Publics and their health: Historical problems and perspectives

The nature of the relationship between publics and their health has long been a concern for those seeking to improve collective and individual health. Attempts to secure the health of the population of any given place are one of the oldest forms of governmental action. Whether it be providing clean water or preventing the spread of disease, such efforts require the involvement of the publics these measures are designed to protect. Despite its importance, surprisingly little attention has been paid to who or what the ‘public' of public health consisted of. This collection addresses this gap by considering ‘who' the public of public health was in an array of places and around a variety of public health problems. Ranging across Europe and North and South America, and from the interwar period to the near present, this book explores the construction of ‘problem publics' to deepen our understanding of the ‘who' of public health. This book offers detailed case studies of the making of ‘problem' publics and public health problems in different places and at different times. By placing examples of the construction of problem publics in contexts as diverse as the USA in the interwar period, East Germany in the 1980s and contemporary Argentina, this collection identifies what is general and what is specific to the processes that make certain kinds of publics appear problematic. In the wake of the COVID-19 pandemic, this volume offers fresh insights into the nature of public health problems, practices and publics. © Manchester University Press 2023.

Introduction: publics and their health – historical problems and perspectives

This chapter introduces the collection by exploring the changing meaning of ‘the public' and ‘public health'. It suggests that there was no single unitary ‘public', and ‘public health' also has multiple meanings. This diversity is echoed in the framing of certain groups, individuals and behaviours as ‘problem publics'. The essays in this collection unpack a range of examples of ‘problem publics'. This introduction summarises the contents of the chapters in the collection, but also highlights a series of key cross-cutting themes. These include the overlapping of ‘problem publics' with identity categories and certain kinds of behaviour, as well as the geographical location of groups and individuals. The introduction places this in the context of the recent COVID-19 pandemic, which has brought fresh interest in how to deal with ‘problem publics', but with many old tropes rising to the fore. © 2023 Manchester University Press.

Shifting Fields: Japanese University Students’ Habitus During the COVID-19 Pandemic

In this chapter, the authors utilize sociologist Pierre Bourdieu’s “thinking tools” of capital, field, and habitus as part of a framework to examine Japanese university classes and the experiences and viewpoints of students in the context of the COVID-19 pandemic. The virtual academic environment resulting from the crisis produced institutional changes in Japanese universities that dramatically altered the experiences of students. The limitation of students’ interactions to briefly realized virtual classroom relationships with peers, the constraints placed upon university-affiliated extracurricular activities, as well as the unforeseen consequences of online instruction in multiple classes created a new environment with new expectations that in some cases ran counter to Japanese cultural norms in academia. Drawing on previous research and qualitative data collected from several universities, we use symbolic interactionism as a methodology to detail how students as social agents negotiated these new environments. © 2023 selection and editorial matter, Karen Monkman, Ann Frkovich, and Amira Proweller;individual chapters, the contributors.

Patient-reported reasons for no-shows to screening mammogram appointments among African American women

Background: Mammography screening significantly reduces breast-cancer related mortality;however, many women fail to undergo screening as recommended by national guidelines. No-shows are responsible for a significant proportion of delayed or missed cancer screening exams. Further, no-shows disproportionately affect underserved and minority populations. We previously identified a high no-show rate for screening mammograms among patients seeking care our institution. African American (AA) women were almost three times more likely to no-show than non-Hispanic white women. The racial disparity in no-shows persisted after adjustment for socioeconomic factors. The objective of this survey study was to identify reasons for missed mammogram screening appointments among AA women. Methods: We conducted a survey (via mail or telephone) of AA women who missed their screening mammogram appointment in summer 2021. Using a structured survey instrument, we collected information on patient-specific and health service barriers. Patient-specific barriers included procedure-related concerns (e.g., concern about discomfort), cognitive-emotional factors (e.g., fear of finding cancer), and changes in health status. Health service barriers included logistical factors (e.g., transportation), cost (e.g., lack of insurance) and scheduling problems (e.g., forgot about appointment or scheduled at an inconvenient time). Here we describe the most common reasons for missed appointments and compared women who reported patient-specific versus health service barriers. Results: 255 women who no-showed for their appointment were contacted and 91 participated in the study survey (35.6% response rate). Most respondents (90%) attributed their no-show to at least one of the listed barriers. Nineteen (7.5%) attributed their no-show to COVID-19, but only 1 person reported this as their only barrier. Scheduling issues were the most commonly reported barriers (57.8%), followed by transportation (38.9%). Three-quarters of respondents reported health service barriers, while only 40.7% reported patient-related barriers. The most common patient-related barriers were cognitiveemotional (25%), changes in health status (20.9%) and procedure-related concerns (15.6%). The majority of respondents (82.6%) were interested in rescheduling their mammogram. Conclusions: Most appointment no-shows among surveyed AA women resulted from potentially preventable scheduling and transportation issues. Relatively few respondents reported cognitive-emotional or procedure-related concerns. Further, the majority of respondents were interested in rescheduling their mammogram;which suggests that these women remain motivated to undergo breast cancer screening. Programs which address preventable health-service related issues may help these women keep their appointments.

A Tale of Two Crises in Peru Livelihoods and Social Reproduction During the 1980s and the COVID-19 Pandemic

The COVID-19 pandemic has wreaked havoc on the livelihoods of people around the world. Structural economic constraints are highlighted at such moments of crisis, while those most affected have recourse to their repertoire of managing strategies. This case study of people from Allpachico, a Peruvian peasant community, compares their responses to the current crisis with their responses to one in the 1980s, showcasing similarities in strategies (especially reciprocity and the sale or exchange of necessary reproductive tasks and products) and differences in the form they take. In the 1980s, women's work and kin reciprocity helped people access use-values. By 2020, neoliberalism had transformed the national economy and Allpachiqueño migrants overwhelmingly had precarious informal and contract work. Reciprocity and reproductive tasks are still central to livelihood, but now tend to be monetized rather than involving use-values. As that earlier crisis shattered both secure employment and peasant farming to lay the basis for neoliberalism, so now it appears that the COVID-19 pandemic, through the monetization of government support and reciprocity alike, is accelerating financialization in the form of financial services and debt. © 2022 University of Toronto. All rights reserved.

Protecting persons at-risk of viral hepatitis and alcohol-related liver disease during the pandemic and beyond: mitigating the impact of Coronavirus disease 2019 on liver health

Background: Treatment seeking for people with alcohol use disorders (AUD), injecting drug use and viral hepatitis is low, and has worsened during the coronavirus disease 2019 (COVID-19) pandemic. Deferring clinical care and increasing drug and alcohol use exacerbate the risks of progression for individuals with chronic liver disease from viral hepatitis and/or alcohol-related liver disease (ALD). We explored the impact COVID-19 epidemic may have on patients with chronic liver disease and suggested mechanisms to protect this at-risk population during and after the pandemic.

Fragility fractures in Mexico: Best practice proposal through fracture liaison services (FLS)

In Mexico, the fragility fractures (FF) represent a public health problem;recent reports state rates of almost 2,000 cases for every 100,000 inhabitants with an expected sevenfold increase by 2050 (Clark.P- 2005). Hip fracture cases will go up from 155,875 to 226,886 in 2050 (5.2 to 7.2 timesmore than those registered in 2005) (Johansson.H-2011). According to ICUROS-Mx study mortality after FF was 20.2%. Quality of life after FF is affected significantly (Borgstrom.F-2013). The costs related with the handling of nonpharmacological low bone mass (osteopenia), osteoporosis and FF are high in our country;they reach over 5,191 million (MXP) in 2010 and $ 7,575 million pesos in 2020 (Carlos.F-2013). TheMexican health care system comprises two sectors: public and private, offers coverage to 82.2% of the 119.5 million inhabitants registered in that year. An example is Instituto Mexicano del Seguro Social (IMSS) Victoriode- la-Fuente-Narváez where the traumatology unit alone will require a budget greater than 315,000,000 million (MXP) per year as per 2050 forecasts. We show the direct costs derived from the most frequent FF according to the Group Related Diagnosis (GRP) published in 2017 by the IMSS with costs updated to 2020 (Gilma.A-2014). Fracture Liaison Services (FLS) with a worldwide successful experience for the care of FF patients offer diverse and feasible models enable to adapt to different Health Systems settings. The aim of this review is to put forward the possible implementation of the International Osteoporosis Foundation (IOF) Capture the Fracture® program) in Mexico. The initial experience in the implementation of the Capture the Fracture program in diverse Mexican institutions shows us that this program is feasible of being adapted for being implemented in countries with fragmented health system such as Mexico. The fishbone diagram below (Figure 1) lists the barriers impacting the development of FLSs inMexico. These barriers include a series of factors required for an effective and efficient FLS. All these factors were exacerbated by the COVID-Sars2. Conclusion: Fragility fractures represent a health problem in Mexico and in the world. This study reviews and puts forward the implementation of FLS as a feasible and cost-effective alternative in health institutions in our country.

Subcutaneous and mediastinal emphysema, uncommon complications of COVID-19 ARDS: A case series

Coronavirus disease 2019 (COVID-19) adult respiratory distress syndrome (C-ARDS) has led to ventilator related complications such as ventilator associated events (VAE), venous thromboembolic events (VTE), barotrauma, and ultimately profound diffuse pulmonary fibrosis. Barotrauma is one such complication, with reports of spontaneous pneumothorax (PTX) and pneumomediastinum. We present a case series of four patients with severe C-ARDS, complicated by subcutaneous emphysema and mediastinal emphysema with and without pneumothroracies, which required supportive care, except one patient with PTX. Of the four patients only one patient was discharged alive. C-ARDS can induce lung injury, resulting in subcutaneous and mediastinal emphysema, which may not represent a PTX as etiology. The exact mechanism of subcutaneous emphysema and mediastinal emphysema without pneumothoracies in the setting of severe C-ARDS has not been clearly elucidated. Two plausible mechanisms may be related to the “Macklin effect” vs. type I and II pneumocyte breakdown when infected by COVID-19. Strategies used to minimize worsening of subcutaneous and mediastinal emphysema with and without pneumothoracies, may be to minimize positive end-expiratory pressure (PEEP), continue to maintain a lung protective strategy (LPS), while utilizing a higher fraction of inspired oxygen (FiO2) concentration. In the majority of cases, supportive care is usually required, unless PTX presents or tension pneumomediastinum develops, at which time treatment with a thoracostomy tube placement may be necessary or cardiothoracic surgery consultation may be warranted, to perform “gills” procedure. © Journal of Emergency and Critical Care Medicine. All rights reserved.