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Making healthy food choices is crucial for health promotion and disease prevention. While there are an increasing number of technology-assisted interventions to promote healthy food choices, the underlying mechanism by which consumption behaviours and weight status change remains unclear. Our scoping review and meta-analysis of 17 studies represents 3,988 individuals with mean ages ranging from 19.2 to 54.2 years old and mean body mass index ranging from 24.5kg/m2 to 35.6kg/m2. Six main outcomes were identified namely weight, total calories, vegetables, fruits, healthy food, and fats and other food groups including sugar-sweetened beverages, saturated fats, snacks, whole grains, sodium, proteins, fibre, cholesterol, dairy, carbohydrates, and takeout meals. Technology-assisted interventions were effective for weight loss (g=-0.29; 95% CI=-0.54, -0.04; I2=65.7%, t=-2.83, P=0.03) but not for promoting healthy food choices. This highlights the complexity in creating effective interactive technology-assisted interventions and understanding its mechanisms of influence and change. We also identified that there needs to be greater application of theory to inform the development of technology-assisted interventions in this area as new and improved interventions are being developed.
Mary Brazelton argues that the territories and peoples associated with China have played vital roles in the emergence of modern international health. In the early twentieth century, repeated epidemic outbreaks in China justified interventions by transnational organizations; these projects shaped strategies for international health. China has also served as a space of creativity and reinvention, in which administrators developed new models of health care during decades of war and revolution, even as traditional practitioners presented alternatives to Western biomedicine. The 1949 establishment of the People's Republic of China introduced a new era of socialist internationalism, as well as new initiatives to establish connections across the non-aligned world using medical diplomacy. After 1978, the post-socialist transition gave rise to new configurations of health governance. The rich and varied history of Chinese involvement in global health offers a means to make sense of present-day crises.
People who make medically serious suicide attempts (MSSAs) share a number of features with those who die by suicide, and are at a high risk of suicide themselves. Studies to date have mostly focused on clinical samples of MSSAs. An epidemiological examination at a national level can help to identify risk profiles and pathways of care in this population.
Methods
We explored the French nationwide hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI) to identify any MSSA taking place between 2012 and 2019. Relevant demographic and medical information was collected about the first MSSA of each attempter. Data from 2010 and 2011 were used to verify the absence of prior attempts.
Results
First occurrences of MSSAs amounted to 81 959 cases over 8 years, with a mean age of 45.8 years, and 53.6% women. Incidence was higher in women (18.1 v. 17.3 per 1 00 000). The most common suicide method was deliberate self-poisoning (64.9% of cases). In comparison, violent methods associated higher mortality and comorbidity and were more frequent in men. The most common mental disorders were mood disorders (55.6%) and substance use disorders (46.2%). A minority of MSSA survivors were hospitalised in psychiatry (32.5%), mostly women.
Conclusions
MSSAs are frequent and easy to identify. There is a need to reinforce the continuity of psychiatric care for this population given the high risk of subsequent suicide, and the low rates of psychiatric hospitalisation after an MSSA even if violent methods are used. Specific care targeting this population could reduce treatment gaps.
Non-alcoholic fatty liver disease (NAFLD) represents an excessive fat accumulation within the liver, usually associated with excess body weight. A liver biopsy is the gold standard for diagnosis, but it is inapplicable in population-based studies. In large populations, non-invasive methods could be used, which may also serve to identify potential protective factors. We aimed to: [a] estimate NAFLD prevalence in the adult population in Chile by using non-invasive methods; and [b] determine the association between the presence of NAFLD and lifestyle habits. The National Health Survey of Chile 2016-2017 was analysed. We included individuals aged 21-75 years, without infectious diseases nor risky alcohol consumption. NAFLD was detected by either Fatty Liver Index (FLI; considers circulating triglycerides, circulating gamma-glutamyl-transferase, body mass index, and waist circumference), Lipid Accumulation Product (LAP; considers sex, circulating triglycerides, and waist circumference), or their combination. Lifestyle habits were determined by questionnaires. We included 2,774 participants, representative of 10,599,094 [9,831,644–11,366,544] adults in Chile. NAFLD prevalence [95%CI] was 39.4% [36.2–42.8] by FLI, 27.2% [24.2–30.4] by LAP, and 23.5% [20.7–26.5] by their combination. The prevalence progressively increased with increasing body mass index. Less smoking, and more moderate-vigorous physical activity and whole-grain consumption were associated with lower odds of having NAFLD, independently of body mass index. At least one out of four adults in Chile is afflicted with NAFLD. Health promotion strategies focused on controlling excess body weight and promoting specific lifestyle habits are urgently required.
The impact of individual symptoms reported post-COVID-19 on subjective well-being (SWB) is unknown. We described associations between SWB and selected reported symptoms following SARS-CoV-2 infection. We analysed reported symptoms and subjective well being from 2295 participants (of which 576 reporting previous infection) in an ongoing longitudinal cohort study taking place in Israel. We estimated changes in SWB associated with reported selected symptoms at three follow-up time points (3–6, 6–12 and 12–18 months post infection) among participants reporting previous SARS-CoV-2 infection, adjusted for key demographic variables, using linear regression. Our results suggest that the biggest and most sustained changes in SWB stems from non-specific symptoms (fatigue −7.7 percentage points (pp), confusion/ lack of concentration −10.7 pp, and sleep disorders −11.5pp, P < 0.005), whereas the effect of system-specific symptoms, such as musculoskeletal symptoms (weakness in muscles and muscle pain) on SWB, are less profound and more transient. Taking a similar approach for other symptoms and following individuals over time to describe trends in SWB changes attributable to specific symptoms will help understand the post-acute phase of COVID-19 and how it should be defined and better managed. Post-acute COVID19 symptoms were associated with a significant decrease in subjective well being up to 18 months after initial infection
This article addresses three main issues: the relationship between commute time and sickness absence, the heterogeneity of the commuting–absenteeism effect between rural migrants and urban citizens, and the effect of China’s Hukou system on the commuting–absenteeism effect. It applies a unique set of employer–employee matched data in China and a zero-inflated negative binomial model. We find clear evidence that a longer commuting time contributes to an increase in sickness absence. The heterogeneity of the commuting–absenteeism effect can also be confirmed: longer commuting leads to higher absence rates for urban citizens but not for rural migrants. Furthermore, we explore the effect of commuting on a set of health-related outcomes. The estimations demonstrate that commuting time has a significant impact on health-related outcomes for both migrants and urban citizens, but unequal access to housing provision and to social health insurance in the Hukou system may mean that rural migrants resort to more informal medical services and thus lack access to the official sickness certificate required to seek legal sickness absence. We recommend accelerated reform of the Hukou system to encourage rural workers to seek appropriate and timely medical services, thereby reducing public health risks.
This discussion paper by a group of scholars across the fields of health, economics and labour relations argues that COVID-19 is an unprecedented humanitarian crisis from which there can be no return to the ‘old normal’. The pandemic’s disastrous worldwide health impacts have been exacerbated by, and have compounded, the unsustainability of economic globalisation based on the neoliberal dismantling of state capabilities in favour of markets. Flow-on economic impacts have simultaneously created major supply and demand disruptions, and highlighted the growing within-country inequalities and precarity generated by neoliberal regimes of labour market regulation. Taking an Australian and international perspective, we examine these economic and labour market impacts, paying particular attention to differential impacts on First Nations people, developing countries, women, immigrants and young people. Evaluating policy responses in a political climate of national and international leadership very different from those in which major twentieth century crises were addressed, we argue the need for a national and international conversation to develop a new pathway out of crisis.
We propose the concept of ‘scientific contagion’ — a mental heuristic through which any form of scientific treatment transfers some essence of ‘science’ to the processed substance, thereby affecting its nature and social acceptability. This was tested regarding the potential treatment of water from natural sources before it is used for religious purposes, as many such sources have dangerous pollutants. For an ancient natural well having a religious narrative, most participants judged that the acceptability of water would be reduced for religious purposes but not for drinking if local officials scientifically treat the water. That is not the case if religious rituals are conducted on the water instead (Study 1). If water from a “holy river” is processed scientifically, most participants predicted that it would reduce acceptability for religious use while increasing acceptability for drinking (Study 2). Potential scientific treatment without altering the composition of water from a natural spring also decreased acceptability for religious use but there was no effect on acceptability for drinking or on willingness to pay money for the water (Study 3). A follow-up study comparing acceptability for different kinds of water sources — from a holy well, natural spring, and household tap water sourced from either underground wells or rivers found lower acceptability for religious usage compared to drinking after potential scientific treatment for all these waters, but more so for holy and natural waters (Study 4). These studies establish the phenomena of scientific contagion that could have significant social implications and open future directions.
The purpose of this commentary article is to explain the causes and effects of the economic migration of health care workers from Poland to Western countries, and to analyse the impact of the migration of doctors and nurses on the functioning of the public health system. We use data from the National Central Statistical Office, our own preliminary research, social surveys and the Watch Health Care database. Domestic data are analysed and compared with trends in Western Europe as described in Eurostat and Organisation for Economic Co-operation and Development reports. The decreasing number of active physicians remaining in the health care system results in long waits for specialist appointments. The demand for doctors from Central and Eastern Europe will continue to grow. Consequently, there will be a further outflow of medical staff from Poland and other countries in the region and the current problems with access to health care will continue.
Essential public health functions (EPHF) are primary responsibility of the state and are fundamental for achieving public health goals through collective action. There are several EPHF frameworks that have core and enabling functions, which should be integrated within health systems. The preferred approach is to identify the framework that best suits the local context. International Health Regulation (IHR) are legally binding set of regulations meant to prevent international spread of diseases and are closely related to EPHF. EPHF focus on building capacity for public health nationally, while IHR respond to the obligations of public health globally. This Chapter makes a case for investing in public health as an obligation and an ethical and moral imperative of governments in every country by ensuring well performing EPHF and IHR.
Reynolds v. McNichols is a 1973 opinion from the Tenth Circuit Court of Appeals. Although the plaintiff was never convicted of prostitution or diagosed with an infection, she was held, examined, and involuntarily treated for sexually transmitted infections under the city of Denver’s “hold and treat” ordinance. The Tenth Circuit rejected her due process and equal protection challenges to the ordinance. In her feminist rewrite, Professor Wendy Parmet questions the health officials’ assumptions that female sex workers are “the primary source of venereal disease” and that the city can only protect the public’s health by forcibly treating them. She holds that the application of the ordinance to the plaintiff was discriminatory and that, under the circumstances, the defendants’ forced treatment of the plaintiff violated her right to privacy and their failure to obtain a warrant before forcing her to submit to a medical examination or remain in detention constituted an unreasonable search. In her commentary, Professor Aziza Ahmed situates the case in terms of historical responses to sex work under the banner of public health.
Public responses to a future novel disease might be influenced by a subset of individuals who are either sensitized or desensitized to concern-generating processes through their lived experiences during the coronavirus disease 2019 (COVID-19) pandemic. Such influences may be critical for shaping public health messaging during the next emerging threat.
Methods:
This study explored the potential outcomes of the influence of lived experiences by using a dynamic multiplex network model to simulate a COVID-19 outbreak in a population of 2000 individuals, connected by means of disease and communication layers. Then a new disease was introduced, and a subset of individuals (50% or 100% of hospitalized during the COVID-19 outbreak) was assumed to be either sensitized or desensitized to concern-generating processes relative to the general population, which alters their adoption of non-pharmaceutical interventions (social distancing).
Results:
Altered perceptions and behaviors from lived experiences with COVID-19 did not necessarily result in a strong mitigating effect for the novel outbreak. When public disease response is already strong or sensitization is assumed to be a robust effect, then a sensitized subset may enhance public mitigation of an outbreak through social distancing.
Conclusions:
In preparing for future outbreaks, assuming an experienced and disease-aware public may compromise effective design of effective public health messaging and mitigative action.
This chapter argues that we can consider policing either a primary good, subject to the requirements of distributive justice, or a feature of the democracy necessary for creating and distributing primary goods secure from threats of populism, majoritarianism, and crime. It uses historical examples of failed states and states in transition to observe that a reduction in government to policing actions and the emergence of a dominant protective association demarcate transitions between states, and become the overriding priority in cases where states falter or fail, highlighting policing as a necessary, core feature of the conception of the state itself, regardless of how minimal that state may be (or how extensive it may become). The chapter closes by considering the potential for a Rawlsian difference principle to guide the distribution of police resources to benefit the least well off, and the utilization of public health metrics and outcomes to ensure policing delivers practical justice by seeking equitable population-level reductions in morbidity and mortality, and increases in health and resilience, rather than relying on crime rates or police productivity as surrogate indications that policing has positively impacted communities and their most vulnerable members.
As we wrestle with the role and limits of policing, a political philosopher who spent over two decades as a New York City police officer and Vermont chief of police presents a normative account of what it means to police a pluralist democracy. Invoking his vast experience, Brandon del Pozo argues that we all have the prerogative to use force to protect others, but police embody the government's unique duty to do so effectively and with restraint. He recasts order maintenance as brokering and enforcing the fair terms of social cooperation in our public spaces, for the protection of minority interests, and for a society where diverse conceptions of the good can flourish. The reasons why we police, he says, must be ones that all citizens can evaluate as equals. His book explains the democratic commitments of policing, and lays the groundwork for meaningful police innovation and reform.
The current COVID-19 pandemic has placed unprecedented strain on underfunded public health resources in the Southeastern United States. The Memphis, TN metropolitan region has lacked infrastructure for health data exchange.
This manuscript describes a multidisciplinary initiative to create a community-focused COVID-19 data registry, the Memphis Pandemic Health Informatics System (MEMPHI-SYS). MEMPHI-SYS leverages test result data updated directly from community-based testing sites, as well as a full complement of public health datasets and knowledge-based informatics. It has been guided by relationships with community stakeholders and is managed alongside the largest publicly funded community-based COVID-19 testing response in the Mid-South. MEMPHI-SYS has supported interactive web-based analytic resources and informs federally funded COVID-19 outreach directed towards neighborhoods most in need of pandemic support.
MEMPHI-SYS provides an instructive case study of how to collaboratively establish the technical scaffolding and human relationships necessary for data-driven, health equity-focused pandemic surveillance, and policy interventions.
This study aimed to investigate the association between the health security capacities at the national level and preparedness for health emergencies in response to the COVID-19 outbreak.
Methods:
Data were extracted from the GHS report to evaluate the global health security capabilities in 180 countries. A linear regression analysis was performed with COVID-19 outcomes, as measured by the rate of incidence and vaccination doses, CFR, and PCR tests. Spearman correlation was used among potential explanatory factors.
Findings:
The GHS Index was inversely correlated with CFR and incidence rates, whereas it was positively associated with the vaccination and the PCR test rates. Countries with high health security capacities were significantly more likely to provide better preparedness for health emergencies in response to the outbreak. However, the vaccination doses rate and the number of PCR tests were significantly differ depending on countries’ income levels.
Conclusions:
Although health security capacity is essential to control public health emergencies effectively, it cannot predict whether or how well a country will use them in a crisis. Policymakers should identify their risk factors and capacity gaps and take into consideration the building of health security capacities in national budgets for long-term public health preparedness.
In June 2019 the Health Protection Team in Yorkshire and Humber, England, was notified of cases of hepatitis A virus (HAV) infection in staff at a secondary school. Investigation revealed that an earlier case worked as a food handler in the school kitchen. Indirect transmission through food from the canteen was considered the most likely route of transmission. Cases were described according to setting of exposure. Oral fluid was obtained from students for serological testing. Environmental investigations were undertaken at settings where food handling was considered a potential transmission risk. Thirty-three confirmed cases were linked to the outbreak. All of those tested (n = 31) shared the same sequence with a HAV IB genotype. The first three cases were a household cluster and included the index case for the school. A further 19 cases (16 students, 3 staff) were associated with the school and consistent with indirect exposure to the food handler. One late onset case could not be ruled out as a secondary case within the school and resulted in vaccination of the school population. Five cases were linked to a bakery where a case from the initial household cluster worked as a food server. No concerns about hygiene standards were noted at either the school or the bakery. Oral fluid samples taken at the time of vaccination from asymptomatic students (n = 219, 11–16 years-old) showed no evidence of recent or current infection. This outbreak included household and foodborne transmission but limited (and possibly zero) person-to-person transmission among secondary school students. Where adequate hygiene exists, secondary transmission within older students may not occur.
This chapter covers the development of social policies and the modern Welfare State. Welfare states represent recognition that the key welfare needs of the country will be met by the state through the provision of income transfers and key public services. Their development has been closely associated with the expansion of citizenship and human rights. In the UK the Poor Law was a long-lasting historical core on which the nation’s welfare state was built, and was associated with the important infrastructure of local authorities, health systems, and education along with the provision of payments in times of need. A well-functioning welfare state is important for the wellbeing of the population and has valuable redistributive roles. They provide social investment in children’s early lives and guard against social risks such as unemployment and poverty. They have the potential to assist economic growth and to provide the infrastructure and support for human capital, such as through the creation of a ‘healthy workforce’. Generally, the more egalitarian states perform better on a range of well-being measures. They remain a central pillar of the maintenance and improvement of the quality of life of people with disabilities associated with mental health conditions.
We aimed to understand which non-household activities increased infection odds and contributed greatest to SARS-CoV-2 infections following the lifting of public health restrictions in England and Wales.
Procedures
We undertook multivariable logistic regressions assessing the contribution to infections of activities reported by adult Virus Watch Community Cohort Study participants. We calculated adjusted weighted population attributable fractions (aPAF) estimating which activity contributed greatest to infections.
Findings
Among 11 413 participants (493 infections), infection was associated with: leaving home for work (aOR 1.35 (1.11–1.64), aPAF 17%), public transport (aOR 1.27 (1.04–1.57), aPAF 12%), shopping once (aOR 1.83 (1.36–2.45)) vs. more than three times a week, indoor leisure (aOR 1.24 (1.02–1.51), aPAF 10%) and indoor hospitality (aOR 1.21 (0.98–1.48), aPAF 7%). We found no association for outdoor hospitality (1.14 (0.94–1.39), aPAF 5%) or outdoor leisure (1.14 (0.82–1.59), aPAF 1%).
Conclusion
Essential activities (work and public transport) carried the greatest risk and were the dominant contributors to infections. Non-essential indoor activities (hospitality and leisure) increased risk but contributed less. Outdoor activities carried no statistical risk and contributed to fewer infections. As countries aim to ‘live with COVID’, mitigating transmission in essential and indoor venues becomes increasingly relevant.