Engaging pharmacogenomics in pain management and opioid selection.

Opioid misuse and mismanagement has been a public health crisis for several years. Pharmacogenomics (PGx) has been proposed as another tool to enhance opioid selection and optimization, with recent studies demonstrating successful implementation and outcomes. However, broad engagement with PGx for opioid management is presently limited. The purpose of this article is to highlight a series of barriers to PGx implementation within the specific context of opioid management. Areas of advancement needed for more robust pharmacogenomic engagement with opioids will be discussed, including clinical and economic research needs, education and training needs, policy and public health considerations, as well as legal and ethical issues. Continuing efforts to address these issues may help to further operationalize PGx toward improving opioid use.

Lessons from the Ebola epidemics and their applications for COVID-19 pandemic response in sub-Saharan Africa.

COVID-19, caused by a novel coronavirus named SARS-CoV-2, was identified in December 2019, in Wuhan, China. It was first confirmed in sub-Saharan Africa in Nigeria on 27 February 2020 and has since spread quickly to all sub-Saharan African countries, causing more than 111,309 confirmed cases and 2,498 deaths as of 03 June 2020. The lessons learned during the recent Ebola virus disease (EVD) outbreaks in some sub-Saharan African countries were expected to shape and influence the region's responses to COVID-19 pandemic. However, some of the challenges associated with the management of the EVD outbreaks persist and create obstacles for the effective management of the COVID-19 pandemic. This article describes the commonalities between the EVD epidemics and COVID-19 pandemic, with a view to draw on lessons learned to effectively tackle the ongoing pandemic. Key successes, failures and lessons learned from previous EVD outbreaks are discussed. Recommendations on how these lessons can be translated to strengthen the COVID-19 response in sub-Saharan Africa are provided.

Association Between Accreditation Engagement and Using The Community Guide for Preventive Services by Local Health Departments.

BACKGROUND: Accreditation is one of the macro trends shaping the future of public health practice, and The Community Guide to Preventive Services is a decision-making tool used to select evidence-based interventions. Although local health departments (LHDs) seeking accreditation use The Community Guide, the relationship between the two remains unknown. The purpose of this study was to determine whether accreditation engagement is associated with the extent to which LHDs use The Community Guide. METHODS: Data from the National Association of County and City Health Officials' 2016 Profile of LHDs were examined for associations between accreditation engagement and the use of The Community Guide. RESULTS: Whereas 52.8% of LHDs used The Community Guide sometimes or consistently, only 21.5% were engaged in the accreditation process. Engaged LHDs were more likely to use The Community Guide consistently (adjusted odds ratios: 8.2; 95% confidence interval, 4.0-16.4) or sometimes (adjusted odds ratios: 3.6; 95% confidence interval, 2.4-5.3) than those not engaged at all. Local health departments serving a population of more than 50 000, organized with a county or mixed level of jurisdiction, and those having a top executive with a masters' or a doctoral degree, were more likely to report some use of The Community Guide. CONCLUSIONS: The extent that LHDs utilize The Community Guide is positively associated with the level of their accreditation engagement. Capacity building and policy measures could encourage LHDs to seek accreditation thereby increasing the use of The Community Guide for evidence-informed practice. Future studies should identify causal factors predicting the use of The Community Guide.

On Answering the Call to Action for COVID-19: Continuing a Bold Legacy of Health Advocacy.

The indelible impacts on our nation from the Coronavirus pandemic along with high fatality rates that disproportionately burden racial and ethnic minorities necessitate long-term coordinated federal, state and local action to improve critical determinants of population health, specifically important health and public health infrastructures as well as emergency and disaster preparedness systems. While our purview as the new pandemic epicenter should be a sufficient driver, coordinated health professionals bringing thoughtful attention to our historical context may be warranted. Prompting our advocacy should be the reality that our collective ability to rebound from such crises may ultimately hinge on protecting and equipping our most vulnerable racial-ethnic minority groups and any susceptible individuals within those populations. Recent historic firsts on behalf of racial and ethnic minorities taken by U.S. Department of Health and Human Services, through the Health Resources and Services Administration, the Office of Minority Health and the Centers for Disease Control and Prevention in response to COVID-19, if proven effective, should be considered for permanency within policy, practice and funding. In addition, given the complex history of Black Americans in this country and persistent and substantial Black-white disparities on health and economic measures across the board, the ultimate solution for improving the health and status Black Americans may look slightly different. Influenced by the 400th year anniversary of the first documented arrival of unfree Africans in North America in 1619, as well as the introduction of bills S.1080 and H.R.40 into Congress (The Commission to Study and Develop Reparation Proposals for African-Americans Act), some kind of reparations for Black Americans might serve as the logical starting point for further advocacy. Nevertheless, we remain supportive allies of all organizations concerned with communities who suffer the weight of this pandemic and any future world health disasters. What is additionally needed is a thoughtful unification of efforts and a commitment to sustained progress with measurable results for as long as the need exists and certainly for the foreseeable future. Let us as humane clinicians and public health professionals capture this moment of challenge and follow through on this urgent call to action.

How risk communication could have reduced controversy about school closures in Australia during the COVID-19 pandemic.

Although there has been consistent evidence indicating that school closures have only limited efficacy in reducing community transmission of coronavirus disease 2019 (COVID-19), the question of whether children should be kept home from school has attracted extensive and often divisive public debate in Australia. In this article we analyse the factors that drove high levels of concern among parents, teachers and the public and led to both demands for school closures in late March 2020, and to many parents' reluctance to return their children to school in May 2020. We discuss how the use of well-established principles of risk communication might have reduced much of this community concern. Then we set out a range of practical suggestions for communication practices that build trust and hence diminish concerns in relation to managing schools over the long term of the COVID-19 pandemic.

How can we support best practice? A situational assessment of injury prevention practice in public health.

BACKGROUND: To effectively impact the significant population burden of injury, we completed a situational assessment of injury prevention practice within a provincial public health system to identify system-wide priorities for capacity-building to advance injury prevention in public health. METHODS: A descriptive qualitative study was used to collect data on the current practice, challenges and needs of support for injury prevention. Data was collected through semi-structured interviews (n = 20) and focus groups (n = 19). Participants included a cross-section of injury prevention practitioners and leadership from public health units reflecting different population sizes and geographic characteristics, in addition to public health researchers and experts from academia, public health and not-for-profit organizations. Thematic analysis was used to code all of the data by one reviewer, followed by a second independent reviewer who coded a random selection of interview notes. Major codes and sub codes were identified and final themes were decided through iterations of coding comparisons and categorization. Once data were analysed, we confirmed the findings with the field, in addition to participating in a prioritization exercise to surface the top three needs for support. RESULTS: Major themes that were identified from the data included: current public health practice challenges; capacity and resource constraints, and; injury as a low priority area. Overall, injury prevention is a broad, complex topic that competes with other areas of public health. Best practices are challenged by system-wide factors related to resources, direction, coordination, collaboration, and emerging injury public health issues. Injury is a reportedly under prioritized and under resourced public health area of practice. Practitioners believe that increasing access to data and evidence, and improving collaboration and networking is required to promote best practice. CONCLUSIONS: The results of this study suggest that there are several system level needs to support best practice in public health injury prevention in Ontario including reducing research to practice gaps and supporting opportunities for collaboration. Our research contributes to the literature of the complexity of public health practice, and presents several mechanisms of support to increase capacity at a system level to improve injury prevention practice, and eventually lessen the population burden of injury.

The Community Guide: A Living Resource for Nursing Practice.

Evidence-based recommendations for preventive health.

A Novel Method for Evaluating and Comparing Community Health Reports.

OBJECTIVES: This study assessed the comprehensiveness and efficiency of existing Flint area public health community data using a novel method. One hundred thirty-eight community public health data reports were identified and screened for inclusion from Internet searches and community partner interviews. METHODS: Forty-two Centers for Disease Control and Prevention (CDC)-based health metrics were adopted as a standard for unbiased comparison. For each report, a percentage "match-to-standard" was calculated (i.e., we calculated the percentage of CDC recommended metrics that were covered in the report). The two locally generated reports with the highest match-to-standard scores were compared for overlap. RESULTS: There were 138 initially identified reports, and 110 unique reports remained after duplicates were removed. Twenty public health data reports met inclusion criteria and were included in the final sample. The top local public health data report yielded a 59.5% match-to-standard, indicating a 23.8% gap in current Flint area community data. Evaluation across all reports yielded an 89.3% match-to-standard with a 10.7% gap. An overlap of 70% exists between the two local reports with the highest match-to-standard scores. CONCLUSIONS: This research identified key health metrics not captured by current locally generated Flint public health reports. The 23.8% gap indicates an opportunity to improve local public health data report comprehensiveness. The 70% overlap across the two local reports with greatest match-to-standard scores generated locally, indicates potential duplication and an opportunity to improve efficiency.