Public Health Informatics in Global Health Surveillance: A Review

Background: Surveillance is the backbone for effective public health practice. Traditionally, surveillance system relies on the collection of information regarding health-related events through healthcare facilities, disease notification system from the physician, syndromic notification networks, selected sentinel healthcare facilities, or by event-based data. However, there are several limitations in using conventional surveillance. Methods: With the advancement of technology and computer science, overcoming those limitations and complementing the traditional method has been recommended. Three leading emerging technologies are applied in public health surveillance: the internet of things, artificial intelligence, and blockchain. Results: Application of informatics in public health surveillance could raise several issues including accessibility and affordability of innovations; public health informatics’ experts, law, and regulation to protect patients’ information; social and ethical considerations, norms, and standards of implementing new technologies; data ownership; privacy and sharing of information; biosecurity; biosafety; and cybersecurity. Conclusion: This article aimed to review several applications of informatics system in public health surveillance practice and its several issues related to the use of technology. Several applications of informatics could be useful for incoming challenges in public health. However, application of informatics can pose significant issues and must be taken into consideration in public health practice.

Patient and Citizen Participation in the Identification of Ethical Considerations Aiming to Address Uncertainty in the Evaluation of Promising Interventions in a Pandemic Context

Since the beginning of the COVID-19 pandemic, numerous studies have been conducted to identify interventions that could contribute to alleviating the burden it has caused. The Institut national d'excellence en santé et en services sociaux (INESSS) has played a key role in informing the government of Québec regarding the evaluation of specific pandemic-related interventions. This process took place in a context characterized by a sense of urgency to assess and recommend potential interventions that could save lives and reduce the effects of the disease on populations and healthcare systems, which increased the pressure on the regulatory agencies leading these evaluations. While some of the interventions examined were considered promising, results from COVID-19 studies often led to uncertainty regarding their efficacy or safety. Regulatory agencies evaluating the value of promising interventions thus face challenges in deciding whether these should be made available to the population, particularly when assessing their benefit-risk balance. To shed light on these challenges, we identified underlying ethical considerations that can influence such an assessment. A rapid literature review was conducted in February 2021, to identify the main challenges associated with the benefit-risk balance assessment of promising interventions. To reinforce our understanding of the underlying ethical considerations, we initiated a discussion among various social actors involved in critical thinking surrounding the evaluation of promising interventions, including ethicists, clinicians and researchers involved in clinical or public health practice, as well as patients and citizens. This discussion allowed us to create a space for exchange and mutual understanding among these various actors who contributed equally to the identification of ethical considerations. The knowledge and perspectives stemming from the scientific literature and those consulted were integrated in a common reflection on these ethical considerations. This allowed patients and citizens, directly affected by the evaluation of pandemic-related interventions and the resulting social choices, to contribute to the identification of the relevant ethical considerations. It also allowed for reflection on the responsibilities of the various actors involved in the development, evaluation, and distribution of promising interventions in a setting of urgency and uncertainty, such as that brought about by the COVID-19 pandemic.

Profiling the Variability and Inequity in the Residential Environment in Cyprus According to Citizens’ Ratings: A Cross-Sectional Internet-Based “Place Standard” Survey

Background The “Place Standard Tool” (PST) offers a practical framework for structuring conversations about physical and social dimensions of Place which can impact on health and well-being. While extensively used in the context of community engagement, its properties as a measurement tool haven’t been explored. Methods Under the auspices of the Cyprus Healthy Cities Office, an open call was addressed to citizens to rate their neighbourhood environment across the 14 PST items (1: large to 7: little room for improvement). Exploratory factor, cluster and regression analyses were used to explore the dimensionality of the scale, depict neighbourhood profiles and explore differences in ratings according to socio-demographic characteristics, area-level census indicators and residents’ assessment of neighbourhood social position on a 10-step ladder. Results With the exception of safety (M=4.4, SD=1.7), 492 participants (mean age 42, 50% residents for >10 years) from 254 postcodes (21.7% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control” and “public transport”. A stepwise pattern of dissatisfaction was observed along the social position continuum both for features rated less favourably as well as more favourably (e.g. social contact). For instance, among participants who placed their neighbourhood at the three top steps of the ladder 48.8% gave a low rating for “influence and sense of control”, while the equivalent figure was 81.0% at the bottom three steps (OR=4.5, 95% CI 2.3, 8.6). A clear dimensionality of Built (6 items, Cronbach’s α coefficient for internal consistency=0.798), Physical (3 items, α = 0.765), Social (2 items, α = 0.749) and Service (3 items, α = 0.58) environment was identified. A social gradient was evident according to objective census measures of socio-economic disadvantage (e.g. pre-1980 housing, single-parent households) with larger differences in terms of the built than the social environment. Conclusions The study profiled the variability and documented the inequity in the health-related neighbourhood environment across Cypriot communities. The readily interpretable dimensionality of the scale supports its construct validity, allowing calculation of composite scores. The PST can be used as measurement tool in research as well as public health practice to advocate for neighbourhood initiatives which support and enhance citizens’ participation.

Combining community wastewater genomic surveillance with state clinical surveillance: A framework for SARS-CoV-2 public health practice

Study objectiveTo garner a framework for combining community wastewater surveillance with state clinical surveillance that influence confirmation of SARS-CoV-2 variants within the community, and recommend how the flow of such research evidence could be expanded and employed for public health response.Design, setting, and participantsThis work involved analyzing wastewater samples collected weekly from 17 geographically resolved locations in Louisville/Jefferson County, Kentucky from February 10 to November 29, 2021. Genomic surveillance and RT-qPCR platforms were used as screening to identify SARS-CoV-2 in wastewater, and state clinical surveillance was used for confirmation.Main resultsThe results demonstrate increased epidemiological value of combining community wastewater genomic surveillance and RT-qPCR with conventional case auditing methods. The spatial scale and temporal frequency of wastewater sampling provides promising sensitivity and specificity to be useful to gain public health screening insights about community emergence, seeding, and spread.ConclusionsBetter national surveillance systems are needed for future pathogens and variants, and wastewater-based genomic surveillance represents opportune coupling. This paper presents current evidence that complementary wastewater and clinical testing is enhanced cost-effectively when linked; making a strong case for a joint public health framework. The findings suggest significant potential for rapid progress to be made in extending this work to consider pathogens of interest as a whole within wastewater, which could be examined in either a targeted fashion as we currently do with SARS-CoV-2 or in terms of a global monitoring of all pathogens found, and developing evidence based public health practice to best support community health.Thumbnail BoxWhat is already known on this subject?The primary approach for the genomic surveillance of SARS-CoV-2 relies on the sequencing of clinical COVID-19 samples. Variants of SARS-CoV-2 can also be tracked in community wastewater.What this study adds?We propose that, for comprehensive community surveillance, the first line of community pathogen screening should involve geographically-resolved wastewater samples collected at a regular frequency and employ both Next Generation Sequencing (NGS) and RT-qPCR. These results could then be compared with state clinical surveillance. This framework is a more comprehensive and cost-effective approach for surveillance in practice to catch community emergence, seeding, and spread.Policy implicationsOur results present a framework that could support the implementation of better surveillance policies directed to solve future community pathogen and variant detection. We anticipate this work can help public health officials implement rational community sampling schemes and develop sensible coordination with other clinical surveillance. The utility of this for COVID-19 extends to many other infectious disease models and other public health hazards such as toxic exposures.

Invisible Spread and Perceived Stress Amidst COVID-19

Aims. To characterize the self-reported stress of participants and examine the relation between potential for asymptomatic spread and perceived stress. Methods. Enrollment of 461 participants occurred from May 4-May 22, 2020. The sample participants were predominantly women (69.6%). On average, participants were 44.9 years of age (SD = 14.6). Measures employed included the perceived stress scale-10 and a comprehensive COVID-19 questionnaire. Results. Worry about asymptomatic spread was significantly associated with greater perceived stress (p<0.001). Higher stress was reported among individuals who were women (p<0.001), Hispanic/Latinx (p=0.001), and non-Black/African American individuals (p<0.001), and those reporting the presence of COVID-19 symptoms (p=0.001). Conclusions. The COVID-19 pandemic has caused significant economic, social, health, and other disruptions around the world. Distress is significantly related to concern over unintentionally contributing to the spread of SARS-CoV-2 through asymptomatic transmission. Future research should characterize the modifiable psychotherapeutic processes that might be targeted through intervention. Keywords. COVID-19/prevention and control, Humans, Psychological Distress, Asymptomatic Viral Shedding, Pandemics, Public Health Practice, Public Policy

Farm living and risk of asthma, atopic eczema, respiratory and food allergy: protocol for a systematic review and meta-analysis

IntroductionAsthma and allergic disorders are of global concern and risk for their development results from the interplay of genetic and environmental factors. Among numerous environmental factors identified to influence the disease risk, the role of exposure to a farming environment has gained interest in recent times, but the underlying evidence is conflicting. The review aims to comprehensively identify, critically appraise and synthesise evidence from studies investigating the association between farm living and risk of asthma and allergic diseases in children and adults.Methods and analysisWe will identify relevant analytical observational epidemiological studies, including cross-sectional, case-control and cohort studies, by searching PubMed, Cochrane Library, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Global Health Library, Web of Science, Scopus and Embase. Screening of identified records, data extraction from eligible studies and risk of bias assssment of eligible studies will be independently undertaken by two reviewers, with arbitration by a third reviewer. The Effective Public Health Practice Project will be employed for the risk of bias assessment. Estimates from studies judged to be clinically, methodologically and statistically homogeneous will be synthesised using random-effects meta-analysis. Heterogeneity will be assessed using the I-squared statistic. We will consider objectively measured or self-reported asthma, atopic dermatitis/eczema, allergic rhinitis, wheeze, and food allergy as primary outcomes.Ethics and disseminationAs this study is based solely on the published literature, no ethics approval is required. The study findings will be presented at scientific meetings related to the field of asthma and allergy and will be published in an international peer-reviewed scientific journal.PROSPERO registration numberCRD42020208805.