Addressing Unmet Social Needs and Social Risks - A Qualitative Interview-Based Assessment of Parent Reported Outcomes and Impact from a Medical Legal Partnership.

Medical legal partnerships address individual legal needs that can create impediments to health. Little is known about outcomes from medical legal partnerships and their relationship to access to justice. This paper reports outcomes from one medical legal partnership from the perspective of the client, with specific emphasis on impact on health and concepts related to access to justice. We suggest a conceptual model for incorporating medical legal partnerships into a broader framework about access to justice.

Community-Centered Epidemic and Pandemic Information and Engagement Platform, the Hive.

The COVID-19 pandemic underlined that communities are key in sharing trusted, timely and relevant information especially during a health emergency where the overabundance of information makes it difficult to make decisions to protect one's health. The WHO Hive project grew out of the desire to create a community-centered solution with the potential to change the way credible health information is shared, adapted, understood and used for health-related decision making before, during and after an epidemic or pandemic. The Hive online platform provides a safe space for knowledge-sharing, discussion, and collaboration, including access to timely scientific information through direct engagement with WHO subject matter experts, and the true innovation lies within the platform's ability to leverage the power of communities to crowdsource solutions to community concerns and needs. The platform is equipped with a set of synchronous and asynchronous features and tools to encourage coworking and facilitate cross-sectorial collaboration. The Hive seeks to leverage the expert communities to share resources and knowledge for epidemic and pandemic preparedness and provide an environment that is able to respond to the challenges faced in a complex information ecosystem.

Community-Centered User Research for the Development of the WHO's Epidemic and Pandemic Preparedness Platform, the Hive.

Each epidemic and pandemic is accompanied by an infodemic. The infodemic during the COVID-19 pandemic was unprecedented. Accessing accurate information was difficult and misinformation harmed the pandemic response, the health of individuals and trust in science, governments and societies. WHO is building a community-centered information platform, the Hive, to deliver on the vision of ensuring that all people everywhere have access to the right information, at the right time, in the right format in order to make decisions to protect their health and the health of others. The platform provides a safe space for knowledge-sharing, discussion, collaboration, and access to credible information. The Hive platform is an innovative minimum viable product that seeks to leverage the complex information ecosystem and the invaluable role of communities to share and access trustworthy health information during epidemics and pandemics.

WHO's Community-Centered Epidemic and Pandemic Information Platform: Hive.

Each epidemic and pandemic is accompanied by an infodemic. The infodemic during the COVID-19 pandemic was unprecedented. Accessing accurate information was difficult and misinformation harmed the pandemic response, the health of individuals and trust in science, governments and societies. WHO is building a community-centered information platform, the Hive, to deliver on the vision of ensuring that all people everywhere have access to the right information, at the right time, in the right format in order to make decisions to protect their health and the health of others. The platform provides access to credible information, a safe space for knowledge-sharing, discussion, and collaborating with others, and a forum to crowdsource solutions to problems. The platform is equipped with many collaboration features, including instant chats, event management, and data analytics tools to generate insights. The Hive platform is an innovative minimum viable product (MVP) that seeks to leverage the complex information ecosystem and the invaluable role communities play to share and access trustworthy health information during epidemics and pandemics.

Measuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference.

Background: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. Objective: In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. Methods: An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. Results: The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. Conclusions: Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

The global hepatitis delta virus (HDV) epidemic: what gaps to address in order to mount a public health response?

BACKGROUND: Co-infection between hepatitis B virus (HBV) and hepatitis delta virus (HDV) causes the severest chronic hepatitis and is associated with a high risk of cirrhosis and hepatocellular carcinoma (HCC). The Global Health Sector Strategy on Viral Hepatitis called for the elimination of hepatitis (- 65% mortality and - 90% incidence) by 2030. Our aims were to summarize key points of knowledge and to identify the gaps that need to be addressed to mount a public health response to HDV. METHODS: We performed a current literature review in terms of epidemiology by WHO regions, genotypes distribution and their pathogenicity, factors associated with HDV infection, mortality due to HDV infection, testing strategies and treatment. RESULTS: Prevalence of infection and genotypes are heterogeneous distributed, with highest prevalence in foci around the Mediterranean, in the Middle East, and in Central, Northern Asia and Eastern Asia. Persons who inject drugs (PWID) and migrants from highly endemic areas are highly affected. While antibody detection tests are available, HDV RNA tests of current infection are not standardized nor widely available. The few therapeutic options, including lofartinib, are not widely available; however several new and promising agents have entered clinical trials. CONCLUSION: HDV infection is an poorly known cause of chronic liver disease. To mount a public health response, we need a better description of the HDV epidemic, standardized testing strategies and better treatment options.

Ribosomal DNA as target for the assessment of DNA degradation of human and canine DNA.

The assessment of DNA amount and DNA integrity can support forensic DNA analysis, in particular of problematic traces such as single telogen hairs where STR typing success is often hampered by low amounts and strong degradation of nuclear DNA. Common strategies consist of quantitative polymerase chain reaction (qPCR)-based analysis of the abundance of a short versus a long nuclear amplicon, the latter prone to DNA degradation. To increase sensitivity, commercial qPCR solutions rest on amplification of multi-copy DNA sequences. Here we show that ribosomal DNA (rDNA) sequences are well suited for the same purpose. Because rDNA sequences are present in high copy number in most eukaryotic species, qPCR strategies can easily be adapted to non-human species. In this paper, we establish qPCR-based assays for human or dog DNA, respectively, which allow for sensitive analysis of DNA amounts and DNA degradation. We show that the human system can be applied to DNA of single telogen hairs, where STR typing success correlates with measured amounts and integrity of the DNA. By adapting the system to dog rDNA sequences we found that single telogen dog hairs often displayed less DNA degradation than human telogen hairs, in most cases allowing for successful STR typing. Thus, qPCR-based analysis of rDNA represents a cost-effective, highly sensitive strategy to assess DNA amount and integrity that can be adapted to hairs or other traces from various animal species.

Benefits of Robotic Camera Assistance in Minimally Invasive Bariatric Procedures: Prospective Clinical Trial Using a Joystick-Guided Camera-Holder.

BACKGROUND: While minimally invasive surgery is a growing sector in medicine, camera assistance remains a problem. Especially in bariatric surgery, the assistant holding the camera faces certain challenges. Furthermore, unless the surgeon controls the camera movement themselves, they will be challenged by an unstable image. The aim of this study was to investigate the benefits of a robotic camera assistant (SoloAssist®, AKTORmed™ GmbH, Barbing, Germany) in bariatric surgery. PATIENTS AND METHODS: Three hundred thirty one consecutive laparoscopic bariatric procedures were performed with the assistance of a camera robot, including Roux-en-Y gastric bypass, laparoscopic gastric banding, sleeve gastrectomy, and gastroplication. Failures and aborts were documented and 6 surgeons were interviewed regarding their experiences using a questionnaire. RESULTS: In 18 of 331 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of a need for frequent changes of position in narrow spaces and adverse angles. Two short circuits, 4 joystick faliures and one malfunction of the control unit were reported. All of the surgeons preferred robotic to human assistance, mostly because of a steady image and the capacity for self-control. DISCUSSION: The SoloAssist® is a reliable system for minimal invasive procedures, especially in bariatric surgery. It provides more comfortable conditions for the surgeon and their assistant by freeing one hand for other purposes. Even in narrow spaces (e.g., between a voluminous stomach and adipose liver), the robot guarantees a steady image. Slight movements of the camera can be precisely controlled, which leads to increased comfort for the surgeon.

Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017.

In 2016, the World Health Assembly passed a resolution to eliminate viral hepatitis as a public health threat by 2030. We aimed to examine the status of the global viral hepatitis response. METHODS: In 2017, the World Health Organization (WHO) asked the Ministries of Health in all 194 Member States to complete a Country Profile on Viral Hepatitis policy uptake indicators, covering national plans/funding, engagement of civil society, testing guidance, access to treatment, and strategic information. RESULTS: Of 194 Member States, 135 (70%) responded, accounting for 87% of the global population infected with hepatitis B virus (HBV) and/or C virus (HCV). Of those responding, 84 (62%) had developed a national plan, of which, 49 (58%) had dedicated funding, and 62 (46%) had engaged with civil society; those engaged with civil society were more likely to have a funded plan than others (52% vs. 23%, p = 0.001). Guidance on testing pregnant women (for HBV) and people who inject drugs (for HCV) was available in 70% and 46% of Member States, respectively; 59% and 38% of Member States reported universal access to optimal therapies for HBV and HCV, respectively. CONCLUSIONS: Most people living with hepatitis B and C reside in a country with a national hepatitis strategy. Governments who engaged with civil society were more advanced in their response. Member States need to finance these national strategies and ensure that those affected have access to hepatitis services as part of efforts to achieve universal health coverage. LAY SUMMARY: The World Health Organization's goal to eliminate viral hepatitis as a public health threat by 2030 requires global action. Our results indicate that progress is being made by countries to scale-up national planning efforts; however, our results also highlight important gaps in current policies.

Viral Hepatitis Strategic Information to Achieve Elimination by 2030: Key Elements for HIV Program Managers.

Evidence documenting the global burden of disease from viral hepatitis was essential for the World Health Assembly to endorse the first Global Health Sector Strategy (GHSS) on viral hepatitis in May 2016. The GHSS on viral hepatitis proposes to eliminate viral hepatitis as a public health threat by 2030. The GHSS on viral hepatitis is in line with targets for HIV infection and tuberculosis as part of the Sustainable Development Goals. As coordination between hepatitis and HIV programs aims to optimize the use of resources, guidance is also needed to align the strategic information components of the 2 programs. The World Health Organization monitoring and evaluation framework for viral hepatitis B and C follows an approach similar to the one of HIV, including components on the following: (1) context (prevalence of infection), (2) input, (3) output and outcome, including the cascade of prevention and treatment, and (4) impact (incidence and mortality). Data systems that are needed to inform this framework include (1) surveillance for acute hepatitis, chronic infections, and sequelae and (2) program data documenting prevention and treatment, which for the latter includes a database of patients. Overall, the commonalities between HIV and hepatitis at the strategic, policy, technical, and implementation levels justify coordination, strategic linkage, or integration, depending on the type of HIV and viral hepatitis epidemics. Strategic information is a critical area of this alignment under the principle of what gets measured gets done. It is facilitated because the monitoring and evaluation frameworks for HIV and viral hepatitis were constructed using a similar approach. However, for areas where elimination of viral hepatitis requires data that cannot be collected through the HIV program, collaborations are needed with immunization, communicable disease control, tuberculosis, and hepatology centers to ensure collection of information for the remaining indicators.

Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries.

BACKGROUND: There have been few reports on programmatic experience of viral hepatitis testing and treatment in resource-limited settings. To inform the development of the 2017 World Health Organization (WHO) viral hepatitis testing guidance and in particular the feasibility of proposed recommendations, we undertook a survey across a range of organisations engaged with hepatitis testing in low- and middle-income countries (LMICs). Our objective was to describe current hepatitis B and C testing practices across a range of settings in different countries, as well as key barriers or challenges encountered and proposed solutions to promote testing scale-up. METHODS: Hepatitis testing programmes in predominantly LMICs were identified from the WHO Global Hepatitis Programme contacts database and through WHO regional offices, and invited to participate. The survey comprised a six-part structured questionnaire: general programme information, description of hepatitis testing, treatment and care services, budget and funding, data on programme outcomes, and perceptions on key barriers encountered and strategies to address these. RESULTS: We interviewed 22 viral hepatitis testing programmes from 19 different countries. Nine were from the African region; 6 from the Western Pacific; 4 from South-East Asia; and 3 from Eastern Europe. All but four of the programmes were based in LMICs, and 10 (45.5%) were supported by non-governmental or international organizations. All but two programmes undertook targeted testing of specific affected populations such as people living with HIV, people who inject drugs, sex workers, health care workers, and pregnant women. Only two programmes focussed on routine testing in the general population. The majority of programmes were testing in hospital-based or other health facilities, particularly HIV clinics, and community-based testing was limited. Nucleic acid testing (NAT) for confirmation of HCV and HBV viraemia was available in only 30% and 18% of programmes, respectively. Around a third of programmes required some patient co-payment for diagnosis. The most commonly identified challenges in scale-up of hepatitis testing were: limited community awareness about viral hepatitis; lack of facilities or services for hepatitis testing; no access to low cost treatment, particularly for HCV; absence of national guidance and policies; no dedicated budget for hepatitis; and lack of trained health care and laboratory workers. CONCLUSIONS: At this early stage in the global scale-up of testing for viral hepatitis, there is a wide variation in testing practices and approaches across different programmes. There remains limited access to NAT to confirm viraemia, and patient self-payment for testing and treatment is common. There was consensus from implementing organizations that scale-up of testing will require increased community awareness, health care worker training, development of national strategies and guidelines, and improved access to low cost NAT virological testing.

Comparison of the Single-Syringe Push-Pull Technique With the Discard Technique for Obtaining Blood Samples From Pediatric Central Venous Access Devices.

The discard technique is the most widely used method of obtaining blood samples from patients with central venous access devices (CVADs), but risks removing more blood than is necessary for laboratory testing and may increase a patient's risk of anemia. We hypothesized that laboratory results from pediatric blood specimens obtained via CVAD using the single-syringe push-pull (formerly called the mixing) method and the discard method would be similar. Blood samples were obtained from pediatric oncology patients in a hospital setting using both collection methods and laboratory values were analyzed for concordance using the pairwise t-test, intraclass correlation coefficient, and Bland-Altman analysis methods. Statistical analysis revealed significant differences for sodium, potassium, chloride, bicarbonate, creatinine, calcium, white blood cell count, hemoglobin, hematocrit, and platelet count, but these differences were not clinically significant and within the standard error of measurement for the instrument. Given the similarity in laboratory results, the push-pull method should be considered for obtaining blood samples from CVADs in pediatric patients to avoid unnecessary blood loss.

Identifying the Bariatric Patient at Risk for Pulmonary Embolism: Prospective Clinical Trial Using Duplex Sonography and Blood Screening.

BACKGROUND: Thromboembolic complications continue to be one of the main reasons for perioperative mortality in bariatric surgery. There is no consensus on which is the safest and most effective thromboprophylaxis. This prospective study aims to evaluate the significance of thrombophilia screening and a venous duplex sonography in bariatric patients. METHODS: One hundred one patients were tested for coagulopathies (activated protein C (APC) resistance, factor II, antithrombin (AT)III, protein S and C). Perioperatively, the patients underwent a venous duplex sonography. A multimodal thromboprophylaxis protocol was set up: 2× 40 mg enoxaparin sodium per day and sequential pneumatic compressions of the lower extremities. RESULTS: In six patients, we identified previously unknown risk factors for thromboembolic complications. Protein S deficiency is found significantly more often in obese patients than in the general population. There are numerous risk factors which, in themselves, increase the risk of venous thromboembolism. In obese patients with obstructive sleep apnea or diabetes mellitus, thrombophilia is found significantly more often than in patients without these diseases. No postoperative thromboses occurred. CONCLUSIONS: The bariatric patient is a potential high-risk patient for venous thromboembolism. Thrombophilia is found significantly more often in obese patients than in the general population. Conceivably, existing conditions such as obstructive sleep apnea and diabetes mellitus have until today been underestimated regarding the entailing thrombosis risk. Thrombophilia screening and duplex sonography are possibilities for identifying patients at risk. The advantage of a reduced risk thanks to an adapted thromboprophylaxis based on the patient's individual risk profile justifies the relative increase in time and cost.

Impact of a statewide childhood vaccine program in controlling hepatitis A virus infections in Alaska.

Historically, Alaska experienced cyclic hepatitis A virus (HAV) epidemics, and the HAV rate among Alaska Native people was significantly higher than among other racial/ethnic groups. We evaluated the impact of universal childhood vaccination, initiated in 1996, on HAV epidemiology in Alaska by analyzing HAV cases reported to the State of Alaska. HAV incidence in all age groups declined 98.6% from 60.0/100,000 in 1972-1995 to 0.9/100,000 in 2002-2007. The largest decrease (99.9%) was in Alaska Native people, whose incidence (0.3) in 2002-2007 was lower than the overall U.S. 2007 rate (1.0). Among age groups, the decrease (99.8%) among children aged 0-14 years was the largest. Routine childhood vaccination has nearly eliminated HAV infection in Alaska.

Home improvement: C57BL/6J mice given more naturalistic nesting materials build better nests.

Environmental enrichment of laboratory mice can improve the quality of research, but debate arises over the means of enrichment and its ability to be used in a sterile environment. One important form of enrichment is nesting material. Mice in the wild build dome-shaped, complex, multilayered nests, but this behavior is not seen in the laboratory, perhaps due to inappropriate nesting material rather than the nest-building ability of the mice. Here we focus on the use of naturalistic nesting materials to test whether they improve nest quality through the use of a 'naturalistic nest score' system; we also focus on materials that can be sterilized and easily used in existing housing systems. We first determined whether C57BL/6J mice build naturalistic nests when given shredded paper strips. We then compared these shredded paper strips with other commonly used nesting enrichments (facial tissues and compressed cotton squares). Nests were scored for 6 d. We found that the shredded paper strips allowed the mice to build higher quality nests than those built with any of the other materials. Nests built with tissues were of intermediate quality, and nests built with compressed cotton squares were of poor quality, similar to those built by the control group. These results suggest that C57BL/6J mice given appropriate nesting materials can build nests similar to those built by their wild counterparts.

Optimizing environmental health training outcomes: a case study of tribal and nontribal trainees.

Approximately 80 percent of the public health workforce lacks formal public health education, thus necessitating ongoing professional development training programs to ensure the delivery of essential environmental public health services. Unfortunately, there is a paucity of literature describing changes in workplace performance directly related to training program attendance. The purpose of the study reported here, which was conducted in the spirit of Essential Public Health Service 8 ("assure a competent workforce"), was to examine training style efficacy and changes in performance among Native Americans and non-Native Americans related to attendance at a two-day professional development course in March 2006. Pre- and post-training knowledge, skills, and abilities (KSA) surveys were administered to a subset of training program attendees. The pre-training survey mapped demographic information and assessed prior knowledge and practices associated with environmental health communications. The post-survey was administered three months after the program to measure changes in these key factors, as well as responses to workshop teaching styles. Data analysis suggests teaching styles did not have a significant impact on the transfer and retention of knowledge among Native Americans and non-Native Americans; however, Native Americans preferred a conversational approach, while non-Native Americans articulated a preference for visual, content-rich presentations. Non-native Americans reported using skills and techniques learned in the workshop more frequently than did their Native-American counterparts.