Public Health Need Research Articles

MHealth Monitoring of Treatment of Cutaneous Leishmaniasis Patients: A Community-Based Implementation Study.

Cutaneous leishmaniasis (CL) remains a global health problem. Compelled by the protracted healing process, initial and final outcomes of treatment are determined at 90 and 180 days, respectively, after initiation of treatment. Loss to follow-up during these intervals is substantial. Consequently, the effectiveness of treatment is largely unknown. We conducted an effectiveness-implementation hybrid design study of a community-based mobile health (mHealth) strategy to monitor adherence to anti-leishmanial treatment, adverse drug reactions, and therapeutic response compared with standard of care in two rural communities of Colombia. Three implementation outcomes were evaluated: usability and acceptability by qualitative methods and fidelity using quantitative methods. Fifty-seven patients were prospectively included in the mHealth intervention and 48 in the standard-of-care group. In addition, 24 community health leaders (CHLs), health workers, and patients participated in qualitative evaluations. The intervention significantly increased the proportion of patients having follow-up of therapeutic outcomes 90 and 180 days after initiating treatment from 4.2% (standard of care) to 82.5% (intervention), P < 0.001. The proportion of patients having records of treatment adherence, adverse drug reactions, and therapeutic response also increased significantly (P < 0.001). Fidelity to the intervention (recording of treatment adherence, adverse drug reactions, lesion photographs, and evaluation of therapeutic response) was 70-100%. The app was highly accepted by CHLs, health workers, and patients, who perceived that the app improved case identification and follow-up and met a public health need. Although usability was high, low connectivity affected real-time transmission of data. This community-based mHealth strategy facilitated access to health care for CL in rural areas and knowledge of treatment effectiveness.

“Digging in”: stigma and surveillance in the lives of pregnant and breastfeeding mothers who consume cannabis

ABSTRACT Since the shift to legalizing recreational cannabis use in Canada in 2018, there has been increased attention on the consequences of cannabis use on women’s reproductive and maternal health, with particular attention to the impact of cannabis in utero and through breastfeeding. This has resulted in an intense focus on the behaviors of individuals who consume cannabis during the perinatal period, which raises questions about the impact this has on women and mothers who have historically been under the surveillance of the Canadian public health, health and social care, and legal systems. Grounded in an intersectional feminist framework that acknowledges how race, ability, class, and other social positions impact and differentiate women’s experience, this paper presents findings emerging from a participatory arts-based research approach called Photovoice with 23 mothers living throughout Canada. All participants consumed cannabis during pregnancy and breastfeeding and illustrated through photographs and individual and group discussion how their experiences of intersectional stigma and surveillance by health and social care providers resulted in barriers to accessing cannabis-related information and support. Implications arising from our inquiry suggest there is a dire need for public health, perinatal care, and social care responses that run counter to the current context where stigma and fear prevent parents from accessing cannabis information and support.

Addressing the gap for racially diverse research involvement: The King's Model for minority ethnic research participant recruitment

ObjectivesEthnic minorities (EM) are still underrepresented in research recruitment. Despite wide literature outlining the barriers, enablers and recommendations for driving inclusion and diversity in research, there is still little evidence for successful diversity in research participation, which has a direct impact on the quality of care provided to ethnically diverse individuals. A new, comprehensive approach to recruitment strategies is therefore necessary. Study designservice improvement initiative. MethodsIn the light of the Covid-19 pandemic and the key public health need to address the disparity in care provided to non-white populations, we used a novel, comprehensive approach (The King's Model) comprising of local and community actions to promote inclusive research recruitment. We then compared rates of diverse recruitment in studies where the novel approach, was applied to studies which had been closed to recruitment at the time of analysis and where ethnicity data was available. ResultsOur results demonstrate that following the introduction of the King's Model for diverse recruitment, commercial interventional study diverse recruitment increased from 6.4% to 16.1%, and for non-commercial studies, from 30.2% to 41.0% and 59.2% in the selected studies. ConclusionsKing's Model is potentially a useful tool in enhancing non-Caucasian recruitment to clinical research. Enriched by additional recommendations based on our experiences during the Covid-19 research recruitment drive, we propose the King's Model is used to support ethnically diverse research recruitment. Further evidence is needed to replicate our findings, although this preliminary evidence provides granular details necessary to address the key unmet need of validating clinical research outcomes in non-white populations.

Prediction of Drug-Drug Interactions by Means of a Graph Look Network Novel Algorithm

Abstract: With the growing need for public health and drug development, combination therapy has become widely used in clinical settings. However, the risk of unexpected adverse effects and unknown toxicity caused by drug-drug interactions (DDIs) is a severe public health issue for polypharmacy safety. Traditional investigational methods for detecting DDIs are expensive and time- consuming. Therefore, many computational methods have been developed in recent years to predict DDIs with the growing availability of data and advancements in artificial intelligence. In silico methods have proven to be effective in predicting DDIs, but detecting potential interactions, especially for newly exposed drugs without an existing DDI network, remains a challenge. In this study, we proposea predicting method of DDIs named HAG-DDI based on graph look networks. We consider the differences in mechanisms between DDIs and add learning of semantic-level attention, which can focus on superior representations of DDIs. By treating interactions as nodes and the presence of the same drug as edges, and constructing small subnetworks during training, we effectively mitigate potential bias issues arising from limited data availability. Our experimental results show that our method achieves an F1-score of 0.952, proving that our model is a viable alternative for DDIs prediction. The codes are available at: https://github.com/xtnenu/DDIFramework.

Prospects for developing an Hepatitis C virus E1E2-based nanoparticle vaccine.

Globally, more than 58 million people are chronically infected with Hepatitis C virus (HCV) with 1.5 million new infections occurring each year. An effective vaccine for HCV is therefore a major unmet medical and public health need. Since HCV rapidly accumulates mutations, vaccines must elicit the production of broadly neutralising antibodies (bnAbs) in a reproducible fashion. Decades of research have generated a number of HCV vaccine candidates. Based on the available data and research through clinical development, a vaccine antigen based on the E1E2 glycoprotein complex appears to be the best choice, but robust induction of humoral and cellular responses leading to virus neutralisation has not yet been achieved. One issue that has arisen in developing an HCV vaccine (and many other vaccines as well) is the platform used for antigen delivery. The majority of viral vaccine trials have employed subunit vaccines. However, subunit vaccines often have limited immunogenicity, as seen for HCV, and thus multiple formats must be examined in order to elicit a robust anti-HCV immune response. Nanoparticle vaccines are gaining prominence in the field due to their ability to facilitate a controlled multivalent presentation and trafficking to lymph nodes, where they can interact with both arms of the immune system. This review discusses the potential for development of a nanoparticle-based HCV E1E2 vaccine, with an emphasis on the potential benefits of such an approach along with the major challenges facing the incorporation of E1E2 into nanoparticulate delivery systems and how those challenges can be addressed.

Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis

With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. ClinicalTrials.gov Identifier: NCT02849587.

The Socio-Economic Determinants of Energy Drink Consumption and Related Health Outcomes in Riyadh, Saudi Arabia

OBJECTIVE: To estimate the prevalence and socio-economic determinants of energy drink (ED) consumption and related health outcomes in Riyadh, Saudi Arabia. &#x0D; &#x0D; METHODS: A self-report survey was used to collect data from 2,024 students (aged 13-20 years). Logistic regression was used to determine the relationship between ED consumption, diet and health-related outcomes. &#x0D; &#x0D; RESULTS: In total, 54% of young people reported ED consumption at least once and 25.5% at least weekly. The most common (38.65%) reason for ED consumption was the enjoyable flavour. Male students reported higher ED consumption compared to females (OR = 1.26, 95% CI 1.08 to 1.46). ED consumption was associated with an unhealthy diet (OR = 1.69, 95% CI 1.53 to 1.87), tobacco use (OR = 5.91, 95% CI 3.47 to 10.07), poor quality sleep (OR = 0.73, 95% CI 0.47 to 0.99). Those who regularly ate breakfast were less likely to report ED consumption (OR = 0.89, 95% CI 0.83 to 0.95). &#x0D; &#x0D; CONCLUSION: More than 1 in 2 young people reported ED consumption among a sample of Riyadh-based students. Consumption was found to be associated with a poor-quality diet and negative health outcomes. Findings suggest that there is a public health need to reduce the consumption of EDs among this population.

A multi-ancestry polygenic risk score improves risk prediction for coronary artery disease

Identification of individuals at highest risk of coronary artery disease (CAD)—ideally before onset—remains an important public health need. Prior studies have developed genome-wide polygenic scores to enable risk stratification, reflecting the substantial inherited component to CAD risk. Here we develop a new and significantly improved polygenic score for CAD, termed GPSMult, that incorporates genome-wide association data across five ancestries for CAD (>269,000 cases and >1,178,000 controls) and ten CAD risk factors. GPSMult strongly associated with prevalent CAD (odds ratio per standard deviation 2.14, 95% confidence interval 2.10–2.19, P < 0.001) in UK Biobank participants of European ancestry, identifying 20.0% of the population with 3-fold increased risk and conversely 13.9% with 3-fold decreased risk as compared with those in the middle quintile. GPSMult was also associated with incident CAD events (hazard ratio per standard deviation 1.73, 95% confidence interval 1.70–1.76, P < 0.001), identifying 3% of healthy individuals with risk of future CAD events equivalent to those with existing disease and significantly improving risk discrimination and reclassification. Across multiethnic, external validation datasets inclusive of 33,096, 124,467, 16,433 and 16,874 participants of African, European, Hispanic and South Asian ancestry, respectively, GPSMult demonstrated increased strength of associations across all ancestries and outperformed all available previously published CAD polygenic scores. These data contribute a new GPSMult for CAD to the field and provide a generalizable framework for how large-scale integration of genetic association data for CAD and related traits from diverse populations can meaningfully improve polygenic risk prediction.

Living With Dementia During a Public Health Emergency: An Examination of the Silent Pandemic

Abstract Date Presented 04/22/2023 Results are shared from a national survey completed with caregivers of persons living with dementia during the COVID-19 public health emergency. One hundred thirteen participants from 30 states reported increased cognitive decline in persons living with dementia (80%), worsening behavioral symptoms (78%), and decreased motor abilities (80%). This public health and preventive need signals an opportunity for OT practitioners to provide care for vulnerable populations in public health emergencies. Primary Author and Speaker: Paul Arthur Additional Authors and Speakers: Chih-Ying Li

A Single Oral Immunization with a Replication-Competent Adenovirus-Vectored Vaccine Protects Mice from Influenza Respiratory Infection.

The development of effective and flexible vaccine platforms is a major public health challenge, especially in the context of influenza vaccines that have to be renewed every year. Adenoviruses (AdVs) are easy to produce and have a good safety and efficacy profile when administered orally, as demonstrated by the long-term use of oral AdV-4 and -7 vaccines in the U.S. military. These viruses therefore appear to be the ideal backbone for the development of oral replicating vector vaccines. However, research into these vaccines is limited by the ineffectiveness of human AdV replication in laboratory animals. The use of mouse AdV type 1 (MAV-1) in its natural host allows infection to be studied under replicating conditions. Here, we orally vaccinated mice with a MAV-1 vector expressing influenza hemagglutinin (HA) to assess the protection conferred against an intranasal challenge of influenza. We showed that a single oral immunization with this vaccine generates influenza-specific and -neutralizing antibodies and completely protects mice against clinical signs and viral replication, similar to traditional inactivated vaccines. IMPORTANCE Given the constant threat of pandemics and the need for annual vaccination against influenza and possibly emerging agents such as SARS-CoV-2, new types of vaccines that are easier to administer and therefore more widely accepted are a critical public health need. Here, using a relevant animal model, we have shown that replicative oral AdV vaccine vectors can help make vaccination against major respiratory diseases more available, better accepted, and therefore more effective. These results could be of major importance in the coming years in the fight against seasonal or emerging respiratory diseases such as COVID-19.

The Public Health Need and Strategic Opportunities for the Accelerated Development of Function-Promoting Therapies for Older Adults.

The Public Health Need and Strategic Opportunities for the Accelerated Development of Function-Promoting Therapies for Older Adults.

National Drug Laws, Policies, and Programs in India: A Narrative Review.

Drug use is a major public health issue in India. Significant changes in the approach toward drug use have happened in the last few decades. Despite this, no systematic attempt has been made to document the same in the scientific literature. This narrative review attempts to discuss the major drug laws, policies, and national programs of the Government of India (GoI). A thorough search was conducted to look for policies, programs, acts, and notifications related to substance use/drug use on various websites of different ministries of the GoI. Acts, programs, and policies addressing substance use were identified. Various drug laws, programs, and acts from the GoI provide a multipronged approach to curbing the procurement of drug use along with its prevention and cure. The Ministry of Social Justice and Empowerment (MoSJE) is the nodal ministry for drug demand reduction. The enactment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act 1985 and Policy 2012 and the implementation of India's Drug De-Addiction Program (DDAP) are important landmarks in this journey. The GoI initiatives for reducing the mental health burden in this country in general and substance use disorders (SUDs), in particular, are immense. The acts/statutes/laws/notifications are all interlinked. Stakeholders in mental health, public health, and policy-making need to upgrade themselves with the relevant statutes to curb the menace of drug use.

Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey.

Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19. Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress. Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying. (Am J Public Health. 2023;113(6):689-699. https://doi.org/10.2105/AJPH.2023.307273).

Public Health Needs the Public Trust: A Pandemic Retrospective

The COVID crisis of the past three years has greatly impacted stakeholder relationships between scientists, health providers, policy makers, pharmaceutical industry employees, and the public. Lockdowns and restrictions of civil liberties strained an already fraught relationship between the public and policy makers, with scientists also seen as complicit in providing the justification for the abrogation of civil liberties. This was compounded by the suppression of open debate over contentious topics of public interest and a violation of core bioethical principles embodied in the Nuremberg Code. Overall, the policies chosen during the pandemic have had a corrosive impact on public trust, which is observable in surveys and consumer behaviour. While a loss of trust is difficult to remedy, the antidotes are accountability and transparency. This narrative review presents an overview of key issues that have motivated public distrust during the pandemic and ends with suggested remedies. Scientific norms and accountability must be restored in order to rebuild the vital relationship between scientists and the public they serve.

A systematic review of in utero cannabis exposure and risk for structural birth defects.

Cannabis use among pregnant women has increased over time. Therefore, there is a great public health need to understand the consequences of in utero cannabis exposure. While several meta-analyses and reviews have summarized the evidence of in utero cannabis exposure on adverse obstetric outcomes (e.g., low birth weight and preterm birth) and long-term offspring development, there has not been a focus on in utero cannabis exposure and risk for structural birth defects. We conducted a systematic review using PRISMA guidelines to evaluate the association between in utero cannabis exposure and structural birth defects. We identified 20 articles to include in our review and focused on interpreting findings from the 12 that adjusted for potential confounders. We report findings by seven organ systems. Within the 12 articles, four reported on cardiac malformations, three reported on central nervous system malformations, one reported on eye malformations, three reported on gastrointestinal malformations, one reported on genitourinary malformations, one reported on musculoskeletal malformations, and two reported on orofacial malformations. Findings on associations between in utero cannabis exposure and birth defects reported in more than two articles were mixed (i.e., findings for cardiac, gastrointestinal, central nervous system malformations). Findings for associations between in utero cannabis exposure and birth defects reported in two articles (i.e., orofacial malformations) or in a single article (eye, genitourinary, and musculoskeletal) suggested that cannabis exposure was not associated with these types of malformations, but strong conclusions cannot be drawn from such sparce research. We review the limitations and gaps in the existing literature and call for more research to rigorously evaluate associations between in utero cannabis exposure and structural birth defects. identifier CRD42022308130.

“ContraceptED”: A Multidisciplinary Framework for Emergency Department-Initiated Contraception

Emergency departments (EDs) are common access points for patients who are at high risk for unintended pregnancy. Low-barrier access to effective contraception represents a crucial and low-cost intervention to address this public health need. Same-day initiation of contraception during an ED visit is a unique opportunity to provide reproductive health care for high-risk patients with otherwise limited health care access. We collaborated with our obstetrics and gynecology (OB/GYN) department, pharmacists, and a team of community health advocates to support emergency clinicians (namely, emergency physicians and advanced practice providers) in assessing pregnancy and contraceptive readiness, increasing proficiency in contraception counseling, prescribing hormonal contraception, counseling on barrier and emergency contraception, and inserting (and removing) the Nexplanon implant, a form of long-acting reversible contraception. With this novel approach, we found that emergency clinicians voluntarily participated in trainings on contraception, including low-threshold long-acting reversible contraception initiation; and, after completing these trainings, clinicians integrated these skills into their workflow in the ED. We report our results after screening 38 patients during our current Pilot Phase of implementing this program.

International Military Vaccination Efforts During the COVID-19 Pandemic: A Literature Review

Introduction:The COVID-19 pandemic created a public health crisis worldwide. Mass vaccination efforts in some cases were initiated without adequate civilian manpower due to critical medical staffing shortages. The governments of many nations deployed their military assets to fill gaps in care and to initiate projects to promote vaccinations. The COVID-19 pandemic created a unique international military vaccination response to an infectious disease disaster.This literature review highlights creative solutions, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their vaccination efforts within their countries. By collating this information into a single document, the collective global experience can be better analyzed and this information utilized to develop a framework for future disaster preparedness and mitigation planning efforts.Method:Medline (PubMed), GoogleScholar and the JSTOR Security Studies collection were searched for English language articles from January 1, 2020 and onwards. Keywords used included civil-military coordination, military, COVID-19, vaccination, vaccine. Titles were initially screened for relevance. The abstracts were then reviewed for a decision on inclusion. Article inclusion was determined by author consensus based on relevance to the objectives. Key papers were also hand searched for additional unidentified references.Results:Data collection and analysis planned for completion by January 2023.Conclusion:The COVID-19 pandemic created a public health need for mass vaccination distribution that was assisted by militaries throughout the world. This literature search demonstrates the ways in which military resources contributed to COVID-19 vaccination efforts, including creative techniques, successes and opportunities for future improvement.

Not Just a Vaccination. Provision of Public Health, Environmental, and Social Needs in an Austere Environment in Miami, Florida

Introduction:The recently approved COVID-19 vaccine in 2021 provided a glimmer of hope to all people who had isolated, or lost loved ones to the SARS-COVID-19 virus. Clinics were rapidly established in non-traditional settings in order to meet the need in the early phases of the vaccination program. Contractor support provided rapid personnel support to meet the needs of many locations in several states. Consideration of basic infrastructure requirements such as Incident Command, security, HVAC, electricity, water and sanitation were part of a state supported vaccine clinic in an economically challenged neighborhood in downtown Miami, Florida.Method:Topics to be discussed include staffing mixes, language/cultural concerns, handheld EMR applications, patient flow, immunization practices, testing practices, vaccine security, adverse event management, infection control procedures and the ever present supply chain challenges. The discussion will be framed from the perspective of the Chief Nursing Officer in an ever challenging vaccine environment.Results:Over 20,000 vaccines were successfully provided in a little over three months, and a community-based Student Internship program was also implemented.Conclusion:Vaccine administration is possible in a variety of settings. Foundational principles of vaccine security, management of the environment and provision of safety and security for patients and staff will help to ensure a successful public health campaign.

The need for healthcare public health to be the third domain

The need for healthcare public health to be the third domain

Public health and clinical medicine need to work in partnership in the US

Public health and clinical medicine need to work in partnership in the US