Assessment of the Current State of Pharmacovigilance System in Pakistan Using Indicator-Based Assessment Tool

Objectives: Pakistan felt the need for an effective and robust pharmacovigilance (PV) system after one of the deadliest drug-related tragedies causing more than 300 deaths in 2012. The country set up its national PV center in 2015 and joined WHO’s Program for International Drug Monitoring (PIDM) in 2018 as a full member. The current study was aimed to evaluate the PV system’s functionality, identify the gaps, areas of improvement, and a strategy to lead a functional PV system in Pakistan.Methods: The descriptive cross-sectional study was conducted by providing an interviewer-administered questionnaire of the PV system across Pakistan by utilizing the Indicator based Pharmacovigilance assessment tool (IPAT). By a convenience sampling method 36 study participants were selected from the Drug Regulatory Authority of Pakistan (DRAP), drug administration of provincial health departments of 4 provinces and federally affiliated areas, 5 national public health programs, and 23 public and private hospitals. The assessment includes document review, interviews of the key informants by structured open-ended questions, and a review of websites of relevant organizations.Results: Drug Regulatory Authority of Pakistan (DRAP) with a national PV center received a 75% overall performance score on IPAT. To be regarded as “minimally functioning,” a country’s PV and drug safety system must meet all core indicators. DRAP scored 80.76% on the core indicators so cannot be deemed functional at this time. The only province with a regional PV center, Punjab, had scored 72.13% on relevant parameters. Despite receiving funding from the Global Fund, none of the National Public Health Programs (PHPs) have PV centers or associated activities. All hospitals except two private hospitals could not qualify the minimum requirements for functional PV. The absence of a legal framework for mandatory ADR reporting, lack of drug information center, budgetary constraints, no active surveillance activities, the nonexistence of pharmacovigilance risk assessment expert committee, and insufficient coordination among stakeholders were identified as major gaps.Conclusion: The results of the study reveal that Pakistan’s PV system is not fully functional at all levels. A two-phased strategy encompassing the non-financial and financial interventions is proposed to improve the PV systems at the national, provincial, PHPs, and hospitals levels.

Do Canadians Support Tailored and Targeted Public Health Programs? A Discrete Choice Experiment

Background. We aimed to assess public support of tailored and targeted public health interventions for various marginalized communities.Methods. We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged >16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target group. Demographically-weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection.Results. 23,889 exercises were completed by 3,054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared with interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs of marginalized communities (e.g. HIV and men who have sex with men).Conclusions. Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.

Distress and Spiritual Well-Being in Brazilian Patients Initiating Chemotherapy during the COVID-19 Pandemic—A Cross-Sectional Study

Social distancing and the priority given to COVID-19 patients in health services, which caused postponement of appointments and cancer treatment, may have triggered unprecedented levels of distress in cancer patients. The aim of this study was to analyze the prevalence of distress and the levels of spiritual well-being of people initiating chemotherapy during the COVID-19 pandemic, identifying the factors associated with distress, and determining if there is a relationship between distress and spiritual well-being. A cross-sectional study was conducted with 91 Brazilians. Data were collected by applying the Spiritual Well-Being Scale (SWBS) and the Distress Thermometer and Problem List for Patients. The prevalence of distress was 59.5%, and the average score of spiritual well-being was 106.54 (±9.06). Emotional issues were the most reported by patients with distress. The Poisson regression showed that male sex (PR = 0.588; 95% CI 0.392–0.881), age (PR = 0.985; 95% CI 0.973–0.996), and spiritual well-being score were predictors of distress (PR = 0.971; 95% CI 0.946–0.996). These findings indicate that distress relief involves implementation of public health programs capable of integrating spiritual interventions into cancer care.

Do Canadians Support Tailored And Targeted Public Health Programs? A Discrete Choice Experiment

Background. We aimed to assess public support of tailored and targeted public health interventions for various marginalized communities. Methods. We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged >16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target group. Demographically-weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection.Results. 23,889 exercises were completed by 3,054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared with interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs of marginalized communities (e.g. HIV and men who have sex with men). Conclusions. Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.

Relationship between internet research data of oral neoplasms and public health programs in the European Union

Background Tobacco and alcohol are the main risk factors for oral squamous cell carcinoma, the low survival rate of which is a public health problem. European-wide health policies (a prevention campaign, tobacco packaging) have been put in place to inform the population of the risks associated with consumption. Due to the increase in smoking among women, the incidence of this disease remains high. The identification of internet research data on the population could help to measure the impact of and better position these preventive measures. The objective was to analyze a potential temporal association between public health programs and interest in oral cancers on the internet in the European Union (EU). Methods A search of data from Google ©, Wikipedia © and Twitter © users in 28 European countries relating to oral cancer between 2004 and 2019 was completed. Bibliometric analysis of press and scientific articles over the same period was also performed. The association between these data and the introduction of public health programs in Europe was studied. Results There was a temporal association between changes in tobacco packaging and a significant increase in internet searches for oral cancer in seven countries. Unlike national policies and ad campaigns, the European awareness program Make Sense has had no influence on internet research. There was an asymmetric correlation in internet searches between publications on oral cancer from scientific articles or "traditional" media (weak association) and those from internet media such as Twitter © or Wikipedia © (strong association). Conclusion Our work highlights seven areas around which oral cancer awareness in Europe could be refocused, such as a change in the communication of health warnings on cigarette packs, the establishment of a more explicit campaign name regarding oral cancer, the involvement of public figures and associations in initiatives to be organized at the local level and the strengthening of awareness of the dangers of tobacco in the development of oral cancer.

State-Level Health Care Expenditures Associated With Disability

This study updated prior (2003) state-level estimates of disability-associated health care expenditures (DAHE). We combined 2013-2015 data from three national data sets to estimate using multivariate regression all state-level DAHE for US adults in total, by payer, and per adult and per (adult) person with disability (PWD). In 2015, DAHE were $868 billion nationally (State range, $1.4 billion to $102.8 billion) accounting for 36% of total health care expenditures (range, 29%-41%). From over a decade ago, total DAHE increased by 65% (range, 35%-125%). DAHE per PWD was $17,431 (range $12,603 to $27,839). From over a decade ago, per-PWD DAHE increased by 13% (range, –20% to 61%). In 2015, Medicare DAHE per PWD ranged from $10,067 to $18,768. Medicaid DAHE per PWD ranged from $9,825 to $43,365. DAHE are substantial and vary by state and payer. Stakeholders can use these results to develop public health programs to support people with disabilities.

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.

The Codification of a Professional: Addressing the Hidden Curriculum in Public Health

Health organizations and public health programs are responding to the current pandemic of racial violence through releasing statements condemning these actions. They recognize that to be a health professional means addressing the structuralized inequities leading to reduced health outcomes and increased violence for portions of our population. However, the written and unwritten codification and curriculum about professionalism and what it looks like leads to the very biases that perpetuate inequities. This commentary examines the disconnect between the hidden curriculum of professionalism and the way we enforce how a professional is supposed to look through dress codes and stipulations on hair as well as other elements of appearance. We will then look at ways to “make the invisible visible” and open up conversation in the classroom. In order to address equity and serve all their students, organizations and public health programs need to open space to discuss the parts of our culture that reinforce biases and how these issues affect their communities.

A scoping review of de-implementation frameworks and models

Background Reduction or elimination of inappropriate, ineffective, or potentially harmful healthcare services and public health programs can help to ensure limited resources are used effectively. Frameworks and models (FM) are valuable tools in conceptualizing and guiding the study of de-implementation. This scoping review sought to identify and characterize FM that can be used to study de-implementation as a phenomenon and identify gaps in the literature to inform future model development and application for research. Methods We searched nine databases and eleven journals from a broad array of disciplines (e.g., healthcare, public health, public policy) for de-implementation studies published between 1990 and June 2020. Two raters independently screened titles and abstracts, and then a pair of raters screened all full text records. We extracted information related to setting, discipline, study design, methodology, and FM characteristics from included studies. Results The final search yielded 1860 records, from which we screened 126 full text records. We extracted data from 27 articles containing 27 unique FM. Most FM (n = 21) were applicable to two or more levels of the Socio-Ecological Framework, and most commonly assessed constructs were at the organization level (n = 18). Most FM (n = 18) depicted a linear relationship between constructs, few depicted a more complex structure, such as a nested or cyclical relationship. Thirteen studies applied FM in empirical investigations of de-implementation, while 14 articles were commentary or review papers that included FM. Conclusion De-implementation is a process studied in a broad array of disciplines, yet implementation science has thus far been limited in the integration of learnings from other fields. This review offers an overview of visual representations of FM that implementation researchers and practitioners can use to inform their work. Additional work is needed to test and refine existing FM and to determine the extent to which FM developed in one setting or for a particular topic can be applied to other contexts. Given the extensive availability of FM in implementation science, we suggest researchers build from existing FM rather than recreating novel FM. Registration Not registered

Prevalence of Transfusion Transmissible Infections Among Blood Donors in South Khorasan Province, Iran: An 11-Year Study

Objectives: Transfusion transmissible infections are the most frequent complication of blood transfusions. This study was done to determine the prevalence of the hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis among blood donors at the South Khorasan Transfusion Center (SKBTC) in South Khorasan Province, Iran. This report is the first of its kind that has been performed in this region. Methods: A retrospective study was carried out on 165,267 blood donors at the SKBTC from 2006 to 2016. Data were analyzed on the metrics of donation status, age, gender, educational level, and serologic results for the infectious markers. Statistical analysis was performed using SPSS software (version 16.0). Results: The overall seroprevalence rates of HBV, HCV, and HIV infections per 100,000 donations were 247, 21, and 0.6, respectively. There was no positive donor for syphilis. HBV and HCV infections in first-time donors were present at significantly higher rates than in regular and repeat donors (P < 0.001 and P = 0.003, respectively). Although gender was not found to be significantly associated with HBV and HCV (P = 0.32), there was a significant relationship between younger age (P < 0.001) as well as lower educational level and hepatitis agents (P < 0.001). Moreover, being single evinced a significant association with HCV seropositivity (P = 0.001). Conclusions: This report found a decreased prevalence of TTIs relative to the most of previous reports. This decrease may have resulted from public health programs, improved donor selection, improved recruitment of repeat/regular donors, and the use of highly sensitive kits for the screening procedure.