Infectious Disease Pandemics Research Articles

Role of social innovations in health in the prevention and control of infectious diseases: a scoping review.

The implementation of social innovations for addressing societal challenges, particularly in health, leverages community participation and technology to optimally meet social needs compared to traditional approaches. A key feature of these innovations is their ability to utilize existing capacities for contributing to resolving infectious disease outbreaks, which has attracted significant attention from health organizations. Given the potential of these innovations, this study has investigated social innovations in the prevention and control of infectious diseases as one of the major global challenges in the form of a comprehensive literature review. This review study examined the relevant literature from January 1, 2010 to December 31, 2022. Based on inclusion and exclusion criteria, 50 documents were retained and fully examined. The documents were analyzed by applying a thematic analysis, and important content related to the application of social innovations for the prevention and control of pandemic infectious diseases was extracted using a data collection form. Five major themes concerning social innovation in the prevention and control of epidemic diseases were discerned as follows: new products, novel processes and policies, empowerment, innovative practices and behaviors, and community engagement. New products include technological products for control and management of epidemics, preventive products, diagnostic and therapeutic products. Novel processes and policies are related to reorienting and reorganizing care methods, control and monitoring policies, participatory and creative strategies. Empowerment is focused on enhancing the capabilities of health workers, community leaders, and communities. Innovative practices and behaviors involve technology-based participation and support mechanisms. Community engagement is related to awareness, consultation, community mobilization, and participation in production and support. During the outbreak of infectious diseases, governments are faced with many challenges, including health, economic and social challenges. To answer these challenges, tools should be used that have the ability to answer the problem from several aspects. Social innovation as an appropriate process in response to health crises has led to new forms of relationships and empowered the communities. And to promote public health, it provides the opportunity for all members of the society to participate in crisis resolution and optimal use of resources.

A tool for the assessment of the risk drivers and public perception of WASH in South Africa.

Therefore, the study findings could be used to optimise the design and targeting of public awareness campaigns on WASH during the coronavirus pandemic or similar infectious disease burdens and related disaster risks.

KNOWLEDGE AND BEHAVIOR OF HATTA HOSPITAL HEALTH CARE PROFESSIONALS REGARDING COVID-19 INFECTION PREVENTION AND CONTROL

Healthcare-associated infection represents a public health problem in all countries. COVID-19 patients can rapidly overwhelm the capacities of healthcare systems. As more patients are hospitalized, healthcare workers (HCW) at the frontline of care are at the greatest risk of infection. This study aimed to assess the knowledge and self-reported behavior of healthcare professionals in Hatta Hospital regarding COVID-19 infection prevention and control (IPC) during this emerging infectious disease pandemic. A descriptive cross-sectional study was conducted in Hatta hospital, United Arab Emirates (UAE) among one hundred HCWs using a self-administered questionnaire based on UAE National and World Health Organization (WHO) IPC guidelines. Of the study participants, 66% received COVID-19 IPC training inside Hatta hospital. The mean knowledge and behavior scores were 75.7% ± 9.4 and 87.6% ± 5.9, respectively. Knowledge score and behavior score were not related to gender (p= 0.232, 0.091, respectively ) and to work position (p= 0.882, 0.994, respectively), however, they were related to the previous contact with COVID -19 patients (p= 001, 0.011, respectively ). Nonetheless, gaps in IPC knowledge and behavior have been identified and need improvement. This includes donning and doffing of PPE and optimal use of protective measures especially respirators (N95 or FFP2).

An electronic patient-reported outcome symptom monitor: the Chinese experience with rapid development of a ready-to-go symptom monitor

BackgroundMonitoring symptoms is crucial for the early detection of disease progression and timely intervention, which is essential for reducing severe cases and mortality rates in rapidly spreading pandemics, such as COVID-19. Therefore, during infectious disease pandemics, the rapid development of real-time symptom monitoring platforms is essential. This study aimed to explore the urgent development process of an electronic system for patient-reported outcome monitoring in emergency situations.MethodsThe development of the electronic patient-reported outcome COVID-19 symptom monitoring platform (ePRO-CoV-SM) included the following steps: (1) modifying an electronic patient-reported outcome symptom-reporting platform to assess patients with COVID-19 and validating its feasibility and sensitivity for longitudinal symptom measurement; (2) updating the system to accommodate the newly emerged severe acute respiratory syndrome coronavirus 2 BA.2.2 variant; and (3) applying it in real-world settings. Literature review, expert consultation, and subject-group discussions were used to develop symptom items. Response rate and missing item rate were used as validation indicators for ePRO-CoV-SM.ResultsThe ePRO-CoV-SM (2.0) consists of a core set of symptom items, a WeChat mini program, an online project design backend, a management and communication front, and a database. During the 2020 verification, the response rate of ePRO symptom monitoring reached 89.47% and the item missing rate was 0.33%, the monitoring revealed that a considerable number of asymptomatic patients were experiencing undesirable symptoms during the isolation period. In its real-world application in 2022, the response rate was 85.93% and the item missing rate was 4.84%, the monitoring found the symptom burden was higher in the younger group (18–40 years old) than in the older group (40–67 years old), and over 30% of patients reported symptoms such as cough (36.08%), dry mouth (35.67%), sleep disorders (32.27%), appetite loss (32.17%), and sputum (30.79%) during the isolation period.ConclusionsElectronic patient-reported outcome measurement was demonstrated to be sensitive and feasible for monitoring symptoms in patients with COVID-19. By integrating smartphone-based data collection with real-time online data transmission and secure data storage using Secure Sockets Layer encryption, an electronic platform for monitoring critical symptoms can be rapidly established in emergency situations.

Incorporation of Silver into Sulfate Groups Enhances Antimicrobial and Antiviral Effects of Fucoidan.

The COVID-19 pandemic has significantly impacted our daily lives. Routine infection-control measures present an effective preventive strategy for a new infectious disease outbreak. Fucoidan, a fucose-rich sulfated polysaccharide found in brown algae, exhibits antiviral activity. Moreover, fucoidan exerts an antimicrobial effect; however, it requires considerably higher concentrations than those needed for its antiviral effect. In this study, we aimed to enhance the antimicrobial activity of fucoidan and prepared a fucoidan silver salt (Ag-Fuc) by incorporating silver ions into the sulfate groups of Yakult Fucoidan derived from Cladosiphon okamuranus Tokida. The fucoidan exhibited a weak inhibitory effect on Escherichia coli growth at significantly higher concentrations, whereas Ag-Fuc inhibited the growth of E. coli and Staphylococcus epidermidis at concentrations comparable to those required for its antiviral effects. Moreover, Ag-Fuc inhibited the growth of Cladosporium cladosporioides. Infections of human cells with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus were more effectively inhibited by lower concentrations of Ag-Fuc compared with fucoidan. Overall, silver ions added to the sulfate groups induced strong antimicrobial activity and enhanced the antiviral effect of fucoidan. We suggest a wide application of Ag-Fuc as a routine preventive material to avoid new infectious disease pandemics.

Assessment of “Knowledge, attitudes and practice” of the population of the Republic of Tajikistan regarding COVID-19

Introduction. Despite the high level of vaccination, some groups of the population still lack reliable information about vaccines and resources with which to familiarize themselves with it. Social and behavioral changes are a key element of an effective response to COVID-19, such as increasing the level of knowledge of the population through the dissemination of information and educational materials on vaccination of the population against coronavirus infection. The purpose of the study: to assess the level of knowledge about COVID-19, behavioral practices, as well as attitudes towards vaccination and other ongoing anti-epidemic measures among the population of the Republic of Tajikistan. Materials and methods. The study was conducted by the NGO “Subhi Tandurusti” from February to May 2024. To assess the level of respondents in the Knowledge, Attitudes and Practices survey regarding issues related to COVID-19, a questionnaire survey was conducted using a specially designed questionnaire. The study involved 2,500 respondents from 15 different districts and cities of the republic. Results. About 93 % of respondents (n = 2322) correctly answered this question regarding modes of transmission of the virus, indicating a high level of awareness of modes of transmission of COVID-19. Relatively high rates of correct answers were recorded to the question “Is it possible to get sick with COVID-19 several times?” 69.5 % of respondents (n = 1737) answered this question correctly, indicating an understanding that it is possible to get sick with COVID-19 several times. Attitude of respondents regarding the safety and effectiveness of vaccination: 78.3 % of respondents (n = 1957) expressed confidence in its safety, 11.3 % (n = 282) did not know the answer, and 10.4 % (n = 261) did not consider the vaccine safe. 2,430 people (97.20 %) have already received the full course of vaccination against COVID-19, 42 people (1.68 %) have only received the first dose of the vaccine and are planning to receive the second. The most popular source of information about COVID-19 was television programs – 44.0 % of respondents (n = 1101), followed by information materials (25.2 %, n = 631) and the Internet, including websites and social networks (22.8 %, n = 571). At the same time, 75.6 % (n = 1889) of respondents rated information and educational materials about COVID-19 as very useful and reliable. To the question “Have you been tested?”: 639 people (25.6 %) “never” got tested, 588 (23.5 %) “often” and 461 (18.4 %) “always” got tested. Conclusion. The results of the study showed that the interviewees had sufficient knowledge about COVID-19, including the transmission of the virus through various routes and clinical symptoms of the disease, as well as the importance of vaccination. Public health initiatives help better protect public health during emergencies such as infectious disease pandemics.

A Novel Bifidobacterium longum Subsp. longum T1 Strain from Cow's Milk: Homeostatic and Antibacterial Activity against ESBL-Producing Escherichia coli.

Background/Objectives: The global emergence of antibiotic-resistant zooanthroponotic Escherichia coli strains, producing extended-spectrum beta-lactamases (ESBL-E) and persisting in the intestines of farm animals, has now led to the development of a pandemic of extra-intestinal infectious diseases in humans. The search for innovative probiotic microorganisms that eliminate ESBL-E from the intestines of humans and animals is relevant. Previously, we received three isolates of bifidobacteria: from milk of a calved cow (BLLT1), feces of a newborn calf (BLLT2) and feces of a three-year-old child who received fresh milk from this calved cow (BLLT3). Our goal was to evaluate the genetic identity of BLLT1, BLLT2, BLLT3 isolates using genomic DNA fingerprinting (GDF), to study the tolerance, adhesion, homeostatic and antibacterial activity of BLLT1 against ESBL-E. Methods: We used a complex of microbiological, molecular biological, and immunological methods, including next generation sequencing (NGS). Results: GDF showed that DNA fragments of BLLT2 and BLLT3 isolates were identical in number and size to DNA fragments of BLLT1. These data show for the first time the possibility of natural horizontal transmission of BLLT1 through with the milk of a calved cow into the intestines of a calf and the intestines of a child. BLLT1 was resistant to gastric and intestinal stresses and exhibited high adhesive activity to calf, pig, chicken, and human enterocytes. This indicates the unique ability of BLLT1 to inhabit the intestines of animals and humans. We are the first to show that BLLT1 has antibacterial activity against ESBL-E strains that persist in humans and animals. BLLT1 produced 145 ± 8 mM of acetic acid, which reduced the pH of the nutrient medium from 6.8 to 5.2. This had an antibacterial effect on ESBL-E. The genome of BLLT1 contains ABC-type carbohydrate transporter gene clusters responsible for the synthesis of acetic acid with its antibacterial activity against ESBL-E. BLLT1 inhibited TLR4 mRNA expression induced by ESBL-E in HT-29 enterocytes, and protected the enterocyte monolayers used in this study as a bio-model of the intestinal barrier. BLLT1 increased intestinal alkaline phosphatase (IAP) as one of the main molecular factors providing intestinal homeostasis. Conclusions: BLLT1 shows promise for the creation of innovative functional nutritional products for humans and feed additives for farm animals that will reduce the spread of ESBL-E strains in the food chain.

Knowledge, attitude, and practice (KAP) survey regarding COVID-19 and factors associated with intention to receive a vaccine in kidney transplant recipients: A cross-sectional study

Post-kidney transplant recipients were recommended to take appropriate infection control measures and receive the third or additional doses of COVID-19 vaccines to reduce the risk of severe COVID-19. However, it remained unclear whether prevention of infection was being adequately implemented and what factors were related to vaccination intention. A cross-sectional questionnaire survey was conducted in March 2022 at Yochomachi Clinic in Tokyo, Japan. The purpose of this study was to identify factors associated with vaccine intentions based on the Knowledge, Attitude, and Practice (KAP) survey regarding COVID-19 and how to promote vaccine acceptance to reduce mortality not only during the COVID-19 pandemic but also in future emerging infectious disease pandemics. Of the 497 participants, 435 intended to receive the third dose of COVID-19 vaccines (including those who actually got it), and 62 did not have such intention. Multivariate logistic regression analysis revealed that male sex (OR: 2.856, 95% CI: 1.377-5.921), positive attitude toward COVID-19 (OR: 1.950, 95% CI: 1.399-2.718), and television as a source of information (OR: 4.165, 95% CI: 1.964-8.831) were associated with vaccination intention, whereas patients who trusted family and friends (OR: 0.343, 95% CI: 0.121-0.968) and those who trusted no-one (OR: 0.173, 95% CI: 0.049-0.613) had no vaccination intention. When considering vaccination policies, media outreach to patients should be given high priority, especially for people at higher risk of developing severe symptoms. This approach can promote vaccine acceptance to reduce mortality not only during the COVID-19 pandemic but also in future emerging infectious disease pandemics.

Development of a personalized mask design method using three-dimensional scan data

Purpose This study aims to develop a novel design method to make personalized masks for the effective prevention of pandemic respiratory infectious disease.Design/methodology/approachThe changes in facial shape during speaking were analyzed using a three-dimensional (3D) scanning technique. In total, 13 anthropometric items were measured, and mask patterns were generated using a parametric pattern design method. Three sizing methods were proposed to reflect not only static but also dynamic body dimensions on the mask patterns.FindingsA significant increase or decrease was observed in 10 out of 13 measurement items. Based on this, four items were selected to be used in the mask pattern design. The nose and cheek areas of a mask were fixed to protect the respiratory tract against viruses. The lower jaw area was deformed to improve the fit.Social implicationsThis study is expected to provide fundamental data to understand the changes in facial shape during movement. In addition, it is expected that the development of individualized personal protective equipment with movement adaptability will facilitate an effective response to various pandemic respiratory diseases.Originality/valueIn order to develop a personal protective equipment (PPE) that has a good fit and can protect against pandemic respiratory infectious diseases, morphological analysis was attempted using 3D facial data. It would be possible to design various products and equipment to be worn on the face by using the method proposed in this study.

Risk Index of Regional Infection Expansion of COVID-19: Moving Direction Entropy Study Using Mobility Data and Its Application to Tokyo.

Policies, such as stay home, bubbling, and stay with your community, recommending that individuals reduce contact with diverse communities, including families and schools, have been introduced to mitigate the spread of the COVID-19 pandemic. However, these policies are violated if individuals from various communities gather, which is a latent risk in a real society where people move among various unreported communities. We aimed to create a physical index to assess the possibility of contact between individuals from diverse communities, which serves as an indicator of the potential risk of SARS-CoV-2 spread when considered and combined with existing indices. Moving direction entropy (MDE), which quantifies the diversity of moving directions of individuals in each local region, is proposed as an index to evaluate a region's risk of contact of individuals from diverse communities. MDE was computed for each inland municipality in Tokyo using mobility data collected from smartphones before and during the COVID-19 pandemic. To validate the hypothesis that the impact of intercommunity contact on infection expansion becomes larger for a virus with larger infectivity, we compared the correlations of the expansion of infectious diseases with indices, including MDE and the densities of supermarkets, restaurants, etc. In addition, we analyzed the temporal changes in MDE in municipalities. This study had 4 important findings. First, the MDE values for local regions showed significant invariance between different periods according to the Spearman rank correlation coefficient (>0.9). Second, MDE was found to correlate with the rate of infection cases of COVID-19 among local populations in 53 inland regions (average of 0.76 during the period of expansion). The density of restaurants had a similar correlation with COVID-19. The correlation between MDE and the rate of infection was smaller for influenza than for COVID-19, and tended to be even smaller for sexually transmitted diseases (order of infectivity). These findings support the hypothesis. Third, the spread of COVID-19 was accelerated in regions with high-rank MDE values compared to those with high-rank restaurant densities during and after the period of the governmental declaration of emergency (P<.001). Fourth, the MDE values tended to be high and increased during the pandemic period in regions where influx or daytime movement was present. A possible explanation for the third and fourth findings is that policymakers and living people have been overlooking MDE. We recommend monitoring the regional values of MDE to reduce the risk of infection spread. To aid in this monitoring, we present a method to create a heatmap of MDE values, thereby drawing public attention to behaviors that facilitate contact between communities during a highly infectious disease pandemic.

Predicting the incidence of rifampicin resistant tuberculosis in Yunnan, China: a seasonal time series analysis based on routine surveillance data

BackgroundRifampicin resistant tuberculosis (RR-TB) poses a growing threat to individuals and communities. This study utilized a seasonal autoregressive integrated moving average (SARIMA) model to quantitatively predict the monthly incidence of RR-TB in Yunnan Province which could guide government health administration departments and the centers for disease control and prevention (CDC) in preventing and controlling the RR-TB epidemic.MethodsThe study utilized routine surveillance reporting data from the infectious Disease Network Surveillance and Reporting System. Monthly incidence rates of RR-TB were collected from January 2019 to December 2022. A time series SARIMA model was used to predict the number of monthly RR-TB cases in Yunnan Province in 2023, and the model was validated using time series plots, seasonal and non-seasonal differencing, autocorrelation and partial autocorrelation analysis, and white noise tests.ResultsFrom 2019 to 2022, the incidence of RR-TB decreases as the incidence of all TB decreases (P < 0.05). There was no significant change in the proportion of RR-TB among all TB cases, which remained within 2.5% (P>0.05). The time series decomposition shows that it presented obvious seasonality, periodicity and randomness after being decomposed. Time series analysis was performed on the original series after 1 non-seasonal difference and 1 seasonal difference, the ADF test showed P < 0.05. According to ACF and PACF, the SARIMA (1, 1, 1) (1, 1, 0)12 model was chosen and statistically significant model parameter estimates (P < 0.05). The predicted seasonal trend of RR-TB incidence in 2019 to 2023 was similar to the actual data. The percentage accuracy in the prediction excesses 80% in 2019 to 2022 and is all within 95% CI. However there was a certain gap between the actual incidence and the predicted value in 2023, and the acutual incidence had increased by 12.4% compared to 2022. The percentage of accuracy in the prediction was only 70% in 2023.ConclusionsWe found the incidence of RR-TB was based on that of all TB in Yunnan. The SARIMA model successfully predicted the seasonal incidence trend of RR-TB in Yunnan Province in 2019 to 2023, but the prediction precision could be influenced by factors such as new infectious disease outbreaks or pandemics, social issues, environmental challenges or other unknown risks. Hence CDCs should pay special attention to the post epidemic effects of new infectious disease outbreaks or pandemics, carry out monitoring and early warning, and better optimize disease prediction models.

Effect of the nurse-led Hospital Elder Life Program on delirium reduction among delirious patients with COVID-19: A randomized clinical trial.

Infectious diseases, such as COVID-19, are high-risk factors for delirium. However, the implementation of nonpharmacological interventions faces major challenges during an infectious disease pandemic. To evaluate the effect of the nurse-led Hospital Elder Life Program (NL-HELP) on delirium reduction among delirious patients with COVID-19. A single-blind randomized clinical trial. This study recruited 122 delirious patients with COVID-19 from internal medicine wards at West China Hospital in China between January 30 and March 31, 2023. Participants were randomized to the NL-HELP group (n = 62) or the usual care group (n = 60). Patients in the intervention group received the NL-HELP protocol three times daily for 7 days. Patients in the control group received usual care. The primary outcome was the absence/presence of delirium during the intervention period measured by the 3-min Diagnostic Confusion Assessment Method. Fewer patients remained delirious in the NL-HELP group than in the control group. There were significantly more delirium-free days in the NL-HELP group than in the usual care group. There were no statistically significant differences between the two groups in terms of delirium severity, length of hospital stay, delirium at 30 days after discharge, 30-day readmission, 30-day mortality, physical function or quality of life. This study demonstrated that NL-HELP could reduce the presence of delirium in delirious patients. No effect was observed in terms of shortening the length of hospital stay, reducing 30-day mortality, or improving quality of life. NL-HELP may be effective in reducing the presence of delirium in delirious patients. Further research is needed to determine whether the NL-HELP can improve patient outcomes (e.g. mortality and quality of life) in a larger study. Caregivers of delirious patients were invited to provide intervention strategies to prevent or abate delirium, including environmental management, orientation communications and identification of alert signs. This study was prospectively registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/) Identifier: ChiCTR2300067874.

Assessment of airborne viral transmission risks in a large-scale building using onsite measurements and CFD method

Screening patients for potential respiratory infections through nucleic acid sampling was a critical non-pharmacologic intervention during a respiratory infectious disease pandemic. Evaluating the cross-infection risk of crowded activities conducted indoors is necessary. We conducted a field study of this event in a large-scale stadium and measured the variation in CO2 concentrations. We conducted simulations on the stadium's flow field, CO2 and N2O concentration distribution using the CFD method, which was validated by the on-site measured data. We simulated the diffusion of virus aerosols exhaled by the sampled individuals under an all-fresh and primary return air system, respectively. It was found that space morphology and airflow pattern are the main factors influencing the concentration distribution of human exhaled contaminants. Primary return air systems can reduce the infection risk for sampled individuals by the filtration system and improve the airflow pattern. With the ratio of fresh air to return air of 1.2, the primary return air systems with 70 %, 85 %, and 95 % filtration levels can reduce the infection risk by an average of 54.5 %, 58.3 %, and 62.1 %, respectively, compared to all-fresh air system. It is necessary to optimize the processes and queue setups for nucleic acid sampling activities in the room based on the room airflow characteristics and the return air system using an efficient filtration system.

AGE-DEPENDENCE OF BIOCHEMICAL MANIFESTATIONS OF HEPATOTOXICINJURY IN RAT EXPOSED TO XENOBIOTICS OF VARIOUS GENESIS

Currently, the problem of liver diseases against the backdrop of the toxic effects of medicinal and industrial (herbicides) xenobiotics on the body is becoming increasingly relevant. The activation of compensatory mechanisms in response to the action of toxic agents –acetaminophen and/or diquat is closely related to age-specific features. Heightened focus on acetaminophen-induced injury is linked to the widespread use of this medication as an analgesic and antipyretic during pandemics of infectious and inflammatory diseases, especially under the conditions of warfare in Ukraine. In return, the widespread use of the herbicide diquat is accompanied by an increase in the registration of cases of diquat -induced acute poisoning. The aim of study was to evaluation the biochemical parameters of the functional state of the liver of different-aged rats under conditions of acetaminophen-and diquat-induced toxic injury. Animals were divided into three age groups: adolescent (60 days), reproductive (150 days), and mature age rats (360 days). Acute toxic injury by acetaminophen was modeled by its oral administration through gastric intubation at a daily dose of 1250 mg/kg of the animal's body weight during the last 2 days of the experiment. Acute toxic damage by diquat was modeled by a single intragastric administration using a probe at a dose of 115.5 mg/kg of the animal's body weight. The functional state of the liver was assessed on an automatic biochemical analyzer NTI Biochem FC-120.Acetaminophen intoxication led to an increase in the absolute liver mass indicator, organ index, changes in the macroscopic structure of the organ, increased serum activities of ALT and AST, total LDH, and a decrease in the De Ritis ratio amidst increased activities of ALP, GGT, and levels of total and indirect bilirubin in all age groups compared to the control. The most significant changes were observed in mature age animals (increase in ALT activity by 76%, AST by 56%, ALP by 51%, GGT by 51%, and a decrease in the De Ritis ratio by 47%). Under conditionsof diquat-induced toxic injury, a slightly different trend and degree in manifestation of established changes are observed. A more pronounced hepatotoxic effect was registered in adolescent animals, manifested by the maximum increase in absolute liver mass by 26%, ALT activity by 71%, AST by 47%, ALP by 50%, Bili-T level by 69%. No statistically significant differences compared to the control and APAP-induced injury in the activity of total LDH and GGT upon administration of toxic doses of the herbicide diquat regardless of age category were observed.Based on the experimental results, an age-related multidirectionality in the adverse effects of the medicinal xenobiotic acetaminophen and the industrial xenobiotic diquat on indicators of the morpho-functional state of the liver is observed. The most sensitive age group of animals to toxic injury by acetaminophen are rats of 360 days of age, while for diquat –60 days of age

Changes in Antibiotic Use and Disruptions to Antimicrobial Resistance Detection in South Africa and Uganda, 2019 – 2020

Background: The COVID-19 pandemic disrupted routine health services worldwide, including systems to detect antimicrobial resistance (AR). AR is a mounting global health threat with some studies showing the highest mortality rate from AR infection is in Sub-Saharan Africa (SSA). Antibiotic use is a major contributor to AR. We sought to characterize COVID-19-related changes to antibiotic use and AR detection capacity in two countries in SSA from 2019 to 2020. Methods: Health facilities (HF) in South Africa and Uganda were surveyed as part of a larger study assessing disruptions to essential health services in SSA in the context of COVID-19. Modified stratified random sampling of HF by facility level was conducted in regions with high COVID-19 cumulative prevalence. Hospital pharmacists were surveyed to identify perceived changes in antibiotic use. Among facilities with the capacity to detect AR, surveys were conducted with AR laboratory managers to identify perceived changes in staff, equipment, training, and supplies. Descriptive data analysis was conducted using frequencies and proportions. Results: A total of 39 HFs in South Africa and 45 HFs in Uganda responded to the antibiotic use survey. Increases in total antibiotic use from 2019 to 2020 were reported by 82% (23/28) of HF in South Africa and 68% (27/40) in Uganda. Increased use of antibiotics for multi-drug resistant bacteria (per World Health Organization Reserve classification) was reported by 36% (9/25) and 38% (8/21) of HFs in South Africa and Uganda, respectively. 19 HFs in South Africa and 12 HFs in Uganda responded to the AR detection capacity survey. HFs in both countries reported decreases in laboratory staff responsible for AR (33% [13/40] in South Africa and 31% [11/35] in Uganda). Decreased availability of reagents and consumables for bacteriology and antimicrobial susceptibility testing was reported by 50% (8/16) and 33% (4/12) of HFs, and decreased availability of specimen collection supplies for bacterial cultures was reported by 41% (7/17) and 42% (5/12) of HFs in South Africa and Uganda, respectively. Diversion of laboratory supplies was reported in both countries (32% [6/19] in South Africa and 25% [3/12] of HF in Uganda). Conclusions: HFs in South Africa and Uganda reported increases in antibiotic prescribing, a risk factor for increased AR, concurrently with disruptions in AR detection capacity during the early phases of the COVID-19 pandemic. These findings emphasize the importance of investing in bacteriology and AR testing in SSA and maintaining support during infectious disease pandemics.

Nurses’ intention to care of COVID-19 patients in hospitals dedicated to infectious disease in South Korea: application of the theory of planned behavior and verification of the moderating effect of ethical nursing competence

BackgroundThe theory of planned behavior is a conceptual framework of recent studies to identify and explain nurses’ intentions to care for patients with emerging infectious diseases. However, correlations between behavioral intentions and variables that explain them have been inconsistent in previous studies. The influence of new variables might be considered in this case. This study aimed to determine moderating effects of ethical nursing competence on nurses’ intention to care for COVID-19 patients in hospitals dedicated to infectious diseases based on the theory of planned behavior.MethodsA cross-sectional survey was conducted. Data on intention to care for COVID-19 patients, perceived behavioral control, attitude toward the behavior, subjective norm, and ethical nursing competence were obtained from 190 nurses in three hospitals dedicated to infectious diseases in South Korea. The moderating effect of ethical nursing competence was analyzed using model I of PROCESS Macro. Ethical considerations: This study was approved by the Institutional Review Board of Ulsan University Hospital, South Korea. Written informed consent was obtained from each subject.ResultsThe ethical nursing competence was a significant moderator in the relation between perceived behavioral control and the intention to care (B = 0.36, t = 2.16, p = 0.032). Ethical nursing competence did not have a significant interaction with attitude toward behavior or subjective norm.ConclusionsThis study showed that the higher the ethical nursing competence level, the greater the effect of perceived behavioral control on nurses’ intention to care for COVID-19 patients. Promoting ethical nursing competence is necessary for nurses who would take care of patients at the frontline of the infectious disease pandemic. Nursing managers should include ethical nursing competence in the assessment of nurses’ competence and design educational programs to enhance ethical nursing competence for efficient nursing staffing during a pandemic.

Impact of COVID-19 pandemic on the dynamic of patients with oral and maxillofacial trauma: interrupted time-series analysis

Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.

Analyzing factors affecting positivity in drive-through COVID-19 testing: a cross-sectional study

BackgroundDemand for COVID-19 testing prompted the implementation of drive-through testing systems. However, limited research has examined factors influencing testing positivity in this setting.MethodsFrom October 2020 to March 2023, a total of 1,341 patients, along with their clinical information, were referred from local clinics to the Sasebo City COVID-19 drive-through PCR center for testing. Association between clinical information or factors related to the drive-through center and testing results was analyzed by Fisher’s exact test and logistic regression models.ResultsIndividuals testing positive exhibited higher frequencies of upper respiratory symptoms; cough (OR 1.5 (95% CI 1.2–1.8), p < 0.001, q = 0.005), sore throat (OR 2.4 (95% CI 1.9-3.0), p < 0.001, q < 0.001), runny nose (OR 1.4 (95% CI 1.1–1.8), p = 0.002, q = 0.009), and systemic symptoms; fever (OR 1.5 (95% CI 1.1-2.0), p = 0.006, q = 0.02), headache (OR 1.9 (95% CI 1.4–2.5), p < 0.001, q < 0.001), and joint pain (OR 2.7 (95% CI 1.8–4.1), p < 0.001, q < 0.001). Conversely, gastrointestinal symptoms; diarrhea (OR 0.2 (95% CI 0.1–0.4), p < 0.001, q < 0.001) and nausea (OR 0.3 (95% CI 0.1–0.6), p < 0.001, q < 0.001) were less prevalent among positives. During omicron strain predominant period, higher testing positivity rate (OR 20 (95% CI 13–31), p < 0.001) and shorter period from symptom onset to testing (3.2 vs. 6.0 days, p < 0.001) were observed compared to pre-omicron period. Besides symptoms, contact history with infected persons at home (OR 4.5 (95% CI 3.1–6.5), p < 0.001, q < 0.001) and in office or school (OR 2.9 (95% CI 2.1–4.1), p < 0.001, q < 0.001), as well as the number of sample collection experiences by collectors (B 7.2 (95% CI 2.8–12), p = 0.002) were also associated with testing results.ConclusionsThese findings underscore the importance of factors related to drive-through centers, especially contact history interviews and sample collection skills, for achieving higher rates of COVID-19 testing positivity. They also contribute to enhanced preparedness for next infectious disease pandemics.

Korean Hospital Nurses’ Experiences with COVID-19: A Meta-Synthesis of Qualitative Findings

During the COVID-19 pandemic, hospital nurses in South Korea cared for patients amid their own anxiety and fear of infection, armed with a sense of professional duty and overcoming all odds to end the country’s infectious disease pandemic. This study aims to provide a meta-synthesis of qualitative studies examining the perceptions and experiences of nurses who cared for patients in dedicated COVID-19 hospitals in South Korea. Electronic databases, including RISS, KISS, KMbase, NDSL, KoreaMed, DBpia, PubMed, CINAHL, and Cochrane, were searched for research published until 2023. The study included research using qualitative approaches. These were reviewed and analyzed using a thematic synthesis approach. The quality of the studies was ascertained using the Critical Appraisal Skills Program checklist for qualitative research. Ultimately, 13 studies involving 219 nurses were included in the final review. Six major themes and thirteen subthemes emerged. The six topics are: “The crisis of a pandemic that suddenly appeared”, “Challenges in nursing patients with infectious diseases”, “A struggle in an unknown time due to a prolonged infectious disease”, “Ethical dilemmas in the face of infectious diseases”, “Duality of the social support system”, and “Professional growth for nurses regarding infectious diseases”. During the unexpected COVID-19 pandemic, nurses were able to overcome difficult situations through their interactions with patients, sense of professional mission, and commitment to nursing. Most importantly, they persevered through their collaboration and closeness with fellow nurses, despite confusion about their professional identity, the ethical dilemmas they faced in patient care, and dual attitudes regarding their social support system. To prepare for future infectious disease outbreaks, a multifaceted support system should be established to enable nurses to have positive interactions with their families, colleagues, and patients, which are central to their resilience.

Design of flexible partitions for physical distancing in buses in Colombia during COVID-19

The scientific community recognizes that the transport of cargo and passengers is a key factor in the spread of infectious disease pandemics. In particular, during the COVID-19 pandemic, public transport systems have been considered high-risk environments for the transmission of the virus; therefore, in many places around the world, restrictions have been imposed on passenger transport. Although different aspects of transport have been studied during the pandemic, there are still gaps in knowledge about the effect of different means of transport and specific interventions for vehicle design strategies to reduce transmission rates. In this context, this article presents the process of co-designing a flexible partition to divide seats on articulated, standard and complementary vehicles of a bus rapid transit system in a Colombian capital city as a vehicle design strategy to contain the spread of the virus and generate a physical barrier when the physical distance of one meter, as required by national regulations, was unable to be maintained. The design methodology followed an incremental and iterative process of 6 stages until reaching the final design. The process began with the identification of the need, the establishment of the design requirements and determinants, the generation of proposals framed within the requirements, the performance of functionality and cost feasibility tests and the building of the prototype with the chosen design. Additionally, a participatory evaluation was carried out based on the identification of relevant aspects, doubts, criticisms and new contributions to the prioritized prototype. Finally, the generated prototype met the design requirements in addition to a significant cost reduction of 70% compared with the initial proposal by the bus rapid transit. The low cost allows the implementation of the partition throughout the bus fleet, but controlled observational and clinical studies on the effectiveness of the partition in the prevention of COVID-19 are required.