Core competencies in applied infectious disease epidemiology: a framework for countries in Europe.

In 2009, the European Centre for Disease Prevention and Control (ECDC) developed a competency framework to support European Union countries and the European Commission in ensuring a competent public health workforce for Europe. The coronavirus disease (COVID-19) pandemic emphasised the importance of harmonised public health strategies and competencies across international boundaries, specifically for infectious diseases. This perspective presents the process to update the competency framework for applied infectious disease epidemiology, highlighting ECDC's efforts to support countries with using the framework. ECDC commissioned the Association of Schools of Public Health in the European Region (ASPHER) to update the framework through publication and dissemination of a technical report and a self-assessment tool linked to training resources. A mixed methods approach to gather input from experts in relevant specialities included qualitative interviews with 42 experts, workshops with ECDC Technical Advisory Group and an online survey of 212 public health professionals across Europe and beyond. Modifications resulted in 157 core competencies in 23 domains, each mapping to one of six subject areas of importance in applied infectious disease epidemiology. The framework serves as a basis to update the curriculum of the ECDC Fellowship programme with two alternative paths: intervention epidemiology or public health microbiology.

Physical activity and emotional-behavioural difficulties in young people: a longitudinal population-based cohort study.

BACKGROUND: There is growing concern around youth mental health. A population health approach to improve mental health must address, among other issues, economic insecurity, access to housing and education, harm reduction from substance use. As a universal public health intervention, increasing physical activity at a population level may have an important role in our approach. The aim of this study was to examine the longitudinal association between physical activity patterns between childhood and early adolescence and emotional-behavioural difficulties in later adolescence. METHODS: This study was based on data from the '98 Child cohort of the Growing Up in Ireland Study. Participants were categorized according to physical activity levels at ages 9 and 13. Emotional-behavioural difficulties at age 17 were measured using the parent-reported Strengths and Difficulties Questionnaire. Logistic regression was used to examine the association between physical activity and emotional-behavioural outcomes. RESULTS: Among 4618 participants included in the regression model, those categorized as Inactive (n=1607) or Reducer (n=1662) were more than twice as likely to have emotional-behavioural difficulties at age 17 compared with those who were Active [adjusted odds ratio (AOR) 2.1, 95% CI 1.46-3.01, P<0.001; AOR 1.93, 95% CI 1.34-2.76, P<0.001, respectively]. Among those with emotional-behavioural difficulties at baseline (n=525), those categorized as Active had 2.3-fold reduced odds for emotional-behavioural problems at age 17 compared with those who were Inactive (AOR 0.43, 95% CI 0.23-0.78, P=0.006). CONCLUSIONS: Increasing physical activity among adolescents is a safe and sustainable public health intervention associated with improved mental health.

Physical activity and mental health in an Irish population.

BACKGROUND: Physical activity represents a modifiable behaviour which may be associated with increased likelihood of experiencing positive mental health. AIMS: The aim of this study was to examine the association between self-rated physical activity and subjective indicators of both positive and negative mental health in an Irish adult population. METHODS: Based on data from a population-based, observational, cross-sectional study, participants were categorised using the International Physical Activity Questionnaire (IPAQ) into those who reported that they did and did not meet recommended physical activity requirements. Self-reported positive and negative mental health indicators were assessed using the Energy and Vitality Index (EVI) and the Mental Health Index-5 (MHI-5) from the SF-36 Health Survey Instrument, respectively. Binary logistic regression was used to identify variables independently associated with self-reported positive and negative mental health. RESULTS: A total of 7539 respondents were included in analysis. Overall, 32% reported that they met recommended minimal physical activity requirements. Self-reported positive and negative mental health were reported by 16 and 9% of respondents, respectively. Compared with those who reported meeting-recommended physical activity requirements, those performing no physical activity were three times less likely to report positive mental health (adjusted odds ratio (OR) 0.39, 95% confidence interval (CI) 0.28-0.55) and three times more likely to report negative mental health (OR 3.27, 95% CI 2.38-4.50). CONCLUSION: Compared with those who do not, those who report meeting-recommended physical activity requirements are more and less likely to report experiencing positive and negative mental health, respectively. Future policy development around physical activity should take cognisance of the impact of this activity on both physical and mental health outcomes.

Management of type 1 diabetes in primary schools in Ireland: a cross-sectional survey.

BACKGROUND: Parents reported experiences of support for diabetes management in schools are variable. Recent data from European countries are sparse and experiences in the Irish primary school setting have not been described previously. AIM: To describe parents' experiences of support for diabetes management in primary schools in Ireland. METHODS: Questionnaires were distributed through nine regional and tertiary paediatric diabetes services to parents of children aged 4-13 years with type 1 diabetes attending primary school. Data sought included patient demographics, treatment regimens, diabetes education of school staff, assistances received, and interactions between the school and family. RESULTS: Responses were received from 418 parents of primary school children with type 1 diabetes. Twenty-six percent of children were not on intensive insulin therapy. Children on a multiple daily injection regime who were unable to self-administer insulin had administration facilitated by attendance of a parent in 95% of cases. Seventy-eight percent of parents were phoned by the school regarding diabetes management, particularly those of younger children (p < 0.001). More than half of parents attended the school at least once per month to assist with diabetes management, particularly those of younger children (p < 0.001). Younger children were also more likely to have a special needs assistant (p < 0.001) and have a written management plan (p = 0.001). CONCLUSIONS: Our research has demonstrated deficits in care with respect to access to intensive insulin therapy, individualised care plans and a high burden on families which should be addressed through the National Clinical Programme for Paediatrics and Neonatology and relevant government departments.

Health-related quality of life and associated factors in people with HIV: an Irish cohort study.

BACKGROUND: Considering the chronic and debilitating nature of HIV infection, health-related quality of life (HRQoL) is an important patient-reported clinical outcome to better understand the effects of this infection and its treatment on patients' lives. The purpose of this study was to assess the HRQoL and its association with sociodemographic, behavioural, clinical, nutrition-related factors and social support in an Irish HIV cohort. METHODS: A cross-sectional, prospective study using the Medical Outcomes Study HIV Health survey assessed the 10 dimensions of HRQoL and summarised as Physical Health Summary (PHS) and Mental Health Summary (MHS) scores. Participants were categorised as having good or poor PHS and MHS using the standardised mean score of 50. The variables independently associated with PHS and MHS were identified using multivariable logistic regression models. RESULTS: Overall, 521 participants completed the HRQoL questionnaire. The median (IQR) PHS and MHS scores were 56 (47-60) and 51 (41-58) respectively. All the covariate groups had lower MHS than PHS. Participants with symptoms of HIV reported the lowest median (IQR) PHS score 44.7 (32.-54.5) and MHS score 36.1 (28.6-48.4). Of the 10 dimensions of HRQoL, the lowest scores were for the energy level and general health. Symptoms of HIV, co-morbidities, social support, employment and ethnicity had independent association with both PHS and MHS. Gender, education, alcohol intake and HIV-complications were associated with PHS. Age, illicit drugs, BMI and malnutrition were associated with MHS. However, CD4 count and viral load were not independently associated with PHS and MHS in multivariable regression models. CONCLUSION: Overall, HIV-infected people in this cohort had an average level of HRQoL. However, it is impaired in people with symptoms and co-morbidities, and not independently associated with CD4 and viral load. Alleviating HIV symptoms and preventing co-morbidities are important in managing HIV. Providing psychosocial supports for behaviour modification and return to work or exploring new opportunities will help to improve HRQoL. Healthcare providers and policy makers need to plan and implement programs to routinely assess the HRQoL in a systematic method to facilitate a holistic management of HIV.

Hepatitis B virus infection among HIV-infected pregnant women in Malawi and transmission to infants.

BACKGROUND & AIMS: The extent of HBV infection to infants of HBV/HIV-coinfected pregnant women in sub-Saharan Africa is unknown. The aim of this study was to assess prevalence of HBV infection among antiretroviral-naïve, HIV-infected pregnant women in Malawi and examine HBV transmission to their infants. METHODS: Plasma from 2048 HIV-infected, Malawian women and their infants were tested for markers of HBV infection. Study participants were provided standard-of-care health services, which included administration of pentavalent vaccine to infants at 6, 10, and 14 weeks of age. RESULTS: One-hundred and three women (5%) were HBsAg-positive; 70 of these HBsAg-positive women were also HBV-DNA-positive. Sixteen women (0.8%) were HBV-DNA-positive but HBsAg-negative. Five of 51 infants (9.8%) born to HBsAg-positive and/or HBV-DNA-positive women were HBV-DNA-positive by 48 weeks of age.HBV DNA concentrations of two infants of mothers who received extended lamivudine-containing anti-HIV prophylaxis were <4 log10 IU/ml compared to ⩾ 8 log10 IU/ml in three infants of mothers who did not. CONCLUSIONS: HBV DNA was detected in nearly 10% of infants born to HBV/HIV-coinfected women. Antenatal testing for HIV and HBV, if instituted, can facilitate implementation of prophylactic measures against infant infection by both viruses.

Risk factors for the development of osteoporosis and osteoporotic fractures among older men.

OBJECTIVE: Osteoporotic fractures are associated with significant morbidity and mortality particularly among older men. However, there is little information regarding risk factors among this population. The aims of our study were to determine risk factors for osteoporosis and fragility fractures and the predictive value of bone mineral density (BMD) measurements for development of fragility fractures in a cohort of elderly Caucasian and African American men. METHODS: We evaluated 257 men aged 70 years or older for risk factors for osteoporosis and fragility fractures using a detailed questionnaire and BMD assessment. Exclusion criteria included conditions known to cause osteoporosis such as hypogonadism and chronic steroid use, current treatment with bisphosphonates, bilateral hip arthroplasties, and inability to ambulate independently. RESULTS: Age, weight, weight loss, androgen deprivation treatment, duration of use of dairy products, exercise, and fracture within 10 years prior to study entry were associated with osteoporosis (p < or = 0.05). Fragility fractures were associated with duration of use of dairy products, androgen deprivation treatment, osteoporosis, and history of fracture within 10 years prior to BMD assessment (p < or = 0.05). There were some differences in risk factors between the Caucasian and African American populations, suggesting that risk factors may vary between ethnic groups. CONCLUSION: Although men with osteoporosis had a higher rate of fractures, the majority of fractures occurred in men with T-scores > -2.5 standard deviations below the mean, suggesting that factors other than BMD are also important in determining risk.