Evidence-based Response Research Articles

Epidemiological Data of Patients Consulted to Physical Therapy Clinic in the 2023 Kahramanmaraş Earthquake

On February 6, 2023, 7.8-magnitude earthquake occurred in Kahramanmaraş, Türkiye. This earthquake was one of the most devastating disasters to hit Türkiye, resulting in an official death count of over 45,000. In this study, we aimed to determine the injury patterns of the patients who were consulted to the physical therapy and rehabilitation clinic after the Kahramanmaraş earthquake, and to ensure that their physicians were better prepared for possible earthquakes. Our study was completed between February and June 2023. All patients, male and female, who had earthquake-related injuries and were consulted to the physical therapy unit were included. Discharged patients were screened retrospectively. Inpatients were investigated prospectively. A total of 220 patients were included in the study. The patients were examined in terms of age, gender, date of application, pain score, time under the dent, complaint at admission, additional disease, type of injury, and treatment applied. Statistical analyzes were performed using SPSS version 22.0 software. The most frequently affected age group was 15-30 years old. The most common complaints were pain, limitation of movement and difficulty in walking. The most common surgical procedures are fasciotomy, internal fixation, and amputation. The most commonly injured limbs are the lower extremities. The most common level of amputation was transtibial amputation. After the earthquake, patients need physical therapy and rehabilitation. The knowledge and experience of the physicians of the relevant branches about the frequently observed injury patterns should be increased. This study is generally in line with most other studies reporting the epidemiology of injury after earthquakes. However, there is no standardization among the studies. Therefore, standardization in reporting earthquake injuries is necessary for evidence-based response policy planning after natural disasters.

‘Now there is no escape’: the impact of the COVID-19 social restrictions on parents experiencing violence and abuse from their children

Child- and adolescent-to-parent violence and abuse (CAPVA) has gained recognition over the past decade and, to an extent, gained momentum on the violence against women and girls (VAWG) policy agenda. However, CAPVA remains subordinate to the omnipresent problem of violence and abuse perpetrated by current and former intimate partners, as do responses to this often-hidden form of violence. This was especially apparent during the peak of the COVID-19 pandemic and consequent social restrictions, when many parent victims of CAPVA faced a silent struggle of enforced proximity with their violent and/or abusive child alongside a significant drop in respite and means of support. In this article, we present research findings from a project conducted during the 2020 lockdown period in the UK, examining parents’ experiences of CAPVA and support during this period, as well as practitioners’ experiences of providing support. In addition to revealing that over two-thirds of parents reported an increase in CAPVA during the initial lockdown, our discussion highlights the need for sustained recognition and attention to be afforded to CAPVA, so that systematic, strategic, and evidence-based nationwide responses can be developed, including adequate risk assessment processes, safeguarding measures and support.

Accuracy of Artificial Intelligence-Based Virtual Assistants in Responding to Frequently Asked Questions Related to Orthognathic Surgery

BackgroundDespite increasing interest in how conversational agents might improve healthcare delivery and information dissemination, there is limited research assessing the quality of health information provided by these technologies, especially in orthognathic surgery (OGS). PurposeThis study aimed to measure and compare the quality of four virtual assistants (VA) in addressing the frequently asked questions about OGS. Study design, setting, and sampleThis in-silico cross-sectional study, assessed the responses of a sample of four VAs through a standardized set of 10 questionnaires related to OGS. Independent variableThe independent variables were the four VAs. The four VAs tested were VA1: Alexa (Seattle, Washington), VA2: Google Assistant (Google Mountain View, California), VA3: Siri (Cupertino, California), and VA4: Bing (San Diego, California). Main outcome variablesThe primary outcome variable was the quality of the answers generated by the four VAs. Four investigators (two orthodontists and two oral surgeons) assessed the quality of response of the four VAs through a standardized set of 10 questionnaires using a five-point modified Likert scale, with the lowest score (1) signifying the highest quality. The main outcome variables measured were the combined mean scores of the responses from each VA, and the secondary outcome assessed was the variability in responses among the different investigators. CovariatesNone AnalysisOne-way analysis of variance (ANOVA) was done to compare the average scores per question. One-way ANOVA followed by Tukey's post-hoc analyses was done to compare the combined mean scores among the VAs and the combined mean scores of all questions were evaluated to determine variability if any amongst different VA’s responses to the investigators. ResultsAmong the four VAs, VA4 (1.32 ± 0.57) had significantly the lowest (best) score, followed by VA2 (1.55±0.78), VA1 (2.67±1.49), and VA3 (3.52±0.50) (p-value<0.001). There were no significant differences in how the VAs: VA3 (p-value = 0.46), VA4 (p-value = 0.45), and VA2 (p-value = 0.44) responded to each of the investigators except VA1 (p-value = 0.003). ConclusionsThe VAs responded to the queries related to OGS, with VA4 displaying the best quality response, followed by VA2, VA1, and VA3. Technology companies and clinical organizations should partner for an intelligent VA with evidence-based responses specifically curated to educate patients.

Addressing High-value Care with Generative Pretrained Transformer 4

Abstract Background: High-value care emphasizes services offering significant health benefits, aligning with patient preferences while minimizing costs and interventions of little benefit. This approach is increasingly vital in a healthcare environment constrained by finite resources and rising costs. Large Language Models (LLMs) like Generative Pretrained transformer-4 (GPT-4), with their vast data processing capabilities, offer a promising avenue for supporting healthcare providers in making evidence-based, high-value care decisions. Aims: This study aims to evaluate the performance of OpenAI’s GPT-4 in providing responses to high-value care clinical scenarios within internal medicine, assessing its accuracy, relevance, and reasoning against established medical guidelines and literature. Materials and Methods: An observational study was conducted using MKSAP-19’s high-value care questions, comparing GPT-4’s responses to the correct answers based on established studies, trials, and guidelines. The study did not involve real patient data, circumventing the need for Institutional Review Board (IRB) approval. Performance metrics focused on the accuracy, relevance, and consistency of GPT-4’s answers. Results: GPT-4 demonstrated a 74.4% accuracy rate (32 out of 43 questions) across a range of high-value care clinical scenarios, including image-based questions. Errors made by GPT-4 were similar to those by medical residents using MKSAP-19, suggesting areas for model improvement and potential educational applications. The study detailed GPT-4’s decision-making pattern, emphasizing its clinical reasoning capabilities. Conclusion: The findings suggest that GPT-4 can significantly support high-value care in internal medicine by providing accurate, evidence-based responses to complex clinical scenarios. Despite its limitations, including a 25.6% error rate and the scope of its training data, GPT-4’s performance indicates its potential as both a clinical and educational tool in healthcare.

It’s time for change: inequities and determinants of health-related quality of life among gender and sexually diverse young people in Australia

PurposeThis study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14–19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors.MethodsThis study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K′ cohort: children aged 4–5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge’s g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes).ResultsHR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence.ConclusionEvidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities

Rates and causes of death after release from incarceration among 1 471 526 people in eight high-income and middle-income countries: an individual participant data meta-analysis

Formerly incarcerated people have exceptionally poor health profiles and are at increased risk of preventable mortality when compared with their general population peers. However, not enough is known about the epidemiology of mortality in this population-specifically the rates, causes, and timing of death in specific subgroups and regions-to inform the development of targeted, evidence-based responses. We aimed to document the incidence, timing, causes, and risk factors for mortality after release from incarceration. We analysed linked administrative data from the multi-national Mortality After Release from Incarceration Consortium (MARIC) study. We examined mortality outcomes for 1 471 526 people released from incarceration in eight countries (Australia, Brazil, Canada, New Zealand, Norway, Scotland, Sweden, and the USA) from 1980 to 2018, across 10 534 441 person-years of follow-up (range 0-24 years per person). We combined data from 18 cohort studies using two-step individual participant data meta-analyses to estimate pooled all-cause and cause-specific crude mortality rates (CMRs) per 100 000 person-years, for specific time periods (first, daily from days 1-14; second, weekly from weeks 3-12; third, weeks 13-52 combined; fourth, weeks 53 and over combined; and fifth, total follow-up) after release, overall and stratified by age, sex, and region. 75 427 deaths were recorded. The all-cause CMR during the first week following release (1612 [95% CI 1048-2287]) was higher than during all other time periods (incidence rate ratio [IRR] compared with week 2: 1·5 [95% CI 1·2-1·8], I2=26·0%, weeks 3-4: 2·0 [1·5-2·6], I2=53·0%, and weeks 9-12: 2·2 [1·6-3·0], I2=70·5%). The highest cause-specific mortality rates during the first week were due to alcohol and other drug poisoning (CMR 657 [95% CI 332-1076]), suicide (135 [36-277]), and cardiovascular disease (71 [16-153]). We observed considerable variation in cause-specific CMRs over time since release and across regions. Pooled all-cause CMRs were similar between males (731 [95% CI 630-839]) and females (660 [560-767]) and were higher in older age groups. The markedly elevated rate of death in the first week post-release underscores an urgent need for investment in evidence-based, coordinated transitional healthcare, including treatment for mental illness and substance use disorders to prevent post-release deaths due to suicide and overdose. Temporal variations in rates and causes of death highlight the need for routine monitoring of post-release mortality. Australia's National Health and Medical Research Council.

Promoting Science Communication for the Purpose of Pandemic Preparedness and Response: An Assessment of the Relevance of Pre-COVID Pandemic “early warnings”

Abstract Given the abrupt global disruption caused by SARS-CoV-2, one might think that the COVID pandemic was an unpredictable event. But in the years leading up to the emergence of the COVID pandemic, several documents had already been warning of the increasing occurrences of new disease outbreaks with pandemic potential and lack of corresponding policies to promote pandemic preparedness and response. In this article, we call these documents “early warnings”. We argue that a survey of early warnings can help science communicators to promote the public understanding of evidence-based pandemic preparedness and response policies at local or international level. Our proposal differs from other approaches to pandemic preparedness and response in that it highlights the relevance of documents published before the COVID outbreak. We show that the early warnings did not become outdated after the COVID outbreak, but, rather, that they are even more pressing now.

Quantifying holistic capacity response and healthcare resilience in tackling COVID-19: Assessment of country capacity by MCDM.

The resilience of a country during the COVID-19 pandemic was determined based in whether it was holistically prepared and responsive. This resilience can only be identified through systematic data collection and analysis. Historical evidence-based response indicators have been proven to mitigate pandemics like COVID-19. However, most databases are outdated, requiring updating, derivation, and explicit interpretation to gain insight into the impact of COVID-19. Outdated databases do not show a country's true preparedness and response capacity, therefore, it undermines pandemic threat. This study uses up-to-date evidence-based pandemic indictors to run a cross-country comparative analysis of COVID-19 preparedness, response capacity, and healthcare resilience. PROMETHEE-a multicriteria decision making (MCDM) technique-is used to quantify the strengths (positive) and weaknesses (negative) of each country's COVID-19 responses, with full ranking (net) from best to least responsive. From 22 countries, South Korea obtained the highest net outranking value of 0.1945, indicating that it was the most resilient, while Mexico had the lowest (-0.1428). Although countries were underprepared, there was a robust response to the pandemic, especially in developing countries. This study demonstrates the performance and response capacity of 22 key countries to resist COVID-19, from which other countries can compare their statutory capacity ranking in order to learn/adopt the evidence-based responses of better performing countries to improve their resilience.

“Using behavioral insights to inform the COVID-19 vaccine response in Kosovo[1]: Population perceptions and interventions”

ObjectiveUnderstand population perceptions in Kosovo[1] regarding COVID-19 vaccination to inform the pandemic response. MethodsFive rounds of a cross-sectional survey in representative samples of adults during 2020–2021. Analysis includes descriptive statistics, hierarchical cluster analysis, segmentation and logistic regressions. ResultsSelf-reported intention to vaccinate increased after the introduction of COVID-19 vaccines in Kosovo.[1] In less than one year, vaccination intentions increased from 36% to 66% of those unvaccinated. Predictors for vaccine intentions included gender, age, trust in health authorities. Segmentation analysis identified population segments that had high vaccine nintentions but low uptake, informing messages and campaign initiatives designed to translate intentions into behavior. ConclusionIdentifying people's perceptions and behavior is essential to support evidence-based policy making, especially during outbreak response. InnovationBI is an innovative focus of research in Kosovo [1] where little BI data had been collected prior, and provided a unique understanding of population views, attitudes and behaviors related to COVID-19. These findings were not only essential for an evidence-based pandemic response but also laid the foundation for future broad application of BI to inform interventions that seek to enable, support and promote health-related behaviurs in Kosovo[1]

Addiction Frameworks, Social Stigma, and NIMBY Syndrome: Examining Barriers to Responding to the Opioid Crisis

Scholars have argued that stigma of opioid use disorder (OUD) is a significant barrier to implementing evidence-based responses to the opioid crisis, including the use of medications for opioid use disorder (MOUD). They have also documented a relationship between addiction frameworks and support for punitive responses to substance use. Using a representative sample of Pennsylvania residents ( N = 1,033), the current study synthesizes this literature by empirically examining the relationship between addiction frameworks, opioid-related stigma, and policy-related attitudes (i.e., NIMBY syndrome, support for punitive treatment of OUD, and support for employment discrimination against individuals prescribed MOUD). Results show that support for the disease model of addiction was negatively associated with endorsing NIMBY syndrome for opioid-treatment centers, support for punitive treatment of OUD, and support for employment discrimination against individuals prescribed MOUD; however, these relationships were fully mediated by opioid-related stigma, such that support for the disease model of addiction impacted outcome measures only indirectly through opioid-related stigma. Policy implications are discussed within.

Suicide prevention during disasters and public health emergencies: a systematic review.

Disasters and public health emergencies increasingly affect populations around the world, posing significant wide-ranging challenges for societies as well as for effective public health and suicide prevention. Intervention research is essential to inform evidence-based responses. Yet, despite evident public concern and growing research interest in heightened suicide risks and impacts, little is known about effective suicide prevention interventions in these contexts. We conducted a systematic review to examine the outcomes of suicide prevention strategies implemented in disasters and public health emergencies. We searched five databases (Medline, Embase, PsycINFO, Web of Science, PTSDpubs) from inception to December 2022 for peer-reviewed quantitative studies that reported relevant intervention outcomes (changes in the frequency of suicide, suicide attempts, self-harm) for populations affected by disasters and public health emergencies. We assessed the quality of eligible studies using the Quality Assessment Tool for Quantitative Studies, and distilled review findings through narrative synthesis. The study protocol was registered with PROSPERO (CRD42021276195). Ten eligible and mostly observational studies were included in this review, which examined a range of universal, selective, and indicated interventions. Three of five studies of interventions in public health emergencies indicated the potential effectiveness and buffering effects of generic disaster related mental health support, access to urban parks, as well as the beneficial role of video-enabled tablets in facilitating treatment access and outcomes. Similarly, three of five studies of interventions in disaster contexts provided evidence of the beneficial role of universal economic security measures, national gun laws and buy back schemes, and volunteer-delivered mental health support. Overall, four of six studies with favorable outcomes examined interventions specifically deployed in disaster or public health emergency contexts, whereas two studies examined ongoing existing interventions. Three studies, respectively, of suicide prevention focused interventions or generic interventions reported favorable outcomes. The quality of included studies was variable, with two studies being rated as 'strong', four studies rated as 'moderate', and four studies rated as 'weak'. Notwithstanding the limited scope and variable quality of published evidence, our review findings highlight the breadth of interventions that have been applied in such contexts with some success. There is a need for further research on effective interventions and intervention adaptations to inform evidence-based suicide prevention responses to disasters and public health emergencies. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276195, PROSPERO ID CRD42021276195.

Universal mental health training for frontline professionals: evaluation of pilot trial in Ukraine

Background Increasing accessibility of mental health services and expanding universal health coverage is possible worldwide by using a task-shifting approach and delegating elements of mental health support to trained non-mental health service providers. The Universal Mental Health Training (UMHT), dedicated to this aim, was developed and piloted in Ukraine. The UMHT is a specialised program for training frontline professionals on high-quality and evidence-based responses to the mental health needs of the population they serve. Methods The controlled pilot trial of UMHTs’ efficacy was conducted with 307 frontline professionals divided into 24 training groups. The control group included 211 persons with the same occupation background who participated in training later (waiting list). All the groups took part in eight-hour training which includes one introductory module that introduces the mental health topic alongside a five-step model, two disorders-focused modules with the steps adjusted to work with specific disorders and the final module that considers possible difficulties and ways of their solving. Three efficacy measurements were used in the outcome assessment: Readiness to interact with people with mental health issues at work, mental health awareness and mental health proficiency. Results Analysis of the outcome data revealed middle-level effect size related to the knowledge of mental health conditions, mental health awareness, and increasing the readiness to interact with people with mental health issues at work in first-line professionals that underwent the UMHT. Conclusions High-level utilisation of the UMHT at work by trained professionals confirms our hypothesis on the efficacy and feasibility of the developed intervention. Results obtained favour the continuation of the development of the UMHT and future implementation research in this field in Ukraine and potentially in other low- and middle-income countries.

COVID-19 Information, Trust, and Risk Perception Across Diverse Communities in the United States: Initial Findings from a Multistate Community Engagement Alliance (CEAL).

Objectives. To provide initial findings from Community Engagement Alliance (CEAL), a multistate effort funded by the National Institutes of Health, to conduct urgent community-engaged research and outreach focused on COVID-19 awareness, education, and evidence-based response. Methods. We collected survey data (November 2020-November 2022) from 21 CEAL teams from 29 state and regional CEAL sites spanning 19 US states, the District of Columbia, and Puerto Rico, which covered priority populations served and trusted sources of information about COVID-19, including prevention behaviors, vaccination, and clinical trials. Results. A disproportionate number of respondents were Latino (45%) or Black (40%). There was considerable variability between CEAL sites regarding trusted sources of information, COVID-19 prevention, and COVID-19 vaccination. For example, more respondents (70%) reported health care providers as a trusted source of COVID-19 information than any other source (ranging from 6% to 87% by site). Conclusions. CEAL rapidly developed novel infrastructure to engage academic, public health, and community organizations to address COVID-19's impacts on underserved communities. CEAL provides an example of how to respond in future public health emergencies to quickly promote trustworthy, evidence-based information in ways that advance health equity. (Am J Public Health. 2024;114(S1):S112-S123. https://doi.org/10.2105/AJPH.2023.307504).

Protocol for clinical management of skin lesions in patients with monkeypox virus infection

Introduction: monkeypox has gained relevance in global health due to its clinical and epidemiological impact. This zoonosis, caused by Orthopoxvirus, has similarities with human smallpox and can present severe complications. In Ecuador, MPOX is a public health concern, especially due to human-animal interaction and the country's tropical environment.Objective: to describe the protocol developed by Omnihospital for the management of skin lesions associated with MPOX, in order to optimize patient care and standardize treatment in cases of this emerging disease.Development: The main symptoms are described and include fever, malaise, headache and a phased rash (macules, papules, vesicles and crusts). Lesions are usually concentrated on the face and extremities, and may affect mucous membranes and organs such as the eyes and genitals. Complications include secondary infections of the skin lesions, treated with topical or systemic antibiotics depending on the severity. The proper use of Personal Protective Equipment (PPE) and hygiene measures is essential to prevent the spread of the virus and protect healthcare personnel.Final considerations: the protocol seeks to provide health professionals with a practical guide for the treatment of patients with MPOX, ranging from the cleaning of lesions to the prevention of complications, thus ensuring an effective and evidence-based response

A global scoping review of adaptations in nurturing care interventions during the COVID-19 pandemic.

During the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for evidence-based responses and preparedness, we analyzed adaptations in NCIs' implementation strategies during COVID-19 according to the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). We conducted a global scoping review including peer-reviewed and non-peer-reviewed literature. The databases searched were PubMed, Embase, Scopus, BVS, Scielo, and Web of Science. This search was complemented by an extensive examination of relevant websites and an additional internet search via Google Scholar. We extracted and analyzed the data following the seven modules of the FRAME-IS. Out of 20 records, 27 NCI were identified across Africa (n = 3), Asia (n = 7), Europe (n = 3), North America (n = 11), Oceania (n = 1), and South America (n = 2). NCIs adapted their content (e.g., adding elements), evaluation (e.g., conducting needs assessment), training (e.g., using experts), and context (e.g., setting-shifting from in-person to remote, and population-expanding interventions' reach). Adaptation goals were to increase acceptability (n = 9, 32.1%), adoption (n = 5, 17.8%), appropriateness (n = 10, 35.7%), feasibility (n = 25, 89.3%), penetration (n = 15, 53.6%), sustainability (n = 23, 82.1%), and fidelity (n = 1, 3.7%). The rationale to adapt varied from sociopolitical (n = 6, 21.4%), organizational (n = 13, 46.4%), implementer (n = 11, 39.3%), practitioner (n = 15, 53.6%), and recipient (n = 11, 39.3%). A quarter were reactive planned adaptations and 75.0% were unplanned modifications. Decisions were led by program leaders (n = 21, 75.0%), funders (n = 9, 32.1%), partners (n = 3, 10.7%), researchers (n = 1, 3.6%), and practitioners (n = 3, 10.7%). Adaptations were widespread from unit (e.g., hospital) (n = 1, 3.6%), organization (n = 4, 14.3%), and community system (e.g., countrywide) (n = 14, 50.0%). The results from our global scoping review show that it is possible for NCIs to continue and even improve their delivery despite the global crisis, suggesting that remote delivery is feasible and can work as an alternative when in lockdown. Strategic planning taking advantage of existing structures and partnerships may have allowed NCI adaptations to be sustainable as well as facilitated replication within the organization network system.

The Most Vulnerable Children Faced Unique Risks During COVID-19: How Agencies Communicated with Communities on Parenting in Low Resource and Humanitarian Settings

Evidence suggests that children in low resource and humanitarian settings experienced added mental health burdens and violence in the home during the SARS-CoV-2 (COVID-19) pandemic, which may have affected their health and development. For humanitarian response agencies, conducting child protection services during this pandemic had been constrained by safety concerns related to the risk of COVID-19 transmission, and logistical issues aligned with social and public health measures. This paper describes how agencies responded to the identified risks children face, integrating remote risk communication and community engagement approaches and safe in-person dialogues with parents and caregivers into child protection interventions to educate about the disease and prevention, encourage a positive parenting environment and mitigate negative effects on children. United Nations (UN) agencies and non-government organizations (NGOs) must reflect on these different approaches and share lessons learned and best practices internally and at an inter-agency level to support evidence-based responses for future epidemics and pandemics.

SARS-CoV-2 co-detection with influenza and human respiratory syncytial virus in Ethiopia: Findings from the severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance, January 01, 2021, to June 30, 2022.

SARS-CoV-2 co-infection with the influenza virus or human respiratory syncytial virus (RSV) may complicate its progress and clinical outcomes. However, data on the co-detection of SARS-CoV-2 with other respiratory viruses are limited in Ethiopia and other parts of Africa to inform evidence-based response and decision-making. We analyzed 4,989 patients' data captured from the national severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance sites over 18 months period from January 01, 2021, to June 30, 2022. Laboratory specimens were collected from the patients and tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR) at the national influenza center. The median age of the patients was 14 years (IQR: 1-35 years), with a slight preponderance of them being at the age of 15 to less than 50 years. SARS-CoV-2 was detected among 459 (9.2%, 95% CI: 8.4-10.0) patients, and 64 (1.3%, 95% CI: 1.0-1.6) of SARS-CoV-2 were co-detected either with Influenza virus (54.7%) or RSV (32.8%) and 12.5% were detected with both of the viruses. A substantial proportion (54.7%) of SARS-CoV-2 co-detection with other respiratory viruses was identified among patients in the age group from 15 to less than 50 years. The multivariable analysis found that the odds of SARS-CoV-2 co-detection was higher among individuals with the age category of 20 to 39 years as compared to those less than 20 years old (AOR: 1.98, 95%CI:1.15-3.42) while the odds of SARS-CoV-2 co-detection was lower among cases from other regions of the country as compared to those from Addis Ababa (AOR:0.16 95%CI:0.07-0.34). Although the SARS-CoV-2 co-detection with other respiratory viral pathogens was minimal, the findings of this study underscore that it is critical to continuously monitor the co-infections to reduce transmission and improve patient outcomes, particularly among the youth and patients with ILI.

OrthoTV: Broadcasting Orthopedics around the World.

OrthoTV has emerged as a pioneering platform in the field of orthopedic education, leveraging technology to create a comprehensive and accessible knowledge repository. Originating from the vision of the Indian Orthopedic Research Group in 2013, OrthoTV has evolved into a global educational hub, streaming thousands of hours of surgical videos, webinars, and podcasts. It provides a dynamic learning environment through live interactive sessions, fostering real-time engagement with experts and facilitating a global exchange of knowledge. OrthoTV's expansion during the COVID-19 pandemic underscored its vital role in continuing medical education amidst travel restrictions. The platform extends beyond educational resources to include career support, collaborative research initiatives, and even virtual fellowships, embodying a multifaceted approach to professional development. With the introduction of OrthoAI, OrthoTV integrates advanced artificial intelligence to offer personalized, evidence-based responses to queries, setting a new standard in digital medical education. This narrative review highlights OrthoTV's foundational principles, its significant impact on orthopedic education and practice, and its commitment to democratizing knowledge across the globe. OrthoTV's innovative use of technology bridges geographical barriers enriches learning experiences, and fosters a vibrant community of orthopedic professionals, marking a significant advance in the field of medical education.

THE EMED TOOLKIT: COLLABORATION TO IMPROVE ELDER MISTREATMENT SCREENING AND RESPONSE

Abstract The National Collaboratory to Address Elder Mistreatment (The Collaboratory) is a group of elder mistreatment (EM) researchers, clinicians, and advocates who came together with the goal of improving elder mistreatment identification and response in hospital emergency departments (ED). Since its inception in 2017, the Collaboratory has prioritized working in close collaboration with health care and aging services providers as well as older adult survivors to develop, test, and disseminate the Elder Mistreatment Emergency Department Toolkit (EMED Toolkit). The EMED Toolkit is a set of streamlined tools designed to improve EM screening and response in hospital EDs and foster improved collaboration between the hospital and community-based services. The EMED Toolkit is comprised of four core components 1) an online staff survey to assess EM practice and drive system change 2) the evidence-based EM Screening and Response Tool designed to efficiently screen all older adult patients for potential mistreatment, 3) online training modules to educate ED staff on elder mistreatment identification and response, including use of the screening tool, and 4) a Community Connections Roadmap designed to help EDs identify and establish connections with community-based services that can support safe discharge and provide ongoing support to older adults experiencing and at risk for mistreatment. In this presentation we will summarize results from a feasibility study testing EMED Toolkit implementation at five hospitals in the US, describe the Collaboratory’s approach to disseminating the EMED Toolkit more widely through local, regional, and national systems change initiatives, and share lessons learned from our efforts.

Changing trend analysis on early detection of rifampicin resistant tuberculosis patients in southwestern area of China, 2016-2020.

There were no data about prevention and control status of RR-TB in a poor area with high burden of TB in China. In order to develop evidence-based RR-TB response strategies and improve enrollment of RR-TB patients in Yunnan province, China, this study was aimed at analyzing the changing trends in the detection and enrollment of RR-TB patients and examining the factors that may have implication on enrollment in treatment. Data, which includes demographics, screening and testing, and treatment enrollment, was collected from the TB Management Information System. Retrospective data analysis and factors analysis were applied. Descriptive statistics, Chi-square test, Rank sum test and logistic regression analysis were used. From 2016 and 2018, the province had been challenged by low levels of screening, detection and enrollment of RR-TB. During the period between 2019 and 2020, a comprehensive model of RR-TB prevention and control was established in Yunnan, characterized by a robust patient-centered approach for RR-TB care and multiple, targeted interventions through the cascade of care from detection to treatment. In 2020, 93.8% of the bacteriologically positive TB patients were screened for RR-TB, which had been significantly increased by 146.9% from 38.0% in 2016. The interval from initial consultation at RR-TB facility to diagnosis (inter-quartile range) was reduced from 29.5 (1-118) days in 2016 to 0 (0-7) days in 2020. Despite the increasing rates of enrollment of RR-TB patients over the years, non-enrollment of those detected was still high (32.3%) in 2020. The main reasons for non-enrollment identified were refusal of treatment due to financial difficulties, loss to follow-up or death before starting treatment. Multivariate analysis showed that the elderly patients aged 65 or above (OR = 2.7, CI: 1.997-3.614), new patients (OR = 0.7, CI: 0.607-0.867), conventional DST used for confirmatory diagnosis of RR-TB (OR = 1.9, CI: 1.620-2.344) and diagnosis of RR-TB being conducted by the RR-TB care facilities at the prefecture and municipal level (OR = 4.4, CI: 3.608-5.250) have implications on RR-TB non-enrollment. As a comprehensive RR-TB model was implemented in Yunnan with scaled up use of molecular test for rapid detection of RR-TB, initial screening of RR-TB were decentralized to the county- and district-level to strengthen rapid, early detection of RR-TB, achieving a higher coverage of screening in the end. However, there remains a major gap in enrollment of RR-TB. The main barriers include: limited knowledge and awareness of RR-TB and financial burdens among patients, delayed diagnosis, loss to follow-up, difficulties in self care and travel for elderly patients, and limited capacity of clinical management at the lower-level RR-TB care facilities. The situation of the RR-TB epidemic in Yunnan could be improved and contained as soon as possible by continuous strengthening of the comprehensive, patient-centered model with targeted interventions coordinated through multi-sectoral engagement to improve enrollment of RR-TB patients.