Strong Public Health Research Articles

10.P. Round table: Public health of the future: innovations in surveillance, communication and knowledge translation

Abstract The social, ecological, economic and health crises exacerbated by COVID-19 pandemic are challenges of extraordinary magnitude and complexity for global public health. Moreover, the context in which the pandemic emerged was characterized by underinvestment in public health and growing distrust in institutions. Public health responses were often fragmented and failed to make use of existing resources and expertise. Nearly 3 years after the start of the COVID-19 pandemic much has been learned and much is still to be learned. Accordingly, European national public health agencies have been pushed to their limits and currently face an urgent need to be renovated incorporating innovations in surveillance, communication and knowledge translation. National agencies should network and collaborate at the EU level. EUPHA may play an important role in this effort. On the one hand, there is the need of improving surveillance of harmful effects of the pandemic, specifically the health inequalities aggravated at local, national and global levels; and, on the other, to improve the availability of this knowledge to policymakers. Public Health communication needs to be further developed as it has been a crucial piece of national and international efforts to protect and promote health in the pandemic and so will be in the future. With this workshop proposal, we would like to bring up for discussion how could we further improve surveillance, communication and knowledge translation to policy makers and citizens in our European national public health agencies. Innovative and updated public health agencies will help regaining trust and strengthening public health institutions. National and European Public Health further development is essential and should be strengthened to protect and promote European populatiońs health. The objectives of the workshop are: – To discuss key innovations to implement in national public health agencies to improve surveillance, communication and knowledge transfer to policy makers and citizens. – To reflect on supranational European coordination mechanisms that would allow for efficient surveillance and a rapid and adequate response to different public health challenges, including social inequalities in health. – To manage public health intelligence in the European Health Data Space and the role of public health in this data lake design. Key messages • COVID19 pandemic has revealed the challenges of creating strong trustworthy national public health institutions to ensure the integrity of public health science and information dissemination. • Structures to facilitate timely and efficient monitoring requires national and supranational coordination mechanisms, including data and experience sharing. Speakers/Panellists Robert Otok ASPHER, Brussels, Belgium Sofia Ribeiro EUPHA-PHPP Manuel Franco University of Alcalá, Madrid, Spain

Applying Essential Public Health Functions in building health systems’ resilience globally

Abstract Background The COVID-19 pandemic has exposed Public Health system weaknesses due to chronic underinvestment in Public Health. In this context, Essential Public Health Functions (EPHFs) have been revitalized as an integrated, cost effective and sustainable approach to operationalising Public Health. The World Health Organization's recent position paper on building health systems resilience towards universal health coverage and health security recommended investing in EPHFs as a key mean for countries’ health systems recovery and transformation during COVID-19 and beyond. There is a need for conceptual and operational clarity of EPHFs to support countries to build back better, fairer and more resilient health systems. Methods A rapid review of peer-reviewed and grey literature regarding the EPHFs was conducted to identify different actors’ understandings of EPHFs and key lessons of applying the EPHFs at the global, regional and national levels, in order to identify the added value and key enablers to operationalising EPHFs. A crosswalk analysis of different authoritative lists of EPHFs was conducted to develop a common list of EPHFs as a reference for countries in response to Public Health challenges. Results A consolidated list of 12 EPHFs derived from the crosswalk analysis of different authoritative lists is presented, underpinning the consideration of health systems components and pressing health challenges. Six key enablers are identified from evidence and experience. These enablers are fundamental for countries to build holistic and strong Public Health capacities. Conclusions The EPHFs provide a clear and integrated framing to operationalise Public Health in countries that can be adapted to country contexts to build resilience. Health authorities and other Public Health stakeholders must seize the opportunity brought by COVID-19 recovery to continue advocating for and strengthening Public Health as a priority in health systems’ reconstruction and reform.

Strengthening National Public Health: first steps towards the Spanish Public Health Agency

Abstract Issue/Problem The social, ecological, health and economic crisis exacerbated by COVID-19 is a challenge of extraordinary magnitude and complexity for global public health. Part of the response to these challenges requires strong public health institutions. Description of the problem Component 18 of the Government of Spain’s Recovery, Transformation and Resilience Plan proposes the creation of a Spanish Agency of Public Health (SAPH), a centre of excellence to perform surveillance and health system preparedness functions in the face of new or emerging public health threats. The government has opened the debate on what design and functions it should have. Results SESPAS, the Spanish Society of Public Health and Public Administration, set out a proposal for the design and organization of the future Spanish Agency for Public Health [SAPH]. A large working group, made up of experts from various fields of public health and from its ten federated scientific societies, has designed the SAPH proposal. The scope of the public health functions to be assumed include: the strategic planning of the State’s public health (including health security), the prioritisation of public health policies and communication strategies, the assessment of the population’s health status and social conditions, the guarantee of the transversality and horizontality of health policies (health and health equity in all State policies), as well as their verticality (serving as an enriching link between the European Union level and the administrations of the Autonomous Communities and local authorities). The proposal also include 11 recommendations on the main elements to be taken into account in the establishment of the future SAPH. Lessons COVID19 pandemic has highlighted the need of creating strong public health institutions. Spain is giving its first steps toward the creation of the SAPH, which constitute a key step in addressing the current and future challenges of public health in Spain. Key messages • Spanish Public Health Agency is an opportunity to transform health policies and to improve the health of the Spanish population. • Strengthening public health starts with building national institutions that ensure comprehensive and integrated health policies.

P-106 CAN POOR ORAL HYGIENE BE RESPONSIBLE FOR MESH INFECTION FOLLOWING HERNIA REPAIR? A SYSTEMATIC REVIEW AND SUGGESTION FOR NEW PRACTICE

Abstract Background There is a reasonable evidence around oral/dental health and implant infection in orthopaedic and cardiovascular surgery. Mesh hernia repair is another area of surgical practice associated with a permanent implant. The aim of this SR was to review the evidence around oral/dental health and mesh infection. Mehods The study was registered at Prospero. A systematic review of the literature was undertaken according to the PRISMA2020 statement. The initial search identified 520 publications. After a review by title and abstract, 40 papers were read in full text. A further 4 papers were identified from references and searching.15 publications were included in the final review. Results There is no published evidence investigating the state of oral hygiene/health and the risk of mesh infection. Improvement in oral hygiene/health can reduce surgical site infection and implant infection in colorectal, gastric, liver, orthopaedic and cardiovascular surgery. Poor oral hygiene/health is associated with a large increase in oral bacteria and bacteraemia on everyday activities such as when chewing or brushing teeth. Antibiotic prophylaxis does not appear to be necessary before invasive dental care in patients with an implant. Conclusion Good oral hygiene and oral health is a strong public health message. The effect of poor oral hygiene on mesh infection and other complications of mesh hernia repair is unknown. While research is clearly needed in this area, extrapolating from evidence in other areas of surgery where implants are used, good oral hygiene/health should be encouraged amongst hernia patients both prior and after their surgery.

Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020.

Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

Seven Years, 3 Surveys, a Changed World: The State Public Health Workforce 2014-2021.

The COVID-19 pandemic and other public health challenges have increased the need for longitudinal data quantifying the changes in the state public health workforce. To characterize the state of governmental public health workforce among state health agency (SHA) staff across the United States and provide longitudinal comparisons to 2 prior fieldings of the survey. State health agency leaders were invited to have their workforce to participate in PH WINS 2021. As in prior fieldings, participating agencies provided staff lists used to send e-mail invitations to employees to participate in this electronic survey. State health agency staff. PH WINS 2021 maintains the 4 primary domains from 2014 and 2017 (ie, workplace engagement, training needs assessment, emerging public health concepts, and demographics) and includes new questions related to the mental and emotional well-being; the impact of the COVID-19 pandemic on staff retention; and the workforce's awareness of and confidence in emerging public health concepts. The percentage of SHA staff who self-identify as Black, Indigenous, and people of color increased from 30% (95% confidence interval [CI]: 29%-32%) to 35% (95% CI: 35%-37%) between 2014 and 2021. Staff younger than 31 years accounted for 11% (95% CI: 10%-12%) of the SHA workforce in 2021 compared with 8% in 2014 (95% CI: 8%-9%). From 2014 to 2021, staff who self-identify as a woman increased from 72% (95% CI: 71%-74%) to 76% (95% CI: 75%-77%). Overall, 22% (95% CI: 21%-23%) of the SHA workforce rated their mental health as poor/fair. The 2021 PH WINS results represent unique and current perspectives on the SHA workforce and can inform future public health infrastructure investments, research, and field practice to ensure a strong public health system.

Comparison of Public Health Investments of Various Countries Amid a Need for Greater Transparency: A Narrative Review.

A robust health system demands investments in public health and healthcare as they aid in closing the health protection gap. They are primarily responsible for longer life expectancies, disease prevention, and protection. Loopholes in the public health system were formed due to a lack of transparency and have only worsened throughout COVID-19. Spending more on public health is associated with fewer deaths, fewer food-borne illnesses, better sanitation, food safety, clean air and water, increased immunizations to stave against infectious diseases, and a decline in low birth weight. A comprehensive literature and data search was conducted using web-based search engines like PubMed, National Center for Biotechnology Information (NCBI), Google Scholar, Science Direct, and the New England Journal of Medicine. The review study standpoints healthcare spending, out-of-pocket expenditures, and other monetary use in various low-to-high-income countries, and the results are graphically represented. Countries with a strong public health system provide all the necessary aid to protect their citizens. They have cost-effective, readily available resources with fewer out-of-pocket expenditures (OOPs), government schemes, and health insurance to help their people. During our research, it was found how little the Indian government spends on healthcare as a percentage of gross domestic product (GDP) as compared to 'thought-to-be' poor countries like Bhutan.

Allogeneic haemopoietic cell transplant services in Australia and New Zealand in the first year of the COVID-19 pandemic: a report from Australia and New Zealand transplant and cellular therapies.

BackgroundThe COVID‐19 pandemic has caused major disruption to health systems, with allogeneic haematopoietic cell transplant (alloHCT) services a particularly vulnerable area. Ongoing provision of alloHCT has required dynamic responses at national and local levels. In Australia and New Zealand (ANZ), a high reliance on unrelated donors from overseas registries has posed an additional challenge.AimsTo describe the impact of COVID‐19 on alloHCT services in ANZ in the first year of the pandemic.MethodsData from the national alloHCT recipient and unrelated donor registries was extracted for a 2‐year time frame. Comparisons were made between a pre‐pandemic period of 1st March 2019 to 29th February 2020 and the corresponding dates during the pandemic, 1st March 2020 to 28th February 2021.ResultsThere was a 13% decrease in the number of allogeneic transplants, a reversal of steady increases in previous years, with the largest decrease in unrelated donor transplants. Local donors supplied a greater proportion of unrelated stem cell products. With a switch to universal cryopreservation, the time from request of a product to infusion increased by a median of 25.5 days for overseas products and 14 days for local products. There was a significant increase in the number of products collected but not used.ConclusionsA strong public health response and coordinated transplant community activities allowed for safe provision of alloHCT in ANZ, however our data suggests that the timely delivery of allogeneic transplants was affected by the COVID‐19 pandemic. Continued dedicated efforts are required to minimise further impacts.This article is protected by copyright. All rights reserved.

A case report of monkeypox as a result of conflict in the context of a measles campaign

IntroductionNorthwest and Southwest Cameroon suffer with ongoing conflict, associated with internal displacement of communities into bushland, violence and destruction of the health system. Case presentationDuring a measles immunisation and surveillance campaign, following a measles outbreak, a 14-year-old boy was identified as having fever and a rash. This developed following close contact with a giant forest rat. He was diagnosed with monkeypox and this was confirmed by PCR. He was treated with oral cloxacillin and topical tetracycline for superadded bacterial skin and eye infections, and isolation policies were put in place. His rash improved over 7 days, when it scabbed over and his fever settled. DiscussionRecent displacement into a bush settlement away from agricultural opportunities increased his family’s reliance on bush meat. Displacement away from established surveillance systems increased the risk of undetected transmission. This is the second confirmed case of Monkeypox in Cameroon in the last year, and the first in the Southwest region. ConclusionConflict led to the breakdown of surveillance systems, a lack of health personnel, destruction of health facilities and displacement of communities, which raised the risk of monkeypox outbreaks within Northwest and Southwest Cameroon. Surveillance for monkeypox is challenging due to clinical similarity to chickenpox. There is a risk of emergence in new regions with suitable hosts. The factors underlying the establishment of monkeypox infections in new regions are multifactorial and require a strong public health response for prevention and control. A OneHealth approach to emerging infectious diseases is essential.

HRSA's Investment in Public Health Training Centers.

HRSA's Investment in Public Health Training Centers.

Early natural menopause is associated with poor lung health and increased mortality among female smokers

Early natural menopause has been regarded as a biomarker of reproductive and somatic aging. Cigarette smoking is the most harmful factor for lung health and also an established risk factor for early menopause. Understanding the effect of early menopause on health outcomes in middle-aged and older female smokers is important to develop preventive strategies. This study aimed to examine the associations of early menopause with multiple lung health and aging biomarkers, lung cancer risk, and all-cause and cause-specific mortality in postmenopausal women who were moderate or heavy smokers. This study was conducted on postmenopausal women with natural (n=1038) or surgical (n=628) menopause from the Pittsburgh Lung Screening Study. The Pittsburgh Lung Screening Study is a community-based research cohort of current and former smokers, screened with low-dose computed tomography and followed up for lung cancer. Early menopause was defined as occurring before 45 years of age. The analyses were stratified by menopause types because of the different biological and medical causes of natural and surgical menopause. Statistical methods included linear model, generalized linear model, linear mixed-effects model, and time-to-event analysis. The average age of the 1666 female smokers was 59.4±6.7 years, with 1519 (91.2%) of the population as non-Hispanic Whites and 1064 (63.9%) of the population as current smokers at baseline. Overall, 646 (39%) women reported early menopause, including 198 (19.1%) women with natural menopause and 448 (71.3%) women with surgical menopause (P<.001). Demographic variables did not differ between early and nonearly menopause groups, regardless of menopause type. Significant associations were identified between early natural menopause and higher risk of wheezing (odds ratio, 1.65; P<.01), chronic bronchitis (odds ratio, 1.73; P<.01), and radiographic emphysema (odds ratio, 1.70; P<.001) and lower baseline lung spirometry in an obstructive pattern (-104.8 mL/s for forced expiratory volume in the first second with P<.01,-78.6 mL for forced vital capacity with P=.04, and-2.1% for forced expiratory volume in the first second-to-forced vital capacity ratio with P=.01). In addition, early natural menopause was associated with a more rapid decline of forced expiratory volume in the first second-to-forced vital capacity ratio (-0.16% per year; P=.01) and incident airway obstruction (odds ratio, 2.02; P=.04). Furthermore, women early natural menopause had a 40% increased risk of death (P=.023), which was mainly driven by respiratory diseases (hazard ratio, 2.32; P<.001). Mediation analyses further identified that more than 33.3% of the magnitude of the associations between early natural menopause and all-cause and respiratory mortality were explained by baseline forced expiratory volume in the first second. Additional analyses in women with natural menopause identified that the associations between continuous smoking and subsequent lung cancer risk and cancer mortality were moderated by early menopause status, and females with early natural menopause who continued smoking had the worst outcomes (hazard ratio, >4.6; P<.001). This study did not find associations reported above in female smokers with surgical menopause. Early natural menopause was found to be a risk factor for malignant and nonmalignant lung diseases and mortality in middle-aged and older female smokers. These findings have strong public health relevance as preventive strategies, including smoking cessation and chest computed tomography screening, should target this population (ie, female smokers with early natural menopause) to improve their postmenopausal health and well-being.

Analysis on Existing Problems and Counter Measures of Public Health Management in the New Era

With the continuous progress of social development, the people have gradually begun to pay attention to the awareness of life, health and safety, especially in all kinds of sporadic emergencies, which seriously threaten the people’s life, health, and safety, thereby forcing the public health management to make timely adjustments and improvements to adapt to the current social development level. In the future, public health management will face more arduous challenges and find a breakthrough in the development bottleneck. At present, there are many factors restricting the development of public health management in China. This paper analyzed the existing problems in China’s public health management, and proposed the corresponding improvement countermeasures in order to improve the level of China’s public health management in the new period. Additionally, suggestions for the stable development of society, and the construction of a strong public health system were also included in this paper.

The Differential Impact of Reopening States With and Without COVID-19 Face Mask Mandates on County-Level Consumer Spending.

Objectives:By the end of 2020, 38 states and the District of Columbia had issued requirements that people wear face masks when in public settings to counter SARS-CoV-2 transmission. To examine the role face mask mandates played in economic recovery, we analyzed the interactive effect of having a state face mask mandate in place on county-level consumer spending after state reopening, adjusting for county rates of new COVID-19 cases and deaths, time trends, and county-specific effects.Methods:We collected county-specific data from state executive orders, consumer spending data from the Opportunity Insights Economic Tracker, and COVID-19 case and death data from the Centers for Disease Control and Prevention COVID-19 tracker. Using an event study approach, we compared county-level changes in consumer spending before and after state-issued closure orders were lifted and assessed the interactive effect of state-issued face mask mandates.Results:The lifting of state-issued closures was associated with an average increase in consumer spending across all counties studied within 1 month. However, the increase was 1.2-1.7 percentage points higher in counties with a state face mask mandate in place than in counties without a state face mask mandate.Conclusions:In addition to their public health benefits, face mask mandates may have assisted economic recovery during the COVID-19 pandemic, suggesting they are a strong public health strategy for policy makers to consider now and for potential future pandemics arising from airborne viruses.

Building a Strong Foundation for Public Health Transformation.

Building a Strong Foundation for Public Health Transformation.

Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020

Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

Changes in the utilisation of acute hospital care in Ireland during the first wave of the COVID-19 pandemic in 2020

Background: Reduced and delayed presentations for non-COVID-19 illness during the COVID-19 pandemic have implications for population health and health systems. The aim of this study is to quantify and characterise changes in acute hospital healthcare utilisation in Ireland during the first wave of COVID-19 to inform healthcare system planning and recovery. Methods: A retrospective, population-based, observational study was conducted using two national datasets, Patient Experience Time (PET) and Hospital In-Patient Enquiry (HIPE). The study period was 6th January to 5th July 2020. Results: Comparison between time periods pre- and post-onset of the COVID-19 pandemic within 2020 showed there were 81,712 fewer Emergency Department (ED) presentations (-18.8%), 19,692 fewer admissions from ED (-17.4%) and 210,357 fewer non-COVID-19 hospital admissions (-35.0%) than expected based on pre-COVID-19 activity. Reductions were greatest at the peak of population-level restrictions, at extremes of age and for elective admissions. In the period immediately following the first wave, acute hospital healthcare utilisation remained below pre-COVID-19 levels, however, there were increases in emergency alcohol-related admissions (Rate Ratio 1.22, 95% CI 1.03, 1.43, p-value 0.016), admissions with self-harm (Rate Ratio 1.39, 95% CI 1.01, 1.91, p-value 0.043) and mental health admissions (Rate Ratio 1.28, 95% CI 1.03, 1.60, p-value 0.028). Discussion: While public health implications of delayed and lost care will only become fully apparent over time, recovery planning must begin immediately. In the short-term, backlogs in care need to be managed and population health impacts of COVID-19 and associated restrictions, particularly in relation to mental health and alcohol, need to be addressed through strong public health and health system responses. In the long-term, COVID-19 highlights health system weakness and is an opportunity to progress health system reform to deliver a universal, high-quality, sustainable and resilient health system, capable of meeting population health needs and responding to future pandemics.

Why are most colorectal cancers diagnosed outside of screening? A retrospective analysis of data from the English bowel screening programme.

ObjectiveDespite several interventions to increase participation in England, most colorectal cancers (CRCs) are diagnosed outside of the screening programme. The aims of this study were to better understand why most CRCs are diagnosed externally, the extent to which this is due to suboptimal uptake of screening, and the extent to which it is due to other factors, such as false-negative test results.Setting / MethodsWe performed a clinical audit of 1011 patients diagnosed with CRC at St Mark's Hospital (Harrow, UK) between January 2017 and December 2020. Data on the diagnostic pathway and screening history of individuals were extracted from the bowel cancer screening system and assessed using descriptive statistics.Results446/1011 (44.1%) patients diagnosed with CRC were eligible for screening at the time of diagnosis. Of these, only 115/446 (25.8%) were diagnosed through screening. Among those diagnosed via non-screening pathways, 210/331 (63.4%) had never taken part in screening, 31/331 (9.4%) had taken part but were not up to date, and 89/331 (26.9%) had taken part and were up-to-date (of these, 82/89 [92.2%] had received a normal or weak positive test result, and 5/89 [5.6%] had received a positive result and declined colonoscopy).ConclusionNearly two-thirds of screening eligible patients diagnosed through a non-screening pathway had never taken part in screening. This represents the single largest source of inefficiency within the screening programme, followed by missed findings and inconsistent participation. Given the improved outcomes associated with screen-detected cancers, there is a strong public health mandate to encourage participation.

COVID-19 on the Navajo Nation: experiences of Diné families of children with asthma

Objective The first case of COVID-19 on the Navajo Nation (NN) was found on March 17, 2020. Even with strong public health efforts, NN saw the highest per capita infection rate in the US during May of 2020 with 2450/100,000. To determine the impact of COVID-19 on families of children with asthma on the NN, families participating in the NHLBI funded Community Asthma Program were contacted to see if they would share their experiences. Methods Sixty-six of 193 families (34%) were interviewed. Results: The average age of the child with asthma was 13.5 (SD = 3.9) and 33% were female. Most Diné children with asthma in our study did not contract COVID-19. However, the pandemic had a significant impact on them and their families. Many family members contracted COVID-19, some children lost family members, and half of interviewed parents reported a decline in their child’s mental health. Twenty-five percent of families sought the help of a traditional healer. Many accessed medical care through telehealth and most were able to obtain asthma medications when needed. Conclusions: Despite significant challenges, our research indicated resilience among Navajo families.

Siobhan Wescott: steadfast advocate for Native American health

At preschool in Cambridge, MA, USA, during the early 1970s, Siobhan Wescott recalls being attacked by her fellow classmates for being a Native American. “At 4, I physically experienced racism for the first time. That really shaped my wanting to not have people feel uncomfortable in new places just because of the colour of their skin or their identity”, she says. Wescott, who is Alaskan Athabascan, became the inaugural Dr Susan and Suzette LaFlesche Professor of American Indian Health and Director of the American Indian Health Program in the College of Public Health at the University of Nebraska Medical Center (UNMC), Omaha, NE, USA, in July, 2021. “Dr Susan was the first Native American physician”, she tells me, but the LaFlesche sisters were “both very strong public health advocates”. This position is a fitting one for Wescott, who says, “public health is my passion”.

Combined exposure to multiple metals on serum uric acid in NHANES under three statistical models

BackgroundThere are rare researches on the correlations between metals exposure and serum uric acid (SUA), and existing research has only investigated the single metal effect. This study aimed to investigate the combined effects of metal mixtures on SUA and hyperuricemia using three statistical models. MethodsIn this study, the data were extracted from three cycle years of the National Health and Nutrition Examination Survey (NHANES). Subsequently, generalized linear regression, weighted quantile regression (WQS) and Bayesian kernel machine regression (BKMR) models were fitted to evaluate the correlations between metal mixtures and both SUA and hyperuricemia. ResultsOf 3926 participants included, 19.13% participants had hyperuricemia. It was found using multi-metals generalized linear regression models that there were positive correlations of arsenic and cadmium with both outcomes. The negative correlations were identified in cobalt, iodine, and manganese with SUA concentration, whereas only cobalt was negatively correlated with hyperuricemia. Based on the WQS regression model fitted in positive direction, it was suggested that the WQS indices were significantly correlated with SUA (β = 6.64, 95% CI: 3.14–10.13) and hyperuricemia (OR = 1.25, 95% CI: 1.08–1.44); however, the result achieved by using the model fitted in negative direction indicated that the WQS indices were only significantly correlated with SUA (β = -5.29, 95%CI: 8.02 ∼ −2.56). With the use of the BKMR model, a significant increasing trend between metal mixtures and hyperuricemia was found, while no significant overall effect of metal mixtures on SUA was identified. The predominant roles of arsenic, cadmium, and cobalt in the change of SUA and hyperuricemia risk were found using all three models. ConclusionThe finding of this study revealed that metal mixtures might have a positive combined effect on hyperuricemia. The mutual verification of two outcomes using the three different models provided strong public health implications for protecting people from heavy metal pollution and preventing hyperuricemia.