The population or the individual in public health?

Summary Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people’s choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people’s reflective capabilities. Information materials are, on the face of it, meant to engage citizens’ reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.

Download Full-text

The Integration of People Convicted of a Sexual Offence Into the Community and Their (Risk) Management

Current Psychiatry Reports ◽

10.1007/s11920-021-01258-4 ◽

2021 ◽

Vol 23 (8) ◽

Author(s):

K. F. McCartan ◽

K. Richards

Keyword(s):

Public Health ◽

Risk Management ◽

Life Course ◽

Ecological Model ◽

Sexual Offending ◽

Community Integration ◽

Sexual Offence ◽

Political Issue ◽

Childhood Experiences ◽

The Individual

Abstract Purpose of Review We are reviewing recent research into the community integration of men convicted of a sexual offence and their (risk) management. This is a high-profile political issue that binds together research in psychology, criminology, politics, health, public health, and policy studies. The review will demonstrate that a multi-disciplinary, life course, EpiCrim-oriented approach is the most effective way of reducing re-offending and promoting desistance in this population. Recent Findings Research demonstrates that life course development, especially from psychology and criminology, has an impact on whether people sexually offend or not. Therefore, to understand sexual offending behaviour, we need to look at the aetiology of said behaviour from a nature and a nurture perspective. Therefore, we need to use an Epidemiological Criminology (a marriage of Public Health and criminology) approach that works at all four stages of the Socio-Ecological Model (SEM) (individual, interrelationship, community, and societal). The research encourages a person first approach, that we look at Adverse Childhood Experiences and past trauma in the lives of men who sexually offend and use this, in conjunction with strength-based approaches, to inclusively integrate them into society. Summary The prevention of sexual offending, both first time offending, and relapse prevention require a multi-level, multi-disciplinary approach. Successful desistance from sexual offending is as much about the community and society as it is about the individual.

Download Full-text

The Michigan BioTrust for Health: Using Dried Bloodspots for Research to Benefit the Community While Respecting the Individual

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2011.00577.x ◽

2011 ◽

Vol 39 (S1) ◽

pp. 98-101 ◽

Cited By ~ 11

Author(s):

Denise Chrysler ◽

Harry McGee ◽

Janice Bach ◽

Ed Goldman ◽

Peter D. Jacobson

Keyword(s):

Public Health ◽

Community Health ◽

Filter Paper ◽

Health Program ◽

The State ◽

Public Health Laboratory ◽

Public Health Program ◽

Personal Use ◽

The Individual ◽

Blood Spot

The Michigan Department of Community Health (MDCH) stores almost 4 million dried blood spot specimens (DBS) in the Michigan Neonatal Biobank. DBS are collected from newborns under a mandatory public health program to screen for serious conditions. At 24 to 36 hours of age, a few drops of blood are taken from the baby’s heel and placed on a filter paper card. The card is sent to the state public health laboratory for testing. After testing, MDCH retains the spots indefinitely for the personal use of the patient and also, pursuant to a 2000 law, for possible research.

Download Full-text

Harnessing testing strategies and public health measures to avert COVID-19 outbreaks during ocean cruises

Scientific Reports ◽

10.1038/s41598-021-95032-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Gerardo Chowell ◽

Sushma Dahal ◽

Raquel Bono ◽

Kenji Mizumoto

Keyword(s):

Public Health ◽

Cost Effective ◽

Contact Network ◽

Social Distancing ◽

Individual Level ◽

Health Measures ◽

Testing Strategies ◽

Novel Coronavirus ◽

The Individual ◽

The Impact

AbstractTo ensure the safe operation of schools, workplaces, nursing homes, and other businesses during COVID-19 pandemic there is an urgent need to develop cost-effective public health strategies. Here we focus on the cruise industry which was hit early by the COVID-19 pandemic, with more than 40 cruise ships reporting COVID-19 infections. We apply mathematical modeling to assess the impact of testing strategies together with social distancing protocols on the spread of the novel coronavirus during ocean cruises using an individual-level stochastic model of the transmission dynamics of COVID-19. We model the contact network, the potential importation of cases arising during shore excursions, the temporal course of infectivity at the individual level, the effects of social distancing strategies, different testing scenarios characterized by the test’s sensitivity profile, and testing frequency. Our findings indicate that PCR testing at embarkation and daily testing of all individuals aboard, together with increased social distancing and other public health measures, should allow for rapid detection and isolation of COVID-19 infections and dramatically reducing the probability of onboard COVID-19 community spread. In contrast, relying only on PCR testing at embarkation would not be sufficient to avert outbreaks, even when implementing substantial levels of social distancing measures.

Download Full-text

PUBLIC HEALTH, NURSING, MEDICAL SOCIAL WORK

PEDIATRICS ◽

10.1542/peds.21.2.319 ◽

1958 ◽

Vol 21 (2) ◽

pp. 319-324

Author(s):

Floyd M. Feldmann

Keyword(s):

Public Health ◽

Patch Test ◽

Tuberculin Test ◽

Preliminary Test ◽

Outpatient Services ◽

Medical Social Work ◽

Striking Change ◽

Tuberculin Testing ◽

Health Nursing ◽

The Individual

As a pediatric problem, tuberculosis has undergone striking change in the past decades, yet few diseases have the complicated interrelationship of personal and community significance that is peculiar to tuberculosis. Management of the tuberculous patient has become largely a matter for hospital and specialized outpatient services, and the individual practitioner has been chiefly concerned with case finding in his own practice. Since the tuberculin test is such an important tool in this respect, the editors thought such a review as presented by Dr. Feldmann of particular importance. A number of controversial points are touched on. In any public health procedure a routine screening test has value in relation to the proportion of positives likely to result. A test which results in more than 50% positive is not very helpful. On the other hand, a test with one positive in 1,000 is probably too expensive. Dr. Feldmann points out the cogent reasons for routine tuberculin testing and the pediatrician will need to consider these reasons in the light of the conditions in his community and the relevant local and state health program. Some may be disturbed by the criticism made of the patch test, yet it is important to recognize its limitations. Failure of the patch test to detect all positives has been well known and most pediatricians have thought it useful chiefly as a preliminary test to find the more sensitive reactors.

Download Full-text

Where Is Disability in Global Public Health?

Oxford Research Encyclopedia of Global Public Health ◽

10.1093/acrefore/9780190632366.013.287 ◽

2021 ◽

Author(s):

Gloria Krahn

Keyword(s):

Public Health ◽

Sustainable Development ◽

Sustainable Development Goals ◽

Global South ◽

Global Public Health ◽

Persons With Disabilities ◽

The Sustainable Development ◽

Models Of Disability ◽

Development Goals ◽

The Individual

Accounting for about 15% of the world’s population, persons with disabilities constitute a critical population. Despite a substantial knowledge base in disability and public health, persons with disabilities have been remarkably invisible within general global public health. Public health’s view of disability is shifting from regarding disability only as an outcome to prevent, to using disability as a demographic characteristic that identifies a population experiencing a range of inequities. Alternative models of disability reflect how disability has been viewed over time. These models vary in their underlying values and assumptions, whether the locus of disability is the individual or the environment or their interaction, who designates “disability,” and the focus of intervention outcomes. The United Nations flagship report on Disability and Sustainable Development Goals, 2018 documents that, as a group, the lives of persons with disabilities are marked by large disparities in Sustainable Development Goal indicators. These include increased likelihood of experiencing poverty, hunger, poor health, and unemployment, and greater likelihood of encountering barriers to education and literacy, clean water and sanitation, energy, and information technology. Overall, persons with disabilities experience greater inequalities, and this is particularly experienced by women and girls with disabilities. The COVID-19 pandemic and other disasters have highlighted the gaps in equality and consequent vulnerability of this population. Global disability data have improved dramatically during the decade from 2010 to 2020 with the advent of standardized disability question sets (Washington Group) and model surveys (Model Disability Survey). New studies from the Global South and North identify areas and strategies for interventions that can effectively advance the Sustainable Development Goals. This call-to-action outlines strategies for increasing visibility and improving wellbeing of persons with disabilities, particularly in the Global South. Increased visibility of the disability population within the global public health community can be achieved through active engagement of persons with disabilities. Improved collection of disability data and routine analysis by disability status can provide information vital to planning and policies. A twin-track approach can provide direction for interventions—inclusion in mainstream programs where possible, use of disability-specific and rehabilitation approaches where necessary. The article ends by outlining ways that multiple roles can increase the inclusion of persons with disabilities in global public health.

Download Full-text

The Rapid Assessment of Aggregated Wastewater Samples for Genomic Surveillance of SARS-CoV-2 on a City-Wide Scale

10.1101/2021.08.17.21262170 ◽

2021 ◽

Author(s):

Eric C. Rouchka ◽

Julia L. Chariker ◽

Kumar Saurabh ◽

Sabine Waigel ◽

Wolfgang Zacharias ◽

...

Keyword(s):

Public Health ◽

Rapid Assessment ◽

Wastewater Management ◽

Catchment Areas ◽

University Of Louisville ◽

Rapid Monitoring ◽

Wide Scale ◽

Neighborhood Scale ◽

Wastewater Samples ◽

The Individual

AbstractThroughout the course of the ongoing SARS-CoV-2 pandemic there has been a need for approaches that enable rapid monitoring of public health using an unbiased and minimally invasive means. A major way this has been accomplished is through the regular assessment of wastewater samples by qRT-PCR to detect the prevalence of viral nucleic acid with respect to time and location. Further expansion of SARS-CoV-2 wastewater monitoring efforts to include the detection of variants of interest / concern through next-generation sequencing have enhanced the understanding of the SARS-CoV-2 outbreak. In this report we detail the results of a collaborative effort between public health and metropolitan wastewater management authorities and the University of Louisville to monitor the SARS-CoV-2 pandemic through the monitoring of aggregate wastewater samples over a period of 28 weeks. Our data indicates that wastewater monitoring of water quality treatment centers and smaller neighborhood-scale catchment areas is a viable means by which the prevalence and genetic variation of SARS-CoV-2 within a metropolitan community of approximately one million individuals may be monitored. Importantly, these efforts confirm that regional emergence and spread of variants of interest / concern may be detected as readily in aggregate wastewater samples as compared to the individual wastewater sheds.

Download Full-text

The Veterinary Treatment Facility as a Readiness Platform for Veterinary Corps Officers

Military Medicine ◽

10.1093/milmed/usab240 ◽

2021 ◽

Author(s):

Sara B Mullaney ◽

Heather Bayko ◽

Gerald D Moore ◽

Hannah E Funke ◽

Matthew J Enroth ◽

...

Keyword(s):

Public Health ◽

Animal Health ◽

Published Data ◽

Veterinary Services ◽

Multiple Sources ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Online Readiness ◽

Representative Random Sample ◽

The Individual

ABSTRACT Introduction U.S. Army Veterinary Corps provides highly skilled and adaptive veterinary professionals to protect and improve the health of people and animals while enhancing readiness throughout the DOD. Army veterinarians must be trained and credentialed for critical tasks within the animal health and food protection missions across all components. The Veterinary Metrics Division in the U.S. Army Public Health Center’s Veterinary Services and Public Health Sanitation Directorate is responsible for tracking readiness metrics of Army veterinarians and maintains a robust online Readiness Metrics Platform. Readiness targets were developed based on trends in readiness platform data, input of senior veterinary subject matter experts, and feedback from the field. To date, no data have been published describing the cases presented to DOD-owned Veterinary Treatment Facilities (VTFs). Without capturing and codifying the types of cases that present to the VTF and comparing to cases typically encountered during deployments, it is difficult to determine whether the VTF serves as an adequate readiness platform. In this study, we compare a representative random sample of non-wellness VTF patient encounters in garrison to cases reported from two different combat zones to determine if the VTF is a suitable clinical readiness platform. Materials and Methods Multiple data sources, including pre-existing published data and new data extracted from multiple sources, were used. The Iraq 2009-2010 dataset includes data collected from a Medical Detachment, Veterinary Service Support (MDVSS) deployed to Iraq from January 5, 2009 through August 23, 2010. The Iraq 2003-2007 dataset originated from a retrospective cross-sectional survey that included database and medical record abstraction. The Afghanistan 2014-2015 dataset includes data collected from the MDVSS deployed to Afghanistan from June 2014 to March 2015. Working dog veterinary encounter data were manually extracted from monthly and daily clinical reports. Data for the Garrison 2016-2018 dataset were extracted from the Remote Online Veterinary Record. A random representative sample of government-owned animal (GOA) and privately owned animal (POA) encounters seen across all DOD-owned VTFs from June 2016 to May 2018 were selected. Results We found that animals present to the VTF for a wide variety of illnesses. Overall, the top 10 encounter categories (90.3%) align with 84.2%, 92.4%, and 85.9% of all the encounter types seen in the three combat zone datasets. Comparing these datasets identifies potential gaps in readiness training relying solely on the VTF, especially in the areas of traumatic and combat-related injuries. Conclusions Ultimately, the success of the DOD Veterinary Services Animal Health mission depends on both the competence and confidence of the individual Army veterinarian. As the MHS transitions and DOD Veterinary Services continues to transform emphasizing readiness through a public health and prevention-based Army medicine approach, Army veterinarians must strike a delicate balance to continue to provide comprehensive health care to GOAs and POAs in the VTFs. Leaders at all levels must recognize the roles VTFs play in overall public health readiness and disease prevention through the proper appropriation and allocation of resources while fostering the development, confidence, and competence of Army veterinarians training within these readiness platforms.

Download Full-text

May Measurement Month 2019: an analysis of blood pressure screening results from Zambia

European Heart Journal Supplements ◽

10.1093/eurheartj/suab043 ◽

2021 ◽

Vol 23 (Supplement_B) ◽

pp. B158-B160

Author(s):

Fastone Goma ◽

Charity Syatalimi ◽

Penias Tembo ◽

Musawa Mukupa ◽

Theresa Chikopela ◽

...

Keyword(s):

Public Health ◽

Diabetes Mellitus ◽

Myocardial Infarction ◽

Blood Pressure ◽

Public Health Policy ◽

Antihypertensive Medication ◽

Population Level ◽

Multiple Imputations ◽

The Individual ◽

Treatable Condition

Abstract In Zambia, hypertension accounts for the highest proportion of deaths due to cardiovascular diseases causing 3.3% of all deaths, killing an average of 670 people per year. May Measurement Month (MMM) is an annual global screening campaign aiming to improve awareness of blood pressure (BP) at the individual and population level. Adults (≥18 years) recruited through opportunistic sampling were screened at multiple sites within Lusaka during May and June 2019. Ideally, three BP readings were measured for each participant, and data on lifestyle factors and comorbidities were collected. Data were analysed centrally by the MMM project team and multiple imputations were performed where necessary. Of the total of 9232 enrolled, 8.7% of them had never had their BP measured, 2.5% had diabetes mellitus, 1.9% had had a myocardial infarction, 1.5% had had a stroke, 10.6% were current smokers, and 10.0% consumed alcohol once or more per week. Blood pressure fell from a mean of 128.6/82.9 mmHg for the 1st reading to a mean of 123.2/80.0 mmHg for the 3rd reading. The lowest proportion of participants with hypertension was identified by the 3rd reading alone (30.0%). Of all the participants, 30.7% had hypertension, though only 42.6% of them were aware of their diagnosis. Seven hundred and eighty-three (27.6%) were on antihypertensive medication though only 35.0% of them had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Compared with MMM17 data, there is deterioration of the monitored parameters calling for urgent and accelerated public health policy and clinical practice interventions. We think that the MMM campaign should continue annually to raise awareness of this treatable condition.

Download Full-text