Important Public Health Measure Research Articles

The cutaneous manifestations of COVID-19, personal protective equipment and treatment

Since the beginning of COVID-19 pandemic in late 2019, the symptoms and signs detailed in the medical literature and the media concentrated on the effect of causative virus SARS-COV-2 on the respiratory tract, the coagulopathy associated with severe forms of the disease and the febrile flu like illness in the mild cases. The widespread publicising of the symptoms has been one of the important public health measures in combatting the rapid spread of COVID-19. Less known is the direct or indirect effect of COVID-19 on the skin and underlying soft tissue. Recognising the various cutaneous manifestations may prove a useful tool in early detection and management of COVID-19.

Information available on consumer-facing websites may affect adherence to important public health measures such as reducing sodium consumption.

Information available on consumer-facing websites may affect adherence to important public health measures such as reducing sodium consumption.

O15 - Introduction of the London Measure of Unplanned Pregnancy at the booking visit

Estimating pregnancy intention is an important public health measure. In the Australian maternity practice setting, pregnancy intention is not consistently reported. Usually, this enquiry consists of a single question, with a dichotomous outcome, about whether the pregnancy was planned or not, with midwives being the health professionals responsible for asking this question. The London Measure of Unplanned Pregnancy(LMUP) is a psychometrically validated measure of the degree of intention of a current or recent pregnancy. The aim of this study is to present the first year of implementation of the LMUP and examine rates of unwanted, ambivalent and intended pregnancies and their demographic associations. We performed a retrospective review of the first year of LMUP data entered in the electronic maternity medical records of women booked for public antenatal care at the two maternity hospitals in Sydney. Routinely collected data from the antenatal booking visit along with sociodemographic information, living situation, relationship status and country of birth were also collected. We identified that 4993 women who booked in for public antenatal care during the study period of whom 44.8% (2791) had all six items of the LMUP completed. Primiparous women accounted for 52% of bookings, and2385 pregnancies were unplanned. 29% of pregnancies were unintended with an 8-fold higher risk in those having their 4th or more birth compared to those having their first. Unintended pregnancies can have serious health, social and financial consequences and we have identified that women are missing out on access to contraception between pregnancies. Our findings are critical research in an emerging area of midwifery which will inform policy and practice and to develop service models that meet women’s needs and scope of practice of Midwives.

The Impact of the COVID-19 Pandemic and Vaccination on Dental Restorative Practices in the Geriatric Population

Objective: Vaccines were considered as one of the most important public health measures during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to quantify and compare restorative dental practices of geriatric patients during pre-pandemic, prevaccination, and post-vaccination periods. Materials and Methods: Dental records of patients aged older than 65 who presented to Bursa Oral and Dental Health Training and Research Hospital were included in the study. Restorative dental practices during the three periods: pre-pandemic period (01.01.2019−10.03.2020), pre-vaccination period (11.03.2020−13.02.2021) and post-vaccination period (14.02.2021−01.09.2021) were reviewed according to the patient’s age (young-old, middle-old and old-old), sex, tooth number (anterior and posterior), restoration type (occlusal, proximal, or cervical) and the type of restoration material (amalgam or composite). Results: Anterior restorations accounted for more than half (53%) of all restorations in the pre-COVID-19 pandemic period and 46.5% and 55.4% of restorations in the pre- and post-vaccination periods, respectively. The distribution of posterior amalgam restorations in the pre-pandemic period (31.5%) was higher than the pandemic period; in contrast, the composite restorations were higher during the pandemic pre-vaccination (73.9%) and post-vaccination (76.3%) periods (p<0.001). The males (odds ratio (OR): 1.17, 95% CI: 1.03-1.34, p=0.02) and middle-old (OR: 0.79, 95% CI: 0.64-0.96, p=0.019) were more likely to use restorative dental services as compared to females and youngold age, respectively. Conclusion: Vaccination had a noticeable effect on increased admissions of geriatric patients and restorative dental treatments compared to the pre-vaccination period. In addition, in the post-COVID-19 vaccination period, composite restorations seem to have replaced amalgam restorations.

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May-July 2021.

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6–31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others.

Twenty years of newborn screening for congenital adrenal hyperplasia and congenital primary hypothyroidism - experiences from the DGKED/AQUAPE study group for quality improvement in Germany.

Congenital primary hypothyroidism (CH) and congenital adrenal hyperplasia (CAH) are targeted by the German and Austrian newborn screening. For both diseases, there are registries for quality improvement, based on standardized observational data from long-term patient follow-up, under the auspices of the DGKED study group. By September 2021, the CH registry HypoDOK includes datasets from 23,348 visits of 1,840 patients, and the CAH registry contains datasets from 36,237 visits of 1,976 patients. Here, we report on the recruitment process, patient characteristics, and research contributions from the registries, and underline that the registries are an important tool to improve patient care and outcomes. Registries for rare conditions should thus be considered as an important public health measure and they should be adequately institutionalized and funded.

Early phase of COVID-19 quarantine impacted insomnia symptoms in Turkish families.

Quarantine and isolation are the most important public health measures used to prevent the transmission of infectious diseases among individuals. Quarantine and social isolation cause some health problems, such as depressive symptoms, sleep disturbances, anxiety, irritability, feeling of loneliness, helplessness, and trauma and post-traumatic stress symptoms. In this study, we aimed to examine early phase of COVID-19 quarantine impacted insomnia symptoms in Turkish families. The population of the study comprised students attending the Department of Healthcare Services of Eldivan Health Vocational School at Çankırı Karatekin University and their families. In total, 564 students and their families completed online surveys. Data was collected with Google forms. Snowball sampling was used as the data collection method. Female participants, those who gained weight during home quarantine, those who put their phones under their pillow or at the bedside and in another room, and those who used a phone or tablet before sleeping were found to have significantly more insomnia compared to others. The mean day of uninterrupted home quarantine was higher for participants experiencing insomnia (p<0.05). This study showed that individuals experienced sleep problems during the home quarantine.

Knowledge, Attitude, and Perception of Community Pharmacists on COVID–19 Vaccine

Background: In the past few years, knowledge of COVID-19, its management, patients' care, and its learning curve have been challenging for the professionals in charge of managing the pandemic. Since community pharmacists were the important health care providers who remained the first point of contact during the pandemic, they played a pivotal role in providing counselling services, care, support, and infection control to the public. COVID-19 vaccine remained an important public health measure in curbing COVID-19. Despite its effectiveness in preventing the spread of the disease, a large proportion of the population is unwilling to be vaccinated owing to the lack of adequate knowledge regarding its effectiveness. Purpose: The present study aimed to investigate the perception, attitude, and knowledge of community pharmacists regarding the COVID-19 vaccine. Methods: A cross-sectional survey was conducted using questionnaires to collect data from the community pharmacists in Saudi Arabia. The questionnaire is comprised of four sections: socio-demographic, knowledge, attitude, and practices. Results: Most of the respondents were young adults between the ages of 23 and 34 years (73.0%). The study had more male participants (89.4%) than female participants (10.6%). Most of the male respondents were non-Saudi nationals (77.9%). The overall percentage of positive responses to the perception questions was 29.9%. The overall percentage of positive responses to the attitude questions was 21.2%. The overall percentage of positive responses to the knowledge questions was 57.4%. No significant difference is recorded between the respondents' intention on taking the vaccine and the age groups (χ² (9) = 7.134, p > 0.05 = 0.623). However, the remaining characteristics of the test showed significant differences. Conclusion: The findings confirmed that the level of knowledge regarding the COVID-19 vaccine amongst the community pharmacists was high enough to offer reliable advice to patients. However, less than 50% of the participants had adequate knowledge of the vaccine.

Using the guidelines as a driver to comprehensively promote the physical activity level of Chinese population

Physical inactivity is responsible for 6% of global deaths, and it is an independent risk factor for cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. The general lack of physical activity has become an important global public health problem. Active and adequate physical activity is an important public health measure to ensure health throughout the life cycle. Under the guidance of the Bureau for Disease Prevention and Control of the National Health Commission, the Chinese Center for Disease Control and Prevention and the Institute of Sports Science of the General Administration of Sport of China jointly organize experts to complete the compilation of The Physical Activity Guidelines for Chinese (2021) based on a large number of domestic and foreign scientific data. We look forward to the release and implementation of the guidelines, which will play an important role in scientifically guiding the physical activity of all types of people in China, reducing the rate of physical inactivity, and promoting the early realization of the goal of the Healthy China Action.

A Brief History of Human Challenge Studies (1900-2021) Emphasising the Virology, Regulatory and Ethical Requirements, Raison D'etre, Ethnography, Selection of Volunteers and Unit Design.

Venetian quarantine 400years ago was an important public health measure. Since 1900 this has been refined to include "challenge" or deliberate infection with pathogens be they viruses, bacteria, or parasites. Our focus is virology and ranges from the early experiments in Cuba with Yellow Fever Virus to the most widespread pathogen of our current times, COVID-19. The latter has so far caused over four million deaths worldwide and 190 million cases of the disease. Quarantine and challenge were also used to investigate the Spanish Influenza of 1918 which caused over 100 million deaths. We consider here the merits of the approach, that is the speeding up of knowledge in a practical sense leading to the more rapid licensing of vaccines and antimicrobials. At the core of quarantine and challenge initiatives is the design of the unit to allow safe confinement of the pathogen and protection of the staff. Most important though is the safety of volunteers. We can see now, as in 1900, that members of our society are prepared and willing to engage in these experiments for the public good. Our ethnology study, where the investigator observed the experiment from within the quarantine, gave us the first indication of changing attitudes amongst volunteers whilst in quarantine. These quarantine experiments, referred to as challenge studies, human infection studies, or "controlled human infection models" involve thousands of clinical samples taken over two to three weeks and can provide a wealth of immunological and molecular data on the infection itself and could allow the discovery of new targets for vaccines and therapeutics. The Yellow Fever studies from 121years ago gave the impetus for development of a successful vaccine still used today whilst also uncovering the nature of the Yellow Fever agent, namely that it was a virus. We outline how carefully these experiments are approached and the necessity to have high quality units with self-contained air-flow along with extensive personal protective equipment for nursing and medical staff. Most important is the employment of highly trained scientific, medical and nursing staff. We face a future of emerging pathogens driven by the increasing global population, deforestation, climate change, antibiotic resistance and increased global travel. These emerging pathogens may be pathogens we currently are not aware of or have not caused outbreaks historically but could also be mutated forms of known pathogens including viruses such as influenza (H7N9, H5N1 etc.) and coronaviruses. This calls for challenge studies to be part of future pandemic preparedness as an additional tool to assist with the rapid development of broad-spectrum antimicrobials, immunomodulators and new vaccines.

From rapid antigen testing for COVID-19 to final outcome: An experience from industrial city of Ludhiana.

Context:The ongoing corona pandemic has created medical crises all over the world. An increased surge in the number of COVID-19 cases was observed in the month of August, September and October 2020. Punjab has around 10 Lakh migrant workers. Intensive rapid antigen testing was done during this surge among factory workers. With this background, the study aims to find out the positivity rate of rapid antigen testing and to find out the final outcome of the COVID positive cases in terms of morbidity.Materials and methods:Screening of factory workers working in various factories was done for COVID-19 by rapid antigen testing from 26th august to 31st October 2020. Those who tested positive were clinically examined, counseled, and followed up telephonically to get information regarding their course of illness. The collected information was entered in Microsoft excel sheet and analyzed using SPSS.Results:A total of 11045 factory workers were screened using the rapid antigen test. The mean age of subjects was 33.37 ± 10.97 years. The majority of them were males (88.3%) and migrants (who did not belong to Punjab) (97.3%). The majority of the subjects (97.3%) had no symptoms at the time of screening. COVID-19 positivity rate increased with age, was found to be higher in males (2.3%) as compared to females.Conclusion:The positivity rate was higher in asymptomatic males and local resident workers. Rapid antigen testing is an important public health measure to prevent the further spread of the disease during a pandemic due to its quick results and detection of asymptomatic patients.

Improving compliance with physical distancing across religious cultures in Israel

BackgroundPhysical distancing contains the corona virus, but compliance with physical distancing across religious minorities in Israel has been shown to be relatively poorer than in the majority population. This study tests the power of messages as drivers of willingness to comply with physical distancing across religious minorities in Israel during the first wave of the COVID-19 from March till June 2020.Methods896 Israeli Muslims, Druze, Bedouins, Jewish Orthodox, Christians, and Jewish Seculars participated in this conjoint-based experimental design. The size of the total sample and of the subgroups is consistent with the suggested size in conjoint analysis studies, particularly when aiming at stability of coefficients rather than stability of means. The dependent variable was ‘willingness to comply’. Independent variables were known contributors to compliance: perceived risk, practices of physical distancing, ways to assure compliance, and the agent communicating the policy.ResultsA regression analysis indicated minor differences in the power of messages across groups despite dramatic cultural differences amongst them. We identified three distinct mindsets that transcend religious cultures from the responses of the study subjects to various messages and named them “pandemic observers,” “obedient followers,” and “sensitive interpreters.” Compliance of "Pandemic Observers" (n = 306) may be improved by messages such as, “Dangerous virus spreading wildly” and “Health experts suggest what to do but the government is reactive rather than proactive” (β = 14, p < .005). Compliance of "Obedient Followers" (n = 242) may be driven by the messages “Socialize and work only from home, using the internet, e.g. zoom/Skype” and “Everyone should stay 2 m. (6 ft.) apart” (β = 16, p < .0050). Compliance of "Sensitive Interpreters" (n = 249) may be improved by messages such as, “Only people who are 60 and over are to be allowed to buy groceries during first 2 h from opening” and by using the media to publicize the official health policy (β = 8; p < .005).ConclusionsMindset-assignment reflects how people think rather than their religious affiliation. A personal viewpoint identifier was developed to predict mindset-assignment and enable health authorities to enhance compliance through mindset-tailored messages for members of each mindset segment. We recommend that health authorities and policy makers consider these different personality types, which range across religious minorities and emphasize the messages that each type responds to in developing and implementing a communication plan to improve physical distancing as an important public health measure.

Managing essential healthcare services during the first nationwide lockdown: experiences from a Regional Referral Hospital in Bhutan

The current COVID -19 pandemic has brought unprecedented burden on healthcare system throughout the world. While the pandemic has hijacked all attention and priorities, there is a significant concern that non-COVID essential healthcare services may be negleccted. Lockdowns have become an important public health measure to contain local outbreaks. We describe our experiences in ensuring the provision of essential healthcare services during the first nationwide lockdown. Adequate preparations with a well-thought of contingency plan , identification of roles, good communication system, 24 -hour hotline and a mobile clinic with the most essential services, form important components of essential healthcare services.

Changes in Behaviors and Attitudes in Response to COVID-19 Pandemic and Vaccination in Healthcare Workers and University Students in Italy.

The objectives of the cross-sectional study were to measure how behaviors and attitudes about preventive measures toward COVID-19 changed over time among Italian vaccinated healthcare workers and university students, and the associated characteristics. The study was carried out between February and March 2021 in the city of Naples, Campania region, Southern Italy. The perceived personal risk of being infected by SARS-CoV-2 after the vaccination was significantly higher among males, in those having a higher perceived personal risk of being infected by SARS-CoV-2 before the vaccination, and in those who were more concerned about the efficacy of the vaccination. The fear of getting the disease as reason to have the COVID-19 vaccination was reported more frequently in younger participants, in those with at least one chronic medical condition, in those with a higher concern about the severity of COVID-19, in those with a higher level of trust in the information received, and in those who acquired information from scientific journals. Overall, 21.3% were willing to engage the three main public health measures (wearing a mask, careful hand washing, physical distancing) after receiving the second dose of the vaccination compared to the behavior before the pandemic began. This willingness was predicted by a higher level of trust in the information received and by a lower self-rated health status. Only 0.1% of participants were willing to engage all three measures after receiving the second dose of the vaccination compared to the behavior before receiving the first dose. These findings are useful in order to develop information strategies regarding vaccine safety and efficacy and the importance of public health measures against COVID-19.

SARS-CoV-2 antibodies in Ontario health care workers during and after the first wave of the pandemic: a cohort study.

Background:Health care workers have a critical role in the pandemic response to COVID-19 and may be at increased risk of infection. The objective of this study was to assess the seroprevalence of SARS-CoV-2 immunoglobulin G (IgG) antibodies among health care workers during and after the first wave of the pandemic.Methods:We conducted a prospective multicentre cohort study involving health care workers in Ontario, Canada, to detect IgG antibodies against SARS-CoV-2. Blood samples and self-reported questionnaires were obtained at enrolment, at 6 weeks and at 12 weeks. A community hospital, tertiary care pediatric hospital and a combined adult–pediatric academic health centre enrolled participants from Apr. 1 to Nov. 13, 2020. Predictors of seropositivity were evaluated using a multivariable logistic regression, adjusted for clustering by hospital site.Results:Among the 1062 health care workers participating, the median age was 40 years, and 834 (78.5%) were female. Overall, 57 (5.4%) were seropositive at any time point (2.5% when participants with prior infection confirmed by polymerase chain reaction testing were excluded). Seroprevalence was higher among those who had a known unprotected exposure to a patient with COVID-19 (p < 0.001) and those who had been contacted by public health because of a nonhospital exposure (p = 0.003). Providing direct care to patients with COVID-19 or working on a unit with a COVID-19 outbreak was not associated with higher seroprevalence. In multivariable logistic regression, presence of symptomatic contacts in the household was the strongest predictor of seropositivity (adjusted odds ratio 7.15, 95% confidence interval 5.42–9.41).Interpretation:Health care workers exposed to household risk factors were more likely to be seropositive than those not exposed, highlighting the need to emphasize the importance of public health measures both inside and outside of the hospital.

Running with Face Masks or Respirators Can Be Detrimental to the Respiratory and Cardiovascular Systems

Since the first cases of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported at the end of 2019, this infection has spread around the globe, becoming a pandemic. The use of face masks and respirators is an important public health measure to reduce or prevent transmission of SARS-CoV-2. Here we discuss the hypothetical mechanisms by which exercise with face masks or respirators can induce detrimental effects on the cardiovascular system, potentially explaining adverse events such as cardiac arrhythmias and spontaneous pneumothorax. Although sudden death associated with the wearing of a face mask during running is a rare event, the risk is higher especially in those with existing cardiac comorbidities. In such cases, a mask designed specifically for runners with no or few side effects of oxygen deficiency should be considered instead.

Systematic review of predictive models of microbial water quality at freshwater recreational beaches.

Monitoring of fecal indicator bacteria at recreational waters is an important public health measure to minimize water-borne disease, however traditional culture methods for quantifying bacteria can take 18-24 hours to obtain a result. To support real-time notifications of water quality, models using environmental variables have been created to predict indicator bacteria levels on the day of sampling. We conducted a systematic review of predictive models of fecal indicator bacteria at freshwater recreational sites in temperate climates to identify and describe the existing approaches, trends, and their performance to inform beach water management policies. We conducted a comprehensive search strategy, including five databases and grey literature, screened abstracts for relevance, and extracted data using structured forms. Data were descriptively summarized. A total of 53 relevant studies were identified. Most studies (n = 44, 83%) were conducted in the United States and evaluated water quality using E. coli as fecal indicator bacteria (n = 46, 87%). Studies were primarily conducted in lakes (n = 40, 75%) compared to rivers (n = 13, 25%). The most commonly reported predictive model-building method was multiple linear regression (n = 37, 70%). Frequently used predictors in best-fitting models included rainfall (n = 39, 74%), turbidity (n = 31, 58%), wave height (n = 24, 45%), and wind speed and direction (n = 25, 47%, and n = 23, 43%, respectively). Of the 19 (36%) studies that measured accuracy, predictive models averaged an 81.0% accuracy, and all but one were more accurate than traditional methods. Limitations identifed by risk-of-bias assessment included not validating models (n = 21, 40%), limited reporting of whether modelling assumptions were met (n = 40, 75%), and lack of reporting on handling of missing data (n = 37, 70%). Additional research is warranted on the utility and accuracy of more advanced predictive modelling methods, such as Bayesian networks and artificial neural networks, which were investigated in comparatively fewer studies and creating risk of bias tools for non-medical predictive modelling.

Seroconversion and fever are dose-dependent in a nonhuman primate model of inhalational COVID-19.

While evidence exists supporting the potential for aerosol transmission of SARS-CoV-2, the infectious dose by inhalation remains unknown. In the present study, the probability of infection following inhalation of SARS-CoV-2 was dose-dependent in a nonhuman primate model of inhalational COVID-19. The median infectious dose, assessed by seroconversion, was 52 TCID50 (95% CI: 23–363 TCID50), and was significantly lower than the median dose for fever (256 TCID50, 95% CI: 102–603 TCID50), resulting in a group of animals that developed an immune response post-exposure but did not develop fever or other clinical signs of infection. In a subset of these animals, virus was detected in nasopharyngeal and/or oropharyngeal swabs, suggesting that infected animals without signs of disease are able to shed virus and may be infectious, which is consistent with reports of asymptomatic spread in human cases of COVID-19. These results suggest that differences in exposure dose may be a factor influencing disease presentation in humans, and reinforce the importance of public health measures that limit exposure dose, such as social distancing, masking, and increased ventilation. The dose-response data provided by this study are important to inform disease transmission and hazard modeling, and, ultimately, mitigation strategies. Additionally, these data will be useful to inform dose selection in future studies examining the efficacy of therapeutics and vaccines against inhalational COVID-19, and as a baseline in healthy, young adult animals for assessment of the importance of other factors, such as age, comorbidities, and viral variant, on the infectious dose and disease presentation.

Violent victimisation trajectories from adolescence through adulthood: consequences for sleep problems

BackgroundViolent victimisation is a stressful experience that has been linked with sleep problems among children, adolescents and adults. However, prior research has not assessed how victimisation trajectories across different stages...

Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection...