Frontline Responders Research Articles

Flooding and Mental Health interventions for vulnerable groups

Abstract Issue/Problem The UK is increasingly vulnerable to flooding due to climate change, which significantly affects mental health. Vulnerable populations are disproportionately impacted, experiencing stress, anxiety, and other severe mental health issues, requiring effective intervention strategies. Description of the problem The UK’s third Climate Change Risk Assessment (CCRA) highlights flooding as a key challenge, with mental health impacts representing a major health burden. Effective interventions are crucial for these communities. Results UKHSA’s flooding and mental health guidance is incorporated into flooding and health advice documents for the public and frontline responders. It includes assessment and support strategies for health and social care staff, emergency responders, and local authorities. It focuses on those most at risk and promotes a phased approach to care-from immediate safety and shelter to long-term psychological support. This strategy accommodates the prolonged nature of mental health recovery, requiring adaptable and sustained interventions. Lessons Addressing the mental health impacts of flooding demands a comprehensive, multi-phase strategy that adapts to the evolving needs of affected populations. Early intervention and long-term support are vital to mitigate the extensive psychosocial damage. Key messages • Flooding severely affects mental health, necessitating structured, long-term interventions. • Flexible support strategies that evolve over time are crucial for effective recovery, ensuring that interventions meet the changing needs of those impacted by flooding.

A Scoping Review of Nurses' Knowledge and Preparedness in Disaster Management in Saudi Arabia

Nurses are the front-line responders to disasters. Providing them with sufficient knowledge, training, and preparedness is essential. Saudi Arabia, a country prone to numerous disasters, needs to enhance the training and preparedness of nurses and first responders to effectively respond to emergencies and minimize the impact on lives and the economy. The aim of this scoping review is to evaluate the preparedness of nurses and identify emerging trends in disaster nursing in Saudi Arabia. This review will serve as a foundation for future rigorous studies. A comprehensive search strategy was developed and implemented, sourcing studies from various online databases. Each study was evaluated for inclusion, followed by a critical appraisal. The key characteristics of the 13 included studies were charted, and the studies were then mapped onto the ICN framework. The key themes and patterns emerging from the appraisal were analyzed using the PAGER framework. In the discussion, the PAGER framework was expanded, incorporating insights from existing literature to identify gaps and develop avenues for future research. The implications of this research include recommendations to focus on experimental studies that investigate the most effective strategies for improving disaster preparedness among nurses.

Sparks of Light, Sparks of Life

This article examines the critical issue of Indigenous mental health in Canada, focusing on First Nations, Inuit, and Métis. It underscores the urgency in addressing Indigenous mental wellness challenges, particularly the high rates of suicide, amid their rapid population growth. The study centers on the role of frontline responders in managing mental health and suicidal distress in these communities, and their work to promote life and mental wellness. Through a synthesis of psychological, critical, and Indigenous perspectives, the article reviews Canadian literature on Indigenous mental health and suicide prevention. The article then highlights reflexive insights derived from a knowledge-sharing event with 33 Indigenous mental health professionals, focusing on the unique challenges and opportunities in this field and the importance of life-affirming dialogues in suicide prevention. The article aims to integrate these insights into broader discussions on Indigenous mental wellness, health, and life promotion systems, proposing enhanced wellness and suicide prevention strategies and frameworks tailored to the needs and aspirations of Indigenous communities.

Evaluating Saudi Arabian nurses' willingness to respond to nuclear and radiological disasters.

We evaluated Saudi Arabian nurses' willingness to engage in nuclear and radiological disaster response. In the face of rising nuclear and radiological threats, it is essential that nurses are fully prepared to handle the health consequences of such emergencies. As frontline responders, nurses play a critical role in managing high-stakes situations, making their readiness a key factor in ensuring public safety during these crises. A cross-sectional survey was conducted among 612 registered nurses in Saudi Arabia. The survey used a structured questionnaire based on the theory of planned behavior, identifying behavioral intentions as the primary outcome and attitudes toward these behaviors, subjective norms, and perceived behavioral control as influencing factors. The data were analyzed using descriptive and inferential statistics. Most respondents lacked specialized training and reported strong behavioral intentions. Attitude and perceived behavioral control were key drivers of these behavioral intentions, with less impact from subjective norms. Behavioral intentions were also shaped by education, the perceived likelihood of nuclear and radiological emergencies in their region, peer influence, perceived self-efficacy, and family concerns. Younger and married nurses showed significantly stronger behavioral intentions. Although most nurses lacked specialized training, their strong engagement intentions and positive responses to active learning and training indicate a desire to close this gap through further education. However, inadequate institutional support, trouble communicating with family, and concerns about personal radiation exposure emerged as potential barriers. Targeted educational initiatives and support systems are needed to enhance nurses' confidence, competence, and willingness to engage in radiological and nuclear emergency scenarios. Policymakers should prioritize the development of specialized training programs and support mechanisms for nurses, ensuring they are adequately prepared to respond effectively to increasing radiological and nuclear threats.

Burn injuries in clinical practice: Principles and management for general physicians

ABSTRACT Burn injuries, although largely preventable, continue to pose a significant global health burden and substantially contribute to morbidity and mortality. This study emphasises the pivotal role of timely and effective burn care in mitigating the adverse consequences of these injuries. General physicians often serve as frontline responders to burn incidents, highlighting the importance of proficiency in burn management for accurate diagnosis, prognosis and appropriate referral to specialised burn units. Prompt initiation of acute burn care is paramount, with first-aid interventions playing a crucial role in shaping patient outcomes and reducing morbidity and it highlights the essential principles of burn care that general physicians should apply to enhance patient care outcomes. This emphasises the critical role of general physicians in implementing these principles effectively. In addition, it underscores the necessity of a multidisciplinary approach, advocating collaboration between general physicians and specialised burn care teams to ensure comprehensive patient management and rehabilitation. Ultimately, effective burn care enhances individual patient outcomes and reduces the overall burden of burn injuries on healthcare systems and society.

A Knowledge Management System for health emergencies: facilitating knowledge continuity and timely decision-making for frontline responders using experiential knowledge captured during action reviews.

A Knowledge Management System for health emergencies: facilitating knowledge continuity and timely decision-making for frontline responders using experiential knowledge captured during action reviews.

Burnout among Polish paramedics: insights from the Oldenburg Burnout Inventory.

Emergency medical services rely heavily on paramedics who, as frontline responders, face unique stressors that can potentially lead to burnout. This pilot study utilizes the Oldenburg Burnout Inventory (OLBI) to assess burnout levels among Polish paramedics. The aim is to contribute to the understanding of burnout in this specific professional context and identify key factors influencing burnout dimensions. Future research will build on these preliminary findings. A cross-sectional study was conducted from March 01 to April 30, 2023, utilizing an online survey accessible to Polish paramedics. The OLBI, a validated tool, was employed to measure burnout, focusing on two dimensions: exhaustion and withdrawal of involvement. Among the 147 participating paramedics, the majority were male (65.99%). Paramedics exhibited burnout symptoms across both dimensions measured by The Oldenburg Burnout Inventory scale (OLBI), with an average level for lack of commitment recorded at 20.09, an average level for exhaustion at 20.60. The study revealed that 41.5% of paramedics experienced low burnout, 44.9% reported moderate burnout, and 13.6% faced high burnout risks. Analysis showed that women experienced significantly higher levels of exhaustion compared to men (p = 0.01). This pilot study provides valuable initial insights into burnout among Polish paramedics. The OLBI's two-factor structure, evaluating exhaustion and disengagement, proved reliable and valid in this context. The prevalence of burnout, with over 60% of paramedics experiencing moderate to high levels, highlights the urgency of addressing burnout in this profession. Future research will be essential to explore the underlying causes and develop targeted interventions. Understanding the factors contributing to burnout among paramedics is crucial for developing targeted interventions. Strategies should focus on stress management training, organizational support, and well-being initiatives. Addressing gender-specific differences in burnout experiences is essential for tailoring interventions effectively. Proactive psychological support mechanisms and optimized working conditions can enhance paramedics' overall well-being, ensuring their continued effectiveness in providing emergency medical services.

CLIMATE CHANGE AND EXTREME EVENTS: EXPLORING THE INTERFACE

This review paper delves into "Resilience to Climate Crisis in the Anthropocene" within the broader context of "Climate Change: Conflict and Resilience in the Age of Anthropocene." It highlights that the issues resulting from climate change are both environmental and societal, intricately woven into the fabric of communities. Emphasizing the proactive cultivation of community resilience as essential for sustainable development, the chapter aims to deliver an in-depth understanding of this dynamic. The significance of this chapter lies in its holistic approach to how communities, as frontline responders, can develop resilience strategies to mitigate vulnerabilities and enhance adaptive capacities. By elucidating the interplay between climate change and community resilience, it seeks to empower policymakers, practitioners, and researchers with interdisciplinary insights. The methodology involves a comprehensive literature review that explores the interrelationship of climate change and community resilience. The paper aims to offer actionable insights and practical implications for policy formulation, governance, and community-based adaptation strategies, thereby serving as a roadmap for stakeholders. It aspires to guide informed decision-making and inspire collaborative efforts to cultivate resilient communities that pave the way for sustainable development in the Anthropocene.

The Study of Gender-Based Violence through a Narrative Approach: Evidence from the European Project IMPROVE

Background: Gender-based violence (GBV) remains largely under-reported and under-detected. The European project IMPROVE seeks to identify the needs of victims in terms of facilitating their access to support services and to assist frontline responder organisations in enhancing their competencies and capabilities to make the most of innovative solutions that enable and accelerate policy implementation. Methods: To meet these goals, IMPROVE uses narrative interviews, understood as unstructured tools that produce and analyse stories that are significant in people’s lives. These interviews provide the space for re-thinking; there is a reflection on implicit and taken-for-granted norms and insights are given into the life and thoughts of vulnerable groups, in this case, the women victim-survivors of GBV. Results: This methodological approach has led to high-quality interviews in which the women involved have felt comfortable, confident, and satisfied, as evidenced by the depth, complexity, and extension of the knowledge generated, and the commitment of the interviewees to the various activities proposed by the researchers. Conclusions: The narrative approach has allowed for a sensitive investigation into the private lives of GBV victim-survivors and, as a consequence, has contributed to the creation of new knowledge that can provide an in-depth and incisive view of the help offered by frontline responder organisations, from which improvements can be proposed.

Physiologic oxygen responses to smoking opioids: an observational study using continuous pulse oximetry at overdose prevention services in British Columbia, Canada

BackgroundIn British Columbia, Canada, smoking is the most common modality of drug use among people who die of opioid toxicity. We aimed to assess oxygen saturation (SpO2) while people smoked opioids during a pilot study that introduced continuous pulse oximetry at overdose prevention services (OPS) sites.MethodsThis was an observational cohort study, using a participatory design. We implemented our monitoring protocol from March to August 2021 at four OPS. We included adults (≥ 18 years) presenting to smoke opioids. A sensor taped to participants’ fingers transmitted real-time SpO2 readings to a remote monitor viewed by OPS staff. Peer researchers collected baseline data and observed the timing of participants’ inhalations. We analyzed SpO2 on a per-event basis. In mixed-effects logistic regression models, drop in minimum SpO2 ≤ 90% in the current minute was our main outcome variable. Inhalation in that same minute was our main predictor. We also examined inhalation in the previous minute, cumulative inhalations, inhalation rate, demographics, co-morbidities, and substance use variables.ResultsWe recorded 599 smoking events; 72.8% (436/599) had analyzable SpO2 data. Participants’ mean age was 38.6 years (SD 11.3 years) and 73.1% were male. SpO2 was highly variable within and between individuals. Drop in SpO2 ≤ 90% was not significantly associated with inhalation in that same minute (OR: 1.2 [0.8–1.78], p = 0.261) or inhalation rate (OR 0.47 [0.20–1.10], p = 0.082). There was an association of SpO2 drop with six cumulative inhalations (OR 3.38 [1.04–11.03], p = 0.043); this was not maintained ≥ 7 inhalations. Demographics, co-morbidities, and drug use variables were non-contributory.ConclusionsContinuous pulse oximetry SpO2 monitoring is a safe adjunct to monitoring people who smoke opioids at OPS. Our data reflect challenges of real-world monitoring, indicating that greater supports are needed for frontline responders at OPS. Inconsistent association between inhalations and SpO2 suggests that complex factors (e.g., inhalation depth/duration, opioid tolerance, drug use setting) contribute to hypoxemia and overdose risk while people smoke opioids.

Nurses' Personality Traits and Perceived Work Environments During Public Health Emergencies: Implications for Nursing Workforce Planning.

The nursing workforce faces substantial challenges, particularly in the aftermath of the COVID-19 era. Developing an effective strategy for workforce maintenance and the strategic deployment of nurses is crucial. This study aimed to explore and categorize nurses' personality traits, with a focus on analyzing differences in their perceptions of the nursing work environment. Between January 2023 and February 2023, a multi-center cross-sectional study was carried out involving nurses from 12 tertiary hospitals actively engaged in frontline COVID-19 response duties. Through cluster sampling, surveys were distributed among eligible nursing staff, comprising a general information questionnaire, the Chinese Big Five Personality Questionnaire-Short Form, subjective evaluations of emergency nursing management, and the Chinese Nursing Work Environment Scale for Public Health Emergencies. Various statistical analyses, such as descriptive analysis, cluster analysis, non-parametric tests, and general linear model analysis, were employed to investigate the correlation between personality types and the perception of nursing work environments. The analysis encompassed 1059 valid questionnaires, reflecting the experiences of frontline nurses. The majority of these nurses possessed 1-5 years of experience, held junior professional titles, volunteered for their roles, and served as attending nurses. Categorization based on personality traits revealed three groups: resilient (35.60%), ordinary (16.15%), and distressed (48.25%) types. Significantly distinct perceptions of nursing work environments emerged among these categories, with resilient and ordinary types expressing notably higher satisfaction compared to the distressed group (H value = 256.487, p < 0.001). This study illustrates the connection between nurses' perceived working environment and their personality traits. Nursing managers should factor in nurses' personality traits when choosing and deploying frontline responders during public health emergencies. Prioritizing resilient-type nurses and crafting a supportive work environment that aligns with nurses' characteristics is indispensable for an effective emergency response.

Definition and characteristics of climate-adaptive cities: a systematic review

BackgroundCities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning.MethodsThis systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities.ResultsOut of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities.ConclusionA climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

SARS-CoV-2 seroprevalence screening study of a children's hospital health care workers.

Health care workers (HCWs) are front line responders to the COVID-19 pandemic, but limited data is available for pediatric HCWs, as the research response has largely focused on adult patients and medical personnel that treat these patients. We conducted a cross-sectional study of SARS-CoV-2 seroprevalence and risk factors in HCWs at a Children's Hospital in CO, USA from September 2020 to April 2021. Pediatric HCWs were defined as clinical care providers and administrative staff. Seroprevalence was determined using the Epitope SARS-CoV-2 anti-Nucleocapsid IgG assay (San Diego, CA) and the Euroimmun SARS-CoV-2 anti-Spike Protein IgG assay. Risk factors and vaccination status were assessed via questionnaire. Overall, 110 HCWs were enrolled, 79 subjects were positive for anti-S antibodies and negative for anti-N antibodies, indicating COVID-19 vaccination. 31 subjects had neither anti-N or anti-S antibodies, indicating no exposure to SARS-CoV-2 and no vaccination. 3/110 had a nucleocapsid serology consistent with a SARS-CoV-2 prior infection. Seroprevalence was observed at 2.7%. It was noted that asthma requiring medication was associated with positive serostatus. During the winter 2020/21, SARS-CoV-2, we found a 2.7% seroprevalence of pediatric HCW at a children's hospital in Colorado. We compared this with publicly available seroprevalence data for seroprevalence rates of pediatric HCWs globally. This suggests that this specific children's hospital COVID-19 personal protective equipment (PPE) and infection control guidelines were effective in limiting SARS-CoV-2 in hospital transmission at the children's hospital prior to the presence of the Delta variant.

Crisis communication during COVID‐19: Insights from Pennsylvania and Florida local governments

AbstractThis study examines the determinants of local governments’ (LGs') adoption of crisis communication strategies during the coronavirus disease 2019 pandemic. Recognizing the pivotal role of crisis communication in public health emergencies and the central role of LGs as frontline responders, this research offers valuable insight into pandemic response and management. Employing ordinary least squares regression, we analyzed data from our Pandemic Management Survey, which was distributed across Pennsylvania and Florida municipal executives during the spring of 2021. According to our results, LG managers’ concerns related to school and business closures, as well as their efficacy beliefs, had a positive impact on the adoption of communication strategies. Our results also showed that funding from the CARES Act significantly improved LGs’ capacity to implement these strategies. Additionally, our study underscores the significance of community vulnerability factors in shaping crisis communication efforts.

Underlay Loosely Coupled Model for Public Safety Networks Based on Device-to-Device Communication

In several emergency situations, during natural or human-caused disasters, frontline responders need to be able to communicate and collaborate to properly carry out relief missions. Some countries build their national Public Safety Mobile Broadband based on cellular LTE technology to provide fast, safe, and secure emergency services. However, in several emergency situations, cellular antennas can be overloaded or partially damaged in a manner that affects group communication services. In the last few years, direct device-to-device (D2D) communications have been proposed by the 3GPP as an underlay of long-term evolution (LTE) networks based on proximity, reuse, and hop gains. This paper focuses on a loosely coupled model based on direct D2D communication in a public safety context. Many scenarios related to user membership and network management are detailed. Both the “less cost” and “optimized tree” approaches are proposed and implemented, and their performance is evaluated in terms of the network update number and the resulting average Channel Quality Indicator (CQI). Other optimization approaches, with different CQI thresholds and optimization interval parameters, are simulated to compare their performance with the “optimized tree” approach. By conducting simulations that combine a CQI threshold = 1 and optimization interval = 2 s, it becomes possible to keep an average CQI level close to the “optimized tree” approach, while the costs related to network updates significantly decrease by almost 35%. Other simulations are also carried out to measure the bandwidth required by the control messages between the server and active users. It was found that both inbound and outbound traffic on the server side can be well supported with LTE and 5G networks.

Going local without localization: Power and humanitarian response in the Syrian war

International aid organizations and donors have committed to localize aid by empowering local actors to deliver and lead in humanitarian response. While international actors do often rely on local actors for aid delivery, their progress on shifting authority falls short. Scholars suggest that while localizing aid may be desirable, the organizational imperatives of international actors and aid’s colonial past and present make it difficult at best. Can localization efforts produce locally led humanitarian response? Adopting a power framework, we argue that localization reinforces and reproduces international power; through institutional processes, localization efforts by international actors allocate capacity to, and constitute local actors as, humanitarians that are more or less capable, funded, and involved in responding to crises in the latter’s own countries. This article interprets aid efforts during the Syria War. In this crucial case, we might expect localization to be “easy” due to the dependence of international actors on local actors because of security concerns and constraints on international access. We draw on fine-grained qualitative data collected through immersive observation and 250 interviews with Syrian and international aid workers in Jordan, Lebanon, and Turkey, as well as descriptive analysis of quantitative data. We reveal the ways Syrians were constituted as frontline responders, recipients of funds or trainings, risk-takers, gateways to access, and tokenistic representatives of the crisis. Our research shows that while the response seemed to “go local” by relying on the labor and risk-taking of Syrians to implement relief, it did not transfer authority to Syrian actors. Findings contribute to current debates in global development and humanitarian scholarship about who holds power within the global aid architecture.

Decision-making, training and support:Lessons from public health response to COVID-19 in Ireland

Abstract Background The COVID-19 pandemic exposed the critical need for a rapid and effective public health emergency response to such crises. This study investigates the public health response to COVID-19 in Ireland, focusing on decision-making, recruitment, training, and specialised support for emergency responders. Methods Using a mixed-methods approach, we analysed data from surveys of volunteer contact tracers recruited in the early days of the pandemic, from government reports, and from the Health Service Executive (HSE) COVID-19 Contact Management Programme work instructions that evolved over the course of the pandemic response. Results Our findings reveal that the public health response in Ireland was moderately rapid and decisive with innovative recruitment strategies, targeted training programmes and the development of specialised support for frontline responders. While volunteer contact tracers were quickly upskilled, they required ongoing expert support on an evolving IT system and for effective clinical and public health responses. We highlight key lessons learned, including the need for interdisciplinary collaboration, ongoing training and support, and effective communication strategies. Conclusions Our study has important policy implications for public health emergency preparedness and response, which include the need for greater investment in training and support for public health professionals, the development of effective communication channels, and the establishment of a coordinated national response system. By implementing these recommendations policymakers can better prepare for, and respond to, future public health emergencies ultimately improving the health and wellbeing of the population. The key lessons presented from this analysis point to the importance of forward planning for early intervention, rather than reactive responses in times of crises. Key messages • Improving emergency preparedness by investing in training for public health professionals, developing effective communication channels, and establishing a coordinated national response system. • The key lessons presented from this analysis point to the importance of forward planning for early intervention, rather than reactive responses in times of crises.

A Phenomenological Study of the Experiences of Front Liner Police Officers Infected with Covid-19

People and civilizations around the world were facing previously unheard-of difficulties as a result of the COVID-19 pandemic, which has thrust frontline fighters to the fore of the conflict against this potentially fatal and extremely contagious virus. Law enforcement officers, who persistently serve and protect their communities despite incurring increased risks of exposure, were among these brave frontline heroes. While navigating the dangers posed by the virus that recognizes no bounds, police officers continued to be resolute in their commitment to upholding law and order as the pandemic continues to change. This study investigated, reported, and evaluated the lived experiences of police officers who contracted COVID-19 while serving as frontline responders in Taguig City, Philippines during the height of the pandemic. Eleven police officers in Taguig City, Police Commissioned Officers (PCO) and Non-Commissioned Police Officers (PNCO), who were part of the COVID-19 frontliners and unfortunately contracted with the virus were purposefully chosen as participants of the study. The primary goal of this study is to extract eidetic insights that can be used to develop a proposed intervention program for police personnel afflicted with COVID-19. The findings revealed thatmost of the participants are male police officers, with only one female cop in the mix. Many participants are married and experienced officers, including PCO and PNCOs. They did, however, recover from the Covid-19 virus after some time. All of them have indicated that they were infected with the virus and assigned to checkpoints while operating on the front lines, particularly during periods of increasing restrictions. The responsibility of the frontline police officers in executing health safety measures elicited a wide range of views from participants. Their taped conversations covered a variety of topics, including personal, family, and work-related issues. The officers' firsthand experiences with the virus span from personal observations to observations in quarantine facilities. The PNP leadership's help for COVID-19-infected police officers on the frontlines evolved from planning, support, facility management, and emergency plan implementation. In the narratives of the officers' family members' assistance during their COVID-19 infection and recovery, two patterns appeared. The first was about police officers receiving emotional support from their family and via in-patient counseling. Six themes emerged from the police officers' recommendation for an Intervention Program for those who had been placed in a similar circumstance. These issues, however, may have an impact on law enforcement. Furthermore, competent counselors and training for dealing with health difficulties and crises are in short supply.

The importance of community health workers as frontline responders during the COVID-19 pandemic, Somalia, 2020-2021.

We examined the contribution of community health workers as frontline responders for the community-based surveillance in Somalia during the first year of the COVID-19 pandemic for detection of COVID-19 cases and identification of contacts. We retrieved COVID-19 surveillance data from 16 March 2020 to 31 March 2021 from the health ministry's central database. These data were collected through community health workers, health facilities or at the points of entry. We compared the number of suspected COVID-19 cases detected by the three surveillance systems and the proportion that tested positive using the chi-squared test. We used logistic regression analysis to assess association between COVID-19 infection and selected variables. During the study period, 154,004 suspected cases of COVID-19 were detected and tested, of which 10,182 (6.6%) were positive. Of the notified cases, 32.7% were identified through the community-based surveillance system, 54.0% through the facility-based surveillance system, and 13.2% at points of entry. The positivity rate of cases detected by the community health workers was higher than that among those detected at health facilities (8.6% versus 6.4%; p < 0.001). The community health workers also identified more contacts than those identified through the facility-based surveillance (13,279 versus 1,937; p < 0.001). The odds of COVID-19 detection generally increased by age. Community-based surveillance and health facility-based surveillance had similar odds of detecting COVID-19 cases compared with the points-of-entry surveillance (aOR: 7.0 (95% CI: 6.4, 7.8) and aOR: 7.5 (95% CI: 6.8, 8.3), respectively). The community health workers proved their value as first responders to COVID-19. They can be effective in countries with weak health systems for targeted community surveillance in rural and remote areas which are not covered by the facility-based surveillance system.

Neutrophils: a subgroup of neglected immune cells in ALS.

Amyotrophic lateral sclerosis (ALS) is a chronic, progressive neurodegenerative disease characterized by the loss of motor neurons. Dysregulated peripheral immunity has been identified as a hallmark of ALS. Neutrophils, as the front-line responders of innate immunity, contribute to host defense through pathogen clearance. However, they can concurrently play a detrimental role in chronic inflammation.With the unveiling of novel functions of neutrophils in neurodegenerative diseases, it becomes essential to review our current understanding of neutrophils and to recognize the gap in our knowledge about their role in ALS. Thus, a detailed comprehension of the biological processes underlying neutrophil-induced pathogenesis in ALS may assist in identifying potential cell-based therapeutic strategies to delay disease progression.