#Emergency #Declarations for #PublicHealth Issues: Expanding Our #Definition of Emergency (J Law Med Ethics, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Law Med Ethics. 2019 Jun;47(2_suppl):95-99. doi: 10.1177/1073110519857328.

Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency.

Sunshine G1, Barrera N1, Corcoran AJ1, Penn M1.

Author information: 1 Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona’s Office of the Attorney General, where she practices public health law. Aubrey Joy’s practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O’Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC’s Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control’s Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia.



Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration.

PMID: 31298138 DOI: 10.1177/1073110519857328

Keywords: USA; Public Health.



#Mandatory #Measles #Vaccination in #NYC — Reflections on a Bold Experiment (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Mandatory Measles Vaccination in New York City — Reflections on a Bold Experiment

Julie D. Cantor, M.D., J.D.


Though a vaccine has been available for more than 50 years, measles has recently reemerged as a public health threat in the United States. Outbreaks have arisen where vaccination rates have waned, and local governments have responded.

In Detroit, officials and religious leaders of an affected community collaborated, encouraging vaccination to control an outbreak. Los Angeles quarantined people exposed to the virus. New York City and Rockland County have seen the most cases, and their extensive vaccination efforts have included free clinics, meetings with community leaders, and email messages to clinicians. They also issued orders restricting the liberty of people who neither had nor were exposed to the virus.



Disclosure forms provided by the author are available at NEJM.org.

This article was published on June 5, 2019, at NEJM.org.

Author Affiliations: From the UCLA School of Law, Los Angeles.

Keywords: Measles; USA; NYC; Society.


#Conceptions within #misconceptions: #Pluralisms in an #Ebola #vaccine #trial in West Africa (Glob Public Health., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Glob Public Health. 2019 Jun 25:1-9. doi: 10.1080/17441692.2019.1632368. [Epub ahead of print]

Conceptions within misconceptions: Pluralisms in an Ebola vaccine trial in West Africa.

Alenichev A1,2, Peeters Grietens K3, Gerrets R1.

Author information: 1a Department of Anthropology , University of Amsterdam , Amsterdam , Netherlands. 2b The Barcelona Institute for Global Health , Barcelona , Spain. 3c Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium.



Ensuring that biomedical information about research procedures is adequately understood by participants and their communities is key for conducting ethical research. This article explores participants’ understanding of trial procedures for an experimental vaccine against Ebola virus disease (EVD) in a West African context. We found that some trial participants believed there was a chance of contracting Ebola and other sicknesses from the vaccine, and others believed both the vaccine and the placebo control would be able to prevent other illnesses than EVD. While these beliefs might be understood as misconceptions about the vaccine trial, this paper shows that such a conclusion is problematic because it excludes local explanatory health models and logics of causality. The paper invites bioethicists to work with anthropologists to take seriously different models of health knowledge in global health research. Investigating and addressing such differences could be the key to understanding human subjects’ motives for participation, and to creating space for studies of empirical ethics.

KEYWORDS: Ebola; clinical trial; misconceptions; pluralism

PMID: 31237180 DOI: 10.1080/17441692.2019.1632368

Keywords: Ebola; Vaccines; Society; Africa region; Bioethics.


#Lassa Fever-associated #Stigmatization among #Staff and #Students of the #University of #Benin, #Nigeria (J Epidemiol Glob Health., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Epidemiol Glob Health. 2019 Jun;9(2):107-115. doi: 10.2991/jegh.k.190514.001.

Lassa Fever-associated Stigmatization among Staff and Students of the University of Benin, Nigeria.

Usifoh SF1, Odigie AE2, Ighedosa SU3, Uwagie-Ero EA4, Aighewi IT5.

Author information: 1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria. 2 Department of Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Benin, Benin City, Nigeria. 3 Department of Community Health, University of Benin Teaching Hospital, Benin City, Nigeria. 4 Department of Surgery, Faculty of Veterinary Medicine, University of Benin, Benin City, Nigeria. 5 Department of Environmental Management and Toxicology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria.



Lassa Fever (LF) remains a health burden in several endemic areas of Nigeria, and its toll remains unabated over several decades. Although most studies have focused on virological and clinical considerations, few studies have attempted to address the perceived psychosocial component of LF disease in Nigeria. Evaluation of stigmatization and discrimination faced by LF survivors is an important step in improving individual health and protecting public health. This study aimed to assess LF-associated stigmatization associated among staff and students of the University of Benin. Descriptive analyses of 600 consenting respondents (300 staff and 300 students) sampled using pretested questionnaires was conducted, and the Chi-square test was used to test for significant association between perceived LF stigmatization and predefined variables. LF was a potential cause of stigmatization in a higher proportion of student (n = 162, 57.9%) than staff (n = 112, 39.9%). LF-associated stigmatization among students was significantly associated with sex (p = 0.012) and poor knowledge (p = 0.013) of LF transmission and prevention. A greater tendency for stigmatization was observed among females than males. A comprehensive emergency response plan incorporating accurate knowledge dissemination about the disease may be a first step toward tackling perceived LF stigmatization.

© 2019 Atlantis Press International B.V.

KEYWORDS: Associated stigmatization; Lassa fever; University of Benin; psychosocial; staff; students

PMID: 31241868 DOI: 10.2991/jegh.k.190514.001

Keywords: Lassa fever; Nigeria; Society.


#Mortality, #morbidity, and #risk #factors in #China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Prof Maigeng Zhou, PhD *, Haidong Wang, PhD *, Xinying Zeng, MS, Peng Yin, PhD, Prof Jun Zhu, MD, Prof Wanqing Chen, PhD, Xiaohong Li, PhD, Prof Lijun Wang, MS, Prof Limin Wang, MS, Yunning Liu, MS, Jiangmei Liu, MS, Mei Zhang, PhD, Jinlei Qi, PhD, Prof Shicheng Yu, PhD, Ashkan Afshin, MD, Prof Emmanuela Gakidou, PhD, Scott Glenn, MSc, Varsha Sarah Krish, BA, Molly Katherine Miller-Petrie, MSc, W Cliff Mountjoy-Venning, BA, Erin C Mullany, BA, Sofia Boston Redford, MPH, Hongyan Liu, PhD, Prof Mohsen Naghavi, PhD, Prof Simon I Hay, DSc, Prof Linhong Wang, MD, Prof Christopher J L Murray, DPhil, Xiaofeng Liang, MD

Open Access / Published: June 24, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30427-1




Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.


We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).


Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer’s disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).


China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system.


China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Keywords: China; Public Health; Society.


Causes of Excess #Mortality in #Veterans Treated for #PTSD (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Causes of Excess Mortality in Veterans Treated for Posttraumatic Stress Disorder

Jenna A. Forehand, MD, MPH1, Talya Peltzman, MPH1, Christine Leonard Westgate, MS1, Natalie B. Riblet, MD, MPH1,2,3, Bradley V. Watts, MD, MPH1,2,4, Brian Shiner, MD, MPH1,2,3,5

DOI: https://doi.org/10.1016/j.amepre.2019.03.014




Published research indicates that posttraumatic stress disorder (PTSD) is associated with increased mortality. However, causes of death among treatment-seeking patients with PTSD remain poorly characterized. The study objective was to describe causes of death among Veterans with PTSD to inform preventive interventions for this treatment population.


A retrospective cohort study was conducted for all Veterans who initiated PTSD treatment at any Department of Veterans Affairs Medical Center from fiscal year 2008 to 2013. The primary outcome was mortality within the first year after treatment initiation. In 2018, collected data were analyzed to determine leading causes of death. For the top ten causes, standardized mortality ratios (SMRs) were calculated from age- and sex-matched mortality tables of the U.S. general population.


A total of 491,040 Veterans were identified who initiated PTSD treatment. Mean age was 48.5 (±16.0) years, 90.7% were male, and 63.5% were of white race. In the year following treatment initiation, 1.1% (5,215/491,040) died. All-cause mortality was significantly higher for Veterans with PTSD compared with the U.S. population (SMR=1.05, 95% CI=1.02, 1.08, p<0.001). Veterans with PTSD had a significant increase in mortality from suicide (SMR=2.52, 95% CI=2.24, 2.82, p<0.001), accidental injury (SMR=1.99, 95% CI=1.83, 2.16, p<0.001), and viral hepatitis (SMR=2.26, 95% CI=1.68, 2.93, p<0.001) versus the U.S. population. Of those dying from accidental injury, more than half died of poisoning (52.3%, 325/622).


Veterans with PTSD have an elevated risk of death from suicide, accidental injury, and viral hepatitis. Preventive interventions should target these important causes of death.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords: PTSD; Psychiatry; Society; Public Health; USA.


#Geographic, Temporal, and #Sociodemographic #Differences in #Opioid #Poisoning (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Geographic, Temporal, and Sociodemographic Differences in Opioid Poisoning

Elinor R. Schoenfeld, PhD1,2, George S. Leibowitz, PhD, LICSW3, Yu Wang, BE4, Xin Chen, PhD4, Wei Hou, PhD1, Sina Rashidian, BS4, Mary M. Saltz, MD2,5, Joel H. Saltz, MD, PhD2, Fusheng Wang, PhD2,4

Open Access / DOI: https://doi.org/10.1016/j.amepre.2019.03.020




Not enough is known about the epidemiology of opioid poisoning to tailor interventions to help address the growing opioid crisis in the U.S. The objective of this study is to expand the current understanding of opioid poisoning through the use of data analytics to evaluate geographic, temporal, and sociodemographic differences of opioid poisoning– related hospital visits in a region of New York State with high opioid poisoning rates.


This retrospective cohort study utilized patient-level New York State all-payer hospital data (2010–2016) combined with Census data to evaluate geographic, patient, and community factors for 9,714 Long Island residents with an opioid poisoning–related inpatient or outpatient hospital facility discharge. Temporal, 7-year opioid poisoning rates and trends were evaluated, and geographic maps were generated. Overall, significance tests and tests for linear trend were based upon logistic regression. Analyses were completed between 2017 and 2018.


Since 2010, Long Island and New York State opioid poisoning hospital visit rates have increased 2.5- to 2.7-fold (p<0.001). Opioid poisoning hospital visit rates decreased for men, white patients, and self-payers (p<0.001) and increased for Medicare payers (p<0.001). Communities with high opioid poisoning rates had lower median home values, higher percentages of high school graduates, were younger, and more often white patients (p<0.01). Maps displayed geographic patterns of communities with high opioid poisoning rates overall and by age group.


Findings highlight the changing demographics of the opioid poisoning epidemic and utility of data analytics tools to identify regions and patient populations to focus interventions. These population identification techniques can be applied in other communities and interventions.

Keywords: Opioids; Illicit drugs; Society; USA.