A Randomized Clinical Trial of Precision Prevention Materials Incorporating MC1R Genetic Risk to Improve Skin Cancer Prevention Activities Among Hispanics

Purpose: Skin cancer incidence is increasing among Hispanics, who experience worse outcomes than non-Hispanic Whites. Precision prevention incorporating genetic testing for (melanocortin-1 receptor) MC1R, a skin cancer susceptibility marker, may improve prevention behavior. Experimental Design: Hispanic participants (n = 920) from Tampa, FL and Ponce, PR, were block-randomized within MC1R higher- and average-risk groups to precision prevention or generic prevention arms. We collected baseline information on demographics, family history of cancer, phenotypic characteristics, health literacy, health numeracy, and psychosocial measures. Participants reported weekday and weekend sun exposure (in hours), number of sunburns, frequency of five sun protection behaviors, intentional outdoor and indoor tanning, and skin examinations at baseline, 3 months, and 9 months. Participants also reported these outcomes for their eldest child ≤10 years old. Results: Among MC1R higher-risk participants, precision prevention increased sunscreen use (OR = 1.74, P = 0.03) and receipt of a clinical skin exam (OR = 6.51, P = 0.0006); and it decreased weekday sun exposure hours (β = −0.94, P = 0.005) and improved sun protection behaviors (β = 0.93, P = 0.02) in their children. There were no significant intervention effects among MC1R average-risk participants. The intervention did not elevate participant cancer worry. We also identified moderators of the intervention effect among both average- and higher-risk participants. Conclusions: Receipt of MC1R precision prevention materials improved some skin cancer prevention behaviors among higher-risk participants and their children and did not result in reduced prevention activities among average-risk participants. Despite these encouraging findings, levels of sun protection behaviors remained suboptimal among participants, warranting more awareness and prevention campaigns targeted to Hispanics Significance: Our results support a precision public health approach to reducing skin cancers among Hispanics, an underserved population in precision medicine, and may additionally improve preventive behaviors among their children.

Knowledge, Attitude and Practices of Breastfeeding Among Mothers of Children Under 6 Months of Age in Suva, Fiji

Breastfeeding is a cost-effective public health approach that decreases infant and child morbidity and mortality. Fiji's exclusive breastfeeding rate was 40 percent compared to the global target of 50 percent. The research aims to evaluate mothers’ breastfeeding infants' level of knowledge, attitudes, and practice less than 6 months of age in Suva. A descriptive quantitative cross-sectional study was carried out in 3 randomly selected medical areas in Suva, Fiji. Knowledge, attitude, and practice (KAP) questionnaire was used to gather data from 415 mothers. The overall mean scores for breastfeeding knowledge of mothers were 12.9, the attitude was 33.7, and practice 7.20. Results showed that mothers were generally found to have good levels of knowledge and practice but a fair attitude. Knowledge was associated with the number of children that mothers had and ethnicity. Attitude had a positive correlation with household income. The practice was positively correlated with the mother's status of employment, the number of children, ethnicity, marital status, and household income. To improve breastfeeding knowledge, attitude and practices of mothers, awareness and education should be strengthened in all health facilities. Improvement in health education materials and advocacy is required.

Harm reduction: a public health approach to prison drug use

Purpose As prison drug use continues to be a concern worldwide, harm reduction practices serve as an alternative approach to traditional abstinence-only or punishment-oriented methods to address substance use behind bars. The purpose of this study is to present a summary of research surrounding prison-based harm reduction programs. Design/methodology/approach This narrative review of the international literature summarizes the harms associated with prison drug use followed by an overview of the literature surrounding three prison-based harm reduction practices: opioid agonist therapy, syringe exchange programs and naloxone distribution. Findings A collection of international research has found that these three harm reduction programs are safe and feasible to implement in carceral settings. Additionally, these services can effectively reduce some of the harms associated with prison drug use (e.g. risky injection practices, needle sharing, fatal overdoses, etc.). However, these practices are underused in correctional settings in comparison to their use in the community. Originality/value Various policy recommendations are made based on the available literature, including addressing ethical concerns surrounding prison populations’ rights to the same standard of health care and services available in the community. By taking a public health approach to prison drug use, harm reduction practices can provide a marginalized, high-risk population of incarcerated individuals with life-saving services rather than punitive, punishment-oriented measures.

The 10th National Public Health Conference on Managing Pandemic, Controlling Endemic, and Preventing Future Endemics Through Public Health Approach

The 10th National Public Health Conference on Managing Pandemic, Controlling Endemic, and Preventing Future Endemics Through Public Health Approach

The Public Health Approach to the Worsening Opioid Crisis in the United States Calls for Harm Reduction Strategies to Mitigate the Harm From Opioid Addiction and Overdose Deaths

ABSTRACT The opioid crisis has devastated the U.S. more than any other country, and the epidemic is getting worse. While opioid prescriptions have decreased by more than 40% from its peak in 2010, unfortunately, opioid-related overdose deaths have not declined but continued to increase. With greater scrutiny on prescription opioids, many users switched to the cheaper and more readily available heroin that drove up heroin-related overdose deaths from 2010 to peak in 2016, being overtaken by the spike in synthetic opioid (mostly fentanyl)-related overdose deaths. The surge in fentanyl-related overdose deaths since 2013 is alarming as fentanyl is more potent and deadly. One thing is certain the opioid crisis is not improving but has become dire with the surge in fentanyl-related overdose deaths. Evidence-based strategies have to be implemented in the U.S. to control this epidemic before it destroys more lives. Other countries, including European countries and Canada, have invested more in harm reduction strategies than the U.S. even though they (especially Europe) do not face anywhere near the level of crisis as the U.S. In the long-run, upstream measures (tackling the social determinants of health) are more effective public health strategies to control the epidemic. In the meantime, however, harm reduction strategies have to be employed to mitigate the harm from addiction and overdose deaths.

Assessment of Food and Waterborne Viral Outbreaks by Using Field Epidemiologic, Modern Laboratory and Statistical Methods—Lessons Learnt from Seven Major Norovirus Outbreaks in Finland

Seven major food- and waterborne norovirus outbreaks in Western Finland during 2014–2018 were re-analysed. The aim was to assess the effectiveness of outbreak investigation tools and evaluate the Kaplan criteria. We summarised epidemiological and microbiological findings from seven outbreaks. To evaluate the Kaplan criteria, a one-stage meta-analysis of data from seven cohort studies was performed. The case was defined as a person attending an implicated function with diarrhoea, vomiting or two other symptoms. Altogether, 22% (386/1794) of persons met the case definition. Overall adjusted, 73% of norovirus patients were vomiting, the mean incubation period was 44 h (4 h to 4 days) and the median duration of illness was 46 h. As vomiting was a more common symptom in children (96%, 143/149) and diarrhoea among the elderly (92%, 24/26), symptom and age presentation should drive hypothesis formulation. The Kaplan criteria were useful in initial outbreak assessments prior to faecal results. Rapid food control inspections enabled evidence-based, public-health-driven risk assessments. This led to probability-based vehicle identification and aided in resolving the outbreak event mechanism rather than implementing potentially ineffective, large-scale public health actions such as the withdrawal of extensive food lots. Asymptomatic food handlers should be ideally withdrawn from high-risk work for five days instead of the current two days. Food and environmental samples often remain negative with norovirus, highlighting the importance of research collaborations. Electronic questionnaire and open-source novel statistical programmes provided time and resource savings. The public health approach proved useful within the environmental health area with shoe leather field epidemiology, combined with statistical analysis and mathematical reasoning.

Support Needs for Bhutanese Family Members Taking Care of Loved Ones Diagnosed with Advanced Illness

Background: Palliative care aims to improve the quality of life of patients diagnosed with an advanced illness and their families. Family members, who often play a central role caring for their very ill loved ones, have significant support needs. In Bhutan, where palliative care is an emerging concept, the needs of family members have not been assessed thus far. Objective: This study explored the support needs of Bhutanese family members caring for their loved ones diagnosed with advanced illness. Design: This is a cross-sectional descriptive study. Setting/Subjects: Study sites included the national referral hospital, the two regional referral hospitals, four district hospitals and Basic Health Units (Grade I and II), spread across Bhutan. Participants were recruited through purposeful and snowball sampling strategies. Data were collected from May to August 2019. The Carer Support Needs Assessment Tools (CSNAT) was used. Results: Despite unforeseen challenges, 46 family members out of 60 identified (77%) participated in the survey. Twenty-three (50%) cared for relatives with advanced cancer and the remainder for loved ones with non-malignant conditions. This study found high support needs among both groups. The priority needs included understanding their relative's illness, managing symptoms, providing personal care, financial aspects, dealing with their own feelings and emotions and knowing what to expect in the future. Conclusion: This study will help inform the World Health Organization recommended public health approach to palliative care modified to the Bhutanese context for enabling a cost-effective intervention to improve the quality of lives of patients and families.

An in-depth analysis of 10 epidemiological terminologies used in the context of COVID-19

Aim: In this paper, we explore the contextual use of 10 epidemiological terminologies, their significance, and interpretation/misinterpretation in explaining various aspects of the 2019 novel coronavirus disease (COVID-19) pandemic. Methods and Results: We first establish the different purposes of the terms ‘pandemic’ and ‘Public Health Emergency of International Concern.’ We then discuss the confusion caused by using the ‘case fatality rate’ as opposed to ‘infection fatality rate’ during the pandemic and the uncertainty surrounding the limited usefulness of identifying someone as ‘pre-symptomatic.’ We highlight the ambiguity in the ‘positivity rate’ and the need to be able to generate data on ‘excess mortality’ during public health emergencies. We discuss the relevance of ‘association and causation’ in the context of the facemask controversy that existed at the start of the pandemic. We point out how the accepted epidemiological practice of discussing ‘herd immunity’ in the context of vaccines has been twisted to suit the political motive of a public health approach. Given that a high proportion of COVID-19 cases are asymptomatic, we go on to show how COVID-19 has blurred the lines between ‘screening/diagnosis’ and ‘quarantine/isolation,’ while giving birth to the new terminology of ‘community quarantine.’ Conclusions: Applying the lessons learned from COVID-19 to better understand the above terminologies will help health professionals communicate effectively, strengthen the scientific agenda of epidemiology and public health, and support and manage future outbreaks efficiently.