Public Health Value Research Articles

COVID-19 Antibody Tests: A Valuable Public Health Tool with Limited Relevance to Individuals.

Antibody tests for detecting past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have many uses for public health decision making, but demand has largely come from individual consumers. This review focuses on the individual relevance of antibody tests: their accuracy in detecting prior infection, what past SARS-CoV-2 infection can currently infer about future immunity or possible medical sequelae, and the potential future importance of antibody tests for vaccine selection and medical screening. Given uncertainty about the antibody tests (quality, accuracy level, positive predictive value) and what those tests might indicate immunologically (durability of antibodies and necessity for protection from reinfection), seropositive test results should not be used to inform individual decision making, and antibody testing should remain a tool of public health at this time.

Endocrine-Disrupting Chemicals Linked to ADHD Behaviors in Adolescents

Back to table of contents Previous article Next article Clinical & ResearchFull AccessEndocrine-Disrupting Chemicals Linked to ADHD Behaviors in AdolescentsTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:5 Nov 2020https://doi.org/10.1176/appi.pn.2020.10b8AbstractChemicals used in common food packaging and personal care products may have a greater impact on boys than on girls.Exposure to endocrine-disrupting chemicals during adolescence may increase the risk of behaviors associated with attention-deficit/hyperactivity disorder (ADHD), a study in JAMA Network Open suggests. These chemicals, such as bisphenols, parabens, and phthalates, are found in food packaging, cosmetics, and other consumer products and are thought to interfere with the body’s hormones.It may be easier to detect the association between exposure to endocrine-disrupting chemicals in boys than girls because boys may have a wider range of ADHD symptoms, says Susan A. Korrick, M.D.Susan Symonds for Infinity Portrait Design“ADHD is the most common behavioral disorder of childhood and can have substantial associated morbidity in health and function. If it turns out that adolescent exposure to endocrine-disrupting chemicals contributes to ADHD behaviors, and exposure could be altered, that could be a valuable public health measure,” said senior author Susan A. Korrick, M.D., an assistant professor in the Department of Environmental Health at the Harvard T.H. Chan School of Public Health and the Department of Medicine at Harvard Medical School. She is also an associate physician at Brigham and Women’s Hospital.Korrick and colleagues analyzed data amassed from the New Bedford Cohort between June 2011 and June 2014. The New Bedford Cohort is a cohort of mother-infant pairs who were recruited after delivery between 1993 and 1998 and who continue to provide information to researchers. In the current study, Korrick and colleagues analyzed urine samples for concentrations of endocrine-disrupting chemicals or their metabolites in 205 adolescents with an average age of 15.3 years. The adolescents, their parents, and their teachers completed behavioral checklists about the adolescents drawn from the Conners Attention Deficit Scale and the Behavior Assessment System for Children, Second Edition. Among the adolescents, 40% had scores on at least one behavioral checklist that suggested a significant behavioral problem, and 19% had an ADHD diagnosis either in their pediatric medical records or reported by their parents.The strongest and most consistent associations were seen for antiandrogenic phthalates. For each twofold increase in antiandrogenic phthalate concentrations, adolescents had a 1.34 increase in the risk of significant behavior problems related to ADHD, a 1.26 increase in risk for attention problems, and a 1.4 increase in risk for hyperactivity problems. For each twofold increase in dichlorophenols, adolescents had a 1.15 increase in the risk of significant behavior problems related to ADHD, a 1.05 increase in risk for attention problems, and a 1.22 increase in hyperactivity problems.The associations tended to be stronger for boys than for girls. Although the study was not designed to determine why, Korrick noted that the results are in line with prior research about exposure to other developmental toxicants in other age groups.“Sex differences in the impact of endocrine-disrupting chemicals on behavior have been seen in other studies, including our own, especially with prenatal exposure. For example, in previous research on the New Bedford Cohort children at age 8 years, boys’ performance on some psychometric tests was more adversely impacted than girls’ after prenatal exposure to methylmercury or polychlorinated biphenyls,” Korrick told Psychiatric News.“Another factor that may contribute to boy-girl differences is that ADHD symptoms are more common in boys,” Korrick added. “Boys potentially have a wider range of symptoms than girls, which can sometimes mean it’s easier to detect an association between exposure and behavioral symptoms.”Korrick noted one caveat to the results. “This was a cross-sectional study, so we can’t say with certainty whether exposure altered behavior or behavior altered exposure. We tried to account for this issue by adjusting our statistical models with information about lifestyle or behaviors that could increase exposure risk,” she said. “The results were unchanged after these adjustments, which supports the potential for exposure to change behavior rather than the reverse. But, bottom line, we can’t be certain of the direction of association in a cross-sectional analysis.”This study was supported by the U.S. Environmental Protection Agency and the National Institute of Environmental Health Sciences. ■“Association of Exposure to Endocrine-Disrupting Chemicals During Adolescence With Attention-Deficit/Hyperactivity Disorder–Related Behaviors” is posted here. ISSUES NewArchived

Early diagnosis and population prevention of coronavirus disease 2019.

To discuss the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by nucleic acid and antibody testing as well as its contribution to mitigating the spread of coronavirus disease 2019. Nucleic acid testing (NAT) is the firstly developed and most widely used diagnostic technique for SARS-CoV-2 infection. However, the sensitivity of SARS-CoV-2 RNA NAT assays is always unsatisfactory, mainly due to insufficient viral RNA in samples, especially when upper respiratory samples were used. Compared with NAT assays, serological tests are more convenient and less dependent on the quality of sample collection. But the sensitivity of antibody assays varies largely to test samples collected at different time after onset of symptoms. The diagnostic sensitivity can be significantly improved by combination of RNA and antibody testing. Due to the lack of effective drugs and vaccines, population prevention results mainly from timely triage and quarantine of SARS-CoV-2 infected individuals. Thus, extensive testing with NAT and antibody assays simultaneously is very important to constrain coronavirus disease 2019 epidemic. Viral RNA testing combining with serological testing could improve the early diagnosis of SARS-CoV-2 infection, which has great value for clinical practice and public health.

The time is now for public health to lead the way on addressing financial strain in Canada

Financial strain was an issue for many Canadians long before the arrival of the global novel coronavirus pandemic in early 2020. However, it has worsened in recent months in relation to the pandemic and public health measures put in place to prevent the spread of COVID-19. Members of underserved groups and people who experience poverty are particularly vulnerable to financial strain and its negative health impacts. As public health professionals, we should be concerned. In this commentary, we discuss the concept of financial strain and its health consequences and highlight how existing research in the area is falling short and why. We suggest next steps to guide research and practice related to financial strain such that it reflects the core values of public health, including equity, life course approaches, and the social determinants of health. This commentary is a call to action for public health researchers and practitioners in Canada to take a more prominent role in shaping the agenda on financial strain to support financial well-being for all.

ТЕОРЕТИЧЕСКАЯ МОДЕЛЬ СОЦИОЛОГИЧЕСКОГО АНАЛИЗА ЦЕННОСТИ ЗДОРОВЬЯ НАСЕЛЕНИЯ АРКТИЧЕСКОГО РЕГИОНА РОССИЙСКОЙ ФЕДЕРАЦИИ

Представлена теоретическая модель социологического анализа ценности здоровья как многокомпонентная система. Приведено описание компонентов модели и их характеристик. Исследованы факторы информированности, поведенческой активности, здоровьесбережения, персональной ответственности за здоровье. Подчеркнута особенная актуальность в условиях Арктической зоны с присущими особенностями климатогеографического положения и экстремальностью жизнеобеспечения. Актуальность вопросы изучения ценности здоровья населения обрели в условиях глобализации ХХI в. Назрела необходимость решения проблем сохранения здоровья человека. Особенную остроту приобретает эта проблема в условиях Арктической зоны Российской Федерации. Природные и антропогенные факторы предъявляют повышенные требования к функциональным системам организма человека, осложняют труд, быт и отдых населения, являясь факторами риска нарушений здоровья. Особую актуальность проблемы здоровья обрели во время пандемии нового коронавируса COVID-19. Это один из худших мировых кризисов в сфере здравоохранения за последние 50 лет. На первый план встали вопросы обеспечения санитарно-эпидемиологического благополучия, здоровьесбережения, повышения ценности здоровья. Цель работы – рассмотрение ценности здоровья населения Арктического региона Российской Федерации через призму теоретических основ и институциональных подходов. Методы: аксиологический подход, предполагающий ценностное измерение исследуемых социокультурных явлений, и социально-конструктивистский подход, рассматривающий ценность здоровья населения Арктического региона как необходимую социальную парадигму. Выводы: во-первых, создание теоретической модели, ее использование в социологическом анализе ценности здоровья населения Арктического региона Российской Федерации и представление исследуемого объекта с разных сторон позволяют достичь наибольшей содержательности и полноты понятий, относящихся к данной области знаний. Во-вторых, содержание теоретической модели, предлагаемой нами, представляет собой определенную целостность, которая в неразрывном единстве включает изучение конкретных аспектов жизни общества, взаимосвязей, а также возможности и способы ее использования в исследовательской деятельности. Благодаря моделированию, при сопоставлении характеристик с конкретной действительностью, общество проявляет себя с разных сторон и выглядит как сложно организованная система. В-третьих, в рассмотренных ранее подходах и концепциях анализировались связи состояния здоровья с различными факторами, среди которых стали преобладать поведенческие. Исследованы также факторы информированности, двигательной активности. В поле рассмотрения попали также здоровьесбережение, персональная ответственность за здоровье, способы выхода из стрессовых состояний. В‑четвертых, особенную актуальность факторы приобретают в условиях Арктической зоны, с присущими особенностями климатогеографического положения и экстремальностью жизнеобеспечения. В-пятых, теоретическая модель является не только способом познания, но и управляющим инструментом исследования.

2D Speckle Tracking echocardiography in the prognostication of left ventricle diastolic dysfunction

The aim of the study: to develop prediction comprehensive criteria for the diastolic dysfunction (DD) of the left ventricle (LV) according to 2D Speckle Tracking echocardiography (STE).Materials and methods. A clinical and instrumental study of 91 patients aged 64.0 was performed [58.0; 70.0] years in the Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology in 2019. Criteria for inclusion: sinus rhythm, essential arterial hypertension, chronic coronary artery disease, previous left myocardial infarction, after which at least six months have passed to stabilize the LV structural and functional parameters, chronic heart failure, patient informed consent. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. Transthoracic echocardiography and STE was performed on ultrasound machine Vivid E9 (GE Healthcare, USA).Results. The leading functional anomalies, interconnected in the development of LV DD, are decline of the LV longitudinal diastolic, regional and global systolic strain, LV mechanical dispersion and dyssynergy. Correlations between LV DD type II and the mechanical dispersion index (r = 0.69, p < 0.001), delta of LV time to peak longitudinal deformation (r = 0.66, p < 0.001), LV global post-systolic index (r = 0.58, p < 0.001), GLSAVG (r = 0.63, p < 0.001) were established. LV DD is characterized by early diastolic longitudinal strain E of the LV basal lateral segment > −6.75%, LV basal septal segment > −5.22%, early and late diastolic longitudinal strain ratio E/A of the LV basal lateral segment ≤0.91, basal-septal segment ≤0.69. LV DD type I is characterized by an LV mechanical dispersion index >49.34 ms, LV delta time to peak longitudinal strain >157 ms. Prognostic values for LV DD type II are LV mechanical dispersion index >49.34 ms, delta time to peak longitudinal strain is >136 ms, global post-systolic index >6.24%, mechanical dyssynergy index >4.60%, global LV peak longitudinal displacement ≤9.88 mm, GLSAVG > −18.5% (sensitivity 88.2%, specificity 83.3%).Conclusions. The use of the developed STE prediction value in practical public health will increase the efficiency of diagnosis of LV DD.

Everyday citizenship and COVID-19: “Staying at home” while homeless

In an effort to slow the spread of the novel coronavirus, local and state authorities have enacted stay-at-home orders, limiting citizens’ movement outside of the home to “essential” activities and work. Although a seemingly mundane action, staying out of public spaces is a form of co-production aimed at co-creating public health value. People who are homeless, lacking the resources needed to stay at home, are unable to equitably participate in this act of co-production. As a result, their status as a citizen in the “everyday” sense is compromised.

Vaccine Hesitancy and Demand for Immunization in Eastern Europe and Central Asia: Implications for the Region and Beyond

Immunization is a global success story. It has saved millions of lives and prevented disease worldwide and millions more have been spared the permanent disabilities caused by diseases such as polio and the long-term morbidity caused by other diseases such as measles. Despite the compelling evidence of the public health and economic value of vaccines, vaccine hesitancy has become a growing concern globally. By calling into question the safety and efficacy of vaccines, vaccine hesitancy threatens the progress made in combating morbidity and mortality including efforts to introduce COVID-19 vaccines. This paper a) examines key factors that drive limited demand for vaccines and vaccine hesitancy, (b) highlights the role of demand promotion for immunization and of risk communication and community engagement to address those challenges, (c) discusses vaccine demand and hesitancy in Eastern Europe and Central Asia, and (d) makes recommendations for public health policy and programming for the introduction of the COVID-19 vaccine and beyond. Recommendations include strengthen social listening and digital engagement to address the concerns of caregivers and healthcare professionals, improve the availability and use of social data for evidence-based programming, reinforce public trust in health institutions and service providers, mainstream demand for immunization, strengthen the communication competencies of health service providers, test and apply solutions based on behavioral insights to reinforce demand, engage regularly with local governments and local actors, and strengthen resilience and response capacities for diseases outbreaks and public health emergencies.

Pattern of Paediatric Mortality of hospitalized patients in a Tertiary Care Hospital Rawalpindi

Introduction: Mortality of children is the prime indicator of a country’s health status and its development. Understanding child mortality among different age groups is one of the valuable public health insights. Therefore, studies regarding child mortality patterns are essential for re-evaluating existing health services.
 Objective: The objective of this study is to describe the pattern of paediatric mortality in our hospital.
 Materials and Methods: A retrospective analysis was done with the medical records of Pediatric patients (up to 12 years)who died in the Pediatrics department of Benazir Bhutto Hospital, Rawalpindi from 1stJan2018 to 31stDec 2018.
 Results: A total of 15,500 children were admitted to the Paediatric department from 1st January 2018 to 31st December 2018. A total of 1738 deaths were recorded. The overall mortality of 11.3% was noted in the cases admitted to the Paediatric Department.
 Conclusion: Septicemia, Acute respiratory infection(ARI)/Pneumonia, Birth asphyxia, and low birth weight (LBW)/prematurity were the major causes of pediatrics mortality.

The Potential Public Health and Economic Value of a Hypothetical COVID-19 Vaccine in the United States: Use of Cost-Effectiveness Modeling to Inform Vaccination Prioritization

Background: Researchers are working at unprecedented speed to develop a SARS-CoV-2 vaccine. We aimed to assess the value of a hypothetical vaccine and its potential public health impact when prioritization is required due to supply constraints.Methods: A Markov cohort model was used to compare COVID-19 related direct medical costs and deaths in the United States (US), with versus without implementation of a 60% efficacious vaccine. To prioritize the vaccine under constrained supply, the population was divided into tiers based on age; risk and age; and occupation and age; and outcomes were compared across one year under various supply assumptions. For each prioritization strategy, the incremental cost per quality-adjusted life-year (QALY) gained versus no vaccine was calculated overall and by tier.Findings: Overall, the cost per QALY gained for all vaccination strategies was $8,200 versus no vaccination. For the tiers at highest risk of complications from COVID-19, vaccination was cost-saving compared to no vaccination. The cost per QALY gained increased as the risk of hospitalization and death within each tier decreased. Under the most optimistic supply scenario and the most efficient prioritization scenario, the vaccine may prevent 32% of expected deaths. As supply becomes more constrained, prioritization is required to optimize the prevention of deaths.Interpretation: A COVID-19 vaccine is predicted to be good value for money (cost per QALY gained Funding: Moderna, Inc.Declaration of Interests: MK and DB are shareholders in Quadrant Health Economics Inc. Quadrant Health Economics Inc. was contracted by Moderna, Inc. to conduct this study. MM and MCW are consultants at Quadrant Health Economics Inc.

Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.

Evidencing value of public health programmes to enable sustainable investment for health & wellbeing

Abstract Issue Global sustainability challenges related to health, inequity, the environment and the economy require urgent innovative action and focus on prevention. Fair evidence-informed prioritisation of scarce resources is pivotal to ensure sustainable investment policies and practices. It is key to capture the value and return on investment of public health (prevention) programmes in order to show their wider benefit to people, communities, society, economy and our planet. Description The Evidencing Value project builds on a global and national drive towards measuring the value of health services and interventions. The World Health Organization Collaborating Centre for Investment in Health and Well-being (WHO CC) is developing an innovative approach and digital solution to assess the holistic (economic, social and environmental) value and return on investment of public health programmes. It uses a Social Return on Investment (SROI) approach, which involves key stakeholders from the beginning and measures what matters most. This helps to identify the wider impact and outcomes of different health protection, disease prevention and health promotion programmes. The evidence is embedded in an interactive digital database to inform investment prioritisation and quality improvement. Results Project outputs include: (i) structured evidence repository detailing the value of public health services and interventions; (ii) interactive digital database for storage, manipulation and presentation of data; (iii) SROI pilots; and (iv) generalised framework for investing in public health/prevention to be used by other public bodies and countries. Lessons It is essential to understand the wider impact and value of public health programmes to facilitate Universal Health Coverage and sustainable investment for health and wellbeing. This project uses an innovative approach and digital solution to enable evidence informed resource allocation and decision-making focused on prevention. Key messages Evidencing value of public health supports the case for investing in prevention. Using innovative methods and digital solutions is essential to inform sustainable investment for health.

Value-driven workforce, systems and leadership

Abstract Background Our norms and values are key to decision making, policy and practice. Some commentators have highlighted need for greater courage and purpose in public health leaders and systems. There is need for greater appreciation of moral mandate of public health and implications for public health system leadership and capacity building activities and practice Objectives Demonstrate the case for value-driven workforce, systems and leadership Share key findings and learning from research by the Faculty of public health around the public health values, and activities to build capacity and competency around the issue. Body of the session Surveys of the public health workforce and schools of public health have consistently highlighted need for education and training in public health ethics and law for some time and their key role for effective public health policy and practice. In this presentation there will be demonstration of the key findings of the surveys and their consequences, including moral distress for the workforce and potential failings of public health systems Some key activities and initiatives in building competency and capacity in public health ethics and law will be described. This will include activities to develop organisational values and professional values and the important distinctions between them, and development of public health code of ethics and professional conduct as part of efforts for professionalisation of the public health workforce. Conclusions Value-driven workforce, systems and leadership are key in meeting complex public health challenges. Building competency and capacity of the workforce and public health institutions are important part of the agenda.

A scorecard for local body election candidates in New Zealand

Abstract Local elections are held every 3 years in NZ for District Health Boards (DHB). The public has low capability to scrutinise candidates for their knowledge/experience in public health governance. As a result, there is low voting turn-out for elections. So, 3 PHA branches developed scorecards for 2019 candidates. Our aims addressed 3 problems: 1. How to raise public awareness about local DHB elections 2. How to engage voters and provide them with information about candidates from a public health perspective 3.Can we encourage candidates to discuss public health issues/ preventative measures publicly. We hoped to promote democracy by increasing informed voter turnout. Scorecards were based on candidates' responses to a survey with 3 dimensions: alignment with public health values; health sector governance experience; views on a specific public health issue (water fluoridation). Survey responses were scored by panels of branch members. Southern branch sent the survey to 28 DHB candidates across 2 DHBs, and 24 replied in time. Wellington branch sent it to 23 CCDHB candidates and 16 replied in time. Canterbury's response rate was just over 50%, 11 of 21 surveys were returned. We produced scorecards for results in formats for printing and sharing online. We shared them on PHA's website, social media and featured them in the e-newsletter. Each branch launched them at local Meet the DHB Candidate events where hundreds of paper copies were distributed. There was good online interest in the scorecards: 3453 previews, 287 downloads for further printing/distribution. Many candidates committed, if elected, to policy solutions presented them at our events. There was significant increase (684 in Southern, 698 in Wellington, 2006 in Canterbury) in DHB voter turnout in 2019, compared to last election with no scorecards. Not all top-scoring candidates were subsequently elected onto respective DHBs, but for Wellington and Southland all elected had high scores. Key messages PHANZ plays a role in supporting NZ democracy by filling a gap in public information about election candidates, whether they are fit for purpose when scrutinised through the public health lens. Election Scorecard are effective for raising public awareness, providing scrutiny of the candidates from a public health perspective, encouraging candidates to consider public health issues.

Model for assessing health damage from air pollution in quarrying area – Case study at Tan Uyen quarry, Ho Chi Minh megapolis, Vietnam

Vietnam has a great demand for stone exploitation for the development of the country's infrastructure, reaching 181 million m3 in 2020. Mining activities are always accompanied by environmental pollution, negatively affecting public health. To accurately assess the level of pollution, as well as quantify the effect of air pollution on human health, a number of structures, methods, and models provide tools to assess the benefits of this control for public health and related economic values. However, there has been no research in Vietnam applied specifically to this type of stone exploitation. This study offers a model to evaluate the economic damage caused by dust exposure from activities related to quarrying, overcoming the lack of continuous monitoring data. The area selected for research is Binh Duong province, in the Ho Chi Minh megapolis, Vietnam, which has two construction quarries, Thuong Tan and Tan My, with a current annual production of approximately 4–5 million m3. The calculation results show that the damage to human health is estimated at approximately 9,643 billion dong a year, equivalent to 15.03 million USD. In addition, if the standard criteria are tightened, damage will continue to increase. This study also analyses some of the difficulties and limitations in the modelling process.

Enhancing partnerships and collaboration in times of change

Abstract Issue In 2019, the government of the Canadian province of Ontario announced major changes to the structure, governance and funding of public health services. Throughout these changes, publicly funded local and regional public health organizations are still expected to provide effective, evidence-informed programming to their communities. The National Collaborating Centre for Methods and Tools (NCCMT) has facilitated collaborations to support Ontario public health through this transition. Description of the problem In order to support evidence-informed public health in Ontario during this transition, the NCCMT reached out to current and potential partners, within and beyond the public health sector for a multidisciplinary approach. We conducted a needs assessment for an evidence review repository, which would allow public health practitioners to share and build upon each other's work. Finally, demonstrating the value of public health to policymakers can be inherently challenging as the return on investment in public health is often very long term. We partnered with health units in varying capacities to find and synthesize evidence to advocate for continued investment in public health. Results This initiative has provided important lessons in developing and maintaining strong partnerships. Looking beyond the public health sector can establish mutually beneficial partners and allies in other disciplines. A key finding was the need to establish infrastructure to support collaboration and resource sharing. Finally, we learned that big picture questions like demonstrating the value of public health require many different perspectives, inputs and areas of expertise. Lessons Through this initiative, we have developed a multidisciplinary, collaborative approach to supporting evidence-informed public health through times of major restructuring. This approach can be applied to future changes to public health on smaller or larger scales, or within other geographic regions. Key messages Multidisciplinary approaches can support collaboration, unity and advocacy in times of change. Establishing infrastructure to support collaboration and sharing of resources is valuable.

25.G. Round table: Public health codes of ethical professional conduct for effective practice

Abstract One of the major outputs of the WHO Regional Office for Europe “Coalition of Partners” initiative has been the development of the “Road map for professionalization of the public health workforce in Europe.” Public health ethics was considered as one of the key pillars for practice for the workforce. The report highlighted the case and urgent need for development of Public Health Codes of ethics and professional conduct (CoC) as an essential part of workforce development strategies. The development of CoCs is considered essential to pursue the mission and moral mandate of public health and to clarify the purpose of professional activities in public health. Scotland has been working as an initial pilot site in Europe to consider developing a CoC for its workforce as part of its public health reform program. The purpose of this roundtable workshop is to share and reflect on the learning from the process, experience and findings from development of the Scottish CoC as the first pilot site in Europe and implications for development of such codes in other public health systems. The workshop will also share the evidence, rationale and background to CoC with research and learning from around the world on the issue. The Roundtable will include brief presentations by an experienced expert panel of senior public health leaders, ethicists and academics who have been working on development of public health Codes of professional conduct. This will be followed by reflection, consultation and debate with participants around the case, nature and options for development of codes of practice and distinguishing features for public health practice. There are issues to whether there is need for country specific, regional or global codes of ethics taking account core public health values and implications for practice. One of the key issues identified is fundamental importance of ensuring such work is linked to a strategy and activities to build competency and capacity around public health ethics and law and to ensure resources, systems and robust education and training activities are put in place for a sustainable development of the issue. Key messages The Development of CoCs is important in order to support the workforce, pursue the mission and moral mandate of public health and clarify the purpose of professional activities. There is need to develop activities and strategy for building competency and capacity in public health ethics alongside development of Code of ethics and professional conduct.

Reimagining Public Health in the Aftermath of a Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for society, affecting those already subject to unacceptable health inequalities and resulting in vast economic impacts. The pandemic reminds everyone of the value and necessity of public health.In the context of an era that will be shaped by COVID-19, we outline the coming series of challenges and transitions in public health and the needed actions over the next 5 years to reinvent our public health systems. Multiple limitations in current US and global public health systems have been uncovered by the pandemic, including insufficient preparedness and surveillance capabilities complicated by long-standing and worsening health inequalities and the rapid spread of misinformation that needs to be countered. We foresee 3 phases for public health over the next 5 years: (1) reactive crisis management, (2) efforts to maintain initial gains, and (3) efforts to sustain and enhance progress.A reinvented public health system will depend highly on leadership and political will, rethinking how we categorize and address population-level risk, employing 21st-century data sciences, and applying new communication skills.

Trauma in Tanzania: Researching Injury in a Low-Resource Setting

The prevalence of surgical trauma as a global public health hazard has been severely neglected. Trauma surgeons in Uganda and Canada have developed the Kampala Trauma Score (KTS), a trauma severity index specific to east African contexts. Hospitals in Tanzania have begun to use this tool to measure their own trauma management protocols in order to measure the validity of this index regionally. This study sought to enhance analysis of data collected through the KTS, by highlighting the efficacy and the lacunae of this registry through evaluation of the data quality of one ongoing round of data collection at an orthopaedic emergency room in Dar es Salaam, Tanzania. The data was screened for missing values that would have impact on prediction of clinical evolution and also analysed for contradictory evidence. Interviews were conducted with data collectors on the main challenges involved in data gathering and analysis for this project. Analysis of the initial round of data collection confirms road accidents cause the most trauma in Dar es Salaam, with pedestrians being particularly vulnerable. However, critical sources of information such as serious injury scores and two-week followup were inconsistently recorded, thereby limiting outcome measurement. The lack of research resources, both financial and human, had a major impact on the ability to sustain the data collection. While the results of this study demonstrate the public health value of having a mechanism to record trauma, research capacity must be supported in low-resource settings in order to enhance clinical care to accident and injury patients.

Chemosensing Test Paper Based on Aggregated Nanoparticles of a Barbituric Acid Derivative

The development of sensitive, cheap, and portable methods for detecting nitroaromatics explosives has a profound significance and value for public health and environmental protection. For this purpose, a new D-π-A barbituric acid derivative CB-CYH with aggregation-induced emission (AIE) behavior was synthesized, which can interact with picric acid through photoinduced electron transfer (PET). Scanning electron microscopy (SEM) and dynamic light scattering (DLS) indicate that the enhanced emission of the compounds is related to the formation of nano-aggregates. It is well known that an important source of mechanochromic fluorescence (MCF) characteristic materials is the compound with AIE characteristics. The chemosensing test paper prepared by aggregated nanoparticles based on AIE properties is often subjected to external friction or squeeze during transportation or storage, resulting in changes of their optical properties, and destruction of test paper followed. Therefore, the development of compounds with AIE properties and stable optical properties in the presence of external stimuli is particularly important for chemosensing test paper. Molecular dynamics simulation (MDS) shows that the presence of hydrophobic cycloalkyl group in CB-CYH, which caused the molecules to be closely interspersed with each other; hence, it is difficult to change the microstructure and stacking mode of molecules by external stimulation simultaneously; the optical properties are not changed by external stimuli. Therefore, the test paper based on the AIE effect of CB-CYH was developed as chemosensing test paper for the detection of nitroaromatics.