RESUMO
BACKGROUND: Infectious diseases persistently pose global threats, and it is imperative to accelerate the professionalization of public health workforce. This study aimed to develop and validate the infectious disease control competency scale (IDCCS) for public health professionals to fill a theoretical gap and elevate practical capabilities by informing public health professionals' development goals. METHODS: The initial item pool was generated through a literature review, and categorized into three dimensions (knowledge, practical skills, and leadership) based on the competency iceberg model and public health leadership framework. A two-round Delphi process was conducted to determine indicators within the scale. A pilot survey was utilized for item analysis and exploratory factor analysis (EFA). A formal survey was employed for confirmatory factor analysis (CFA). The weight value of each indicator was calculated using the analytic hierarchy process. RESULTS: An initial scale with three primary items, 14 secondary items, and 81 tertiary items was generated. Twenty experts participated in the two rounds of the Delphi process. Authority coefficients exceeded 0.9 in both rounds. Kendall's W was 0.29 and 0.19, respectively (both P < 0.001). Item analysis presented a Cronbach's Alpha of 0.98, with corrected item-total correlation coefficients ranging from 0.33 to 0.78. EFA demonstrated that cumulative variance explanations for the four primary dimensions (knowledge, practical skills, leadership, and personal quality) were 77.463%, 73.976%, 81.174%, and 68.654%, respectively. CFA indicated that all composite reliability values and average variance extracted surpassed 0.8 and 0.5, respectively. The standardized factor loadings of the items ranged from 0.630 to 0.977. Among the seven model fit indices, each of the four dimensions satisfied at least five criteria. A final three-level scale comprising four primary items, 14 secondary items, and 64 tertiary items was constructed. The weight values for the four primary items were 0.4064, 0.2878, 0.2082, and 0.0981, respectively. CONCLUSIONS: The IDCCS was established to evaluate the competencies of knowledge, practical skills, leadership, and personal quality for public health professionals in infectious disease control. This scale demonstrates good reliability and validity, and can be used for performance evaluation, recruitment processes, curriculum development, and individual self-assessment.
Assuntos
Técnica Delphi , Humanos , Competência Profissional/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Liderança , Saúde Pública/estatística & dados numéricos , Inquéritos e Questionários , Pessoal de Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Reprodutibilidade dos Testes , Adulto , Feminino , MasculinoRESUMO
Traditional public health surveillance efforts are generally based on self-reported data. Although well validated, these methods may nevertheless be subjected to limitations such as biases, delays, and costs or logistical challenges. An alternative is the use of smart technologies (eg, smartphones and smartwatches) to complement self-report indicators. Having embedded sensors that provide zero-effort, passive, and continuous monitoring of health variables, these devices generate data that could be leveraged for cases in which the data are related to the same self-report metric of interest. However, some challenges must be considered when discussing the use of mobile health technologies for public health to ensure digital health equity, privacy, and best practices. This paper provides, through a review of major Canadian surveys and mobile health studies, an overview of research involving mobile data for public health, including a mapping of variables currently collected by public health surveys that could be complemented with self-report, challenges to technology adoption, and considerations on digital health equity, with a specific focus on the Canadian context. Population characteristics from major smart technology brands-Apple, Fitbit, and Samsung-and demographic barriers to the use of technology are provided. We conclude with public health implications and present our view that public health agencies and researchers should leverage mobile health data while being mindful of the current barriers and limitations to device use and access. In this manner, data ecosystems that leverage personal smart devices for public health can be put in place as appropriate, as we move toward a future in which barriers to technology adoption are decreasing.
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Saúde Pública , Telemedicina , Humanos , Canadá , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Telemedicina/estatística & dados numéricos , Telemedicina/tendências , Saúde Digital/estatística & dados numéricos , Saúde Digital/tendênciasRESUMO
CONTEXT: The Public Health 3.0 (PH3.0) framework encourages local health departments (LHDs) to address the social determinants of health (SDOHs) that impact health equity. OBJECTIVE: This study sought to understand how often LHDs are working to address SDOH, which SDOHs are most often being addressed, as well as the mix of strategies that have been proposed to address this work. DESIGN: We reviewed recent Community Health Improvement Plans (CHIPs) to analyze the current involvement of LHDs in addressing SDOH. SETTING: CHIPs published from 2020. PARTICIPANTS: Accredited LHDs from across the United States (n = 80). MAIN OUTCOME MEASURES: We developed a qualitative guidebook to characterize CHIP strategies based on the SDOH domain they addressed and the strategic mechanism they proposed. RESULTS: Across our entire sample, CHIPs were roughly 1.5 times more likely to address Health Care Access than Food Insecurity and Access to Healthy Food (65%), Neighborhood Infrastructure (61%), or Affordable Housing (65%), and they were 3 to 4 times more likely to address Health Care Access than Safe Housing (23%), Education Access and Quality (31%), or Economic Stability (24%). Across all major domains, a few concerned policy changes and a handful focused on improving systems or developing the built environment. Most strategies focused on service provision through events or the education of the public and professionals on health-related topics. CONCLUSIONS: The results of this study demonstrate that not all SDOHs are addressed equally by LHDs within their CHIPs. There is significant variation in how SDOHs are addressed along at 2 dimensions: first, in the likelihood that a CHIP addresses the domain and, second, in the mechanism by which each domain is addressed. Practically, the list of strategies we documented from the 80 CHIPs included in our sample may serve as the basis for strategies that other communities may wish to consider when addressing SDOH.
Assuntos
Saúde Pública , Determinantes Sociais da Saúde , Determinantes Sociais da Saúde/estatística & dados numéricos , Humanos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Governo Local , Estados UnidosAssuntos
Detecção Precoce de Câncer , Neoplasias da Próstata , Grupos Raciais , Humanos , Masculino , Detecção Precoce de Câncer/ética , Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/ética , Programas de Rastreamento/estatística & dados numéricos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/etnologia , Saúde Pública/ética , Saúde Pública/estatística & dados numéricos , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Grupos Raciais/estatística & dados numéricos , IncidênciaRESUMO
This Medical News article is an interview with US Surgeon General Vivek Murthy, MD, MBA, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about a new advisory that declares gun violence a public health crisis.
Assuntos
Violência com Arma de Fogo , Saúde Pública , Humanos , Armas de Fogo/legislação & jurisprudência , Violência com Arma de Fogo/prevenção & controle , Violência com Arma de Fogo/estatística & dados numéricos , Violência com Arma de Fogo/tendências , Homicídio/prevenção & controle , Homicídio/estatística & dados numéricos , Homicídio/tendências , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/prevenção & controle , Ferimentos por Arma de Fogo/epidemiologiaRESUMO
CONTEXT: Population health rankings can be a catalyst for the improvement of health by drawing attention to areas in need of relative improvement and summarizing complex information in a manner understood by almost everyone. However, ranks also have unintended consequences, such as being interpreted as "hard truths," where variations may not be significant. There is a need to improve communication about uncertainty in ranks, with accurate interpretation. The most common solutions discussed in the literature have included modeling approaches to minimize statistical noise or borrow strength from covariates. However, the use of complex models can limit communication and implementation, especially for broad audiences. OBJECTIVES: Explore data-informed grouping (cluster analysis) as an easier-to-understand, empirical technique to account for rank imprecision that can be effectively communicated both numerically and visually. DESIGN: Cluster analysis, specifically k-means clustering with Wasserstein (earth mover's) distance, was explored as an approach to identify natural and meaningful groupings and gaps in the data distribution for the County Health Rankings' (CHR) health outcomes ranks. SETTING: County-level health outcomes from the 2022 CHR. PARTICIPANTS: 3082 counties that were ranked in the 2022 CHR. MAIN OUTCOME MEASURE: Data-informed health groups. RESULTS: Cluster analysis identified 30 health groupings among counties nationwide, with cluster size ranging from 9 to 184 counties. On average, states had 16 identified clusters, ranging from 3 in Delaware and Hawaii to 27 in Virginia. Number of clusters per state was associated with number of counties per state and population of the state. The method helped address many of the issues that arise from providing rank estimates alone. CONCLUSIONS: Public health practitioners can use this information to understand uncertainty in ranks, visualize distances between county ranks, have context around which counties are not meaningfully different from one another, and compare county performance to peer counties.
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Saúde da População , Humanos , Análise por Conglomerados , Saúde da População/estatística & dados numéricos , Estados Unidos , Saúde Pública/métodos , Saúde Pública/normas , Saúde Pública/estatística & dados numéricosRESUMO
OBJECTIVE: Recent shifts in public health (PH) include consistent budget cuts, workforce attrition, and loss of vital skills and institutional knowledge followed by heightened pandemic-driven attention, new responsibilities, and renewed funding. This study investigates whether frontline employees working in different types of public health departments have different educational characteristics and whether these characteristics are associated with differentials in skill gaps toward informing targeted interventions to nurture a competitive workforce. METHODS: Utilizing 2021 Public Health Workforce Interests and Needs Survey (PH WINS) data, we document variations in educational qualifications, skill gaps, and workforce characteristics among frontline workers in different sizes of health departments and examine attributes associated with skill gaps: level and field of education, years of experience, program areas, and job classifications using a negative binomial model. RESULTS: Skill gaps in resource management, systems and strategic thinking, and change management persist across all local health departments (LHDs), but the extent of these gaps is greater in small LHDs. Small LHDs also have few employees with graduate and public health degrees. Additionally, whereas public health degrees were not associated with fewer skill gaps, tenure in public health was, suggesting people learn on the job. CONCLUSION: The results highlight the role regional training centers can play in emphasizing the need for strategic skills and foundational public health concepts, as well as customizing training content by agency size and educational levels to improve accessibility, particularly for small LHDs with resource constraints.
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Saúde Pública , Humanos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Inquéritos e Questionários , Recursos Humanos/estatística & dados numéricos , Recursos Humanos/normas , Recursos Humanos/tendências , Competência Profissional/estatística & dados numéricos , Competência Profissional/normas , Mão de Obra em Saúde/estatística & dados numéricos , Adulto , MasculinoRESUMO
Background: According to study on the under-estimation of COVID-19 cases in African countries, the average daily case reporting rate was only 5.37% in the initial phase of the outbreak when there was little or no control measures. In this work, we aimed to identify the determinants of the case reporting and classify the African countries using the case reporting rates and the significant determinants. Methods: We used the COVID-19 daily case reporting rate estimated in the previous paper for 54 African countries as the response variable and 34 variables from demographics, socioeconomic, religion, education, and public health categories as the predictors. We adopted a generalized additive model with cubic spline for continuous predictors and linear relationship for categorical predictors to identify the significant covariates. In addition, we performed Hierarchical Clustering on Principal Components (HCPC) analysis on the reporting rates and significant continuous covariates of all countries. Results: 21 covariates were identified as significantly associated with COVID-19 case detection: total population, urban population, median age, life expectancy, GDP, democracy index, corruption, voice accountability, social media, internet filtering, air transport, human development index, literacy, Islam population, number of physicians, number of nurses, global health security, malaria incidence, diabetes incidence, lower respiratory and cardiovascular diseases prevalence. HCPC resulted in three major clusters for the 54 African countries: northern, southern and central essentially, with the northern having the best early case detection, followed by the southern and the central. Conclusion: Overall, northern and southern Africa had better early COVID-19 case identification compared to the central. There are a number of demographics, socioeconomic, public health factors that exhibited significant association with the early case detection.
Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , África/epidemiologia , Fatores Socioeconômicos , SARS-CoV-2 , Saúde Pública/estatística & dados numéricosRESUMO
OBJECTIVES: To evaluate the effectiveness of the program interventions on cardiovascular disease in Nebraska women who are low income and have no health insurance. DESIGN: This evaluation used pre- and post-comparison approach. Paired t test and McNemar's test were used to examine the changes after the program interventions. PARTICIPANTS: Nebraska women aged 40 to 64 years, without health insurance, and with household incomes up to 225% Federal Poverty Level. SETTING AND INTERVENTION: A network of community-clinical linkages in which medical providers provided preventive screening services and risk reduction counseling in clinical settings and community health workers provided lifestyle interventions in community settings either over the phone or in person. MAIN OUTCOME MEASURE: The data included weight, blood pressure measures, self-blood pressure monitoring and management, total cholesterol, fasting glucose or A1C, smoking status, nutrition, and physical activities. RESULTS: Among 2649 participants, 82.2% were overweight, 50.3% had hypertension, 52.7% had high cholesterol, 20.7% had diabetes, 22.5% were current smokers, and 56.4% had more than 1 risk factor. A total of 1312 participants (57.3%) participated in at least 1 lifestyle intervention session, and among them, 65.8% completed at least 3 sessions. Paired t test and McNemar's test indicated significant improvement in hypertension control and self-management; a significant amount of weight loss with 24.1% losing at least 5 pounds; and an increase in healthy eating and physical activity. CONCLUSIONS: These participants benefited from the Nebraska program. Utilizing a statewide clinical network and participating in lifestyle interventions through local health departments, participants improved some chronic health conditions and decreased their risks of developing cardiovascular diseases.
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Doenças Cardiovasculares , Pobreza , Humanos , Feminino , Nebraska , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Pobreza/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodosRESUMO
CONTEXT: Vision Zero (VZ) aims to reduce fatalities and serious injuries from road traffic crashes to zero through multidisciplinary coordination. While public health officials are often recognized as critical to VZ, their involvement in VZ across the United States has not been quantified. OBJECTIVE: To explore how United States public health officials were involved in VZ development and implementation. DESIGN: We used a mixed-method design including a quantitative assessment of VZ plans and in-depth interviewing with VZ coordinators. SETTING: United States. PARTICIPANTS: Twenty-two in-depth interviews with municipal (n = 12) and regional (n = 10) VZ coordinators and 43 VZ plans were reviewed. MAIN OUTCOME MEASURE: Public health involvement in VZ development and implementation. RESULTS: In the United States, 64 municipalities and 21 regional entities had first-time VZ plans published between 2014 and 2022. We abstracted a sample of municipal (n = 22) and all (n = 21) regional plans. Most plans described key groups involved in plan development (municipal 81.8%, regional 100%). About two-thirds (67.4%; 59.1% municipal, 76.2% regional) of the plans noted public health officials in the plan development. Most plans described the principles forming the foundation of their plan (83.7%), but few mentioned public health as part of the plan principles (22.7% municipal, 14.3% regional). Public health officials were involved in engaging the community (9.1% municipal, 33.3% regional) and providing data (22.7% municipal, 52.4% regional) for plan development, as documented in the plans. For proposed implementation, public health officials were identified as involved in: community engagement (31.8% municipal, 42.9% regional), sharing/analyzing data (40.9% municipal, 33.3% regional), and identifying/providing funding sources (13.6% municipal, 4.8% regional). The in-depth interviews provided further context and a more detailed understanding of public health involvement in VZ. CONCLUSIONS: Evidence from the VZ plans and interviews provided examples of how public health officials engaged in the development and implementation of VZ initiatives.
Assuntos
Saúde Pública , Humanos , Estados Unidos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Acidentes de Trânsito/estatística & dados numéricos , Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/tendências , Pesquisa Qualitativa , Entrevistas como Assunto/métodosRESUMO
CONTEXT: The COVID-19 pandemic highlighted the need for a well-trained public health workforce prior to the public health crisis. Public health training centers regularly assess workforce needs and their pre-pandemic data play vital roles in guiding public health workforce development beyond the crisis. PROGRAM: In 2019, Oklahoma partners of the Region 6 South Central Public Health Training Center (R6SCPHTC) co-conducted an online survey of the public health workforce located in the Health Resources & Services Administration Region 6. IMPLEMENTATION: Between March and April, the R6SCPHTC collected 503 surveys, including 201 surveys from Oklahoma. Questions inquired about demographic and workforce characteristics, work contexts, training needs and interests, training access and logistics, and knowledge of R6SCPHTC online resources. EVALUATION: Key findings included that two-thirds of the pre-pandemic Oklahoma public health workforce consisted of employees age 40 or older with few holding public health or medical degrees. The majority of respondents worked for health departments and Tribes, and almost half were frontline workers. Although at least half of the participants interested in training on public health activities and topics were familiar with them, confidence in their abilities related to these activities and topics was expressed by less than half. Qualitative data provided details on training needs addressed quantitatively and described new training areas. Survey participants expressed interest in diverse training delivery methods and technological devices. Most respondents were not familiar with the free trainings available through the R6SCPHTC. DISCUSSION: Similar to the regional and national public health workforce, Oklahoma's workforce needed training and support already before COVID-19. Time and resources need to be invested into the current and future workforce. While addressing priority public health skills and topics remains important, training on current and emerging topics is needed. Providing accessible trainings with expanded content will prepare Oklahoma's public health workforce for the future.
Assuntos
COVID-19 , Avaliação das Necessidades , Saúde Pública , Humanos , Oklahoma/epidemiologia , COVID-19/epidemiologia , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/educação , Avaliação das Necessidades/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , SARS-CoV-2 , Pandemias , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Recursos Humanos/estatística & dados numéricosAssuntos
Mudança Climática , Saúde Pública , Humanos , Mudança Climática/mortalidade , Mudança Climática/estatística & dados numéricos , Europa (Continente)/epidemiologia , Aquecimento Global/mortalidade , Aquecimento Global/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendênciasRESUMO
This JAMA Patient Page discusses social isolation and loneliness as important public health concerns, especially among older adults.
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Isolamento Social , Idoso , Feminino , Humanos , Masculino , Solidão/psicologia , Isolamento Social/psicologia , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricosRESUMO
OBJECTIVE: Escalating global challenges (such as disasters, conflict, and climate change) underline the importance of addressing Chemical, Biological, Radiological, and Nuclear (CBRN) terrorism for sustainable public health strategies. This study aims to provide a comprehensive epidemiological analysis of CBRN incidents in the Middle East and North Africa (MENA) region, emphasizing the necessity of sustainable responses to safeguard healthcare infrastructures. METHOD: Utilizing a retrospective approach, this research analyzes data from the Global Terrorism Database (GTD) covering the period from 2003 to 2020. The study focuses on examining the frequency, characteristics, and consequences of CBRN incidents in the MENA region to identify patterns and trends that pose significant challenges to public health systems. RESULTS: The analysis revealed a significant clustering of CBRN incidents in Iraq and Syria, with a predominant involvement of chemical agents. These findings indicate the extensive impact of CBRN terrorism on healthcare infrastructures, highlighting the challenges in providing immediate health responses and the necessity for long-term recovery strategies. CONCLUSIONS: The study underscores the need for improved healthcare preparedness, robust emergency response systems, and the development of sustainable public health policies. Advocating for international collaboration, the research contributes to the strategic adaptation of healthcare systems to mitigate the impacts of CBRN terrorism, ensuring preparedness for future incidents in the MENA region and beyond.
Assuntos
Saúde Pública , Terrorismo , Humanos , África do Norte/epidemiologia , Oriente Médio/epidemiologia , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , Saúde Pública/tendências , Estudos Retrospectivos , Terrorismo/estatística & dados numéricos , Terrorismo/tendênciasRESUMO
Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach. We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents. Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (-110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed. Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.
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Objetivos , Estudos de Casos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Inglaterra/epidemiologia , Medicina Estatal/organização & administração , Medicina Estatal/tendências , Estudos de Casos Organizacionais/estatística & dados numéricos , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Distribuição por Idade , Atenção Primária à Saúde/estatística & dados numéricos , Medicina de Emergência/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Apoio Social/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Humanos , Masculino , Feminino , Adulto , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , IdosoAssuntos
Armas de Fogo , Violência com Arma de Fogo , Saúde Pública , Decisões da Suprema Corte , Humanos , Armas de Fogo/legislação & jurisprudência , Armas de Fogo/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Suicídio , Estados Unidos/epidemiologia , Violência com Arma de Fogo/legislação & jurisprudência , Violência com Arma de Fogo/estatística & dados numéricosRESUMO
OBJECTIVES: To inform researchers of central considerations and limitations when applying biochemical laboratory-generated registry data in clinical and public health research. STUDY DESIGN AND SETTING: After review of literature on registry-based studies and the utilization of clinical laboratory registry data, relevant paragraphs and their applicability toward the creation of considerations for the use of biochemical registry data in research were evaluated. This led to the creation of an initial ten considerations. These were elaborated, edited, and merged after several read-throughs by all authors and discussed thoroughly under influence by the authors' personal experiences with laboratory databases and research registries in Denmark, leading to the formulation of five central considerations with corresponding items and illustrative examples. RESULTS: We recommend that the following considerations should be addressed in studies relying on biochemical laboratory-generated registry data: why are biochemical laboratory data relevant to examine the hypothesis, and how were the variable(s) utilized in the study? What were the primary indications for specimen collection in the study population of interest? Were there any pre-analytical circumstances that could influence the test results? Are data comparable between producing laboratories and within the single laboratory over time? Is the database representative in terms of completeness of study populations and key variables? CONCLUSION: It is crucial to address key errors in laboratory registry data and acknowledge potential limitations.
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Saúde Pública , Sistema de Registros , Sistema de Registros/estatística & dados numéricos , Humanos , Dinamarca , Saúde Pública/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , Pesquisa Biomédica/normas , Projetos de Pesquisa , Bases de Dados Factuais , Laboratórios Clínicos/estatística & dados numéricosRESUMO
Objetivo: Nos últimos anos, a epidemia de HIV tem incidido consideravelmente e de forma silenciosa na população de mulheres gestantes, sobretudo devido à subnotificação, ao diagnóstico tardio e à negligência quanto à realização de teste anti-HIV pelas infectadas. Diante disso, este estudo tem por objetivo descrever o perfil clínico e epidemiológico de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina. Métodos: Trata-se de um estudo ecológico, ana- lítico, retrospectivo, com base em dados secundários retirados das plataformas Sistema de Informações de Agravos de Notificação (Sinan) e Sistema de Monitora- mento Clínico das Pessoas Vivendo com HIV/AIDS (SIMC), acerca de gestantes que vivem com HIV na Macrorregião Sul de Saúde de Santa Catarina, no período entre 2019 e 2022. Resultados: A partir dos dados sociodemográficos, obteve-se um perfil epidemiológico prevalente de mulheres com idade entre 30 e 49 anos, brancas, com baixo nível de escolaridade e entre 1 a 13 semanas de gestação no momento da notificação de infecção por HIV. O perfil clínico apontou para a prevalência de mulheres em uso de terapia antirretroviral, com carga viral acima de 1.000 cópias/ mL e contagem de linfócitos T-CD4+ superior a 350 células/mm3. Conclusão: Apesar do baixo nível de escolaridade e da elevada carga viral, o resultado foi positivo para a população selecionada, uma vez que foi demonstrada boa adesão ao tra- tamento e alta contagem de linfócitos, sendo esses bons preditores de evolução clínica para o HIV.
Objective: In recent years, the HIV epidemic has significantly and silently affected the population of pregnant women, mainly due to underreporting, late diagnosis, and neglect of HIV testing among infected individuals. In light of this, the aim of this study is to describe the clinical and epidemiological profile of pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina. Methods: This is an ecological, analytical, retrospective study based on secondary data retrieved from the Notifiable Diseases Information System (Sinan) and the Clinical Monitoring System for People Living with HIV/ AIDS (SIMC), regarding pregnant women living with HIV in the Southern Health Macroregion of Santa Catarina from 2019 to 2022. Results: Based on sociodemographic data, a prevalent epidemiological profile was identified, with women aged 30 to 49 years, white, with low educational level, and between 1 to 13 weeks of gestation at the time of HIV infection notifica- tion. The clinical profile revealed a prevalence of women on antiretroviral therapy, with a viral load above 1,000 copies/ mL and a T-CD4+ lymphocyte count above 350 cells/mm3. Conclusion: Despite the low educational level and high viral load, the outcome was positive for the selected population, as good treatment adherence and high lymphocyte count were demonstrated, both of which are good predictors of clinical progression for HIV.
Assuntos
Humanos , Feminino , Gravidez , Perfil de Saúde , Infecções por HIV/epidemiologia , Prontuários Médicos/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Terapia Antirretroviral de Alta Atividade/métodos , Diagnóstico Tardio , Sistemas de Informação em Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Teste de HIVAssuntos
Astrocitoma , Aprendizado Profundo , Humanos , Isocitrato Desidrogenase/genética , Homozigoto , Saúde Pública/estatística & dados numéricos , Deleção de Sequência , Astrocitoma/diagnóstico por imagem , Astrocitoma/genética , Astrocitoma/patologia , Imageamento por Ressonância Magnética , Inibidor p16 de Quinase Dependente de Ciclina/genéticaRESUMO
BACKGROUND: Delays in preventative service uptake are increasing in the UK. Universal, comprehensive monthly outreach by Community Health and Wellbeing Workers (CHW), who are integrated at the GP practice and local authority, offer a promising alternative to general public health campaigns as it personalises health promotion and prevention of disease holistically at the household level. We sought to test the ability of this model, which is based on the Brazilian Family Health Strategy, to increase prevention uptake in the UK. METHODS: Analysis of primary care patient records for 662 households that were allocated to five CHWWs from July 2021. Primary outcome was the Composite Referral Completion Indicator (CRCI), a measure of how many health promotion activities were received by members of a household relative to the ones that they were eligible for during the period July 2021-April 2022. The CRCI was compared between the intervention group (those who had received at least one visit) and the control group (allocated households that were yet to receive a visit). A secondary outcome was the number of GP visits in the intervention and control groups during the study period and compared to a year prior. RESULTS: Intervention and control groups were largely comparable in terms of household occupancy and service eligibilities. A total of 2251 patients in 662 corresponding households were allocated to 5 CHWs and 160 households had received at least one visit during the intervention period. The remaining households were included in the control group. Overall service uptake was 40% higher in the intervention group compared to control group (CRCI: 0.21 ± 0.15 and 0.15 ± 0.19 respectively). Likelihood of immunisation uptake specifically was 47% higher and cancer screening and NHS Health Checks was 82% higher. The average number of GP consultations per household decreased by 7.4% in the intervention group over the first 10 months of the pilot compared to the 10 months preceding its start, compared with a 0.6% decrease in the control group. CONCLUSIONS: Despite the short study period these are promising findings in this deprived, traditionally hard to reach community and demonstrates potential for the Brazilian community health worker model to be impactful in the UK. Further analysis is needed to examine if this approach can reduce health inequalities and increase cost effectiveness of health promotion approaches.