Trust-building in temporary public health partnerships: a qualitative study of the partnership formation process of a Covid-19 test, trace and protect service.

BACKGROUND: Public health initiatives require coordinated efforts from healthcare, social services and other service providers. Organisational theory tells us that trust is essential for reaching collaborative effectiveness. This paper explores the drivers for initiating and sustaining trust in a temporary public health partnership, in response to a sudden health threat. METHODS: This qualitative study analysed the formation process of a multisector partnership for a Covid-19 contact tracing service. Data was collected through 12 interviews, two focus groups, one feedback workshop, and an online survey with workforce members from all seven partner organisations. Purposive maximum variation sampling was used to capture the reflections and experiences of workforce members from all seven partner organisations. A deductive code scheme was used to identify drivers for building and sustaining trust in inter-organisational collaboration. RESULTS: Relational mechanisms emanating from the commitment to the common aim, shared norms and values, and partnership structures affected trust-building. Shared values and the commitment to the common aim appeared to channel partners' behaviour when interacting, resulting in being perceived as a fair, reliable and supportive partner. Shared values were congruent with the design of the partnership in terms of governance structure and communication lines reflecting flat hierarchies and shared decision-making power. Tensions between partner organisations arose when shared values were infringed. CONCLUSIONS: When managing trust in a collaboration, partners should consider structural components like governance structure, organisational hierarchy, and communication channels to ensure equal power distribution. Job rotation, recruitment of candidates with the desired personality traits and attitudes, as well as training and development, encourage inter-organisational networking among employees, which is essential for building and strengthening relationships with partner organisations. Partners should also be aware of managing relational dynamics, channelling behaviours through shared values, objectives and priorities and fostering mutual support and equality among partner organisations.

Health in Persons Deprived of Their Liberty in South America: A Painful Reflection of Our Public Health.

Objectives: To describe sociodemographic characteristics and health-related data in persons deprived of liberty (PDL) from South America in the last five years. Methods: Documentary descriptive study. Results: There are 1.5 million PDL in Latin America and the Caribbean; the average overcrowding is 64%; 58% do not sleep in beds, 20% do not have access to clean water and 29% do not receive medical care. In Peru, during 2021, there were 87,245 PDL and 69 penal institutions. The national average overcrowding is 120%, the second-highest in South America. In South America, the prevalence of tuberculosis is 2.0% SD = 0.64 and the median of illegal substances prevalence is 34.6 (IQR = 7.5-41.4). In Peru, the prevalence of tuberculosis has decreased since 2016 (4.3%), 2018(3.5%), and 2021(2.5%). Among the health problems by country, there were more data on substance use: 8/10, and tuberculosis, 7/10 countries. Cardiovascular diseases had the least available data. Regarding COVID-19, during the first wave in Peru, 54% of the total PPL were infected, and by the end of the wave, 446 PDL and 46 members of the prison staff had died. In Colombia, between April and October 2020, there were 16,804 cases (80 in ICU) and 136 deaths. In Brazil, up to March 2021, 340 people had died, and there were over 67,000 infections. Conclusions: Overcrowding is an unresolved problem; tuberculosis and substance use are the most frequent issues. Data are limited in quality, homogeneity and availability. Greater effort is needed from health authorities to improve health management and information systematization. Source: MesH.

Medicaid Eligibility Loss Among Dual-Eligible Beneficiaries Before and During COVID-19 Public Health Emergency.

Importance: Medicaid coverage loss can substantially compromise access to and affordability of health care for dual-eligible beneficiaries. The extent to which this population lost Medicaid coverage before and during the COVID-19 public health emergency (PHE) and the characteristics of beneficiaries more at risk for coverage loss are currently not well known. Objective: To assess the loss of Medicaid coverage among dual-eligible beneficiaries before and during the first year of the PHE, and to examine beneficiary-level and plan-level factors associated with heightened likelihood of losing Medicaid. Design, Setting, and Participants: This repeated cross-sectional study used national Medicare data to estimate annual rates of Medicaid loss among dual-eligible beneficiaries before (2015 to 2019) and during the PHE (2020). Individuals who were dual eligible for Medicare and Medicaid at the beginning of a given year and who continuously received low-income subsidies for Medicare Part D prescription drug coverage were included in the sample. Multivariable regression models were used to examine beneficiary-level and plan-level factors associated with Medicaid loss. Data analyses were conducted between March 2023 and October 2023. Exposure: Onset of PHE. Main Outcomes and Measures: Loss of Medicaid for at least 1 month within a year. Results: Sample included 56 172 736 dual-eligible beneficiary-years between 2015 and 2020. In 2020, most dual-eligible beneficiaries were aged over 65 years (5 984 420 [61.1%]), female (5 868 866 [59.9%]), non-Hispanic White (4 928 035 [50.3%]), full-benefit eligible (6 837 815 [69.8%]), and enrolled in traditional Medicare (5 343 537 [54.6%]). The adjusted proportion of dual-eligible beneficiaries losing Medicaid for at least 1 month increased from 6.6% in 2015 to 7.3% in 2019 and then dropped to 2.3% in 2020. Between 2015 and 2019, dual-eligible beneficiaries who were older (ages 55-64 years: -1.4%; 95% CI, -1.8% to -1.0%; ages 65-74 years: -2.0%; 95% CI, -2.5% to -1.5%; ages 75 and older: -4.5%; 95% CI, -5.0% to -4.0%), disabled (-0.8%; 95% CI, -1.1% to -0.6%), and in integrated care programs were less likely to lose Medicaid. In 2020, the disparities within each of these demographic groups narrowed significantly. Notably, while Black (0.6%; 95% CI, 0.2% to 0.9%) and Hispanic (0.7%; 95% CI, 0.3% to 1.2%) dual-eligible beneficiaries were more likely to lose Medicaid than their non-Hispanic White counterparts between 2015 and 2019, such gap was eliminated for Black beneficiaries and narrowed for Hispanic beneficiaries in 2020. Conclusions and Relevance: During the PHE, Medicaid coverage loss declined significantly among dual-eligible beneficiaries, and disparities were mitigated across subgroups. As the PHE unwinds, it is crucial for policymakers to implement strategies to minimize Medicaid coverage disruptions and racial and ethnic disparities, especially given that loss of Medicaid was slightly increasing over time before the PHE.

Dietary intake with supplementation of vitamin D, vitamin B6, and magnesium on depressive symptoms: a public health perspective.

Objective: This study aims to understand the impact of dietary intake through supplementation of vitamins D, B6, and magnesium on elevated depressive symptoms, a mental health illness that is a leading contributor to global disability and a public health concern. Methods: Multiple datasets from the National Health and Nutrition Examination Survey 2017-March 2020 investigated the associations between vitamin D, B6, and magnesium on depression screening scores. A cross-sectional sample of adults over 20 was extracted (n = 9,232). Chi-square tests and logistic regression analyses were used to investigate the associations. Results: Individuals with low amounts of vitamin D (p = 0.0481) were more likely to report elevated depressive symptoms relative to those with low amounts of vitamin B6 (p = 0.0225). These results remained significant among those with high magnesium (p = 0.0133) proportionate to high vitamin B6 (p = 0.0225). In the age-adjusted model, a lower intake of vitamin D, vitamin B6, and magnesium showed a relationship with elevated depressive symptoms (Vitamin D: OR = 0.611, 95% CI 0.382-0.980 Vitamin B6: OR = 0.503, 95% CI 0.291-0.867 Magnesium: OR = 0.458, 95% CI 0.277-0.759). The fully adjusted regression model (gender, race/ethnicity, and household food security) showed that a lower intake of vitamin B6 and magnesium correlated with elevated depressive symptoms (Vitamin B6: OR = 0.439, 95% CI 0.260-0.738 Magnesium: OR = 0.465, 95% CI 0.303-0.714). Conclusion: Preventive measures could be addressed by identifying the risks of vitamin deficiencies. Further epidemiological research is needed for the individual effects of vitamin supplementation and depression screening scores. Future prospective cohort studies exploring these associations, focusing on daily dietary intake, are needed to validate the direction of causation further and understand the underlying mechanisms.

Research on smart city public health detection system and improvement technology based on intelligent multi-objective.

Introduction: With the increase of urban population density, urban sanitation becomes more severe; urban sanitation has important influence on public health. Therefore, in order to realize the detection of public health in smart cities, the research will use cutting-edge scientific and technological methods to improve urban environmental health, so as to promote the realization of public health achievements. This study introduces public health detection and optimizationtechnologies for smart cities. Methods: Firstly, a data detection system for urban public health environment was established using sensors and intelligent multi-objective technology to evaluate the water quality, air quality, and noise level of the city. Then, an intelligent garbage management system based on Tensor-flow was constructed to achieve efficient garbage collection and treatment. Finally, an intelligent traffic management system was developed to monitor and regulate urban traffic flow. Results: The results of the simulation experiment demonstrated that the life data detection system was operationally stable, with a high success rate of 98%. Furthermore, its accuracy in detecting residents' living environment data was above 95%, the maximum relative error was only 0.0465, making it a reliable and efficient tool. The waste recycling system achieved a minimum accuracy of 83.6%, the highest accuracy rate was 95.3%, making it capable of sorting and recycling urban waste effectively. Additionally, the smart traffic management system led to a 20% reduction in traffic congestion rates, 20 tonnes less tailpipe emissions and an improvement in public health and well-being. Discussion: In summary, the plan proposed in this study aims to create a more comfortable, safe, and healthy urban public health environment, while providing theoretical support for environmental health management in smart cities.

Key Factors Impacting a Medical Ventilator Supply Chain During the COVID- 19 Pandemic: Lessons for Pandemic Preparedness.

OBJECTIVES: Future pandemics may cause more severe respiratory illness in younger age groups than COVID-19, requiring many more mechanical ventilators. This publication synthesizes the experiences of diverse contributors to Medtronic's mechanical ventilator supply chain during the pandemic, serving as a record of what worked and what didn't, while identifying key factors affecting production ramp-up in this healthcare crisis. METHOD: In-depth, one-on-one interviews (n = 17) were held with key Medtronic personnel and suppliers. Template analysis was used, and interview content was analyzed for signals, initiatives, actions, and outcomes, as well as influencing forces. RESULTS: Key findings revealed many factors limiting ventilator production ramp-up. Supply chain strengths and weaknesses were identified. Political factors played a role in allocating ventilators and also supported production. Commercial considerations were not priority, but economic awareness was essential to support suppliers. Workers were motivated and flexible. Component shortages, space, production processes, and logistics were challenges. Legally based pressures were reported e.g., import and export restrictions. CONCLUSION: Crisis response alone is not enough; preparation is essential. Coordinated international strategies are more effective than individual country responses. Supply chain resilience based on visibility and flexibility is key. This research can help public health planners and the medical device industry prepare for future healthcare crises.

Estimated public health impact of concurrent mask mandate and vaccinate-or-test requirement in Illinois, October to December 2021.

BACKGROUND: Facing a surge of COVID-19 cases in late August 2021, the U.S. state of Illinois re-enacted its COVID-19 mask mandate for the general public and issued a requirement for workers in certain professions to be vaccinated against COVID-19 or undergo weekly testing. The mask mandate required any individual, regardless of their vaccination status, to wear a well-fitting mask in an indoor setting. METHODS: We used Illinois Department of Public Health's COVID-19 confirmed case and vaccination data and investigated scenarios where masking and vaccination would have been reduced to mimic what would have happened had the mask mandate or vaccine requirement not been put in place. The study examined a range of potential reductions in masking and vaccination mimicking potential scenarios had the mask mandate or vaccine requirement not been enacted. We estimated COVID-19 cases and hospitalizations averted by changes in masking and vaccination during the period covering October 20 to December 20, 2021. RESULTS: We find that the announcement and implementation of a mask mandate are likely to correlate with a strong protective effect at reducing COVID-19 burden and the announcement of a vaccinate-or-test requirement among frontline professionals is likely to correlate with a more modest protective effect at reducing COVID-19 burden. In our most conservative scenario, we estimated that from the period of October 20 to December 20, 2021, the mask mandate likely prevented approximately 58,000 cases and 1,175 hospitalizations, while the vaccinate-or-test requirement may have prevented at most approximately 24,000 cases and 475 hospitalizations. CONCLUSION: Our results indicate that mask mandates and vaccine-or-test requirements are vital in mitigating the burden of COVID-19 during surges of the virus.

Fishing effort dynamics around the Galápagos Marine Reserve as depicted by AIS data.

The waters around the Galápagos Marine Reserve (GMR) are important fishing grounds for authorized artisanal vessels fishing within the reserve as well as for national and foreign industrial fleets operating in the wider Ecuadorian Insular Exclusive Economic Zone (IEEZ). Although it was not originally designed for fisheries management, Automatic Identification System (AIS) data provides useful, open access, near real-time and high-resolution information that allows for increased monitoring, particularly around Marine Protected Areas (MPAs) and in Areas Beyond National Jurisdiction. This study uses AIS data provided by Global Fishing Watch to assess the spatial distribution and seasonal dynamics of fishing effort by vessel flag within the GMR and the IEEZ from 2012 to 2021. Based on kernel density estimation analysis, we determinate the core-use areas (50%) and spatial extent (95%) of fishing activities by fleets (Ecuadorian and foreign), gear types and seasons (warm, from December to May; and cold, from June to November). Our results show that the Ecuadorian fleet recorded the most observed fishing hours in the study area, with 32,829 hours in the IEEZ and 20,816 hours within the GMR. The foreign flags with the most observed fishing hours in the IEEZ were Panama (3,245 hours) and Nicaragua (2,468.5 hours), while in the GMR were the 'Unknown flag' (4,991.4 hours) and Panama (133.7 hours). Vessels fished employing different fishing gears, but the waters of the GMR and IEEZ were mostly targeted by tuna purse-seiners and drifting longlines. The spatial distribution of the fishing effort exhibits marked seasonal variability, likely influenced by seasonal migrations of target species such as tunas (e.g., Thunnus albacares, T. obesus and Katsuwonus pelamis), marlins (e.g., Makaira nigricans) and sharks (e.g., Alopias pelagicus). The collection and use of this type of spatial and seasonal information is an essential step to understand the dynamics of fishing activities in national waters and improve fisheries management, particularly in less studied areas and fisheries.

PANDEM-Source, a tool to collect or generate surveillance indicators for pandemic management: a use case with COVID-19 data.

Introduction: PANDEM-Source (PS) is a tool to collect and integrate openly available public health-related data from heterogeneous data sources to support the surveillance of infectious diseases for pandemic management. The tool may also be used for pandemic preparedness by generating surveillance data for training purposes. It was developed as part of the EU-funded Horizon 2020 PANDEM-2 project during the COVID-19 pandemic as a result of close collaboration in a consortium of 19 partners, including six European public health agencies, one hospital, and three first responder organizations. This manuscript describes PS's features and design to disseminate its characteristics and capabilities to strengthen pandemic preparedness and response. Methods: A requirement-gathering process with EU pandemic managers in the consortium was performed to identify and prioritize a list of variables and indicators useful for surveillance and pandemic management. Using the COVID-19 pandemic as a use case, we developed PS with the purpose of feeding all necessary data to be displayed in the PANDEM-2 dashboard. Results: PS routinely monitors, collects, and standardizes data from open or restricted heterogeneous data sources (users can upload their own data). It supports indicators and health resources related data from traditional data sources reported by national and international agencies, and indicators from non-traditional data sources such as those captured in social and mass media, participatory surveillance, and seroprevalence studies. The tool can also calculate indicators and be used to produce data for training purposes by generating synthetic data from a minimal set of indicators to simulate pandemic scenarios. PS is currently set up for COVID-19 surveillance at the European level but can be adapted to other diseases or threats and regions. Conclusion: With the lessons learnt during the COVID-19 pandemic, it is important to keep building capacity to monitor potential threats and develop tools that can facilitate training in all the necessary aspects to manage future pandemics. PS is open source and its design provides flexibility to collect heterogeneous data from open data sources or to upload end users's own data and customize surveillance indicators. PS is easily adaptable to future threats or different training scenarios. All these features make PS a unique and valuable tool for pandemic management.

Unconventional data, unprecedented insights: leveraging non-traditional data during a pandemic.

Introduction: The COVID-19 pandemic prompted new interest in non-traditional data sources to inform response efforts and mitigate knowledge gaps. While non-traditional data offers some advantages over traditional data, it also raises concerns related to biases, representativity, informed consent and security vulnerabilities. This study focuses on three specific types of non-traditional data: mobility, social media, and participatory surveillance platform data. Qualitative results are presented on the successes, challenges, and recommendations of key informants who used these non-traditional data sources during the COVID-19 pandemic in Spain and Italy. Methods: A qualitative semi-structured methodology was conducted through interviews with experts in artificial intelligence, data science, epidemiology, and/or policy making who utilized non-traditional data in Spain or Italy during the pandemic. Questions focused on barriers and facilitators to data use, as well as opportunities for improving utility and uptake within public health. Interviews were transcribed, coded, and analyzed using the framework analysis method. Results: Non-traditional data proved valuable in providing rapid results and filling data gaps, especially when traditional data faced delays. Increased data access and innovative collaborative efforts across sectors facilitated its use. Challenges included unreliable access and data quality concerns, particularly the lack of comprehensive demographic and geographic information. To further leverage non-traditional data, participants recommended prioritizing data governance, establishing data brokers, and sustaining multi-institutional collaborations. The value of non-traditional data was perceived as underutilized in public health surveillance, program evaluation and policymaking. Participants saw opportunities to integrate them into public health systems with the necessary investments in data pipelines, infrastructure, and technical capacity. Discussion: While the utility of non-traditional data was demonstrated during the pandemic, opportunities exist to enhance its impact. Challenges reveal a need for data governance frameworks to guide practices and policies of use. Despite the perceived benefit of collaborations and improved data infrastructure, efforts are needed to strengthen and sustain them beyond the pandemic. Lessons from these findings can guide research institutions, multilateral organizations, governments, and public health authorities in optimizing the use of non-traditional data.

Lessons Learned from COVID-19 Response in Correctional and Detention Facilities.

The COVID-19 pandemic disproportionately affected persons held in and working in correctional and detention facilities, causing facilities' traditional priorities to shift when healthcare and public health needs temporarily drove many aspects of operations. During July-August 2022, we interviewed members of health departments and criminal justice organizations to document lessons learned from the COVID-19 response in correctional settings. Participants valued enhanced partnerships, flexibility, and innovation, as well as real-time data and corrections-specific public health guidance. Challenges included cross-sector collaborations, population density, scarcity of equipment and supplies, and mental health. Most participants reported improved relationships between criminal justice and public health organizations during the pandemic. Lessons from COVID-19 can be applied to everyday public health preparedness and emergency response in correctional facilities by ensuring representation of correctional health in public health strategy and practice and providing timely, data-driven, and partner-informed guidance tailored to correctional environments when public health needs arise.

Lessons Learned from Cross-Systems Approach to COVID-19 Pandemic Response in Juvenile Justice System, Colorado, USA.

The global COVID-19 pandemic illustrates the importance of a close partnership between public health and juvenile justice systems when responding to communicable diseases. Many setting-specific obstacles must be navigated to respond effectively to limit disease transmission and negative health outcomes while maintaining necessary services for youth in confinement facilities. The response requires multidisciplinary expertise and collaboration to address unique considerations. Public health mitigation strategies must balance the risk for disease against the negative effects of restrictions. Key aspects of the COVID-19 response in the juvenile justice system of Colorado, USA, involved establishing robust communication and data reporting infrastructures, building a multidisciplinary response team, adapting existing infection prevention guidelines, and focusing on a whole-person health approach to infection prevention. We examine lessons learned and offer recommendations on pandemic emergency response planning and managing a statewide public health emergency in youth confinement settings that ensure ongoing readiness.

Development and Evaluation of Surveillance System for Identifying Jail-Associated COVID-19 Cases in Minnesota, USA, 2022.

Confinement facilities are high-risk settings for the spread of infectious disease, necessitating timely surveillance to inform public health action. To identify jail-associated COVID-19 cases from electronic laboratory reports maintained in the Minnesota Electronic Disease Surveillance System (MEDSS), Minnesota, USA, the Minnesota Department of Health developed a surveillance system that used keyword and address matching (KAM). The KAM system used a SAS program (SAS Institute Inc., https://www.sas.com) and an automated program within MEDSS to identify confinement keywords and addresses. To evaluate KAM, we matched jail booking data from the Minnesota Statewide Supervision System by full name and birthdate to the MEDSS records of adults with COVID-19 for 2022. The KAM system identified 2,212 cases in persons detained in jail; sensitivity was 92.40% and specificity was 99.95%. The success of KAM demonstrates its potential to be applied to other diseases and congregate-living settings for real-time surveillance without added reporting burden.

Lessons Learned from Public Health and State Prison Collaborations during COVID-19 Pandemic and Multifacility Tuberculosis Outbreak, Washington, USA.

The large COVID-19 outbreaks in prisons in the Washington (USA) State Department of Corrections (WADOC) system during 2020 highlighted the need for a new public health approach to prevent and control COVID-19 transmission in the system's 12 facilities. WADOC and the Washington State Department of Health (WADOH) responded by strengthening partnerships through dedicated corrections-focused public health staff, improving cross-agency outbreak response coordination, implementing and developing corrections-specific public health guidance, and establishing collaborative data systems. The preexisting partnerships and trust between WADOC and WADOH, strengthened during the COVID-19 response, laid the foundation for a collaborative response during late 2021 to the largest tuberculosis outbreak in Washington State in the past 20 years. We describe challenges of a multiagency collaboration during 2 outbreak responses, as well as approaches to address those challenges, and share lessons learned for future communicable disease outbreak responses in correctional settings.

Informing the pandemic response: the role of the WHO's COVID-19 Weekly Epidemiological Update.

On 31 December 2019, the Municipal Health Commission of Wuhan, China, reported a cluster of atypical pneumonia cases. On 5 January 2020, the WHO publicly released a Disease Outbreak News (DON) report, providing information about the pneumonia cases, implemented response interventions, and WHO's risk assessment and advice on public health and social measures. Following 9 additional DON reports and 209 daily situation reports, on 17 August 2020, WHO published the first edition of the COVID-19 Weekly Epidemiological Update (WEU). On 1 September 2023, the 158th edition of the WEU was published on WHO's website, marking its final issue. Since then, the WEU has been replaced by comprehensive global epidemiological updates on COVID-19 released every 4 weeks. During the span of its publication, the webpage that hosts the WEU and the COVID-19 Operational Updates was accessed annually over 1.4 million times on average, with visits originating from more than 100 countries. This article provides an in-depth analysis of the WEU process, from data collection to publication, focusing on the scope, technical details, main features, underlying methods, impact and limitations. We also discuss WHO's experience in disseminating epidemiological information on the COVID-19 pandemic at the global level and provide recommendations for enhancing collaboration and information sharing to support future health emergency responses.

A qualitative study to explore experiences of anti-racism teaching in medical residency programs across the United States and subsequent creation of the SPOC (Support - Pipeline - Outcomes - Community) Model to guide future curricula design.

BACKGROUND: Racism contributes to health disparities and is a serious threat to public health. Teaching physicians about racism, how to address it in medical practice, and developing high quality and sustainable curricula are essential to combating racism. OBJECTIVE: This study aimed to (1) describe the experience of racism and anti-racism teaching in residency programs, and elicit recommendations from key informants, and (2) use these data and formative research to develop recommendations for other residencies creating, implementing, and evaluating anti-racism curricula in their own programs. METHODS: From May to July 2023, 20 faculty and residents were recruited via convenience sampling for key informant interviews conducted via Microsoft Teams. Interviews were audio recorded, transcribed, and coded. An initial list of themes was developed using theoretical frameworks, and then refined using a grounded-theory approach. A brief online optional anonymous demographic survey was sent to participants in August of 2023.  RESULTS: Eighty percent (20/25) of participants approached were interviewed. Seventy-five percent (15/20) answered a brief optional demographic survey. Seven themes emerged: (1) Racism in medicine is ubiquitous; (2) Anti-racism teaching in medicine varies widely; (3) Sustainability strategies should be multifaceted and include recruitment, resource allocation, and outcome measures; (4) Resources are widely available and accessible if one knows where to look; (5) Outcomes and metrics of success should include resident- faculty-, patient- community-, and system-focused outcomes; (6) Curricular strategies should be multilayered, longitudinal, and woven into the curriculum; and (7) Self-reflection and discomfort are necessary parts of the process.  CONCLUSIONS: This study is one of the first to qualitatively examine perspectives of key stakeholders invested in anti-racism teaching for residents. The Support - Pipeline - Outcomes - Community (SPOC) Model, that was developed using information collected during this study, can be used in the future as a guide for others working to design and implement sustainable and high quality anti-racism curricula for residents.

Associations between Polish school principals' health literacy and implementation of the Health Promoting School approach during the COVID-19 pandemic.

The coronavirus pandemic has contributed to increasing the responsibility of school principals for the health of all school community members. Moreover, evidence confirms the significant role of school principals' health literacy (HL) for health promotion in schools. Therefore, the presented study aims to evaluate the associations between Polish school principals HL and the implementation of the Health Promoting School (HPS) approach in Polish schools. The present study was conducted as part of an international survey on the global COVID-HL network (www.covid-hl.eu) between June 2021 and December 2021. Three subscales of the HPS were considered and an exploratory analysis were used in this study. Associations between the median split of each subscale of HPS (outcome) and health literacy (predictor) were performed using logistic regression. Research results showed that the highest level of HPS implementation was directed at pupils. Principals perceived themselves as having the highest HL on the 'accessibility' subscale and these respondents had significantly higher odds of implementing learning opportunities for students. The study suggests that principals with adequate HL may be more likely to effectively implement HPS strategies in schools. This research could provide insights into the complex interplay between HL and the HPS approach and inform the development of more effective strategies for promoting health and HL in schools.

Sex-structured disease transmission model and control mechanisms for visceral leishmaniasis (VL).

BACKGROUND: Leishmaniasis are a group of diseases caused by more than 20 species of the protozoan that are transmitted through the bite of female sand fly. The disease is endemic to 98 countries of the world. It affects most commonly the poorest of the poor and mainly males. Several research has been conducted to propose disease control strategies. Effective medical care, vector control, environmental hygiene, and personal protection are the mainstays of the current preventative and control methods. The mathematical models for the transmission dynamics of the disease studied so far did not consider the sex-biased burden of the disease into consideration. METHODOLOGY: Unlike the previous VL works, this study introduces a new deterministic sex-structured model for understanding the transmission dynamics of visceral leishmaniasis. Basic properties of the model including basic reproduction number ([Formula: see text]), and conditions for the existence of backward bifurcation of the model are explored. Baseline parameter values were estimated after the model was fitted to Ethiopia's VL data. Sensitivity analysis of the model was performed to identify the parameters that significantly impact the disease threshold. Numerical simulations were performed using baseline parameter values, and scenario analysis is performed by changing some of these parameters as appropriate. CONCLUSION: The analysis of the model shows that there is a possibility for a backward bifurcation for [Formula: see text], which means bringing [Formula: see text] to less than unity may not be enough to eradicate the disease. Our numerical result shows that the implementation of disease-preventive strategies, as well as effectively treating the affected ones can significantly reduce the disease prevalence if applied for more proportion of the male population. Furthermore, the implementation of vector management strategies also can considerably reduce the total prevalence of the disease. However, it is demonstrated that putting more effort in treating affected reservoir animals may not have any significant effect on the overall prevalence of the disease as compared to other possible mechanisms. The numerical simulation infers that a maximum of 60% of extra preventative measures targeted to only male population considerably reduces the total prevalence of VL by 80%. It is also possible to decrease the total prevalence of VL by 69.51% when up to 50% additional infected males receive treatment with full efficacy. Moreover, applying a maximum of 15% additional effort to reduce the number of vectors, decreases the total VL prevalence by 57.71%. Therefore, in order to reduce the disease burden of visceral leishmaniasis, public health officials and concerned stakeholders need to give more emphasis to the proportion of male humans in their intervention strategies.