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Journal Description

JMIR Public Health & Surveillance (JPHS, Editor-in-chief: Travis Sanchez, Emory University/Rollins School of Public Health) is a PubMed-indexed, peer-reviewed international multidisciplinary journal with a unique focus on the intersection of innovation and technology in public health, and includes topics like public health informatics, surveillance (surveillance systems and rapid reports), participatory epidemiology, infodemiology and infoveillance, digital disease detection, digital epidemiology, electronic public health interventions, mass media/social media campaigns, health communication, and emerging population health analysis systems and tools. 

JPHS has an international author- and readership and welcomes submissions from around the world.

We publish regular articles, reviews, protocols/system descriptions and viewpoint papers on all aspects of public health, with a focus on innovation and technology in public health. The main themes/topics covered by this journal can be found here.

Apart from publishing traditional public health research and viewpoint papers as well as reports from traditional surveillance systems, JPH was one of the first (if not the only) peer-reviewed journals to publish papers with surveillance or pharmacovigilance data from non-traditional, unstructured big data and text sources such as social media and the Internet (infoveillance, digital disease detection), or reports on novel participatory epidemiology projects, where observations are solicited from the public.  

Among other innovations, JPHS is also dedicated to support rapid open data sharing and rapid open access to surveillance and outbreak data. As one of the novel features we plan to publish rapid or even real-time surveillance reports and open data. The methods and description of the surveillance system may be peer-reviewed and published only once in detail, in a  "baseline report" (in a JMIR Res Protoc or a JMIR Public Health & Surveill paper), and authors then have the possibility to publish data and reports in frequent intervals rapidly and with only minimal additional peer-review (we call this article type "Rapid Surveillance Reports"). JMIR Publications may even work with authors/researchers and developers of selected surveillance systems on APIs for semi-automated reports (e.g. weekly reports to be automatically published in JPHS and indexed in PubMed, based on data-feeds from surveillance systems and minimal narratives and abstracts).

Furthermore, during epidemics and public health emergencies, submissions with critical data will be processed with expedited peer-review to enable publication within days or even in real-time.

We also publish descriptions of open data resources and open source software. Where possible, we can and want to publish or even host the actual software or dataset on the journal website.

 

Recent Articles:

  • Source: Image created by the Authors; Copyright: The Authors; URL: https://publichealth.jmir.org/2019/4/e14348; License: Licensed by JMIR.

    Preventing Emerging and Re-emerging Infections in the Eastern Mediterranean Region: Gaps, Challenges, and Priorities

    Abstract:

    Background: The Eastern Mediterranean Public Health Network, supported by the Biosecurity Engagement Program, contributed significantly to strengthening the preparedness and response to the emerging and reemerging infections in the region. Objective: This study aimed to determine the gaps, challenges, and priorities for preventing the emerging and reemerging infections, with a focus on biosafety and biosecurity in 4 countries of the region, namely, Egypt, Iraq, Jordan, and Morocco. Methods: A total of two different methods were used to determine the gaps and priorities for preventing the emerging and reemerging infections. The first method was a rapid assessment for the preparedness and response to the emerging and reemerging infections in 4 countries of the region, with a focus on biosafety and biosecurity. The second method was a face-to-face round table meeting of the participating teams for two days, where the teams from all countries presented their countries’ profiles, findings, priorities, and gaps based on the countries’ assessments. Results: The assessment and meeting resulted in several priorities and recommendations for each of the countries in the areas of legislation and coordination, biosafety and biosecurity, surveillance and human resources, case management and response, infection control and prevention, and risk communication and laboratory capacity. Conclusions: Many recommendations were relatively consistent throughout, including improving communication or building collaborations to improve the overall health of the country.

  • Source: freepik; Copyright: pressfoto; URL: https://www.freepik.com/free-photo/doctor-working-computer_5534953.htm#page=1&query=diagnosis&position=8; License: Licensed by JMIR.

    Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study

    Abstract:

  • Source: Pexels; Copyright: Pixabay; URL: https://www.pexels.com/photo/2-boy-sitting-on-brown-floor-while-using-their-smartphone-near-woman-siiting-on-bench-using-smartphone-during-daytime-159395/; License: Licensed by JMIR.

    Youth Study Recruitment Using Paid Advertising on Instagram, Snapchat, and Facebook: Cross-Sectional Survey Study

    Abstract:

  • Source: Unsplash.com; Copyright: ‏ فی عین الله; URL: https://unsplash.com/photos/X3dMlJmK7lA; License: Licensed by JMIR.

    Knowledge, Attitude, and Practices of Food Handlers on Food Safety and Personal Hygiene During Arbaeenia Mass Gathering, Baghdad, Iraq, 2014: Cross-Sectional...

    Abstract:

    Background: Millions of pilgrims attend Arbaeenia mass gathering (MG) in Iraq each year. Thousands of individuals work voluntarily at temporary rest areas (locally called Mawakib), distributed in most of Iraq governorates, to provide food and other services to the MG attendees. The potential for improper handling of food at Mawakib increases the risk of waterborne and foodborne diseases. Objective: This study was aimed to assess the knowledge, attitude, and practices (KAP) of food handlers in Mawakibs in Baghdad city during Arbaeenia MG. Methods: A random sample of 100 Mawakibs was selected in Baghdad, 50 from the eastern side (Rusafa) and 50 from the western side (Kerkh), and 5 food handlers were randomly selected from each Mawakib. A questionnaire was used to collect demographic data and KAP for food safety and personal hygiene. The questionnaire included 25 questions addressing knowledge, 10 addressing attitudes, and 14 addressing practices of the food handlers with respect to food safety and personal hygiene. QQuestions on knowledge and attitudes were answered through direct interview with the food handlers, whereas the questions on practices were answered through direct observation while handling or serving the food. SPSS version 20 (IBM SPSS Statistics 20) was used for data analysis and describing proportions. Results: There was a varied knowledge of food safety practices among the individuals interviewed. On a scale of 3, the overall average score for both the attitude and practices for food safety and personal hygiene was 2, which corresponds to fair attitude and practices. The attitudes varied significantly by location, age group, and education, whereas the practices varied by location, age groups, employment, and previous experiences. Conclusions: The food handlers had unsatisfactory attitudes and practices toward food handling and personal hygiene. Their participation in food handling at Mawakib carries a potential risk of spreading foodborne and waterborne diseases. All individuals intending to serve in Mawakib as food handlers should be licensed from the Ministry of Health after completing a formal training in food safety and personal hygiene.

  • Source: Unsplash; Copyright: Trent Szmolnik; URL: https://unsplash.com/photos/lBofBW3IuXQ; License: Licensed by JMIR.

    The Association Between Internet Searches and Moisturizer Prescription in Japan: Retrospective Observational Study

    Abstract:

    Background: Heparinoid is a medication prescribed in Japan for skin diseases, such as atopic dermatitis and dry skin. Heparinoid prescription has increased with instances of Internet blogs recommending its use as a cosmetic. Objective: This study aimed to examine the prescription trends in moisturizer use and analyze their association with Internet searches. Methods: We used a claims database to identify pharmacy claims of heparinoid-only prescriptions in Japan. Additionally, we used Google Trends to obtain internet search data for the period between October 1, 2007, and September 31, 2017. To analyze the association between heparinoid prescriptions and Internet searches, we performed an autoregressive integrated moving average approach for each time series. Results: We identified 155,733 patients who had been prescribed heparinoid. The number of prescriptions increased from 2011 onward, and related Internet searches increased from 2012 onward. Internet searches were significantly correlated with total heparinoid prescription (correlation coefficient=.25, P=.005). In addition, internet searches were significantly correlated with heparinoid prescription in those aged 20-59 years at −1-month lag in Google Trends (correlation coefficient=.30, P=.001). Conclusions: Google searches related to heparinoid prescriptions showed a seasonal pattern and increased gradually over the preceding several years. Google searches were positively correlated with prescription trends. In addition, in a particular age group (20-59 years), prescriptions increased with the increase in internet searches. These results suggest that people obtained health-related information on the internet and that this affected their behavior and prescription requests.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: https://publichealth.jmir.org/2019/4/e13027/; License: Creative Commons Attribution (CC-BY).

    A Crowdsourced Physician Finder Prototype Platform for Men Who Have Sex with Men in China: Qualitative Study of Acceptability and Feasibility

    Abstract:

    Background: Men who have sex with men (MSM), including both gay and bisexual men, have a high prevalence of HIV and sexually transmitted infections (STIs) in China. However, healthcare seeking behaviors and engagement in clinical services among MSM are often suboptimal. Global evidence shows that embedding online HIV or sexual health services into gay social networking applications holds promise for facilitating higher rates of healthcare utilization among MSM. We developed a prototype of a gay-friendly health services platform, designed for integration within a popular gay social networking app (Blued) in China. Objective: The purpose of this study was to evaluate the acceptability of the platform and ask for user feedback through focus group interviews with young MSM in Guangzhou and Shenzhen, cities in Southern China. Methods: The prototype was developed through an open, national crowdsourcing contest. Open crowdsourcing contests solicit community input on a topic in order to identify potential improvements and implement creative solutions. The prototype included a local, gay-friendly, STI physician finder tool and online psychological consulting services. Semistructured focus group discussions were conducted with MSM to ask for their feedback on the platform, and a short survey was administered following discussions. Thematic analysis was used to analyze the data in NVivo, and we developed a codebook based on the first interview. Double coding was conducted, and discrepancies were discussed with a third individual until consensus was reached. We then carried out descriptive analysis of the survey data. Results: A total of 34 participants attended four focus group discussions. The mean age was 27.3 years old (SD 4.6). A total of 32 (94%) participants obtained at least university education, and 29 (85%) men had seen a doctor at least once before. Our survey results showed that 24 (71%) participants had interest in using the online health services platform and 25 (74%) thought that the system was easy to use. Qualitative data also revealed that there was a high demand for gay-friendly healthcare services which could help with care seeking. Men felt that the platform could bridge gaps in the existing HIV or STI service delivery system, specifically by identifying local gay-friendly physicians and counselors, providing access to online physician consultation and psychological counseling services, creating space for peer support, and distributing preexposure prophylaxis and sexual health education. Conclusions: Crowdsourcing can help develop a community-centered online platform linking MSM to local gay-friendly HIV or STI services. Further research on developing social media–based platforms for MSM and evaluating the effectiveness of such platforms may be useful for improving sexual health outcomes.

  • Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/couple-using-twitter-application-mobile-phone_2611111.htm#page=1&query=twitter&position=9; License: Licensed by JMIR.

    Prevalence and Characteristics of Twitter Posts About Court-Ordered, Tobacco-Related Corrective Statements: Descriptive Content Analysis

    Abstract:

    Background: Three major US tobacco companies were recently ordered to publish corrective statements intended to prevent and restrain further fraud about the health effects of smoking. The court-ordered statements began appearing in newspapers and on television (TV) in late 2017. Objective: The objective of this study was to examine the social media dissemination of the tobacco corrective statements during the first 6 months of the implementation of the statements. Methods: We conducted a descriptive content analysis of Twitter posts using an iterative search strategy through Crimson Hexagon and randomly selected 19.74% (456/2309) of original posts occurring between November 1, 2017, and March 27, 2018, for coding and analysis. We assessed post volume over time, source or author, valence, linked content, and reference to the industry (eg, big tobacco, tobacco industry, and Philip Morris) and media outlet (TV or newspaper). Retweeted content was coded for source/author and prevalence. Results: Most posts were published in November 2017, surrounding the initial release of the corrective statements. Content was generally neutral (58.7%, 268/456) or positive (33.3%, 152/456) in valence, included links to additional information about the statements (94.9%, 433/456), referred to the industry (87.7%, 400/456), and did not mention a specific media channel on which the statements were aired or published (15%). The majority of original posts were created by individual users (55.2%, 252/456), whereas the majority of retweeted posts were posted by public health organizations (51%). Differences by source are reported, for example, organization posts are more likely to include a link to additional information compared with individual users (P=.03). Conclusions: Conversations about the court-ordered corrective statements are taking place on Twitter and are generally neutral or positive in nature. Public health organizations may be increasing the prevalence of these conversations through social media engagement.

  • A vaccinator gives an MMR shot to a school-age child while the other health care worker supports the child. Source: Image created by the Authors; Copyright: The Authors; URL: https://publichealth.jmir.org/2019/4/e14451; License: Creative Commons Attribution (CC-BY).

    Impact of Training of Primary Health Care Centers’ Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study

    Abstract:

    Background: Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children’s Fund estimates of immunization coverage in Iraq in 2015 revealed a 58% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objective: The goal of this study was to assess the impact of training of primary health care centers’ (PHCs) vaccinators on the quality of ISPs. Methods: This was an interventional study conducted on 10 (18%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, “Managing an Immunization Session”, and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores. Results: A total of 42 vaccinators were trained, with 25 (60%) of them having graduated from technical health institutes, but only 15 (36%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02). Conclusions: The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services.

  • Source: freepik; Copyright: katemangostar; URL: https://www.freepik.com/free-photo/portrait-cheerful-excited-tablet-user-wearing-eyeglasses_4010316.htm#page=1&query=mobile%20apps&position=1; License: Licensed by JMIR.

    Combining Nonclinical Determinants of Health and Clinical Data for Research and Evaluation: Rapid Review

    Abstract:

    Background: Nonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective: This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. Methods: We conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. Results: A total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location. Conclusions: A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.

  • Communicable disease surveillance is part of the activities run by the Temporary Mobile Clinics during the Arbaeenia Mass Gathering, Iraq. Source: Images created by Authors; Copyright: The Authors; URL: http://publichealth.jmir.org/2019/4/e10920/; License: Creative Commons Attribution (CC-BY).

    Syndromic Surveillance of Communicable Diseases in Mobile Clinics During the Arbaeenia Mass Gathering in Wassit Governorate, Iraq, in 2014: Cross-Sectional...

    Abstract:

    Background: Arbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Outbreaks of communicable diseases are a significant risk due to overcrowding and potential food and water contamination. Syndromic surveillance is often used for rapid detection and response to disease outbreaks. Objective: This study was conducted to identify the main communicable diseases syndromes among pilgrims during the Arbaeenia mass gathering in Wassit governorate, Iraq, in 2014. Methods: This cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering. Six communicable disease syndromes were selected: acute watery diarrhea, bloody diarrhea, fever and cough, vomiting with or without diarrhea, fever and bleeding tendency, and fever and rash. A simple questionnaire was used to directly gather basic demographics and the syndromic diagnosis from the attendees. Results: A total of 87,865 patients attended the clinics during the 10-day period, with an average of 219 patients/clinic/day. Approximately 5% (3999) of the attendees had communicable diseases syndromes: of these, 1693 (42%) had fever and cough, 1144 (29%) had acute diarrhea, 1062 (27%) presented with vomiting with/without diarrhea, and 100 (2%) had bloody diarrhea. The distribution of the syndromes did not vary by age or gender. Stool specimen cultures for Vibrio cholerae performed for 120 patients with acute diarrhea were all negative. Conclusions: Syndromic surveillance was useful in determining the main communicable diseases encountered during the mass gathering. Expansion of this surveillance to other governorates and the use of mobile technology can help in timely detection and response to communicable disease outbreaks.

  • People masses during the Arbaeenia religious gathering. Source: Wikimedia Commons; Copyright: Mostafameraji; URL: https://commons.wikimedia.org/wiki/File:The_Arba%27een_Pilgrimage_is_the_world%27s_largest_public_gathering_that_is_held_every_year_in_Iraq._Photo_by_mostafa_meraji_20.jpg; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Real-Time Surveillance of Infectious Diseases and Other Health Conditions During Iraq’s Arbaeenia Mass Gathering: Cross-Sectional Study

    Abstract:

    Background: The most common religious mass gatherings in the Middle East are the Hajj at Mecca in Saudi Arabia, which occurs annually, and the Arbaeenia in Karbala. The importance of developing public health surveillance systems for mass gatherings has been previously emphasized in other reports. Objective: This study aimed to describe the common illnesses and health conditions affecting people during the Arbaeenia mass gathering in Iraq in 2016. Methods: A total of 60 data collectors took part in the field data collection over a period of 11 days, from November 12, 2016 to November 22, 2016. Data were collected from 20 health outlets along the major route from Najaf to Karbala (10 health facilities in each governorate). Two digital forms, the Health Facility Survey and the Case Survey, were used for data collection. Results: A total of 41,689 patients (33.3% female and 66.7% male) visited the 20 healthcare facilities over a period of 11 days from November 12, 2016 to November 22, 2016. More than three quarters of patients (77.5%; n=32,309) were between 20-59 years of age, more than half of patients were mainly from Iraq (56.5%; n=23,554), and about 38.9% (n=16,217) were from Iran. Patients in this study visited these healthcare facilities and presented with one or more conditions. Of a total 41,689 patients, 58.5% (n=24,398) had acute or infectious conditions and symptoms, 33.1% (n=13,799) had chronic conditions, 23.9% (n=9974) had traumas or injuries, 28.2% (n=11,762) had joint pain related to walking long distances, and 0.3% (n=133) had chronic dermatologic conditions. Conclusions: The Arbaeenia mass gathering in 2016 exerted a high burden on the Iraqi health care system. Therefore, efforts must be made both before and during the event to ensure preparedness, proper management, and control of different conditions.

  • Source: Unsplash.com; Copyright: فی عین الله; URL: https://unsplash.com/photos/HjakCLfFGNk; License: Licensed by JMIR.

    Assessment of Temporary Community-Based Health Care Facilities During Arbaeenia Mass Gathering at Karbala, Iraq: Cross-Sectional Survey Study

    Abstract:

    Background: Arbaeenia mass gathering (MG) in Karbala, Iraq, is becoming one of the largest MGs in the world. The health care infrastructure in Iraq is inadequately prepared to serve the health needs of the millions of pilgrims. Objective: This study aimed to describe the temporary health care facilities installed and run by the local community to provide health care services to Arbaeenia pilgrims in Karbala, Iraq. Methods: A survey was conducted in all community-based health care facilities located along part of Najaf to Karbala road within Karbala governorate. A structured questionnaire was answered through an interview with the workers and direct observation. Data were collected on staff profile, type of services provided, use of basic infection control measures, medical equipment, drugs and supplies, and the most commonly encountered medical problems. Results: The total number of health care facilities was 120, staffed by 659 workers. Only 18 (15.0%, 18/120) facilities were licensed, and 44.1% (53/120) of the workers were health professionals. The health services provided included dispensing drugs (370/1692, 21.87%), measuring blood pressure and blood sugar (350/1692, 20.69%), and caring for wounds and injuries (319/1692, 18.85%). The most commonly encountered medical problems were musculoskeletal disorders (97%) and the least were injuries (17%). The drugs available in the clinic were analgesics, drugs for gastrointestinal and respiratory diseases, and antibiotics, with an availability range of 13.3% to 100.0%. Infection control practices for individual protection, environmental sanitation, and medical waste disposal were available in a range of 18.1% to 100.0%. Conclusions: Community-based health care facilities experienced a profound shortage of trained human resources and medical supplies. They can significantly contribute to health services if they are adequately equipped and follow standardized operation procedures.

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