Local Health Officials Research Articles

Masking Behaviors in the Absence of Local Mandate-An Observational Study from Hillsborough County, Florida.

The purpose of this study was to understand the predictors of masking-especially age, race/ethnicity and gender-in Hillsborough County Florida, a region without mask mandates. Masking and social distancing behaviors of individuals were observed in Hillsborough County during one-week intervals in July 2021, August 2021 and Late September-early October 2021. Demographic and behavioral observations were recorded and logistic regression was utilized to determine the odds ratio of wearing a mask amongst various groups. Overall, masking ranged from 36.80% to 48.64%, peaking during the second observation period. Masking rates were highest amongst people of color, women and seniors. Establishments posting mask-negative language, such as "masks NOT required," saw a 46% decrease in the odds of masking compared to establishments without mask-related signage (thereby defaulting to no mandate). Understanding who engaged in masking and social distancing behaviors will provide local public health officials with a deeper understanding of the effectiveness of previously used strategies, which can be leveraged in future surges of COVID-19 and other emergencies to create maximum impact. Lessons learned regarding policy implementation and understanding patterns of uptake of health guidelines are important for the continuous improvement of public health practice.

Feasibility and outcomes of using a novel artificial intelligence enhanced breast thermography technique, Thermalytix, in screening for breast abnormalities at primary health centres at the community level in South India

Background: Women from low-income families have poorer health-seeking behavior, particularly when it comes to cancer screening. A community health initiative was launched by Niramai in collaboration with city officials in Bangalore as a pilot to increase awareness and make breast health screening available to all. This study describes a community-level breast screening for underprivileged women in south India adopting Thermalytix, a thermography-based artificial intelligence device.Methods: This observational study was conducted at 25 municipal primary health centers where women over 18 years of age were enrolled. The project started on 14 November 2017 and is ongoing. Procedures include a brief meeting on camp procedures, identification of eligible candidates, health education, and Thermalytix testing.Results: A total of 6935 women underwent artificial intelligence (AI)-powered Thermalytix screening in 25 Bruhat Bengaluru Mahanagara Palike (BBMP) hospitals. The median age was 42 (range 18-86) of the 5248 women enrolled as per inclusion. Among the 5248 women recruited, 62 (1.18%) women were detected with some abnormalities in Thermalytix. Out of the women who underwent follow-up investigations (11/62), eight were positive on radiological evaluation, further histopathological evaluation confirmed one ductal carcinoma in situ.Conclusions: Community participation with the engagement of the local government health officials enabled us to develop screening strategies for underprivileged women. Thermalytix could be a potential screening tool in resource-constrained settings and the portable equipment enabled easy movement across different primary health centers (PHCs). Since it is a privacy-aware test, there was less refusal to participate in the test.

Sosialisasi Pencegahan Stunting di Desa Bandur Picak, Kecamatan Koto Kampar Hulu

Stunting is a health problem that is often found in developing countries, including Indonesia. The prevalence of stunting in Indonesia is the fifth largest in the world. Stunting is a linear growth disorder caused by chronic malnutrition. People who live in the outlying areas receive less attention from the local health office so the stunting sufferers have not received a proper treatment. Currently, Indonesia has entered a new normal era where community activities run as usual, whether it’s the center of government, educational institutions, health agencies and others. This is the background for us to hold a stunting socialization program, especially in Bandur PicakVillage, Koto Kampar Hulu District. This article aims to provide information related to stunting socialization and stunting prevention interventions for pregnant women about nutrition during pregnancy in an effort to prevent stunting. This socialization is quite effective in providing information on how to prevent and reduce the incidence of stunting in children through pregnant women. With the socialization of stunting in Bandur Picak Village, this socialization can increase public awareness regarding child growth and development , so hoped that it can prevent stunting and reduce the percentage of stunting in Indonesia, especially in Bandur Picak Village, Koto Kampar Hulu District, Kampar Regency, Riau Province.
 Keywords : Stunting, Educational, Health Agencies

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic.

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

94 (PB-094) Poster - Real world evidence from a Breast Screening pilot for the underprivileged: Experiences from Bruhat Bengaluru Mahanagara Palike hospitals

Background: In India, less than 5% of women get routine screening for breast cancer due to lack of awareness and the absence of a coordinated national breast cancer screening programme. A community health initiative was launched by Niramai in collaboration with City Health officials in Bangalore as a pilot to increase awareness and make breast health screening available to all. Free breast cancer screening using AI powered Thermalytix test is being offered to all the underprivileged women walking into Bruhat Bengaluru Mahanagara Palike (BBMP) government hospitals from November 14, 2017 till today (after a break for 15 months during COVID). Materials and methods: This observational study was conducted in 22 BBMP-affiliated primary health centers where outpatient women over the age of 18 years and not pregnant were enrolled. The procedure included a briefing on camp procedures, taking patient consent, identification of eligible candidates, general health education, and conducting the Thermalytix test by a healthcare worker who was trained to use the Thermalytix software tool. Women were triaged using the output generated by Thermalytix 180. Those triaged as red were referred for further detailed imaging investigation in a district hospital using mammography, ultrasound and FNAC/biopsy. Results: A total of 6935 women underwent Thermalytix screening in 22 BBMP hospitals during Nov 2017 to July 2022. A total of 1687 participants were excluded from the analysis as they did not meet the eligibility criteria. The median age of the 5248 eligible participants was 42 years (range 18–86). Among them, 90 women (1.71%) had previously noticed a lump in their breast, 431 women (8.12%) had breast pain, 16 women had complained of nipple discharge, and 5 women had noticed skin discoloration. When screened, 62 (1.2%) women were detected with abnormalities and triaged positive by Thermalytix. Among them 11 women have so far gone through diagnostic investigations, of which 8 were radiologically positive and were recommended for histopathology correlation. The overall test positivity rate of Thermalytix in this cohort was 1.2% and positive predictive value with radiological positivity as reference was found to be 9/11 = 81.81%. Furhter histological analysis reported 1 DCIS and 8 benign fibroadenoma. The tests were conducted in screening camps and the average cost of conducting the test in the field came to around 6.5 USD per person. Conclusions: Thermalytix could be a potential automated screening tool for population-level screening in resource constrained settings. The portable equipment enabled easy movement across different PHCs. Since it is a privacy-aware test, there was less refusal to participate in the test. Community mobilization with the help of the local government health officials was crucial to ensure walk-ins. Conflict of interest: Ownership: yes Board of Directors: yes Corporate-sponsored Research: yes

Euregional Youth Survey Structure and results of the cross border youth surveys

Abstract The Euregional Youth Study takes place at intervals of currently 4 years since 2001. The Dutch, German and Belgian municipalities of the Euregio Meuse-Rhine (EMR) can participate. Pupils in the 8th and 10th grades are asked about various topics in an online questionnaire. These include: physical and emotional well-being, physical activity, nutrition, media behaviour, drug use and school behaviour. In 2019, 88 schools with more than 13,500 participants took part. With its cross-border approach, the study provides the opportunity to compare the living conditions, behaviour and health situation of pupils in the three countries. Ideally, this would result in common policy and prevention approaches and best practice options. For example, there are differences between the regions of the EMR regarding drug use or overweight, while risky media use is rather universal. It is striking that the Dutch participants almost consistently show the best values. It is also important to stress the importance of insight in policy along the border. Changes in policy actions have a huge effect on border regions. Examples are: The change in drinking age in the Netherlands: from 16 to 18 resulted in organizing their parties in the neighbouring countries. The change in cannabis policy in the Netherlands in the 2000s, is clearly reflected in the purchasing behaviour of German young people. Independent of the cross-border aspects, the Euregional Youth Survey provides a standard data set (also with trends over time) for the adolescents of the participating districts, which the local health offices could not realise on their own and which is not self-evident for German municipalities.On the other hand, it is certainly considered as problematic that there is no binding and uniform participation of the EMR partners in the study. This leads to a partial loss of comparability and significance of the Euregional Youth Study.

Association between COVID-19 vaccine hesitancy and trust in the medical profession and public health officials

One's personal physician, national and state or local public health officials, and the broader medical profession play important roles in encouraging vaccine uptake for COVID-19. However, the relationship between trust in these experts and vaccine hesitancy has been underexplored, particularly among racial/minority groups where historic medical mistrust may reduce uptake.Using an April 2021 online sample of US adults (n = 3041) that explored vaccine hesitancy, regression models estimate levels of trust in each of these types of experts and between trust in each of these experts and the odds of being COVID-19 vaccine takers vs refusers or hesitaters. Interaction terms assess how levels of trust in the medical profession by race/ethnicity are associated with vaccine hesitancy. Trust in each expert is positively associated with trust in other experts, except for trust in the medical profession. Only trust in one's own doctor was associated with trust in the medical profession, as measured by factor scores derived from a validated scale. Lower levels of trust in experts were significantly associated with being either a hesitater or a refuser compared to being a taker. Black respondents had higher odds of being either a hesitater or a refuser compared to white respondents but the interaction with trust was insignificant. For Hispanic respondents only, the odds of being a hesitater declined significantly when trust in the medical profession rose. Mistrust in the medical profession, one's doctor and national experts contributes to vaccine hesitancy. Mobilizing personal physicians to speak to their own patients may help.

The Role of Harassment in the Mental Well-being of Local Public Health Professionals and Its Relationship With an Intent to Leave Their Organization During the COVID-19 Pandemic.

Since the onset of the COVID-19 pandemic, news and nationwide survey efforts have reported harassment and bullying among local health officials, departments, and personnel, concurrent to a shortage of public health staff in the United States. We examined a nationally representative sample of local public health professionals (LPHPs) from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) data set to explore reported experiences with harassment, threats, and bullying; self-rated mental and emotional well-being; and intent to leave an organization. Results indicated that experience of harassment was negatively associated with ratings of mental and emotional health and positively associated with an intent to leave an organization. We discuss implications and recommendations to mitigate these risks for the nation's local public health workforce.

Patient perception of doctor communication skills and patient trust in rural primary health care: the mediating role of health service quality

BackgroundThis study aimed to explore the relationship between communication skills, health service quality, and patient trust in primary health services.MethodThis study was conducted in village clinics in rural China. A simple random sampling method was used to select volunteer village clinics and patients. In total, 574 participants from 25 village clinics were selected with the help of local health officers and village doctors. The response rate was 90%. Statistical analyses (hierarchical linear regression analysis and a structural equation model) were performed to analyze the data.ResultsPatient trust in doctors in rural primary health was influenced by patient perceptions of doctors’ communication skills and health service quality. However, health service quality fully mediated the relationship between doctors’ communication skills and patient trust in village clinics. In other words, doctors’ communication skills indirectly influence patients’ trust in doctors.ConclusionsThis study found a link between doctors’ communication skills and patient trust. The findings suggest that health managers and doctors should attach great value to communication skills and health service quality in promoting the rural doctor-patient relationship. Moreover, the relationship between doctors and patients should be considered when reforming the primary health system.

Pemeliharaan Peralatan dan Pengawasan Pengolahan Depot Air Minum Isi Ulang dengan Kontaminasi Escherichia coli Pada Air Minum

Escherichia coli bacteria found in refilled drinking water shows that the quality of the drinking water does not meet the requirements of drinking water refill depots (DAMIU) set by the government, both in terms of bacteriological examination and human resources. It is probably caused by poor equipment maintenance as well as irregular sanitation and hygiene measure by the owner. According to Permenkes No 492/Menkes/PER/IV/2010, one of the requirements of drinking water is said to be consumable if the total content of Escherichia coli bacteria is 0 per 100 ml. The purpose of this study was to analyze the relationship between equipment maintenance and monitoring of drinking water refill depots with Escherichia Coli contamination in drinking water refill depots in Dolok Masihul District, Serdang Bedagai Regency. This study was an analytical type of research with a cross-sectional design. The population in this study was all DAMIU in Dolok Masihul District, Serdang Bedagai Regency, amounted to 15 DAMIU. By employing a total sampling technique, a total number of 15 DAMIU served as research samples. Based on the results of the Fisher Exact test, it was found that there was a relationship between equipment maintenance and Escherichia coli contamination (p-value = 0.007), and there was a relationship between processing supervision and Escherichia coli contamination in drinking water refill depots in Dolok Masihul District, Serdang Bedagai Regency (p-value = 0.017). It is recommended to the DAMIU manager to complete sanitation facilities and equipment such as closed trash cans, SPAL with a fluent and closed flow, replace gallon brush bristles every 3 months, and carry out regular drinking water quality checks and report to the local Health Office.

Outbreak of SARS-CoV-2 B.1.617.2 (Delta Variant) in a Youth Camp Associated With Community Spread, Nebraska, June-July 2021.

Objectives:During June–July 2021, an outbreak of SARS-CoV-2 occurred among attendees of a summer youth camp in Nebraska. We assessed the factors that contributed to onward transmission of disease.Methods:The Four Corners Health Department conducted an outbreak investigation and recorded both laboratory-confirmed and self-reported cases of SARS-CoV-2 and mitigation measures employed. We generated sequences on positive specimens, created an epidemic curve to assist with outbreak visualization, and examined epidemiologic, genomic, and laboratory outcomes.Results:Evaluation of 3 index cases led to the identification of 25 people with COVID-19 who interacted directly with the camp. Contact tracing revealed an additional 18 cases consistent with onward community transmission. Most (24 of 35, 68.5%) vaccine-eligible community cases were not vaccinated. We sequenced 8 positive specimens; all were identified as the Delta variant. Precamp planning incorporated local health officials who recommended wearing face masks, practicing social distancing, and using attendee cohorts to limit mixing of people involved in various activities.Conclusion:Low vaccination levels and poor face mask–wearing habits among attendees resulted in secondary and tertiary spread of SARS-CoV-2 and severe outcomes among young adults. This outbreak of COVID-19 at a youth camp highlights the importance of vaccination and use of other measures to interrupt opportunities for SARS-CoV-2 spread in the community and shows that vaccinated people remain vulnerable to infection when in an environment of high exposure to SARS-CoV-2. Proactive case identification and interruption of chains of transmission can help decrease the number of cases and avoid further severe outcomes.

Malaria Surveillance - United States, 2018.

Malaria Surveillance - United States, 2018.

Food handler's level of COVID-19 prevention practice and preparedness of food and drinking establishments to combat the pandemic in Eastern Ethiopia.

BackgroundFood and drinking establishments are potential hotspots for the spread of coronavirus. Food handler's have a higher risk of contracting the disease and transmitting it to others. The aim of this study was to assess the food handler's level of preventive practices toward COVID-19 and the preparedness of food and drinking establishments to tackle the pandemic in Eastern Ethiopia.MethodsThe cross-sectional study design was conducted from September 1 to 30, 2020. A stratified sampling technique was used to select 276 licensed public food and drinking establishments and a simple random sampling technique was employed to select 422 food handlers from the selected establishments. A face-to-face interview and checklist-based observation were used to collect data. The collected data were entered into Epidata 3.1 and exported to STATA version 16 for analysis. Binary logistic regression analysis were conducted to identify factors associated with COVID-19 preventive practice. Statistical significance was declared at p < 0.05.ResultsAbout 406 food handler's participated in this study, making the response rate 96.2%. The study showed that 38.4% of study participants (95% CI: 33.5, 43.1) had good preventive practices for COVID-19. Only 10.5% of food and drinking establishments fulfilled all requirements to prevent COVID-19 transmission. Being male [AOR = 0.61, 95% CI(0.61, (0.39, 0.93)], attending secondary education [AOR = 2.20, (95% CI: 1.37, 3.53)], having a favorable attitude toward COVID-19 [AOR = 1.89, (95% CI: 1.22, 2.95)], and having good knowledge about COVID-19 [AOR = 1.78, (95% CI: 1.13, 2.81)] were significantly associated with the level of COVID-19 preventive practices.ConclusionThe level of good COVID-19 preventive practice was found to be low among the food handler's. Only one in ten food and drink establishments fulfilled the national guideline for preventing COVID-19 transmission. Being male, attending secondary education, having knowledge about COVID-19, and having a favorable attitude toward COVID-19 were significantly associated with good COVID-19 preventive practices. A vibrant guideline on prevention practices should be in place at all establishments, and compliance should be monitored. Local health office experts should take comprehensive measures to make all food and drinking establishments accountable for practicing all preventive measures.

Redesain formulir deteksi dini tumbuh kembang di Rumah Sakit Muslimat Singosari

Growth monitoring is the main activity of the nutrition improvement program, which focuses on efforts to prevent and improve the nutritional condition of toddlers according to Saurina, 2016. Medical records are used as a reference in planning the service process or therapy for patients in carrying out further actions, so that the quality of health information is always maintained and continues to improve and is sustainable. It is necessary to have good management of medical records, organized the flow of the examination process so that on the Early Detection of Growth and Development (DDTK) form in the Hospital, there needs to be consideration for more detail, detail and structure in accordance with the reference provided by the local Health Office, no longer joining the general examination form. And it can be socialized used as it should be for the form to be more effective in establishing the diagnosis. This study aims to redesign the early detection form of growth and development (DDTK) in children at Muslimat Hospital. Research methods with a descriptive qualitative approach. Analyze existing forms to be added with references from DINKES, to facilitate the work of implementing officers (Medical Personnel) and medical record officers to be developed in a detailed and structured manner. It is hoped that the new DDTK form can facilitate the work of medical record officers and health workers.&#x0D;

THE RELATIONSHIP OF KNOWLEDGE OF POST PARTUM MOTHERS ON BREASTFEEDING TECHNIQUES WITH THE OCCUPATION OF BREAST MILK DAMS IN THE WORK AREA OF THE HEALTH CENTER, BUILDING AJI, TULANG BAWANG REGENCY

The local health office managed to collect data on postpartum women, including postpartum women, including 3000 physiological postpartum women, and postpartum women with problems, including 60 postpartum women who experienced uterine atony, 445 people. experienced breast milk dams, 4112 postpartum women experienced bleeding, 150 postpartum women experienced uterine involution, 100 postpartum women experienced dizziness, 25 postpartum women experienced an increase in body temperature and 266 postpartum women experienced mastitis. Based on the data from the Preliminary Study that I did at BPM Diana Ariyanti, I got data for the period May - August 2020, it was found that there were 19 postpartum mothers who experienced breast milk dams and for the period September - December 2020, 32 postpartum mothers received and who experienced breast milk dams. as many as 21 breastfed people. The purpose of this study is to determine the relationship between postpartum mother's knowledge about breastfeeding techniques and the occurrence of breast milk dams in the Working Area of the Aji Building Health Center, Tulang Bawang Regency in 2021.This type of research is quantitative. This type of research is descriptive correlation with the aim of knowing the relationship between one variable and another by using a cross sectional design. In this study, the number of samples to be taken were 32 respondents from postpartum mothers, total population technique. Analysis of univariate and bivariate data using chi square.good knowledge as many as 14 people (43.8%), and poor knowledge as many as 18 (56.2%). 15 respondents (46.9%) did not experience breast milk dam, and 17 respondents (53.1%) had breast milk dam. The results of the study obtained a p-value of 0.005 (0.05), which means that there is a relationship between postpartum mother's knowledge about breastfeeding techniques and the occurrence of breast milk dams in the Working Area of the Puskesmas Gedung Aji, Tulang Bawang Regency in 2021, with an Odds Ratio of 12.833 which means that the respondents' knowledge is not good. will be 13 times at risk of experiencing breast milk dam. It is hoped that the results of this study can be used as input for and improvement of programs related to the implementation of prevention of breast milk dams in their respective Puskesmas Working Areas. In addition, increasing exposure can also be done by presenting PPT or leaflets related to the handling and prevention of breast milk dams

Impact of COVID-19 on Texas Rural Transit Districts with Emphasis on their Older Adult Riders

The COVID-19 pandemic presented rural transit districts (RTDs) challenges in providing services to riders, but also led to opportunities. This study’s objectives are to gain insight on the effect of COVID-19 on older adult RTD ridership, and gain an understanding of how RTDs were affected by and are adapting to the health crisis. Leaders from 30 of the 36 Texas RTDs completed an online questionnaire with 26 agreeing to participate in a semi-structured interview concerning the impact of COVID-19 on their district. Few differences are found between the responses of RTDs. RTDs followed recommended guidelines and implemented heightened cleaning standards that most leaders felt will likely remain in place for the future. Main information sources for responding to the pandemic were local health officials, the Center for Disease Control and Prevention, and other transit districts. Most RTDs projected a financial loss because of the pandemic but received additional funding to help cope with the pandemic. RTDs believe their older adults may be suffering from social isolation but older adults are appreciative of their efforts. Many RTDs developed contactless payment methods, although they were divided on the future role of new technologies. Incorporating RTDs into disaster and pandemic planning increases rural areas’ resiliency and ability to respond to disasters and pandemics lessening the effect of these events on rural populations and communities.

Spatial and temporal pattern of cannabis use disorder in California 2010-2019

As cannabis use is being legalized in an increasing number of states, it is important to understand the changing dynamic of the risk in cannabis use disorder (CUD). Shape-based time-series clustering was used to identify ZIP Code Tabulation Areas (ZCTAs) with similar changing pattern in CUD over time. We conducted a cross-sectional logistic regression analysis to investigate the most recent ZCTA socio-demographic characteristics in relation to the changing CUD rates. The emergency discharge rates generally increased during 2010-2016. Increase during 2017-2019 was found in Sacramento and Santa Barbara County. Approximately 13% of ZCTAs showed an increasing trend of hospitalization discharge during 2017-2019. Males and non-Hispanic Black had larger increase than other groups during 2017-2019. The recent growing trend was found associated with greater racial diversity and rural ZCTAs. The findings from this study hold promise for local public health officials to adjust the cannabis intervention strategies in target districts and improve overall health outcomes.

All Public Health is Local: Lessons From Eagle County During the First 2 Years of the Coronavirus Disease-2019 Pandemic.

Background:During the coronavirus disease-2019 (COVID-19) pandemic cumulative United States COVID-19 deaths per capita were higher than all other large, high-income nations, but with substantial variation across the country.Objective:The aim was to detail the public health response during the pandemic in Eagle County, Colorado.Research Design and Measures:Observational study using pre-COVID-19 county public health metrics. Pandemic actions were recorded from a narrative summary of daily phone consultations by a county-wide taskforce and interviews. Outcomes obtained from local, state, and nationally reported databases.Methods:Eagle County began with a life expectancy of 85.9, low all-cause age-adjusted death rates equal for both White and Latinx populations, a high household median income, and other prepandemic advantages. It also launched an innovative, independent county-wide taskforce lead by experienced mid-level managers. The taskforce implemented rapid communication of decision consequences, made immediate course corrections without traditional organizational approvals or contradictory political pressures.Results:Eagle County was first in Colorado to obtain Personal Protective Equipment and to establish a drive-through testing facility. The COVID-19 case fatality rate was 0.34%. The sole intensive care unit never reached maximum capacity. By March 2022, Eagle County had administered at least 1 vaccine dose to 100% of the population and 83% were fully vaccinated.Conclusions:It is not possible to directly attribute superior outcomes to either the baseline characteristics of Eagle County or its innovative taskforce design and deployment. Rather this report highlights the potential impact that improving the baseline health status of US citizens and permitting novel problem-solving approaches by local public health officials might have for the next pandemic.

Comparison of National Vulnerability Indices Used by the Centers for Disease Control and Prevention for the COVID-19 Response.

Objective:Vulnerability indices use quantitative indicators and geospatial data to examine the level of vulnerability to morbidity in a community. The Centers for Disease Control and Prevention (CDC) uses 3 indices for the COVID-19 response: the CDC Social Vulnerability Index (CDC-SVI), the US COVID-19 Community Vulnerability Index (CCVI), and the Pandemic Vulnerability Index (PVI). The objective of this review was to describe these tools and explain the similarities and differences between them.Methods:We described the 3 indices, outlined the underlying data sources and metrics for each, and discussed their use by CDC for the COVID-19 response. We compared the percentile score for each county for each index by calculating Spearman correlation coefficients (Spearman ρ).Results:These indices have some, but not all, component metrics in common. The CDC-SVI is a validated metric that estimates social vulnerability, which comprises the underlying population-level characteristics that influence differences in health risk among communities. To address risk specific to the COVID-19 pandemic, the CCVI and PVI build on the CDC-SVI and include additional variables. The 3 indices were highly correlated. Spearman ρ for comparisons between the CDC-SVI score and the CCVI and between the CCVI and the PVI score was 0.83. Spearman ρ for the comparison between the CDC-SVI score and PVI score was 0.73.Conclusion:The indices can empower local and state public health officials with additional information to focus resources and interventions on disproportionately affected populations to combat the ongoing pandemic and plan for future pandemics.

Healthcare provider and medical student impressions of vaccine hesitancy in Romania

ObjectivesVaccine hesitancy, including vaccination delay and refusal, threatens gains made to improve global health. Recent outbreaks of measles attributed to lower vaccination rates and the COVID-19 pandemic have added urgency to the need for current and future healthcare providers to effectively identify and address barriers to vaccination. Study designCross-sectional interviews and online surveys. MethodsHealthcare providers in Cluj-Napoca, Romania were interviewed. Transcripts were translated for inductive coding. Medical students at the Iuliu Hațieganu University completed an online survey accessed via a university social media group. Descriptive statistics were calculated for each survey question. ResultsPracticing clinicians lack confidence in their ability to communicate risks and benefits of vaccination, including the need to use social media for this purpose and seek greater support from the Ministry of Health and parents. Medical students have higher confidence in national and local health officials than practitioners. ConclusionNeither practicing clinicians nor medical students feel adequately prepared to effectively address vaccine hesitancy. They need additional support from health authorities, particularly around communication and policy.