Browsing by Subject "Public Health"
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Item Open Access Anthropology, knowledge-flows and global health.(Global public health, 2010-01) Feierman, S; Kleinman, A; Stewart, K; Farmer, D; Das, VGlobal health programmes are damaged by blockages in the upward flow of information from localities and regional centres about realities of professional practice and about patients' lives and conditions of treatment. Power differentials between local actors and national or international decision-makers present further obstacles to effective action. Anthropological research and action, in its most effective current forms, make important contributions to these issues. This research often continues over the long term, intensively. It can be multi-sited, studying actors at local, national and international levels simultaneously. It studies the relative knowledge and power of impoverished patients and global decision-makers, all within a single frame. By doing so, anthropological research is capable of providing new and important insights on the diverse meanings of patient decision-making, informed consent, non-compliance, public health reporting, the building of political coalitions for health and many other issues.Item Open Access Assessing the Evidence on the Differential Impact of Menthol versus Non-menthol Cigarette Use on Initiation and Progression to Regular Smoking: A Systematic Review and Meta-analysis.(American journal of health behavior, 2022-04) Kim, Mimi M; Curtin, Geoffrey MBackground: Despite numerous assessments of the public health impact of menthol cigarettes, a rigorous synthesis related to menthol cigarettes and behavioral outcomes is lacking. This systematic review and meta-analysis examined the question: Does menthol cigarette use have a differential impact on initiation and progression to regular smoking compared to non-menthol cigarette use? Methods: We consulted 6 databases from their inception to October 15, 2021. We included articles comparing menthol versus non-menthol smokers among 4 predefined smoking initiation and progression outcomes. We assessed risk of bias was using the Agency for Healthcare Research and Quality Evidence-Based Practice Center approach. We applied a random-effects model to pool adjusted odds ratios. Results: We qualitatively synthesized 16 adjusted studies across the outcomes. Results from one meta-analysis suggested no difference between menthol and non-menthol smokers in likelihood to report daily versus non-daily smoking. Conclusion: This systematic review and meta-analysis did not identify a consistent, statistically significant, or differential association between menthol use and progression to regular smoking. Varying definitions of outcome measures and lack of longitudinal evidence limited the confident conclusions that could be drawn from this evidence base.Item Open Access Assessing the Evidence on the Differential Impact of Menthol versus Non-menthol Cigarette Use on Smoking Dependence in the US Population: A Systematic Review and Meta-analysis.(American journal of health behavior, 2022-09) Kim, Mimi M; Curtin, Geoffrey MBackground: Menthol's effect on cigarette smoking behaviors is an intensely scrutinized US public health issue. This systematic review and meta-analysis examined the question: Does menthol cigarette use have a differential impact on smoking dependence compared with non-menthol cigarette use? Methods: We consulted 6 databases from inception to October 15, 2021. We included articles comparing menthol versus non-menthol cigarette smokers against predefined smoking dependence outcomes. Risk of bias was assessed using the AHRQ Evidence-Based Practice Center approach. We applied a random-effects model to pool adjusted odds ratios. Results: We synthesized 37 demographically adjusted studies. Meta-analytic results suggested non-menthol smokers were equally/more likely to report daily versus non-daily smoking; menthol use was associated with needing a cigarette within one hour; cigarettes per day was not associated with menthol use; menthol use was associated with a low (vs high) Heaviness of Smoking Index score; and results were either non-significant or associated menthol use with lower TTFC. Conclusions: Despite consistently good or fair quality adjusted studies across several measures, results were discordant depending on measures used and means of measurement. Overall, the evidence is insufficient to draw clear conclusions on a differential association between menthol (vs non-menthol) cigarette use and smoking dependence.Item Open Access Brazilian road traffic fatalities: a spatial and environmental analysis.(PLoS One, 2014) de Andrade, Luciano; Vissoci, João Ricardo Nickenig; Rodrigues, Clarissa Garcia; Finato, Karen; Carvalho, Elias; Pietrobon, Ricardo; de Souza, Eniuce Menezes; Nihei, Oscar Kenji; Lynch, Catherine; de Barros Carvalho, Maria DalvaBACKGROUND: Road traffic injuries (RTI) are a major public health epidemic killing thousands of people daily. Low and middle-income countries, such as Brazil, have the highest annual rates of road traffic fatalities. In order to improve road safety, this study mapped road traffic fatalities on a Brazilian highway to determine the main environmental factors affecting road traffic fatalities. METHODS AND FINDINGS: Four techniques were utilized to identify and analyze RTI hotspots. We used spatial analysis by points by applying kernel density estimator, and wavelet analysis to identify the main hot regions. Additionally, built environment analysis, and principal component analysis were conducted to verify patterns contributing to crash occurrence in the hotspots. Between 2007 and 2009, 379 crashes were notified, with 466 fatalities on BR277. Higher incidence of crashes occurred on sections of highway with double lanes (ratio 2∶1). The hotspot analysis demonstrated that both the eastern and western regions had higher incidences of crashes when compared to the central region. Through the built environment analysis, we have identified five different patterns, demonstrating that specific environmental characteristics are associated with different types of fatal crashes. Patterns 2 and 4 are constituted mainly by predominantly urban characteristics and have frequent fatal pedestrian crashes. Patterns 1, 3 and 5 display mainly rural characteristics and have higher prevalence of vehicular collisions. In the built environment analysis, the variables length of road in urban area, limited lighting, double lanes roadways, and less auxiliary lanes were associated with a higher incidence of fatal crashes. CONCLUSIONS: By combining different techniques of analyses, we have identified numerous hotspots and environmental characteristics, which governmental or regulatory agencies could make use to plan strategies to reduce RTI and support life-saving policies.Item Open Access Broadening the Perspective on Gun Violence: An Examination of the Firearms Industry, 1990-2015.(American journal of preventive medicine, 2017-11) Smith, Victoria M; Siegel, Michael; Xuan, Ziming; Ross, Craig S; Galea, Sandro; Kalesan, Bindu; Fleegler, Eric; Goss, Kristin AIntroduction
Firearm violence injures or kills 100,000 Americans each year. This paper applies the Host-Agent-Vector-Environment model to this issue. Research on firearm violence tends to focus on two elements-the host (i.e., victims of firearm violence) and the environment (i.e., gun policies)-but little attention has been paid to the agent (the gun and ammunition) or the vector (firearm manufacturers, dealers, and the industry lobby).Methods
Using Bureau of Alcohol, Tobacco, Firearms and Explosives data, trends in firearm manufacturing were investigated from 1990 to 2015. Outcome measures included: (1) trends in domestic gun manufacturing by weapon type; (2) trends in production by firearm caliber; and (3) 2015 market share by type of firearm and company. Data were collected and analyzed in 2016.Results
Overall domestic firearms production decreased slightly from 1996 through 2004, and then steadily increased from 1.7% in 2005 to 13.8% in 2013, when >10 million firearms were produced for the domestic market. The increase in total firearm production was driven by the increased production of pistols and rifles. Within the pistol category, increased production was attributable to an increase in higher caliber weapons. Similar trends were observed in gun purchases and recovered and traced crime guns.Conclusions
Trends in firearm manufacturing reveal a shift toward more-lethal weapons, and this trend is also observed in gun purchases and crime gun traces. This may reflect a societal shift in cultural practices and norms related to guns and could inform strategies to reduce firearm violence.Item Open Access Collective action and individual choice: rethinking how we regulate narcotics and antibiotics.(J Med Ethics, 2013-12) Anomaly, JonnyGovernments across the globe have squandered treasure and imprisoned millions of their own citizens by criminalising the use and sale of recreational drugs. But use of these drugs has remained relatively constant, and the primary victims are the users themselves. Meanwhile, antimicrobial drugs that once had the power to cure infections are losing their ability to do so, compromising the health of people around the world. The thesis of this essay is that policymakers should stop wasting resources trying to fight an unwinnable and morally dubious war against recreational drug users, and start shifting their attention to the serious threat posed by our collective misuse of antibiotics.Item Open Access COVID-19: The Time for Collaboration Between Long-Term Services and Supports, Health Care Systems, and Public Health Is Now.(The Milbank quarterly, 2021-06) Dawson, Walter D; Boucher, Nathan A; Stone, Robyn; VAN Houtven, Courtney HPolicy Points To address systemic problems amplified by COVID-19, we need to restructure US long-term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near-term and long-term policy solutions. Seven near-term policy recommendations include requiring the uniform public reporting of COVID-19 cases in all LTSS settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing barriers to telehealth in LTSS; and providing incentives to care for vulnerable populations. Long-term reform should focus on comprehensive workforce development, comprehensive LTSS financing reform, and the creation of an age-friendly public health system.Context
The heavy toll of COVID-19 brings the failings of the long-term services and supports (LTSS) system in the United States into sharp focus. Although these are not new problems, the pandemic has exacerbated and amplified their impact to a point that they are impossible to ignore. The primary blame for the high rates of COVID-19 infections and deaths has been assigned to formal LTSS care settings, specifically nursing homes. Yet other systemic problems have been unearthed during this pandemic: the failure to coordinate the US public health system at the federal level and the effects of long-term disinvestment and neglect of state- and local-level public health programs. Together these failures have contributed to an inability to coordinate with the LTSS system and to act early to protect residents and staff in the LTSS care settings that are hotspots for infection, spread, and serious negative health outcomes.Methods
We analyze several impacts of the COVID-19 pandemic on the US LTSS system and policy arrangements. The economic toll on state budgets has been multifaceted, and the pandemic has had a direct impact on Medicaid, the primary funder of LTSS, which in turn has further exacerbated the states' fiscal problems. Both the inequalities across race, ethnicity, and socioeconomic status as well as the increased burden on unpaid caregivers are clear. So too is the need to better integrate LTSS with the health, social care, and public health systems.Findings
We propose seven near-term actions that US policymakers could take: implementing a uniform public reporting of COVID-19 cases in LTSS settings; identifying and supporting unpaid caregivers; bolstering support for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing the barriers to telehealth in LTSS; and providing incentives to care for our most vulnerable populations. Our analysis also demonstrates that our nation requires comprehensive reform to build the LTSS system we need through comprehensive workforce development, universal coverage through comprehensive financing reform, and the creation of an age-friendly public health system.Conclusions
COVID-19 has exposed the many deficits of the US LTSS system and made clear the interdependence of LTSS with public health. Policymakers have an opportunity to address these failings through a substantive reform of the LTSS system and increased collaboration with public health agencies and leaders. The opportunity for reform is now.Item Open Access Elusive consensus: Polarization in elite communication on the COVID-19 pandemic.(Science advances, 2020-07) Green, Jon; Edgerton, Jared; Naftel, Daniel; Shoub, Kelsey; Cranmer, Skyler JCues sent by political elites are known to influence public attitudes and behavior. Polarization in elite rhetoric may hinder effective responses to public health crises, when accurate information and rapid behavioral change can save lives. We examine polarization in cues sent to the public by current members of the U.S. House and Senate during the onset of the COVID-19 pandemic, measuring polarization as the ability to correctly classify the partisanship of tweets' authors based solely on the text and the dates they were sent. We find that Democrats discussed the crisis more frequently-emphasizing threats to public health and American workers-while Republicans placed greater emphasis on China and businesses. Polarization in elite discussion of the COVID-19 pandemic peaked in mid-February-weeks after the first confirmed case in the United States-and continued into March. These divergent cues correspond with a partisan divide in the public's early reaction to the crisis.Item Open Access Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States.(Proceedings of the National Academy of Sciences of the United States of America, 2022-04) Cramer, Estee Y; Ray, Evan L; Lopez, Velma K; Bracher, Johannes; Brennen, Andrea; Castro Rivadeneira, Alvaro J; Gerding, Aaron; Gneiting, Tilmann; House, Katie H; Huang, Yuxin; Jayawardena, Dasuni; Kanji, Abdul H; Khandelwal, Ayush; Le, Khoa; Mühlemann, Anja; Niemi, Jarad; Shah, Apurv; Stark, Ariane; Wang, Yijin; Wattanachit, Nutcha; Zorn, Martha W; Gu, Youyang; Jain, Sansiddh; Bannur, Nayana; Deva, Ayush; Kulkarni, Mihir; Merugu, Srujana; Raval, Alpan; Shingi, Siddhant; Tiwari, Avtansh; White, Jerome; Abernethy, Neil F; Woody, Spencer; Dahan, Maytal; Fox, Spencer; Gaither, Kelly; Lachmann, Michael; Meyers, Lauren Ancel; Scott, James G; Tec, Mauricio; Srivastava, Ajitesh; George, Glover E; Cegan, Jeffrey C; Dettwiller, Ian D; England, William P; Farthing, Matthew W; Hunter, Robert H; Lafferty, Brandon; Linkov, Igor; Mayo, Michael L; Parno, Matthew D; Rowland, Michael A; Trump, Benjamin D; Zhang-James, Yanli; Chen, Samuel; Faraone, Stephen V; Hess, Jonathan; Morley, Christopher P; Salekin, Asif; Wang, Dongliang; Corsetti, Sabrina M; Baer, Thomas M; Eisenberg, Marisa C; Falb, Karl; Huang, Yitao; Martin, Emily T; McCauley, Ella; Myers, Robert L; Schwarz, Tom; Sheldon, Daniel; Gibson, Graham Casey; Yu, Rose; Gao, Liyao; Ma, Yian; Wu, Dongxia; Yan, Xifeng; Jin, Xiaoyong; Wang, Yu-Xiang; Chen, YangQuan; Guo, Lihong; Zhao, Yanting; Gu, Quanquan; Chen, Jinghui; Wang, Lingxiao; Xu, Pan; Zhang, Weitong; Zou, Difan; Biegel, Hannah; Lega, Joceline; McConnell, Steve; Nagraj, VP; Guertin, Stephanie L; Hulme-Lowe, Christopher; Turner, Stephen D; Shi, Yunfeng; Ban, Xuegang; Walraven, Robert; Hong, Qi-Jun; Kong, Stanley; van de Walle, Axel; Turtle, James A; Ben-Nun, Michal; Riley, Steven; Riley, Pete; Koyluoglu, Ugur; DesRoches, David; Forli, Pedro; Hamory, Bruce; Kyriakides, Christina; Leis, Helen; Milliken, John; Moloney, Michael; Morgan, James; Nirgudkar, Ninad; Ozcan, Gokce; Piwonka, Noah; Ravi, Matt; Schrader, Chris; Shakhnovich, Elizabeth; Siegel, Daniel; Spatz, Ryan; Stiefeling, Chris; Wilkinson, Barrie; Wong, Alexander; Cavany, Sean; España, Guido; Moore, Sean; Oidtman, Rachel; Perkins, Alex; Kraus, David; Kraus, Andrea; Gao, Zhifeng; Bian, Jiang; Cao, Wei; Lavista Ferres, Juan; Li, Chaozhuo; Liu, Tie-Yan; Xie, Xing; Zhang, Shun; Zheng, Shun; Vespignani, Alessandro; Chinazzi, Matteo; Davis, Jessica T; Mu, Kunpeng; Pastore Y Piontti, Ana; Xiong, Xinyue; Zheng, Andrew; Baek, Jackie; Farias, Vivek; Georgescu, Andreea; Levi, Retsef; Sinha, Deeksha; Wilde, Joshua; Perakis, Georgia; Bennouna, Mohammed Amine; Nze-Ndong, David; Singhvi, Divya; Spantidakis, Ioannis; Thayaparan, Leann; Tsiourvas, Asterios; Sarker, Arnab; Jadbabaie, Ali; Shah, Devavrat; Della Penna, Nicolas; Celi, Leo A; Sundar, Saketh; Wolfinger, Russ; Osthus, Dave; Castro, Lauren; Fairchild, Geoffrey; Michaud, Isaac; Karlen, Dean; Kinsey, Matt; Mullany, Luke C; Rainwater-Lovett, Kaitlin; Shin, Lauren; Tallaksen, Katharine; Wilson, Shelby; Lee, Elizabeth C; Dent, Juan; Grantz, Kyra H; Hill, Alison L; Kaminsky, Joshua; Kaminsky, Kathryn; Keegan, Lindsay T; Lauer, Stephen A; Lemaitre, Joseph C; Lessler, Justin; Meredith, Hannah R; Perez-Saez, Javier; Shah, Sam; Smith, Claire P; Truelove, Shaun A; Wills, Josh; Marshall, Maximilian; Gardner, Lauren; Nixon, Kristen; Burant, John C; Wang, Lily; Gao, Lei; Gu, Zhiling; Kim, Myungjin; Li, Xinyi; Wang, Guannan; Wang, Yueying; Yu, Shan; Reiner, Robert C; Barber, Ryan; Gakidou, Emmanuela; Hay, Simon I; Lim, Steve; Murray, Chris; Pigott, David; Gurung, Heidi L; Baccam, Prasith; Stage, Steven A; Suchoski, Bradley T; Prakash, B Aditya; Adhikari, Bijaya; Cui, Jiaming; Rodríguez, Alexander; Tabassum, Anika; Xie, Jiajia; Keskinocak, Pinar; Asplund, John; Baxter, Arden; Oruc, Buse Eylul; Serban, Nicoleta; Arik, Sercan O; Dusenberry, Mike; Epshteyn, Arkady; Kanal, Elli; Le, Long T; Li, Chun-Liang; Pfister, Tomas; Sava, Dario; Sinha, Rajarishi; Tsai, Thomas; Yoder, Nate; Yoon, Jinsung; Zhang, Leyou; Abbott, Sam; Bosse, Nikos I; Funk, Sebastian; Hellewell, Joel; Meakin, Sophie R; Sherratt, Katharine; Zhou, Mingyuan; Kalantari, Rahi; Yamana, Teresa K; Pei, Sen; Shaman, Jeffrey; Li, Michael L; Bertsimas, Dimitris; Skali Lami, Omar; Soni, Saksham; Tazi Bouardi, Hamza; Ayer, Turgay; Adee, Madeline; Chhatwal, Jagpreet; Dalgic, Ozden O; Ladd, Mary A; Linas, Benjamin P; Mueller, Peter; Xiao, Jade; Wang, Yuanjia; Wang, Qinxia; Xie, Shanghong; Zeng, Donglin; Green, Alden; Bien, Jacob; Brooks, Logan; Hu, Addison J; Jahja, Maria; McDonald, Daniel; Narasimhan, Balasubramanian; Politsch, Collin; Rajanala, Samyak; Rumack, Aaron; Simon, Noah; Tibshirani, Ryan J; Tibshirani, Rob; Ventura, Valerie; Wasserman, Larry; O'Dea, Eamon B; Drake, John M; Pagano, Robert; Tran, Quoc T; Ho, Lam Si Tung; Huynh, Huong; Walker, Jo W; Slayton, Rachel B; Johansson, Michael A; Biggerstaff, Matthew; Reich, Nicholas GShort-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks.Item Open Access Global air quality and health co-benefits of mitigating near-term climate change through methane and black carbon emission controls.(Environ Health Perspect, 2012-06) Anenberg, Susan C; Schwartz, Joel; Shindell, Drew; Amann, Markus; Faluvegi, Greg; Klimont, Zbigniew; Janssens-Maenhout, Greet; Pozzoli, Luca; Van Dingenen, Rita; Vignati, Elisabetta; Emberson, Lisa; Muller, Nicholas Z; West, J Jason; Williams, Martin; Demkine, Volodymyr; Hicks, W Kevin; Kuylenstierna, Johan; Raes, Frank; Ramanathan, VeerabhadranBACKGROUND: Tropospheric ozone and black carbon (BC), a component of fine particulate matter (PM ≤ 2.5 µm in aerodynamic diameter; PM(2.5)), are associated with premature mortality and they disrupt global and regional climate. OBJECTIVES: We examined the air quality and health benefits of 14 specific emission control measures targeting BC and methane, an ozone precursor, that were selected because of their potential to reduce the rate of climate change over the next 20-40 years. METHODS: We simulated the impacts of mitigation measures on outdoor concentrations of PM(2.5) and ozone using two composition-climate models, and calculated associated changes in premature PM(2.5)- and ozone-related deaths using epidemiologically derived concentration-response functions. RESULTS: We estimated that, for PM(2.5) and ozone, respectively, fully implementing these measures could reduce global population-weighted average surface concentrations by 23-34% and 7-17% and avoid 0.6-4.4 and 0.04-0.52 million annual premature deaths globally in 2030. More than 80% of the health benefits are estimated to occur in Asia. We estimated that BC mitigation measures would achieve approximately 98% of the deaths that would be avoided if all BC and methane mitigation measures were implemented, due to reduced BC and associated reductions of nonmethane ozone precursor and organic carbon emissions as well as stronger mortality relationships for PM(2.5) relative to ozone. Although subject to large uncertainty, these estimates and conclusions are not strongly dependent on assumptions for the concentration-response function. CONCLUSIONS: In addition to climate benefits, our findings indicate that the methane and BC emission control measures would have substantial co-benefits for air quality and public health worldwide, potentially reversing trends of increasing air pollution concentrations and mortality in Africa and South, West, and Central Asia. These projected benefits are independent of carbon dioxide mitigation measures. Benefits of BC measures are underestimated because we did not account for benefits from reduced indoor exposures and because outdoor exposure estimates were limited by model spatial resolution.Item Open Access Health Misinformation Exposure and Health Disparities: Observations and Opportunities.(Annual review of public health, 2023-04) Southwell, Brian G; Otero Machuca, Jessica; Cherry, Sabrina T; Burnside, Melissa; Barrett, Nadine JThe concepts of health misinformation and health disparities have been prominent in public health literature in recent years, in part because of the threat that each notion poses to public health. How exactly are misinformation proliferation and health disparities related, however? What roles might misinformation play in explaining the health disparities that we have documented in the United States and elsewhere? How might we mitigate the effects of misinformation exposure among people facing relatively poor health outcomes? In this review, we address such questions by first defining health disparities and misinformation as concepts and then considering how misinformation exposure might theoretically affect health decision-making and account for disparate health behavior and health outcomes. We alsoassess the potential for misinformation-focused interventions to address health disparities based on available literature and call for future research to address gaps in our current evidence base.Item Open Access How Misinformation Research Can Mask Relationship Gaps that Undermine Public Health Response.(American journal of health promotion : AJHP, 2022-03) Calac, Alec J; Southwell, Brian GItem Open Access Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study.(The Lancet. Public health, 2020-08) Blewer, Audrey L; Ho, Andrew Fu Wah; Shahidah, Nur; White, Alexander Elgin; Pek, Pin Pin; Ng, Yih Yng; Mao, Desmond Renhao; Tiah, Ling; Chia, Michael Yih-Chong; Leong, Benjamin Sieu-Hon; Cheah, Si Oon; Tham, Lai Peng; Kua, Jade Phek Hui; Arulanandam, Shalini; Østbye, Truls; Bosworth, Hayden B; Ong, Marcus Eng HockBackground
Bystander cardiopulmonary resuscitation (CPR) increases an individual's chance of survival from out-of-hospital cardiac arrest (OHCA), but the frequency of bystander CPR is low in many communities. We aimed to assess the cumulative effect of CPR-targeted public health interventions in Singapore, which were incrementally introduced between 2012 and 2016.Methods
We did a secondary analysis of a prospective cohort study of adult, non-traumatic OHCAs, through the Singapore registry. National interventions introduced during this time included emergency services interventions, as well as dispatch-assisted CPR (introduced on July 1, 2012), a training programme for CPR and automated external defibrillators (April 1, 2014), and a first responder mobile application (myResponder; April 17, 2015). Using multilevel mixed-effects logistic regression, we modelled the likelihood of receiving bystander CPR with the increasing number of interventions, accounting for year as a random effect.Findings
The Singapore registry contained 11 465 OHCA events between Jan 1, 2011, and Dec 31, 2016. Paediatric arrests, arrests witnessed by emergency medical services, and healthcare-facility arrests were excluded, and 6788 events were analysed. Bystander CPR was administered in 3248 (48%) of 6788 events. Compared with no intervention, likelihood of bystander CPR was not significantly altered by the addition of emergency medical services interventions (odds ratio [OR] 1·33 [95% CI 0·98-1·79]; p=0·065), but increased with implementation of dispatch-assisted CPR (3·72 [2·84-4·88]; p<0·0001), with addition of the CPR and automated external defibrillator training programme (6·16 [4·66-8·14]; p<0·0001), and with addition of the myResponder application (7·66 [5·85-10·03]; p<0·0001). Survival to hospital discharge increased after the addition of all interventions, compared with no intervention (OR 3·10 [95% CI 1·53-6·26]; p<0·0001).Interpretation
National bystander-focused public health interventions were associated with an increased likelihood of bystander CPR, and an increased survival to hospital discharge. Understanding the combined impact of public health interventions might improve strategies to increase the likelihood of bystander CPR, and inform targeted initiatives to improve survival from OHCA.Funding
National Medical Research Council, Clinician Scientist Award, Singapore and Ministry of Health, Health Services Research Grant, Singapore.Item Open Access Implementation of the HEART Pathway: Using the Consolidated Framework for Implementation Research.(Critical pathways in cardiology, 2018-12) Gesell, Sabina B; Golden, Shannon L; Limkakeng, Alexander T; Carr, Christine M; Matuskowitz, Andrew; Smith, Lane M; Mahler, Simon AOBJECTIVE:The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Consolidated Framework for Implementation Research, we sought to identify important barriers and facilitators to implementation of the HEART Pathway. STUDY SETTING:Data were collected at 4 academic medical centers. STUDY DESIGN:We conducted semi-structured interviews with 25 key stakeholders (e.g., health system leaders, ED physicians). We conducted interviews before implementation of the HEART Pathway tool to identify potential barriers and facilitators to successful adoption at other regional academic medical centers. We also conducted postimplementation interviews at 1 medical center, to understand factors that contributed to successful adoption. DATA COLLECTION:Interviews were recorded and transcribed verbatim. We used a Consolidated Framework for Implementation Research framework-driven deductive approach for coding and analysis. PRINCIPAL FINDINGS:Potential barriers to implementation include time and resource burden, challenges specific to the electronic health record, sustained communication with and engagement of stakeholders, and patient concerns. Facilitators to implementation include strength of evidence for reduced length of stay and unnecessary testing and iatrogenic complications, ease of use, and supportive provider climate for evidence-based decision tools. CONCLUSIONS:Successful dissemination of the HEART Pathway will require addressing institution-specific barriers, which includes engaging clinical and financial stakeholders. New SMART-FHIR technologies, compatible with many electronic health record systems, can overcome barriers to health systems with limited information technology resources.Item Open Access Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.(Nature, 2019-10-16) Burstein, Roy; Henry, Nathaniel J; Collison, Michael L; Marczak, Laurie B; Sligar, Amber; Watson, Stefanie; Marquez, Neal; Abbasalizad-Farhangi, Mahdieh; Abbasi, Masoumeh; Abd-Allah, Foad; Abdoli, Amir; Abdollahi, Mohammad; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abrigo, Michael RM; Acharya, Dilaram; Adebayo, Oladimeji M; Adekanmbi, Victor; Adham, Davoud; Afshari, Mahdi; Aghaali, Mohammad; Ahmadi, Keivan; Ahmadi, Mehdi; Ahmadpour, Ehsan; Ahmed, Rushdia; Akal, Chalachew Genet; Akinyemi, Joshua O; Alahdab, Fares; Alam, Noore; Alamene, Genet Melak; Alene, Kefyalew Addis; Alijanzadeh, Mehran; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almalki, Mohammed J; Al-Mekhlafi, Hesham M; Altirkawi, Khalid; Alvis-Guzman, Nelson; Amegah, Adeladza Kofi; Amini, Saeed; Amit, Arianna Maever Loreche; Anbari, Zohreh; Androudi, Sofia; Anjomshoa, Mina; Ansari, Fereshteh; Antonio, Carl Abelardo T; Arabloo, Jalal; Arefi, Zohreh; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Artaman, Al; Asadi, Anvar; Asadi-Aliabadi, Mehran; Ashraf-Ganjouei, Amir; Assadi, Reza; Ataeinia, Bahar; Atre, Sachin R; Quintanilla, Beatriz Paulina Ayala; Ayanore, Martin Amogre; Azari, Samad; Babaee, Ebrahim; Babazadeh, Arefeh; Badawi, Alaa; Bagheri, Soghra; Bagherzadeh, Mojtaba; Baheiraei, Nafiseh; Balouchi, Abbas; Barac, Aleksandra; Bassat, Quique; Baune, Bernhard T; Bayati, Mohsen; Bedi, Neeraj; Beghi, Ettore; Behzadifar, Masoud; Behzadifar, Meysam; Belay, Yared Belete; Bell, Brent; Bell, Michelle L; Berbada, Dessalegn Ajema; Bernstein, Robert S; Bhattacharjee, Natalia V; Bhattarai, Suraj; Bhutta, Zulfiqar A; Bijani, Ali; Bohlouli, Somayeh; Breitborde, Nicholas JK; Britton, Gabrielle; Browne, Annie J; Nagaraja, Sharath Burugina; Busse, Reinhard; Butt, Zahid A; Car, Josip; Cárdenas, Rosario; Castañeda-Orjuela, Carlos A; Cerin, Ester; Chanie, Wagaye Fentahun; Chatterjee, Pranab; Chu, Dinh-Toi; Cooper, Cyrus; Costa, Vera M; Dalal, Koustuv; Dandona, Lalit; Dandona, Rakhi; Daoud, Farah; Daryani, Ahmad; Das Gupta, Rajat; Davis, Ian; Davis Weaver, Nicole; Davitoiu, Dragos Virgil; De Neve, Jan-Walter; Demeke, Feleke Mekonnen; Demoz, Gebre Teklemariam; Deribe, Kebede; Desai, Rupak; Deshpande, Aniruddha; Desyibelew, Hanna Demelash; Dey, Sagnik; Dharmaratne, Samath Dhamminda; Dhimal, Meghnath; Diaz, Daniel; Doshmangir, Leila; Duraes, Andre R; Dwyer-Lindgren, Laura; Earl, Lucas; Ebrahimi, Roya; Ebrahimpour, Soheil; Effiong, Andem; Eftekhari, Aziz; Ehsani-Chimeh, Elham; El Sayed, Iman; El Sayed Zaki, Maysaa; El Tantawi, Maha; El-Khatib, Ziad; Emamian, Mohammad Hassan; Enany, Shymaa; Eskandarieh, Sharareh; Eyawo, Oghenowede; Ezalarab, Maha; Faramarzi, Mahbobeh; Fareed, Mohammad; Faridnia, Roghiyeh; Faro, Andre; Fazaeli, Ali Akbar; Fazlzadeh, Mehdi; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, João C; Filip, Irina; Fischer, Florian; Foigt, Nataliya A; Foroutan, Masoud; Francis, Joel Msafiri; Fukumoto, Takeshi; Fullman, Nancy; Gallus, Silvano; Gebre, Destallem Gebremedhin; Gebrehiwot, Tsegaye Tewelde; Gebremeskel, Gebreamlak Gebremedhn; Gessner, Bradford D; Geta, Birhanu; Gething, Peter W; Ghadimi, Reza; Ghadiri, Keyghobad; Ghajarzadeh, Mahsa; Ghashghaee, Ahmad; Gill, Paramjit Singh; Gill, Tiffany K; Golding, Nick; Gomes, Nelson GM; Gona, Philimon N; Gopalani, Sameer Vali; Gorini, Giuseppe; Goulart, Bárbara Niegia Garcia; Graetz, Nicholas; Greaves, Felix; Green, Manfred S; Guo, Yuming; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hall, Brian James; Hamidi, Samer; Haririan, Hamidreza; Haro, Josep Maria; Hasankhani, Milad; Hasanpoor, Edris; Hasanzadeh, Amir; Hassankhani, Hadi; Hassen, Hamid Yimam; Hegazy, Mohamed I; Hendrie, Delia; Heydarpour, Fatemeh; Hird, Thomas R; Hoang, Chi Linh; Hollerich, Gillian; Rad, Enayatollah Homaie; Hoseini-Ghahfarokhi, Mojtaba; Hossain, Naznin; Hosseini, Mostafa; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Househ, Mowafa; Hsairi, Mohamed; Ilesanmi, Olayinka Stephen; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Nazrul; Islam, Sheikh Mohammed Shariful; Jürisson, Mikk; Balalami, Nader Jafari; Jalali, Amir; Javidnia, Javad; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Ji, John S; Jobanputra, Yash B; Johnson, Kimberly; Jonas, Jost B; Shushtari, Zahra Jorjoran; Jozwiak, Jacek Jerzy; Kabir, Ali; Kahsay, Amaha; Kalani, Hamed; Kalhor, Rohollah; Karami, Manoochehr; Karki, Surendra; Kasaeian, Amir; Kassebaum, Nicholas J; Keiyoro, Peter Njenga; Kemp, Grant Rodgers; Khabiri, Roghayeh; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khan, Ejaz Ahmad; Khan, Junaid; Khan, Muhammad Shahzeb; Khang, Young-Ho; Khatab, Khaled; Khater, Amir; Khater, Mona M; Khatony, Alireza; Khazaei, Mohammad; Khazaei, Salman; Khazaei-Pool, Maryam; Khubchandani, Jagdish; Kianipour, Neda; Kim, Yun Jin; Kimokoti, Ruth W; Kinyoki, Damaris K; Kisa, Adnan; Kisa, Sezer; Kolola, Tufa; Kosen, Soewarta; Koul, Parvaiz A; Koyanagi, Ai; Kraemer, Moritz UG; Krishan, Kewal; Krohn, Kris J; Kugbey, Nuworza; Kumar, G Anil; Kumar, Manasi; Kumar, Pushpendra; Kuupiel, Desmond; Lacey, Ben; Lad, Sheetal D; Lami, Faris Hasan; Larsson, Anders O; Lee, Paul H; Leili, Mostafa; Levine, Aubrey J; Li, Shanshan; Lim, Lee-Ling; Listl, Stefan; Longbottom, Joshua; Lopez, Jaifred Christian F; Lorkowski, Stefan; Magdeldin, Sameh; Abd El Razek, Hassan Magdy; Abd El Razek, Muhammed Magdy; Majeed, Azeem; Maleki, Afshin; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A; Manafi, Navid; Manda, Ana-Laura; Mansourian, Morteza; Martins-Melo, Francisco Rogerlândio; Masaka, Anthony; Massenburg, Benjamin Ballard; Maulik, Pallab K; Mayala, Benjamin K; Mazidi, Mohsen; McKee, Martin; Mehrotra, Ravi; Mehta, Kala M; Meles, Gebrekiros Gebremichael; Mendoza, Walter; Menezes, Ritesh G; Meretoja, Atte; Meretoja, Tuomo J; Mestrovic, Tomislav; Miller, Ted R; Miller-Petrie, Molly K; Mills, Edward J; Milne, George J; Mini, GK; Mir, Seyed Mostafa; Mirjalali, Hamed; Mirrakhimov, Erkin M; Mohamadi, Efat; Mohammad, Dara K; Mohammad, Dara K; Darwesh, Aso Mohammad; Mezerji, Naser Mohammad Gholi; Mohammed, Ammas Siraj; Mohammed, Shafiu; Mokdad, Ali H; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Ghobad; Moradi, Masoud; Moradi, Yousef; Moradi-Lakeh, Maziar; Moradinazar, Mehdi; Moraga, Paula; Morawska, Lidia; Mosapour, Abbas; Mousavi, Seyyed Meysam; Mueller, Ulrich Otto; Muluneh, Atalay Goshu; Mustafa, Ghulam; Nabavizadeh, Behnam; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Nahvijou, Azin; Najafi, Farid; Nangia, Vinay; Ndwandwe, Duduzile Edith; Neamati, Nahid; Negoi, Ionut; Negoi, Ruxandra Irina; Ngunjiri, Josephine W; Thi Nguyen, Huong Lan; Nguyen, Long Hoang; Nguyen, Son Hoang; Nielsen, Katie R; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Nixon, Molly R; Nnaji, Chukwudi A; Nojomi, Marzieh; Noroozi, Mehdi; Nosratnejad, Shirin; Noubiap, Jean Jacques; Motlagh, Soraya Nouraei; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oladimeji, Kelechi E; Olagunju, Andrew T; Olfatifar, Meysam; Olum, Solomon; Olusanya, Bolajoko Olubukunola; Oluwasanu, Mojisola Morenike; Onwujekwe, Obinna E; Oren, Eyal; Ortega-Altamirano, Doris DV; Ortiz, Alberto; Osarenotor, Osayomwanbo; Osei, Frank B; Osgood-Zimmerman, Aaron E; Otstavnov, Stanislav S; Owolabi, Mayowa Ojo; P A, Mahesh; Pagheh, Abdol Sattar; Pakhale, Smita; Panda-Jonas, Songhomitra; Pandey, Animika; Park, Eun-Kee; Parsian, Hadi; Pashaei, Tahereh; Patel, Sangram Kishor; Pepito, Veincent Christian Filipino; Pereira, Alexandre; Perkins, Samantha; Pickering, Brandon V; Pilgrim, Thomas; Pirestani, Majid; Piroozi, Bakhtiar; Pirsaheb, Meghdad; Plana-Ripoll, Oleguer; Pourjafar, Hadi; Puri, Parul; Qorbani, Mostafa; Quintana, Hedley; Rabiee, Mohammad; Rabiee, Navid; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi, Zohreh; Rahimi-Movaghar, Vafa; Rahimzadeh, Shadi; Rajati, Fatemeh; Raju, Sree Bhushan; Ramezankhani, Azra; Ranabhat, Chhabi Lal; Rasella, Davide; Rashedi, Vahid; Rawal, Lal; Reiner, Robert C; Renzaho, Andre MN; Rezaei, Satar; Rezapour, Aziz; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Roever, Leonardo; Roro, Elias Merdassa; Roser, Max; Roshandel, Gholamreza; Roshani, Daem; Rostami, Ali; Rubagotti, Enrico; Rubino, Salvatore; Sabour, Siamak; Sadat, Nafis; Sadeghi, Ehsan; Saeedi, Reza; Safari, Yahya; Safari-Faramani, Roya; Safdarian, Mahdi; Sahebkar, Amirhossein; Salahshoor, Mohammad Reza; Salam, Nasir; Salamati, Payman; Salehi, Farkhonde; Zahabi, Saleh Salehi; Salimi, Yahya; Salimzadeh, Hamideh; Salomon, Joshua A; Sambala, Evanson Zondani; Samy, Abdallah M; Santric Milicevic, Milena M; Jose, Bruno Piassi Sao; Saraswathy, Sivan Yegnanarayana Iyer; Sarmiento-Suárez, Rodrigo; Sartorius, Benn; Sathian, Brijesh; Saxena, Sonia; Sbarra, Alyssa N; Schaeffer, Lauren E; Schwebel, David C; Sepanlou, Sadaf G; Seyedmousavi, Seyedmojtaba; Shaahmadi, Faramarz; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamshirian, Amir; Shamsizadeh, Morteza; Sharafi, Kiomars; Sharif, Mehdi; Sharif-Alhoseini, Mahdi; Sharifi, Hamid; Sharma, Jayendra; Sharma, Rajesh; Sheikh, Aziz; Shields, Chloe; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Shuval, Kerem; Siddiqi, Tariq J; Silva, João Pedro; Singh, Jasvinder A; Sinha, Dhirendra Narain; Sisay, Malede Mequanent; Sisay, Solomon; Sliwa, Karen; Smith, David L; Somayaji, Ranjani; Soofi, Moslem; Soriano, Joan B; Sreeramareddy, Chandrashekhar T; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Sykes, Bryan L; Sylaja, PN; Tabarés-Seisdedos, Rafael; Tabb, Karen M; Tabuchi, Takahiro; Taveira, Nuno; Temsah, Mohamad-Hani; Terkawi, Abdullah Sulieman; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; Thirunavukkarasu, Sathish; To, Quyen G; Tovani-Palone, Marcos Roberto; Tran, Bach Xuan; Tran, Khanh Bao; Ullah, Irfan; Usman, Muhammad Shariq; Uthman, Olalekan A; 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Hay, Simon ISince 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.Item Open Access Mortality among heroin users and users of other internationally regulated drugs: A 27-year follow-up of users in the Epidemiologic Catchment Area Program household samples.(Drug and alcohol dependence, 2015-11) Lopez-Quintero, Catalina; Roth, Kimberly B; Eaton, William W; Wu, Li-Tzy; Cottler, Linda B; Bruce, Martha; Anthony, James CIn contrast to research on more restricted samples of drug users, epidemiological studies open up a view of death rates and survivorship of those who have tried heroin a few times, with no acceleration toward sustained use patterns often seen in treatment and criminal justice samples. At their best, epidemiological estimates of heroin effects on risk of dying are not subject to serious selection biases faced with more restricted samples.Data are from 7207 adult participants aged 18-48 years in United States Epidemiologic Catchment Area Program field surveys, launched in 1980-1984. US National Death Index (NDI) records through 2007 disclosed 723 deaths. NDI enabled estimation of heroin-associated risk of dying as well as survivorship.Estimated cumulative mortality for all 18-48 year old participants is 3.9 deaths per 1000 person-years (95% confidence interval, CI=3.7, 4.2), relative to 12.4 deaths per 1000 person-years for heroin users (95% CI=8.7, 17.9). Heroin use, even when non-sustained, predicted a 3-4 fold excess of risk of dying prematurely. Post-estimation record review showed trauma and infections as top-ranked causes of these deaths.Drawing strengths from epidemiological sampling, standardized baseline heroin history assessments, and very long-term NDI follow-up, this study of community-dwelling heroin users may help clinicians and public health officials who need facts about heroin when they seek to prevent and control heroin outbreaks. Heroin use, even when sporadic or non-sustained, is predictive of premature death in the US, with expected causes of death such as trauma and infections.Item Open Access Multiple models for outbreak decision support in the face of uncertainty.(Proceedings of the National Academy of Sciences of the United States of America, 2023-05) Shea, Katriona; Borchering, Rebecca K; Probert, William JM; Howerton, Emily; Bogich, Tiffany L; Li, Shou-Li; van Panhuis, Willem G; Viboud, Cecile; Aguás, Ricardo; Belov, Artur A; Bhargava, Sanjana H; Cavany, Sean M; Chang, Joshua C; Chen, Cynthia; Chen, Jinghui; Chen, Shi; Chen, YangQuan; Childs, Lauren M; Chow, Carson C; Crooker, Isabel; Del Valle, Sara Y; España, Guido; Fairchild, Geoffrey; Gerkin, Richard C; Germann, Timothy C; Gu, Quanquan; Guan, Xiangyang; Guo, Lihong; Hart, Gregory R; Hladish, Thomas J; Hupert, Nathaniel; Janies, Daniel; Kerr, Cliff C; Klein, Daniel J; Klein, Eili Y; Lin, Gary; Manore, Carrie; Meyers, Lauren Ancel; Mittler, John E; Mu, Kunpeng; Núñez, Rafael C; Oidtman, Rachel J; Pasco, Remy; Pastore Y Piontti, Ana; Paul, Rajib; Pearson, Carl AB; Perdomo, Dianela R; Perkins, T Alex; Pierce, Kelly; Pillai, Alexander N; Rael, Rosalyn Cherie; Rosenfeld, Katherine; Ross, Chrysm Watson; Spencer, Julie A; Stoltzfus, Arlin B; Toh, Kok Ben; Vattikuti, Shashaank; Vespignani, Alessandro; Wang, Lingxiao; White, Lisa J; Xu, Pan; Yang, Yupeng; Yogurtcu, Osman N; Zhang, Weitong; Zhao, Yanting; Zou, Difan; Ferrari, Matthew J; Pannell, David; Tildesley, Michael J; Seifarth, Jack; Johnson, Elyse; Biggerstaff, Matthew; Johansson, Michael A; Slayton, Rachel B; Levander, John D; Stazer, Jeff; Kerr, Jessica; Runge, Michael CPolicymakers must make management decisions despite incomplete knowledge and conflicting model projections. Little guidance exists for the rapid, representative, and unbiased collection of policy-relevant scientific input from independent modeling teams. Integrating approaches from decision analysis, expert judgment, and model aggregation, we convened multiple modeling teams to evaluate COVID-19 reopening strategies for a mid-sized United States county early in the pandemic. Projections from seventeen distinct models were inconsistent in magnitude but highly consistent in ranking interventions. The 6-mo-ahead aggregate projections were well in line with observed outbreaks in mid-sized US counties. The aggregate results showed that up to half the population could be infected with full workplace reopening, while workplace restrictions reduced median cumulative infections by 82%. Rankings of interventions were consistent across public health objectives, but there was a strong trade-off between public health outcomes and duration of workplace closures, and no win-win intermediate reopening strategies were identified. Between-model variation was high; the aggregate results thus provide valuable risk quantification for decision making. This approach can be applied to the evaluation of management interventions in any setting where models are used to inform decision making. This case study demonstrated the utility of our approach and was one of several multimodel efforts that laid the groundwork for the COVID-19 Scenario Modeling Hub, which has provided multiple rounds of real-time scenario projections for situational awareness and decision making to the Centers for Disease Control and Prevention since December 2020.Item Open Access Recommendations for future university pandemic responses: What the first COVID-19 shutdown taught us.(PLoS biology, 2020-08-27) Coyne, Carolyn; Ballard, Jimmy D; Blader, Ira JThe SARS-CoV-2 epidemic challenged universities and other academic institutions to rapidly adapt to urgent and life-threatening situations. It forced most institutions to shut down nearly every aspect of their research and educational enterprises. In doing so, university leaders were thrust into unchartered waters and forced them to make unprecedented decisions. Successes and failures along the way highlighted how the autonomous nature of the American academic research enterprise and skillsets normally required of university leaders were ill-suited to mounting an emergency response. Here, as faculty from medical centers in the United States, we draw lessons from these experiences and apply them as we plan for the next possible COVID-19-induced shutdown as well as other large-scale pandemics and emergencies at universities in the United States and throughout the world.Item Open Access Relational Mobility Predicts Faster Spread of COVID-19: A 39-Country Study.(Psychological science, 2020-10) Salvador, Cristina E; Berg, Martha K; Yu, Qinggang; San Martin, Alvaro; Kitayama, ShinobuIt has become increasingly clear that COVID-19 is transmitted between individuals. It stands to reason that the spread of the virus depends on sociocultural ecologies that facilitate or inhibit social contact. In particular, the community-level tendency to engage with strangers and freely choose friends, called relational mobility, creates increased opportunities to interact with a larger and more variable range of other people. It may therefore be associated with a faster spread of infectious diseases, including COVID-19. Here, we tested this possibility by analyzing growth curves of confirmed cases of and deaths due to COVID-19 in the first 30 days of the outbreaks in 39 countries. We found that growth was significantly accelerated as a function of a country-wise measure of relational mobility. This relationship was robust either with or without a set of control variables, including demographic variables, reporting bias, testing availability, and cultural dimensions of individualism, tightness, and government efficiency. Policy implications are also discussed.Item Open Access Reply to Ngoh et al. Comment on "Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18, 1817".(International journal of environmental research and public health, 2022-04-13) Surendran, Shilpa; Foo, Chuan De; Tam, Chen Hee; Ho, Elaine Qiao Ying; Matchar, David Bruce; Car, Josip; Koh, Gerald Choon HuatWe carefully read the comment [...].