Public Health Outcomes Research Articles

Bayesian interpretation of likelihood ratios in clinical diagnosis and public health

Purpose of review This study provides a Bayesian interpretation of likelihood ratios and their role in updating the pretest probability of disease, typically represented by the prevalence, to a posttest probability. Recent findings We highlight the importance of likelihood ratios in this process, particularly in low prevalence settings. For example, we demonstrate that a high LR+ can significantly increase the posttest probability of disease, providing crucial information for clinical decision-making. Furthermore, we emphasize the significance of the fold increase in the probability of disease given a positive test result, particularly in low prevalence settings. Summary This study underscores the importance of considering likelihood ratios on our posttest updated probability of disease and highlights their implications for public health and individual diagnosis. Understanding these factors can enhance the accuracy and effectiveness of diagnostic decision-making, ultimately leading to improved public health outcomes and patient care.

Motivators and Barriers to Career Choices in Community Medicine Among Medical Students in South Punjab, Pakistan: A Cross-Sectional Survey.

Background Community medicine plays a vital role in public health, yet research on medical students' career choices in this field is limited, especially in underserved areas like South Punjab, Pakistan. This study explores the factors that influence undergraduate medical students' interest in pursuing a career in community medicine. Methodology A cross-sectional survey was conducted with 305 fourth- and final-year undergraduate medical students from various colleges in South Punjab. Data were collected via a structured online questionnaire, focusing on students' interests, motivations, barriers, and perceptions related to community medicine. Results The survey found that 40% of students showed interest in community medicine, with higher interest among females. Key motivators included preventive healthcare and public health initiatives, while financial constraints and unclear career progression were significant barriers. A gap was noted between students' interest and their perceived preparedness to address public health challenges. Conclusion Female students showed greater interest in community medicine and were more likely to recommend it. Bridging the gap between interest and perceived preparedness requires enhancing practical experiences, increasing the visibility of community medicine successes, and addressing financial and career progression concerns. Implementing these strategies can help attract and retain students in community medicine and improve public health outcomes.

Contingent Effects of E-Cigarette Warning Label Messages on Cognitive Elaboration and Fear Among U.S. Youth Ages 14-17 by Vaping Experience and Peer Vaping Behavior.

The U.S. Food and Drug Administration (FDA) currently requires a warning about the addictive nature of nicotine to be placed on electronic cigarette advertisements and packaging. To consider the value of additional warning messages on public health outcomes, this study examines the additive effect of new warnings that are based on recent claims from U.S. federal authorities. We conducted a secondary analysis of recent data from 1,202 U.S. youth ages 14-17 to test the impact of exposure to additional warnings placed on advertisements for vaping products on cognitive elaboration, fear, and willingness to vape and smoke. This investigation also looked closely at effects on youth who may have increased risk of future vaping due to prior vaping experiences or having friends who vape. Exposure to the alternative warnings did not amplify cognitive elaboration compared to the current FDA warning alone, but it did increase fear. Youth elaboration on both the benefits and risks of vaping was associated with willingness to both vape and smoke, but fear was not associated with either outcome. The effects of warning label exposure and cognitive elaboration varied by prior vaping experience and having at least one friend who vapes. We conclude by discussing the implications of this contingent pattern of effect and association.

Analyzing spatial delays of tuberculosis from surveillance and awareness surveys in Eastern China

The spatial delays of pulmonary tuberculosis (PTB) have been less explored. In this study, a total of 151,799 notified PTB cases were included, with median patient and diagnostic delays of 15 [interquartile range (IOR), 4–35] and 2 (IOR, 0–8) days, respectively. The spatial autocorrelation analysis and spatial–temporal scan statistics were used to determine the clusters, indicating that the regions in the southwestern and northeastern parts of Zhejiang Province exhibited high rates of long-term patient delay (LPD, delay ≥ 15 days) and long-term diagnostic delay (LDD, delay ≥ 2 days). Besides, the Mantel test indicated a moderately positive correlation between public awareness of suspicious symptoms and the LPD rate in 2018 (Mantel's r = 0.4, P < 0.05). These findings suggest that PTB delays can reveal deficiencies in public health education and the healthcare system. Also, it is essential to explore methods to shift PTB knowledge towards real changes in attitude and behavior to minimize patient delay. Addressing these issues will be crucial for improving public health outcomes related to PTB in Zhejiang Province.

Efficiency of Healthcare Financing: Case of European Countries

Global turbulence and uncertainty force civil servants and executors to optimise public finance distribution. The COVID-19 pandemic aligned with the necessity of assessing the efficiency of healthcare financing due to its capability in overcoming the negative consequences. The paper analyses the peculiarities of healthcare financing in 34 European countries and points out trends and changes in its structure and dynamics. It also realises cluster analysis to reveal models of healthcare financing and their specific features. Panel data regression analysis was used to assess the efficiency of healthcare financing within each cluster by clarifying the relationship between healthcare expenditures and public health outcome—life expectancy. The distributed lag model was also used to test for time lags between financial inflows in healthcare and its outcome. Empirical results highlight key tips for optimising healthcare financing and creating the benchmark model.

Seafood Consumption Trends among U.S. Consumers: Influences of the COVID-19 Pandemic.

The Dietary Guidelines for Americans (DGA) recommend twice-weekly consumption of seafood for health benefits, yet many U.S. consumers have historically fallen short of this target. The economic and societal impacts of the COVID-19 pandemic brought concern about further declines in seafood intake. This study evaluated the influence of COVID-19 on seafood intake among U.S. residents, toward understanding potential public health implications. A nationally representative cross-sectional survey of 1200 U.S. residents conducted in June 2021 evaluated the frequency and types of seafood consumed, and purchase methods used, before and during the early stages of the COVID-19 pandemic. The results (weighted data) indicate most U.S. consumers (90%) eat seafood, yet only 19% meet the seafood DGA. The likelihood of meeting the DGA was higher among consumers who were Asian, Black, or Hispanic; older; unmarried; of higher income; familiar with the DGA; choosing seafood for health reasons; and living in Atlantic or Gulf coast states. During COVID-19, some increased seafood intake for health reasons (45%), while others reduced intake due to factors such as cost (29%), limited availability (16%), and challenges with preparation (11%). Fresh salmon (68%), frozen shrimp (59%), and cooked oysters (41%) were most frequently purchased by consumers of these foods. More consumers indicated purchasing wild salmon (62%), shrimp (44%), and oysters (51%) than farm-raised products, though many were unsure. Fewer consumers included seafood in online grocery orders (36%) than meal kit orders (61%) when using these services. Though many consumers continued to eat seafood despite decreased restaurant patronage, most did not reach the intake level needed to maximize health benefits. Educational and marketing efforts promoting the health benefits of seafood and the convenience of procurement via online purchase methods may encourage intake across demographic groups to benefit public health outcomes in the U.S.

Using mHealth Technologies for Case Finding in Tuberculosis and Other Infectious Diseases in Africa: Systematic Review.

Mobile health (mHealth) technologies are increasingly used in contact tracing and case finding, enhancing and replacing traditional methods for managing infectious diseases such as Ebola, tuberculosis, COVID-19, and HIV. However, the variations in their development approaches, implementation scopes, and effectiveness introduce uncertainty regarding their potential to improve public health outcomes. We conducted this systematic review to explore how mHealth technologies are developed, implemented, and evaluated. We aimed to deepen our understanding of mHealth's role in contact tracing, enhancing both the implementation and overall health outcomes. We searched and reviewed studies conducted in Africa focusing on tuberculosis, Ebola, HIV, and COVID-19 and published between 1990 and 2023 using the PubMed, Scopus, Web of Science, and Google Scholar databases. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review, synthesize, and report the findings from articles that met our criteria. We identified 11,943 articles, but only 19 (0.16%) met our criteria, revealing a large gap in technologies specifically aimed at case finding and contact tracing of infectious diseases. These technologies addressed a broad spectrum of diseases, with a predominant focus on Ebola and tuberculosis. The type of technologies used ranged from mobile data collection platforms and smartphone apps to advanced geographic information systems (GISs) and bidirectional communication systems. Technologies deployed in programmatic settings, often developed using design thinking frameworks, were backed by significant funding and often deployed at a large scale but frequently lacked rigorous evaluations. In contrast, technologies used in research settings, although providing more detailed evaluation of both technical performance and health outcomes, were constrained by scale and insufficient funding. These challenges not only prevented these technologies from being tested on a wider scale but also hindered their ability to provide actionable and generalizable insights that could inform public health policies effectively. Overall, this review underscored a need for organized development approaches and comprehensive evaluations. A significant gap exists between the expansive deployment of mHealth technologies in programmatic settings, which are typically well funded and rigorously developed, and the more robust evaluations necessary to ascertain their effectiveness. Future research should consider integrating the robust evaluations often found in research settings with the scale and developmental rigor of programmatic implementations. By embedding advanced research methodologies within programmatic frameworks at the design thinking stage, mHealth technologies can potentially become technically viable and effectively meet specific contact tracing health outcomes to inform policy effectively.

Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review.

The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry's influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.

Identifying patterns and profiles of vaccination hesitancy among nurses for tailoring healthcare policies in the UK: A cross-sectional study.

To profile the characteristics of nurses with varying levels of vaccine hesitancy toward the COVID-19 and influenza vaccines. In many countries across the world, healthcare workers, and nurses in particular, display significant reluctance toward COVID-19 and influenza vaccines due to concerns about safety, distrust in healthcare policies, and media influences. To address this, a proposed approach involves profiling nurses to tailor vaccination campaigns and to improve acceptance rates and public health outcomes. This cross-sectional study adopted the Vaccination Attitudes Examination scale to assess hesitancy toward COVID-19 and influenza vaccines among 294 registered nurses in the UK between March and July 2023. A K-means cluster analysis was performed. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were adopted. Three profiles were identified. Profile A showed low vaccination hesitancy, profile B showed average hesitancy, and profile C showed high hesitancy toward vaccines. The highest concern for all profiles was related to unforeseen future effects of vaccination. Profile C had more nurses in early career roles, whereas nurses in profiles A and B were in more senior roles. Profile A showed higher educational attainment. Nurses in profile C used Snapchat more, whereas nurses in profile A used Twitter more frequently. This study identified specific characteristics associated with higher levels of vaccination hesitancy in nursing. Unforeseen future effects of vaccination are a core aspect to consider in promoting vaccination. Policies and vaccination campaigns should be targeted on early career nurses and should deliver tailored messages to dispel misinformation about unforeseen future effects of vaccination through specific social media platforms. Senior nurses should be involved as role models in promoting vaccination. These results are key for enhancing an evidence-based approach to implementing global health policies in healthcare.

Prehospital Factors Contributing to Delays in the Timely Management of ST-Elevation Myocardial Infarction

Background: Prehospital factors are critical contributors to delays in managing patients with ST elevation myocardial infarction (STEMI), potentially leading to increased mortality and morbidity. Identifying and addressing these obstacles could significantly reduce the mortality and morbidity of these patients and enhance healthcare performance. Objectives: This study aims to evaluate the prehospital factors associated with delays in primary percutaneous coronary intervention (PPCI) among patients with STEMI. Methods: In this prospective study, 394 STEMI patients treated with PPCI were evaluated, with the interval between symptom onset and the start of the procedure being measured and recorded. Patients were categorized into two groups based on this interval: Appropriate and delayed (&lt; 90 minutes vs. ≥ 90 minutes). The potential predictors of delay were identified and assessed. Results: In this study, 394 STEMI patients were evaluated and categorized into 192 patients with delayed PPCI and 202 patients with on-time PPCI. Multivariate analysis revealed that being female (OR: 1.59, 95% CI: 1.08 - 2.01, P-value: &lt; 0.01), having no past medical history of cardiovascular disease (CVD) (OR: 1.49, 95% CI: 1.09 - 1.90, P-value: &lt; 0.01), no family history of CVD (OR: 1.28, 95% CI: 1.04 - 1.53, P-value: 0.03), a lower education level than academic (OR: 1.44, 95% CI: 1.05 - 1.84, P-value: &lt; 0.01), symptom onset between 18:00 and 06:00 (OR: 1.58, 95% CI: 1.10 - 2.06, P-value: 0.01), and transport by ambulance versus private vehicle (OR: 1.57, 95% CI: 1.07 - 2.08, P-value: &lt; 0.01) were significantly associated with a higher risk of delayed PCI. Conversely, higher socioeconomic status (OR: 0.68, 95% CI: 0.51 - 0.86, P-value: 0.02) and having a caregiver at home (OR: 0.52, 95% CI: 0.32 - 0.72, P-value: &lt; 0.01) were significantly associated with a lower risk of delayed PPCI. Conclusions: Reducing factors that contribute to delays in PPCI can lead to improved public health outcomes and greater health opportunities for the population. Delays in STEMI patients were significantly associated with living in rural areas, lower education levels, and female gender. Conversely, using private vehicles for transport, having a caregiver present, and higher socioeconomic status may reduce the risk of delayed PPCI.

Barriers and Facilitators That Influence HIV Pre-exposure Prophylaxis (PrEP)-Prescribing Behaviors Among Primary Care Providers in the Southern United States.

The Southern United States (US) bears the highest burden of HIV prevalence in the country, disproportionately affecting African American communities. Despite the proven efficacy of pre-exposure prophylaxis (PrEP) in reducing HIV transmission, its uptake remains suboptimal in this region. This study aimed to identify factors influencing PrEP-prescribing behaviors among primary care providers (PCPs) in the Southern USthrough the application of the transtheoretical model of behavior change. A cross-sectional survey was conducted among PCPs in 10 Southern states to assess their PrEP-prescribing practices, barriers, and facilitators. The results indicate that non-White PCPs and those practicing in urban and suburban settings are more likely to prescribe PrEP. Key barriers include lack of training, perceived stigma, and systemic issues such as health insurance coverage and time constraints. Significant facilitators are access to prescribing resources, streamlined insurance procedures, and patient motivation. Targeted educational programs and policy changes to address these barriers can enhance PrEP uptake, thereby reducing HIV transmission in high-risk populations. The findings underscore the need for tailored interventions to support PCPs in integrating PrEP into routine care, ultimately contributing to better public health outcomes in the Southern US.

The Urgent Need for Dengue Vaccination: Combating an Escalating Public Health Crisis in Pakistan.

Dengue fever, caused by the dengue virus (DENV), poses a significant global health threat, with a dramatic increase in cases driven by climate change, urbanization, and mosquito resistance. In Pakistan, a country with a population of 240 million, the world's fifth largest, dengue has emerged as an escalating public health crisis, with seasonal outbreaks severely straining the healthcare system. Despite decades of vector control efforts, there has not been much success, necessitating the introduction of dengue vaccination to boost population immunity. Recent advancements in vaccine development demonstrate promising efficacy and safety profiles, even in dengue-naive individuals. Implementing a dengue vaccination program in Pakistan could significantly reduce the disease burden, lower healthcare costs, and prevent future outbreaks. Integrating vaccination with existing public health initiatives can achieve high coverage and improve overall public health outcomes.

The Impact of Lifestyle and Environmental Factors on Cancer Risk and Prevention

Cancer remains a leading cause of mortality globally, with a multifaceted etiology involving genetic, lifestyle, and environmental factors. This review article examines the impact of lifestyle and environmental factors on cancer risk and prevention, focusing on dietary habits, physical activity, tobacco use, alcohol consumption, and environmental exposures such as pollution, occupational hazards, and radiation. Lifestyle factors such as a balanced diet, regular exercise, and smoking cessation are shown to significantly influence cancer risk, while environmental factors like pollution and radiation exposure also play critical roles in cancer development. The review details the mechanisms through which these factors contribute to cancer, including DNA damage, inflammation, and hormonal regulation. Public health initiatives, policy regulations, and screening strategies are discussed as essential components of effective cancer prevention. Methodologically, this review synthesizes recent research findings and current evidence to provide a comprehensive overview of how lifestyle and environmental modifications can be leveraged to reduce cancer risk. Through this analysis, the article aims to offer valuable insights into enhancing cancer prevention strategies and improving public health outcomes. Keywords: Cancer Prevention, Lifestyle Factors, Environmental Exposure, Public Health, Risk Reduction

Optimal cut-off points of anthropometric and body roundness indices associated with diabetes: Persian (Shahedieh) cohort study.

Diabetes is a chronic and concerning health condition that poses a significant public health challenge. Given that preventing, detecting early, and treating T2DM can enhance public health outcomes, the objective of this study was to identify the most effective obesity indices and determine their optimal cut-off points for predicting the risk of T2DM in an Iranian population. This study was conducted on 8,019 male and female participants aged between 35 and 70 years in the context of Shahedieh cohort study. The ROC curve analysis was utilized to determine the optimal cut-off point of each anthropometric index to predict diabetes in age-sex categories. The overall diabetes incidence in the study population was 2.5%, with 2.5% in men and 2.4% in women. In men, significant differences in most of the anthropometric indices were observed between diabetic individuals and healthy counterparts. This study found that for women 45-65, BMI and weight, and for men under 65 years, weight, WHR, BMI, WC, WHTR, AVI, and BRI are efficient T2DM predictors. The AUC of these indices varied from 0.593 (95% CI: 0.510-0.676) to 0.668 (95% CI: 0.586-0.750) in men, and from 0.587 (95% CI: 0.510-0.664) to 0.644 (95% CI: 0.535-0.754) in women. Anthropometric indices and body roundness are simple, inexpensive, and noninvasive means markers to predict the risk of diabetes. Our findings show that most of the studied indices had acceptable prediction power for men except for elderly. For women over 45 years old, weight and BMI are appropriate predictors. It seems that the approach of reducing diabetes incidence through early detection and primary prevention is achievable.

Nutritional Properties of Fortified Rice (PDS) Distributed at KGBV Hostels of Telangana State, India

Rice is a vital staple crop that serves as the primary source of calories for over half of the global population, particularly in Asia. Despite its importance, rice is inherently deficient in several essential micronutrients, and the nutritional value is further diminished through processing. This study examines the nutritional composition of fortified rice provided through the Public Distribution System (PDS) in KGBV hostels, emphasizing its potential to address nutritional deficiencies. The analysis focused on key parameters including moisture, ash, fat, crude fiber, protein, carbohydrates, energy, and iron content. Results revealed that fortified rice contains 11.8% moisture, 1.57% ash, 0.78% fat, and 31.05 mg of iron, crude fiber content was 0.3%, protein levels were 7.7%, carbohydrate content was 77.85g, and energy content was 349.22 kcal. These findings highlight the superior nutritional profile of fortified rice, particularly in terms of its ash, energy, and iron content, making it a highly beneficial option for addressing nutritional deficiencies and improving public health outcomes.

Effects of Community Assets on Major Health Conditions in England: A Data Analytic Approach.

The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model. The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty. The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health.

Age-Related Blood Pressure Gradients Are Associated With Blood Pressure Control and Global Population Outcomes.

The strong relationship between blood pressure (BP) and age is well known. Limited evidence suggests that a steeper age-BP slope may be associated with an increased risk of adverse outcomes. The May Measurement Month campaign enables an investigation of geographic, socioeconomic, and sex differences in age-related BP gradients and their association with public-health outcomes. Cross-sectional, annual global BP May Measurement Month screening data were analyzed. Average systolic BP and age-related BP slopes across different age groups were calculated to assess regional, socioeconomic, and sex-stratified variations. The association of BP slopes derived from adjusted linear regression models with country-level health metrics was investigated. Age-related systolic BP gradients differed distinctly across global geographic regions, income levels, and between sexes. The steepest age gradients of BP were observed in populations from Africa and Europe. Women had lower BP levels than men at younger ages (20s and 30s) but subsequently experienced more pronounced age-related BP gradients. Geographically divergent age-related BP gradients were significantly associated with major national public health indicators. Globally, steeper age-related BP slopes were associated with poor BP control, increased disability-adjusted life years, and death rates. A steeper population age-BP slope of 1 mm Hg per 10 years was associated with a decrease in life expectancy of 3.3 years in this population (95% CI, -5.1 to -1.4; P=0.0007). Age-related BP gradients vary considerably across global populations and are associated with variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of adverse BP gradients to improve health outcomes.

Lessons from the COVID-19 Pandemic: Promoting Vaccination and Public Health Resilience, a Narrative Review.

The COVID-19 pandemic has underscored the critical importance of adaptable and resilient public health systems capable of rapid response to emerging health crises. This paper synthesizes the lessons learned from the COVID-19 vaccination campaign and explores strategies to enhance vaccine uptake in the post-pandemic era. Key challenges identified include logistical, economic, sociocultural, and policy dimensions that impact vaccination efforts, particularly in low-resource settings. The analysis highlights the need for resilient supply chains, effective communication, community engagement, and equitable access to healthcare resources. The rapid development and deployment of mRNA vaccines exemplify the potential of innovative vaccine technologies, though public trust and acceptance remain crucial. Strategies such as partnerships with local leaders, tailored messaging, and integration of digital tools are essential for combating vaccine hesitancy. By applying these insights, future vaccination campaigns can be more efficient, equitable, and resilient, ultimately improving public health outcomes globally. This paper aims to inform policy and practice, ensuring that public health strategies are evidence based and context specific, thus better preparing for future health challenges.

Health and non-health benefits and equity impacts of individual-level economic relief programs during epidemics/pandemics in high income settings: a scoping review

BackgroundEconomic relief programs are strategies designed to sustain societal welfare and population health during a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity.MethodsWe conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3, 2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and economic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in duplicates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach.ResultsWe identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19 and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9) were most common. Individual-level economic relief programs were reported to have varying degrees of impact on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave programs had the highest number of studies reporting health-related outcomes and positively impacted public health measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services). Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food security, financial resilience, and job security.ConclusionsOur findings suggest that individual-level economic relief programs can have significant impacts on public health measures, population health outcomes and equity. As countries prepare for future pandemics, our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal when designing pandemic preparedness policies.

Is There an Interplay between Environmental Factors, Microbiota Imbalance, and Cancer Chemotherapy-Associated Intestinal Mucositis?

Interindividual variation in drug efficacy and toxicity is a significant problem, potentially leading to adverse clinical and economic public health outcomes. While pharmacogenetics and pharmacogenomics have long been considered the primary causes of such heterogeneous responses, pharmacomicrobiomics has recently gained attention. The microbiome, a community of microorganisms living in or on the human body, is a critical determinant of drug response and toxicity. Factors such as diet, lifestyle, exposure to xenobiotics, antibiotics use, illness, and genetics can influence the composition of the microbiota. Changes in the intestinal microbiota are particularly influential in drug responsiveness, especially in cancer chemotherapy. The microbiota can modulate an individual's response to a drug, affecting its bioavailability, clinical effect, and toxicity, affecting treatment outcomes and patient quality of life. For instance, the microbiota can convert drugs into active or toxic metabolites, influencing their efficacy and side effects. Alternatively, chemotherapy can also alter the microbiota, creating a bidirectional interplay. Probiotics have shown promise in modulating the microbiome and ameliorating chemotherapy side effects, highlighting the potential for microbiota-targeted interventions in improving cancer treatment outcomes. This opinion paper addresses how environmental factors and chemotherapy-induced dysbiosis impact cancer chemotherapy gastrointestinal toxicity.