Mutation of Mycobacterium tuberculosis and Implications for Using Whole-Genome Sequencing for Investigating Recent Tuberculosis Transmission

Tuberculosis (TB) control programs use whole-genome sequencing (WGS) of Mycobacterium tuberculosis (Mtb) for detecting and investigating TB case clusters. Existence of few genomic differences between Mtb isolates might indicate TB cases are the result of recent transmission. However, the variable and sometimes long duration of latent infection, combined with uncertainty in the Mtb mutation rate during latency, can complicate interpretation of WGS results. To estimate the association between infection duration and single nucleotide polymorphism (SNP) accumulation in the Mtb genome, we first analyzed pairwise SNP differences among TB cases from Los Angeles County, California, with strong epidemiologic links. We found that SNP distance alone was insufficient for concluding that cases are linked through recent transmission. Second, we describe a well-characterized cluster of TB cases in California to illustrate the role of genomic data in conclusions regarding recent transmission. Longer presumed latent periods were inconsistently associated with larger SNP differences. Our analyses suggest that WGS alone cannot be used to definitively determine that a case is attributable to recent transmission. Methods for integrating clinical, epidemiologic, and genomic data can guide conclusions regarding the likelihood of recent transmission, providing local public health practitioners with better tools for monitoring and investigating TB transmission.

Knowledge and Attitude towards Orthodontic Treatment among Non-Orthodontic Specialists: An Online Survey in Croatia

Objectives: The aim of this study was to examine the knowledge and attitudes towards orthodontic treatment among non-orthodontic specialists. Methods: A web-based survey was formulated for non-orthodontic dental specialists to respond to statements regarding an orthodontic treatment. It contained 20 multiple-choice questions with three or more possible answers. Two hundred and fifty questionnaires were sent via email, with explanatory letters, to randomly selected non-orthodontic Croatian dental specialists. Data were assessed using IBAM SPSS 23.0. and p < 0.01 was considered significant. Results: The results indicate that the majority of respondents were well informed about principles and practices in orthodontics. All the respondents (100%) were aware that malocclusions can affect a patient’s facial aesthetic and masticatory function. The results also showed statistically significant differences in answers about contraindications for orthodontics therapy among different non-orthodontic specialists (p < 0.01). Private health practitioners were better informed about the ideal time for the first orthodontic appointment (74.2%) and that implants and periodontal problems are not contraindications for orthodontic treatment (over 70%), in comparison with public health practitioners. Conclusion: Non-orthodontic specialists in this sample exhibit encouraging awareness and knowledge of the principals and practices of orthodontic treatment. Additional improving of practitioners’ knowledge and awareness can help patients with malocclusion to decide upon orthodontic treatment at earlier stages and avoid later complications in the future.

Introduction

This edited volume treats policy as an ethnographic object. Examining both policy spaces and sites of practice, the chapters illuminate both professionals’ and lay people’s intimate encounters with health policies. By ‘studying up’ and considering the multiplicity of actors and interests involved in global policies for improving maternal and reproductive health, the ten chapters in this volume track the processes and politics of policymaking and the mechanisms of their implementation in diverse contexts in Asia, Africa, Europe and South America. The chapters provide in-depth analyses of the complexities of policy formulation and implementation, the impact of socio-political contexts, as well as issues of local agency, equity and accessibility. Together, they demonstrate the value of ethnography as well as reproduction as a unique site for the generation of rich insights into the working of global health policies and their impacts. Such critical social science research is increasingly recognised as a crucial part of the evidentiary basis upon which people-centred and equitable health policy and systems everywhere are built. This volume will be of interest to scholars working at the intersection of critical global health, medical anthropology, and health policy and systems research, as well as to global public health practitioners.

Coronavirus (COVID-19) Spike in Georgia: An Epidemiologic Study of Data, Modelling, and Policy Implications to Understand the Gender-and Race-Specific Variations

ObjectiveThe purpose of this study was to investigate the gender-and race-specific predictive variations in COVID-19 cases and deaths in Georgia, USA.MethodsThe data were extracted from the Georgia Department of Public Health (GDPH). Statistical methods, such as descriptive statistics, Artificial neural networks (ANN), and Bayesian approach, were utilized to analyze the data.ResultsMore Whites died from COVID-19 than African-Americans/Blacks in Cobb, Hall, Gwinnett, and non-Georgia residents; however, more Blacks died in Dekalb and Fulton counties. The highest posterior mean for female deaths was obtained in Gwinnett County (77.17; 95% CI, 74.23–80.07) and for male deaths in Fulton County (73.48; 95% CI, 72.18–74.49). For overall race/ethnicity, Whites had the highest posterior mean for deaths (183.18; 95% CI, 128.29–238.27) compared with Blacks (162.48; 95% CI, 127.15– 197.42). Assessing the classification of the chronic medical conditions using ANN, Cobb and Hall Counties showed the highest mean AUC-ROC of the models (78% and 79%, respectively).ConclusionsThe predictive models of COVID-19 transmission will help public health practitioners and researchers to better understand the course of the COVID-19 pandemic. The study findings are generalizable to populations with geographic and racial/ethnic similarities and may be used to determine gender/race-specific future virus models for effective interventions or policy modifications.Human SubjectsNo personal identifiable information was obtained.

Developing Equity-Focused Education in Academic Public Health: A Multiple-Step Model

Education and training support public health practitioners in identifying and addressing challenges related to equitable health concerns. This article details a four-step Curricular Responsive Review Model (CRRM) generated by educators in a Council on Education for Public Health–accredited public health program to systematically understand and gather feedback on how to develop a responsive curriculum for their students. A review of all course syllabi was conducted by two faculty members and a doctoral student to identify curricular gaps and overlap. These findings, critical team dialogues, and a review of the literature informed the development of a survey to identify the health equity concepts and skills needed by MPH students. Community partners ( n = 4) responded to health equity education questions to detail the essential concepts and skills needed to teach students. Health equity educators (HEEs; n = 4) were then consulted on how to address knowledge gaps through pedagogy and educational resources. Community partners provided a list of areas that students should be educated in to enrich their health equity understandings. Recommendations were generated for integrating those concepts/skills into course teaching plans. The four-step CRRM in health equity education provides an opportunity for public health programs to engage in systematic mapping and critically reflective review processes to address curricular gaps and overlap. Mechanisms to receive real-world knowledge on health equity from a variety of stakeholders are essential to ensure real-word practical learning. The CRRM identifies systematic, responsive curricular mapping and review in public health as essential for meaningful, real-world equity education in disciplines beyond public health and health promotion.

Application of Grey-Based SWARA and COPRAS Techniques in Disease Mortality Risk Assessment

The health industry is amongst the most affected systems in terms of multiobjective decision-making, rendering the final solution, vulnerable to errors; however, multicriteria decision analysis (MDCA) emerges as a supportive tool for the process of decision-making. Therefore, the present study seeks to offer an MCDA framework for assessing and identifying the potential influence of socioeconomic risk factors on noncommunicable disease mortality. We adopted a subjective approach of grey-based Step-wise Weight Assessment Ratio Analysis (SWARA) and COmplex PRoportional Assessment (COPRAS) approach to calculate weights of parameters and criteria, respectively, and then rank them based on their degree of significance. The findings reveal that CRD mortality is potentially affected by the selected socioeconomic risk variables followed by IHD and cancer. Implementing MCDA techniques in the present study will assist the public health practitioners and policymakers in drawing decisions on the best strategy to reduce CRD mortality, which contributes significantly to raising overall mortality.

The Middle–Out Perspective — an approach to formalise 'normal practice' in public health advocacy

Background: The Middle–Out Perspective (MOP) provides a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote broader societal changes from the middle–out (rather than the top–down or bottom–up). The MOP has been used in recent years in the fields of energy, climate change, and development studies. Public health practitioners involved with advocacy activities and creating alliances to amplify health promotion actions will be familiar with the general MOP concept if not the formal name. Methods: This paper introduces the MOP conceptual framework and customises it for a public health audience by positioning it among existing concepts and theories for actions within public health. Using two UK case studies (increasing signalised crossing times for pedestrians and the campaign for smoke–free legislation), we illustrate who middle actors are and what they can do to result in better public health outcomes. Results: These cases studies show that involving a wider range of middle actors, including those not traditionally involved in improving the public's health, can broaden the range and reach of organisations and individuals involving in advocating for public health measures. They also demonstrate that middle actors are not neutral. They can be recruited to improve public health outcomes, but they may also be exploited by commercial interests to block healthy policies or even promote a health-diminishing agenda. Conclusions: Using the MOP as a formal approach can help public health organisations and practitioners consider potential 'allies' from outside traditional health-related bodies or professions. Formal mapping can expand the range of who are considered potential middle actors for a particular public health issue. By applying the MOP, public health organisations and staff can enlist the additional leverage that is brought to bear by involving additional middle actors in improving the public's health.

Transmission potential of vaccinated and unvaccinated persons infected with the SARS-CoV-2 Delta variant in a federal prison, July-August 2021

Background The extent to which vaccinated persons who become infected with SARS-CoV-2 contribute to transmission is unclear. During a SARS-CoV-2 Delta variant outbreak among incarcerated persons with high vaccination rates in a federal prison, we assessed markers of viral shedding in vaccinated and unvaccinated persons. Methods Consenting incarcerated persons with confirmed SARS-CoV-2 infection provided mid-turbinate nasal specimens daily for 10 consecutive days and reported symptom data via questionnaire. Real-time reverse transcription-polymerase chain reaction (RT-PCR), viral whole genome sequencing, and viral culture was performed on these nasal specimens. Duration of RT-PCR positivity and viral culture positivity was assessed using survival analysis. Results A total of 978 specimens were provided by 95 participants, of whom 78 (82%) were fully vaccinated and 17 (18%) were not fully vaccinated. No significant differences were detected in duration of RT-PCR positivity among fully vaccinated participants (median: 13 days) versus those not fully vaccinated (median: 13 days; p=0.50), or in duration of culture positivity (medians: 5 days and 5 days; p=0.29). Among fully vaccinated participants, overall duration of culture positivity was shorter among Moderna vaccine recipients versus Pfizer (p=0.048) or Janssen (p=0.003) vaccine recipients. Conclusions As this field continues to develop, clinicians and public health practitioners should consider vaccinated persons who become infected with SARS-CoV-2 to be no less infectious than unvaccinated persons. These findings are critically important, especially in congregate settings where viral transmission can lead to large outbreaks.

Weight Stigma and Social Media: Evidence and Public Health Solutions

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content that perpetuates problematic norms about weight. Individuals may also be more likely to engage in attacks due to increased anonymity and lack of substantive consequences online. The critical influence of social media in shaping beliefs may also lead to the internalization of weight stigma. However, social media could also be used as a positive agent of change. Movements such as Body Positivity, the Fatosphere, and Health at Every Size have helped counter negative stereotypes and provide more inclusive spaces. To support these efforts, governments should continue to explore legislative solutions to enact anti-weight discrimination policies, and platforms should invest in diverse content moderation teams with dedicated weight bias training while interrogating bias in existing algorithms. Public health practitioners and clinicians should leverage social media as a tool in weight management interventions and increase awareness of stigmatizing online content among their patients. Finally, researchers must explore how experiences of stigma differ across in-person and virtual settings and critically evaluate existing research methodologies and terminology. Addressing weight stigma on social media will take a concerted effort across an expansive set of stakeholders, but the benefits to population health are consequential and well-worth our collective attention.

Genetic epidemiology

The integration of epidemiological methods with genome-wide technologies has provided unprecedented insights into the complex biological mechanisms of traits and diseases in human populations. These advances have revolutionized the scope and scale of what can be done, ranging from studies of single gene variants measured in small samples through to the emergence of high-throughput genotyping, genome-wide association studies, and next-generation whole genome sequencing technologies which produce information on millions of genetic variants in thousands of individuals. In parallel, as these genomic technologies provide new opportunities to better understand disease biology, it is becoming increasingly apparent that a knowledge of genomic medicine will be essential for public health practitioners in meeting the public’s future healthcare needs. As our understanding of disease aetiology and its underlying biological mechanisms increases, there is the potential for new drug development and improved therapeutic strategies to manage disease at the population level. At the same time, there is growing interest in the use of these genetic variants to predict individual disease risk over and above classical risk factors, and to develop stratified and personalized approaches to diagnosis and disease management. The public health community has a central role to play in critically and systematically evaluating these discoveries for their potential use in disease management. Thus, in this 21st century era of genetic epidemiology and genomic science, public health practitioners cannot overlook the global relevance of genetic epidemiology on our understanding of models of disease, personalized medicine, and the relationship between individuals and populations, treatment, and prevention strategies.