Public Health Value Research Articles

Effects of a Forest Meditation Therapy Program on Reducing Daily Stress and Promoting Coping

Background and objective: This study aimed to assess the effectiveness of a Self-compassion-based forest meditation therapy program in reducing daily stress and enhancing coping resources. Based on growing evidence supporting nature-based interventions for mental health, this program was designed to explore the effects of forest meditation therapy on stress, connectedness to nature, and self-compassion.Methods: Thirty participants (2 males, 28 females) recruited as adults (mean age 60 years) living in Seoul and Gyeonggi were assigned to experimental and control groups based on the order of enrollment. Two forest meditation therapy sessions were held between October and November 2023, with a two-week interval between sessions. Data were collected at three time points: before the intervention, after the first session, and after the second session. The primary measures included perceived stress, positive and negative affect, salivary cortisol levels, connectedness to nature, and self-compassion.Results: The experimental group showed significant reductions in perceived stress (F = 6.213, <i>p</i> = .007) and increases in positive affect compared to the control group (F = 3.556, <i>p</i> =.036). While negative affect significantly decreased in the experimental group (F = 5.509, <i>p</i> = .024), no significant difference was observed between the two groups. Cortisol levels significantly decreased in the experimental group post-intervention (z = -2.341, <i>p</i> = .019). Furthermore, the experimental group showed significant improvements in connectedness to nature (F = 6.205, <i>p</i> = .007) and a significant positive trend toward increased self-compassion compared to the control group (F = 4.046, <i>p</i> = .023).Conclusion: The Self-compassion-based Forest Meditation Therapy Program appears to be effective in managing stress and enhancing key coping resources such as connectedness to nature and self-compassion. These findings suggest that forest meditation therapy could serve as a valuable public health intervention for stress reduction. Future research with larger samples and extended follow-up periods is recommended to further explore its long-term benefits.

Profile of Cervical Cancer Screening in a Family Health Unit in Salvador, Bahia State, Brazil: an Evaluative Study of the 2020-2023 Period

Objective: The objective of this study is to outline the profile of cervical cancer screening at the Family Health Unit (FHU) San Martin 3, in the municipality of Salvador, Bahia, Brazil, from 2020 to 2023, in order to analyze the coverage of the preventive exam or Pap smear. Theoretical Framework: Brazil performs opportunistic screening of women with pre-neoplastic lesions or precursor lesions of Cervical Cancer (CC), through the performance of the Preventive Exam (PE) or Pap smear. Where the woman occasionally seeks the health service. The recommendation of the Brazilian Ministry of Health (BMH) is to screen primarily women in the age group at risk, from 25 to 64 years, delimited by the highest incidence and mortality rate of CC. Method: This is a descriptive ecological study, where the trend of the historical series of cytopathological tests performed for cervical cervical cancer screening in women at FHU San Martin 3, in the municipality of Salvador, Bahia, Brazil, between 2020 and 2023, from the date of inauguration of the unit until December 2023, was analyzed. The data were taken from the electronic medical record, Sistema Vida, and from the unit's PE record book, in February 2024. Results and Discussion: The results obtained revealed [synthesize the main results of the research]. In the discussion section, these results are contextualized in light of the theoretical framework, highlighting the implications and relationships identified. Possible discrepancies and limitations of the study are also considered in this section. Research Implications: The cytopathological examination of the cervix performed by the unit is the procedure chosen by the World Health Organization (WHO) and adopted by the BMH for cervical cancer screening, in the study in question most of the reports with precursor alterations for this type of cancer are in the standardized age range for PE, from 25 to 64 years old. The altered results in women under 25 years of age were low-grade intraepithelial lesions, a common alteration in women under 25 years of age, usually associated with the HPV virus, which in most cases regress without treatment. Originality/Value: The research on the profile of cervical cancer screening in a family health unit in Salvador presents significant originality and value for public health.

Psychometric validation of the Vaccination Attitudes Examination (VAX) scale in German pre-pandemic and mid-pandemic samples

Despite the public health value of immunizations, vaccine hesitancy is a widespread phenomenon and received special attention during the global COVID-19 pandemic. The Vaccination Attitudes Examination (VAX) Scale aims to identify anti-vaccination attitudes for understanding vaccine hesitancy. The present study is the validation of the German version of the VAX scale in pre-/mid-pandemic samples. All individuals completed an online-survey assessing prior and expected future vaccination behaviors, further constructs associated with vaccine hesitancy, as well as anti-vaccination attitudes using the translated VAX scale among others. In a first study, 297 individuals were surveyed before the COVID-19 pandemic. A second study included 260 individuals recruited during the COVID-19 pandemic. For validation, two confirmatory factor analyses have been conducted. Reliability measures (internal consistency, test–retest-correlation) were determined. The four subscales were confirmed by Confirmation Factor Analysis with a very good to excellent fit. The subscales showed good to excellent reliability and convergent validity determinants. Average VAX values significantly distinguished between individuals who had previously received or refused immunization and predicted expected vaccination behavior. The German translation of the VAX scale is effective in identifying anti-vaccination attitudes and can be used for further research on anti-vaccination attitudes and vaccine hesitancy.

Rethinking village malaria workers in Cambodia: Perspectives from the communities, programme managers, and international stakeholders.

Since the early 2000s, malaria cases in Cambodia have declined steadily. Village malaria workers (VMWs) have played a critical role in reducing malaria transmission and progress towards malaria elimination. To prevent malaria re-establishment, however, implementation strategies need to consider carefully the changing healthcare needs in the communities as well as challenges to, and opportunities for, programme adaptation. We conducted in-depth interviews with a diverse range of stakeholders involved in the planning or implementation of the VMW programme in Cambodia, to elicit their views and experiences about health priorities in the communities, the public health value of VMWs and community-based care, and prospects for future programme development. Respondents included managers and implementers involved in the VMW programme at the central and provincial level (n = 9), technical officers at international agencies in Cambodia (n = 7), international stakeholders in non-governmental and research organisations based in Cambodia or other countries in the region (n = 5), as well as VMWs (n = 10), and community members (n = 16) in six endemic communes of Kravanh District, Pursat Province. In Kravanh, we also conducted four focus group discussions with 19 community members who had previous experience of malaria. The qualitative dataset was analysed using a thematic approach. VMWs, particularly mobile malaria workers tasked with active case detection among forest workers, were deemed necessary to maintain effective malaria control. However, there was a clear demand in the communities for additional services including treatment for common illnesses, monitoring of blood pressure and blood sugar levels, and relief of general symptoms through medication, such as for fever, headache, and stomach pain. Programme managers and international stakeholders agreed that the VMW programme needs a rethinking of the current implementation model to ensure continued uptake, relevance, and motivation of VMWs. Suggestions for add-on activities included adoption of new tests for febrile illnesses such as dengue and chikungunya, and screening for the prevention and monitoring of non-communicable diseases. There was emphasis on the needs for more sustainable financing mechanisms and integration with the existing community health infrastructure. The potential expansion of VMW services will benefit from the continued involvement of external donors and partners for technical and financial support. However, the implementation strategy should consider since the outset opportunities for enhanced local ownership and health system integration. To maintain domestic political momentum and access new potential sources of domestic funding, further programme development should align with national health priorities and the ongoing process of administrative decentralisation, while being responsive to changing public health needs within the communities.

Urban political ecologies of sewage surveillance: Creating vital and valuable public health data from wastewater

AbstractWith the outbreak of COVID‐19, wastewater surveillance for public health rapidly emerged and expanded globally. In this article we chart the variegated ecosystem of private firms that work closely with public and non‐profit entities to transform metabolic flows of sewage into vital and valuable bioinformation, thereby creating new multi‐institutional spaces of public health governance. We draw on literature in urban political ecology and political economy to ask: what are the emerging political economic actors, practices, and relations of wastewater surveillance? And how are emergent multi‐institutional public‐private partnerships and contracts transforming public health governance? To answer these questions, we use mixed qualitative methods to trace the field across North America, the Middle East and South Asia. Drawing on interviews, document and report reviews, financial reporting and observation at conferences, we find that these emerging public‐private partnerships present concerning transformations in health governance where profits displace public health needs, proprietary technologies blackbox public health decisions, and vulnerable populations are experimented on for prototyping technology. Our work contributes to renewed interest in urban political ecology's analysis of metabolism by tracing how, during health crises and their aftermath, public and private actors are together reconfiguring flows of waste, labour and technology to unlock new metabolic reservoirs of bioinformation.

How leisure involvement impacts visitors' perceived health benefits in urban forest parks: examining the moderating role of place attachment.

Urban forest park leisure is a significant means for residents to achieve health and well-being, thus possessing high public health value. However, the relationship between visitors' leisure involvement and perceived health benefits has not been clarified. This study introduced restorative experiences and positive emotions as mediators and place attachment as a psychological moderator, innovatively constructing a stimulus-organism-response-moderator (SORM) integrated model. This moderated mediation model aimed to examine the mechanism through which visitors' leisure involvement influenced perceived health benefits. A field survey was conducted in Fuzhou National Forest Park in Fujian, China, resulting in the collection of 588 valid questionnaires. The results showed that visitors' leisure involvement positively impacted restorative experiences and positive emotions. Restorative experiences and positive emotions completely mediated the indirect relationship between visitors' leisure involvement and perceived health benefits. Place attachment enhanced the impact of restorative experiences on perceived health benefits, thereby positively moderating the mediation effect of restorative experiences. Place attachment also diminished the impact of positive emotions on perceived health benefits, thereby negatively moderating the mediation effect of positive emotions. Therefore, significant differences existed in the psychological processes involved in acquiring perceived health benefits among visitors with different levels of place attachment. Our findings might enrich the existing knowledge of place attachment and forest health benefits, providing valuable references for designing and optimizing urban forest parks.

Real-World Assessment of Economic and Clinical Outcomes in Thai Patients With Respiratory Syncytial Virus Infection Across Age Groups: A Retrospective Cohort Analysis.

Respiratory syncytial virus (RSV) is an important cause of acute lower respiratory infections worldwide, including Thailand. This study aimed to assess clinical and economic burdens of RSV infections across different age groups in Thailand. A retrospective cohort study was conducted using data from a tertiary care hospital from 2014 to 2021. Patients who tested at least one positive RSV were included and stratified into five age groups (< 2, 2-5, 5-18, 18-65, and > 65 years). Healthcare resource utilization, direct medical costs, and clinical outcomes were analyzed with descriptive statistics. Generalized linear models with gamma distributions and log link were used to model cost outcomes. Costs were reported in 2021 US dollars (USD), with 1 USD = 31.98 Thai Baht. A total of 2122 RSV-positive patients were identified, half of which (1097) were hospitalized. The median (interquartile range [IQR]) total hospitalization costs ranged from USD780 (IQR: USD488-USD1185) in those < 2 years to USD2231 (IQR: USD1250-USD4989) in those aged 65+ years. Case fatality rates among hospitalized patients also varied from 2.5% to 28.4% depending on age. Increased age, presence of comorbidities, and need for critical care were associated with higher hospitalization costs. Among RSV-positive patients, younger children experienced the greatest burden, but poorer outcomes were observed in older adults. Higher costs were associated with older age, comorbidities and critical care needs. Understanding RSV economic burdens is crucial for assessing the cost-effectiveness and public health value of vaccination programs that prioritize at-risk groups to mitigate the public health impact.

Agile, on-demand wastewater surveillance of virus infections to support pandemic and outbreak response in Rotterdam-Rijnmond, the Netherlands, 2020 to 2022.

BackgroundWastewater surveillance may support early and comprehensive detection of infectious diseases' community transmission, particularly in settings where other health surveillance systems provide biased or limited information. Amid the SARS-CoV-2 pandemic, deploying passive samplers to monitor targeted populations gained importance. Evaluation of the added public health value of this approach in the field can support its broader adoption.AimWe aimed to assess the feasibility and utility of on-demand wastewater surveillance, employing passive samplers, for SARS-CoV-2 and monkeypox virus (MPXV) in small/targeted populations, also considering ethical aspects.MethodsPilot case studies in the Rotterdam-Rijnmond region were used for a systematic assessment of the feasibility and utility of wastewater monitoring of SARS-CoV-2 (variants) and MPXV using passive sampling. Each case study was instigated by actual questions from the Public Health Service about disease transmission.ResultsCase study results demonstrated the feasibility and utility of on-demand wastewater surveillance with successful identification of a local peak in SARS-CoV-2 transmission, early detection of wider Omicron variant transmission after the first case was reported, as well as indication of no emerging local MPXV transmission. Ethical considerations led to the abandonment of one case study involving a displaced population.ConclusionsThe study confirms the feasibility and utility of passive sampling for real-time infectious disease surveillance, at desired spatiotemporal resolution. Ethical concerns and operational challenges were identified, highlighting the need for early stakeholder engagement and ethical guideline adherence. The method could be used to study under-surveyed populations and be extended beyond SARS-CoV-2 and MPXV to other pathogens.

Association between dietary fiber intake and suicidal ideation: a cross-sectional survey.

Dietary fiber is beneficial for improving mental health. However, few studies have evaluated the relationship between fiber-rich food and suicidal ideation. Thus, we aimed to assess whether dietary fiber consumption was associated with the risk of suicidal ideation. Data of 21,865 American adults were retrieved from the National Health and Nutrition Examination Survey (NHANES). Logistic and restricted cubic spline regression analyses were performed in order to evaluate the association of dietary fiber intake with suicidal ideation, as indicated by item nine of the nine-item Patient Health Questionnaire (PHQ-9). These analyses took into consideration several confounding factors that may potentially influence the results. Herein, we detected an L-shaped association between dietary fiber intake and the risk of suicidal ideation. For the most conclusive model, an increase of 1 g/1000 kcal/d in dietary fiber intake was accompanied by a 5% reduction in the risk of suicidal ideation. The inflection point of the L-shaped association was located at 7.8 g/1000 kcal/d. When dietary fiber intake exceeded the above level, the risk of suicidal ideation no longer decreased. Our findings of reduced risk of suicidal ideation in people with higher dietary fiber intake suggest the potential clinical and public health value of dietary fiber. Interventional investigations are warranted to prove whether adhering to a high-fiber diet prevents and reduces suicidality.

Scientific and Regulatory Lessons Learnt on Building a Chemistry, Manufacturing, and Controls (CMC) Package for COVID-19 Variant Vaccine Updates in the EU-A Regulator's Perspective.

During the COVID-19 pandemic, eight COVID-19 vaccines were authorised in the European Union (EU); as a result of emerging SARS-CoV-2 variants and waning immunity, some of these have been adapted to broaden the immunity against circulating variants. The pace at which variants emerge challenges the technical feasibility to make adapted vaccines available in a suitable timeframe and in sufficient quantities. Despite the current absence of a clear-cut seasonal spread for COVID-19, the EU regulatory approach thus far is a pragmatic approach following a pathway similar to that of seasonal influenza. This approach currently requires chemistry, manufacturing, and controls (CMC-the design, development and consistent manufacture of a specified medicinal product of good quality) and non-clinical data (from product laboratory and animal studies), as well as demonstrating that updated vaccines induce an immune response that can predict clinical efficacy and safety in humans. For CMC data, COVID-19 mRNA vaccine adaptations generally made use of the same formulation, control strategy, manufacturing process, and inclusion of registered manufacturing sites for the drug product; therefore assessment was generally streamlined. The experience gained from the vaccine adaptations, combined with a continuous early regulator-developer scientific discussion, permits increasingly greater predictability for timing and positive regulatory outcomes. Here, we review key aspects of the quality control and manufacture of updating COVID-19 vaccines to protect against new variants. Although most experience has been gained with mRNA vaccines, we note that investment in the streamlining of manufacturing processes for recombinant protein vaccines would facilitate future strain updates/adaptations thereby safeguarding availability of different COVID-19 vaccine types, which is considered of value for public health. We also reflect on the challenges and opportunities in establishing more predictable regulatory mechanisms for future COVID-19 vaccine adaptions and more widely for future vaccines containing rapidly evolving pathogens with the potential to cause health threats.

Herd immunity and sustainable development goals: role of nurses in strengthening primary health care

Herd immunity has proven as a highly valuable public health concept for dealing with reinfection. It is the immunity developed in a population to an infectious disease through vaccination or previous infection which is contributed by the virulence of the organism, susceptibility of an individual to infection, extent of immunity developed towards the pathogen, occurrence of clinical and subclinical infection in the herd and herd structure. Herd immunity assessment is imperative for continuously monitoring the risk of epidemics. The minimum proportion of the population that needs to be immune to herd effect is called herd immunity threshold which can be achieved through adequate immunization coverage. Immunization contributes to 14 out of its 17 sustainable development goals (SDGs) and is important in reaching SDGs. Nurses play a vital role in strengthening primary health care through vaccination campaigns, addressing vaccine hesitancy, community outreach programs, monitoring and surveillance of diseases, advocacy, and policy development. Nurse practitioners and nurse-led vaccination programs help in reaching underserved communities or groups with vaccine hesitancy and lead to an upsurge in vaccination rates, patient satisfaction, and attainment of community immunity. Thus, vaccination is a powerful, cost-effective public health tool to achieve the eradication of diseases through proper coverage and development of population immunity.

Ensuring sustainable impact of the national report on climate change and health in Germany 2023

Abstract Issue/problem The Robert Koch Institute recently coordinated a status report on climate change and health for Germany, detailing the current and future impact of climate change on health through 14 chapters. Description of the problem A central aim was to ensure the report’s long-term impact and public health value. Essential areas of focus have therefore been stakeholder-specific communication and establishing a network of experts for continued scientific exchange. Results The publication of the report as peer-reviewed articles has served to reach the scientific community. Another target group are public health practitioners and decision makers at subnational levels, who can contribute towards climate change mitigation and adaptation measures relevant to health, as recommended in the report. This latter group was reached through various methods and formats of science communication, including conferences aimed at the public health sector, through target-group oriented podcasts, social media engagement and digital town hall discussions. Following publication, the experts involved in writing, reviewing and using the report were invited to establish a network in order to support long-term scientific exchange and collaborations and in turn ensure the report’s sustainable impact and value. Lessons Through follow-up evaluations, the reception of the report and the further communication needs of this target group were analysed. A major lesson was to include the insights of public health practitioners more systematically and at an earlier stage in any future reports. As for the establishment of a network, a survey amongst the authors and other experts showed what this group considers the goals of this network: creating synergies and connections with existing initiatives and providing a platform for further exchange, especially amongst researchers addressing similar questions, such as the efficacy of mitigation and adaptation measures, from different angles. Key messages • Local public health practitioners are important stakeholders for climate change and health for ensuring public health impact. • The expertise in the network will support continued scientific exchange on climate change and health and thus ensure the national report’s sustainability.

Using Existing Clinical Data to Measure Older Adult Inpatients' Frailty at Admission and Discharge: Hospital Patient Register Study.

Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH's 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=-0.844; P<.001). An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty.

Assessment of Public Health Impact of 20 Non-Research HIV Demonstration Projects by Use of the CDC Science Impact Framework, United States, 2018-2022.

Compared with traditional measures of scientific impact, the CDC Science Impact Framework more broadly, directly, and quickly assesses impact of public health science. For 20 CDC-funded HIV prevention projects that were conducted during 2018-2022, health departments documented impact, based on CDC Science Impact Framework domains: Disseminating Science, Creating Awareness, Catalyzing Action, Effecting Change, and Shaping the Future. Health departments reported 282 impacts: the most common were new partnerships (n=17, Catalyzing Action), capacity building (n=16, Effecting Change), new projects or initiatives begun (n=15, Shaping the Future), new collaborations (n=14, Catalyzing Action), improved program (n=13, Shaping the Future), new guidelines or practices (n=13, Effecting Change), and informed persons affected by work (n=13, Creating Awareness). Health departments documented substantial impact with a simple, timely, and broad approach. Demonstrating impact is important for community-based organizations, funders, and others interested in public health and helps them better understand the value of public health.

Epidemiologic and clinical features of cyanobacteria harmful algal bloom exposures reported to the National Poison Data System, United States, 2010–2022: a descriptive analysis

BackgroundHarmful algal bloom occurrences have been increasingly reported globally and over time. Exposure to the variety of toxins and co-contaminants that may be present in harmful algal blooms can cause illness and even death. Poison control data is a valuable public health information source that has been used to characterize many types of toxin exposures, including harmful algal blooms. Prior studies have been limited by location and time, and knowledge gaps remain regarding cyanobacteria harmful algal bloom (cyanoHAB) exposure circumstances, and the breadth and severity of associated clinical effect.MethodsThe objective of this study was to characterize epidemiologic and clinical features of cyanoHAB exposure cases reported to 55 US poison control centers and available in the National Poison Data System (NPDS). We identified 4260 NPDS cyanoHAB exposure cases reported from 2010 to 2022, including symptomatic exposure cases with and without clinical effects related to the exposure and asymptomatic exposure cases. We assessed demographics; exposure routes, locations, chronicity; clinical effects; and medical outcomes. We calculated case rates annually and 13-year case rates by US geographic division.ResultsOver half of cyanoHAB exposure cases were children < 20 years old (n = 2175). Most cyanoHABs exposures occurred in a “public area” (n = 2902, 68.1%); most were acute (≤ 8 h) (n = 3824, 89.8%). Dermal and ingestion routes and gastrointestinal effects predominated. 2% (n = 102) of cases experienced a moderate or major medical outcome; no deaths were reported. National rates increased from 0.4 cases/1 million (1 M) person-years in 2010 to 1.4 cases/1 M person-years in 2022. The Mountain division had the highest 13-year rate (7.8 cases/1 M person-years).ConclusionsCyanoHAB exposure case rates increased 2010–2022, despite a decrease in all-cause exposure cases during the same period. NPDS data provide valuable public health information for characterization of cyanoHAB exposures, an emerging public health challenge.

Emotional competence self-help app versus cognitive behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled trial

Effective, scalable interventions are needed to prevent poor mental health in young people. Although mental health apps can provide scalable prevention, few have been rigorously tested in high-powered trials built on models of healthy emotional functioning or tailored to individual profiles. We aimed to test a personalised emotional competence app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to prevent an increase in depression symptoms in young people. This multicentre, parallel, open-label, randomised controlled trial, within a cohort multiple randomised trial (including a parallel trial of wellbeing promotion) was done at four university trial sites in the UK, Germany, Spain, and Belgium. Participants were recruited from schools, universities, and social media from the four respective countries. Eligible participants were aged 16-22 years with increased vulnerability indexed by baseline emotional competence profile, without current or past diagnosis of major depression. Participants were randomly assigned (1:1:1) to usual practice plus either the personalised emotional competence self-help app, the generic CBT self-help app, or the self-monitoring app by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. Outcome assessors were masked to group allocation. The primary outcome was depression symptoms (according to Patient Health Questionnaire-9 [PHQ-9]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed. Between Oct 15, 2020, and Aug 3, 2021, 1262 participants were enrolled, including 417 to the emotional competence app, 423 to the CBT app, and 422 to the self-monitoring app. Mean age was 18·8 years (SD 2·0). Of 1262 participants self-reporting gender, 984 (78·0%) were female, 253 (20·0%) were male, 15 (1·2%) were neither, and ten (0·8%) were both. 178 participants in the emotional competence app group, 191 in the CBT app group, and 199 in the self-monitoring app group completed the follow-up assessment at 3 months. At 3 months, depression symptoms were lower with the CBT app than the self-monitoring app (mean difference in PHQ-9 -1·18 [95% CI -2·01 to -0·34]; p=0·006), but depression symptoms did not differ between the emotional competence app and the CBT app (0·63 [-0·22 to 1·49]; p=0·15) or the self-monitoring app and emotional competence app (-0·54 [-1·39 to 0·31]; p=0·21). 31 of the 541 participants who completed any of the follow-up assessments received treatment in hospital or were admitted to hospital for mental health-related reasons considered unrelated to interventions (eight in the emotional competence app group, 15 in the CBT app group, and eight in the self-monitoring app group). No deaths occurred. The CBT app delayed increases in depression symptoms in at-risk young people relative to the self-monitoring app, although this benefit faded by 12 months. Against hypotheses, the emotional competence app was not more effective at reducing depression symptoms than the self-monitoring app. CBT self-help apps might be valuable public mental health interventions for young people given their scalability, non-consumable nature, and affordability. European Commission.

Building Public Health Workforce Capacity: Longer-Term Effectiveness of a Capacity Building Intervention to Improve Community-Based Public Health Prevention Work

Objective: There is an urgent need to build capacity among existing and incoming public health workers to enhance community-based work focused on prevention and health promotion. Public Health Essentials (PHE), a cohort-based facilitated asynchronous online capacity building intervention, was designed to build public health workers’ strategic skills and professional confidence. Earlier research reported on the short-term learning outcomes of the intervention; here we report on results from a longer-term outcomes evaluation, including skill retention, skill application, and possible indicators of workforce retention and community health improvement.Methods: A sequential mixed-methods research study was used to assess and explore longer-term outcomes among a sample of PHE graduates working in community public health roles.Results: Some 46% of eligible PHE graduates (n=70) completed a skills survey at three timepoints: Pre-PHE, post-PHE, and 3-to-6 months post-PHE completion. Longitudinal analysis of responses showed statistically significant skill gains over baseline (Beginner → Proficient, p<0.005), despite a slight drop in self-perceived ability in the 3-6 months post-PHE completion. Qualitative interviews with respondents and focus groups with their supervisors suggest PHE completion benefits participants’ everyday work by developing strategic skills, and grounding their work in shared public health language, paradigms, and values. Broader reported benefits include the ability to apply new skills to community public health prevention projects and expressed motivation to continue to work in public health.Conclusions: Successful completion of PHE provides learners with durable skills applicable to public health work and may spur interest in continuing to work in the field of public health. The importance of developing and retaining a competent community-focused public health workforce cannot be overstated. Comprehensive facilitated, online asynchronous capacity building programs may be an effective tool.

Entomological effects of attractive targeted sugar bait station deployment in Western Zambia: vector surveillance findings from a two-arm cluster randomized phase III trial

BackgroundAttractive targeted sugar bait (ATSB) stations are a novel tool with potential to complement current approaches to malaria vector control. To assess the public health value of ATSB station deployment in areas of high coverage with standard vector control, a two-arm cluster-randomized controlled trial (cRCT) of Sarabi ATSB® stations (Westham Ltd., Hod-Hasharon, Israel) was conducted in Western Province, Zambia, a high-burden location were Anopheles funestus is the dominant vector. The trial included 70 clusters and was designed to measure the effect of ATSBs on case incidence and infection prevalence over two 7-month deployments. Reported here are results of the vector surveillance component of the study, conducted in a subset of 20 clusters and designed to provide entomological context to guide overall interpretation of trial findings.MethodsEach month, 200 paired indoor-outdoor human landing catch (HLC) and 200 paired light trap (LT) collections were conducted to monitor An. funestus parity, abundance, biting rates, sporozoite prevalence, and entomological inoculation rates (EIR).ResultsDuring the study 20,337 female An. funestus were collected, 11,229 from control and 9,108 from intervention clusters. A subset of 3,131 HLC specimens were assessed for parity: The mean non-parous proportion was 23.0% (95% CI 18.2–28.7%, total n = 1477) in the control and 21.2% (95% CI 18.8–23.9%, total n = 1654) in the intervention arm, an OR = 1.05 (95% CI 0.82–1.34; p = 0.688). A non-significant reduction in LT abundance (RR = 0.65 [95% CI 0.30–1.40, p = 0.267]) was associated with ATSB deployment. HLC rates were highly variable, but model results indicate a similar non-significant trend with a RR = 0.68 (95%CI 0.22–2.00; p = 0.479). There were no effects on sporozoite prevalence or EIR.ConclusionsAnopheles funestus parity did not differ across study arms, but ATSB deployment was associated with a non-significant 35% reduction in vector LT density, results that are consistent with the epidemiological impact reported elsewhere. Additional research is needed to better understand how to maximize the potential impact of ATSB approaches in Zambia and other contexts.Trial registration number: This trial was registered with Clinicaltrials.gov (NCT04800055, 16 March 2021).

Impact of a Virtual Care Navigation Service on Member-Reported Outcomes Among Lesbian, Gay, Bisexual, Transgender, and Queer Populations: Case Study.

While the significance of care navigation in facilitating access to health care within the lesbian, gay, bisexual, transgender, queer, and other (LGBTQ+) communities has been acknowledged, there is limited research examining how care navigation influences an individual's ability to understand and access the care they need in real-world settings. By analyzing private sector data, we can bridge the gap between theoretical research findings and practical applications, ultimately informing both business strategies and public policy with evidence grounded in real-world efficacy. The objective of this study was to evaluate the impact of specialized virtual care navigation services on LGBTQ+ individuals' ability to comprehend and access necessary care within a national cohort of commercially insured members. This case study is based on the experience of commercially insured members, aged 18 or older, who used the LGBTQ+ Health Care Navigation (LGBTQ+ Navigation) service by Included Health between January 26 and July 31, 2023. Care coordinators assisted members by connecting them with vetted identity-affirming in-network providers, helping them navigate and understand their LGBTQ+ health benefits, and providing education and advocacy for clinical and nonclinical needs. We examined the impact of navigation on 5 member-reported outcomes. In addition to reporting the proportion who agreed or strongly agreed, we calculated an impact score that averaged assigned numerical values to all 5 question responses (1=strongly disagree to 5=strongly agree) for each respondent. We used ANOVA with Tukey post hoc tests and t tests to explore the relationships between the impact score and member characteristics, including optional self-reported demographics. Out of 4703 LGBTQ+ Navigation cases, 7.53% (n=354) had member-reported outcomes. A large majority of LGBTQ+ members agreed or strongly agreed that care navigation resulted in less stress (315/354, 89%), less care avoidance (305/354, 86.2%), higher confidence in finding an identity-affirming provider (327/354, 92.4%), improved ability to comprehend health care information (312/354, 88.1%), and improved ability to engage with providers (308/354, 87%). The average impact score was 4.44 (SD 0.69), with statistically significant differences by gender identity (P=.003), race (P=.01), ethnicity (P=.008), and pronouns (P=.02). The scores were highest for members with multiple gender identities (mean 4.56, SD 0.37), and members who did not provide their race, ethnicity, or their pronouns (mean 4.55, SD 0.64). Impact scores were lowest for transgender members (mean 4.11, SD 0.95). The LGBTQ+ Navigation service, by enhancing members' comprehension and use of necessary care, demonstrates potential public health utility and value. Continuous evaluation of navigation services can serve as a supplementary tool for employers seeking to promote health equity and improve belonging among employees. This is particularly important as discrimination and stigma against LGBTQ+ communities persist in the United States. Therefore, scalable and system-level changes that use navigation services are essential to reach a larger proportion of the LGBTQ+ population.

Vaccine value profile for invasive non-typhoidal Salmonella disease

Invasive non-typhoidal Salmonella (iNTS) disease is an under-recognized high-burden disease causing major health and socioeconomic issues in sub-Saharan Africa (sSA), predominantly among immune-naïve infants and young children, including those with recognized comorbidities such as HIV infection. iNTS disease is primarily caused by Salmonella enterica serovar Typhimurium sequence type (ST) 313 and ‘African-restricted clades’ of Salmonella Enteritidis ST11 that have emerged across the African continent as a series of epidemics associated with acquisition of new antimicrobial resistance. Due to genotypes with a high prevalence of antimicrobial resistance and scarcity of therapeutic options, these NTS serovars are designated by the World Health Organization as a priority pathogen for research and development of interventions, including vaccines, to address and reduce NTS associated bacteremia and meningitis in sSA. Novel and traditional vaccine technologies are being applied to develop vaccines against iNTS disease, and the results of the first clinical trials in the infant target population should become available in the near future.The “Vaccine Value Profile” (VVP) addresses information related predominantly to invasive disease caused by Salmonella Enteritidis and Salmonella Typhimurium prevalent in sSA. Information is included on stand-alone iNTS disease candidate vaccines and candidate vaccines targeting iNTS disease combined with another invasive serotype, Salmonella Typhi, that is also common across sSA. Out of scope for the first version of this VVP is a wider discussion on either diarrheagenic NTS disease (dNTS) also associated with Salmonella Enteritidis and Salmonella Typhimurium or the development of a multivalent Salmonella vaccines targeting key serovars for use globally.This VVP for vaccines to prevent iNTS disease is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic, and societal value of pipeline vaccines and vaccine-like products. Future versions of this VVP will be updated to reflect ongoing activities such as vaccine development strategies and a “Full Vaccine Value Assessment” that will inform the value proposition of an iNTS disease vaccine. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations, and in collaboration with stakeholders from the World Health Organization African Region. All contributors have extensive expertise on various elements of the iNTS disease VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.