Japan's intensive health guidance program has limited effects on cardiovascular risk factors: a regression discontinuity analysis.

OBJECTIVES: It is uncertain whether the effects of health counselling programs differ depending on their intensity. This study compared the effectiveness of intensive health guidance (IHG) and less intensive motivation-enhancing guidance (MEG) on cardiovascular risk factors. STUDY DESIGN: A regression discontinuity design (RDD) was applied. METHODS: In Japan's specific health checkup (SHC) and guidance program, those with a high risk of metabolic syndrome are assigned to IHG or MEG. An RDD was applied using an SHC results database. Four groups were created in which IHG or MEG assignment was solely determined by single cut-off values of the running variables of triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), or haemoglobin A1c (HbA1c) measured during SHC. Outcomes were one year's changes in body mass index (BMI), waist circumference (WCF), systolic and diastolic blood pressure, HDL-C, low-density lipoprotein cholesterol, FBG, and HbA1c. RESULTS: A total of 541,809 observations among 225,115 people from 2008 to 2017 were analysed. Men assigned to IHG had a significantly but slightly lower BMI and WCF than those assigned to MEG the next year, only when TG or FBG was a running variable. There were no significant differences between IHG and MEG for women's BMI and WCF and other cardiovascular risk factors for both sexes. CONCLUSION: Since IHG has limited additional effects on cardiovascular risk factors compared with MEG, abolishing IHG may have little negative impact on the general public's health.

Health guidance intervention mitigates the escalation of predicted comprehensive cardiovascular disease risk: Interrupted time series design.

INTRODUCTION: Metabolic syndrome increases the risk of cardiovascular events. Despite the Japanese healthcare system's efforts in early detection and intervention, particularly through Specific Health Checkup and Guidance programs, research on their effectiveness is limited. This study evaluated the impact of Specific Health Guidance on the predicted risk of atherosclerotic cardiovascular disease (ASCVD) in working-age Japanese individuals. METHODS: Employing an Interrupted Time Series (ITS) design, this study compared the trends in predicted ASCVD risk and each individual risk factor used for the prediction of ASCVD risk before and after intervention in individuals participating in the guidance. RESULTS: Analyses based on the ITS design indicated that participation in Specific Health Guidance programs, specifically the intensive level program, mitigates the increase trend of the predicted ASCVD risk. On the other hand, the impact on the trends of individual cardiovascular risk factors was minimal. CONCLUSIONS: The intensive level Specific Health Guidance appeared to reduce the increasing trend in ASCVD risk, emphasizing the importance of comprehensive risk assessment in evaluating health interventions. However, the results are limited owing to the specific demographics and short evaluation period. Further research is necessary to understand the long-term impacts and broader applicability.

[Utilization of the standard questionnaire in specific health checkups].

Objectives　Interviewing people about their health behaviour in specific health checkups (SHCs) is thought to promote awareness of and help improve such behaviour. The standard questionnaire (SQ) for SHCs consists of 22 items presented in the guidelines of the Ministry of Health, Labour, and Welfare. However, using items other than those necessary for stratification for specific health guidance (SHG) is optional. We believe that clarifying the actual utilization of SQ items could contribute to improving the procedure used for the fourth SHCs and SHG, which will be initiated in 2024.　This study seeks to clarify the actual utilization of the SQ for (1) conducting SHCs, (2) planning, implementing, and evaluating SHG and health programs aimed at preventing lifestyle-related diseases, and (3) planning, implementing, and evaluating the data health plan.Methods　We enrolled 3,179 people from 1,741 departments in charge of national health insurance, 47 Japan Health Insurance Association branches, and 1,391 health insurance societies across all municipalities in Japan. One participant among the study participants was the main person in charge of SHCs and SHG at each facility. We conducted a self-reported survey on the implementation of SHCs and SHG in February 2022. This study was approved by the ethics review board of the institution to which the first author belongs.Results　A total of 1,221 (38.4%) were received. The proportions of valid responses from national health insurance departments, Japan Health Insurance Association branches, and health insurance societies were 816 (46.9%), 47 (100%), and 358 (25.7%), respectively. Over 96% of responders used the group SHCs method, and over 93% of those adopting the individual SHCs method used each of the 22 SQ items. However, 187 (18.2%) responders found it difficult to use the item "If you had the opportunity to receive health guidance for lifestyle improvement, would you take it?" The reason was that the on-request SHG system was misunderstood. Additionally, only approximately 50% of respondents used the SQ to develop, implement, and evaluate their health program.Conclusion　We believe there will be no problem in implementing the SQ even if using all its component items is required. However, the aforementioned item needs to be revised. Methods to encourage health insurers and their supporters to use the SQ for health-related data collection and health program planning should be devised.

Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey.

Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.

Effect of sleep report feedback using information and communication technology combined with health guidance on improving sleep indicators in community-dwelling older people: a pilot trial.

BACKGROUND: This study evaluated the preliminary effect of an integrated novel intervention comprising visualised sleep report feedback using information and communication technology and periodic health guidance on improving sleep indicators among community-dwelling older people. METHODS: The intervention was implemented among 29 older people in Sakai City, Japan, in a 3 months pilot trial. Non-worn actigraph devices were placed under participants' bedding to continuously measure their sleep state, and they received monthly sleep reports in writing. Sleep efficiency, total sleep time, sleep latency, and the number of times away from bed were recorded. A trained nurse expertly interpreted participants' sleep data and provided telephone health guidance. The first month's data were used as the baseline (T1), the second month provided data for the first intervention (T2), and the third month provided data for the second intervention (T3). Friedman tests and Wilcoxon signed-rank tests were used to examine differences in sleep outcomes between different time points. RESULTS: Participants' mean age was 78.97 ± 5.15 years, and 51.72% (15/29) were female. Comparison of T2 and T1 showed the intervention decreased participants' sleep latency at T2 (P = 0.038). Compared with T1, the intervention significantly decreased sleep latency (P = 0.004), increased total sleep time (P < 0.001), and improved sleep efficiency (P < 0.001) at T3. When T3 was compared with T2, only total sleep time was significantly increased (P < 0.001). There were no significant differences in the number of times away from bed across the three time points (P > 0.05). CONCLUSIONS: This visualised sleep report feedback and periodic health guidance intervention for community-dwelling older people showed promising, albeit small preliminary effects on sleep. A fully powered randomised controlled trial is required to verify the significance of this effect.

Formative Evaluation of a Student Symptom Decision Tree for COVID-19.

Objectives: In support of schools restarting during the COVID-19 pandemic, some schools partnered with local experts in academia, education, community, and public health to provide decision-support tools for determining what actions to take when presented with students at risk for spreading infection at school. Methods: The Student Symptom Decision Tree, developed in Orange County, California, is a flow chart consisting of branching logic and definitions to assist school personnel in making decisions regarding possible COVID-19 cases in schools which was repeatedly updated to reflect evolving evidence-based guidelines. A survey of 56 school personnel evaluated the frequency of use, acceptability, feasibility, appropriateness, usability, and helpfulness of the Decision Tree. Results: The tool was used at least 6 times a week by 66% of respondents. The Decision Tree was generally perceived as acceptable (91%), feasible (70%), appropriate (89%), usable (71%) and helpful (95%). Suggestions for improvement included reducing the complexity in content and formatting of the tool. Conclusions: The data suggest that school personnel found value in the Decision Tree, which was intended to assist them with making decisions in a challenging and rapidly evolving pandemic.

Effects of being eligible for specific health guidance on health outcomes: A regression discontinuity analysis using Japan's data on specific health checkups.

The significance of general health checkups and guidance is controversial. To examine the effectiveness of Japan's specific health checkup (SHC) and specific health guidance (SHG) programs, this study applied a regression discontinuity design (RDD) using the SHC results database collected by a private company. We applied a sharp RDD with a cutoff body mass index (BMI) of 25 kg/m2 for those with a waist circumference (WCF) of <85 cm in men and < 90 cm in women, with risks of hypertension, dyslipidemia or diabetes, and aged between 40 and 64 years. Study outcomes were differences in BMI, WCF, and major cardiovascular risk factors between the baseline year and the following year. We analyzed the data of baseline years of 2015, 2016, and 2017 separately and their pooled data. We judged the results to be robust significant when significant results in the same direction were found in all four analyses. A total of 1,041,607 observations out of 614,253 people were analyzed. We found robust significant results that those eligible for SHG in the baseline year had a lower BMI (both men and women) and lower WCF (men only) in the following year than those not eligible for SHG: BMI for men (-0.12 kg/m2, 95% CI [confidence interval]: -0.15 to -0.09); BMI for women (-0.09 kg/m2, 95% CI: -0.13 to -0.06); and WCF for men (-0.36 cm, 95% CI: -0.47 to -0.28) in the pooled data. Robust significant results were not found in WCF for women or in major cardiovascular risk factors.

The Effect of a mHealth App (KENPO-app) for Specific Health Guidance on Weight Changes in Adults With Obesity and Hypertension: Pilot Randomized Controlled Trial.

BACKGROUND: Commercial smartphone apps that promote self-monitoring of weight loss are widely available. The development of disease-specific apps has begun, but there is no app for specific health guidance (SHG) to prevent metabolic syndrome, type 2 diabetes, and cardiovascular diseases in middle-aged adults in Japan. OBJECTIVE: This study aimed to determine the efficacy of an SHG mobile health app in facilitating weight loss in Japanese adults with obesity and hypertension. METHODS: In a 12-week, statistician-blinded, randomized parallel controlled trial, 78 overweight and obese men aged 40-69 years were assigned in a 1:1 ratio to either the usual support plus KENPO-app group (intervention group) or the active control group. KENPO-app (release April 10, 2019; OMRON Healthcare Co., Ltd.) was developed by the study team and focus groups and uses behavior change techniques (ie, self-monitoring and goal-setting theory). This app was developed for SHG based on the four specific health checkups and guidance system in Japan: (1) focusing primarily on achieving the target (weight loss of ≥2 kg); (2) assessing healthy eating, exercise habits, smoking habits, relaxation, and self-weighing; (3) providing information on the results of specific health checkups; and (4) starting an intervention period of 6 months with the interim assessment at 3 months. The initial assessment explored the following: personality traits (4 types), health checkup data concerns (10 items), symptom concerns (10 items), and the aim of the intervention (weight loss, improving fitness, symptoms, laboratory data). Chatbot-supported health information on health and health behavior was selected from 392 quizzes based on app data and was provided to participants. The KENPO-app had chatbot-supported feedback and information provision combined with a self-monitoring tool (weight, steps, and blood pressure). Data on active exercise, healthy eating, and healthy lifestyle habits were obtained using a web-based self-administered questionnaire at baseline and 12 weeks. RESULTS: The trial's retention rate was 95% (74/78). The adherence to daily self-weighing, wearing the pedometer, and blood pressure monitoring in the KENPO-app group was significantly higher than those in the active control group. Compared with the active control group, the median body weight and BMI of the intervention group significantly decreased at 3 months (-0.4, IQR -2.0 to 0.6 kg vs -1.1, IQR -2.7 to -0.5 kg; P=.03; -0.1, IQR -0.6 to 0.3 kg vs -0.4, IQR -0.8 to -0.2 kg; P=.02, respectively). The intervention increased the percentage of participants who self-reported taking ≥8000 steps, eating vegetables before rice, eating slowly, and relaxing. Personality traits were associated with the degree of weight loss in the intervention group. CONCLUSIONS: The SHG-specific KENPO-app was feasible and induced modest but significant weight loss in adults with obesity. TRIAL REGISTRATION: University Hospital Medical Information Network Center UMIN000046263; https://tinyurl.com/bderys3b.

Evaluating the Effectiveness of Letter and Telephone Reminders in Promoting the Use of Specific Health Guidance in an At-Risk Population for Metabolic Syndrome in Japan: A Randomized Controlled Trial.

Japan has introduced a nationwide lifestyle intervention program (specific health guidance) for people aged 40-74 years. Medical insurers apply a reminder system to improve their utilization rates. This study examined the effectiveness of two methods of reminders (mailed letters and telephone calls) in a randomized controlled trial. Subscribers to National Health Insurance in Yokohama City, Kanagawa Prefecture, who were eligible for specific health guidance in 2021, were recruited. A total of 1377 people who met the criteria of having or being at risk of developing metabolic syndrome (male: 77.9%, mean age: 63.1 ± 10.0 years) were randomly assigned to one of three groups: a "no reminder" group, a "letter reminder" group, or a "telephone reminder" group. The utilization rates of specific health guidance were not significantly different between the three groups (10.5%, 15.3%, and 13.7%, respectively). However, in the case of the telephone reminder group, a subgroup analysis showed that the utilization rate was significantly higher among participants who received the reminder than those who did not answer the calls. Although the effectiveness of a telephone reminder might be underestimated, this study suggests that neither method impacted the utilization rates of specific health guidance among the population at risk of metabolic syndrome.

[Effectiveness of letter and telephone reminders for specific health guidance use: A randomized controlled trial for those intending to use health guidance in a large city].

Objectives　Medical insurers have applied a reminder (i.e., recall) system to improve the implementation rate of specific health guidance. However, the effectiveness of the system has not been verified. This study aims to examine the effectiveness of two methods of specific health guidance reminders (i.e., letter and telephone) using a randomized controlled trial.Methods　Subscribers of National Health Insurance in Yokohama City, Kanagawa Prefecture, who were eligible for specific health guidance in 2020, were recruited. A specific health examination questionnaire was used to identify participants intending to use health guidance. The intervention period was from September to November 2020, with 252 people being randomly assigned to one of the three groups: a "no-reminder group," "a letter-reminder group," or "a telephone-reminder group" (84 people each). Those in the letter-reminder group received a reminder by mail and those in the telephone-reminder group received a reminder by phone from a public health nurse two weeks after the specific health guidance coupon was sent to the participants by mail. The outcome showed the utilization rate of specific health guidance. Chi-square tests were performed to compare the three groups and conduct multiple comparisons (post-hoc test).Results　The participants had a mean age of 61.4±11.0 years and 70.6% were male. There was no difference among the three groups in terms of demographic characteristics and the results of specific health examinations. The utilization rates of specific health guidance were 20.2% in the no-reminder group, 22.6% in the letter-reminder group, and 20.2% in the telephone-reminder group; thus, the three groups did not significantly differ (χ2=0.191, P=0.909). Multiple comparisons also showed no difference between any two groups. However, in the telephonereminder group, 56.0% of the participants themselves or their family members could be reached by a public health nurse, and their utilization rate was higher than those participants whom a public health nurse could not reach.Conclusion　Neither letter nor telephone reminders changed the participants' utilization rates of specific health guidance compared to those with no reminder. Although the effectiveness of a telephone reminder might be underestimated, this study suggests setting a lower priority in reminding those who intend to use health guidance.

A New Health Promotion Program That Includes Wadaiko Rhythm Exercise to Maintain the Health of Persons Excluded from Receiving Specific Health Guidance.

This study examined the effectiveness of a new health promotion program, which is a collective intervention program aimed at improving lifestyle habits. It was designed as a one-year prospective cohort study. This program targeted non-obese persons at risk of developing lifestyle-related diseases and participants with hypertension, dyslipidemia, or hyperglycemia who were not included in the specific health guidance system in Japan. The Wadaiko rhythm exercise, which is a traditional performing art, is incorporated into this intervention as an enjoyable routine that can help participants continue the program, preventing them from dropping out. After a one-year follow-up, the effectiveness of the health promotion program was evaluated in 18 participants (2 males, 16 females; mean age 65.2 ± 3.4 years) and 92 controls. The results showed that triglyceride in the intervention group significantly decreased (−24.5 mg/dL; p = 0.02; 95% confidence interval [CI], −44.73 to −4.27) and high-density lipoprotein cholesterol significantly increased (+6.1 mg/dL; p < 0.01; 95% CI, 2.46 to 9.65), although levels in the control group did not change. These results suggest that the health promotion program could contribute to lifestyle habit improvements in those who are excluded from receiving specific health guidance.

The impact of the National Health Program on diabetes incidence among working-age men with prediabetes: A regression discontinuity analysis of a nation-wide database in Japan.

AIM: This study aimed to investigate the impact of the National Health Program in Japan ("Specific Health Check-ups and Specific Health Guidance") on diabetes prevention among working-age men with prediabetes. METHODS: This study used a regression discontinuity design, based on the program's criterion that the program starts at age 40 or older and that the intervention is provided only to prediabetic individuals with abdominal obesity, to assess the impact of the program on the diabetes incidence in a total of 49,848 men with prediabetes, aged 37-42 years. RESULTS: The National Health Program in which interventions were provided for individuals aged 40 years or over with both prediabetes and abdominal obesity was associated with a decrease in diabetes incidence rate equivalent to 10.1 reduction/1000 person-years. The relative risk was 0.75. However, among those without abdominal obesity and not subjected to the intervention, there was no significant change in the diabetes incidence at age 40. CONCLUSIONS: The National Health Program in Japan was associated with a decrease in the incidence of diabetes among working-age men with prediabetes and abdominal obesity and may have a meaningful impact among working-age men.

Efficient searching for NICE public health guidelines: Would using fewer sources still find the evidence?

Systematic searches are integral to identifying the evidence that is used in National Institute for Health and Care Excellence (NICE) public health guidelines (PHGs). This study analyses the sources, including bibliographic databases and other techniques, required for PHGs. The aims were to analyse the sources used to identify the publications included in NICE PHGs; and to assess whether fewer sources could have been searched to retrieve these publications. Data showing how the included publications had been identified was collated using search summary tables. Three scenarios were created to test various combinations of sources to determine whether fewer sources could have been used. The sample included 29 evidence reviews, compiled using 13 searches, to support 10 PHG topics. Across the PHGs, 23 databases and six other techniques retrieved included publications. A mean reduction in total results of 6.5% could have been made if the minimum set of sources plus Cochrane Library, Embase, and MEDLINE were searched. On average, Cochrane Library, Embase, and MEDLINE contributed 76.8% of the included publications, with other databases adding 11% and other techniques 12.2%. None of the searches had a minimum set that was comprised entirely of databases. There was not a core set of sources for PHGs. A range of databases and techniques, covering a multi-disciplinary evidence base, was required to identify all included publications. It would be possible to reduce the number of sources searched and make some gains in productivity. It is important to create a tailored set of sources to do an efficient search.

Common Pregnancy Complaints Can Lead to Motor Vehicle Collisions or Near-Miss Incidents.

Pregnant women commonly report various health complaints during pregnancy, the occurrence of which is believed to cause human error. However, no study has examined the relationship between the occurrence of pregnancy complaints and the risk of motor vehicle collisions (MVCs). This study aimed to clarify the relationship between the frequency and severity of common pregnancy complaints and the occurrence of MVCs or near-miss incidents. We conducted a multicenter cross-sectional survey of 1000 pregnant women in Shiga Prefecture, Japan. The event group experiencing MVCs or near-miss incidents during pregnancy comprised 10.8% of respondents. The frequency of compression of the stomach or abdomen, tension and cramps in the lower abdomen, pelvic pain, irritability, depressed mood, distractedness, and hot flashes was significantly higher in the event group. The results of our multivariate logistic regression analysis revealed that tension and cramps in the lower abdomen, distractedness, and irritability were independent contributory factors to such events, with an odds ratio of 2.414, 1.849, and 1.746, respectively. Educating pregnant women to avoid driving when experiencing these symptoms would improve maternal and fetal safety.

The Family Is My Priority: How Motherhood Frames Participation in Physical Activity in a Group of Mothers Living in a Low Socioeconomic Status Area.

Socioeconomic status (SES) is known to influence strongly both life expectancy and healthy life expectancy. Whilst there are multiple factors with complex interactions that provide the explanation for this observation, differences in the uptake of physical activity between high and low SES groups play a role. This in-depth qualitative study set out to understand the response of a group of mothers with young children living in a low SES area of a London (UK) borough to the current physical activity guidance and to investigate whether existing and established interventions based on behavior change are appropriate for this group. A series of three in depth interviews was carried out with the mothers (n = 20) over a period of 16 months, and the data collected were analyzed thematically. Four main themes were identified: (1) mothering comes before exercise; (2) mothers are a special case; (3) alone or together; and (4) facilities fail mothers. The mothers were unsure about the benefits of exercise, whether it was relevant for them and how to accommodate exercise alongside their mothering responsibilities. Family and peer group could be both a barrier and a facilitator to participation in physical activity. Without an in depth understanding of the role of physical activity in the lives of mothers of young children, behavior change-based public interventions are likely to fail to meet the needs of this group. A reduction in the current health inequities will only be possible when the needs of the mothers are acknowledged and used as the basis of appropriate public health guidance.

Relationship between the Appearance of Symptoms and Hospital Visits in Childhood Based on Japanese Statistical Data.

BACKGROUND: Childhood health problems affect healthy growth. This study aimed to assess the symptoms and diseases requiring hospital visits commonly found in children in Japan and analyze their effects on health status. METHODS: Anonymized data on 1315 children aged 6-14 years were obtained from a national survey questionnaire. The survey items addressed symptoms, disease names, and hospital visits. Associations between symptoms and other factors were examined by means of a contingency table analysis and logistic regression. RESULTS: The proportions of responses for health status were compared for each question item; significant differences were found in age group (p < 0.01), subjective symptoms (p < 0.01), hospital visits (p < 0.01), and lifestyle (p < 0.01). The proportion of responses indicating "poor" perceived health status was high among those with subjective symptoms (4.8%) and hospital visits (4.7%). From the logistic regression, significant odds ratios were found for subjective symptoms (2.10, 95% confidence interval (C.I.) 1.15-3.83) and age group (1.98, 95% C.I. 1.05-3.72). CONCLUSION: Among measures to improve quality of life from childhood, comprehensive health guidance that emphasizes understanding symptoms and includes age and living conditions is important.

Ineffectiveness of antenatal guidance intervention for vitamin D insufficiency and deficiency in pregnant women in Kyoto, Japan.

AIM: The aim of this study was to investigate the vitamin D status among healthy pregnant women in Japan, and to evaluate the effectiveness of the antenatal health guidance intervention for the pregnant women who were informed about their low vitamin D levels. METHODS: We measured the level of 25-hydroxyvitamin D (25[OH]D) using chemiluminescent immunoassay among the singleton pregnant women who received at antenatal routine check-up (8-24 weeks of gestation) with written consent during September 2017-September 2018. The measurement values were informed by the concerned physician and health guidance intervention was given to the pregnant women with inadequate Vitamin D status (25[OH]D < 30 ng/mL). At around 36 weeks of gestation, the measurement of 25(OH)D and a questionnaire regarding behavioral changes after the guidance was conducted. RESULTS: The average value of 25(OH)D of 1192 pregnant women before the guidance was 14.89 ± 4.85 ng/mL, and the prevalence of sufficient vitamin D status (25(OH)D ≥ 30 ng/mL) was 0.67% (8/1192). Nine hundred eighty-two pregnant women who had inadequate vitamin D status were followed, thereafter-guidance prevalence of sufficiency was 1.02% (10/982); insufficiency, 14.66% (144/982); and deficiency, 84.32% (828/982), respectively. Although the prevalence of deficiency was decreased after guidance intervention significantly, the prevalence was still high and the effect on behavioral changes was a little. CONCLUSION: The prevalence of vitamin D sufficient status among pregnant women in Japan was extremely low, which is a serious condition. It was also revealed the effectiveness of the antenatal health guidance intervention for pregnant women was not enough.

Developing a sampling method and preliminary taxonomy for classifying COVID-19 public health guidance for healthcare organizations and the general public.

BACKGROUND: Development and dissemination of public health (PH) guidance to healthcare organizations and the general public (e.g., businesses, schools, individuals) during emergencies like the COVID-19 pandemic is vital for policy, clinical, and public decision-making. Yet, the rapidly evolving nature of these events poses significant challenges for guidance development and dissemination strategies predicated on well-understood concepts and clearly defined access and distribution pathways. Taxonomies are an important but underutilized tool for guidance authoring, dissemination and updating in such dynamic scenarios. OBJECTIVE: To design a rapid, semi-automated method for sampling and developing a PH guidance taxonomy using widely available Web crawling tools and streamlined manual content analysis. METHODS: Iterative samples of guidance documents were taken from four state PH agency websites, the US Center for Disease Control and Prevention, and the World Health Organization. Documents were used to derive and refine a preliminary taxonomy of COVID-19 PH guidance via content analysis. RESULTS: Eight iterations of guidance document sampling and taxonomy revisions were performed, with a final corpus of 226 documents. The preliminary taxonomy contains 110 branches distributed between three major domains: stakeholders (24 branches), settings (25 branches) and topics (61 branches). Thematic saturation measures indicated rapid saturation (≤5% change) for the domains of "stakeholders" and "settings", and "topic"-related branches for clinical decision-making. Branches related to business reopening and economic consequences remained dynamic throughout sampling iterations. CONCLUSION: The PH guidance taxonomy can support public health agencies by aligning guidance development with curation and indexing strategies; supporting targeted dissemination; increasing the speed of updates; and enhancing public-facing guidance repositories and information retrieval tools. Taxonomies are essential to support knowledge management activities during rapidly evolving scenarios such as disease outbreaks and natural disasters.

Presenting or Spinning Facts? Deconstructing the U.S. Centers for Disease Control Statement on the Importance of Reopening Schools Under COVID-19.

Credible, reliable and consistent information to the public, as well as health professionals and decision makers, is crucial to help navigate uncertainty and risk in times of crisis and concern. Traditionally, information and health communications issued by respected and established government agencies have been regarded as factual, unbiased and credible. The U.S. Centers for Disease Control and Prevention (CDC) is such an agency that addresses all aspects of health and public health on behalf of the U.S Government for the benefit of its citizens. In July 2020, the CDC issued guidelines on reopening schools which resulted in open criticism by the U.S. President and others, prompting a review and publication of revised guidelines together with a special "Statement on the Importance of Reopening Schools under COVID-19." We hypothesize that this statement introduced bias with the intention to shift the public perception and media narrative in favor of reopening of schools. Using a mixed methods approach, including an online text analysis tool, we demonstrate that document title and structure, word frequencies, word choice, and website presentation did not provide a balanced account of the complexity and uncertainty surrounding school reopening during the COVID-19 pandemic. Despite available scientific guidance and practical evidence-based advice on how to manage infection risks when reopening schools, the CDC Statement was intentionally overriding possible parent and public health concerns. The CDC Statement provides an example of how political influence is exercised over the presentation of science in the context of a major pandemic. It was withdrawn by the CDC in November 2020.

Indoor Air Quality at Home-An Economic Analysis.

Background: People with respiratory conditions are susceptible to health problems caused by exposure to indoor air pollutants. An economic framework was developed to inform a guideline developed by National Institute for Health and Care Excellence (NICE) to estimate the required level of efficacy necessary for an intervention to be cost-saving in dwellings across England. Methods: An economic modelling framework was built to estimate the incremental costs pre- and post-implementation of interventions designed to reduce exposure to indoor air pollution within dwellings of varying building-related risk factors and profiles. The intervention cost was varied simultaneously with the relative reduction in symptomatic cases of each health condition to estimate the point at which an intervention may become cost-saving. Four health conditions were considered. Results: People living in dwellings with either an extreme risk profile or usable floor area <90m2 have the greatest capacity to benefit and save National Health Service (NHS) costs from interventions at any given level of effectiveness and upfront cost. Conclusions: At any effectiveness level, the threshold for the upfront intervention cost to remain cost-saving is equivalent across the different home characteristics. The flexible model can be used to guide decision-making under a range of scenarios.