Identifying SARS-CoV-2 regional introductions and transmission clusters in real time

The unprecedented SARS-CoV-2 global sequencing effort has suffered from an analytical bottleneck. Many existing methods for phylogenetic analysis are designed for sparse, static datasets and are too computationally expensive to apply to densely sampled, rapidly expanding datasets when results are needed immediately to inform public health action. For example, public health is often concerned with identifying clusters of closely related samples, but the sheer scale of the data prevents manual inspection and the current computational models are often too expensive in time and resources. Even when results are available, intuitive data exploration tools are of critical importance to effective public health interpretation and action. To help address this need, we present a phylogenetic summary statistic which quickly and efficiently identifies newly introduced strains in a region, resulting clusters of infected individuals, and their putative geographic origins. We show that this approach performs well on simulated data and is congruent with a more sophisticated analysis performed during the pandemic. We also introduce Cluster Tracker (https://clustertracker.gi.ucsc.edu/), a novel interactive web-based tool to facilitate effective and intuitive SARS-CoV-2 geographic data exploration and visualization. Cluster-Tracker is updated daily and automatically identifies and highlights groups of closely related SARS-CoV-2 infections resulting from inter-regional transmission across the United States, streamlining public health tracking of local viral diversity and emerging infection clusters. The combination of these open-source tools will empower detailed investigations of the geographic origins and spread of SARS-CoV-2 and other densely-sampled pathogens.

The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial

Background Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. Methods The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. Results There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). Conclusion Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. Trial registration: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir

The Nutritional Profile and On-Pack Marketing of Toddler-Specific Food Products Launched in Australia between 1996 and 2020

With the food system evolving, it is not clear how the nutrition and on-pack claims of toddler foods have been impacted. Data on the trends in Australia are lacking, so we sought to determine the changes in the nutrition and on-pack claims of toddler-specific packaged foods over time. A retrospective cross-sectional analysis was conducted using the Mintel Global New Products Database. The number of toddler-specific foods increased from 1996 to 2020. Over time, a lower proportion of meals and snacks were classified as “ultra-processed”, but a higher proportion of snacks were classified as “discretionary”. Meals launched after 2014 had higher median values for energy, saturated fat, and sugar than those in earlier years. Toddler snacks launched after 2014 had lower median values for sodium, and higher median values for fat, saturated fat, and sugar than those in earlier years. The mean number of total claims per package increased over time for snacks, with an increase in unregulated claims for both meals and snacks. Public health action is needed to ensure that the retail food environment for young children is health-promoting, including stringent and clear regulations for on-pack claims, and compositional guidelines and guidance on how to reduce the number of ultra-processed foods for toddlers.

Promoção da Saúde e Medicalização: Notas Inquietantes em Conversas de Foucault com Canguilhem

Este artigo visa problematizar práticas de promoção de saúde no Brasil, a partir da história da saúde pública no país, em uma analítica da medicalização e da gestão higienista do hospital, da cidade, dos pobres e do Estado. Busca-se pensar como emerge junto com a saúde na atenção básica um modo de gerir a política pública de saúde como tática medicalizante dos corpos, do espaço, do hospital, da comunidade e das relações sociais. Interroga-se no seguinte ensaio temático um conjunto de práticas que operam um mecanismo biopolítico e de governo da vida e das existências por meio de intensa medicalização na atuação preventivista da saúde. Portanto, questiona-se o estilo de vida saudável na sociedade contemporânea a partir de uma estratégia medicalizadora do direito à saúde com Michel Foucault e Georges Canguilhem.Palavras-chave: Saúde. Medicalização. Práticas. Biopolítica. Prevenção. Health Promotion And Medicalization: Disturbing Notes In Talk Of Foucault With CanguilhemABSTRACTThis article aims to problematize health promotion practices in Brazil, based on the history of public health in the country, in an analysis of medicalization and hygienist management of the hospital, the city, the poor and the State. It seeks to think about how a way to manage public health policy emerges together with health in primary care as a medicalizing tactic of bodies, space, hospital, community and social relations. in the following thematic essay a set of practices that operate a biopolitical and government mechanism of life and existences through intense medicalization in preventative health action. Therefore, the healthy lifestyle in contemporary society is questioned based on a medicalizing strategy of the right to health.Keywords: Health. Medicalization. Practices. Biopolitics. Prevention.

New UK Chapter of the Alliance for a Cavity-Free Future

The Alliance for a Cavity-Free Future (ACFF), started in 2010, has been based at King's College London since 2013. It is a dental caries-focused charity promoting integrated clinical and public health action. ACFF Chapters seek to improve caries prevention and management locally, based on best global evidence. The UK Chapter has been created in response to a continuing need combined with opportunities including the implementation of the latest UK version of the Delivering better oral health guidance on prevention (version 4). The Chapter has been formed through a coordinating committee with UKwide representation combining expertise in dental caries management across the patient life course. This committee co-created the Chapter Values Statement: 'in pursuit of a cavity-free future across the UK we value: collaboration and innovation; realistic and implementable prevention-based solutions; approaches that reduce health inequalities; action across both oral and general health settings; and working comprehensively from the population through to the individual level.' The agreed Chapter focus is on advocating for the implementation of appropriate, effective, pragmatic caries prevention and care across three themes: 1) in everyday dental practice; 2) in health and social care curricula; and 3) for vulnerable people across their life course on the basis of increased caries risk/susceptibility.

CHARM: COVID-19 Health Action Response for Marines – association of antigen-specific interferon-gamma and IL2 responses with asymptomatic and symptomatic infections after a positive qPCR SARS-CoV-2 test

SARS-CoV-2 T cell responses are associated with COVID-19 recovery, and Class I- and Class II-restricted epitopes have been identified in the spike (S), nucleocapsid (N) and membrane (M) proteins and others. This prospective COVID-19 Health Action Response for Marines (CHARM) study enabled assessment of T cell responses in symptomatic and asymptomatic SARS-CoV-2 infected participants. At enrollment all participants were negative by qPCR; follow-up occurred biweekly and then bimonthly for the next 6 weeks. Study participants who tested positive by qPCR SARS-CoV-2 test were asked to enroll in an immune response sub-study. FluoroSpot interferon-gamma (IFN-γ) and IL2 responses following qPCR-confirmed infection at enrollment (day 0), day 7 and 14 and more than 28 days later were measured using pools of 17mer peptides covering S, N, and M proteins, or CD4+CD8 peptide pools containing predicted epitopes from multiple SARS-CoV-2 antigens. Among 124 asymptomatic and 105 symptomatic participants, SARS-CoV-2 infection generated IFN-γ responses to the S, N and M proteins that persisted longer in asymptomatic cases. IFN-γ responses were significantly (p=0.001) more frequent to the N pool (51.4%) than the M pool (18.9%) among asymptomatic subjects; however, the difference was not statistically significant (p=0.06) for symptomatic subjects (N pool: 44.4%; M pool: 25.9%). In asymptomatic participants IFN-γ responders to the CD4+CD8 pool responded more frequently to the S pool (55.6%) and N pool (57.1%), than the M pool (7.1%), but symptomatic participants, IFN-γ responses were more frequent to the S pool (75.0%) than N pool (33.3%) and M pool (33.3%). The frequencies of IFN-γ responses to the S and N+M pools peaked 7 days after the positive qPCR test among asymptomatic (S pool: 22.2%; N+M pool: 28.7%) and symptomatic (S pool: 15.3%; N+M pool 21.9%) participants and dropped by >28 days. Magnitudes of post-infection IFN-γ and IL2 responses to the N+M pool were significantly correlated with IFN-γ and IL2 responses to the N and M pools. These data further support the central role of Th1-biased cell mediated immunity IFN-γ and IL2 responses, particularly to the N protein, in controlling COVID-19 symptoms, and justify T cell-based COVID-19 vaccines that include the N and S proteins.

Immunological and Genetic Investigation of SARS-CoV-2 Reinfection in an Otherwise Healthy, Young Marine Recruit

We used epidemiologic and viral genetic information to identify a case of likely reinfection in an otherwise healthy, young Marine recruit enrolled in the prospective, longitudinal COVID-19 Health Action Response for Marines (CHARM) study, and we paired these findings with serological studies. This participant had a positive RT-PCR to SARS-CoV-2 upon routine sampling on study day 7, although he was asymptomatic at that time. He cleared the infection within seven days. On study day 46, he had developed symptoms consistent with COVID-19 and tested positive by RT-PCR for SARS-CoV-2 again. Viral whole genome sequencing was conducted from nares swabs at multiple time points. The day 7 sample was determined to be lineage B.1.340, whereas both the day 46 and day 49 samples were B.1.1. The first positive result for anti-SARS-CoV-2 IgM serology was collected on day 49 and for IgG on day 91. This case appears most consistent with a reinfection event. Our investigation into this case is unique in that we compared sequence data from more than just paired specimens, and we also assayed for immune response after both the initial infection and the later reinfection. These data demonstrate that individuals who have experienced an infection with SARS-CoV-2 may fail to generate effective or long-lasting immunity, similar to endemic human beta coronaviruses.

Integrating mental health into primary care: Evaluating the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria, using the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) to treat common mental and neurological disorders in the primary care setting. This study evaluates the impact of the HAPPINESS pilot project training on trainees’ beliefs and attitudes about mental disorders and explores the perspectives of trainees, trainers, and health services officials on its implementation using a convergent, mixed-methods approach. Methods Trainees completed a 43-item questionnaire, before and after their 5-day training, to assess perceptions of mental disorders and attitudes towards people with mental illness. Paired-sample t-tests were conducted with respect to four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured Key Informant Interviews with trainees, trainers, and local health officials who participated in or supported the HAPPINESS Project were also analyzed. Findings from the questionnaire and interviews were merged using a convergent, mixed method approach. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. The HAPPINESS Project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Lastly, respondents suggested ways that the HAPPINESS Project could be improved and expanded in the future. Conclusion This study adds to the limited existing evidence on the impact of mhGAP-IG-based training for primary care workers in Nigeria. Notably, it quantitatively evaluates pre and post training change in stigma level among trainees. Future efforts should focus on clinical support, supervision and implementation outcomes as well as scaling up and assessing the cost-effectiveness of the HAPPINESS Project intervention.

The Study to Investigate COVID-19 Infection in People Living in Ireland (SCOPI): A seroprevalence study, June to July 2020

Background Robust data on SARS-CoV-2 population seroprevalence supplement surveillance data in providing evidence for public health action. Aim To conduct a SARS-CoV-2 population-based seroprevalence survey in Ireland. Methods Using a cross-sectional study design, we selected population samples from individuals aged 12–69 years in counties Dublin and Sligo using the Health Service Executive Primary Care Reimbursement Service database as a sampling frame. Samples were selected with probability proportional to the general population age–sex distribution, and by simple random sampling within age–sex strata. Antibodies to SARS-CoV-2 were detected using the Abbott Architect SARS-CoV-2 IgG Assay and confirmed using the Wantai Assay. We estimated the population SARS-CoV-2 seroprevalence weighted for age, sex and geographic area. Results Participation rates were 30% (913/3,043) and 44% (820/1,863) in Dublin and Sligo. Thirty-three specimens had detectable SARS-CoV-2 antibodies (1.9%). We estimated weighted seroprevalences of 3.12% (95% confidence interval (CI): 2.05–4.53) and 0.58% (95% CI: 0.18–1.38) for Dublin and Sligo, and 1.69% (95% CI: 1.13–2.41) nationally. This equates to an estimated 59,482 (95% CI: 39,772–85,176) people aged 12–69 years nationally having had infection with SARS-CoV-2, 3.0 (95% CI: 2.0–4.3) times higher than confirmed notifications. Ten participants reported a previous laboratory-confirmed SARS-CoV-2 -infection; eight of these were antibody-positive. Twenty-five antibody-positive participants had not reported previous laboratory-confirmed infection. Conclusion The majority of people in Ireland are unlikely to have been infected with SARS-CoV-2 by June–July 2020. Non-pharmaceutical public health measures remained key pending widespread availability of vaccination, and effective treatments.

Defining Priorities for Action and Research on the Commercial Determinants of Health: A Conceptual Review

In recent years, the concept of commercial determinants of health (CDoH) has attracted scholarly, public policy, and activist interest. To date, however, this new attention has failed to yield a clear and consistent definition, well-defined metrics for quantifying its impact, or coherent directions for research and intervention. By tracing the origins of this concept over 2 centuries of interactions between market forces and public health action and research, we propose an expanded framework and definition of CDoH. This conceptualization enables public health professionals and researchers to more fully realize the potential of the CDoH concept to yield insights that can be used to improve global and national health and reduce the stark health inequities within and between nations. It also widens the utility of CDoH from its main current use to study noncommunicable diseases to other health conditions such as infectious diseases, mental health conditions, injuries, and exposure to environmental threats. We suggest specific actions that public health professionals can take to transform the burgeoning interest in CDoH into meaningful improvements in health. (Am J Public Health. 2021;111(12):2202–2211. https://doi.org/10.2105/AJPH.2021.306491 )