Public Health Tool Research Articles

Factors affecting on Consumers Use of food labels in Benghazi/Libya

Food labels found to be very important public health tools that are assist people who are on special diet or with nutrition related health problems and diseases. The current study aims to identify various factors influencing in using of food label. A descriptive cross sectional study was conducted at supermarkets and malls in Benghazi city. Study included four hundred participants, data were collected by questionnaires. Data were analysed by using descriptive statistics. Chi-Square test used to examine the significant differences in the sample. The majority of consumers reported to use of the food label information in making purchasing decisions, the expiration date was the most used food label information, while the fat and calorie/energy were the most used nutrition label components. The present study revealed that price of food products as a most motivating factor to use and read food label. Unfamiliar language and small font sizes of food label were mentioned as difficulties and circumstances encountered in using food label information. Findings from this study will facilitate future public education efforts to promote the use of food labels.

The impact of SARS-CoV-2 on healthcare workers of a large University Hospital in the Veneto Region: risk of infection and clinical presentation in relation to different pandemic phases and some relevant determinants.

The aim of this study is to evaluate the incidence of SARS-CoV-2 infection and the prevalence of COVID-19-related symptoms in relation to pandemic phases and some relevant variables in a cohort of 8,029 HCWs from one of the largest Italian University Hospitals. A single-center retrospective study was performed on data collected during SARS-CoV-2 infection surveillance of HCWs. Cox's multiple regression was performed to estimate hazard ratios of SARS-CoV-2 infection. Logistic multivariate regression was used to assess the risk of asymptomatic infections and the onset of the most frequent symptoms. All analyses were adjusted for sociodemographic and occupational factors, pandemic phases, vaccination status, and previous infections. A total of 3,760 HCWs resulted positive (2.0%-18.6% across five study phases). The total incidence rate of SARS-CoV-2 infection was 7.31 cases per 10,000 person-days, significantly lower in phase 1 and higher in phases 4 and 5, compared to phase 3. Younger HCWs, healthcare personnel, and unvaccinated subjects showed a higher risk of infection. Overall, 24.5% were asymptomatic infections, with a higher probability for men, physicians, and HCWs tested for screening, fully vaccinated, and those with previous infection. The clinical presentation changed over the phases in relation to vaccination status and the emergence of new variants. The screening activities of HCWs allowed for the early detection of asymptomatic cases, limiting the epidemic clusters inside the hospital wards. SARS-CoV-2 vaccination reduced infections and symptomatic cases, demonstrating again its paramount value as a preventive tool for occupational and public health.

Identifying modifiable factors associated with COVID-19 vaccine hesitancy and acceptance among cancer patients in Jordan

IntroductionVaccines stand amongst the most effective medical interventions for the management of infectious diseases, and are pivotal tools for public health. The acceptance of vaccines is heavily influenced by perceptions of efficacy, safety and other modifiable factors.PurposeThis cross-sectional study sought to identify and examine the modifiable factors that can help address COVID-19 vaccine hesitancy and acceptance among cancer patients.MethodsThe study was conducted between February and April 2021 using an online survey questionnaire comprising of four domains. The survey was administered to cancer patients in Jordan.ResultsAmong the 1,029 cancer patients who completed the online questionnaire (response rate= 73%), 58% (n=597) expressed willingness (intent) to take the vaccine. Notably, 72.5% (n=433) of those intending to take the vaccine were currently undergoing treatment. Knowledge and awareness played a significant role, with 54.3% considering them essential for vaccine acceptance. Fear of infection significantly influenced vaccine acceptance (p<0.001), with 66.8% expressing concern about potential infections. Peer encouragement was also a crucial factor, as 82.4% regarded it as an important driver for influencing vaccine acceptance (p<0.001).ConclusionPeer encouragement, awareness, and fear emerged as the primary modifiable factors associated with greater vaccine acceptance by patients with active malignancies. Study results suggest that providing personalized and tailored information about vaccinations, focusing on safety and potential interactions with cancer and its treatment, are potentially excellent strategies for improving vaccine acceptance among cancer patients.

409. Unvaccinated Adolescents Bear the Majority of Disease Burden of Severe COVID-19 Among Those Admitted to the Intensive Care Unit (ICU)

Abstract Background COVID-19 vaccination is one of the most important public health tools to prevent severe COVID-19. Methods COVID-19 vaccine (Pfizer-BioNTech) first received the U.S. Food and Drug Administration (FDA) Emergency use authorization (EUA) for individuals 16 years of age and older on 12/11/2020 and for 12-15 years of age on 5/10/2021. We evaluated clinical and epidemiologic characteristics of critically ill adolescents with COVID-19 admitted to the intensive care unit (ICU) at our tertiary-care centers in Northwestern Iowa (encompassing Sioux City and Sergeant Bluff locations) during the 1-year post-vaccination approval period from June 1, 2021- May 31, 2022. Adolescence was defined as age-group 12-21 years per WHO definition. Results Twenty-one adolescents were admitted to the ICU with a median age of 16 years (IQR 12-20 years) and male: female ratio of 1:1.3. The majority (77%) were admitted with COVID-19 related pneumonia and 10 developed hypoxemic respiratory failure; 19 of 21 (90%) adolescent patients admitted to the ICU during this period were unvaccinated and all adolescents developing respiratory failure (10/10, 100%) were unvaccinated. Majority of patients with respiratory failure (70%) required mechanical ventilation (MV). Seventy % of patients with respiratory failure were obese (BMI of >30); 40% of patients had two or more pre-existing comorbidities; those with BMI >40 were 4.3 times more likely to develop respiratory failure (p< 0.0001). Inflammatory markers were 5-20 times higher among patients with respiratory failure (p< 0.05); 60% of those with respiratory failure developed complications including ARDS, acute renal injury and cerebral anoxic encephalopathy. All with respiratory failure required parenteral steroids. Mean duration of ICU stay was significantly longer for patients with respiratory failure [14.6 (±1.7) days versus 7.5 (± 2.6) days, p< 0.0001)]. None of the patients died. After hospital discharge, 30% patients reported post COVID-19 fatigue at 3-month follow up. Conclusion Our results showed that all of the critically ill adolescent patients with COVID-19 associated hypoxemic respiratory failure were unvaccinated and majority developed complications. These results further emphasize importance of COVID-19 vaccination efforts for adolescents. Disclosures All Authors: No reported disclosures

Low Risk of SARS-CoV-2 Reinfection for Fully or Boosted mRNA Vaccinated Subjects in Sicily: A Population-Based Study Using Real-World Data.

Background: Reinfections occur as a response to natural infections wanes and novel strains of SARS-CoV-2 emerge. The present research explored the correlation between sex, age, COVID-19 vaccination, prior infection hospitalization, and SARS-CoV-2 reinfection in Sicily, Italy. Materials and Methods: A population-based retrospective cohort study was articulated using the vaccination flux from a regional registry and the Sicilian COVID-19 monitoring system of the Italian Institute of Health. Only adult Sicilians were included in the study, and hazard ratios were calculated using Cox regression. Results: Partial vaccination provided some protection (adj-HR: 0.92), when compared to unvaccinated individuals; furthermore, reinfection risk was reduced by full vaccination (adj-HR: 0.43), and the booster dose (adj-HR: 0.41). Males had a lower risk than females of reinfection with SARS-CoV-2 (adj-HR: 0.75). Reinfection with SARS-CoV-2 was diminished by hospitalization during the first infection (adj-HR: 0.78). Reinfection risk was higher among those aged 30-39 and 40-49 compared to those aged 18-29, whereas those aged 60-69, 70-79, and 80+ were statistically protected. Reinfection was significantly more frequent during the wild-type-Alpha, Delta, Delta-Omicron, and Omicron dominance/codominance waves compared to the wild type. Conclusions: This study establishes a solid base for comprehending the reinfection phenomenon in Sicily by pinpointing the most urgent policy hurdles and identifying some of the major factors. COVID-19 vaccination, one of the most effective public health tools, protects against reinfection, mostly caused by the Omicron strain. Elderly and hospitalized people's lower risk suggests stricter PPE use.

Critical analysis of tobacco taxation policies in Pakistan after two decades of FCTC: Policy gaps and lessons for low- and middle-income countries.

Tobacco taxation remains a poorly used intervention to control tobacco use in many low- and middle-income countries (LMICs) including Pakistan even after two decades of FCTC adoption. This study identifies gaps and implementation challenges in the current Tobacco Taxation and Pricing Policies (TTPP) in Pakistan, and highlights key policy implications and lessons for LMICs to strengthen tobacco control measures. We used qualitative document analysis to examine the policy documents to assess the TTPP against the WHO Framework Convention on Tobacco Control (FCTC) guidelines for the implementation of Article 6 of the FCTC. In addition, we used secondary data on tobacco tax and prices to assess the impact of TTPP on tobacco affordability in the country. Although Pakistan taxes raw tobacco, cigarettes and other tobacco products (cigarillos, cigars, cheroots), the existing TTPP falls below the WHO FCTC requirements of: uniform tax level, simple tax structure and 70% share of excise tax in the price of a product's pack; among others. There are also multiple issues in tobacco tax administration such as lack of monitoring. This is leading to the availability of highly affordable tobacco products in the country. Pakistan does not have a clear strategy on using tobacco taxation and prices as a public health tool in the country. Existing TTPP face dual issues of flawed structure and poor administration translating into highly affordable tobacco products and low revenues in the country. There is a need to introduce multisectoral tobacco control policies in countries like Pakistan in the context of the tobacco sector political economy.

Incorporating migrants into National COVID-19 Vaccination Plans in Latin America: A comparative analysis of policies in seven countries

Vaccination against COVID-19 is an essential public health tool for pandemic control. Inclusion of migrants in COVID-19 vaccination is not only ethically necessary from a right-to-health perspective but also technically indispensable for disease control. This study aimed to characterize the inclusion of international migrants, refugees, and asylum seekers in COVID-19 vaccination policies in Latin American countries that have the greatest recent increase in the reception of migrants.We conducted a content analysis of public policy documents issued between March 11, 2020, and June 30, 2022 by the Ministries of Health of seven countries: Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico and Peru. Documents were located through Ministries of Health web pages, references in scientific literature, and the Pan American Health Organization's Information Platform on Health and Migration in the Americas. A content analysis was performed of the documents that were located, along six dimensions: migrants' right to vaccination, temporality of vaccination, administrative discretion, policies to facilitate access, language or cultural considerations, and normative, ethical or technical justifications provided.Eighty-six public policy documents were reviewed. Their contents showed that none of the countries explicitly excluded migrants from vaccination, nor did they explicitly define restrictions on this population. One barrier that was detected was to require identity documents in order to be vaccinated or to receive a vaccination certificate, which could be difficult for migrants to obtain. Few countries defined actions to facilitate or promote the vaccination of migrants. The documents that mentioned justifications for vaccinating migrants presented reasons that were mainly based on the recognition of the right to health, the principle of non-discrimination and equity.The countries studied generally had inclusive policies but were limited in terms of dealing with potential barriers to access. The lack of mechanisms to guarantee the right to health is a limitation that countries in the region should address.

Surgical Treatment for Early Cervical Cancer in the HPV Era: State of the Art.

Cervical cancer (CC) is the fourth most common cancer among women worldwide. The aim of this study is to focus on the state of the art of CC prevention, early diagnosis, and treatment and, within the latter, the role of surgery in the various stages of the disease with a focus on the impact of the LACC study (Laparoscopic Approach to Cervical Cancer trial) on the scientific debate and clinical practice. We have discussed the controversial application of minimally invasive surgery (MIS) for tumors < 2 cm and the possibility of fertility-sparing surgery on young women desirous of pregnancy. This analysis provides support for surgeons in the choice of better management, including patients with a desire for offspring and the need for sentinel node biopsy (SNB) rather than pelvic lymphadenectomy for tumors < 4 cm, and without suspicious lymph nodes' involvement on imaging. Vaccines and early diagnosis of pre-cancerous lesions are the most effective public health tool to tackle cervical cancer worldwide.

A health equity framework to support the next generation of cancer population simulation models.

Over the past 2 decades, population simulation modeling has evolved as an effective public health tool for surveillance of cancer trends and estimation of the impact of screening and treatment strategies on incidence and mortality, including documentation of persistent cancer inequities. The goal of this research was to provide a framework to support the next generation of cancer population simulation models to identify leverage points in the cancer control continuum to accelerate achievement of equity in cancer care for minoritized populations. In our framework, systemic racism is conceptualized as the root cause of inequity and an upstream influence acting on subsequent downstream events, which ultimately exert physiological effects on cancer incidence and mortality and competing comorbidities. To date, most simulation models investigating racial inequity have used individual-level race variables. Individual-level race is a proxy for exposure to systemic racism, not a biological construct. However, single-level race variables are suboptimal proxies for the multilevel systems, policies, and practices that perpetuate inequity. We recommend that future models designed to capture relationships between systemic racism and cancer outcomes replace or extend single-level race variables with multilevel measures that capture structural, interpersonal, and internalized racism. Models should investigate actionable levers, such as changes in health care, education, and economic structures and policies to increase equity and reductions in health-care-based interpersonal racism. This integrated approach could support novel research approaches, make explicit the effects of different structures and policies, highlight data gaps in interactions between model components mirroring how factors act in the real world, inform how we collect data to model cancer equity, and generate results that could inform policy.

Enhancing Health through Built Environment Improvement: A Southern Nevada Health Impact Assessment Case Study

Background: Health Impact Assessment (HIA) is a public health tool to evaluate how choices made outside the health sector can affect health. HIAs are utilized in transportation, housing, planning, and other fields. Since the built environment can impact community health outcomes, including physical activity rates, injuries, and overweight and obesity, an interdisciplinary team composed of public health, planning, transportation, and land use professionals conducted an HIA in Las Vegas, Nevada.&#x0D; Methods: The HIA consisted of (1) screening, (2) scoping, (3) assessment, (4) recommendations, (5) reporting, and (6) monitoring and evaluation. It examined proposed physical improvements to a 0.66 mile stretch of a major arterial roadway in the City of Las Vegas where nearby residents experience many health inequities. Collection and analysis of land use and survey data, analysis of secondary data, and literature reviews were completed to predict potential health effects produced by built environment changes. Stakeholder feedback informed each HIA step.&#x0D; Results: The HIA generated recommendations to improve physical activity, reduce pedestrian and bicyclist injury rates, and decrease obesity and overweight prevalence, by presenting “good,” “better,” and “best” physical infrastructure improvements. The process and resulting recommendations enhanced collaboration among health and nonhealth sectors.&#x0D; Conclusions: Data and analysis revealed that the proposed changes could improve walkability and bikeability and reduce pedestrian and bicyclist injury. By encouraging active transportation through bicycling and walking, the plan could, over time, contribute to reduced overweight and obesity. The HIA facilitated inter-sector cross collaboration and the integration of health into future decision-making.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

ABSTRACT The decline in children’s vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents’ vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach’s alpha test (α) and McDonald’s omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

“Health is a serious game”: Gamification as a tool for primary prevention in Public Health

Abstract Background Gamification, according to literature, is the use of game design elements in non-game contexts. Rewards (e.g. points, badges and rankings) are a gamification strategy to entice users to complete required tasks and could be useful for Public Health (PH) interventions to promote healthy lifestyles. This study aims to find out which gamification approaches are most useful in PH. Methods We investigated PubMed, Scopus and Web of Science databases to conduct our systematic review, including articles published up to February 3, 2023. Prisma Statement 2020 guidelines were used. No time limits were included. Only articles in Italian or English that discussed gamification interventions in PH, effectiveness and user satisfaction were taken into account. The quality of the studies will be assessed using the NIH quality assessment tool. Results 327 articles were found, 27 of which were included in the review. Pre-post studies were the most included (n = 12), conducted in Europe (n = 7) and USA (n = 6). The target population was mainly young adults and teens (n = 7). Most gamification interventions involved physical activity (n = 13), nutrition (n = 5) and smoking cessation (n = 2). Overall, the interventions proved to be all effective, but the ones about physical activity were the most useful, engaging and with longer-lasting results over time. Where satisfaction was assessed (n = 16), users gave positive feedback. Conclusions The research outcomes have shown how gamification may engage not only individuals, but masses, using game design elements in different Public Health areas. The implementation of gamification tools in PH is an innovative intervention that often uses graphic language to simplify and deliver messages to all kinds of users. Gamification is easy to use and could be a good strategy for primary prevention, to support a sustainable behavior change following the game period. More large scale controlled trials are needed in order to confirm these results. Key messages • Gamification is an important tool in public health useful for primary prevention. • The mass appeal of gamification can reach many users leading to healthier lifestyles, especially among young adults.

Israel’s repeal of sugar-sweetened beverages tax harms public health

Abstract Issue The consumption of sugar-sweetened beverages (SSBs) exerts negative consequences on both individual and public health. High sugar consumption is associated with the development of non-communicable diseases, increases health care costs, and reduces labor productivity. The WHO and the World Bank thus encourage countries to tax SSBs. Description In January 2023, the Israeli government decided to repeal the SSB tax which had been imposed a year earlier. Our study seeks to attain an in-depth understanding of the reasons for the tax repeal by analyzing such documents as parliamentary protocols and media articles. Results Israel's SSB tax was criticized severely by the ultra-orthodox community, which maintains a tradition of consuming sweets as part of its customs and culture. In the absence of a plan to change the community's habits, the tax was perceived as a politically motivated economic burden. Moreover, this perception was intensified by the ultra-orthodox political leaders, who portrayed the tax as unfairly targeting the ultra-orthodox community. Lessons When considering the implementation of a tax on SSBs, policymakers must ensure that this tax is not perceived as an economic sanction or as a means of targeting a specific community. To this end, it is critical to illustrate that the tax seeks solely to promote public health. The public should thus be informed about the harmful effects of SSBs and about the importance of reducing their consumption. Furthermore, this information should be adapted to different sectors and conveyed through various means. In this respect, it is particularly important to understand the attitudes and potential conflicts of closed communities and to obtain the support of community leaders. Key messages • To successfully implement an SSB tax, health authorities must clarify that the tax is a public health tool, not an economic or political sanction. • Policy makers should endeavor to convince all communities to support and accept the transition to healthier beverages before taxing SSBs.

Nutritional quality of food intakes according to the Nutri-Score and blood biomarker concentrations

Abstract Background Diet has a direct impact on our health and as such is an important leverage in public health prevention strategies. Nutri-Score is a scientifically validated 5-color front-of-pack nutrition label based on a nutrient profile called FSAm-NPS that was proposed as a tool to help people choose healthier foods. It has been adopted by several European countries, but remains optional under current EU labeling regulation (under revision). This study aimed to provide insights into the relevance of the FSAm-NPS to characterize healthier foods by studying associations with a range of biomarkers reflecting pathways underlying nutrition-health associations. Methods This analysis included healthy participants from the EPIC cohort study (inclusion in 1992-2000, 8 European countries) for which blood biomarkers were measured from baseline samples in several case-control studies. Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruit and vegetables. Multi-adjusted linear models were computed. Results Consuming foods with higher FSAm-NPS scores (lower nutritional quality) was positively associated with the concentration of C-peptide (n = 788, β = 0.02, P = 0.04) and C-reactive protein (n = 899, β = 0.04, P = 0.04) and with a multi-marker profile characterized by apolipoprotein B, total and LDL cholesterol concentrations derived from principal component analysis (n = 498, lsmeans = -0.35 in quintile 1 and -0.03 in quintile 5, P = 0.02). Conclusions In this European context, higher concentrations of blood biomarkers reflecting hyperinsulinism, inflammation and dyslipidemia were observed in participants consuming foods and beverages with higher FSAm-NPS scores (lower nutritional quality/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help people eat healthier food products. Key messages • The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with concentrations of blood biomarkers reflecting hyperinsulinism, inflammation and dyslipidemia. • This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help people choose healthier foods and beverages.

Determinants of vaccine uptake in the elderly. Results from a mobile health clinic survey in Italy

Abstract Background Vaccination is one of the most effective public health tools for improving the quality of life of adults and reducing healthcare utilisation. Despite numerous vaccination campaigns targeting this population, vaccine uptake is generally low. The aim of this study was to investigate the main determinants of vaccine uptake in people aged 65 years and over. Methods A mobile health clinic initiative for health promotion has been set up in a railway wagon in the Veneto Region, Italy, in October 2022. Access was free and voluntary. Information was collected on age, gender, nationality, education level, BMI, as well as on smoking, physical activity, vegetable consumption and presence of hypertension, hypercholesterolemia and diabetes. Uptake of flu, zoster, pneumococcal and tetanus vaccines was reported by participants, as was any recommendation by healthcare professional. The effect of the variables on uptake was assessed using a multivariable logistic regression. Results A total of 638 participants were included, of whom 50.9% female. Mean age 72.6±6.1. Uptake of flu vaccine was 61.8%, while zoster 17.1%, pneumococcal 21.6% and tetanus 10.0%. The main factor for uptake was having received a recommendation from a healthcare professional (flu: AOR=4.29 95%CI 2.77-6.63; zoster: AOR=3.12, 95%CI 1.52-6.40; pneumococcal: AOR=5.11, 95%CI 2.50-10.44; tetanus: AOR=14.23, 95%CI 4.20-48,35). Flu vaccine uptake was associated with hypertension (AOR=1.77, 95%CI 1.03-3.06) and smoking (AOR=1.84, 95%CI 1.04-3.25). No association was found with other comorbidities, lifestyle or SES. Conclusions Population growth and increasing average life expectancy in Europe make vaccine uptake by older adults an integral part of a healthy lifestyle. Among factors involved in the decision whether or not to vaccinate, the recommendation from a healthcare provider remains the most important determinant, and this is more evident in the absence of specific campaigns, as in the case of tetanus. Key messages • Among possible determinants, recommendation from a healthcare provider is associated with a significantly higher uptake for flu, zoster, pneumococcal and tetanus vaccine in the 65+ population. • The magnitude of this effect is even greater in the absence of specific campaigns, as in the case of tetanus, when it increases uptake 14-fold.

ORAL HEALTH EDUCATION AND MOTIVATION FOR PARENTS AND THEIR CHILDREN IN NURSERIES

Introduction: Health education and motivation are essential public health tools and effective primary preventive methods. Nurseries can serve as ideal settings for health promotion. Purpose: To organize and conduct oral health education and motivation panel for children and parents in nurseries. Materials and methods: A motivational and educational panel for nursery-age children and their parents was created. The panel included 1. Motivational and educational module for parents in the form of a PowerPoint lecture; 2. Motivational and educational module for children - fairytale - "How Yoni defeats the Tooth Monsters" and two games - "What Mr. Toothy likes to eat "and "Let us wipe the germs from Mr. Toothy." Results: All mothers confirmed that the PowerPoint presentation was helpful. Nearly 98% of mothers learned new and valuable things about teething. The same percentage of mothers admitted that they had gained new knowledge on increasing their child's interest in performing regular oral hygiene. The results showed increased interest in oral hygiene and diet games in both groups of children included in the educational panel. The older children get, the more interest they show in listening to fairytales. Conclusion: Mothers and children have received the module very well, so it would be a valuable part of any nursery program.

Climate variability and water-related infectious diseases in Pacific Island Countries and Territories, a systematic review

Background Climate induced changes in water-related infectious disease (WRID) transmission are a growing public health concern. The effects of climate on disease vary regionally, as do key socioeconomic modifiers. Regional syntheses are necessary to develop public health tools like risk maps and early warning systems at this scale. There is a high burden of WRID in the Pacific Island Countries and Territories (PICTs). There has been significant work on this topic in the PICTs, however, to date, there has been no regional systematic review of climate variability and WRID. Methods We searched the PubMed, Web of Science and Scopus scientific databases in September 2022 using a combination of disease, climate, and country terms. We included studies that evaluated the association between climate or weather variability and a WRID in the PICTs using a quantitative epidemiological design. We assessed risk of bias using validated tools. We analysed spatiotemporal publication patterns, synthesised the outcomes of studies in relation to the international literature and identified missing evidence. Results &amp; discussion We identified 45 studies of climate and malaria, dengue, diarrhoea, leptospirosis, and typhoid, which represent major WRIDs of concern in the Pacific Islands. More than half of the studies were set in Papua New Guinea or Fiji. The number of studies published each year increased exponentially over time from the 1980s to present. We found few comparable outcomes per disease and setting across epidemiological studies which limited the potential for meta-analysis. However, we identified consistent increased incidence of diarrhoea, dengue, leptospirosis, and typhoid following extreme weather events, highlighting the necessity for adequate water, sanitation, and hygiene access across the PICTs. Additionally, there were consistent positive associations between temperature and dengue incidence in New Caledonia, highly seasonal malaria in PNG, increased diarrhoea incidence with high and low rainfall, and positive associations between leptospirosis and rainfall. These findings are biologically plausible and consistent with the international literature. Future work on this topic in the PICTs can take advantage of increasingly available health and climate data to consolidate the field across a greater diversity of settings and apply these findings to strengthening climate resilient health systems. Registration This review is registered with the international prospective register of systematic reviews (PROSPERO CRD42022353853), in accordance with PRISMA guidelines.

Survey of Food Product Labels to Assess Compliance With Labelling Provisions in Canada

Food product labels are a public health tool that guides consumers in making food choices. In December 2016, the Government of Canada amended the Food and Drug Regulations (i.e., nutrition labelling, list of ingredients, and food colour requirements). Health Canada and the Canadian Food Inspection Agency (CFIA) developed an implementation plan that focussed on education and compliance promotion of the new labelling provisions (Canadian Food Inspection Agency, 2022a). This progressive approach allows regulated parties to transition to the new changes gradually. As of December 15, 2021, the former regulations are no longer in effect, and the new labelling requirements apply. This study will survey food labels on products available in the marketplace, regarding the current labelling requirements, and determine whether there is a discrepancy in properly labelled food products between chain versus independent grocery stores of different ethnicity.

Targeted community wastewater surveillance for SARS-CoV-2 and Mpox virus during a festival mass-gathering event

Wastewater surveillance has emerged recently as a powerful approach to understanding infectious disease dynamics in densely populated zones. Wastewater surveillance, while promising as a public health tool, is often hampered by slow turn-around times, complex analytical protocols, and resource-intensive techniques. In this study, we evaluated an affinity capture method and microfluidic digital PCR as a rapid approach to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mpox (formerly known as monkeypox) virus, and fecal indicator, pepper mild mottle virus (PMMoV) in wastewater during a mass-gathering event. Wastewater samples (n = 131) were collected from residential and commercial manholes, pump stations, and a city's wastewater treatment plant. The use of Nanotrap® Microbiome Particles and microfluidic digital PCR produced comparable results to other established methodologies, with reduced process complexity and analytical times, providing same day results for public health preparedness and response. Using indigenous SARS-CoV-2 and PMMoV in wastewater, the average viral recovery efficiency was estimated at 10.1 %. Both SARS-CoV-2 N1 and N2 genes were consistently detected throughout the sampling period, with increased RNA concentrations mainly in wastewater samples collected from commercial area after festival mass gatherings. The mpox virus was sporadically detected in wastewater samples during the surveillance period, without distinct temporal trends. SARS-CoV-2 RNA concentrations in the city's wastewater mirrored the city's COVID-19 cases, confirming the predictive properties of wastewater surveillance. Wastewater surveillance continues to be beneficial for tracking diseases that display gastrointestinal symptoms, including SARS-CoV-2, and can be a powerful tool for sentinel surveillance. However, careful site selection and a thorough understanding of community dynamics are necessary when performing targeted surveillance during temporary mass-gathering events as potential confirmation bias may occur.

Social media as a public health tool during the UK mpox outbreak: a qualitative study of stakeholders’ experiences

ObjectivesThis rapid response research explored the experiences of key stakeholder groups during the 2022–2023 mpox outbreak in the UK, and in particular, the use of social media as a tool...