Disaster Medicine and Public Health Preparedness

BackgroundThe accelerating pace of urbanization worldwide has highlighted the improvement of disaster response in cities as a global priority. Yet, there remains a poor understanding of the emergency response to mass casualty incidents (MCI) in these environments. This study aimed to develop a conceptual framework for cities responses and potential policy levers. MethodsWe conducted a scoping review followed by in-depth interviews (IDIs), focus group discussions (FGDs), and a modified Delphi process to develop the framework for Cities Assessment of Mass Casualty Emergency Response and Action (CAMERA). ResultsCAMERA framework consists of six essential components of urban emergency response systems: 1) communication, 2) safety and security, 3) human resources, 4) policy and plans, 5) command control and coordination, and 6) care delivery. IDIs and FGDs also provided insight on assessment methodologies for evaluating response capacity. Using these components, we then developed a framework consisting of a diagnostic and management approach that city leadership can undertake in MCI management to ensure effective functioning at various levels of incident response. ConclusionThe CAMERA framework offers novel and simplified guidance to policymakers and other stakeholders in their attempt to improve MCI response systems across cities globally.

BackgroundEmerging in January 2020, the SARS-CoV-2 pandemic quickly exposed the limitations of traditional contact tracing and overwhelmed the contact tracing efforts of US health departments. In response, Kaiser Permanente partnered with the Public Health Institute to launch the California Contact Tracing Support Initiative. This innovative, clinically integrated program aimed to link Kaiser Permanente members diagnosed at their facilities directly with contact tracing and supportive clinical care via their network. This approach promised to address key logistical and behavioral challenges hampering traditional public health agencies. This paper evaluates the programs implementation in two California counties. MethodsWe conducted a retrospective, mixed-methods process evaluation of program activities from August 2020 to June 2021, including contact tracing implementation in Fresno and San Bernardino Counties. Our methods included scoping discussions with program stakeholders, development of an epidemiological timeline and program impact model, and document review. We also conducted semi-structured interviews with program stakeholders and staff. Interviews were conducted and audio-recorded via Zoom, transcribed, and analyzed in NVivo using inductive and deductive coding with a Framework Approach. ResultsWe reviewed 474 program documents and interviewed 47 participants. Study findings highlighted difficulties in adapting program scope due to competing partner visions of program mission and collaboration. Unforeseen data demands and complex external data sharing with public health systems further complicated and delayed program implementation. ConclusionEvaluation of this contact tracing program offers key insights into public health interventions during emergencies. While the California Contact Tracing Support Initiatives integrated design showed promise, challenges arose from data systems, inter-organizational dynamics, and planning. Findings emphasize the need for clear operational steps, real-time data monitoring, defined roles, and formalized public-private partnerships in preparedness planning. These are key lessons for future complex public health interventions, especially regarding adapting programs versus maintaining fidelity amidst evolving contexts.

BackgroundRisk communication is critical in shaping public response during infectious disease outbreaks. This study quantitatively examined whether Nigerian media coverage during the 2024 cholera outbreak reflected a proactive or reactive risk communication pattern. MethodsA Python-based systematic content analysis was conducted on 352 unique news articles published by major Nigerian media sources in 2024. K-Means was used to cluster and quantify thematic patterns, TextBlob for sentiment polarity, and time-series analysis to determine the features of media engagement. ResultsThe analysis identified a dominant reactive, crisis-driven communication pattern with media coverage surging by over 400% in June, matching the peak of reported cholera cases. Thematic analysis portrayed a severe reporting imbalance focused on Outbreak Reports and Mortality (41.5% of articles), while structural and preventive themes such as WASH and Health Education received marginal attention (less than 25% of coverage). Furthermore, communication was overwhelmingly neutral (76.4%) in sentiment, potentially limiting the perceived urgency required for public action. ConclusionsMedia reporting on the 2024 cholera outbreak in Nigeria was reactive and focused disproportionately on threat rather than solutions. These findings support the need for a strategic dual-focus communication model that shifts from crisis-driven coverage to sustained, year-round preventive messaging centered on WASH accountability and community resilience.

Introduction Louisiana ranks last in the United States of America in terms of maternal health outcomes. Previous works have highlighted the impact of some social determinants of health on the incidence of adverse birth outcomes. These works have subjectively selected specific social determinants of health from larger datasets. Here, we attempt to replicate their results with objective variable selection techniques. Methods By deriving principal components from the Agency of Healthcare Research and Quality's parish-level social determinants of health dataset, we were able to objectively find social determinants of health associations instead of the conventional subjective variable selection approach. Then, we applied Bayesian linear mixed-effects models to calculate more conservative parameter estimates about the effects of social determinants of health on adverse birth outcome incidence. Then, we used local Moran's I to identify clusters of spatially autocorrelated parishes. Finally, we combined the results of these two methods and inspected the relationship between important predictors and clusters of spatial autocorrelation. Results We identified several significant effects on the incidence of adverse birth outcomes, including populational composition and economic attainment, and several clusters of high and low incidences of adverse birth outcomes in Louisiana. There was also a concordant relationship between important predictors from our predictive models and the cluster assignments of Local Moran's I. Conclusion Our results validate previous works in the subject area and hold implications for precision development of maternal health interventions in Louisiana.

PurposeTo create a publicly available, interactive data platform to visualize various data measures reflecting Colorado and its residents to support research and outreach efforts, specifically focusing on cancer burden and disparities throughout the state. This platform, named ECCO (Exploring Cancer in Colorado), aims to integrate diverse public data sources into a unified, user-friendly interface, accessible to researchers, community members, and outreach programs alike. MethodsA multi-disciplinary team developed ECCO, leveraging public data sources like Cancer InFocus, State Cancer Profiles, and the Colorado Department of Public Health and Environment. The platforms architecture employs a three-tiered web application model, utilizing a PostgreSQL database, a backend API built with FastAPI, and a Vue 3 frontend with an Open Layers map. Data is organized geographically at the county and/or census tract levels, categorized into measure categories (e.g., socio-demographics, cancer risk factors), and further filterable by demographic characteristics. An automated Extract-Transform-Load (ETL) data pipeline ensures regular updates of the data. ResultsThe platform visualizes data such as socio-demographics, cancer risk factors, screening adherence, and cancer incidence and mortality rates. Additionally, ECCO incorporates location-specific data for cancer care facilities, health services, environmental exposures, and political boundaries. To date, ECCO has had 1.1K unique visitors and over 19K pageviews according to Google Analytics. ConclusionThe ECCO platform provides a valuable tool for understanding and addressing cancer disparities in Colorado. By integrating diverse data sources and offering interactive visualization, ECCO enhances the ability of researchers, community members, and outreach programs to identify populations at risk, inform interventions, and support research priorities. AvailabilityThe application and code are available at https://coe-ecco.org/ and https://github.com/colorado-cancer-center/ecco. CONTENT SUMMARYO_ST_ABSKey ObjectiveC_ST_ABSThis work sought to develop ECCO (Exploring Cancer in Colorado), an interactive, easily-accessible data platform designed to visualize and understand diverse cancer-related data measures reflective of Colorado and its residents. Knowledge generatedECCO integrates public data from sources like Cancer InFocus, State Cancer Profiles, and the Colorado Department of Public Health and Environment, visualizing measures such as socio-demographics, cancer risk factors, screening adherence, and cancer incidence and mortality rates at both county and census tract levels. The platform also incorporates location-specific data on cancer care facilities, health services, environmental exposures, and political boundaries.

Emergency nursing is essential to healthcare systems worldwide. Triage plays a pivotal role in emergency nursing, prioritizing patients based on the urgency of their medical condition and focusing on rapid assessment and prioritization of patient care according to their condition and its severity. In the emergency department, the triage nurse assesses vital signs and gathers information from the patient to determine the severity of their condition. This aims to provide appropriate medical intervention quickly for life-threatening cases and minimize waiting times for less critical cases, thus contributing to the efficient allocation of scarce resources. Our study aimed to evaluate the triage knowledge, skills, and practices of emergency nurses in Mafraq, Jordan. MethodsA cross-sectional study used a previously validated questionnaire. Fifty emergency nurses from two public and one private hospital in Mafraq participated. We collected data through an online survey then analyzed in SPSS. Results92% of nurses had sufficient triage knowledge ([&ge;]60%), while 14% exhibited deficient triage skills (<60%) and 86% had moderate skills (60-80%). Regarding practices, 32% rated as "poor" (<60%) and 68% as "adequate" (>60%). Length working in emergency, hospital type significantly related to nurses triage knowledge, skills, and practices. ConclusionThe study underscores continual trainings, simulation programs and mentorships importance for enhancing emergency nurses triage knowledge, skills, especially in rural settings. Implementing clear triage protocols, continuous support and integrating triage competencies into curricula are recommended to improve overall triage competency

PurposeMost spatio-temporal models identify COVID-19 sociodemographic and socioeconomic risk factors using methods that assume a single spatial dependency pattern across the city, which may not reflect reality. The purpose of this study is to apply a spatially and temporally localized Bayesian model to identify COVID-19 risk factors that account for localized context. MethodsFor this study, a spatio-temporal localized Bayesian Hierarchical Model (ST-LCAR) was used to assess the relationships between population factors (age, sex, income, visible minority status, and education) and COVID-19 relative risk. The ST-LCAR model accounts for spatial and temporal autocorrelation through spatio-temporal random effects along with piecewise intercepts to capture step changes in relative risk patterns that might be reflective of underlying local contexts. This study focuses on the first four complete waves of the COVID-19 pandemic across Forward Sortation Areas (FSAs) in the City of Toronto. ResultsA 10-percentage-point increase in the proportion of residents who identify as visible minorities was associated with a 3% increase in COVID-19 relative risk; however, this association varied across different social contexts. On the other hand, a 10-percentage-point increase in the proportion of residents with post-secondary education was associated with a 22% decrease in relative risk. Beyond quantitative relationships, our model identified 3 times higher COVID-19 relative risk in the northwestern portion of the city, with patterns varying over time. ConclusionThe different COVID-19 patterns in the city of Toronto may have been shaped by the complex and diverse social contexts, products of ingrained systems of structural inequities that influence the living, working, and economic conditions of city residents. Public health interventions and pandemic preparedness should integrate an equity-focused lens that considers the diverse social contexts across the city and how it shapes health outcomes.

PurposeTo characterize maternal transport patterns in Iowa, a state with levels of maternal care and without formal perinatal regions, and assess whether transport decisions reflect efficient, risk-appropriate coordination. MethodsWe analyzed 2010-2023 Iowa birth records, which included 2,251 maternal transports between obstetric facilities across 106 unique routes. We characterized transport patterns and applied a community detection algorithm to identify "communities" of obstetric facilities that disproportionately transport among themselves. FindingsSuburban and rural counties have elevated transport rates compared to urban counties. 2,189 transports (97%) were from lower-to higher-level facilities. Among these, 2,037 (93%) were to Level III tertiary care centers. 567 transports (25.2%) bypassed a closer facility offering an equivalent or higher level of care than its destination facility. Health system affiliation was associated with bypassing transport, indicating potential organizational rather than purely geographic drivers of transport decisions. Three "communities" of obstetric facilities largely shaped by geographic proximity were identified. ConclusionsAlthough Iowa does not have formal perinatal regions, patterns of maternal transport are mostly in line with three de facto regions. Some potential inefficiencies were identified, such as obstetric facilities transporting to a farther facility when a closer facility offered the same level of care or higher. These findings may help identify opportunities to enhance care coordination among obstetric facilities, optimize maternal transport networks, and improve regionalization of maternal care.

BackgroundMississippi consistently ranks among the lowest U.S. states in health-related quality of life (HRQoL) outcomes, with disparities most severe in rural and socioeconomically disadvantaged counties, particularly the Mississippi Delta. Understanding longitudinal spatial and temporal patterns is essential for equity-focused public health strategies and chronic disease prevention. ObjectiveThis study examined geographic disparities in HRQoL across Mississippis 82 counties from 2015 to 2025 to identify persistent hotspots, assess convergence with national averages, and inform targeted interventions. MethodsCounty-level data from the County Health Rankings & Roadmaps (2015-2025 releases) were used to construct an annual principal component analysis-derived composite HRQoL score from Behavioral Risk Factor Surveillance System measures (percentage reporting poor or fair health, physically unhealthy days, and mentally unhealthy days). Spatial patterns were assessed using choropleth maps, Morans I, and Local Indicators of Spatial Association (LISA). A spatial autoregressive lag model with year fixed effects identified key drivers. ResultsMississippi showed persistent disadvantage in poor or fair health (stable gap of 0.06-0.07 percentage points above national averages) but recent convergence in physically unhealthy days and reversal in mentally unhealthy days (fewer days in disadvantaged subgroups, e.g., high child poverty and low education). LISA maps revealed enduring High-High hotspots of poor HRQoL in the Delta region, while Low-Low cold spots along the Gulf Coast contracted substantially by 2025 (many formerly advantaged counties now non-significant). The spatial lag model confirmed significant dependence ({rho} = 0.13, P < .001), with adult smoking and uninsurance as leading modifiable predictors. ConclusionsMississippis HRQoL trajectory shows symptom-based improvements alongside enduring structural disparities in self-rated health and persistent geographic inequities. Expanding smoke-free policies (particularly in the Delta), strengthening primary care access, and increasing insurance coverage represent high-impact strategies to reduce disparities, advance health equity, and support chronic disease prevention in high-burden regions of the U.S. South.

IntroductionClimate change is a global adverse phenomenon affecting the health and wellbeing of all humans, and timely awareness can help mitigate these health effects. ObjectiveTo understand the knowledge and attitudes of Sri Lankan adults towards climate change and its effects on human health. MethodsA web based cross-sectional survey was conducted using a structured, pretested, web based, self-administered questionnaire, using a respondent driven sampling technique, among Sri Lankan adults. Data was collected over three months, from 1st September 2022. Responses were automatically stored in a cloud-based database and were imported into a spreadsheet and analysed using MS Excel. ResultsMajority of the 118 respondents were young, educated, employed adults from western province, and 56.78% were females. Overall knowledge on climate change was good among 82.20%, while over 90% had a good or favourable knowledge on health effects associated with climate change. Respondents demonstrated a good awareness of climate effects on skin cancer (92.37%), mental illnesses (82.2%) and asthma (82.2%), but were less aware of the effects on diabetes (28.8%), COPD (38.1%) and heart diseases (46.6%), and vector borne diseases such as Malaria (57.6%) and Dengue (61.8%). Over 90% had a good attitude towards the need for climate change mitigation and climate friendly activities being implemented. ConclusionsUrban, educated Sri Lankan adults had a good understanding and awareness on the health effects of climate change, and the importance of mitigating it in relation to its health effects, but further studies are needed to understand the awareness levels of the less educated rural communities.

Scorpionism is a public health concern in warm regions, particularly affecting children under 10 years old. Timely treatment with antivenom, provided free by the Brazilian Unified Health System, at strategic care points (PEs) is crucial to prevent avoidable deaths. Our study focused on the Sao Paulo state (SP), which has the largest population in Brazil. The objectives were to adapt a network analysis method suited to SPs context; to assess the efficiency of the SP PE network coverage, considering the 90-minute response time; and to determine the ideal number of vials to be stored at each PE. After adapting the healthcare network analysis, we applied spatial coverage models to evaluate the adequacy of PE response times. We also estimated the demand for antivenom vials at each PE based on Notifiable Diseases Information System data from 2021 to 2023, which is currently limited to the state level. We identified 12 areas lacking coverage, of which only one was suitable for a new PE. The estimated serum requirements aligned with SP's current distributions. However, the estimation carried out according to the PEs has the advantage of reducing the risk of antivenom shortages, especially in emergencies, thus ensuring timely care to prevent avoidable deaths. Our adapted method and PE serum estimates can enhance the scorpion sting care system by supporting geographic planning and optimizing resource allocation. Moreover, these findings and methodologies have potential applicability to other Brazilian regions and warm countries facing similar challenges, contributing to improved access and outcomes for scorpionism victims.

BackgroundDisparities in injury and death indicate that Latinos and Hispanics are disproportionately affected by firearm violence. Understanding the factors that impact Latino and Hispanic engagement with firearm safety is integral to developing nuanced interventions, yet these factors remain largely understudied. This study explores the social ecological factors related to firearm safety engagement among Latino and Hispanic adults residing in New Mexico. MethodsThe study used a convergent mixed-methods design with quantitative and qualitative components. Data were collected from a predominantly Latino-Hispanic community experiencing high rates of firearm violence near Albuquerque, New Mexico. Quantitative data (n=303) were collected using a community-based survey with a non-random sample on firearm safety engagement, collective efficacy, and sociodemographic characteristics. Qualitative data (n=18) included semi-structured interviews from a subset of the survey population who expressed interest in participating. Quantitative data was used to explore descriptive statistics and correlations between reported levels of collective efficacy and firearm safety engagement. Qualitative data were used to explore the firearm safety experiences of Latino and Hispanic participants. AnalysesMultivariate regression analyses examined associations between collective efficacy (exposure) and engagement with firearm safety (outcome). I also explored associations across key domains: collective efficacy, neighborhood characteristics, individual characteristics, and sociodemographic factors. Interviews were analyzed using framework analysis to generate a cohesive thematic structure informed by a social ecological model. The results from the quantitative and qualitative data were then integrated to develop a robust understanding of social ecological factors related to firearm safety engagement using a mixed methods joint display. ResultsThere were 303 survey participants (40.6% male; 55.1% female; 4.3% other gender identity) and 18 interview participants in this study. 57.1% of survey participants reported engaging with at least one firearm safety practice or initiative. Results from multivariate regression indicated that higher collective efficacy ({beta} = 0.082, p = 0.002), higher informal social control ({beta} = 0.174, p = 0.001), stronger endorsement of gun safety principles ({beta} = 0.079, p < 0.001), being married vs. unmarried ({beta} = -0.334, p < 0.001), speaking Spanish in the home vs. English ({beta} = 1.048, p < 0.001), and not owning a gun ({beta} = - 0.638, p = 0.006) were significantly and positively associated with firearm safety engagement. Themes from the qualitative data included barriers (insecure environment; lack of meaningful engagement) and facilitators (location-specific contributors to safety; collective identity and pride) to firearm safety engagement, organized by social ecological domain. Mixed methods findings indicate factors associated with participants individual firearm safety engagement, while providing insights into the perceived barriers and facilitators across social ecological domains. DiscussionFindings from this mixed-methods study suggest that processes of empowerment and collective efficacy may contribute to greater firearm safety engagement within Latino and Hispanic communities. Findings expand injury prevention research by exploring the factors influencing firearm safety engagement among a marginalized and hard-to-reach population who have disproportionate experiences with firearm victimization, perpetration, and injury. ConclusionThis study offers unique methodological approaches by using concurrent mixed methods and collecting complementary data sources to understand firearm safety engagement among Latinos and Hispanics. Findings highlight the need for culturally specific and community-engaged interventions that address social ecological disparities to strengthen safety practices and reduce firearm-related harms.

Misinformation circulating through digital platforms and community networks increasingly challenges public health communication, particularly in low- and middle-income countries. Frontline health educators play a critical role in addressing misinformation and promoting accurate health information within primary health care systems; however, empirical evidence on their preparedness to manage infodemics remains limited. This study assessed the training needs and response capacity of primary health care health educators in Lagos State, Nigeria. A convergent mixed-methods design was employed across three districts. Quantitative data were collected from 95 health educators using the 30-item Health Educators Infodemic Management Training Needs Assessment Questionnaire (HEIM-TNAQ). Qualitative data were obtained through six focus group discussions involving 56 educators and 25 key informant interviews with supervisors and programme managers. Quantitative data were analysed using descriptive statistics and t-tests, while qualitative data were analysed thematically. Participants demonstrated relatively strong knowledge of health misinformation (mean = 71.5), but only moderate decision-response skills (48.6) and low confidence in addressing misinformation (42.5). Integration of misinformation response into routine practice was also limited (46.3), and no significant differences were observed between respondents with or without prior training. Qualitative findings revealed frequent exposure to vaccine rumours, spiritual explanations for illness, and misinformation circulating through social media and community networks. Strengthening infodemic management within primary health care requires practical training, behavioural communication skills, and institutional mechanisms for systematic rumour monitoring and response.

Background/Objectives: Women+ (e.g., women and individuals assigned female at birth) experience disproportionate health risks and persistent gaps in access to care, despite regionally coordinated health systems. Women+ health research remains significantly underfunded and understudied, contributing to inequities in diagnosis, treatment, and outcomes. This study aims to collaboratively identify and prioritize the most pressing unanswered research questions related to women+ health in the Maritime provinces of Canada. Methods: This study will use a modified Priority Setting Partnership (PSP) methodology based on the James Lind Alliance framework. A mixed-methods participatory approach will be used, including bilingual online surveys (French, English) and a one-day consensus workshop. Participants will include women+, healthcare professionals, researchers, policymakers, and the public residing in the Maritime provinces (Nova Scotia, New Brunswick, and Prince Edward Island). An initial survey will collect research uncertainties through open-ended questions. A second interim survey will rank verified uncertainties, followed by a facilitated workshop to achieve consensus on the Top 10 research priorities. Qualitative data will be analyzed using content analysis, and descriptive statistics will summarize participant demographics. Anticipated Results: This project is expected to generate a collaboratively developed, evidence-informed Top 10 list of research priorities for women+ health in the Maritimes. The process will also identify thematic gaps in existing research and assess feasibility considerations to inform future study design and implementation. Conclusions: By centering women+ voices and engaging diverse interest holders, this study will establish a shared regional research agenda to guide future research, funding, and policy initiatives for women+ health research.

IntroductionWe aim to examine whether state-level telehealth policies in 2020 were associated with a reduction in the urban-rural disparity in telehealth utilization. MethodA multilevel model was used to assess state actions impact on urban-rural differences in healthcare utilization. We used the percentage of Medicare Fee-for-Service beneficiaries receiving any telehealth services (measured by county level) in 2020 as the dependent variable. We examined the following state-level policies as key independent variables at the state level: 1) telehealth coverage parity requirement for payers; 2) recognizing a call from patients address as the originating site of telehealth visit; 3) mandating the coverage of audio-only telehealth visits. ResultsBoth mandating the coverage of audio-only visits and telehealth coverage parity requirement were significantly associated with higher level of telehealth utilization. For audio-only reimbursement mandate and telehealth coverage parity requirement, the interaction between the state policy and the countys rurality was associated with a significant increase in telehealth utilization rate, whereas the interaction between the states waiver for the requirement of originating site and the countys rurality was negatively associated with telehealth utilization rate. ConclusionThe audio-only telecare reimbursement mandate and telehealth payment parity could help close the urban-rural gap in telehealth utilization.

IntroductionThe Interim Canada Dental Benefit (CDB), a precursor to the Canadian Dental Care Plan (CDCP), provided financial support to low-income families of children < 12 years of age to address affordability challenges in accessing dental care. This study investigated Manitoba parents awareness of, views on, and experiences with the Interim CDB. MethodsAn interview-led survey was conducted between May through December 2023 with parents recruited through community dental clinics in Manitoba. The questionnaire captured participant demographics, awareness, views, and other experiences with the Interim CDB. Statistical analyses included descriptive statistics (frequencies, means, standard deviation), bivariate analysis (Chi-square), and logistic regression modelling. A p-value [&le;]0.05 was significant. ResultsOverall, 150 parents participated, with the majority being mothers (72.7%), married (69.8%), and living in urban areas (92.6%). Most parents (86.7%) had heard of the Interim CDB, but only 52.7% applied for their children, as only 48% were aware of the income criteria. Most parents (97.3%) agreed that the benefit improved access to care. Multivariate logistic regression models showed that uninsured parents were significantly more likely to have heard of the Interim CDB and to have applied for it. ConclusionParents believed that the Interim CDB improved access to dental care. However, informational barriers remained. These findings underscore the need for simplified and inclusive communication to strengthen the reach and effectiveness of future public dental programs.

The protracted Rohingya refugee crisis continues to deteriorate with approximately 1.2 million refugees currently sheltering in Coxs Bazar, Bangladesh. This study aimed to estimate the prevalence and identify factors associated with psychosocial distress among Rohingya refugees. Data were sourced from the 2023 Joint Multi-Sectoral Needs Assessment - a representative cross-sectional household survey conducted across the 33 Rohingya refugee camps of Coxs Bazar. Households were selected using stratified (by camp) random sampling. Psychosocial distress was assessed via proxy report by an adult household respondent and defined as the presence of at least one of eleven symptoms in the two weeks preceding the survey. Binary logistic regression was conducted to investigate household characteristics and individual factors associated with psychosocial distress status. The prevalence of psychosocial distress was 14.9% (95%CI: 14.1%-15.7%) among 16,455 Rohingya refugees sampled from 3,400 households. After adjustment, psychosocial distress was associated with individuals from aid-dependent households (aOR= 1.42 [95%CI: 1.21-1.67]), stress livelihood coping strategies (aOR= 3.03 [95%CI: 1.94-4.74]), crisis livelihood coping strategies (aOR= 4.40 [95%CI: 2.81-6.89]), emergency livelihood coping strategies (aOR= 4.15 [95%CI: 2.58-6.66]), individuals who required and received healthcare (aOR= 1.27 [95%CI: 1.12-1.43]), individuals who required and did not receive healthcare (aOR=1.49 [95%CI: 1.16-1.91]), individuals aged 18-34 years (aOR= 8.38 [95%CI: 6.99-10.04]), aged 35-59 years (aOR= 10.33 [95%CI: 8.44-12.65]), and aged 60+ years (aOR= 13.31 [95%CI: 10.25-17.30]). Psychosocial distress among Rohingya refugees was highly prevalent and associated with increasing age groups, aid dependency, negative livelihood coping strategies, and healthcare needs. The findings emphasise the need for comprehensive mental health and psychosocial support services in protracted humanitarian emergencies. Additional validation studies may be required to measure both the prevalence and severity of psychosocial distress to better inform humanitarian programming.

This study evaluates the feasibility of implementing artificial intelligence (AI)-driven disease surveillance systems at Julius Nyerere International Airport (JNIA) in Tanzania, a key hub for regional and international travel. Through a mixed-methods approach combining qualitative interviews and quantitative surveys, the research assesses the infrastructure, human resource capacity, and regulatory frameworks necessary for AI integration. Findings indicate that while Port Health Officers are strongly optimistic about AIs potential to enhance disease detection, the airport faces significant barriers, including outdated infrastructure, insufficient technical resources, and a lack of trained personnel. Ethical and privacy concerns, particularly surrounding data security, also emerged as key challenges, compounded by limited public awareness and the socio-cultural acceptability of AI systems. Furthermore, the study identifies gaps in national policies and inter-agency coordination that hinder the effective implementation of AI technologies. The research concludes that while current conditions render AI adoption infeasible, strategic investments in infrastructure, workforce training, and policy development could pave the way for future integration, enhancing public health surveillance at JNIA and potentially other airports in low- and middle-income countries. This study contributes critical insights into the barriers and opportunities for AI-driven disease surveillance in low-resource settings, specifically focusing on a high-priority transit point, international airports. It emphasizes the importance of region-specific solutions to enhance health security in East Africa and supports the broader global health agenda by advocating for international collaboration and the development of scalable disease surveillance systems. Future research should explore pilot AI implementations at other airports to evaluate real-world challenges and refine AI systems for broader applicability, including cost-effectiveness analyses and integration of public perspectives on AI.

BackgroundSea fish traditionally serves as a protein source and plays a crucial and indispensable role in providing nutrition for the people of Bangladesh. However, frequent consumption may potentially indicate health risks through contamination with toxic heavy metals. The main purpose of this study is to evaluate the levels of heavy metal concentrations (Cr, Fe, Ni, Mn, Cu, and Pb) in selected sea fish from Chattogram and Coxs Bazar districts in Bangladesh. MethodsA wet digestion technique was employed to prepare the samples for analyzing heavy metals. Atomic Absorption Spectrophotometry (AAS) in flame and furnace technique was utilized for the estimation of heavy metal content. The health risk of human was evaluated grounded on Estimated Daily Intake (EDI), Target Hazard Quotient (THQ), Total Target Hazard Quotient (TTHQ) or Hazard Index (HI), and Target Cancer Risk (CR). ResultThe descending chronology of average concentrations for the selected heavy metals was as follows: Fe (32.36) > Ni (12.12) > Pb (9.70) > Cu (7.29) > Mn (5.94) > Cr (5.22). The correlations (r0.587) between Cr and Mn were found significantly positive which indicated the parameters were interconnected with each other and likely have a common origin within the study area. EDI values of four samples in the case of Cr and six values for Pb exceeded the reference doses (RfD) which included Bombay Duck, Ilish, Silver Pomfret, Longfin Tuna, Indian Threadfin, and Bigeye Ilisha. In six sea fish samples, the THQ for Cr and Pb crossed the allowable limit of 1. The TTHQ/HI values for seven fish species were higher than 1 ranging from Bigeye Ilisha (3.25) to Indian Mackerel (1.35). The CR values for the majority of the heavy metals fell within an acceptable range. ConclusionsFrom a public health perspective, this study revealed that continuous consumption of heavy metals, resulting in non-oncogenic and oncogenic health implications as well.

ObjectivesTo describe COVID-19 case investigation and contact tracing outcomes from an intervention conducted in two California counties under the California Contact Tracing Support Initiative (CCTSI). MethodsWe analyzed contact tracing program metrics in two counties using de-identified individual-level records from COVID-19 cases and their contacts. Interviews with 47 program staff were conducted and analyzed using thematic analysis. ResultsIn one county, 64% of assigned COVID-19 cases (2,722 of 4,279) were successfully interviewed, with 77% (2,105) of interviews occurring within 48 hours of receiving test results; 63% of assigned contacts (418 of 660) were notified, with 82% (348) of notifications occurring within 48 hours of contact elicitation. In a second county, 52% of cases (1,743 of 3,352) were interviewed, with 48% (1,621) interviewed occurring within 48 hours; 79% of contacts (155 of 196) were notified, with 82% (127) notified within 48 hours. CCTSI staff reported faster receipt of test results in the early months and positive perceptions of wrap-around service referrals. ConclusionsThe performance of the CCTSI contact tracing intervention differed across two California counties. In both counties, there was moderate to high case interview completion and contact notification overall and within 48 hours of case and contact identification, but relatively few contacts were elicited per case. The perceived benefit of several program features was high among staff and stakeholders. The evaluation highlighted generalizable challenges in contact tracing investigations and linking contact and case records in contact tracing databases.