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PubMed2006

A susceptible-infected model of early detection of respiratory infection outbreaks on a background of influenza.

The threat of biological warfare and the emergence of new infectious agents spreading at a global scale have highlighted the need for major enhancements to the public health infrastructure. Early detection of epidemics of infectious diseases requires both real-time data and real-time interpretation of data. Despite moderate advancements in data acquisition, the state of the practice for real-time analysis of data remains inadequate. We present a nonlinear mathematical framework for modeling the transient dynamics of influenza, applied to historical data sets of patients with influenza-like illness. We estimate the vital time-varying epidemiological parameters of infections from historical data, representing normal epidemiological trends. We then introduce simulated outbreaks of different shapes and magnitudes into the historical data, and estimate the parameters representing the infection rates of anomalous deviations from normal trends. Finally, a dynamic threshold-based detection algorithm is devised to assess the timeliness and sensitivity of detecting the irregularities in the data, under a fixed low false-positive rate. We find that the detection algorithm can identify such designated abnormalities in the data with high sensitivity with specificity held at 97%, but more importantly, early during an outbreak. The proposed methodology can be applied to a broad range of influenza-like infectious diseases, whether naturally occurring or a result of bioterrorism, and thus can be an integral component of a real-time surveillance system.

Algorithms↗
PubMed1997

The impact of the economic crisis and the US embargo on health in Cuba.

OBJECTIVES: This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders. RESULTS: Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly. CONCLUSIONS: To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster.

Adolescent↗
PubMedDate not supplied

Occupational and environmental medicine in the United States: A proposal to abolish workers' compensation and reestablish the public health model.

The workers' compensation model of occupational and environmental medicine should be converted to a public health model. Occupational and environmental medicine, as a part of the public health infrastructure,could play a much more substantive part in bringing about a national program to deal with occupational and environmental health. The workers' compensation insurance system could be discontinued at any time,but it will be vital to do so when national health insurance is adopted in the United States. Abolishing workers' compensation would remove the perverse incentives that currently undermine the practice of occupational medicine. Medical care for workers should be provided by health care professionals who are not subject to influence by employers or insurers. Eligibility for benefits should not be determined by health and safety professionals. Wage-replacement benefits for workers should be determined by guidelines established by government and industry that prevent manipulation of health and safety professionals by employers and insurers. A nationwide comprehensive system to track work-related injury and illness, superior to the current reliance on records provided by employers and collated by government agencies, should be adopted. When unusually high rates of injuries, illnesses,and fatalities occur, government inspectors ought to respond and regulate the industry accordingly. Occupational health and safety professional strained in public health can and should participate in these activities, but not when they are in the employ of industry or insurers.

Accidents, Occupational↗
PubMed2001

What we need to know about bioterrorism preparedness: results from focus groups conducted at APIC 2000.

Infection control practitioners (ICPs) are important partners in enhancing the US public health infrastructure, both as essential recipients of continuing education and as instructors responsible for providing this education. Focus groups were conducted at APIC 2000, the annual meeting for the Association for Professionals in Infection Control and Epidemiology, Inc, to determine the ICPs' priorities for educational opportunities in bioterrorism preparedness and the preferred methods of education delivery. Focus group participants affirmed the need to provide education in sessions of less than 60 minutes, with use of a variety of technologies and methods of presentation such as video, Internet, and paper-based self-learning texts. The participants' comments suggested a lack of awareness by employees in health care institutions about the potential threat of bioterrorism in the United States and a deficiency in knowledge about the potential consequences of an attack. The focus group participants believed this lack of awareness also leads to unwillingness by their administrators to allocate funds for planning and education. Since it appears that ICPs will be looking for direction and expertise from the local health departments in their communities, the first subset of professionals to target for bioterrorism education and preparedness should probably be the public health professionals.

Adult↗
PubMed2002

The World Cities Project: rationale, organization, and design for comparison of megacity health systems.

This article provides an overview of the World Cities Project (WCP), our rationale for it, our framework for comparative analysis, and an overview of current studies in progress. The WCP uses New York, London, Paris, and Tokyo as a laboratory in which to study urban health, particularly the evolution and current organization of public health infrastructure, as well as the health status and quality of life in these cities. Comparing world cities in wealthier nations is important because of (1) global trends in urbanization, emerging health risks, and population aging; (2) the dominant influence of these cities on "megacities" of developing nations; and (3) the existence of data and scholarship about these world cities, which provides a foundation for comparing their health systems and health. We argue that, in contrast to nation-states, world cities provide opportunities for more refined comparisons and cross-national learning. To provide a framework for WCP, we define an urban core for each city and examine the similarities and differences among them. Our current studies shed light on inequalities in health care use and health status, the importance of neighborhoods in protecting population health, and quality of life in diverse urban communities.

Delivery of Health Care↗
PubMedDate not supplied

Assessing the readiness and training needs of non-urban physicians in public health emergency and response.

Emergency readiness has become a public health priority for United States communities after the 9/11 attacks. Communities that have a less developed public health infrastructure are challenged to organize preparedness and response efforts and to ensure that health care providers are capable of caring for victims of terrorist acts. A survey was used to assess non-urban physicians' prior experience with and self-confidence in treating, and preferred training needs for responding to chemical, biologic, radiologic, nuclear, and explosive (CBRNE) cases. Data were collected through a mailed and Web-based survey. Although the response rate was calculated at 30%, approximately one third of the surveys were not able to be delivered. Most respondents reported never having seen or treated CBRNE-inflicted cases and were not confident in their ability to diagnose or treat CBRNE cases, but many were willing to participate in a state-led response plan. Almost half of the individuals had not participated in any related training but expressed interest in receiving training in small group workshops or through CD-ROM. These results provide potential direction for strategic preparedness planning for non-urban health care providers.

Attitude of Health Personnel↗
PubMed2005

Patterns of childhood mortality in a region of Belarus, 1980-2000.

UNLABELLED: The public health infrastructure of the former Soviet Union was impacted by both the Chernobyl disaster in 1986 and the Soviet breakup in 1991. This paper examines mortality patterns among children aged 1-14 years within the Mogilev region of Belarus between 1980 and 2000. This study utilized a regional cohort design that included all childhood deaths (ages 1-14 years) occurring among persons residing within the Mogilev oblast of Belarus between 1980 and 2000. Patterns of death and death rates were examined across three intervals: 1980-1985 (pre-Chernobyl), 1986-1991 (post-Chernobyl and pre-Former Soviet Union (FSU) breakup) and 1992-2000 (post-Chernobyl and post-FSU breakup) based upon administrative death files. Annual death rates among children aged 1-4 years declined between 1980 and 2000, while mortality rates among children aged 5-9 years and 10-14 years remained steady over this time period. Average annual mortality rates among males aged 5-9 years and 10-14 years increased significantly between 1986 and 1991. Compared to the baseline interval, mortality among both males and females aged 1-4 years was significantly decreased during 1986-1990 and 1992-2000. In general, mortality rates among males were 24%-95% greater compared to females. Injuries and poisonings accounted for the largest proportion of deaths across all age and gender groups examined. Subsequent to the Chernobyl disaster, significant decreases were noted in mortality rates among children aged 1-4 years while mortality rates among children aged 5-9 and 10-14 remained stable. CONCLUSION: Similar to the findings in other countries, injuries and poisonings predominated as the leading cause of death among Belarussian children.

Adolescent↗
PubMed1992

The mosquito genome: organization, evolution and manipulation.

Apart from the genetic flexibility of the vectors, impediments to the control of vector-borne diseases include the rapid spread of drug resistance throughout parasite populations, the increasing movement of people to and from disease-endemic regions and the limited funds and public health infrastructures of most developing countries. The widely used residual insecticides and antiparasitic drugs have been inadequate solutions to the problem of vector-borne disease control. New approaches are needed. The enormous impact of recent developments in molecular genetics on the understanding of basic biology and human disease has stimulated a re-examination of the prospects for genetic manipulation of vector populations as a means for reducing or eliminating vector-borne diseases, especially malarial. Although control scenarios that exploit this technology may never be realized, Nora Besansky and Frank Collins emphasize that the increase in knowledge of basic mosquito biology on which these ideas depend will inevitably stimulate novel approaches to the control of mosquito-borne diseases.

Journal Article↗
PubMed1990

Chemotherapy: principles in practice--a case study of the Philippines.

This paper reports on the principles that form the basis of chemotherapy and examines the operational considerations that affect their practice in a developing country like the Philippines, where malaria endemicity is synonymous with difficult topography, poor public health infrastructure, and alternative means of obtaining medication. The practice of using microscopic diagnosis for radical treatment is followed routinely and uniformly. Where policy dictates that all fever cases be screened, the result is an overload of the system and a corresponding delay in the slide-examination rate which makes such microscopic diagnosis cease to serve as a basis for prompt radical treatment and control in transmission.

Animals↗
PubMed2004

Evaluation of field training in the epidemic intelligence service: publications and job choices.

BACKGROUND: Since 1951, the Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) has provided training in applied epidemiology to physicians, nurses, veterinarians, dentists, and doctoral-level health scientists. About one third of these EIS officers have been trained in the setting of state and local health departments (the field). METHODS: To evaluate two specific outcomes of field EIS training, the authors reviewed the published work and career choices of field EIS officers after completing the program. The EIS classes of 1991-1996 were selected for study. A field officer was defined as an EIS Officer who completed at least the second year of a 2-year EIS assignment in a state or local health department position. RESULTS: During this period, 430 EIS officers completed the program; 117 (27.2%) were field officers. Of these, 84 (71.8%) published one or more scientific paper as first author for a total of 202 first authored manuscripts in over 50 different journals, an average of 1.7 (range, 0-8) per officer. Most (71%) were on infectious disease topics; 16% were on environmental health or injury control topics, and 11% were on chronic diseases. Field officers were more likely than headquarters-based officers to choose positions in state or local health departments for their first job after graduating (32/117 [27.4%] versus 22/313 [7.0%]; relative risk = 3.9, 95% confidence interval = 2.4-6.4). CONCLUSIONS: EIS training in the field has contributed to the scientific literature and to the strengthening of public health infrastructure at the state and local level.

Career Choice↗
PubMedDate not supplied

Global warming and infectious disease.

Global warming has serious implications for all aspects of human life, including infectious diseases. The effect of global warming depends on the complex interaction between the human host population and the causative infectious agent. From the human standpoint, changes in the environment may trigger human migration, causing disease patterns to shift. Crop failures and famine may reduce host resistance to infections. Disease transmission may be enhanced through the scarcity and contamination of potable water sources. Importantly, significant economic and political stresses may damage the existing public health infrastructure, leaving mankind poorly prepared for unexpected epidemics. Global warming will certainly affect the abundance and distribution of disease vectors. Altitudes that are currently too cool to sustain vectors will become more conducive to them. Some vector populations may expand into new geographic areas, whereas others may disappear. Malaria, dengue, plague, and viruses causing encephalitic syndromes are among the many vector-borne diseases likely to be affected. Some models suggest that vector-borne diseases will become more common as the earth warms, although caution is needed in interpreting these predictions. Clearly, global warming will cause changes in the epidemiology of infectious diseases. The ability of mankind to react or adapt is dependent upon the magnitude and speed of the change. The outcome will also depend on our ability to recognize epidemics early, to contain them effectively, to provide appropriate treatment, and to commit resources to prevention and research.

Animals↗
PubMed2005

Tuberculosis, a re-emergent disease.

Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. In Western Europe, regions with a high incidence of TB usually also have a high incidence of HIV infection; TB and HIV co-infection have increased over the past decade and among HIV infected patients, nearly half also develop TB. In settings where HIV is prevalent, TB drug resistance has also increased and several reports of TB and multi-drug resistant TB outbreaks, especially in health care settings, raise serious concerns about nosocomial transmission. Further research and new developments into more rapid diagnostic methods and sensitivity testing as well as the development of new anti-TB drugs are important to fight the disease. In addition, public health infrastructures have to be strengthened in order to increase adherence to TB treatment, where directly observed treatment strategy is the cornerstone for a successful outcome.

Antitubercular Agents↗
PubMed2005

Innovative approaches to the prevention and control of bacterial sexually transmitted infections.

Bacterial STI continues to be a major problem in developed nations. Research and evolving standards of public health practice are cause for optimism and concern. Innovations in case-finding and treatment, particularly the application of NAATs to test for chlamydial infection in nonclinical settings, are successes that merit more widespread application. EPT, selective STI screening in men, and rescreening are all promising, but are not yet in widespread use and may face significant operational barriers. To date, public health efforts to alter sexual behavior, at least through specific interventions, are more discouraging. Although some behavioral interventions have been effective, none has been widely instituted. Moreover, the likelihood that existing behavioral interventions will be widely applied seems remote. Future research efforts in this area will need to focus less on proof-of-concept efficacy trials and more on developing and testing sustainable, cost-effective interventions that focus on those at greatest risk and that can be scaled-up within the existing public health infrastructure.

Adolescent↗
PubMedDate not supplied

Status of women and infants in complex humanitarian emergencies.

Women and children bear the greatest burden in the midst of war and long-term disasters. Complex humanitarian emergencies are characterized by social disruption, armed conflict, population displacement, collapse of public health infrastructure, and food shortages. Humanitarian assistance for refugees and internally displaced populations requires particular attention to the common issues affecting morbidity and mortality in women and infants. Gender-based violence and reproductive health concerns are discussed within the context of populations affected by conflict and forced migration. Recommendations for midwives and women's health care providers engaging in care for women and children in complex humanitarian emergencies are discussed.

Developing Countries↗
PubMed2004

Influenza in Thailand: a case study for middle income countries.

Recent studies in Hong Kong and Singapore suggest that the annual impact of influenza in these wealthy tropical cities may be substantial, but little is known about the burden in middle-income tropical countries. We reviewed the status of influenza surveillance, vaccination, research, and policy in Thailand as of January 2004. From 1993 to 2002, 64-91 cases of clinically diagnosed influenza were reported per 100,000 persons per year. Influenza viruses were isolated in 34% of 4305 specimens submitted to the national influenza laboratory. Vaccine distribution figures suggest that less than 1% of the population is immunized against influenza each year. In January 2004, Thailand reported its first documented outbreak of influenza A H5N1 infection in poultry and the country's first human cases of avian influenza. Thailand's growing economy, well-developed public health infrastructure, and effective national immunization program could enable the country to take more active steps towards influenza control.

Communicable Disease Control↗
PubMed2026

Making waves: toward systems-level interpretation of hormonal and endogenous biomarkers in wastewater-based epidemiology.

Wastewater-based epidemiology (WBE) has proven invaluable for population health monitoring, most notably during the COVID-19 pandemic. Yet current WBE largely relies on exogenous markers such as drugs, pathogens, and their metabolites, limiting surveillance to what communities are exposed to. We argue for expanding WBE towards endogenous biomarkers, particularly hormones, which provide insights into physiological stress, metabolic function, and endocrine activity. Hormone-based WBE offers new opportunities to capture population-level biological responses to societal and environmental stressors, disasters, and chronic disease burdens at the community scale. This perspective outlines a systems-level framework for integrating hormonal signals in wastewater with clinical data, behavioral indicators, environmental factors, and digital markers to support more robust and context-aware public health surveillance. We highlight key technical considerations, interpretive challenges, and opportunities for translational pilot studies. By moving beyond exposure tracking toward more integrated interpretation of biological responses, hormone-informed WBE may contribute to more resilient, inclusive, and actionable public health infrastructure.

Humans↗
PubMed2005

Epilepsy-associated stigma in sub-Saharan Africa: the social landscape of a disease.

Many studies in developed regions of the world have confirmed that stigma contributes substantially to the psychological and social burden of epilepsy. Relatively few studies of epilepsy-associated stigma have been conducted in Africa, where much of the world's burden of epilepsy exists. In sub-Saharan Africa (SSA), particularly in rural regions, close family ties, communal living situations, and traditional belief systems undoubtedly influence the expression of stigmatization. A review of the epidemiologic, anthropologic, and sociologic studies of epilepsy in SSA provides significant insights into how people with epilepsy (PWE) are perceived by their communities and families and how these perceptions translate into limited social and economic opportunities and possibly worsen the physical vulnerability of PWE in this region. The medical community is not exempt from the social process of stigmatization, and poor public health infrastructure and medical services undoubtedly contribute to the cycle of epilepsy-associated stigma through wide treatment gaps, poor seizure control, and high rates of seizure-related injury. In this review, we extrapolate data from existing studies of epilepsy in SSA coupled with our own experience providing epilepsy care in the region to give an overview of the social landscape of this common, devastating condition.

Africa South of the Sahara↗
PubMed1999

BERNA: a century of immunobiological innovation.

At the time the Swiss Serum and Vaccine Institute Berne (BERNA) was found in 1898, few vaccines or immune globulins were available. This short list included vaccines against cholera, typhoid fever, plague, smallpox and rabies and equine anti-tetanus and diphtheria immune globulins. Furthermore, their use was restricted due to limited production capacity, uncertainty regarding safety and no public health infrastructure to promote their utilization. Today, safe and effective vaccines exist for more than 30 infectious diseases while human hyperimmune globulins exist to treat or prevent rabies, tetanus, respiratory syncytial virus, cytomegalovirus, hepatitis A, hepatitis B, and herpes virus (Varicella zoster) infections. Throughout its 100 years of existence, BERNA has played a key role in the evolution of the field by introducing novel technology leading to safer, and more efficacious vaccines. It was a pioneer in the development of freeze dried smallpox vaccine free from bacterial contamination. The Salmonella typhi Ty21a typhoid fever vaccine strain demonstrated that oral immunization against enteric bacterial pathogens was not only feasible, but could be accomplished with a virtual lack of attendant adverse reactions. This finding has served as an impetus to develop other live attenuated bacterial strains not only as vaccines, but also as vectors for vaccine antigens and gene therapy. One such example is Vibrio cholerae CVD 103-HgR, the first live vaccine for human use derived through recombinant DNA technology. Subsequent studies have shown that these two vaccine strains can be combined without sacrificing safety or immunogenicity, setting the cornerstone for combined orally administered vaccines. Recently, a novel vaccine antigen delivery system, termed virosomes, has been utilized to construct hepatitis A and influenza vaccines. Such vaccines elicit fewer local adverse reactions than their classical counterparts and display enhanced immunogenicity. Virosome-formulated influenza vaccine has also been shown to be safe and immunogenic, when administered by the intranasal route.

Academies and Institutes↗