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public health - Top 30 Publications

Consumer use and response to online third-party raw DNA interpretation services.

With the availability of raw DNA generated from direct-to-consumer (DTC) testing companies, there has been a proliferation of third-party online services that are available to interpret the raw data for both genealogy and/or health purposes. This study examines the current landscape and downstream clinical implications of consumer use of third-party services.

10 best resources on power in health policy and systems in low- and middle-income countries.

Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We undertook a two-stage process to identify these resources. First, we conducted a collaborative exercise involving crowdsourcing and participatory validation, resulting in 24 proposed articles. Second, we conducted a structured literature review in four phases, resulting in 38 articles reviewed. We present the 10 selected resources in the following categories to bring out key facets of the literature on power and health policy and systems-(1) Resources that provide an overarching conceptual exploration into how power shapes health policy and systems, and how to investigate it; and (2) examples of strong empirical work on power and health policy and systems research representing various levels of analyses, geographic regions and conceptual understandings of power. We conclude with a brief discussion of key gaps in the literature, and suggestions for additional methodological approaches to study power.

Specialized pro-resolving lipid mediators regulate ozone-induced pulmonary and systemic inflammation.

Exposure to ozone (O3) induces lung injury, pulmonary inflammation, and alters lipid metabolism. During tissue inflammation, specialized pro-resolving lipid mediators (SPMs) facilitate the resolution of inflammation. SPMs regulate the pulmonary immune response during infection and allergic asthma; however, the role of SPMs in O3-induced pulmonary injury and inflammation is unknown. We hypothesized that O3 exposure induces pulmonary inflammation by reducing SPMs. To evaluate this, male C57Bl/6J mice were exposed to filtered air (FA) or 1 ppm O3 for 3h and necropsied 24h after exposure. Pulmonary injury/inflammation was determined by bronchoalveolar lavage (BAL) differentials, protein, and lung tissue cytokine expression. SPMs were quantified by liquid chromatography tandem mass spectrometry and SPM receptors leukotriene B4 receptor 1 (BLT-1), formyl peptide receptor 2 (ALX/FPR2), chemokine-like receptor 1 (ChemR23), and SPM-generating enzyme (5-LOX and 12/15-LOX) expression were measured by real time PCR. 24h post-O3 exposure, BAL PMNs and protein content were significantly increased compared to FA controls. O3-induced lung inflammation was associated with significant decreases in pulmonary SPM precursors (14-HDHA, 17-HDHA), the SPM PDX, and in pulmonary ALX/FPR2, ChemR23 and 12/15-LOX expression. Exogenous administration of 14-HDHA, 17-HDHA, and PDX 1h prior to O3 exposure rescued pulmonary SPM precursors/SPMs, decreased proinflammatory cytokine and chemokine expression, and decreased BAL macrophages and PMNs. Taken together, these data indicate that O3-mediated SPM reductions may drive O3-induced pulmonary inflammation.

The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention.

As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.

Cypermethrin Promotes Lung Cancer Metastasis via Modulation of Macrophage Polarization by Targeting MicroRNA-155/Bcl6.

Cypermethrin (CYM), a type II pyrethroid, is widely used as an insecticide for agriculture and household. Cumulative evidence indicates that acute and chronic exposure to CYM might cause a number of health problems, such as cancer and neuronal system diseases. However, the molecular mechanism underlying this pathology is not known. The main objective of our study was to define the effects of CYM on macrophages and the implication of such effects in cancer metastasis and the potential mechanism involved. The effects of CYM on the macrophages were evaluated by detecting the expression of M1 and M2 macrophage polarization markers through ELISA, quantitative RT-PCR and Western blot assay. Transwell and wound healing assay were used to test the migration of lung cancer cells after exposure to CYM in vitro and a metastasis animal model in vivo. Treatment with CYM significantly suppressed lipopolysaccharide (LPS)-induced M1 macrophage polarization and promoted a shift toward M2 macrophage status. Mechanistically, CYM downregulated miR-155 significantly, leading to enhanced expression of its target gene Bcl6, thereby reducing the expression of Mitogen-activated protein kinase kinase 4 (MKK4), an upstream kinase of c-Jun N-terminal kinases (JNK), and inhibiting JNK activation. Impaired JNK activation thus promoted a shift in macrophage polarization from the M1 to the M2 phenotype. Finally, CYM-treated macrophages promoted metastasis of Lewis lung cancer cells in both in vitro and in vivo models. Taken together, our findings show that CYM is able to inhibit the M1 polarization and promote the macrophages to the M2 phenotype, which plays an important role in tumor metastasis.

Reproducibility of work ability and work functioning instruments.

Work ability (WA) and work functioning (WF) instruments can be useful in occupational health practice. The reproducibility of both instruments is important to their relevance for daily practice. Clinimetrics concerns the methodological and statistical quality of instruments and their performance in practice.

Effect of exposure to second-hand smoke from husbands on biochemical hyperandrogenism, metabolic syndrome and conception rates in women with polycystic ovary syndrome undergoing ovulation induction.

Does second-hand smoke (SHS) exposure from husbands have adverse effects on sex hormones, metabolic profiles, clinical phenotypes and fertility outcomes in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction?

Anodyne by Design; Measuring the Prevalence of Esoteric Designer Opioids in Pain Management Patients.

The recent increase in illicit opioids sold on the black market, cut into heroin and masqueraded as prescription pills prompts a significant public health concern. Most designer opioids possess unknown potencies and unknown pharmacokinetics and their unregulated, variable dosages lead to rashes of overdoses. Additionally, many of the designer opioids, especially the fentanyl analogs are significantly more potent than heroin. High-profile cases involving overdoses of U-47700 and carfentanil have been reported in the media; however, the true prevalence of these and other designer opioids is unknown. Independent LC-MS-MS screen and confirmation methods have been developed and validated to identify and quantify fentanyl, and 18 designer opioids and their metabolites; methods were then exercised on urine specimens from contract pain management clients. Assuming patients in a pain management program may have a higher probability to seek out self-medication, samples from pain management patients were investigated for designer opioids. Similarly, pain management patients identified as using heroin may be more likely to experiment with or be accidentally exposed to designer opioids, specimens screening positive for the heroin metabolite 6-acetylmorphine were specifically chosen for designer opioid screening. Within this small group of pain management and heroin-positive samples, nine designer opioids were detected at a total prevalence of 25%. When screening random pain management samples not positive for heroin, a considerably lower percentage of samples (<1%) were identified as positive for designer opioids. Furanyl fentanyl, fluorobutyryl fentanyl and acetylfentanyl were the most prevalent designer opioids detected in both test groups.

Should acute Q-fever patients be screened for valvulopathy to prevent endocarditis?

Echocardiographic screening of acute Q-fever patients and antibiotic prophylaxis for patients with cardiac valvulopathy are considered an important approach to prevent chronic Q-fever-related endocarditis. During a large Q-fever epidemic in the Netherlands, routine screening echocardiography was discontinued, raising controversy in the international literature. We followed a cohort of acute Q-fever patients to estimate the risk for developing chronic Q-fever, and we evaluated the impact of screening in patients who were not yet known to have a valvulopathy.

A study of the knowledge, attitudes and practices of Tibetan yak herders with respect to brucellosis.

Little information is available regarding the knowledge, attitudes and practices (KAP) of the owners of yaks in Tibet with respect to brucellosis.

Family Medicine Clinic: a case study of a hospital-family medicine practice redesign to improve chronic disease care in the community in Singapore.

Singapore's health care system is strained by the health care needs of a rapidly aging population. The unprecedented collaboration between a public hospital and a private family practice to set up the Family Medicine Clinic (FMC) to co-manage patients with chronic disease is an example of efforts to shift care to the community.

Seasonal Effects and the Impact of In-Hive Pesticide Treatments on Parasite, Pathogens, and Health of Honey Bees.

Honey bee, Apis mellifera (L.; Hymenoptera: Apidae), populations are in decline and their losses pose a serious threat for crop pollination and food production. The specific causes of these losses are believed to be multifactorial. Pesticides, parasites and pathogens, and nutritional deficiencies have been implicated in the losses due to their ability to exert energetic stress on bees. While our understanding of the role of these factors in honey bee colony losses has improved, there is still a lack of knowledge of how they impact the immune system of the honey bee. In this study, honey bee colonies were exposed to Fumagilin-B, Apistan (tau-fluvalinate), and chlorothalonil at field realistic levels. No significant effects of the antibiotic and two pesticides were observed on the levels of varroa mite, Nosema ceranae (Fries; Microsporidia: Nosematidae), black queen cell virus, deformed wing virus, or immunity as measured by phenoloxidase and glucose oxidase activity. Any effects on the parasites, pathogens, and immunity we observed appear to be due mainly to seasonal changes within the honey bee colonies. The results suggest that Fumagilin-B, Apistan, and chlorothalonil do not significantly impact the health of honey bee colonies, based on the factors analyzed and the concentration of chemicals tested.


Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit.

Personal protective equipment (PPE) protects healthcare workers (HCWs) caring for patients with Ebola virus disease (EVD), and PPE doffing is a critical point for preventing viral self-contamination. We assessed contamination of skin, gloves, and scrubs after doffing Ebola-level PPE contaminated with surrogate viruses: bacteriophages MS2 and Φ6.

Commentary: Beyond child survival: public policy priorities for avoiding premature adult mortality.

Cohort Profile: Maternal mental health and child development in situations of past violent conflict and ongoing adversity: the DILI birth cohort study.

A registry for patients with asplenia/hyposplenism reduces the risk of infections with encapsulated organisms.

Overwhelming post-splenectomy infection (OPSI) is a serious complication of asplenia. Clinical guidelines recommend a number of measures to reduce the risk of OPSI, but awareness and adherence to preventative measures is generally poor. We aimed to determine whether a registry for asplenic/hyposplenic patients was associated with a reduction in the incidence of infection with encapsulated bacteria.

Effect of lemon leaves on energy and C-N balances, methane emission, and milk performance in Murciano-Granadina dairy goats.

The objective of this experiment was to find out the effect of lemon leaves on energy and C-N balances, methane emission, and milk performance in dairy goats. Lemon leaves were used to replace alfalfa as forage in a diet for Murciano-Granadina goats. Ten Murciano-Granadina dairy goats (44.1 ± 4.47 kg of BW) in late lactation (185 ± 7.2 d) were selected in a crossover design experiment, where each goat received two treatments in 2 periods. One group was fed a mixed ration with 450 g of pelleted alfalfa/kg of DM (ALF diet) and, the other group replaced alfalfa with 450 g of pelleted lemon leaves/kg DM (LEM diet). The concentrate was pelleted, being the same for the two groups (forage to concentrate ratio was 45/55). The goats were allocated to individual metabolism cages. After 14 days of adaptation, feed intake, total fecal and urine output and milk yield were recorded daily over a 5 d period. Then, gas exchange measurements were recorded individually by an open-circuit indirect calorimetry system using a head box. Higher dietary lipids in LEM diet reduced DMI (200 g/d) and energy intake (251 kJ/kg of BW0.75), although no differences between treatments were observed for ME intake (998 kJ/kg of BW0.75, on average) and oxidation of nutrients (64% and 25% for carbohydrates and fat oxidation respectively, on heat production from oxidation basis). Greater (P < 0.05) milk fat values for C18:2n6t and CLA 9c11t + 9t11c were found in LEM compared to ALF diet. Goats fed LEM diet produced significantly fewer CH4 emissions than ALF diet (18%). Likewise, the use of lemon leaves as forage reduced the amount of CH4 in 2.7 g/ kg of milk. Results suggest lemon leaves are effective in reducing CH4 emission without detrimental effect on milk yield.

Poor immunogenicity, not vaccine strain egg adaptation, may explain the low H3N2 influenza vaccine effectiveness in 2012-13.

Influenza vaccination aims to prevent infection by influenza virus and reduce associated morbidity and mortality; however, vaccine effectiveness (VE) can be modest, especially for subtype A(H3N2). Low VE has been attributed to mismatches between the vaccine and circulating influenza strains and to the vaccine's elicitation of protective immunity in only a subset of the population. The low H3N2 VE in the 2012-2013 season was attributed to egg-adaptive mutations that created antigenic mismatch between the actual vaccine strain (IVR-165) and both the intended vaccine strain (A/Victoria/361/2011) and the predominant circulating strains (clades 3C.2 and 3C.3).

Gendered Pathways to Burnout: Results from the SALVEO Study.

Burnout is a pervasive mental health problem in the workforce, with mounting evidence suggesting ties with occupational and safety outcomes such as work injuries, critical events and musculoskeletal disorders. While environmental [work and non-work, work-to-family conflict (WFC)] and individual (personality) pathways to burnout are well documented, little is known about how gender comes to influence such associative patterns. The aim of the study consisted in examining gendered pathways to burnout.

Coaching primary care clinics for HPV vaccination quality improvement: Comparing in-person and webinar implementation.

State health departments commonly use quality improvement coaching as an implementation strategy for improving low human papillomavirus (HPV) vaccination coverage, but such coaching can be resource intensive. To explore opportunities for improving efficiency, we compared in-person and webinar delivery of coaching sessions on implementation outcomes, including reach, acceptability, and delivery cost. In 2015, we randomly assigned 148 high-volume primary care clinics in Illinois, Michigan, and Washington State to receive either in-person or webinar coaching. Coaching sessions lasted about 1 hr and used our Immunization Report Card to facilitate assessment and feedback. Clinics served over 213,000 patients ages 11-17. We used provider surveys and delivery cost assessment to collect implementation data. This report is focused exclusively on the implementation aspects of the intervention. More providers attended in-person than webinar coaching sessions (mean 9 vs. 5 providers per clinic, respectively, p = .004). More providers shared the Immunization Report Card at clinic staff meetings in the in-person than webinar arm (49% vs. 20%; p = .029). In both arms, providers' belief that their clinics' HPV vaccination coverage was too low increased, as did their self-efficacy to help their clinics improve (p < .05). Providers rated coaching sessions in the two arms equally highly on acceptability. Delivery cost per clinic was $733 for in-person coaching versus $461 for webinar coaching. In-person and webinar coaching were well received and yielded improvements in provider beliefs and self-efficacy regarding HPV vaccine quality improvement. In summary, in-person coaching cost more than webinar coaching per clinic reached, but reached more providers. Further implementation research is needed to understand how and for whom webinar coaching may be appropriate.

Pro: The rationale for dietary therapy for patients with advanced chronic kidney disease.

Dietary treatment offers many benefits to patients with advanced chronic kidney disease (CKD) who are approaching the need for renal replacement therapy. A large number of these benefits are independent of whether diets slow the rate of progression of CKD. These diets are low in protein and many minerals, and provide adequate energy for the CKD patient. The diets can reduce accumulation of potentially toxic metabolic products derived from protein and amino acid degradation, maintain a healthier balance of body water, sodium, potassium, phosphorus, calcium and other minerals, and prevent or improve protein-energy wasting. Such diets may enable patients to safely delay the onset of chronic dialysis therapy or kidney transplantation. Dietary therapy may also augment the effectiveness of infrequent or incremental dialysis by maintaining healthier metabolic and clinical status and may enable some end-stage renal disease patients to avoid the need for temporary placement of hemodialysis catheters while their arterial venous fistulae or grafts mature. The anxiety that many advanced CKD patients commonly experience with regard to starting dialysis may incentivize them to accept and adhere to dietary therapy.

Effects of resistance training, endurance training and whole-body vibration on lean body mass, muscle strength and physical performance in older people: a systematic review and network meta-analysis.

A variety of different types of exercise are promoted to improve muscle strength and physical performance in older people.

Protecting the Community through Child Vaccination.

The direct impact of vaccines upon children is well described, but the major public health impact of indirect protection provided to the community by vaccines is under-appreciated. Community protection occurs when vaccinated people block the chain of transmission, protecting undervaccinated or unvaccinated susceptible community members by preventing exposure and limiting the spread of the pathogen through the community. Substantial declines in disease incidence have occurred shortly after implementing new childhood vaccines, including declines among vaccine-ineligible children, adolescents, and adults. Protection of susceptible community members depends on maintaining high vaccination rates. Improved recognition of community protection will strengthen childhood vaccination strategies that will protect our communities into the future.

Relation of Sex Hormone Levels with Prevalent and 10-year Change in Aortic Distensibility Assessed by MRI: The Multi-Ethnic Study of Atherosclerosis.

Women experience a steeper decline in aortic elasticity related to aging compared to men. We examined whether sex hormone levels were associated with ascending aortic distensibility (AAD) in the Multi-Ethnic Study of Atherosclerosis.

Development of a health assessment instrument for people with intellectual disabilities: a Delphi study.

People with intellectual disabilities (IDs) experience health inequalities. Applying health assessments is one way of diminishing these inequalities. A health assessment instrument can support general practitioners (GPs) in providing better medical care to people with ID.

Effectiveness of Seven and Thirteen Valent Pneumococcal Conjugate Vaccines in a Schedule without a Booster dose: a Ten Year Observational Study.

Uniquely among high income countries, Australia uses a 3+0 schedule (3 primary doses; no booster) for infant pneumococcal conjugate vaccine since January 2005, initially 7-valent (PCV7) then 13-valent (PCV13) from July 2011. We measured vaccine effectiveness (VE) of both PCVs against invasive pneumococcal disease (IPD) by two methods.

GWAS Identifies Two Novel Colorectal Cancer Loci at 16q24.1 and 20q13.12.

Colorectal cancer is the fourth leading cause of cancer mortality worldwide. Genome-wide association studies (GWAS) identified more than 50 colorectal cancer loci. However, most of the previous studies were conducted in European populations, and host genetic factors among Japanese population are largely remained to be identified. To identify novel loci in the Japanese population, here, we performed a large-scale GWAS using 6,692 cases and 27,178 controls followed by a replication analysis using more than 11,000 case-control samples. We found the significant association of ten loci (P < 5 x 10-8), including two novel loci on 16q24.1 (IRF8-FOXF1, rs847208, P = 3.15 x 10-9 and odds ratio = 1.107 with 95% confidence interval (CI) of 1.071-1.145) and 20q13.12 (TOX2, rs6065668, P = 4.47 x 10-11 and odds ratio = 0.897 with 95% CI of 0.868-0.926). Moreover, 35 previously reported SNPs in 24 regions were validated in the Japanese population (p < 0.05) with the same risk allele as in the previous studies. SNP rs6065668 was significantly associated with TOX2 expression in the sigmoid colon. In addition, nucleotide substitutions in the regulatory region of TOX2 were predicted to alter the binding of several transcription factors, including KLF5. Our findings elucidate the important role of genetic variations in the development of colorectal cancer in the Japanese population.

Predicting user adherence to behavioral eHealth interventions in the real world: examining which aspects of intervention design matter most.

Existing frameworks have identified a range of intervention design features that may facilitate adherence to eHealth interventions; however, empirical data are lacking on whether intervention design features can predict user adherence in the real world-where the public access available tools-and whether some design aspects of behavioral eHealth interventions are more important than others in predicting adherence. This study examined whether intervention design qualities predict user adherence to behavioral eHealth interventions in real-world use and which qualities matter the most. We correlated the online activities of users of 30 web-based behavioral interventions-collected from a proprietary data set of anonymized logs from consenting users of Microsoft Internet Explorer add-on-with interventions' quality ratings obtained by trained raters prior to empirical examination. The quality ratings included: Usability, Visual Design, User Engagement, Content, Therapeutic Persuasiveness (i.e., persuasive design and incorporation of behavior change techniques), and Therapeutic Alliance. We found Therapeutic Persuasiveness (i.e., the incorporation of persuasive design/behavior change principles) to be the most robust predictor of adherence (i.e., duration of use, number of unique sessions; 40 ≤ rs ≤ .58, ps ≤ .005), explaining 42% of the variance in user adherence in our regression model. Results indicated up to six times difference in the percentage of users utilizing the interventions for more than a minimum amount of time and sessions based on Therapeutic Persuasiveness. Findings suggest the importance of persuasive design and behavior change techniques incorporation during the design and evaluation of digital behavioral interventions.

Ethics, effectiveness and population health information interventions: a Canadian analysis.

Population health information interventions (PHIIs) use information in efforts to promote health. PHIIs may push information to a target audience (communication), pull information from the public (surveillance), or combine both in a bidirectional intervention. Although PHIIs have often been framed as non-invasive and ethically innocuous, in reality they may be intrusive into people's lives, affecting not only their health but their senses of security, respect, and self-determination. Ethical acceptability of PHIIs may have impacts on intervention effectiveness, potentially giving rise to unintended consequences. This article examines push, pull, and bidirectional PHIIs using empirical data from an ethnographic study of young mothers in Greater Vancouver, Canada. Data were collected from October 2013 to December 2014 via naturalistic observation and individual interviews with 37 young mothers ages 16-22. Transcribed interviews and field notes were analyzed using inductive qualitative thematic analysis. Both push and pull interventions were experienced as non-neutral by the target population, and implementation factors on a structural and individual scale affected intervention ethics and effectiveness. Based on our findings, we suggest that careful ethical consideration be applied to use of PHIIs as health promotion tools. Advancing the 'ethics of PHIIs' will benefit from empirical data that is informed by information and computer science theory and methods. Information technologies, digital health promotion services, and integrated surveillance programs reflect important areas for investigation in terms of their effects and ethics. Health promotion researchers, practitioners, and ethicists should explore these across contexts and populations.