Machine learning for emerging infectious disease field responses.

Emerging infectious diseases (EIDs), including the latest COVID-19 pandemic, have emerged and raised global public health crises in recent decades. Without existing protective immunity, an EID may spread rapidly and cause mass casualties in a very short time. Therefore, it is imperative to identify cases with risk of disease progression for the optimized allocation of medical resources in case medical facilities are overwhelmed with a flood of patients. This study has aimed to cope with this challenge from the aspect of preventive medicine by exploiting machine learning technologies. The study has been based on 83,227 hospital admissions with influenza-like illness and we analysed the risk effects of 19 comorbidities along with age and gender for severe illness or mortality risk. The experimental results revealed that the decision rules derived from the machine learning based prediction models can provide valuable guidelines for the healthcare policy makers to develop an effective vaccination strategy. Furthermore, in case the healthcare facilities are overwhelmed by patients with EID, which frequently occurred in the recent COVID-19 pandemic, the frontline physicians can incorporate the proposed prediction models to triage patients suffering minor symptoms without laboratory tests, which may become scarce during an EID disaster. In conclusion, our study has demonstrated an effective approach to exploit machine learning technologies to cope with the challenges faced during the outbreak of an EID.

Evaluation of the Effectiveness of Breastfeeding as a Factor in the Prevention of Breast Cancer.

BACKGROUND & OBJECTIVE: As cancer is one of the main causes of fatal illnesses in the world, and breast cancer is responsible for an elevated number of deaths in women, it is important to implement measures to prevent this disease. METHOD: In order to assess the influence of breastfeeding in preventing breast cancer in women, forteen prospective cohort articles are included in this study, and their methodological quality has been assessed through the Newcastle Ottawa quality assessment scale cohort studies. After determining the risk of bias for each case study, those with fewer systematic errors and therefore greater validity, have been selected to demonstrate the relationship they propose exists between breastfeeding and breast cancer. RESULTS: 50% percent of the research included found that breastfeeding does not reduce the risk of breast cancer, while the other 50% argue that it is a protective factor. However, with regards to quality, the case studies that conclude that breastfeeding is not associated with breast cancer have more evidential support. CONCLUSION: It is difficult to establish whether or not breastfeeding prevents breast cancer, given the diversity of conclusions in the literature. Nevertheless, the findings of this study reinforce the importance of developing strategies to improve long-term women's health in the field of prevention.

Screens for infants and preschool children: Assessment of medical prevention with parents and assessment of exposure.

BACKGROUND: Regarding the massive increase of interactive mobile screen household equipment and the omnipresence of television, many recommendations are in favor of a limitation of use, especially among the youngest. OBJECTIVE: We aimed to evaluate the proportion of parents who report having discussed the subject of their child's exposure to screens during a consultation with a health professional. We also aimed to assess preschool exposure to television and mobile media devices, and to explore parents' views on the benefits and risks of exposing their children under 3 years old. METHODS: A questionnaire was administered to parents of children aged 6 months to 3 years in a pediatric emergency ward and several nurseries. This observational, cross-sectional and multicenter study was conducted from January to May 2019. RESULTS: We included 451 responses in the analyses. Only 99 (22.7%; 95% CI: 18.7-26.6) parents reported having discussed their child's exposure to screens with a doctor, on the initiative of the parents themselves for 52 households (53.1%; 95% CI: 43.2-62.9). Feelings of a benefit of screens on child learning concerned 134 (34.5%; 95% CI: 29.8-39.3) parents; 300 (68.5%; 95% CI: 64.1-72.8) said they were sufficiently informed about benefits and risks. In a typical week, 240 (53.7%; 95% CI: 49.1-58.3), 160 (35.8%; 95% CI: 31.3-40.2), and 58 (13.0%; 95% CI: 9.9-16.1) children were exposed at least once a week to television, smartphones, and tablets, respectively. CONCLUSIONS: Our study showed that the theme of exposure to screens was hardly addressed by physicians in consultation. Our findings help target prevention messages, including fighting the widespread belief that media are beneficial to child development, emphasizing the importance of screen-free time (eating, going to bed, after waking up) and encouraging support and interaction during exposure in families who choose to expose their children.

Knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana.

BACKGROUND: COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it's unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana. METHODS: A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables. RESULTS: The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices. CONCLUSION: Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities.

The barriers and enablers to downloading the COVIDSafe app - a topic modelling analysis.

OBJECTIVE: We report a survey in regional Queensland to understand the reasons for suboptimal uptake of the COVIDSafe app. METHODS: A short five-minute electronic survey disseminated to healthcare professionals, mining groups and school communities in the Central Queensland region. Free text responses and their topics were modelled using natural language processing and a latent Dirichlet model. RESULTS: We received a total of 723 responses; of these, 69% had downloaded the app and 31% had not. The respondents' reasons for not downloading the app were grouped under four topics: lack of perceived risk of COVID-19/lack of perceived need and privacy issues; phone-related issues; tracking and misuse of data; and trust, security and credibility. Among the 472 people who downloaded the app and provided text amenable to text mining, the two topics most commonly listed were: to assist with contact tracing; and to return to normal. CONCLUSIONS: This survey of a regional population found that lack of perceived need, concerns around privacy and technical difficulties were the major barriers to users downloading the application. Implications for public health: Health promotion campaigns aimed at increasing the uptake of the COVIDSafe app should focus on promoting how the app will assist with contact tracing to help return to 'normal'. Additionally, health promotors should address the app's impacts on privacy, people's lack of perceived need for the app and technical barriers.

Iran COVID-19 Epidemiology Committee: A Review of Missions, Structures, Achievements, and Challenges.

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee. STUDY DESIGN: A rapid review . METHODS: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study. RESULTS: The efforts of the committee's working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling. CONCLUSION: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education.

COVID-19 Prevention Behaviors among Health Staff: Data from a Large Survey in the West of Iran.

BACKGROUND: Hospital staffs are at high risk of Novel Coronavirus (2019-nCoV preventive behaviors play a peculiar role in the reduction of the incidence and mortality of this infection. Therefore, the present study aimed to assess the prevention behaviors of COVID-19 among health staff based on the Extended Parallel Model (EPPM) in western Iran. STUDY DESIGN: It was a cross-sectional study. . METHODS: The present study was performed in the west of Iran in April 2020. In total, 1,664 cases were enrolled in this study via multi-stage sampling. The data were collected using a questionnaire, including the demographic characteristics of participants and EPPM constructs. All analyses were conducted in Stata software (version 14) at a 5% significant level. RESULTS: As evidenced by the obtained results,  1,523 (91.53%), 1,226 (73.68%), 1,526 (91.71%), 893 (53.67%), and 862 (51.86%) of health staff wear gloves, use masks, avoid contact with others, maintain a good distance from other people, and wash their hands frequently with water and soap, respectively. In terms of using gloves and avoiding contacts with others, participants with high perceived threat had higher odds of observing health behaviors (OR= 3.14, 95% CI: 2.08, 4.73; P<0.001) and (OR= 3.1, 95% CI: 2.04, 4.69; P<0.001), respectively. In all categories of EPPM, the participants with high efficacy had higher odds of exhibiting health behaviors, compared to those with low efficacy (P<0.001). CONCLUSION: The results of the present study demonstrated that  health workers are expected to be at the highest level of threat and efficiency. Moreover, the findings emphasized the effectiveness of the recommended strategies in the prevention of COVID-19 disease.

An Observational Study in Manipur State, India on Preventive Behavior Influenced by Social Media During the COVID-19 Pandemic Mediated by Cyberchondria and Information Overload.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency posing unprecedented challenges for health authorities. Social media may serve as an effective platform to disseminate health-related information. This study aimed to assess the extent of social media use, its impact on preventive behavior, and negative health effects such as cyberchondria and information overload. METHODS: A cross-sectional observational study was conducted between June 10, 2020 and August 9, 2020 among people visiting the outpatient department of the authors' institution, and participants were also recruited during field visits for an awareness drive. Questions were developed on preventive behavior, and the Short Cyberchondria Scale and instruments dealing with information overload and perceived vulnerability were used. RESULTS: The study recruited 767 participants with a mean age of about 45 years. Most of the participants (>90%) engaged in preventive behaviors, which were influenced by the extent of information received through social media platforms (ß=3.297; p<0.001) and awareness of infection when a family member tested positive (ß=29.082; p<0.001) or a neighbor tested positive (ß=27.964; p<0.001). The majority (63.0%) of individuals often searched for COVID-19 related news on social media platforms. The mean±standard deviation scores for cyberchondria and information overload were 9.09±4.05 and 8.69±2.56, respectively. Significant and moderately strong correlations were found between cyberchondria, information overload, and perceived vulnerability to COVID-19. CONCLUSIONS: This study provides evidence that the use of social media as an information- seeking platform altered preventive behavior. However, excessive and misleading information resulted in cyberchondria and information overload.

Characterising polypharmacy in the very old: Findings from the Newcastle 85+ Study.

BACKGROUND: Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ Study-a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845). METHODS: The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines-so-called 'no polypharmacy', 'monotherapy', 'minor polypharmacy', 'polypharmacy' and 'hyperpolypharmacy.' Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5-90.5). Participant characteristics were examined through descriptive statistics. RESULTS: Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4-8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD. CONCLUSION: Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.

Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study.

BACKGROUND: Reproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking. OBJECTIVE: To investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage. METHODS: A cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest. RESULTS: The percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16-1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17-1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04-1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10-1.25), non-working women (PR = 1.09; 95% CI: 1.04-1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04-1.24) had a higher risk of not using modern contraceptives. CONCLUSION: Our study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.

Health Promotion Programs and Policies in the Workplace: An Exploratory Study With Alaska Businesses.

INTRODUCTION: We examined health insurance benefits, workplace policies, and health promotion programs in small to midsize businesses in Alaska whose workforces were at least 20% Alaska Native. Participating businesses were enrolled in a randomized trial to improve health promotion efforts. METHODS: Twenty-six Alaska businesses completed from January 2009 through October 2010 a 30-item survey on health benefits, policies, and programs in the workplace. We generated frequency statistics to describe overall insurance coverage, and to detail insurance coverage, company policies, and workplace programs in 3 domains: tobacco use, physical activity and nutrition, and disease screening and management. RESULTS: Businesses varied in the number of employees (mean, 250; median, 121; range, 41-1,200). Most businesses offered at least partial health insurance for full-time employees and their dependents. Businesses completely banned tobacco in the workplace, and insurance coverage for tobacco cessation was limited. Eighteen had onsite food vendors, yet fewer than 6 businesses offered healthy food options, and even fewer offered them at competitive prices. Cancer screening and treatment were the health benefits most commonly covered by insurance. CONCLUSION: Although insurance coverage and workplace policies for chronic disease screening and management were widely available, significant opportunities remain for Alaska businesses to collaborate with federal, state, and community organizations on health promotion efforts to reduce the risk of chronic illness among their employees.

Indigenous community perspectives on dogs in Northern Canada after 10 years of veterinary services indicates improved animal and human welfare.

Access to veterinary services in marginalized communities has important implications for people and animals around the world. Subsidized veterinary services are occasionally provided, however, they are seldom evaluated for their value to stakeholders and overall animal health. In 2017, we evaluated a decade-long veterinary program in four remote communities in the Sahtu Settlement Area of the Northwest Territories, Canada to understand if there were changes in dog husbandry and community perceptions of, and experiences with, dogs since an initial assessment at the beginning of the program in 2008. Using questionnaires and a dog census, we found a significant increase over time in dog health indicators, including the proportion of dogs that had received preventive veterinary care and had been sterilized. We documented significant changes in the described purpose of dogs, husbandry practices, experiences with dogs, and attitudes towards dogs and veterinary services. In 2017, respondents commonly described their dog(s) as companions and as part of their family. However, communities differed in the way dogs were housed and fed and in their attitudes towards dogs and dog-related issues. These inter-community differences are noteworthy as they impact service provision, uptake, and evaluation and must be taken into consideration in order to develop effective programs. Regular program evaluations are critical to check in with stakeholders, to ensure the program is meeting community needs, and to optimize effective use of resources.

Why do graduates choose to work in a less attractive specialty? A cross-sectional study on the role of personal values and expectations.

BACKGROUND: Primary health care (PHC), of which preventive medicine (PM) is a subspecialty, will have to cope with a deficiency of staff in the future, which makes the retention of graduates urgent. This study was conducted in Vietnam, where PM is an undergraduate degree in parallel to medical training. It aims to identify facilitating and hindering factors that impact recruitment and retention of PM graduates in the specialty. METHODS: A cross-sectional study enrolled 167 graduates who qualified as PM doctors from a Vietnamese medical school, between 2012 and 2018. Data were collected via an online questionnaire that asked participants about their motivation and continuation in PM, the major life roles that they were playing, and their satisfaction with their job. Multiple regression analyses were used to identify which life roles and motivational factors were related to the decision to take a PM position and to stay in the specialty, as well as how these factors held for subgroups of graduates (men, women, graduates who studied PM as their first or second study choice). RESULTS: Half of the PM graduates actually worked in PM, and only one fourth of them expressed the intention to stay in the field. Three years after qualification, many graduates had not yet decided whether to pursue a career in PM. Satisfaction with opportunities for continuous education was rated as highly motivating for graduates to choose and to stay in PM. Responsibility for taking care of parents motivated male graduates to choose PM, while good citizenship and serving the community was associated with the retention of graduates for whom PM was their first choice. CONCLUSIONS: The findings demonstrate the importance of social context and personal factors in developing primary care workforce policy. Providing opportunities for continued education and enhancing the attractiveness of PM as an appropriate specialty to doctors who are more attached to family and the community could be solutions to maintaining the workforce in PM. The implications could be useful for other less popular specialties that also struggle with recruiting and retaining staff.

The Impact of Sickle Cell Anemia and Mental Health Diagnoses on Healthcare Use and Preventive Care among Children Enrolled in Medicaid, 2005-2012.

OBJECTIVE: To examine mental health diagnoses, healthcare use, and receipt of age-appropriate preventive care, including antibiotic prophylaxis, hydroxyurea therapy, and transcranial Doppler screenings, among children with sickle cell anemia (SCA). STUDY DESIGN: Children aged 1-17 years with SCA from 6 states having 3 or more Medicaid claims with a SCA diagnosis within a year (2005-2012) were included. Children with mental health diagnoses were identified with 1 or more mental health encounters. Poisson and logistic regression models with general estimating equations assessed the relationship between mental health diagnoses, healthcare use, and receipt of age-appropriate preventive care. RESULTS: In total, 7963 children with SCA were identified (22 424 person-years); 1593 person-years (7.1%) included 1 or more mental health diagnoses. Children with a mental health diagnosis were more likely to have inpatient admissions (incidence rate ratio [IRR] 1.46, 95% CI 1.36-1.56) and outpatient (IRR 1.27, 95% CI 1.21-1.34), emergency department (IRR 1.39, 95% CI 1.30-1.48), and well-child visits (IRR 1.19, 95% CI 1.11-1.29). Those with a mental health diagnosis were more likely to receive hydroxyurea therapy (odds ration [OR] 1.17, 95% CI 1.03-1.33) and less likely to receive transcranial Doppler screenings (OR 0.79, 95% CI 0.68-0.93). CONCLUSIONS: Children with SCA do not receive adequate age-appropriate preventive care. Further research is necessary to identify key points of coordination between mental health and SCA services throughout the life course. This approach may help to increase receipt of age-appropriate preventive care and decrease reliance on acute care.

The Affordable Care Act's Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review.

BACKGROUND: Health reform and the merits of Medicaid expansion remain at the top of the legislative agenda, with growing evidence suggesting an impact on cancer care and outcomes. A systematic review was undertaken to assess the association between Medicaid expansion and the goals of the Patient Protection and Affordable Care Act in the context of cancer care. The purpose of this article is to summarize the currently published literature and to determine the effects of Medicaid expansion on outcomes during points along the cancer care continuum. METHODS: A systematic search for relevant studies was performed in the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases. Three independent observers used an abstraction form to code outcomes and perform a quality and risk of bias assessment using predefined criteria. RESULTS: A total of 48 studies were identified. The most common outcomes assessed were the impact of Medicaid expansion on insurance coverage (23.4% of studies), followed by evaluation of racial and/or socioeconomic disparities (17.4%) and access to screening (14.5%). Medicaid expansion was associated with increases in coverage for cancer patients and survivors as well as reduced racial- and income-related disparities. CONCLUSIONS: Medicaid expansion has led to improved access to insurance coverage among cancer patients and survivors, particularly among low-income and minority populations. This review highlights important gaps in the existing oncology literature, including a lack of studies evaluating changes in treatment and access to end-of-life care following implementation of expansion.

Preventive medicine's equivalence problem.

The structure of preventive medicine residency training in the U.S. warrants serious examination. U.S. public health and general preventive medicine residencies have suffered a 17% decline in the number of residency programs since 2000, and current residency programs are, on average, half-empty. The required clinical year is not unique to preventive medicine, a basic, undifferentiated MPH for preventive medicine doesn't distinguish the preventive medicine specialist, and practicum year requirements are overly broad and not necessarily specific to the specialty, leaving the specialty vulnerable to equivalence by most other specialties. Strategies including creation of an additional preventive medicine-specific clinical year, developing a new public health degree for the specialty, and more specific practicum rotations, as well as potentially changing the specialty's name and altering the annual structure of training, are proposed along with an equivalence test.

Health Literacy as Communicative Action-A Qualitative Study among Persons at Risk in the Context of Predictive and Preventive Medicine.

Predictive and preventive medicine play an increasingly important role in public debates on health, providing cutting-edge technologies with the potential to measure and predict individual risks of getting ill. This leads to an ever-expanding definitional space between being "healthy" and being "ill", challenging the individual's everyday life, attitudes and perceptions towards the self and the process of health-related decision-making. "How do the condition of 'being at risk' and individual health literacy interrelate?" is the leading question of the current contribution. Drawing on empirical qualitative data, collected by means of narrative interviews with persons at risk in four clinical fields, a bottom-up ethnographic and health sciences perspective on health literacy (with an emphasis on critical health literacy) is employed. The findings will be embedded within theoretical approaches dealing with power relations and communication in healthcare encounters, particularly Habermas' theory of communicative action. The core outcome of our study is a concept for an overarching model of health literacy in the context of health-related risk prediction across indications, based on empirical insights gained through interpretative analysis of the four clinical domains.