Health Care Continuum Research Articles

Research and scholarly methods: Community‐engaged research

AbstractCommunity‐engaged research (CER) is a collaborative approach used by health services researchers to integrate the voice of community stakeholders in research design to increase the relevance and impact of research in advancing health outcomes. CER is guided by principles such as leveraging strengths and resources of a community, ensuring research is mutually beneficial for all partners, facilitating co‐learning among all partners, disseminating findings to all partners, and committing long term to a community. The level of community engagement can range on a continuum from outreach, consultations, and community‐academic partnerships to community‐based participatory research depending on the type and extent of community stakeholder involvement. Given pharmacists' accessibility to the public and role as the medication expert across the health care continuum, pharmacist researchers can use CER to authentically engage communities to better understand medication‐related needs and design community‐informed interventions to optimize medication outcomes. The purpose of this paper is to provide a practical overview of CER for pharmacist researchers by: (1) introducing the CER continuum and describing how CER principles can be used before, during, and after a study, (2) describing practical considerations for conducting CER, and (3) discussing two examples of CER in improving medication‐related outcomes in health services research.

Predicting the drop out from the maternal, newborn and child healthcare continuum in three East African Community countries: application of machine learning models

BackgroundFor optimal health, the maternal, newborn, and child healthcare (MNCH) continuum necessitates that the mother/child receive the full package of antenatal, intrapartum, and postnatal care. In sub-Saharan Africa, dropping out from the MNCH continuum remains a challenge. Using machine learning, the study sought to forecast the MNCH continuum drop out and determine important predictors in three East African Community (EAC) countries.MethodsThe study utilised Demographic Health Surveys data from the Democratic Republic of Congo (DRC) (2013/14), Kenya (2014) and Tanzania (2015/16). STATA 17 was used to perform the multivariate logistic regression. Python 3.0 was used to build five machine learning classification models namely the Logistic Regression, Random Forest, Decision Tree, Support Vector Machine and Artificial Neural Network. Performance of the models was assessed using Accuracy, Precision, Recall, Specificity, F1 score and area under the Receiver Operating Characteristics (AUROC).ResultsThe prevalence of the drop out from the MNCH continuum was 91.0% in the DRC, 72.4% in Kenya and 93.6% in Tanzania. Living in the rural areas significantly increased the odds of dropping out from the MNCH continuum in the DRC (AOR:1.76;95%CI:1.30–2.38), Kenya (AOR:1.23;95%CI:1.03–1.47) and Tanzania (AOR:1.41;95%CI:1.01–1.97). Lower maternal education also conferred a significant increase in the DRC (AOR:2.16;95%CI:1.67–2.79), Kenya (AOR:1.56;95%CI:1.30–1.84) and Tanzania (AOR:1.70;95%CI:1.24–2.34). Non exposure to mass media also conferred a significant positive influence in the DRC (AOR:1.49;95%CI:1.15–1.95), Kenya (AOR:1.46;95%CI:1.19–1.80) and Tanzania (AOR:1.65;95%CI:1.13–2.40). The Random Forest exhibited superior predictive accuracy (Accuracy = 75.7%, Precision = 79.1%, Recall = 92.1%, Specificity = 51.6%, F1 score = 85.1%, AUROC = 70%). The top four predictors with the greatest influence were household wealth, place of residence, maternal education and exposure to mass media.ConclusionsThe MNCH continuum dropout rate is very high in the EAC countries. Maternal education, place of residence, and mass media exposure were common contributing factors to the drop out from MNCH continuum. The Random Forest had the highest predictive accuracy. Household wealth, place of residence, maternal education and exposure to mass media were ranked among the top four features with significant influence. The findings of this study can be used to support evidence-based decisions in MNCH interventions and to develop web-based services to improve continuity of care retention.

Disparities in the maternal healthcare continuum among Bangladeshi women: evidence from nationally representative surveys

IntroductionUtilisation of maternal healthcare is low, and it consistently decreases across antenatal to postnatal period in Bangladesh. However, there is paucity of knowledge in Bangladesh to understand gaps and associated factors in seeking continuum of maternal healthcare along the pathway. Therefore, we aimed to assess the trend in socioeconomic and demographic factors and wealth inequity in maternal CoC using the Bangladesh Multiple Indicator Cluster Survey (MICS). MethodsWe performed a secondary analysis on nationally representative data from the last two MICS survey, carried out in 2012–13 and 2019. The study included women of reproductive age (15–49 years) with a live birth within two years preceding the survey. Total of 7,950 and 9,183 respondents were identified from these two surveys, respectively. We used multivariable logistic regression and concentration index to examine the covariates and inequity, respectively, in the utilisation of CoC. ResultsUtilisation of ≥4 antenatal care, skilled delivery, and postnatal care for both mother and newborn increased from 13 percent in 2012–13 to 25 percent in 2019 survey. Moreover, wealth inequity persists favouring the rich in utilisation of CoC in Bangladesh. Women belonging to wealthier quintile, urban areas, and non-Muslim families, with higher education, a household head with higher education, media use, and fewer children were most likely to avail complete CoC in both the surveys. ConclusionOverall utilisation of maternal CoC increased between 2012 and 13 and 2019, however, women in Bangladesh still lack the CoC with persistent wealth inequality. Integrated provision of ANC, delivery by SBA, and PNC should be introduced, comprising both private and public health facilities, and targeting women in poor and rural communities. Efforts should also focus on women's education, autonomy, fertility rate, and exposure to media.

Clinical management and infection control protocols during the COVID-19 pandemic: An online survey.

SARS-CoV-2 (COVID-19) is considered a highly infectious and life threatening disease. The present paper aims to evaluate various aspects of preventive measures and clinical management of the scheduled visits for orthodontic patients to the dental clinics during the outbreak of COVID-19, and to assess how orthodontists dealt with this challenge. Orthodontists in private and public clinics were invited to fill a questionnaire that addressed infection control protocols and concerns about clinical management of patients in the clinics during the pandemic. Frequncies and percentages of the responses were obtained and compared using Chi-square tests. About 77% of those working in private clinics, and 63% of those working in private and governmental clinics performed room disinfection following each patient. In case of patients needing urgent management and have active infection, 56% of the participants provided care under high infection control measures; on the contrary, 64% provided symptomatic intervention including orthodontic wax, analgesics and sometimes mouthwash. The COVID-19 pandemic has had a negative impact on the orthodontic treatments. All pre-cautionary measures have to be made available in the clinic in order to minimize the spread of viral infection with continuous dental health care training.

Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews

BackgroundMaternal mortality in low- and middle-income countries (LMIC) has reduced considerably over the past three decades, but it remains high. Effective interventions are available, but their uptake and coverage remain low. We reviewed and synthesised evidence from systematic reviews on interventions to increase healthcare services utilisation to reduce maternal mortality in LMICs.MethodsWe searched Medline PubMed and Cochrane Library databases for systematic reviews published between January 2014 and December 2021, investigating interventions to increase healthcare services uptake among pregnant women in LMICs. We used the AMSTAR tool (A Measurement Tool to Assess Systematic Reviews) to assess the methodological quality of the included reviews. We extracted data on the interventions and their effects and grouped them into broad groups based on the outcomes reported in each systematic review.ResultsWe retrieved 4,022 articles. After removing duplicates and screening, we included 14 systematic reviews.Male-partner interventions were effective in increasing skilled birth attendance (SBA) postnatal visits and maternal antiretroviral (ART) uptake for HIV-positive pregnant women. However, there was no evidence of their effectiveness on increased early ANC initiation or adequate ANC visits.Mobile health interventions were effective in increasing adequate ANC visits, SBA, facility-based service utilisation, early ANC initiation, and adherence to nutritional supplements.Incentive-based interventions, particularly financial incentives, were effective in increasing the number of ANC visits but not postnatal visits.Facility-based interventions were effective in increasing postnatal visits, maternal ART initiation and uptake, immunisation uptake and follow-up ANC visits. None of the reviews assessed their impact on SBA or adequate ANC visits.Community-based interventions were effective in increasing SBA, ANC service utilisation, ART initiation and uptake, and nutritional supplements and immunisation uptake.ConclusionOur findings show that the different interventions effectively improved different outcomes on the maternal healthcare continuum. Implementing these interventions in combination has the potential to enhance healthcare service uptake further.

Collate of UK and Malaysia Buildings Defects Data: Triangulation Converged of Qualitative and Quantitative Real Project Data Census

Buildings serve several societal needs – occupancy, primarily as shelter from weather, security, living space, privacy, to store belongings, and to comfortably live and work. So, societally, building assures us the spaces needed for our continued work, education, entertainment, healthcare, and general well-being. To maintain buildings in good condition is a big challenge. Buildings do leaks. Here are some effects of building leakage: Metals in the building start to corrode. Timber decays because of dry rot as a result of a damp environment. All electric fittings deteriorate due to dampness. Thus, regardless in Malaysia or UK (United Kingdom), building maintenance practice need good practice indeed. In UK, there are different types of maintenance been practiced. Those are four different types of maintenance: corrective, preventative, risk-based and condition-based. In this paper, the triangulation of the qualitative and quantitative data of the UK and Malaysia building defects info been converged in various tables using IBM’s SPSS (version 27) statistical software. The triangulation convergence of the UK and Malaysia data reveals that UK has always been right at the top. The UK developers deliver very good quality buildings and always have a heritage of ambitious designers. However, the statistical findings still reveal that BLS (Building Leakage Syndrome) was adding to the bill. Problem solving may not have standardised solutions. As a conclusion, the issue around BLS need to look at very carefully even in the UK side.

Aviator Healthcare Hesitance: An Examination of Healthcare Avoidance, Pilot Mistrust, Presenteeism, & Risk

Safe aviation operations require pilots to maintain constant physical and psychological well-being. While the FAA and pilot advocacy organizations encourage aviators to discuss health concerns with their medical providers, studies demonstrate continued healthcare hesitance behaviors. This article explores possible factors impacting aviator healthcare hesitancy, including pilot personalities, financial considerations, and pilot mistrust. After providing a background of these areas, the article turns to research into the impact of presenteeism within the community, along with its associated personal and operational safety risks. Ultimately, this article seeks to prompt and aid future research by providing an overview of the current literature on the prevalence and implications of healthcare hesitance in the aviation community.

Roles and Responsibilities in the Transition to Working Independently: A Qualitative Study of Recently Graduated Radiographers' Perspectives in Australia.

Medical imaging features along the entire healthcare continuum and is known for its fast-paced technological evolution which enables it to keep up with the demands of the healthcare system to provide safe, quality services. The overall efficacy and efficiency of the system depends on practitioners' clinical competence, achieved through professional education and continuous professional development. Recent studies have revealed concerns regarding newly graduated healthcare professionals' preparedness and readiness to handle actual practice. We conducted qualitative face-to-face and telephonic interviews with a convenient and purposive sample of 23 participants consisting of recently graduated radiographers (n=14), radiography students (n=5) and supervising radiographers (n=4) in Australia. Verbatim transcriptions were analyzed inductively to identify themes pertaining to perspectives and experiences of the work readiness of novice radiographers. The findings of our study suggest that the workplace immersion and transitioning of recently graduated radiographers into their professional roles requires a process of experiential learning and honing of knowledge and skills if they are to function efficiently and independently in a team-oriented workplace. Radiographic services are spread across various levels of care and are an integral part of the organizational structure of a healthcare system. Maladaptive transitions to the workplace may be the result of low self-confidence, a lack of support, uncertainty in inter-collegial interactions, or unrealistic performance expectations. The overarching themes of communication and interaction emerged clearly as recently graduated radiographers navigated the four roles of coordinator, collaborator, mediator, and advocate. The application of radiographic skills is embedded in a workplace culture of communication and safety. Transitioning to independent practice takes place in a complex, multifaceted environment and is accompanied by internal and external expectations. Because each workplace has a unique context, system and culture, no novice radiographic professional can ever be fully prepared through pre-service training and workplace induction.

Survivorship transitions in blood cancer: Identifying experiences and supportive care needs for caregivers.

Survivorship care often refers to continued healthcare after cancer treatment. Jacobsen and colleagues advocated to expand this to include patients on extended treatments and maintenance/prophylactic therapies, recognizing the care continuum as more complex. Transitions of care for individuals diagnosed with a blood cancer can be complicated. We sought to better understand blood cancer caregivers' experiences as their diagnosed family member encountered "survivorship transitions" across the continuum. We conducted semi-structured interviews with adults caring for a parent or a child with a blood cancer. Caregivers were segmented into survivorship groups based on two transitional contexts: (1) when patients transitioned to a new line of therapy (active treatment or maintenance therapy); (2) when patients ended treatment. We conducted a thematic analysis and triangulated findings to compare transitional experiences. Caregivers in both groups reported experiencing a "new normal," which included personal, relational, and environmental adjustments. Caregivers in the treatment transitions group (n = 23) also described uncertainty challenges (e.g., losing their "safety net") and disrupted expectations (e.g., feeling "caught off guard" by challenges). Whereas caregivers in the end-of-treatment transitions group (n = 15) described relief coupled with worry (e.g., feeling hopeful yet worried). Survivorship transitions for caregivers are riddled with challenges that include difficult readjustments, uncertainty/worry, and unmet expectations. While there seems to be a cohesive experience of "survivorship transitions," each transition group revealed nuanced distinctions. Tailored supportive resources are needed for caregivers throughout survivorship transitions.

An Accountable Care Organization Maintains Access for Appendicitis During the COVID-19 Pandemic

IntroductionIt has been reported that pediatric patients experienced a delay in treatment for acute appendicitis during the pandemic, resulting in increased rates of complicated appendicitis. We investigated the association of the COVID-19 pandemic and the incidence and severity of acute appendicitis among pediatric Medicaid patients using a population-based approach. MethodsThe claims database of Partners For Kids, a pediatric Medicaid accountable care organization (ACO) in Ohio, was queried for cases of acute appendicitis from April to August 2017-2020. The monthly rate of acute appendicitis/100,000 covered lives was calculated each year and compared over time. Rates of complicated appendicitis were also compared. Diagnosis code validation for classification as complicated or uncomplicated appendicitis was performed for patients treated at our hospital. ResultsDuring the study period, 465 unique cases of acute appendicitis were identified. Forty percent (186/465) were coded as complicated. No significant difference in the incidence of acute appendicitis cases was observed across the 4 y, either in an overall comparison or in pairwise comparisons (P > 0.15 for all). The proportion of acute appendicitis cases that were coded as complicated did vary significantly over the 4-year study period (P = 0.005); this was due to this proportion being significantly higher in 2018 than in either 2019 (P = 0.005 versus 2018) or 2020 (P = 0.03 versus 2018). ConclusionsThe COVID-19 pandemic was not associated with reduced access to treatment for acute appendicitis among patients in a pediatric Medicaid ACO. This suggests that an ACO may promote continued healthcare access for their covered population during an unexpected crisis.

A true continuous healthcare system for type 1 diabetes

Continuous monitoring of vital signs and timely treatment are the future trends for wearable and implantable healthcare systems, which inevitably require ceaseless power supply. Discharged batteries could be detrimental to the health of people, such as those with type 1 diabetes, whose glucose levels should be monitored and controlled through timely insulin injections. Here, we demonstrate a feasible true continuous healthcare system for type 1 diabetes by combining a low-energy micropump, self-powered glucose sensor, and ceaseless power supply. By converting body heat into electricity to charge a battery for 790.1 s, we acquired 136.8 mJ (100%) of energy, which was used to operate the micropump and sensor for 74.6 mJ (54.5%) and 25.3 mJ (18.5%), respectively; the surplus 36.9 mJ (27.0%) was stored in the battery. These findings can help realize a true continuous healthcare system in the future.

Utilisation of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women

ObjectivesThe continuum of maternal care along antenatal (ANC), intrapartum and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic interrupted the provision and use of...

Risk Should Not Be a “Four-Letter Word” in Healthcare. Risk and the Future of Musculoskeletal Care

Orthopaedics has seen a rapid transition to value-based care. As we transition away from fee-for-service models, healthcare systems, groups, and surgeons are being asked to take on an increasing amount of risk. While on the surface risk may have a negative connotation, managing risk allows surgeons to maintain autonomy while taking on value-based care to the next level. The purpose of this paper, the first in a series of 2, is to walk through the impact that value-based care has had on musculoskeletal surgeons, to understand the continued movement healthcare is making into risk sharing models, and to introduce the concept of surgeon specialist-led care.

Examining the relationship between armed conflict and coverage of maternal and child health services in 35 countries in sub-Saharan Africa: a geospatial analysis

Armed conflict is on the rise in sub-Saharan Africa and affects public infrastructures, including health systems, although evidence on population health is sparse. We aimed to establish how these disruptions ultimately affect health service coverage. We geospatially matched Demographic and Health Survey data with the Uppsala Conflict Data Program Georeferenced Events Dataset, covering 35 countries for the period from 1990 to 2020. We relied on linear probability models with fixed effects to capture the effect of nearby armed conflict (within 50 km of the survey cluster) on four service coverage indicators along the continuum of maternal and child health care. We also investigated effect heterogeneity by varying conflict intensity and duration, and sociodemographic status. The estimated coefficients represent the decrease in the probability (in percentage points) of the child or their mother being covered by the respective health service following deadly conflicts within 50 km. Any nearby armed conflict was associated with reduced coverage for all examined health services, with the exception of early antenatal care: early antenatal care (-0·5 percentage points, 95% CI -1·1 to 0·1), facility-based delivery (-2·0, -2·5 to -1·4), timely childhood vaccination (-2·5, -3·1 to -1·9), and treatment of common childhood illnesses (-2·5, -3·5 to -1·4). For all four health services, the negative effects increased for high-intensity conflicts and were significant throughout. When examining conflict duration, we did not find negative effects on the treatment of common childhood illnesses in prolonged conflicts. The analysis on effect heterogeneity revealed that, except for timely childhood vaccination, the negative effects of armed conflict on health service coverage were more pronounced in urban settings. Our findings suggest that health service coverage is significantly affected by contemporaneous conflict, but health systems can adapt to provide routine services, such as child curative services, in situations of prolonged conflict. Our analysis underlines the importance of studying health service coverage during conflict both at the finest possible scales and across different indicators, pointing at the need for differential policy interventions. None. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Changes and Determinants of Maternal Health Services Utilization in Ethnic Minority Rural Areas in Central China, 1991-2015: An Ecological Systems Theory Perspective.

Universal maternal health coverage is a proven, effective strategy for maternal survival. This study aimed to describe the changes and determinants of maternal health service use between 1991 and 2015 in central China. The study was conducted in Enshi Prefecture. Women were eligible for inclusion if they were rural women who lived in villages, had live births during 1991-2015, could recall their maternal care histories, and had no communication problems. This retrospective study included 470 rural women in 9 villages and collected 770 records. The conceptual framework was designed based on the Society Ecosystem Theory. The determinants included micro-factors (individual characteristics), meso-factors (family factors, community factors, healthcare factors), and macro-factors (government-run maternal and child health programs, abbreviated as MCH programs). Multivariate logistic regressions were applied to analyze the determinants of maternal health service utilization. The utilization of maternal healthcare has improved in Enshi. The hospital birth rate was 98.1% in 2009 and mostly 100% in subsequent years. The prenatal examination rate, the postpartum visit rate, and the continuum of maternal health service (CMHS) rate increased to 73.3%, 67.7%, and 53.4%, respectively, in 2009-2015. The utilization of maternal health services was affected by macro-factors, meso-factors, and micro-factors, with macro-factors being the most notable contributors. Despite the remarkable improvements in antenatal care (ANC) use and hospital birth, gaps in postpartum visits remain. Promoting the integrated continuum of maternal and child healthcare in ethnic minority rural areas requires the joint efforts of the government, health and other sectors, communities, families, and individuals.

Short-Term Psychological Impact of the 2019 Coronavirus Disease (COVID-19) Pandemic on Healthcare Workers of a Cancer Treatment Center: A Cross-Sectional Study

Background: The sudden emergence of the novel and severe 2019 Coronavirus disease (COVID-19) would be expected to impact the mental health of healthcare workers and thus represent a challenge to psychological resilience. In order to reduce psychological impacts, more research data are needed to help develop evidence-based strategies. We conducted a single center, cross-sectional study, with the aim of assessing the immediate psychological impact of COVID-19 pandemic on medical and paramedical staff in a cancer treatment center providing continuous health care during the pandemic. Methods: From April 19th to May 5th, 2020, medical and nursing staff from Oncology and Hematology Center of Mohammed VI University Teaching Hospital was invited to participate with a self-report questionnaire. We used Impact of Event Scale-Revised (IES-R), Hospital Anxiety and Depression scale (HADS), and Insomnia Severity Index (ISI) to evaluate stress, anxiety, depression, and insomnia, respectively. Additional information on demographic characteristics, medical history, exposure to COVID-19, and accessed mental health services were included in the questionnaire. Results: We received 93 completed questionnaires. Among all healthcare workers included in this study, 30.1% reported stress, 32.3% had anxiety, 30.1% reported depression, and 31.2% had insomnia symptoms. Occupation, female gender, concomitant chronic diseases, history of mental disorders, and history of contact with suspected or confirmed patients were risk factors for psychological disturbances, whereas care provided by hospital decision-makers, and full coverage of all departments with protective measures were protective factors. Conclusion: During the initial phase of COVID-19 outbreak in Morocco, about one-third of the respondents reported moderate to severe psychological impact, and more than half rated their anxiety, depression symptoms, and insomnia as moderate to severe. Our findings emphasize the importance ...........

Creating a Health Emergency and Disaster Risk Management (EDRM) Learning Community

Introduction:Disaster research is primarily posthoc analysis, locally focused or within response organizations, overlooking the wellness and safety of first and second responders or the broad multi- and interdisciplinary activities necessary to foster and sustain recovery. A broad framework to span locality, institutional, and professional boundaries supports the development of a true learning community–a health EDRM sector that supports society in recognizing lessons, refining findings, and free and fluid global sharing.Method:Several organizations joined to create a robust disaster health learning community: CREDO, GloHSA, ICDM, and ECDM, a multi-national, multi-disciplinary collaborative network of patients, universities, societies, regulators, publishing, healthcare, and technology partners designed to foster expert level education and training with shared educational design concepts, milestones, and core curricula that embrace the strength of a standardized base upon which to link unique pillars of excellence of separate functions, institutions, nations, and regions.Results:The Emergency Disaster Global Health Sciences (EDGHS) model developed by University of Texas Southwestern Medical Center is interactive, open, and responsive. EDGHS addresses critical gaps in applied research by convening leaders across the healthcare and public health continuum to map the way forward, designing and implementing high-quality, evidence-based practical and policy research.This defines essential public health functions for national contexts, including a focus on emergency preparedness and response, strengthening competency-based education on essential public health functions, and mapping and measurement of occupations delivering EDRM functions, offering an exportable model of global relevance.Conclusion:Putting disaster prevention into recovery processes is a strategic opportunity to improve the well-being of future generations. The survivability and well-being needs of present and future generations are contingent on knowledge-based, lived experiences of recoverable disaster loss and damage, and the capacity to thrive sustainably. This presentation serves as an invitation to join the growing momentum of creating a learning health EDRM community.

The Premier Case Management Event of the Year Is for Everyone: 2023 CMSA Annual Conference & Expo.

Address correspondence to Amy Black, CAE, Case Management Society of America, Parthenon Management Group, LLC, 5034A Thoroughbred Lane, Brentwood, TN 37027 ([email protected]). The author reports no conflicts of interest. The Case Management Society of America (CMSA) facilitates the growth and development of professional case managers across the full health care continuum, promoting high-quality, ethical practice benefitting patients and their families. We strive for improved health outcomes by providing evidence-based resources, impacting health care policy, and sustaining the CMSA-developed Standards of Practice for Case Management (www.cmsa.org).

Commentary on Jones et al.: We must consider emergency medical services data an opportunity for a view into a community.

Jones et al. demonstrate that through hard work and thoughtful review, even disparate data can assist the advancement of public health and public policy across jurisdictions. An emergency medical services industry-led focus on documentation standards and data integration can make this easier and more effective for our patients. Jones et al. have taken on the challenging task of identifying the characteristics of opioid-related incidents (ORI) from emergency medical services (EMS) calls to assess the impact of opioids in Massachusetts. They responded to a legislative mandate to review EMS records by creating a free text search and a five-tier severity cascade where opioid use can be identified, even without overdoses [1]. These researchers demonstrate the need to review all available data despite the fact that Massachusetts [2], like much of the United States, utilizes multiple EMS documentation platforms, written in disparate documentation styles, then aggregated through the National EMS Information System (NEMSIS) [3]. Authors have focused previously upon the use of naloxone to identify a non-fatal overdose [4-6], but many ORI do not receive naloxone [7]. Jones et al. used a free text search for terms in the narrative to point to specific types of ORI. This search function was elegantly designed to go beyond the discrete variables of NEMSIS and search for ORI by intoxicant name and concerning symptoms. Jones et al. have previously demonstrated gender disparity with EMS naloxone administration, indicating why it is vital to use narrative data to identify ORI [8]. The strength of this search and the ORI severity cascade is further demonstrated, as 29% of the opioid intoxications and 36% of all ORI did not receive naloxone. The OTHER ORI allows a broad range of conditions that can factor into the impact of opioid use disorder and serve as a further marker for opportunity for intervention and change. EMS records are the first chapter of the story of nearly every critical patient encounter and assist in the care of vulnerable patients. However, when hospital systems implement an electronic health record they frequently save money by not integrating local EMS data. When embedded in the health-care continuum, EMS data can help to advance public health and public policy. Jones et al.’s multi-tiered approach to ORI is an important step towards realizing this goal. Michael Winter Dailey: Writing—original draft (lead); writing—review and editing (equal). Emma Furlano: Writing—original draft (supporting); writing—review and editing (equal).

Elimination of hepatitis C virus in a prison: An 18-year experience

IntroductionDespite the decrease of hepatitis C in Spanish prisons in the last years, it still remains a reservoir for infection. The aim of this work is to analyze the characteristics of these patients and the response to antiviral treatment over the last 18 years. MethodsRetrospective observational study in inmates of Araba penitentiary center diagnosed with HCV infection between 2002 and 2020.A descriptive analysis of patient characteristics and the response to the three antiviral treatment modalities was performed: peg-interferon and ribavirin, peg-interferon, ribavirin and a first-generation protease inhibitor and different combinations of direct-acting antivirals. ResultsA total of 248 antiviral treatments were prescribed. Treatment response rate up to 2015 was 65% and 93,7% after that year. Interferon non-responders were the main cause of non-response to treatment in periods 1 and 2 (40%–50%). Conversely, in period 3 viral breakthrough (67%) was the main culprit. ConclusionAfter 18 years, active hepatitis C infection in prison inmates has resolved with treatment according to clinical criteria. Therefore, the stay in prison may represent an opportunity to reduce the reservoir of the disease in the community, together with continued health care for those released from prison.