Burnout among public health workers in Canada: a cross-sectional study.

BACKGROUND: This study presents the prevalence of burnout among the Canadian public health workforce after three years of the COVID-19 pandemic and its association with work-related factors. METHODS: Data were collected using an online survey distributed through Canadian public health associations and professional networks between November 2022 and January 2023. Burnout was measured using a modified version of the Oldenburg Burnout Inventory (OLBI). Logistic regressions were used to model the relationship between burnout and work-related factors including years of work experience, redeployment to pandemic response, workplace safety and supports, and harassment. Burnout and the intention to leave or retire as a result of the COVID-19 pandemic was explored using multinomial logistic regressions. RESULTS: In 2,079 participants who completed the OLBI, the prevalence of burnout was 78.7%. Additionally, 49.1% of participants reported being harassed because of their work during the pandemic. Burnout was positively associated with years of work experience, redeployment to the pandemic response, being harassed during the pandemic, feeling unsafe in the workplace and not being offered workplace supports. Furthermore, burnout was associated with greater odds of intending to leave public health or retire earlier than anticipated. CONCLUSION: The high levels of burnout among our large sample of Canadian public health workers and its association with work-related factors suggest that public health organizations should consider interventions that mitigate burnout and promote recovery.

Facility-Based Maternal Quality of Care Frameworks: A Systematic Review and Best Fit Framework Analysis.

OBJECTIVES: The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. METHODS: PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. RESULTS: An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support.

Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care.

Limitations of COVID-19 testing and case data for evidence-informed health policy and practice.

BACKGROUND: Coronavirus disease 2019 (COVID-19) became a pandemic within a matter of months. Analysing the first year of the pandemic, data and surveillance gaps have subsequently surfaced. Yet, policy decisions and public trust in their country's strategies in combating COVID-19 rely on case numbers, death numbers and other unfamiliar metrics. There are many limitations on COVID-19 case counts internationally, which make cross-country comparisons of raw data and policy responses difficult. PURPOSE AND CONCLUSIONS: This paper presents and describes steps in the testing and reporting process, with examples from a number of countries of barriers encountered in each step, all of which create an undercount of COVID-19 cases. This work raises factors to consider in COVID-19 data and provides recommendations to inform the current situation with COVID-19 as well as issues to be aware of in future pandemics.

Virtual Clinics: A Student-Led, Problem-Based Learning Approach to Supplement Veterinary Clinical Experiences.

The COVID-19 pandemic created an abrupt need for effective remote clinical experiences for senior clinical veterinary students. Subsequently, the authors created virtual clinics. This activity was derived from a problem-based learning (PBL) model wherein students designed clinical cases and participated through virtual role play as clients and clinicians. The purpose of this article is to describe virtual clinics and to report data from focus groups of participating students and faculty facilitators from two institutions regarding the positive and negative aspects of the shift in practice. A few common emerging themes included that case rounds were fun and engaging, students could learn at their own pace, and peer-to-peer learning opportunities had perceived value. Themes are reflected against the pedagogical literature to draw out areas that resonated. Students felt this activity was more engaging than listening to a discussion of a case they had no ownership of, and facilitators agreed that the peer-to-peer interactions added to student engagement. Additionally, students developed deeper knowledge about the underlying disease process and clinical presentation of their case, which required independent and self-directed learning, enabling students to think about a case from a client's perspective. By participating in these activities, students developed skills of classroom-to-clinic transitional value. While virtual clinics should not replace in-person clinical experiences, this activity might be useful to facilitate students' transition from a structured classroom setting to a less-structured clinical experience.

The EMBOLDEN Co-design study: Partnering with older adults and communities to develop a community program to enhance mobility.

Context: Physical mobility and social participation are requisite for independence and quality of life as one ages. Barriers to mobility lead to social isolation, poor physical and mental health, all of which are precursors to frailty. To date, most mobility-enhancing interventions in older adults have been designed by researchers without citizen input and delivered in controlled settings; their translation to real-world contexts is often impractical and rarely occurs. Objectives: i) To engage older adults and community service providers to qualitatively explore priorities, needs, enablers and barriers to mobility and community participation faced by older adults, and ii) To co-design an evidence-informed, feasible, acceptable group intervention to support mobility and promote health among older adults facing health inequities. Study Design: Adapted experience-based co-design, conducted in collaboration with a Strategic Guiding Council comprised of older adults and service providers. Setting: Community-based. Population studied: Community-dwelling older adults (55+) and local health and social service providers. Outcome Measures: EMBOLDEN's Strategic Guiding Council and the research team collectively interpreted qualitative study findings, together with results of completed systematic reviews and an environmental scan, to determine priority design features of a community-based mobility-enhancing intervention to enable health and well-being in older adults in Hamilton, ON. Results: Eighteen diverse older adults and 16 service providers completed persona scenario interviews. These lived experience perspectives were analyzed, interpreted, and integrated with research and local evidence in the intervention co-design process. Priority design features for the intervention included duration, intensity, mode of delivery, characteristics of interventionists, and implementation strategies. Findings highlighted key strategies related to participant motivation, recruitment, and engagement, as well as important equity, diversity, and inclusion considerations. Conclusions: Partnering with diverse stakeholders is critical to identifying optimal design features of a community-based intervention to promote mobility. Ultimately, we aim to implement and evaluate a health promoting intervention that is sustainable, scalable, addresses health inequities, and effectively improves the lives of older adults.

Community-based physical activity and/or nutrition interventions to promote mobility in older adults: An umbrella review.

Background: Physical activity and a healthy diet are important in helping to maintain mobility and quality of life with aging. Delivery of physical activity and nutrition interventions in a group setting adds the benefits of social participation. Several published systematic reviews have explored a broad range of PA and/or nutrition interventions for older adults, making it challenging to bring together the best scientific evidence to inform program design and to inform multicomponent intervention development. This umbrella review aims to identify group-based physical activity and nutrition interventions for community-dwelling older adults that improve mobility. Methods: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to April 28, 2020. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity and/or nutrition interventions, delivered in a group setting for community-dwelling older adults. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to assess the overall certainty of the evidence. Older adult/provider research partners informed data synthesis and results presentation. Results: In total, 54 systematic reviews (1 high, 21 moderate, 32 low/critically low quality) were identified; 46 included physical activity only, and eight included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions: Multicomponent group-based physical activity interventions can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review.

BACKGROUND: Physical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes. METHODS: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation. RESULTS: In total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. CONCLUSIONS: Group-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Patient contracts for chronic medical conditions: Scoping review.

OBJECTIVE: To describe how and why patient contracts are used for the management of chronic medical conditions. DATA SOURCES: A scoping review was conducted in the following databases: MEDLINE, Embase, AMED, PsycInfo, Cochrane Library, CINAHL, and Nursing & Allied Health. Literature from 1997 to 2017 was included. STUDY SELECTION: Articles were included if they were written in English and described the implementation of a patient contract by a health care provider for the management of a chronic condition. Articles had to present an outcome as a result of using the contract or an intervention that included the contract. SYNTHESIS: Of the 7528 articles found in the original search, 76 met the inclusion criteria for the final review. Multiple study types were included. Extensive variety in contract elements, target populations, clinical settings, and cointerventions was found. Purposes for initiating contracts included behaviour change and skill development, including goal development and problem solving; altering beliefs and knowledge, including motivation and perceived self-efficacy; improving interpersonal relationships and role clarification; improving quality and process of chronic care; and altering objective and subjective health indices. How contracts were developed, implemented, and assessed was inconsistently described. CONCLUSION: More research is required to determine whether the use of contracts is accomplishing their intended purposes. Questions remain regarding their rationale, development, and implementation.

Biomonitoring of airborne trace elements using transplanted lichens around a paper industry (Morelia, Mexico).

The deposition of trace elements around a pulp and paper industry in Morelia, Mexico, was evaluated using two lichen species as biomonitors. Samples of the foliose lichen Flavopunctelia praesignis and the fruticose lichen Usnea ceratina were collected in two remote areas and transplanted at different distances and directions from the pollution source. Lichen samples were exposed for 4 months (1) around the industrial area and (2) in their native habitats (control sites). We investigated the bioaccumulation of 11 trace elements in lichen thalli, and we compared the response of the two lichen species. To identify possible common sources, we evaluated the relationships between trace elements by correlations and cluster analyses. Our results showed that Cd was a good tracer for air pollution from the pulp and paper mills. In samples of Usnea ceratina exposed around the industrial area, Cd was significantly higher than in the remote area. Within the study area, trace element contents increase with the distance from the source, and they showed high depositions in the direction of prevailing winds. Moreover, we were able to detect groups of elements with similar behavior and common origins. Our results indicated that Flavopunctelia praesignis showed a higher capacity to accumulate trace elements than Usnea ceratina.

Health risk assessment of gaseous elemental mercury (GEM) in Mexico City.

Emissions of gaseous elemental mercury (GEM or Hg0) from different sources in urban areas are important subjects for environmental investigations. In this study, atmospheric Hg measurements were conducted to investigate air pollution in the urban environment by carrying out several mobile surveys in Mexico City. This work presents atmospheric concentrations of GEM in terms of diurnal variation trends and comparisons with criteria for pollutant concentrations such as CO, SO2, NO2, PM2.5, and PM10. The concentration of GEM was measured during the pre-rainy period by using a high-resolution active air sampler, the Lumex RA 915 M mercury analyzer. In comparison with those for other cities worldwide, the GEM concentrations were similar or slightly elevated, and they ranged from 0.20 to 30.23 ng m-3. However, the GEM concentration was significantly lower than those in contaminated areas, such as fluorescent lamp factory locations and gold mining zones. The GEM concentrations recorded in Mexico City did not exceed the WHO atmospheric limit of 200 ng m-3. We performed statistical correlation analysis which suggests equivalent sources between Hg and other atmospheric pollutants, mainly NO2 and SO2, emitted from urban combustion and industrial plants. The atmospheric Hg emissions are basically controlled by sunlight radiation, as well as having a direct relationship with meteorological parameters. The area of the city studied herein is characterized by high traffic density, cement production, and municipal solid waste (MSW) treatment, which constantly release GEM into the atmosphere. In this study, we included the simulation with the HYSPLIT dispersion model from three potential areas of GEM release. Emissions from industrial corridors and volcanic plumes localized outside the urban area contribute to the pollution of Mexico City and mainly affect the northern area during specific periods and climate conditions. Using the USEPA model, we assessed the human health risk resulting from exposure to inhaled GEM among residents of Mexico City. The results of the health risk assessment indicated no significant noncarcinogenic risk (hazard quotient (HQ) < 1) or consequent adverse effects for children and adults living in the sampling area over the study period. GEM emissions inventory data is necessary to improve our knowledge about the Hg contribution and effect in urban megacity areas with the objective to develop public safe policy and implementing the Minamata Convention.

Veterinary and Pharmacy Students' Expectations Before and Experiences After Participating in an Interdisciplinary Access to Care Veterinary Clinic, WisCARES.

This pilot survey study describes student expectations and experiences at WisCARES, a low-cost veterinary medical teaching clinic where students from multiple disciplines collaborate. We hypothesized that prior to the workday, students would describe different expectations of working in an interdisciplinary access to care clinic than what they ultimately experienced. We surveyed 62 students from the School of Veterinary Medicine (46) and pharmacy (16) who spent a clinic day at WisCARES. Before introductory rounds, students completed a short survey consisting of four open-ended questions about their learning expectations; at the end of the day, they reviewed their initial responses and added what they actually learned. Qualitative information was categorized and analyzed using descriptive statistics. Thirteen major themes emerged: diversity, confidence, communication, case lead/case management, financial experience, helping people, teamwork, technical skills, inter-professional experience, mentoring, non-specific positive regard, appreciation for resources, and rounds. Students reported improved confidence in managing and leading cases with specific positive outcomes in communicating with clients, particularly regarding leading financial conversations. Developing greater insight into diversity was a common theme expressed in students' expectations but was less frequently noted as an end-of-day outcome. Veterinary students less frequently described the value of the inter-professional environment and collaboration, but this was a major theme noted among pharmacy students. Student feedback was positive overall. The current study is useful in identifying areas for improving collaborative instruction and access to care professional student learning opportunities.

Does community engaged Carnegie status matter for county health rankings in the United States?

BACKGROUND: Community engagement is commonly used to address social inequities. The Carnegie Foundation offers an optional designation for which U.S. colleges and universities may apply to facilitate better educational outcomes through the institutionalization of community engagement. This study is the first to examine the relationship between Carnegie community engaged status and community health outcomes. METHODS: Ordinal logistic regression was conducted to investigate the association between the presence of a community engaged institution and county health outcomes, including health behaviors, clinical care relating to access and quality, social and economic factors, and physical environment from the 2016 Robert Wood Johnson County Health Rankings and 2015 New England Resource Center for Higher Education Community engaged list. We examined 820 U.S. counties containing a university or college, 240 of which had a community engaged designation. RESULTS: Findings indicated that the presence of a community-engaged institution was positively associated with Clinical Care (OR = 1.99; 95% CI: 1.09, 3.64). Other county health factors were not similarly associated. CONCLUSIONS: Our findings suggest that community engagement status may be most relevant for achieving better access and quality of clinical care. More research is needed to explore this association in the U.S. and internationally.

Where Are We Now? A Content Analysis of Canadian Master of Public Health Course Descriptions and the Public Health Agency of Canada's Core Competencies.

OBJECTIVE: To examine the degree to which Master of Public Health (MPH) programs' course descriptions align with the Public Health Agency of Canada's (PHAC's) core competency categories in order to identify strengths and training gaps in such programs across Canada. METHODS: A content analysis of MPH programs in Canada was conducted from July 2019 to November 2019. A sampling frame of programs was obtained from a list from the PHAC Web site. Program information, including mandatory and elective course descriptions, was extracted from each program's Web site and analyzed in NVivo 12. Course descriptions were independently categorized by 2 researchers into 1 or more of the 7 categories of the core competencies outlined by the PHAC. RESULTS: We identified 18 universities with MPH programs with 267 courses across Canada. Thematic analysis revealed that 100% of programs had coursework that addressed the "Public Health Sciences" and "Assessment and Analysis" categories; 93% addressed "Policy and Program Planning, Implementation, and Evaluation"; 67% addressed each of "Communication," "Leadership," and "Partnerships, Collaboration, and Advocacy"; and only 56% had course descriptions addressing "Diversity and Inclusiveness." CONCLUSIONS: We find that Canadian MPH programs may lack course offerings addressing core competency categories relating to diversity and inclusiveness, communication, and leadership. Our findings were limited in scope as we relied on program Web sites; thus, further research should explore course content in more depth than this course description analysis allowed and identify ways to close the MPH curricular gaps we identified.

Historical trends of metals concentration in PM10 collected in the Mexico City metropolitan area between 2004 and 2014.

In this work, we report metals concentrations in 80 PM10 samples collected at four sites in the Mexico City Metropolitan Area (MCMA): Tlalnepantla (NE), Xalostoc (NE), Merced (C), and Pedregal (S), during the dry/cold season (October to January) for the 2004-2014 period. Mean PM10 mass concentration (66.1 µg m-3) significantly exceeds the annual mean air quality guidelines recommended by the World Health Organization. The statistical analysis of concentration data and meteorological parameters allows us to recognize the importance of wind intensity speed (Wsp) and wind direction conditions in the enrichment of PM concentrations. The proximity and magnitude of the emitting source is also relevant for PM concentration. Such conditions favored that higher metal concentration was recognized at the north of the studied area. By means principal component analysis (PCA) was difficult to identify the groups of metals associated with specific sources (anthropogenic and geogenic) given the high complexity of the study area and the long period of time evaluated. Metal concentration trend shows an important positive trend for Pt, V and Cr, while PM10, Ni, Cu, Ag and Sb show a trend of moderate increase. In contrast, Pb and Co registered a strong percentage reduction, while Hg, Mn, As and Cd show a slight reduction, probably resulting from the implementation of regulatory measures and influenced by urban changes associated at the north of the studied area. The results of this research provide information that should be considered for evaluating the impact of anthropogenic sources and applying regulatory measures to control emissions.

Metal(loid) exposure on children from a historical metallurgical site.

The data obtained in this study represent a comprehensive assessment of human exposure to metal(loids) enriched in the environment, derived from metallurgical activities in Cedral, a town in North-Central Mexico. A multi-elemental analysis (As, Cd, Cr, Cu, Fe, Mn and Sb) shows high metal(loid) content in environmental media (tailings samples, dust samples and particulate matter < 2.5 µm collected in the urban area). Blood samples from school-age children were collected and analyzed to determine exposure levels. The assessment of the data obtained from this study shows that Sb and Cd are highly enriched elements in the environment of Cedral; their respective levels in the blood samples analyzed are 10.9 and 11.3 times higher than their pediatric reference levels. The statistical analysis indicates a strong relationship between metal(loid)s in blood samples and both dust and PM2.5 samples, which reveal that ingestion and inhalation could represent important exposure routes for metal(loid) intake. Continuous monitoring in the area is paramount to assess the health impact posed by the different routes of exposure. It is also important to implement health education programs to decrease the population's exposure to metal(loid)s and to design urgent remediation measures, to be implemented as soon as possible.

Mercury, Platinum, Antimony and Other Trace Elements in the Atmospheric Environment of the Urban Area of Mexico City: Use of Ficus benjamina as Biomonitor.

The application of Sb, Pt and Hg in the development of new strategic technologies has increased significantly in recent years. This study evaluates the impact of vehicular traffic on the rise in emission of Sb, Pt and Hg in the atmospheric environmen of Mexico City and their correlation to Co, Cr, Cu, Ni, Pb, V and Zn. Ficus benjamina leaves were collected as biomonitor of atmospheric metals deposited in areas exposed to heavy vehicular traffic. High enrichment factor values (metal(loid) concentration/background values) were calculated: 146 (Sb), 52.8 (Pb), 29.7 (Pt) and 25.1 (Cr). Enrichment factors of Ni, Zn, Co, V, Cu and Hg decrease in that order and are < 10. Principal component analysis allows recognize that most of the analyzed metal(loids) are related to traffic sources; Ni and Cr are also attributable to an additional anthropogenic source. No relationship was found relating Pb to vehicular sources.

Gaseous Elemental Mercury (GEM) in the Mexico City Metropolitan Area.

This paper presents atmospheric gaseous elemental mercury (GEM) data recorded during two short-term monitoring surveys in the Mexico City Metropolitan Area (MCMA) at 12th May 2019 and at 22nd May 2020, during conditions of low and high human activity respectively. Results, although they are limited, can be considered as the representative range of exposure to GEM of the inhabitants of MCMA; differences in results reveal the impact of human activities on GEM background levels (2.53 and 3.76 ng m-3, respectively). GEM concentrations and their spatial distribution does not allow for the identification of important industrial sources and do not reach intervention pollution levels. The activity of the Popocatépetl volcano is not likely to have an effect on GEM in the MCMA. In spite the evident decrease in GEM concentrations compared with data previously reported, monitoring must be carried out routinely given Mexico's participation in the Minamata Convention on Mercury.

How to Approach Cultural Humility Debriefing within Clinical Veterinary Environments.

Cultural humility debriefing provides learners with the opportunity to consider how they engage with clients and patients while keeping their own identities and biases in mind. In this article, we invite a deeper understanding of the cultural humility debrief by reviewing its history and uses, describing the state of mind and communication skills required for successful facilitation, and providing a step-by-step process as a framework for veterinary educators to implement effective cultural humility debriefing in practice. This teaching technique is rooted in established communication tools-specifically, permission seeking, open-ended questions, reflective listening, and empathy. Drawing on experience from an inter-professional clinic that serves people who live at or below the national poverty level, this article offers insights to veterinary educators so they can use the cultural humility debrief. By utilizing the outlined debriefing strategies in a clinical setting, it is possible to augment any existing veterinary curriculum and strengthen education around cultural topics.

Defining and classifying public health systems: a critical interpretive synthesis.

BACKGROUND: The introduction of the determinants of health has caused a shift towards understanding health from a holistic perspective as well as increased recognition of public health's contributions to the health of the population. Several frameworks exist to conceptualise healthcare systems, highlighting the stark contrast of frameworks unique to public health systems. The objectives of this study were to define public health systems and assess differences between healthcare systems and public health systems within established health systems frameworks. METHODS: A critical interpretive synthesis was conducted. Databases searched included EBSCOhost, OVID, Scholars Portal, Web of Science, Cochrane Library and Health Systems Evidence. Data extraction, coding and analysis followed a best-fit framework analysis method. Initial codes were based on a current leading health systems and policy classification scheme - health systems arrangements (governance, financial and delivery arrangements). RESULTS: A total of 5933 unique documents were identified and 67 were included in the analysis. Definitions of public health and public health systems varied significantly as did their roles and functions across jurisdictions. Public health systems arrangements generally followed those of health systems, with the addition of partnerships (community and inter-sectoral) and communication playing a larger role in public health. A public health systems framework and conceptualisation of how public health currently fits within health systems are presented. CONCLUSIONS: Public health systems are unique and vital entities within health systems. In addition to examining how public health and public health systems have been defined within the literature, this review suggests that establishing the scope of public health is crucial to understanding its role within the larger health system and adds to the discourse around the relationship between public health, healthcare and population health. More broadly, this study addresses an important gap in understanding public health systems and provides conceptual and practical contributions as well as areas for future research.

Use of an Interactive Online Teaching Module Improved Students' Ability to Write a Clinically Appropriate SOAP Note.

The veterinary problem-based medical records lesson (Subjective-Objective-Assessment-Plan [SOAP] notes) at the University of Wisconsin, previously taught in lecture format, provides students little time for reflection. Moreover, evaluation of student-written SOAPs from subsequent courses demonstrates poor knowledge retention and application of the SOAP note structure. This article hypothesized that a virtual, interactive, case-based module would improve student SOAP-writing skills. A second-year student cohort (n = 79) was taught SOAP skills in lecture format (LECTURE-2); 2 years later, another second-year student cohort (n = 73) used the virtual module (MODULE-2). All students wrote SOAPs, which were evaluated using a standardized rubric and the cohorts' scores were compared. SOAPs were then compared between a third-year student cohort who received lecture-based SOAP instruction the year before (LECTURE-3, n = 55) and a third-year student cohort who received the virtual module (MODULE-3, n = 44). SOAP scores were significantly higher in the MODULE-2 group (Mdn = 6.5, range = 1.5-9.0) than in the LECTURE-2 group (Mdn = 5.0, range = 2.0-9.0, p = .006). Similarly, the MODULE-3 students scored higher on the differential diagnosis SOAP component than the LECTURE-3 students (Mdn = 1, range = 0-2, vs. Mdn = 0.5, range = 0-2, p = .041). Student feedback on the online module was positive. An online teaching module improved students' short- and long-term ability to write clinically appropriate SOAP notes. The findings suggest the module encouraged student engagement and reflection, leading to long-term retention and skill application.