Range Of Public Health Research Articles

Abrupt termination of the 2019/20 influenza season following preventive measures against COVID-19 in Denmark, Norway and Sweden.

BackgroundIn mid-March 2020, a range of public health and social measures (PHSM) against the then new coronavirus disease (COVID-19) were implemented in Denmark, Norway and Sweden.AimWe analysed the development of influenza cases during the implementation of PHSM against SARS-CoV-2 in the Scandinavian countries.MethodBased on the established national laboratory surveillance of influenza, we compared the number of human influenza cases in the weeks immediately before and after the implementation of SARS-CoV-2 PHSM by country. The 2019/20 influenza season was compared with the five previous seasons.ResultsA dramatic reduction in influenza cases was seen in all three countries, with only a 3- to 6-week duration from the peak of weekly influenza cases until the percentage dropped below 1%. In contrast, in the previous nine influenza seasons, the decline from the seasonal peak to below 1% of influenza-positive samples took more than 10 weeks.ConclusionsThe PHSM against SARS-CoV-2 were followed by a dramatic reduction in influenza cases, indicating a wider public health effect of the implemented measures.

Disgust or Dignity? The Moral Basis of Harm Reduction.

Harm reduction has been advocated to address a diverse range of public health concerns. The moral justification of harm reduction is usually presumed to be consequentialist because the goal of harm reduction is to reduce the harmful health consequences of risky behaviors, such as substance use. Harm reduction is contrasted with an abstinence model whose goal is to eradicate or reduce the prevalence of such behaviors. The abstinence model is often thought to be justified by 'deontological' considerations: it is claimed that many risky behaviors are morally unacceptable, and therefore that we have a moral obligation to recommend abstinence. Because harm reduction is associated with a consequentialist justification and the abstinence model is associated with a deontological justification, the potential for a deontological justification of harm reduction has been overlooked. This paper addresses this gap. It argues that the moral duty to protect autonomy and dignity that has been advocated in other areas of medical ethics also justifies the public health policy of harm reduction. It offers two examples-the provision of supervised injection sites and the Housing First policy to address homelessness-to illustrate the argument.

Education and the ethics of refugee health

Abstract Background While meeting the health needs of refugees is defensible as a human right, asserting this right is insufficient to ensure that health care needs of refugees are actually met. In addition to political will and social commitment, a well-trained workforce is needed. Problems faced by refugees mean taking a range of public health and other measures, requiring a mix of skills to help health care professionals [HCPs] meet the needs of this vulnerable population. Objectives In taking an overview of global health problems associated with the health care needs of refugees, ethics and human rights are assessed to see what practical steps can be taken by public health leaders to better enable HPCs address unmet needs. Results Given the scale of the problem and the moral implications, there is a case for making refugee health a core topic in global health education. Ethical analysis is used to devise learning outcomes that could be included in programmes for continuing education and professional development. Twelve indicative learning objectives are offered, including to ‘demonstrate leadership when trying to affect change and address health problems faced by refugees' and to ‘demonstrate sensitivity to social customs without necessarily acceding to unlawful or unethical practices'. Conclusions When focusing on the health needs of refugees, practical and ethical considerations should be taken into account in support of efforts at finding educational solutions. Making refugee health a core topic in postgraduate global health education could help HCPs acquire new skills. Key messages The right to health is insufficient to ensure that refugees receive the care they need. There is an ethical case for building refugee health into education programmes for global (public) health.

CARE: The development of an intervention for kinship carers with teenage children.

The study addresses the needs of Scottish kinship carers of teenage children who have been identified as being in need of extra support. It designs and tests an appropriate support programme, defined as CARE. The CARE intervention study reported here applied the Six Steps for Quality Intervention Development framework, a pragmatic, evidence-based framework. The Six Steps for Quality Intervention Development framework comprises six steps: the first three steps seek to reveal the concerns of the kinship carer group and to generate a theory of change; the remaining three steps generate a theory of action for the intervention, and subsequently for its implementation. There were three main benefits reported: first, the self-care techniques had a reportedly positive stress-reduction effect on kinship carers, and in their dealings with their teenager; second, kinship carers reported an increased self-awareness of their communication or 'connectedness' with their teenager; and third, there was a reported positive impact upon behaviour control as a result of the stress-reduction and improved connectedness. The development of the CARE intervention programme suggests that the Six Steps in Quality Intervention Development provides a useful methodological underpinning for intervention procedures which can be applied in a range of public health and social work settings.

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care.

There is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research.

Patterns of Infection and Patterns of Evolution: How a Malaria Parasite Brought "Monkeys and Man" Closer Together in the 1960s.

In 1960, American parasitologist Don Eyles was unexpectedly infected with a malariaparasite isolated from a macaque. He and his supervisor, G. Robert Coatney of the National Institutes of Health, had started this series of experiments with the assumption that humans were not susceptible to "monkey malaria." The revelation that a mosquito carrying a macaque parasite could infect a human raised a whole range of public health and biological questions. This paper follows Coatney's team of parasitologists and their subjects: from the human to the nonhuman; from the American laboratory to the forests of Malaysia; and between the domains of medical research and natural history. In the course of this research, Coatney and his colleagues inverted Koch's postulate, by which animal subjects are used to identify and understand human parasites. In contrast, Coatney's experimental protocol used human subjects to identify and understand monkey parasites. In so doing, the team repeatedly followed malaria parasites across the purported boundary separating monkeys and humans, a practical experience that created a sense of biological symmetry between these separate species. Ultimately, this led Coatney and his colleagues make evolutionary inferences, concluding "that monkeys and man are more closely related than some of us wish to admit." In following monkeys, men, and malaria across biological, geographical, and disciplinary boundaries, this paper offers a new historical narrative, demonstrating that the pursuit of public health agendas can fuel the expansion of evolutionary knowledge.

Unravelling a web of confusion

PurposeThe purpose of this paper is to discuss the reporting of quality of care in hospitals.Design/methodology/approachThe paper takes the form of a narrative review.FindingsThe American Federal Agency for Healthcare Research and Quality recently conducted a funding opportunity in recognition that the science of public reporting was insufficiently understood, which underlies relatively weak impact to date of public information web sites on hospital quality and safety. Whether the fundamental purpose of such web sites is to inform consumer choices or to stimulate facility leadership toward accelerated quality improvement, which relates to which metrics would be the most appropriate, and whether public audiences perceive concepts of evidence‐based best practices differently from professional audiences, all remain in question. Whether reporting physical harm of adverse events is the best metric, or whether damage to dignity and trust should be included, or whether more holistic measures of institutional culture would be even more meaningful remain in contention. While it is premature to set standards unifying how and what hospital performance measures should be displayed on public information web sites, there are existing efforts to ensure developers can learn from the natural experiment afforded by the current abundance of independently developed North American reporting programs, league tables and public information web sites.Practical implicationsDevelopers of public policy and of electronic health information systems can benefit in terms of efficiency and effectiveness by capitalizing on the recent work of several interdisciplinary teams. They can benefit from the generic approach used by some who are attempting to harmonize the broad range of public health reporting programs' data flow into one use case model capable of accommodating all reporting streams, and from others who are applying evidence‐based criteria to rank public information web sites while also evaluating performance of scoring criteria they are developing from broad principles acquired from various cited sources.Originality/valuePublic trust in healthcare facility quality and safety has fallen into mistrust, and the information web sites developed to address that consumer issue are known to have problems in ease of use, believability and helpfulness. This paper describes recent North American projects that acknowledge those problems but also provide potential paths toward solving them.

The importance of the couple relationship for children's mental health

This paper reviews the links between distressed couple relationships and adult and child mental health issues. It shows that the quality of couple relationships has an effect on a range of public health concerns that health visitors are involved with. It is implicated in adult and child mental health, in physical health, and in the attachment status of children. This paper reviews research evidence which suggests that focusing on the couple relationship can give greater benefits than focusing on parenting alone. The more couples that can manage their conflicts in a cooperative way, the better the outcomes for their children. It offers pointers for practice on the basis that health visitors are ideally placed to work with families through ‘thinking couple’ as well as ‘thinking parent’.

Can social marketing bring about long-term behaviour change?

Amanda Jackson, Director of Social Change at ICE Marketing & Communications, an agency working with NHS partners and PCTs nationwide helping to tackle a range of public health concerns, offers her perspective

Health impact assessment of quality wine production in Hungary

Alcohol-related health outcomes show strikingly high incidence in Hungary. The effects of alcohol consumption are influenced not only by the quantity, but also the quality of drinks; therefore, wine production can have an important effect on public health outcomes. Nevertheless, the Hungarian wine sector faces several vital problems and challenges influenced by the country's accession to the European Union and by the need for restructuring. A comprehensive health impact assessment (HIA) based on the evaluation of the Hungarian legislation related to the wine sector has been carried out, aiming to assess the impact of the production of quality wine versus that of table wine, using a range of public health and epidemiological research methods and data as well as HIA guidelines. The study finds that the toxic effects of alcohol can be reduced with an increased supply of quality wine and with decreased overall consumption due to higher cost, although this might drive some people to seek illegal sources. Quality wine production allows for improved use of land, creates employment opportunities and increases the incomes of producers and local communities; however, capital-scarce producers unable to manage restructuring may lose their source of subsistence. The supply of quality wine can promote social relations, contribute to a healthy lifestyle and reduce criminality related to alcohol's influence and adulteration. In general, the production and supply of quality wine can have an overall positive impact on health. Nevertheless, because of the several possible negative effects expected without purposeful restructuring, recommendations for the maximization of favourable outcomes and suggestions for monitoring the success of the analysis have been provided.

Exploring the contribution of district nurses to public health.

To date the public health role of district nursing has been less well defined than in other branches of community nursing. A qualitative study examining the public health role of district nurses was undertaken in a West Yorkshire primary care trust. The study explored the range of public health activities currently undertaken by district nurses, the agendas perceived as most conducive to input and the organizational barriers that prevented greater involvement in public health from district nurses. Focus group and individual semi-structured interviews were undertaken with 21 members of the district nursing team and analysed using thematic content analysis. The findings suggest that district nurses were already undertaking a range of public health and health education activities but much of the work was opportunistic. District nurses perceived themselves as well placed to undertake locally based health action because of their profile in the local communities together with local intelligence. However, ineffective referral criteria were considered to be the most prohibitive barrier against making a greater contribution to health improvement.

Structural interventions in public health

To review structural interventions in public health, identify distinct approaches to structural interventions, and assess their implications for HIV-prevention interventions. The MEDLINE, HealthStar, PsychInfo and Sociofile databases were searched on specific health issues, types of public health interventions, and conceptual topics (e.g. empowerment, social structure, and inequality) to compile a list of public health interventions in the United States. We excluded interventions focused on testing and surveillance unless they specifically facilitated prevention, and educational or media campaigns focused on increasing individuals' level of knowledge about a particular health problem. The term 'structural' is used to refer to interventions that work by altering the context within which health is produced or reproduced. Structural interventions locate the source of public-health problems in factors in the social, economic and political environments that shape and constrain individual, community, and societal health outcomes. We identified two dimensions along which structural interventions can vary. They may locate the source of health problems in factors relating to availability, acceptability, or accessibility; and they may be targeted at the individual, organizational, or environmental levels. All together, this framework suggests nine kinds of structural interventions, and it is possible to identify examples of each kind of intervention across a range of public health issues. The relevance of this framework for developing HIV prevention interventions is considered.