Public Health Prevention Interventions Research Articles

Preventive interventions on vector-borne diseases related to climate change: an Umbrella review

Abstract Background Vector-borne diseases (VBDs) are a global challenge to public health, being influenced by ecological factors and climate change. Despite the several preventive public health interventions that can be implemented, the evidence of their impact is still fragmented. An organic overview of the current evidence can provide relevant information on the effectiveness of these actions. Methods We conducted an umbrella review following the PRIOR checklist. Relevant reviews were searched using PubMed and Cochrane databases. We considered eligible all systematic reviews published in English between 2013 and 2023, containing meta-analysis on public health interventions aimed at reducing incidence, prevalence, or the burden of disease of VBDs, without demographic restrictions. Results We screened 1971 records. 51 reviews were included. 38 reported outcomes targeting Malaria, 9 Dengue, 2 Yellow Fever, 1 Leishmaniasis,1 Zika, 1 Chikungunya, 1 Crimean-Congo haemorrhagic fever, 1 Lyme disease and 1 Schistosomiasis. Several interventions were assessed worldwide. 18 reviews considered chemoprophylaxis, 9 net/curtains, 8 vaccines, 6 repellents, 3 housing interventions, 2 community participation, 2 MTaT and 2 oral supplementations. Authors stated conclusions are favourable to the interventions assessed for the 73%, but the certainty level is mostly considered low. Conclusions Public health preventive interventions are fundamental in responding to the threat of VBDs, but their impact may vary depending on several factors. Further research must provide more effective interventions and strategies, with a cohesive presentation of their evidence. Key messages • Effective reduction of VBDs burden requires a combination of interventions that must be tailored to local ecological, social, and epidemiological factors. • Evidence presented in this umbrella review can inform evidence-based policies and programs aimed at combating VBDs at local, national, and global levels.

Facilitating subgroup identification: the use of decision trees in breast cancer screening uptake

Abstract Introduction Organized breast cancer screening (BCS) programs are effective prevention measures for women aged 50-69 to prevent the sixth cause of death in Germany. It is unclear which sociodemographic factors and potential interactions are associated with never-attendance. Explorative approaches such as decision trees offer an inductive approach to intersectional subgroup identification based on different computational decisions. This study discusses two approaches for estimating the likelihood of not attending BCS in Germany. Methods Women aged 50-69 (N = 3,644) were selected from the German 2020 European Health Interview Survey. We estimate the risk of not attending BCS first by employing cross-classification regression analysis utilising known social dimensions and second by leveraging the nodes of the best-performing decision tree as exposure variables. Results The first approach, adjusting for age, found that women born in Germany had 1.97 higher odds (p = 0.015) of never attending BCS than high-income women not born in Germany. Conditional Inference Tree (mincriterion= 0.6040046, maxdepth=3) adjusted to optimise sensitivity and the Area Under the Curve (71.43% sensitivity, 63.21% AUC), identified 8 relevant intersectional groups characterised by unique combinations of family status, perceived social support, working situation, experienced physical limitation, and region, with the highest odds of 4.85 (p < 0.001) of not attending BCS for women living with their couple and children or non-conventional household constellations who perceived little, uncertain or a lot of social support. Conclusions Using explorative decision trees for subgroup identification, the study provides more detailed insights into women at higher risk of not attending BCS in Germany, aiding, on the one hand, more precise health reporting data and, on the other hand, enhanced preventive public health interventions. Key messages • Explorative decision trees for subgroup identification allow for more detailed insights into women at higher risk of not attending BCS in Germany for enhanced preventive public health interventions. • Women living with their couple and children or non-conventional constellations who perceived little, uncertain or a lot of social support are at the highest odds of never attending BCS in Germany.

Measuring accumulation: Constructing a tool for evaluating cumulative harm in children engaged with an intensive family support service

AbstractThere is a significant body of research that attests to the deleterious impact of an accumulation of adverse childhood experience across the lifespan, which provides a strong rationale for the development of a means for evaluating this accumulation in a high‐risk population. We developed a theory‐driven measure, the Cumulative Experiences Index, and conducted a pilot study to test its utility. The Cumulative Experiences Index derives a cumulative harm score that can be used to inform intervention and prevention strategies, programmes and initiatives across all tiers of public health prevention intervention. The Cumulative Experiences Index was piloted with 50 participants aged 8–17 years old who were actively engaged with an Intensive Family Support service. The study explores whether cases rated as low, medium or high severity on the Cumulative Experiences Index corresponded with severity ratings on the three measures of concurrent validity: the Strengths and Difficulties Questionnaire, Kessler‐10 and Children's Revised Impact of Events Scale. The Index provides a valid and accurate means of reflecting the interconnectedness and complexity of exposure to different forms of harm that accumulates over time. Practitioners and researchers will benefit from using the Cumulative Experiences Index—a new valid and reliable measure of cumulative harm.

Comparing times of self-harm presentations to hospital emergency departments in children, adolescents, young adults and adults: a national registry study 2007–2019

PurposeThe few studies that have explored self-harm presentation times at hospital emergency departments (EDs) – an important factor that can determine if a patient receives a mental health assessment – primarily focus on adult samples. This study examined the times of self-harm presentations to EDs, self-harm methods used, mental health assessments, and admission data across different age-groups.MethodsUsing data from the National Self-Harm Registry Ireland over a 13-year timeframe (2007–2019), this study compared times, days, seasons, methods of self-harm, and admission data for children (8–12 years), adolescents (13–17 years), young adults (18–25 years) and adults (> 25 years).ResultsThe majority of the 152,474 self-harm presentations (78.6%) for all ages occurred out-of-hours (outside the standard working hours or in-hours times of 09:00–17:00, Monday-Friday). The four hours before midnight had the highest proportions of self-harm presentations for adolescents (27.9%) and adults (23.1%), whereas the four hours after midnight had the highest proportion of self-harm presentations for young adults (22.9%). The 16:00-midnight timeframe had highest proportion of self-harm presentations in children (52.3%). Higher proportions of patients received a mental health assessment in-hours compared to out-of-hours among young adults (78.2% vs. 73.3%) and adults (76.1% vs. 72.0%). Self-harm presentations were lowest during summer months in children and adolescents.DiscussionHospitals should ensure that adequate resources are available for individuals presenting with self-harm, especially in the case of overcrowded EDs, and protocols need to be designed for those presenting with self-harm due to intoxication. In line with national policy, protocols for patients presenting during out-of-hours should be designed that can incorporate services from allied health multidisciplinary teams, social work, addiction services and counselling organisations. Given the lower rates of self-harm during school holidays for children and adolescents, the school environment must be considered in the context of mental health and self-harm public health prevention interventions.

Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods.

The maintenance of oral health is a crucial aspect of general well-being; however, a significant proportion of the worldwide population experiences a range of oral diseases. Dental caries is a highly prevalent non-communicable disease globally, especially in children and adolescents. Fluoride is involved in the control of dental caries, primarily by decreasing the critical pH for dental hard tissue dissolution and decreasing enamel solubility. Due to the substantial data supporting the efficacy of fluoride in controlling dental caries, many community-level fluoridation initiatives have been devised and executed as global public health preventive interventions. These initiatives encompass the fluoridation of water, salt, and milk. Water fluoridation is considered safe and effective when fluoride levels are maintained within the recommended range (0.6 to 1.1 mg/L). Salt fluoridation has a cariostatic potential similar to that of water fluoridation, and a fluoride concentration of 250 micrograms per gram in salt is not associated with an increased risk of developing dental fluorosis. However, there is currently an effort to reduce the consumption of table salt in order to mitigate the harmful effects of excessive salt consumption. It has been hypothesized that fluoride food supplementation, such as fluoridated milk, is associated with a decrease in caries experience in permanent teeth; however, the effect is not clear in primary teeth. Public-level fluoride interventions are more cost-effective than the operative care of caries lesions and limit the burden of care. The administration of fluorides should be conducted using safe methods, limiting ingestion, and adhering to the guidelines set by international and national health agencies in each country. This is particularly important when considering children with developing dentitions. Fluoride is an important tool in the control of dental caries, but it is crucial to combine it with good oral hygiene, a healthy diet, and regular visits to a dental professional to maintain long-term oral health.

Incidence of Lyme Borreliosis in Germany: A retrospective observational healthcare claims study

Lyme borreliosis (LB) is the most common tick–borne disease in Germany. Although the incidence of LB in Germany has been assessed in several studies, those studies either used data from statutory surveillance, which frequently underreport cases, or data from health claims databases, which may overestimate cases due to non–specific LB case definitions. Here, using a more specific case definition, we describe the incidence of medically–attended LB by disease manifestation, age group, and federal state for the period 2015–2019. Both inpatient and outpatient cases were analyzed from a claims database. To be eligible for inclusion, patients were required to have an LB specific ICD–10 GM diagnosis code plus an antibiotic prescription, and for disseminated manifestations, a laboratory test order additionally. LB cases were classified as erythema migrans (EM), or disseminated disease including Lyme arthritis (LA), Lyme neuroborreliosis (LNB), and all other disease manifestations (OTH). Between 2015 and 2019, the incidence of medically–attended LB cases ranged from 195.7/100,000 population per year (95% confidence interval [CI], 191.0 – 200.5) to 254.5/100,000 population per year (95% CI, 249.0 – 260.0) per year. The majority of cases (92.2%) were EM, while 2.8% presented as LA, 3.8% as LNB, and 1.2% as OTH. For both EM and disseminated disease, the incidence peaked in children aged 5–9 years and in older adults. By federal state, the incidence of medically–attended EM ranged from 74.4/100,000 population per year (95% CI, 71.9 – 77.0) per year in Hamburg, to 394.1/100,000 population per year (95% CI, 370.7 – 417.6) per year in Saxony, whereas for medically–attended disseminated disease, the highest incidence was in Thuringia, Saxony, and Bavaria (range: 22.0 [95% CI, 19.9 – 24.0] to 35.7 [95% CI, 34.7 – 36.7] per 100,000 population per year). This study comprehensively estimated the incidence of all manifestations of medically–attended LB and showed a high incidence of LB throughout Germany. Results from the study support performing epidemiological studies in all federal states to measure the burden of LB and to invest in public health interventions for prevention.

Impact of normalized COVID-19 prevention and control measures on lower respiratory tract infection pathogenesis in hospitalized children.

This study aimed to investigate the epidemiological characteristics of common pathogens contributing to childhood lower respiratory tract infections (LRTIs) in Xiangtan City, Hunan Province before and during the coronavirus disease 2019 (COVID-19) pandemic. A total of 11,891 enrolled patients, aged 1 month to 14 years, diagnosed with LRTIs and admitted to Xiangtan Central Hospital from January 2018 to December 2021 were retrospectively reviewed in this study. Specifically, the epidemiological characteristics of these pathogens before and during the COVID-19 pandemic were analyzed. There was a significant decrease in the number of children hospitalized with LRTIs during the COVID-19 pandemic (2020-2021) compared to data from 2018 to 2019 (before the COVID-19 pandemic). Of these cases, 60.01% (7,136/11,891) were male and 39.99% (4,755/11,891) were female. 78.9% (9,381/11,891) cases occurred in children under 4 years of age. The average pathogen detection rate among 11,891 hospitalized LRTIs children was 62.19% (7,395/11,891), with the average pathogen detection rate of 60.33% (4,635/7,682) and 65.57% (2,670/4,209) before and during COVID-19 pandemic, respectively. The detection rates of adenovirus (ADV), bordetella pertussis (BP) and moraxella catarrhalis (M. catarrhalis) decreased dramatically, while the detection rates of influenza viruses (IFV), parainfluenza viruses (PIV), respiratory syncytial virus (RSV), haemophilus influenzae (H. influenzae), streptococcus pneumoniae (S. pneumoniae), and staphylococcus aureus (S. aureus) increased significantly during the COVID-19 pandemic. Overall, RSV, mycoplasma pneumoniae (MP), H. influenzae, and IFV were the major pathogens causing LRTIs in hospitalized children before and during the COVID-19 pandemic. Public health interventions for COVID-19 prevention are beneficial to reduce the incidence of LRTIs in children by limiting the prevalence of ADV, MP, BP, and M. catarrhalis, but which have limited restrictive effects on other common LRTIs-associated pathogens. Collectively, the data in this study comprehensively investigated the effects of COVID-19 pandemic on the epidemiological characteristics of respiratory pathogens, which will be beneficial for improving early preventive measures.

Incidence of central retinal artery occlusion peaks in winter season.

Stroke incidence exhibits seasonal trends, with the highest occurrences observed during winter. This study investigates the incidence of central retinal artery occlusion (CRAO), a stroke equivalent of the retina, and explores its monthly and seasonal variations, as well as potential associations with weather and ambient air pollutants. A retrospective search of medical records spanning 15 years (January 2008-December 2022) was conducted at the University Eye Hospital Tübingen, Germany, focusing on diagnosed cases of CRAO. Incidences were evaluated on a monthly and seasonal basis (winter, spring, summer, fall). Weather data (temperature, precipitation, atmospheric pressure) and concentrations of ambient air pollutants [fine particulate matter (PM2.5), coarse particulate matter (PM10), nitrogen dioxide (NO2), and ozone (O3)], were analyzed for a potential association with CRAO incidence. Out of 432 patients diagnosed with CRAO between 2008 and 2022, significantly varying incidences were observed monthly (p = 0.025) and seasonally (p = 0.008). The highest rates were recorded in February and winter, with the lowest rates in June and summer. Concentrations of NO2, PM2.5 and lower ambient air temperature (average, minimum, maximum) showed significant correlations with CRAO incidence. This comprehensive 15-year analysis reveals a pronounced winter peak in CRAO incidence, with the lowest occurrences in summer. Potential associations between CRAO incidence and ambient air pollutants and temperature underscore the importance of considering seasonal trends and call for further investigations to elucidate contributing factors, potentially leading to targeted preventive strategies and public health interventions.

The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022.

Posttraumatic osteoarthritis of the knee (PTOAK) is a known sequela of bony and soft-tissue articular knee injuries, although its historically reported prevalence is highly variable with no recent population-based studies. The TriNetX/US Collaborative Network database was queried to identify adult patients diagnosed with a history of knee trauma using ICD-10-CM coding. Primary outcomes measured were yearly incidence proportion (IP), incidence rate (IR), and prevalence of knee osteoarthritis in the United States from 2000 to 2022. Chi square analyses were conducted to compare outcomes across categorical data. Regression modeling was performed to project PTOAK epidemiology to 2030. Statistical significance was held at P < 0.05 for all analyses. Nine hundred forty-eight thousand eight hundred fifty-three patients meeting criteria were identified. As of 2022, the IP of PTOAK was 5.93%, IR was 2.26 × 10 -4 cases/person-day, and prevalence was 21.1%. By strata in 2022, posttraumatic knee OA is most prevalent among the 54 to 59-year-old age group (50.9%), 60 to 64-year-old age group (50.3%), 50 to 54-year-old age group (49.7%), female patients (24.2%), and White patients (23.1%). Regression analyses revealed that the IP, IR, and prevalence of PTOAK have increased exponentially from 2000 to 2022. By 2030, the model predicts that the IP will further increase to 10.7% (95% PI = 9.79% to 11.7%), IR will be 3.79 × 10 -4 cases/person-day (95% PI = 3.28 × 10 -4 to 4.29 × 10 -4 ), and prevalence of PTOAK in the United States will be 40.6% (95% PI = 39.1% to 42.0%). These findings echo earlier, smaller scale studies but reveal an alarming rise in PTOAK prevalence, potentially doubling by 2030. The financial burden of knee OA treatment in the United States is already substantial, costing between $5.7 and $15 billion USD annually. This projected increase in prevalence could further increase healthcare expenditures by $1 to 3 billion by 2030. These results emphasize the need for additional research into factors contributing to PTOAK, evidence-based preventive public health interventions, and the development of multidisciplinary system-based care delivery optimization pathways.

Recent HIV infection and annualized HIV incidence rates among sexual and gender minorities in Brazil and Peru (ImPrEP seroincidence study): a cross-sectional, multicenter study

HIV incidence estimation is critical for monitoring the HIV epidemic dynamics and the effectiveness of public health prevention interventions. We aimed to identify sexual and gender minorities (SGM) with recent HIV infections, factors associated with recent HIV infection, and to estimate annualised HIV incidence rates. Cross-sectional multicentre study in HIV testing services in Brazil and Peru (15 cities). Inclusion criteria: 18+ years, SGM assigned male at birth, not using pre-/post-exposure prophylaxis. We identified recent HIV infection using the Maxim HIV-1 LAg-Avidity EIA assay as part of a recent infection testing algorithm (RITA). Annualized HIV incidence was calculated using the UNAIDS/WHO incidence estimator tool. Multivariable logistic regression models were used to estimate factors associated with recent HIV infection. Trial registration: NCT05674682. From 31-Jan-2021 to 29-May-2022, 6899 individuals participated [Brazil: 4586 (66.5%); Peru: 2313 (33.5%)]; 5946 (86.2%) cisgender men, 751 (10.9%) transgender women and 202 (2.9%) non-binary/gender diverse. Median age was 27 (IQR: 23-34) years. HIV prevalence was 11.4% (N=784/6899); 137 (2.0%) SGM were identified with recent HIV infection. The overall annualized HIV incidence rate was 3.88% (95% CI: 2.86-4.87); Brazil: 2.62% (95% CI: 1.78-3.43); Peru: 6.69% (95% CI: 4.62-8.69). Participants aged 18-24 years had higher odds of recent HIV infection compared to those aged 30+ years in both countries. Our results highlight the significant burden of HIV epidemic among SGM in large urban centres of Brazil and Peru. Public health policies and interventions to increase access to effective HIV prevention methods such as PrEP are urgently needed in Latin America. Unitaid, WHO (Switzerland), Ministry of Health from Brazil and Peru.

Tackling a global epidemic threat: Nipah surveillance in Bangladesh, 2006-2021.

Human Nipah virus (NiV) infection is an epidemic-prone disease and since the first recognized outbreak in Bangladesh in 2001, human infections have been detected almost every year. Due to its high case fatality rate and public health importance, a hospital-based Nipah sentinel surveillance was established in Bangladesh to promptly detect Nipah cases and respond to outbreaks at the earliest. The surveillance has been ongoing till present. The hospital-based sentinel surveillance was conducted at ten strategically chosen tertiary care hospitals distributed throughout Bangladesh. The surveillance staff ensured that routine screening, enrollment, data, and specimen collection from suspected Nipah cases were conducted daily. The specimens were then processed and transported to the reference laboratory of Institute of Epidemiology, Disease Control and Research (IEDCR) and icddr,b for confirmation of diagnosis through serology and molecular detection. From 2006 to 2021, through this hospital-based surveillance platform, 7,150 individuals were enrolled and tested for Nipah virus. Since 2001, 322 Nipah infections were identified in Bangladesh, 75% of whom were laboratory confirmed cases. Half of the reported cases were primary cases (162/322) having an established history of consuming raw date palm sap (DPS) or tari (fermented date palm sap) and 29% were infected through person-to-person transmission. Since the initiation of surveillance, 68% (218/322) of Nipah cases from Bangladesh have been identified from various parts of the country. Fever, vomiting, headache, fatigue, and increased salivation were the most common symptoms among enrolled Nipah patients. Till 2021, the overall case fatality rate of NiV infection in Bangladesh was 71%. This article emphasizes that the overall epidemiology of Nipah virus infection in Bangladesh has remained consistent throughout the years. This is the only systematic surveillance to detect human NiV infection globally. The findings from this surveillance have contributed to early detection of NiV cases in hospital settings, understanding of Nipah disease epidemiology, and have enabled timely public health interventions for prevention and containment of NiV infection. Although we still have much to learn regarding the transmission dynamics and risk factors of human NiV infection, surveillance has played a significant role in advancing our knowledge in this regard.

The Impact of Covid-19 Pandemic on Child Routine Immunization Programs: A Systematic Review

Immunization is one of the most successful, most accepted and proven cost-effective public health preventive interventions in the world and has saved 2 to 3 million children from immunization-preventable diseases. The COVID-19 outbreak and the effort being made to overcome the outbreak could cause negative impacts on the utilization of basic immunization services. During the outbreak, basic immunization coverage rate in various regions had decreased. This article conducted a comprehensive and systematic literature search in electronic databases (PubMed, ScienceDirect, Sage Journal, SpringerLink, ClinicalKey, and Oxford Academic) with articles published in the last 5 years and adjusted according to inclusion and exclusion criteria. This systematic review use PRISMA (Preferred, Reporting Items for Systematic Review and Meta-analysis). There were 2 studies that met the final inclusion criteria. The results showed a significant reduction of basic immunization coverage happen especially during the early period of pandemic. Six themes are identified related to the decrease: 1) Covid-19 lockdown; (2) motivation for childhood immunization; (3) availability of biosafety procedures and personal protective equipment (PPE); (4) service adjustments and guidelines during the pandemic; (5) the availability of vaccines; and (6) the resilience of the immunization program in view of COVID-19. Childhood routine immunization coverage rate significantly decreased during the early period of the pandemic. Interventions for providers and parents is required to ensure adequate catch-up of delayed/missed immunizations in order to prevent potential outbreaks of vaccine-preventable diseases.

The Effect of Social Contacts on the Uptake of Health Innovations among Older Ethnic Minorities in the UK: A Mixed Methods Study

Several studies have highlighted specific views on ageing among older migrants in Europe that tend to be outdated or more pessimistic than the general population. However, the current literature does not provide explanations for such observations. This mixed methods study considers the diffusion of innovation among older migrants as a possible explanatory factor. A critical component of the diffusion of innovation theory is how information is accessed, exchanged, and communicated through social contacts. This study employs the fundamental mathematical model of diffusion to examine the differential effects of diffusion of innovation based on the social contact rates among migrant groups compared to the overall UK population. As there is no direct information on social contact rates among migrants in the UK, the analysis uses the equivalence from the migrants’ home countries as proxies. This study utilises social matrices of contact data for the UK based on publicly available information from a European survey and other publications for the contact rate for three sending countries where there are large migrant groups in the UK and Europe (India, Pakistan and Turkey). The analysis shows that, when controlling for other factors, migrants are likely to suffer considerable delays in the diffusion of innovations compared to the majority UK population. The findings have several policy implications concerning promoting inclusive public health and disease prevention interventions, which are essential components of a sustainable healthcare system for an increasingly diverse UK older population.

Global incidence of non-alcoholic fatty liver disease: A systematic review and meta-analysis of 63 studies and 1,201,807 persons

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing. We aimed to estimate the pooled global NAFLD incidence. We performed a systematic review and meta-analysis of cohort studies of adults without NAFLD at baseline to evaluate the global incidence of ultrasound-diagnosed NAFLD. A total of 63 eligible studies (1,201,807 persons) were analyzed. Studies were from Mainland China/Hong Kong (n= 26), South Korea (n= 22), Japan (n= 14), other (n= 2, Sri Lanka, Israel); 63.8% were clinical center studies; median study year 2000 to 2016; 87% were good quality. Among the 1,201,807 persons at risk, 242,568 persons developed NAFLD, with an incidence rate of 4,612.8 (95% CI 3,931.5-5,294.2) per 100,000 person-years and no statistically significant differences by study sample size (p=0.90) or study setting (p=0.055). Males had higher incidence vs. females (5,943.8 vs. 3,671.7, p=0.0013). Both the obese (vs. non-obese) and the overweight/obese groups (vs. normal weight) were about threefold more likely to develop NAFLD (8,669.6 vs. 2,963.9 and 8,416.6 vs. 3,358.2, respectively) (both p <0.0001). Smokers had higher incidence than non-smokers (8,043.2 vs. 4,689.7, p=0.046). By meta-regression, adjusting for study year, study setting, and study location, study period of 2010 or after and study setting were associated with increased incidence (p=0.010 and p=0.055, respectively). By country, China had a higher NAFLD incidence compared to non-China regions (p=0.012) and Japan a lower incidence compared to non-Japan regions (p=0.005). NAFLD incidence is increasing with a current estimate of 4,613 new cases per 100,000 person-years. Males and overweight/obese individuals had significantly higher incidence rates compared to females and those of normal weight. Public health interventions for prevention of NAFLD are needed with a special emphasis on males, overweight/obese individuals, and higher risk regions. Non-alcoholic fatty liver disease (NAFLD) affects approximately 30% of people worldwide and appears to be increasing, but data to estimate the incidence rate are limited. In this meta-analytic study of over 1.2 million people, we estimated an incidence rate of NAFLD of 46.13 per 1,000 person-years with significant differences by sex, BMI, geography, and time-period. As treatment options for NAFLD remain limited, prevention of NAFLD should remain the focus of public health strategies. Studies such as these can help policy makers in determining which and whether their interventions are impactful.

Health economic evaluation of preventive digital public health interventions using decision-analytic modelling: a systematized review

BackgroundDigital public health (DiPH) provides novel approaches for prevention, potentially leading to long-term health benefits in resource-limited health systems. However, cost-effectiveness of DiPH interventions is unclear. This systematized review investigates the use of decision-analytic modelling in health economic evaluations of DiPH primary prevention and health promotion interventions, focusing on intervention’s design, methods used, results, and reporting quality.MethodsPubMed, CINAHL, and Web of Science were searched for studies of decision-analytic economic evaluations of digital interventions in primary prevention or health promotion, published up to June 2022. Intervention characteristics and selected items were extracted based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratios (ICERs) were then extracted and price-adjusted to compare the economic evaluation results. Finally, the included studies’ reporting quality was assessed by building a score using CHEERS.ResultsThe database search (including search update) produced 2,273 hits. After removing duplicates, 1,434 titles and abstracts were screened. Of the 89 studies meeting the full-text search criteria, 14 were ultimately reviewed. The most common targets were physical activity (five studies) and weight loss (four). Digital applications include text messages, web-based inventions, app-based interventions, e-learning devices, and the promotion of smartphone apps. The mean ICER of the 12 studies using quality-adjusted life years (QALYs) is €20,955 per QALY (min. − €3,949; max. €114,211). The mean of reported CHEERS items per study is 81% (min. 59%; max. 91%).ConclusionsThis review only includes primary prevention and health promotion, and thus excludes other DiPH fields (e.g. secondary prevention). It also focuses on decision-analytic models, excluding study-based economic evaluations. Standard methods of economic evaluation could be adapted more to the specifics of DiPH by measuring the effectiveness of more current technologies through alternative methods, incorporating a societal perspective, and more clearly defining comparators. Nevertheless, the review demonstrates using common thresholds that the new field of DiPH shows potential for cost-effective preventive interventions.

Ovitrap Monitoring of Aedes aegypti and Aedes albopictus in Two Selected Sites in Quezon City, Philippines

In recent years, Aedes mosquitoes have become a serious health threat in the Philippines, causing a dramatic increase in dengue incidence. To design and implement adapted vector control measures, knowledge of vector composition and abundance is essential. Surveillance of mosquito populations using ovitraps was conducted for about two years (from April 2018–February 2020) in two selected sites (Sitio Payong and Villa Beatriz in Old Balara, Quezon City). These areas were identified as potential sites for small-scale pilot trials of the sterile insect technique. Aedes aegypti and Ae. albopictus were present in both sites, but Ae. aegypti was about 20 times more abundant than Ae. albopictus. There was a significant difference between the two sites in the number of eggs collected weekly but not in the OI. The number of Aedes spp. eggs collected were found to positively correlate with the maximum daily temperature. These data provide comprehensive, evidence- based information that will help in the design and implementation of Aedes control measures, as part of wider public health interventions for prevention and control.

China's Fight Against COVID-19: What We Have Done and What We Should Do Next?

BackgroundChinese government conducted unprecedented massive public health prevention interventions at the national level, which have effectively contained the spread of Coronavirus Disease 2019 (COVID-19) infections. Specifically, the outbreak in Wuhan has been effectively controlled. Meanwhile, the Chinese efforts to contain the virus have been widely recognized. Even the World Health Organization has praised the efforts of the Chinese government and advised other countries to learn from China's experience in the fight against COVID-19. However, the measures that have been conducted by China to effectively prevent the spread of COVID 19 in the country have not been rigorously analyzed. Therefore, this study aimed to explore the characteristics of China's control and prevention strategies, and identify the elements that changed the epidemiological curve of rapidly rising new confirmed cases of COVID-19.MethodsPublic health intervention measures and their effects on the spread of COVID-19 in terms of daily newly confirmed and cumulative cases were collected between January 20, 2020, and March 5. Notices of the Joint Prevention and Control Mechanism for COVID-19 of the State Council on Implementing Measures in Hubei were collected. Information obtained by relevant important documents and announcements was collected from the official website of the Chinese government. Additionally, from other media platforms, news, articles, and reviews were used to explain the intervention measure. Thus, using these data, we performed a retrospective description of the intervention strategies at three stages.ResultsThe Chinese government adopted non-pharmacological interventions measures (NPIs) timely and efficiently. On February 20, the declining epidemic trend in China indicated that the three strictest disease prevention and control strategies issued by the Hubei Government had contributed to a smooth decline in the spread of the epidemic.ConclusionsThe NPIs taken by China play a decisive role to control the spread of novel coronavirus outbreaks. Further research and action are needed to ensure a sufficiently sensitive surveillance system and strong response mechanism, including the establishment of a highly accessible laboratory network, maintenance of awareness of both primary healthcare providers and the public, and regular training and exercise of local Centers for Disease Control and Prevention and general practitioners in the community-level.

The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study

BackgroundPublished reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020–January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles. MethodsA total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles. ResultsAnxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period. LimitationsA reliance on self-report measures and convenience sampling constitute key study limitations. ConclusionsResults suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.

Correlates of prevalent syphilis infection among men who have sex with men (MSM) living with HIV attending the HIV clinic in Trinidad.

BackgroundSyphilis among men who have sex with men (MSM) living with HIV is of public health concern, thus the objective of the study is to determine the correlates of prevalent syphilis infection in this population so that urgent interventions could be instituted.MethodsA cross-sectional study was conducted during the period September 2020-June 2021 among MSM who attended a large HIV Clinic in Trinidad. A questionnaire was administered to obtain socio-demographic data and correlates of prevalent syphilis and patients were screened for syphilis using the traditional algorithm. Descriptive and bivariate analyses were conducted and multivariable logistic regression factors was used to assess factors significantly associated with a syphilis diagnosis.ResultsTwo hundred and sixty four MSM were enrolled; age range 18–64 years, median age 33 years and 89 (34.4%) were actively bisexual. The prevalence of syphilis was 28% (74/264) and 89.2% (66/74) of these infections were asymptomatic. Multivariable logistic regression analysis showed that those patients who participated in sex with anonymous partners (OR 2.09; 95% CI, 1.03–4.26), those with a previous diagnosis of syphilis (OR 5.16; 95% CI, 1.03–25.83) and those who used marijuana in the last 12 months (OR 2.13; 95% CI, 1.14–3.96) were more likely to be diagnosed with syphilis.ConclusionThere is a high prevalence of asymptomatic syphilis among MSM living with HIV in Trinidad. Repeat episodes of syphilis and anonymous sex may play a role in the transmission dynamics of T pallidum infection in this population, thus urgent public health prevention interventions are warranted.

Spatial Epidemiology of COPD in Delhi, India

Introduction Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common chronic respiratory illnesses. COPD is one of the three most common causes of death worldwide. The main burden of mortality from COPD is seen in Latin America, sub-Saharan Africa, India, China, and South-East Asia. Absence of true prevalence values and mortality burden hinder planning and operationalization of public health interventions for prevention, control, and treatment of the disease. Further, the aggregated value of prevalence estimates calculated for a whole city or a larger geographical area does not provide the location of patients and presence of locally prevalent risk factors. The objective of this study was to understand the spatial distribution of COPD in a large, highly polluted city of a developing country. Materials and Methods A cross-sectional community-based study was conducted in the National Capital Territory of Delhi (NCTD). All surveyed households were geocoded. GOLD screening criteria and pulmonary function tests using portable digital spirometer were used for diagnosis of COPD. Results Results are presented as a series of maps depicting spatial epidemiology. Overall prevalence rate was 9.8/1,000 population. Highest prevalence was seen in industrial area. Most of the spatial hotspots were seen in industrial and slum areas. Similarly, Kernel density was also highest in industrial area. Conclusion In the city of NCTD, we found the COPD being distributed in all types of habitations but spatial distribution helped us understand clustering of cases and compare prevalence rates in subunits of residential clusters within a metropolitan city.