Explore the vast range of titles available.

Much health communication during the COVID-19 pandemic has been designed to persuade people more than to inform them. For example, messages like “masks save lives” are intended to compel people to wear face masks, not to enable them to make an informed decision about whether to wear a face mask or to understand the justification for a mask mandate. Both persuading people and informing them are reasonable goals for health communication. However, those goals can sometimes be in conflict. In this article, we discuss potential conflicts between seeking to persuade or to inform people, the use of spin to persuade people, the ethics of persuasion, and implications for health communication in the context of the pandemic and generally. Decisions to persuade people rather than enable them to make an informed choice may be justified, but the basis for those decisions should be transparent and the evidence should not be distorted. We suggest nine principles to guide decisions by health authorities about whether to try to persuade people.

Background During the COVID-19 response in Norway, many municipalities used the Fiks contact tracing tool (FiksCT) to register positive individuals and follow-up contacts. This tool is based on DHIS2, an open source, web-based platform. In this study we examined if data completeness in FiksCT improved after integration with national registers between May 2020 and September 2021. Methods Data from municipalities using FiksCT was extracted from the Norwegian Emergency Preparedness Register for COVID-19 (Beredt C19). We linked FiksCT data to the Norwegian Surveillance System for Communicable Diseases (MSIS), the National Population Register (FREG), and the Norwegian Vaccine Registry (SYSVAK) using unique identification numbers (ID). Completeness for each variable linked with a national register was calculated before and after integration with these registers. Results Of the 125 municipalities using FiksCT, 87 (69.6%) agreed to share and upload their data to Beredt C19. Data completeness for positive individuals improved after integration with national registers. After integration with FREG, the proportion of missing values decreased from 12.5 to 1.6% for ID, from 4.5 to 0.9% for sex, and from 1.2 to 0.4% for date of birth. Missing values for vaccine type decreased from 63.0 to 15.2% and 39.3–36.7% for first and second dose, respectively. In addition, direct reporting from FiksCT to MSIS increased the proportion of complete records in MSIS (on the selected variables) from 68.6% before to 77.0% after integration. Conclusion The completeness of local contact tracing data can be improved by enabling integration with established national registers. In addition, providing the option to submit local data to the national registers could ease workload and reduce the need to collect duplicate data.

AbstractObjectiveTo evaluate the personal protective effects of wearing versus not wearing surgical face masks in public spaces on self-reported respiratory symptoms over a 14 day period.DesignPragmatic randomised superiority trial.SettingNorway.Participants4647 adults aged ≥18 years: 2371 were assigned to the intervention arm and 2276 to the control arm.InterventionsParticipants in the intervention arm were assigned to wear a surgical face mask in public spaces (eg, shopping centres, streets, public transport) over a 14 day period (mask wearing at home or work was not mentioned). Participants in the control arm were assigned to not wear a surgical face mask in public places.Main outcome measuresThe primary outcome was self-reported respiratory symptoms consistent with a respiratory infection. Secondary outcomes included self-reported and registered covid-19 infection and self-reported sick leave.ResultsBetween 10 February 2023 and 27 April 2023, 4647 participants were randomised of whom 4575 (2788 women (60.9%); mean age 51.0 (standard deviation 15.0) years) were included in the intention-to-treat analysis: 2313 (50.6%) in the intervention arm and 2262 (49.4%) in the control arm. 163 events (8.9%) of self-reported symptoms consistent with respiratory infection were reported in the intervention arm and 239 (12.2%) in the control arm. The marginal odds ratio was 0.71 (95% confidence interval (CI) 0.58 to 0.87; P=0.001) favouring the face mask intervention. The absolute risk difference was −3.2% (95% CI −5.2% to −1.3%; P<0.001). No statistically significant effect was found on self- reported (marginal odds ratio 1.07, 95% CI 0.58 to 1.98; P=0.82) or registered covid-19 infection (effect estimate and 95% CI not estimable owing to lack of events in the intervention arm). Self-reported sick leave was equally distributed between the intervention and control groups (marginal odds ratio 1.00, 0.81 to 1.22; P=0.97).ConclusionWearing a surgical face mask in public spaces over 14 days reduces the risk of self-reported symptoms consistent with a respiratory infection, compared with not wearing a surgical face mask.Trial registrationClinicalTrials.gov NCT05690516.

Increased mortality and morbidity from non-COVID-related causes were seen in many countries,4 with an estimated 15 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021 alone.5 6 The impact on livelihoods and society has also exacerbated social inequities and negatively impacted on mental health,7 while misinformation has undermined trust in health services.8 Throughout the pandemic, national structures with responsibility for the delivery of public health, including national public health institutions (NPHIs), were key for the rapid development of diagnostics, strengthening of surveillance systems, and the synthesis and generation of evidence to inform policy and practice.9 However, NPHIs in many countries have a broad range of responsibilities in addition to communicable disease control, including health promotion and tackling inequality, and there is a risk that these functions will be neglected if political priorities in the recovery phase focus exclusively on health protection. To this end, there has been renewed attention and focus on essential public health functions (EPHFs), with the WHO proposing a unified list of 12 fundamental activities in 2021 (box 1).10Box 1 Unified list of essential public health functions Public health surveillance and monitoring: monitoring and surveillance of population health status, risk, protective and promotive factors, threats to health, and health system performance and service use. Health protection: protecting populations against health threats, including environment and occupational hazards, communicable and non-communicable diseases including mental health conditions, food insecurity, chemical and radiation hazards. During COVID-19, emergency funding for the health response was substantial, and subsequent commitments to strengthen preparedness have eclipsed anything previously available (eg, pandemic fund initiative; the Independent Panel for Pandemic Preparedness and Response; the global accord on pandemic prevention, preparedness and response).14 15 However, the question remains whether the resolve demonstrated during the crisis to be better prepared for future pandemics will be translated into building more resilient health systems that are sustainably funded at levels which can accelerate progress towards universal health coverage and improved population health and well-being, as well as strengthening health security.

The COVID-19 epidemic is the latest evidence of critical gaps in our collective ability to monitor country-level preparedness for health emergencies. The global frameworks that exist to strengthen core public health capacities lack coverage of several preparedness domains and do not provide mechanisms to interface with local intelligence. We designed and piloted a process, in collaboration with three National Public Health Institutes (NPHIs) in Ethiopia, Nigeria and Pakistan, to identify potential preparedness indicators that exist in a myriad of frameworks and tools in varying local institutions. Following a desk-based systematic search and expert consultations, indicators were extracted from existing national and subnational health security-relevant frameworks and prioritised in a multi-stakeholder two-round Delphi process. Eighty-six indicators in Ethiopia, 87 indicators in Nigeria and 51 indicators in Pakistan were assessed to be valid, relevant and feasible. From these, 14–16 indicators were prioritised in each of the three countries for consideration in monitoring and evaluation tools. Priority indicators consistently included private sector metrics, subnational capacities, availability and capacity for electronic surveillance, measures of timeliness for routine reporting, data quality scores and data related to internally displaced persons and returnees. NPHIs play an increasingly central role in health security and must have access to data needed to identify and respond rapidly to public health threats. Collecting and collating local sources of information may prove essential to addressing gaps; it is a necessary step towards improving preparedness and strengthening international health regulations compliance.

The diurnal temperature range (DTR) (or difference between the maximum and minimum temperature within a day) is one of many climate parameters that affects health, agriculture and society. Understanding how DTR evolves under global warming is therefore crucial. Physically different drivers of climate change, such as greenhouse gases and aerosols, have distinct influences on global and regional climate. Therefore, predicting the future evolution of DTR requires knowledge of the effects of individual climate forcers, as well as of the future emissions mix, in particular in high-emission regions. Using global climate model simulations from the Precipitation Driver and Response Model Intercomparison Project (PDRMIP), we investigate how idealized changes in the atmospheric levels of a greenhouse gas (CO2) and aerosols (black carbon and sulfate) influence DTR (globally and in selected regions). We find broad geographical patterns of annual mean change that are similar between climate drivers, pointing to a generalized response to global warming which is not defined by the individual forcing agents. Seasonal and regional differences, however, are substantial, which highlights the potential importance of local background conditions and feedbacks. While differences in DTR responses among drivers are minor in Europe and North America, there are distinctly different DTR responses to aerosols and greenhouse gas perturbations over India and China, where present aerosol emissions are particularly high. BC induces substantial reductions in DTR, which we attribute to strong modeled BC-induced cloud responses in these regions.

Atmospheric aerosols from anthropogenic and natural sources reach the polar regions through long-range transport and affect the local radiation balance. Such transport is, however, poorly constrained in present-day global climate models, and few multi-model evaluations of polar anthropogenic aerosol radiative forcing exist. Here we compare the aerosol optical depth (AOD) at 550 nm from simulations with 16 global aerosol models from the AeroCom Phase II model intercomparison project with available observations at both poles. We show that the annual mean multi-model median is representative of the observations in Arctic, but that the intermodel spread is large. We also document the geographical distribution and seasonal cycle of the AOD for the individual aerosol species: black carbon (BC) from fossil fuel and biomass burning, sulfate, organic aerosols (OAs), dust, and sea-salt. For a subset of models that represent nitrate and secondary organic aerosols (SOAs), we document the role of these aerosols at high latitudes. The seasonal dependence of natural and anthropogenic aerosols differs with natural aerosols peaking in winter (seasalt) and spring (dust), whereas AOD from anthropogenic aerosols peaks in late spring and summer. The models produce a median annual mean AOD of 0.07 in the Arctic (defined here as north of 60 degrees N). The models also predict a noteworthy aerosol transport to the Antarctic (south of 70 degrees S) with a resulting AOD varying between 0.01 and 0.02. The models have estimated the shortwave anthropogenic radiative forcing contributions to the direct aerosol effect (DAE) associated with BC and OA from fossil fuel and biofuel (FF), sulfate, SOAs, nitrate, and biomass burning from BC and OA emissions combined. The Arctic modelled annual mean DAE is slightly negative (-0.12 W m(exp. -2), dominated by a positive BC FF DAE in spring and a negative sulfate DAE in summer. The Antarctic DAE is governed by BC FF. We perform sensitivity experiments with one of the AeroCom models (GISS modelE) to investigate how regional emissions of BC and sulfate and the lifetime of BC influence the Arctic and Antarctic AOD. A doubling of emissions in eastern Asia results in a 33 percent increase in Arctic AOD of BC. A doubling of the BC lifetime results in a 39 percent increase in Arctic AOD of BC. However, these radical changes still fall within the AeroCom model range.

Atmospheric aerosols and greenhouse gases affect cloud properties, radiative balance and, thus, the hydrological cycle. Observations show that precipitation has decreased in the Mediterranean since the beginning of the 20th century, and many studies have investigated possible mechanisms. So far, however, the effects of aerosol forcing on Mediterranean precipitation remain largely unknown. Here we compare the modeled dynamical response of Mediterranean precipitation to individual forcing agents in a set of global climate models (GCMs). Our analyses show that both greenhouse gases and aerosols can cause drying in the Mediterranean and that precipitation is more sensitive to black carbon (BC) forcing than to well-mixed greenhouse gases (WMGHGs) or sulfate aerosol. In addition to local heating, BC appears to reduce precipitation by causing an enhanced positive sea level pressure (SLP) pattern similar to the North Atlantic Oscillation-Arctic Oscillation, characterized by higher SLP at midlatitudes and lower SLP at high latitudes. WMGHGs cause a similar SLP change, and both are associated with a northward diversion of the jet stream and storm tracks, reducing precipitation in the Mediterranean while increasing precipitation in northern Europe. Though the applied forcings were much larger, if forcings are scaled to those of the historical period of 1901-2010, roughly one-third (31+/-17%) of the precipitation decrease would be attributable to global BC forcing with the remainder largely attributable to WMGHGs, whereas global scattering sulfate aerosols would have negligible impacts. Aerosol-cloud interactions appear to have minimal impacts on Mediterranean precipitation in these models, at least in part because many simulations did not fully include such processes; these merit further study. The findings from this study suggest that future BC and WMGHG emissions may significantly affect regional water resources, agricultural practices, ecosystems and the economy in the Mediterranean region.

Observational evidence shows that Sahel summer precipitation has experienced a considerable increase since the 1980s, coinciding with significant diverging trends of increased sulfate emissions in Asia and decreased emissions in Europe (dipole pattern of aerosols between Asia and Europe). The decrease in European sulfate aerosols has substantial effects on the Sahel summer precipitation increase, but the corresponding effect of increased Asian sulfate is unknown. Multi-model simulations in the Precipitation Driver and Response Model Intercomparison Project (PDRMIP) show, compared to decreased European aerosols, that increased Asian aerosols similarly enhance the Sahel summer precipitation but with different large-scale atmospheric circulation changes. Further analysis of the Sixth Coupled Model Intercomparison Project (CMIP6) simulations under historical attribution and various emission scenarios reinforces the results about the climate impacts of anthropogenic aerosols and suggests that in future scenarios with strong international cooperation and rapid climate mitigations (SSP2-45), the Sahel drought will be intensified likely due to the decline in Asian aerosol emissions. Our results suggest that Asian anthropogenic aerosols are likely a non-negligible driver of the recent recovery in Sahel precipitation amounts.