Public Health Management Research Articles

Analysis of errors in medical certificates of cause of death (MCCD) at a tertiary care institute in 2022

AimMedical Certificates of Cause of Death (MCCD) play a pivotal role in shaping national health statistics and public health initiatives. This study investigates the quality of MCCD completion at a Tertiary Care Institute in India, focusing on certification errors made by physicians while issuing death certificates. MethodsUsing a retrospective, cross-sectional approach, 1603 MCCDs issued during the study period were analyzed for formal correctness and mistakes. The study employed predefined categories to assess the nature and impact of these errors. While this research did not verify the factual accuracy of the MCCDs against patients’ medical records, it categorized errors into major and minor, based on their potential to influence the accurate classification of the underlying cause of death.ResultsThe study showed the presence of errors in all 1603 death certificates examined, categorizing them as major, minor, or both. Notably, 99.2% of cases lacked the mention of the time interval between death and the morbid condition. Analysis of major errors indicated that in 64.6% of cases, competing causes of death were mentioned, while 77.4% featured multiple causes of death. Furthermore, improper sequencing of the cause of death was identified in 11.2%, whereas 7.9% had poorly defined conditions as the cause of death.ConclusionTo improve the quality of healthcare data and public health management, these findings highlight the necessity for precise MCCD reporting and the significance of comprehending mortality patterns. For informed decision-making and changes to the healthcare system, addressing the found errors and patterns is essential.

Advancements in Biological Dosimetry Techniques for Surge Response to Radiation Emergencies in Ghana

The awareness of the use of biodosimetry to estimate external radiation doses received by individuals and in radiation oncology, nuclear medicine, diagnostic, and interventional radiology has gained traction in recent years. At present Ghana is poised to integrate about 1GW of nuclear power into its electricity mix by 2034. The increased awareness of biodosimetry is probably due to increased radiological threats and incidents, medical and forensic applications, the quest to strengthen emergency response to unplanned radiation exposures such as radiological accidents, and the malevolent use of radioactive sources. Biodosimetry capabilities would play an effective role during public health management of radiation emergencies for rapid dose estimation and help to medically categorize the exposures for the purpose of prioritizing treatment of the affected persons. Moreover, it will also serve to provide reassurance and psychological support for the “worried-well”. Biodosimetry methods and infrastructure can also be utilized for various applications, including molecular research, medical cytogenetics, and forensics. This write-up assesses the status of biodosimetry methods and infrastructure capabilities available at the Ghana Atomic Energy Commission (GAEC), which could be leveraged during radiological or allied scenarios.

Predicting the risk of nursing home placement of elderly persons using a population-based stratification score

ObjectiveTo develop and validate a novel score predictive of nursing home placement in elderly. Study designPopulation-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy. MethodsThe 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration. ResultsTwenty-one factors were identified as predictive of nursing home admission and were included in the “Elderly Nursing Home Placement” (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk. ConclusionsA simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.

Circulating dengue virus serotypes, demographics, and epidemiology in the 2023 dengue outbreak in Chittagong, Bangladesh.

Dengue is a serious epidemic for Bangladesh affecting thousands of lives. This study aimed to identify and determine the prevalence of the circulating variants of dengue virus (DENV) and their association with demographics and clinical manifestations among the dengue-infected patients. A total of 711 participants with NS1 antigen positivity were enrolled, followed by viral RNA extraction from the collected blood samples and a multiplex real-time reverse transcription-polymerase chain reaction (RT-PCR) assay to determine the dengue virus serotypes. Of 711 dengue-infected patients, 503 (70.7%) were male. Among different age groups, most of the patients were 21-30 years old (n = 255, 35.9%). The DENV2 (n = 483, 67.9%) serotype was more prevalent than the DENV3 (n = 144, 20.3%) and DENV1 (n = 84, 11.8%). The duration of fever was highest in the DENV-1 patients (4.79 ± 1.84 days) in contrast to DENV-3 (4.48 ± 1.68 days) and DENV-2 (4.33 ± 1.45 days) (P = 0.039). Importantly, five highly populated areas were identified as dengue hotspots in Chittagong metropolitan city. Our results provide crucial insights into the patterns of dengue virus transmission and severity among southern Bangladeshi population, thereby aiding in the development of targeted public health interventions and management strategies to combat future outbreaks.

Vaccine-associated measles in an immunocompromised host: Hospital infection prevention and control and public health response

Introduction: Vaccine-associated measles is generally not considered to be transmissible, as opposed to wild-type measles, which is one of the most highly contagious diseases. Data on contact and exposure management of vaccine-associated measles is limited, with varied approaches to such cases described in the literature. Methods: We report the case of a 2-year-old immunosuppressed child who developed a febrile exanthem with mild conjunctivitis 18 days after receiving the measles-mumps-rubella-varicella vaccine. Results: Given the patient's recent measles-containing vaccination while on immunosuppressive medications, consistent clinical findings and the lack of epidemiological risk factors for wild-type infection, the decision was made to treat this as a presumptive case of vaccine-associated measles virus prior to return of confirmatory genotyping results. After consultation with public health experts, contact tracing was not considered necessary. No secondary measles cases were identified, despite a large exposure potential due to lack of consistent airborne precautions during hospital admission. Discussion: This case highlights the lack of transmissibility of vaccine-associated measles in immunocompromised hosts, adding to the scant body of literature on this topic, with the potential to inform hospital infection prevention and control as well as public health management in similar situations.

Characterization of azithromycin-resistant Shigella flexneri serotype 2a isolates using whole genome sequencing in Ontario from 2016 to 2018.

Azithromycin-resistant shigellosis is increasing globally. This retrospective analysis of Shigella flexneri serotype 2a isolates from 2016 to 2018 in Ontario found nearly half were azithromycin (47.7%, 72/151) and ciprofloxacin (50.7%, 77/152) resistant. Moreover, 34.7% (25/72) of azithromycin-resistant isolates were also ciprofloxacin-resistant. Four isolates were ceftriaxone-resistant, although all azithromycin-resistant isolates were ceftriaxone-susceptible. Overall, 83.6% (127/152) of all S. flexneri 2a isolates were recovered from males and 97.2% (70/72) of the azithromycin-resistant cases were males. Among the azithromycin-resistant cases, some (8/72) reported international travel. Phylogenetic analysis of azithromycin-resistant isolates revealed two large male-dominated clusters, and one cluster may have been due to importation of resistant strain. Comparison of plasmids isolated from the clusters in Ontario revealed the presence of incFII plasmid with high percentage of similarity to plasmids present in global outbreaks affecting mostly males including men who have sex with men (MSM). These two large azithromycin-resistant clusters are suggestive of an outbreak among MSM, though disease exposure or sexual orientation of patients was unknown. The presence of plasmid-borne azithromycin resistance in ciprofloxacin-resistant isolates is a public health concern. Antimicrobial surveillance is important for patient management, understanding the spread of novel resistance types in local communities which sometimes is introduced by travel. We found ongoing multidrug-resistant outbreaks spanning multiple years affecting males. Reduction of future outbreaks in high-risk communities like MSM requires consorted information flow between laboratory, public health, and physicians. We impart genomic and antimicrobial characteristics of multidrug S. flexneri 2a which may serve as reference by clinicians and public health.IMPORTANCEOral ciprofloxacin and azithromycin are generally considered as the first-line therapy of shigellosis. Here, we report the emergence and transmission of azithromycin and ciprofloxacin-resistant S. flexneri serotype 2a among male adults in Ontario during 2016-2018. The percentage of azithromycin and ciprofloxacin resistance among S. flexneri 2a is higher compared to previous reports from Canada and United States. Here, we show the genetic basis of the antimicrobial resistance among these unique groups of S. flexneri 2a isolates. We describe a domestically acquired azithromycin-resistant and ciprofloxacin-resistant S. flexneri 2a lineage in Ontario. Combining whole-genome sequencing (WGS) data with travel-associated data helped in understanding dissemination and transmission. We employed WGS, which not only helped us in understanding the genetic-relationship between isolates but also mine information regarding plasmids. In the future, linking WGS, travel-related data, and clinical data can provide enhanced contact tracing and improve public-health management.

Evaluation of the effectiveness of a segmented alternating shift pattern based on wearable vital signs monitoring devices during COVID-19: a cross-sectional study

AimTo explore the feasibility and effectiveness of an alternating shift pattern in two-hour segments in the state of emergency management of public health events.MethodsA cross-sectional research design was conducted in our study. The nursing staff working in the admission ward of suspected or confirmed patients with COVID-19 in December 2022 were selected as subjects by the whole-group sampling method. We adopted a shift pattern of alternating shifts every two-hour in the isolation wards. The vital signs parameters were captured by uniformly wearing the multi-signs sensing devices, and the questionnaires collected the symptoms.ResultsSixty-seven female participants, with a mean age of 33.09 ± 5.96 years, were included in this study. Measurements of body temperature (T), blood oxygen saturation (SpO2), respiratory rate (RR), and heart rate (HR) while wearing personal protective equipment (PPE) all remained within normal limits. None of the nurses reported sweating, dizziness, blurred vision, palpitations, or dyspnea. Statistical analysis showed significant differences between the critical care group and the non-critical care group in terms of age (P = 0.041), working duration (P = 0.036), and the total number of entries into isolation areas for nursing care (rounds) (P = 0.007). However, there were no statistically significant differences in vital signs based on age, work duration, or body mass index (BMI). The data indicated a notable increase in body temperature compared to other vital sign parameters with increasing work time while wearing PPE. Body temperature approached the upper limit when working close to 2 h long.ConclusionsThe alternating shift pattern in two-hour segments can effectively maintain the physical well-being of nurses wearing PPE without increasing the burden on nursing staff or the wastage of protective materials. This approach is recommended for addressing similar public health events in the future.

Unveiling spatial variations in atmospheric CO2 sources: a case study of metropolitan area of Naples, Italy

In the lower atmosphere, CO2 emissions impact human health and ecosystems, making data at this level essential for addressing carbon-cycle and public-health questions. The atmospheric concentration of CO2 is crucial in urban areas due to its connection with air quality, pollution, and climate change, becoming a pivotal parameter for environmental management and public safety. In volcanic zones, geogenic CO2 profoundly affects the environment, although hydrocarbon combustion is the primary driver of increased atmospheric CO2 and global warming. Distinguishing geogenic from anthropogenic emissions is challenging, especially through air CO2 concentration measurements alone. This study presents survey results on the stable isotope composition of carbon and oxygen in CO2 and airborne CO2 concentration in Naples’ urban area, including the Campi Flegrei caldera, a widespread hydrothermal/volcanic zone in the metropolitan area. Over the past 50 years, two major volcanic unrests (1969–72 and 1982–84) were monitored using seismic, deformation, and geochemical data. Since 2005, this area has experienced ongoing unrest, involving the pressurization of the underlying hydrothermal system as a causal factor of the current uplift in the Pozzuoli area and the increased CO2 emissions in the atmosphere. To better understand CO2 emission dynamics and to quantify its volcanic origin a mobile laboratory was used. Results show that CO2 levels in Naples’ urban area exceed background atmospheric levels, indicating an anthropogenic origin from fossil fuel combustion. Conversely, in Pozzuoli's urban area, the stable isotope composition reveals a volcanic origin of the airborne CO2. This study emphasizes the importance of monitoring stable isotopes of atmospheric CO2, especially in volcanic areas, contributing valuable insights for environmental and public health management.

Public Health Management: Innovative Facility Arrangement Framework Towards Emergency Relief

The better public health organizations are contingent on the healthier distribution of earthquake relief facilities when there is an immediate seismic event. Choosing the perfect site for these emergency relief centers that would suitably integrate cities is a challenging task. Heuristic calculations are practical methods for resolving these kinds of complex optimization problems. This study's objective is to develop a novel method for allocating parcels to assistance facilities and figuring out where they should be placed: swarm-tuned war strategy optimization (SWSO). The SWSO method syndicates the investigative efficiency of the WSO strategy with Particle Swarm Optimization (PSO) to solve the complex elements of this task by humanizing directional skills. Using GIS, possible sites were designated, and letters were brought utilizing a suggested SWSO method that reduced the quantity of trip. The method exceeded present approaches in terms of meeting cumulatively the achievement of emergency managers and public health managers in providing disaster relief and, eventually, maximizing people's seismic resilience.

Prediction of Drinking Water Quality for Effective Public Health Management to Avoid Water Borne Diseases

The issue of water quality failure is a persistent global concern that leads to sickness, toxicity, the spread of diseases, and loss of life in metropolitan areas. Various physical, functional, and ecological factors may affect drinking water quality. These concerns include the incursion of pollutants into water pipes, leakage, the formation of disinfectant waste products, the penetration of chemicals or microbes, and pollution. Water-borne Diseases (WD) have emerged as a significant global public health issue. It is imperative to forecast the quality of drinkable water by utilizing an automated model that provides a preventive strategy that may be created to enhance public health management (PHM). This study forecasted the Drinking Water Quality (DWQ) to promote Public Health Management (PHM) strategies to prevent WD. Convolutional Neural Network (CNN) with Inverse Distance Loaded (IDL) interpolation has been used to forecast DWQ. One hundred five water specimens from the research region underwent thorough examination via physiochemical and microbiological analyses. The tested characteristics were pH, turbidity, temperature, fluoride concentration levels, and bacterial counts (Faecal Coliforms) to prevent WD. The test findings indicated that the CNN-IDL projected 35% of water specimens from the domestic pipeline network had bacteria levels below what the WHO considers acceptable. Also, about 57% of the samples from the home pipeline network met the fluoride reference values set by the WHO. The sanitary assessment rating clearly showed that the lack of appropriate measures to protect against multiple barriers resulted in declining water quality for users. The findings of this research will be valuable to administrators in implementing essential strategies to avoid WD before it significantly impacts public health.

Management of Public Health: A Study on Novel Strategy for Securing Health Data

The effective management and security of sensitive health data is becoming exponentially important to public health administration. This research examines and evaluates innovative ways to improve health data security in public health management systems to provide accessibility for authorized stakeholders. The study introduces the War Strategy Optimized Elliptic Curve Cryptography (WSO-ECC) encryption method for improving the security of primary healthcare medical records. The WSO-ECC technique, based on a war strategy framework, optimizes encryption and decryption processes by balancing exploration and exploitation phases, enhancing security while maintaining efficiency. It significantly reduces encryption and decryption times compared to traditional methods.The proposed method offers a robust solution for safeguarding medical information in public health management systems, demonstrating superior performance of 24.6 in encryption time, 23 decryption times, execution efficiency, and delay.

Healthcare Technology Management: Electronic Health Records and Informatics

The application of health informatics enables the creation of customised health interventions based on each person's requirements, preferences, and risk factors. Public health organisations can identify people who are at high risk for specific illnesses and provide tailored interventions to reduce risk factors and enhance outcomes by using data analytics and predictive modelling. Furthermore, via the use of social media platforms, digital health technologies, and personalised health interventions, health informatics enables public health organisations to interact with communities, encourage healthy lifestyles, and address health inequities. The importance of promoting teamwork, standardising data exchange procedures, and investing in workforce development is emphasised in this work. Public health management can meet these obstacles and fully utilise the advantages of health informatics to enhance population health outcomes.

Novel AI-driven Malaria Prediction for Optimizing Public Health Management

Malaria is an unmoving real common well-being apprehension in Asian nations like the Republic of India, where the state characterizes approximately 55% of the session events cutting-edge the infirmaries. They are usually distinguished by the absence of appropriate therapeutic care provision and the often late and error-prone diagnosis of the condition. In particular, commonly used devices such as the Rapid Diagnosis Test (RDT) are not completely dependable. They are primarily notable for their failure to provide adequate medical treatment and their tendency to diagnose the disease late and incorrectly. For example, widely used devices like the RDT are not consistent. To improve public health management actions, this work offers a unique augmented tree with penguin search optimization (AT+PSO) methodology for malaria forecasting. The suggested method combines the PSO algorithm with the augmented tree model, also known as random forest (RF). In the preprocessing stage, raw data samples are subjected to data normalization. Then, we applied the PSO to improve the characteristics of the RF model after successfully predicting malaria with the RF. The Python program is used to implement the suggested technique and analyze performance using a range of measures, including accuracy (0.988), sensitivity (0.987), specificity (0.991), F1-score (0.988), and MCC (0.975). In summary, our suggested approach produced the best results in terms of accuracy as opposed to other current strategies for predicting malaria to improve governance of public health.

Electrical Stimulation Therapies for Public Health Management and Chronic Pain Management

All progressive lung diseases, respiratory disorders, chronic bronchitis, and stubborn (non-reversible) asthma are collectively referred to as chronic obstructive pulmonary disease, or COPD. When a person with COPD maintains their level of muscle strength and mobility, which is crucial for all COPD patients, they can live for several years and profit from life. Conscription is one approach to accomplish physical mobility inside a structured programme, like a physical training programme. It is a part of the COPD management guidelines and has been shown to be a beneficial tool in managing COPD. Neuromuscular electrical stimulation (NMES) has been successfully used as a limited to a small region preparation strategy in seriously impaired patients WHO do not appear to be capable of adhering to strict pulmonary rehabilitation (PR) and/or enduring superior coaching frequencies. In order to evaluate public health concerns and predict the onset of illnesses, the objective of this project is to create an intelligent framework for electrical stimulation therapies for the management of chronic pain and public health.

A Real-Time Air Quality and Public Health Monitoring and Management Model

Inhalation of air contaminants leads to various detrimental health consequences. These harmful effects happen whenever people are directly exposed to air pollution. Health Risks (HR) lowers the intensity, duration, and regularity of exposure to air pollution. The system provides customized Air Quality (AQ) data and related HR information. This system depends on pollution, the city layout, the weather, and the chemical and physical processes that affect the pollutant’s mobility. It measures the AQ levels in many places, like homes, schools, businesses, and transportation for Public Health (PH). It uses Big Data (BD) and a surveillance system to monitor the street-level AQ. The street-level AQ modeling shows higher accuracy than reference data [17]. The PH and prediction of HR are parts of the ongoing process. It shares knowledge about air pollution and its impact on PH.

Public Health Policy and Advocacy: A Management Perspective

The division of authority and accountability between the federal government and the states is one of the public health governance system's most significant advantages and concurrent problems. The policy management suggests that the best course of action is to develop institutional frameworks for consultative decision-making, allocate resources in an equitable manner, and implement policies in a coordinated manner. The proposed methods include improved fiduciary risk management, capacity building, technical support for state-specific strategic plans, active local self-government engagement, and community-based health output monitoring. The idea put forth in this paper is that HR rules, which are centred around the requirement that individuals with a background in public health management hold high positions in the field, should be tightened.

Enhancement of Health Services: Advanced Security Mechanism for Telemedicine in Public Health Practice

The sudden advancement of telemedicine in the healthcare industry presents potential hazards such as cyber-attacks and network susceptibilities, in addition to difficulties in patient privacy, data protection, and public health monitoring. To avoid illegal access, digital watermarking and precise medical image transfer are essential. Thus, for telemedicine in public health action, we introduce a unique security mechanism termed wavelet crypto fast decomposition with penguin optimization (WCFD-PO). Rivest-Shamir-Adelman (RSA), wavelet transforms (WT), and fast random singular value decomposition (FRSVD) encryption algorithms make up the suggested security methodology. By using the methods WT and FRSVD, one can decrease computing complexity and increase robustness. The PO approach offers a better-optimized scale factor in the fewest groups and repetitions as compared to the RSA approach, which is used for encrypting the watermarked image. The proposed mechanism is implemented by employing a Python application. Comprehensive testing indicates that our novel approach functions better than the current techniques, demonstrating the technique's higher efficiency. With the assistance of secure telemedicine solutions, this investigation offers physicians and tech programmers insightful information that will boost public health management.

Pesticide Reduction through Organic Farming for Promoting Public Health Management and Food Security

There is a growing global interest in sustainable food consumption to ensure food security. One significant factor driving this demand is the belief that consuming organic food affects Public Health (PH). This research examines the historical context of sustainable agriculture. This article specifically examines the impact of sustainable agriculture on health-related substances, pesticide residues, and contaminants in crops. It also explores the connections between organic food and health indicators. In Organic Farming (OF), the use of pesticides is often restricted or non-existent, which is different from Traditional Farming (TF) methods that heavily depend on pesticides to preserve crops. The notable disparities in pesticide usage between the two agricultural systems profoundly affect the comparative nutritional exposure, hazards, and ecological impacts associated with pesticides. Pesticide Usage Monitoring (PUM) information has been used to compare pesticide usage across organically certified and adjacent traditional farms for tomato crops. This work suggested methods for PR by promoting the widespread use of organic agricultural techniques. Additionally, emphasis on many alternatives available within organic food supply chains to further minimize the usage of pesticides, contact, and adverse effects on workers has been proposed to provide food security.

The Role of High-Level Isolation Units in Response to High-Consequence and Emerging Infectious Diseases: Experience of the German STAKOB Network.

This case study describes the experience of the German Permanent Working Group of Competence and Treatment Centers for High Consequence Infectious Diseases, known as STAKOB (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger). STAKOB brings together public health authorities (competence centers) and high-level isolation units (treatment centers) to collaborate on the clinical management of high-consequence infectious diseases (HCIDs) and emerging infectious diseases. The network is coordinated by the Robert Koch Institute, Germany's federal public health institute. The main tasks of STAKOB are to strengthen HCID clinical and public health management and increase expert knowledge on HCID and non-HCID emerging infectious diseases in Germany. STAKOB enables the exchange of knowledge and experiences; development of guidelines on infection prevention and control measures, clinical management, and therapy; and support for the World Health Organization and other outbreak responses internationally. The past years have shown how important the STAKOB network is for Germany-not only in providing critical care for HCID cases but also increasing capacity to support public health and clinical management of emerging infectious disease cases. However, maintaining several high-level isolation units in Germany requires a high commitment of financial, material, and human resources. Due to the rarity of HCID and emerging infectious disease events, maintaining the appropriate level of preparedness and ensuring sufficient investments is an ongoing struggle. Nevertheless, it is essential to have a network ready to react to HCID and non-HCID emerging infectious diseases in times of a changing biosecurity and infectious landscape.

Onward Virus Transmission after Measles Secondary Vaccination Failure.

Measles in persons with secondary vaccination failure (SVF) may be less infectious than cases in unvaccinated persons. Our systematic review aimed to assess transmission risk for measles after SVF. We searched PubMed, Embase, and Web of Science databases from their inception dates. Inclusion criteria were articles describing persons who were exposed to measles-infected persons who had experienced SVF. Across the included 14 studies, >3,030 persons were exposed to measles virus from SVF cases, of whom 180 were susceptible, indicating secondary attack rates of 0%-6.25%. We identified 109 cases of SVF from the studies; 10.09% (n = 11) of case-patients transmitted the virus, resulting in 23 further cases and yielding an effective reproduction number of 0.063 (95% CI 0.0-0.5). These findings suggest a remarkably low attack rate for SVF measles cases, suggesting that, In outbreak situations, public health management of unvaccinated persons could be prioritized over persons with SVF.