Inadequate Supplies Research Articles

Aerosol—Cloud Interaction with Summer Precipitation over Major Cities in Eritrea

This paper presents the spatiotemporal variability of aerosols, clouds, and precipitation within the major cities in Eritrea and it investigates the relationship between aerosols, clouds, and precipitation concerning the presence of aerosols over the study region. In Eritrea, inadequate water supplies will have both direct and indirect adverse impacts on sustainable development in areas such as health, agriculture, energy, communication, and transport. Besides, there exists a gap in the knowledge on suitable and potential areas for cloud seeding. Further, the inadequate understanding of aerosol-cloud-precipitation (ACP) interactions limits the success of weather modification aimed at improving freshwater sources, storage, and recycling. Spatiotemporal variability of aerosols, clouds, and precipitation involve spatial and time series analysis based on trend and anomaly analysis. To find the relationship between aerosols and clouds, a correlation coefficient is used. The spatiotemporal analysis showed larger variations of aerosols within the last two decades, especially in Assab, indicating that aerosol optical depth (AOD) has increased over the surrounding Red Sea region. Rainfall was significantly low but AOD was significantly high during the 2011 monsoon season. Precipitation was high during 2007 over most parts of Eritrea. The correlation coefficient between AOD and rainfall was negative over Asmara and Nakfa. Cloud effective radius (CER) and cloud optical thickness (COT) exhibited a negative correlation with AOD over Nakfa within the June–July–August (JJA) season. The hybrid single-particle Lagrangian integrated trajectory (HYSPLIT) model that is used to find the path and origin of the air mass of the study region showed that the majority of aerosols made their way to the study region via the westerly and the southwesterly winds.

COVID-19 Pandemic Impacts on U.S. Hospice Agencies: A National Survey of Hospice Nurses and Physicians.

Hospice agencies face unique challenges during times of widespread public health emergencies. The pandemic of novel coronavirus disease COVID-19 is widely affecting global healthcare systems. This study assesses effects of the COVID-19 pandemic on U.S. hospice agencies, staff, and patients as reported by hospice agency staff. An anonymous electronic survey was developed. Free-text comments were assessed for impacts on hospice agencies, staff, and patients and their families. The target audience was members of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association who self-identified as being active with hospice agencies in the United States. Reported impacts include inadequate supplies of personal protective equipment, changes in hospice services, and decreased access by hospice personnel to patients in long term care facilities. Flow of patients through hospice care settings was impeded. Agencies experienced changes in workforce availability and increased emotional support needs of staff. Patient and families experienced increased bereavement needs. Nearly one-third of respondents reported negative effects on patient outcomes, such as inadequate symptom management and negative psychosocial effects. Respondents indicate that the COVID-19 pandemic had negative effects on both hospice patient care and hospice agency functioning. Hospice agencies appear to face challenges unique among U.S. healthcare agencies due to their service delivery model and focus on interdisciplinary care. There is need for further exploration of the effects that the COVID-19 pandemic has on hospice agencies in order to improve care for their patient population during public health emergencies.

Self-reported challenges to border screening of travelers for Ebola by district health workers in northern Ghana: An observational study.

BackgroundThe 2013–2016 Ebola Virus Disease (EVD) outbreak remains the largest on record, resulting in the highest mortality and widest geographic spread experienced in Africa. Ghana, like many other African nations, began screening travelers at all entry points into the country to enhance disease surveillance and response. This study aimed to assess the challenges of screening travelers for EVD at border entry in northern Ghana.Design and methodsThis was an observational study using epidemiological weekly reports (Oct 2014-Mar 2015) of travelers entering Ghana in the Upper East Region (UER) and qualitative interviews with 12 key informants (7 port health officers and 5 district directors of health) in the UER. We recorded the number of travelers screened, their country of origin, and the number of suspected EVD cases from paper-based weekly epidemiological reports at the border entry. We collected qualitative data using an interview guide with a particular focus on the core and support functions (e.g. detection, reporting, feedback, etc.) of the World Health Organization’s Integrated Disease Surveillance and Response system. Quantitative data was analyzed based on travelers screened and disaggregated by the three most affected countries. We used inductive approach to analyze the qualitative data and produced themes on knowledge and challenges of EVD screening.ResultsA total of 41,633 travelers were screened, and only 1 was detained as a suspected case of EVD. This potential case was eventually ruled out via blood test. All but 52 of the screened travelers were from Ghana and its contiguous neighbors, Burkina Faso and Togo. The remaining 52 were from the four countries most affected by EVD (Guinea, Liberia, Sierra Leone, and Mali). Challenges to effective border screening included: inadequate personal protective equipment and supplies, insufficient space or isolation rooms and delays at the border crossings, and too few trained staff. Respondents also cited lack of capacity to confirm cases locally, lack of cooperation by some travelers, language barriers, and multiple entry points along porous borders. Nonetheless, no potential Ebola case identified through border screening was confirmed in Ghana.ConclusionScreening for Ebola remains sub-optimal at the entry points in northern Ghana due to several systemic and structural factors. Given the likelihood of future infectious disease outbreaks, additional attention and support are required if Ghana is to minimize the risk of travel-related spread of illness.

Effectiveness of Groundwater Boiling as Household Water Treatment in Metro and Bekasi Cities, Indonesia

Groundwater serves as a major drinking water source due to inadequate piped supplies in Indonesia. To eliminate the health risks associated with groundwater consumption, boiling appears as the most suitable and cost-effective treatment technique and widely practiced in Indonesia. Despite treatment efforts, inappropriate water storage and handling practices pose a higher risk of recontamination after treatment. The objective of this study was to analyse the effectiveness of groundwater boiling and treated water recontamination in Metro and Bekasi cities, Indonesia. Groundwater at the source and point of use samples were surveyed and assessed from a total of 116 households, resulting in 60% and 35% E. coli contamination, respectively. Paired testing involving boiling observed a reduction in microbial risk for 45% of households. However, 12% samples had an increase in risk even though boiling was reported. Furthermore, E. coli concentration at source prior to boiling and point of use after boiling showed a statistically significant difference (N=111, P<0.01). This study demonstrated the effectiveness of boiling in reducing contamination, although recontamination was evident in some cases, likely due to unsafe water storage and unhygienic environment.

Essential Drugs Inadequacy is an Impediment to Utilization of Universal Health Coverage; the Case of Seme Sub-County in Kisumu County, Kenya

Introduction: Many countries have been putting more effort in Universal Health Coverage through strengthening health systems to provide affordable, safe and high quality care. The Kenya government prioritized attainment of Universal Health Coverage which aimed at cushioning citizens against out of pocket expenditure on health services, though faced with challenges of staffing and inadequate medical supplies for proper implementation. Aim: This was a descriptive cross sectional study design which examined the factors influencing utilization of Universal Health Coverage utilization in Seme Sub County. Subject and Methods: The study targeted both community members and health facility managers. The health facilities were stratified according to their levels of care and randomly selected. The catchment population was stratified by administrative locations and a proportionate sampling technique applied giving a computed sample size of 377 participants, determined by Fischer’s formula. The descriptive statistics were organized and summarized using tables and charts, while logistic regression analysis determined relationship between variables. Results: The study revealed that availability of essential drugs in health facilities contributed positively in utilization of UHC as the availability of drugs in health facility is 2.52 times more likely to make people solely use UHC (OR=2.52, 95%CI=1.36- 4.69, p<0.05). Conclusion: Essential drugs have direct significant influence on utilization of UHC services by community members. Considerable progress will only to materialize through improved supply of adequate essential drugs and procurement of essential medical equipment in the government health facilities in Kisumu County.

Study of Utilization of Integrated Disease Surveillance and Response Data in Controlling Infectious Diseases among Public Health Facilities in Kiambu County, Kenya

Integrated Disease Surveillance and Response entails data collection, analysis, interpretation, and feedback on communicable and non-communicable diseases. It enables health workers to detect and respond to these diseases. Poor utilization of disease surveillance and response data was identified as a core factor responsible for increasing mortality and morbidity due to infectious diseases in developing countries like Kenya. This study assessed utilization of Integrated Disease Surveillance and Response data in control of infectious diseases among Public health facilities in Kiambu County, Kenya. It specifically investigated the proportion of Health workers trained on IDSR, level of knowledge regarding IDSR and Health system factors influencing IDSR utilization. This was a descriptive cross-sectional survey. It involved public health facilities with key respondents being the health care workers providing curative and preventive health services within the selected health facilities. Stratified sampling technique was used to stratify the 108 health facilities into levels of health care while proportionate sampling was used to select 143 participants in the respective level of care. An interviewer-administered questionnaire was used to collect data which was entered and analysed using the Statistical Package for Social Sciences (SPSS) software version 20. Chi-square test of independence was used to assess the associations between utilization of IDSR data, training, level of knowledge and health system factors while Regression analysis was used to establish the predictors of utilization of IDSR data. Utilization of IDSR index score shows 64.9% inadequate utilization of IDSR data. The available data has not been adequately utilized to inform action plans, public education, and resource mobilization. The study shows that 13.7% of health care workers had been adequately trained on IDSR while 75% had moderate knowledge of IDSR function. Accordingly, 54.6% of respondents had the opinion that there were inadequate essential supplies for IDSR. Chi-square analysis shows that the respondent’s duration of practice χ2 (2.437, df=3, p=0.045) and level of knowledge on IDSR were associated with utilization of IDSR data χ2 (0.227 df=2, p=0.048). Logistic regression analysis illustrates that the level of knowledge (A.O. R=1.55, p=0.041) and Cadre of respondents (A.O. R=0.827, p=0.023) were predictors of utilization of IDSR data.

Factors associated with low tuberculosis preventive therapy prescription rates among health care workers in rural South Africa

ABSTRACT Background Despite extensive rollout of tuberculosis preventive therapy (TPT) in South Africa to reduce the incidence of tuberculosis among people living with HIV (PWH), rates of initiation and completion have remained suboptimal. Objective This study aimed to identify factors associated with low TPT prescription rates among health care workers (HCWs) in rural South Africa. Methods A cross-sectional study was conducted using an anonymous 39-item questionnaire guided by the Consolidated Framework for Implementation Research (CFIR). HCWs from a government district hospital and 14 primary healthcare clinics (PHCs) in the rural Msinga sub-district of KwaZulu-Natal were surveyed from November 2019 to January 2020. Self-reported data on prescription rates as well as knowledge, attitudes, beliefs, and practices regarding isoniazid preventative therapy, the current TPT regimen, were obtained. Factor analysis and logistic regression were used to determine associations with low prescription rates (< 50% of PWH) for TPT prescribers, and results were placed within CFIR-driven context. Results Among 160 HCWs, the median (IQR) age was 39 (33–46) years, 76% were women, 78% worked at a PHC, and 44% had experience prescribing TPT. On multivariable analysis, prescribers (n = 71) who believed their patients would not disclose TPT use to others were significantly less likely to prescribe TPT (aOR 4.19 95% CI 1.35–13.00; p = 0.01). Inadequate isoniazid supplies trended towards significance (aOR 10.10 95% CI 0.95–106.92; p = 0.06) in association with low prescription rates. Conclusions Strengthening HCW training to emphasize TPT prescription to all eligible PWH regardless of beliefs about patient disclosure and ensuring a consistent isoniazid supply at the health systems-level are both critical steps to enhancing TPT implementation in rural South Africa.

Structure of a logistics chain of coffee producers in Lengupá, Boyacá

The inconveniences in the logistics chain, associated with intermediation and with this the low remuneration to the producer originated this research, which aims to characterize the logistics chain of small coffee producers in the province of Lengupá. Methodologically it is based on a descriptive investigation, with an explanatory approach carried out in three moments; In the first, a bibliographic inquiry was carried Keywords out, followed by the processing of the information collected and finally, the analysis of the data. The stages carried out show that the logistics chain of the coffee producers of Lengupá is characterized by having a flow of inadequate supplies and materials, in addition, there is little monitoring of the quality records and in short, the inconveniences in the chain represent losses profits for the coffee grower.

Resuming Business in A COVID Normal Environment

Although pandemics of its scale and geographical coverage are not unprecedented as widely claimed, coronavirus continues to pose novel and complex challenges to governments, businesses, and individuals. Governments had and continue to have obligations to respond speedily with both health and economic policies to prevent irrevocable damages to their respective economies and sovereignties-some more successful than others. The speed at which governments responded meant there had to be incremental knowledge on the virus, hence public health handling methodologies and policies morphed from form to form in the face of balancing economic realities with health imperatives, inadequate supplies of personal protective equipment and manpower. Amongst all these, MKPro Engineering Pty Ltd identified a critical oversight as of May 2020 official advice had not recognized that aerosol mode of transmission was clearly feasible and was of grave danger. In our modelling, we mathematically established that coronavirus, at published mass of 33.8kDa and 1million cells/mL cluster density, is about 22 billion times lighter than air, and can be air-borne, hence able to travel as aerosol particles under suitable conditions for at least several meters before the aerosols become considerably dispersed.

Effects of Graded Crude Protein Diet on Haematological Indices and Body ‎Weight of African Giant Rat (Cricetomys gambianus)‎

The domestication of the African giant rat (AGRs) (Cricetomys gambianus) to compliment the inadequate animal protein supplies in Nigeria and its potential to serve as a model for biomedical research is yet to be fully exploited. This study determines the effects of varied crude protein (CP) diet on haematological indices and body weight of AGRs. Blood samples were obtained from the orbital sinus of 30 apparently healthy adult male and female AGRs. The AGR’s were kept in captivity and divided into 6 rats per group (A, B, C, D and E). Group A served as control group. The groups werefed with graded levels of crude protein (CP) of (E) 9.83%, (D) 14.79%, (A) 21.21%, (C) 23.93% and (B) 27.84%. Each chloroform pre-anaesthetized AGRs were weighed at days 0 and 14, 28, 42 and 56, while blood samples were collected at days 28 and 56. The samples were each analyzed for erythrocyte and leucocyte parameters and platelet counts by standard methods. All data collected were subjected to analysis of variance and student t-test. At 28 days post-feeding, AGRs fed with 27.84% CP showed no significant elevations in erythrocyte and leucocyte values compared with control values (21.21% CP). However, at 56 days post-feeding, RBC, Hb, PCV, total WBC, eosinophil, lymphocyte and monocyte counts were significantly lowered in the group fed with 27.84% CP. No significant differences in body weights were observed in rats that were fed 27.84%, 21.21%, 14.8% and 9.8% crude protein diets for 28 and 56 days.This study shows improved body weight with 27.84% CP compared with other crude protein percentage used while 14.79% CP had the best haematological parameters when compared with other crude protein groups.

A qualitative exploration of barriers to health-facility-based delivery in Bomachoge-Borabu and Kaloleni, Kenya.

To explore barriers to utilization of health-facility-based delivery in Kenya, use of which is associated with reduced maternal mortality. In April 2017, a qualitative study utilizing key informant interviews (KIIs) and focus group discussions (FGDs) was carried out in Bomachoge-Borabu and Kaloleni, Kenya. Twenty-four KIIs were performed including health service providers, community health workers, religious leaders, local government representatives, Ministry of Health representatives, and representatives of women's organizations. Sixteen FGDs were held separately with adolescent females, adult females, adult males, and Community Health Committee members. Data were transcribed, coded, and categorized thematically to illustrate supply-side and demand-side barriers to use of health-facility-based delivery services. Supply-side barriers included staff shortages, inadequate supplies and space, poor interpersonal relations, few trained staff, long distance to services, poor transport infrastructure, and limited service hours. Demand-side barriers included financial constraints, limited spousal support, observance of birthing traditions, limited knowledge on importance of health-facility-based delivery, and fear of health-facility procedures. Diverse barriers continue to influence use of health-facility-based delivery services in Kenya. Practical, integrated interventions are urgently needed to reduce barriers noted, to further reduce the maternal mortality rate.

Reimagining India's health system: a Lancet Citizens’ Commission

Reimagining India's health system: a Lancet Citizens’ Commission

An ensemble learning and fog-cloud architecture-driven cyber-attack detection framework for IoMT networks

Internet of Medical Things (IoMT), an application of Internet of Things (IoT), is addressing countless limitation of traditional health-care systems such as quality of patient care, healthcare costs, shortage of medical staff and inadequate medical supplies in an efficient manner. With the use of the IoMT systems, there are unparalleled benefits that are enhancing the quality and efficiency of treatments and thereby are improving patients health. However, the 2018 Ransomware cyber-attack on Indiana hospital system exposed the critical fault-lines among IoMT environment. The gravity and frequency of cyber-attacks are expanding at an alarming rate. Motivated from aforementioned challenges, we propose an ensemble learning and fog-cloud architecture-driven cyber-attack detection framework for IoMT networks. The ensemble design, combines Decision Tree, Naive Bayes, and Random Forest as first-level individual learners. In the next level, the classification results are used by XGBoost for identifying normal and attack instances. Second, for dynamic and heterogeneous networks such as IoMT, fog, and cloud, we present a deployment architecture for the proposed framework as, Software as a Service (SaaS) in fog side and Infrastructure as a Service (IaaS) in cloud side. Further, most of the existing work is evaluated using KDD CUP99 or NSL-KDD dataset. These datasets lack modern IoMT-based attacks. Therefore, the proposed model uses a realistic dataset namely, ToN-IoT which is collected from a heterogeneous and large-scale IoT network. The experimental result shows that the proposed framework can achieve detection rate of 99.98%, accuracy of 96.35%, and can reduce false alarm rate up to 5.59%.

The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review.

Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.

Workers at long-term care facilities and their risk for severe COVID-19 illness

Given the high concentration of COVID-19 cases in long-term care (LTC) facilities in the United States, individuals working in these facilities are at heightened risk of SARS-CoV-2 exposure. Using data from the nationally-representative 2017 and 2018 National Health Interview Surveys on adults who reported working in LTC facilities, this study examines the extent to which LTC workers are also at increased risk or potentially at increased risk for severe illness from COVID-19 including hospitalization, intubation, or death. We used the Centers for Disease Control and Prevention's list of conditions placing individuals in these risk categories to the extent possible. We also examined the sociodemographic characteristics of LTC workers by occupation and COVID-19 illness severity risk status.One percent (552 out of 52,159) of the weighted NHIS sample worked in LTC facilities. Workers in LTC facilities were disproportionately Black, female, and low income. Half of LTC workers (50%) were at increased risk of severe illness from COVID-19 and another 19.6% were potentially at increased risk. There were few significant differences in demographic characteristics between risk groups, though those at increased risk had lower educational attainment and recent trouble affording prescription medications.Despite the high degree of vulnerability of both LTC residents and workers to severe illness from COVID-19, many LTC facilities still have inadequate supplies of personal protective equipment and COVID-19 tests. Given that state budget deficits due to the COVID-19 pandemic limit the potential for state actions, enhanced federal efforts are needed to protect LTC residents and staff from COVID-19.

Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals

BackgroundThe study was designed as quasi-experimental research to investigate the effectiveness of multifaceted interventions for improving the quality of antenatal care in referral hospitals in Nigeria. Two referral hospitals (the Central Hospital in Benin City, South-South Nigeria, and the General Hospital in Minna) served as intervention sites, while two hospitals in comparable locations, (the Central Hospital Warri and the Suleja Hospital Abuja) were the control hospitals.MethodsIntervention activities consisted of the introduction of a strategic plan with the shared vision of reducing maternal mortality by 50% in 1 year in the hospitals; staff training and re-training; the establishment of an automated appointment system; composite health education involving couples and providers; advocacy with policymakers; and the implementation of maternal death reviews and surveillance. These activities were implemented in the intervention hospitals over 21 months (October 2017 to June 2019). Exit interviews of pregnant women at intervention and control sites by trained interviewers were used to assess the quality of antenatal care after their visit, A total of 777 women were interviewed (427 in the intervention sites and 350 in the control sites). Data were analyzed with univariate and multivariate Poisson and logistic regression to determine the extent to which health providers in the clinics completed the 18 signal functions identified in the WHO assessment tool.ResultsThe regression analyses showed the interventions were effective in improving six quality indicators (QIs) for counseling and information sharing. The difference between intervention and control sites on these QIs was significant at < 0.05. On the contrary, the interventions were less effective for maternal and fetal measurements; and disease testing and management QIs.ConclusionThe positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources.Trial registrationThis study was registered in the ISRCTN on August 14th, 2020. Trial Registration Number.SRCTN17985403. Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209).

Risk communication on behavioral responses during COVID-19 among general population in China: A rapid national study

ObjectivesTo describe the risk perception and behavioral responses among Chinese adults and to assess the associations of risk communication, risk perception, and behavioral adherence during the COVID-19 epidemic. MethodsA national cross-sectional survey was conducted in 31 provinces in China with a total number of 5039 effective questionnaires collected. The questionnaire included sociodemographic characteristics, COVID-19 risk communication factors, mask and soap supply, and engagement in preventive behaviors during the epidemic. Multivariable Logistic regression was used. ResultsAn overwhelmingly high prevalence of Chinese people was exposed to COVID-19 related risk communication messages (86.5%) and an overwhelming majority of respondents reported engagement in preventive behaviors (88.3%). Exposed to risk communication messages were positively associated with engaging in preventive behaviors, whereas, believing in misinformation were negatively associated with wearing masks when in public (p < 0.01). Respondents encountered an inadequate supplies of personal protection materials were negatively associated with their outdoor hygiene behaviors. People who were male, in an older age group, minorities, with lower education, with lower income, and lived in rural area showed lower exposures to risk communication messages. ConclusionsFuture risk communication practices are recommended to better monitor population risk perceptions and pay attention to socio-demographically disadvantaged people.

8 Emergency Physician COVID-19 Readiness and Practices

The purpose of this survey study was to assess the working environment of emergency physicians (EPs) early in the Corona Virus Disease 2019 (COVID-19) pandemic. Areas of interest included access to appropriate personal protective equipment (PPE), hospital policy, personal effects of the pandemic on EPs, and how the pandemic has changed their individual practices. An anonymous Survey Monkey survey for all practicing EPs was released on an EPs social medial group in mid-April 2020. The survey consisted of 15 questions covering demographics, hospital policies and work environment, individual physician concerns and changes in practice and habits. 220 emergency physicians responded to the survey with 209 complete submissions. 41 of 50 states, Puerto Rico, and Canada had at least one response. Almost one-third have been in practice for either 5-9 years and 10-19 years post-residency each. More than half work in a community hospital (58%) and approximately one-third work at a tertiary or regional medical center. There was a wide spread in the number of ICU beds at their facility on a scale of 0-50 in increments of 10. Although the vast majority report isolated COVID-19 areas and limited visitors, nearly 15% reported that their site did not have any current plans to create an isolated area. About half reported a hospital policy requiring N95 respirators in COVID-19 positive or suspected rooms although a quarter of those also included wearing N95 respirators in all patient rooms (N95s). Other common policies included universal masking and N95s for high risk or aerosolizing procedures only. N95s and surgical masks were the most commonly provided PPE. 86% were concerned about short term shortages or were already facing shortages. More than half reported access to a powered air-purifying respirator (PAPR). N95s were the most likely to run out (82%) followed by gowns (60%) and surgical masks (42%). Most purchased at least one item of PPE (86%). Three-quarters report not self-quarantining at home, although almost all (98%) have added steps to reduce risk of bringing contaminants home. Removing shoes and work clothes prior to entering the home (86%) and immediately showering upon arriving home (88%) were the most common practices followed by showering and/or changing at the hospital (45%). Other responses included cleaning or separating personal work items, temporarily living in a separate location, or limiting contact with others in the household. The majority were concerned about transmitting COVID-19 to low and/or high-risk friends or family members (74% and 72%, respectively). Almost one-quarter were high risk and were concerned about becoming ill. More than half were concerned about the personal financial impact of the pandemic. One month after COVID-19 was declared a pandemic by the World Health Organization and a national emergency by the United States we surveyed emergency physicians, COVID-related policy changes, supply chains, and personal effects. At that time most hospitals had enacted policies regarding PPE use, created isolated COVID areas, and limited visitors. Most EPs had concerns regarding immediate and short-term inadequate PPE supplies and have bought at least one PPE item to use at work. Very few emergency physicians reported no concerns regarding personal risks of contracting or transmitting COVID.

The impact of COVID-19 lockdown in a developing country: narratives of self-employed women in Ndola, Zambia

Women are normally self-employed in businesses involving buying and selling of goods. Such businesses were severely affected by the COVID-19 pandemic lock-down. The researchers explored the impact the of COVID-19 lockdown on self-employed women. The researchers used a qualitative approach. Interviews were used to collect data. Forty participants took part in the study. The data was thematically analyzed. The researchers found that participants were affected by Inadequate food supplies, Hopelessness to revive business, Poor access to health services, Psychological trauma, Defaulting medications, and Challenges of keeping children indoors. There is need to provide social and economic support to self-employed women.

Prevalence and risk factors of mental distress in China during the outbreak of COVID‐19: A national cross‐sectional survey

ObjectiveAs a result of the pandemic of COVID‐19, the public have been experiencing psychological distress. However, the prevalence of psychological distress during the COVID‐19 pandemic remains unknown. Our objective was to evaluate the prevalence of psychological distress during COVID‐19 outbreak and their risk factors, especially their internal paths and causality.MethodsA nationwide cross‐sectional survey of the prevalence of mental disorders was conducted. We used Hospital Anxiety and Depression Scale (HADS) to estimate the prevalence of anxiety and depression. The internal paths and the causality of the psychological health were analyzed using a structural equation modeling (SEM) approach.ResultsA total of 24,789 respondents completed the survey. We found that the overall prevalence of anxiety, depression, combination of anxiety, and depression were 51.6% (95% CI: 51.0–52.2), 47.5% (95% CI: 46.9–48.1), and 24.5% (95% CI: 24.0–25.0), respectively. The risk of psychological disorders in men was higher than that in women. The status of psychological health was different across different age groups, education levels, occupations, and income levels. The SEM analysis revealed that inadequate material supplies, low income, low education, lack of knowledge or confidence of the epidemic, and lack of exercise are major risk factors for psychological distress.ConclusionsThe evidence from this survey poses serious challenges related to the high prevalence of psychological distress, but also offers strategies to deal with the mental health problems caused by the COVID‐19 pandemic.