Public Health Need Research Articles

The implementation and sustainment facilitation strategy improved implementation effectiveness and intervention effectiveness: Results from a cluster-randomized, type 2 hybrid trial.

Background:Substance use disorders (SUDs) among people with HIV are both prevalent and problematic. The Substance Abuse Treatment to HIV care project was funded to test the Implementation and Sustainment Facilitation (ISF) strategy as an adjunct to the Addiction Technology Transfer Center (ATTC) strategy for integrating a motivational interviewing-based brief intervention (MIBI) for SUDs within HIV community-based organizations.Methods:Using a cluster-randomized, type 2 hybrid trial design, 39 HIV organizations were randomized to either (1) ATTC (n = 19) or (2) ATTC + ISF (n = 20). Each HIV organization identified two staff members to be prepared to implement the MIBI (N = 78). Subsequently, during the implementation phase, HIV organizations in each condition randomized client participants (N = 824) to one of the two intervention conditions: usual care (UC; n = 415) or UC + MIBI (n = 409). Both staff-level outcomes and client-level outcomes were examined.Results:The ISF strategy had a significant impact on the implementation effectiveness (i.e., the consistency and the quality of implementation; β = .65, p = .01) but not on time-to-proficiency (β = −.02) or level-of-sustainment (β = .09). In addition, the ISF strategy was found to have a significant impact on the intervention effectiveness (the effectiveness of the MIBI), at least in terms of significantly decreasing the odds (odds ratio = 0.11, p = .02) of clients using their primary substance daily during follow-up.Conclusion:The ISF strategy was found to be an effective adjunct to the ATTC strategy in terms of implementation effectiveness and intervention effectiveness. It is recommended that future efforts to integrate the project’s MIBI for SUD within HIV organizations use the ATTC + ISF strategy. However, given the ISF strategy did not have a significant impact on level-of-sustainment, implementation research testing the extent to which the ATTC + ISF strategy can be significantly enhanced through effective sustainment strategies is warranted.Plain language abstractSubstance use among people living with HIV is associated with increased mental health problems, worse medication adherence, and worse HIV viral suppression. Increasing substance use-related services in HIV community-based organizations is an important public health need. The Substance Abuse Treatment to HIV care project tested two strategies for helping HIV organizations implement a brief intervention (BI) designed to motivate clients to decrease their substance use. The project also tested if receiving a BI improved clients’ outcome. Two staff from each of the 39 participating organizations were taught how to deliver the BI using the Addiction Technology Transfer Center (ATTC) training strategy (online and in-person training, monthly feedback, and coaching). Half of the organizations also received the Implementation and Sustainment Facilitation (ISF) strategy, which included monthly meetings with an ISF coach for the two BI staff and one or more leadership staff from the organization. Organizations that received both the ATTC and ISF strategies delivered more BIs and higher quality BIs than organizations that only received the ATTC strategy. In addition, clients receiving BIs at organizations that received both strategies were more likely to decrease their substance use. However, receiving both strategies did not improve how quickly staff learned to deliver the BI or improve the number of BIs delivered during the project’s 6-month sustainment phase. Future research focused on implementing BIs within HIV organizations should consider using the ATTC and ISF strategies while also seeking to enhance the strategies to improve sustainment.

Executive Summary: Identification, Evaluation, and Management of Children With Autism Spectrum Disorder.

* Abbreviations: ASD — : autism spectrum disorder DSM-5 — : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). ASD significantly influences the lives of affected children and families because they may need extensive behavioral, educational, health, and other services. Primary care providers play a critical role in identifying, diagnosing, and managing ASD in children and providing support for their families. This document provides a summary of the clinical report “Identification, Evaluation, and Management of Children with Autism Spectrum Disorder,” published concurrently in the online version of Pediatrics . In the years since 2007, when the American Academy of Pediatrics published the clinical reports “Identification and Diagnosis of Children with Autism Spectrum Disorders” and “Management of Children with Autism Spectrum Disorders,” reported prevalence rates of children with ASD have increased, understanding of potential risk factors has expanded, awareness of co-occurring medical and behavioral conditions and genetic contribution to etiology has improved, and the body of research supporting evidence-based interventions has grown substantially. The updated document discusses evaluation and treatment as a continuum in 1 publication with a table of contents to help the reader identify topic areas within the report. ASD is more commonly diagnosed than in the past, and the significant health, educational, and social needs of individuals with ASD and their families constitute an area of critical need for resources, research, and professional education. Address correspondence to Susan L. Hyman, MD. E-mail: susan_hyman{at}RMC.Rochester.edu

Developing a Comprehensive, Interdisciplinary Concussion Program.

There has been a growing trend of local and national coverage of and interest in concussion injuries over the past 2 decades. Increasing public concern over potential catastrophic and unknown long-term effects of sports-related concussion injuries has led to an acknowledgment of the strong public health need for addressing all concussion injuries, regardless of mechanism of injury. In efforts to address this need for concussion prevention and management, both in sports and nonsports, The University of Kansas Health System initiated the interdisciplinary Center for Concussion Management program in 2012. The program was created as a virtual clinic concept and includes voluntary participation from various providers across the institution, limited budget, and space obstacles. Since its inception, the program has continued to operate as its initial design of a multidisciplinary team model outside the sole ownership of 1 department, and has expanded to include education and outreach to local and regional schools and groups.

You're not alone: A public health response to immigrant/refugee distress in the current sociopolitical context.

Recent political events and policy changes in the United States have fueled antirefugee/immigrant rhetoric and an increase of xenophobic harassment and intimidation, which together present a significant threat to the physical and mental health of refugee/immigrant children and families. This article aims to provide an overview of how the current sociopolitical context threatens the public health of refugee and immigrant communities and to describe the role of psychologists in advocating for social justice and responding to this urgent public health need through interprofessional collaboration and translation of scientific knowledge into multilevel intervention development. The case study of the You're Not Alone (YNA) initiative describes swiftly mobilized advocacy efforts (e.g., press conference, webinars, resources development and dissemination) and participatory development and roll-out of community capacity-building trainings to address the needs of refugee/immigrant children and families. Trainings aimed to raise awareness of the refugee/immigrant experience and to equip refugee/immigrant community members and providers across a variety of public sectors to implement culturally responsive and trauma-informed strategies to promote resilience, respond to distress, and prevent mental health crises. Between March 2017 and June 2018, a total of 1,642 individuals attended 48 training events. The role of psychologists in future policy and advocacy efforts to promote mental health among refugee/immigrant families is discussed as well as implications for how other marginalized communities affected by the current sociopolitical climate might benefit from broadening the scope of this public health response. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Influenza Vaccination: Accelerating the Process for New Vaccine Development in Older Adults.

Increased susceptibility to the serious complications of influenza is common in older adults. It is often ascribed to weakening of the immune system with age, and 90% of influenza-related deaths occur in older adults despite widespread vaccination programs. Common chronic conditions not only contribute to the loss of immune protection after vaccination and increase the risk for serious outcomes of influenza, but also increase the long-term consequences following hospitalization. Interactions of T and B cell ageing, chronic elevation of inflammatory cytokines (sometimes dubbed "inflammaging"), and dysregulated acute cytokine production pose major challenges to the development of new and more effective vaccines. However, these age-related problems are modifiable, as we have shown, and provide a clear margin for improvement. This chapter describes how an exclusive focus on developing influenza vaccines to stimulate strain-specific antibody responses against the hemagglutinin surface glycoprotein of the influenza virus, to the exclusion of other potentially important mechanisms, is missing the mark in terms of preventing the serious complications of influenza in older adults. Novel approaches are needed to enhance antibody-mediated protection against infection and stimulate cell-mediated immune responses to clear influenza virus from the lungs. These strategies for improving vaccine effectiveness will address the public health need for "vaccine prevention of disability" to mitigate the global pressures of aging populations on health and social care systems.

Eating and lifestyle habits of overweight and obese teenagers in Thulamela municipality, South Africa

AbstractA survey made worldwide (including South Africa) revealed that most teenagers are overweight and obese and that they eat little nutritious food. Obesity and overweight are public health problems and need to be addressed from a community perspective. The reason for exploring this problem in this study was that South Africa has one of the highest rates of overweight and obesity in the world among urban and rural black women. The objective was to investigate the eating and lifestyle habits of overweight and obese female teenagers in Thulamela Local Municipality, Limpopo province, South Africa. This was an exploratory, descriptive study conducted amongst 125 female teenagers aged 13 to 18 years from rural schools in Thulamela Local Municipality. Eating and lifestyle habits, physical activity, meaning of healthy and unhealthy dietary habits, weight, height and body mass index were measured. A hundred and twenty-five questionnaires were completed and data were gathered on the demographics, anthropometry, social and lifestyle habits, nutrition-related problems, dietary patterns and dietary history of the participants. The BMI revealed that 34.4% were of normal weight, 39.2% overweight and 26.4 obese. Seventy percent of the respondents actively consumed meals in a day, 83% consumed starchy snacks, whilst 72% of the respondents carried lunchboxes to school. Regarding lifestyle habits, 88% of the respondents slept more hours than recommended (8 hours) while 88% performed sedentary activities and 66% did physical activities such as walking. The results pointed out unhealthy eating and lifestyle habits influencing teenagers’ weight and provided information on which of these must be considered in order to develop tailored nutrition interventions, improving teenagers’ consciousness about s adopting a healthy lifestyle.

Factors affecting the access to health services among waste collectors in Hanoi, Vietnam: A qualitative study.

BackgroundWaste collection is a common practice in Vietnam. In general, the working and living conditions of waste collectors are poor. Thus, they might be exposed to occupational and environmental risk factors, which affect their health or could further exacerbate their health vulnerabilities. Moreover, they have difficulties to access to health services.ObjectiveThe aim of this study was to understand factors affecting the access to health services among waste collectors in Hanoi, Vietnam.MethodsThe qualitative design was used for this study. A total of 30 in-depth interviews with waste collectors and 3 focused group discussions were conducted in Hanoi, Vietnam in 2017.ResultsFindings showed the participants considered factors that affect the access to health services among waste collectors such as geographical accessibility, the availability of health facilities, the acceptance of the quality of health services, health insurance, and affordability.ConclusionsPolicy makers concerned with public health and social work need to have the suitable policies in order to promote actions on the access to health services among waste collectors.

Volunteering at CerviCusco in Peru.

Cervical cancer is the leading cancer-specific cause of death in Peruvian women.1 The incidence of cervical cancer in Peru is double that seen in other South American countries and approximately 10 times the incidence rate in the United States. The prevalence of high-risk human papillomavirus (HPV) in adult Peruvian women is equally high and ranges between 12% and 35%.2, 3 The morbidity and mortality of impoverished women who develop invasive squamous cell carcinoma of the cervix in this resource-poor setting are dismaying. Unfortunately, there are several challenges for adequately controlling cervical cancer in Peru, including cultural and geographic barriers, a lack of education, a limited number of specialists in rural areas, the loss of women with abnormal Papanicolaou (Pap) tests to follow-up, inadequate HPV vaccination, and no widespread HPV testing.2, 4, 5 To address this public health need, Dr. Daron Ferris from Augusta University in Augusta, Georgia, started a nonprofit clinic in the city of Cusco called CerviCusco. Cusco, once the capital of the Inca Empire, is the gateway to Machu Picchu. The clinic offers comprehensive and culturally sensitive prevention, screening, diagnosis, and treatment of cervical cancer.6 CerviCusco is relatively well equipped and staffed by Peruvian gynecologists, several nurse midwives, nurses, and local cytotechnologist Erika P. Escalante. The clinic provides free gynecological examinations with Pap tests and liquid-based Pap test screening and, when necessary, offers follow-up colposcopy. Ferris visits the clinic regularly to perform colposcopy. Dr. David Wilbur from Massachusetts General Hospital in Boston, Massachusetts, previously donated a telepathology system to the clinic. This has enabled Escalante to have weekly telecytology sessions with experts in the United States, who help her to resolve challenging abnormal Pap tests.7 The adoption of a novel mobile clinic model in rural Peru has been shown to reduce some of the barriers to cervical cancer screening.8 Hence, for women who live deep in the Andes Mountains, the clinic staff partake in regular campaigns in which they drive to these indigenous communities. There, they set up shop, educate women about the value of getting a Pap test, and perform free Pap smears on those individuals who opt to have one. Some of the main barriers to receiving Pap smears for Peruvian women are fear, embarrassment, and a lack of knowledge.9 Many of the women arrive accompanied by their children. Within no time, these makeshift clinics are accordingly buzzing with numerous kids. Therefore, providing everyone present with some musical entertainment, food, and perhaps even hot chocolate is an equally important task during these campaigns. Not surprisingly, CerviCusco previously received the American Society for Clinical Pathology humanitarian award. CerviCusco has started offering HPV vaccinations for free to children in the region. The clinic has continued to expand its services, and it is currently working on providing mammography and hopefully soon HPV testing of Pap tests. The success of CerviCusco is largely due to generous donations from several corporations and institutions in the United States. For example, Beckton Dickinson donated equipment, reagents, and plenty of slides to perform tens of thousands of free SurePath Pap tests. Volunteers at CerviCusco are of immense help and are always welcome. Volunteers can have varying skills and levels of training. They may include cytologists, physicians, and medical students as well as any health care providers or students. They get to participate in clinic-based care and remote mobile clinics. Dr. Liron Pantanowitz (cytopathologist) and his son Joshua Pantanowitz (premedical college student) recently volunteered at CerviCusco. This entailed screening of Pap tests (Fig. 1A), aiding with processing of specimens (Fig. 1B), and helping with outreach campaigns (Fig. 1C,D). Peru is a remarkable country with spectacular geography, including rainbow-colored mountains that nestle glaciers, a desert that abuts the coastline, and parts of the Amazon jungle. Therefore, when people are not volunteering, there are ample tourist sites to visit (Fig. 1E). Thanks to a generous grant from Hologic, Escalante was subsequently able to visit the University of Pittsburgh Medical Center for 3 weeks (Fig. 1F). During her visit, she benefitted from spending valuable time with many of the cytotechnologists and received continuing education, including ThinPrep screening certification, and she was trained to perform HPV testing on Pap test samples. In conclusion, if you are feeling adventurous and looking to apply your cytology skills toward something meaningful, we strongly recommend that you consider volunteering at CerviCusco in Peru. To volunteer, visit https://www.friendsofcervicusco.org/ or email Friends of CerviCusco at [email protected]. No specific funding was disclosed. Erika P. Escalante reports employment by CerviCusco. Debra Krotish reports nonfinancial support from CerviCusco and personal fees from Friends of CerviCusco outside the submitted work. The other authors made no disclosures.

Lyme disease prevention: A content analysis of Canadian patient group and government websites.

The quality of information presented on health-related websites-in terms of comprehensiveness, accuracy and consistency-is a public health concern. To date, the consistency of information across Canadian websites devoted to Lyme disease (LD) prevention has not been evaluated. The first aim of this study was to describe the contents and recommendations of LD prevention websites provided by two types of Canadian organizations: government (n=3) and patient groups (n=3). A second objective was to analyse the level of convergence among these websites in terms of their prevention-related content. Initial coding of the content resulted in information segments grouped into 114 subthemes related to nine overarching themes: tick habitat suitability, risk period, transmission, personal protection, peridomestic environmental management, tick identification and removal, early symptoms, testing and diagnosis and preventive treatment. Comparative content analyses were performed both within and between the content of websites of the two organization types. The themes most frequently addressed by both organization types were personal protection (20% of the prevention-related content in patient group websites and 22% of the prevention-related content in government websites), transmission (12% and 16%, respectively) and tick identification and removal (19% and 15%, respectively). Government websites' information was generally convergent with that of patient group websites (four highly convergent themes, three moderately convergent and two divergent). Nevertheless, of particular concern were divergent messages and inaccurate information found on 11 subthemes out of 103. Examples included other possible modes of transmission and the ineffectiveness of DEET insect repellent. These results suggest the need for public health and health communications research on the issue of the quality of LD prevention information found on the Internet.

Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) statement.

Spatial lifecourse epidemiology is an interdisciplinary field that utilizes advanced spatial, location-based, and artificial intelligence technologies to investigate the long-term effects of environmental, behavioural, psychosocial, and biological factors on health-related states and events and the underlying mechanisms. With the growing number of studies reporting findings from this field and the critical need for public health and policy decisions to be based on the strongest science possible, transparency and clarity in reporting in spatial lifecourse epidemiologic studies is essential. A task force supported by the International Initiative on Spatial Lifecourse Epidemiology (ISLE) identified a need for guidance in this area and developed a Spatial Lifecourse Epidemiology Reporting Standards (ISLE-ReSt) Statement. The aim is to provide a checklist of recommendations to improve and make more consistent reporting of spatial lifecourse epidemiologic studies. The STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cohort studies was identified as an appropriate starting point to provide initial items to consider for inclusion. Reporting standards for spatial data and methods were then integrated to form a single comprehensive checklist of reporting recommendations. The strength of our approach has been our international and multidisciplinary team of content experts and contributors who represent a wide range of relevant scientific conventions, and our adherence to international norms for the development of reporting guidelines. As spatial, location-based, and artificial intelligence technologies used in spatial lifecourse epidemiology continue to evolve at a rapid pace, it will be necessary to revisit and adapt the ISLE-ReSt at least every 2-3 years from its release.

Health equity monitoring is essential in public health: lessons from Mozambique

BackgroundCountries must be able to describe and monitor their populations health and well-being needs in an attempt to understand and address them. The Sustainable Development Goals (SDGs) have re-emphasized the need to invest in comprehensive health information systems to monitor progress towards health equity; however, knowledge on the capacity of health information systems to be able do this, particularly in low-income countries, remains very limited. As a case study, we aimed to evaluate the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with SDG 3 (Good Health and Well Being for All at All Ages).MethodsA data source mapping of the health information system in Mozambique was conducted. We followed the World Health Organization’s methodology of assessing data sources to evaluate the information available for every equity stratifier using a three-point scale: 1 - information is available, 2 - need for more information, and 3 - an information gap. Also, for each indicator we estimated the national average inequality score.ResultsEight data sources contain health information to measure and monitor progress towards health equity in line with the 27 SDG3 indicators. Seven indicators bear information with nationally funded data sources, ten with data sources externally funded, and ten indicators either lack information or it does not applicable for the matter of the study. None of the 27 indicators associated with SDG3 can be fully disaggregated by equity stratifiers; they either lack some information (15 indicators) or do not have information at all (nine indicators). The indicators that contain more information are related to maternal and child health.ConclusionsThere are important information gaps in Mozambique’s current national health information system which prevents it from being able to comprehensively measure and monitor health equity. Comprehensive national health information systems are an essential public health need. Significant policy and political challenges must also be addressed to ensure effective interventions and action towards health equity in the country.

Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions

Cardiovascular disease is a major cause of death among homeless adults, with mortality rates that are substantially higher than in the general population. It is unknown whether differences in hospitalization-related care contribute to these disparities in cardiovascular outcomes. To evaluate differences in intensity of care and mortality between homeless and nonhomeless individuals hospitalized for cardiovascular conditions (ie, acute myocardial infarction, stroke, cardiac arrest, or heart failure). This retrospective cross-sectional study included all hospitalizations for cardiovascular conditions among homeless adults (n = 24 890) and nonhomeless adults (n = 1 827 900) 18 years or older in New York, Massachusetts, and Florida from January 1, 2010, to September 30, 2015. Statistical analysis was performed from February 6 to July 16, 2019. Risk-standardized diagnostic and therapeutic procedure rates and in-hospital mortality rates. Of the 1 852 790 total hospitalizations for cardiovascular conditions across 525 hospitals, 24 890 occurred among patients who were homeless (11 452 women and 13 438 men; mean [SD] age, 65.1 [14.8] years) and 1 827 900 occurred among patients who were not homeless (850 660 women and 977 240 men; mean [SD] age, 72.1 [14.6] years). Most hospitalizations among homeless individuals were primarily concentrated among 11 hospitals. Homeless adults were more likely than nonhomeless adults to be black (38.6% vs 15.6%) and insured by Medicaid (49.3% vs 8.5%). After accounting for differences in demographics (age, sex, and race/ethnicity), insurance payer, and clinical comorbidities, homeless adults hospitalized for acute myocardial infarction were less likely to undergo coronary angiography compared with nonhomeless adults (39.5% vs 70.9%; P < .001), percutaneous coronary intervention (24.8% vs 47.4%; P < .001), and coronary artery bypass graft (2.5% vs 7.0%; P < .001). Among adults hospitalized with stroke, those who were homeless were less likely than nonhomeless individuals to undergo cerebral angiography (2.9% vs 9.5%; P < .001) but were as likely to receive thrombolytic therapy (4.8% vs 5.2%; P = .28). In the cardiac arrest cohort, homeless adults were less likely than nonhomeless adults to undergo coronary angiography (10.1% vs 17.6%; P < .001) and percutaneous coronary intervention (0.0% vs 4.7%; P < .001). Risk-standardized mortality was higher for homeless persons with ST-elevation myocardial infarction compared with nonhomeless persons (8.3% vs 6.2%; P = .04). Mortality rates were also higher for homeless persons than for nonhomeless persons hospitalized with stroke (8.9% vs 6.3%; P < .001) or cardiac arrest (76.1% vs 57.4%; P < .001) but did not differ for heart failure (1.6% vs 1.6%; P = .83). There are significant disparities in in-hospital care and mortality between homeless and nonhomeless adults with cardiovascular conditions. There is a need for public health and policy efforts to support hospitals that care for homeless persons to reduce disparities in hospital-based care and improve health outcomes for this population.

Edukasi Kesehatan Bagi Ibu Dan Calon Ibu Sebagai Upaya Pencegahan Masalah Stunting Di Desa Jatiadi Kecamatan Gending Kabupaten Probolinggo

Government efforts to improve the level of public health need to be supported by all parties. The desire to create a superior generation can only be achieved if the community has a good degree of health. One of the problems in the health sector is still relatively high stunting in Indonesia. Stunting is the failure of a child to grow and develop optimally due to the impact of cumulative and ongoing nutritional deficiencies. Or chronic nutrition problems where families and the community do not feel that this is a problem, this is because not many people know the causes, impacts and prevention. The central and regional governments together are trying to overcome these problems. The Local Government of Probolinggo Regency also strives to solve this problem with various policies adopted. Panca Marga University Probolinggo Real Work Lecture (KKN) placed in Jatiadi Village, Gending District, Probolinggo Regency tried to participate in preventing stunting problems through Health Education activities for mothers and prospective mothers as an effort to prevent stunting problems in Teati Village, Gending District, Probolinggo Regency, which is intended for mothers who have toddlers and pregnant mothers. It is expected that with this activity the community's understanding of health can be increased and stunting sufferers can be reduced, so that the desire to realize a smart and superior healthy community can be achieved.&#x0D; Keywords: Stunting, Health Education, Pregnant Women, Toddler

Is optometry ready for myopia control? Education and other barriers to the treatment of myopia.

Background: With the increasing prevalence of myopia there is growing interest in active myopia control. However, the majority of progressive myopes are still prescribed single vision spectacles. This prospective study aims to elucidate the knowledge and attitudes of optometrists toward myopia control, and thereby identify perceived barriers to the implementation of a risk focussed model of myopia management. Methods: A series of four focus group discussions were conducted involving optometrists in different settings and career stages. Results: The key finding to emerge is a clear disconnect between academic optometrists, optometry students and clinicians in practice. Academic faculty considered themselves competent in managing progressive myopia and believed the optometry curriculumprovides undergraduates with sufficient clinical skills and knowledge to practise myopia control. Final-year optometry students regarded themselves as knowledgeable about myopia control but lack confidence in their ability to practise myopia control, with only one student indicating they would initiate myopia control therapy. The majority of clinicians do not offer myopia control treatments, other than to communicate lifestyle advice to modify risk of myopia progression. Clinicians alluded to a lack of availability of myopia control interventions and identified a range of barriers relating to their training, clinical practice and public health challenges, financial, technological and other constraints that affect the implementation of such interventions. Conclusion: It appears optometrists have to yet embrace myopia control as a core element of the clinical eye care service they provide. Education, training, finance, and time restrictions, as well as limited availability of myopia control therapies were among the main perceived barriers to myopia control. This study revealed a distinct need for alignment between optometric training and the public health need for effective myopia control.

Identification of novel influenza A virus exposures by an improved high-throughput multiplex MAGPIX platform and serum adsorption.

BackgroundThe development of serologic assays that can rapidly assess human exposure to novel influenza viruses remains a public health need. Previously, we developed an 11‐plex magnetic fluorescence microsphere immunoassay (MAGPIX) by using globular head domain recombinant hemagglutinins (rHAs) with serum adsorption using two ectodomain rHAs.MethodsWe compared sera collected from two cohorts with novel influenza exposures: animal shelter staff during an A(H7N2) outbreak in New York City in 2016‐2017 (n = 119 single sera) and poultry workers from a live bird market in Bangladesh in 2012‐2014 (n = 29 pairs). Sera were analyzed by microneutralization (MN) assay and a 20‐plex MAGPIX assay with rHAs from 19 influenza strains (11 subtypes) combined with serum adsorption using 8 rHAs from A(H1N1) and A(H3N2) viruses. Antibody responses were analyzed to determine the novel influenza virus exposure.ResultsAmong persons with novel influenza virus exposures, the median fluorescence intensity (MFI) against the novel rHA from exposed influenza virus had the highest correlation with MN titers to the same viruses and could be confirmed by removal of cross‐reactivity from seasonal H1/H3 rHAs following serum adsorption. Interestingly, in persons with exposures to novel influenza viruses, age and MFIs against exposed novel HA were negatively correlated, whereas in persons without exposure to novel influenza viruses, age and MFI against novel HAs were positively correlated.ConclusionsThis 20‐plex high‐throughput assay with serum adsorption will be a useful tool to detect novel influenza virus infections during influenza outbreak investigations and surveillance, especially when well‐paired serum samples are not available.

Bridging towards the future of public health in Europe (I). Where can and should we go from here?

Abstract Europe is entering the third decade of the 21st century and health is on the agenda. Or is it? It seems that with Europeans healthier than ever and enormously improving our ability to prevent and treat current diseases, health seems to be a theme of the past. At the same time, the society is in turmoil and both old and new health challenges are threatening Europe. The changing demographics–climate change, urbanization, migration and ageing–the technological and digital revolution–given us both medical technology as fake news, genetic mapping and new addictions (gaming)–and the resurgence of old diseases such as measles, all lead to the necessity of bridging our previous successes with the need for a new public health in the future. In 2019, several changes are occurring: we will have a new regional director for WHO Europe and we will have both a new European Parliament, a new European president of the European Commission, a new European Commission and a new European Commissioner for Health. And these changes have led to a new discussion on the necessity of health as a European topic. In this plenary session, we will look at the priorities in public health from the perspective of the European Commission, the Finnish presidency of the European Council and the European Public Health Association. Finally, we have invited a young professional to reflect on the plans proposed in this session. Panellists Anne Bucher Directorate-General for Health and Food Safety (DG SANTE), European Commission Liisa-Maria Voipio-Pulkki Ministry of Social Affairs and Health, Finland Dineke Zeegers Paget Executive Director EUPHA Sara McQuinn Coordinator EUPHAnxt

Prevalence, Onset, and Course of Suicidal Behavior Among Adolescents and Young Adults in Germany

Suicidal behavior is a leading cause of death among adolescents and young adults. In light of the ideation-to-action framework, the delineation of frequency and temporal characteristics of such behavior during this developmental period is crucial. To provide lifetime and 12-month prevalence estimates of suicidal behavior, including ideation, plan, and attempt, in adolescents and young adults of the general population, and to provide information about age at onset, temporal characteristics of suicidal behavior, including duration (number of years between onset and last occurrence) and frequency (number of episodes), and transition patterns across suicidal behaviors. A cross-sectional epidemiological study was conducted in a random community sample of 1180 adolescents and young adults aged 14 to 21 years assessed in 2015 to 2016 in Dresden, Germany. Data analysis was performed from October 2018 to March 2019. Lifetime and 12-month suicidal behavior (ideation, plan, and attempt) were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview) by trained clinical interviewers. The onset, frequency, and duration of suicidal behavior were assessed by questionnaire. Of the 1180 participants (495 male [weighted percentage, 51.7%]; mean [SD] age, 17.9 [2.3] years), 130 participants (10.7%; 95% CI, 9.0%-12.8%), 65 participants (5.0%; 95% CI, 3.9%-6.5%), and 41 participants (3.4%; 95% CI, 2.4%-4.7%) reported lifetime suicidal ideation, plan, and attempt, respectively. Any lifetime suicidal behavior was reported by 138 participants (11.5%; 95% CI, 9.7%-13.7%). Age-specific cumulative incidence estimates indicated an increase in suicidal behavior during adolescence, starting at age 10 years (<1%), increasing slightly until the age of 12 years (2.2%), and then increasing sharply thereafter until age 20 years (13.5%). There were different patterns among female and male participants for ideation, plan, and attempt, with an overall higher incidence among female participants for ideation (hazard ratio, 1.51; 95% CI, 1.02-2.22; P = .04), for plan (hazard ratio, 3.31; 95% CI, 1.72-6.36; P < .001), and, among those older than 14 years, for attempt (hazard ratio, 3.07; 95% CI, 1.11-8.49; P = .03). Of those with suicidal ideation, 66.0% reported persistent or recurrent ideation over more than 1 year with 75.0% reporting more than 1 episode. Of the participants with lifetime suicidal ideation, 47.0% reported a suicide plan and 23.9% reported a suicide attempt. The transition to suicide plan or attempt occurred mainly in the year of onset of suicidal ideation or plan; of those who transitioned, 74.9% transitioned from ideation to plan, 71.2% transitioned from ideation to attempt, and 85.4% transitioned from plan to attempt in the same year. There is an urgent public health need for timely identification of suicidal behavior in adolescents and young adults to terminate persistent or recurrent suicidal tendencies and to interrupt the ideation-to-action transition.

Evaluation of the teeth and jaw deformities in children with special health needs

Introduction: Special needs children (SNC) are a public health concern and need specific oral care. Globally, SNC have a significantly higher prevalence of teeth and jaw deformities (TJD). The malocclusions are often related to dental trauma, which immensely complicates the dental status of these children (e.g. big protrusion of the incisors is a predisposition for inflicting traumatic harm); create functional problems (e.g. masticatory function, saliva ejection); speech impediment and dysfunction of the temporomandibular joint (TMJ). The data in Bulgaria regarding SNC and their oral health is scarce. Aim: The aim of this article is to determine the relative share of SNC among the treated at the University Medico-Dental Centre (UMDC) patients, who have teeth and jaw deformities. Materials and М ethods: In the period January 2015-December 2019, 402 children with late mixed dentition and special health needs were included in a longitudinal clinical research. Teeth and jaw deformities were rare to be observed. The results were statistically evaluated using descriptive statistics, comparisons between groups were analyzed by non-parametric χ 2 test with IBM SPSS v.20.0. Results: Teeth and jaw deformities were diagnosed in 231 (57.5%) of SNC , and a significant difference was determined between children with and without malocclusions for different conditions (р<0.001). Children with mental retardation had the highest relative share of malocclusions (75%), while children with cerebral palsy had the lowest – 44.1%. In the analysis of the type of malocclusion, there was a significant difference among the children with different conditions (р<0.01). Conclusion: SNC experience predominantly teeth and jaw deformities, which means that individualized care for their oral health has to be focused not only on treating dental caries and its complications, but on prophylaxis and treatment of orthodontic problems as well.

The Quest for a Truly Universal Influenza Vaccine.

There is an unmet public health need for a universal influenza vaccine (UIV) to provide broad and durable protection from influenza virus infections. The identification of broadly protective antibodies and cross-reactive T cells directed to influenza viral targets present a promising prospect for the development of a UIV. Multiple targets for cross-protection have been identified in the stalk and head of hemagglutinin (HA) to develop a UIV. Recently, neuraminidase (NA) has received significant attention as a critical component for increasing the breadth of protection. The HA stalk-based approaches have shown promising results of broader protection in animal studies, and their feasibility in humans are being evaluated in clinical trials. Mucosal immune responses and cross-reactive T cell immunity across influenza A and B viruses intrinsic to live attenuated influenza vaccine (LAIV) have emerged as essential features to be incorporated into a UIV. Complementing the weakness of the stand-alone approaches, prime-boost vaccination combining HA stalk, and LAIV is under clinical evaluation, with the aim to increase the efficacy and broaden the spectrum of protection. Preexisting immunity in humans established by prior exposure to influenza viruses may affect the hierarchy and magnitude of immune responses elicited by an influenza vaccine, limiting the interpretation of preclinical data based on naive animals, necessitating human challenge studies. A consensus is yet to be achieved on the spectrum of protection, efficacy, target population, and duration of protection to define a “universal” vaccine. This review discusses the recent advancements in the development of UIVs, rationales behind cross-protection and vaccine designs, and challenges faced in obtaining balanced protection potency, a wide spectrum of protection, and safety relevant to UIVs.

Stigma, Misunderstanding Among the Barriers to MAT Treatment

Stigma, Misunderstanding Among the Barriers to MAT Treatment