Public Health Institutions Research Articles

The Robert Koch Institute's cross-sectoral efforts to address climate change and health

Abstract The Robert Koch Institute (RKI) is Germany's national public health institute (NPHI). It recognises that climate change poses a significant threat to the health and wellbeing of people and that as an NPHI it has an important role to play. To reflect this, we have been strengthening our work on climate change and health in the institute, particularly in the last 18 months, guided by the “IANPHI Roadmap for Action on Health and Climate Change” amongst other resources. At the RKI, we see that our contribution on climate change and health is part of efforts together with an extensive landscape of actors, each with their own disciplinary and sector-specific expertise and resources. We have therefore been exploring our possible sector-specific contribution and further developing our cross-sectoral working in line with the institute's strategy for climate change and health. The RKI is also already underway with specific cross-sectoral exchange and projects on climate change and health. This includes taking part in the cross-sectoral German national agencies’ network on climate adaptation, carrying out a comprehensive and ambitious situation report on the evidence base on climate change and health in Germany, as well as through a cross-sectoral programme to develop new measurable climate adaptation goals as part of the German Adaptation strategy for Climate Change. This presentation will share how the RKI is developing and implementing its cross-sectoral contribution on climate change and health, and will include some lessons learnt and suggestions for how other health actors might be able to apply this learning for their own work. The presentation aims to: • illustrate how cross-sectoral work can be implemented and how use of the “health argument” can help with this; • stimulate thinking on how other health actors, including in the audience, might be able to engage in cross-sectoral working in their own fields and organisations.

7.C. Workshop: Health for all Policies: The co-benefits of intersectoral action

Abstract The objective of this roundtable discussion will be to provide the arguments and evidence for increased intersectoral action to achieve the sustainable development goals (SDGs). Country responses to the COVID-19 pandemic have demonstrated that large scale intersectoral action for health is possible- if the policy issue is of high importance and sufficiently consensual. Most countries have implemented measures preventing disease transmissions, adjusting health systems, controlling borders and mobility, redirecting the economy, and securing civil protection. To this end, heads of government and their minister of health are working closely with all other ministries, departments, and sectors including social affairs, the home office, foreign affairs, research and education, transport, agriculture, business, and state aid. The problem this panel addresses is how to keep this invaluable intersectoral work flourishing long after the COVID-19 pandemic has passed. The framework of and the commitment to the Sustainable Development Goals (SDG) offers an opportunity to reinforce action on health- but also to go beyond the Health in All Policies (HiAP) concept and towards a greater commitment to co-benefits. HiAP has introduced the idea that co-benefits from other sectors to health are valuable; however, the concept neglects the focus on co-benefits that arise from health or health systems to other sectors. Health for all Policies (HfAP) builds on HiAP in that it also Identifies co-benefits from health or health systems to other sectors. This bi-directional relationship can strengthen the case for investing in health, and emphasizes the contribution of health and health systems to societal wellbeing. In this panel, the basic question we are asking is: How can we better understand and communicate the health effects and co-benefits that intersectoral action can produce? To do this the panel draws on and makes a case for changing the argument about intersectoral action, from one focusing on health and health sector as the main beneficiary to one based on co-benefits, focusing on benefits for all sectors. It makes the case for a Health for All Policies approach, one that focuses on co-benefits between sectors. Format This will be a roundtable discussion where a brief keynote will be given on the concept of co-benefits and Health for All policies. The rest of the roundtable will be interactively facilitated and cover the economic argument for co-benefits and then, to demonstrate these co-benefits and spark audience engagement, three SDGs that speak clearly to the conferences theme of our food, our health our earth will be given the spotlight. These include: SDG 11 sustainable cities and communities, SDG 8 Decent work and economic growth and SDG 13 climate action. This workshop is based on a comprehensive study that has produced a Lancet article, a policy brief and we will be presenting the final results from our forthcoming manuscript. Key messages • The health for all policies concept can strengthen the case for investing in health and achieving the SDGs. • Intersectoral collaboration and action is key to producing co-benefits. Speakers/Panelists Scott Greer University of Michigan, Ann Arbor, USA Luigi Siciliani University of York, York, UK Michelle Falkenbach European Observatory on Health Systems and Policies, Brussels, Belgium Andrea Schmidt Austrian Public Health Institute, Vienna, Austria Roshanak Mehdipanah University of Michigan, Ann Arbor, USA

Professional Public Health Practice in Spain - Insights from the Spanish Public Health White Paper

Abstract Issue/Problem The public health professionals has gained attention during the COVID-19 pandemic. However, the weakness of Spain's public health structures has been exposed during the crisis, which is partly due to the delay in modernising institutions and the low percentage of GDP dedicated specifically to theses public health institutions. In addition, there is a lack of specific training for public health practitioners to acquire the necessary multidisciplinary competences for high quality public health practice. Description of the problem The Spanish Society of Public Health and Health Administration (SESPAS) has developed a white paper of the public health profession. The main objective is to contribute to strengthening the professional practice of public health by identifying some of its problems and agreeing on possible solutions. The specific objectives were to frame public health as a profession, to describe the socio-demographic characteristics of the people affiliated to the associations federated in SESPAS, to carry out a qualitative analysis of the discourse of public health professionals on its meaning, and developing conclusions and recommendations to address public health challenges. Results The demographic and employment data of the 3,467 people belonging to seven SESPAS societies show that, overall, about 60% are women and 40% were under 50 years of age. Undergraduate degrees were Medicine (35.9 %), Nursing (17.4 %) and Pharmacy and Veterinary Medicine (10.4 %), other life science degrees (4.3 %). Key aspects of the meaning of public health, training, employability and career and institutionalisation of public health were collected through 19 interviews and 6 focus groups. Lessons In order to agree on the conclusions and recommendations, a meeting was organised with the participation of 29 members of SESPAS. A total of 25 conclusions and 24 recommendations were drawn. Key messages • White paper is a step forward in the strengthening of public health in Spain. • Public health should develop leadership and advocacy skills for people's health from a multidisciplinary and cross-sectoral practice.

Digoxin-specific antibodies: anovel dosing strategy.

Digoxin-specific antibodies (digoxin-Fabs) are of value in the treatment of astrongly suspected or aknown, potentially life-threatening digoxin toxicity. These antibodies are not registered for use in Europe; therefore Dutch hospital pharmacies are not allowed to keep them in stock. In the Netherlands, digoxin-Fabs are stored in anational calamity stock of emergency medicines at the National Institute for Public Health and the Environment. In the case of amedical emergency, digoxin-Fabs are available after contact with the Dutch Poisons Information Centre. Recent studies have shown that the dose of digoxin-Fabs required to effectively treat digoxin toxicity is lower than previously thought. In this article, we present the adjusted digoxin-Fab dosing strategy currently recommended by the Dutch Poisons Information Centre ( www.vergiftigingen.info ). This new dose titration strategy is safe and effective and has acost-saving side-effect.

Challenges and enablers faced by HIV/AIDS supporting organizations during COVID-19

The dynamics of multi-sectoral collaborations between HIV/AIDS-supporting non-governmental organizations and public health institutions can significantly affect how programs are implemented, especially during emergencies like the once-in-100-year COVID-19 pandemic. These collaboration dynamics were explored in a South African context in the Western Cape province during COVID-19. Interviews and a focus group discussion were conducted with participants (n=6) from two small-scale HIV/AIDS-supporting NGOs and one public health institution. Challenges of multi-sectoral collaboration identified included inadequate engagement opportunities, limited opportunities to contribute during engagements, and being forced to innovate to survive. Enablers of multi-sectoral collaboration, such as communication, leadership, coordination of responsibilities, and trust and transparency, were found to be crucial for effective and strong working relationships during times of unparalleled disaster. New insights are offered on how enablers of collaboration that apply during normal circumstances should be thought of during times of crisis, and how these can be adapted and augmented to help HIV/AIDS collaborative partnerships survive future potentially disastrous situations like climate change.

Algorithms to improve the EMIAS system to optimize the routing of adolescents with atopic dermatitis

Atopic dermatitis is a systemic, chronic, relapsing, inflammatory disease affecting mainly the skin. In recent decades, the incidence of atopic dermatitis has been steadily increasing. The burden of atopic dermatitis in adolescents is particularly severe because they are in a transitional and vulnerable growth phase with associated biological, cognitive, social, and emotional transformations.
 Early and correct diagnosis of atopic dermatitis, as well as the identification of adolescents with an uncontrolled course of the disease, will provide an opportunity to select/change therapy, which can lead to remission, preventing the negative effects of the disease. A number of studies have shown that the negative mental health effects of atopic dermatitis on adolescents include an increased risk for depression, attention deficit hyperactivity disorder, anxiety and behavior disorders, sleep disturbances, and suicidal ideation.
 EMIAS is a unified medical information and analytical system, which was created to improve the availability and quality of medical services provided by Moscow public health institutions. The introduction of EMIAS has led to improvements in the healthcare system.
 The article proposes validated and simple tools, the integration of which into the EMIAS system, will facilitate the verification of diagnosis and personalized (based on recommendations at the population level) management of adolescents with atopic dermatitis in the outpatient phase by pediatrician and allergist.

Pathogens detected from patients with acute respiratory infections negative for SARS-CoV-2, Saitama, Japan, 2020.

During the coronavirus disease pandemic in Japan, all patients with respiratory symptoms were initially tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study describes the respiratory pathogens detected from patients who tested negative for SARS-CoV-2 at the Saitama Institute of Public Health from January to December 2020. We performed pathogen retrieval using multiplex real-time polymerase chain reaction on samples from patients with acute respiratory diseases who tested negative for SARS-CoV-2 in Saitama in 2020 and analysed the results by age and symptoms. There were 1530 patients aged 0-104 years (1727 samples), with 14 pathogens detected from 213 patients (245 samples). Most pathogens were human metapneumovirus (25.4%, 54 cases), rhinovirus (16.4%, 35 cases) and Mycoplasma pneumoniae (13.1%, 23 cases). Human metapneumovirus, human coronavirus (but not NL63) and M. pneumoniae were detected in almost all age groups without any significant bias. Seasonal human coronaviruses, human metapneumovirus, M. pneumoniae and several other pathogens were detected until April 2020. Multiple respiratory pathogens were circulating during 2020 in Saitama, including SARS-CoV-2 and influenza viruses. We suggest introducing a system that can comprehensively monitor the regional prevalence of all viruses that cause acute respiratory infections.

The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia

ABSTRACT Background: Women are disproportionally affected by HIV and are at greater risk of OIs and malignancies. This study investigated the spectrum of OIs and malignancies among women living with HIV (WLHIV) in Ethiopia. Methods: A retrospective longitudinal study was conducted among 3,817 WLHIV on Antiretroviral Treatment (ART) from 2007 to 2019 in Ethiopia. Data on OIs, malignancies, and clinical characteristics were retrieved from medical records. Prevalence, incidence, and mortality rates were measured over 13 years of follow-up. The Kaplan-Meier survival curve and multivariable Cox-proportional hazard regression were used to estimate incidence and identify predictors of OIs and malignancies, respectively. Result: The pooled prevalence of OIs or malignancies was 47%. OIs accounted for 39% and malignancies were 23.3%. The incidence of OIs and malignancies were 19.4 (95%CI:9.2-29.5) and 11.5 (95%CI:2.2-20.8) per 100 person-years of observation, respectively. Incidence of candidiasis was 14.1 per 100 person-years followed by Lymphoma (11.9), Cervical Cancer (11.5), and TB (10.9). The risk of OIs was higher in patients with baseline CD4 count ≤500 cells/mm3 [AHR (95%CI): 2.0 (1.8-2.3)] and VL>1000 copies/ml [AHR (95%CI): 1.5 (1.1-1.9)]. Overall, 24.6% died, and of them, 62.2% had a history of OIs or malignancies. The risk of death was higher among WLHIV with a history of Toxoplasmosis, TB and PCP. Conclusion: OIs and malignancies was recently increasing and two-thirds of all deaths were associated with these co-morbidities. The high rates of OIs and malignancies were attributed to poor treatment outcomes. The finding calls to enhance the diagnosis and treatment of these co-morbidities. Abbreviations AIDS: acquired immune deficiency syndrome; CI: confidence interval; EPHI: Ethiopian Public Health Institute; HAART: highly active antiretroviral therapy; HIV: human immunodeficiency virus; HR: hazard ratio; Mg/dl: milligram per deciliter; TB: tuberculosis; PCP: pneumocystis carinii pneumonia; ZJU: Zhejiang University

Cultural competence and associated factors among nurses working in public health institutions in the Assosa zone, Benishangul Gumuz regional state, Ethiopia, 2022

BackgroundCultural competence is one of the principal foundations of clinical nursing. In Ethiopia, nurses in nursing care still focus more on physical needs, the healing process, and treatment and less on the cultural aspects of the patient.ObjectiveThis study aims to assess the cultural competence and associated factors among nurses working in public health institutions found in the Assosa Zone, West Ethiopia, in 2022.MethodsAn institution-based cross-sectional study design was conducted on 362 nurses who were selected by simple random sampling. Data was collected using a structured, self-administered English version of the Nurse Cultural Competence Scale Questionnaire for Nurses. The data were entered into Epi Data version 3.1 and exported to SPSS version 25. Linear regression analysis was used to identify factors statistically significantly associated with the cultural competence of nurses at a p-value < 0.05.ResultOverall The mean score of cultural competence of participants was 113 (CI, 111.7–115.7), with a mean item score of 3.2 (CI, 3.15–3.26).Nurse-to-patient ratio (B;.93, CI;.59_1.3), experience with previously working in a primary hospital than the current health institution (B; -11.1, CI; -18_-4.2), and experience with previously working in a health center than the current health institution (B; -11.5, C;-18.5_-4.8), being diploma education level (B; -23.2, CL;-32_-14.8), being BSC education level (B;-20.3, CI;-28_-12.3), and the presence of a feedback system in a health facility (B; 13.5, CI; 9.5_17.5) were identified as predicted factors of cultural competences.ConclusionThe overall mean score of the cultural competencies of the participants was moderate. To improve the cultural competence of nurses, it is typically necessary to provide educational opportunities to raise their educational level and establish a feedback system in all health institutions across the nation.

Trust in public health institutions moderates the effectiveness of COVID-19 vaccine discussion groups on Facebook

ABSTRACT Background Distrust and partisan identity are theorized to undermine health communications. We examined the role of these factors on the efficacy of discussion groups intended to promote vaccine uptake. Method We analyzed survey data from unvaccinated Facebook users (N = 371) living in the US between January and April 2022. Participants were randomly assigned to Facebook discussion groups (intervention) or referred to Facebook’s COVID-19 Information Center (control). We used Analysis of Covariance to test if the intervention was more effective at changing vaccination intentions and beliefs compared to the control in subgroups based on participants’ partisan identity, political views, and information trust views. Results We found a significant interaction between the intervention and trust in public health institutions (PHIs) for improving intentions to vaccinate (P = .04), intentions to encourage others to vaccinate (P = .03), and vaccine confidence beliefs (P = .01). Among participants who trusted PHIs, those in the intervention had higher posttest intentions to vaccinate (P = .008) and intentions to encourage others to vaccinate (P = .002) compared to the control. Among non-conservatives, participants in the intervention had higher posttest intentions to vaccinate (P = .048). The intervention was more effective at improving intentions to encourage others to vaccinate within the subgroups of Republicans (P = .03), conservatives (P = .02), and participants who distrusted government (P = .02). Conclusions Facebook discussion groups were more effective for people who trusted PHIs and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views.

Health beyond clinical protocol: institutional traps and limitations of modern medicine

The article is aimed to describe the ineffective health care mechanisms and find ways to overcome them. Some variants of institutional dysfunctions (or institutional traps) in medical practice are considered. The resort to natural methods of healing and self-healing is regarded as a way to overcome various institutional dysfunctions. The work combines several qualitative methods: a non-standardized survey of experts (doctors), included observation (25 years of work as a doctor and independent use of natural healing methods for the past 12 years), and analysis of documents, literary sources and messages on the topic of self-healing in relevant Facebook groups. The themes of the talks with doctors were health self- management and alternative healing practices (intensive physical exercises, medical fasting, and breathing exercises). During conversations with the doctors found that only some senior doctors have positive experience of using therapeutic fasting and breathing exercises (both personal and clinical), and young doctors who have been working in medicine for over 10-20 years are not familiar with these methods ("because this treatment is not carried out according to the approved clinical protocols”, and “we treat according to modern protocols"). The most problematic points of the use of such health practices and the reasons for their increase in society are discussed. It is concluded that both in the institutional and ideological aspect, the essential component of the public health institute should be outside the scope of official medicine, which is aimed at the use of medicinal and high-tech means of treatment and prevention.

Health Policy Reform through Strengthening Indonesia's Health Resilience System

The National Health System in Indonesia is developing and being discussed more seriously after entering the COVID-19 pandemic. With a national health system and several existing tools, Indonesia needed more time to be ready to face the challenges of that time. Upstream health policies should be optimized to mobilize resources and increase the nation's efforts to build a national resilience system. This paper was built using selected policy documents up-to-date and reliable literature. By reviewing empirical evidence, the author believes and shows the role of strengthening health policies in building a robust national health resilience system. Indonesia has several policies that have the potential to become a sub-system for national health resilience. The health resilience system is formed from the health system and health resilience components, which impact creating a Healthy Indonesia. Health system resilience can be seen from stable funding, good governance, flowing and integrated information systems, risk adaptation, adequate health workforce capacity, logistics, and robust health efforts. The interaction between the health system, health resilience, and the health resilience system formed is within the umbrella of health policy, the completeness of resilience policy, and the highest public health institutions. Strengthening the role of health policy in the formation of a health resilience system in a country is one proof of health policy reform. Health policy is no longer seen as the upstream side of health programs or efforts but as an essential side in functioning a system to create a healthy country. Reforming the national health system should followed by institutional reform of The Ministry of Health to become the Ministry of Public Health, and health policy reform by strengthening health resilience.

Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic

Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.

#HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information.

Social media has become an integral part of modern society. Many people now turn to social media platforms to share or gain knowledge about best practices for personal health. This new form of health information dissemination has greatly increased in popularity especially among young adults. Currently, more research is needed to identify why so many individuals choose to turn to social media for health information. Using Q methodology, this study aimed to uncover the attitudes, opinions, and beliefs of young adults who engage with social media as a means of obtaining health and fitness information. Results revealed four primary factors: the Health Connoisseurs, the Health Enthusiasts, the Loyalists, and the Virtual Befrienders. Each group possessed different motivations for accessing health-related content on social media. The insights gained from this study can benefit public health institutions, advertisers, and social media content creators as they disseminate health information on social media platforms.

Screening for psychosocial risks among physicians in a pediatric hospital

Over the past decades, productivity practices at hospital resulted in staff overload and burnout. Prompted by physicians’ complaints, this study assessed the level of psychosocial risk among senior pediatricians in a university hospital.The survey used the checklist of Quebec's National Institute of Public Health that comprises two six-indicator parts: “Context” and “Key Components” of the Organization.The psychosocial risk level was evaluated by a physician–psychologist duo during interviews of homogeneous groups of workers. The indicators were scored, tabulated, and discussed.The survey led to a substantial qualitative and quantitative clarification of physicians’ working conditions, claims, and needs. Regarding Context, the staff reported mainly: (a) cumbersome organization and norms vs. limited human resources (lack of stability, incentives, and promotions); (b) absenteeism and presenteeism; (c) reluctance to seek care or advice for fear of discredit; (d) presence of verbal violence; (e) self-imposed harsh returns-to-work; (f) work–life conflicts and difficult mental disconnection from work. Regarding the Key Components, the staff reported mainly: (a) work overload (physical, mental, psychological, and relational/social), continuous stress, and perceived exhaustion; (b) low job satisfaction and insufficient recognition; (c) inconstant support by their superiors; (d) poor job relationships and colleagues’ support; (e) occasional participation and lack of real autonomy and/or strategy sharing.The survey succeeded in underlining concerning issues that required the immediate attention of occupational physicians and managers. It proved the method feasible and valuable in the medical context despite a high diversity of staff functions and degrees.

B-108 T-cell-mediated Immunity against SARS-CoV-2 in Health Care Workers: Head-to-head Comparison of Two Interferon-Gamma Release Assays and Associations between Cellular and Humoral Immunity

Abstract Background T-cell responses are a crucial constituent in the adaptive immunity to SARS-CoV-2 and can be quantified using interferon-gamma (IFN-γ) release assays (IGRAs). This study aimed at comparing the results of two commercial IGRA systems, the EUROIMMUN Quan-T-Cell SARS-CoV-2 and the Oxford Immunotec T-SPOT.COVID, presenting the first head-to-head comparison of these two assays for the evaluation of SARS-CoV-2-specific T-cell activity. Methods Blood samples were collected at the Public Health Institute Ostrava from 90 health care professionals with a history of COVID-19 infection or vaccination. All samples were tested for T-cell-mediated immunity using the two IGRAs as well as for humoral immunity using the EUROIMMUN Anti-SARS-CoV-2 QuantiVac ELISA IgG and an in-house virus neutralization test. Results Similar results were obtained by both IGRAs, yet the sensitivity of the Quan-T-Cell appeared to be insignificantly higher than that of the T-SPOT.COVID. Conclusion Both assays demonstrated excellent overall agreement with virus neutralization activity and anti-S IgG positivity, with the only exception that 4/6 subjects in the subgroup of unvaccinated Omicron convalescents were devoid of IgG. In these cases, however, T-cell responses were at least borderline positive, indicating that IGRAs provide higher sensitivity in detecting immune responses to SARS-CoV-2 than do IgG-specific assays. This applies particularly to unvaccinated persons who contracted only SARS-CoV-2 Omicron variant infection but is also likely to be relevant to other patient groups.

96 Foreign Body Aspiration in Children: A Review of the Public Health Prevention Guidelines by Analyzing the Circumstances of Choking Episodes in a Canadian Tertiary Centre from 2006 to 2020

Abstract Background Choking and foreign body aspiration are major causes of morbidity and mortality in infants and young children. To prevent choking episodes and their complications, many associations, from the Canadian Paediatric Society to National Public Health Institutes, have suggested prevention guidelines for parents and health professionals. They specify what types of food should be restricted in young children, such as nuts and raw hard vegetables, and give advice on surveillance. Yet, every year, children are admitted to our centre following a choking episode that requires a bronchoscopy under general anesthesia. Objectives Our objective was to identify the risks factors associated with choking episodes in children and compare them with actual prevention guidelines to determine if public health recommendations are still adequate. Design/Methods This retrospective study included all patients, from 0 to 17 years old, who presented to our tertiary centre between April 2006 and December 2020 and underwent a bronchoscopy under general anesthesia for a suspicion of foreign body aspiration. Data on demographic characteristics of the patients, the circumstances of the episodes and on severity criteria were collected from the patients’ electronic files and compared to the prevention guidelines. Results One-hundred and ninety-one patients with a history of suspected foreign body aspiration were included. Among them, 101 had a positive bronchoscopy. Close to 65% of patients were boys. The mean age at presentation was 31,5 months. Food was the most common type of foreign body, causing 73,3% of all choking episodes. Close to 70% of those choking episodes involved nuts, seeds or raw hard vegetables. 84,5% of those events happened at home, and 79,4% of choking episodes happened under the surveillance of one or both parents. Thirty patients ended in the paediatric intensive care unit where they spent an average of 6,47 days. Conclusion Our results show that most choking episodes in children result from a non-respect of actual recommendations. They involve types of food and circumstances that are already restricted by the prevention guidelines. It highlights the need for better parent education and should inspire clinicians to make some time to address choking hazards with families.

Using a quality improvement tool, Plan-Do-Study-Act cycle, to boost TB notification in India post-Covid-19 pandemic

Quality improvement tools such as the Plan-Do-Study-Act (PDSA) cycle hold tremendous potential to improve the quality of healthcare in India. The electronic-PDSA tool was previously developed by CETI (Collaboration to Eliminate TB among Indians) and successfully piloted in small groups. In this study the e-PDSA was scaled up across the nation over a brief 10 week period to boost TB notification by training District Tuberculosis Officers (DTOs) virtually post-Covid-19 pandemic. Quality improvement counselors, who were interns from Masters in Public Health Institutions, were liaisons to “hand-hold” and assist the DTOs through the PDSA cycle. The course was voluntary and offered to all DTOs through Central TB Division and State TB Officers from May 2022 to July 2022. Of the 779 Districts in India and nearly equal number of DTOs, 546 (70%) DTOs enrolled in the course and of these 437 (80%) conducted a PDSA while 342 (43%) districts/DTOs did not enroll or did not complete a PDSA. With a baseline notification in February-March-April 2022 and intervention in May-June-July 2022; 55% of the districts in the PDSA group showed improvement in TB Notification compared to 45% in the non-PDSA group. When data was analyzed by population (not district) there was a trend in increase in notification post-pandemic in both PDSA and non-PDSA groups, and the PDSA group had a slightly higher 5.6 per 100,000 population improvement compared to 5.0 per 100,000 in the non-PDSA group. The cost of intervention was $40,000 or $92 per DTO for three months. The course was highly acceptable with DTOs rating 4.3 out of 5 in recommending the course to other DTOs. Our data shows that a large scale-up of the PDSA cycle is feasible, economical and effective with little additional resources. The focus was on increasing the efficiency of the existing processes well within the authority of the DTO. Repeat cycle of PDSA with notification and other measures such as presumptive sputum examination could significantly impact the program and help to achieve TB Free India.

Unexpected vaginal bleeding and COVID-19 vaccination in nonmenstruating women.

The association between coronavirus disease 2019 (COVID-19) vaccination and vaginal bleeding among nonmenstruating women is not well studied. The Norwegian Institute of Public Health followed several cohorts throughout the pandemic and early performed a systematic data collection of self-reported unexpected vaginal bleeding in nonmenstruating women. Among 7725 postmenopausal women, 7148 perimenopausal women, and 7052 premenopausal women, 3.3, 14.1, and 13.1% experienced unexpected vaginal bleeding during a period of 8 to 9 months, respectively. In postmenopausal women, the risk of unexpected vaginal bleeding (i.e., postmenopausal bleeding) in the 4 weeks after COVID-19 vaccination was increased two- to threefold, compared to a prevaccination period. The corresponding risk of unexpected vaginal bleeding after vaccination was increased three- to fivefold in both nonmenstruating peri- and premenopausal women. In the premenopausal women, Spikevax was associated with at 32% increased risk as compared to Comirnaty. Our results must be confirmed in future studies.

Key Contributions by the Swiss Tropical and Public Health Institute Towards New and Better Drugs for Tropical Diseases.

Thanks to its expertise in clinical research, epidemiology, infectious diseases, microbiology, parasitology, public health, translational research and tropical medicine, coupled with deeply rooted partnerships with institutions in low- and middle-income countries (LMICs), the Swiss Tropical and Public Health Institute (Swiss TPH) has been a key contributor in many drug research and development consortia involving academia, pharma and product development partnerships. Our know-how of the maintenance of parasites and their life-cycles in the laboratory, plus our strong ties to research centres and disease control programme managers in LMICs with access to field sites and laboratories, have enabled systems for drug efficacy testing in vitro and in vivo, clinical research, and modelling to support the experimental approaches. Thus, Swiss TPH has made fundamental contributions towards the development of new drugs - and the better use of old drugs - for neglected tropical diseases and infectious diseases of poverty, such as Buruli ulcer, Chagas disease, food-borne trematodiasis (e.g. clonorchiasis, fascioliasis and opisthorchiasis), human African trypanosomiasis, leishmaniasis, malaria, schistosomiasis, soil-transmitted helminthiasis and tuberculosis. In this article, we show case the success stories of molecules to which Swiss TPH has made a substantial contribution regarding their use as anti-infective compounds with the ultimate aim to improve people's health and well-being.