Journal of Public Health Management and Practice最新文献

Objectives: Countries implemented COVID-19 containment measures based on their decentralization level, which influenced public trust in both the government and the vaccine. This study aimed to evaluate how decentralization influenced the effectiveness of COVID-19 containment measures, public trust in government, and trust in the vaccine across 18 countries.

Design: A cross-sectional design was employed, drawing on a multi-country dataset from an international survey conducted in 2022. Data were collected through stratified random sampling, using an online survey administered via country-specific panels.

Setting: Multiple states with 18 countries.

Participants: 18 000 adult participants.

Main outcome measures: Decentralization was assessed using the Regional Authority Index, and government containment responses were measured with the COVID-19 Government Response Stringency Index. Trust in government and trust in COVID-19 vaccines were evaluated through survey items on confidence in equitable vaccine delivery and perceived vaccine safety, respectively, both measured on a 5-point Likert scale. Sociodemographic characteristics (age, gender, education, and income) were included as individual-level covariates, while country-level indicators (GDP per capita, Socio-Demographic Index, Healthcare Access and Quality Index, Global Health Security Index, Sustainable Development Goals Index, health expenditure, COVID-19 case rates, and inflation) were incorporated as contextual variables.

Results: Decentralization significantly increased public trust in government but was negatively associated with the stringency of containment measures. Vaccine trust and higher education were positively linked to trust in government and vaccine acceptance. However, higher COVID-19 case rates correlated with reduced public trust. Government stringency was driven more by outbreak severity than decentralization alone.

Conclusions: Decentralization can bolster trust in government, but its impact on containment effectiveness depends on local capacity and coordination. These findings highlight the importance of institutional trust and governance structures in pandemic response outcomes.

Context: Widespread implementation (ie, scale-up) of interventions typically involves providing training, technical assistance, and other implementation strategies to the settings intended to deliver the intervention. Researchers rarely plan for how to provide these strategies beyond the period of research funding. Specifically, they do not develop the infrastructure (ie, workforce, resources) required to sustain scale-up. Our research team addressed this gap by developing the infrastructure needed to sustain scale-up of the Med-South Lifestyle Intervention (Med-South) following the end of 10 years of research funding.

Program: Med-South is a research-tested intervention with demonstrated effectiveness at improving participants' dietary and physical activity behaviors. Existing staff in health departments and community clinics deliver Med-South over a series of 4 monthly counseling sessions and 3 booster phone calls. Implementation strategies (eg, training, technical assistance) also have been developed to support Med-South scale-up.

Implementation: We followed a 3-step process to develop infrastructure to support Med-South scale-up. We assessed existing infrastructure (step 1), identified determinants (ie, barriers and facilitators) of adoption (step 2), and then tailored scale-up to fit existing infrastructure and address determinants (step 3). Scale-up infrastructure included: (1) workforce to support implementation, (2) training curriculum, (3) intervention protocols, (4) data monitoring systems, and (5) communication systems.

Evaluation: We engaged 170 public health practitioners in 3 iterative improvement cycles to refine scale-up infrastructure. We evaluated impact on participants' engagement, perceptions of Med-South acceptability, and confidence to deliver and implement Med-South. A total of 88 public health practitioners engaged in all training sessions (51.8%). Practitioners reported high levels of acceptability and confidence in their ability to deliver and implement Med-South.

Discussion: Findings suggest that our 3-step process has potential for use in developing the infrastructure needed to sustain intervention scale-up following the end of research funding.

The Centers for Disease Control and Prevention (CDC) conducted 14 rapid community assessments (RCAs) to identify factors affecting COVID-19 vaccine confidence and demand. In May 2022, CDC's COVID-19 Vaccine Task Force conducted case studies of 3 communities to evaluate the RCA's impact and scalability. We convened online semi-structured interviews with 16 health department and community-based organization staff to explore the perceived value of RCAs, suggestions for improving the RCA process, and outcomes. We employed a general inductive analysis method with a priori codes and summarized findings. The CDC's RCA process engaged vaccine-hesitant populations, identified the causes of their hesitancy, and built internal capacity for conducting RCAs and using data effectively. Despite challenges in planning and coordinating across jurisdictions, RCAs proved valuable in enhancing vaccine confidence and demand efforts. Key lessons included allowing up to 2 months for planning, involving culturally competent, bilingual scientists, and offering post-RCA technical assistance to implement recommendations.

Background: Hypertensive retinopathy reflects systemic microvascular injury and serves as a prognostic marker for cardiovascular risk. Racial disparities in hypertension-related outcomes are well documented, but limited data exist on whether the presence of hypertensive retinopathy confers differential cardiovascular risk across Black and White populations.

Methods: In this retrospective cohort study using the TriNetX Research Network (2010-2021), we analyzed 49 14 propensity score-matched adults (24 557 Black and 24 557 White) with diagnoses of hypertension and hypertensive retinopathy. Baseline characteristics were balanced across 34 variables. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for major cardiovascular outcomes.

Results: Black patients with hypertensive retinopathy had significantly higher rates of all-cause hospitalization (46.4% vs. 43.9%; HR 1.076, 95% CI 1.048-1.105), acute heart failure (10.9% vs. 9.7%; HR 1.125, 95% CI 1.064-1.189), myocardial infarction (5.7% vs. 5.0%; HR 1.139, 95% CI 1.055-1.230), and ischemic stroke (9.7% vs. 7.9%; HR 1.228, 95% CI 1.157-1.304). Atrial fibrillation/flutter was less common in Black patients (8.9% vs. 10.4%; HR 0.848, 95% CI 0.801-0.898).

Conclusions: Among patients with hypertensive retinopathy, Black individuals experienced worse cardiovascular outcomes compared to White individuals. These findings highlight the importance of hypertensive retinopathy as a clinical risk marker and emphasize the need for equitable, targeted interventions to mitigate racial disparities in hypertension-related complications.

Background: People coinfected with HIV and hepatitis C (HCV) have complex needs that include pharmaceutical therapy, psychiatric care, and social work. Multidisciplinary care coordination (MCC) is the concerted effort to address health using a diverse team of primary care physicians, mental health specialists, and social workers.

Methods: To determine the effect of MCC in reducing avoidable hospital use, we examined longitudinal data from an academic equity-focused program in Upper Manhattan (CHP). In 2015, CHP implemented MCC, which integrated team members, panel management, and open access (walk-in) activities to better link, engage, and treat those who are coinfected. We compared health care utilization trends before 2015 ("preintervention") to after 2015 ("postintervention").

Results: We found that the implementation of MCC was associated with a decrease in per-year hospital visits among those coinfected.

Conclusion: To assist in future upscaling, we hope to identify strategies that facilitated the implementation of MCC in a setting like CHP.

Pediatric asthma disparities persist. In a randomized, controlled trial (2017-2022), the Richmond, Virginia (RVA) Breathes program, which was a series of community-based asthma interventions, was tested in a sample of 250 children (5-11 years; 78% African American/Black). Results suggested reduced asthma-related hospitalizations for the full intervention arm (asthma education, home environment remediation, and school intervention). Leveraging detailed costs from program expense reports, this study analyzed the costs of the RVA Breathes full intervention. Five-year costs of the full intervention were $1 922 514 (on average $3314 annually per participating household). Personnel costs contributed the largest share (74.8%), followed by overhead costs (18.9%). Costs for follow-up, outreach staff, and academic leadership were key cost drivers. When restricting these cost drivers collectively, as in a public health implementation approach, average annual costs per participating household decreased by 45.0%. In practice, streamlining the implementation of the RVA Breathes full intervention could improve program affordability.

Context: Vision Zero (VZ) is a road safety initiative that seeks to address the problem of road fatalities using a Safe System approach, a holistic endeavor embedded in public health principles that seeks to build layers of protection across transportation systems to eliminate road fatalities and serious injuries. Since 2020, a multidisciplinary research team established a statewide collaborative to support communities pursuing VZ initiatives across North Carolina.

Program: The North Carolina VZ collaborative "support model" was created to meet the need for community-based, multisector efforts using a Safe System approach. The support model aims to increase community capacity to more effectively build cross-disciplinary coalitions, pool needed resources, and strengthen adaptive leadership skills to reduce roadway fatalities.

Implementation: The support model approach is used to engage communities in building skills in cross-sector collaboration, adaptive leadership, and evidence-based safety procedures. This is accomplished through structured monthly touchpoint meetings with small groups of community partners for peer learning, quarterly "all-hands" meetings to coordinate efforts across the state and provide resources, and an annual team-based multiday Leadership Institute.

Evaluation: From 2020 to 2025, there was notable growth in community participation, from 7 to 33 communities. Of communities with more than 1 year of participation (n = 19), more than half advanced VZ implementation with communities moving from an exploration stage to an installation (n = 8) or initial implementation (n = 2) stage. In 2023, interviews with partner community leads (n = 15) indicated that partners utilized resources provided, applied skills they learned at the Leadership Institute, benefited from the peer network, and identified opportunities for increasing the benefits of the support model.

Discussion: The support model demonstrates a promising practice for increasing capacity building and cross-sector collaboration for road safety initiatives requiring complex systems change such as VZ.

Context: The use of traditional glazed-clay pottery is associated with elevated blood lead levels and is one of the main factors of nonoccupational lead exposure in the Mexican population. Most of the traditional Mexican foods are acidic. Lead leaching from pottery into acidic foods increases the potential for lead exposure in individuals consuming food cooked in these items.

Objective: To explore the possibility that cooking traditional Mexican acidic dishes in lead-glazed pottery cookware enhances lead leaching compared to nonacidic dishes.

Methods: A sample of 33 glazed-clay pottery items sold in Reynosa City, Tamaulipas, Mexico, was collected. The official Mexican regulatory test for lead leaching was conducted using 8 cookware items. Twenty-five lead-glazed ceramic items were used to evaluate the soluble lead by testing the leaching ability of acidic (13 cookware items) and nonacidic (12 cookware items) traditional Mexican dishes. Similarly, acidic and nonacidic foods were cooked in standard cookware for comparison. The lead content in food was determined by atomic absorption spectrophotometry after acid digestion.

Results: Only 1 of the cookware items met the lead leaching standards established by the Mexican regulatory guidelines, whereas the other 7 exceeded the maximum permissible level of leached lead. Acidic food cooked on glazed pottery showed a median lead concentration of 103.4 mg/kg (IQR = 14.8-186.1), whereas nonacidic food cooked on glazed pottery showed a median lead concentration of 11.19 mg/kg (IQR = 2.17-27.82 mg/kg; P < .05), indicating that acidic food extracted 9 times lead compared to nonacidic food when cooked in traditional ceramics.

Conclusion: Cooking acidic dishes with earthen pottery cookware resulted in significantly higher lead leaching than cooking nonacidic foods. The consumption of a single portion of acidic food prepared in lead-glazed ceramics produces a significant increase in blood lead levels and resulting health consequences.