Comparative analysis of the incidence of enteroparasitosis andthe COVID-19 pandemic profile in the city of Bananeiras - PB / Análise comparativa da incidência de enteroparasitoses e doperfil pandêmico da COVID-19 na cidade de Bananeiras - PB

Enteroparasitosis are diseases caused by parasitic agents present in the environment and in the gastrointestinal tract of living beings. In addition, they are still considered neglected diseases, but of great importance for public health, especially when they are related to secondary infections and currently their co-infection profile with COVID-19. The interaction of protozoa and/or helminths with the SARS-CoV-2 virus is timely and its signs and symptoms are confused with other pathogen relationships. In this way, this study aims to correlate the incidence of enteroparasitosis and COVID-19, in the pandemic period from 2020 to April 2022. This is a documentary and exploratory study of secondary data from laboratory tests of patients who were treated and diagnosed with COVID-19 and enteroparasitosis at Hospital Doutor Cloves Bezerra Cavalcante, Municipal Hospital of Bananeiras, Paraíba, Brazil. In the analysis of the database, a significant increase of approximately 48.85% in the incidence of COVID-19 cases from 2020 to 2021 stands out, remaining high until 2022. In contrast, cases of enteroparasites peaked at 48.74% in 2021, followed by an average reduction of 23.12%, with a deviation of 1.49%, in relation to the years 2020 and 2022. It was concluded that COVID-19 is predominantly associated with an increase in secondary infections, highlighting the crucial need to promote health education, improve basic sanitation and guarantee access to health services as essential components in combating the increase in parasitic infections, especially those related to viral pathologies.

As enteroparasitoses são enfermidades originadas por agentes parasitários presentes no meio ambiente e no trato gastrointestinal dos seres vivos. Ademais, ainda são consideradas doenças negligenciadas, porém de grande importância para a saúde pública, em especial, quando estão relacionadas com infecções secundárias e atualmente seu perfil de coinfecção com a COVID-19. A interação de protozoários e/ou helmintos com o vírus SARS-CoV-2 é oportuna e seus sinais e sintomas são confundidos com outras relações de patógenos. Desta maneira, este estudo visa correlacionar a incidência de enteroparasitoses e COVID-19, no período pandêmico de 2020 a abril de 2022. Trata--se de uma pesquisa documental e exploratória, de dados secundários dos exames laboratoriais de pacientes que foram atendidos e diagnosticados com COVID-19 e enteroparasitoses no Hospital Doutor Cloves Bezerra Cavalcante, Hospital Municipal de Bananeiras, Paraíba, Brasil. Na análise da base de dados, destaca-se um aumento significativo de aproximadamente 48,85% na incidência de casos de COVID-19 de 2020 a 2021, mantendo-se elevado até 2022. Em contraste, os casos de enteroparasitas atingiram um pico de 48,74% em 2021, seguido por uma redução média de 23,12%, com um desvio de 1,49%, em relação aos anos de 2020 e 2022. Conclui-se que a COVID-19 está predominantemente associada ao aumento de infecções secundárias, destacando a necessidade crucial de promover a educação em saúde, melhorar o saneamento básico e garantir o acesso aos serviços de saúde como componentes essenciais no combate ao aumento de infecções parasitárias, especialmente aquelas relacionadas a patologias virais.

Predicting public mental health needs in a crisis using social media indicators: a Singapore big data study.

Mental health issues have increased substantially since the onset of the COVID-19 pandemic. However, health policymakers do not have adequate data and tools to predict mental health demand, especially amid a crisis. Using time-series data collected in Singapore, this study examines if and how algorithmically measured emotion indicators from Twitter posts can help forecast emergency mental health needs. We measured the mental health needs during 549 days from 1 July 2020 to 31 December 2021 using the public's daily visits to the emergency room of the country's largest psychiatric hospital and the number of users with "crisis" state assessed through a government-initiated online mental health self-help portal. Pairwise Granger-causality tests covering lag length from 1 day to 5 days indicated that forecast models using Twitter joy, anger and sadness emotions as predictors perform significantly better than baseline models using past mental health needs data alone (e.g., Joy Intensity on IMH Visits, χ2 = 14·9, P < ·001***; Sadness Count on Mindline Crisis, χ2 = 4·6, P = ·031*, with a one-day lag length). The findings highlight the potential of new early indicators for tracking emerging public mental health needs.

Advancing governance for digital transformation in health: insights from Georgia's experience.

Enhancing digital health governance is critical to healthcare systems in low-income and middle-income countries. However, implementing governance-enhancing reforms in these countries is often challenging due to the multiplicity of external players and insufficient operational guidance that is accessible. Using data from desktop research, in-depth interviews, focus group discussions and three stakeholder workshops, this paper aims to provide insights into Georgia's experience in advancing digital health governance reforms. It reveals how Georgia has progressed on this path by unpacking the general term 'governance' into operational domains, where stakeholders and involved institutions could easily relate their institutional and personal roles and responsibilities with the specific function needed for digital health. Based on this work, the country delineated institutional responsibilities and passed the necessary regulations to establish better governance arrangements for digital health. The Georgia experience provides practical insights into the challenges faced and solutions found for advancing digital health governance in a middle-income country setting. The paper highlights the usefulness of operational definitions for the digital health governance domains that helped (a) increase awareness among stakeholders about the identified domains and their meaning, (b) discuss possible governance and institutional arrangements relevant to a country context, and (c) design the digital health governance architecture that the government decreed. Finally, the paper offers a broad description of domains in which the governance arrangements could be considered and used for other settings where relevant. The paper points to the need for a comprehensive taxonomy for governance domains to better guide digital health governance enhancements in low-middle-income country settings.

Using digital tools and antigen rapid testing to support household-level SARS-CoV-2 detection by community health workers in Rwanda: an operational pilot study.

OBJECTIVE: To evaluate the use of antigen-based rapid diagnostic tests (Ag-RDTs) alongside a digital tool to deliver household-level COVID-19 testing by community health workers (CHWs), in line with Rwanda's ambition to decentralise COVID-19 testing. DESIGN: This was an operational pilot study to evaluate the impact and operational characteristics of using the digital e-ASCov tool combined with Ag-RDTs to support COVID-19 symptom screening and rapid testing by CHWs across eight districts in Rwanda. A total of 800 CHWs selected from both rural and urban areas were trained in delivering Ag-RDTs for COVID-19 testing and using the e-ASCOV application for data capture on a smartphone. Laboratory technicians repeated a subset of Ag-RDTs to assess the concordance of results obtained by CHWs. The study also assessed CHWs' experience of the intervention using a mixed-methods approach. SETTING: Eight rural, urban and semiurban districts in Rwanda. PARTICIPANTS: A total of 19 544 individuals were enrolled and screened for signs and symptoms of COVID-19. INTERVENTIONS: Community-based screening for COVID-19 by CHWs using the digital tool e-ASCov combined with rapid testing using Ag-RDTs. MAIN OUTCOME MEASURES: Number of participants screened and tested; concordance of Ag-RDT results between CHWs and laboratory technicians; feasibility of study procedures by CHWs and CHWs perceptions of the digital tool and Ag-RDT testing. RESULTS: From February to May 2022, CHWs screened 19 544 participants, of whom 4575 (23.4%) had COVID-19-related symptoms or a history of exposure to the infection. Among them, 86 (1.9%) were positive on Ag-RDTs. Concordance of Ag-RDT results between CHWs and laboratory technicians was 100%. Of the 800 trained CHWs, 746 (93.3%) were independently able to conduct household-based COVID-19 screening, perform the Ag-RDTs and send data to the central server. Most CHWs (>80%) found Ag-RDTs and e-ASCOV easy to use. CONCLUSIONS: This study demonstrated the feasibility of deploying a digital tool and Ag-RDTs for household-level SARS-CoV-2 detection in Rwanda. The findings support a broader roll-out of digitally supported rapid testing by CHWs to broaden access to testing for priority diseases.

Differential associations of physical job demands with cognitive impairment in Korean workers aged 45 and older: a 14-year longitudinal study using the Korean Longitudinal Study of Aging (KLoSA).

OBJECTIVES: To investigate the association between subelements of physical job demands and cognitive impairment risk in middle-aged and older workers in Korea. DESIGN: Longitudinal study using eight waves (2006-2020) of the Korean Longitudinal Study of Aging. SETTING: Nationally representative sample of the Korean population aged 45 years and older. PARTICIPANTS: 2170 workers aged 45 and older at baseline. PRIMARY OUTCOME MEASURES: Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination and cognitive impairment was defined as a score below 24. RESULTS: High physical strength demands were inversely associated with cognitive impairment (OR 0.31, 95% CI 0.14 to 0.68 for 'always' vs 'never' category). Conversely, frequent heavy lifting (OR 2.67, 95% CI 1.36 to 5.26) and bending, kneeling or squatting (OR 1.69, 95% CI 0.82 to 3.47) tasks were associated with increased impairment risk. Dose-response relationships were observed between all physical job demands and cognitive impairment, persisting among those with lower education but not among those with higher education. CONCLUSIONS: Different types of physical job demands have varying relationships with cognitive impairment in middle-aged and older workers. Tasks requiring high physical strength may protect against cognitive impairment while tasks involving heavy lifting and bending, kneeling or squatting may increase the risk. These findings highlight the need for tailored interventions that consider the type of physical job demands and workers' educational levels to mitigate cognitive impairment risks. Further research is needed to explore the underlying mechanisms and validate these findings.

Understanding the struggle: Unique challenges of adherence in male diabetic patients in Tshwane.

BACKGROUND:  Type 2 diabetes prevalence is steadily increasing worldwide, and South Africa is one of the countries in Africa with the highest prevalence of this disease, along with other non-communicable diseases. The adherence to treatment in male patients with type 2 diabetes is influenced by their attitudes towards medication and how they perceive their condition. To some extent, these factors impact the treatment outcomes for patients undergoing type 2 diabetes treatment. The purpose of this study was to investigate the perceptions of male patients with type 2 diabetes on their adherence to diabetic therapy. The study was conducted in the clinics of the City of Tshwane Metropolitan municipality in Gauteng. METHODS:  This study followed a qualitative, exploratory design. Data were gathered from 15 male patients who were purposefully sampled through in-person, one-on-one interviews with the principal investigator. The eight steps outlined by Tesch were used to analyse the participant data. RESULTS:  Emergent themes indicated that there were barriers to adherence to diabetic treatment and also factors that promoted adherence to diabetic treatment among the participants. Several factors were found to affect treatment uptake among the participants. CONCLUSION:  Patients demonstrated various reactions to diabetic treatment, highlighting the need for reinforcing education at the time of diagnosis and treatment initiation. Additionally, regular patient follow-up may be essential to improve adherence among patients.Contribution: The study highlights the importance of health promotion and the need to develop materials for medication-specific counselling for patients receiving diabetic treatment, in order to promote adherence.

Market survey of food product indicators and their credibility as a healthy food product in Klang Valley, Malaysia.

INTRODUCTION: The presence of food product indicators may facilitate consumers in making informed healthy choices. However, it may also mislead consumers. This study aims to determine the prevalence of food products carrying food product indicators; the compliance of products bearing Malaysia's Healthier Choice Logo (HCL) and nutrition and health claims (NHC) towards the local regulations; and the credibility of the aforementioned products as healthy food products based on the international regulation in the Malaysian market. METHOD: This is a cross-sectional market survey conducted from February to May 2023 on 3428 products sold in Malaysian supermarkets. Product information including the brand, name, nutrition information panel, food product indicator (front-of-pack nutrition labelling, NHC, other claims), ingredients list and manufacturer or importer were collected. Compliance of products carrying NHC and HCL is evaluated against local guidelines. Credibility as a healthy product is evaluated against the WHO Nutrient Profile Model for the Western Pacific Region on a subsample (products with HCL and/or NHC). RESULTS: 53% of food products surveyed had food product indicators (n=1809). A total of 32% carried at least one NHC (n=1101), of which 47% had excellent overall compliance (n=522). Only 4% carried Malaysia's HCL (n=138), of which 48% had excellent nutrient compliance (n=66). Only 13% of the products carrying Malaysia's HCL and NHC could be identified as absolute healthy food products as defined by the WHO standard (n=147). CONCLUSION: Although half of the products surveyed had food product indicators, merely half of them had excellent compliance towards the standards. Only 13% of the subsample qualified as healthy food products. Voluntary application of the local HCL was low among food industries. Ensuring high standards of compliance and credibility of food products in the Malaysian market is crucial for food companies and government authorities.

Cohort profile: Understanding the influence of early life environments and health and social service system contacts over time and across generations through the Western Australian Aboriginal Child Health Survey (WAACHS) Linked Data Study.

PURPOSE: Despite the volume of accumulating knowledge from prospective Aboriginal cohort studies, longitudinal data describing developmental trajectories in health and well-being is limited. The linkage of child and carer cohorts from a historical cross-sectional survey with longitudinal health-service and social-service administrative data has created a unique and powerful data resource that underpins the Western Australian Aboriginal Child Health Survey (WAACHS) linked data study. This study aims to provide evidence-based information to Aboriginal communities across Western Australia, governments and non-government agencies on the heterogeneous life trajectories of Aboriginal children and families. PARTICIPANTS: This study comprises data from a historical cross-sectional household study of 5289 Aboriginal children from the WAACHS (2000-2002) alongside their primary (N=2113) and other (N=1040) carers, and other householders. WAACHS data were linked with Western Australia (WA) government administrative datasets up to 2020 including health, education, child protection, police and justice system contacts. The study also includes two non-Aboriginal cohorts from WA, linked with the same administrative data sources allowing comparisons of outcomes across cohorts in addition to between-group comparisons within the Aboriginal population. FINDINGS TO DATE: Linked data coverage rates are presented for all WAACHS participants. Child health outcomes for the WAACHS children (Cohort 1) are described from birth into adulthood along with other outcomes including child protection and juvenile justice involvement. FUTURE PLANS: Analysis of data from both the child and carer cohorts will seek to understand the contribution of individual, family (intergenerational) and community-level influences on Aboriginal children's developmental and health pathways, identify key developmental transitions or turning points where interventions may be most effective in improving outcomes, and compare service pathways for Aboriginal and non-Aboriginal children. All research is guided by Aboriginal governance processes and study outputs will be produced with Aboriginal leadership to guide culturally appropriate policy and practice for improving health, education and social outcomes.

Drivers and barriers of seasonal influenza vaccination 2015/16 & 2019/20 to 2022/23 - a survey on why most Norwegians don't get the flu vaccine.

BACKGROUND: This study aimed to explore the reasons adults in the general population, influenza risk groups (RGs) and health care workers (HCWs) in Norway give for their vaccination choices and whether these reasons vary between groups or over time in order to further improve influenza vaccination coverage. METHODS: Respondents of a nationally representative telephone survey conducted by Statistics Norway were asked "What was the most important reason why you did/did not get vaccinated?". The question on influenza non-vaccination was included in 2016 and in 2020 to 2023 and the question on influenza vaccination in 2021 to 2023. RESULTS: The study included 9 705 individuals aged 18-79 years. Influenza vaccination coverage in the RGs increased from 20.6% in 2016 to 63.1% in 2022, before a reduction to 58.3% in 2023. Common reasons for non-vaccination were similar in all groups. The most cited reasons were "no need" for the vaccine and "no specific reason", followed by "not recommended/offered the vaccine", "worry about side effects" and "vaccine refusal". The most frequent reasons for vaccination among the general population and RGs were protection against influenza and belonging to a RG, while the most frequent responses among HCWs were being offered the vaccine at work/work in health care, followed by a desire for protection against influenza. Receiving a vaccine recommendation from a health professional was mentioned in all groups. We also observed that the proportion reporting "no need" for the vaccine decreased over time, especially among HCWs, and that the proportions reporting vaccine refusal and worry about side effects as reasons for non-vaccination were temporarily reduced during the COVID-19 pandemic. CONCLUSIONS: The general population and RGs cite protection against influenza as their primary incentive for vaccination, while HCWs mainly refer to their professional role or workplace vaccination. For non-vaccination we see a similar pattern in all groups, with "no need" and "no specific reason" as the main reasons. Of note, worry about side effects and vaccine refusal is as frequent among HCWs as in other groups. Continued efforts to maintain and increase vaccine confidence are needed.

Navigating the complexity of a collaborative, system-wide public health programme: learning from a longitudinal qualitative evaluation of the ActEarly City Collaboratory.

BACKGROUND: Addressing the upstream social determinants of health (e.g. built environment, education) can reduce the burden of non-communicable diseases. To do so effectively often requires system-wide collaboration. However, collaborating across multiple sectors, organizations and disciplines within a complex system can be challenging. ActEarly was a public health research consortium that aimed to improve child health by building an interdisciplinary, cross-city partnership to develop and/or evaluate upstream interventions, increase research capacity and improve collaboration between researchers, local authorities and communities. This paper explores ActEarly's experiences of navigating complexity to identify mechanisms that supported its implementation and proposes recommendations for future intersectoral and interdisciplinary population health research collaborations. METHODS: We conducted a longitudinal qualitative study of ActEarly, integrating findings from inductive documentary analysis of internal documents (mainly meetings minutes and reports) (n = 114) and interviews (n = 70) with 45 consortium members at three different timepoints (2018, 2021, 2023). Participants worked across different organizations, cities, roles and levels of seniority in the consortium. FINDINGS: Clarity, Unity, Flexibility and Feasibility were seen as the key mechanisms required to support ActEarly's implementation. Clear aims, governance structures and communication were necessary to manage the uncertainty of the complex system. A unified approach, characterized by strong relationships, having a shared vision and communal access to resources supported effective collaboration. Flexibility was required to adjust to different ways of working, respond to wider system events and manage the consortium. Establishing feasible aims that responded to the limitations of the system, the available resources and research infrastructure was required for teams to deliver the work. CONCLUSIONS: Implementing multi-faceted programmes in a complex system can be challenging. We recommend that future whole-systems consortia seeking to improve population health build Clarity, Unity, Flexibility and Feasibility into their programmes, noting the complex interrelationships between these factors. Iterative reflections from all parties should support delivery amidst the uncertainty that comes with running a population health research collaboration, and strong leadership and governance should play a key role in ensuring that these are built into foundations the programme.

Risk factors for COVID-19 transmission in England: a multilevel modelling study using routine contact tracing data.

Contact tracing for COVID-19 in England operated from May 2020 to February 2022. The clinical, demographic and exposure information collected on cases and their contacts offered a unique opportunity to study secondary transmission. We aimed to quantify the relative impact of host factors and exposure settings on secondary COVID-19 transmission risk using 550,000 sampled transmission links between cases and their contacts. Links, or 'contact episodes', were established where a contact subsequently became a case, using an algorithm accounting for incubation period, setting, and contact date. A mixed-effects logistic regression model was used to estimate adjusted odds of transmission. Of sampled episodes, 8.7% resulted in secondary cases. Living with a case (71% episodes) was the most significant risk factor (aOR = 2.6, CI = 1.9-3.6). Other risk factors included unvaccinated status (aOR = 1.2, CI = 1.2-1.3), symptoms, and older age (66-79 years; aOR = 1.4, CI = 1.4-1.5). Whilst global COVID-19 strategies emphasized protection outside the home, including education, travel, and gathering restrictions, this study evidences the relative importance of household transmission. There is a need to reconsider the contribution of household transmission to future control strategies and the requirement for effective infection control within households.

Predominance of enterotoxigenic Escherichia coli among ESBL/plasmid-mediated AmpC-producing strains isolated from diarrheic foals: a public health concern.

BACKGROUND: The upsurge of diarrheagenic E. coli pathotypes carrying extended-spectrum beta-lactamases (ESBLs)/plasmid-mediated AmpC ß-lactamase (pAmpC) among animals constitutes an emerging threat for humans and animals. This study investigated the burden of ESBL-/pAmpC-producing diarrheagenic E. coli among diarrheic foals and its potential public health implications. Rectal swabs were collected from 80 diarrheic foals. These swabs were processed to isolate and identify ESBL/pAmpC-producing E. coli using a selective culture medium, biochemical tests, phenotypic identification, and molecular identification of ESBL- and pAmpC-encoding genes. Moreover, all ESBL-/pAmpC-producing E. coli isolates were examined for different virulence genes related to diarrheagenic E. coli pathotypes. RESULTS: Out of 80 examined foals, 26 (32.5%) were confirmed as ESBL-/pAmpC-producing E. coli, of which 14 (17.5%) animals carried only ESBL-producing E. coli, whereas 12 (15%) animals possessed ESBL-pAmpC-producing E. coli. The only detected diarrheagenic pathotype was enterotoxigenic, encoded by the heat-stable enterotoxin gene (ST) with a prevalence rate of 80.8% (21/26). The ST gene was further characterized where STa, STb, and STa + STb were found in one, four, and 16 strains, respectively. Moreover, all enterotoxigenic E. coli (ETEC) isolates exhibited a multidrug-resistance pattern. The phylogenetic analysis of 3 obtained partial STb sequences revealed high genetic relatedness to ETEC isolates retrieved from humans, conferring such sequences' public health significance. CONCLUSIONS: These findings highlight that diarrheic foals could serve as a potential reservoir for multidrug-resistant ESBL-/pAmpC-producing enterotoxigenic E. coli.

Longitudinal survey of hepatitis E virus in extensively raised pigs in Spain.

Hepatitis E virus (HEV) is an emerging zoonotic virus of public health concern, of which pigs, wild boar and red deer are the main reservoirs. The European Food Safety Authority (EFSA) has recently prioritized the development of monitoring programs of HEV at different stages of the pig food chain, including outdoor pig farming. Pigs managed under these extensive production systems frequently share habitat and natural resources with wild boar and red deer during fattening stages and cross-species transmission of HEV among these species has previously been suggested. In this context, we aimed to (I) to evaluate the risk of HEV circulation within the production phases of extensively raised pigs and at the domestic-wildlife interface, and (II) to identify the genotypes circulating within these hosts. A total of 1452 pigs from seven different pig farms were longitudinally sampled during the breeding, rearing, and fattening production phases. In addition, 138 and 252 sympatric wild boar and red deer, respectively, were analysed. Anti-HEV antibodies were found in 1245 (85.7 %) out of the 1452 Iberian pigs sampled. The seroprevalence was 30.4 % in the breeding phase, 95.4 % in the rearing phase and 97.0 % in the fattening phase. Statistically significant differences (P < 0.05) were found among the three production phases. The seroprevalence was significantly higher (P < 0.001) in fattening pigs compared to those found in sympatric wild boar (31.9 %) and red deer (2.0 %). Three (1.0 %) out of the 293 serum pools analysed were positive for viral RNA. One of them was identified in pigs at the rearing phase (genotype 3 f) and two in wild boar (genotypes 3 f and 3 m). The high seroprevalence detected in extensively raised pigs, together with the detection of the zoonotic HEV-3 f and HEV-3 m subtypes in sympatric domestic and wild swine, highlights the risk of zoonotic transmission and the need to establish surveillance programs and control measures, particularly in breeding and rearing phase, in these epidemiological scenarios.

Patterns and trends in melanoma mortality in Spain (1999-2022).

AIM: To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. METHODS: Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. RESULTS: Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. CONCLUSION: Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

Policing of youth in the hospital.

BACKGROUND: Each year millions of children seek care in emergency departments, many of whom are from marginalized and minoritized groups who lack access to primary and preventive care. Law enforcement personnel are also commonly present in pediatric and adult emergency departments serving in a range of roles. Therefore, pediatric emergency departments sit at the nexus of the health system and the legal system for many vulnerable youth and families. OBJECTIVE: Herein, we explore several common specific legal issues surrounding policing of youth in the hospital setting: patient privacy and disclosure of information, questioning and visitation restriction, autonomy and decision making, restraints and use of force, and patient property. METHODS: Our team of legal scholars and clinician researchers examined the literature on policing of youth in healthcare settings and patients' legal rights in healthcare settings through searches using PubMed, Westlaw, and Lexis. FINDINGS: Through rigorous analysis of the medical literature, legal scholarship, and relevant case law, several important themes were identified which present challenges to clinicians caring for vulnerable children. CONCLUSIONS AND RELEVANCE: Pediatric clinicians, highly trained professionals in the medical and social care of youth and children, are often unaware of legal rules and procedures that guide law enforcement interaction with youth. This lack of knowledge may result in unknowing and unwitting violations of patients' rights while also compromising the quality of health care provided. Therefore, it is imperative that clinicians are educated on their roles and their institutions' roles in safeguarding patients' privacy and autonomy while still promoting effective collaboration with law enforcement.

Prevalence and distribution of Legionella in municipal drinking water supply systems in Madrid (Spain) and risk factors associated.

The presence and concentration of Legionella in drinking water supply systems, in hot water (DHW) for human consumption in public buildings in Madrid with potential health risk was studied. Sampling covered a total of 1695 DHW samples and 30 cold water (DCW) as a control taken in the 21 districts of the city over a period of 14 years (2007-2020). The detection and quantification of Legionella was carried out by plate culture and quantitative qPCR. The study evaluated a series of variables including sampling year, districts, type of building, seasonality, sampling points (taps, tanks and showers), water temperature and type of disinfection used. The degree of compliance of Legionella in the water supply network of Madrid was very high (96.1 %). The degree of colonization of the positive samples ranged from 0.3 × 103 and 1.5 × 105 GU/L for a 97 % of the samples. A higher presence of this bacterium was detected in older facilities in the peripheral districts and end points able to produce aerosols such as showers. The highest number of samples with Legionella growth occurred in the 35-40 °C range. The strategies implemented have contributed to a remarkable decrease in the presence of Legionella in the last years of sampling.

Personal responsibility for health in Bulgarian public health law and social legislation.

BACKGROUND: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation. METHODS: Through a search of national legal databases 7 documents were selected and subjected to content analysis. RESULTS: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics. CONCLUSION: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

Identifying skills required of new epidemiologists: a content analysis of Canadian job postings and master's programs.

Introduction: The rise of emerging public health threats has increased the need for qualified epidemiologists in Canada. Our study aimed to identify the knowledge, skills, and abilities (KSAs) required of epidemiologists entering the workforce and determine whether these align with those taught in graduate epidemiology programs. Methods: An inductive content analysis of Canadian job postings from May to December 2023 containing the keyword "epidemiology" and requiring master's degrees in epidemiology or related fields was conducted to identify the KSAs required in the workforce. Inductive content analysis of Master of Science (MSc) program descriptions and core course descriptions was completed to discern skills gained through Canadian graduate epidemiology and public health programs. Results: Based on the 295 job postings analyzed, five KSA categories were identified: communication skills (n = 268, 90.8%), analytical skills (n = 267, 90.5%), soft skills (n = 254, 86.1%), research methodology (n = 217, 73.6%), and knowledge of epidemiological concepts (n = 170, 57.6%). Analysis of 18 MSc programs found that that all of them described analytical skills, research methodology, and epidemiological concepts within their curriculum. Communication skills were described in 94.4% (n = 17) of programs, while soft skills were mentioned in 50.0% (n = 9). However, only 66.7% (n = 12) of programs outlined learning objectives or specified the skills acquired from their programs in their descriptions. Conclusion: There was alignment between the needs of the Canadian epidemiology job market and MSc programs, particularly in analytical skills and research methodology. However, development of soft skills should be emphasized within graduate epidemiology programs to better prepare graduates for the job market. Future research should aim to develop competency statements for epidemiologists in training to ensure consistency across graduate programs and promote career readiness.

Scaling up! Staff e-learning for a national take-home naloxone program.

Background: A staff e-learning course was developed to prepare for scaling up a national take-home naloxone (THN) program in Norway. The aims of the study were to (a) describe participant characteristics for those that completed a THN e-learning course, (b) compare opioid overdose knowledge scores before and after e-learning course completion, and (c) to explore subsequent THN distribution by those trained. Methods: This was a quasi-experimental pre-test, post-test longitudinal cohort study of individuals completing a THN e-learning course from April 2021 to May 2022. Frequency analyses were performed for participant characteristics and subsequent naloxone distributions at 1-week and 1-month follow-up. The opioid overdose knowledge scale (OOKS) was used to measure pre-test-post-test knowledge among participants. Wilcoxon signed-rank test was performed for comparison between pre-test and post-test. Effect size was calculated using Cohen criteria. Results: In total, 371 individuals were included in this study. Most were either nurses or social workers (n = 277, 75%). Participant knowledge increased by medium or large effect for all items measured. At 1-month follow-up, 15% reported naloxone distribution. During the study period, 94 naloxone kits were distributed. Major reasons for not distributing were "clients not interested", "workplace not distributing" and "workplace in process of distributing". Conclusions: Our findings suggest that an e-learning course is equally effective in terms of knowledge transfer as an in-person classroom setting, and may provide engagement in terms of naloxone distribution. However, our findings also emphasize the importance of clear implementation routines, including support from central coordinators to optimize the implementation process.