Public Health Education Campaigns Research Articles

Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana

BackgroundUnderstanding the underlying epidemiology that shapes Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT) infections can contribute to data driven policies directed towards curbing the proliferation of these pathogens in Ghana. Information on the symptoms and risk factors for STIs will help to identify high-risk individuals which will in turn inform STI syndromic management and tailor the use of public health resources.MethodsParticipants were from 4 military clinics and 1 civilian STI clinic in Ghana and eligible if they had symptoms suggestive of STI. First void urine samples were collected and tested with Nucleic Acid Amplification Test (NAAT). A structured questionnaire was administered to all participants. Multivariate logistic regression identified factors associated with infection, separately for NG and for CT and for men and women.ResultsA total of 950 patients, 58% of whom were females were enrolled, 28% had gonorrhea and 11% had chlamydia with more males testing positive than females. Reported symptoms that were more common among patients who tested positive for gonorrhea were painful urination and urethral discharge (all P values < 0.05). Additionally, multiple sexual partners and alcohol use were statistically associated with higher rates of gonorrhea in males while only the frequency of condom use was associated with gonorrhea for females. None of the symptoms or risk factors except marital status was associated with testing positive for chlamydia.ConclusionIdentifying these symptoms and risk factors help inform health care delivery systems for STIs in Ghana. Furthermore, men and women presenting with these symptoms and risk factors are a prime target for public health education campaigns, aimed at curbing the spread of gonorrhea and chlamydia infections.

Obesity and increased cancer risk: the development of a public health education campaign

Obesity and increased cancer risk: the development of a public health education campaign

Abstract 180: Association of Risk Factor-Based Educational Programs on Stroke Hospitalization and Death Rates in West Central Florida

Background: Since 2003 six public health educational campaigns were begun in Florida to reduce stroke rate and mortality by increasing public awareness of stroke-related symptoms and its risk factors. Hypothesis: The public health campaigns reduced hospitalization and death rates due to stroke in West Central Florida (WCF). Methods: Using the Florida Department of Health databases, we tabulated the annual stroke-related rates of hospitalization and death in 10 WCF counties (Polk, Hardee, Sarasota, Hillsborough, Hernando, Pasco, Pinellas, Manatee, Desoto, and Highlands) from 1997-2016. Population (total: 4.75 million), median age, race/ethnicity distribution, and median income were recorded for each county. The pre-campaign period was defined from 1997 to 2002. Annual rates/100,000 population for stroke-related hospitalization and death were compared yearly before and after the campaigns were launched to determine their impact. Results (graphs): Compared to other WCF counties, Sarasota had the lowest baseline rate for stroke hospitalization, but its death rates did not significantly differ. Post-initiation, yearly declines average hospitalization (6.51%) and death rates (0.67%) were observed, but the decline in annual death rate was attenuated after 2006, suggesting the greatest impact was due to the Get With The Guidelines® campaign begun in 2003. Conclusions: Public health campaigns were associated with an almost linear decline in West Central Florida stroke hospitalization rates, suggesting a benefit from improved stroke recognition and risk factor reduction. The blunted effect on the death rate may reflect the limitations of therapeutic measures and implementation protocols employed during this period.

Strategies to find audience segments on Twitter for e-cigarette education campaigns

The development of public health education campaigns about tobacco products requires an understanding of specific audience segments including their views, intentions, use of media, perceived barriers, and benefits of change. For example, identifying and targeting individuals who express ambivalence about e-cigarette use on Twitter may be helpful in devising and focusing public health campaigns to reduce e-cigarette use. This study developed a novel analytic strategy using social network analysis to identify audience segments on Twitter based on positive, negative, and neutral e-cigarette sentiment. Using Twitter data collected from April 2015 to March 2016, we identified different sub-groups of users who retweeted about e-cigarettes, and measured each sub-group's clustering coefficient (CC), which describes how tightly people cluster together. Ten high CC and ten low CC groups were randomly selected; then 100 randomly selected tweets from each group were coded for e-cigarette sentiment (positive, negative, neutral). Results indicate that differences in e-cigarette sentiment are associated with clustering of Twitter network ties. Statistical analyses revealed that high CC groups were more likely to have strong e-cigarette sentiments, suggesting that tightly clustered groups may be “echo chambers” (i.e., like-minded people repeating the same messages). By contrast, low CC groups were more likely to have neutral sentiments, and had greater fluctuation in sentiment over time, suggesting that they may be more flexible in their opinions about e-cigarettes and may be particularly receptive to targeted public health campaigns. Informatics techniques such as determination of clusters using social network analysis can be useful in identifying audience segments for future public health campaigns.

Breaking the mold: Socio-ecologic factors to influence the development of non-harsh parenting strategies to reduce risk for child physical abuse

Corporal punishment (CP) continues to be a common form of discipline in the U.S despite indications of its long-term harm to children, including strong risk for child physical abuse. Parents that are exposed to CP or physical abuse in childhood are at heightened risk for using CP with their own children. In examining parenting practices relevant to preventing child physical abuse, Positive Deviance relates to those parents who choose effective, positive parenting strategies to discipline their children, despite being exposed to CP and physical abuse in childhood. Little is known about buffering or motivating factors that prevent parents from using CP, or how these factors are influenced by parental childhood history or CP social norms. Therefore, this study examines the motives for use of positive parenting practices, including non-use of CP, for mothers who were exposed to CP and physical abuse in childhood (Positive Deviance). Qualitative interviews were conducted with seventeen mothers with a history of childhood CP and physical abuse. Results indicate that participating mothers believe CP is not an effective discipline strategy and is harmful for children. Mothers opted to use positive parenting practices, rather than CP, with their own children based on empathy, knowledge of harm, as well as rejection of intergenerational transmission of CP and community norms. Findings provide evidence that a Positive Deviance approach can inform target areas for primary prevention strategies aimed at reducing child physical abuse. Directions for multi-level public health prevention approaches and educational campaigns are discussed.

Analysis and Mathematical Modelling of HIV/AIDS and Transmission Dynamics subject to the Influence of Public Health Education Campaign

Analysis and Mathematical Modelling of HIV/AIDS and Transmission Dynamics subject to the Influence of Public Health Education Campaign

Timeliness of Presentation and Referral Among Cancer Patients Who Presented With Abdominal Symptoms: Evidence to Inform Symptom Awareness Campaigns

Background: Abdominal symptoms at presentation are common among patients subsequently diagnosed with cancer. While public health education campaigns in England and other countries have traditionally focused on 'red flag' symptoms associated with a single common cancer (e.g., 'blood in poo' and colorectal cancer), there is increasing interest in raising awareness of symptoms grouped by body area or system (eg 'abdominal symptoms'). Evidence regarding the frequency and nature of abdominal symptoms at presentation among a representative cancer patient cohort could inform the design and evaluation of community based cancer symptom awareness campaigns. Aim: To describe the frequency of abdominal symptoms at presentation among an incident cohort of cancer patients, examine variation in diagnostic timeliness and subsequently diagnosed cancer sites by abdominal symptom. Methods: The presenting symptom(s) of 15,956 cancer patients from a national audit of primary care records in England was coded into symptom categories. Eight abdominal symptoms with a range of predictive values and specificity for cancer were studied: abdominal pain, change in bowel habit, bloating/distension, dyspepsia, rectal bleeding, dysphagia, reflux, and nausea/vomiting. We investigated the prevalence of abdominal symptoms among the cancer patient population, examined variation in the length of the patient interval (time from symptom onset to presentation to primary care) and primary care interval (time from presentation to specialist referral) by symptom, and described the associated spectrum of diagnosed cancer sites for each individual symptom. Results: Almost a quarter (23%) of the incident cancer patient population had abdominal symptom(s) at presentation (n=3,661/15,956). The relative lengths of the patient and primary care intervals varied greatly by abdominal symptom. One in two cancer patients who had dysphagia before diagnosis presented 30 days after symptom onset (median (IQR) patient interval: 30 (10-61) days), but were referred immediately (median (IQR) primary care interval: 0 (0-14) days). In comparison, cancer patients who presented with abdominal pain had longer intervals postpresentation (median (IQR) patient interval: 7 (0-28) days, median (IQR) primary care interval: 16 (2-43) days). The majority (88.6%) of cancer patients who presented with an abdominal symptom were diagnosed with an abdominal or adjacent cancer, including colorectal, esophageal, ovarian, and pancreatic cancers. However, the remainder of patients were diagnosed with solid tumors of nonabdominal organ origin (7.6%) or a hematologic cancer (3.8%). Conclusion: Cancer symptom awareness campaigns focusing on abdominal symptoms could contribute to the earlier diagnosis of numerous common and rarer cancers. Evidence regarding the relative lengths of the patient and primary care intervals could be used as a measure of relative need for raising awareness.

Strengthening the Evidence Base of Cancer Symptom Awareness Campaigns: A Conceptual Framework

Background: Cancer control strategies in different countries increasingly encompass public health education campaigns that aim to promote earlier presentation and diagnosis of cancer by raising awareness of possible cancer symptoms. However, the theoretical understanding that underpins these complex early diagnosis interventions remains underdeveloped. Aim: To propose a theoretical framework to guide the design, implementation, and evaluation of cancer symptom awareness campaigns and motivate further relevant research. Methods: Informed by Wilson and Junger's principles of early disease detection for screening (1968) and existing conceptual frameworks for early diagnosis of cancer, we considered the logic model underlying cancer symptom awareness campaigns and relevant emerging evidence from disciplines including health psychology, cancer epidemiology, and health services research. Real-world examples across high-/low-income settings were used where possible to illustrate discussions of implications for practice. Results: We identified four major factors that contribute to the logic model of cancer symptom awareness campaigns beyond contextual and practical factors. Disease burden statistics (cancer site-specific incidence, survival, mortality) could be used to gauge relative need for raising awareness. This should be triangulated with symptom epidemiology (including existing levels of awareness, symptom prevalence, the associated predictive value for cancer, symptom-specific diagnostic timeliness, and whether the symptom is a sign of early stage disease) to motivate selection of individual symptoms in a campaign. Psychosocial factors (such as cancer fatalism or fear and health literacy) and their interaction with symptom awareness should also be considered as they affect symptom appraisal. Further, an understanding and awareness of system factors (availability and access to healthcare, investigation processes, and clinical capacity) will be important for assessing campaign feasibility and knock-on effects in the health system. Based on the above, campaigns should ideally target symptoms that are strongly predictive of early stage (treatable) cancer for which there is low awareness in the target population, and are associated with long intervals to help-seeking. Campaign impact should be amplified by targeting psychosocial barriers to prompt presentation. Additionally, campaigns should be accompanied by downstream capacity planning for potential cancer investigation and subsequent treatment. Conclusion: The proposed framework considers the logic model of cancer symptom awareness campaigns, acknowledging key factors that should be taken into account beyond contextual factors. This could help identify evidential gaps in early diagnosis research, and improve campaign design and evaluation.

Does the Mexican sugar-sweetened beverage tax have a signaling effect? ENSANUT 2016.

ObjectiveTo evaluate the potential signaling effect of the Mexican tax on sugar-sweetened beverages (SSBs) by analyzing the association between awareness of and opinions about its effectiveness with current consumption of taxed SSBs and with a self-reported change in consumption of SSBs since the implementation of the tax. We also examined the association between psychosocial and environmental determinants of SSB consumption with current consumption of taxed SSBs and with a reported change in consumption of SSBs.MethodsCross-sectional analyses of survey and food-frequency questionnaire data from the Mexican National Health and Nutrition Survey 2016. Participants were Mexican adults (20–59 years, N = 6,650). Logistic regression was used to evaluate the probability of a person reporting a decrease in SSB consumption, given their awareness of the tax, opinion about its effectiveness, psychosocial (SSB health-related beliefs, self-efficacy, and liking of SSBs) and environmental (availability of potable water) determinants. Multiple linear regression analysis was utilized to examine the association between the aforementioned factors and current consumption of taxed SSBs.ResultsCompared with adults not aware, adults who were aware of the SSB tax were more likely (OR = 1.30) to report a decrease in SSB consumption (p = .012). In urban areas, adults aware of the tax drank a significantly lower amount of taxed SSBs (-15.7%; p = .023) than those not aware. Self-efficacy and liking of SSBs were significantly associated with a reported decrease in consumption and with current consumption (p < .001), while health beliefs and availability of potable water were not significantly associated with either reported change in SSB consumption or current consumption of taxed SSBs.ConclusionsImplementation of an SSB tax accompanied by highly visible campaigns may further influence the impact of taxes on SSBs consumption. Future public health and nutrition education campaigns designed to increase knowledge and enhance motivation should be complemented by programs to assist individuals develop self-efficacy and self-regulation skills.

“The Next Great Plague to Go”

During the Great Depression, U.S. Surgeon General Thomas Parran Jr. initiated a public health education campaign that told Americans venereal diseases such as syphilis and gonorrhea needed to be “The next great plague to go.” The next phase of the campaign included his request to the U.S. Congress for public funds for training medical personnel and additional facilities to service those who had contracted VD. This article discusses how Parran used public relations techniques to generate awareness of the dangers of VD, ameliorate the social stigma associated with those diseases, and receive more funding for VD control. This case study of how Parran used media relations, controlled media output, and legislative lobbying provides a means to understand how public relations was used to achieve organizational goals in the 1930s, specifically by a government agency and its leader.

Exposure to environmental tobacco smoke in non - smoking adults in Israel: results of the second Israel biomonitoring survey

BackgroundExposure to environmental tobacco smoke (ETS) increases the risk of heart and respiratory disease, cancer, and premature mortality in non-smoking individuals. Results from the first Israel Biomonitoring Study in 2011 showed that over 60% of non-smoking adults are exposed to ETS. The purpose of the current study was to assess whether policies to restrict smoking in public places have been associated with reductions in exposure to ETS, and to examine predictors of exposure.MethodsWe analyzed urinary cotinine and creatinine concentrations in 194 adult participants in the National Health and Nutrition (RAV MABAT) Survey in 2015–2016. Study participants were interviewed in person on smoking status and exposure to ETS. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means and medians among smokers and non-smokers. We analyzed associations in univariable analyses, between socio-demographic variables and self – reported exposure, and urinary cotinine concentrations.ResultsThere was no reduction in geometric mean urinary cotinine levels in non-smokers in the current study (1.7 μg/g) compared to that in 2011 (1.6 μg/g). Median cotinine levels among the non – smoking Arab participants were higher in comparison to the Jewish and other participants (2.97 versus 1.56 μg/l, p = 0.035). Participants who reported that they were exposed to ETS at home had significantly higher median levels of creatinine adjusted urinary cotinine than those reporting they were not exposed at home (4.19 μg/g versus 2.9 μg/g, p = 0.0039).ConclusionsDespite additional restrictions on smoking in public places in 2012–2016, over 60% of non-smoking adults in Israel continue to be exposed to ETS. Urinary cotinine levels in non-smokers have not decreased compared to 2011. Results indicate higher exposure to ETS in Arab study participants and those reporting ETS exposure at home. There is an urgent need: (1) to increase enforcement on the ban on smoking in work and public places; (2) for public health educational programs and campaigns about the adverse health effects of ETS; and (3) to develop and disseminate effective interventions to promote smoke free homes. Periodic surveys using objective measures of ETS exposure (cotinine) are an important tool for monitoring progress, or lack thereof, of policies to reduce exposure to tobacco smoke in non-smokers.

Breastfeeding practices among currently married women of selected tribes of Jharkhand, India

Background: An exclusive breastfeeding for 6 months and an extended breastfeeding for 24 months protects the infant from infectious disease and promotes child spacing. Therefore, the knowledge, attitude and practice about infant and child feeding is important to overcome morbid conditions prevailing among mothers and her child. The present study aimed at investigating the factors influencing an exclusive breastfeeding among currently married tribal women in Jharkhand, India.Methods: A cross sectional study was conducted among the 919 currently married Santal, Oraon, Mahli and Ho women in the age group of 15-29 years from forty villages of Purbi Singhbhum district of Jharkhand using interview schedule method.Results: The mean duration of exclusive breastfeeding and breastfeeding up to 24 months was found to be 4.1 and 12.9 months respectively. Also, not much difference in the average duration of exclusive breast feeding was found between working and non-working women. The results of multinomial regression showed maternal age (OR=1.92, p&lt;0.05), place of delivery (OR=2.3, p&lt;0.05), distance from health facility (OR=4, p&lt;0.01) and sex of last child born (OR=2.5, p&lt;0.01) among the significant determinants for exclusive Breastfeeding.Conclusions: The duration and initiation of breastfeeding in a marginalised society depends to a great extent on how family members participate and decide on the type of feeding for new-borns. Also, several public health education campaigns should be launched aiming at increasing the familiarity of family relations on exclusive breastfeeding.

Public Awareness of Low-Risk Alcohol Use Guidelines.

Objective. To evaluate the effectiveness of a population-based, public education campaign designed to increase awareness of the Canadian Low-Risk Alcohol Drinking Guidelines (LRDG). Method. A province-wide mass media campaign was introduced. To measure campaign effectiveness, we completed a cross-sectional study using pre- and postcampaign surveys. Measurements included awareness of the LRDG, specific knowledge of the LRDG, and beliefs toward drinking and behavior change. Results. Postsurvey respondents were more likely to be aware of the LRDG (19.2% vs. 25.8%). However, increased awareness was largely driven by females being significantly more aware of the guidelines after the campaign (odds ratio = 1.74; 95% confidence interval = [1.38, 2.19]). Men were not found to be more aware postcampaign. The results did not show a significant increase in specific knowledge of the LRDG or change in beliefs toward drinking and behavior change after the campaign. Independent of the survey cycle, males and those aged 19 to 25 years were less likely to be aware of the LRDG, select the correct drink limit or less, and believe that consuming alcohol in excess has short- and long-term health consequences when compared to females and those aged 56 to 70 years. Conclusions. A provincial public health education campaign was effective at increasing awareness of the LRDG, though uptake was lowest among those at highest risk for heavy drinking.

Assessment of Knowledge on Weaning among Mothers of Urban Slum

Background: Today’s children are the wealth of tomorrow. They are regarded as the future citizens of the nation. Every child has the right to have a healthy growth. Hence it is essential to nurture them to strive for their well being. Infancy is a period where rapid growth and development takes place. To attain this, the child requires good nutrition. As the child grows, the demand of nutrients increases. Insufficiency in the dietary intake may lead to poor growth and development and results in various physical, social and psychological problems later. Aim: The study aim to assess the level of knowledge on weaning among mothers of selected urban slum. Method: A descriptive approach was used to collect data from 50 mothers, selected by purposive sampling technique in a selected Urban Slum, to assess the level of knowledge on weaning among mothers. Data were collected by using structured interview schedule. Results: Results reveals that highest percentage of (40.4% SD=3.49) of mothers had average knowledge. Conclusion: This study results revealed that there is a deficiency in knowledge of mothers on weaning, and There is a need for health care system interventions, family interventions, and public health education campaigns to promote optimal practice of weaning, especially in less educated women.

Health information exposure from information and communication technologies and its associations with health behaviors: Population-based survey

Health information and communication technologies (ICTs) are increasingly used but little is known about routine exposure to health information from ICTs and its associations with health behaviors. A territory-wide population-based dual landline and mobile telephone survey was conducted in 2016 in Hong Kong, where smartphone ownership and Internet access are among the most prevalent, easiest and fastest in the world. Health information exposure from traditional sources (television/radio/newspaper/magazine), Internet websites, social media sites and instant messaging (IM); and information on smoking, alcohol consumption and physical activity were recorded. Prevalence was weighted by age, sex and education level of the general population. Multinomial logistic regression was used to assess the association of health information exposure with smoking and alcohol consumption, whilst multivariable linear regression was used to assess the association with frequency of moderate and vigorous physical activity (days/week). Of 3063 respondents, most (71.6%) were often or sometimes exposed to health information from traditional sources, followed by Internet websites (40.9%), social media sites (40.7%), and IM (27.0%). Respondents with lower education and household income were less frequently exposed to health information from Internet websites, social media sites and IM (all P < 0.001). Health information exposure from IM was associated with being never smokers, and more frequent moderate and vigorous physical activity (all P for trend <0.05). Health information exposure from IM was least frequent but associated with healthier behaviors. Further public health education campaigns can consider using IM to deliver information, particularly to disadvantaged groups.

Zika Virus: Knowledge Assessment of Residents and Health-Care Providers in Roatán, Honduras, following an Outbreak.

Few studies have evaluated the effectiveness of Zika virus (ZIKV) public health educational campaigns. Following a ZIKV educational campaign in Roatán, Honduras (October 2016), a survey was administered (March-May 2017) to residents (N = 348) and health-care professionals ([HCPs]; N = 44) to evaluate ZIKV knowledge, attitudes, and preventive practices, with attention to sexual health. Knowledge scores were calculated and mapped using participants' home locations. The knowledge scores between HCPs and residents were significantly different (mean 17 versus 11; P < 0.001). Only 6% of residents and 14% of HCPs knew that ZIKV was sexually transmissible. Few reported abstinence (2.6% residents; 9.4% HCPs) or condom use (1.6% residents; 12.5% HCPs) to prevent ZIKV infection. Of all subjects, 15.6% were pregnant or had a pregnant partner in the past year; 57.6% expressed concern over ZIKV. Mapping demonstrated spatial heterogeneity in knowledge. The findings suggest a need for improved public health messaging in ZIKV-affected areas.

Sociodemographic predictors of tobacco smoking among expatriate and national adolescents in the United Arab Emirates.

Tobacco use among adolescents is an important public health concern as it causes various forms of smokingrelated health problems and can create a gateway for other substance abuse. This study examined the prevalence, profile and predictors of tobacco use among expatriate and national adolescents living in the United Arab Emirates (UAE). Using a cross-sectional study design (2007-2009), we collected data on the prevalence of tobacco use in 6363 adolescents aged 13-20 years, including current smokers of cigarettes, midwakh, shisha and any other form of tobacco. We also collected demographic, socioeconomic, residential and behavioural data. In the previous 30 days, 505 (8.9%) participants had smoked cigarettes, 355 (6.3%) had smoked midwakh, 421 (7.4%) had smoked shisha and 380 (6.4%) had smoked any other form of tobacco. Overall, 818 (14.0%) adolescents were current smokers, who reported occasional or daily use of at least one form of tobacco in the past 30 days. Results consistently indicated that the prevalence of tobacco use was higher among men than women, regardless of age and tobacco form. Among men, cigarette smoking was the most popular, whereas shisha was the most smoked form of tobacco among women. Being male and ever having used illegal drugs consistently emerged as significant predictors of all forms of tobacco use. There is a need for continued public health strategies and education campaigns to discourage adolescents in the UAE from using tobacco.

Stop the Bleed: The Effect of Hemorrhage Control Education on Laypersons' Willingness to Respond During a Traumatic Medical Emergency.

The "Stop the Bleed" campaign advocates for non-medical personnel to be trained in basic hemorrhage control. However, it is not clear what type of education or the duration of instruction needed to meet that requirement. The objective of this study was to determine the impact of a brief hemorrhage control educational curriculum on the willingness of laypersons to respond during a traumatic emergency. This "Stop the Bleed" education initiative was conducted by the University of Texas Health San Antonio Office of the Medical Director (San Antonio, Texas USA) between September 2016 and March 2017. Individuals with formal medical certification were excluded from this analysis. Trainers used a pre-event questionnaire to assess participants knowledge and attitudes about tourniquets and responding to traumatic emergencies. Each training course included an individual evaluation of tourniquet placement, 20 minutes of didactic instruction on hemorrhage control techniques, and hands-on instruction with tourniquet application on both adult and child mannequins. The primary outcome in this study was the willingness to use a tourniquet in response to a traumatic medical emergency. Of 236 participants, 218 met the eligibility criteria. When initially asked if they would use a tourniquet in real life, 64.2% (140/218) responded "Yes." Following training, 95.6% (194/203) of participants responded that they would use a tourniquet in real life. When participants were asked about their comfort level with using a tourniquet in real life, there was a statistically significant improvement between their initial response and their response post training (2.5 versus 4.0, based on 5-point Likert scale; P<.001). In this hemorrhage control education study, it was found that a short educational intervention can improve laypersons' self-efficacy and reported willingness to use a tourniquet in an emergency. Identified barriers to act should be addressed when designing future hemorrhage control public health education campaigns. Community education should continue to be a priority of the "Stop the Bleed" campaign. Ross EM , Redman TT , Mapp JG , Brown DJ , Tanaka K , Cooley CW , Kharod CU , Wampler DA . Stop the bleed: the effect of hemorrhage control education on laypersons' willingness to respond during a traumatic medical emergency. Prehosp Disaster Med. 2018;33(2):127-132.

A study of the knowledge, attitudes and practices of Tibetan yak herders with respect to brucellosis.

Little information is available regarding the knowledge, attitudes and practices (KAP) of the owners of yaks in Tibet with respect to brucellosis. This manuscript reports on the results of a cross-sectional survey using a structured questionnaire investigating the KAP of 317 yak herders from 34 villages in the three main yak-rearing counties of Maizhokunggar, Damxung and Yadong from April to August 2015. Although 60.6% of the respondents had heard of brucellosis, there was an overall low level of knowledge about the disease. Herders did, however, adopt management/husbandry practices which would reduce transmission of the disease to humans and other animals. Multivariable logistic modelling showed that a better knowledge was predicted by age, production system adopted, education level and number of people in a household. Differences in attitudes and practices were predicted by education level, production system and household size. In order to increase the awareness of herders on brucellosis and to reduce the risk of infection in both humans and other animals, public health education campaigns should be developed and offered to livestock owners in Tibet.

Travel-related Zika virus cases in Canada: October 2015-June 2017.

Zika virus (ZIKV) is an emerging mosquito-borne disease that can cause severe birth defects if contracted congenitally. Since late 2015, there has been a large increase in the number of travel-related cases of Zika virus infection in Canada. The objective of this study was to describe the epidemiology of travel-related Zika cases in Canada from October 2015 to June 2017 and review them in the context of the international outbreak in the Americas. Zika virus infections were confirmed by polymerase chain reaction (PCR) detection of viral RNA and/or the serological identification of ZIKV-specific antibodies in serum. Cases of ZIKV infection were identified by provincial and territorial health authorities, and reported on a regular basis to the Public Health Agency of Canada (PHAC). Case information requested included date of illness onset, age category, sex, pregnancy status, and location(s) and dates of travel. Estimates for the monthly number of Canadians travelling outside of Canada to other countries in the Americas were obtained from Statistics Canada and the International Air Transport Association (IATA). Data to produce the epidemic curves of autochthonous cases for each region of the Americas were extracted from country-specific epidemic curves on the Pan American Health Organization website. As of June 7, 2017, 513 laboratory confirmed cases and two Zika-related birth/fetal anomalies were reported across all 10 provinces. Illness in Canadian travellers generally coincided with outbreak intensity in the country of exposure rather than travel volume. There has been no evidence of autochthonous (local) transmission in Canada. Currently, cases are on the decline both in Canada and internationally. The surge in Canadian ZIKV infections in 2016 was directly related to the incursion and spread of ZIKV into the Americas. Although cases are now on the decline worldwide, it remains to be seen whether a resurgence of cases in previously affected or new areas will occur. Both outbreak intensity and seasonality of ZIKV transmission should be monitored over time in order to inform the timing of public health education campaigns, as some may turn out to be more effective in the off-peak travel season when the risk of disease transmission may be higher. Ongoing education and awareness among travellers, particularly for pregnant women and those planning pregnancies, is still indicated.