Progression of the Pathway for Public Health Care during the COVID-19 Outbreak at District Health Offices

Public health activities under district health offices (DHOs) play a major role in Malaysia’s fight against COVID-19. This article aims to describe and illustrate the public health activity pathway in combating the COVID-19 pandemic, and a team of public health workers who are familiar with DHO work settings was created in April 2020 for that purpose. Review of documents and the Ministry of Health’s updates was carried out, followed by a series of discussions with stakeholders. Based on the steps in the outbreak investigation tasks, the flow of activities from January to May 2020 was listed in line with the phases of the country’s National Movement Control Order 2020. Results show that the activities can be classified into three different sections—namely, the main action areas, category of cases, and level of care. The main process flow of activities comprised the case management and support activities. Case management flow was split into tasks for patients under investigation and persons under surveillance, while the support services existed throughout the phases. The pathways illustrate that the progression of the pandemic translated directly to changes in the pattern of activities, with additional subgroups of activities in accordance with all imposed guidelines.

Policing and public health calls for service in Philadelphia

This contribution outlines various spatial and temporal aspects of medical or public-health related calls for service from the public to police in Philadelphia in 2019. These incidents comprise about 8% of the police department’s workload that originates from the public. Calls appear to be highly concentrated in a few areas, and specifically the Center City and Kensington neighborhoods. They are also more likely to occur late afternoon and evening. The article shows that some medical or public health activity initially masquerades as crime or other policing work and some events eventually determined to be police/crime activity can initially appear to be public health related. About 20% of activity in this area does not appear predictable from the initial call type as handled by police dispatch.

Effectiveness of harm reduction intervention: results of low threshold service centres‘ activity

Background Harm reduction programmes are recommended as an effective HIV prevention among injection drug users by the WHO and UN. Monitoring of clients' risky behaviour is carried out to evaluate the effectiveness of low threshold centres' (LTCs) activity, which allows assessment of services' effect on the public health. Aim Evaluation of effectiveness of LTCs' activity, changing clients' behaviour, during 1997-2019. Methods Analysis of LTCs’ documentation during 1997–2019; survey of the anonymous questionnaire carried out in the LTC of Klaipėda Mental Health Centre in 2019 (sample 130 people), comparison of the data with the results of 2001 survey. Results during 1997-2019 the average number of one client visits to the centre per year increased from 5 to131. The number of means supplied to clients was increasing: the amount of returned used syringes (83% in 1998, 101% in 2019) was increasing in comparison with the amount of issued sterile means. In 2001 58% of respondents who did not attend the centre would hand over used syringes to others while in 2019, after taking the centre services, the number dropped to 13%. A certain number of clients would accept used syringes until coming to the centres (in 2001 25% did not do this), after visits to the centres in 2019 91% did not use used syringes. Clients more often started using condoms with casual partners (17% in 2001, 84% in 2019). The more often clients attend the centres, the more of them take HIV tests (62% in 2001, 96% in 2019). 58% of respondents in 2001 and 97% of respondents in 2019 expressed a wish to give up drug use. Conclusions the activity of the LTCs during 1997-2019 attracted increasing number of drug users. The study demonstrated: activity of LTCs is effective in changing risky behaviour of drug users to a more safe one while injecting drugs and having sexual contacts. Majority of clients have a wish to stop using drugs and the more they attend the LTCs the more realistic possibility to do this they see. Key messages Monitoring of clients‘ risky behaviour is carried out to evaluate the effectiveness of low threshold centres‘ (LTCs) activity, which allows assessment of services‘ effect on the public health. Activity of LTCs is effective in changing risky behaviour of drug users to a more safe one while injecting drugs and having sexual contacts.

Public health services at community pharmacies and strategies for expanding the role of pharmacists

Pharmacy practice is evolving and the role of pharmacists in public health is expanding in many countries. The objective of this work was to analyse involvement of community pharmacy staff in public health activities, as well as to identify opinion of pharmacy professionals about strategies for expanding their public health role in Armenia. Survey was conducted in different regions of Armenia. Pharmacists and technicians working in community pharmacies were asked to complete pre-tested questionnaire that includes questions about their involvement in public health activity, motivation and opinion on strategies for improvement of the situation. 162 pharmacy professionals completed the questionnaire. Data were analysed with SPSS statistical software, version 22.0. 76.5% of responders indicated that they agree that community pharmacy practice should involve provision of public health services. Only 22.2% of community pharmacists and technicians reported that they are currently engaged in any public health activity. The main reasons for providing public health services indicated by responders are professional responsibility (84.6%), patients' satisfaction (66.0%) and personal satisfaction (63.6%). 80.2% of responders suppose that providing public health services in community pharmacies can have an impact on improving population health. Respondents indicated strategies which could be effective for expanding pharmacists' role in public health: increasing public awareness (82.7%), expanding pharmacists' knowledge (82.1%) and guidelines (71.6%). Only part of pharmacy professionals is engaged in public health activity. Many of them believe that certain strategies are able to improve the situation with involvement of community pharmacy staff in providing public health services in Armenia. Key messages Pharmacists are motivated to implement public health services. Special strategies should be introduced to increase engagement of pharmacists in public health.

Assessing the health of populations

Assessing population health is a fundamental element of most public health activity. We cannot improve health and measure success without being able to conduct health assessments. These may be components of, for example: measuring burden of disease; needs assessment; assessing health equity and health inequality; resource allocation; planning; health impact assessment (HIA); service evaluation.

Inaccuracy of Official Estimates of Public Health Spending in the United States, 2000–2018

Objectives. To examine the accuracy of official estimates of governmental health spending in the United States. Methods. We coded approximately 2.7 million administrative spending records from 2000 to 2018 for public health activities according to a standardized Uniform Chart of Accounts produced by the Public Health Activities and Services Tracking project. The official US Public Health Activity estimate was recalculated using updated estimates from the data coding. Results. Although official estimates place governmental public health spending at more than $93 billion (2.5% of total spending on health), detailed examination of spending records from state governments shows that official estimates include substantial spending on individual health care services (e.g., behavioral health) and that actual spending on population-level public health activities is more likely between $35 billion and $64 billion (approximately 1.5% of total health spending). Conclusions. Clarity in understanding of public health spending is critical for characterizing its value proposition. Official estimates are likely tens of billions of dollars greater than actual spending. Public Health Implications. Precise and clear spending estimates are material for policymakers to accurately understand the effect of their resource allocation decisions.

The Breakfast Club – co-creational meal practices as rehabilitation strategies in nursing homes

Background A growing aging population demands new welfare public health activities in nursing homes. Involving residents in meal activity through a co-creational approach as part of a rehabilitation strategy has been suggested as a solution, but knowledge is limited. This project explore how co-creational meal practices in a breakfast club might improve residents’ food related functionality and quality of life. Methods The project is designed as a three-year complex intervention study in a Danish nursing home. A breakfast club is held with 4-5 residents (16 all together) and 2-6 staff members on a weekly basis during a period of 10 month. Residents are on shift hosting the club and all members are preparing the meal together. The degree of food related functionality is assessed after each club and is analyzed through paired t-test on mean values. Semi-structured interviews in combination with Research Driven Photo-Elicitation is conducted with 16 residents and 8-10 staff members before, during and after holding the clubs in order to evaluate quality of life and potentials for implementing meal practices to everyday practices. A hermeneutic analysis strategy is applied. Results Preliminary results from 12 breakfast clubs finds an increase in residents food related functionality. Data will be presented in November 2019. All residents express impact on quality of life independent of physical or mental state. Improved functionality is not the main value for participation in the breakfast club. Staff became aware of utilizing residents food related functionality. Conclusions The study will contribute with new knowledge about whether co-creational meal activities could have a positive effect on functional abilities and improve health-related quality of life in residents in nursing homes. A meal practice based on co-creation has potential to become implemented as a public health activity in nursing homes and increase residents’ quality of life and food related functionality.

Analisis Risiko Non Karsinogenik Pajanan PM10 di Kawasan Komersial, Kota Jambi

<p>PM ¹⁰ Pollutant is an air particulate that cannot be detected by a nose hair. It contains carcinogenic and non-carcinogenic chemical components. This study, therefore, aims to quantify the concentration of PM ¹⁰ and identify the risks of the non-carcinogenic type’s exposure to the public’s health in the commercial area of Pasar Jambi sub-district. Measurement of PM concentration was performed on Sunday (weekend) and Monday (weekday) using high volume air sampler (HVAS). Furthermore, questionnaire and interviewing were implemented on 95 people amounting to 12% of the total population. The result shows that PM ¹⁰ concentrations were observed to have exceeded ambient air quality standards of 196.9 µg/m3 on weekend and 2.094 µg/m3 weekday. Further- more, the average concentration of Al and Mn in PM ¹⁰ were 1.69384 µg/m3 and 0.04191 µg/m3 respectively. Although the public health activity was already at the risk of PM10 non-carcinogenic exposure in the commercial district (i.e RQ &gt; 1), there has notbeen any environmental health risks for the non-carcinogenic metals (Al and Mn) to the society. Therefore, risk management is carried out to protect the population from PM risks. Risk management comprises calculating the safe concentration, duration, frequency, and time of exposure on these weekend and weekday</p>

Making the Case for “Whole System” Approaches: Integrating Public Health and Housing

Housing conditions have been an enduring focus for public health activity throughout the modern public health era. However, the nature of the housing and health challenge has changed in response to an evolution in the understanding of the diverse factors influencing public health. Today, the traditional public health emphasis on the type and quality of housing merges with other wider determinants of health. These include the neighbourhood, community, and “place” where a house is located, but also the policies which make access to a healthy house possible and affordable for everyone. Encouragingly, these approaches to policy and action on housing have the potential to contribute to the “triple win” of health and well-being, equity, and environmental sustainability. However, more effective housing policies (and in public health in general) that adopt more systemic approaches to addressing the complex interactions between health, housing, and wider environment are needed. This paper illustrates some of the key components of the housing and health challenge in developed countries, and presents a conceptual model to co-ordinate activities that can deliver the “triple win.” This is achieved by offering a perspective on how to navigate more effectively, inclusively and across sectors when identifying sustainable housing interventions.