut across financial, human and capital resources to external control. Specifically, inadequate resources, dwindling volunteerism, poor social mobilization, weak governmental commitment and weak monitoring were major challenges to implementation. These factors work individually and in combination to impede effective implementation. Ensuring state ownership, re-structuring implementation approaches to include top-down and bottom-up approaches and building capacity in monitoring and evaluation are recommended in order to meet the programme objectives and ensure sustainability. This study forms part of an original study on Implementation of the NTDs programme in Ghana. Aside the key issues discussed, it presents first-hand information on major implementation challenges that are relevant to researchers, students, practitioners and the general public and will apply widely to vertically implemented programmes in Ghana.