Selecting Review Outcomes for Systematic Reviews of Public Health Interventions

For systematic reviews to have an impact on public health, they must report outcomes that are important for decision-making. Systematic reviews of public health interventions, however, have a range of potential end users, and identifying and prioritizing the most important and relevant outcomes represents a considerable challenge.In this commentary, we describe potentially useful approaches that systematic review teams can use to identify review outcomes to best inform public health decision-making. Specifically, we discuss the importance of stakeholder engagement, the use of logic models, consideration of core outcome sets, reviews of the literature on end users' needs and preferences, and the use of decision-making frameworks in the selection and prioritization of outcomes included in reviews.The selection of review outcomes is a critical step in the production of public health reviews that are relevant to those who use them. Utilizing the suggested strategies may help the review teams better achieve this.

Public Health Interventions' Effect on Hospital Use in Patients With COVID-19: Comparative Study

BACKGROUND

Different states in the United States had different nonpharmaceutical public health interventions during the COVID-19 pandemic. The effects of those interventions on hospital use have not been systematically evaluated. The investigation could provide data-driven evidence to potentially improve the implementation of public health interventions in the future.

OBJECTIVE

We aim to study two representative areas in the United States and one area in China (New York State, Ohio State, and Hubei Province), and investigate the effects of their public health interventions by time periods according to key interventions.

METHODS

This observational study evaluated the numbers of infected, hospitalized, and death cases in New York and Ohio from March 16 through September 14, 2020, and Hubei from January 26 to March 31, 2020. We developed novel Bayesian generalized compartmental models. The clinical stages of COVID-19 were stratified in the models, and the effects of public health interventions were modeled through piecewise exponential functions. Time-dependent transmission rates and effective reproduction numbers were estimated. The associations of interventions and the numbers of required hospital and intensive care unit beds were studied.

RESULTS

The interventions of social distancing, home confinement, and wearing masks significantly decreased (in a Bayesian sense) the case incidence and reduced the demand for beds in all areas. Ohio's transmission rates declined before the state's "stay at home" order, which provided evidence that early intervention is important. Wearing masks was significantly associated with reducing the transmission rates after reopening, when comparing New York and Ohio. The centralized quarantine intervention in Hubei played a significant role in further preventing and controlling the disease in that area. The estimated rates that cured patients become susceptible in all areas were small (<0.0001), which indicates that they have little chance to get the infection again.

CONCLUSIONS

The series of public health interventions in three areas were temporally associated with the burden of COVID-19-attributed hospital use. Social distancing and the use of face masks should continue to prevent the next peak of the pandemic.

COVID-19: Fear, quackery, false representations and the law

Fear, anxiety and even paranoia can proliferate during a pandemic. Such conditions, even when subclinical, tend to be a product of personal and predispositional factors, as well as shared cultural influences, including religious, literary, film, and gaming, all of which can lead to emotional and less than rational responses. They can render people vulnerable to engage in implausible conspiracy theories about the causes of illness and governmental responses to it. They can also lead people to give credence to simplistic and unscientific misrepresentations about medications and devices which are claimed to prevent, treat or cure disease. In turn such vulnerability creates predatory opportunities for the unscrupulous. This article notes the eruption of quackery during the 1889-1892 Russian Flu and the 1918-1920 Spanish Flu and the emergence during 2020 of spurious claims during the COVID-19 pandemic. It identifies consumer protection strategies and interventions formulated during the 2020 pandemic. Using examples from the United States, Japan, Australia and the United Kingdom, it argues that during a pandemic there is a need for three responses by government to the risks posed by conspiracy theories and false representations: calm, scientifically-based messaging from public health authorities; cease and desist warnings directed toward those making extravagant or inappropriate claims; and the taking of assertive and well publicised legal action against individuals and entities that make false representations in order to protect consumers rendered vulnerable by their emotional responses to the phenomenology of the pandemic.

Patterns of pesticide usage in agriculture in rural Tanzania call for integrating agricultural and public health practices in managing insecticide-resistance in malaria vectors

BACKGROUND

Unrestricted use of pesticides in agriculture is likely to increase insecticide resistance in mosquito vectors. Unfortunately, strategies for managing insecticide resistance in agriculture and public health sectors lack integration. This study explored the types and usage of agricultural pesticides, and awareness and management practices among retailers and farmers in Ulanga and Kilombero districts in south-eastern Tanzania, where Anopheles mosquitoes are resistant to pyrethroids.

METHODS

An exploratory sequential mixed-methods approach was employed. First, a survey to characterize pesticide stocks was conducted in agricultural and veterinary (agrovet) retail stores. Interviews to assess general knowledge and practices regarding agricultural pesticides were performed with 17 retailers and 30 farmers, followed by a survey involving 427 farmers. Concurrently, field observations were done to validate the results.

RESULTS

Lambda-cyhalothrin, cypermethrin (both pyrethroids) and imidacloprids (neonicotinoids) were the most common agricultural insecticides sold to farmers. The herbicide glyphosate (amino-phosphonates) (59.0%), and the fungicides dithiocarbamate and acylalanine (54.5%), and organochlorine (27.3%) were also readily available in the agrovet shops and widely used by farmers. Although both retailers and farmers had at least primary-level education and recognized pesticides by their trade names, they lacked knowledge on pest control or proper usage of these pesticides. Most of the farmers (54.4%, n = 316) relied on instructions from pesticides dealers. Overall, 93.7% (400) farmers practised pesticides mixing in their farms, often in close proximity to water sources. One-third of the farmers disposed of their pesticide leftovers (30.0%, n = 128) and most farmers discarded empty pesticide containers into rivers or nearby bushes (55.7%, n = 238).

CONCLUSION

Similarities of active ingredients used in agriculture and malaria vector control, poor pesticide management practices and low-levels of awareness among farmers and pesticides retailers might enhance the selection of insecticide resistance in malaria vectors. This study emphasizes the need for improving awareness among retailers and farmers on proper usage and management of pesticides. The study also highlights the need for an integrated approach, including coordinated education on pesticide use, to improve the overall management of insecticide resistance in both agricultural and public health sectors.

How can cities tackle hoarding? Examining an intervention program bringing together fire and health authorities in Vancouver

Hoarded homes can pose a threat to public safety, with heightened risks of fire hazards, pest infestations and noxious odours in both the home and neighbouring dwellings. Communities across North America are responding to these public safety concerns through a harm reduction approach. This descriptive study explores the implementation and outcomes of the City of Vancouver's approach involving a partnership between fire prevention and public health. Data were collected from the team's 2016-2018 case tracking systems, consisting of health records and team intervention record, as well as notes taken from case briefing meetings. Study objectives included describing the intervention model, providing descriptive statistics on clients and their clutter volume, the interventions undertaken, and exploring predictors of clutter volume and case outcome through exploratory analyses. The sample included 82 cases involving severely hoarded conditions or more moderate hoarding conditions paired with additional client vulnerabilities (e.g. health conditions, frailty). Results from paired samples t-tests and regression analysis, suggest the Hoarding Action Response Team's (HART) model of a community-based intervention for hoarding was associated with clutter reduction and tenancy preservation. HART successfully maintained engagement with most clients, and most cases were closed within six home visits. Despite these successes, the team dealt with several barriers including client avoidance and limited resources. This paper provides guidance for communities who are working to develop a coordinated response to problems associated with hoarding and begins to establish expectations for what can be achieved through a community-based hoarding intervention model.

Organizational Supports for Research Evidence Use in State Public Health Agencies: A Latent Class Analysis

OBJECTIVE

Use of research evidence in public health decision making can be affected by organizational supports. Study objectives are to identify patterns of organizational supports and explore associations with research evidence use for job tasks among public health practitioners.

DESIGN

In this longitudinal study, we used latent class analysis to identify organizational support patterns, followed by mixed logistic regression analysis to quantify associations with research evidence use.

SETTING

The setting included 12 state public health department chronic disease prevention units and their external partnering organizations involved in chronic disease prevention.

PARTICIPANTS

Chronic disease prevention staff from 12 US state public health departments and partnering organizations completed self-report surveys at 2 time points, in 2014 and 2016 (N = 872).

MAIN OUTCOME MEASURES

Latent class analysis was employed to identify subgroups of survey participants with distinct patterns of perceived organizational supports. Two classify-analyze approaches (maximum probability assignment and multiple pseudo-class draws) were used in 2017 to investigate the association between latent class membership and research evidence use.

RESULTS

The optimal model identified 4 latent classes, labeled as "unsupportive workplace," "low agency leadership support," "high agency leadership support," and "supportive workplace." With maximum probability assignment, participants in "high agency leadership support" (odds ratio = 2.08; 95% CI, 1.35-3.23) and "supportive workplace" (odds ratio = 1.74; 95% CI, 1.10-2.74) were more likely to use research evidence in job tasks than "unsupportive workplace." The multiple pseudo-class draws produced comparable results with odds ratio = 2.09 (95% CI, 1.31-3.30) for "high agency leadership support" and odds ratio = 1.74 (95% CI, 1.07-2.82) for "supportive workplace."

CONCLUSIONS

Findings suggest that leadership support may be a crucial element of organizational supports to encourage research evidence use. Organizational supports such as supervisory expectations, access to evidence, and participatory decision making may need leadership support as well to improve research evidence use in public health job tasks.

Ten-year narrative review on antimicrobial resistance in Singapore

Antimicrobial resistance (AMR) results in drug-resistant infections that are harder to treat, subsequently leading to increased morbidity and mortality. In 2008, we reviewed the problem of AMR in Singapore, limiting our discussion to the human healthcare sector. Ten years later, we revisit this issue again, reviewing current efforts to contain it in order to understand the progress made as well as current and emerging challenges. Although a significant amount of work has been done to control AMR and improve antibiotic prescribing in Singapore, most of it has focused on the hospital setting, with mixed impact. The role of antibiotic use and AMR in food animals and the environment - and the link to human health - is better understood today. This issue of AMR encompasses both human health as well as animal/food safety, and efforts to control it will need to continually evolve to maintain or improve on current gains.

[Local public health services: a descriptive study of the municipalities of Catalonia in 2016]

OBJECTIVE

The health system in Spain rests mostly in the Autonomous Communities (similar to the states in the US). The public health activities of many local governments are little studied. The objective of this work was to bring knowledge about the public health activities of the municipalities, providing information obtained from a recent survey in Catalonia.

METHODS

Descriptive study based on a survey to public health officers in the 119 municipalities above 10,000 population in Catalonia, excluding the city of Barcelona. The survey was conducted between May and October 2016, with 103 municipalities (86.6%) reporting on their services in 2015, prior to the survey. Data were collected and descriptive analyses performed.

RESULTS

A consolidation of both political and professional public health structures of the municipalities was observed. Most frequent activities in health protection were related to legionella control, the control of urban pests and the management of complaints and requests by citizens. Most frequent activities in the field of health promotion were related to physical activity and health, prevention in tobacco and alcohol, food and nutrition. There were relatively few changes reported in public health structures and their officers, as well as in human resources.

CONCLUSIONS

In Catalonia, municipalities above 10,000 population have a remarkable level of activity in public health. Both the areas of health protection (with mandatory minimum services for local governments) and of health promotion show high levels of activity. The system seems stable regarding political changes and budget constraints. There are opportunities for improvement in the training of professionals and service accreditation. It would be desirable to find ways to improve coordination among these services.

Impacts of Federal Prevention Funding on Reported Gonorrhea and Chlamydia Rates

INTRODUCTION

The Centers for Disease Control and Prevention allocates funds annually to jurisdictions nationwide for sexually transmitted infection prevention activities. The objective of this study was to assess the effectiveness of federal sexually transmitted infection prevention funding for reducing rates of reported sexually transmitted infections.

METHODS

In 2017-2018, finite distributed lag regression models were estimated to assess the impact of sexually transmitted infection prevention funding (in 2016 dollars per capita) on reported chlamydia rates from 2000 to 2016 and reported gonorrhea rates from 1981 to 2016. Including lagged funding measures allowed for assessing the impact of funding over time. Controls for state-level socioeconomic factors, such as poverty rates, were included.

RESULTS

Results from the main model indicate that a 1% increase in annual funding would cumulatively decrease chlamydia and gonorrhea rates by 0.17% (p<0.10) and 0.33% (p<0.05), respectively. Results were similar when stratified by sex, with significant decreases in rates of reported chlamydia and gonorrhea in males of 0.33% and 0.34% (both p<0.05) respectively, and in rates of reported gonorrhea in females of 0.32% (p<0.05). The results were generally consistent across alternative model specifications and other robustness tests.

CONCLUSIONS

The significant inverse associations between federal sexually transmitted infection prevention funding and rates of reported chlamydia and gonorrhea suggest that federally funded sexually transmitted infection prevention activities have a discernable effect on reducing the burden of sexually transmitted infections. The reported sexually transmitted infection rate in a given year depends more on prevention funding in previous years than on prevention funding in the current year, demonstrating the importance of accounting for lagged funding effects.

A public health approach to mobilizing community partners for injury prevention: A scoping review

OBJECTIVES

Reducing injuries in adults requires work with diverse stakeholders across many sectors and at multiple levels. At the local level, public health professionals need to effectively bring together, facilitate, and support community partners to initiate evidence-based efforts. However, there has been no formal review of the literature to inform how these professionals can best create action among community partners to address injuries in adults. Thus, this scoping review aims to identify theories, models or frameworks that are applicable to a community-based approach to injury prevention.

METHODS

Searches of scientific and less formal literature identified 13,756 relevant items published in the English language between 2000 and 2016 in North America, Europe and Australia. After screening and review, 10 publications were included that (1) identified a theory, framework or model related to mobilizing partners; and (2) referred to community-based adult injury prevention.

RESULTS

Findings show that use of theories, frameworks and models in community-based injury prevention programs is rare and often undocumented. One theory and various conceptual models and frameworks exist for mobilizing partners to jointly prevent injuries; however, there are few evaluations of the processes to create community action.

CONCLUSIONS

Successful community-based injury prevention must build on what is already understood about creating partnership action. Evaluating local public health professional injury prevention practice based on available theories, models and frameworks will identify successes and challenges to inform process improvements. We propose a logic model to more specifically guide and evaluate how public health can work locally with community partners.

State-Level Point-of-Sale Tobacco News Coverage and Policy Progression Over a 2-Year Period

BACKGROUND

Mass media content may play an important role in policy change. However, the empirical relationship between media advocacy efforts and tobacco control policy success has rarely been studied. We examined the extent to which newspaper content characteristics (volume, slant, frame, source, use of evidence, and degree of localization) that have been identified as important in past descriptive studies were associated with policy progression over a 2-year period in the context of point-of-sale (POS) tobacco control.

METHOD

We used regression analyses to test the relationships between newspaper content and policy progression from 2012 to 2014. The dependent variable was the level of implementation of state-level POS tobacco control policies at Time 2. Independent variables were newspaper article characteristics (volume, slant, frame, source, use of evidence, and degree of localization) and were collected via content analysis of the articles. State-level policy environment contextual variables were examined as confounders.

RESULTS

Positive, significant bivariate relationships exist between characteristics of news content (e.g., high overall volume, public health source present, local quote and local angle present, and pro-tobacco control slant present) and Time 2 POS score. However, in a multivariate model controlling for other factors, significant relationships did not hold.

DISCUSSION

Newspaper coverage can be a marker of POS policy progression. Whether media can influence policy implementation remains an important question. Future work should continue to tease out and confirm the unique characteristics of media content that are most associated with subsequent policy progression, in order to inform media advocacy efforts.

Comparative study of post-graduate training programs in public health in the great maghreb countries

BACKGROUND

Training in public health, an essential lever for the success of health programs, mobilizes several disciplines, from the description of health situations to the study of their determinants, and to health management.

OBJECTIVE

To compare postgraduate training programs in Public Health, provided in the countries of the Greater Maghreb.

METHODS

Through a documentary study, various components of post-graduate training in Public Health in the Maghreb have been identified: offers and methods of training, learning objectives, program content and reference skills.

RESULTS

In the Maghreb, and with the exception of Mauritania, Training offers are limited to teaching in Public Health with a medical orientation, integrated in the university system in the form of residency. Other training (masters ...) are provided in the context of continuing professional development. Areas of competence include, in addition to medical and scientific expertise, communication and interdisciplinary collaboration. The programs focus on methodological aspects in relation to related disciplines such as health promotion, anthropology, sociology and health planning.

CONCLUSION

The pooling of training experiences in Public Health, in the Maghreb countries, would be essential to launch a quality homogeneous training based on the paradigm of global health.

Maternal and child characteristics and health practices affecting under-five mortality: A matched case control study in Gamo Gofa Zone, Southern Ethiopia

BACKGROUND

Though Ethiopia has shown a considerable improvement in reducing under-five mortality rate since 1990, many children still continue to die prematurely. Mixed results have been reported about determinants of under-five mortality. Besides, there is paucity of mortality studies in the current study site. Therefore, this study was conducted to assess maternal and child health related predictors of under-five mortality in Southern Ethiopia.

METHODS

A matched case control study was conducted in 2014 in Arba Minch Town and Arba Minch Zuria District of Gamo Gofa Zone, Southern Ethiopia. Conditional logistic regression was employed to identify the predictors of under-five mortality. Sampling weight was applied to account for the non-proportional allocation of sample to different clusters. Based on the Mosley & Chen's analytical framework for under-five and infant mortalities, the predictors were organized in to three groups: 1) personal illness control, 2) child feeding and newborn care and 3) other maternal and child related factors.

RESULTS

Among personal illness control related factors: lack of post-natal care, immunization status of the child and lack of Vitamin A supplementation were significantly associated with higher rate of under-five mortality. Not breastfeeding and delaying first bath at least for 24 hours were child feeding and newborn care related factors which were found to be significantly associated with under-five mortality. Among other maternal and child related factors, shorter previous birth interval, history of death of index child's older sibling, being multiple birth and live birth after the index child were significantly associated with under-five mortality.

CONCLUSIONS

In order to maintain reduction of under-five mortality during the Sustainable Development Goals era, strengthening of maternal and child health interventions, such as post-natal care, family planning, immunization, supplementation of Vitamin A for children older than six months, breastfeeding and delaying of first bath after delivery at least for 24 hours are recommended.

Health policy programs realised in Poland in 2016-2017

BACKGROUND

Health Policy Program (Program Polityki Zdrowotnej – PPZ) is a state policy tool for engaging local government units into the mechanism of granting provision of health services. Authors show areas in which self-governments most often took preventive health care actions and describe legislative changes in the Act on provision of health services.

OBJECTIVE

The aim of the article is to quantitative and qualitative statement of PPZ prepared in Poland in 2016 and 2017, as well as presenting changing legal situation in the scope of evaluation of these projects.

MATERIALS AND METHODS

Authors use descriptive method, presenting changes of legal status. The article includes data available in the Bulletin of Public Information by The Agency for Health Technology Assessment. 590 programs were analyzed (239 from 2016 and 351 from 2017).

RESULTS

In 2016 – 67% of submitted programs were given a positive opinion and in 2017 – 71%. The most of positively evaluated PPZ submitted by local government units (53% in 2016; 47% in 2017) referred to prevention of infectious diseases by vaccines. On the basis of analyses conducted, significant differences were observed in the implementation of the PPZ in various regions of Poland.

CONCLUSIONS

In the recent years a big improvement in the quality of planned self-government health programs is observed. It is suggested that due to the regulation defining the model of the health policy program and the model of the final report, this trend will continue.

Public health information in crisis-affected populations: a review of methods and their use for advocacy and action

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality. The paper also quantifies the availability of a minimal essential set of information in large armed conflict and natural disaster crises since 2010: we show that information was available and timely only in a small minority of cases. On the basis of this observation, we propose an agenda for methodological research and steps required to improve on the current use of available methods. This proposition includes setting up a dedicated interagency service for public health information and epidemiology in crises.

When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program

This study investigates the impact of and behavioral responses to cost sharing in Korea's National Cancer Screening Program, which provides free stomach and breast cancer screenings to those with an income below a certain cutoff. Free cancer screening substantially increases the screening take up rate, yielding more cancer detections. However, the increase in cancer detection is quickly crowded out by cancer detection through other channels such as diagnostic testing and private cancer screening. Further, compliers are much less likely to have cancer than never takers. Crowd-out and selection help explain why the program has been unable to reduce cancer mortality.

Programmatic Factors Related to Smallpox Vaccine Uptake by Healthcare Workers and Others

We surveyed program coordinators at 106 hospitals and health departments that participated in the National Smallpox Vaccination Program to ascertain how program-level factors affected the rate of smallpox vaccine uptake by staff. In a fully adjusted multivariate model, health departments achieved significantly higher vaccination rates than did hospitals, as did facilities that invited fewer employees to be vaccinated.

Health technology assessment of public health programmes in Poland, years 2010 and 2013

BACKGROUND

In Poland, among other responsibilities, local governments are obliged to organize public health activities for local communities. To fulfill their obligations in this respect, authorities can organize preventive care in the form of health programs. Prior to their implementation, local governments must seek however opinion of the Polish HTA (Health Technology Assessment) agency. HTA recommendations do inform final decision making process but are not obligatory to be followed.

OBJECTIVE

Firstly, It was to provide an insight into what extend local governments utilize health programs in their endeavors and the scope of health topics included. Secondly, it was to elicit recommendations for future authors of health programs in order to increase the chances of positive HTA recommendation.

METHODS

The retrospective analysis of HTA recommendations issued by the Polish HTA agency (AHTAPol) in 2010 and 2013 was conducted.

RESULTS

There were 67 and 294 HTA recommendations issued in 2010 and 2013 respectively of which 47.8% and 34.4% were negative. Among authors, city councils and communes dominated. Vaccinations were the most commonly chosen target health intervention. In total, six key recommendations for local governments interested in the implementation of health programs were elicited.

CONCLUSIONS

To increase the chances for positive HTA recommendations, the health program has to be designed for health problems supported by sound clinical evidence which is not covered by the scope of reimbursement offered by National Health Fund. The targeted health intervention has to be supported by the evidence of proven clinical efficacy and safety and utilize available epidemiological data.

Tuberculosis control in South African gold mines: mathematical modeling of a trial of community-wide isoniazid preventive therapy

A recent major cluster randomized trial of screening, active disease treatment, and mass isoniazid preventive therapy for 9 months during 2006-2011 among South African gold miners showed reduced individual-level tuberculosis incidence but no detectable population-level impact. We fitted a dynamic mathematical model to trial data and explored 1) factors contributing to the lack of population-level impact, 2) the best-achievable impact if all implementation characteristics were increased to the highest level achieved during the trial ("optimized intervention"), and 3) how tuberculosis might be better controlled with additional interventions (improving diagnostics, reducing treatment delay, providing isoniazid preventive therapy continuously to human immunodeficiency virus-positive people, or scaling up antiretroviral treatment coverage) individually and in combination. We found the following: 1) The model suggests that a small proportion of latent infections among human immunodeficiency virus-positive people were cured, which could have been a key factor explaining the lack of detectable population-level impact. 2) The optimized implementation increased impact by only 10%. 3) Implementing additional interventions individually and in combination led to up to 30% and 75% reductions, respectively, in tuberculosis incidence after 10 years. Tuberculosis control requires a combination prevention approach, including health systems strengthening to minimize treatment delay, improving diagnostics, increased antiretroviral treatment coverage, and effective preventive treatment regimens.

Accuracy of Trained Canines for Detecting Bed Bugs (Hemiptera: Cimicidae)

Detection of low-level bed bug, Cimex lectularius L. (Hemiptera: Cimicidae), infestations is essential for early intervention, confirming eradication of infestations, and reducing the spread of bed bugs. Despite the importance of detection, few effective tools and methods exist for detecting low numbers of bed bugs. Scent dogs were developed as a tool for detecting bed bugs in recent years. However, there are no data demonstrating the reliability of trained canines under natural field conditions. We evaluated the accuracy of 11 canine detection teams in naturally infested apartments. All handlers believed their dogs could detect infestations at a very high rate (≥95%). In three separate experiments, the mean (min, max) detection rate was 44 (10-100)% and mean false-positive rate was 15 (0-57)%. The false-positive rate was positively correlated with the detection rate. The probability of a bed bug infestation being detected by trained canines was not associated with the level of bed bug infestations. Four canine detection teams evaluated on multiple days were inconsistent in their ability to detect bed bugs and exhibited significant variance in accuracy of detection between inspections on different days. There was no significant relationship between the team's experience or certification status of teams and the detection rates. These data suggest that more research is needed to understand factors affecting the accuracy of canine teams for bed bug detection in naturally infested apartments.

Four-year longitudinal impact evaluation of the Action for Children UK Neglect Project: outcomes for the children, families, Action for Children, and the UK

Neglect has a devastating impact on children and is the most pervasive form of child maltreatment in the United Kingdom. The study purpose was to establish outcomes for neglected children following structured assessment and intervention to ascertain what worked and why it worked. This prospective cohort study included 85 cases of neglected children under 8 years of age from 7 centers across the United Kingdom. Data were collected between 2008 and 2012 through serial quantitative recording of the level of concern about neglect. Serial review of qualitative case-file data was undertaken for detail of assessment, interventions, and evidence of outcomes for the child. Data analysis was undertaken by paired t-test, Chi Square, descriptive statics for categorical data, and, for narrative data, identification of recurring factors and patterns, with correlation of presenting factors, interventions, and outcomes. Paired t-test demonstrated significant decrease in overall Action for Children Assessment Tool scores between assessment (M=43.77, SD=11.09) and closing the case (M=35.47, SD=9.6, t(84)=6.77, p<0.01). Improvement in the level of concern about neglect was shown in 79% of cases, with only 21% showing no improvement. In 59% of cases, concern about neglect was removed completely. Use of the assessment tool fostered engagement by parents. The relationship between lack of parental engagement and children being taken into care was statistically significant, with a large effect size (χ(2) 10.66, df1, p=0.0001, OR=17.24). When parents refused or were unable to respond positively to the intervention, children benefited from an expedited move into care.

How effective are public health departments at preventing mortality?

This study estimates the causal impact of variation in the expenditures of California county departments of public health on all-cause mortality rates and the associated value of lives saved. Since the activities of county departments of public health are likely to affect mortality rates with a lag, Koyck distributed lag models are estimated using the Lewbel instrumental variables estimator. The findings show that an additional $10 per capita of public health expenditures reduces all-cause mortality by 9.1 deaths per 100,000. At current funding levels, the long-run annual number of lives saved by the presence of county departments of public health in California is estimated to be approximately 27,000 (26,937 lives, 95% confidence interval: [11,963, 41,911]). The annual value of these lives is estimated to be worth $212.8 billion using inflation-adjusted standard U.S. government estimates of the value of a statistical life ($7.9 million).

Increasing coverage in mass drug administration for lymphatic filariasis elimination in an urban setting: a study of Malindi Town, Kenya

INTRODUCTION

Implementation of Mass Drug Administration (MDA) in urban settings is an obstacle to Lymphatic Filariasis (LF) elimination. No urban-specific guidelines on MDA in urban areas exist. Malindi district urban area had received 4 MDA rounds by the time the current study was implemented. Programme data showed average treatment coverage of 28.4% (2011 MDA), far below recommended minimum of 65-80%.

METHODS

To identify, design and test strategies for increased treatment coverage in urban areas, a quasi-experimental study was conducted in Malindi urban area. Three sub-locations with lowest treatment coverage in 2011 MDA were purposively selected. In the pre-test phase, 947 household heads sampled using systematic random method were interviewed for quantitative data. For qualitative data, 12 Focus Group Discussions (FGDs) with single sex adult and youth male and female groups and 3 with community drug distributors (CDDs) were conducted. Forty in-depth interviews with opinion leaders and self-administered questionnaires with District Public Health officers purposively selected were carried out. The quantitative data were analyzed using SPSS version 16 and statistical significance assessed by χ(2) test.The qualitative data were analyzed manually according to study's themes.

RESULTS AND DISCUSSION

The identified strategies were implemented prior to and during 2012 MDA in two sub-locations (experimental) while in the third (control), usual MDA strategies were applied. In the post-test phase, 2012 MDA coverage in experimental and control sub-locations was comparatively assessed for effect of the newly designed strategies on urban MDA. Results indicated improved treatment coverage in experimental sub-locations, 77.1% in Shella and 66.0% in Barani. Central (control) sub-location also attained high coverage, 70.4% indicating average treatment coverage of 71%.

CONCLUSION

The identified strategies contributed to increased treatment coverage in experimental sites and should be applied in urban areas. Due to closeness of sites, spillover effects may have contributed to increased coverage in the control site.