WHO Hemoglobin Thresholds to Define Anemia in Clinical Medicine and Public Health: A Scoping Exercise

Abstract Objectives WHO is reviewing the use and interpretation of hemoglobin thresholds for assessing iron status in individuals and populations following established evidence-informed guideline development procedures to culminate in updated guidelines for clinical and public health use. Methods To define priorities and identify key questions a scoping exercise was developed via a two-stage international consultation based on the Child Health and Nutrition Research Initiative method. The first survey allowed respondents to suggest priorities, and the second asked respondents to rank the key questions with established criteria. A transparent approach was used to identify more than 4000 international experts in anemia research based on publication records and ensuring representatives from all WHO regions and low income and middle-income countries. Results The first survey received 123 respondents from 48 countries across all six WHO regions. The 553 proposed questions spanned many themes and were consolidated to a shortlist of 48 questions spanning six subtopics, including physiology of anemia, hemoglobin thresholds for different population groups, definition of anemia across clinical and environmental contexts, approach to development of anemia thresholds, laboratory and diagnostic considerations, and implementation of WHO's hemoglobin threshold guidelines. The second survey received 195 respondents from 64 countries across all six WHO regions. Questions covered diverse themes, including variation in thresholds between individuals of different sex and age, categorisation of anaemia severity and the burden of anaemia, optimal clinical and field laboratory measurements of haemoglobin, and antenatal and infant haemoglobin concentrations associated with adverse developmental outcomes. Conclusions Based on the normative needs identified in this scoping exercise the available evidence will be summarized and presented to a WHO guideline development group after input from an expert panel. This rigorous, inclusive, and transparent approach should enable international harmonization of hemoglobin thresholds used to define anemia in both clinical and public health practice. Funding Sources The World Health Organization The United States Agency for International Development (USAID), USA Centers for Disease Control and Prevention (CDC), USA.

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The Arab region’s contribution to global COVID-19 research: Bibliometric and visualization analysis

Globalization and Health ◽

10.1186/s12992-021-00690-8 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Sa’ed H. Zyoud

Keyword(s):

Public Health ◽

Saudi Arabia ◽

Population Size ◽

Low Income ◽

Research Output ◽

Arab World ◽

The United States ◽

Arab Countries ◽

Public Health Issue ◽

Global Research

Abstract Background At the global level and in the Arab world, particularly in low-income countries, COVID-19 remains a major public health issue. As demonstrated by an incredible number of COVID-19-related publications, the research science community responded rapidly. Therefore, this study was intended to assess the growing contribution of the Arab world to global research on COVID-19. Methods For the period between December 2019 and March 2021, the search for publications was conducted via the Scopus database using terms linked to COVID-19. VOSviewer 1.6.16 software was applied to generate a network map to assess hot topics in this area and determine the collaboration patterns between different countries. Furthermore, the research output of Arab countries was adjusted in relation to population size and gross domestic product (GDP). Results A total of 143,975 publications reflecting the global overall COVID-19 research output were retrieved. By restricting analysis to the publications published by the Arab countries, the research production was 6131 documents, representing 4.26% of the global research output regarding COVID-19. Of all these publications, 3990 (65.08%) were original journal articles, 980 (15.98%) were review articles, 514 (8.38%) were letters and 647 (10.55%) were others, such as editorials or notes. The highest number of COVID-19 publications was published by Saudi Arabia (n = 2186, 35.65%), followed by Egypt (n = 1281, 20.78%) and the United Arab Emirates (UAE), (n = 719, 11.73%). After standardization by population size and GDP, Saudi Arabia, UAE and Lebanon had the highest publication productivity. The collaborations were mostly with researchers from the United States (n = 968), followed by the United Kingdom (n = 661). The main research lines identified in COVID-19 from the Arab world are related to: public health and epidemiology; immunological and pharmaceutical research; signs, symptoms and clinical diagnosis; and virus detection. Conclusions A novel analysis of the latest Arab COVID-19-related studies is discussed in the current study and how these findings are connected to global production. Continuing and improving future collaboration between developing and developed countries will also help to facilitate the sharing of responsibilities for COVID-19 in research results and the implementation of policies for COVID-19.

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PERCENTAGE OF UNINSURED CHILDREN HAS INCREASED

PEDIATRICS ◽

10.1542/peds.88.5.1051 ◽

1991 ◽

Vol 88 (5) ◽

pp. 1051-1051

Author(s):

STUDENT

Keyword(s):

Public Health ◽

United States ◽

Health Care ◽

Low Income ◽

Health Care Policy ◽

The United States ◽

Public Health Insurance ◽

Care Policy ◽

Low Income Families ◽

Uninsured Children

The proportion of children in the United States without private or public health insurance increased from roughly 13 percent to 18 percent between 1977 and 1987, according to a new study by the Agency for Health Care Policy and Research (AHCPR). The growth in the proportion of uninsured children in poor and low-income families over the decade was even more dramatic—it rose from 21 percent to 31 percent.

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(Mis)Information on Digital Platforms: Lessons from Twitter and Sina Weibo in the COVID-19 Pandemic (Preprint)

10.2196/preprints.31793 ◽

2021 ◽

Author(s):

Sarah Kreps

Keyword(s):

Public Health ◽

World Health Organization ◽

Public Discourse ◽

The United States ◽

World Health ◽

Sina Weibo ◽

Digital Platforms ◽

The World ◽

Health Organization ◽

Relative Prevalence

BACKGROUND Misinformation about COVID-19 has presented challenges to public health authorities during pandemics. Understanding the prevalence and type of misinformation across contexts offers a way to understand the discourse around COVID-19 while informing potential countermeasures. OBJECTIVE The aim of the study was to study COVID-19 content on two prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, and compare the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. METHODS A total of 3,579,575 posts were scraped from both Weibo and Twitter, focusing on content from January 30th, 2020, when the World Health Organization (WHO) declared COVID-19 a “Public Health Emergency of International Concern” and February 6th, 2020. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags. Misinformation on each platform was compared by manually coding and comparing posts using the World Health Organization fact-check page to adjudicate accuracy of content. RESULTS Both platforms posted about the outbreak and transmission but posts on Sina Weibo were less likely to reference controversial topics such as the World Health Organization and death and more likely to cite themes of resisting, fighting, and cheering against the coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Weibo content. CONCLUSIONS Quantitative and qualitative analysis of content on both platforms points to cross-platform differences in public discourse surrounding the pandemic and informs potential countermeasures for online misinformation.

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Feeding the disparities: the geography and trends of breastfeeding in the United States

10.1101/451435 ◽

2018 ◽

Author(s):

Romain Garnier ◽

Ana I. Bento ◽

Pejman Rohani ◽

Saad B. Omer ◽

Shweta Bansal

Keyword(s):

Public Health ◽

United States ◽

Breast Milk ◽

Low Income ◽

Temporal Trends ◽

State Level ◽

The United States ◽

Poverty Level ◽

Future Health ◽

Breastfeeding Rates

AbstractThere is scientific consensus on the importance of breastfeeding for the present and future health of newborns, in high- and low-income settings alike. In the United States, improving breast milk access is a public health priority but analysis of secular trends are largely lacking. Here, we used data from the National Immunization Survey of the CDC, collected between 2003 and 2016, to illustrate the temporal trends and the spatial heterogeneity in breastfeeding. We also considered the effect sizes of two key determinants of breastfeeding rates. We show that, while access to breast milk both at birth and at 6 months old has steadily increased over the past decade, large spatial disparities still remain at the state level. We also find that, since 2009, the proportion of households below the poverty level has become the strongest predictor of breastfeeding rates. We argue that, because variations in breastfeeding rates are associated with socio-economic factors, public health policies advocating for breastfeeding are still needed in particular in underserved communities. This is key to reducing longer term health disparities in the U.S., and more generally in high-income countries.

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Global Surge in Intimate Partner Violence after Mandatory Lockdown: Implications for Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.595 ◽

2021 ◽

pp. 1-3

Author(s):

Butool Hisam ◽

Mohammad Nadir Haider ◽

Ghazala Saleem ◽

Admin

Keyword(s):

Public Health ◽

Intimate Partner Violence ◽

Violence Against Women ◽

Interpersonal Violence ◽

Partner Violence ◽

Public Health Problem ◽

The United States ◽

Intimate Partner ◽

World Health ◽

Public Health Issue

We are observing with great concern the global spread of the COVID19 Pandemic. What is equally alarming is a less visible, albeit serious Public health issue; one that the United Nations has dubbed as the ‘Shadow Pandemic’ [1]. This is none other than the globally prevalent issue of violence against women, particularly Intimate Partner Violence. Intimate Partner Violence (IPV) is a serious, possibly preventable public health problem globally. Pakistan ranks among the countries with the highest IPV rates [2]. On 11th March 2020, the World Health Organization declared the highly infectious and lethal Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) to be a pandemic [3]. Drastic measures were enforced universally to curb the spread of COVID-19. Countries issued strict nationwide lockdowns to isolate the population and implemented social distancing. The economy was impacted tremendously, and many people experienced financial and emotional hardship during this mandatory confinement. While everyone was affected, one population was in a far worse situation than others. Survivors of IPV were trapped alongside their perpetrators and faced difficulty/less freedom to escape threatening situations compared to the past. It is not surprising given that historical periods of uncertainty such as war or economic crisis have resulted in increased interpersonal violence, including violence against women [4]. The Hubei province of China, the first region to undergo a lockdown, saw nearly a doubling of their rates of IPV with the start of COVID19 Pandemic. Similarly, tragic stories gained nationwide coverage in the United States. IPV may also have risen in Pakistan, even if it is not being covered as extensively. During pandemics, fear causes us to minimize our personal needs and make sacrifices we would not normally make. This could be a reasonable approach for most but should not be for survivors of IPV. IPV survivors live in constant fear for themselves and their children; they are now devoid of their only means of mitigation; avoidance. Local woman’s support groups in Pakistan should act and spread awareness about this grim reality hiding underneath the Pandemic. Resources/funding should be made available for survivors to be able to reach out for support without having to leave the watchful eyes of their perpetrators. Public health officials ought to investigate and document the rise in IPV to help identify the leading causes of the increase. These steps will assist in developing crisis-specific guidelines to provide adequate resources for the future. Continuous....

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Water and Sanitation in Urban America, 2017–2019

American Journal of Public Health ◽

10.2105/ajph.2020.305833 ◽

2020 ◽

Vol 110 (10) ◽

pp. 1567-1572

Author(s):

Drew Capone ◽

Oliver Cumming ◽

Dennis Nichols ◽

Joe Brown

Keyword(s):

United States ◽

United Nations ◽

Low Income ◽

Monitoring Program ◽

The United States ◽

World Health ◽

Water And Sanitation ◽

Urban America ◽

Joint Monitoring ◽

Health Organization

Objectives. To estimate the population lacking at least basic water and sanitation access in the urban United States. Methods. We compared national estimates of water and sanitation access from the World Health Organization/United Nations Children’s Fund Joint Monitoring Program with estimates from the US Department of Housing and Urban Development on homelessness and the American Community Survey on household water and sanitation facilities. Results. We estimated that at least 930 000 persons in US cities lacked sustained access to at least basic sanitation and 610 000 to at least basic water access, as defined by the United Nations. Conclusions. After accounting for those experiencing homelessness and substandard housing, our estimate of people lacking at least basic water equaled current estimates (n = 610 000)—without considering water quality—and greatly exceeded estimates of sanitation access (n = 28 000). Public Health Implications. Methods to estimate water and sanitation access in the United States should include people experiencing homelessness and other low-income groups, and specific policies are needed to reduce disparities in urban sanitation. We recommend similar estimation efforts for other high-income countries currently reported as having near universal sanitation access.

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Epidemiological surveillance of West Nile virus in the world and Brazil

Brazilian Journal of Veterinary Research and Animal Science ◽

10.11606/issn.1678-4456.bjvras.2019.164335 ◽

2020 ◽

Vol 56 (4) ◽

pp. e164335

Author(s):

Erica Azevedo Costa ◽

José Joffre Martins Bayeux ◽

Aila Solimar Gonçalves Silva ◽

Guilherme Alves De Queiroz ◽

Beatriz Senra Álvares da Silva Santos ◽

...

Keyword(s):

Public Health ◽

West Nile Virus ◽

Animal Health ◽

Public Health Intervention ◽

The United States ◽

World Health ◽

West Nile ◽

Serological Screening ◽

The World ◽

Health Organization

West Nile virus (WNV) is a neurovirulent mosquito-borne Flavivirus that is maintained in nature by a zoonotic transmissioncycle between avian hosts and ornithophilic mosquito vectors, mostly from the Culex genus. Until the 1990s, WNV wasconsidered to be an old-world arbovirus, but in 1999, WNV emerged in the United States (US) and spread rapidly, becoming amajor threat to public health. WNV adapted to the transmission cycle involving American mosquitoes and birds and reachedCentral and South America in subsequent years. In 2003, the National West Nile Fever Surveillance System was created in Brazilbased on serological screening of animals and sentinel vectors, as recommended by the Pan American Health Organization(PAHO) and the World Health Organization (WHO). Since 2008, serological evidence of WNV infection in Brazilian horseshas been reported, and the circulation of WNV has been monitored through the regular serological screening of sentinel horsesand reporting of encephalomyelitis cases. Horses are highly susceptible to WNV infection, and outbreaks of neurologicaldisease among horses often precede human cases. In this regard, equine surveillance has been essential in providing earlywarning to public and animal health authorities in several countries, including Brazil. This demonstrates the need for animaland public health intervention programs to allocate resources to make veterinarians aware of the role they can play in thehuman surveillance processes by monitoring horses. This review discusses the importance of equine surveillance and the gapthat veterinarians can fill on the front line in human surveillance, in Brazil and worldwide, in the context of “One Health”

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Policy liberalism and source of news predict pandemic-related health behaviors and trust in the scientific community

PLoS ONE ◽

10.1371/journal.pone.0252670 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252670

Author(s):

Madeleine Reinhardt ◽

Matthew B. Findley ◽

Renee A. Countryman

Keyword(s):

Public Health ◽

United States ◽

Health Behaviors ◽

News Media ◽

Perceived Risk ◽

Scientific Community ◽

The United States ◽

World Health ◽

Health Crisis ◽

Health Measures

In March of 2020, the United States was confronted with a major public health crisis caused by the coronavirus disease (COVID-19). This study aimed to identify what factors influence adherence to recently implemented public health measures such as mask-wearing and social distancing, trust of scientific organizations like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) on information pertaining to the pandemic, and level of perceived risk. Data were collected from June 30, 2020 to July 22, 2020 on 951 adult residents of the United States using an online survey through Microsoft Forms. Multiple linear regression was used to identify the strongest predictors for compliance to pandemic-related health measures, trust in the scientific community, and perceived risk. Results showed that the strongest predictor of all variables of interest was degree of policy liberalism. Additionally, participants who consumed more conservative news media conformed less to the pandemic health guidelines and had less trust in the scientific community. Degree of policy liberalism was found to have a significant moderating effect on the relationship between gender and conformity to pandemic-related health behaviors. These findings have concerning implications that factors like degree of policy liberalism and source of news are more influential in predicting adherence to life-saving health measures than established risk factors like pre-existing health conditions.

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Siu G. Wong, O.D., M.P.H.

Hindsight Journal of Optometry History ◽

10.14434/hindsight.v51i2.30282 ◽

2020 ◽

Vol 51 (2) ◽

pp. 53-59

Author(s):

Siu G. Wong

Keyword(s):

Public Health ◽

Health Service ◽

Low Income ◽

Chinese Americans ◽

The United States ◽

Indian Health Service ◽

Care Hospital ◽

Special Olympics ◽

Indian Health ◽

The University

This memoir, written by Dr. Siu G. Wong, chronicles her early influences and education, and profiles her first career as a public health optometrist and her second career as a community activist and public historian. Dr. Wong graduated from the University of California, Berkeley with her doctorate in optometry in 1970 and received her master's in public health in 1973. Her first position as an educator at the University of Houston (UH) included pioneering an interdisciplinary community health program in a low-income neighborhood as well as coordinating the first externship program for UH optometry students with the United States Public Health Service-Indian Health Service (USPHS-IHS). Dr. Wong joined the USPHS in 1978 where she was the first female commissioned officer assigned to the Indian Health Service (IHS), the first chief optometrist of an administrative region, and eventually the first woman to hold the position of chief optometric consultant to the IHS. During her tenure, she spearheaded quality assurance programs and was active in both the American Optometric Association (AOA) and the American Public Health Association (APHA), serving in leadership roles in the AOA's Council on Clinical Optometric Care, Hospital Privileges Committee, the QA Committee, and the Multidisciplinary Practice Section. She also became a member of the APHA's Vision Care Section and the Armed Forces Optometric Society. After retirement, Dr. Wong continued her role in public service, serving as the Clinical Director for the Special Olympics Opening Eyes program and as a clnical consultant. She became active also in public history, joining the Chinese American Citizens Alliance where she works to raise awareness of the contributions of Chinese Americans to American history. This article was annotated by Kirsten Hebert.

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SARS: current overview, aetiology and epidemiology

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2003.3555 ◽

2003 ◽

Vol 3 (2) ◽

pp. 46-55

Author(s):

Semra Čavaljuga ◽

Michael Faulde ◽

Jerrold J. Scharninghausen

Keyword(s):

Public Health ◽

World Health Organisation ◽

The United States ◽

Air Travel ◽

World Health ◽

New Disease ◽

The Past ◽

Health Authorities ◽

The World ◽

Public Health Authorities

At this moment, public health authorities, physicians and scientists around the world are struggling to cope with a severe and rapidly spreading new disease in humans called severe acute respiratory syndrome, or SARS. According to World Health Organisation (WHO) this appears to be the first severe and easily transmissible new disease to emerge in the 21st century. Though much about the disease remains poorly understood, including the details of the causative virus, we do know that it has features that allow it to spread rapidly along international air travel routes. As of 10 May 2003, a cumulative 7296 probable SARS cases with 526 deaths have been reported from 30 countries on three continents (WHO, ProMED). In the past week, more than 1000 new probable cases and 96 deaths were reported globally. This represents an increase of 119 new cases and 8 new deaths compared with 9 May 2003 (China (85), Taiwan (23), and Hong Kong (7) represented the overwhelming majority, with one additional case each reported from France, Malaysia, Singapore, and the United States). Only in China, as of 10 May 2003 (WHO) total of 4884 with 235 deaths have been reported. Some outbreaks have reassuring features.

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