ObjectivesMany public health officials faced threats and harassment while doing their jobs during the coronavirus disease 2019 (COVID-19) pandemic. The Adaptive Leadership Framework (ALF) serves as a useful lens through which the dangers of exercising leadership in a crisis situation can be analyzed and understood.MethodsThis study employed a systematic qualitative media content analysis to examine U.S. newspaper coverage of public health officials during the COVID-19 pandemic. We identified articles using Newspaper Source Plus and Newswires (EBSCO) databases and then screened and coded them using a deductive approach guided by the ALF. A total of 50 articles were analyzed using directed thematic analysis.ResultsMedia coverage revealed widespread and multifaceted resistance to public health leadership during the pandemic. Opposition originated from both the public (e.g., harassment, threats, and protests) and authority figures (e.g., firing). Despite these challenges, public health officials demonstrated adaptive leadership behaviors, particularly maintaining stability and building strong partnerships.ConclusionThreats and harassment reflected broader institutional and political pressures, underscoring the importance of institutional protection and leadership preparation for future public health crises.
ObjectiveTo assess the health impact of industrial and urban air pollution in the Haifa Bay area using biological monitoring of micro- and ultrafine particles (UFPs), and to examine their associations with functional, inflammatory, and clinical outcomes.MethodsThe study included 99 hospital staff members: 50 from Bnai Zion Medical Center in the Haifa Bay area and 49 from Tel Aviv Medical Center as controls. Participants underwent spirometry, fractional exhaled nitric oxide (FeNO) measurement, exhaled breath condensate (EBC) and saliva collection, and completed a health questionnaire. Assessments were repeated after 1 year. Latent class analysis (LCA) was used to identify homogeneous subgroups based on biological and clinical parameters.ResultsLCA identified a cluster characterized by higher body mass index, increased UFP concentrations in EBC, and elevated salivary LDH-calcium levels. This cluster consisted predominantly of participants from Haifa and showed higher salivary lymphocyte counts. Participants in this subgroup also reported more frequent respiratory symptoms, including cough, sputum production, and atopic complaints.ConclusionBiological monitoring of nanosized particles may provide early indicators of adverse health effects associated with urban-industrial air pollution exposure.
ObjectivesDeaths of despair—alcohol, substance use, suicide and non-organic mental health related—have attracted international attention, but English evidence remains limited. We examined trends in deaths of despair in England (2014–2022), including COVID-19 impacts and inequalities by sex and deprivation.MethodsWe analysed all registered deaths in England (2014–2022), identifying deaths of despair by ICD-10 code. Age-standardised mortality rates, years of life lost, and inequalities by sex and deprivation were calculated. Log-linear regression estimated pre-pandemic trends and deviations during COVID-19.ResultsThere were 133,600 deaths of despair (2.9% of all deaths). Age-standardised mortality rates rose 33%, from 22.6 to 30.1 per 100,000. Mortality was consistently higher in men and deprived areas, with widening inequalities. During COVID-19, mortality temporarily exceeded the pre-pandemic trend, particularly among women and deprived groups, before returning to trend. Deaths of despair accounted for a rising share of years of potential life lost (13.9%–16.6%).ConclusionDeaths of despair increased substantially in England, contributing a growing burden of premature mortality. Persistent, widening inequalities highlight a public health challenge requiring surveillance and interventions addressing immediate causes and social determinants.
ObjectiveThis study investigates the feasibility of using an automated approach to extract injury-related information from narrative text in a paediatric emergency department to improve data basis on injuries among children and adolescents in Switzerland.MethodsThe dataset comprises paediatric injury cases treated between 2018 and 2022 at the University Children’s Hospital Zürich emergency department (N = 30,876). Model development involved (1) adapting EU-IDB, a domain-specific hierarchical coding-system; (2) manual data annotation; and (3) fine tuning and (4) evaluation of a transformer-based model for multi-label text span classification.ResultsInterrater reliability improved from moderate (κ = 0.45) to substantial (κ = 0.73) following adaptation of the coding system. Variable level classification performance was encouraging across three training variants (macro F1: ALL = 0.57, IND = 0.64, VAR = 0.63). Performance declined at lower levels, particularly at level 3 (macro F1: ALL = 0.08, IND = 0.23). Automated prevalence estimates correlated strongly with manual annotations (ρ = 0.948).ConclusionAutomated text span classification of injury-relevant information from electronic patient records shows promising first results to provide valuable information for injury surveillance and prevention, missing in Switzerland. However, more annotated data and detailed validation are needed to draw robust conclusions.
ObjectivesIn response to growing interest in local action to promote public health, this study explores how municipalities perceive their role in health promotion (HP), how far HP is integrated into municipal policies, and what support is needed to strengthen local action.MethodsAn online survey was distributed to 300 municipalities in the Canton of Vaud (February - April 2025). Complete responses from 110 municipalities (39% response rate) were included in the analyses. An adaptation of the Maturity Model of Health in All Policies (MM-HiAP) guided the cluster analysis used to identify profiles of municipal engagement in HP.ResultsFour clusters were identified: Not engaged (39%), Relying on others (26%), Engaged but isolated (19%), and Engaged and somewhat structured (16%). Among the key factors influencing HP integration, municipal size and the presence of committed local leadership emerged greatly. Moreover, clusters revealed specific resources and needs, suggesting that support should be adapted to these specific needs.ConclusionThe study provides a framework for strengthening municipal engagement in HP along a maturity continuum, with implications for policy, practice, and future research across diverse local contexts.
ObjectivesRapid urbanization in China has been accompanied by residential segregation, which may influence wellbeing of rural-urban migrants (RUMs). This study aims to investigate the impact of residential segregation on life satisfaction among RUMs, with particular attention to the mediating role of social capital.MethodsWe screened 1,255 participants who met the inclusion criteria from the 2016 China Labor-force Dynamics Survey to investigate the relationship between residential segregation and life satisfaction using ordinary least squares regression and instrumental variable estimation. The mediating role of social capital was evaluated by mediation analysis.ResultsResidential segregation has a significant negative impact on life satisfaction of RUMs. This effect is partially mediated by cognitive social capital, whereas no mediating effect is observed for structural social capital. Among the dimensions of cognitive social capital, neighborhood trust and reciprocity are more significant mediators than familiarity.ConclusionResidential segregation undermines life satisfaction among RUMs partly through weakening cognitive social capital. Policies aimed at reducing residential segregation and promoting trust as well as reciprocity within neighborhoods may help improve the life satisfaction of migrants.
Objective:Alzheimer's disease and other dementias (ADOD) impose growing systemic stress. This study compared epidemiological trends and risk factors between the US and G20 to guide resource allocation. Methods:Using GBD 2023 data, we analyzed incidence, mortality, and DALY rates with Joinpoint regression (1990-2023) and ARIMA forecasting (to 2040). Results:In 2023, US age-standardized incidence rate was 130 (95% CI: 110.5-147.3), mortality rate 30 (7.4-73.2), and DALY rate 510 (224.8-1059.6), all declining from 1990. G20 rates remained lower but showed an upward inflection after 2020. Joinpoint analysis revealed overall downward trends, with a transient US resurgence (1998-2004); projections suggest continued deceleration. Smoking and high fasting plasma glucose burdens in the US were disproportionately elevated compared to G20. Conclusion:The US achieved morbidity compression yet faced rising absolute caseloads due to demographic momentum. G20's post-2020 upturn signals an emerging burden. A shift from smoking to metabolic drivers necessitates primary prevention for G20 and targeted metabolic management for the US.
ObjectivesIncarcerated people carry many health problems. While prisons provide structured healthcare and meals, micronutrient status remains unclear. We assessed plasma zinc, selenium, and copper status in incarcerated men in Vaud (French-speaking canton in Switzerland) and explored prevention-relevant patterns.MethodsCross-sectional study (May-September 2023) of incarcerated men in three prisons. Participants (n = 206) completed a health-related questionnaire and provided venous blood. Plasma trace elements were measured by inductively coupled-plasma-mass spectrometry. Associations with individual characteristics were examined and differences between-prisons were assessed. Micronutrient concentrations were compared with community-men, adjusting for age and body mass index.ResultsPrevalence of men with micronutrient plasma level below the normal range did not differ between incarcerated and community men. Adjusted means showed modestly lower selenium and higher zinc and copper in men experiencing incarceration. Within prisons, lower selenium was associated with older age, lower pre-incarceration income, and smoking. Zinc was lower with age and in one facility.ConclusionOverall micronutrient status was reassuring, yet the heterogeneity, possibly reflecting individual vulnerabilities and institutional conditions, supports continued, facility-aware monitoring to identify at-risk groups and protect health.
ObjectivesGuided by the Model for Adaptation Design and Impact (MADI), this paper explores how the Individual Placement and Support (IPS) model has been adapted for delivery in drug and alcohol treatment services in England.MethodsInterviews, focus groups and surveys with IPS practitioners, commissioners of drug and alcohol services, treatment service managers and experts.ResultsEfforts to publicize the IPS service and sharing client ‘success stories’ with treatment staff are perceived to facilitate effective integration as a key implementation outcome. These adaptations also strengthen referrals to the IPS service, alongside changes to the referral process and schemes to incentivize referrals. Employer engagement is supported by careful framing of IPS and sharing client experiences and outcomes. Flexible and supportive communication with clients, adjusting the pace and taking breaks where needed, is perceived as crucial to achieving employment outcomes. Adaptations are shaped by the local and national context, including the scale of IPS delivery across England, which enables peer-to-peer networking and information sharing.ConclusionEffective adaptations in IPS are those that strengthen integration, tackle stigma, tailor support, and enable learning networks.
ObjectivesTo develop a framework of policy-level domains for analyzing the sustainment and scale-up of Individual Placement and Support and, tentatively, other complex evidence-based psychosocial interventions.MethodsIntegrative review of 41 empirical studies on contextual determinants of Individual Placement and Support (IPS) sustainment and scale-up was conducted. The results were synthesized inductively and interpreted abductively using implementation science, policy implementation research, and welfare policy literature.ResultsThe LEL framework organizes recurring external-context patterns into three policy-level domains: Policy Legitimacy addresses policy legitimization and decision chains linking high-level policy decisions to implementation; Policy Embedding addresses multi-level and cross-sector implementation structure; and Policy Learning addresses implementation evidence infrastructure through which implementation experience informs practice, policy, and model refinement.ConclusionThe Legitimacy–Embedding–Learning (LEL) framework proposes policy-level domains for analyzing IPS sustainment and scale-up. It functions as an integrative analytical framework that supports cumulative evidence-building and comparative research within IPS, with testable relevance for other evidence-based complex psychosocial interventions.
ObjectivesSchool-based health promotion is critical for enhancing health literacy and academic performance. In South Africa, preventable visual impairment among school children may be exacerbated by the absence of structured eyecare promotion interventions. The objective of the study was to implement and evaluate the effectiveness of eyecare health promotion in the Thabo Mofutsanyane district, Free State province.MethodsA school-based cross-sectional interventional study was conducted. Following a simple randomised assignment, 10 schools received the intervention while the remaining 10 received no intervention. An adopted and piloted questionnaire was administered at baseline and readministered 6 months after the intervention. The McNemar’s chi-square test was used for statistical analysis.ResultsThe baseline study included 199 participants, and following attrition, stood at 136 learners, parents, and teachers. The learner experimental arm demonstrated a statistically significant change in eyecare knowledge (p < 0.05). While no statistically significant changes were noted among teachers, parents and learners had statistically significant variables.ConclusionDespite limitations, this study demonstrated that targeted eye health promotion can improve eyecare knowledge.
ObjectivesAs population needs continuously evolve new technologies have to find ways to address healthcare challenges. Inputs of key stakeholders are critical when adopting new technologies. Our objective was to map stakeholders along the Access and Delivery Partnership value chain framework (ADP) in relation to the RTS,S malaria vaccine introduction in Ghana.MethodsStakeholders engaged with the SAVING consortium were identified and an online questionnaire distributed to map stakeholders positioning in relation to the ADP framework. A workshop was also held to validate findings and to examine the decision processes in adopting new interventions.Results31 stakeholders responded the questionnaire reporting their involvement in the ADP framework, most of them identified with stages close to “service delivery”, as opposed to the preceding research and regulatory stages. A few stakeholders were seen as having the highest interest and influence on vaccine introduction.ConclusionThere is an imbalance between Ghana’s high demand for vaccines and its Research and Development (R&D) capacity, similar to other African countries. Enhancing upstream R&D capacity and fostering more inclusive stakeholder contributions could strengthen the pathway to new technologies adoption.
ObjectivesTo compare employment outcomes reported by a completed randomised controlled trial (IPS-AD: Individual Placement and Support - Alcohol and Drug Dependence) with those observed during the English national expansion of IPS services, and to identify factors associated with improved outcomes.MethodsThis was a secondary comparative analysis of five employment outcomes – employment rate, time to employment attainment, job tenure (longest single appointment duration), total time employed and job sustainment defined as ≥13 consecutive weeks employment, in two cohorts: the IPS-AD study intervention arm (n = 843) and IPS expansion participants (n = 3,182).ResultsCompared with the IPS-AD cohort, the expansion cohort showed a higher employment rate (52% versus 30%; p-value <0.001); faster employment attainment (143 versus 180 days; p-value <0.001); longer job tenure (254 versus 110 days; p-value <0.001); greater total time employed (300 versus 133 days; p-value <0.001); and higher job sustainment (76% versus 42%; p-value <0.001).ConclusionExpansion outcomes were consistently more favourable than those observed in the IPS-AD study. Factors that may have contributed to improved outcomes included implementation and delivery enhancements, broadened eligibility criteria, and favourable environmental and economic conditions.
ObjectiveThis study aims to determine accuracy of GlucoNeo Check, PPG-Based Non-Invasive Glucose Screening Device in interpreting patients’ blood glucose levels and to understand participants’ perspectives on their experiences.MethodThis study uses a mixed-methods with a cross-sectional diagnostic accuracy design to obtain a comprehensive overview through Clarke Error Grid Analysis using 660 participants with 3300 data sets, while incorporating qualitative components to assess feasibility and acceptance, using interviews and FGDs from 31 respondents, and analyzed thematically to understand user experience perspectives when using the device.ResultsGlucoNeo Check performance had a Mean Absolute Percentage Error of 3.6% ± 0.621 and classification accuracy of 89.2% ± 0.0515. Most data fell within Zone A, with a small amount in Zone B and no data in Zones C and D. Thematic analysis identified 4 themes: 1) device quality and practicality, 2) comfort of use, 3) facilitating technology, and 4) inclusive interface design.ConclusionGlucoNeo Check is accurate, innovative, and well-received tool for supporting community-based diabetes prevention but requires further validation to be adopted as a standard clinical monitoring tool.
