Public Health Reports最新文献

Objectives: Infection mitigation practices and health care infrastructure challenges during the COVID-19 pandemic caused delays in medical care and chronic disease detection and management. These challenges also hindered healthy lifestyle choices. We analyzed diabetes and cardiovascular disease (CVD) mortality independent of COVID-19 comorbidity to assess the effect of the COVID-19 pandemic on chronic disease mortality.

Methods: We obtained Illinois Vital Records System death records for calendar year 2019 (January 1 through December 1, 2019) and COVID-19 year 1 (March 16, 2020, through March 15, 2021). We included Illinois residents with causes of death recorded as diabetes or CVD and the absence of COVID-19 infection. We calculated age-adjusted mortality rates for diabetes and CVD as underlying causes of death. We examined data by age, sex, race and ethnicity, education, geography, and CVD subtypes.

Results: The infection-independent, all-cause mortality rate per 100 000 population in Illinois increased 3.6% from January 1, 2019, through March 15, 2021 (765.8 [95% CI, 761.2-770.3] vs 793.2 [95% CI, 788.6-797.8]). The overall diabetes mortality rate increased 19.9% (19.6 [95% CI, 18.9-20.3] vs 23.5 [95% CI, 22.7-24.3]). The overall CVD mortality rate change (3.9%; 239.2 [95% CI, 236.7-241.7] vs 248.5 [95% CI, 245.9-251.1]) was similar to the all-cause mortality rate change. Sex, minority race, ethnicity, those with high school diplomas or some college education, middle to older age, and urban residence influenced mortality rate increases among people with diabetes and CVD.

Conclusion: The COVID-19 pandemic had an infection-independent effect on chronic disease mortality. This knowledge may help public health officials guide policy that protects chronic disease management during future public health emergencies.

Because breastfeeding behaviors are influenced by social norms, we examined public opinions toward societal supports for breastfeeding using data from the 2015 and 2024 SummerStyles surveys (N = 4127 and N = 4371, respectively, from the noninstitutionalized US population). In 2024, 81.9% of respondents agreed "there should be paid maternity leave for workers," 73.5% believed "women should have the right to breastfeed in public places," 66.9% agreed "women should be encouraged to breastfeed," and 65.9% agreed "a mother needs a lot of support to breastfeed her baby"-up 12, 11, 5, and 17 percentage points, respectively, from 2015. High and increased positive public opinions about supports for breastfeeding suggest heightened approval for breastfeeding-supportive programs and policies.

Access to specialized health care often requires patients and caregivers to travel long distances, imposing logistical and financial burdens. Temporary lodging near hospitals is essential for health care access, yet information is fragmented, forcing patients and caregivers to search across multiple websites to see all options available. We conducted a cross-sectional review (April 2023-May 2024) of publicly available data, cataloging US organizations that offer temporary lodging near health care facilities. We geocoded and integrated data into the Healthcare Housing Navigator, an interactive map built with ArcGIS Experience Builder. Our review identified 510 lodging organizations. The tool uses geographic information systems for interactive filtering and displays key details, such as organization name, location, cost, and eligibility criteria. By centralizing fragmented information on medical lodging, the Healthcare Housing Navigator addresses an overlooked health-related social need and equips patients, caregivers, and care teams with timely, accessible information.

One Health clinics integrate human, animal, and environmental health to provide interdisciplinary health care and community resources to people experiencing homelessness (PEH). Five mobile, public health-led One Health clinics were newly implemented in Pima County, Arizona, during October 2023-February 2024. Clinic locations included parks, libraries, and homeless shelters to reduce transportation-related barriers and integrate public health, veterinary, and housing services. Originally designed for PEH and their pets, Pima County One Health clinics were open to everyone in neighborhoods where clinics were hosted to promote community engagement with clinics and strengthen relationships with public health. We evaluated the performance of these clinics by describing service patterns, client perceptions, and lessons learned to support development of clinics by other jurisdictions. During clinic visits, basic demographic information was collected for people and pets, along with data on housing status, environmental and resource concerns, use of clinic services, and perceptions of clinics. The first 5 monthly mobile community clinics served 108 clients and 93 pets; 44% of clients were unhoused or unstably housed, 36% of clients were housed, and housing status was unknown for 20% of clients. Clinics facilitated partnership among service providers and with housed and unhoused community members. Clinics supported vaccine uptake among people and their pets and identified 3 cases of sexually transmitted infections that might otherwise have remained undetected. By implementing a One Health Clinic framework, our local health department helped address gaps in human and veterinary health care services. Other public health agencies might consider implementing similar models to enhance public health engagement with local communities.

Objectives: Although wastewater monitoring for virus detection has increased in communities worldwide, public awareness, understanding, questions, and concerns about wastewater monitoring are largely unknown. We assessed awareness, knowledge, and support for wastewater monitoring for detection of viruses and bacteria among US residents and elicited questions and concerns from residents about its use.

Methods: We conducted a survey among a racially and ethnically diverse sample of residents in Colorado, Maryland, Missouri, Nebraska, and Texas to assess awareness, knowledge, and support of wastewater monitoring. We also asked an open-ended question to elicit further questions and concerns from survey participants about wastewater monitoring. Two independent reviewers coded the responses to the open-ended question.

Results: Among 516 survey participants (52% White, 31% Black, 27% Hispanic ethnicity), 289 (56%) were aware that local public health departments and federal health agencies tested sewer water yet 334 (65%) knew "little or nothing" about wastewater monitoring. After participants were exposed to a brief description of the wastewater monitoring process, 80% "supported" or "strongly supported" wastewater monitoring to detect viruses and bacteria. When we analyzed responses to the open-ended question on wastewater monitoring, 3 broad categories and 9 subcategories of questions and concerns about wastewater monitoring emerged: (1) how wastewater monitoring works (mechanics, accuracy, cost, safety), (2) what is done with the findings generated by wastewater monitoring (public accessibility, government trust, public health response), and (3) what protections were in place against misuse of findings (privacy, fairness).

Conclusions: Proactive public education is needed to increase understanding, build support, and prevent disinformation about wastewater monitoring. Local systems are needed to share findings rapidly, clearly, and simply.

Objective: COVID-19 exacerbated health inequities for American Indian/Alaska Native (AI/AN) populations. Tribal public health departments and Tribal Epidemiology Centers are critical in addressing these challenges, particularly among people on or near tribally owned land. In this study, we described an example of the value of Tribal Epidemiology Centers and tribal public health departments and estimated the prevalence of post-COVID-19 condition (PCC), defined as symptoms persisting ≥90 days postinfection, in a tribal community.

Methods: This retrospective cohort study evaluated the prevalence of PCC and functional limitations among adults diagnosed with COVID-19 on the Tule River Reservation from July 2020 through February 2023. Tule River Indian Health Center, Inc staff conducted telephone surveys to assess symptoms at 30 and 90 days postinfection and functional outcomes using the Post-COVID-19 Functional Status scale. We stratified prevalence rates by age and sex and compared functional limitations before and after infection.

Results: We estimated PCC prevalence at 21% (15 of 76). We also found that 37% (24 of 65) of survey participants reported more functional limitations after COVID-19 infection than before.

Conclusions: Our study highlights the need for further research and inclusion of AI/AN communities in PCC research and new vertical policy solutions such as those used for diabetes. AI/AN communities have had inequitably higher rates of COVID-19 and appear poised to also have inequitably higher rates of PCC.

In the United States, rates of fatal and nonfatal firearm injuries differ substantially by race and sex, with Black men being more likely than any other group to be shot. Many people who survive a gunshot wound have complex physical, psychological, and social challenges during their recovery. Public health programs, including hospital-based violence intervention programs (HVIPs), have been designed to reduce the likelihood of reinjury for their participants and to support their well-being. However, little is known about how Black men who survive a gunshot wound and receive care from these programs conceptualize the best ways to support their healing and the barriers they experience in achieving their health-related goals. This case study, drawing from ethnographic research conducted during 2013-2023 at the second busiest HVIP in Maryland, examines the experiences of 6 Black men who were treated with a colostomy after surviving a gunshot wound. Emergent themes included increased psychological stress from being treated with a colostomy and wearing a waste collection pouch, disruptions to everyday life, and insufficient access to colostomy care and education. The findings from this case study highlight the importance of providing access to psychological services, colostomy education, and health care supplies to meet the needs of HVIP participants and improve health outcomes for this population.

Objectives: Yearly rolling aggregate trends or rates are commonly used to analyze trends in overdose deaths, but focusing on long-term trends can obscure short-term fluctuations (eg, daily spikes). We analyzed data on spikes in daily fatal overdoses and how various spike detection thresholds influence the identification of spikes.

Materials and methods: We used a spike detection algorithm to identify spikes among 16 660 drug-related overdose deaths (from any drug) reported in Massachusetts' vital statistics from 2017 through 2023. We adjusted the parameters of the algorithm to define spikes in 3 distinct scenarios: deaths exceeding 2 adjusted moving SDs above the 7-, 30-, and 90-day adjusted moving average.

Results: Our results confirmed the on-the-ground observation that there are days when many more people die of overdoses than would be expected based on fluctuations due to differences among people alone. We identified spikes on 5.8% to 20.6% of the days across the 3 scenarios, annually, constituting 11.1% to 31.6% of all overdose deaths. The absolute difference in percentage points of days identified as spikes varied from 5.2 to 11.5 between 7- and 30-day lags and from 0 to 4.6 between 30- and 90-day lags across years. When compared with the adjusted moving average across the 3 scenarios, in 2017 an average of 3.9 to 5.5 additional deaths occurred on spike days, while in 2023 the range was 3.7 to 6.0.

Practice implications: A substantial percentage of deaths occurred annually on spike days, highlighting the need for effectively monitoring short-term overdose trends. Moreover, our study serves as a foundational analysis for future research into exogenous events that may contribute to spikes in overdose deaths, aiming to prevent future deaths.