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BACKGROUND: Dioxin-like chemicals are a group of ubiquitous environmental toxicants that received intense attention in the last two decades of the 20th century. Through extensive mechanistic research and validation, the global community has agreed upon a regulatory strategy for these chemicals that centers on their common additive activation of a single receptor. Applying these regulations has led to decreased exposure in most populations studied. As dioxin-like chemicals moved out of the limelight, research and media attention has turned to other concerning contaminants, including per- and polyfluoroalkyl substances (PFAS). During the 20th century, PFAS were also being quietly emitted into the environment, but only in the last 20 years have we realized the serious threat they pose to health. There is active debate about how to appropriately classify and regulate the thousands of known PFAS and finding a solution for these "forever chemicals" is of the utmost urgency. OBJECTIVES: Here, we compare important features of dioxin-like chemicals and PFAS, including the history, mechanism of action, and effective upstream regulatory strategies, with the objective of gleaning insight from the past to improve strategies for addressing PFAS. DISCUSSION: The differences between these two chemical classes means that regulatory strategies for dioxin-like chemicals will not be appropriate for PFAS. PFAS exert toxicity by both receptor-based and nonreceptor-based mechanisms, which complicates mixtures evaluation and stymies efforts to develop inexpensive assays that accurately capture toxicity. Furthermore, dioxin-like chemicals were unwanted byproducts, but PFAS are useful and valuable, which has led to intense resistance against efforts to restrict their production. Nonetheless, useful lessons can be drawn from dioxin-like chemicals and applied to PFAS, including eliminating nonessential production of new PFAS and proactive investment in environmental remediation to address their extraordinarily long environmental persistence., Introduction The Stockholm Convention on Persistent Organic Pollutants (POPs) was enacted in 2004 as an international response to concern over some of the world's most harmful chemicals. (1) This framework [...]

Rapid and accurate identification of Salmonella enterica serotypes Typhi and Paratyphi (A, B and C), the causal agents of enteric fever, is critical for timely treatment, case management and evaluation of health policies in low and middle-income countries where the disease still remains a serious public health problem. The present study describes the development of a multiplex assay (EFMAtyping) for simultaneous identification of pathogens causing typhoid and paratyphoid fever in a single reaction by the MeltArray approach, which could be finished within 2.5 h. Seven specific genes were chosen for differentiation of typhoidal and nontyphoidal Salmonella. All gene targets were able to be detected by the EFMAtyping assay, with expected Tm values and without cross-reactivity to other relevant Salmonella serovars. The limit of detection (LOD) for all gene targets was 50 copies per reaction. The LOD reached 10.sup.2-10.sup.3 CFU/ml for each pathogen in simulated clinical samples. The largest standard deviation value for mean Tm was below 0.5 [degrees]C. This newly developed EFMAtyping assay was further evaluated by testing 551 clinical Salmonella isolates, corroborated in parallel by the traditional Salmonella identification workflow, and serotype prediction was enabled by whole-genome sequencing. Compared to the traditional method, our results exhibited 100% of specificity and greater than 96% of sensitivity with a kappa correlation ranging from 0.96 to 1.00. Thus, the EFMAtyping assay provides a rapid, high throughput, and promising tool for public health laboratories to monitor typhoid and paratyphoid fever. Keywords: Typhoid and paratyphoid fever, Melting curve analysis, Rapid identification, Multiplex PCR, Author(s): Yixiang Jiang[sup.1,2], Min Jiang[sup.2], Rui Cai[sup.2], Xiaolu Shi[sup.2], Qinghua Hu[sup.2] and Biao Kan[sup.1] Introduction Enteric fever (EF), caused by Salmonella enterica serovars Typhi and Paratyphi (A, B and C), [...]

Background: Cancer hazard identification is critical to informing decisions on preventive actions. However, the influence of cancer hazard assessments on the creation of health-protective regulations is poorly understood. Although prior studies have measured the health and economic benefits of regulatory actions in general, we are not aware of efforts to explicitly study the influence of cancer hazard identification on policy decisions in the United States. OBJECTIVES: In this commentary, we present an approach to examine whether formal identification of a substance as a human carcinogen may prompt a regulatory action to reduce exposure to carcinogens and enhance public health. Further, we discuss the broader implications of cancer hazard identification on policy decision-making, including identifying gaps and providing recommendations. Methods: Using the Report on Carcinogens (RoC) as a test case, we systematically searched U.S. federal and state databases for notices of regulations mentioning the RoC from 1995 to 2023. For each regulation, we extracted information on the carcinogen(s) regulated, the regulatory agency, the regulatory purpose, the economic sector exposure sources, and the analyzed public health benefits and costs. We created a publicly available, web-based interactive tool to visualize the data. Discussion: U.S. regulatory agencies have been using cancer hazard evaluations, such as the RoC, for decades to inform public health policy actions to prevent or mitigate cancer risks. Specifically, nonregulatory cancer hazard assessments have been used to prioritize chemical evaluations, support regulatory-based assessments, and trigger regulatory action. Our approach showed that assessing the influence of cancer hazard identification on science-based public health policies is feasible, informative, and needed, and our study is a first step in this direction. We recommend expanding this approach to other cancer and noncancer hazard assessments to ultimately inform our understanding of the influence of hazard classifications on policymaking. https://doi.org/10.1289/EHP12681, Introduction Cancer is a major public health crisis worldwide. In the United States, 1.9 million new cancer cases and ~600,000 deaths were reported in 2019, (1) of which 42% of [...]

One of the central goals of almost all politicians in democracies is to get reelected. To achieve this, they generally try to keep track of the public's desires and expectations, [...]

Problem Political economy factors are important in determining the adoption and implementation of health policies. Yet these factors are often overlooked in the development of policies that have the potential to influence health. Approach Political economy analysis provides a way to take into consideration political and social realities, whether at the community, subnational, national, regional or global levels. We aim to demonstrate the value of political economy analysis and to promote its wider use in technical programmes of work. Local setting We provide examples from across a range of World Health Organization areas of work, including participatory governance, health financing, health taxes, malaria prevention and control, capacity-building and direct country support. Relevant changes Existing examples of how political economy analysis can be incorporated into technical support demonstrate the variability of this analytical approach, as well as its potential to support policy progress. Applying political economy analysis within the specified programmes of work has enabled more contextually relevant technical support to enhance the likelihood of advancing countries' health-related objectives. Lessons learnt Embedding political economy into technical work has many benefits, including: enhancing voice and participation in health policies; supporting the adoption and implementation feasibility of technically sound policies; and building capacity to incorporate and understand political factors that influence health-related priorities. Probleme Lesfacteurs llesa l'economie polltlquejouent un role crucial dans l'adoptlon et la mise en ceuvre de mesures sanitaires. Pourtant, ces facteurs sont souvent negllges lors de l'elaboration de politiques susceptibles d'avoir un Impact sur la sante. Approche Analyser l'economie politique represente un moyen de tenir compte des realites politiques et sociales au niveau communautaire, infranational, national, regional ou International. Nous voulons demontrer l'importance de l'analyse de l'economie politique et promouvolr son usage dans les programmes techniques de travail. Environnement local Nous donnons des exemples Issus d'une serie de domalnes traites par l'Organisation mondlale de la Sante, parmi lesquels la gouvernance participative, le financement de la sante, les taxes sanltalres, la prevention et la lutte contre la malaria, le renforcement des capacltes et l'appul direct aux pays. Changements significatifs Les exemples portant sur l'integration de l'analyse de l'economie politique dans l'appul technique illustrent la variabilite de cette approche analytique, mais aussi sa potentielle contribution aux progres politiques. Appliquer une analyse de l'economie politique a des programmes de travail specifiques a permls de fournir un soutien technique adapte au contexte, augmentant ainsi les chances d'avancement des pays vers la realisation des objectifs en matierede sante. Lecons tirees Incorporer l'economie politique dans le travail technique comporte de nombreux avantages: amelloration de la representation et de la participation dans le cadre des mesures sanitalres; mellieures possibilites d'adoption et de mise en ceuvre de politiques solides sur le plan technique; et enfin, renforcement des capacites afin de comprendre et d'inclure les facteurs politiques qui ont une influence sur les priorites relatives a la sante. Situacion Los factores de economia politica son Importantes para determinar la adopcion y aplicacion de las politicas sanitarias. Sin embargo, se suelen Ignorar estos factores cuando se elaboran politicas que pueden Influir en la salud. Enfoque El analisis de economia politica permite tener en cuenta las realidades politicas y sociales, ya sea a nivel local, subnaclonal, nacional, regional o mundial. El objetivo de este proyecto es demostrar el valor del analisis de la economia politica y promover su uso generalizado en los programas tecnicos de trabajo. Marco regional Se ofrecen ejemplos de diversas areas de trabajo de la Organizacion Mundial de la Salud, como la gobernanza participativa, la financiacion sanitaria, los Impuestos sanitarios, la prevencion y la contencion del paludismo, la creacion de capacidades y el apoyo directo a los paises. Cambios importantes Los ejemplos existentes de como se puede Incorporarei analisis de economia politica al apoyo tecnico demuestran la variabilidad de este enfoque analitico, asi como su potencial para apoyar el progreso de las politicas. La aplicacion del analisis de la economia politica en los programas de trabajo especificados ha permitido que el apoyo tecnico sea mas pertinente segun el contexto para aumentar la probabilidad de avanzar en los objetivos sanitarios de los paises. Lecciones aprendidas Integrar la economia politica en el trabajo tecnico tiene muchos beneficios, entre los que se Incluyen: potenciar las opiniones y la participacion en las politicas sanitarias; apoyar la adopcion y la viabilidad de la aplicacion de politicas tecnicamente solldas;y crear capacidad para Incorporar y comprender los factores politicos que Influyen en las prioridades sanitarias., Introduction As the coronavirus disease 2019 pandemic has demonstrated, policies that impact health and well-being are not only influenced by scientific evidence, but also by the political views and underlying [...]

Food environments exert a significant effect on population dietary choices and health outcomes. Policies that influence the food environment, can have a significant impact on individual and population dietary choices. This rapid review assessed the nature and interaction within the Ghanaian food environment, and the impact that existing school, workplace, and national food policies have on dietary intake and nutritional outcomes. Online databases and university repositories were searched for relevant articles and documents. A total of forty articles and documents were included in the review. Majority of the reviewed papers (85%) used a cross-sectional design. The findings show that traditional outlets (open markets) constitute the main food source among the Ghanaian populace, while convenience stores serve as an important source of processed foods. Prepared local foods are often consumed outside the home and are mainly sourced from street food vendors. Street foods are perceived as less expensive, convenient, and delicious. The food environment was found to influence dietary acquisition, intake, and nutritional outcomes. Although most nutrients provided by the School Feeding Programme (SFP) are below recommended intake standards, the SFP contributes positively to improved diets and nutrition status of school-age children. Children attending SFP-implementing schools experience higher intakes of protein, iron, zinc, calcium, vitamin A, folate, and have higher haemoglobin, and lower prevalence of stunting, underweight, and thinness than children in non-SFP implementing schools. Availability of a private room for breastfeeding mothers improved breastfeeding frequency. Ghana's fatty meat restriction policy has reduced the availability and sale of fatty meat on the Ghanaian market. Reported drivers and barriers to healthy foods consumption include socio-economic factors, media information, food storage facilities, cultural perception, fruit seasonality, knowledge on the nutrient value of fruits and vegetables, safety profile of fruits and vegetables, and contribution of household production to dietary intake. In conclusion, the food environment review reveals the drivers of availability, barriers to healthy food access, and impact of interventions and policies on the Ghanaian food environment. Key words: Ghana, Food environment, policies, nutritional impact, health impact, BACKGROUND Population health, well-being, and development are linked intimately with the physical environments they live, work, play, eat, and interact [1]. The food environment constitutes the domain or conditions within [...]

In the United States, routine vaccination rates have plummeted across all age groups due to the COVID-19 pandemic, with our most vulnerable and underserved populations suffering the greatest declines. Returning to a 'new normal' and recovering our nation's health and economy is of the utmost importance; however, there is a critical need to recover and protect communities against the spread of other vaccine-preventable diseases and outbreaks. While routine vaccination rates are slowly recovering for certain age groups, the introduction of COVID-19 vaccines adds complexities and challenges to recovery efforts. If not addressed, hard-won gains in routine vaccination may be lost, which could result in communities missing out on the social, economic, and health benefits offered by vaccinations. There is an urgent need to utilize evidence-based and innovative strategies to support both immediate and long-term efforts to recover, maintain, and sustain routine vaccination. Key short-term strategies include leveraging digital and mainstream media to drive awareness, coordinating across health and education sectors, utilizing centralized reminder recall, expanding access points to vaccination services, and elevating trusted voices for vaccination. In order to build back stronger, long-term strategies include enhancing immunization information systems, mitigating financial barriers to vaccination, investing in building vaccine confidence, and ensuring sustainable funding for immunization infrastructure. Key words: COVID-19; vaccine; vaccination; immunization; vaccine ecosystem; recovery; health policy; health equity; child health; adolescent health; vaccine equity, INTRODUCTION The COVID-19 Pandemic is a Critical Reminder of the Importance of Vaccination (1) To help end the COVID-19 pandemic, individuals across the United States, from government officials to frontline [...]

Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease., Author(s): Jill R. Krissberg [sup.1] , Scott M. Sutherland [sup.1] , Lisa J. Chamberlain [sup.2] , Paul H. Wise [sup.3] Author Affiliations: (1) grid.168010.e, 0000000419368956, Division of Nephrology, Department of [...]

Since January 2020, the coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching impact on global morbidity and mortality. The effects of varying degrees of implementation of public health and social measures between countries is evident in terms of widely differing disease burdens and levels of disruption to public health systems. Despite Thailand being the first country outside China to report a positive case of COVID-19, the subsequent number of cases and deaths has been much lower than in many other countries. As of 7 January 2021, the number of confirmed COVID-19-positive cases in Thailand was 9636 (138 per million population) and the number of deaths was 67 (1 per million population). We describe the nature of the health workforce and function that facilitated the capacity to respond to this pandemic. We also describe the public health policies (laboratory testing, test-and-trace system and mandatory 14-day quarantine of cases) and social interventions (daily briefings, restriction of mobility and social gatherings, and wearing of face masks) that allowed the virus to be successfully contained. To enhance the capacity of health-care workers to respond to the pandemic, the government (i) mobilized staff to meet the required surge capacity; (ii) developed and implemented policies to protect occupational safety; and (iii) initiated packages to support morale and well-being. The results of the policies that we describe are evident in the data: of the 66 countries with more than 100 COVID-19-positive cases in health-care workers as at 8 May 2020, Thailand ranked 65th. Depuis janvier 2020, la pandemie de maladie a coronavirus (COVID-19) a eu un impact considerable sur la morbidite et la mortalite a l'echelle globale. Les degres de mise en oeuvre des mesures sociales et sanitaires, qui varient d'un pays a l'autre, ont des consequences evidentes, notamment sur les differences de charge que represente la maladie et sur l'ampleur des perturbations touchant les systemes de sante publique. Meme si la Thailande est, apres la Chine, la premiere nation a avoir signale un cas positif de COVID-19, le nombre de cas et de deces qui ont suivi a ete nettement moins eleve que dans de nombreux autres pays. Au 7 janvier 2021, la Thailande comptait 9636 cas positifs confirmes de COVID-19 (138 par million d'habitants) et 67 deces (1,0 par million d'habitants). Dans le present document, nous decrivons la nature des professionnels de sante et des fonctions qui ont renforce les capacites de reaction face a cette pandemie. Nous detaillons egalement les politiques de sante publique (tests en laboratoire, systeme de depistage et de suivi, quarantaine obligatoire de 14 jours pour les cas detectes) et les interventions sociales (seances d'information quotidiennes, restriction des deplacements et des rassemblements, port du masque) qui ont permis de contenir le virus avec succes. Afin d'aider les soignants a lutter contre la pandemie, le gouvernement (i) a mobilise du personnel pour fournir les capacites d'intervention requises; (ii) a developpe et applique des mesures de protection pour garantir la securite au travail; et enfin, (iii) a propose des programmes de soutien au moral et au bien-etre. Les politiques que nous evoquons se traduisent par des resultats sans equivoque: sur les 66 pays depassant les 100 cas positifs de COVID-19 chez les professionnels de sante au 8 mai 2020, la Thailande se classait a la 65e place. Desde enero de 2020, la pandemia de la enfermedad por coronavirus (COVID-19) ha tenido un impacto de gran alcance en la morbilidad y la mortalidad mundial. Los efectos de los diferentes grados de aplicacion de las medidas sociales y de salud publica entre los paises son evidentes en terminos de cargas virales muy diferentes y niveles de perturbacion de los sistemas de salud publica. A pesar de que Tailandia fue el primer pais fuera de China en notificar un caso positivo de COVID-19, el numero posterior de casos y muertes ha sido mucho menor que en muchos otros paises. Hasta el 7 de enero de 2021, el numero de casos positivos confirmados de COVID-19 en Tailandia era de 9.636 (138 por millon de poblacion) y el numero de muertes era de 67 (1,0 por millon de poblacion). Describimos la naturaleza del personal sanitario y la funcion que facilito la capacidad de respuesta a esta pandemia. Tambien describimos las politicas de salud publica (pruebas de laboratorio, sistema de prueba y rastreo y cuarentena obligatoria de 14 dias), asi como las intervenciones sociales (sesiones informativas diarias, restriccion de la movilidad y de las reuniones sociales, uso de mascarillas, etc.) que permitieron contener el virus con exito. Para mejorar la capacidad de los trabajadores sanitarios para responder a la pandemia, el gobierno (i) movilizo al personal para satisfacer la capacidad de respuesta requerida; (ii) desarrollo y aplico politicas para proteger la seguridad laboral; y (iii) puso en marcha paquetes para apoyar la moral y el bienestar de la poblacion. Los resultados de las politicas que describimos son evidentes en los datos: de los 66 paises con mas de 100 casos positivos de COVID-19 en trabajadores sanitarios a 8 de mayo de 2020, Tailandia ocupaba el puesto 65., Introduction Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia of unknown etiology, later named coronavirus disease 2019 (COVID-19), on 31 December 2019. (1) In response to [...]

Context: The burden of mental health needs is high and varies by race and ethnicity. While inadequate access to mental health treatment is universal, there are notable disparities in Black, Asian, Hispanic, Native Hawaiian, and multiracial communities. Structural barriers to accessing care perpetuate systemic inequities. Federal policy action is needed to advance mental health equity across the United States. Objective: To identify policies and case studies to inform the development of federal policy recommendations to improve equity in behavioral health. Study Design and Analysis: Policy and environmental scan guided by the Intersectionality-Based Policy Analysis Framework. A national advisory panel also provided expert input. Setting or Dataset: National Conference of State Legislatures policy databases; plus environmental scan and literature review results. Population Studied: A focus on policies to improve racial equity, with attention to intersectionality. Intervention: Federal policies; state and local policies with potential for federal scaling. Outcome Measures: Policies to reduce the economic and health burden of mental health disparities. Results: Six cross cutting policy principles were developed to guide policy recommendations, including sufficient and sustainable funding, improved data collection and disaggregation by race and ethnicity, establishing behavioral health equity and quality measures, prioritizing community-driven interventions, addressing stigmatizing language in laws and policies, and creating more equitable governance structures and policy making processes. Policy recommendations include actions to increase access to care, address social determinants of health, expand and re-train the workforce to better meet the needs of minoritized communities, expand insurance coverage and enforcement of parity, and acknowledgement of the additional disparities and burden imbedded in intersectional populations due to racism, systematic oppression, and minority stress. Case studies of successful or promising implementation will also be presented. Conclusion: Improving behavioral health equity among minoritized communities requires a multi-prong approach. There are policy solutions to amplify primary care's role in providing equitable behavioral health care. Scaling and expansion of existing policies and implementation of new policies can be mechanisms to reduce behavioral health disparities for youth and adults, Presenters Emma Gilchrist, MPH, Bahroze Rakeen, Shale Wong, MD, MSPH, Stephanie Gold, MD, Jessica Kenny, [...]

Objective To profile the prevalence of the three body mass index (BMI) categories by sociodemographic characteristics, and to calculate the percentage transitioning (or not) from one BMI category to another, to inform South African health policy for the control of obesity and noncommunicable diseases. Methods We used data from the National Income Dynamics Study, including sociodemographic characteristics and BMI measurements collected in 2008, 2010, 2012, 2014 and 2017. For each data collection wave and each population group, we calculated mean BMI and prevalence by category. We also calculated the percentage making an upwards transition (e.g. from overweight to obese), a downwards transition or remaining within a particular category. We used a multinomial logistic regression model to estimate transition likelihood. Findings Between 2008 and 2017, mean BMI increased by 2.3 kg/[m.sup.2]. We calculated an increased prevalence of obesity from 19.7% (3686/18 679) to 23.6% (3412/14 463), with the largest increases in prevalence for those aged 19-24 years and those with at least high school education. The percentages of upwards transitions to overweight or obese categories increased sharply between the ages of 19 and 50 years. Once overweight or obese, the likelihood of transitioning to a normal BMI is low, particularly for women, those of higher age groups, and those with a higher income and a higher level of education. Conclusion In the development of national strategies to control obesity and noncommunicable diseases, our results will allow limited public health resources to be focused on the relevant population groups. Objectif Etablir la prevalence des trois categories d'indice de masse corporelle (IMC) en fonction des caracteristiques sociodemographiques, et calculer le pourcentage de transition (ou d'absence de transition) d'une categorie d'IMC a l'autre, afin de renseigner les politiques de sante sud-africaines visant a lutter contre l'obesite et les maladies non transmissibles. Methodes Nous avons exploite les donnees provenant de l'Enquete nationale sur la dynamique des revenus (NIDS), notamment les caracteristiques sociodemographiques et les mesures de l'IMC recoltees en 2008, 2010, 2012, 2014 et 2017. Pour chaque vague de collecte de donnees et chaque groupe de population, nous avons calcule l'IMC moyen et la prevalence par categorie. Nous avons egalement determine le pourcentage de passages vers la categorie superieure (en surpoids a obese par exemple), de passages vers la categorie inferieure et de maintien au sein d'une categorie specifique. Enfin, nous avons employe un modele de regression logistique multinomiale pour estimer la probabilite de transition. Resultats Entre 2008 et 2017, l'IMC moyen a augmente de 2,3 kg/[m.sup.2]. Nous avons observe une prevalence accrue pour l'obesite, passee de 19,7% (3686/18 679) a 23,6% (3412/14 463). Cette hausse touche principalement les 19-24 ans et ceux possedant au moins un diplome d'etudes secondaires. Le pourcentage de passage a la categorie superieure, vers le surpoids ou l'obesite, a fortement augmente chez les personnes agees de 19 a 50 ans. Une fois en surpoids ou obese, la probabilite de repasser a un IMC normal est faible, surtout chez les femmes, les personnes plus agees, ceux dont les revenus sont plus importants et dont le niveau d'education est plus eleve. Conclusion Dans le cadre du developpement de strategies nationales destinees a lutter contre l'obesite et les maladies non transmissibles, nos resultats permettront d'affecter des ressources de sante publique limitees aux groupes de population les plus touches. Objetivo Describir la prevalencia de las tres categorias del indice de masa corporal (IMC) por caracteristicas sociodemograficas y calcular el porcentaje que pasa (o no) de una categoria del IMC a otra con el fin de fundamentar la politica sanitaria de Sudafrica para controlar la obesidad y las enfermedades no transmisibles. Metodos Se usaron los datos del Estudio nacional de la dinamica de los ingresos (NIDS, por sus siglas en ingles), incluidas las caracteristicas sociodemograficas y las mediciones del IMC que se obtuvieron en 2008, 2010, 2012, 2014 y 2017. Se calculo el IMC medio y la prevalencia por categoria para cada fase de recopilacion de datos y cada grupo de poblacion. Tambien se calculo el porcentaje que hace una transicion ascendente (por ejemplo, del sobrepeso a la obesidad), una transicion descendente o que permanece dentro de una categoria en particular. En este contexto, se aplico un modelo de regresion logistica polinomial para estimar la probabilidad de la transicion. Resultados Entre 2008 y 2017, el IMC medio aumento en 2,3 kg/[m.sup.2]. Se calculo un aumento de la prevalencia de la obesidad del 19,7 % (3686/18 679) al 23,6 % (3412/14 463), siendo los mayores aumentos de la prevalencia para las personas de 19 a 24 anos de edad y las que habian cursado al menos estudios secundarios. Los porcentajes de transiciones ascendentes a las categorias de sobrepeso u obesidad aumentaron de manera considerable entre los 19 y los 50 anos de edad. Cuando se tiene sobrepeso o se es obeso, la probabilidad de pasar a un IMC normal es baja, en especial en el caso de las mujeres, las de los grupos de edad avanzada y las que tienen mayores ingresos y un nivel de educacion mas alto. Conclusion Los resultados obtenidos permitiran destinar los recursos limitados de la salud publica a los grupos de poblacion correspondientes en la elaboracion de estrategias nacionales para controlar la obesidad y las enfermedades no transmisibles. [phrase omitted], Introduction The mean body mass index (BMI) of the African population is increasing, (1) resulting in a steady rise of the prevalence of people being overweight or obese across Africa, [...]

Objective To determine the regional- and district-level newborn prevalence of sickle cell trait and disease, and the prevalence of haemoglobin variants and genetic modifiers of sickle cell disease, in the nine regions of north-western United Republic of Tanzania. Methods We repurposed dried blood spot samples from children (aged 0-24 months) born to mothers living with human immunodeficiency virus (HIV), collected as part of the HIV Early Infant Diagnosis programme, for sickle cell diagnosis. We performed isoelectric focusing to determine whether samples had normal haemoglobin, sickle cell trait, sickle cell disease or a rare haemoglobin variant. We shipped samples diagnosed as disease or variant to Cincinnati Children's Hospital in the United States of America for deoxyribonucleic-acid-based analyses to determine the prevalence of [alpha]-thalassaemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency or fetal haemoglobin genetic modifiers. Findings We analysed a total of 17 200 specimens during February 2017-May 2018. We observed a prevalence of sickle cell trait and disease of 20.3% (3492/17 200) and 1.2% (210/17 200), respectively. District-level trait varied from 8.6% (5/58) to 28.1% (77/274). Among confirmed sickle cell disease specimens, we noted 42.7% (61/143) had 1-gene deletion and 14.7% (21/143) had 2-gene deletion [alpha]-thalassaemia trait. We documented G6PD [A.sup.-] deficiency in 19.2% (14/73) of males. Conclusion Our calculated prevalence is twice as high as previously reported and reinforces the need for enhanced sickle cell diagnostic services. Our district-level data will inform public health policy, allowing screening and disease-modifying hydroxyurea therapy to be focused on high-prevalence areas, until universal newborn screening is available. Objectif Determiner la prevalence de la drepanocytose et du trait drepanocytaire chez les nouveau-nes, ainsi que la prevalence de variants d'hemoglobine et de modificateurs genetiques de la drepanocytose dans les neufregions du nord-ouest de la Republique-Unie de Tanzanie. Methodes Nous avons reutilise des echantillons de gouttes de sang seche provenant d'enfants (ages de 0 a 24 mois) nes de meres atteintes du virus de l'immunodeficience humaine (VIH), preleves dans le cadre du programme de diagnostic precoce de l'infection a VIH chez le nourrisson pour detecter une eventuelle drepanocytose. Nous avons procede a une focalisation isoelectrique pour savoir si les echantillons presentaient une hemoglobine normale, un trait drepanocytaire, une drepanocytose ou un variant d'hemoglobine rare. Ensuite, nous avons envoye les echantillons identifies comme porteurs de la maladie ou d'un variant a l'hopital pour enfants de Cincinnati, aux Etats-Unis, afin d'analyser l'acide desoxyribonucleique et de mesurer la prevalence d'une [alpha]-thalassemie, d'un deficit en glucose-6-phosphate deshydrogenase (G6PD) ou de modificateurs genetiques de l'hemoglobine foetale. Resultats Nous avons etudie 17 200 specimens au total entre fevrier 2017 et mai 2018. Nous avons observe une prevalence de 20,3% (3492/17 200) pour la drepanocytose, et de 1,2% (210/17 200) pour le trait drepanocytaire. D'un district a l'autre, la presence du trait variait de 8,6% (5/58) a 28,1% (77/274). Nous avons constate que 42,7% (61/143) des specimens chez qui une drepanocytose avait ete confirmee etaient prives d'un gene, et 14,7% (21/143) de deux genes du trait [alpha]-thalassemique. Enfin, nous avons repertorie un deficit en G6PD [A.sup.-] chez 19,2% (14/73) des males. Conclusion La prevalence que nous avons calculee est deux fois superieure aux chiffres mentionnes precedemment, et souligne la necessite d'instaurer de meilleurs services de diagnostic de la drepanocytose. Nos donnees reparties par district fourniront des informations en matiere de politique de sante publique, afin que le depistage et le traitement modificateur de la maladie, a base d'hydroxyuree, se concentrent sur les zones de forte prevalence jusqu'a ce qu'un depistage universel des nouveau-nes soit disponible. Objetivo Determinar la prevalence de la enfermedad y del rasgo de las celulas falciformes en los recien nacidos a nivel regional y de distrito, y la prevalencia de las variantes de hemoglobina y de los modificadores geneticos de la drepanocitosis en las nueve regiones del noroeste de la Republica Unida de Tanzania. Metodos Se reutilizaron las muestras de las manchas de sangre seca de los ninos (de 0 a 24 meses de edad) nacidos de madres que padecian el virus de la inmunodeficiencia humana (VIH); estas muestras se obtuvieron a traves del programa de Diagnostico precoz del VIH en ninos para diagnosticar las celulas falciformes. Se aplico la tecnica del enfoque isoelectrico para determinar si las muestras tenian hemoglobina, rasgos de celulas falciformes, drepanocitosis normales o una variante de hemoglobina poco frecuente. Se enviaron muestras diagnosticadas como enfermedad o variante al Hospital Infantil de Cincinnati (Cincinnati Children's Hospital) en los Estados Unidos de America para analizarlas a base de acido desoxirribonucleico y asi determinar la prevalencia de talasemia a, de deficiencia de glucosa-6-fosfato deshidrogenasa (G6PD, por sus siglas en ingles) o de modificadores geneticos de hemoglobina fetal. Resultados Se analizaron un total de 17 200 muestras entre febrero de 2017 y mayo de 2018. Se observo una prevalencia del rasgo de las celulas falciformes y de la drepanocitosis del 20,3 % (3492/17 200) y del 1,2 % (210/17 200), respectivamente. El rasgo a nivel de distrito vario del 8,6 % (5/58) al 28,1 % (77/274). Se observo que en las muestras de drepanocitosis confirmadas, el 42,7 % (61/143) presentaba la eliminacion de un gen y el 14,7 % (21/143) la eliminacion de dos genes en el rasgo de talasemia a. Se registro una deficiencia de G6PD [A.sup.-] en el 19,2 % (14/73) de los varones. Conclusion La prevalencia que se calcula aqui es el doble de la que se notifico anteriormente y refuerza la necesidad de mejorar los servicios para el diagnostico de la drepanocitosis. Estos datos a nivel de distrito contribuiran a la politica de salud publica, ya que permitiran que los cribados y la terapia con hidroxicarbamida que modifica la enfermedad se centren en las zonas de alta prevalencia, hasta que se disponga de un cribado universal de los recien nacidos. [phrase omitted], Introduction Sickle cell disease is an inherited disorder of haemoglobin, caused by a mutation in the [beta]-globin subunit of adult haemoglobin. In classic autosomal recessive fashion, inheritance of one abnormal [...]

Although in Canada, hearing screening and early intervention are presented as a health need, we question whether young deaf and hard of hearing children's access to language is adequately supported by public health and children's services. The Ontario Infant Hearing Program has the stated mandate of supporting the language development of deaf and hard of hearing infants and young children. However, this program presents parents with early intervention service options involving either spoken or signed language, but not both together. This policy effectively restricts access to sign language learning for a majority of Ontario's deaf children. Consequently, some deaf children suffer language deprivation and its deleterious effects on cognition and emotional development. In support of our arguments, we refer to Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which Canada has signed and ratified. The CRPD supports recognition of deaf children's right to sign language as a health need because language deprivation occurs in many children who are not offered sign language, and this is a permanent impairment imposed on top of hearing loss. We conclude that in Canada, health services for deaf children do not align with accessibility and human rights legislation, thus creating a policy gap that leaves deaf children vulnerable to additional impairment., Author(s): Kristin Snoddon [sup.1] , Jennifer Jackson Paul [sup.2] Author Affiliations: (1) grid.68312.3e, 0000 0004 1936 9422, School of Early Childhood Studies, Ryerson University, , 350 Victoria St., M5B 2K3, [...]

Objectives Provision of long-acting reversible contraception (LARC) after delivery and prior to discharge is safe and advantageous, yet few Texas hospitals offer this service. Our study describes experiences of Texas hospitals that implemented immediate postpartum LARC (IPLARC) programs, in order to inform the development of other IPLARC programs and guide future research on system-level barriers to broader adoption. Methods Eight Texas hospitals that had implemented an IPLARC program were identified, and six agreed to participate in the study. Interviews with 19 key hospital staff covered (1) factors that led the development of an IPLARC program; (2) billing, pharmacy, and administrative operations related to implementation; (3) patient demand and readiness; (4) the consent process; (5) staff training; and (6) hospital plans for monitoring and evaluation of IPLARC services. Results Most hospitals in this study primarily served Medicaid and un- or under-insured populations. Participants from all six hospitals perceived high levels of patient demand for IPLARC and provider interest in providing this service. The major challenges were related to financing IPLARC programs. Participants from half of the hospitals reported that leadership had concerns about financial viability of providing IPLARC. The hospitals with the longest-running IPLARC programs were safety net hospitals with family planning training programs. Conclusions for Practice We found that hospitals with IPLARC programs all had strong support from both providers and hospital leadership and had funding sources to offset costs that were not reimbursed. Strategies to reduce the financial risks related to IPLARC provision could provide the impetus for new programs to launch and support their sustainability., Author(s): Ashley V. Hill [sup.1] [sup.2] , Eileen Nehme [sup.3] , Nagla Elerian [sup.3] , Ella D. Puga [sup.1] [sup.3] , Brandie D. Taylor [sup.2] [sup.4] , David Lakey [sup.3] [...]