Public Health Model Research Articles

Influence of Physiographic Region on Pathogen Concentrations Between Stream Types

Predicting public health risk associated with exposure to and recreational use of surface waters is often challenging due to substantial variability in concentrations of pathogenic bacteria, even among seemingly similar streams. In this study, we document significant differences in the surface water concentrations of the common bacteria indicators Escherichia coli and fecal coliform between two major stream types—blackwater and redwater streams (p < 0.001). We propose and present evidence that these findings result from natural biogeochemical variation between physiographic regions (p < 0.001). These findings suggest that physiographic stream type may influence the degree of exposure to waterborne pathogens and risk of waterborne disease. Future research is needed to assess whether the inclusion of stream type in risk assessments can improve public health modeling and mapping.

Lay Perspectives on Drug (De)Criminalization and the (De)Stigmatization of People Who Use Illicit Drugs

Background: Substance use stigma has been framed as contributing to the drug toxicity crisis. We theorize the political function of drug criminalization as contributing to a system of stigma that exerts social control over people who use illicit drugs (PWUID). Consequently, drug decriminalization may be a potential destigmatizing solution. Since decriminalization is often positioned as an antistigma intervention targeting the public, it is important to understand how laypeople conceptualize decriminalization. Methods: We acquired, via a Freedom of Information request, 221 deputations sent to the City of Vancouver regarding Motion B.4, which would advance decriminalization. We used reflexive thematic analysis to explore: (1) how laypeople conceptualized drug (de)criminalization and its relation to the (de)stigmatization of PWUID; and (2) the potential implications of the various conceptualizations of (de)criminalization for the autonomy of PWUID. Results: Supporters of Motion B.4 commonly assumed decriminalization would destigmatize PWUID. Supporters also often argue that the drug toxicity crisis is a public health problem, not a criminal one. However, the public health model of decriminalization advocated by some supporters still limited the autonomy of PWUID. Meanwhile, those opposed commonly positioned social control of PWUID as necessary, including opponents who argued that decriminalization was a form of systemic neglect that abandons PWUID. This view was echoed by some proponents, notably those who argued for a public health model of decriminalization. Finally, some proponents asserted that PWUID should be included in the policymaking process, though few deputations came from self-identified PWUID. All PWUID argued that decriminalization must exclude the police. Conclusion: Our analysis of lay perspectives on decriminalization highlights the importance of models that adequately address all levels of stigma for PWUID. Models that fail to preserve the autonomy of PWUID are likely to reproduce their stigmatization.

Manhattan's Street Trees: An Unfinished Public Health Story.

Stephen Smith launched a 40-year effort to bring trees to New York City streets in 1872, the year he founded the American Public Health Association (APHA). Smith argued that street trees would mitigate the adverse health effects of Manhattan's summer heat and help purify the air. The young APHA endorsed Smith's position and gave trees a prominent role in urban sanitation, but public health turned away from trees and urban reform movements as it adopted a biomedical public health model in the late 19th century. Nevertheless, Smith wrote and campaigned for a successful 1902 law requiring the New York City Parks Department to assume management of street trees in the name of public health. He then led a 1914 campaign to force the department to uphold his law. New York's street tree program has had an erratic trajectory, but it now generally follows Smith's vision. Public health could play a bigger role in creating greener cities and mitigating climate change with more field research and the health in all policies approach that Smith used to bring trees to Manhattan's streets in 1914. (Am J Public Health. Published online ahead of print October 31, 2024:e1-e9. https://doi.org/10.2105/AJPH.2024.307856).

Public Health Benefits of Applying Evidence-Based Best Practices in Managing Patients Hospitalized for COVID-19.

As COVID-19-related mortality remains a concern, optimal management of patients hospitalized for COVID-19 continues to evolve. We developed a population model based on real-world evidence to quantify the clinical impact of increased utilization of remdesivir, the effectiveness of which has been well established in hospitalized patients with COVID-19. The PINC AI healthcare database records for patients hospitalized for COVID-19 from January to December 2023 were stratified by those treated with or without remdesivir ("RDV" and "No RDV") and by supplemental oxygen requirements: no supplemental oxygen charges (NSOc), low-flow oxygen (LFO), and high-flow oxygen/non-invasive ventilation (HFO/NIV). Key vulnerable subgroups such as elderly and immunocompromised patients were also evaluated. The model applied previously published hazard ratios (HRs) to 28-day in-hospital mortality incidence to determine the number of potential lives saved if additional "No RDV" patients had been treated with remdesivir upon hospital admission. Of 84,810 hospitalizations for COVID-19 in 2023, 13,233 "No RDV" patients were similar in terms of characteristics and clinical presentation to the "RDV" patients. The model predicted that initiation of remdesivir in these patients could have saved 231 lives. Projected nationally, this translates to >800 potential lives saved (95% CI: 469-1,126). Eighty-nine percent of potential lives saved were elderly and 19% were immunocompromised individuals. Seventy-one percent were among NSOc or LFO patients. This public health model underscores the value of initiating remdesivir upon admission in patients hospitalized for COVID-19, in accordance with evidence-based best practices, to minimize lives lost due to SARS-CoV-2 infection.

Health inequalities and health-related economic inactivity: Why good work needs good health

Tackling health inequalities demands whole systems strategies with reach beyond the traditional sphere of influence of health care systems. Practitioners and researchers have long recognised that wider social determinants, where people are born, the communities they live in, their built environment, access to education and resources and, most significantly for this discussion, their relationship to the labour market, profoundly shape health experiences and expectations over the lifecourse. At macro-level, economic structures and systems play a fundamental role in the distribution of good health and incidence of inequalities. Regionally, the health of local labour markets, a phenomenon shaped by macro, national and global economic forces, is a powerful determinant of opportunities to access and remain in work. Simultaneously, health status impacts significantly on ability to participate in paid employment. Absence from the labour market is both a cause and symptom of health inequalities.Economic inactivity, where people are both not participating in the labour market, or actively seeking or available for work, is strongly correlated with poor health. In the UK, over one third of the economically inactive experience long-term health problems. The implications for health inequalities, as both cause and symptom are clear. Participation in paid work, where appropriate, can be beneficial both economically and for health and wellbeing. Continued absence from the labour market is directly correlated with ill health. The determinants of health-related economic inactivity are complex and can only be understood using ecological models of public health. This presents significant challenges for politicians and policymakers alike concerned with reducing economic inactivity, delivering economic growth and redressing regional disparities.

A Practical Approach to SARS-CoV-2 Prevention and Containment in a National Sporting Event in Italy: A Public Health Model Applicable Also to Other Respiratory Viruses?

A Practical Approach to SARS-CoV-2 Prevention and Containment in a National Sporting Event in Italy: A Public Health Model Applicable Also to Other Respiratory Viruses?

Impact of primary care and public health integration of chronic conditions in China: a protocol for a prospective multicentre cohort study

IntroductionThe prevalence of chronic conditions is increasing. Given that the majority of chronic patients are managed by primary healthcare providers, there is a need to integrate primary care with public...

Concept of Artificial Intelligence-oriented Public Health Model in Cancer Care

Abstract In recent years, the escalating volume of essential information for oncologists has created a challenge, making it arduous to stay abreast of the latest developments in the multifaceted field of cancer care. Although Artificial Intelligence (AI) is increasingly applied in healthcare, particularly for tasks like image recognition and big data analysis, we advocate for an AI-centric public health model tailored to comprehensive cancer care. This model aims to guide patients from their initial doctor’s visit to the conclusion of treatment, thereby minimizing direct doctor involvement. Results. The proposed AI system comprises distinct units: Regional AI (RAI) for patient management and coordination with healthcare specialists and facilities in specific areas, General AI (GAI) to oversee healthcare processes on a broader scale, and Scientific AI (SAI) for data analysis and hypothesis generation, essential for scientific research and clinical trials. To enhance cost efficiency, we suggest introducing an intermediate layer, Teacher AI (TAI), facilitating the development of AI systems like GAI or RAI based on human needs without necessitating extensive specialist intervention. Conclusions. Implementing this model can simplify oncologists’ daily tasks, reduce errors, improve treatment outcomes, and lower the cost of cancer care while maintaining its high quality. The Human–TAI–AI development model can streamline the system’s development and implementation, making it more cost-effective.

A call for multi-agency collaboration in the Pacific Island countries' mental health - The World Federation for Mental Health viewpoint.

To introduce the World Federation for Mental Health (WFMH) viewpoint on the Pacific Island countries' mental health capacity building. Multi-agency collaboration guided by a nuanced understanding of the local context can enable a public health model of mental health service delivery in the Pacific Island countries.

Modeling health outcomes of air pollution in the Middle East by using support vector machines and neural networks

This study investigates the impact of air pollution on health outcomes in Middle Eastern countries, a region facing severe environmental challenges. As such, these are important in an effort to add up to policy-level as well as interventional changes that can be put in practice in the area of public health. Numeration analysis and association with health parameters was carried out by using Analytical tools such as, AIR Data, ARIMA,ANN, SVM and Exponential smoothing. Amongst the models, Support Vector Machine came again on top, with high accuracy yielding Mean Absolute Percentage Error of approximately 1%. Mortality of Air pollution in Qat from the case of Mortality of Air Pollution in Qatar is 959 while Auto regressive Integrated Moving average is 11.096, Exponential Smoothing 9.892 and Artificial Neural Networks are the source of inspiration for the development of this paper 4.61. The above perceptions indicate that there is need to adapt modeling strategies depending on the context and establish that it is possible to implement ML models in public health planning basket. This paper publishes the methodological frameworks for the purpose of modeling and analysis of the EHDs and serves as policy prescription for the policy makers to intending to reduce the effects of air borne pollution on health.

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

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

Comparison of In-Person and Virtual Implementations of an Obesity Prevention and Culinary Nutrition Education Program for Family Care Providers

Start Strong, a 4-week culinary nutrition education and obesity prevention program designed for rural family care providers in low-income areas of Minnesota, was initially an in-person training program and was recently adapted into a virtual version. Using a quasi-experimental design, this study examined within-group and between-group (in-person versus virtual) changes in culinary skill confidence and familiarity with food assistance programs after Start Strong participation. Additionally, we examined post-program participant experiences. The in-person program (n = 12, mean age of 45 years, September 2019) took place at community locations. The virtual program (n = 27, mean age of 41 years, Fall 2021–Winter 2022) used online learning and videoconferencing. Following data collection pre- and post-program, we used t-tests to examine within-group changes after Start Strong participation, repeated measures analysis of variance tests to compare outcomes between the in-person and virtual implementations, and Fisher’s exact test to compare post-survey outcomes. The in-person and virtual programs demonstrated similar improvements in cooking skill confidence and familiarity with food assistance programs. Compared to the virtual program, in-person participants reported significantly greater connection with other providers. This evaluation is relevant to addressing disparities in obesity prevention and provides an initial model for public health and community partnerships with ECE providers.

Public Health Nurses in an Internal Negotiation Process When There Is Concern About the Child’s Care

The aim of the study was to explore and describe how public health nurses at child health clinics experience and perceive the follow-up of children and families when there is concern about the child’s care. The goal was to contribute to knowledge development to guide health-promoting nursing care for children and their families. Theoretical perspectives included health promotion, child-centered and family-centered care, in addition to nursing care. An exploratory qualitative design informed by a hermeneutic approach was used. Data were collected in 3 focus groups with 16 public health nurses and analyzed using latent content analysis. The findings detail public health nurses’ internal negotiation processes in the follow-up of children and the family, and the ways these negotiation processes were influenced by various prerequisites, the approaches for follow-up, dilemmas that affected public health nurses’ approaches, and prolonged dwellings on past responses to children and families of concern. The lack of routines and goals for follow-up, a dominant parental perspective, and ambiguity related to health promotion and disease prevention, all created challenges for the public health nurses. Based on these findings, a model of public health nurse’s follow-up when there is concern about the child’s care was developed for future research.

New York City’s Rapid Response to the 2022 Mpox Outbreak

Human society is facing emerging infectious disease threats with increasing frequency, potentially with novel medical countermeasures available, but often with initial limited access and supply. Long-standing racial health inequities create barriers to accessing critical new treatments that can further exacerbate health disparities in an emergency. During the 2022 mpox outbreak, the antiviral tecovirimat was made available from federal stockpiles for the treatment of mpox disease. Here, the authors describe New York City’s multipronged approach to ensure access to mpox therapeutics, which built on related work during the Covid-19 pandemic. This approach can serve as a road map to addressing systemic barriers to treatment and care during emergency responses. It includes (1) targeting messaging and outreach to providers serving marginalized communities, (2) use of a centralized pharmacy process for medication access, (3) setting up a treatment evaluation and referral process, and (4) monitoring utilization through integration of data across multiple public health data sources. The result was tecovirimat treatment prescribed to 32% of all patients with mpox in New York City. This approach to tecovirimat access during the mpox outbreak in New York City illustrates a model for public health and health care delivery partnerships that could be implemented when novel medical countermeasures become available in the setting of an emerging infectious disease outbreak.

The Community As A Full Partner: A New Model For Public Health.

The COVID-19 pandemic demonstrated a need to strengthen the US public health system by shifting toward much greater community engagement and leadership. In November and December 2023, we conducted separate online surveys of community-based organizations and large metropolitan health departments to identify barriers and opportunities for building a public health system with strong community partnerships. Identified barriers included mistrust, siloed health departments with structural challenges in funding community-based organizations, and insufficient shared decision making. The surveys helped inform our six policy recommendations: establish state and local community councils to formalize the roles of community-based organizations in public health decision making; dedicate funding to these organizations; offer funding that is not limited to a specific disease or condition; simplify procurement and reporting processes directed to community-based organizations; create a training and technical assistance program for these organizations; and increase public health worker diversity, including sustainable funding for community health workers.

Challenges in the distribution of antimicrobial medications in community dispensaries in Accra, Ghana.

The dispensation of medicines in some low- and middle-income countries is often carried out by private vendors operating under constrained conditions. The aim of this study was to understand the challenges reported by employees of dispensaries, specifically, chemical and herbal shops and pharmacies in Accra, Ghana. Our objectives were twofold: (1) to assess challenges faced by medicine vendors related to dispensing antimicrobials (antibiotic and antimalarial medications), and (2) to identify opportunities for improving their stewardship of antimicrobials. Data were collected in 79 dispensaries throughout Accra, in 2021, using a survey questionnaire. We used open-ended questions, grounded on an adapted socioecological model of public health, to analyze these data and determine challenges faced by respondents. We identified multiple, interlocking challenges faced by medicine vendors. Many of these relate to challenges of antimicrobial stewardship (following evidence-based practices when dispensing medicines). Overall, medicine vendors frequently reported challenges at the Customer and Community levels. These included strained interactions with customers and the prohibitive costs of medications. The consequences of these challenges reverberated and manifested through all levels of the socioecological model of public health (Entity, Customer, Community, Global). The safe and effective distribution of medications was truncated by strained interactions, often related to the cost of medicines and gaps in knowledge. While addressing these challenges requires multifaceted approaches, we identified several areas that, if intervened upon, could unlock the great potential of antimicrobal stewardship. The effective and efficient implementation of key interventions could facilitate efforts spearheaded by medicine vendors and leverage the benefits of their role as health educators and service providers. Addressing barriers faced by medicine vendors would provide an opportunity to significantly improve the provision of medications, and ultimately population health. Such efforts will likely expand access to populations who may otherwise be unable to access medications and treatment in formal institutions of care such as hospitals. Our findings also highlight the broad range of care provided by shopkeepers and vendors at dispensaries. These findings suggest that the meaningful engagement of dispensaries as valued conduits of community health is a promising pathway for interventions aiming to improve antimicrobial stewardship.

Seeking the public health angle in Missouri newspaper coverage of the opioid crisis

The public health model of reporting calls for public health professionals and journalists to work together to provide social and environmental context, risk factors, and prevention information in news coverage of public health issues. This quantitative content analysis describes the prevalence of contextual information in Missouri newspaper coverage of the opioid crisis. Results indicate Missouri newspapers are not depicting the opioid crisis as a public health issue. The study has implications for research and practice.

Limitations and consequences of public health models centred on hospitals and lacking connections with territorial and home-based social and health services

BackgroundDelayed discharge from hospital to home or other care institutions is a significant problem and has been investigated in the international scientific literature for many years.Behind this condition is a health care system based on a hospital-centered concept characterized by a lack of territorial health and social welfare services.This phenomenon causes two different problems: an excessive length of hospital stay, resulting in slow turnover of bed utilization; and overcrowding in emergency rooms (ERs).The phenomenon of frequent users assumes particular importance in this context. These patients repeatedly visit the emergency department (ED) in the same year because care needs are not met by primary care services.The authors in this study tried to describe the Frequent users (FUs) population and the variables associated with this condition.Materials and methodsA retrospective "single-arm" descriptive study was conducted by analysing all accesses made to the ED of Policlinico Tor Vergata (PTV) from January 1, 2022, to December 31, 2022.FUs were defined as patients who had 4 or more accesses to PTV ER during the year.ResultsA total of 37,800 accesses occurred during the study period. A total of 31,691 users accessed the PS, with a mean age of 55.8 ± 22.2 years.There were 359 FU patients (approximately 1%) who had a total of 1984 accesses, corresponding to 5.2% of the total accesses.The triage codes for the FU patients were red, 2%; orange, 21%; blue, 45%; green, 26%; white, 5%; and not performed, 1%.Considering the 1984 FU accesses, the most frequently attributed "main problems" in the ED were "other symptoms or disorders" (54%), "psychomotor agitation" (12%), "trauma or burn" (8%), "abdominal pain" (6%), "chest pain" (4%), "dyspnea" (4%) and "urological symptoms or disorders" (4%). Multivariate analysis revealed that the main determinants of FUs were psychomotor agitation (HR = 7,23; CL95%:6,194–8,443), urological disorders (HR = 2,16; CL95%:1,68–2,76) and poor socioeconomic status (HR = 2,40; CL95%:2,213–2,663).ConclusionsThe FUs phenomenon expresses an area of health and social distress where poverty and lack of territorial services oblige people to refer to the ED. Primary care interventions integrated with social support are crucial for managing access to the ED.

Mister Rogers (1928-2003) Through the Holistic "Health & Wellness" Lens : Current and Historiographic Lessons.

In the 1960s, Fred Rogers created Mr. Rogers' Neighborhood ( MRN ), a television shows for children. Although Rogers may not have been aware that his series carried the potential for a public health model, such an observation becomes apparent in contemporary terms. This transdisciplinary narrative explores MRN through the lens of holistic "health & wellness." Several themes come in perspective as they relate to health as defined by the World Health Organization for present and future communities. Targeting a young population, Rogers focuses on emotional nurturing and health with safety for all and within a happy and healthy community-themes that are the core of public health. Through the "health & wellness" lens, the footprints for a child's behavioral and social model are evident; a model particularly relevant to present and future generations with emotional growth, health, and community spirit as essential. In MRN , children are learning through the visual and audio arts, self-esteem, caring, and positive behaviors for personal and social health. Through this lens, besides the footprints to an educational model, another evidence manifests itself, which is the timeless impact of the content of Rogers' life lessons that are constantly adjusting to the next audience of this age group by updating its format in parallel with an advancing technology, which supports the validity of MRN ' potential for a holistic public health model toward complete physical, mental, spiritual, and social well-being, and as previously proposed by the World Health Organization.

Homebirth and the National Health Service in Italy. A qualitative study in the Emilia- Romagna Region

Introduction: Medicalization of birth has increased all over the world in the past decades. The Italian caesarean birth rate (38%) is among the highest in the world. Could be birth at home as a public model of care a superior alternative to current practices? This paper focuses on the experience of the Emilia-Romagna region, where the National Health Service (NHS) has carried out a home birth service for more than 13 years. The aim is to discuss the strengths and weaknesses of homebirth as a public health model compared to homebirth within the private practice system. Methods: Qualitative data were collected between 2010 and 2013, as part of a wider anthropological research project on out-of-hospital birth in Italy and Spain. Seventy participants were interviewed in total. In Emilia-Romagna, in- depth interviews were conducted with 21 participants; these included midwives, women, doctors and health managers. Focus groups, a field diary and participant observation were also used for data collection. Data were analyzed using ethnographic method and content analysis. Results: Main findings suggest that the added value provided by the NHS home birth service in the Emilia-Romagna region (home births attended by community- based or hospital-based midwives) compared to the private care model encompass increasing of the social legitimacy of homebirth, the transfer of best practices from homebirth to hospital birth, increasing the continuity of care when the woman is referred to the hospital, increasing the continuity of training and the autonomy of midwives in caring for normal births in the hospital and providing free services. Homebirth managed by the NHS contributes to the promotion of a physiological model of care also in the hospital.