Public Health Specialties Research Articles

Best practices for hepatitis C linkage to care in pregnant and postpartum women: perspectives from the Treatment In Pregnancy for Hepatitis C Community of Practice

There is an increasing burden of hepatitis C virus among persons of reproductive age, including pregnant and breastfeeding women, in many regions worldwide. Routine health services during pregnancy present a critical window of opportunity to diagnose and link women with hepatitis C virus infection for care and treatment to decrease hepatitis C virus-related morbidity and early mortality. Effective treatment of hepatitis C virus infection in women diagnosed during pregnancy also prevents hepatitis C virus-related adverse events in pregnancy and hepatitis C virus vertical transmission in future pregnancies. However, linkage to care and treatment for women diagnosed in pregnancy remains insufficient. Currently, there are no best practice recommendations from professional societies to ensure appropriate peripartum linkage to hepatitis C virus care and treatment. We convened a virtual Community of Practice to understand key challenges to the hepatitis C virus care cascade for women diagnosed with hepatitis C virus in pregnancy, highlight published models of integrated hepatitis C virus services for pregnant and postpartum women, and preview upcoming research and programmatic initiatives to improve linkage to hepatitis C virus care for this population. Four-hundred seventy-three participants from 43 countries participated in the Community of Practice, including a diverse range of practitioners from public health, primary care, and clinical specialties. The Community of Practice included panel sessions with representatives from major professional societies in obstetrics/gynecology, maternal fetal medicine, addiction medicine, hepatology, and infectious diseases. From this Community of Practice, we provide a series of best practices to improve linkage to hepatitis C virus treatment for pregnant and postpartum women, including specific interventions to enhance colocation of services, treatment by nonspecialist providers, active engagement and patient navigation, and decreasing time to hepatitis C virus treatment initiation. The Community of Practice aims to further support antenatal providers in improving linkage to care by producing and disseminating detailed operational guidance and recommendations and supporting operational research on models for linkage and treatment. Additionally, the Community of Practice may be leveraged to build training materials and toolkits for antenatal providers, convene experts to formalize operational recommendations, and conduct surveys to understand needs of antenatal providers. Such actions are required to ensure equitable access to hepatitis C virus treatment for women diagnosed with hepatitis C virus in pregnancy and urgently needed to achieve the ambitious targets for hepatitis C virus elimination by2030.

Book of Abstracts: Lusófona Nutrition Conference IV

The IV Jornadas Lusófonas de Nutrição is an academic event that aims to analyze several emerging themes in the area of nutrition sciences, highlighting the importance of nutritionists in their most distinct areas of activity, with special attention on the role of nutritionists’ clinical practice, sports and child nutrition, and politics. This event has the participation of several specialists in clinical nutrition, public health, and other specialties, so the presence of nutritionists, researchers, doctors, nurses, pharmacists, food engineers, and other health professionals and the agri-food industry is of particular interest.

Climate Change, Public Health, Health Policy, and Nurses Training.

There are few educational programs in the United States that have a primary focus on preparing nurses to engage in all levels of public health, health policy, and climate change. The United Nations sustainability development goals (SDG) and the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021) report underscored the importance of key stakeholders, including nurses, engaging in advocacy and policy to promote health equity. We discuss the role of nursing at the intersection of public health, policy, climate change, and the SDG. We also discuss the history and merger of the University of California San Francisco (UCSF) School of Nursing public health and health policy specialties, a significant innovation in our effort to promote health equity. We provide a brief overview of the redesigning of our curriculum that meets the needs of today's learners by including content on climate change, data analytics, and racial, social, and environmental justice. Finally, we emphasize the need to train the next cadre of nurses interested in careers in public health and health policy for us to meet the challenges facing our communities. (Am J Public Health. 2022;112(S3):S321-S327. https://doi.org/10.2105/AJPH.2022.306826).

TP8.2.20 Gongs galore: phaleristic study of the relative risk of a healing art related new-year honour

Abstract Aims To compare proportional representation of healthcare specialty workers, in receipt of New Year honours (NYHs) and examine system bias. Methods Observational study of recipients of NYHs from 2010 to 2019 within the UK honours system including comparative analysis of proportional representation of the UK medical workforce Absolute risk of receiving a NYH, related to medical specialty, gender, and geographical region. Relative Risk (RR) of receiving an NYH for services to healthcare related to specialty. Results 11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving a NYH was 0.76 (95% CI 0.68 to 0.84, p < 0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n = 181), with Public Health, Clinical Oncology, and General Medicine specialties most likely to be rewarded (RR 20.35 (CI 9.61 to 43.08, p < 0.001), 8.43 (CI 2.70 to 26.30, p < 0.001) and 8.22 (CI 6.22 to 10.86, p < 0.001)) respectively; Anaesthetists received fewest NYHs (RR 0.52 (0.13 to 2.10), p = 0.305). Men were more likely to receive NYHs than women (OR 0.44, 95%CI 0.36 to 0.54; p < 0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p = 0.003), 39 (10.6%) Wales (p < 0.001), and 26 (7.1%) Northern-Ireland (p < 0.001). Conclusions Relative risk of receiving a NYH varied over 150-fold by specialty, two-fold by gender, and three-fold by geographical location. Public Health Physicians are perceived to be the pick of the parade.

Organization of public health activities within university hospitals in France

Purpose of research: This study, conducted at the initiative of the French academic college of public health, aimed to describe, from the point of view of public health physicians, the outlines and organization of public health activities within French university hospitals. In the first half of 2018, a survey was sent to physicians in charge of public health specialties and to chiefs of public health divisions from the 41 French university hospitals. The survey was supplemented by 10 telephone interviews.Results: Among the 33 hospitals from which we received answers, 28 had a division that encompassed the majority of public health activities, usually combined with other disciplines (occupational medicine, pharmacy…). The existence of a public health division improved the visibility of this specialty and allowed to leverage its strengths. Epidemiology, biostatistics and health information were the most represented activities. Several public health activities were shared with other divisions and directions (healthcare quality and safety, infection control, etc.), due, in part, to a lack of public health physicians. Most respondents cited health promotion, health economics and big data analytics as activities that need to be developed in their institution.Conclusion: While most institutions have an identified public health division, their organizations are still heterogeneous and constantly evolving. Despite several difficulties, hospital public health activities are more diversified than before, but need the collaboration of extra hospital public health departments to progress.

Gongs galore: phaleristic study of the relative risk of a healing art related New Year Honour

ObjectivesTo compare proportional representation of healthcare specialty workers, in receipt of New Year Honours (NYHs) and examine system bias.DesignObservational study of UK honours system including comparative analysis of proportional representation...

Out with the Old and in With the New: Deimplementation in Emergency Medicine.

Much of emergency medicine care and quality standards are rooted in evidence-based guidelines. The Society for Academic Emergency Medicine (SAEM) and the journal Academic Emergency Medicine through publications, conferences, and various initiatives have encouraged the emergency medicine community to create and disseminate evidence-based guidelines. New and updated guidelines must also be implemented into practice. Increasing numbers of publications in this journal and elsewhere are shining light on how the theories and frameworks of implementation science can increase the uptake, reach, and sustainability of evidence-based guidelines in emergency medicine.

Rethinking Clinical Trials and Personalized Medicine with Placebogenomics and Placebo Dose.

Pharmacogenomics, nutrigenomics, vaccinomics, and the nascent field of plant omics are examples of variability science. They are embedded within an overarching framework of personalized medicine. Across these public health specialties, the significance and biology of the placebo response have been historically neglected. A placebo is any substance such as a sugar pill administered in the guise of medication, but one that does not have pharmacological activity. Placebos do have clinical effects, however, that can be substantive in magnitude and vary markedly from person-to-person depending, for example, on the type of disease, symptoms, or clinical trial design. Research over the past several decades attests to a genuine neurobiological basis for placebo effects. All drugs have placebo components that contribute to their overall treatment effect. Placebos are used in clinical trials as control groups to ascertain the net pharmacological effect of a drug candidate. Not only less well known but also relevant to rational therapeutics and personalized medicine is the nocebo. A nocebo effect occurs when an inert substance is administered in a context that induces negative expectations, worsening patients' symptoms. With the COVID-19 pandemic, there are high public expectations for new vaccines and medicines to end the contagion, while at the same time antiscience, post-truth, and antivaccine movements are worrisomely on the rise. These social movements, changes in public health cultures, and conditioned behavioral responses can trigger both placebo and nocebo effects. Hence, in clinical trials, forecasting and explaining placebo and nocebo variability are more important than ever for robust science and personalized health care. Against this overarching context, this article provides (1) a brief history of placebo and (2) a discussion on biology, mechanisms, and variability of placebo effects, and (3) discusses three emerging new concepts: placebogenomics, nocebogenomics, and augmented placebo, that is, the notion of a "placebo dose." We conclude with a roadmap for placebogenomics, its synergies with the nascent field of social pharmacology, and the ways in which a new taxonomy of drug and placebo variability can be anticipated in the next decade.

Importance of the big-five in the future medical specialty preference

BackgroundThe most crucial decision in the physician’s career after graduation is undoubtedly the choice of specialization. It is conditioned by many factors such as intellectual challenges, clinical experience, economic and social influences. The aim of this study was to determine whether personality traits affect the choice of medical specialty at the University of Osijek, Croatia.MethodsThis cross-sectional study included a total of 407 medical students. To assess the personality traits, the IPIP Big-Five questionnaire was used.ResultsThere were no differences in four of the five personality traits of the Big-Five questionnaire when comparing the groups based on their specialty preference: extroversion, agreeableness, conscientiousness, and emotional stability. A significant difference was found for openness to experience (intellect/imagination) trait, where students who preferred psychiatry specialties achieved the highest score, and those who chose public health specialties scored the lowest. We observed no significant effect between gender and specialty preference based on personality traits.ConclusionsWe could not attribute the differences in personality traits to specialty preference. Medical students with higher scores on agreeableness and openness (intellect/imagination) scales were more inclined to psychiatric specialties, and more conscientiousness students preferred the anesthesiology and emergency medicine specialties. Even if variations in personality traits do not exist across different specialties, many other factors influence specialty preference.

Development of a CONSORT extension for interventions in public health and related disciplines

BackgroundMany interventions in public health and related specialties are complex and challenging to assess. These interventions can have interacting components at several levels, with multiple and variable outcomes that require sophisticated assessments and analyses. Understanding randomised studies of these complex UPSCaLE (pUblic health, Psychology, Social work, CriminoLogy, and Education) interventions requires detailed reports of the interventions tested and methods used to assess them; however, reports of these trials often omit important information. Poor reporting hinders proper critical appraisal and synthesis of trials in systematic reviews, thereby impeding the effective transfer of research evidence to policy and practice decision-making. The CONSORT statement is a guideline for reporting randomised trials that has versions for reporting cluster, pragmatic, and non-pharmacological intervention trials. Despite improvements in reporting of these trials in medical disciplines, several studies have shown persistent deficiencies in the reporting quality of randomised studies of UPSCaLE interventions. Several researchers have suggested developing a new CONSORT extension for UPSCaLE interventions because of their unique and complex features, which is the objective of this multiphased project. MethodsThis project has five phases. The first phase, which has been completed, included scientific literature reviews to assess reporting guidelines for and the current reporting quality of publications of UPSCaLE intervention trials. The second phase will be a Delphi exercise to generate a prioritised list of possible items to include in the CONSORT extension. The third phase will be a formal consensus meeting to select reporting items to add to or modify for the CONSORT extension. The fourth phase is writing the guideline documents, including an explanation and elaboration document that provides detailed advice and examples of good reporting for each reporting standard. The final phase will consist of simultaneous publication of the guideline in many journals, guideline endorsement by journals and funding organisations, presentations at conferences and organisational meetings, and a dedicated website allowing feedback about the guideline. FindingsWe identified 14 reporting guidelines and five reporting quality assessment methods, yielding a total of 147 relevant reporting standards. Official CONSORT guidelines had better practices for development and dissemination of reporting guidelines, yet other reporting guidelines for empirical intervention research yielded 89 modified standards for UPSCaLE interventions not identified in CONSORT guidance. A systematic review of UPSCaLE intervention trials (n=239) showed that many key aspects of UPSCaLE intervention trials were often poorly reported. The Delphi exercise is set to begin in January, 2013. InterpretationA new CONSORT extension for UPSCaLE interventions could improve reporting of these trials. This extension could improve the critical appraisal of research and its use in evidence-based decision-making. We aim to enlist stakeholders in UPSCaLE intervention research in the development and dissemination of the guideline to reach the best-informed consensus on guideline content and to improve empirical intervention methods in public health science. FundingSG holds a linked University of Oxford Clarendon Fund-Green Templeton College Annual Fund Scholarship. The UK Economic and Social Research Council has indicated that it will fund the project's future phases. No other funding sources were provided for the research to date.

IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

AbstractEvidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.

Executive Summary: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.

Oferta y demanda de médicos especialistas en los establecimientos de salud del Ministerio de Salud: brechas a nivel nacional, por regiones y tipo de especialidad

Objectives. To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Materials and methods. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. Results. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. Conclusions. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

Oferta y demanda de médicos especialistas en los establecimientos de salud del Ministerio de Salud: brechas a nivel nacional, por regiones y tipo de especialidad

To characterize the supply, demand and the gap of medical specialists in facilities of the Ministry of Health of Peru (MINSA) at the national, regional and specialty type levels. Observational, descriptive study through which we calculated the supply of medical specialists using secondary sources of MINSA. The analysis of the demand for medical specialists was based on two methodologies: the need for specialists according to the guidelines of classification of the health facilities and according to the epidemiological and demographic profile. The arithmetic difference between the estimated demand and the supply was the procedure used to calculate the gap of medical specialists. The Ministry of Health has a total supply at the national level of 6,074 medical specialists of which 61.5% belong to the clinical specialties, 33.2% to the surgical specialties, 4.9% specialities related to aid to diagnosis and treatment and 0.4% to public health specialties. According to the categorization guideline there is a total demand of 11,176 medical specialists and according to the epidemiological and demographic profile of 11,738. The national estimated gaps found are similar in both methods, although they differ widely across regions and by type of specialty. At the regional level, the gaps are greater in Loreto, Piura, Puno and Madre de Dios when estimating the defficit in relation to the supply. Regarding the speciality, the gap is greater in the four basic specialties: gynecology and obstetrics, pediatrics, internal medicine and general surgery. There is a waid gap between supply and demand of medical specialists at the national and regional levels, as a whole representing approximately 45% of the current offer, regardless of the estimation method.

(A112) Development of Model Medical Care Protocols for Alternate Care Sites during Pandemics and Public Health Emergencies

IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites which can serve as areas for primary screening and triage or short-term medical treatment, can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Maintaining consistent standards of care in these settings is essential to a uniform approach to the medical management of a public health emergency.MethodsSubject matter experts in emergency and disaster medicine, public health, pediatrics, and various other medical specialties were convened at regular intervals over an 18-month period. Through a consensus-based process this working group created a universal standard of care along with model clinical protocols to manage patients in an out-of-hospital setting using medical and non-medical personnel.ResultsThese protocols were designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting for a limited period of time and then return to their homes for convalescence. Of particular importance are that these protocols applicable to all public health emergencies and do not rely on the active presence of physicians at the alternate care site to render care.ConclusionThe development of consistent standards of care and the ability to care for patients in an out-of-hospital setting during a pandemic or public health emergency is essential to preserve the sustained operation of acute care hospitals and the entire healthcare system. Diverting patients to a community- based alternate care site or encouraging the early discharge of patients to these locations can assist in managing the large numbers of casualties anticipated during a pandemic or public health crisis.

Development of an interest in a career in public health during medical school

In The Netherlands, approximately 12% of medical graduates spend their professional life in public health, but it is the authors' belief that few of them become interested in such a career during medical school. The aim of this study was to investigate students' development of interest in a career in a public health specialty during medical school. A written questionnaire was completed by students of all years at a Dutch medical school in 2002 (n=1371) and 2003 (n=1293). Students indicated their interest in a career in 37 Dutch medical specialties. Three public health specialties were distinguished and compared with the least popular specialty, the most popular specialty and with the average interest over all specialties. Interest in a career in occupational health and social insurance health was low throughout medical school. However, almost 15% of students indicated a high level of interest in youth health care in the first year of medical school, which is over twice as many as for the average specialty. This percentage decreased dramatically during medical school. At graduation, all three public health specialties had interest figures well below the average. Students have little interest in careers in public health. However, given that approximately 12% of medical graduates spend their professional life in public health, the factors that influence career preferences should be investigated. Targeted measures may yield more primary career preference in this direction. Reasons for the loss of interest in youth health care need to be investigated.

Income inequality between the sexes in male-dominated public health specialties

Four explanations have been developed to explain women's low wage earnings. Human capital and sex-role socialization theories provide individualistic explanation, while dual labor and split labor market analyses focus on labor market segmentation. This research examines structural factors and finds that females in male-dominated public health specialties earn considerably less than males even when “investments” and opportunities” are controlled.

IMPROVING RECRUITMENT AND RETENTION OF PUBLIC HEALTH PERSONNEL.

Imaginative recruitment programs for public health positions at practically all governmental levels are a barren and neglected area. Time does not permit an extensive analysis, but four conspicuous requirements may be stressed: 1. Better Public Relations-Too little attractive publicity. and active campaigning for quality personnel are noted in the nation's schools and colleges. Better liaison and communication of personnel needs must be developed with universities and other sources of personnel. More and better descriptive information in brochures and periodicals must be broadcast to students and faculty. Faculty members should be invited to act as consultants or to hold appointments in public health organizations during their vacation or sabbatical year. Speakers from public health organizations should address university professional groups more frequently. 2. Cooperation with Universities and Technical Schools-Closer cooperation is essential between public health services and the educational institutions. Too few courses are taught pertaining to public health specialties, thus limiting the number and quality of the applicants for such work. Public health departments can obtain university cooperation in developing a combined system of formal education and on-the-job training. This will encourage potential recruits who need to earn while they learn. 3. Raising Salaries-Low salaries do not attract graduates in national shortage areas such as engineers, research scientists, nurses, and technicians to careers in public health activities. The same educational qualifications required for medical, social service, and other professional occupations are far better recompensed in private hospitals and private social health service organizations than in public service jurisdictions. Public health organizations under current city, county, state, and federal salaries simply do not and cannot compete effectively with private and industrial enterprises, particularly at entrance levels. At the higher ranks they constantly lose their key specialists to uni-