Public Health Workers Research Articles

Creating good career prospects for professionals in the infectious disease control in the Netherlands

Abstract Background A strong public health system in the Netherlands requires sufficient and motivated professionals. In preparation for new large outbreaks and pandemics, a strong workforce is essential. Providing good career prospects is crucial to attract, engage and retain professionals at the 25 Dutch Regional Public Health Services (RPHSs). However, it is unclear what opportunities and barriers professionals experience concerning their career prospects in the infectious disease control. Methods We aimed to identify these barriers and opportunities using focus groups with infectious disease medical doctors, nurses and assistants. Tangible solutions to address barriers and strengthen facilitating factors were gathered using in-depth interviews with key figures within the board, management, training coordinators and human resources of the RPHSs. Results Forty-six professionals participated in six focus groups. Barriers and opportunities for good career prospects included whether or not professionals experienced: personal development opportunities, achievement appreciation, and opportunities for (financial) growth. Interviews with key figures identified solutions to career prospect barriers, which were grouped into five themes: 1) Engage in conversations about career prospects, 2) Provide sufficient achievement appreciation, 3) Ensure connectivity between RPHSs, 4) Develop a perspective on career prospects, 5) Improve the image of RPHSs. Recommendations A guideline was developed for RPHSs to improve the career prospects of infectious disease control professionals including 17 recommendations. Implementation of these recommendations will contribute to the attractiveness of working in the public healthcare. Key messages • Addressing barriers and encouraging opportunities for good career prospects is essential to captivate, engage and retain public health professionals for pandemic preparedness. • Career prospects can be improved by developing and communicating a perspective on career prospects, increasing appreciation of achievements, and improving the image of working in public health.

Climate Change, Air Pollution, African Dust Impacts on Public Health and Sustainability in Europe

Abstract Climate change poses a significant threat to environmental sustainability and public health, leading to extreme weather events, rising sea levels, and biodiversity loss. Research on air pollution from African dust adversely associated with climate change highlights its significant role in trapping heat in the atmosphere and causing heat-related illnesses, cardiovascular disorders, and respiratory ailments. Smog, dust, acid rain, and ozone depletion also negatively impact ecosystems. The methods of the study also include the dynamics of climate change-induced air pollution. The implications for public health and environmental sustainability through GWR modeling and MODIS-NDVI analysis of controlling air pollution are crucial for reducing the climate crisis, safeguarding public health, and maintaining ecosystem sustainability. Results from particulate matter (PM 2.5-10), which consists of tiny particles with varying diameters, can enter the respiratory system through inhalation. This can lead to a diameter of less than 10 μm (PM 2.5-10). According to the relevant legislation, the limit value refers to the daily average value and must not exceed 50 μg/m3. While ozone in the stratosphere serves a protective function against ultraviolet radiation, excessive levels at ground level can be harmful and have been recorded in atmospheric samples ranging from 146.6 μg/m3 up to 702.3 μg/m3. impacting the respiratory and cardiovascular systems. Policy leaders, businesses, and individuals need to be proactive in reducing air pollution, adopting clean energy technology, and implementing stricter pollution rules. Stricter pollution rules, environmentally friendly transportation choices, and the adoption of clean energy technology. The sustainability of the ecosystem and public health are significantly impacted by climate change linked to air pollution. To solve these global problems and move toward a healthier, cleaner future for future generations, we must act now on climate justice. Key messages • Examine the impact of African dust air pollution on public health and its significant impacts from climate change, provide solutions to mitigate its effects on environmental sustainability in Europe. • Public health workers, Policymakers and stakeholders must prioritize reducing emissions and enforcing strict air quality laws to mitigate the negative impact of African dust on European populations.

Sociodemographic disparities in depression and anxiety symptom severity among young adults in Sweden

Abstract Background Young adults are disproportionately affected by mental health problems such as depression and anxiety. While previous studies have identified sociodemographic predictors using the four-item Patient Health Questionnaire (PHQ-4), differences in symptom severity remain less explored. This study aimed to evaluate the sociodemographic predictors of different levels of depression and anxiety symptoms among young adults in Sweden. Methods Survey data from a population-based sample of Swedish adults aged 20-21 (n = 3,226) was used. Symptom severity was categorized into three levels: normal/mild, moderate, and severe, based on established cutoff scores on the PHQ-4. Gender, parental education and birth country, and upper secondary education were assessed through linked registry information. Multinomial logistic regression was used. Results Females had a higher risk of moderate (RR = 1.8, 95% CI 1.5, 2.2) and severe (RR = 2.3, 95% CI 1.8, 3.1) symptoms (compared to no or mild symptoms) relative to males. Among males, the risk of moderate symptoms was higher without a secondary degree (RR = 1.9, 95% CI 1.0, 3.4) compared to an academic degree. Males with parents born abroad faced elevated risks of moderate (RR = 1.9, 95% CI 1.3, 2.9) and severe (RR = 2.2, 95% CI 1.3, 3.7) symptoms relative to males with Swedish-born parents. Among females, parental tertiary education was associated with a lower risk of moderate symptoms (RR = 0.7, 95% CI 0.5, 0.9) compared to lower education. Further, females having a vocational (RR = 1.5, 95% CI 1.1, 2.1) or no secondary degree (RR = 3.6, 95% CI 2.1, 6.1) had an increased risk of severe symptoms compared to females with an academic degree. Conclusions This study identified sociodemographic predictors for moderate and severe symptoms of depression and anxiety among young men and women in Sweden. Mental health promotion and prevention should specifically target young adults at elevated risk of experiencing moderate to severe symptoms. Key messages • Understanding sociodemographic predictors of depression and anxiety symptoms in young adulthood is essential for public health work. • Mental health promotion and prevention needs to include appropriate interventions for young men and women from diverse socioeconomic and cultural backgrounds.

A Grounded Theory of Healthy Masculinity and Identity Reconceptualization

ABSTRACT Research related to masculine studies focuses largely on negative aspects of masculinity rather than highlighting possibilities of healthy masculine development. The aim of this study was to provide evidence that emerging social and cultural narratives are helping assist some men to become more emotionally healthy. This study used constructivist grounded theory tools to explore broader, non-dichotomous descriptions of male emotional development and vulnerability as shared by men reflecting on their own experience of navigating cultural expectations of masculinity. Data gathered from online discussions illustrate how many men are rejecting aspects of hegemonic masculinity in favor of more positive traits, including attempts to be both strong and vulnerable. Results of this study can inform approaches to individual therapy, couples therapy, other intervention programs, and public health work for men who are seeking to develop or improve their emotional vulnerability. Specific benefits may include applications in domestic violence reduction and gender equality.

Evaluation of a massive open online course for just-in-time training of healthcare workers.

COVID-19 created a global need for healthcare worker (HCW) training. Initially, mass trainings focused on public health workers and physicians working in intensive care units. However, in resource-constrained settings, nurses and general practitioners provide most patient care, typically lacking the training and equipment to manage critically ill patients. We developed a massive open online course (MOOC) for HCWs in resource-constrained settings aimed at training bedside providers caring for COVID-19 patients. We describe the development, implementation and analysis of this MOOC. From May through June 2020, the course was developed by a multi-disciplinary team and launched on two online platforms in July. The 4-hour course comprises 6 video-based modules. Student knowledge was assessed using pre- and post-module quizzes and final exam, while demographics and user experience were evaluated by pre- and post-course surveys and learning platform data. From July 17th to September 24th, 30,859 students enrolled, 18,818 started, and 7,101 completed the course. Most participants worked in healthcare (78%) and resided in lower middle- (38%) or upper middle- (20%) income countries. Learners from upper middle-income and lower middle-income countries had higher completion rates. Knowledge gains were observed from pre-module to post-module quizzes and a final exam. Afterward, participants reported increased self-efficacy regarding course objectives, a 0.63 mean increase on a 4-point scale (95% CI [0.60,0.66]). Most participants (93%) would recommend the course to others. This article demonstrates the potential of MOOCs to rapidly provide access to emerging medical knowledge during a public health crisis, particularly for HCWs in high- and middle-income countries.

Essential core competencies for health policy graduates: a multi-method consensus type study

BackgroundIn light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.MethodsThe study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel’s findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus.ResultsIn the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work.ConclusionsIt is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

Predictors of Pandemic Impact in a Rural Community: Survey Results from a Community Partnership to Support Health and Well-Being.

Rural communities have struggled to fight the COVID-19 pandemic. Despite slower spread at the start of the pandemic in these areas, by 2021, they experienced higher death and hospitalization rates compared with urban areas. Increased mental health issues including stress, depression, and anxiety were also reported in rural areas following the start of the pandemic. Young people in these communities were significantly impacted by COVID-19, reporting increased stress and mental health issues. To examine the effects of COVID-19 on these local rural communities, authors conducted a survey in coordination with their community partners. The survey was completed by 119 participants across three rural counties and included 69 questions from the Pandemic Stress Index and the World Health Organization COVID-19 Rapid Quantitative Assessment Tool. Authors' results indicated that age, depression, and anxiety were predictors of higher self-reported COVID-19 impact. The strongest predictor of high pandemic impact in the sample was the combination of depression and anxiety symptoms. Authors used these results to inform their partners about the need for increased mental health services that are tailored for young adults in their communities. More research is needed to determine which services will be most beneficial and how to best reach those in need. Social workers in both public health and mental health settings are poised to help.

From Crisis to Catalyst: How COVID-19 Helped Humanity to Come Back Stronger Against the Pandemic

Background: The COVID-19 pandemic has brought unprecedented human suffering but has taught the human race several lessons on survival as well. Aim: In this narrative review, we discuss how humanity implemented the lessons it learned from the pandemic to ultimately win over it. Methods: Literature with documented evidence-based findings was searched using ‘Litcovid’ and Google Scholar databases using keywords such as ‘positive lessons,’ ‘learnings,’ ‘beneficial effects,’ and ‘COVID-19 pandemic’. Relevant peer-reviewed human studies published between 2020 and June 2023 were included, along with pertinent reports from newspapers and global health bodies. Conclusion: The world experienced immense suffering during the COVID-19 pandemic. However, while the pandemic has left indelible marks in terms of emptying the glass of life, somewhere, as evident, it has also helped fill it up in a never-before manner. Results: The pandemic has spurred technological progress, heightened public health awareness, and increased investment in public health infrastructure, surveillance, and research. International collaboration to meet global needs has been strengthened. Public health and healthcare workers' roles were redefined, emphasising health as an investment. This pandemic has presented new perspectives for healthcare research. Greenhouse gas emissions have decreased, and green energy has been promoted. Lockdowns have allowed nature to recover, giving wildlife the opportunity to repopulate. Improved air and water quality, better work-life balance, and increased self-growth have led to paradoxical improvements in lifestyle disorders. Interpersonal and intersectoral collaboration was valued more, and food security, reduced crime rates, and increased self-reliance were observed.

Prevalence of Trehalase Enzymopathy Genetic Determinants in Siberian and Russian Far East Populations.

. Using the Infinium iSelect HD Custom BeadChip biochip (Illumina, United States) on the iScan platform and real-time polymerase chain reaction on a Bio-Rad CFX96 Touch amplifier, genotyping of 1068 DNA samples was carried out, of which 667 represent 10 ethnic groups of the indigenous people of the North of Siberia and the Far East of the Russian Federation. Two reference groups (357 samples) of Russians (n=311) and Yakuts (n = 46) represent the "Caucasoid" and "Mongoloid" poles of the Russian population. : The reduced trehalase activity that the heterozygous GA*TREH genotype determines can manifest itself in 19.8-53.7% of indigenous northerners. An additional 1.0 to 19.7% of the population are carriers of the AA*TREH genotype, which is associated with apparent trehalose malabsorption. The carriers may experience nausea, abdominal pain, and other dyspeptic symptoms after eating trehalose containing foods. The total risk of trehalase enzymopathy among the indigenous northerners in the Asian part of the Russian Federation is very high and can reach 60-70%. There is a gradient in the A*TREH allele frequencies in the small-numbered indigenous northern groups of Russia from the west (Khanty, Mansi, Nenets) to the east (peoples of the Far East). : The results are consistent with previously reported data on the higher carriage of the A*TREH mutant allele in Mongoloid populations compared to Caucasoid groups. It was hypothesized that, while the initial A*TREH allele prevalence in Mongoloid groups was moderately high, an adaptation to a low-sugar protein-lipid "high-latitude" diet led to a weaker control over the maintenance of the carriage of the ancestral G* allele. Trehalose malabsorption requires special attention of specialists in the field of nutrition, gastroenterology, public health, and medical genetics working in high-latitude regions.

Social and humanitarian issues in nephrology and hypertension.

Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease. Undoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering. It is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.

A 2-Day Postpartum CBT-Based Training for Nurses.

Public health nurses (PHNs) are often a first point of contact for postpartum individuals seeking mental health support, but report limited training related to mental health. To determine whether a two-day cognitive behavioral therapy (CBT)-based training program focused on postpartum maternal mental health can improve PHN perceptions of their ability to deliver CBT techniques, their confidence working with distressed clients, and with managing client resistance to treatment recommendations. A convenience sample of 45 PHNs working in the Family Health Division of Niagara Region Public Health in Ontario, Canada were assessed before and after they received a two-day CBT-based training program. Before attending training, PHNs reported their current professional position, years of experience working in public health, and any previous mental health training. Their confidence in delivering CBT techniques, working with distressed clients, and with managing client resistance to treatment recommendations was assessed pre- and post-training. Participants also rated their satisfaction with the training. Statistically significant improvements were seen in confidence using CBT techniques, and in supporting and managing distressed or resistant clients. The two-day training was highly rated overall by participants. Medium to large effect sizes were found for changes in confidence-related questions. Providing PHNs with brief CBT-based mental health-related training can increase their confidence in this aspect of their practice, and could potentially improve the quality of care they provide.

Experiences and Lessons Learned From Surging the Governmental Public Health Workforce During the COVID-19 Pandemic.

During the COVID-19 pandemic, the United States relied on the public health workforce to control the spread of COVID-19 while continuing to provide foundational public health services. Facing longstanding staffing shortages, state, tribal, local, and territorial (STLT) public health agencies (PHAs) used various strategies and supports to surge the workforce in response to the pandemic. The study explored (1) the types of strategies and supports STLT PHAs used to surge the public health workforce during the pandemic, (2) assessments of surge strategies and supports, and (3) approaches to using the range of surge strategies available. We conducted 27 semi-structured interviews in 2023 and performed thematic analysis. Interviewees included STLT public health officials, leaders of organizations that directly supported the COVID-19 workforce surge, and public health workforce experts indirectly involved in the workforce surge. To surge the workforce, interviewees relied on partnerships, staffing agencies, the National Guard, the Centers for Disease Control and Prevention Foundation's COVID-19 Corps, the Medical Reserve Corps, and other strategies. Interviewees valued strategies that rapidly engaged staff and volunteers at no cost to their PHA and flexible funding from the federal government to support surge efforts but noted shortcomings in the strategies and supports available. Interviewees described using multiple strategies simultaneously but noted challenges in implementing these strategies due to inadequate planning and insufficient staff and resources. The study underscores the need for STLT PHAs to establish mechanisms to surge the workforce as part of ongoing planning for emergency preparedness. Focus areas include building administrative and hiring capacity within STLT PHAs and sustaining partnerships and contractual agreements that helped fill staffing gaps during the pandemic. To support efforts to build workforce capacity to meet future surge management needs, STLT PHAs should consider creative solutions to attract and retain staff, as well as opportunities to engage students in public health work.

The Role of Outdoor Mindfulness Intervention in Optimizing Mental Well-Being in Adolescents with Specific Learning Disabilities

Adolescents with specific learning disabilities may experience mental well-being challenges as a result of struggling academically, facing social stigma, being subjected to negative stereotypes, and experiencing heightened levels of anxiety, poor mental health, lower self-esteem, and increased stress. This study explores the potential benefits of outdoor-based mindfulness interventions as a complementary approach to remedial education, in improving mental well-being in adolescents with specific learning disabilities. This study was conducted at an institution that gives remedial education for children with specific learning disability in Thrissur, Kerala. Convenient sampling was used to select 30 students aged 13-18 years. Later, participants were randomly divided into two groups the experimental group (n=15) received outdoor mindfulness training in addition to their regular remedial education program. In contrast, the control group (n=15) received only remedial training. The study duration spanned four weeks, during which the mindfulness group participated in weekly outdoor mindfulness sessions conducted individually. They were instructed to practice mindfulness exercises daily between sessions. Both groups were assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) at the beginning (pre-intervention) and at the end (post-intervention) of the four weeks to measure changes in mental well-being. The outdoor mindfulness interventions included a range of activities, designed to optimize the level of well-being experienced by the participants in their day-to-day lives. These activities focused on enhancing the skills of mindfully listening, walking, breathing, and observing without any judgments of self and surroundings and being in the present at the moment. Results indicated significant improvements in mental well-being scores among participants in the mindfulness group compared to the control group. This underscores the potential of integrating mindfulness practices into educational settings to enhance emotional regulation and overall well-being in adolescents with specific learning disabilities, highlighting interdisciplinary opportunities across psychology, education, environmental psychology, public health, and social work to support comprehensive student development.

The Relationships between Job Performance, Job Burnout, and Psychological Counselling: A Perspective on Sustainable Development Goals (SDGs)

Job burnout (as an independent variable) and job performance (as a dependent variable) are often correlated, and one of the main arguments is that psychological counseling can mitigate job burnout, which in turn influences job performance. This article aims to introduce a new perspective on the subject by establishing a new paradigm in the field. It also explores the role of psychological counseling as a precautionary measure. Furthermore, it aligns with the United Nations Sustainable Development Goals (SDGs) 3 and 8, which seek to enhance public health, collective well-being, and decent work or at least equitable workplace conditions. Adopting a quantitative analysis method, this study used panel data from 2020 to 2023 and group regression to analyze these data. The instruments comprise job performance (KPI) and mental health records. This study revealed that job burnout as experienced by academics is regulated by their job performance (β = −0.013, p < 0.001. This study revealed that academics’ job performance remained unchanged despite the number of psychological counseling and interventions conducted, so consequently, psychological counseling and interventions do not affect performance directly. This research contributes to the literature by utilizing a novel measurement approach. It is concluded that competency is the key to having a decent work environment and staff experiencing collective well-being.

Application of the Health Belief Model (HBM) in Buruli Ulcer Education: A Literature Review

Introduction: The basic principles of the Health Belief Model as a theoretical foundation were employed to examine Buruli ulcer education. The study employed various strategies to obtain relevant studies about the constructs of the Health Belief Model which were relevant in the context of Buruli ulcer education. Method: The strategies used sought to uncover studies that have applied the Health Belief Model as a theoretical framework or theoretical foundation in Buruli ulcer education especially within Ghana and found none. Review of studies was carried out through electronic databases searches, grey materials and electronic books. Search strategy with key terms related to Health Belief Model and Buruli ulcer were employed to retrieve relevant documents. The study considered only references that were relevant to the constructs of the theory and could be used to explain Buruli ulcer education. Results: The study considered the six constructs of the theory and these included (people perceived susceptibility to Buruli ulcer, perceived severity of Buruli ulcer, perceived benefit of not contracting Buruli ulcer, perceived barriers to Buruli ulcer healthcare, cues to action for Buruli ulcer and Buruli ulcer knowledge self-efficacy), and modifying factors. The theory has been used in health education for health related events and hence was considered the appropriate theory in the context of Buruli ulcer education. Conclusion: The fundamental idea of the theory is based on the individual personal belief about the disease and the methods that exist to be used to help in the reduction of risk factors. Hence public health workers could employ the theory to help in reduction of risk factors exposures among the population especially in endemic communities in Africa.

Impact of a Stage-Based Classification on the Incidence of Fetal Growth Restriction, Preterm Birth Rates, and Birthweight in a Rural Community of Central India

Introduction: The objective of this study was to determine the impact of the stage-based classification of fetal growth restriction (FGR) on the magnitude of FGR, preterm births (PTBs), and birthweight (BW) in a rural population of Madhya Pradesh in Central India. Methods: The program covered 168 public sector centers for pregnant women and infants that provided services to nearly 220,000 people. The third-trimester assessments included fetal biometry, growth and environment assessments, and Doppler assessments. Fetal growth was staged using the Barcelona protocol as stages 1–4 FGR, small for gestational age, and no FGR. The data from the last ultrasound assessment before childbirth were considered. Regular training programs covering preconception care, antenatal and postnatal care were organized in the local language for the public sector community health workers of the program district. Childbirth outcomes were collected from the obstetric service of the local public sector hospital. Results: The analysis included 1,229 pregnancies from 2019 to 2023. The overall magnitude of FGR using estimated fetal weight <10th centile was 19.61% and reduced to 13.34% with the stage-based classification. The magnitude of FGR using the stage-based classification reduced from 27.59% in 2019 to 8.95% in 2023. The PTB in the stage-based FGR subgroup declined from 35.0% in 2019 to 3.45% in 2023 and 96.55% of the stage 1 FGR babies in 2023 were delivered at term. The overall mean BW in the program area improved from 2,772.41 (357.11) g in 2019 to 2,819.68 (377.31) g in 2023. The perinatal mortality rate (8.95 per 1,000 pregnancies) in the program area for 2019–2023 was much lower than the 31.9 per 1,000 pregnancies reported for Madhya Pradesh. Conclusion: The change to a stage-based classification of FGR integrated with low-dose aspirin and fetal Doppler studies reduced the incidence of FGR and PTB and perinatal mortality and increased BW in this rural community.

Understanding the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic: A cross-sectional study

BackgroundThere is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors.MethodsA cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health.ResultsAmong the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16–20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12–4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28–2.68), burnout (aOR = 1.61; 95% CI = 1.16–2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13–2.37).ConclusionsDuring the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

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

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

The “Cycle” of HIV: Limits of Personal Responsibility in HIV Vulnerability Among Transgender Adolescents and Young Women in Lima, Peru

Globally, transgender women (TW) face a high burden of the HIV epidemic. In Peru, HIV prevalence among TW rises at age 25, indicating a need to understand HIV vulnerability as adolescents reach adulthood. The life course of TW is often marked by abuse, discrimination and poverty fueled by transphobic stigma. Approaches to the HIV epidemic among TW and adolescents emphasize problem behaviors such as unprotected sex and substance. However, there has been a call for HIV research and interventions to understand and leverage community strengths. This qualitative study utilized a transgender-oriented, strength-based, intersectional and feminist approach to understand the strengths and protective health behaviors among 17 transgender adolescents and young women (TAYW) age 16–24 in Lima, Peru. Most participants re-located to Lima from the Amazon due to familial rejection, and engaged in obligatory sex work. TAYW demonstrated self-knowledge, motivation for education, efforts to secure employment, strong community networks, legal advocacy, avoiding problem substance use, HIV knowledge and condom use. However, strengths were impeded by multi-level barriers such as familial physical abuse, educational discrimination, and sexual assault which led to increased HIV vulnerability. We created a conceptual model of the “cycle” of HIV to describe the limits of personal responsibility within a vulnerable community denied access to family, education, employment and human rights. We recommend researchers, clinicians and public health workers follow the lead of TAYW at the frontlines of the HIV epidemic, and support beloved communities and enabling environments which may permit protective behaviors to mitigate HIV vulnerability.

Generating "Différance" or an Ontology That Is Same Old Same Old Comment on "The Generative Mechanisms of Financial Strain and Financial Well-Being: A Critical Realist Analysis of Ideology and Difference"

Glenn and colleagues carefully conducted a realist review of initiatives introduced in high-income countries intended to improve financial well-being (FWB) or reduce financial strain (FS) during the early days of the pandemic. They found that these initiatives were underpinned by either neoliberal or social equity ideologies, within which, social location acted on different groups. In this commentary, we suggest caution in applying labels such as neoliberalism and social equity when lumping social welfare policies; labour policies; housing and financial services policies; and service provision for health, seniors, childcare, and education across welfare state regimes. We also caution against aggregating equity-deserving groups from different contexts into a single otherness. We suggest a pragmatic reinterpretation of the study’s findings and in future examinations of post-pandemic recovery in accordance with long-standing pragmatic methods of working in public health that seek to improve population health and well-being through collective action.