Public Health Measures to Address the Impact of Climate Change on Population Health-Proceedings from a Stakeholder Workshop.

BACKGROUND: The World Health Organization identified climate change as the 21st century's biggest health threat. This study aimed to identify the current knowledge base, evidence gaps, and implications for climate action and health policymaking to address the health impact of climate change, including in the most underserved groups. METHODS: The Horizon-funded project ENBEL ('Enhancing Belmont Research Action to support EU policy making on climate change and health') organised a workshop at the 2021-European Public Health conference. Following presentations of mitigation and adaptation strategies, seven international researchers and public health experts participated in a panel discussion linking climate change and health. Two researchers transcribed and thematically analysed the panel discussion recording. RESULTS: Four themes were identified: (1) 'Evidence is key' in leading the climate debate, (2) the need for 'messaging about health for policymaking and behaviour change' including health co-benefits of climate action, (3) existing 'inequalities between and within countries', and (4) 'insufficient resources and funding' to implement national health adaptation plans and facilitate evidence generation and climate action, particularly in vulnerable populations. CONCLUSION: More capacity is needed to monitor health effects and inequities, evaluate adaptation and mitigation interventions, address current under-representations of low- or middle-income countries, and translate research into effective policymaking.

The relationship among air pollution, meteorological factors and COVID-19 in the Brussels Capital Region.

In great metropoles, there is a need for a better understanding of the spread of COVID-19 in an outdoor context with environmental parameters. Many studies on this topic have been carried out worldwide. However, there is conflicting evidence regarding the influence of environmental variables on the transmission, hospitalizations and deaths from COVID-19, even though there are plausible scientific explanations that support this, especially air quality and meteorological factors. Different urban contexts, methodological approaches and even the limitations of ecological studies are some possible explanations for this issue. That is why methodological experimentations in different regions of the world are important so that scientific knowledge can advance in this aspect. This research analyses the relationship between air pollution, meteorological factors and COVID-19 in the Brussels Capital Region. We use a data mining approach that is capable of extracting patterns in large databases with diverse taxonomies. Data on air pollution, meteorological, and epidemiological variables were processed in time series for the multivariate analysis and the classification based on association. The environmental variables associated with COVID-19-related deaths, cases and hospitalization were PM2.5, O3, NO2, black carbon, radiation, air pressure, wind speed, dew point, temperature and precipitation. These environmental variables combined with epidemiological factors were able to predict intervals of hospitalization, cases and deaths from COVID-19. These findings confirm the influence of meteorological and air quality variables in the Brussels region on deaths and cases of COVID-19 and can guide public policies and provide useful insights for high-level governmental decision-making concerning COVID-19. However, it is necessary to consider intrinsic elements of this study that may have influenced our results, such as the use of air quality aggregated data, ecological fallacy, focus on acute effects in the time-series study, the underreporting of COVID-19, and the lack of behavioral factors.

The New Precision Stewards?

The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the "right drug, at the right dose, at the right time." Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub "precision stewardship." However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for "the ELSI of precision stewardship." In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.

Eastern Mediterranean Health Journal [2022;Vol.28, Issue 5]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services;and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

The COVID Positive Pathway: a collaboration between public health agencies, primary care, and metropolitan hospitals in Melbourne.

OBJECTIVES: To assess the capacity of the COVID Positive Pathway, a collaborative model of care involving the Victorian public health unit, hospital services, primary care, community organisations, and the North Western Melbourne Primary Health Network, to support people with coronavirus disease 2019 (COVID-19) isolating at home. DESIGN, SETTING, PARTICIPANTS: Cohort study of adults in northwest Melbourne with COVID-19, 3 August - 31 December 2020. MAIN OUTCOME MEASURES: Demographic and clinical characteristics, and social and welfare needs of people cared for in the Pathway, by care tier level. RESULTS: Of 1392 people referred to the Pathway by the public health unit, 858 were eligible for enrolment, and 711 consented to participation; 647 (91%) remained in the Pathway until they had recovered and isolation was no longer required. A total of 575 participants (81%) received care in primary care, mostly from their usual general practitioners; 155 people (22%) received care from hospital outreach services, and 64 (9%) needed high tier care (hospitalisation). Assistance with food and other basic supplies was required by 239 people in the Pathway (34%). CONCLUSIONS: The COVID Positive Pathway is a feasible multidisciplinary, tiered model of care for people with COVID-19. About 80% of participants could be adequately supported by primary care and community organisations, allowing hospital services to be reserved for people with more severe illness or with risk factors for disease progression. The principles of this model could be applied to other health conditions if regulatory and funding barriers to information-sharing and care delivery by health care providers can be overcome.

COVID-19 attributed mortality and ambient temperature: a global ecological study using a two-stage regression model.

A negative correlation between ambient temperature and COVID-19 mortality has been observed. However, the World Meteorological Organization (WMO) has reinforced the importance of government interventions and warned countries against relaxing control measures due to warmer temperatures. Further understanding of this relationship is needed to help plan vaccination campaigns opportunely. Using a two-stage regression model, we conducted cross-sectional and longitudinal analyses to evaluate the association between monthly ambient temperature lagged by one month with the COVID-19 number of deaths and the probability of high-level of COVID-19 mortality in 150 countries during time t = 60, 90, and 120 days since the onset. First, we computed a log-linear regression to predict the pre-COVID-19 respiratory disease mortality to homogenize the baseline disease burden within countries. Second, we employed negative binomial and logistic regressions to analyze the linkage between the ambient temperature and our outcomes, adjusting by pre-COVID-19 respiratory disease mortality rate, among other factors. The increase of one Celsius degree in ambient temperature decreases the incidence of COVID-19 deaths (IRR = 0.93; SE: 0.026, p-value<0.001) and the probability of high-level COVID-19 mortality (OR = 0.96; SE: 0.019; p-value<0.001) over time. High-income countries from the northern hemisphere had lower temperatures and were most affected by pre-COVID respiratory disease mortality and COVID-19 mortality. This study provides a global perspective corroborating the negative association between COVID-19 mortality and ambient temperature. Our longitudinal findings support the statement made by the WMO. Effective, opportune, and sustained reaction from countries can help capitalize on higher temperatures' protective role including the timely rollout of vaccination campaigns.

The Effectiveness of Intervening on Social Isolation to Reduce Mortality during Heat Waves in Aged Population: A Retrospective Ecological Study.

BACKGROUND: Heat waves are correlated with increased mortality in the aged population. Social isolation is known as a vulnerability factor. This study aims at evaluating the correlation between an intervention to reduce social isolation and the increase in mortality in the population over 80 during heat waves. METHODS: This study adopted a retrospective ecologic design. We compared the excess mortality rate (EMR) in the over-80 population during heat waves in urban areas of Rome (Italy) where a program to reduce social isolation was implemented, to others where it was not implemented. We measured the mortality of the summer periods from 2015 to 2019 compared with 2014 (a year without heat waves). Winter mortality, cadastral income, and the proportion of people over 90 were included in the multivariate Poisson regression. RESULTS: The EMR in the intervention and controls was 2.70% and 3.81%, respectively. The rate ratio was 0.70 (c.i. 0.54-0.92, p-value 0.01). The incidence rate ratio (IRR) of the interventions, with respect to the controls, was 0.76 (c.i. 0.59-0.98). After adjusting for other variables, the IRR was 0.44 (c.i. 0.32-0.60). CONCLUSIONS: Reducing social isolation could limit the impact of heat waves on the mortality of the elderly population.

Country-level determinants of COVID-19 case rates and death rates: An ecological study.

The Coronavirus Disease 2019 (COVID-19) pandemic has had a variable worldwide impact, likely related to country-level characteristics. In this ecological study, we explored the association of COVID-19 case rates (per 100,000 people) and death rates (per 100,000 people) with country-level population health characteristics, economic and human development indicators, and habitat-related variables. To calculate country-level COVID-19 case and death rates, the number of cases and deaths were extracted from the Johns Hopkins Coronavirus Resource Center through September 30, 2021. Country-level population health characteristics, economic, human development, and habitat-related indicators were extracted from several publicly available online sources of international organizations. Results were tabulated according to world zones and country economies. Unadjusted and adjusted multiple imputation linear regression analyses were performed to examine the association between country-level variables (per 1-standard deviation [SD] increase) and COVID-19 case and death rates. To satisfy the linear regression model assumptions of normality of residuals, we used the square root transformation of both outcomes. A total of 187 countries and territories were analyzed, with a median (25th, 75th percentiles) aggregate COVID-19 case rate of 3,605 (463, 8,228) per 100,000, a COVID-19 death rate of 45.9 (8.9, 137.1) per 100,000, and a case-fatality rate of 1.6% (1.2%, 2.6%). On multivariable analyses, each country-level 1-SD higher percentage of adults with obesity (ß coefficient 13.7; 95% confidence interval [CI] 13.7; 8.9, 18.4), percentage of smokers (5.8; 95% CI 1.2, 10.5), percentage of adults with high blood pressure (4.9; 95% CI 0.3, 9.6), and gross national income (GNI) per capita (9.5; 95% CI 4.6, 14.5) was independently associated with higher square root of COVID-19 case rate, while average household size (-1.7; 95% CI -12.3, -3.2) was independently associated with lower square root of COVID-19 case rate. Similarly, each 1-SD higher percentage of adults with obesity (1.76; 95% CI 0.99, 2.52), percentage of adults with high blood pressure (1.11; 95% CI 0.48, 1.74), percentage of adults with physical inactivity (1.01; 95% CI 0.10, 1.191), and travel & tourism competitiveness index (1.05; 95% CI 0.06, 2.04) was independently associated with higher square root of COVID-19 death rate, whereas GNI per capita (-0.92; 95% CI -1.81, -0.03), and average household size (-1.07; 95% CI -1.87, -0.27) was independently associated with lower square root of COVID-19 death rate. This ecological study informs the need to develop country-specific public health interventions to better target populations at high risk for COVID-19, and test interventions to prevent transmission of SARS-CoV-2, taking into consideration cross-country differences in population health characteristics, and economic, human development and habitat-related factors.

Large-Scale Screening of Asymptomatic Persons for SARS-CoV-2 Variants of Concern and Gamma Takeover, Brazil.

We performed a large-scale severe acute respiratory syndrome coronavirus 2 screening campaign using 2 PCR-based approaches, coupled with variant genotyping, aiming to provide a safer environment for employees of Federal University in Curitiba, Brazil. We observed the rapid spread of the Gamma variant of concern, which replaced other variants in <3 months.

[Factors associated with the incidence and mortality from COVID-19 in the autonomous communities of Spain]. / Factores asociados a la incidencia y la mortalidad por COVID-19 en las comunidades autónomas.

OBJECTIVE: Analyze the evolution of the epidemic of COVID-19 after the alarm state and identify factors associated with the differences between the autonomous communities. METHOD: Ecological study that used epidemiological, demographic, environmental and variables on the structure of health services as explanatory variables. The analysis period was from March 15th (the start of the alarm state) until April 22nd, 2020. Incidence and mortality rates were the main response variables. The magnitude of the associations has been estimated using the Spearman correlation coefficient and multiple regression analysis. RESULTS: Incidence and mortality rates at the time of decree of alarm status are associated with current incidence, mortality and hospital demand rates. Higher mean temperatures are significantly associated with a lower current incidence of COVID-19 in the autonomous communities. Likewise, a higher proportion of older people in nursing homes is significantly associated with a higher current mortality in the autonomous communities. CONCLUSION: It is possible to predict the evolution of the epidemic through the analysis of incidence and mortality. Lower temperatures and the proportion of older people in residences are factors associated with a worse prognosis. These parameters must be considered in decisions about the timing and intensity of the implementation of containment measures. In this sense, strengthening epidemiological surveillance is essential to improve predictions.

An investigation of psychological responses to COVID-19 in Irish healthcare workers: longitudinal quantitative and nested qualitative study.

COVID-19 is an unprecedent occurrence in modern times and individuals who work within healthcare settings, face a broad array of challenges in responding to this worldwide event. Key information on the psychosocial responses of such healthcare workers (HCWs) in the context of COVID-19 is limited and in particular there is a need for studies that utilise longitudinal methods, an overarching theoretical model, and use of a cohort of participants within a defined geographical area across acute and community settings. The work packages making up the current research project use quantitative and qualitative methods to examine the psychological sequelae for HCWs in the context of COVID-19 in geographically adjacent healthcare areas (South and Mid-West of Ireland) across four time points (induction, 3 months, 6 months, and 1 year follow-up). The quantitative arm of the project (WP 1) utilises the Common-Sense Model of Self-Regulation (CSM-SR) and examines a number of key psychological factors pertinent to this model including perceptions about COVID-19 and infection more generally, coping, formal and informal support and a number of impact variables including mood, sleep quality, and perceptions of stigma. The qualitative study (WP 2) will address HCWs experiences of working during the pandemic, ascertain any additional areas of psychological functioning, environmental and workplace factors and resources that may be utilised by HCWs and that are not assessed by the quantitative study protocol, focusing particularly on those staff groups typically underrepresented in previous studies.

A Systematic Scoping Review of the Impacts of Community Food Production Initiatives in Kenya, Cameroon, and South Africa.

BACKGROUND: Even before the COVID-19 pandemic, one in two people in Africa were food insecure. The burden of malnutrition remains high (e.g. childhood stunting, anaemia in women of reproductive age) or are increasing (e.g. overweight and obesity). A range of coordinated actions are required to improve this situation, including increasing local food production and consumption. The aim of this review was to provide a systematic and comprehensive overview of recently published research into the health, social, economic, and environmental impacts of community food production initiatives (CFPIs) in Kenya, Cameroon and South Africa. METHODS: We searched eight electronic databases covering health, social, environmental, economic and agricultural sciences. Primary research studies published from 1 January 2014 to 31 December 2018 were considered. Data on geographic location, study design, type of CFPI and the impacts assessed were abstracted from eligible articles. FINDINGS: We identified 4828 articles, 260 of which required full-text review and 118 met our eligibility criteria. Most research was conducted in Kenya (53.4%) and South Africa (38.1%). The categories of CFPIs studied were (in order of decreasing frequency): crop farming, livestock farming, unspecified farming, fisheries, home / school gardens, urban agriculture, and agroforestry. The largest number of studies were on the economic and environmental impacts of CFPIs, followed by their health and social impacts. The health impacts investigated included food security, nutrition status and dietary intake. One study investigated the potential impact of CFPIs on non-communicable diseases. Over 60% of studies investigated a single category of impact. Not one of the studies explicitly used a theoretical framework to guide its design or interpretation. CONCLUSIONS: Our findings on research studies of CFPIs suggest the need for a greater focus on interdisciplinary research in order to improve understanding of the relationships between their health, environmental, economic, and social impacts. Greater use of explicit theoretical frameworks could assist in research design and interpretation, helping to ensure its relevance to informing coordinated intersectoral interventions and policy initiatives.

Epidemiological and viral features of a cohort of SARS-CoV-2 symptomatic and asymptomatic individuals in an area of the Colombian Caribbean.

BACKGROUND: Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is an emerging viral pandemic disease. In the last 6 months, SARS-CoV-2 has caused millions of reported cases and hundreds of thousands of deaths. As other world regions, South America has not contained the pandemic's advance since it lacks the hospital and economic capacities. Public health implications of transmission, while the asymptomatic/presymptomatic infection is a critical concern at the current pandemic. OBJECTIVE: Describe the socio-demographic, clinical, and viral features of a cohort of SARS-CoV-2 infected individuals from the Colombian Caribbean. METHODS: Six hundred eighty-six clinical samples of suspected SARS-CoV-2 infection cases and contacts individuals from several hospital centers in the department of Córdoba, Colombia, were received at our laboratory between April 9th and May 16th, 2020. RNA was extracted using lysis buffers and spin columns. The samples were tested for SARS-CoV-2 by reverse transcription real-time polymerase chain reaction (RT-qPCR) using commercially available multiplex real-time PCR assay for simultaneous detection of 3 target genes of SARS-CoV-2 (Allplex™, 2019-nCoV assay, Korea). Viral copies quantification was done using a standard curve constructed from seriated dilutions of a SARS-CoV-2 positive control. Statics descriptive methods were used. RESULTS: Thirty-five nasopharyngeal samples were positive for SARS-CoV-2 infection; the average age was 43 (range, 1-95 years). Seventeen of 35 (49%) of the patients showed symptoms. Most of them had a cough, fever, and odynophagia; three of the patients reported having arthralgia. Only two patients required hospitalization. None of the patients had known co-morbidities. RT-qPCR results show that two of the symptomatic patients had significantly higher RNA copies than the rest. Eighteen of 35 (51%) individuals were asymptomatic, and the average age was 30 (range, 6-61 years). Four asymptomatic individuals showed a higher copy than some symptomatic patients; nonetheless, the average of RNA copies 8.26 × 1010 was lower than the symptomatic. CONCLUSIONS: This study shows that asymptomatic patients may develop infections with a high number of RNA copies. Since a considerable percentage of infections may be asymptomatic/presymptomatic, enhanced testing approaches may be needed to detect these persons. Due the occurrence of a large proportion of infections being a result from transmission originated in asymptomatic/presymptomatic individuals, public health interventions in Colombia should be based on two steps: a massive molecular screening, and viral load quantification. Finally, a remarkable issue in our study is the average age of symptomatic and asymptomatic groups (43 and 30 respectively) which may be important because of the economic impact that has been caused by the coronavirus pandemic and may be probably the cause of the reduced lethality observed in the country and the department at the time of this study.