Academic literature on the topic 'Public and population health, n.e.c'

Bacterial sexually transmitted infections including Chlamydia trachomatis and Neisseria gonorrhoeae remain an important public health concern. We aimed to assess the population-based incidence of C. trachomatis and N. gonorrhoeae in an age-standardized cohort over time. A retrospective study of a large Canadian health region was undertaken between 2010 and 2015 using linked census and digital laboratory data. C. trachomatis and N. gonorrhoeae tests were linked to patient data. Sex and age-standardized incidence rates (IR) and ratios (IRR) were calculated for cases and testing rates. The annual mean population was 1,150,556 individuals (50.1% female). A total of 15,109 cases of chlamydia and 981 cases of gonorrhoea occurred. The overall IR for chlamydia ranged from 18.81 to 25.63 cases per 10,000 person-years. The IRR was 1.27 (95% CI 1.20–1.34, p < 0.001) for the comparison of 2015 and 2010 rates. For gonorrhoea, overall rates ranged from 0.92 to 1.86 cases per 10,000 person-years. The IRR for gonorrhoea was 2.02 (95% CI 1.56–2.59, p < 0.001) for 2015 and 2010 rates. In our large population-based study spanning six years, we observed increasing rates of C. trachomatis and N. gonorrhoeae with low testing rates.

I n t r o d u c t i o n : Hepatitis C is a RNA virus isolated in 1988 but still not cultured in the laboratory. Hepatitis-C infection is aserious global public health issue, WHO estimates worlds 3 % population is HCV positive. Pakistan is also facing the huge burden of thisdisease. Accurate prevalence information for hepatitis C infection is scant in Pakistan. Few population based studies are available, the mostcomprehensive being that of Luby et al which after testing a representative sample from a population of 150,000 in Hafizabad, Pakistanfound an overall sero-prevalence of 6%. This increased to 30% with increasing age. They also found sero-prevalence of 16% in householdmembers of HCV infected cases. Aslam et al reported a population prevalence of 16% from Lahore and 23.8% in Gujranwala. In our studypublished in Medical Forum showed prevalence of HCV antibodies in population attending our department of ophthalmology is 27.06%.There is no data from Pakistan about prevalence of hepatitis C in Paramedical staff. It appears that paramedical staff is at higher risk ofcontracting this infection as they are exposed to multiple risk factors like needle stick injuries. Little is known about the prevalence of HepatitisC in this group of population. The objective of our study was to assess the perceived increased incidence of Hepatitis C in this group ofpopulation. M e t h o d s & Materials:This is a retrospective audit of the data from the records kept by clinical laboratory of University MedicalCollege, Faisalabad. All paramedical staff members were invited for HCV antibody test on 13.1.2007 to 20.1.2007.Any staff member workingin those days was included in the study. Persons on holidays or did not give free informed consent was excluded from the study. Serumof blood samples were analyzed by EXCEL a one step test device for the qualitative detection of antibodies to Hepatitis C virus in serumor plasma by trained professional. This test has a relative sensitivity of 96.8%, relative specificity 99% and accuracy 98.9% as comparedto HCV EIA test. Statistical analysis was performed by SPSS system.Results: A total 80 staff members were working in the hospital at thattime, 61 attended for the test (F: 31, M: 30). We found 7 (11.4%) were HCV positive and 54 (88.52%) were HCV negative including 2 weeklypositive. Among HCV positive 4 (6.55%) were male and 3 (4.91 %) were females. Age distribution was 17 - 75 years with mean age 32.51years. Among HCV positive 3 were analyzed by ELISA technique. 2 weekly positive by EXCEL were negative by ELISA and 1 positive byEXCEL was positive by ELISA. C o n c l u s i o n : Paramedical staff is perhaps not at higher risk of contracting HCV infection. However morestudies are required to further assess this finding.

BackgroundReliable data on clinical biomarkers are necessary in order to assess the health risks of populations and especially in assessing long-term trends related to disease incidence.MethodsTen European laboratories participated in a two-phase quality control exercise of total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) analysis. The European Health Examination Survey Reference Laboratory prepared plasma batches for analysis, and provided target values for them. Two criteria were set for the precision and the systematic error (bias). Three plasma samples were analysed in duplicate on separate days (n=12).ResultsIn Round 1, all laboratories met the acceptable criterion (3%) for precision of TC. The mean bias of all laboratories was 0.99% (95% CI 0.03% to 1.95%). Six laboratories measured samples from Round 2. Five laboratories met the goal criterion of 3%; one failed to meet the acceptable criterion of 5%. The mean bias for HDL-C of the three batches of six laboratories was within goal limits (±5% from target) and that of all 10 within acceptable (±10%). The mean bias of all laboratories was 1.1% (95% CI −0.18 to 2.32). In Round 2 four laboratories met the goal criterion and one the acceptable criterion.ConclusionThe quality control exercise demonstrated that although the majority of the laboratories met the strict criteria for systematic error for TC and HDL-C, standardisation of methods is still needed to improve the accuracy of biomarker measurements of laboratories engaged in population health surveys. A protocol is recommended for obtaining reliable and comparable biomarker data between countries.

I n t r o d u c t i o n . The article analyzes modern literary sources and scientific ideas devoted to the study of the role of healthy nutrition and the influence of nutrition factors on health. Proper and healthy nutrition is the basis of a high-quality human life, affects health, longevity and performance. Modern nutrition should not only satisfy the physiological needs of a person for nutrients and energy, but also perform preventive and therapeutic functions. Diets based entirely on the consumption of plant products are becoming increasingly popular due to the many claimed health benefits. Numerous studies conducted in recent years indicate that a plant-based diet with a restriction of animal products is accompanied by a lower risk of developing chronic diseases, and in some nosologies contributes to disease control. The goals and objectives of the prevention of healthy eating are to preserve and strengthen the health of the population, prevent diseases caused by inadequate and unbalanced nutrition. M a t e r i a l s a n d m e t h o d s . A review of the literature on the control of food safety, the fullness and balance of nutrition, compliance with dietary regimes. R e s u l t s . With eating disorders, the ability to withstand adverse environmental influences, stress, increased mental and physical exertion sharply decreases. An imbalance of nutrients, vitamins and minerals in the composition of food leads to metabolic disorders and subsequently to disease. D i s c u s s i o n . Rational nutrition is considered as one of the components of “lifestyle medicine”. At the same time, most researchers emphasize the need for large-scale population-based research in this area in accordance with modern principles of evidence-based medicine. C o n c l u s i o n . The results of numerous studies indicate the significant role of nutrition in the development of various diseases, their prevention and treatment. Nutrition is the basis for all metabolic processes of the human body, therefore, a violation of nutrition contributes to the occurrence of the disease. A healthy diet and a healthy lifestyle are the basis of disease prevention.

We sought to investigate the prevalence of Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in men presenting to a sexually transmitted infection (STI) clinic, with special attention to M. genitalium, its occurrence in Israeli patients, coinfections, and risk factors. In a cross-sectional study, 259 men were successively enrolled in the Tel Aviv Levinsky Clinic for STIs between November 2008 and November 2010. There were 118 men with urethritis and 141 high-risk men without symptoms. M. genitalium, C. trachomatis, N. gonorrhoeae, and T. vaginalis were detected using nucleic acid amplification tests. Demographic characteristics and risk factors were documented. The overall prevalence of infection with M. genitalium, C. trachomatis, N. gonorrhoeae, and T. vaginalis, were 6.6%, 12.7%, 23.1%, and 0%, respectively. Prevalences in men with urethritis were 11.9%, 22%, and 49%, for M. genitalium, C. trachomatis, and N. gonorrhoeae, respectively. Prevalences in men without symptoms were 2.1%, 5.0%, and 1.4%, for M. genitalium, C. trachomatis, and N. gonorrhoeae, respectively. Co-infections were found only in symptomatic individuals, in whom 5.9% were infected concomitantly with C. trachomatis and N. gonorrhoeae, and 2.5% had dual infection with M. genitalium and N. gonorrhoeae. N. gonorrhoeae, C. trachomatis, and M. genitalium were significantly more prevalent in patients with urethritis. M. genitalium was significantly more prevalent in the heterosexual population than in homosexual males. To conclude, we have found that M. genitalium infection is associated with urethritis in Israeli men, and more so in the heterosexual population. Testing men for M. genitalium as a cause of non-gonococcal urethritis is warranted, particularly because of its poor response to doxycycline and possible failure of azithromycin.

The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7%, 8.7%, and 7.5%, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5% children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6% and 43.5% of the children, respectively. Evidence of anemia was found in only 47.6% of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum.

Coxiella burnetii is an intracellular bacterium and the cause of the zoonotic infection, Q fever. National surveillance data on C. burnetii seroprevalence is currently not available for any South American country, making efforts of public health to implement strategies to mitigate infections in different at-risk groups within the population extremely challenging. In the current study, we used two commercial anti-C. burnetii immunoassays to screen sera collected from a sample of the Chilean population as part of a 2016–2017 national health survey (n = 5166), nationwide and age-standardized. The seroprevalence for C. burnetii for persons ≥ 15 years was estimated to be 3.0% (95% CI 2.2–4.0), a level similar to national surveys from The Netherlands (2.4%) and USA (3.1%), but lower than Australia (5.6%). A linear increase of C. burnetii seropositivity was associated with an individual’s age, with the peak seroprevalence 5.6% (95% CI 3.6–8.6) observed in the ≥65 years’ group. C. burnetii seropositivity was significantly higher in the southern macro-zone 6.0% (95% CI 3.3–10.6) compared to metropolitan region 1.8% (95% CI 0.9–3.3), the former region being home to significant livestock industries, particularly dairy farming. These data will be useful to inform targeted strategies for the prevention of Q fever in at-risk populations in Chile.

Objectives: The care cascade, a method for tracking population-level progression from diagnosis to cure, is an important tool in addressing and monitoring the hepatitis C virus (HCV) epidemic. However, little agreement exists on appropriate care cascade steps or how best to measure them. The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sought to construct a care cascade by using laboratory surveillance data with clinically relevant categories that can be readily updated over time. Methods: We identified all NYC residents ever reported to the DOHMH surveillance registry with HCV through June 30, 2017 (n = 175 896). To account for outmigration, death, or treatment before negative RNA results became reportable to the health department, we limited the population to people with any test reported since July 1, 2014. Of these residents, we identified the proportion with a reported positive RNA test and estimated the proportion treated and cured since July 2014 by using DOHMH-developed surveillance-based algorithms. Results: Of 78 886 NYC residents ever receiving a diagnosis of HCV and tested since July 1, 2014, a total of 70 397 (89.2%) had ever been reported as RNA positive through June 30, 2017; 36 875 (46.7%) had initiated treatment since July 1, 2014, and 23 766 (30.1%) appeared cured during the same period. Conclusion: A substantial gap exists between confirming HCV infection and initiating treatment, even in the era of direct-acting antivirals. Using this cascade, we will monitor progress in improved treatment and cure of HCV in NYC.

Objectives. To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States. Methods. Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6,016,425) or Rhode Island (RI; 1990 population = 1,003,464) for: STIs (MA: 1994–1998, n = 26,535 chlamydia, 7,464 gonorrhea, 2,619 syphilis; RI: 1994–1996, n = 4,473 chlamydia, 1,256 gonorrhea, 305 syphilis); TB (MA: 1993–1998, n = 1,793; RI: 1985–1994, n = 576), and non-fatal weapons related injuries (MA: 1995–1997, n = 6,628). Results. Analyses indicated that: ( a) block group and tract socioeconomic measures performed similarly within and across both states, with results more variable for the ZIP Code level measures; ( b) measures of economic deprivation consistently detected the steepest socioeconomic gradients, considered across all outcomes (incidence rate ratios on the order of 10 or higher for syphilis, gonorrhea, and non-fatal intentional weapons-related injuries, and 7 or higher for chlamydia and TB); and ( c) results were similar for categories generated by quintiles and by a priori categorical cut-points. Conclusions. Supplementing U.S. public health surveillance systems with census tract or block group area-based socioeconomic measures of economic deprivation could greatly enhance monitoring and analysis of social inequalities in health in the United States.

Reports of small business owner motivations for participation in health promotion interventions are rarely reported in the literature, particularly in relation to healthy eating interventions. This study explicates and defines the development of healthy corner stores as community-based enterprises (CBEs) within eight low-income, suburban communities. CBEs are defined as community-oriented small businesses with a common goal to improve population health. The corner stores assessed in this study were participants in Healthy HotSpot (HH), a corner store initiative of the Cook County Department of Public Health. To determine store alignment with the CBE construct, a case study design was used for qualitative inquiry. Participant narratives from store owners ( n = 21), community-based organizations (CBOs; n = 8) and consumer focus groups ( n = 51) were analyzed using an iterative process to determine how store owners aligned with the CBE construct, and how this influenced continuation of health promotion activities. Several key factors influenced the strength of store owners’ alignment with the CBE construct. They included the following: (a) shared ethno-cultural identities and residential area as consumers; (b) positive, trustworthy relationships with consumers; (c) store owners valuing and prioritizing community health, often over profits; and (d) collaboration with a highly engaged CBO in the HH project. Results can assist in theory development and intervention design in working with corner store owners, and other small business owners, as health promotion agents to improve and sustain health outcomes and help ensure the economic vitality of low-income communities.

Starting in late 2013, new direct-acting antiviral medicines (DAAs) offered the chance of a cure for chronic hepatitis C virus (HCV) infection. In clinical trials, DAAs helped more than 90% of patients achieve sustained viral response (SVR), commonly considered to be a cure that will stop progression of related liver disease and prevent transmission of the virus to others. Prices for these medicines are now around $20,000 per treatment after discounts from manufacturers, due to competition.

In late 2016, the medical director for D.C. Medicaid asked what it would take to eradicate hepatitis C in the city. This dissertation focused on that question for Medicaid alone, to inform policy discussions and identify next steps. I profiled beneficiaries with chronic HCV infection based on medical claims from 2014-2016; interviewed medical providers and policymakers to learn more about their decision-making processes and to identify opportunities to expand treatment, as well as potential barriers; and created an Excel-based Markov model that estimates outcomes and costs under different scenarios.

Only 799 individuals, about 10% of the D.C. Medicaid beneficiaries identified as having chronic HCV infection, received treatment with DAAs in 2014-2016. Providers and policymakers are committed to treating this population, but treatment rates remained low through 2018. I estimate that roughly 80% of Medicaid beneficiaries with chronic HCV had not been treated at the start of 2019.

Beneficiaries with chronic HCV infection often have other physical, mental, and behavioral health conditions that might keep them from seeking treatment for an often-asymptomatic HCV infection. They often miss scheduled appointments and/or are lost to follow-up. Most live east of the Anacostia River, where there are fewer providers. Even if they engage in care, government or health plan policies might discourage or prevent individuals with low levels of liver damage from getting prior authorization for treatment.

Broader use of DAAs in D.C. Medicaid will allow more people to achieve SVR, potentially decreasing future healthcare costs for some and saving lives. A moderate (50%) increase in treatment rates among those with low liver damage could enable about 300 additional patients to achieve SVR over 10 years, at a net cost of $6.1 million. A 50% increase in treatment rates among those with moderate liver damage could enable more than 500 additional patients to achieve SVR over 10 years, keep more than 160 from severe liver damage, and avoid 19 early deaths. The net cost of the second scenario is $6.5 million, a smaller increase per person achieving SVR because curing those with moderate liver damage is more likely to avoid high healthcare costs.

The District must weigh the upfront costs of expanding use of DAAs against uncertain long-term benefits and inherent budget limitations. I recommend that D.C. develop a more complete profile of Medicaid beneficiaries with HCV infection; work toward universal screening and sustained monitoring of at-risk populations; collaborate with key stakeholders to develop policies, practices, and tools to engage beneficiaries in care; and reduce prior authorization requirements that might deter or prevent treatment when beneficiaries and health care providers are ready.

This thesis explored whether individual differences in taste perception (as measured by the rated intensity of 6-n-propylthiouracil (PROP)) were associated with tobacco use, alcohol use and misuse and obesity in the Dunedin Multidisciplinary Health and Development Study birth cohort at age 32. This cohort of 1037 participants was assessed at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26 and, most recently, at 32 years, when 96% of the living study members were interviewed. At age 32, participants rated the intensity of a 0.0032mol/L solution of PROP using the general labelled magnitude scale (gLMS). PROP is almost tasteless to some but tastes bitter to others. As bitter tastes are aversive, due to their association with toxicity, it has been suggested that responses to PROP may reflect individual differences in taste perception that, in turn, have a protective effect on health. Study One sought to establish correlates of rated PROP intensity in this sample. A model controlling for sex, childhood socio-economic status (SES), childhood IQ and gLMS use predicted approximately 12% of the variability in PROP ratings. This finding highlighted the importance of using appropriate covariates in research attempting to link PROP perception with health risk behaviours, as these factors have also been associated with tobacco use, alcohol use and adiposity. Study Two did not find that greater perceived intensity from PROP was protective against smoking, as pack years smoked was not associated with PROP rating and ratings between groups of smokers were not significantly different. Differences in PROP perception were not protective against the lifetime smoking in this sample. Similarly, Study Three found no evidence to suggest that greater intensity from PROP was associated with reduced alcohol misuse. Furthermore, the previously observed association between PROP and yearly alcohol consumption may be better explained by the fact that SES accounts for some of the variance in both measures. In Study Four, rated PROP intensity was associated with Body Mass Index (BMI), waist circumference and body fat percentage, in women, but not in men. These associations were weakened after the inclusion of covariates in the models, but remained significant for both BMI and body fat percentage. Findings from Study Four indicate that taste perception may be associated with measures of adiposity in women. Taken together, these results highlight the importance of using appropriate control variables in research and indicate that a single measure of PROP perception may not adequately reflect the full effect of individual differences in taste perception on tobacco use or alcohol use and misuse. Since PROP perception was associated with differences in adiposity in women, however, individual differences in taste perception may be of public health importance. Future research should use continuous measures of a wider range of taste stimuli, to establish how taste perception (rather than just bitterness perception) affects health. Research should also ensure that covariates associated with tobacco use, alcohol use and misuse and adiposity (such as sex, SES and IQ) are included in analyses.

BACKGROUND: Hepatitis C (HCV) is the most common chronic blood-borne infection in the US5,6 and has life-threatening complications.10,11,18,27,44 HCV rates in Cambodian Americans are as high as national rates,5,11,22,37,41 but the transmission risks for Cambodians in the US are unclear. Rates of drug use, the most common national transmission risk,3,6,21 are not as high in this population.14,21 With the second largest population of Cambodians nationally, Lowell, Massachusetts12,19 provides a unique opportunity to study the risk factors associated with HCV transmission. OBJECTIVE: The objective of this study is to examine the risk factors associated with HCV in Cambodian Americans. The hypothesis is that HCV infected Cambodian Americans will have different rates of the United States Preventive Services Task Force (USPSTF) recognized risk factors compared to HCV infected non-Cambodian Americans.28 METHODS: This is a cross sectional study of HCV infected Cambodian and non-Cambodian Americans. Medical record data were abstracted for adults with reactive HCV antibody or RNA virus testing at Lowell Community Health Center (LCHC) between 2009 and 2012. Information regarding USPSTF-designated HCV risk factors was collected, and a comparison was made of HCV risk factors between infected Cambodian and non-Cambodian Americans. RESULTS: Cambodian Americans with HCV (n=128) were older (mean age 53 vs. 43 years old) and less likely to be male (41%) than the non-Cambodian group (67% male, n=541). Cambodians had far lower rates of overall recreational drug use (2.3% vs. 82.1%) and intravenous drug use (1.6% vs. 33.6%). The predominant HCV risk factor in Cambodians was birth between 1945 and 1965, while that for non-Cambodians was drug use. CONCLUSION: Most HCV infected Cambodian Americans treated at LCHC between 2009 and 2012 lacked any history of drug use. In contrast, the major risk factor for HCV infected non-Cambodian Americans treated at LCHC was drug use, consistent with the major risk factor for HCV transmission nationwide.3,6,21 This suggests that the current major HCV risk factors fail to describe how this virus was transmitted to Cambodian Americans who seek care at LCHC.

The aim of this study was to map existing country policies and initiatives addressing population dietary sodium reduction in the Region of the Americas; to identify policy gaps following what is outlined in the World Health Organization (WHO) “Best Buys” most cost-effective recommendations for the prevention and control of diet-related noncommunicable diseases (NCDs); and to discuss priorities for future work to reduce population salt/sodium intake. We analyzed data from 34 countries in the Region. A review of different databases informed the mapping. Databases included (1) responses from the online Survey on National Initiatives for Salt/Sodium Reduction in the Americas carried out by PAHO in 2016; (2) the databases from the 2017 and 2019 PAHO Country Capacity Surveys for NCDs and Risk Factors; and (3) the repositories of legislation of the PAHO REGULA initiative as of 2018. Research in these databases was complemented by electronic searches on official websites from the ministries of health, education, and agriculture and the library of the national congress in each country. Additionally, when available, government regulatory gazettes were reviewed. National policies that have adopted the most cost-effective interventions for preventing and controlling diet-related NCDs of WHO “Best Buys” included reformulating food products with both voluntary (n=11/34) and mandatory (n=2/34) targets; establishing a supportive environment in public institutions (n=13/34); consumer awareness programs (n=26/34) and behavior-change communication and mass media campaigns (n=(0/34); and implementing front-of-pack labeling (n=5/34). We also found that some countries have implemented regulations that restrict marketing of foods high in salt/sodium to children (n=5/34), or are using nutritional labeling that includes sodium content, either voluntary (n=9/34) or mandatory (n=10/34). However, no country in the Region has implemented taxes on high salt/sodium foods. Based on our review, we concluded that there has been a significant advance in policies to reduce sodium intake in the Region of the Americas in recent years. However, we identified that the level of implementation is quite varied and is challenging to assess. Despite the progress, there remains much work to do on this issue, especially in countries where there is limited or no action yet. Reducing sodium consumption is a cost-effective intervention that can save many lives by preventing and reducing the burden of diet-related NCDs. Therefore, a further call to action is needed for governments to accelerate efforts to meet the 2025 global target of a 30% relative reduction in mean population intake of sodium.

The single most important thing we can do as a society to positively transform the lives of children and prevent social, emotional, and behavioral problems and child maltreatment is to increase the knowledge, skills, and confidence of parents in the task of raising children at a whole-of-population level. This book provides an in-depth description of a comprehensive population-based approach to enhancing competent parenting known as the Triple P—Positive Parenting Program. Delivered as a multilevel system of intervention within a public health framework, Triple P represents a paradigm shift in how parenting support is provided. The Power of Positive Parenting is structured in eight sections that address every aspect of the Triple P system, including (a) the foundations and an overview of the approach; (b) how the system can be applied to a diverse range of child presentations; (c) the theoretical and practical issues involved in working with different types of parents and caregivers; (d) the importance of, and how parenting support can be provided in, a range of delivery contexts; (e) how the system can respond to and embrace cultural diversity of families everywhere; (f) the strategies needed to make large-scale, population-level implementation of the system succeed; (g) lessons learned from real-world applications of the full multilevel approach to parenting support at a population level; and (h) future directions and how further program development and innovation can be supported for this approach to reach its full potential in positively transforming the lives of all children, parents, and communities.

In 2001, taxonomic reorganization of the bacterial genera Anaplasma, Ehrlichia, Cowdria and Neorickettsia resulted in the transfer of numerous species between these taxa, and the renaming of the transferred species to reflect their new taxonomic position (Dumler et al. 2001). Among the members of these genera, there are four species of established zoonotic importance, which are therefore the subject of this chapter. Two of these species were affected by the changes outlined above.Although these four species possess markedly different ecologies, they share the fundamental biological character of being obligate intracellular bacteria that reside within vacuoles of eukaryotic cells. This lifestyle underlies their fastidious nature in the laboratory and hence our limited knowledge of their biology and pathogenicity. Nonetheless, despite this shortfall, all four are associated with diseases of established or emerging importance: E. chaffeensis provokes human monocytic ehrlichiosis (HME), E. ewingii causes human ewingii ehrlichiosis (HEE), A. phagocytophilum causes human granulocytic anaplasmosis (HGA), N. sennetsu is the agent of sennetsu neorickettsiosis.The first three pathogens are transmitted by hard (ixodid) ticks and are encountered across the temperate zones of the northern hemisphere (and maybe beyond), although the vast majority of human infections caused by them are currently reported in the USA. There, HME and HGA are second only to Lyme disease (caused by Borrelia burgdorferi) in terms of public health significance. Furthermore, given that there is evidence of increasing population sizes and changing distributions for ixodid species (Scharlemann et al. 2008), it is not unreasonable to predict that the infections they transmit will present an increased medical burden in the future. N. sennetsu remains an enigmatic pathogen; case reports remain scarce, but serological surveys suggest high levels of exposure. The widespread consumption of raw fish across east Asia presents specific infection risks to this region, and an increased awareness that sennetsu neorickettsiosis is among the infections that can be acquired from this source is required before its public health importance can be accurately assessed.

Influenza is a highly infectious, acute illness which has affected humans and animals since ancient times. Influenza viruses form the Orthomyxoviridae family and are grouped into types A, B, and C on the basis of the antigenic nature of the internal nucleocapsid or the matrix protein. Infl uenza A viruses infect a large variety of animal species, including humans, pigs, horses, sea mammals, and birds, occasionally producing devastating pandemics in humans, such as in 1918 when it has been estimated that between 50–100 million deaths occurred worldwide.There are two important viral surface glycoproteins, the haemagglutinin (HA) and neuraminidase (NA). The HA binds to sialic acid receptors on the membrane of host cells and is the primary antigen against which a host’s antibody response is targeted. The NA cleaves the sialic acid bond attaching new viral particles to the cell membrane of host cells allowing their release. The NA is also the target of the neuraminidase inhibitor class of antiviral agents that include oseltamivir and zanamivir and newer agents such as peramivir. Both these glycoproteins are important antigens for inducing protective immunity in the host and therefore show the greatest variation.Influenza A viruses are classified into 16 antigenically distinct HA (H1–16) and 9 NA subtypes (N1–9). Although viruses of relatively few subtype combinations have been isolated from mammalian species, all subtypes, in most combinations, have been isolated from birds. Each virus possesses one HA and one NA subtype.Last century, the sudden emergence of antigenically different strains in humans, termed antigenic shift, occurred on three occasions, 1918 (H1N1), 1957 (H2N2) and 1968 (H3N2), resulting in pandemics. The frequent epidemics that occur between the pandemics are as a result of gradual antigenic change in the prevalent virus, termed antigenic drift. Epidemics throughout the world occur in the human population due to infection with influenza A viruses, such as H1N1 and H3N2 subtypes, or with influenza B virus. Phylogenetic studies have led to the suggestion that aquatic birds that show no signs of disease could be the source of many influenza A viruses in other species. The 1918 H1N1 pandemic strain is thought to have arisen as a result of spontaneous mutations within an avian H1N1 virus. However, most pandemic strains, such as the 1957 H2N2, 1968 H3N2 and 2009 pandemic H1N1, are considered to have emerged by genetic re-assortment of the segmented RNA genome of the virus, with the avian and human influenza A viruses infecting the same host.Influenza viruses do not pass readily between humans and birds but transmission between humans and other animals has been demonstrated. This has led to the suggestion that the proposed reassortment of human and avian influenza viruses takes place in an intermediate animal with subsequent infection of the human population. Pigs have been considered the leading contender for the role of intermediary because they may serve as hosts for productive infections of both avian and human viruses, and there is good evidence that they have been involved in interspecies transmission of influenza viruses; particularly the spread of H1N1 viruses to humans. Apart from public health measures related to the rapid identification of cases and isolation. The main control measures for influenza virus infections in human populations involves immunization and antiviral prophylaxis or treatment.

Nationalism: Past as Prologue began as a single volume being compiled by Ad Akande, a scholar from South Africa, who proposed it to me as co-author about two years ago. The original idea was to examine how the damaging roots of nationalism have been corroding political systems around the world, and creating dangerous obstacles for necessary international cooperation. Since I (Bruce E. Johansen) has written profusely about climate change (global warming, a.k.a. infrared forcing), I suggested a concerted effort in that direction. This is a worldwide existential threat that affects every living thing on Earth. It often compounds upon itself, so delays in reducing emissions of fossil fuels are shortening the amount of time remaining to eliminate the use of fossil fuels to preserve a livable planet. Nationalism often impedes solutions to this problem (among many others), as nations place their singular needs above the common good. Our initial proposal got around, and abstracts on many subjects arrived. Within a few weeks, we had enough good material for a 100,000-word book. The book then fattened to two moderate volumes and then to four two very hefty tomes. We tried several different titles as good submissions swelled. We also discovered that our best contributors were experts in their fields, which ranged the world. We settled on three stand-alone books:” 1/ nationalism and racial justice. Our first volume grew as the growth of Black Lives Matter following the brutal killing of George Floyd ignited protests over police brutality and other issues during 2020, following the police assassination of Floyd in Minneapolis. It is estimated that more people took part in protests of police brutality during the summer of 2020 than any other series of marches in United States history. This includes upheavals during the 1960s over racial issues and against the war in Southeast Asia (notably Vietnam). We choose a volume on racism because it is one of nationalism’s main motive forces. This volume provides a worldwide array of work on nationalism’s growth in various countries, usually by authors residing in them, or in the United States with ethnic ties to the nation being examined, often recent immigrants to the United States from them. Our roster of contributors comprises a small United Nations of insightful, well-written research and commentary from Indonesia, New Zealand, Australia, China, India, South Africa, France, Portugal, Estonia, Hungary, Russia, Poland, Kazakhstan, Georgia, and the United States. Volume 2 (this one) describes and analyzes nationalism, by country, around the world, except for the United States; and 3/material directly related to President Donald Trump, and the United States. The first volume is under consideration at the Texas A & M University Press. The other two are under contract to Nova Science Publishers (which includes social sciences). These three volumes may be used individually or as a set. Environmental material is taken up in appropriate places in each of the three books. * * * * * What became the United States of America has been strongly nationalist since the English of present-day Massachusetts and Jamestown first hit North America’s eastern shores. The country propelled itself across North America with the self-serving ideology of “manifest destiny” for four centuries before Donald Trump came along. Anyone who believes that a Trumpian affection for deportation of “illegals” is a new thing ought to take a look at immigration and deportation statistics in Adam Goodman’s The Deportation Machine: America’s Long History of Deporting Immigrants (Princeton University Press, 2020). Between 1920 and 2018, the United States deported 56.3 million people, compared with 51.7 million who were granted legal immigration status during the same dates. Nearly nine of ten deportees were Mexican (Nolan, 2020, 83). This kind of nationalism, has become an assassin of democracy as well as an impediment to solving global problems. Paul Krugman wrote in the New York Times (2019:A-25): that “In their 2018 book, How Democracies Die, the political scientists Steven Levitsky and Daniel Ziblatt documented how this process has played out in many countries, from Vladimir Putin’s Russia, to Recep Erdogan’s Turkey, to Viktor Orban’s Hungary. Add to these India’s Narendra Modi, China’s Xi Jinping, and the United States’ Donald Trump, among others. Bit by bit, the guardrails of democracy have been torn down, as institutions meant to serve the public became tools of ruling parties and self-serving ideologies, weaponized to punish and intimidate opposition parties’ opponents. On paper, these countries are still democracies; in practice, they have become one-party regimes….And it’s happening here [the United States] as we speak. If you are not worried about the future of American democracy, you aren’t paying attention” (Krugmam, 2019, A-25). We are reminded continuously that the late Carl Sagan, one of our most insightful scientific public intellectuals, had an interesting theory about highly developed civilizations. Given the number of stars and planets that must exist in the vast reaches of the universe, he said, there must be other highly developed and organized forms of life. Distance may keep us from making physical contact, but Sagan said that another reason we may never be on speaking terms with another intelligent race is (judging from our own example) could be their penchant for destroying themselves in relatively short order after reaching technological complexity. This book’s chapters, introduction, and conclusion examine the worldwide rise of partisan nationalism and the damage it has wrought on the worldwide pursuit of solutions for issues requiring worldwide scope, such scientific co-operation public health and others, mixing analysis of both. We use both historical description and analysis. This analysis concludes with a description of why we must avoid the isolating nature of nationalism that isolates people and encourages separation if we are to deal with issues of world-wide concern, and to maintain a sustainable, survivable Earth, placing the dominant political movement of our time against the Earth’s existential crises. Our contributors, all experts in their fields, each have assumed responsibility for a country, or two if they are related. This work entwines themes of worldwide concern with the political growth of nationalism because leaders with such a worldview are disinclined to co-operate internationally at a time when nations must find ways to solve common problems, such as the climate crisis. Inability to cooperate at this stage may doom everyone, eventually, to an overheated, stormy future plagued by droughts and deluges portending shortages of food and other essential commodities, meanwhile destroying large coastal urban areas because of rising sea levels. Future historians may look back at our time and wonder why as well as how our world succumbed to isolating nationalism at a time when time was so short for cooperative intervention which is crucial for survival of a sustainable earth. Pride in language and culture is salubrious to individuals’ sense of history and identity. Excess nationalism that prevents international co-operation on harmful worldwide maladies is quite another. As Pope Francis has pointed out: For all of our connectivity due to expansion of social media, ability to communicate can breed contempt as well as mutual trust. “For all our hyper-connectivity,” said Francis, “We witnessed a fragmentation that made it more difficult to resolve problems that affect us all” (Horowitz, 2020, A-12). The pope’s encyclical, titled “Brothers All,” also said: “The forces of myopic, extremist, resentful, and aggressive nationalism are on the rise.” The pope’s document also advocates support for migrants, as well as resistance to nationalist and tribal populism. Francis broadened his critique to the role of market capitalism, as well as nationalism has failed the peoples of the world when they need co-operation and solidarity in the face of the world-wide corona virus pandemic. Humankind needs to unite into “a new sense of the human family [Fratelli Tutti, “Brothers All”], that rejects war at all costs” (Pope, 2020, 6-A). Our journey takes us first to Russia, with the able eye and honed expertise of Richard D. Anderson, Jr. who teaches as UCLA and publishes on the subject of his chapter: “Putin, Russian identity, and Russia’s conduct at home and abroad.” Readers should find Dr. Anderson’s analysis fascinating because Vladimir Putin, the singular leader of Russian foreign and domestic policy these days (and perhaps for the rest of his life, given how malleable Russia’s Constitution has become) may be a short man physically, but has high ambitions. One of these involves restoring the old Russian (and Soviet) empire, which would involve re-subjugating a number of nations that broke off as the old order dissolved about 30 years ago. President (shall we say czar?) Putin also has international ambitions, notably by destabilizing the United States, where election meddling has become a specialty. The sight of Putin and U.S. president Donald Trump, two very rich men (Putin $70-$200 billion; Trump $2.5 billion), nuzzling in friendship would probably set Thomas Jefferson and Vladimir Lenin spinning in their graves. The road of history can take some unanticipated twists and turns. Consider Poland, from which we have an expert native analysis in chapter 2, Bartosz Hlebowicz, who is a Polish anthropologist and journalist. His piece is titled “Lawless and Unjust: How to Quickly Make Your Own Country a Puppet State Run by a Group of Hoodlums – the Hopeless Case of Poland (2015–2020).” When I visited Poland to teach and lecture twice between 2006 and 2008, most people seemed to be walking on air induced by freedom to conduct their own affairs to an unusual degree for a state usually squeezed between nationalists in Germany and Russia. What did the Poles then do in a couple of decades? Read Hlebowicz’ chapter and decide. It certainly isn’t soft-bellied liberalism. In Chapter 3, with Bruce E. Johansen, we visit China’s western provinces, the lands of Tibet as well as the Uighurs and other Muslims in the Xinjiang region, who would most assuredly resent being characterized as being possessed by the Chinese of the Han to the east. As a student of Native American history, I had never before thought of the Tibetans and Uighurs as Native peoples struggling against the Independence-minded peoples of a land that is called an adjunct of China on most of our maps. The random act of sitting next to a young woman on an Air India flight out of Hyderabad, bound for New Delhi taught me that the Tibetans had something to share with the Lakota, the Iroquois, and hundreds of other Native American states and nations in North America. Active resistance to Chinese rule lasted into the mid-nineteenth century, and continues today in a subversive manner, even in song, as I learned in 2018 when I acted as a foreign adjudicator on a Ph.D. dissertation by a Tibetan student at the University of Madras (in what is now in a city called Chennai), in southwestern India on resistance in song during Tibet’s recent history. Tibet is one of very few places on Earth where a young dissident can get shot to death for singing a song that troubles China’s Quest for Lebensraum. The situation in Xinjiang region, where close to a million Muslims have been interned in “reeducation” camps surrounded with brick walls and barbed wire. They sing, too. Come with us and hear the music. Back to Europe now, in Chapter 4, to Portugal and Spain, we find a break in the general pattern of nationalism. Portugal has been more progressive governmentally than most. Spain varies from a liberal majority to military coups, a pattern which has been exported to Latin America. A situation such as this can make use of the term “populism” problematic, because general usage in our time usually ties the word into a right-wing connotative straightjacket. “Populism” can be used to describe progressive (left-wing) insurgencies as well. José Pinto, who is native to Portugal and also researches and writes in Spanish as well as English, in “Populism in Portugal and Spain: a Real Neighbourhood?” provides insight into these historical paradoxes. Hungary shares some historical inclinations with Poland (above). Both emerged from Soviet dominance in an air of developing freedom and multicultural diversity after the Berlin Wall fell and the Soviet Union collapsed. Then, gradually at first, right wing-forces began to tighten up, stripping structures supporting popular freedom, from the courts, mass media, and other institutions. In Chapter 5, Bernard Tamas, in “From Youth Movement to Right-Liberal Wing Authoritarianism: The Rise of Fidesz and the Decline of Hungarian Democracy” puts the renewed growth of political and social repression into a context of worldwide nationalism. Tamas, an associate professor of political science at Valdosta State University, has been a postdoctoral fellow at Harvard University and a Fulbright scholar at the Central European University in Budapest, Hungary. His books include From Dissident to Party Politics: The Struggle for Democracy in Post-Communist Hungary (2007). Bear in mind that not everyone shares Orbán’s vision of what will make this nation great, again. On graffiti-covered walls in Budapest, Runes (traditional Hungarian script) has been found that read “Orbán is a motherfucker” (Mikanowski, 2019, 58). Also in Europe, in Chapter 6, Professor Ronan Le Coadic, of the University of Rennes, Rennes, France, in “Is There a Revival of French Nationalism?” Stating this title in the form of a question is quite appropriate because France’s nationalistic shift has built and ebbed several times during the last few decades. For a time after 2000, it came close to assuming the role of a substantial minority, only to ebb after that. In 2017, the candidate of the National Front reached the second round of the French presidential election. This was the second time this nationalist party reached the second round of the presidential election in the history of the Fifth Republic. In 2002, however, Jean-Marie Le Pen had only obtained 17.79% of the votes, while fifteen years later his daughter, Marine Le Pen, almost doubled her father's record, reaching 33.90% of the votes cast. Moreover, in the 2019 European elections, re-named Rassemblement National obtained the largest number of votes of all French political formations and can therefore boast of being "the leading party in France.” The brutality of oppressive nationalism may be expressed in personal relationships, such as child abuse. While Indonesia and Aotearoa [the Maoris’ name for New Zealand] hold very different ranks in the United Nations Human Development Programme assessments, where Indonesia is classified as a medium development country and Aotearoa New Zealand as a very high development country. In Chapter 7, “Domestic Violence Against Women in Indonesia and Aotearoa New Zealand: Making Sense of Differences and Similarities” co-authors, in Chapter 8, Mandy Morgan and Dr. Elli N. Hayati, from New Zealand and Indonesia respectively, found that despite their socio-economic differences, one in three women in each country experience physical or sexual intimate partner violence over their lifetime. In this chapter ther authors aim to deepen understandings of domestic violence through discussion of the socio-economic and demographic characteristics of theit countries to address domestic violence alongside studies of women’s attitudes to gender norms and experiences of intimate partner violence. One of the most surprising and upsetting scholarly journeys that a North American student may take involves Adolf Hitler’s comments on oppression of American Indians and Blacks as he imagined the construction of the Nazi state, a genesis of nationalism that is all but unknown in the United States of America, traced in this volume (Chapter 8) by co-editor Johansen. Beginning in Mein Kampf, during the 1920s, Hitler explicitly used the westward expansion of the United States across North America as a model and justification for Nazi conquest and anticipated colonization by Germans of what the Nazis called the “wild East” – the Slavic nations of Poland, the Baltic states, Ukraine, and Russia, most of which were under control of the Soviet Union. The Volga River (in Russia) was styled by Hitler as the Germans’ Mississippi, and covered wagons were readied for the German “manifest destiny” of imprisoning, eradicating, and replacing peoples the Nazis deemed inferior, all with direct references to events in North America during the previous century. At the same time, with no sense of contradiction, the Nazis partook of a long-standing German romanticism of Native Americans. One of Goebbels’ less propitious schemes was to confer honorary Aryan status on Native American tribes, in the hope that they would rise up against their oppressors. U.S. racial attitudes were “evidence [to the Nazis] that America was evolving in the right direction, despite its specious rhetoric about equality.” Ming Xie, originally from Beijing, in the People’s Republic of China, in Chapter 9, “News Coverage and Public Perceptions of the Social Credit System in China,” writes that The State Council of China in 2014 announced “that a nationwide social credit system would be established” in China. “Under this system, individuals, private companies, social organizations, and governmental agencies are assigned a score which will be calculated based on their trustworthiness and daily actions such as transaction history, professional conduct, obedience to law, corruption, tax evasion, and academic plagiarism.” The “nationalism” in this case is that of the state over the individual. China has 1.4 billion people; this system takes their measure for the purpose of state control. Once fully operational, control will be more subtle. People who are subject to it, through modern technology (most often smart phones) will prompt many people to self-censor. Orwell, modernized, might write: “Your smart phone is watching you.” Ming Xie holds two Ph.Ds, one in Public Administration from University of Nebraska at Omaha and another in Cultural Anthropology from the Chinese Academy of Social Sciences, Beijing, where she also worked for more than 10 years at a national think tank in the same institution. While there she summarized news from non-Chinese sources for senior members of the Chinese Communist Party. Ming is presently an assistant professor at the Department of Political Science and Criminal Justice, West Texas A&M University. In Chapter 10, analyzing native peoples and nationhood, Barbara Alice Mann, Professor of Honours at the University of Toledo, in “Divide, et Impera: The Self-Genocide Game” details ways in which European-American invaders deprive the conquered of their sense of nationhood as part of a subjugation system that amounts to genocide, rubbing out their languages and cultures -- and ultimately forcing the native peoples to assimilate on their own, for survival in a culture that is foreign to them. Mann is one of Native American Studies’ most acute critics of conquests’ contradictions, and an author who retrieves Native history with a powerful sense of voice and purpose, having authored roughly a dozen books and numerous book chapters, among many other works, who has traveled around the world lecturing and publishing on many subjects. Nalanda Roy and S. Mae Pedron in Chapter 11, “Understanding the Face of Humanity: The Rohingya Genocide.” describe one of the largest forced migrations in the history of the human race, the removal of 700,000 to 800,000 Muslims from Buddhist Myanmar to Bangladesh, which itself is already one of the most crowded and impoverished nations on Earth. With about 150 million people packed into an area the size of Nebraska and Iowa (population less than a tenth that of Bangladesh, a country that is losing land steadily to rising sea levels and erosion of the Ganges river delta. The Rohingyas’ refugee camp has been squeezed onto a gigantic, eroding, muddy slope that contains nearly no vegetation. However, Bangladesh is majority Muslim, so while the Rohingya may starve, they won’t be shot to death by marauding armies. Both authors of this exquisite (and excruciating) account teach at Georgia Southern University in Savannah, Georgia, Roy as an associate professor of International Studies and Asian politics, and Pedron as a graduate student; Roy originally hails from very eastern India, close to both Myanmar and Bangladesh, so he has special insight into the context of one of the most brutal genocides of our time, or any other. This is our case describing the problems that nationalism has and will pose for the sustainability of the Earth as our little blue-and-green orb becomes more crowded over time. The old ways, in which national arguments often end in devastating wars, are obsolete, given that the Earth and all the people, plants, and other animals that it sustains are faced with the existential threat of a climate crisis that within two centuries, more or less, will flood large parts of coastal cities, and endanger many species of plants and animals. To survive, we must listen to the Earth, and observe her travails, because they are increasingly our own.

AbstractAs the fertility transition proceeds, women have fewer births which in turn leads to fewer young people in subsequent years. The resulting changes in the population age structure include an increase in the proportion of the population of working age. The first dividend from lower fertility refers to an acceleration of growth in GDP per capita as the proportion of the working-age population rises. The benefits can last for decades but are ultimately transitory. The second dividend follows the first and refers to a rise in savings and investment in human and physical capital which raise worker productivity. The second dividend is typically larger than the first dividend and lasts longer. The magnitude and duration of these dividends vary from country to country and depend on the magnitude and pace of fertility decline and the ability if a county to take advantage of the changes in age structure. Over the six decades from 1955 to 2015, the first and second dividend together were highest in Asia and N. Africa (where the fertility transition was completed quickly and early) and lowest in SS Africa (where the fertility transition was slower and later). Projections to 2075 expect the situation to be reversed in the future: Asia’s dividend will likely be smaller than Africa’s. Although much of the contemporary literature on population and development focuses on the demographic dividend, there are other important benefits from fertility decline: the improvement of health, the empowerment of women, the government’s increased ability to maintain public capital (e.g. schools, clinics, infrastructure), increased political stability, an improved environment, and a slower depletion of natural resources.

It has been conventional to locate the origins of public health in early efforts to combat epidemics and to regulate the sanitary environment accompanying urban life and to trace its history in the gradual evolution of such measures in relation to politics, administrative practices, public laws, and medical science’s changing aetiology. Such an historical account provides important insights and understanding but it is also de-limited in one significant sense. Public health is cast in a responsive role in relation to the processes of economic development. However, the nature of the relationship between public health and global economic development can appear very differently when it is viewed over the long-term, encompassing the whole process of modern economic transformation from the singular matrix of its origins in the early modern society and economy of England, c.1600–1800. This chapter will show that state policies to promote the social order, security, and health of the population in fact pre-date and crucially underpinned the process through which the modern world’s economic transformation originated—in early modern England.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, alcohol, and non-alcoholic fatty liver disease (NAFLD) are major risk factors in the development of chronic liver disease (CLD), cirrhosis, and hepatocellular carcinoma (HCC). Various estimates have been proposed regarding the global prevalence of HBV and HCV carriers. According to a recent Polaris Observatory HCV Collaborators and the World Health Organization (WHO) burden estimates that 257 and 71 million people are living in the world with HBV and HCV infection, respectively, leading to an annual death from cirrhosis/liver failure and HCC of ~900,000 and ~400,000, respectively. Alcohol consumption, which is a major risk factor for CLD and HCC, is responsible for about 3.3 million deaths annually worldwide and for 5.1% of the global burden of disease as measured in disability-adjusted life years (DALYs). In recent years NAFLD and non-alcoholic steatohepatitis (NASH) associated with the metabolic syndrome, have captured the attention of hepatologists, public health experts, and the pharma industry alike. Indeed, the incidence of NAFLD and NASH and its complications including cirrhosis and HCC, is rising to epidemic proportions in the Western population, and constitute a major health problem worldwide.

Rabies is a lethal zoonotic disease that affects all the homeotherms, including humans, and is caused by the Rabies virus of Rhabdoviridae family. Every year, this disease kills about 55,000 individuals globally. The stray dog is a key player in the spread of rabies. The disease is usually transmitted through the bite of a rabid animal. After being exposed to the virus, the virus must travel to the brain before generating symptoms. Delirium, unusual behaviour, hallucinations, hydrophobia and insomnia may occur as the condition advances. Diagnostic tests such as direct fluorescent antibody test (dFAT), direct rapid immunohistochemical test (dRIT), lateral flow assay (LFA), reverse transcriptase polymerase chain reaction (RT-PCR), nuclear sequencing, etc. are used in diagnosis of this dreadful disease. The genotype and lineage of the rabies virus can be determined via N gene sequencing and phylogenetic analysis. There is no effective treatment for rabies. Even though a tiny number of people have survived rabies, the disease is usually fatal. Rabies can be completely avoided in people if they receive timely and adequate medical treatment. Vaccinating and sterilising the dogs in our neighbourhoods effectively and humanely limit their population and eliminate rabies in both dogs and humans.

A cohort study is one in which the outcome (usually disease status) is ascertained for groups of individuals defined on the basis of their exposure. At the time exposure status is determined, all must be free of the disease. All eligible participants are then followed up over time. Since exposure status is determined before the occurrence of the outcome, a cohort study can clarify the temporal sequence between exposure and outcome, with minimal information bias. The historical and the population cohort study (Box 9.1) are efficient variants of the classical cohort study described above, which nevertheless retain the essential components of the cohort study design. The exposure can be dichotomous [i.e. exposed (to obstetric complications at birth) vs. not exposed], or graded as degrees of exposure (e.g. no recent life events, one to two life events, three or more life events). The use of grades of exposure strengthens the results of a cohort study by supporting or refuting the hypothesis that the incidence of the disease increases with increasing exposure to the risk factor; a so-called dose–response relationship. The essential features of a cohort study are: ♦ participants are defined by their exposure status rather than by outcome (as in case–control design); ♦ it is a longitudinal design: exposure status must be ascertained before outcome is known. The classical cohort study In a classical cohort study participants are selected for study on the basis of a single exposure of interest. This might be exposure to a relatively rare occupational exposure, such as ionizing radiation (through working in the nuclear power industry). Care must be taken in selecting the unexposed cohort; perhaps those working in similar industries, but without any exposure to radiation. The outcome in this case might be leukaemia. All those in the exposed and unexposed cohorts would need to be free of leukaemia (hence ‘at risk’) on recruitment into the study. The two cohorts would then be followed up for (say) 10 years and rates at which they develop leukaemia compared directly. Classical cohort studies are rare in psychiatric epidemiology. This may be in part because this type of study is especially suited to occupational exposures, which have previously been relatively little studied as causes of mental illness. However, this may change as the high prevalence of mental disorders in the workplace and their negative impact upon productivity are increasingly recognized. The UK Gulf War Study could be taken as one rather unusual example of the genre (Unwin et al. 1999). Health outcomes, including mental health status, were compared between those who were deployed in the Persian Gulf War in 1990–91, those who were later deployed in Bosnia, and an ‘era control group’ who were serving at the time of the Gulf war but were not deployed. There are two main variations on this classical cohort study design: they are popular as they can, depending on circumstances, be more efficient than the classical cohort design. The population cohort study In the classical cohort study, participants are selected on the basis of exposure, and the hypothesis relates to the effect of this single exposure on a health outcome. However, a large cohort or panel of subjects are sometimes recruited and followed up, often over many years, to study multiple exposures and outcomes. No separate comparison group is required as the comparison group is generally an unexposed sub-group of the panel. Examples include the British Doctor's Study in which over 30,000 British doctors were followed up for over 20 years to study the effects of smoking and other exposures on health (Doll et al. 1994), and the Framingham Heart Study, in which residents of a town in Massachusetts, USA have been followed up for 50 years to study risk factors for coronary heart disease (Wolf et al. 1988). The Whitehall and Whitehall II studies in the UK (Fuhrer et al. 1999; Stansfeld et al. 2002) were based again on an occupationally defined cohort, and have led to important findings concerning workplace conditions and both physical and psychiatric morbidity. Birth cohort studies, in which everyone born within a certain chronological interval are recruited, are another example of this type of study. In birth cohorts, participants are commonly followed up at intervals of 5–10 years. Many recent panel studies in the UK and elsewhere have been funded on condition that investigators archive the data for public access, in order that the dataset might be more fully exploited by the wider academic community. Population cohort studies can test multiple hypotheses, and are far more common than any other type of cohort study. The scope of the study can readily be extended to include mental health outcomes. Thus, both the British Doctor's Study (Doll et al. 2000) and the Framingham Heart Study (Seshadri et al. 2002) have gone on to report on aetiological factors for dementia and Alzheimer's Disease as the cohorts passed into the age groups most at risk for these disorders. A variant of the population cohort study is one in which those who are prevalent cases of the outcome of interest at baseline are also followed up effectively as a separate cohort in order (a) to study the natural history of the disorder by estimating its maintenance (or recovery) rate, and (b) studying risk factors for maintenance (non-recovery) over the follow-up period (Prince et al. 1998). Historical cohort studies In the classical cohort study outcome is ascertained prospectively. Thus, new cases are ascertained over a follow-up period, after the exposure status has been determined. However, it is possible to ascertain both outcome and exposure retrospectively. This variant is referred to as a historical cohort study (Fig. 9.1). A good example is the work of David Barker in testing his low birth weight hypothesis (Barker et al. 1990; Hales et al. 1991). Barker hypothesized that risk for midlife vascular and endocrine disorders would be determined to some extent by the ‘programming’ of the hypothalamo-pituitary axis through foetal growth in utero. Thus ‘small for dates’ babies would have higher blood pressure levels in adult life, and greater risk for type II diabetes (through insulin resistance). A prospective cohort study would have recruited participants at birth, when exposure (birth weight) would be recorded. They would then be followed up over four or five decades to examine the effect of birth weight on the development of hypertension and type II diabetes. Barker took the more elegant (and feasible) approach of identifying hospitals in the UK where several decades previously birth records were meticulously recorded. He then traced the babies as adults (where they still lived in the same area) and measured directly their status with respect to outcome. The ‘prospective’ element of such studies is that exposure was recorded well before outcome even though both were ascertained retrospectively with respect to the timing of the study. The historical cohort study has also proved useful in psychiatric epidemiology where it has been used in particular to test the neurodevelopmental hypothesis for schizophrenia (Jones et al. 1994; Isohanni et al. 2001). Jones et al. studied associations between adult-onset schizophrenia and childhood sociodemographic, neurodevelopmental, cognitive, and behavioural factors in the UK 1946 birth cohort; 5362 people born in the week 3–9 March 1946, and followed up intermittently since then. Subsequent onsets of schizophrenia were identified in three ways: (a) routine data: cohort members were linked to the register of the Mental Health Enquiry for England in which mental health service contacts between 1974 and 1986 were recorded; (b) cohort data: hospital and GP contacts (and the reasons for these contacts) were routinely reported at the intermittent resurveys of the cohort; (c) all cohort participants identified as possible cases of schizophrenia were given a detailed clinical interview (Present State examination) at age 36. Milestones of motor development were reached later in cases than in non-cases, particularly walking. Cases also had more speech problems than had noncases. Low educational test scores at ages 8,11, and 15 years were a risk factor. A preference for solitary play at ages 4 and 6 years predicted schizophrenia. A health visitor's rating of the mother as having below average mothering skills and understanding of her child at age 4 years was a predictor of schizophrenia in that child. Jones concluded ‘differences between children destined to develop schizophrenia as adults and the general population were found across a range of developmental domains. As with some other adult illnesses, the origins of schizophrenia may be found in early life’. Jones' findings were largely confirmed in a very similar historical cohort study in Finland (Isohanni et al. 2001); a 31 year follow-up of the 1966 North Finland birth cohort (n = 12,058). Onsets of schizophrenia were ascertained from a national hospital discharge register. The ages at learning to stand, walk and become potty-trained were each related to subsequent incidence of schizophrenia and other psychoses. Earlier milestones reduced, and later milestones increased, the risk in a linear manner. These developmental effects were not seen for non-psychotic outcomes. The findings support hypotheses regarding psychosis as having a developmental dimension with precursors apparent in early life. There are many conveniences to this approach for the contemporary investigator. ♦ The exposure data has already been collected for you. ♦ The follow-up period has already elapsed. ♦ The design maintains the essential feature of the cohort study, namely that information bias with respect to the assessment of the exposure should not be a problem. ♦ As with the Barker hypothesis example, historical cohort studies are particularly useful for investigating associations across the life course, when there is a long latency between hypothesized exposure and outcome. Despite these important advantages, such retrospective studies are often limited by reliance on historical data that was collected routinely for other purposes; often these data will be inaccurate or incomplete. Also information about possible confounders, such as smoking or diet, may be inadequate.

The worldwide prevalence of the hepatitis C virus takes a heavy toll on lives, communities, and health systems. Every year more than 4 million peoples die from hepatitis C-related liver cancers and cirrhosis- a mortality tool comparable to that of HIV and tuberculosis. It needs for a global health sector strategy stems from the scale and complexity of the hepatitis C epidemic, along with growing recognition of its massive public health burden, and the huge opportunities for action. It is a golden time now to establish a coherent public health hepatitis C response that prioritizes effective interventions, promotes service delivery approaches that ensure quality and equity to test and treat every hepatitis C infected individual, takes programs to achieve the sustained impact of hepatitis C diagnostics and therapeutics at the population level, and establishes clear stakeholder responsibility and accountability. There are unprecedented opportunities to act while ending the hepatitis C epidemic and are feasible with the tools and approaches currently available and in the pipeline. For the greatest impact, these opportunities should be combined and tailored for specific populations, locations, and settings. New opportunities and health sector policies provide a ray of hope for the elimination of hepatitis C as a public health threat. In this book chapter, we will highlight the goals, aims, opportunities, and barriers to a coherent public health policy for hepatitis C effective interventions at screening, diagnostic, and therapeutic scale in general and vulnerable hepatitis C infected populations and their consensus implementations to healthcare systems.

Under pandemic conditions, it is important to communicate local infection risks to better enable the general population to adjust their behaviors accordingly. In Japan, our team operates a popular non-government and not-for-profit dashboard project – “Japan LIVE Dashboard” – which allows the public to easily grasp the evolution of the pandemic on the internet. We presented the Dashboard design concept with a generic framework integrating socio-technical theories, disease epidemiology and related contexts, and evidence-based approaches. Through synthesizing multiple types of reliable and real-time local data sources from all prefectures across the country, the Dashboard allows the public access to user-friendly and intuitive disease visualization in real time and has gained an extensive online followership. To date, it has attracted c.30 million visits (98% domestic access) testifying to the reputation it has acquired as a user-friendly portal for understanding the progression of the pandemic. Designed as an open-source solution, the Dashboard can also be adopted by other countries as well as made applicable for other emerging outbreaks in the future. Furthermore, the conceptual design framework may prove applicable into other ehealth scaled for global pandemics.

The population approach to parenting support evolved over a period of four decades from its historical roots in behavioral parent training. Impetus for this evolution came from three primary sources: (a) the undoubted success of parent training models based primarily on social learning theory in assisting parents of children with conduct problems; (b) the recognition that traditional ways of delivering parenting programs were reaching few parents; and (c) the success of public health approaches in modifying health risk behaviors. This chapter introduces the Triple P—Positive Parenting Program as a multilevel system of parenting support. We highlight the defining features of the multilevel system, including its logic model and the essential criteria that need to be met for a population approach to work.

India is rapidly growing towards a demographic future where a significant proportion of the population is over 60 years and above. In the COVID-19 pandemic, the restrictions imposed to minimize the virus transmission have a detrimental effect on the Quality of Life (QoL) of the elderly, limiting their mobility and social interaction. As a result, social isolation and loneliness have become significant health issues. This study attempts to understand the QoL of Indian elderly during COVID-19 pandemic from universal design (UD) perspective. The objectives were: (a) Discuss the QoL of Indian elderly during COVID-19; (b) Identify the factors affecting QoL of elderly during pandemic; (c) Find the link between factors associated with QoL and UD philosophy. These objectives were achieved by desk-based literature review and a pilot study of Solanipuram, a typical urban neighborhood in Roorkee located in Northern India. Personal in-depth interview sessions with limited number of (n=20) participants aged 60 years and above; belonging to upper-middle income group, are conducted and analyzed using the inductive thematic technique. The previous research suggests that, to date, QoL has been described as well-being resulting from physical, functional, emotional, social, and environmental factors. Whereas, UD allows for the inclusion of the ‘cultural’ dimension into the discussions. Especially in a country with diversity like India, where elderly discusses the impact of physical distancing, limited mobility, and social interactions on their QoL during COVID-19. This study indicates that the application of UD philosophy in response to pandemic can promote well-being and enhance the QoL of elderly.

This chapter begins with an overview of public health in developing regions. From this population-level perspective, we discuss the information challenges in each of the four domains of public health: research, education, health-care delivery, and disease surveillance. We introduce health-related use classes—categories of specific use cases—to provide a structured presentation of health and information communication technologies in developing regions. In this regard, we define and discuss the following six use classes: (a) surveillance and information gathering, (b) research, (c) provider to provider, (d) provider to patient,(e) education, and (f) logistics. Defining ICT broadly, we argue that the design or selection of technology requires consideration of the cost, ease of use, infrastructure, culture of ICT use, penetration of different ICTs, and population health profile. All of these factors vary among resource-scarce settings, and each factor can greatly impact the appropriate choice in any given setting. We discuss the following three types of assessment, each of which plays a crucial role in project evaluation: systems issues, usability, and health outcomes. Designing ICT for health applications in developing countries requires a deep understanding of various contextual factors, such as health and ICT infrastructure, disease burden, and sociocultural issues. With this in mind, and with some understanding of future trends in health and ICT utilization, we provide forward-looking recommendations for practitioners, researchers, funders, and policy makers.

Introduction: COVID19 vaccination had high positive results on infections worldwide. Even if someone has been infected after the vaccination; it will be less severe symptoms and will have a better prognosis. The aim: To assess the COVID-19 clinical presentation, the vaccination status and the need for hospitalization both before and after vaccination among Ghor ELSafi residents. Materials and methods: A community-based study was conducted in Ghor ElSafi, al-Karak, Jordan. A questionnaire was conducted on the google form. A total of 101 participants were classified into: first group (n = 58) (Participants infected before COVID-19 vaccination) and second group (n = 43) (participants infected at least 2 weeks after COVID-19 vaccination). Demographic data, History of SARS-CO2 infection and vaccination, Different COVID-19 symptoms, hospitalization, ICU admission and oxygen therapy need were assessed for all participants. Results: All participants were COVID-19 vaccinated. The mean age was 38 (±12.3) years with 51.9% was males. About 32.6% had comorbidities. There was no significant differences between both groups regarding the prevalence of either general, gastrointestinal, respiratory, cardiovascular or gynecological symptoms (Figure 1). There were variations in some COVID-19 symptoms; Group (1) participants had a higher rate of anosmia/ageusia, a lower rate of sneezing and dry cough than Group (2). About 12.9% of participants required hospitalization, 7 participants required O2 therapy, and 2 were admitted to the ICU. The mean hospital stay was 7.38 (±6.16) days without statistical significant difference between both groups. Conclusions: most of the COVID symptoms were statistically non-significant between pre-vaccinated and post-vaccination groups, except few symptoms. Participants who got infected before vaccination had a higher rate of anosmia/ageusia, a lower rate of sneezing and dry cough. Keywords: COVID19, Vaccinations, clinical symptoms

Childhood obesity is one of the most serious public health issues of the twenty-first century. Obesity in children can be influenced by both genetic and environmental factors. The aim of this study is to determine the association between birth weight and obesity in children, as well as the impact that residence has on this relationship. The 2018 Riset Kesehatan Dasar (or Basic Health Research), cross-sectional, Indonesian population survey with a nationwide representative sample, was subjected to secondary analysis. In 2018, parents of children aged 0 to 5 years (n = 71,925) provided height, weight, child's birth weight, and other basic characteristics. With LBW, there was a substantial rise in weight, BMI z-score, and the likelihood of pediatric obesity. LBW children from rural had higher BMI z-scores (mean + Standard Error (SE): 1.39 + 0.03) and higher odds of obesity (odds ratio (OR) (95 percent confidence interval (CI)): 7.45 (6.76 – 8.21)), than those from urban areas. Childhood obesity must be adequately prevented and addressed as soon as possible. Initiatives, policies, and goals are needed to reduce LBW prevalence. According to our findings, children born to LBW in rural areas should be treated as soon as possible with forceful intervention.

ABSTRACT Background: Previous studies suggest that individual and environmental factors were associated lack of vegetable and fruit consumption, which can lead to obesity. Recent studies have indicated the level of vegetable and fruit intake in children aged 2-7 years is particularly low. The purpose of this study was to examine the effect of fruits and vegetables intake on obesity in school-aged children. Subjects and Method: This was meta-analysis and systematic review. The study was conducted by collecting published articles from Google Scholar, PubMed, Research Gate, dan Springer Link databases, from year 2011 to 2019. Keywords used ”Nutrition” OR “Obesity” AND ”Cross sectional”. The inclusion criteria were full text, using English OR Indonesian language, using cross-sectional study design, and reporting adjusted odds ratio. The study population (P) was school-aged children. Intervention (I) was fruits and vegetables intake with comparison (C) malnutrition. The study outcome (O) was obesity. The collected articles were selected by PRISMA flow chart. The quantitative data were analyzed using Revman 5.3. Results: 6 studies from Ethiopia, South Afrika, Nepal, Ghana, Saudi Arabia, reported that low fruits and vegetables intake increased the risk of obesity in school-aged children (aOR= 1.34; 95% CI= 1.06 to 1.70; p<0.001; I2= 92%). Conclusion: Low fruits and vegetables intake increased the risk of obesity in school-aged children. Keywords: obesity, nutrition, fruits and vegetables intake, school-aged children Correspondence: Utami Pangestu. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: utamipangestu@gmail.com. Mobile: 087836021638. DOI: https://doi.org/10.26911/the7thicph.03.129

Background: Previous studies reported that adults with certain comorbid conditions are at increased risk for severe illness of Covid-19. The purpose of this meta-analysis study was to assess the effect of diabetes mellitus comorbidity on the severity in patients with Covid-19 infection. Subjects and Method: Meta-analysis and systematic review was conducted by collecting articles from Pubmed, Google Scholar, and Springer Link online databases, from 2019 to 2020. Keywords used “COVID-19 and comorbidity”, “COVID-19 and severity and diabetes”, “comorbidity or severity or diabetes or adjusted odd ratio”. The inclusion criteria were full text, using English and Indonesian language, using observational study, primary study in hospital. The study population (P) was COVID-19 patients. Intervention (I) was diabetes mellitus with comparison (C) without diabetes mellitus. The study outcome (O) was risk of severity. The data were analyzed using random effect model in Revman 5.3. Results: There were 6 studies from South Korea, United States, and China. This study had high heterogeneity (I2= 65%, p= 0.01). DM comorbidity increased the risk of severity 2.74 times in patients with comorbidity than those without DM comorbidity (aOR=2.74; 95% CI= 1.37 to 5.48; p=0.004). Conclusion: Diabetes mellitus comorbidity increases the risk of severity in patients with COVID-19. Keywords: COVID-19, severity, diabetes mellitus, comorbidity Correspondence: Utin Ilma Agni Kun’ain. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: utinilmaagni8p@gmail.com Mobile: +628111044542. DOI: https://doi.org/10.26911/the7thicph.05.57

ABSTRACT Background: It is widely known that physical activity has benefits on overall quality of life. Several studies have reported that children with higher physical activity levels had greater whitematter integrity and subcortical structures which critical for learning and memory than children in lower physical activity levels. The purpose of this study was to investigate the effect of physical activity on the academic achievement in primary school students. Subjects and Method: This was meta-analysis and systematic review. The study was conducted by collecting published articles from Google Scholar, PubMed, Springer Link, and Research Gate databases, from 2011-2020. Keywords used “Physical activity” OR “Academic achievement” AND “Cross sectional”. The inclusion criteria were full text, using English or Indonesian language, using cross-sectional study design, and reporting adjusted odds ratio. The study population (P) was primary school students. Intervention (I) was physical activity with comparison (C) sedentary behavior. The study outcome (O) was academic achievement. The collected articles were selected by PRISMA flow chart. The quantitative data were analyzed using Revman 5.3. Results: 6 studies from Saudi Arabia, Malaysia, Chili, United Kingdom, Spanish, and Norway, were met the criteria 6. This study showed that high physical activity improved academic achievement in primary school students (aOR= 1.44; 95% CI= 1.16 to 1.80; p<0.001, with I2= 94%). Conclusion: High physical activity improves academic achievement in primary school students. Keywords: physical activity, academic achievement Correspondence: Fatchurrohmah Ines Prabandari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: inesfatchur@gmail.com. Mobile: 087836588843. DOI: https://doi.org/10.26911/the7thicph.03.128

Public safety and economic growth are some of the key factors in motivating governments to keep their civil infrastructures, in particular bridges, safe and sound. However, the American Society for Civil Engineers gave a C+ grade for U.S. bridges in 2017. It has been observed that many parameters associated with bridges, such as geographical locations, designs, materials used, and traffic patterns, play key roles in determining the safety and deterioration rates of bridges. However, there is still a lack of studies that analyze the exact impact of all relevant parameters. The motivation of this study is to propose a new data-driven model that employs the concept of population analysis in assessing the impact of each potential parameter and extracting critical information associated with civil infrastructures and their deterioration patterns. We use a correlation network model to analyze and visualize the big data associated with more than 600,000 bridges in the national bridge inventory database. Graph theoretic analysis is applied to the correlation networks to find elements or clusters of interest. A sub-set of 268 bridges across the US of the same age are considered for this case study and the Markov clustering algorithm is used to obtain the clusters from the correlation network. Enrichment analysis is applied to the clusters to identify the significantly enriched input parameters. Preliminary results reveal several facts, including that prestressed concrete bridges in the Southeast region perform better than steel bridges in the Midwestern region. The obtained results are supported by previous research and further validated by the exploratory factor analysis when dividing the clusters into two groups. The proposed network model provides a new data-driven methodology for evaluating the safety and performance of structures. It provides domain experts with valuable information on how to efficiently allocate time and funds for inspecting existing bridges and how to identify key bridge parameters suitable for designing and constructing new bridges in various geographical areas.

The key idea of the well-being concept strives to answer the question about how well the needs of people in a society are met in different spheres of social life - the physical, economic, social, educational, environmental, emotional, and spiritual – as well as individuals’ evaluations of their own lives and the way that their society operates (Gilbert, Colley, Roberts, 2016). One of the possible suggestions for answering the question: “How well are the needs of people in a society met?” could be the monitoring of citizen’s satisfaction with public services while applying a standardized questionnaire for population covering 193 primary indicators (health, social security, culture, public transport, utilities, environment, recreation and sport, public communication, education, etc). Even 23 indicators are about education that makes educational services a considerable part of all social service system. As the researchers aimed to analyze satisfaction of rural population with public services stressing the education issue, indicators about education dominated in the survey. The data were collected in 2016 - 2017 in 2 regional municipalities: municipalities: Jonava and Radviliskis (N=2368). The results of the analysis demonstrate that rural residents' satisfaction with formal general education services is relatively high. The only negative exception is the "the placement of a child in a pre-school institution based on the place of residence". Furthermore, rural residents poorly evaluated educational services that are related to non-formal education, adult education, the education of children with disabilities, child safety, meaningful xtracurricular activities of children and young people during all day, preventive programs. These major conclusions let the researchers state that local self-governmental institutions are not capable to cope with the quality challenges of some educational services without special intervention policy of the central government and the EU responsible structural units. A negative impact is also reinforced by a rapidly deteriorating demographic situation in Lithuanian rural areas.

Background: The fear and terror of epidemic emerge as a highly complex issue that affects not only the society as a whole but also come out to be a huge medical issue. It results extremity in stress and anxiety which continually evolving uncontrollably when comparing to the everyday experienced stress (Main et al., 2011). Generally the people are more prone to experience distress because of stressful events of their life, specifically the women (Kessler & McLeod, 1984), thus leads towards work interferences and disturbance which eventually influence their work performance (Bhagat, 1983). Therefore the work related factors of employees (Bacharach et al., 1990), personal factors (Adams et al., 1996), environmental and situational factors (Wang et al., 2020) steps towards various forms of psychological distress and physical health issue (Enshassi et al., 2016; Johari & Omar, 2019). Thus the current pandemic of COVID-19 has not only been influencing the people's life physically (illness, health issues, hospitalization) but it also targeted them financially (financial insecurity, redundancy) (McKibbin & Fernando, 2021) as well as psychologically (such as stigmatization of pandemic, anxiety, depression, stress, loneliness etc.) (Mamun & Griffiths, 2020; Pappa et al., 2020; Shin & Liberzon, 2010). Consequently, the workplace environment of healthcare units for the frontline healthcare providers is remarkably influenced and giving medical and non-medical services will slushily be difficult because of stress, depression incertitude and stigmatization. Objective: The given study was aimed at to evaluate direct and indirect impact of fear of COVID-19 pandemic on organizational citizenship behavior and job performance with mediating role of psychological distress Method: Study was cross-sectional and convenience sampling technique was used to collect data (n=216), regardless of their gender, via google forms and questionnaires, from healthcare professionals of twin cities; Rawalpindi and Islamabad. Statistical Analysis was performed on data by using IBM SPSS 23. Inferential Statistics including correlation and regression via Preacher & Hayes method was applied on collected data to find out relationship between study variables. P-value ≤ 0.05 was considered statistically significant. Statistical analysis has revealed significant results Results: Correlation analysis and regression analysis has shown significant association of CVID-19 fear with psychological distress and psychological distress with OCB and job performance. Psychological distress was fully mediating the relationship of COVID-19 fear with OCB and job performance. Out of four hypotheses, two were accepted. Results of this study cannot be generalized on whole population of Pakistan as study was only limited to the two cities of Punjab, and sample size was small. Future studies may explore the ways to enhance job performance and OCB for the progress of healthcare organizations. Conclusion: . Emphasis should be on the effective and efficient management and implementation of SOPs and policies pandemic prevention and consequences. This could be helpful in minimizing psychological distress and maximizing OCB and job performance as it could be the stepping stone towards success of the healthcare organization. Study has justified the research gap of using process, interaction and environment factors of total quality management as precursors of patient's satisfaction and loyalty. Keywords: Fear of COVID-19, Psychological Distress, Organizational Citizenship Behavior, Job Performance.

Background: Antibiotics are antimicrobial drugs used in the treatment and prevention of bacterial infections. They played a pivotal role in achieving major advances in medicine and surgery (1). Yet, due to increased and inappropriate use of antibiotics, antibiotic resistance (AR) has become a growing public health problem. Information on antibiotic prescription patterns are vital in developing a constructive approach to deal with growing antibiotic resistance (2). The study aims to describe the population based antibiotic prescriptions among patients attending primary care centers in Qatar. Methodology: A population based observational study of all medications prescribed in the all Primary Health Care Centers during the period of 2017-2018 in Qatar. Records with all medication prescriptions were extracted and linked to medical diagnosis. Antibiotics prescriptions records were compared to non- antibiotics records using logistic regression model in identifying the potential predictors for antibiotic prescriptions. Results: A total of 11,069,439 medication prescriptions given over a period of two-years, we found about 12.1% (n= 726,667) antibiotics prescriptions were antibiotics, and 65% of antibiotics are prescribed and received by the patients at the first visits. Paracetamol (22.3%) was the first highest medication prescribed followed by antibiotics (12.1 %) and vitamin D2 (10.2 %). More than half of all antibiotics prescribed during the period of January 2017 to December 2018 were Penicillin (56.9%). We found that half of the antibiotics (49.3 %) have been prescribed for the respiratory system comparing to the other body system. We found that males were 29% more likely be given an antibiotic compared to females (OR=1.29, 95% CI= 1.24- 1.33). Implications: The study provides a baseline data to enable PHCC management to design effective intervention program to address the problem of antibiotics resistance. Furthermore, it will help the policymakers to comprehend the size of the issue and develop a system to manage the antibiotics therapy. Conclusion: Antibiotics was the second highest medication prescribed in the Primary Health Care Centers in Qatar after paracetamol and most of the patients received it at the first visit. Most of the prescriptions in Primary Health Care Centers in Qatar were for the respiratory system, and Penicillin was the highest class prescribed. Male visitors were prescribed antibiotics more than female visitors.

Background: In September 2018, the prohibition of partially hydrogenated oils (PHO) came into effect in Canada to reduce industrially produced trans fats (TFA) in the food supply to the lowest level possible. Canada’s public health objective is that ≥90% of the population consume <1% of total energy (1%En) as TFA (WHO recommendation). Objective: Estimate the intakes of TFA by Canadians before the PHO prohibition. Methods: Data from 19,670 participants of the cross-sectional Canadian Community Health Survey (CCHS)–Nutrition 2015 was analyzed. Foods were classified based on the source of TFA (industrially produced only (i-TFA), naturally occurring only (n-TFA), or a mix of both). Food content in TFA originated from 2016 label information and the 2015 Canadian Nutrient File. Mean usual intakes of total TFA and TFA from different sources were estimated for Canadians aged 1-75y. Results: For the overall population, the mean intake of total TFA represented 0.57%En (SE:0.001), with the 95 percentile at 0.93%En (SE:0.005). All age-sex groups had mean TFA intakes <1%E, ranging from 0.52 to 0.71%En. On average, foods containing only n-TFA provided >1/2 of total TFA intake (0.32%En, SE:0.005). Foods containing only i-TFA provided <1/3 of total TFA intake (0.19%En, SE:0.005). The target of ≥90% of the population consuming <1%En as TFA had already been achieved before the PHO prohibition in all age-sex groups, except children 1-3 years old, with 86% within target. In that group, foods containing only n-TFA provided >2/3 of total TFA intake (0.48%En, SE:0.02).Conclusions: Total TFA intakes in Canada before the PHO prohibition were relatively low, likely due to previous initiatives to reduce industrially produced TFA in foods, starting with labelling of the amount of TFA on most pre-packaged foods, which became mandatory in 2007. These analyses will be repeated using post-PHO prohibition data to continue monitoring progress after the prohibition.

Campylobacter spp. are the most common bacterial cause of foodborne illness in the UK, with chicken considered to be the most important vehicle for this organism. The UK Food Standards Agency (FSA) agreed with industry to reduce Campylobacter spp. contamination in raw chicken and issued a target to reduce the prevalence of the most contaminated chickens (those with more than 1000 cfu per g chicken neck skin) to below 10 % at the end of the slaughter process, initially by 2016. To help monitor progress, a series of UK-wide surveys were undertaken to determine the levels of Campylobacter spp. on whole UK-produced, fresh chicken at retail sale in the UK. The data obtained for the first four years was reported in FSA projects FS241044 (2014/15) and FS102121 (2015 to 2018). The FSA has indicated that the retail proxy target for the percentage of highly contaminated raw whole retail chickens should be less than 7% and while continued monitoring has demonstrated a sustained decline for chickens from major retailer stores, chicken on sale in other stores have yet to meet this target. This report presents results from testing chickens from non-major retailer stores (only) in a fifth survey year from 2018 to 2019. In line with previous practise, samples were collected from stores distributed throughout the UK (in proportion to the population size of each country). Testing was performed by two laboratories - a Public Health England (PHE) laboratory or the Agri-Food & Biosciences Institute (AFBI), Belfast. Enumeration of Campylobacter spp. was performed using the ISO 10272-2 standard enumeration method applied with a detection limit of 10 colony forming units (cfu) per gram (g) of neck skin. Antimicrobial resistance (AMR) to selected antimicrobials in accordance with those advised in the EU harmonised monitoring protocol was predicted from genome sequence data in Campylobacter jejuni and Campylobacter coli isolates The percentage (10.8%) of fresh, whole chicken at retail sale in stores of smaller chains (for example, Iceland, McColl’s, Budgens, Nisa, Costcutter, One Stop), independents and butchers (collectively referred to as non-major retailer stores in this report) in the UK that are highly contaminated (at more than 1000 cfu per g) with Campylobacter spp. has decreased since the previous survey year but is still higher than that found in samples from major retailers. 8 whole fresh raw chickens from non-major retailer stores were collected from August 2018 to July 2019 (n = 1009). Campylobacter spp. were detected in 55.8% of the chicken skin samples obtained from non-major retailer shops, and 10.8% of the samples had counts above 1000 cfu per g chicken skin. Comparison among production plant approval codes showed significant differences of the percentages of chicken samples with more than 1000 cfu per g, ranging from 0% to 28.1%. The percentage of samples with more than 1000 cfu of Campylobacter spp. per g was significantly higher in the period May, June and July than in the period November to April. The percentage of highly contaminated samples was significantly higher for samples taken from larger compared to smaller chickens. There was no statistical difference in the percentage of highly contaminated samples between those obtained from chicken reared with access to range (for example, free-range and organic birds) and those reared under standard regime (for example, no access to range) but the small sample size for organic and to a lesser extent free-range chickens, may have limited the ability to detect important differences should they exist. Campylobacter species was determined for isolates from 93.4% of the positive samples. C. jejuni was isolated from the majority (72.6%) of samples while C. coli was identified in 22.1% of samples. A combination of both species was found in 5.3% of samples. C. coli was more frequently isolated from samples obtained from chicken reared with access to range in comparison to those reared as standard birds. C. jejuni was less prevalent during the summer months of June, July and August compared to the remaining months of the year. Resistance to ciprofloxacin (fluoroquinolone), erythromycin (macrolide), tetracycline, (tetracyclines), gentamicin and streptomycin (aminoglycosides) was predicted from WGS data by the detection of known antimicrobial resistance determinants. Resistance to ciprofloxacin was detected in 185 (51.7%) isolates of C. jejuni and 49 (42.1%) isolates of C. coli; while 220 (61.1%) isolates of C. jejuni and 73 (62.9%) isolates of C. coli isolates were resistant to tetracycline. Three C. coli (2.6%) but none of the C. jejuni isolates harboured 23S mutations predicting reduced susceptibility to erythromycin. Multidrug resistance (MDR), defined as harbouring genetic determinants for resistance to at least three unrelated antimicrobial classes, was found in 10 (8.6%) C. coli isolates but not in any C. jejuni isolates. Co-resistance to ciprofloxacin and erythromycin was predicted in 1.7% of C. coli isolates. 9 Overall, the percentages of isolates with genetic AMR determinants found in this study were similar to those reported in the previous survey year (August 2016 to July 2017) where testing was based on phenotypic break-point testing. Multi-drug resistance was similar to that found in the previous survey years. It is recommended that trends in AMR in Campylobacter spp. isolates from retail chickens continue to be monitored to realise any increasing resistance of concern, particulary to erythromycin (macrolide). Considering that the percentage of fresh, whole chicken from non-major retailer stores in the UK that are highly contaminated (at more than 1000 cfu per g) with Campylobacter spp. continues to be above that in samples from major retailers more action including consideration of interventions such as improved biosecurity and slaughterhouse measures is needed to achieve better control of Campylobacter spp. for this section of the industry. The FSA has indicated that the retail proxy target for the percentage of highly contaminated retail chickens should be less than 7% and while continued monitoring has demonstrated a sustained decline for chickens from major retailer stores, chicken on sale in other stores have yet to meet this target.

This human campylobacteriosis sentinel surveillance project was based at two sites in Oxfordshire and North East England chosen (i) to be representative of the English population on the Office for National Statistics urban-rural classification and (ii) to provide continuity with genetic surveillance started in Oxfordshire in October 2003. Between October 2015 and September 2018 epidemiological questionnaires and genome sequencing of isolates from human cases was accompanied by sampling and genome sequencing of isolates from possible food animal sources. The principal aim was to estimate the contributions of the main sources of human infection and to identify any changes over time. An extension to the project focussed on antimicrobial resistance in study isolates and older archived isolates. These older isolates were from earlier years at the Oxfordshire site and the earliest available coherent set of isolates from the national archive at Public Health England (1997/8). The aim of this additional work was to analyse the emergence of the antimicrobial resistance that is now present among human isolates and to describe and compare antimicrobial resistance in recent food animal isolates. Having identified the presence of bias in population genetic attribution, and that this was not addressed in the published literature, this study developed an approach to adjust for bias in population genetic attribution, and an alternative approach to attribution using sentinel types. Using these approaches the study estimated that approximately 70% of Campylobacter jejuni and just under 50% of C. coli infection in our sample was linked to the chicken source and that this was relatively stable over time. Ruminants were identified as the second most common source for C. jejuni and the most common for C. coli where there was also some evidence for pig as a source although less common than ruminant or chicken. These genomic attributions of themselves make no inference on routes of transmission. However, those infected with isolates genetically typical of chicken origin were substantially more likely to have eaten chicken than those infected with ruminant types. Consumption of lamb’s liver was very strongly associated with infection by a strain genetically typical of a ruminant source. These findings support consumption of these foods as being important in the transmission of these infections and highlight a potentially important role for lamb’s liver consumption as a source of Campylobacter infection. Antimicrobial resistance was predicted from genomic data using a pipeline validated by Public Health England and using BIGSdb software. In C. jejuni this showed a nine-fold increase in resistance to fluoroquinolones from 1997 to 2018. Tetracycline resistance was also common, with higher initial resistance (1997) and less substantial change over time. Resistance to aminoglycosides or macrolides remained low in human cases across all time periods. Among C. jejuni food animal isolates, fluoroquinolone resistance was common among isolates from chicken and substantially less common among ruminants, ducks or pigs. Tetracycline resistance was common across chicken, duck and pig but lower among ruminant origin isolates. In C. coli resistance to all four antimicrobial classes rose from low levels in 1997. The fluoroquinolone rise appears to have levelled off earlier and among animals, levels are high in duck as well as chicken isolates, although based on small sample sizes, macrolide and aminoglycoside resistance, was substantially higher than for C. jejuni among humans and highest among pig origin isolates. Tetracycline resistance is high in isolates from pigs and the very small sample from ducks. Antibiotic use following diagnosis was relatively high (43.4%) among respondents in the human surveillance study. Moreover, it varied substantially across sites and was highest among non-elderly adults compared to older adults or children suggesting opportunities for improved antimicrobial stewardship. The study also found evidence for stable lineages over time across human and source animal species as well as some tighter genomic clusters that may represent outbreaks. The genomic dataset will allow extensive further work beyond the specific goals of the study. This has been made accessible on the web, with access supported by data visualisation tools.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.

Unsafe abortion constitutes a major public health problem throughout the world, leading to high levels of maternal morbidity and mortality. Abortion accounts for roughly one-third of maternal mortality in the world. Millions of other women experience short- and long-term morbidity, such as infertility and pain. The concept of postabortion care (PAC) has gained wide acceptance as a means to improve services provided to women with complications from spontaneous or unsafely induced abortions. One way to improve emergency treatment is through introducing manual vacuum aspiration (MVA), which has been shown to be safer and less costly than dilation and curettage (D&C). Providing the second element, postabortion family planning, will enable women to avoid unwanted pregnancies and unsafe abortions. A study to test different ways of providing improved PAC services has been conducted by the Population Council’s Africa Operations Research and Technical Assistance Project II in collaboration with the Kenyan Ministry of Health and Ipas. As stated in this report, the study focused primarily on the first two components of PAC: improving emergency treatment through introducing or upgrading MVA services and comparing three models of postabortion family planning provision.