Regional Public Health Research Articles

Status of quality indicators in a mycobacteriology culture laboratory, Hawassa, Sidama, Ethiopia.

We aimed to assess performance parameters in a Hawassa Tuberculosis Culture Laboratory, in the Sidama Regional Public Health Institute. A cross-sectional survey was conducted between 27 October 2020 and 31 May 2021, on 439 clinical specimens. The specimens were processed using standard procedures, and the final suspension was inoculated into a Microbial Growth Indicator Tube and Lowenstein-Jensen media slant. Ziehl-Neelsen staining and the Bioline test kit were used to identify and confirm Mycobacterium tuberculosis. The data were analyzed using the IBM Statistical Package for Social Sciences (SPSS, version 26). Out of a total of 439 specimens that were processed, the recovery rates for smear-positive specimens were 61% (25 out of 41) and 58.5% (24 out of 41) for the Mycobacterial Growth Indicator Tube, and the Lowenstein-Jensen methods, respectively. For smear-negative samples, the recovery rates were 4.5% (18 out of 398) for both methods. Only 4 (0.9%) specimens were rejected. The mean turnaround times to detect mycobacteria from smear-positive samples were 14 and 32 days for the Mycobacterial Growth Indicator Tube and Lowenstein-Jensen methods, respectively. The standard deviations were ±6.3 days and ±9.7 days, respectively. For smear-negative samples, the mean turnaround times were 17.7 and 31 days for the Mycobacterial Growth Indicator Tube and Lowenstein-Jensen methods, respectively. The standard deviations were ±9.2 days and ±9.6 days, respectively. The contamination rates for the Mycobacterial Growth Indicator Tube and Lowenstein-Jensen methods were 9.8% (43 out of 439) and 9.6% (42 out of 439), respectively. The detection rate of nontuberculosis mycobacteria was 1.4% (6 out of 439). It demands attention to improve the low recovery rate among smear-negative cultures and culture contamination rates.

The Need for Responsive Workforce Development During the Pandemic and Beyond: A Case Study of the Regional Public Health Training Centers

Context: The COVID-19 pandemic underscored the importance of a strong public health infrastructure for protecting and supporting the health of communities. This includes ensuring an adaptive workforce capable of leading through rapidly changing circumstances, communicating effectively, and applying systems thinking to leverage cross-sector partnerships that help promote health equity. The 10 Regional Public Health Training Centers (PHTCs) advance the capacity of the current and future public health workforce through skill development and technical assistance in these and other strategic areas. Program: This study examines activities through which the Regional PHTCs and their partners supported the public health workforce during the pandemic. Representatives of the 10 Regional PHTCs completed a survey in the spring of 2022. The survey included (1) pulling trends in training usage from 2018-2021 annual performance reports and (2) questions assessing the type, content, and reach of training needs assessments, training and technical assistance, student placements, and PHTC Network collaborative activities that occurred from January 1, 2020, to December 31, 2021. Respondents also reflected on trends in use, challenges, lessons learned, stories of impact, and future PHTC practice. Evaluation: During the pandemic, the Regional PHTCs engaged in numerous efforts to assess needs, provide training and technical assistance to the practice community, facilitate projects that built student competency to support public health agency efforts, and collaborate as the PHTC Network on national-level initiatives. Across these activities, the Regional PHTCs adjusted their approaches and learned from each other in order to meet regional needs. Discussion: The Regional PHTCs provided student and professional development in foundational public health knowledge and skills within their regions and nationally while being flexible and responsive to the changing needs of the field during the pandemic. Our study highlights opportunities for collaboration and adaptive approaches to public health workforce development in a postpandemic environment.

Creation of a telehealth application empowering patients with multiple sclerosis: MyApp4SEP

Introduction: Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system. International recommendations advocate multidisciplinary management in specialized centers, still not widely accessible at present. Moreover, this doesn’t fit to newly diagnosed or pauci-symptomatic patients that are still professionally active. Ultimately, the lack of recognition of invisible disorders still persists.
 The use of e-health as tool for care has been evaluated for many years and its growth is supported by various evidence of its effectiveness in MS.
 To our knowledge no comprehensive e-health tool exists in Belgium that aims at empowering MS patients from the prodromal to a more advanced disease stage.
 Policy Context And Objective: Following our involvement in the national and regional public health plan "Integrated Care for a better health" (www.integreo.be) via the federal project Chronicopôle, we gave up the ""symptom and discipline-centered"" approach to develop a more integrated one : health promotion tied to the daily life of patients.
 A strong involvement of users in every stages of development of a e-health solution is required to meet their specificities and needs. Placing them at the heart of the thinking process was therefore mandatory.
 Such a design needs a multi-step approach involving: Analysis of user needs, definition of desired functionality and finally, development and testing of acceptability and user experience.
 We partnered with the Wallonia e-health Living Lab (WeLL) for methodological guidance to achieve this. Based on their approach, different workshops were proposed, first to a group of MS patients, but also to a group of health professionals, in order to leave a dichotomous thinking framework.
 Target Population: Any Belgian French speaking person (Dutch translation pending) with MS. Healthcare professionals involved in MS patients care.
 Highlights: Two workshops (n = 11 patients) were organized in collaboration with the WeLL. They took place at their offices and focused on fundamental needs/issues in care pathways of patients. Furthermore, a specific workshop for health professionals was also organized. From the aggregation of these two expertises emerged the architecture and functionalities of our tool.
 The application content was determined as follow: patient record, documentation (developing literacy), peer’s good tips, toolbox (exercises, questionnaires), diary and logbook, directory (personal and relevant resources).
 During the IT development, all the patients/partners were able to give their opinion and validate each step via a functional analysis of each module. Finally, about 20 patients tested the application during a period of 3 months. Final modifications were made before publishing on the main application stores.
 Conclusion: MyApp4SEP is fully developed and available for free on the Play Store and the App Store starting from november 2022.
 Co-creation leads our project and aims at maximize health literacy by putting as first objective coping with real world caveats of our patients.
 The goal for the next few years is evolve the app based on patients/users feedbacks and propositions but also by developing partnership with other teams working in a "patient-centered" approach among other chronic diseases.

Effectiveness and impact of covid-19 response and vaccination challenges in Namibia: A systematic review.

Namibia, as with many countries around the world is experiencing devastating impact of Covid-19 disease on the economy, psycho-social interactions, and well-being of the populace. These countries implemented several measures to limit the spread of the virus responsible for the severe acute respiratory syndrome (SARS-CoV-2). Namibia also put measures in place to curtail the spread and fatalities due to the virus. However, the nature and implementation strategies of Public Health regulations seriously have impact on preventing the spread and curtailing fatalities arising from the virus. This article presents a report on the effectiveness and impact of Public Health measures instituted by the Health Authority towards curtailing the scourge of covid-19 on the general populace. Elements of the PRISMA protocol was utilised in the review which enabled the synthesis of data on focused area. Multifaceted databases on covid-19 such as Scopus, Science Direct, Google Scholar, World Health Organisation and the Ministry of Health and Social Services of Namibia (MoHSS) among others was used. A steady increase in covid-19 infection at an average rate of eleven (11) per day was noted in the country up till June 2021. Highest rate was linked to densely populated regions of Erongo and Khomas. Control measures for infection prevention and vaccination drive was ineffective majorly as a result of misinformation. A paradigm shift of enhanced interaction with local populace for effective information dissemination is required towards limiting the scourge of the virus and hence, saving of lives.

Examining the relationship between regional economic resilience and epidemiologic spread of COVID-19: evidence from Greece

AbstractThe experience of the COVID-19 pandemic has become a challenge worldwide for reconsidering the complex relationship between epidemiological vulnerability (EV) and regional economic resilience (RER). Building on statistical and empirical analysis, this paper detects that epidemiological vulnerability is positively related to geographical size, urbanization, economic size, and production capacity. The analysis distinguishes between the importance of the contribution of non-land transportation to epidemiological spread at the early stage of the pandemic, and of land transportation at later stages of the pandemic. It detects distinct spatiotemporal patterns in the distribution of epidemiological waves in Greek regions, illustrating a saturated temporal pattern and a “major” geographical configuration following the S-type dynamics of spatial development in Greece. Further, this paper highlights the importance of economies of scale and transportation connectivity in the configuration of the RER-EV nexus, emphasizing the significance of land transport connectivity for the control of neighborhood-scale socioeconomic activities once the pandemic is imported into a region. Finally, the analysis distinguishes land transport connectivity and urbanization degree as determinants related the most to long-term effects in the configuration of the RER-EV nexus and provides insights into the effectiveness of stringent policy measures implemented at the early stage of the pandemic. Overall, beyond its empirical case study, this paper provides a methodological framework to shed more light on a research field growing on the intersection of regional economics and public health and motivate more evidence-based policymaking enhancing the resilience of places in the face of future health crises.

Role of the first WHO mutation catalogue in the diagnosis of antibiotic resistance in Mycobacterium tuberculosis in the Valencia Region, Spain: a retrospective genomic analysis

In June, 2021, WHO published the most complete catalogue to date of resistance-conferring mutations in Mycobacterium tuberculosis. Here, we aimed to assess the performance of genome-based antimicrobial resistance prediction using the catalogue and its potential for improving diagnostics in a real low-burden setting. In this retrospective population-based genomic study M tuberculosis isolates were collected from 25 clinical laboratories in the low-burden setting of the Valencia Region, Spain. Culture-positive tuberculosis cases reported by regional public health authorities between Jan 1, 2014, and Dec 31, 2016, were included. The drug resistance profiles of these isolates were predicted by the genomic identification, via whole-genome sequencing (WGS), of the high-confidence resistance-causing variants included in the catalogue and compared with the phenotype. We determined the minimum inhibitory concentration (MIC) of the isolates with discordant resistance profiles using the resazurin microtitre assay. WGS was performed on 785 M tuberculosis complex culture-positive isolates, and the WGS resistance prediction sensitivities were: 85·4% (95% CI 70·8-94·4) for isoniazid, 73·3% (44·9-92·2) for rifampicin, 50·0% (21·1-78·9) for ethambutol, and 57·1% (34·0-78·2) for pyrazinamide; all specificities were more than 99·6%. Sensitivity values were lower than previously reported, but the overall pan-susceptibility accuracy was 96·4%. Genotypic analysis revealed that four phenotypically susceptible isolates carried mutations (rpoB Leu430Pro and rpoB Ile491Phe for rifampicin and fabG1 Leu203Leu for isoniazid) known to give borderline resistance in standard phenotypic tests. Additionally, we identified three putative resistance-associated mutations (inhA Ser94Ala, katG Leu48Pro, and katG Gly273Arg for isoniazid) in samples with substantially higher MICs than those of susceptible isolates. Combining both genomic and phenotypic data, in accordance with the WHO diagnostic guidelines, we could detect two new multidrug-resistant cases. Additionally, we detected 11 (1·6%) of 706 isolates to be monoresistant to fluoroquinolone, which had been previously undetected. We showed that the WHO catalogue enables the detection of resistant cases missed in phenotypic testing in a low-burden region, thus allowing for better patient-tailored treatment. We also identified mutations not included in the catalogue, relevant at the local level. Evidence from this study, together with future updates of the catalogue, will probably lead in the future to the partial replacement of culture testing with WGS-based drug susceptibility testing in our setting. European Research Council and the Spanish Ministerio de Ciencia.

Identifying policy options to regulate high potency cannabis: A multiple stakeholder concept mapping study in Washington State, USA

BackgroundCannabis legalization in some U.S.A. states has catapulted the mass production of concentrates, with tetrahydrocannabinol (THC) concentrations ranging from 50-90%. A major public health concern is that these products will increase cannabis-related harms such as use disorders, psychotic symptoms, and accidental poisonings. This paper describes and contextualizes the results of a study requested by the WA State Legislature to understand perspectives of WA stakeholders on the topic. MethodsConcept Mapping (CM), a mixed-methods research approach that supports people-centered policy decisions was utilized. The goal of the study was to explore stakeholders’ concern levels and support of policies to address the availability of high THC cannabis products. For analysis purposes, stakeholders were categorized into three groups: community, professionals, and cannabis advocates. ResultsCM generated an inventory of policy ideas for regulating high-potency cannabis from a variety of stakeholders. Notably, stakeholders from community and professional groups supported environmental policy changes such as such as taxation, increasing minimum age for high concentration cannabis products, and advertising prohibition. Meanwhile, cannabis advocates (mostly industry actors) opposed taxation per THC content, proposed lowering taxes, and supported policies with low population impact such as educating parents, teachers, and youth. ConclusionSupport for regulating high concentration THC products varied by stakeholder group. Consistent with how other health compromising industries have historically acted, cannabis industry stakeholders rejected regulation of their products. Future studies should explore non-cannabis industry stakeholders’ willingness to work towards minimizing the influence of the cannabis industry in policy development processes to assure public health regulations prevail.

Health service factors affecting the COVID-19 vaccination campaign in a Ghanaian metropolis: A qualitative exploratory study

ObjectiveThe study sought to explore the perspectives of vaccinators on the health system factors that impacted the COVID-19 vaccination campaign.DesignThe study employed an exploratory-descriptive qualitative design. Key-informants’ interviews were conducted...

The Somatechnic and Spatio-legal Regulation of Stagnant Water in Singapore

Using a critical legal geography approach that incorporates theories of law, space, and power, this paper explores how the public health surveillance of dengue fever is utilised by the state in an ongoing ‘war against the mosquito’ in Singapore. Here, the state deploys biopower as a form of spatio-legal ‘lawscaping’ – consisting of and implicating a host of actors, institutions, and objects – in order to seek and eradicate sources of stagnant water (and the mosquitoes that breed in them) in spaces across the city. The paper demonstrates how, in combating dengue fever this way, the public health surveillance and regulation of dengue fever in Singapore informs four distinct yet interconnected forms of spatio-legal materiality and normativity: a) the inspection of space; b) the invisibilisation of death; c) the implementation of self-regulatory objects; and d) the illegality of uncleanliness. Therefore, in tracing the public health surveillance of dengue fever as it relates to the biopolitical regulation of stagnant water, this paper is also able to evince how the state uses spatio-legal means to govern a range of sites as well as a host of human and non-human bodies, and in doing so reveal how state biopower can be exerted across different species. At the same time, these acts of biopolitical lawscaping serve to flatten different typologies of urban space – be they public, private, or even transient (or under construction). In its desire to eradicate mosquito breeding grounds, the state reduces urban space to that which is clean and unclean – even if unwittingly.

Assessment of wastewater impact on a natural reservoir in Kyrgyzstan

Introduction: Anthropogenic activities artificially increase the concentration of toxic substances in surface reservoirs by discharging polluted water back into the natural environment. Maximum risks for aquatic ecosystems are observed in regions with limited wastewater treatment, which includes Kyrgyzstan. The purpose of the work – research and analysis of factors of pollution of natural reservoirs of Kyrgyzstan by wastewater, consequences for regional aquatic ecosystems and public health, and search for optimal solutions to minimise destructive pollution. Material and Methods: The research was conducted using general scientific methods of cognition, in particular, system analysis, synthesis, generalisation, and concretisation. Results and Discussion: In the course of the research the ecological state of natural water resources of Kyrgyzstan, into which wastewater is discharged, the dynamics of pollution of the aquatic environment depending on various factors of influence is analysed, optimal and feasible to implement measures to reduce the adverse effects of wastewater on the state of natural reservoirs and public health, and improve the overall environmental situation in the region are developed. In addition, the possibilities of applying modern management and technological measures to minimise the content of pollutants in wastewater, based on the synergy of environmental safety and economic efficiency, with the introduction of modern innovative systems of control and monitoring of environmental pollution have been explored. Conclusion: It is established that there is no safe wastewater, therefore, optimisation of the water use and water treatment system in Kyrgyzstan involves the application of an ecosystem approach and the introduction of integrated water resources management.

Exploring trends in benzodiazepine-positive fatal drug overdoses in Tennessee, 2019–2021

Background Benzodiazepine-positive overdoses increased between 2019 and 2021 in Tennessee. We sought to determine the changes in the number and characteristics of prescription and illicit benzodiazepine-positive fatal drug overdoses during this period. Materials and Methods A statewide study was conducted to determine changes in the number and characteristics of benzodiazepine-positive drug overdose decedents using 2019–2021 data from the Tennessee State Unintentional Drug Overdose Reporting System. The analyses were limited to Tennessee residents aged ≥ 18 years. A benzodiazepine-positive overdose was defined as any benzodiazepine on toxicology, regardless of the presence of other substances. Frequencies were generated to compare demographics, circumstances, prescription history, and toxicology between 2019 and 2021 for illicit and prescription benzodiazepine-positive fatal overdoses. Results Between 2019 and 2021, 1666 benzodiazepine-positive unintentional or undetermined fatal drug overdoses out of 5916 total overdoses that occurred among adult Tennessee residents with available toxicological information. Prescription benzodiazepines were identified in 80.7% of deaths, whereas illicit benzodiazepines were identified in 12.0% of deaths. Many decedents had an anxiety disorder (45.5%), while over half of all decedents had a history of substance use disorder (52.3%). Most benzodiazepine-positive overdoses involved fentanyl (71.3%). Conclusions This analysis can inform local and regional public health workers to implement focused prevention and intervention efforts for people with co-occurring mental health conditions and substance use disorders to curb overdose epidemics among persons using benzodiazepines in Tennessee. Public health campaigns should focus on educating people on appropriate prescription medication use and the dangers of obtaining substances illicitly. Given the high proportion of opioids in this population, further education also is needed on the dangers of polysubstance drug use. The differences between prescription and illicit benzodiazepine-positive fatal overdoses indicate the need to develop substance-specific prevention and treatment strategies.

Inpatient covid-19-related comorbidities and ct-semiotics

Introduction. In the Russian Federation, registration of individual COVID-19 cases started at the end of January 2020 that markedly increased in the second half of March. At the moment, the situation with COVID-19 is unstable. As of 2023, COVID-19 incidence in descending order is as follows: USA (104 958 987 people), India (44 684 775 people) and France (39 582 057 people). Russia ranked 10th regarding total COVID-19 incidence (22 137 084 people, including 395 727 fatalities). The infection is able to “overlap” with the underlying pathology, thereby worsening patient’s condition up to death. Lung multislice computed tomography (MSCT) is recommended for all patients with COVID-19. If unavailable, a chest X-ray is performed. The aim of the study was to identify the most frequent comorbid diseases and changes on radiological scan in patients with COVID-19.Materials and methods. The study was carried out at the Infectious Disease Department No. 1, Regional Public Health Institution “Clinical Hospital No. 1” Smolensk. For this, there were analyzed 69 hospital patient records with basic diagnosis — coronavirus infection. The data of anamnesis and additional instrumental investigations were taken into account.
 Results. 69 patients aged between 18 and 91 years were included in the study. Respiratory failure was not observed in 75.81% of cases. A group of patients (66.67%) with comorbidities of organs and systems was identified, among which most common were: arterial hypertension (95.65%), coronary heart disease (78.26%), diabetes mellitus (30.43%), grade 1–2 obesity (17.39%), chronic hepatitis (17.39%). Diseases of the gastrointestinal tract and respiratory system were less prevalent. The rate of reported complications is as follows: bilateral polysegmental pneumonia — 72.46%; unilateral polysegmental pneumonia — 2.8%; pleurisy — 4.35%; unilateral hydrothorax — 1.45%. Each of the inpatients underwent radiological examination during hospitalisation. X-ray examination accounted for a smaller proportion (39.13%) and multispiral chest computed tomography (MSCT) — for a bigger percentage (60.87%). Chest MSCT at the beginning of inpatient treatment visualized CT-2 stage (64.29%) in the vast majority, less — CT-1 (26.19%), least frequently — CT-3 (7.14%) and CT-4 (2.38%). Before patient discharge, an average of 12.16% improvement in the radiological picture was found in patients with initial CT-1 stage, 14% — in CT-2, 12% and 26% — in CT-3 and CT-4, respectively.Conclusion. The moderate disease course without respiratory depression prevailed among the patients. Co-morbidities were found mainly in the anamnesis of persons over 50 years old. The most frequent clinical complication of coronavirus infection was bilateral pneumonia. After patient’s hospitalization, clinical and instrumental picture gradually improved, which was confirmed by radiological data.

A resilience view on health system resilience: a scoping review of empirical studies and reviews

BackgroundPrompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature.MethodsWe searched the Pubmed database for concepts related to ‘resilience’ and ‘health systems’. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation.ResultsThe intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, ‘resilience engineering’ is the most prominent one, followed by ‘community resilience’ and ‘organisational resilience’. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature.ConclusionsOur review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.

Concerns Over Vuse E-cigarette Digital Marketing: Implications for Public Health Regulation (Preprint)

Concerns Over Vuse E-cigarette Digital Marketing: Implications for Public Health Regulation (Preprint)

Force Health Surveillance inNATO Does Not Meet the Needs ofIts Users: A Structured Evaluation ofEpiNATO-2.

Disease and non-battle injuries (DNBIs) cause substantial losses among military personnel. NATO has monitored DNBIs among its personnel since 1996 using multiple versions of a tool now called EpiNATO-2, but the surveillance system has never been systematically evaluated. Following a request from NATO to the CDC, the objective of this study was to assess surveillance system attributes of EpiNATO-2 using CDC's updated guidelines for evaluating public health surveillance systems. Between June and October 2022, a literature review and key informant interviews were conducted to assess the following attributes: usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, stability, informatics system quality, informatics service quality, and informatics interoperability. Key informant interviews were conducted in Kosovo, Germany, and remotely with EpiNATO-2 users spanning three levels: clinical and data entry personnel (tactical level); regional medical and public health officers (operational level); and senior commanders and other governmental entities (strategic level). Fourteen EpiNATO-2 users participated in interviews, representing 3 of the 5 major NATO missions, 3 partner entities, and 7 nationalities. All users (100%) reported that the system did not meet their needs, with most users noting the following challenges: lack of clearly defined system objectives; poor data quality due to ambiguous case definitions and frequently unsubmitted reports (37% missing during January to June 2022); long delay between the occurrence of health events and the availability of corresponding data (≥2 weeks); and an antiquated and inflexible data management system. Overall, performance was deemed unsatisfactory on 11 of the 13 attributes. This multinational sample of EpiNATO-2 users at all military levels reported that the system is currently not useful with respect to its stated objectives. Opportunities exist to improve the performance and usefulness of EpiNATO-2: improve case definitions, modernize data infrastructure, and regularly evaluate the surveillance system.

Social construction of the health of modern Russianyouth: the main vectors of domestic discourse

The article presents a systematic analysis of trends and trends in the field of research of health problems in the youth environment, which relate to the attitude to health in general, the field of preserving and strengthening health.The author identifies significant risk factors that significantly affect both the health level of the younger generation and the life expectancy of its representatives, shows the ambivalence and inconsistency of data on the attitude of young people to their health obtained by various researchers. Based on the analysis of various sociological studies, including the author’s study conducted in July 2023, the results of the discussions conducted by domestic scientists addressing the health-saving problems of the younger generation of Russia are summarized.The first group includes macro-social problems related to the general state regulation of public health. Among them are the lack of health care of the population among the state priorities; inadequate social policy of the Russian Federation in the field of healthcare; the activities of institutions included in the management of the health sector, including its regulatory regulation. The second group of problems is related to the conceptualization of the concept of “health” and “healthy lifestyle”, the interpretation of which is usually ambiguous. It is obvious that the normative definition of a “healthy lifestyle” has medical, physiological, psychological and social structural components, which include various external factors — the influence of family and social environment, fashion on social habits, as well as the nature of media exposure.The data obtained by the author indicate that the greatest influence on the formation of young people’s ideas about health problems and practices for its maintenance is exerted by their own experience, social networks, family and the opinion of friends. They also confirm the prevailing trend: although the overwhelming majority of respondents (85%) are sure that people need to lead a healthy lifestyle, one in four believes that their lifestyle is unhealthy rather than healthy, and 5% of them do not consider their lifestyle healthy at all.The author refers to a special group of problems the impact on the health of the digital media environment, into which the younger generation is actively integrated today, first of all, about the so-called “new media”, which include: internet portals of online media, blogosphere, social networks, virtual communities, virtual games and other Web resources. By broadcasting ideas, behavioral models, new media in modern society become “legislators” in various spheres of social life. To a certain extent, they participate in the construction of an individual’s behavior in relation to health, which is both constructive and destructive in nature.

Investigating the impact of COVID-19 on the provision of pediatric burn care

The COVID-19 pandemic had widespread effects on the healthcare system due to public health regulations and restrictions. The following study shares trends observed during these extraordinary circumstances to investigate the impact of the COVID-19 pandemic on the provision of pediatric burn care at an American-Burn-Association verified tertiary pediatric hospital in Ontario, Canada. Pediatric burn patient data for new burn patients between March 17th, 2019, and March 17th, 2021, was retrospectively extracted and two cohorts of patients were formed: pre-pandemic and pandemic, through which statistical analysis was performed. No significant changes in the number of admitted patients, age, and sex of patients were observed. However, a significant increase in fire/flame burns was observed during the pandemic period. Additionally, a decrease in follow-up care was observed while an increase in acute burn care (wound care and surgical interventions) was found for the pandemic cohort. Despite changes to hospital care facilities to maximize resources for COVID-19-related care, our findings demonstrate that burn care remained an essential service and significant reductions in patient volumes were not observed. Overall, this study will aid in future planning and management for the provision of pediatric burn resources during similar public health emergencies.

The origins and early development of the ILAE/IBE/WHO global campaign against epilepsy: Out of the shadows.

The International League Against Epilepsy (ILAE)/International Bureau for Epilepsy (IBE)/World Health Organization (WHO) Global Campaign Against Epilepsy was launched in Geneva and Dublin in the summer of 1997. The second phase of the Campaign was launched by a major event in Geneva, led by WHO Director General Dr. Gro Harlem Brundtland in February 2001. Since then, the Campaign has been gathering momentum around the world culminating in the WHO General Assembly Resolution (WHA 68.20) on Epilepsy in May 2015 supported by 194 countries. Recently, the World Federation of Neurology and other neurological non-governmental organizations (NGOs) have joined forces with the Epilepsy Campaign, leading to the WHO General Assembly Resolution (WHA 73.10) in May 2022 promoting a 10-year Intersectoral Global Action Plan (IGAP) for Epilepsy and Other Neurological Disorders. I was privileged to serve as the first Chairperson of the Global Campaign Against Epilepsy and this year all my documents and correspondence relating to the Campaign have been delivered to the Wellcome Collection in London. These are the basis for this detailed account of the origins and early development of the Campaign. I describe the events leading to the birth of the concept, planning for the Campaign, the launch, development, and the achievements of phase one. This first phase focused on awareness raising, education, and involvement, especially within WHO, ILAE, and IBE, including a series of five Regional Public Health meetings and Declarations on Epilepsy. In 1999, the WHO raised the status of the Campaign to the highest level, the first ever for a Non-Communicable Disease, resulting in the high profile launch of phase two in 2001, paving the way to the continuing global momentum and achievements, including the 2015 and 2022 WHO Resolutions.

The Role of Defense Diplomacy to Support Covid-19 Pandemic Responses Indonesia in 2019-2022

The COVID-19 pandemic has impacted the economy, society, and the military. Defense diplomacy supports efforts to tackle the COVID-19 pandemic in Indonesia in 2019–2022 by involving the TNI in logistics, public health regulations, and restrictions on movement and large gatherings. This research uses a qualitative method, which is based on the philosophy of postpositivism or interpretivism, to research natural object conditions. The researcher is the key instrument; data collection is done by triangulation (observation, interview, and documentation); data analysis is inductive or qualitative; and research results are more understanding. This research resulted in several findings: 1) Defense Diplomacy provided TNI combat equipment and health services during the COVID-19 pandemic response period in Indonesia in 2019–2022. The health diplomacy strategy emphasizes the creativity of health diplomacy as a bureaucratic institution to communicate more inclusively, effectively, and efficiently. 2) Health diplomacy is less well implemented in bilateral relations with other countries. 3) The obstacles faced have hampered health diplomacy, so to strengthen international relations, health diplomacy must be utilized properly. TNI and Ministry of Health personnel should improve health diplomacy by: 1) To increase the supply of vaccinations from abroad, health diplomacy should be enhanced with possible partners. 2) To legally import vaccinations from abroad, the TNI, the Ministry of Health, and the private sector should form a Joint Secretariat for Health Diplomacy.

How effective is public health policy in Scotland on vitamin D deficiency during pregnancy?

To evaluate the uptake of universal vitamin D supplementation during pregnancy, its effectiveness in preventing vitamin D deficiency and the factors associated with these. The regional public health organisation in Ayrshire, Scotland has a policy of universal provision of vitamin D supplements (10 µg/d) to all pregnant women for the duration of their pregnancy. Pregnant women in this area were recruited at their 12-week antenatal appointment. Blood samples were collected at the 12-week and 34-week appointments. To account for the seasonal variation, women were recruited in two cohorts: summer and winter. Telephone interviews were conducted at 34 weeks to assess the uptake of vitamin D supplements during pregnancy. Other variables were obtained from medical records. The study was conducted in the NHS Ayrshire and Arran Health Board in Scotland. 612 pregnant women (aged 15-44 years) living in Ayrshire (latitude 55°), Scotland. Sixty-six percentage took supplementation as recommended. Consumption of supplementation was significantly associated with a higher median serum 25-hydroxyvitamin D concentrations at 34 weeks. Despite this at 34 weeks, 33 % of the summer cohort had insufficient or deficient vitamin D status, while 15 % of the winter cohort had insufficient or deficient status. In multivariable analysis, only adherence and season were independent predictors of vitamin D status. While supplementation improved and maintained vitamin D status during pregnancy, it was not adequate to ensure all those insufficient at 12 weeks achieved sufficient status at the end of pregnancy.