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The Icelandic Prevention Model (IPM) is a sequential 10-step community-driven collaborative intervention that is designed to support the prevention of substance use in youth by establishing healthy developmental contexts. The IPM has been implemented across Iceland for over 20 years and is now being implemented in other countries. Recognizing the need to explore how to adapt the IPM to new contexts and document the implementation of the model, this paper describes a process evaluation of the first three steps of the IPM within a Canadian rural community to capture experiences during the early development. Specifically, this study addresses the following research questions: (1) What are the processes of development and contextual features that influence the implementation of the IPM within Lanark County, Ontario? and (2) What adaptations are needed to successfully implement the IPM in Canada? Semi-structured interviews were conducted to examine experiences and lessons learned through the implementation of the model. Thematic analyses were completed using QSR NVivo. A deductive and inductive approach was applied, whereby some interview guide questions were derived from the IPM implementation steps and others were more exploratory, examining context and processes of development. Nine interviews were conducted with key partners who were leading the implementation of the IPM. Themes highlighting cultural factors that influence implementation, processes of development related to community engagement, and themes relating to youth participation, fidelity issues, fundraising, health equity and challenges related to the COVID-19 pandemic were identified. This paper contributes new scientific knowledge related to implementation processes within upstream prevention of substance use and practical information that is useful for communities interested in implementing the IPM.

Background: On April 7, 2024, the Uganda Ministry of Health was notified of a measles outbreak in Kakumiro District involving death of a suspected case. We investigated to determine the scope of the outbreak, assess risk factors for disease transmission, and recommend evidenced-based interventions.

Methods: We defined a suspected case as onset of fever and maculopapular generalized rash with ≥ 1 of cough, coryza, or conjunctivitis in any resident of Kakumiro District during February-May 2024. A confirmed case was a suspected case with laboratory confirmation for measles Immunoglobulin M (IgM) antibody. We line-listed cases, performed descriptive analysis, and conducted a 1:1 case-control study with 100 randomly selected cases and village-matched controls. We identified risk factors using logistic regression and estimated vaccine coverage using the percentage of eligible controls who had received ≥ 1 dose of measles vaccine. We calculated Vaccine Effectiveness (VE) as VE = 1 - OR _adj  × 100%, where OR_adj is the adjusted odds ratio associated with having received ≥ 1 dose of measles vaccine.

Results: We identified 188 suspected cases, including 6 (3.2%) confirmed and 1 (0.5%) death. The overall attack rate (AR) was 67/100,000 persons. Children aged < 9 months (AR = 232/100,000) and those aged 9 months-≤ 5 years (AR = 177/100,000) were the most affected. The most affected sub-counties were Kisengwe (AR = 313/100,000), Kasambya (AR = 126/100,000) and Kakumiro Town Council (AR = 110/100,000). Non-vaccination (aOR = 2.9, 95%CI 1.1-7.6), exposure to a measles case in a health facility during exposure period (aOR = 47, 95%CI 6.09-369) and exposure to measles case in the same household during exposure period (aOR = 9.3, 95%CI 2.9-30) were associated with measles infections. Vaccine coverage was 88% (95%CI 79%-94%) and vaccine effectiveness was 65% (95%CI 13%-91%). We observed crowding and lack of triaging/isolation in health facilities.

Conclusions: This outbreak was facilitated by non-vaccination and propagated by exposure to infected persons in health facilities and households. We recommended to MoH to conduct a supplementary immunization activity that included children < 9 months in the target group. Triaging and isolation of cases might help to reduce the spread of measles in future outbreaks. There is also need to develop strategies to improve vaccine effectiveness in the district.

Following the onset of the COVID-19 pandemic, an ever-increasing number of people have died from the toxic drug supply in Canada. Emerging evidence suggests that reduced access to harm reduction services has been a contributing factor. However, the precise impacts of the pandemic on supervised consumption service (SCS) delivery have not been well characterized. The present study sought to explore the impacts of the pandemic on SCS delivery in Vancouver and Surrey, Canada. Between October 2021 and March 2022, in-depth, semi-structured interviews were conducted with staff from two SCS: SafePoint in Surrey (n = 12) and Insite in Vancouver (n = 9). Thematic analysis focused on key changes to SCS delivery after the emergence of the COVID-19 pandemic, with a focus on associated challenges and emergent staff responses. Participants described key challenges as: capacity restrictions hindering service access and compromising care quality; exclusion of frontline staff perspectives from evolving SCS policy and practice decision-making; intensified power dynamics between staff and service users; and modified overdose response procedures, combined with a rise in complex overdose presentations, undermining service accessibility and quality. Emergent staff responses to these challenges included: collective staff organizing for changes to policy; individual frontline staff non-compliance with emerging policies; and staff experiencing burnout in their roles. This study highlights how COVID-19-related changes to service delivery produced challenges for SCS staff and service users, while identifying strategies employed by staff to address these challenges. Additionally, the findings point to opportunities to improve care for people who use drugs during intersecting public health crises.

This study assesses COVID-19 booster intentions and hesitancy in Texas, a state known for its diversity and libertarian values. A survey was conducted with 274 participants residing in Texas between June and July 2022. The analysis examined sociodemographic and health-related factors, trusted information sources, and preventive behaviors. The survey focused on vaccinated participants and their intention to receive the booster dose, which was categorized into three outcomes: yes, no, and not sure. Machine learning techniques were employed to analyze the survey responses of vaccinated participants to identify the most critical factors. Among the participants, 113 expressed their intention to get the booster (41.2%), 107 did not plan to receive the booster (39.1%), and 54 remained undecided (19.7%). Our findings indicate that the perception of vaccine safety significantly influenced the decision to receive the booster dose. Those who reported trust in social media contacts as reliable information sources were more likely to intend to boost. Additionally, among those hospitalized when diagnosed with COVID-19, the largest proportion were unwilling to receive the booster (47.0%) compared to those who intended to receive the booster (33.3%). In contrast, most of those who believed they would be hospitalized if infected with COVID-19 intended to get the booster. Other factors did not demonstrate a significant association. Our findings are highly transferable and can offer valuable insights, particularly for countries where COVID-19 remains prevalent and are pivotal both presently and in the future for developing strategies to improve booster uptake and shape public health initiatives in epidemic and pandemic outbreaks.

Background: Nepal, like other low- and middle-income countries, is experiencing a rapid increase in the number of older adults and the rate of aging in the population. This has increased the number of older adults with age-associated chronic illnesses, which in turn will escalate the demand for specialized healthcare and long-term care in Nepal. However, very little is known regarding the current healthcare system and health policies for older adults in Nepal. In this paper, we aimed to advance this understanding.

Methods: We reviewed the existing literature on the health, healthcare system, and policies related to older adults in Nepal.

Results: Our findings revealed that older adults have a high prevalence of chronic conditions such as cardiovascular, musculoskeletal, and chronic kidney diseases, and the number of patients with Alzheimer's disease and related dementias is on the rise. Additionally, there is a decline in historical family caregiving for several reasons such as international migration of offspring, and the country currently lacks a skilled geriatric workforce and formal long-term care support and services (LTSS). Together, this has created a challenge in adequately meeting the health and care needs of the older population. Findings also indicated that several geriatric health policies exist in the country, which ensure primarily free healthcare services for older adults. However, economic constraints limit the financial resources to implement these policies, build appropriate care facilities, and improve access and utilization.

Conclusion: Therefore, the government must develop sustainable financing to adequately provide quality healthcare and LTSS for older adults as the population ages.