Genome-Wide Association Study of Temporomandibular Disorder-Related Pain in Finnish Populations.

BACKGROUND: Temporomandibular disorders (TMD) are multifactorial musculoskeletal pain and dysfunctions in temporomandibular joints (TMJs) and masticatory muscles. Genetic factors play a role in TMD-related pain, but only a few genome-wide association studies (GWAS) have been conducted. OBJECTIVE: The aim of this GWAS was to explore genetic factors associated with painful TMD in Finnish populations. METHODS: Data from two epidemiological surveys, the Northern Finland Birth Cohort 1966 (NFBC1966) and the Health 2000 Survey in Finland, including altogether 468 cases and 6833 controls, were used. Case definition was based on pain on palpation of masticatory muscles and/or TMJs. GWASs of the whole data and stratified by sex were conducted from both cohorts using additive models, followed by meta-analysis of the two cohorts. Replications of the previously reported TMD risk loci (rs73460075, DMD; rs4794106, SGCA; rs73271865, SP4; rs60249166, RXP2; rs1531554, BAHCCI; rs5862730, OTUD4/SMAD1; rs10092633, SFRP1; rs34612513, SOX14/CLDN18; rs878962, TSPAN9) were also investigated. RESULTS: Four genome-wide significant loci were found in sex-stratified analysis of NFBC1966, including associations at three loci in males (rs1023114, PRIM2, p = 5 × 10-9; rs4244867, ALG10, p = 3 × 10-8; rs79841648, ADCYAP1, p = 4 × 10-9) and one locus in females (rs148476652, DNER, p = 4 × 10-9). However, the results could not be replicated in the Health 2000 Survey or in the meta-analysis of these two cohorts. The previous TMD GWAS associations did not replicate in our data either. CONCLUSION: Several TMD pain-associated variants were found in sex-stratified analysis of NFBC1966, suggesting the role of neuroendocrine stress responses and central nervous system. These findings need to be confirmed in future studies.

Sexual violence against children and adolescents in Paraná State: geospatial analysis and main socioeconomic indicators

Abstract Objective Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. Methods The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. Results Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. Conclusion The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

A virtual assistant for primary care's food and nutrition surveillance system: Development and validation study in Brazil.

OBJECTIVE: The study aimed to develop and validate a conversational agent (chatbot) designed to support Food and Nutrition Surveillance (FNS) practices in primary health care settings. METHODS: This mixed-methods research was conducted in three stages. Initially, the study identified barriers and challenges in FNS practices through a literature review and feedback from 655 health professionals and FNS experts across Brazil. Following this, a participatory design approach was employed to develop and validate the chatbot's content. The final stage involved evaluating the chatbot's user experience with FNS experts. RESULTS: The chatbot could accurately understand and respond to 60 different intents or keywords related to FNS. Themes such as training, guidance, and access emerged as crucial for guiding FNS initiatives and addressing implementation challenges, primarily related to human resources. The chatbot achieved a Global Content Validation Index of 0.88. CONCLUSION: The developed chatbot represents a significant advancement in supporting FNS practices within primary health care. PRACTICE IMPLICATION: By providing an innovative, interactive, educational tool that is both accessible and reliable, this digital assistant has the potential to facilitate the operationalization of FNS practices, addressing the critical need for effective training and counseling in developing countries.

Barriers and facilitators for using administrative data for surveillance purpose: A narrative overview.

Although administrative data are not originally intended for surveillance purposes, they are frequently used for monitoring public health and patient safety. This article provides a narrative overview of the barriers and facilitators for the use of administrative data for surveillance, with a focus on healthcare-associated infection (HAI) in Canada. In this case, only articles on administrative data in general or related to HAI were included. Validation study and meta-analyses on administrative data accuracy were excluded. Medline, Embase and Google Scholar were searched as well as references list of all included articles, for a total of 90 articles included. Our analysis identifies 78 barriers at the individual, organizational and systemic levels and outlines 75 facilitators and solutions to improve administrative data utilization and quality. This narrative overview will help to understand barriers, facilitators and offer practical recommendations for optimizing the use of administrative data.

Action needed to address molecular HIV surveillance ethical concerns.

There have been growing ethical concerns about the widespread use of HIV-related molecular epidemiological public health surveillance and research-or what has come to be known as molecular HIV surveillance. The varied concerns of the practice originate due to lack of informed consent, lack of demonstrated benefit for communities, potential for eroded patient care relationships leading to poor health outcomes, and potential implications for information sharing and findings which could increase stigmatization and other negative impacts in contexts where HIV, drug use, sex work, migration, and poverty are criminalized. As people living with HIV, lawyers, clinicians, and social scientists, we are part of the growing movement calling for critical and ethical attention to the practice of molecular HIV surveillance and the public health logic which underwrites the practice. We urge Canadian public health actors and researchers working with molecular surveillance data to heed global guidance and recommendations for culturally informed ethical practices, to engage community members in HIV surveillance programs, and to ensure that people living with HIV are provided appropriate consent processes for uses of secondary data analysis. Furthermore, we urge researchers and Research Ethics Boards to interrogate assumptions of impracticality in seeking subsequent consent to use persons' health information held in data repositories and explore new methods of informed consent.

RéSUMé: L'utilisation généralisée de la surveillance et de la recherche en santé publique axées sur l'épidémiologie moléculaire du VIH, ou ce qu'il est aujourd'hui convenu d'appeler la surveillance moléculaire du VIH, commence à soulever des préoccupations éthiques. Ces préoccupations ont trait à l'absence de consentement éclairé, à l'absence d'avantages démontrés pour les communautés, au potentiel d'érosion de la relation entre les patients et les services de santé, et donc à la détérioration de la santé, et aux implications possibles sur le plan du partage d'informations et des constats, qui pourraient accroître la stigmatisation et avoir d'autres effets nuisibles dans les contextes où le VIH, l'usage de drogues, le travail du sexe, la migration et la pauvreté sont criminalisés. Nous sommes des personnes vivant avec le VIH, des avocats, des cliniciens et des spécialistes des sciences sociales qui nous inscrivons dans un mouvement croissant pour accorder une attention critique et éthique à la pratique de la surveillance moléculaire du VIH et à la logique de santé publique sous-jacente. Nous exhortons les acteurs de la santé publique canadienne et les chercheurs qui travaillent avec des données de surveillance moléculaire à prêter attention aux orientations et aux recommandations mondiales en faveur de pratiques éthiques culturellement éclairées, à dialoguer avec les membres de la communauté dans le cadre des programmes de surveillance du VIH et à veiller à ce que les personnes vivant avec le VIH aient la possibilité d'exprimer leur consentement à l'analyse secondaire de leurs données. Nous exhortons aussi les chercheurs et les comités d'éthique de la recherche à remettre en cause le postulat selon lequel il est peu pratique d'obtenir a posteriori un consentement à l'utilisation des renseignements médicaux personnels stockés dans des bases de données, et à envisager de nouvelles méthodes de consentement éclairé.

Risk of opioid-related harms by occupation within a large cohort of formerly injured workers in Ontario, Canada: findings from the Occupational Disease Surveillance System.

OBJECTIVE: Working-age individuals have been disproportionately affected by the opioid crisis, prompting interest in the potential role of occupation as a contributor. This study aimed to estimate the risk of opioid-related poisonings and mental and behavioural disorders by occupation and industry within a cohort of 1.7 million formerly injured workers. METHODS: Workers were identified in the Occupational Disease Surveillance System, a system linking workers' compensation data (1983-2019) to emergency department and hospitalisation records (2006-2020) in Ontario, Canada. Cox proportional hazards models were used to estimate HRs and 95% CIs for hospital encounters for opioid-related poisonings and mental and behavioural disorders by occupation and industry compared with all other workers, adjusted for age, sex and birth year. RESULTS: In total, 13 702 opioid-related poisoning (p) events (n=10 064 workers) and 19 629 opioid-related mental and behavioural (mb) disorder events (n=11 755 workers) were observed. Elevated risks were identified among workers in forestry and logging (HRp=1.45, 95% CI 1.09 to 1.94; HRmb=1.70, 95% CI 1.34 to 2.16); processing (minerals, metals, clay, chemical) (HRp=1.27, 95% CI 1.14 to 1.42; HRmb=1.26, 95% CI 1.14 to 1.39); processing (food, wood, textile) (HRp=1.12, 95% CI 1.01 to 1.24; HRmb=1.19, 95% CI 1.09 to 1.31); machining (HRp=1.13, 95% CI 1.04 to 1.21; HRmb=1.17, 95% CI 1.09 to 1.25); construction trades (HRp=1.57, 95% CI 1.48 to 1.67; HRmb=1.59, 95% CI 1.51 to 1.68); materials handling (HRp=1.32, 95% CI 1.22 to 1.43; HRmb=1.22, 95% CI 1.13 to 1.31); mining and quarrying (HRmb=1.68, 95% CI 1.34 to 2.11); and transport equipment operating occupations (HRp=1.18, 95% CI 1.09 to 1.27). Elevated risks were observed among select workers in service, sales, clerical and health. Findings by industry were similar. CONCLUSIONS: Results provide additional evidence that opioid-related harms cluster among certain occupational groups. Findings can be used to strategically target prevention and harm reduction activities in the workplace.

Portrait of training and worker health surveillance actions in Santa Catarina.

Introduction: Since 2005, the Centro de Referência em Saúde do Trabalhador in the state of Santa Catarina has promoted several training in Vigilância em Saúde do Trabalhador for public health inspectors in the state, so that they can intervene in potentially sick work environments. Objectives: To evaluate the Vigilância em Saúde do Trabalhador actions carried out by the health surveillance agencies of the state of Santa Catarina and to verify the perception of inspectors regarding the technical preparation for the performance. Methods: Sample: 257 inspectors from 134 municipalities. Data collection: self-administered questionnaire sent to 733 state inspectors; the number of Vigilância em Saúde do Trabalhador actions planned and executed in 2018, extracted from the Pharos System. The study was cross-sectional, descriptive and with a convenience sample. Results: Most municipal workers' health surveillance did not carry out five Vigilância em Saúde do Trabalhador actions per month; most inspectors have difficulties in carrying out Vigilância em Saúde do Trabalhador actions and that they are related to organizational issues. There was no association between the variables training received and actions performed. Conclusions: It is inferred that the difficulties faced by inspectors may have contributed to the low number of Vigilância em Saúde do Trabalhador actions carried out. It is necessary to make structural and organizational advances in workers' health in the municipalities.

Introdução: O Centro de Referência em Saúde do Trabalhador do estado de Santa Catarina promove, desde 2005, diversas capacitações em Vigilância em Saúde do Trabalhador para os fiscais sanitaristas do estado, para que eles possam intervir nos ambientes de trabalho potencialmente adoecedores. Objetivos: Avaliar as ações de Vigilância em Saúde do Trabalhador realizadas pelas Vigilâncias Sanitárias do estado de Santa Catarina e verificar a percepção dos fiscais a respeito do preparo técnico para a atuação. Métodos: A amostra foi composta por 257 fiscais de 134 municípios. A coleta de dados foi feita por meio de questionário autoaplicável enviado aos 733 fiscais do Estado e do número de ações de Vigilância em Saúde do Trabalhador planejadas e executadas no ano de 2018, extraídas do Sistema Pharos. O estudo foi transversal, descritivo e com amostra de conveniência. Resultados: A maioria das vigilâncias em saúde do trabalhador municipais não realizaram cinco ações de Vigilância em Saúde do Trabalhador por mês; a maioria dos fiscais têm dificuldades na execução das ações de Vigilância em Saúde do Trabalhador e que elas se relacionam às questões organizacionais. Não foi verificada associação das variáveis capacitações recebidas e ações realizadas. Conclusões: Infere-se que as dificuldades enfrentadas pelos fiscais possam ter contribuído para o baixo número de ações de Vigilância em Saúde do Trabalhador realizadas. É necessário que se façam avanços estruturais e organizacionais da saúde do trabalhador nos municípios.

US public health surveillance, reimagined.

Introduction: This study presents two novel concepts for standardizing electronic health records (EHR)-based public health surveillance through utilization of existing informatics methods and data platforms. Methods: Drawing from the collective experience in applied epidemiology, health services research and health informatics, the author presents a vision for an alternative path to public health surveillance by repurposing existing tools and resources, such as (1) computable phenotypes which have already been created and validated for a variety of chronic diseases of interest to public health and (2) large data platforms/collaboratives, such as All of Us Research Program and National COVID Cohort Collaborative. Opportunities and challenges are discussed regarding EHR-based chronic disease surveillance, as well as the concept of phenotype definitions and large data platforms reuse for public health needs. Results/Framework: Reusing of computable phenotypes for EHR-based public health surveillance would require secure data platforms and nationally representative data. Standardization metrics for reuse of previously developed and validated computable phenotypes are also necessary and are currently being developed by the author. This study presents a reimagined Learning Health System framework by incorporating Public Health and two novel concept sets of solutions into the healthcare ecosystem. Conclusion/Next Steps: Alternative approaches to limited resources and current infrastructure of the US Public Health System, especially as applied to disease surveillance, are needed and may be possible when repurposing the resources and methodologies across the Learning Health System.

Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany.

BACKGROUND: Contact tracing was implemented in many countries during the COVID-19 pandemic to prevent disease spread, reduce mortality, and avoid overburdening health care systems. In several countries, including Germany, new systems were needed to trace potentially infected individuals. OBJECTIVE: Using data collected in the Rhine-Neckar and Heidelberg (RNK/HD) districts in southwest Germany (population: 706,974), this study examines the overall effectiveness and efficiency of contact tracing in different age groups and stages of the pandemic. METHODS: From January 27, 2020, to April 30, 2022, the RNK/HD Health Authority collected data on COVID-19 infections, quarantines, and deaths. Data on infection, quarantine, and death was grouped by age (young: 0-19 years; adult: 20-65 years; and senior citizens: >65 years) and pandemic phase (infectious wave plus subsequent lull periods) and analyzed for proportion, risk, and relative risk (RR). The overall effectiveness and efficiency of contact tracing were determined by calculating quarantine sensitivity (proportion of the infected population captured in quarantine), positive predictive value (PPV; proportion of the quarantined population that was infected), and the weighted Fß-score (combined predictive performance). RESULTS: Of 706,974 persons living in RNK/HD during the study period, 192,175 (27.2%) tested positive for SARS-CoV-2, 74,810 (10.4%) were quarantined, and 932 (0.132%) died following infection. Compared with adults, the RR of infection was lower among senior citizens (0.401, 95% CI 0.395-0.407) and while initially lower for young people, was ultimately higher for young people across all 5 phases (first-phase RR 0.502, 95% CI 0.438-0.575; all phases RR 1.35, 95% CI 1.34-1.36). Of 932 COVID-19-associated deaths during the study period, 852 were senior citizens (91.4%), with no deaths reported among young people. Relative to adults, senior citizens had the lowest risk of quarantine (RR 0.436, 95% CI 0.424-0.448), while young people had the highest RR (2.94, 95% CI 2.90-2.98). The predictive performance of contact tracing was highest during the second and third phases of the pandemic (Fß-score=0.272 and 0.338, respectively). In the second phase of the pandemic, 5810 of 16,814 COVID-19 infections were captured within a total quarantine population of 39,687 (sensitivity 34.6%; PPV 14.6%). In the third phase of the pandemic, 3492 of 8803 infections were captured within a total quarantine population of 16,462 (sensitivity 39.7%; PPV 21.2%). CONCLUSIONS: The use of quarantine aligned with increasing risks of COVID-19 infection and death. High levels of quarantine sensitivity before the introduction of the vaccine show how contact tracing systems became increasingly effective at capturing and quarantining the infected population. High levels of PPV and Fß-scores indicate, moreover, that contact tracing became more efficient at identifying infected individuals. Additional analysis of transmission pathways is needed to evaluate the application of quarantine in relation to infection and death risks within specific age groups.

Epidemic Intelligence Threat Reporting Profile in Portugal during the COVID-19: 2 Years of Decrease in Reporting on Non-COVID-19 Threats.

Background: Epidemic intelligence (EI) ensures early detection, assessment, and communication of public health threats. Threat reporting defines priorities and mobilize resources for surveillance, prevention, and control. In Portugal, the Directorate-General of Health (DGS) is responsible for EI and publishes a weekly public health threat report (RONDA). Changes in threats in regular threat reports since COVID-19 have not been previously described. We analysed changes in non-COVID threat reporting in the weekly threat report. Methods: Using the DGS Emergency Operations Centre's threat reporting database, we compared threats reported in RONDAs from 2016 to 2022 in three sequential periods: P1 before COVID-19 (January 2016-March 2020), P2 during acute COVID-19 restrictions (April 2020-February 2022), and P3 in post-acute COVID-19 phase (February 2022-September 2022). We described the monthly average frequency of reports on non-COVID-19 threats in those periods considering different disease groups, geographical focus, and information sources. We estimated expected non-COVID-19 reports on threats using a forecast model fitted to the time series until March 2020 and compared observed and expected values. Results: Non-COVID-19 threats had a decrease in the monthly average frequency of reporting in period 2 ( x ¯ 1 : 4.7 vs. x ¯ : 2.3, p < 0.001) compared to period 1. Using the forecast methods, there were 114 fewer non-COVID threats than the 162 expected (-70%) in period 2. In period 3, there were 105 more threats than expected (+256%). The ECDC and the WHO were the most frequent sources of information followed by national Public Health sources. Conclusions: During COVID-19, there was a decrease in reports on non-COVID threats in Portugal. COVID-19 possibly affected global EI, by shifting attention and resources from other threats to the pandemic. However, the number of threats that warrant follow-up and communication is increasing. Further research is necessary to inform the EI research and development agenda, to ensure that all relevant threats are detected, accessed, and communicated according to evolving EI objectives and priorities while resources and preparedness are guaranteed.

Introdução: A epidemic intelligence (EI) assegura a deteção precoce, a avaliação e a comunicação das ameaças para a saúde pública para definir prioridades e mobilizar recursos para a investigação, vigilância, prevenção e controlo. Em Portugal, a Direção-Geral da Saúde (DGS) é responsável pela EI e publica semanalmente um relatório de ameaças para a saúde pública (RONDA) que é partilhado com a rede de autoridades de saúde, instituições e profissionais de saúde pública. As alterações nas ameaças comunicadas em relatórios periódicos de ameaças desde a COVID-19 não foram descritas anteriormente. Métodos: Comparámos as ameaças reportadas na RONDA entre 2016 a 2022 em três períodos sequenciais: antes da COVID-19 (janeiro de 2016 - março de 2020), P2 durante as restrições (abril de 2020 - fevereiro de 2022) e P3 na fase pós-aguda da COVID-19 (fevereiro de 2022 - setembro de 2022). Comparamos a frequência média mensal de ameaças não COVID-19 relatadas entre todas as ameaças relatadas nesses períodos, considerando diferentes categorias dentro do grupo de doenças, foco geográfico e fontes de informação. Resultados: As ameaças não-COVID-19 tiveram uma diminuição na frequência média mensal de reporte no Período2 (14,7 vs. 2,3 p < 0.001) em comparação com o Período1, antes da COVID-19. Houve um retorno ao padrão pré-pandêmico de notificação no Período 3 (14,67 vs. 17,63 p < 0.208) para ameaças não COVID-19 com um aumento nas doenças virais emergentes (2,20 vs. 7,62 p < 0.001). O ECDC e a OMS são as fontes de informação mais frequentes, seguidas das fontes nacionais de saúde pública. Conclusões: Durante a COVID-19, houve alterações no reporte de ameaças em Portugal. A COVID-19 possivelmente afetou a EI e os relatórios de ameaças epidémicas globais, possivelmente desviando a atenção e os recursos de outras ameaças para a pandemia. No entanto, a quantidade de ameaças que justificam o acompanhamento e a comunicação pode estar a aumentar. É necessária investigação em comunicação de ameaças detetadas no âmbito da EI a fim de assegurar que todas as ameaças relevantes são avaliadas e comunicadas de acordo com os objetivos da EI, garantindo simultaneamente o investimento em recursos e a preparação para a prevenção e resposta.

Validation of the Warwick-Edinburgh Mental Well-Being Scale for the Mental Health Surveillance (MHS) of German adults.

BACKGROUND: Mental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany. METHODS: Using data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18-79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity. RESULTS: Means of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups. CONCLUSIONS: Both versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health.

Determinants of Citizens' Intention to Participate in Self-Led Contact Tracing: Cross-Sectional Online Questionnaire Study.

BACKGROUND: Contact tracing (CT) is a key intervention to contain outbreaks of communicable diseases. During large-scale outbreaks, public health services may lack the resources required to perform CT effectively. One way of mitigating this issue is to shift some of the tasks in CT normally performed by public health services to cases and their contacts, supported by digital tools. We refer to this as "self-led CT." However, while the effectiveness of the self-led CT inherently depends on the willingness and skills of citizens to participate, the determinants of citizens' intention to participate in self-led CT are not yet fully understood. OBJECTIVE: We aimed to identify determinants of Dutch citizens' intention to participate in self-led CT and assess their potential for behavioral change, so as to identify "behavior change targets," which may be used in the development and implementation of self-led CT to increase citizens' intention to participate. METHODS: In March 2022, we performed an online cross-sectional questionnaire study. The questionnaire was developed based on findings from a previous exploratory semistructured interview study and distributed among a Dutch consumer panel. Using all questionnaire items as potential predictors, we performed a random forest analysis to identify determinants of citizens' intention to participate in self-led CT. We then performed an Agglomerative Hierarchical Cluster Analysis to identify groups of related determinants that may be considered overarching behavior change targets. Finally, we used Confidence Interval-Based Estimation of Relevance and calculated the Potential for Change Indices to compare the potential for behavioral change of the selected individual determinants and determinant clusters. RESULTS: The questionnaire was completed by 3019 respondents. Our sample is representative of the Dutch population in terms of age, gender, educational level, and area of residence. Out of 3019 respondents, 2295 (76%) had a positive intention to participate in self-led CT. We identified 20 determinants of citizens' intention that we grouped into 9 clusters. In general, increasing citizens' trust in the digital tools developed for self-led CT has the highest potential to increase citizens' intention, followed by increasing the belief that using digital tools makes participating in self-led CT easier, reducing privacy-related concerns, and increasing citizens' willingness-and sense of responsibility-to cooperate in CT in general. CONCLUSIONS: Overall, Dutch citizens are positive toward participating in self-led CT. Our results provide directions for the development and implementation of self-led CT, which may be particularly useful in preparing for future, large-scale outbreaks.

COVID-19 Pandemic and Hospitalizations due to Abortion among 10- to 14-Year-Old Girls in Brazil.

Introduction: Various non-pharmacological interventions to prevent coronavirus dissemination were implemented during the COVID-19 pandemic, including school closures. The effect of these interventions on particular aspects of people's lives such as sexual and reproductive health outcomes has not been adequately discussed. The objective of the study was to compare the monthly hospital admission rates due to abortion before and during school closure. Methods: We used an interrupted time series (IES) design to estimate the hospital admission rates before and during the school closure (intervention in March 2020) period. The analysis was performed considering all girls from age groups of interest and by stratifying the age groups according to skin color (white and non-white) in which the non-white category comprised both the black and mixed ethnicity together. Coefficients and 95% confidence intervals (95% CIs) were calculated using segmented linear regression models. Results: The results showed positive and statistically significant coefficients, suggesting post-intervention trend changes both in the population as a whole (coefficient: 0.07; 95% CI: 0.02; 0.11) and the non-white population group (coefficient: 0.07; 95% CI: 0.03; 0.11), indicating that the monthly hospital admission rates increased over the post-intervention period compared to baseline pre-intervention period. The ITS analysis did not detect statistically significant trend changes (coefficient: 0.02; 95% CI: -0.01; 0.05) in abortion admission rates in the white girl population group. Conclusion: The hospitalizations in Brazil due to abortions in 10- to 14-year-old girls increased during the COVID-19 pandemic in 2020 compared to 2019, and the number of abortions was higher in the non-white population than the white population. Furthermore, recognizing that the implementation of school closure has affected the minority population differentially can help develop more effective actions to face other future similar situations.

[Intentional search and reclassification of maternal deaths: quality information and its analysis to reduce maternal mortalityBusca intencional e reclassificação de mortes maternas: informação de qualidade e sua análise para reduzir a mortalidade materna]. / Búsqueda intencionada y reclasificación de muertes maternas: información de calidad y su análisis para reducir la mortalidad materna.

Objective: To describe the methodology of the intentional search and reclassification of maternal deaths (BIRMM, acronym in Spanish), which allows the identification and correction of misclassification and underreporting of maternal deaths. Methods: The BIRMM methodology, initially developed in Mexico in 2003 and disseminated in other Latin American countries since 2012, was used. BIRMM consists of four key components: i) reclassification of confirmed maternal deaths; ii) identification and investigation of suspected cases of maternal death; iii) cross-referencing with other information sources; and iv) publication of results and statistical analysis. Results: The application of BIRMM makes it possible to identify and analyze maternal deaths in maternal mortality committees, which has facilitated the implementation of effective response plans, contributing to a sustained reduction in maternal mortality in the countries. Conclusions: The BIRMM methodology is an effective tool for correcting underreporting and misclassification of maternal deaths, allowing better surveillance and response to this problem. Its adoption and routine implementation are essential to improve the quality of maternal mortality information and reduce maternal deaths in the Region of the Americas. The sustainability of this methodology depends on institutional commitment and political will in the countries.

Objetivo: Descrever a metodologia da busca intencional e reclassificação de mortes maternas (BIRMM), que permite identificar e corrigir erros de classificação e subnotificação de mortes maternas. Método: Foi utilizada a metodologia BIRMM, desenvolvida inicialmente no México em 2003 e disseminada em outros países da América Latina a partir 2012. A BIRMM consiste em quatro componentes principais: i) reclassificação de mortes maternas confirmadas ii) identificação e investigação de mortes maternas suspeitas; iii) confrontação com outras fontes de informação e iv) publicação de resultados e análise estatística. Resultados: A aplicação da BIRMM permite identificar e analisar as mortes maternas nos comitês de mortalidade materna, o que facilitou a implementação de planos de resposta eficazes, contribuindo para uma redução sustentada da mortalidade materna nos países. Conclusões: A metodologia BIRMM é uma ferramenta eficaz para corrigir a subnotificação e a classificação incorreta de mortes maternas, permitindo uma melhor vigilância e resposta a este problema. Sua adoção e implementação rotineira são essenciais para melhorar a qualidade da informação sobre mortalidade materna e reduzir as mortes maternas na Região das Américas. A sustentabilidade desta metodologia depende do compromisso institucional e da vontade política dos países.

The role of digital health in pandemic preparedness and response: securing global health?

BACKGROUND: Digital health technologies, such as mobile applications, wearable devices, and electronic health record systems, have significantly enhanced global health security by enabling timely data collection and analysis, identifying infectious disease trends, and reducing infection risk through remote services. OBJECTIVE: This study assesses the role of digital health in pandemic preparedness and global health security response. It examines the application of digital health to early detection, surveillance, and data management in patient care. METHODS: We gathered data from scholarly articles published between 2019 and 2024 (found in PubMed, Science Direct, Google Scholar, and Web of Science), reports from the WHO, and case studies of recent pandemics. Topics discussed include digital health technologies, their use, benefits, and issues. We paid special attention to gathering the informed opinions and perspectives of specialists from various fields, including public health, technology, and government. The commentary synthesises these findings to offer suggestions for incorporating digital health into future pandemic preparedness and response. RESULTS: Digital tools improve communication, combat fake news, and reach the public, but data protection and public health remain challenges. Integration requires extensive research and collaboration between governments and the private sector. CONCLUSION: The COVID-19 outbreak demonstrated the importance of digital technology in outbreak management, patient care, communication, and data sharing. As the world transitions into the post-pandemic phase, it will be important to build on these innovations and prepare for the challenges ahead in order to strengthen healthcare systems for future pandemics.

Main finding Digital health technology services like mobile health, big data analytics, and artificial intelligence are essential components of pandemic preparedness and response.Added knowledge This commentary integrates COVID-19 lessons and examines digital health's development in the global health security system, highlighting shortcomings and opportunities for further discoveries.Global health impact for policy and action This commentary highlights priorities for digital health in public health preparedness and makes the case for investment in infrastructure, workforce, and technology access. It highlights the need for international collaboration in combating global health threats and advancing a collaborative, equitable strategy for pandemic readiness.

Multi-biomarker approach for estimating population size in a national-scale wastewater-based epidemiology study.

This study identifies biochemical markers (BCIs) that can be used as population markers in wastewater-based epidemiology (WBE) and compares their estimates with other established population size estimation (PE) methods, including census data (PECEN). Several groups of BCIs (64 targets: genetic and chemical markers) were investigated in an intercity study, including 10 cities/towns within England equating to a population of ∼7 million people. Several selection criteria were applied to identify the best BCIs to provide robust estimation of population size at a catchment level: (1) excellent performance with analytical methods; (2) excellent fit of the linear regression model which indicates PE-driven BCI daily loads; (3) low temporal variability in usage; (4) human-linked origin. Only a few tested BCIs showed a strong positive linear correlation between daily BCI loads and PE indicating their low spatiotemporal variability. These are: cimetidine, clarithromycin, metformin, cotinine, bezafibrate, metronidazole and hydroxymetronidazole, diclofenac, and benzophenone 1. However, only high/long term usage pharmaceuticals: cimetidine and metformin as well as cotinine (metabolite of nicotine) performed well when tested in two independent datasets and catchments accounting for both spatial and temporal scales. Strong seasonal usage trends were observed for antihistamines, NSAIDs (anti-inflammatories), antibiotics and UV filters, invalidating them as PE markers. Key conclusions from the study are: (1) Cimetidine is the best performing BCI; (2) Chemical markers outperform genetic markers as PE BCIs; (3) Water utility PE estimates (PEWW) align well with PECEN and PEBCI values; (4) Ammonium/orthophosphate as well as viral PE markers suffer from high temporal variability, hence, they are not recommended as PEBCI markers, and, most importantly, (5) PEBCI calibration/validation at the country/region level is advised in order to establish the best PE markers suited for local/national needs and accounting for site/region specific uncertainties.

Effects of Injury Registry Data on Policy Making, Hospitalizations, and Mortality: Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: Initiated in 2021, a Brazilian project aims to establish a national injury registry, compiling comprehensive data on events and individuals across the country, irrespective of injury severity. The registry integrates information from prehospital and hospital care, diverse health systems lacking interoperability, and sectors such as firefighters and the police. Its primary goal is to enhance health surveillance by providing timely, high-quality information, guiding prevention strategies, and informing policy making. The project still aims to reduce long-term morbidity and mortality associated with injuries. OBJECTIVE: A knowledge gap remains regarding the effects of injury registries in relation to policies and injury outcomes. This protocol outlines a systematic review and meta-analysis to answer "What is the effect of implementation and use of injury registry data on policy making, hospitalization, and mortality?" METHODS: The systematic review follows PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on studies reporting results related to the implementation and use of injury registries, including trauma registries. Outcomes of interest include policy making, hospitalization rates or duration, and mortality. Registries within well-defined administrative boundaries will be included. Data will be collected from PubMed, Embase, Scopus, Web of Science, Lilacs, and references. Records will be independently screened by 2 reviewers, with any disagreements resolved through arbitration by a third reviewer. Homogeneous studies, with 3 or more evaluating the same outcome, may undergo meta-analysis. Subgroup analyses by registry type, injury groups, and other selected variables of interest will be conducted. Sensitivity analysis, risk of bias assessment, publication bias evaluation, and quality appraisal will also be performed. RESULTS: This systematic review will run from November 2023 to June 2024. No identical review was found. Search strategies were finalized, the bibliographic search started, duplicates were eliminated, and title and abstract screening began. Of 35 studies retrieved, 85 were excluded due to duplication, leaving 50 for selection. CONCLUSIONS: This study is timely, aligning with ongoing national efforts to implement an injury registry. By synthesizing available evidence, we will identify the potential of injury registries to guide the decisions of Brazilian policy makers. TRIAL REGISTRATION: PROSPERO CRD42023481528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=481528. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55029.

Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design.

BACKGROUND: Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone-based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. OBJECTIVE: This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. METHODS: In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. RESULTS: For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. CONCLUSIONS: In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method.

Triagem otoneurológica em trabalhadores expostos à altura / Otoneurological screening in workers exposed to height / Triaje otoneurológica en trabajadores expuestos a la altura

O trabalho em altura está entre as principais causas de acidentes ocupacionais no Brasil e é o fator que apresenta o maior risco de morte no ambiente laboral. Objetivo: Avaliar a presença de sinais e sintomas otoneurológicos em trabalhadores expostos à altura, no Distrito Federal. Método: Trata-se de um estudo observacional, transversal, de triagem otoneurológica, com 46 trabalhadores da construção civil, expostos à altura, localizados no Distrito Federal. Resultados: 52,2% dos participantes apresentaram alterações significativas no teste de Fukuda e correlação estatisticamente relevante (valor-p< 0.05) entre a média da idade e as queixas de tontura e desequilíbrio. Conclusão: A triagem mostrou-se uma ferramenta prática rápida, de baixo custo e eficaz para avaliar as queixas, sinais, sintomas e alterações otoneurológicas que podem comprometer a segurança do trabalhador quanto ao risco de queda.

Working at height is among the leading causes of occupational accidents in Brazil and is the factor that presents the greatest risk of death in the workplace. Objective: To evaluate the presence of otoneurological signs and symptoms in workers exposed to heights in the Federal District. Method: This is an observational, cross-sectional study of otoneurological screening, with 46 construction workers exposed to heights, located in the Federal District. Results: 52.2% of the participants had significant alterations in the Fukuda test and a statistically relevant correlation (p-value < 0.05) between the mean age and complaints of dizziness and unbalance. Conclusion: The screening proved to be a quick, low-cost and effective practical tool to assess complaints, signs, symptoms, and otoneurological changes that may jeopardize the safety of the worker as to the risk of falling.

El trabajo en altura está entre las principales causas de accidentes laborales en Brasil y es el factor que presenta mayor riesgo de muerte en el lugar de trabajo. Objetivo: Evaluar la presencia de signos y síntomas otoneurológicos en trabajadores expuestos a la altura, en el Distrito Federal. Método: Se trata de un estudio observacional, transversal, de triaje otoneurológico, con 46 trabajadores de la construcción, expuestos a la altura, ubicados en el Distrito Federal. Resultados: el 52,2% de los participantes mostró cambios significativos en el test de Fukuda y una correlación estadísticamente relevante (valor p < 0,05) entre la edad promedio y las quejas de mareos y desequilibrio. Conclusión: El screening demostró ser una herramienta práctica rápida, de bajo costo y efectiva para evaluar quejas, signos, síntomas y cambios otoneurológicos que podrían comprometer la seguridad del trabajador frente al riesgo de caída.