Misinformation making a disease outbreak worse: Outcomes compared for influenza, monkeypox and norovirus

Health misinformation can exacerbate infectious disease outbreaks. Especially pernicious advice could be classified as “fake news”: manufactured with no respect for accuracy and often integrated with emotive or conspiracy-framed narratives. We built an agent-based model that simulated separate but linked circulating contagious disease and sharing of health advice (classified as useful or harmful). Such advice has potential to influence human risk-taking behavior and therefore the risk of acquiring infection, especially as people are more likely in observed social networks to share bad advice. We test strategies proposed in the recent literature for countering misinformation. Reducing harmful advice from 50% to 40% of circulating information, or making at least 20% of the population unable to share or believe harmful advice, mitigated the influence of bad advice in the disease outbreak outcomes. How feasible it is to try to make people “immune” to misinformation or control spread of harmful advice should be explored

Rapid risk assessment for communicable diseases in humanitarian emergencies: validation of a rapid risk assessment tool for communicable disease risk in humanitarian emergencies

Background: Communicable diseases pose a significant risk in humanitarian emergencies. This paper reports on the development and validation of a rapid risk assessment tool for communicable diseases in humanitarian emergencies. Methods: We developed a tool assessing the 20 most critical risk factors for disease outbreaks in humanitarian emergencies. This paper reports on the development and validation of the tool consisting of face and content validation with key informant interviews (n=25) and a reliability validation (inter-rater reliability test) with groups of volunteer aid workers (n=4 groups). Findings: Face and content validation confirmed the importance of rapid risk assessment methods and the suitability and usefulness of the developed tool. Participants without prior health protection experience were able fill in the tool with an accuracy of 81·25% (SD 77·17-85·33) across both scenarios (82·35% and 80·15% for scenarios 1 and 2 respectively). Errors primarily occurred when judging the severity of risk factors that could not be captured quantitatively. Revisions of the tool have been made based on the validation process. Conclusion: The tool was successfully validated for the use in different humanitarian emergency settings and is suitable for users with and without experience in health protection

An agent-based model about the effects of fake news on a norovirus outbreak

Concern about health misinformation is longstanding, especially on the Internet. Using agent-based models, we considered the effects of such misinformation on a norovirus outbreak, and some methods for countering the possible impacts of ‘good’ and ‘bad’ health advice. The work explicitly models spread of physical disease and information (both online and offline) as two separate but interacting processes. The models have multiple stochastic elements; repeat model runs were made to identify parameter values that most consistently produced the desired target baseline scenario. Next, parameters were found that most consistently led to a scenario when outbreak severity was clearly made worse by circulating poor quality disease prevention advice. Strategies to counter ‘fake’ health news were tested. A 10% reduction in circulating bad advice or making at least 20% of people fully resistant to believing in and sharing bad health advice were effective thresholds to counteract the negative impacts of bad advice during a norovirus outbreak. How feasible it is to achieve these targets within communication networks (online and offline) should be explored

(Re-) Conceptualising vulnerability as a part of risk in global health emergency response: Updating the pressure and release model for global health emergencies

Vulnerability has become a key concept in emergency response research and is being critically discussed across several disciplines. While the concept has been adopted into global health, its conceptualisation and especially its role in the conceptualisation of risk and therefore in risk assessments is still lacking. This paper uses the risk concept pioneered in hazard research that assumes that risk is a function of the interaction between hazard and vulnerability rather than the neo-liberal conceptualisation of vulnerability and vulnerable groups and communities. By seeking to modify the original pressure and release model, the paper unpacks the representation or lack of representation of vulnerability in risk assessments in global health emergency response and discusses what benefits can be gained from making the underlying assumptions about vulnerability, which are present whether vulnerability is sufficiently conceptualised and consciously included or not, explicit. The paper argues that discussions about risk in global health emergencies should be better grounded in a theoretical understanding of the concept of vulnerability and that this theoretical understanding needs to inform risk assessments which implicitly used the concept of vulnerability. By using the hazard research approach to vulnerability, it offers an alternative narrative with new perspectives on the value and limits of vulnerability as a concept and a tool

Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: A qualitative systematic review

Background: Communicable diseases are a major concern during complex humanitarian emergencies. Descriptions of risk factors for infectious disease outbreaks are often non-specific and yet not easily generalizable to similar situations. This review attempts to capture relevant evidence and explore whether it is possible to better generalize the role of risk factors and the risk factor cascades these factors may form. Methods: A systematic search of the key databases and websites was conducted. Search terms included terms for complex humanitarian emergencies (per United Nations Office for the Coordination of Humanitarian Affairs definition) and terms for communicable diseases. Due to the types of evidence found, a thematic synthesis was conducted. Results: 26 articles met inclusion criteria. Key contextual risk factors include crowded conditions, forced displacement, poor quality shelter, poor water, sanitation and hygiene conditions, lack of health care facilities and lack of adequate surveillance. Most identified risk factors do not relate to specific diseases, or are specific to a group of diseases such as diarrheal diseases and not to a particular disease within that group. Risk factors are often listed in general terms but are poorly evidenced, not contextualized and not considered with respect to interaction effects in individual publications. The high level of the interrelatedness of risk factors became evident, demonstrating risk factor cascades that are triggered by individual risk factors or clusters of risk factors. Conclusions: Complex humanitarian emergencies pose a significant threat to public health. More rigorous research on the risk of communicable disease outbreaks in complex humanitarian emergencies is needed, both from a practitioner and from an academic point of view

Age, sex and other correlates with active travel walking and cycling in England: Analysis of responses to the Active Lives Survey 2016/17

Active travel (walking or cycling for transport) can generate personal and environmental benefits. We determined the frequency of participation in walking or cycling active travel by age and sex, as well as used multivariate analysis to find correlations with many other factors using a large cross-sectional 2016/17 survey of people living in England. Walking and cycling active travel were explored separately. Most respondents reported no active travel, but at least 25% of people under age 45 met activity recommendations only from active travel. Otherwise, (unlike other types of physical activity) active travel declined consistently with increased age. Men reported much more cycling active travel than women, who were more likely to do any active travel walking and therefore more likely to meet activity guidelines from just active travel walking. Lower levels of disability, fewer children in household, and working full time increased active travel. Season was sometimes relevant. BMI, personal-effectiveness, deprivation and rurality had mixed relationships with types of active travel. Understanding differences in correlates for cycling vs. walking active travel could help tailor local promotion programmes for each. The analysis suggests that motivators and barriers for active travel greatly by age

Factors that influence treatment seeking expectations in response to infectious intestinal disease: original survey and multinomial regression

Background: Infectious intestinal disease affects 25% of the UK population annually; 1 in 50 affected people consult health professionals about their illness. Aims: We tested if anticipated treatment-seeking decisions for suspected infectious intestinal disease could be related to emotional response, tolerance of symptoms, or beliefs about the consequential benefits and harms of seeking treatment (or not). Methods: Questionnaire survey of adults living in the UK with statistical analysis of responses. A vignette was presented about a hypothetical gastrointestinal illness. People stated their emotional reactions, expected actions in response and beliefs about possible benefits or harms from seeking treatment (or not getting treatment). Multinomial regression looked for predictors of anticipated behaviour. Results: People were inclined to consult a GP when they believed that seeking treatment would be beneficial and that its absence would be harmful. Seeking treatment was less anticipated if the condition was expected to improve quickly. Respondents were also more likely to consult if they strongly disliked fever or headache, and/or if the illness made them feel anxious or angry. Treatment-seeking (or lack of it) was not linked to harms from treatment-seeking, other specific symptoms and emotional responses. Conclusion: It was possible to link anticipated treatment-seeking behaviour to specific factors: expected prognosis, perceived benefits of seeking treatment, some emotions and some specific symptoms. (C) 2019 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences

Healthy Ageing in Europe:Prioritizing Interventions to improve Health Literacy

Background: Health literacy (HL) is low for 40-50% of the population in developed nations, and is strongly linked to many undesirable health outcomes. Older adults are particularly at risk. The Irohla project systematically created a large inventory of HL interventions targeting adults age 50+, to support practical production of policy and practice guidelines for promoting health literacy in European populations. Methods: We comprehensively surveyed international scientific literature, grey literature and other sources (published 2003+) for implemented HL interventions that involved older adults. Studies were screened for eligibility criteria and further selected for aspects important in European public health policy, including priority diseases, risk factors and vulnerable target groups. Interventions were prioritised using a multiple criteria tool to select final interventions that also featured strong evidence of efficacy and a broad range of strategies. Results: From nearly 7000 written summaries, 1097 met inclusion criteria, of which 233 were chosen for scoring and ranking. Of these, 7 had the highest multi-criteria scores. Eight more articles were selected based on rounded criteria including a high multi-criteria score as well as elements of innovation. Final selections were 18 articles describing 15 programmes. Conclusions: 15 promising intervention projects that feature strong evidence of efficacy among important diseases or risk factors and vulnerable groups, or that had success with elements of innovation were identified. These programmes have multiple positive attributes which could be used as guidance for developing innovative intervention programmes to trial on European older adults. They provide evidence of efficacy in addressing high priority diseases and risk factors