How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach.

The COVID-19 pandemic has exposed faults in the way we assess preparedness and response capacities for public health emergencies. Existing frameworks are limited in scope, and do not sufficiently consider complex social, economic, political, regulatory, and ecological factors. One Health, through its focus on the links among humans, animals, and ecosystems, is a valuable approach through which existing assessment frameworks can be analysed and new ways forward proposed. Although in the past few years advances have been made in assessment tools such as the International Health Regulations Joint External Evaluation, a rapid and radical increase in ambition is required. To sufficiently account for the range of complex systems in which health emergencies occur, assessments should consider how problems are defined across stakeholders and the wider sociopolitical environments in which structures and institutions operate. Current frameworks do little to consider anthropogenic factors in disease emergence or address the full array of health security hazards across the social-ecological system. A complex and interdependent set of challenges threaten human, animal, and ecosystem health, and we cannot afford to overlook important contextual factors, or the determinants of these shared threats. Health security assessment frameworks should therefore ensure that the process undertaken to prioritise and build capacity adheres to core One Health principles and that interventions and outcomes are assessed in terms of added value, trade-offs, and cobenefits across human, animal, and environmental health systems.

A call to prioritise prevention: Action is needed to reduce the risk of zoonotic disease emergence.

Anthropogenic changes to the environment are facilitating the spread of animal pathogens into human populations. A global focus on detecting and containing emerging infectious diseases has deflected from the need for upstream prevention measures to reduce the risk of pathogen emergence. The drivers of infectious disease emergence have predominantly been considered as environmental and conservation issues and not as risks to human health. There is an opportunity for the UK to take a leadership position on this complex issue. This will require the establishment and maintenance of effective governance and policy mandates. Novel ways of policymaking are needed urgently to achieve three key aims: coordination and collaboration across sectors and government departments, the inclusion of diverse expertise, and the prioritisation of measures directed at prevention.

Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation.

BACKGROUND: Digital health care is increasingly used to improve health service accessibility and reduce costs. Remote health care requires a significant self-management role for service users, and this generates information provision and support needs that should be reflected in service planning. SMS text messaging offers a convenient and low-cost method of communication and is increasingly used across digital health care services to provide remote support. OBJECTIVE: The aim of this study was to quantify the number of messages generated through user interaction with a two-way SMS text messaging support service within an online sexual health service and to thematically explore the content of the messages and type of support required to facilitate self-management. METHODS: The content of all SMS text messages received by an online sexual health service was analyzed from April 4, 2018, to July 5, 2018. Messages were classified as being either administrative or clinical in nature and service or user initiated. For those messages that were both clinical and user initiated, a qualitative thematic analysis was completed to fully describe the content of the interactions. RESULTS: A total of 267 actionable messages were generated per 1000 orders requested through the service. Of the 8562 messages, 5447 (63.62%) messages were administrative and 3115 (36.38%) were clinical. Overall, 4306 of the 8562 messages (50.29%) responded to service-generated queries reflecting the public health and clinical responsibilities of an online provider, and 4256 (49.71%) were user-generated queries, demonstrating a willingness by users to proactively engage with a two-way SMS text messaging support service. Of the 3115 clinical messages, 968 (31.08%) clinical messages were user initiated and shared personal and complex clinical information, including requests for help with the self-testing process and personalized clinical advice relating to symptoms and treatment. CONCLUSIONS: This study demonstrates the willingness of users of an online sexual health service to engage with two-way SMS text messaging and provides insight into the quantity and nature of the support required to facilitate service delivery and self-care. Further work is required to understand the range of clinical problems that can be managed within this medium.

Active travelling to school is not associated with increased total daily physical activity levels, or reduced obesity and cardiovascular/pulmonary health parameters in 10-12-year olds: a cross-sectional cohort study.

BACKGROUND/OBJECTIVES: Childhood obesity has increased enormously. Several lifestyle factors have been implicated, including decreased physical activity, partially involving a decline in active travel to school. We aimed to establish the association between school transport mode and physical activity levels of primary 6 and 7 children (aged 10-12). Secondary outcomes were body mass index standard deviation scores, blood pressure levels and lung function. SUBJECTS/METHODS: A cross-sectional study was conducted with a total number of 432 children from three primary schools in North East Scotland. Actigraph accelerometers were used to provide objective measures of physical activity. Ninety-two children in primary 6 and 90 children in primary 7 (40 in common) had adequate data. Modes of transport to school were assessed by a questionnaire. Two hundred and seventeen children in primary 6 and one hundred and sixty-five in primary 7 returned adequate questionnaires. Children who used active transport modes for >70% of their journeys to school over the week were coded as active travellers and <30% were coded as passive travellers. All children also had height, weight, blood pressure levels and lung function measured. RESULTS: Children who lived further away from school, and in more expensive properties were more likely to travel passively to school. Actively commuting children (70% walking) had significantly higher activity levels than passive commuters during the 30 min that encompassed their journey to and from school. However, there were no significant differences between active and passive school travellers in total daily physical activity, BMI SDS, and both systolic and diastolic blood pressure and lung function. CONCLUSIONS: There was no evidence that more days of active travel to school had a significant influence on total physical activity, obesity and related health parameters. Public health interventions promoting active travel to school may have limited success in quelling the childhood obesity epidemic.

How good is our neonatal BCG uptake? A snapshot in Grampian.

BACKGROUND: The Neonatal BCG Immunisation programme is a key part of tuberculosis (TB) control efforts in the UK; however, there is considerable variability in the method of delivery of the programme and monitoring of performance. This study aimed to review the extent to which infants at risk of exposure to TB are being identified in Grampian and to assess the uptake of BCG vaccination in eligible infants. METHODS: The Practitioner Services database and Scottish Immunisation Recall System records for all babies born in Grampian in 2012 and 2013 were reviewed to identify the number of babies who had a TB risk status recorded and to assess the uptake of BCG immunization in at-risk babies. RESULTS: The proportion of babies with a risk status recorded was 96.6% in 2012 and 95.5% in 2013. The uptake of BCG vaccination in at-risk babies was 85.9% in 2012 and 89.9% in 2013. CONCLUSIONS: NHS Grampian has an efficient method for identifying infants at risk of exposure to TB and has good neonatal BCG vaccination coverage.