Fuzzy cognitive mapping in participatory research and decision making: a practice review.

BACKGROUND: Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023. RESULTS: The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases. CONCLUSIONS: A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.

Sociodemographic Profile of Blood Donations and Ways to Encourage Them.

INTRODUCTION: Maintaining blood stocks in Brazil faces challenges; hence, it is crucial to develop effective strategies to recruit and retain donors, such as campaigns and social marketing programs to raise awareness, but there is a lack of studies about the donators' profiles, as well as their barriers or incentives. OBJECTIVE: The objective of this study was to analyze the characteristics of donors and the factors that influence their decisions. METHODS: This was a cross-sectional study carried out between April and November 2022 using a structured questionnaire sent through a community created on Facebook, addressing common people over 18 years old, containing closed questions, supported by Google Forms. Statistical analyses were carried out using IBM SPSS Statistics for Windows, Version 17 (Released 2008; IBM Corp., Armonk, New York, United States) and the Chi-square and Fisher's exact tests, with p < 0.05. RESULTS: The sample relied on 1019 participants, women (72.8%), age group > 30 years (81.1%), the most represented blood type was O positive (37.5%), and men donated more frequently than women (76.5% vs. 40.6%). The main reasons for not donating are medical conditions (39.7%) and lack of time (33.8%). The main reasons for donating are helping voluntarily (97.6%) and donating to family/friends (96.4%). CONCLUSION: There was a significant difference between the genders of blood donors, with more men donating, especially those over 30 years old, and with income between 1-8 minimum wages. The main barriers to donating are lack of time and information. Based on this, it is possible to target campaigns at women, young people, and people with income above nine minimum wages. The main reasons for donating are altruism, obtaining test results, and financial benefits.

Public Health Strategies in the Face of Crisis: A Comprehensive Review of the Zika Outbreak in India.

This review provides a comprehensive analysis of the public health strategies employed during the Zika outbreak in India, focusing on the identification, surveillance, and containment efforts. The multifaceted approach, including vector control measures, healthcare infrastructure enhancement, and public communication strategies, played a pivotal role in mitigating the impact of the virus. Government policies and international collaborations emerged as influential factors, underscoring the significance of a coordinated response to infectious disease crises. The study emphasizes the importance of ongoing vigilance and preparedness in public health systems, acknowledging the dynamic nature of emerging infectious diseases. The Zika outbreak in India serves as a valuable case study, offering insights into the strengths and weaknesses of crisis management responses. As the global community faces ongoing health challenges, the lessons learned from this review contribute to refining strategies, improving coordination, and fostering a proactive and resilient approach to safeguarding public health.

In COVID Times: Scholars of Health and Medicine Meet Disaster Studies.

This essay builds on the exciting trove of disaster social science research surfacing since the earliest days of the COVID-19 pandemic. It tracks the ways that both practitioners of medicine and public health, and their social science analogues, have approached the pandemic, explicitly considering the ways they reached for new concepts to explain the temporal phenomena presented by COVID-19 and its global course. The essay highlights a series of interviews conducted in the first two years of the pandemic as part of the COVIDCalls podcast. COVID is the moment for a scholarly convergence that was missed after September 11, and again after Hurricane Katrina, and should not be missed again. Accordingly, this essay explores themes where medicine/health studies and disaster studies seem to offer great help to one another in making sense of our COVID times: the origins of disaster, disasters in combination, and the end of a disaster.

TikTok as a Source of Health Information and Misinformation for Young Women in the United States: Survey Study.

BACKGROUND: TikTok is one of the most-used and fastest-growing social media platforms in the world, and recent reports indicate that it has become an increasingly popular source of news and information in the United States. These trends have important implications for public health because an abundance of health information exists on the platform. Women are among the largest group of TikTok users in the United States and may be especially affected by the dissemination of health information on TikTok. Prior research has shown that women are not only more likely to look for information on the internet but are also more likely to have their health-related behaviors and perceptions affected by their involvement with social media. OBJECTIVE: We conducted a survey of young women in the United States to better understand their use of TikTok for health information as well as their perceptions of TikTok's health information and health communication sources. METHODS: A web-based survey of US women aged 18 to 29 years (N=1172) was conducted in April-May 2023. The sample was recruited from a Qualtrics research panel and 2 public universities in the United States. RESULTS: The results indicate that the majority of young women in the United States who have used TikTok have obtained health information from the platform either intentionally (672/1026, 65.5%) or unintentionally (948/1026, 92.4%). Age (959/1026, 93.47%; r=0.30; P<.001), education (959/1026, 93.47%; ρ=0.10; P=.001), and TikTok intensity (ie, participants' emotional connectedness to TikTok and TikTok's integration into their daily lives; 959/1026, 93.47%; r=0.32; P<.001) were positively correlated with overall credibility perceptions of the health information. Nearly the entire sample reported that they think that misinformation is prevalent on TikTok to at least some extent (1007/1026, 98.15%), but a third-person effect was found because the young women reported that they believe that other people are more susceptible to health misinformation on TikTok than they personally are (t1025=21.16; P<.001). Both health professionals and general users were common sources of health information on TikTok: 93.08% (955/1026) of the participants indicated that they had obtained health information from a health professional, and 93.86% (963/1026) indicated that they had obtained health information from a general user. The respondents showed greater preference for health information from health professionals (vs general users; t1025=23.75; P<.001); the respondents also reported obtaining health information from health professionals more often than from general users (t1025=8.13; P<.001), and they were more likely to act on health information from health professionals (vs general users; t1025=12.74; P<.001). CONCLUSIONS: The findings suggest that health professionals and health communication scholars need to proactively consider using TikTok as a platform for disseminating health information to young women because young women are obtaining health information from TikTok and prefer information from health professionals.

Canada's THC unit: Applications for the legal cannabis market.

The legalization of cannabis in Canada has accelerated the need for a standardized approach to measuring and communicating the amount of delta-9-tetrahydrocannabinol (THC) in cannabis products. This article offers an overview of the considerations associated with establishing and implementing a standard THC unit in the Canadian context. The article begins by discussing the applications of a standard THC unit, emphasizing its potential use in product labelling, consumer education, and product reporting and surveillance. The article then examines key considerations for identifying what a Canadian THC unit should be set at, specifically within the context of a country with a regulated commercial cannabis market. This is followed by a discussion of additional considerations related to the adoption of a Canadian THC unit, including its use across various product formats and modes of administration. A significant focus of this article is on prioritizing public health and safety and informed decision-making among adult consumers as the legal cannabis market evolves. Collaboration among various stakeholders, such as government agencies, industry, and public health professionals, is highlighted as crucial for a successful transition to the use of Canada's THC unit.

The development of an EU-wide nutrition and physical activity expert knowledge base to support a personalised mobile application across various EU population groups.

A healthy lifestyle comprising regular physical activity and an adequate diet is imperative for the prevention of non-communicable diseases such as hypertension and some cancers. Advances in information computer technology offer the opportunity to provide personalised lifestyle advice directly to the individual through devices such as smartphones or tablets. The overall aim of the PROTEIN project (Wilson-Barnes et al., 2021) was to develop a smartphone application that could provide tailored and dynamic nutrition and physical activity advice directly to the individual in real time. However, to create this mobile health (m-health) smartphone application, a knowledge base of reference ranges for macro-/micronutrient intake, anthropometry, biochemical, physiological and sleep parameters was required to underpin the parameters of the recommender systems. Therefore, the principal aim of this emerging research paper is to describe the process by which experts in nutrition and physiology from the PROTEIN consortium collaborated to develop the nutritional and physical activity requirements, based upon existing recommendations, for 10 separate population groups living within the EU including, but not limited to healthy adults, adults with type 2 diabetes mellitus, cardiovascular disease, excess weight, obesity and iron deficiency anaemia. A secondary aim is to describe the development of a library of 24-h meal plans appropriate for the same groups and also encompassing various dietary preferences and allergies. Overall, the consortium devised an extensive nutrition and physical activity knowledge base that is pertinent to 10 separate EU user groups, is available in 7 different languages and is practically implemented via a library of culturally appropriate, 24-h meal plans.

Should we be concerned about the use of non-fluoride toothpaste? A survey study in two European countries.

BACKGROUND: Toothpastes available in Europe contain a range of fluoride concentrations, with some meeting the recommended level for caries prevention (>1000 ppm fluoride (ppm)) and others containing low or no fluoride. This study evaluated toothpaste fluoride concentrations in Latvia and Lithuania to inform targeted public health strategies in regions with a high prevalence of dental caries. METHODS: This cross-sectional study was conducted from May 2019 to May 2020, using a validated questionnaire in Latvia and Lithuania. Nationally representative samples (1309 families and 5436 members) provided data through a mixed-mode survey (paper and online) on sociodemographic information, toothpaste type, brand, and type. Descriptive statistics and chi-square tests (p < 0.05) were used for analysis. RESULTS: Fifteen percent of families used non-fluoridated toothpaste and 12% used <1000 part per million (ppm) fluoride. In Latvia, 56.8% of preschoolers and 28.7% of schoolchildren used <1000 ppm or non-fluoride toothpaste, whereas in Lithuania, 47.2% of preschoolers and 29.1% of schoolchildren used <1000 ppm or non-fluoride toothpaste; 63% of adolescents and 73% of adults used toothpaste with optimal fluoride content (≥1000 ppm). Of the 228 registered toothpaste types, 62% contained more than 1000 ppm, which is optimal for caries prevention; 29% of Latvian and 24% of Lithuanian families used at least one non-fluoridated toothpaste. CONCLUSION: This study revealed significant gaps in the use of fluoride toothpaste among families in Latvia and Lithuania, especially among children. To effectively prevent dental caries, targeted interventions, and education must promote optimal fluoride toothpaste use, particularly among vulnerable populations.

Human Epidemiology and RespOnse to SARS-CoV-2 (HEROS): Objectives, Design and Enrollment Results of a 12-City Remote Observational Surveillance Study of Households with Children using Direct-to-Participant Methods.

The Human Epidemiology and Response to SARS-CoV-2 (HEROS) is a prospective multi-city 6-month incidence study which was conducted from May 2020-February 2021. The objectives were to identify risk factors for SARS-CoV-2 infection and household transmission among children and people with asthma and allergic diseases, and to use the host nasal transcriptome sampled longitudinally to understand infection risk and sequelae at the molecular level. To overcome challenges of clinical study implementation due to the coronavirus pandemic, this surveillance study used direct-to-participant methods to remotely enroll and prospectively follow eligible children who are participants in other NIH-funded pediatric research studies and their household members. Households participated in weekly surveys and biweekly nasal sampling regardless of symptoms. The aim of this report is to widely share the methods and study instruments and to describe the rationale, design, execution, logistics and characteristics of a large, observational, household-based, remote cohort study of SARS-CoV-2 infection and transmission in households with children. The study enrolled a total of 5,598 individuals, including 1,913 principal participants (children), 1,913 primary caregivers, 729 secondary caregivers and 1,043 other household children. This study was successfully implemented without necessitating any in-person research visits and provides an approach for rapid execution of clinical research.

Predictors of HIV Viral Load Suppression After Enhanced Adherence Counseling, Nekemte, Ethiopia.

BACKGROUND: Enhanced adherence counseling refers to the counseling intervention for Human Immunodeficiency Virus (HIV) patients with an elevated viral load result, a viral load of > 1000 copies/ml, on a routine or need-based viral load test. The Federal Ministry of Health, Ethiopia, has launched routine viral load testing and enhanced adherence counseling since 2016 for high-viral load people living with HIV, which is applicable throughout the country for all health facilities providing HIV care and treatment. Our study aimed to assess viral load suppression after enhanced adherence counseling and its predictors among high viral load people living with HIV who were on antiretroviral therapy. METHOD: We conducted a health facility-based retrospective follow-up study among 352 HIV-infected high-viral load people enrolled in enhanced adherence counseling from July 2018 to June 2021 in Nekemte town public health facilities. Cox proportional hazard analysis was used to identify independent predictors. RESULTS: The overall 65.1% of 352 persons on antiretroviral treatment achieved HIV viral load suppression after enhanced adherence counseling, (15.01 per 100 person months (95% CI13.02-16.99)). The median time to viral load suppression was 5 months. Age ≥ 15 years (AHR = 1.99, 95% CI: 1.11-3.57), no history of opportunistic infection (AHR = 2.01, 95% CI: 1.18-3.41), and not using substances (AHR = 2.48, 95% CI: 1.19-5.14) were more likely to have viral load suppressed, while having an initial viral load count greater than 50,000 RNA copies/ml (AHR = 0.56, 95% CI: 0.37-0.85) were less likely to have viral load suppressed after enhanced adherence counseling. CONCLUSION: Age, history of opportunistic infections, substance use, and an initial viral load count > 50,000 RNA copies/mL were significant predictors of viral load suppression. Enrolling all high-viral-load patients in enhanced adherence counseling is recommended for viral load suppression.

Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020-2021) in 12 Countries of the C-MOR Consortium.

BACKGROUND: This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. METHODS: We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. RESULTS: Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). CONCLUSIONS: This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.

Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study.

Background: China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China. Methods: We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results. Findings: Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening. Interpretation: Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China. Funding: Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.

Prevalence and Related Factors of Postpartum Depression among Jordanian Mothers with a History of COVID-19 during Pregnancy or After Childbirth in a Developing Country.

Background: The magnitude of postpartum depression in Jordan during the COVID-19 pandemic is under-documented, and little is known about its potential social, demographic, and clinical correlates. This study aimed to explore the prevalence and related factors of postpartum depression among Jordanian mothers with a history of COVID-19 during pregnancy or after childbirth. Materials and Methods: This cross-sectional descriptive study was carried out in March-June 2021 among a convenient sample of 109 women with a history of COVID-19 during pregnancy or after childbirth, who were at a leading hospital equipped to care for COVID-19 cases in North Jordan. An online survey using the Edinburgh Postnatal Depression Scale (EPDS) was used to collect information from mothers with a history of COVID-19-positive tests. Results: Among the total number of women who participated in the study (n = 109), 73 women had postpartum depression. The prevalence of postpartum depression in the present study was 67%. In addition, the study found a positive statistically significant correlation between EPDS scores and being a smoker, delivery method, experiencing severe COVID-19 symptoms, and being hospitalized. Conclusions: During the COVID-19 pandemic, women had a high level of postpartum depression. It would be necessary to follow further the confirmed cases of COVID-19, and mothers should be screened for depressive symptoms during pregnancy and followed up for antenatal and postnatal care.

A 12-year follow up of principles learned in a pediatric dentistry Master of Public Health dual degree program applied to professional practice.

Introduction: Dental public health professionals play a critical role in preventing and controlling oral diseases. The purpose of this study was to assess the application of public health principles learned in a pediatric dentistry Master of Public Health (MPH) dual degree program to professional practice upon graduation. Methods: Semi-structured interviews were conducted with pediatric dentistry/MPH dual degree alumni who graduated from the program between 2012 and 2023. Interview questions inquired about characteristics of patient population, location of providers' clinic/organization, whether the program was worthwhile to their practice and application of principles learned in the program to their professional practice. Results: Twenty of the 22 program alumni agreed to be interviewed. All alumni thought the program was extremely worthwhile to their practice. They felt the MPH component of the program gave them the public health background and tools they needed to provide comprehensive and holistic care to their patients. Additionally, all alumni reported applying the public health principles they learned in the program to their professional practice through leadership roles, research and teaching that focuses on oral disease prevention and the promotion of dental health. Discussion: Given the importance of a dental public health professionals' role in reducing oral health disparities at the population level, more pediatric dentistry MPH dual degree programs are urgently needed. Additionally, more research is necessary to demonstrate the effectiveness of these programs, which will be critical to helping ensure the value of a dual degree in dentistry and public health is recognized and promoted worldwide.

Social Safety for Black Women in Perinatal Health Care: A Concept Analysis.

INTRODUCTION: Non-Hispanic Black women and their infants experience the worst pregnancy-related outcomes in the United States. Social safety is a health-relevant resource found in environments communicating safety, connectedness, inclusion, and protection. Approaches promoting social safety may be particularly relevant to preventing adverse perinatal health outcomes among Black women. However, there remains a lack of conceptual clarity. The purpose of this concept analysis was to provide a theoretical clarification of the concept social safety for Black women within perinatal health care. METHODS: PubMed, PsycINFO, and CINAHL were searched using Boolean search strategy. Retrieved articles were managed in Zotero. Duplicates were removed, and each article was assessed and categorized by both investigators. Articles reporting Black women's perinatal health care experiences were included. Thematic analysis guided by Rodgers' evolutionary method identified defining attributes, antecedents, and consequences of social safety in perinatal care for Black women. RESULTS: Social safety for Black women is defined as the process of feeling understood, respected, cared for, and in control in perinatal health care settings that make space, care for, and recognize strengths, thereby cultivating safety and empowerment. DISCUSSION: Social safety offers actionable insights for practice and research that have the potential to drive positive change in perinatal care delivery for Black women. Developing interventions and measurements that are valid, reliable, and reflect social safety are essential to promote positive experiences and equity in health care practices and policies.

Accumulation of resistance genes in Salmonella Typhimurium transmitted between poultry and dairy farms increases the risk to public health.

Salmonella Typhimurium is a zoonotic pathogen that poses a major threat to public health. This generalist serotype can be found in many hosts and the environment where varying selection pressures may result in the accumulation of antimicrobial resistance determinants. However, the transmission of this serotype between food-producing hosts, specifically between poultry layer flocks and nearby dairy herds, was never demonstrated. We investigated an outbreak at a dairy in Israel to determine the role of nearby poultry houses to be sources of infection. The 2-month outbreak resulted in a 47% mortality rate among 15 calves born in that period. Routine treatment of fluid therapy, a nonsteroidal anti-inflammatory, and cefquinome was ineffective, and control was achieved by the introduction of vaccination of dry cows against Salmonella (Bovivac S, MSD Animal Health) and a strict colostrum regime. Whole genome sequencing and antimicrobial sensitivity tests were performed on S. Typhimurium strains isolated from the dairy (n = 4) and strains recovered from poultry layer farms (n = 10). We identified acquired antimicrobial-resistant genes, including the blaCTX-M-55 gene, conferring resistance to extended-spectrum cephalosporins, which was exclusive to dairy isolates. Genetic similarity with less than five single nucleotide polymorphism differences between dairy and poultry strains suggested a transmission link. This investigation highlights the severe impact of S. Typhimurium on dairy farms and the transmission risk from nearby poultry farms. The accumulation of potentially transferable genes conferring resistance to critically important antimicrobials underscores the increased public health risk associated with S. Typhimurium circulation between animal hosts.IMPORTANCESalmonella Typhimurium is one of the major causes of food-borne illness globally. Infections may result in severe invasive disease, in which antimicrobial treatment is warranted. Therefore, the emergence of multi-drug-resistant strains poses a significant challenge to successful treatment and is considered one of the major threats to global health. S. Typhimurium can be found in a variety of animal hosts and environments; however, its transmission between food-producing animals, specifically poultry layers flocks and dairy herds, was never studied. Here, we demonstrate the transmission of the pathogen from poultry to a nearby dairy farm. Alarmingly, the multi-drug-resistant strains collected during the outbreak in the dairy had acquired resistance to extended-spectrum cephalosporins, antibiotics critically important in treating Salmonellosis in humans. The findings of the study emphasize the increased risk to public health posed by zoonotic pathogens' circulation between animal hosts.