Impact of Semi-Annual Albendazole on Lymphatic Filariasis and Soil-Transmitted Helminth Infection: Parasitological Assessment after 14 Rounds of Community Treatment.

Between October 2012 and October 2015, we conducted a community trial to assess the impact of semi-annual (twice yearly) community treatment with albendazole on lymphatic filariasis in Seke Pembe, a village in the Republic of the Congo. Semi-annual community treatment with albendazole has been continued in the community since October 2015. We conducted an additional parasitological assessment survey in October 2019, 6 months after the 14th round of semi-annual treatment. Between October 2012 and October 2015, Wuchereria bancrofti antigenemia and microfilaremia rates in the community had decreased from 17.3% to 4.7% and from 5.3% to 0.3%, respectively. In October 2019, the antigenemia rate had decreased further to 2.8% (19 of 687). No microfilariae were found in night blood smears from persons with circulating filarial antigenemia (0 of 16), suggesting that W. bancrofti transmission has been interrupted in Seke Pembe. Semi-annual albendazole treatments also reduced significantly infection rates with soil-transmitted helminths.

Multiomics and Health: A Holistic Approach to Better Understand the Role of the Microbiome.

The present Special Issue focuses on the latest approaches to health and public health microbiology using multiomics [...].

Equitable and Holistic Public Health Measures During the Singaporean COVID-19 Pandemic.

This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic. The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.

Uniting Public Health and Primary Care for Healthy Communities in the COVID-19 Era and Beyond.

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.

Master Clinician and Public Health Practitioner: Selected Occupational and Environmental Pulmonary Cases.

Occupational and environmental exposures contribute to the development and progression of most lung diseases, yet their impact is greatly under-recognized in clinical practice. Clinicians caring for patients with respiratory diseases should maintain a high index of suspicion for occupational and environmental contributing factors. Mastering occupational and environmental medicine clinical decision making requires specialized clinical skills. These skills include obtaining an appropriate work and exposure history; making an assessment of the magnitude and relevance of exposures and their contribution to a patient's respiratory disease; utilizing appropriate resources for evaluation and management of exposure-related disease; and considering socioeconomic and public health factors.

The completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa.

INTRODUCTION: most maternal and 24.3% of infant deaths occur during childbirth. Interventions during childbirth may reduce maternal and neonatal deaths. The Guidelines for maternity care in South Africa (2015) stipulates that all observations during labour should be recorded on a partogram. The objective of this study was to assess the knowledge and attitudes of nursing personnel and to evaluate their practices of completing partograms at National District Hospital, South Africa. METHODS: a two-phase, quantitative, cross-sectional, descriptive study design was used. In phase 1, the knowledge and attitudes of midwives and nurses were evaluated. Midwives and nurses completed anonymous, self-administered questionnaires that assessed their knowledge and attitudes. In Phase 2, partogram practices were measured by assessing completed partograms using a data collection tick sheet. RESULTS: twelve of the 17 nursing personnel completed the questionnaires. More than 90% of participants answered basic partogram knowledge questions correctly, but only two thirds knew the criteria for obstructive labour and just more than half that for foetal distress. Participants displayed a positive attitude toward the use of partograms. Of the 171 randomly selected vaginal deliveries during the study period, only 57.1% delivered with a completed partogram. Most elements of foetal monitoring and progress of labour scored above 80%, however, for maternal monitoring scored poorly in 26.4% of cases. CONCLUSION: although 71.4% of partograms scored more than 75% for completion, the critical components that influence maternal and foetal death, like the identification of foetal distress, maternal wellbeing and progress of labour, were lacking.

Nutrition Claims Frequency and Compliance in a Food Sample of the Spanish Market: The BADALI Study.

Nutrition claims (NCs) have been shown to affect customers' perceptions and behaviour. In Europe, they are regulated by Regulation (EC) No 1924/2006. The aim of this work was to analyse the prevalence and compliance of NCs according to this regulation in Spain. For this purpose, we used the BADALI database, which included 3197 foods present in the Spanish market. Our results show that 36.1% of all foods carried NCs, at a rate of 3.3 NCs/food. The prevalence was very heterogeneous among food groups. Nuts and seeds, legumes and non-alcoholic beverages were the groups with the highest prevalence. Micronutrients, fat, fibre and sugars were the nutrients most referred to in NCs. Overall, the compliance was low, with 49.2% NCs correct. Fibre and proteins were the nutrients with most correct NCs. Vegetables and non-alcoholic beverages were the food groups with the highest proportion of correct NCs. The main reason for incorrect NCs was because the amount of the nutrient was not stated in the label. The results of our study reveal that the aim of the European Commission to ensure a high level of protection for consumers regarding NCs has not been fulfilled. Therefore, we consider it crucial that European institutions invest in guaranteeing regulation compliance.

Effects of an Active Music Therapy Program on Functional Fitness in Community Older Adults.

BACKGROUND: Health problems common among older adults living in community settings include a lack of functional fitness. Many studies have confirmed that exercises and static music therapy improve physical and psychological health problems. Exercise programs involving music have a higher frequency of attendance and motivation than other exercise programs. Active participation in active group music therapy results in better therapeutic effects. PURPOSE: This study was designed to test the effectiveness of a 3-month active group music therapy program on the functional fitness of community older adults in Taiwan. METHODS: A quasi-experimental design with repeated measures was applied. A convenience cluster sample of older adults was drawn from seven senior-citizen activity centers in southern Taiwan. All participants were assigned to either an experimental group (n = 77) or a comparison group (n = 69) based on the requests of each senior center. The experimental group participated in the active group music therapy program for 3 months (twice per week and 60 minutes per session). The comparison group maintained their daily activities. Each participant's level of functional fitness was measured at baseline and at 1 and 3 months after the start of the intervention. RESULTS: Seventy-one participants in the experimental group and 62 participants in the comparison group completed the 3-month study. At the 1-month measurement, the experimental group had greater improvements in cardiopulmonary fitness, upper body flexibility, lower body flexibility, upper limb muscle power, lower limb muscle endurance, and balance than the comparison group (all ps < .05). These significant improvements persisted through the 3-month intervention (all ps < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Active group music therapy is an effective complementary and alternative therapy for improving six items of functional fitness in community-dwelling older adults. Healthcare professionals may incorporate this active group music therapy program as a health promotion activity for older adults living in community settings.

Public health guidelines should recommend reducing saturated fat consumption as much as possible: YES.

Based on decades of research, there is strong evidence that supports ongoing dietary recommendations to decrease intakes of SFAs and, more recently, to replace SFAs with unsaturated fat, including PUFAs and MUFAs. Epidemiologic research has shown that replacement of SFAs with unsaturated fat, but not refined carbohydrate and added sugars, is associated with a reduction in coronary heart disease events and death. There is much evidence from controlled clinical studies demonstrating that SFAs increase LDL cholesterol, a major causal factor in the development of cardiovascular disease. When each (nonprotein) dietary macronutrient isocalorically replaces SFA, the greatest LDL-cholesterol-lowering effect is seen with PUFA, followed by MUFA, and then total carbohydrate. New research on full-fat dairy products high in saturated fat, particularly fermented dairy foods, demonstrates some benefits for cardiometabolic diseases. However, compared with food sources of unsaturated fats, full-fat dairy products increase LDL cholesterol. Thus, current dietary recommendations to decrease SFA and replace it with unsaturated fat should continue to the basis for healthy food-based dietary patterns.

The urgent need for integrated science to fight COVID-19 pandemic and beyond.

The COVID-19 pandemic has become the leading societal concern. The pandemic has shown that the public health concern is not only a medical problem, but also affects society as a whole; so, it has also become the leading scientific concern. We discuss in this treatise the importance of bringing the world's scientists together to find effective solutions for controlling the pandemic. By applying novel research frameworks, interdisciplinary collaboration promises to manage the pandemic's consequences and prevent recurrences of similar pandemics.

Lessons learned from the fight against COVID-19 in the Great Maghreb.Five lessons for better resilience.

OBJECTIVE: To compile the lessons learned in the Greater Maghreb, during the first six months of the fight against the COVID-19 pandemic, in the field of "capacity building" of community resilience. METHODS: An expert consultation was conducted during the first week of May 2020, using the "Delphi" technique. An email was sent requesting the formulation of a lesson, in the form of a "Public Health" good practice recommendation. The final text of the lessons was finalized by the group coordinator and validated by the signatories of the manuscript. RESULTS: A list of five lessons of resilience has been deduced and approved : 1. Elaboration of "white plans" for epidemic management; 2. Training in epidemic management; 3. Uniqueness of the health system command; 4. Mobilization of retirees and volunteers; 5. Revision of the map sanitary. CONCLUSION: Based on the evaluation of the performance of the Maghreb fight against COVID-19, characterized by low resilience, this list of lessons could constitute a roadmap for the reform of Maghreb health systems, towards more performance to manage possible waves of COVID-19 or new emerging diseases with epidemic tendency.

Lessons learned from the fight against COVID-19 in the Great Maghreb. Five lessons for a better response.

OBJECTIVE: Identify the lessons learned in the Greater Maghreb, during the first semester of the fight against the COVID-19 pandemic, in the field of response. METHODS: During the first week of May 2020, a consultation of experts was conducted, using the "Delphi" technique, through an email asking each of them, the drafting of a good practice recommendation for "Public health". The Group coordinator finalized the text of the lessons, later validated by the signatories of the manuscript. RESULTS: Five lessons of good «response¼ against epidemics have been deduced and approved by Maghreb experts, linked to the following aspects: 1. Total reservation of hospital beds for patients; 2. Clinical management of the response; 3. Discreet conflict of interest; 4. Community participation in the response; 5. Contextualization of the global fight strategy. CONCLUSION: Based on the finding of low relevance of the Maghreb response against COVID-19, this list of lessons would help support the performance of Maghreb health systems in the management of epidemics.

External validation of the EORTC and NCCN bladder cancer recurrence and progression risk calculators in a U.S. community-based health system.

OBJECTIVES: To externally validate the European Organization for the Research and Treatment of Cancer (EORTC) risk calculator and National Comprehensive Cancer Network (NCCN) guidelines in a contemporary population of U.S. non-muscle-invasive bladder cancer (NMIBC) patients treated in a community-based setting and compare our findings to those from another U.S. health system. MATERIALS AND METHODS: We identified 1,491 NMIBC patients with a median follow-up of 2.1 years (recurrence) and 4.1 years (progression). We calculated NCCN risk groupings and EORTC prognostic index for recurrence and progression. We followed Royston and Altman's guidelines for the external validation of prognostic calculators. RESULTS: For predicting recurrence using the EORTC framework, Harrell's C (a measure of discrimination) was smaller in our sample (0.66) than in the European Association of Urology sample (0.61), whereas for progression, Harrell's C was larger in our sample (0.78 vs. 0.75). The EORTC calculator overestimated progression risk in the highest stratum for our sample; calibration and discrimination were adequate for all groups except the highest risk group. For NCCN risk groupings, Harrell's C was 0.54 for recurrence and 0.62 for progression, suggesting poor to fair discrimination in our sample. The NCCN framework had slightly better performance for predicting progression vs. recurrence. CONCLUSIONS: Existing NMIBC risk-stratification frameworks have acceptable accuracy to predict outcomes. However, further innovation in NMIBC care will require predictive tools with more granularity to reflect the differential risks of subgroups of NMIBC recurrence, prior treatment histories, and other prognostic variables.

Parallel Simulation Decision-Making Method for a Response to Unconventional Public Health Emergencies Based on the Scenario-Response Paradigm and Discrete Event System Theory.

Given the non-repeatability, complexity, and unpredictability of unconventional public health emergencies, building accurate models and making effective response decisions based only on traditional prediction-response decision-making methods are difficult. To solve this problem, under the scenario-response paradigm and theories on parallel emergency management and discrete event system (DES), the parallel simulation decision-making framework (PSDF), which includes the methods of abstract modeling, simulation operation, decision-making optimization, and parallel control, is proposed for unconventional public health emergency response processes. Furthermore, with the example of the severe acute respiratory syndrome (SARS) response process, the evolutionary scenarios that include infected patients and diagnostic processes are transformed into simulation processes. Then, the validity and operability of the DES-PSDF method proposed in this paper are verified by the results of a simulation experiment. The results demonstrated that, in the case of insufficient prior knowledge, effective parallel simulation models can be constructed and improved dynamically by multi-stage parallel controlling. Public health system bottlenecks and relevant effective response solutions can also be obtained by iterative simulation and optimizing decisions. To meet the urgent requirements of emergency response, the DES-PSDF method introduces a new response decision-making concept for unconventional public health emergencies.

The effect of community dialogues and sensitization on patient reporting of adverse events in rural Uganda: Uncontrolled before-after study.

BACKGROUND: Patients experiencing adverse drug events (ADE) in many developing countries are in the best position to report these events to the authorities but need to be empowered to do so. Systematic evaluation of community engagement and patient support especially in rural areas would provide evidence for a program to monitor potential harm from medicines. The aim of this study was to assess the effects of a community dialogue and sensitization (CDS) program on the knowledge, attitude and practises of community members for reporting ADE. METHODS: This an uncontrolled before-after study was conducted in two eastern Ugandan districts between September 2016 and August 2017. RESULTS: After implementation of the community dialogue and sensitization (CDS) program, there was an overall 20% (95% CI:16% to 25%) increase in knowledge about ADE in the community compared to before the program began. Awareness levels increased by 50% (95% CI: 37% to 63%) among those with little or no education and by41% (95% CI: 31% to 52%) among young people (15-24 years). Furthermore, 5% (95% CI: 3% to 7%) more respondents recognized the need for reporting ADEs compared to before the program. Finally, there was a significant increase of 115% (95% CI:137% to 217%) in respondent recognition and reporting of ADEs compared to the beginning of the CDS program. Overall, this community found the CDS program acceptable and proposed aspects that could be improved for future use. CONCLUSION: Our evaluation showed that the CDS program increased knowledge and improved attitudes by catalyzing discussions among community members and healthcare professionals on health issues and monitoring safety of medicines compared to before the program. Successful implementation of the program depends on holistic health systems strengthening and adaptation to the community's way of life.

An Assessment of a Public Health Initiative of Homeopathy for Primary Teething.

BACKGROUND: During primary teething, children suffer from running nose, mild fever, diarrhoea and other mild irritations and inflammations. A public health programme, 'Homoeopathy for the Healthy Child', was undertaken on a pilot basis focusing on promotion of healthy teething by provision of home-based care through six pre-identified homeopathic medicines for complaints commonly observed during primary teething. This article assesses the feasibility of this programme and reports the impact of this initiative on teething profile in children and episodes of diarrhoea and upper respiratory tract infection (URTI). MATERIALS AND METHODS: Accredited Social Health Activists (ASHAs) were trained in child care and usage of a kit comprising six medicines, namely Calcarea phosphoricum 6X (CP), Ferrum phosphoricum 3X, Magnesium phosphoricum 6X, Belladonna 30C, Chamomilla 30C and Podophyllum 30C. Calcarea phosphoricum was given regularly to each participating child from 6 months to 1 year of age. Home-based care for diarrhoea, URTI and mild fever was provided by ASHAs using the other five medicines in the kit. Dentition pattern and diarrhoea/URTI episodes were recorded over a period of the next 12 months. RESULTS: Eleven thousand four-hundred and twenty-six children were followed up regularly. Amongst those who enrolled at 6-7 months, a larger proportion of children were approaching expected teething in successive months as compared with children enrolled at 12 months, thus indicating that teething delays, if any, were overcome during this period. Incidence of diarrhoea and URTI showed decrease in the months after enrolment. Children responded favourably to the medicines given by ASHAs at the time of diarrhoea/URTI episodes, and ASHAs expressed satisfaction with the programme. CONCLUSION: An approach with regular use of CP and home-based care with homeopathy through health workers for common problems in teething children is acceptable to the community and enhances outreach of services to the public at large. Observations in terms of the healthy teething period may be further validated through studies of homeopathy with suitable comparator group.

Toward a National Conversation on Health: Disruptive Intervention and the Transformation from Health Care to Health.

Over a century ago, Abraham Flexner's landmark report on medical education resulted in the most extensive reforms of medical training in history. They led to major advances in the diagnosis and treatment of disease and the relief of suffering. His prediction that "the physician's function is fast becoming social and preventive, rather than individual and curative," however, was never realized.Instead, with the rise of biomedical science, the scientific method and the American Medical Association, the health care system became increasingly distanced from a holistic approach to life that recognizes the critical role social determinants play in people's health. These developments created the beginning of the regulatory controls that have come to define and shape American health care - and our unhealthy obsession with illness, disease and curative medicine that has resulted in a system that has little to do with health.To realize Flexner's prediction, and to transform health care into a holistic system whose primary goals are focused on health outcomes, six disruptive interventions are proposed. First, health needs to be placed in the context of community. Second, the model of primary care needs to be revised. Third, big data need to be harnessed to provide personalized, consumable, and actionable health knowledge. Fourth, there needs to greater patient engagement, but with fewer face-to-face encounters.Fifth, we need revitalized, collaborative medical training for physicians. And finally, true transformation will require market-driven, not regulatory-constrained, innovation. The evolution from health care to health demands consumer-driven choices that only a deregulated, free market can provide.