Management Of Communicable Diseases Research Articles

Health State and Barriers to the Provision of Health Services among Forcibly Displaced Myanmar Nationals in Bangladesh

Background: Forcibly displaced Myanmar nationals (FDMNs) are one of the most persecuted minorities groups, suffering from an abundance of health issues. They are exposed to a wide range of stressful events that are associated with adverse health consequences, which leads to decreased life expectancy due to increased morbidity and mortality. Methodology: A descriptive cross-sectional survey among conveniently selected 203 healthcare workers (HCWs) to assess the health state and barriers to the provision of health services to FDMNs in the Kutupalong and Balukhali camps at Ukhiya Upazilla, Cox's Bazar. Data were collected by face-to-face interviews by using a semi-structured questionnaire. Results: The mean age of the HCW was 29.2±3.6 years and mean service duration was 5.8±4.1 months. Most of the health facilities provided treatment for CDs (62.5%) and NCDs (80.0%). About one-third of the facilities had no laboratory facilities for diagnosing CDs (32.2%) and NCDs (40.0%). More than half of HCCs (55.0%) were maintain sterilization processes, such as boiling (90.9%), chemical components (45.5%) and an autoclave machine (13.6%). One-fourth of the HCWs (25.6%) get training during their joining times and above two-thirds of the HCWs (69.5%) received training after joining their service. The most frequently cited challenges faced during the provision of health services were transportation barriers (96.4%), language barriers (87.2%), scarcity of drugs (67.5%), vague disease histories (60.9%), unfavorable weather (59.4%) and electricity problems (44.7%). Conclusion: This study suggests that an organized primary healthcare service, specially designed for communicable and non-communicable disease prevention and management is necessary to improve health condition of FDMNs. Eastern Med Coll J. July 2023; 8 (2): 33-39

Patients and Health Professionals' Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review.

This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals' perceptions of PHC. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals' perspectives on Primary Healthcare in KSA. A total of 38 publications were selected for the scoping review. Several studies examined patients' overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals' perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals' job satisfaction and burnout (n=6). Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician-patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.

Engagement of private health sector in communicable disease and immunization programmes in Pakistan.

In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision. To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage. We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes. Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government. We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases.

A cross-sectional study on adherence to treatment and life-style modifications in hypertensive patients attending the urban health centre of a teaching hospital in Hyderabad.

The burden of hypertension is expected to double by 2025 and adherence to treatment has a key role in disease outcome. The World Health Organization defines adherence as the extent to which a person's behaviour of taking medication, following a diet and/or exceeding life-style changes, corresponds with the agreed recommendations of health care providers. The study tries to assess the level of adherence to medication and life-style modifications in hypertensive patients. It is a cross-sectional study among patients attending urban health centres of a teaching hospital. The study population included all hypertensive patients above 30 years. Based on the prevalence of non-adherence to hypertensive medication, 70% of the sample size is calculated as 182. A Morisky medication adherence scale is used to find adherence to treatment. Life-style modification was also assessed. Scoring was done based on their adherence to treatment and life-style modifications and quantified. The mean age of the study population was 55 years (38-80 years). In total, 58.33% were illiterate and 21% were retired from work. Around 87.5% had to spend money on medication. Mean weight, height, hip and waist circumference was 66 kg, 157 cm, 108 cm and 100 cm, respectively. Mean BMI was 26.6. Prevalence of good adherence to medication was 129 (70.83%) and that of good life-style modifications was 127 (70.17%). The adherence to medication and life-style modification was satisfactory. Family physicians have a key role in Non communicable diseases (NCD) management and should focus on ongoing education programmes for treatment adherence and life-style modifications at a community level, and grass-root level workers should conduct regular follow-up activities.

Comparative Analysis of the Healthcare Delivery System in China and Nigeria: A Review

ObjectivesEquitable distribution of quality healthcare services among different subpopulations in China and Nigeria is inconsistent. This necessitates an examination of potential avenues for improving healthcare provision in both countries. A comparative analysis of both health systems was carried out to provide insights into the progress each nation has made, the obstacles they face, and areas both countries can learn from each other. MethodsWe assessed 3 key dimensions of these systems using the Hsiao analytical framework. First, we scrutinized the policy levers of the health systems. Next, we evaluated intermediate outcomes, such as access to healthcare and the quality of care. Lastly, we assessed the extent to which the health systems achieve their ultimate goals, including improving citizen health status and enhancing overall patient satisfaction with the healthcare services. ResultsChina surpasses Nigeria in terms of better birth outcomes, life expectancy, and management of communicable diseases. Both countries offer minimal protection against out-of-pocket spending on medical bills, which consequently exacerbates the poverty rate. ConclusionsChina surpasses Nigeria in every health metrics. However, Nigeria's healthcare system offers services to a larger proportion of its populace because of the involvement of the private sector in healthcare delivery. Both countries continue to experience significant challenges, such as limited access to healthcare services in rural areas and overall patient dissatisfaction with the quality of care provided.

Factors associated with pediatric febrile illnesses in 27 countries of Sub-Saharan Africa

BackgroundEvidence on the relative importance of various factors associated with febrile illness in children and their heterogeneity across countries can inform the prevention, identification, and management of communicable diseases in resource-limited countries. The objective of the study is to assess the relative significance of factors associated with childhood febrile illness in 27 sub-Saharan African countries.MethodsThis cross-sectional study of 298,327 children aged 0 to 59 months assessed the strengths of associations of 18 factors with childhood fevers, using Demographic and Health Surveys (2010-2018) from 27 sub-Saharan African countries. A total of 7 child level factors (i.e., respiratory illness, diarrhea, breastfeeding initiation; vitamin A supplements; child's age; full vaccination; sex), 5 maternal factors (maternal education; maternal unemployment; antenatal care; maternal age, and maternal marriage status) and 6 household factors (household wealth; water source; indoor pollution, stool disposal; family planning needs and rural residence) were assessed. Febrile illness was defined as the presence of fever in 2 weeks preceding the survey.ResultsAmong the 298,327 children aged 0 to 59 months included in the analysis, the weighted prevalence of fever was 22.65% (95% CI, 22.31%-22.91%). In the pooled sample, respiratory illness was the strongest factor associated with fever in children (adjusted odds ratio [aOR], 5.46; 95% CI, 5.26-5.67; P < .0001), followed by diarrhea (aOR, 2.96; 95% CI, 2.85-3.08; P < .0001), poorest households (aOR, 1.33; 95% CI,1.23-1.44; P < .0001), lack of maternal education (aOR, 1.25; 95% CI, 1.10-1.41; P < .0001), and delayed breastfeeding (aOR, 1.18; 95% CI, 1.14-1.22; P < .0001. Febrile illnesses were more prevalent in children older than >6 months compared to those 6 months and younger. Unsafe water, unsafe stool disposal, and indoor pollution were not associated with child fever in the pooled analysis but had a large country-level heterogeneity.ConclusionsMajor causes of fevers in sub-Saharan Africa could be attributed to respiratory infections and possibly viral infections, which should not be treated by antimalarial drugs or antibiotics. Point-of-care diagnostics are needed to identify the pathogenic causes of respiratory infections to guide the clinical management of fevers in limited-resource countries.

ENDIG: Interactive Geovisualization of Surveillance Systems for Notifiable Diseases in Europe

Abstract. National disease surveillance systems are among the most important tools for the observation and management of communicable diseases. They help to detect outbreaks and monitor the success of public health responses. The European Union aims to harmonize the European landscape of disease surveillance systems for better interoperability across the member states. However, the progress of these efforts is difficult to assess, as information is available in different formats, written reports or numerous tables for individual diseases. Here we present ENDIG, an interactive geovisualization tool, that makes the existing information easily accessible to end users and researchers in public health and adjoining disciplines. ENDIG allows for convenient exploration about the development of national disease surveillance systems for more than 60 diseases in the EU member states, as well as Iceland, Liechtenstein and Norway, over the course of the past 7 years (2015–2021).

GC-MS Analysis, Antiglycation, Antioxidant and Anti-lipid Peroxidation Activities of Harungana madagascariensis Methanolic Stem Bark Extract

Plants’ natural products make excellent lead for the development of new drugs used for prevention, management and treatment of communicable and non-communicable diseases. The specific aim of the study was to investigate the antioxidant and antiglycation activities of Harungana madagascariensis methanolic stem bark extract. The active compounds present in the plant were extracted using methanol by maceration and resulting extract was subjected to phytochemical screening, antioxidant and antiglycation analysis. The extract was fractioned on silica gel to isolate the antioxidant compounds domiciled in the extract and fractions were identified by bioautography. The H. madagascariensis methanolic stem bark extract showed the presence of tannins, alkaloids, saponins, steroids and flavonoids. From the antioxidant assays, the extract scavenged 2,2-diphenyl-1-picryhydrazyl (DPPH) and nitric oxide radicals, inhibited lipid peroxidation in a dose dependent manner showing IC50 higher than ascorbic acid while it inhibited albumin glycation with IC50 lower than ascorbic acid. From the 12 fractions obtained only 7 fractions showed antioxidant activity and quercetin, flavone, 6-hydroxyflavone, ferulic and o-coumaric acid were inferred. From the GC-MS analysis, fatty acids and their esters, terpenoids and steroids were identified such as Hexadecanoic acid ethyl ester (6.53 %), 9,12,15-Octadecatrienoic acid (5.92 %), 9,12,15-Octadecatrienoic acid methyl ester (0.95 %), vitamin E (1.22 %), phytol (3.87 %), squalene (1.66 %) and Pregn-5-en-3-ol, 21-bromo-20-methyl-(3.beta.)- (1.94 %). In conclusion, H. madagascariensis methanolic stem bark extract possessed antioxidant and antiglycation activities, thus, can be used for new drug development to reduce or combat oxidative stress related diseases in humans. HIGHLIGHTS The methanolic stem bark extract of Harungana madagascariensis exhibited strong antiglycation and antioxidant activities Antioxidant compounds including flavonoids and phenolic acids (quercitin, flavone, 6-hydroxyflavone, ferulic and o-coumaric acid), terpenoids (vitamin E, phytol and squalene) fatty acids and their esters were found in the extract The stem bark extract of Harungana madagascariensis could be used as a source of antiglycation and antioxidant activity for new drug development in preventing oxidative stress related diseases and diabetic complications GRAPHICAL ABSTRACT

Special Section: Consumer Healthcare Technologies in Smart Cities

This Special Issue takes an in-depth look into the recent developments in consumer technology that blend into everyone's health and safety in a smart city environment. Smart wearables, such as watches and wristbands, have been widely used in health monitoring in recent years. These connected consumer electronics devices not only provide indicative information for consumers' health management, but also play a vital role in communicable disease management and prevention. In the context of consumer technology as part of a smart city infrastructure, wireless communication and sensing technologies have evolved substantially over the past decade and have seen an accelerating trend of technical advances, particularly in the consumer healthcare sector. Optimization techniques have been developed significantly and smart devices have become more efficiently designed and implemented both for the betterment of individual consumers and health service providers.

Integrative medicine: The future of Indian health care

Integrative medicine is a patient-focused healing-oriented medicine selectively incorporating elements of complementary (chiropractic therapy, yoga, and meditation) medicine and alternative medicine (drugs, surgery, and lifestyle changes) evidence-based and experience-based therapy into comprehensive treatment methods. It is a form of health care that seeks to understand the individual as a whole (body, mind, and spirit) including all aspects of lifestyle, and use all appropriate therapeutic approaches within a framework that focuses on health, the therapeutic relationship, and the whole person. In recent years, integrative medicine has developed into a distinct medical specialty as more and more health-care professionals have embraced it as an approach to patient care and the public has also become more educated and conscious enough about its foundational concepts. As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine combines mainstream medical therapies and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness. The term integration is used to express the formalization and official incorporation of traditional medicine into the National Health Services.[1] India is a reservoir of the antiquity of health practices supported by a strong foundation of indigenous traditional knowledge. The health needs of modern society are enormous and no single established and approved health-care system can address all the needs. Hence, became evident the need for a new collaborative regimen to guide health interventions and programs. India is backed with a rich heritage of indigenous knowledge coupled with a robust infrastructure and skilled workforce in modern medicine serving as a fertile land for medical pluralism to bloom. The integrative approach has thus proved effective in formulating strategies for healthy senescence, promoting self-management, and managing health-care expenditures. The Government of India has also promoted the integrative approach by mainstreaming Ayurveda and Yoga (AYUSH) with the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke in 2015 by the Ministry of AYUSH and Central Council of Research in Ayurvedic Sciences in collaboration with the Directorate General of Health Services with the objective to reduce drug dependency in chronic cases through yoga practices and Ayurveda and lifestyle changes. The application of Ayurveda as an adjuvant therapy has been used to reduce morbidities and associated ailments, to incorporate yoga sessions among admitted patients during their stay at the hospital for enhancing metabolism and positive physical and mental health. The National Health Policy 2017 advocates the improvement of health status through coordinated policy implementation in all sectors. The WHO Global Report on Traditional and Complementary Medicine 2019 reiterates the need for integrating the best of traditional and complementary medicine and that of conventional medicine to tackle the unique health challenges posed in the 21st century.[23] Scope of Integrative Medicine and Ways Forward Integrative health recognizes that modern systems and AYUSH systems have their own strengths and limitations in a way that they complement each other. The strengths of modern medicine include emergency management, anesthesia, surgical management, antimicrobial therapy, and management of communicable and noncommunicable diseases. In contrast, the conventional systems of traditional Indian health practices have strengths in preventive and promotive health, dietetics, advocacy of moral conduct, yoga, etc., An integrative approach incorporating the strengths of different systems of medicine provides scope for holistic and comprehensive care. Integrative Medicine is Not… Unfortunately, integrative medicine has often been mislabeled as mixopathy necessitating the need for the professions and consumers to distinguish between the two. Understanding the reason for integration is a pivotal step in preserving, protecting, and rejuvenating health along with effective, ethical, and safe management of different ailments. Integration aims to bring together the best practices of each system without losing their identity. In contrast, mixopathy is the unethical practice of self-perpetuated and self-convenient methods by unqualified people, which is not supported by any evidence. A system of integrative medicine can thus avoid the ballooning of health-care expenditure and provide a continuum of care and help us realize the Sustainable Development Goal 3 of universal health care.[3]

The lessons of COVID-19 pandemic for communicable diseases surveillance system in Kurdistan Region of Iraq

ObjectivesThis study aimed to determine the opportunities of and barriers to communicable diseases surveillance system (CDSS) during the COVID-19 pandemic and the extent to which the disease integrated into the CDSS in the Kurdistan region of Iraq. Study designA descriptive qualitative approach was applied. MethodsWe conducted seven semi-structured interviews and seven interviewee in a focus group discussion (FGD) with purposefully identified Key Informants (KI) from June to December 2020. All interviews were digitally recorded and transcribed verbatim. We adopted a mixed deductive-inductive approach for thematic data analysis, facilitated by using MAXQDA20 software for data management. ResultsAlthough the CDSS was considered appropriate and flexible, the COVID-19 was interpreted not to be integrated into the system due to political influence. The main concerns regarding core and support activities were the lack of epidemic preparedness, timeliness, and partial cessation of training and supervision during the pandemic. The existence of reasonable surveillance infrastructure, i.e., trained staff, was identified as an opportunity for improvement. The main challenges include staff deficiency, absence of motivation and financial support for present staff, scarce logistics, managerial and administrative issues, and lack of cooperation, particularly among stakeholders and surveillance staff. ConclusionOur findings revealed that the CDSS in the Kurdistan region requires substantial enhancement in epidemic preparedness, strengthening human resources, and logistics. the system can be developed by fostering meaningful intersectoral collaboration. We advocate that the health authorities and policy-makers prioritise the surveillance and effective management of communicable diseases.

Changing Teaching Trends During Covid-19 And Its Impact On Ent Residency Program In India: A Cross Sectional Study.

The online version contains supplementary material available at 10.1007/s12070-022-03377-7.

1172. Factors Associated With Febrile illnesses in Children in 27 Countries of Sub-Saharan Africa

Abstract Background Evidence on the relative importance of various factors associated with febrile illness in children and their heterogeneity across countries can inform the prevention, identification, and management of communicable diseases in resource-limited countries. Heatmap of odds ratios. Country-Specific Odds Ratios for 18 Factors Associated With Febrile illness From Multivariable Adjusted Models. Methods This cross-sectional study of 298 327 children aged 0 to 59 months assessed the strengths of associations of 18 factors with childhood fevers, using Demographic and Health Surveys (2010-2018) from 27 sub-Saharan African countries. A total of 7 direct factors (i.e., respiratory illness, diarrhea, breastfeeding initiation; vitamin A supplements; child's age; full vaccination; sex) and 11 indirect factors (household wealth; maternal education; maternal unemployment, water source; indoor pollution, stool disposal; antenatal care; family planning needs; maternal age, rural residence, and maternal marriage status) were assessed. Febrile illness was defined as the presence of fever in 2 weeks preceding the survey. Results Among the 298 327 children aged 0 to 59 months included in the analysis, the weighted prevalence of fever was 22.65% (95% CI, 22.31%-22.91%). In the pooled sample, respiratory illness was the strongest factor associated with fever in children (adjusted odds ratio [aOR], 5.46; 95% CI, 5.26-5.67; P &amp;lt; .0001), followed by diarrhea (aOR, 2.96; 95% CI, 2.85-3.08; P &amp;lt; .0001), poorest household wealth (aOR, 1.33; 95% CI,1.23-1.44; P &amp;lt; .0001), lack of maternal education (aOR, 1.25; 95% CI, 1.10-1.41; P &amp;lt; .0001), and delayed breastfeeding (aOR, 1.18; 95% CI, 1.14-1.22; P &amp;lt; .0001. Febrile illnesses were more prevalent in older children &amp;gt;6 months than those 6 months and younger. Conclusion In this study, respiratory illness, diarrhea, and socioeconomic conditions were the strongest factors associated with fevers in children of sub-Saharan Africa. Major causes of fevers in sub-Saharan Africa may mostly be attributed to respiratory infections and possibly viral—that may not be treated by antimalarial or antibiotics. Point of care diagnostics are needed to identify the pathogenic causes of respiratory infections to guide the clinical management of fevers in limited-resource countries. Disclosures All Authors: No reported disclosures.

Impact of COVID-19 on non-communicable disease management services at selected government health centers in Addis Ababa, Ethiopia.

The global pandemic of COVID-19 forced the world to divert resources and asked the public to shelter-in-place, so the diagnosis surveillance system and management of non-communicable diseases has become more challenging. To identify the impact of COVID-19 on non-communicable diseases management services at government health centers in Addis Ababa, Ethiopia. Health facility based cross-sectional study was conducted from August to September, 2020. A total of 30 health centers were included in this study. Bivariate and multiple logistic regression models were used to assess association between the outcome and independent variables. The majority, 24 (80%), of the study participants perceived that the COVID-19 pandemic severely disrupted the non-communicable disease management services. There was a statistically significant association between a decrease in outpatient volume at non communicable disease (NCD) management services (25 (83.3%), P-value: 0.006), closure of population level screening programs of NCDs (22 (73.3%), P-value: 0.007), and closure of disease specific NCD clinics and the occurrence of the COVID-19 pandemic (23 (76.7%), P-value: 0.013). The most critical health-care services for non-communicable diseases management were severely disrupted by the COVID-19 pandemic. Therefore, during public health emergencies, policymakers should ensure continuation of critical clinical services and inform the public about proper service utilization.

The Role of Nutrition on Meta-inflammation: Insights and Potential Targets in Communicable and Chronic Disease Management.

Purpose of ReviewChronic low-grade inflammation may contribute to the onset and progression of communicable and chronic diseases. This review examined the effects and eventual mediation roles of different nutritional factors on inflammation.Recent FindingsPotential nutritional compounds influencing inflammation processes include macro and micronutrients, bioactive molecules (polyphenols), specific food components, and culinary ingredients as well as standardized dietary patterns, eating habits, and chrononutrition features. Therefore, research in this field is still required, taking into account critical aspects of heterogeneity including type of population, minimum and maximum intakes and adverse effects, cooking methods, physiopathological status, and times of intervention. Moreover, the integrative analysis of traditional variables (age, sex, metabolic profile, clinical history, body phenotype, habitual dietary intake, physical activity levels, and lifestyle) together with individualized issues (genetic background, epigenetic signatures, microbiota composition, gene expression profiles, and metabolomic fingerprints) may contribute to the knowledge and prescription of more personalized treatments aimed to improving the precision medical management of inflammation as well as the design of anti-inflammatory diets in chronic and communicable diseases.

From pandemic to endemic: A comparison of first, second, and third waves of COVID-19 for applicability in communicable disease management

Background: The COVID-19 pandemic created pressure on healthcare systems worldwide. Hospitals have developed strategies to efficiently address the demand for inpatient beds.Objective: This paper examines changes in length of stay at a southern academic medical center and documents the intervention efforts aimed at providing high quality care and reduced lengths of stay.Methods: Data include 3,279 patients receiving inpatient treatment for COVID-19 between March 29, 2020, and October 31, 2021. The study data mirrors the three major waves of COVID-19 pandemic in Alabama as reported in Johns Hopkins’ coronavirus resource center. To account for the chronological change in care processes, we interviewed Hospitalists and categorized the interventions by month, June 2020-February 2021. We examined changes in average length of stay and differences in sociodemographic characteristics among the three waves using ANOVA and chi-square tests. Socio demographic factors analyzed include age, gender, race/ethnicity, marital status, and insurance.Results: The average length of stay, ICU admissions, and 30-day readmissions each decreased in the second and third waves compared to the first wave. Statistically significant differences were found for ICU admission, age, and insurance for hospitalized patients among waves.Conclusions: This study contributes to the COVID-19 literature by providing the chronological evolution of ALOS and interventions during the pandemic by highlighting the case of a southern academic medical center.

Predicting the Risk Factors Associated With Severe Outcomes Among COVID-19 Patients-Decision Tree Modeling Approach.

BackgroundThe COVID-19 pandemic has seen a large surge in case numbers over several waves, and has critically strained the health care system, with a significant number of cases requiring hospitalization and ICU admission. This study used a decision tree modeling approach to identify the most important predictors of severe outcomes among COVID-19 patients.MethodsWe identified a retrospective population-based cohort (n = 140,182) of adults who tested positive for COVID-19 between 5th March 2020 and 31st May 2021. Demographic information, symptoms and co-morbidities were extracted from a communicable disease and outbreak management information system and electronic medical records. Decision tree modeling involving conditional inference tree and random forest models were used to analyze and identify the key factors(s) associated with severe outcomes (hospitalization, ICU admission and death) following COVID-19 infection.ResultsIn the study cohort, nearly 6.37% were hospitalized, 1.39% were admitted to ICU and 1.57% died due to COVID-19. Older age (>71Y) and breathing difficulties were the top two factors associated with a poor prognosis, predicting about 50% of severe outcomes in both models. Neurological conditions, diabetes, cardiovascular disease, hypertension, and renal disease were the top five pre-existing conditions that altogether predicted 29% of outcomes. 79% of the cases with poor prognosis were predicted based on the combination of variables. Age stratified models revealed that among younger adults (18–40 Y), obesity was among the top risk factors associated with adverse outcomes.ConclusionDecision tree modeling has identified key factors associated with a significant proportion of severe outcomes in COVID-19. Knowledge about these variables will aid in identifying high-risk groups and allocating health care resources.

Retrospective Cohort Study Examining the Correlates of Reported Lifetime Stimulant Use in Persons Diagnosed With Infectious Syphilis in Alberta, Canada, 2018 to 2019.

We sought to examine the correlates for stimulant use in persons diagnosed with infectious syphilis during an outbreak in Alberta to help guide public health interventions. Infectious syphilis data were extracted from the Communicable Disease and Outbreak Management database from January 1, 2018, to December 31, 2019. Behavioral, demographic, and lifetime reported stimulant use data were obtained. Descriptive analyses and logistic regression were performed for 3 subpopulations (gay, bisexual, and other men who have sex with men; men who have sex with women; and women). Of 3627 individuals diagnosed with infectious syphilis, 23.9% (n = 867) cases were not interviewed for substance use and were removed from further analysis. Of the remaining 2759 people, 41.8% (n = 1153) self-reported lifetime stimulant use. Gay, bisexual, and other men who have sex with men reported stimulant use less often than women (24.6% vs. 44.1%; P < 0.0001) and men who have sex with women (24.6% vs. 46.2%; P < 0.0001). Multivariable analyses demonstrated that stimulant use was associated with persons who injected drugs, had correctional involvement, or reported multiple sex partners. Men who have sex with women were more likely to self-report First Nations ethnicity (adjusted odds ratio, 1.76 [95% confidence interval, 1.25-2.49]), and women were more likely to have a concurrent gonorrhea infection (adjusted odds ratio, 1.62 [95% confidence interval, 1.15-2.28]). Nearly half of infectious syphilis cases in Alberta reported lifetime nonprescription stimulant use. Infectious syphilis cases with stimulant use were associated with injection drug use, multiple sex partners, and correctional involvement. Our observations highlight the need for integration of sexual health services into programs for people who use substances and those in corrections custody.

COVID-19 pandemic and quick evolution of telemedicine: A gap analysis

Telemedicine though not a newer concept to healthcare community, it is relatively a new acquaintance to both healthcare providers and the general public. Since 11th of March 2020, the day when WHO declared COVID-19 infection as pandemic, the telemedicine services had achieved quick popularity. In fact this pandemic boosted a solid foundation for telemedicine and now it is one among the scope of services offered by any reputed healthcare organization globally. This article aims to emphasize how a symbiosis between telemedicine, POCT and mobile health units can help to deliver a high quality healthcare eliminating the risk of infection spread to both patients and health care providers. The methodology adopted includes collective viewpoints of authors which are based upon working experience gained during the current pandemic and literature review of recent and relevant articles related to process and pitfalls of telemedicine. Literature search was conducted by searching using key words and phrases like ‘Telemedicine’, ‘COVID-19 and Telemedicine’ and ‘Non- Communicable Diseases management during pandemic’. The scope and gaps observed by literature survey and personal experience included infrastructure, awareness and training of both health care providers and patient population, utilization of POCT devices, internet connectivity, need for an nationwide unified Health Information Management System (HIMS) to aid easy access to patient health information and easy referrals to higher centers. In summary telemedicine is an absolute necessity during this on-going pandemic and its enhancement by integration with artificial intelligence and machine learning algorithms is a real need of hour.

Lessons from management of syphilis in Nunavut, Canada, 2012-2020.

Nunavut, part of Inuit Nunangat, is a geographically vast territory in northern Canada, with a population of over 38,000 people. Most (85%) of the population identify as Inuit. Nunavut has experienced a significant rise in heterosexual infectious syphilis cases since 2012. Management of communicable diseases, including syphilis, is challenging due to high staff turnover and long delays in specimen transport times. Social determinants of health are also an important contributor. The aim of this study is to describe the epidemiology and program elements for infectious syphilis from 2012-2020 and to highlight beneficial interventions. Syphilis is a notifiable disease in Nunavut with all cases reported to the Territorial Department of Health. Cases were staged by a medical consultant. Data were analyzed and released in public reports as part of the public health program. From 2012 to 2020, 655 infectious syphilis cases were reported, with 53% of reported cases among females. Infection rates were highest in 20 to 39-year-olds. There was significant variability in reported cases over this time period by geographic region, with the majority of infectious cases reported from the Kivalliq region. Despite 48 reported cases in pregnancy, no confirmed congenital syphilis cases were identified. Program staff identified strengths of the response as well as ongoing needs, such as plain language resources available in multiple languages. Despite the logistical challenges with syphilis management in the territory, the overall outcomes have been positive, with no confirmed congenital cases identified. We attribute this to a coordinated effort by multiple partners including key actions by public health nurses and community health representatives.