REDCap to Epic interfaces create an efficient hybrid software solution for a public health registry.

A public health registry and intervention was created in response to the Flint water crisis to identify and refer exposed individuals to public health services to ameliorate the deleterious impact of lead exposure. Traditional technology architecture domains, funded scope of work, as well as community input were considered when defining the requirements of the selected solutions. A hybrid software solution was created using Research Electronic Data Capture (REDCap) to deploy an open participant survey and bypass requirements to create user accounts, and Epic to manage deduplication and participant communication and tracking. To bridge the two software systems, REDCap to Epic unidirectional ADT and Documentation Flowsheet interfaces were built to automate creation of subject records in Epic identical to those created in REDCap and to copy key protocol-driving variables from REDCap to Epic. The interfaces were critical to deliver a successful hybrid solution in which the desired features of each software could be leveraged to satisfy specific protocol requirements and community input. Data from the start of survey administration (December 2018) through 31 December 2020 are reported to demonstrate the usefulness of the interfaces.

A Translational Case Study of a Multisite COVID-19 Public Health Intervention Across Sequenced Research Trials: Embedding Implementation in a Community Engagement Phased Framework.

Through a COVID-19 public health intervention implemented across sequenced research trials, we present a community engagement phased framework that embeds intervention implementation: (1) consultation and preparation, (2) collaboration and implementation, and (3) partnership and sustainment. Intervention effects included mitigation of psychological distress and a 0.28 increase in the Latinx population tested for SARS-CoV-2. We summarize community engagement activities and implementation strategies that took place across the trials to illustrate the value of the framework for public health practice and research. (Am J Public Health. 2024;114(S5):S396-S401. https://doi.org/10.2105/AJPH.2024.307669).

National Public Health Dashboards: Protocol for a Scoping Review.

BACKGROUND: The COVID-19 pandemic highlighted the importance of robust public health data systems and the potential utility of data dashboards for ensuring access to critical public health data for diverse groups of stakeholders and decision makers. As dashboards are becoming ubiquitous, it is imperative to consider how they may be best integrated with public health data systems and the decision-making routines of diverse audiences. However, additional progress on the continued development, improvement, and sustainability of these tools requires the integration and synthesis of a largely fragmented scholarship regarding the purpose, design principles and features, successful implementation, and decision-making supports provided by effective public health data dashboards across diverse users and applications. OBJECTIVE: This scoping review aims to provide a descriptive and thematic overview of national public health data dashboards including their purpose, intended audiences, health topics, design elements, impact, and underlying mechanisms of use and usefulness of these tools in decision-making processes. It seeks to identify gaps in the current literature on the topic and provide the first-of-its-kind systematic treatment of actionability as a critical design element of public health data dashboards. METHODS: The scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review considers English-language, peer-reviewed journal papers, conference proceedings, book chapters, and reports that describe the design, implementation, and evaluation of a public health dashboard published between 2000 and 2023. The search strategy covers scholarly databases (CINAHL, PubMed, Medline, and Web of Science) and gray literature sources and uses snowballing techniques. An iterative process of testing for and improving intercoder reliability was implemented to ensure that coders are properly trained to screen documents according to the inclusion criteria prior to beginning the full review of relevant papers. RESULTS: The search process initially identified 2544 documents, including papers located via databases, gray literature searching, and snowballing. Following the removal of duplicate documents (n=1416), nonrelevant items (n=839), and items classified as literature reviews and background information (n=73), 216 documents met the inclusion criteria: US case studies (n=90) and non-US case studies (n=126). Data extraction will focus on key variables, including public health data characteristics; dashboard design elements and functionalities; intended users, usability, logistics, and operation; and indicators of usefulness and impact reported. CONCLUSIONS: The scoping review will analyze the goals, design, use, usefulness, and impact of public health data dashboards. The review will also inform the continued development and improvement of these tools by analyzing and synthesizing current practices and lessons emerging from the literature on the topic and proposing a theory-grounded and evidence-informed framework for designing, implementing, and evaluating public health data dashboards. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52843.

Public health intervention amidst conflict: Violence, politics, and knowledge frames in the 2018-20 Ebola epidemic in Democratic Republic of the Congo.

Research, policy, and donor interest in health systems in conflict environments has grown rapidly in recent years. The 2018-20 Ebola outbreak in Democratic Republic of the Congo is a critical case of healthcare militarization. The first-ever such outbreak in an active conflict zone, it grew notorious for violence against response teams, with attacks aggravating the spread of disease. However, while medical responders observed physical attacks, the causes of the violence remained largely unknown. Drawing on interviews and participant observation, we contribute civilian vantages of the way health intervention grew militarized, or associated with conflict. The argument builds in two core steps. A first reconstructs civilian experiences of conflict prior to Ebola to trace how the response took on a political meaning. We find that relationships linking state forces with the health response inadvertently tethered Ebola to what civilians perceived as security threats and that by repeating government statements about conflict, response teams unintentionally endorsed a version of the truth that silenced local voices. A second step addresses a central paradox: residents communicated these concerns directly, repeatedly, and via official response channels, yet healthcare teams failed to apply these insights. We locate this gap in the knowledge structures, or frames, accompanying intervention. Medical emergencies in warzones operate with dual sets of frames casting conflict players as "non-state" and public health resistance as "ignorance." Both frames intersect in ways that amplify invisibilities in each, clouding understandings of the nature of conflict and humanitarians' role in it. We suggest this places intervention teams at heightened risk of mis-stepping on political fault lines-and not understanding why. The study advances work on community engagement by showing that instead of simply providing scientific knowledge, effective engagement requires adjusting socio-political lenses within the response. It contributes to studies on health intervention, humanitarian emergencies, and the limits of medical neutrality.

Time for Medicine and Public Health to Leave Platform X.

Unlabelled: For more than 50 years, digital technologies have been employed for the creation and distribution of knowledge in health services. In the last decade, digital social media have been developed for applications in clinical decision support and population health monitoring. Recently, these technologies have also been used for knowledge translation, such as in the process where research findings created in academic settings are established as evidence and distributed for use in clinical practice, policy making, and health self-management. To date, it has been common for medical and public health institutions to have social media accounts for the dissemination of novel research findings and to facilitate conversations about these findings. However, recent events such as the transformation of the microblog Twitter to platform X have brought to light the need for the social media industry to exploit user data to generate revenue. In this viewpoint, it is argued that a redirection of social media use is required in the translation of knowledge to action in the fields of medicine and public health. A new kind of social internet is currently forming, known as the "fediverse," which denotes an ensemble of open social media that can communicate with each other while remaining independent platforms. In several countries, government institutions, universities, and newspapers use open social media to distribute information and enable discussions. These organizations control their own channels while being able to communicate with other platforms through open standards. Examples of medical knowledge translation via such open social media platforms, where users are less exposed to disinformation than in general platforms, are also beginning to appear. The current status of the social media industry calls for a broad discussion about the use of social technologies by health institutions involving researchers and health service practitioners, academic leaders, scientific publishers, social technology providers, policy makers, and the public. This debate should not primarily take place on social media platforms but rather at universities, in scientific journals, at public seminars, and other venues, allowing for the transparent and undisturbed communication and formation of opinions.

[What does Harm Reduction in Tobacco Use means to Public Health]. / Reducción de daños en tabaquismo desde la Salud Pública.

Harm reduction is a classic Public Health concept to refer to the reduction of the negative effect of drug use/abuse with a focus on justice and human rights, but the tobacco industry has been perverting this concept for years and using it as a tool for its own marketing. This publication details what real harm reduction action on tobacco use would be, when it should be implemented, and what pillars it should be based on. Different methods of reducing the harmful effects of tobacco and nicotine have been tried and tested over time, but the results have been poor; therefore, smoking cessation by the various officially recognised methods is recommended as a priority objective, using the tools that are truly supported by science. In contrast, it also explains the strategies developed by the industry to manipulate consumers and make them dependent on products that can eventually kill them: from the development of filtered cigarettes to light cigarettes, and from menthol to flavoured vapes. In all cases, they have falsely led people to believe that they were developing less toxic products when they were not. Nowadays, both light and menthol cigarettes are banned in Spain, filters have not reduced risk but increased the use, and vapes try to replace cigarettes with their attractive flavours and their false legend of healthier products when what they are really doing is maintaining the same addiction by changing the object, encouraging dual use, and attracting younger and younger non-smokers. At the same time, a strategy of dividing the opinion of health professionals has been developed, using medical doctors and researchers with recognised conflicts of interest but who manage to confuse consumers. In conclusion, we consider that, although nicotine releasing devices may be useful elements in some particular cases, they are not recommended at the population level as they can promote onset, prevent cessation, as well as maintaining the addictive capacity. The only nicotine products that are recommended are those of pharmacological use approved for the case and provided they are used as a transitional tool to complete cessation.

La reducción de daños es un concepto clásico de la Salud Pública para referirse a la reducción del impacto negativo del consumo de drogas con un enfoque de justicia y derechos humanos, pero la industria tabacalera lleva años pervirtiendo este concepto y utilizándolo como una herramienta de su propio marketing. La presente publicación detalla qué sería una verdadera acción de reducción de daños en tabaquismo, cuándo debería aplicarse y en qué pilares debería sostenerse. A lo largo del tiempo se han probado distintos métodos de minorar los efectos perjudiciales del tabaco y de la nicotina, si bien los resultados han sido escasos; así pues, se propone como objetivo prioritario la cesación tabáquica por los distintos métodos reconocidos, utilizando como herramientas las verdaderamente amparadas por la Ciencia. En contraste, se explican también las estrategias desarrolladas por la industria para manipular a los consumidores y hacerles dependientes de unos productos que eventualmente pueden acabar con sus vidas: desde el desarrollo de los cigarrillos con filtro a los light, y de los mentolados a los vapers de sabores. En todos los casos han hecho creer falsamente que desarrollaban productos menos tóxicos cuando no era así. Hoy en día, tanto los cigarrillos light como los mentolados están prohibidos en España, los filtros no han conseguido una disminución del riesgo y sí un aumento del consumo, y los vapers intentan sustituir a los cigarrillos con sus aromas atractivos y su falsa leyenda de productos más sanos cuando lo que están haciendo en realidad es mantener la misma adicción cambiando el objeto, fomentando el consumo dual, y atrayendo a consumidores no-fumadores previos cada vez más jóvenes. Paralelamente, se ha desarrollado una estrategia de división de la opinión de los profesionales sanitarios, con médicos e investigadores con reconocidos conflictos de interés pero que logran confundir al consumidor. Como conclusión consideramos que, si bien en algún caso particular los DSLN (dispositivos susceptibles de liberar nicotina) puedan ser elementos útiles, no son recomendables a nivel poblacional ya que pueden promover el inicio del consumo e impedir la cesación, además de mantener la capacidad adictógena. Los únicos productos de nicotina que se recomiendan son aquellos de uso farmacológico aprobados para el caso y siempre que se usen como herramienta transitoria para la cesación completa.

Public Health Responses to CBRN Terrorism in the Middle East and North Africa.

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.

Trust in public health policy in the time of the COVID-19 epidemic in Israel.

The government of Israel provides universal health care through four health care organizations ("sick funds") that enjoy general public trust. In hindsight, the response of the government to the COVID-19 epidemic seems reasonable. In the first year of the epidemic, tests and vaccines were developed and other measures were taken, including social distancing, focusing on risk factors for infection and disease severity, and improving treatment. The COVID-19 mortality rate between January 2000 and June 2021 was around 750 per million inhabitants, well below the OECD average of 1300. Still, although the control measures were largely well received, the media and an ad hoc non-governmental Emergency Council for the coronavirus crisis in Israel criticized the government's response to the epidemic thereby contributing to a decline in public trust in government policy. This commentary provides an overview of the importance of trust in medical institutions and the difficulties of evaluating healthcare decisions in an attempt to justify three conclusions. First, when physicians and self-appointed experts publicly disapprove of a government policy, they should consider the trade-off between improving care and undermining public trust. Second, when evaluating a medical decision, experts should not ask, "Would I have acted differently?" but rather, "Was the decision under review completely unreasonable?" Thirdly, criticism is certainly worth listening to. However, I believe that by calling for organized resistance against the government, the publicly announced establishment of the Emergency Council for the Corona crisis blatantly crossed the line between constructive criticism and destructive mistrust.

The Need to Widen the Concept of Health and to Include the Spiritual Dimension.

For many, the World Health Organization's (WHO) definition of health does not reflect their own understanding of health, because it lacks aspects such as spiritual wellbeing. Responding to these concerns, the WHO called in 2023 for a vision of health that integrates physical, mental, psychological, emotional, spiritual, and social wellbeing. To date, medical practitioners are often reluctant to consider spiritual aspects, because of a perceived lack of statistical evidence about the strength of relations. Research on this topic is emerging. A recent study among 800 young people living with HIV in Zimbabwe showed how study participants navigated three parallel, at times contradicting health systems (religious, traditional, medical). Conflicting approaches led to multifaceted dilemmas (= spiritual struggles), which were significantly related to poorer mental and physical health. This illustrates the need for inclusion of spiritual aspects for health and wellbeing in research, and of increased collaboration between all stakeholders in healthcare.

Community Voices and Whole-Genome Sequencing for Tuberculosis: Storytelling and the Importance of Listening.

One of the primary public health functions of a tuberculosis (TB) program is to arrest the spread of infection. Traditionally, TB programs have relied on epidemiological information, gathered through contact tracing, to infer that transmission has occurred between people. The ability of drawing such inferences is extensively context dependent. Where epidemiological information has been strong, such as 2 cases of TB occurring sequentially within a single household, confidence in such inferences is high; conversely, public health authorities have been less certain about the significance of TB cases merely occurring in the same wider social group or geographic area. Many current laboratory tests for TB used globally may be sufficient to confirm a diagnosis and guide appropriate therapy but still be insufficiently precise for distinguishing two strains reliably. In short, drawing inferences regarding a chain of transmissions has always been as much art as science.

Intervención participativa comunitaria: necesidades de salud de las personas mayores durante el período de la pandemia por COVID-19 / Community participatory intervention: health needs of older people during the COVID-19 pandemic period

Objetivo. Proponer una intervención participativa comunitaria según las necesidades de salud percibida por las personas mayores del Programa de Salud Cardiovascular de un centro de salud familiar y comunitaria de una comuna de Santiago de Chile durante el período de la pandemia de la COVID-19. Métodos. Se utilizó una metodología participativa de la comunidad, la cual se desarrolló en dos fases: diagnóstico participativo comunitario y desarrollo de la propuesta participativa de una intervención en salud comunitaria. Resultados. Desde el diagnóstico participativo comunitario, los participantes eligieron el desarrollo de un programa educativo fundamentado en las necesidades de salud, además de la entrega de material educativo sobre estilos de vida saludable y recomendaciones para tener un buen control de sus enfermedades. Conclusión. Desde el diagnóstico y planificación participativa, es posible intervenir en pro de las necesidades de las personas, familias y comunidades y capacitarlas en el manejo de su propia salud. (AU)

Aim. To propose a community participatory intervention according to the health needs perceived by elderly people in the Family and Community Health Centre Cardiovascular Health programme of a Santiago de Chile commune during the COVID-19 pandemic. Methods. A community participatory methodology was used, which was developed over two phases: community participatory diagnosis and development of a participatory proposal for a community health intervention. Results. From the community participatory diagnosis, participants opted for development of an educational programme based on health needs, in addition to the delivery of educational material related to healthy lifestyles and recommendations for robust control of their diseases. Conclusion. From diagnosis and participatory planning, it is possible to intervene in favour of the needs of individuals, families and communities and train them in managing their own health. (AU)

Alfabetización en salud: proceso de aprendizaje significativo personal y comunitario / Health literacy: meaningful personal and community learning process

El aprendizaje y la salud son dos elementos vinculados entre sí. El hecho de cuidar de la salud requiere del aprendizaje de conocimientos, habilidades, comportamientos y actitudes que se desarrollan a lo largo de nuestra vida. Los aprendizajes relacionados con la salud comportan estilos de vida más saludables, la mejora del bienestar, la calidad de vida y la salud de la comunidad. El aprendizaje significativo transforma las vidas, abriendo nuevas oportunidades, posibilitando nuevas competencias y formando nuevas redes sociales. Este artículo pretende reflexionar sobre la relación entre elementos de la alfabetización en salud y el proceso de aprendizaje significativo. (AU)

Learning and health are both interrelated aspects. The act of looking after health requires learning knowledge, skills, behaviors, and attitudes that develop throughout our lives. Health-related learning leads to healthier lifestyles, improved well-being, better quality of life and community health. Significant learning transforms lives, paving the way towards new opportunities, enabling new skills and forming new social networks. This paper aims to reflect on the relationship between aspects of health literacy and the meaningful learning process. (AU)

A reproducible ensemble machine learning approach to forecast dengue outbreaks.

Dengue fever, a prevalent and rapidly spreading arboviral disease, poses substantial public health and economic challenges in tropical and sub-tropical regions worldwide. Predicting infectious disease outbreaks on a countrywide scale is complex due to spatiotemporal variations in dengue incidence across administrative areas. To address this, we propose a machine learning ensemble model for forecasting the dengue incidence rate (DIR) in Brazil, with a focus on the population under 19 years old. The model integrates spatial and temporal information, providing one-month-ahead DIR estimates at the state level. Comparative analyses with a dummy model and ablation studies demonstrate the ensemble model's qualitative and quantitative efficacy across the 27 Brazilian Federal Units. Furthermore, we showcase the transferability of this approach to Peru, another Latin American country with differing epidemiological characteristics. This timely forecast system can aid local governments in implementing targeted control measures. The study advances climate services for health by identifying factors triggering dengue outbreaks in Brazil and Peru, emphasizing collaborative efforts with intergovernmental organizations and public health institutions. The innovation lies not only in the algorithms themselves but in their application to a domain marked by data scarcity and operational scalability challenges. We bridge the gap by integrating well-curated ground data with advanced analytical methods, addressing a significant deficiency in current practices. The successful transfer of the model to Peru and its consistent performance during the 2019 outbreak in Brazil showcase its scalability and practical application. While acknowledging limitations in handling extreme values, especially in regions with low DIR, our approach excels where accurate predictions are critical. The study not only contributes to advancing DIR forecasting but also represents a paradigm shift in integrating advanced analytics into public health operational frameworks. This work, driven by a collaborative spirit involving intergovernmental organizations and public health institutions, sets a precedent for interdisciplinary collaboration in addressing global health challenges. It not only enhances our understanding of factors triggering dengue outbreaks but also serves as a template for the effective implementation of advanced analytical methods in public health.

Visual Analytics for Data-Driven Understanding of the Substance Use Disorder Epidemic.

The substance use disorder epidemic has emerged as a serious public health crisis, presenting complex challenges. Visual analytics offers a unique approach to address this complexity and facilitate effective interventions. This paper details the development of an innovative visual analytics dashboard, aimed at enhancing our understanding of the substance use disorder epidemic. By employing record linkage techniques, we integrate diverse data sources to provide a comprehensive view of the epidemic. Adherence to responsive, open, and user-centered design principles ensures the dashboard's usefulness and usability. Our approach to data and design encourages collaboration among various stakeholders, including researchers, politicians, and healthcare practitioners. Through illustrative outputs, we demonstrate how the dashboard can deepen our understanding of the epidemic, support intervention strategies, and evaluate the effectiveness of implemented measures. The paper concludes with a discussion of the dashboard's use cases and limitations.

A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.