Capabilities Of Health System Research Articles

Mapping the existing body of knowledge on new and repurposed TB vaccine implementation: A scoping review.

There is global consensus on the urgent need for a safe and effective TB vaccine for adults and adolescents to improve global TB control, and encouragingly, several promising candidates have advanced to late-stage trials. Significant gaps remain in understanding the critical factors that will facilitate the successful implementation of new and repurposed TB vaccines in low- and middle-income countries (LMICs), once available. By synthesizing the existing body of knowledge, this review offers comprehensive insights into the current state of research on implementation of these adult and adolescent vaccines. This review explores four key dimensions: (1) epidemiological impact, (2) costing, cost-effectiveness, and/or economic impact, (3) acceptability, and the (4) feasibility of implementation; this includes implementation strategies of target populations, and health system capabilities. Results indicate that current research primarily consists of epidemiological and costing/cost-effectiveness/economic studies in India, China, and South Africa, mainly modelling with M72/AS01, BCG revaccination, and hypothetical vaccines. Varying endpoints, vaccine efficacies, and vaccination coverages were used. Globally, new, and repurposed TB vaccines are estimated to save millions of lives. Economically, these vaccines also demonstrate promise with expected cost-effectiveness in most countries. Projected outcomes were dependent on vaccine characteristics, target population, implementation strategy, timing of roll out, TB burden/country context, and vaccination coverage. Potential barriers for vaccine acceptability included TB-related stigma, need for a second dose, and cost, while low pricing, community and civil society engagement and heightened public TB awareness were potential enablers in China, India, and South Africa. Potential implementation strategies considered spanned from mass campaigns to integration within existing vaccine programs and the primary target group studied was the general population, and adults and adolescents. In conclusion, future research must have broader geographical representations to better understand what is needed to inform tailored vaccine programs to accommodate diverse country contexts and population groups to achieve optimal implementation and impact. Furthermore, this review underscores the scarcity of research on acceptability of new and repurposed TB vaccines and their delivery among potential beneficiaries, the most promising implementation strategies, and the health system capabilities necessary for implementation. The absence of this knowledge in these areas emphasizes the crucial need for future research to ensure effective TB vaccine implementation in high burden settings worldwide.

Immigration medical examination at the Regional Referral Hospitals: strengthening health system capabilities

Immigration medical examination at the Regional Referral Hospitals: strengthening health system capabilities

Hip-specific and generic patient-reported outcome measure scores after primary hip replacement are associated with early revision surgery: a national registry study

BackgroundThe ability to efficiently identify patients at higher risk of poor outcomes after joint replacement would enable limited resources for post-operative follow-up to be directed to those with the greatest clinical need. This is particularly important as joint replacement rates continue to grow internationally, stretching health system capabilities. Patient-reported outcome measures (PROMs) are routinely administered in many settings and offer an opportunity to detect suboptimal patient outcomes early. This study aimed to determine whether hip-specific and generic PROM scores are associated with early revision hip replacement within six to 24 months after the primary procedure.MethodsPre-operative and six-month post-operative PROM scores for patients undergoing primary total hip replacement (THR) were obtained from the Australian Orthopaedic Association National Joint Replacement Registry and Arthroplasty Clinical Outcomes Registry National and linked to revision surgery data. Clinically important improvement was defined using anchor-based thresholds. Associations between PROM scores (hip pain, Oxford Hip Score, HOOS-12, EQ-5D-5L, EQ VAS, patient-perceived change, satisfaction) and revision surgery were evaluated using t-tests, chi-square tests and regression models.ResultsData were analysed for 21,236 primary THR procedures between 2013 and 2022. Eighty-eight revision procedures were performed at six to 24 months. Patients who were revised had more back pain and worse HOOS-12 scores pre-operatively but between-group differences were small. Worse post-operative PROM scores (hip pain, Oxford, HOOS-12, EQ-5D-5L, EQ VAS) were associated with early revision, after adjusting for age and sex (p < 0.001 for all analyses). Patient dissatisfaction (relative risk (RR) 10.18, 95%CI 6.01–17.25) and patient-perceived worsening (RR 19.62, 95%CI 11.33–33.98) were also associated with a higher likelihood of revision. Patients who did not achieve clinically important improvement in hip pain, function, or quality of life had a higher revision risk (RRs 2.54–5.64), compared with those who did (reference).ConclusionSix-month hip-specific and generic PROM scores can identify patients at higher risk of early revision surgery. Our data highlight the utility of routine post-operative PROM assessment for signaling suboptimal surgical outcomes.

Measuring income-associated inequalities in COVID-19 vaccination on a global scale: a modeling study.

Inequalities in the accessibility and utilization of quality, safe, and effective coronavirus disease 2019 (COVID-19) vaccines across and within countries limited their value in protecting health during the COVID-19 pandemic. We quantified cross-country, income-associated inequality in COVID-19 vaccination using statistical models based on the data for 79 countries through December 2021. We found notable inequality in vaccinations per capita. At least 11.9% of doses administered in high-income countries could be redistributed to low-income countries to substantially reduce income-associated inequality in vaccinations. The results of this modeling study indicate that reliance on multiple doses of vaccine to attain optimal protection from COVID-19 is a significant contributor to inequality in vaccinations per capita. Dose-sharing mechanisms should account for and include efforts to optimize the capabilities of health systems to deliver vaccines.

Transmission dynamics and baseline epidemiological parameter estimates of Coronavirus disease 2019 pre-vaccination: Davao City, Philippines.

The Coronavirus disease 2019 (COVID-19) has exposed many systemic vulnerabilities in many countries' health system, disaster preparedness, and adequate response capabilities. With the early lack of data and information about the virus and the many differing local-specific factors contributing to its transmission, managing its spread had been challenging. The current work presents a modified Susceptible-Exposed-Infectious-Recovered compartmental model incorporating intervention protocols during different community quarantine periods. The COVID-19 reported cases before the vaccine rollout in Davao City, Philippines, are utilized to obtain baseline values for key epidemiologic model parameters. The probable secondary infections (i.e., time-varying reproduction number) among other epidemiological indicators were computed. Results show that the cases in Davao City were driven by the transmission rates, positivity proportion, latency period, and the number of severely symptomatic patients. This paper provides qualitative insights into the transmission dynamics of COVID-19 along with the government's implemented intervention protocols. Furthermore, this modeling framework could be used for decision support, policy making, and system development for the current and future pandemics.

Setting a research agenda to advance maternal, newborn, and child health in Ethiopia: An adapted CHNRI prioritization exercise.

Critical to the improvement of maternal, newborn, and child health (MNCH) in Ethiopia - where 14 000 mothers die from pregnancy-, childbirth-, or postpartum-related complications each year - is high-quality research and its effective translation into policy and practice. While Ethiopia has rapidly expanded the number of institutions that train and conduct MNCH research, the absence of a shared research agenda inhibits a coordinated approach to inform critical MNCH policy needs. The HaSET Maternal and Child Health Research Program (MCHRP) conducted a mixed methods formative assessment and prioritization exercise to guide investments in future MNCH research in Ethiopia. We adapted the Child Health and Nutrition Research Initiative (CHNRI) method, soliciting 56 priority research questions via key informant interviews. Through an online survey, experts scored these on their ability to generate new, actionable evidence that could inform more effective and equitable MNCH programs in Ethiopia. At a workshop in Addis Ababa, experts scored the questions by answerability and ethics, usefulness, disease burden reduction, and impact on equity. Research priority scores were calculated for both the online survey and workshop scoring and averaged to attain a ranked priority list. We validated and contextualized the results by conducting consensus-building discussions with MNCH experts and two community workshops. In total, approximately 100 participants were involved. Average research priority scores ranged from 58.4 to 83.7 out of 100.0. The top identified research priorities speak to critical needs in the Ethiopian context: to improve population coverage of proven interventions like integrated community case management (ICCM), family integrated newborn care, and kangaroo mother care (KMC); to better understand the determinants of outcomes like home deliveries, immunization drop-out, and antenatal and postpartum care-seeking; and to strengthen health system and workforce capabilities. This exercise expanded on the CHNRI methodology by comparing prioritization across different audiences, formats, and criteria. Agreement between both scoring rounds and consensus-building discussions was strong, demonstrating the reliability of the CHNRI method. By sharing this research priority list broadly among researchers, practitioners, and donors, we aim to improve coordinated MNCH evidence generation and translation into policy in Ethiopia.

Factors Influencing Healthcare Workers’ Perception of South African Health System Capability for Managing COVID-19 Pandemic

Background: During the emergence of the COVID-19 pandemic in South Africa in March 2020, there was an urgent mobilization of healthcare workers (HCWs) who had to adapt quickly to a challenging health system. Therefore, this paper examines factors associated with HCWs’ perceptions of the South African health system’s capability for managing COVID-19 during the early stages of the pandemic. Methods: Data utilised in this paper were obtained from an online survey conducted among HCWs using a structured questionnaire on a data-free online platform. The study population included all HCWs in South Africa. Bivariate and multivariate logistic regression models were used to examine the factors influencing HCWs’ perceptions of the South African health system capability for managing COVID-19. Results: Of the 5,274 respondents, 22.0% indicated that the South African health system would manage the COVID-19 pandemic. Increased odds of perceiving that the South African health system was capable of managing COVID-19 were significantly associated with being male (aOR = 1.55 95%CI [1.22-1.97], p&lt;0.001), being 50-59 years old (aOR = 1.94 [1.31-2.87], p=0.001) and 60 years and older (aOR = 2.27 [1.34-3.84], p=0.002), working in other sector (aOR = 1.42 [1.10-1.84], p=0.007), and having confidence in their overall knowledge about COVID-19 (aOR = 1.92 [1.52-2.41], p&lt;0.001). Decreased odds of perceiving that the South African health system was capable of managing COVID-19 were significantly associated with HCWs being White (aOR = 0.29 [0.22-0.38], p&lt;0.001) and Indian/Asian (aOR = 0.45 [0.33-0.62], p&lt;0.001), being medical practitioner (aOR = 0.55 [0.41-0.73], p&lt;0.001), and having moderate (aOR = 0.70 [0.50-0.99], p=0.042) or high risk perceptions (aOR = 0.55 [0.39-0.77], p&lt;0.001) of contracting COVID-19. Conclusion: In the early days of the pandemic, most HCWs felt that the health system would not cope with COVID-19. Healthcare workers’ experience (a proxy for HCWs’ age), work sector, confidence in their knowledge about COVID-19, and their risk perceptions were key factors affecting their perception of the health system’s capability.

Local Public Health System Capabilities and COVID-19 Death Rates.

Objectives:Efforts to contain the health effects of the COVID-19 pandemic have achieved less success in the United States than in many comparable countries. Previous research documented wide variability in the capabilities of local public health systems to carry out core disease prevention and control activities, but it is unclear how this variability relates to COVID-19 control. Our study explored this relationship by using a nationally representative sample of 725 US communities.Methods:We used data collected from the National Longitudinal Survey of Public Health Systems to classify each community into 1 of 3 ordinal categories indicating limited, intermediate, or comprehensive public health system capabilities. We used 2-part generalized linear models to estimate the relationship between public health system capabilities and COVID-19 death rates while controlling population and community characteristics associated with COVID-19 risk.Results:Across 3 waves of the pandemic in 2020, we found a significant negative association between COVID-19 mortality and public health system capabilities. Compared with comprehensive public health systems, intermediate public health systems had an average of 4.97 to 19.02 more COVID-19 deaths per 100 000 residents, while limited public health systems had an average of 5.95 to 18.10 more COVID-19 deaths per 100 000 residents.Conclusion:Overall, communities with stronger public health capabilities had significantly fewer deaths. Future initiatives to strengthen pandemic preparedness and reduce health disparities in the United States should focus on local public health system capabilities.

Adoption of Patient-Reported Outcomes by Health Systems and Physician Practices in the USA.

Patient-reported outcome measures (PROs) can help clinicians adjust treatments and deliver patient-centered care, but organizational adoption of PROs remains low. This study examines the extent of PRO adoption among health systems and physician practices nationally and examines the organizational capabilities associated with more extensive PRO adoption. Two nationally representative surveys were analyzed in parallel to assess health system and physician practice capabilities associated with adoption of PROs of disability, pain, and depression. A total of 323 US health system and 2,190 physician practice respondents METHODS: Multivariable regression models separately estimated the association of health system and physician practice capabilities associated with system-level and practice-level adoption of PROs. Health system and physician practice adoption of PROs for depression, pain, and disability. Pain (50.6%) and depression (43.8%) PROs were more commonly adopted by all hospitals and medical groups within health systems compared to disability PROs (26.5%). In adjusted analyses, systems with more advanced health IT functions were more likely to use disability (p<0.05) and depression (p<0.01) PROs than systems with less advanced health IT. Practice-level advanced health IT was positively associated with use of depression PRO (p<0.05), but not disability or pain PRO use. Practices with more chronic care management processes, broader medical and social risk screening, and more processes to support patient responsiveness were more likely to adopt each of the three PROs. Compared to independent physician practices, system-owned practices and community health centers were less likely to adopt PROs. Chronic care management programs, routine screening, and patient-centered care initiatives can enable PRO adoption at the practice level. Developing these practice-level capabilities may improve PRO adoption more than solely expanding health IT functions.

Site Readiness Framework to Improve Health System Preparedness for a Potential New Alzheimer’s Disease Treatment Paradigm

New therapies that address the underlying pathophysiology of Alzheimer’s Disease (AD), coupled with the growth of the AD population, will transform the AD care pathway and present significant challenges to health systems. We explored real-world challenges health systems may face in delivering potential new AD therapies with diverse stakeholders. Key challenges in care included integrating primary care providers into assessment and management, availability of memory care specialists, understanding payment and coverage issues and training mid-level providers to help coordinate care and serve as a shared resource across the system. This input informed a novel Site Readiness Framework for AD, comprising self-assessment exercises to identify health system capabilities and gaps and a framework of core strategies and responsive tools to help prepare to integrate new AD therapies. These resources may help health systems improve readiness to modify care pathways to integrate new therapies for AD.

Feasibility and Acceptability of a Digital Patient-Reported Outcome Tool in Routine Outpatient Diabetes Care: Mixed Methods Formative Pilot Study.

BackgroundImprovements in the digital capabilities of health systems provide new opportunities for the integration of patient-reported outcome (PRO) solutions in routine care, which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialog support tool for use by people with diabetes and their health care professionals (HCPs) to improve person-centered diabetes care quality and outcomes.ObjectiveThis study evaluates the feasibility, acceptability, and perceived benefits and impacts of using a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care.MethodsOverall, 12 people with diabetes scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2 to 5 days before their visit. During the visit, HCPs used a digital PRO tool to review PRO data with the person with diabetes for collaborative care planning. Participants completed evaluation forms before and after the visit and were interviewed for 30 to 45 minutes after the visit. HCPs completed the evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data were analyzed using quantitative, qualitative, and mixed methods analyses.ResultsPeople with diabetes found the PRO diabetes questionnaire to be relevant, acceptable, and feasible to complete from home. People with diabetes and HCPs found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCPs were able to use the tool in a person-centered manner, as intended. For several people with diabetes, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialog by improving the identification and focus on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool, whereas HCPs highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit.ConclusionsThe Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits, and this tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights on a larger scale and in diverse health care settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation tools for a forthcoming large-scale multisector implementation study in Denmark.

Prevalence of SARS-CoV-2 antibodies among nurses: Asystematic review and meta-analysis.

Aims and ObjectivesThis systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses.BackgroundWith a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system’s capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally.DesignSystematic review and meta‐analyses.MethodsThis systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE; CINAHL; and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model.ResultsOur electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies.ConclusionThe seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting.Relevance to clinical practiceFear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures.

Spatial Analysis of Perceived Health System Capability and Actual Health System Capacity for COVID-19 in South Africa

Introduction: People’s confidence in the health system's capability in managing the COVID-19 pandemic can determine public support, risk perceptions, and compliance to the required behaviors during the pandemic. Therefore, this paper investigated people’s perception of health system capability to manage the COVID-19 pandemic in different spatial areas across the country using data from an online survey. Methods: Multivariate logistic regression models were used to examine factors associated with people’s perception of the health system capability to manage the COVID-19 pandemic at the national and provincial levels. Spatial comparative analysis was conducted to contrast spatial density indicators of the number of hospitals, hospital beds, and ICU beds per given population across various provinces. Results: Findings showed that South Africans had low confidence in the health system capability, with only two in five (40.7%) reporting that they thought that the country’s health system was able to manage the COVID-19 pandemic. Sex and knowledge on COVID-19 were significantly associated with the people’s perception of the health system capability to manage the pandemic at the national level and in four of the nine provinces. Conclusion: Overall, the findings of this study clearly highlight challenges facing the country’s health system, both perceived or real, that needed to be addressed as part of the preparation for the COVID-19 pandemic. Timeous implementation of a countrywide National Health Insurance (NHI) system is now more critical than ever in improving healthcare outcomes of the South African population beyond the existence of the COVID-19 epidemic.

Local Public Health System Capacity and Its Relationship to COVID‐19 Mortality Patterns across the U.S

Research ObjectiveAs of January 5, 2020, the United States confirmed over 20 million cases of COVID‐19 resulting in at least 353,730 deaths. The public health response to COVID‐19 in the U.S. is trailing many countries and the bulk of the response burden is left to state and local public health systems. Studies comparing public health systems across the U.S. reveal gaps in the capacity and capabilities of public health systems at the state and local level. These gaps can lead to further disparities in public health access, policy enactment, emergency preparedness and preventable outcomes. Our study explores the potential associations between local public health system capacity and COVID‐19 death rates.Study DesignPublic health system capacity was assessed using a public health system composite measure developed from the National Longitudinal Survey of Public Health Systems (NALSYS). This measure combines information about the extent to which a set of 20 guideline‐recommended public health activities are implemented in the community (i.e., conducting needs assessments for the community's health status, investigating adverse health events, etc.) and information about the network of community organizations that contribute to implementing these activities. Combining this information into a composite measure resulted in three distinct classifications of local public health system capacity: Comprehensive, Conventional and Limited. Comprehensive systems deliver the most public health activities and have the largest network of community partners, while limited systems deliver the fewest public health activities and have the smallest network of community partners. Two‐part generalized linear models (GLM) were used to estimate the relationship between this system composite measure and COVID‐19 death rates while controlling for a range of population and community characteristics associated with COVID‐19 risks, distinguishing counties with and without at least one COVID‐19 death. Falsification tests and several model‐specification checks where performed to further verify the association between the system composite measure and COVID‐19 death rates.Population StudiedThe 2018 wave of the NALSYS includes a stratified national sample of 725 local governmental public health agencies.Principal FindingsUsing mortality data between April and July 2020, counties served by comprehensive public health systems had 11.9 fewer COVID‐19 deaths per 100,000 residents than counties with conventional systems (z‐statistic = 3.13; p‐value = 0.002), and 9.94 fewer COVID‐19 deaths per 100,000 residents than counties with limited systems (z‐statistic = 3.69; p‐value <0.001) after controlling for other model covariates. These results remained consistent and significant when mortality data were included from later in the pandemic through January 2021.ConclusionsCommunities with stronger local public health systems, as measured by scope of activity and network density, experienced significantly fewer deaths attributable to COVID‐19.Implications for Policy or PracticeEfforts to contain the adverse health consequences associated with COVID‐19 and future public health threats should include initiatives to strengthen local public health system capacity, such as through increased funding, training and network coordination.Primary Funding SourceThe Robert Wood Johnson Foundation.

Association of COVID-19 case fatality rate with disease burden: an ecological analysis in Italy during the first wave

Objectives: In Italy, the case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) during the first wave of the pandemic showed significant geographic heterogeneity. The aim of this study was to explore the possible association between the CFR and measures of disease burden in the Italian regions using an ecological approach.Methods: Cumulated regional data for the period February 24 to May 11, 2020 were analysed to assess the association of the CFR with the cumulative incidence of COVID-19 and the ratio between the maximum number of COVID-19 patients in intensive care units (ICU) and ICU beds available before the pandemic (ICU load), adjusting for median age of the patients at disease onset, number of nasopharyngeal swabs performed per confirmed case, and prevalence of chronic diseases .Results: During the study period, the COVID-19 CFR in the Italian regions ranged between 5.0% and 18.4%. On multivariable regression analysis, the CFR was found to be significantly associated with the cumulative incidence (relative rate (RR) 1.02 per 100 cases/1 million increase), median patient age (RR 1.07 per 1 year increase), and ICU load (RR 1.72, 2.18, and 2.57, for >40–70% vs ≤40%, 70–140% vs ≤40%, and ≥140 vs ≤40%, respectively).Conclusions: A high burden of COVID-19 may contribute to increased disease fatality, possibly as a result of the increasing demand for care of critically ill patients beyond health system capability.

Principles of Genomic Newborn Screening Programs

Genomic newborn screening (gNBS) may optimize the health and well-being of children and families. Screening programs are required to be evidence based, acceptable, and beneficial. To identify what has been discovered following the reporting of the first gNBS pilot projects and to provide a summary of key points for the design of gNBS. A systematic literature review was performed on April 14, 2021, identifying 36 articles that addressed the following questions: (1) what is the interest in and what would be the uptake of gNBS? (2) what diseases and genes should be included? (3) what is the validity and utility of gNBS? and (4) what are the ethical, legal, and social implications? Articles were only included if they generated new evidence; all opinion pieces were excluded. In the 36 articles included, there was high concordance, except for gene disease inclusion, which was highly variable. Key findings were the need for equitable access, appropriate educational materials, and informed and flexible consent. The process for selecting genes for testing should be transparent and reflect that parents value the certainty of prediction over actionability. Data should be analyzed in a way that minimizes uncertainty and incidental findings. The expansion of traditional newborn screening (tNBS) to identify more life-threatening and treatable diseases needs to be balanced against the complexity of consenting parents of newborns for genomic testing as well as the risk that overall uptake of tNBS may decline. The literature reflected that the right of a child to self-determination should be valued more than the possibility of the whole family benefiting from a newborn genomic test. The findings of this systematic review suggest that implementing gNBS will require a nuanced approach. There are gaps in our knowledge, such as the views of diverse populations, the capabilities of health systems, and health economic implications. It will be essential to rigorously evaluate outcomes and ensure programs can evolve to maximize benefit.

Telehealth and Medical Student Education in the Time of COVID-19-and Beyond.

The COVID-19 pandemic continues to limit medical students’ full reintegration into clinical learning environments, thus exacerbating an ongoing challenge in identifying a robust number of clinical educational activities at excellent clinical sites for all students. Because medical students across the United States were removed from direct patient care activities in mid-March 2020 due to COVID-19, medical centers have prioritized and implemented changes to the process of patient care. As some barriers are being lifted in the face of a highly contagious and deadly infection, the use of telehealth (delivery of health services remotely via telephone, video, and secure messaging), although not new, is rapidly expanding into all aspects of patient care. Health care providers have been encouraged to conduct many interactions at a physical distance. Telehealth largely replaced face-to-face visits for nonemergency care in an attempt to slow viral transmission while enabling physicians to continue to deliver patient education, manage acute and chronic illness, and nurture caring doctor–patient relationships. Health care providers, many of whom were initially reluctant to embrace telehealth technology and logistics, are becoming nimbler and more aware of the many positive aspects of telehealth. The authors suggest that integrating medical students into telehealth activities would help maintain and improve patients’ health, extend the capabilities of health care teams and systems during and after the pandemic, and increase medical students’ opportunities for experiential learning and professional identity formation. The authors expand on these 3 goals, suggest several concrete student telehealth activities, propose a curricular strategy, and outline opportunities to overcome key barriers to full alignment of telehealth and undergraduate medical education.

The COVID-19 crisis as an opportunity to strengthen global regulatory coordination for sustained enhanced access to diagnostics and therapeutics.

The coronavirus disease 2019 (COVID-19) pandemic presents an unparalleled opportunity for regulators globally to strengthen coordination, advance alignment initiatives, and exercise regulatory agility to facilitate access to the surge in diagnostics, therapies and vaccines without compromising public safety. We describe international collaborative initiatives, summarise key experiences, and urge the global regulatory community to apply lessons from the current pandemic to strengthen and sustain cooperation for future public health emergencies and enhanced health products access.

Национальные и коллективные практики преодоления пандемии COVID-19 в Европе

The article deals with the national and collective pandemic responses at the early stage of the COVID&amp;#8209;19 spread in Europe. It is noted that the European Union was not ready for such a cataclysm, despite the history of the spread of serious infectious diseases and the presence of special services and road maps. The virus that began to circulate in Asia, was not initially perceived by the EU representatives as a real threat. Moreover, its leadership ignored the voices of some member states of the Union, focusing on solving other problems. In turn, the countries left without Brussels’ attention began to counteract the new Coronavirus independently, using the anti-crisis tools that were prescribed in the existing pandemic plans. The existence of such national programs determined the specificity of the measures taken in the very first days. The author identifies three models of the EU member states’ behavior. The first one was common for the states of the so-called “political core of the EU” which refused to adopt strict lockdown measures due to their unwillingness to weaken democracy, violate human rights and limit civil liberties. The second group, comprised mainly of the EU&amp;#8209;11 countries, imposed severe measures. The author sees the rationale for this step in the fact that local authorities doubted the capabilities of national health systems in passing a pandemic stress test. The third group includes states that have chosen the way of achieving herd immunity – the most controversial option of resistance to viral infection, that has not proven its effectiveness. The article demonstrates that the period of growing national egoism was followed by a stage of decisive measures by the central authorities of the EU. They were able to develop a suitable package of measures that took into consideration the interests of the most affected countries of the Union. The consolidation of the EU after a temporary weakening became possible due to the “reset” of the Franco-German tandem.

Measuring Heart Rate Variability in Free-Living Conditions Using Consumer-Grade Photoplethysmography: Validation Study

Background Heart rate variability (HRV) is used to assess cardiac health and autonomic nervous system capabilities. With the growing popularity of commercially available wearable technologies, the opportunity to unobtrusively measure HRV via photoplethysmography (PPG) is an attractive alternative to electrocardiogram (ECG), which serves as the gold standard. PPG measures blood flow within the vasculature using color intensity. However, PPG does not directly measure HRV; it measures pulse rate variability (PRV). Previous studies comparing consumer-grade PRV with HRV have demonstrated mixed results in short durations of activity under controlled conditions. Further research is required to determine the efficacy of PRV to estimate HRV under free-living conditions. Objective This study aims to compare PRV estimates obtained from a consumer-grade PPG sensor with HRV measurements from a portable ECG during unsupervised free-living conditions, including sleep, and examine factors influencing estimation, including measurement conditions and simple editing methods to limit motion artifacts. Methods A total of 10 healthy adults were recruited. Data from a Microsoft Band 2 and a Shimmer3 ECG unit were recorded simultaneously using a smartphone. Participants wore the devices for &gt;90 min during typical day-to-day activities and while sleeping. After filtering, ECG data were processed using a combination of discrete wavelet transforms and peak-finding methods to identify R-R intervals. P-P intervals were edited for deletion using methods based on outlier detection and by removing sections affected by motion artifacts. Common HRV metrics were compared, including mean N-N, SD of N-N intervals, percentage of subsequent differences &gt;50 ms (pNN50), root mean square of successive differences, low-frequency power (LF), and high-frequency power. Validity was assessed using root mean square error (RMSE) and Pearson correlation coefficient (R2). Results Data sets for 10 days and 9 corresponding nights were acquired. The mean RMSE was 182 ms (SD 48) during the day and 158 ms (SD 67) at night. R2 ranged from 0.00 to 0.66, with 2 of 19 (2 nights) trials considered moderate, 7 of 19 (2 days, 5 nights) fair, and 10 of 19 (8 days, 2 nights) poor. Deleting sections thought to be affected by motion artifacts had a minimal impact on the accuracy of PRV measures. Significant HRV and PRV differences were found for LF during the day and R-R, SDNN, pNN50, and LF at night. For 8 of the 9 matched day and night data sets, R2 values were higher at night (P=.08). P-P intervals were less sensitive to rapid R-R interval changes. Conclusions Owing to overall poor concurrent validity and inconsistency among participant data, PRV was found to be a poor surrogate for HRV under free-living conditions. These findings suggest that free-living HRV measurements would benefit from examining alternate sensing methods, such as multiwavelength PPG and wearable ECG.