Zika Virus and Zika Virus Disease

During recent months, there has been growing international public concern about the Zika virus. As scientific understanding of the Zika virus unfolds, there are still many unanswered questions. Public health officials, clinicians, and consumers alike have questions about the Zika virus and the Zika virus disease. There is a need to know where to turn for the most up-to-date and reliable online information sources. Although aspects of Zika virus disease and associated medical conditions can be frightening, information seekers may find reassurance in the following online sources to guide their understanding of risk, prevention, transmission, affected geographical areas, symptoms, and disease management.     

University Students’ Knowledge,Attitudes, and Sources of Information About Zika Virus

Colleges and universities are valuable partners for community health education outreach targeted to young adults. After the outbreak of Zika virus infection in the Americas was declared to be a Public Health Emergency of International Concern on February 1, 2016, postsecondary institutions played an important role in educating at-risk communities about health promotion and disease prevention strategies. In April 2016, we recruited 613 undergraduate students from a large public university to complete a survey about their Zika-related knowledge, attitudes, and information seeking behaviors. We standardized the results so that the participants’ reports would be representative of the age, sex, major (course of study), and other characteristics of the university’s student population. Most students knew that Zika virus is spread by mosquitoes (88.1%), but only about half knew that the virus could be transmitted through sexual intercourse (56.8%). Students perceived Zika to be a health risk for pregnant women in Zika-affected countries (83.0%), but did not personally feel at risk (12.1%). Many students (43.8%) reported not knowing where to get accurate information about Zika. Identifying gaps in scientific knowledge, misperceptions about personal susceptibility, and opportunities for behavioral risk reduction is an important foundation for designing community-based health interventions when future emerging infectious disease events occur.     

A Literature Review of Zika Virus

Zika virus is a mosquitoborne flavivirus that is the focus of an ongoing pandemic and public health emergency. Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika virus infections are characterized by subclinical or mild influenza-like illness, severe manifestations have been described, including Guillain-Barre syndrome in adults and microcephaly in babies born to infected mothers. Neither an effective treatment nor a vaccine is available for Zika virus; therefore, the public health response primarily focuses on preventing infection, particularly in pregnant women. Despite growing knowledge about this virus, questions remain regarding the virus’s vectors and reservoirs, pathogenesis, genetic diversity, and potential synergistic effects of co-infection with other circulating viruses. These questions highlight the need for research to optimize surveillance, patient management, and public health intervention in the current Zika virus epidemic.     

Understanding social inequalities in Zika infection and its consequences: A model of pathways and policy entry-points

The health consequences of arbovirus infections such as dengue fever (DENV), Chikungunya (CHIKV) and Zika (ZIKV) has in recent years become a public health challenge, due to failure of prevention followed by increased incidence and pronounced social inequality in occurrence and consequences. This motivates a more systematic analysis of the potential mechanisms and pathways that generate these inequalities. We present in the paper a model that delineates five possible mechanisms driving the inequality of ZIKV and congenital Zika syndrome (CZS). They include differential exposure to bad housing and sanitary conditions, differential exposure to vector density and virus, differential vulnerability to the health effects of exposure to virus, differential intrauterine susceptibility to the teratogenic effects of ZIKV infection and differential social consequences of caring for a disabled child. For each mechanism, we present empirical evidence or need for more research as well as a discussion about policy implications.     

Knowledge,attitudes, and practices regarding dengue,chikungunya, and Zika in Cali,Colombia.

Dengue fever (DENF), chikungunya (CHIK), and Zika are responsible for the majority of the burden caused by vector-borne diseases (VBDs); which are produced by viruses primarily transmitted by the Aedes mosquito. Aedes have become prolific in urban areas due to a combination of climate change, rapid urbanization, increased human mobility, and globalization, causing the three VBDs to emerge in novel regions. Community knowledge can provide detailed insights about the spatial heterogeneity of disease risk and rates within a particular region, improving public health interventions. Knowledge, Attitude, and Practice (KAP) surveys are used to shed light on at-risk communities’ understanding of the vector, the pathogen, prevention and treatment strategies. Little is known how KAP varies among diseases, and among neighborhoods within a city. Understanding KAP variation among co-circulating VBDs at a fine-level, especially differences between endemic and emerging diseases, can improve targeted interventions, education programs, and health policy. We administered KAP surveys to 327 individuals in healthcare centers and selected neighborhoods in Cali, Colombia in June 2019. We utilized generalized linear models (GLMs) to identify significant predictors of KAP. Our findings suggest that knowledge is related to community characteristics (e.g. strata), while attitudes and practices are more related to individual-level factors. Access to healthcare also forms significant predictor of residents participating in preventative practices. The results can be leveraged to inform public health officials and communities to motivate at-risk neighborhoods to take an active role in vector surveillance and control, while improving educational and surveillance resources in Cali, Colombia.     

Research on Pisa University student's life style and health

Surveys on life and health conditions of university students besides providing useful epidemiologic data partly related to the young population. They are potentially useful for the intervention planning aimed to remove possible environmental or behavioural risk factors. Following these purpose a survey sample about 1200 student attending the University of Pisa was carried out through an anonymous questionnaire about 41 questions focused on behaviours and lifestyles of young people, possible health problems, self-perception of the health state, the use of public health services, and the more commonly used (or preferred) sources of information on health topics. The results suggest that although the self perception of the state of health is broadly positive for the majority of students, there is also a significant frequency of individuals declaring significant at risk behaviours (persistence of sexual practices at risk, drug use, alcohol and smoke abuse). The consumption, also sporadic, of psicoattive substances has been declared gives beyond 40% of the students, in particular 37% asserts to have tried drugs. The habit to smoke appeared diffused much between the students; the percentage of smokers turns out equal to 41% in total (40% females, 42% males). 76% of the interviewed ones has declared to be sexually active, the percentage of those who have declared multiple relations or occasional is elevated (12%), and 47% of the students asserts to use the condom with fixed partner and 77% with occasional partner. Moreover there seems to be a significant association between the changes in the diet and other lifestyles that are due to the "university lifestyle" (as a consequence of leaving the family or increased commuting) and the insurgence of several types of sickness, e.g. gastroenteric disturbances and fever attacks. Finally, the present investigation suggests that few interventions on services offered to students (such as accommodation, teaching structures and especially the creation of a "health office" where students can acquire information on health and other topics related to their condition) could have a significantly beneficial impact on the general state of health of the university population.     

Social support networks and maternal mental health and well-being

The link between social networks and mental health has increasingly been recognized by public health as an important topic of interest. In this paper, we explore this association among a specific group: mothers. Specifically, we discuss how maternal mental health can be understood in the context of social networks, the influence of specific social relationships, and how the type and quality of support can mediate maternal mental health outcomes. We review interventions that foster social networks to address maternal mental health as well as other related health outcomes. Findings suggest that interventions that combine multiple treatment approaches may be more effective in addressing mental health. Also, traditional measures of social networks may not be appropriate for vulnerable populations, with qualitative, rather than quantitative, indicators of social networks being more predictive of maternal health and well-being. The implications of these findings and future research directions are discussed.     

寨卡病毒病流行病学概述

寨卡病毒病是一种由寨卡病毒引起的,主要通过伊蚊传播的新发急性病毒性传染病,尚无疫苗和特异性治疗药物。为了加强对寨卡病毒病流行病学特征的了解,本文通过Medline数据库检索寨卡病毒病相关信息,结合相关政府部门、国际卫生组织报告等资料对寨卡病毒病流行病学特征进行综述。目前,该病主要在美洲地区流行,呈快速蔓延之势,34个国家存在病毒本地传播,多个国家报告输入病例。该病临床表现通常较轻,死亡罕见,部分病例可出现神经系统综合征,婴儿出生缺陷等较严重的后果,引起国际社会广泛关注,中国存在因输入病例引发的疫情局部扩散的风险。但该病是一种可防可控的传染病,只要各项策略和措施落实到位,就能够有效控制疫情扩散。     

Linking the oceans to public health: current efforts and future directions

We review the major linkages between the oceans and public health, focusing on exposures and potential health effects due to anthropogenic and natural factors including: harmful algal blooms, microbes, and chemical pollutants in the oceans; consumption of seafood; and flooding events. We summarize briefly the current state of knowledge about public health effects and their economic consequences; and we discuss priorities for future research.We find that:? There are numerous connections between the oceans, human activities, and human health that result in both positive and negative exposures and health effects (risks and benefits); and the study of these connections comprises a new interdisciplinary area, "oceans and human health."? The state of present knowledge about the linkages between oceans and public health varies. Some risks, such as the acute health effects caused by toxins associated with shellfish poisoning and red tide, are relatively well understood. Other risks, such as those posed by chronic exposure to many anthropogenic chemicals, pathogens, and naturally occurring toxins in coastal waters, are less well quantified. Even where there is a good understanding of the mechanism for health effects, good epidemiological data are often lacking. Solid data on economic and social consequences of these linkages are also lacking in most cases.? The design of management measures to address these risks must take into account the complexities of human response to warnings and other guidance, and the economic tradeoffs among different risks and benefits. Future research in oceans and human health to address public health risks associated with marine pathogens and toxins, and with marine dimensions of global change, should include epidemiological, behavioral, and economic components to ensure that resulting management measures incorporate effective economic and risk/benefit tradeoffs.     

Where there is no state: household strategies for the management of illness in Chad

The current structure of the health care system in Chad, which is characterized by a weak public health system and a nascent and largely unaffordable private sector, raises questions about how low-income households manage illnesses. These questions are also compelling because of claims about the potential of oil-related investments to restructure the current landscape of care over the next 25-30 years. This paper focuses on household strategies for treating episodes of malaria reported in an on-going, longitudinal study of household health and access to care in Chad. Treatment of malaria outside the health care system is widespread in endemic areas, therefore it is not surprising that low-income households in this study rely heavily on unregulated drug markets for care. However, the paper shows how self-medication and the use of these drug markets are shaped by the current organization and delivery of care, and are not simply the outcome of a lack of information about the dangers associated with such practices. The paper also shows the consequences of this particular constellation of services for health in low-income households. We see, for example, the emergence of regimes for managing illness that consist of keeping debilitating symptoms at bay through the use of intermittent, sub-optimal therapies that provide a temporary reprieve but not a 'cure.' We also see that households ignore health problems--absorbing them into the experience of everyday life--that might elsewhere demand attention. When illnesses appear as crises it is often because cash-strapped households are unable to sustain this type of management regime, and easily treatable problems spiral out of control. Whether and how the experiences of the low-income households described in this paper will be impacted by the public investment of oil revenues in the health sector is the question our longitudinal study is designed to address.     

The Imperative for Research to Promote Health Equity in Indigenous Communities

Health disparities exact a devastating toll upon Indigenous people in the USA. However, there has been scant research investment to develop strategies to address these inequities in Indigenous health. We present a case for increased health promotion, prevention, and treatment research with Indigenous populations, providing context to the recent NIH investment in the Intervention Research to Improve Native American Health (IRINAH) network. We discuss the disproportionate costs and consequences of disparities borne by Indigenous groups, the limited evidence base on effective intervention for this population, how population uniqueness often makes transfer of existing intervention models difficult, and additional challenges in creating interventions for Indigenous settings. Given the history of colonial disruption that has included genocide, forced removal from lands, damaging federal, state and local policies and practices, environmental contamination, and most recently, climate change, we conclude research that moves beyond minor transformations of existing majority population focused interventions, but instead truly respects Indigenous wisdom, knowledge, traditions, and aspirations is needed, and that investment in intervention science to address Indigenous health disparities represent a moral imperative.

     

Integration of social epidemiology and community-engaged interventions to improve health equity

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.     

QALYs, standard gambles, and the expected budget constraint

This paper shows that when quality adjustment factors for use in constructing QALY indices are established through answers to standard-gamble questions or similar methods, the assumptions that are made by respondents about the financial consequences of changing probabilities of illness and death are critically important for the use of QALYs in cost-utility analysis (CUA). It qualifies Meltzer's [Journal of Health Economics 16 (1997) 33] result that the cost per quality-adjusted life-year (QALY) for life-saving medical interventions should include the future consumption of those who would otherwise not have survived, by showing that its validity depends on how the QALY index has been established. The paper also shows that, contrary to a widely held notion, allocation of a fixed health care budget through CUA does not generally result in a second-best efficient allocation. Another finding is that failure to specify carefully what respondents to standard-gamble questions are supposed to assume about the financial consequences of ill health may result in a bias against providing care to older individuals.     

The global financial crisis: whither women's health?

The global integration of trade and financial markets that has been the hallmark of the past 30 years of neoliberal globalization means that local economies can be shaped by economic events seemingly unrelated to the scale or geography where women's empowerment projects unfold. These global–local interactions raise questions so far largely absent in public discussions of the 2008 crisis precipitated by the US sub-prime loan scandal: what are the gendered effects of global financial crises; specifically, how do these crises affect women? And how do these market crises intersect with the non-market activities that are key to understanding gendered health issues in developing countries. This article addresses these questions by reviewing the literature on gendered health impacts of financial crises over the past two decades. We find that the manner in which national governments and the broader international community react to crises can either magnify (as illustrated through the impacts of structural adjustment programmes on women's health) or mitigate (as illustrated through the policies pursued following the loss of support from the collapsed Soviet Union on Cuban women's health) gendered health-negative effects. Lack of attention to gender-specific consequences of past crises or health-positive interventions into such crises has weakened the ability to advance policy advice on protecting women's health during the present crisis. The article concludes with a gender-focused critique of the dominant policy responses to the 2008 financial crisis and a call to undertake real-time investigation of gendered health risks and opportunities arising from the present crisis.     

La infección por virus Zika: una nueva emergencia de salud pública con gran impacto mediático

Infection with Zika virus (ZV) has become a new epidemic, with great impact on the media, and is having a strong effect in Latin American countries. Its possible association with microcephaly and Guillain-Barré syndrome prompted the World Health Organization (WHO) to declare on 1 February 2016 that this epidemic is a public health emergency of international concern. Epidemiological data show an increasing incidence in countries like Brazil and Colombia, and that the epidemic is still expanding in many other countries. Between January 2007 and 27 April 2016, the WHO detected transmission in 55 countries (in 42 of these, this was the first outbreak of Zika) and 1,198 microcephalies and other neurological disorders in Brazil. Also, during 2015-2016, 13 countries detected an increase in Guillain-Barré syndrome and/or confirmation of ZV associated with Guillain-Barré syndrome. Research has already demonstrated a causal relationship between microcephaly and other serious brain disorders in newborns and ZV infection in the mother. Clinically, many cases are asymptomatic and it can be difficult to distinguish this diagnosis from that of other arboviruses. Vector control in Spain is a priority because of the presence of the Aedes albopictus (tiger mosquito). Early diagnosis is recommended, as is avoiding travel to endemic areas and unprotected sex, and ensuring that the high political profile, which can prevent this epidemic from becoming a high prevalence endemic disease, does not cause us to forget about other health problems.     

Performing purity: reproductive decision-making and implications for a community under threat of zika in iquitos,Peru

The long-term management and prevention of Zika virus requires understanding of reproductive and sexual health behaviours, including mechanisms of partnered decision-making. In this article, we report on a qualitative study conducted before the arrival of Zika in Iquitos, Peru. We assessed existing patterns of reproductive decision-making among partnered men and women in a community under threat of Zika and discuss how these may impact Zika prevention in the long-term. We used a rapid qualitative assessment methodology, including in-depth semi-structured interviews with partnered women (28) and men (21). Deeply unequal gender role expectations limit discussion of reproductive decisions until after a first child is born. Women needed to perform a domestic ‘of-the-house’ role to be considered suitable partners, leading them to hide their knowledge of sexual and reproductive health. Condoms symbolise risk and are unused with partners in committed relationships. A shared perception that men must take care of female partner’s sexual health, translates into male sexual and reproductive preferences overcoming female desires. Existing decision-making patterns lead to an increased risk of Zika exposure. Long-term response should expand Zika virus information and preventive messages to men and young people, in addition to engaging with broader societal challenges to gender inequity.     

Systematic reviews and knowledge translation

Proven effective interventions exist that would enable all countries to meet the Millennium Development Goals. However, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. Also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. We propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. This framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. We have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. Future work to empirically validate and evaluate the usefulness of this framework is needed. We invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. We also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings.     

Valuing child health utility 9D health states with a young adolescent sample

QALYs are increasingly being utilized as a health outcome measure to calculate the benefits of new treatments and interventions within cost-utility analyses for economic evaluation. Cost-utility analyses of adolescent-specific treatment programmes are scant in comparison with those reported upon for adults and tend to incorporate the views of clinicians or adults as the main source of preferences. However, it is not clear that the views of adults are in accordance with those of adolescents on this issue. Hence, the treatments and interventions most highly valued by adults may not correspond with those most highly valued by adolescents. Ordinal methods for health state valuation may be more easily understood and interpreted by young adolescent samples than conventional approaches. The availability of young adolescent-specific health state values for the estimation of QALYs will provide new insights into the types of treatment programmes and health services that are most highly valued by young adolescents. The first objective of this study was to assess the feasibility of applying best-worst scaling (BWS) discrete-choice experiment (DCE) methods in a young adolescent sample to value health states defined by the Child Health Utility 9D (CHU9D) instrument, a new generic preference-based measure of health-related quality of life developed specifically for application in young people. The second objective was to compare BWS DCE questions (where respondents are asked to indicate the best and worst attribute for each of a number of health states, presented one at a time) with conventional time trade-off (TTO) and standard gamble (SG) questions in terms of ease of understanding and completeness. A feasibility study sample of consenting young adolescent school children (n = 16) aged 11-13 years participated in a face-to-face interview in which they were asked to indicate the best and worst attribute levels from a series of health states defined by the CHU9D, presented one at a time. Participants were also randomly allocated to receive additional conventional TTO or SG questions and prompted to indicate how difficult they found them to complete. The results indicate that participants were able to readily choose 'best' and 'worst' dimension levels in each of the CHU9D health states presented to them and provide justification for their choices. Furthermore, when presented with TTO or SG questions and prompted to make comparisons, participants found the BWS DCE task easier to understand and complete. The results of this feasibility study suggest that BWS DCE methods are potentially more readily understood and interpretable by vulnerable populations (e.g. young adolescents). These findings lend support to the potential application of BWS DCE methods to undertake large-scale health state valuation studies directly with young adolescent population samples.