BMC Proceedings最新文献

Recent public health emergencies, including the COVID-19 pandemic, MERS, and Avian Influenza outbreaks, underscore the need for effective surveillance systems for respiratory pathogens with epidemic and pandemic potential. In 2022, WHO initiated a project to help national public health professionals identify and address gaps in coordinating multiple surveillance systems for early detection and monitoring of viral respiratory events. The project involved developing country-specific approaches to address these gaps and identifying generalizable best practices. WHO headquarters collaborated with the WHO Regional Office for Africa (AFRO) to select three pilot countries: South Africa, Togo, and the United Republic of Tanzania. Each country conducted a landscape assessment of relevant surveillance activities followed by national workshops to discuss coordination, collaboration, and strengthening of Public Health Intelligence (PHI) for respiratory surveillance.National workshops were held in Dar es Salaam (United Republic of Tanzania), Kpalimè (Togo), and Johannesburg (South Africa), bringing together professionals from various domains and sectors. The workshops highlighted system-specific and cross-cutting challenges and best practices related to respiratory surveillance. These findings informed a stakeholder workshop at the WHO Hub for Pandemic and Epidemic Intelligence in Berlin on 24-25 July 2024, which convened stakeholders from WHO headquarters, WHO AFRO, US CDC, and representatives from the pilot countries.The workshop underscored the critical importance of coordination and collaboration in respiratory surveillance. By integrating multiple surveillance systems and fostering cross-sectoral communication, countries can enhance their ability to detect and respond to respiratory pathogens with epidemic and pandemic potential. The shared best practices and recommendations provide a valuable framework for strengthening global health security and preparedness.

The human papillomavirus (HPV) Prevention and Control Board organized a meeting to explore effective strategies for accelerating the elimination of HPV-related cancers, starting from WHO's cervical cancer elimination campaign targets-vaccination of 90% of girls by age 15, two HPV screenings with a high-performance test for 70% of women between 35-45 years, and 90% treatment and care of women with cervical disease. Nevertheless, the global HPV vaccination coverage remains low (~ 30%), as does screening coverage, with only 24% (48/139) of programmes utilising recommended high-performance tests (such as HPV testing). The meeting explored various strategies, including the extension of vaccination for women at older ages. While vaccination of HPV-positive individuals has demonstrated safety and immunogenicity, further research is required to confirm the potential protective effects and reduced viral transmission among infected populations. Several innovative approaches were discussed, including the HPV Faster strategy, promoting combined HPV vaccination and screening for women up to age 45. This strategy aims to substantially reduce cervical cancer incidence by decreasing future screening needs among HPV-negative women and intensifying follow-up for those already HPV-positive. A variant of this approach, Sweden's "HPV EVEN Faster," simultaneously vaccinates and screens younger women (ages 23-30), aiming at significantly reducing HPV circulation and effectively reaching underserved populations. Moreover, in resource-limited settings, transitioning to single-dose vaccination emerged as a promising strategy to expand vaccine coverage, as modelled in India, Rwanda, and Brazil. Modelling data reinforced the prioritisation of increasing vaccination coverage and expanding targets in girls up to age 20 as the most efficient strategy to reduce cervical cancers. However, when increasing coverage is challenging, extending vaccination to boys could potentially enhance herd protection. Finally, the discussions underlined that successful "accelerated" HPV elimination strategies must be context-specific, taking into consideration local resources, health system capacities, and socio-economic factors. Political commitment, targeted implementation research, and innovations such as affordable new vaccines and point-of-care tests are key to speed up global progress toward HPV-related cancer elimination.

Background: Despite evidence showing the important role of a robust primary health care (PHC) in achieving health equity, many nations still need strong, directional policies and unyielding commitments to strengthening PHC after the Astana Declaration. The "PHC Forum: Towards Health Equity and Resilient Communities" was held in November 2023, in Jakarta, Indonesia, to discuss the challenges and opportunities in actualising the commitments towards a robust PHC system globally.

Methods: This paper presents a thematic analysis of the PHC Forum. The Forum was organised into two days with a total of 783 participants, categorised as policymakers, academics, health workers, civil society leaders, and community members, mostly from the Global South countries. The Forum aimed to democratise stakeholders participation by creating an inclusive platform for all relevant actors, including civil society organisations (CSOs) and community health workers (CHWs). This was intended to generate empirical insights derived from lived experiences. To synthesise key findings from the Forum, expert statements were systematically compiled, categorised, and triangulated with relevant prior studies.

Results: The Forum resulted in the identification of key messages that can be organised into seven themes: (i) health for all vision, reinforcing that investing in a robust PHC system is central to achieving the universal health coverage (UHC); (ii) community participation and empowerment, reiterating community not just as beneficiaries; (iii) importance of CHWs, with a focus on realising decent work; (iv) financing and prioritisation, calling for increased investment towards PHC; (v) innovations, underlining the role of innovative technologies and approaches to improve health equity; (vi) PHC integration, stressing the need for both vertical and horizontal integration of public and private health services; and (vii) climate change, with an emphasis on recognising the increasingly critical role of a robust PHC system in facing climate change.

Conclusions: The key messages that emerged from the Forum emphasise the essential elements for building a robust PHC system, particularly in the Global South. A paradigm shift beyond health to focus on the bigger systems is needed to achieve health for all. The Forum emphasised that communities are the leaders in PHC transformation, driving towards equitable health outcomes.

Precision public health (PPH) approaches use big data to inform tailored, population-level interventions. The field has roots in genomics, but it has expanded to encompass data-informed public health programs across various types of data or applications. The Precision Public Health Network hosted a 2023 conference focused on implementation science-the study of how to integrate PPH programs into practice. Some implementation needs that emerged across speakers included establishing robust evidence of clinical utility and feasibility, disseminating clinical best practices through guidelines and tools for providers, sharing tools or information to reduce duplicated efforts across settings, and considering context-specific factors. Considering feasibility, setting-specific factors, and meaningful engagement with relevant user groups throughout the research and implementation process are critical to the successful and sustainable implementation of PPH programs. The Network also hosted an interactive workshop to generate ideas and ongoing collaboration on essential outcomes or data measures for PPH programs, and strategies to center health equity in PPH. This conference and workshop are part of the ongoing work of the PPHN to convene experts across disciplines and settings, share knowledge, and galvanize the field of PPH.

Purpose: Although urinary tract infections (UTIs) are one of the most common infections encountered in clinical practice, many challenges remain with respect to classification and management. The purpose of this report is to discuss key issues in the management of UTIs and identify gaps in current knowledge and guidelines, as well as future research needs.

Design: A multidisciplinary panel of 13 experts from 6 European countries and the United States met on April 27, 2024. They discussed predefined key clinical questions, including classification of UTIs, current management guidelines, management of UTIs in men, antimicrobial switching, and post-treatment asymptomatic bacteriuria.

Results: The panel agreed that differentiation between complicated and uncomplicated UTIs is crucial to antimicrobial selection and can impact outcomes. In particular, definitions of complicated UTIs (cUTIs) vary widely between guidelines and in the literature. Patients with cUTIs are not a homogeneous group and differences in risk factors and prognosis should be considered. However, a balance must be sought between appropriate antimicrobial treatment and complexity of guidelines, which can hinder their implementation, especially in primary care. Guidelines published by the European Urology Association and the Infectious Diseases Society of America differ in their antimicrobial treatment recommendations for cUTIs, which is important at a time of increasing antimicrobial resistance. In men with UTIs, it has been established that a longer duration of antimicrobial therapy is needed in cases where fever is present. De-escalation from broad- to narrow-spectrum antimicrobials is recommended wherever possible, and is associated with similar outcomes in many patients relative to remaining on broad-spectrum treatment. Post-treatment asymptomatic bacteriuria should not be assessed, and treatment is not recommended. Non-specialist physician education is crucial to achieving better outcomes for patients with UTIs.

Implications: Many challenges remain in the management of UTIs in adults, most notably making an accurate classification, which drives antimicrobial treatment selection. A balance between adequacy of management guidelines and their uptake in routine clinical practice is needed to improve outcomes.