Local Health Services Research Articles

Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study

ObjectivesTo examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes.Study designRetrospective analysis of health service use data over...

Palliative care delivery in India during COVID-19 pandemic: role of faith-based hospitals – a qualitative study

ObjectivesThe COVID-19 pandemic challenged palliative care (PC) services globally. We studied the ways healthcare professionals (HCPs) working in faith-based hospitals (FBHs) experienced and adapted care through the pandemic, and how...

Disaster Response and Management: The Integral Role of Rehabilitation.

With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation; challenges and key future perspectives in this area.

Extended brief interventions for weight management and obesity prevention in children: A rapid evidence review.

Uptake of child weight management (CWM) support is typically low, and services are not available in all areas. Extended brief interventions (EBIs) have been proposed as an affordable way to provide enhanced support, at a level between one-off brief advice and intensive CWM programs. This rapid systematic review sought to synthesize evidence on the efficacy of EBIs for weight management and obesity prevention in children (2-18 years). Embase and Web of Science were searched from January 2012 to January 2022. Nineteen studies, reporting on 17 separate EBIs, were included. The quality of studies was variable, and the EBIs were heterogeneous. The majority of EBIs (n= 14) were based on motivational interviewing. Five of the included studies reported significant improvements in parent or child determinants of health behavior change. However, robust measures of behavioral determinants were rarely used. No studies reported significant positive effects on child weight. No clear patterns in outcomes were identified. There is currently insufficient evidence for EBIs to be adopted as part of CWM services. To improve the evidence base, EBIs that are currently being implemented by local health services, should be evaluated to establish the most effective content, how it should be delivered, and by whom.

Closing the gap in Indigenous Australian cancer care: Initiatives to foster cultural safety and improve access to radiation therapy

IntroductionAboriginal and Torres Strait Islander peoples receive a poorer cancer prognosis compared to non-Indigenous Australians. Indigenous access to cancer care is limited by several factors, including differences in cultural understanding surrounding cancer and distrust of mainstream health institutions. It is believed that radiation therapy is being under-utilised by the Indigenous community. In response, several strategies were implemented to increase presentation and attendance by Indigenous Australians at a rural, private radiation therapy practice. MethodsA local Indigenous health service, Traditional Owners and Elders and the clinic's Reconciliation Action Plan Working Group were consulted to implement initiatives to reduce barriers to engaging in healthcare. One of these initiatives involved community consultation to select a culturally safe, Indigenous word to name one of the clinic's linear accelerators. Indigenous patient referrals into the clinic were tracked using an oncology information system. It is expected that by implementing several culturally safe strategies, there would be an increase in utilisation of the radiation therapy service and therefore, a decrease in Indigenous cancer burden across the local region. If strategies were yielding positive outcomes, there would be scope to implement these at other sites across a broader monitored network. ResultsCurrently, service utilisation is being monitored to determine whether initiatives have been successful. Initial data evaluation has been conducted and results are showing increased service utilisation by the Indigenous community. ConclusionWork has been undertaken to implement strategies to improve cultural safety and improve access to radiation therapy for Indigenous cancer patients. Preliminary results show an increase in the number of presentations to the clinic for radiation therapy treatment.

Adult dysphagia services in acute and subacute settings in Singapore

ABSTRACT International studies examining dysphagia management have identified that a degree of practice variability exists globally, with multiple factors within the local health service context influencing the nature of services. Understanding current practices and service inefficiencies is a foundational step for service optimization. Thus, this study aimed to understand service characteristics and issues associated with adult dysphagia service provision within acute and subacute settings in Singapore. Two online anonymous surveys were conducted with: (a) managers to explore practice documents used to guide dysphagia services, and (b) speech-language pathologists (SLPs) to understand dysphagia practices and service issues. Data were analyzed using descriptive statistics and content analysis. Responses from 12 managers and 68 SLPs working in acute and subacute settings were analyzed. There was a lack of national practice documents to guide dysphagia clinical training and service provision, and services were generally guided by internal documents. Despite this, dysphagia services were similar across acute and subacute settings. However, differences between settings were identified in screening and instrumental assessments services, perceived rehabilitation intensity, perceived rehabilitation adherence among patients, and extent of challenges with onward referrals. Whilst Singapore’s dysphagia services were largely aligned with other countries, challenges unique to the Singapore context was found relating to enteral feeding management, language barrier, financing framework, and care transitions. These findings build on the knowledge of dysphagia practices internationally, and provide direction for service optimization in Singapore.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis.

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Temporal trends of dengue cases and deaths from 2007 to 2020 in Belo Horizonte, Brazil

ABSTRACT Dengue, a disease with multifactorial determinants, is linked to population susceptibility to circulating viruses and the extent of vector infestation. This study aimed to analyze the temporal trends of dengue cases and deaths in Belo Horizonte, Minas Gerais, Brazil, from 2007 to 2020. Data from the Notifiable Diseases Information System (Sinan) were utilized for the investigation. To assess the disease's progression over the study period and predict its future incidence, time series analyses were conducted using a generalized additive model (GAM) and a seasonal autoregressive integrated moving average (SARIMA) model. Over the study period, a total of 463,566 dengue cases and 125 deaths were reported. Notably, there was an increase in severe cases and deaths, marking hyperendemics characterized by simultaneous virus circulation (79.17% in 2016–50% in 2019). The generalized additive model revealed a non-linear pattern with epidemic peaks in 2010, 2013, 2016, and 2019, indicating an explosive pattern of dengue incidence. The SARIMA (3,1,1) (0,0,0)12 model was validated for each year (2015 to 2019). Comparing the actual and predicted numbers of dengue cases, the model demonstrated its effectiveness for predicting cases in the municipality. The rising number of dengue cases emphasizes the importance of vector surveillance and control. Enhanced models and predictions by local health services will aid in anticipating necessary control measures to combat future epidemics.

The Role of Ibu Nyai for The Development of Local Community-Based Public Health Services

People with mental disorders are continually increasing every year. However, they are very few who seek treatment. The causative factor is the limited mental health services. One solution is to develop services based on Islamic boarding schools or pesantren. For pesantren, mental health is part of da'wah bil-irsyad or counseling.This paper aims to describe the role and potential of ibu nyai (female scholars of pesantren) in developing local community-based public health services. The study used a qualitative method with an ethnographic-hermeneutic approach. The results show that firstly, ibu nyai had the potential as leaders for female students, many are highly educated, some have colleges and health facilities, and some have sizeable social capital. Second, ibu nyai had a concern for health services because of her theological motivation and passion for da’wah. Third, ibu nyai has a powerful social network, which is expected to be helpful as a communication strategy for strengthening public health. Islamic boarding school-based public health has its own appeal and market share. This research is useful for developing public health science based on local wisdom. Masyarakat yang mengalami gangguan jiwa setiap tahun selalu meningkat. Mereka sedikit sekali yang berusaha mencari pengobatan. Faktor penyebabnya, karena terbatasnya layanan kesehatan mental. Salah satu solusinya, mengembangkan layanan yang berbasis pesantren. Bagi pesantren, kesehatan mental termasuk bagian dakwah bil-irsyad atau konseling. Tujuan tulisan ini untuk mendeskripsikan peran dan potensi ibu nyai dalam mengembangkan layanan kesehatan masyarakat berbasis komunitas lokal. Penelitian ini menggunakan metode kualitatif dengan pendekatan etnografi-hermeneutik. Hasil penelitian menunjukkan bahwa pertama, para ibu nyai berpotensi sebagai pemimpin bagi santri perempuan, banyak yang berpendidikan tinggi, ada yang memiliki perguruan tinggi dan fasilitas kesehatan serta memiliki modal sosial yang besar. Kedua, ibu nyai memiliki kepedulian terhadap layanan kesehatan karena motivasi teologis dan semangat khidmah dalam berdakwah. Ketiga, ibu nyai memiliki jejaring sosial yang sangat kuat, yang diharapkan bermanfaat sebagai strategi komunikasi dalam penguatan kesehatan masyarakat. Kesehatan masyarakat berbasis pesantren memiliki daya tarik dan pangsa pasar tersendiri. Penelitian ini berguna untuk mengembangkan ilmu kesehatan masyarakat yang berbasis kearifan lokal.

Where does it hurt? Small area estimates and inequality in the prevalence of chronic pain.

Chronic pain affects up to half of UK adults, impacting quality of life and demand on local health services. Whilst local health planning is currently based on subnational prevalence estimates, associations between pain and sociodemographic characteristics suggest that inequalities in the prevalence of chronic and high-impact chronic pain between neighbourhoods within local authorities are likely. We aimed to derive lower super output area (LSOA) estimates of the prevalence of chronic and high-impact chronic pain. Presence of self-reported chronic and high-impact chronic pain were measured in adults aged 35+ in North Staffordshire and modelled using multilevel regression as a function of demographic and geographic predictors. Multilevel model predictions were post-stratified using the North Staffordshire age-sex population structure and LSOA demographic characteristics to estimate the prevalence of chronic and high-impact chronic pain in 298 LSOAs, corrected for ethnic diversity underrepresented in the data. Confidence intervals were generated for high-impact chronic pain using bootstrapping. Data were analysed from 4162 survey respondents (2358 women, 1804 men). The estimated prevalence of chronic and high-impact chronic pain in North Staffordshire LSOAs ranged from 18.6% to 50.1% and 6.18 [1.71, 16.0]% to 33.09 [13.3, 44.7]%, respectively. Prevalence of chronic and high-impact chronic pain in adults aged 35+ varies substantially between neighbourhoods within local authorities. Further insight into small-area level variation will help target resources to improve the management and prevention of chronic and high-impact chronic pain to reduce the impact on individuals, communities, workplaces, services and the economy. Post-stratified multilevel model predictions can produce small-area estimates of pain prevalence and impact. The evidence of substantial variation indicates a need to collect local-level data on pain and its impact to understand health needs and to guide interventions.

Multi-period location routing: An application to the planning of mobile clinic operations in Iraq

Health service access and delivery are hampered during humanitarian crises due to disrupted health systems, damaged infrastructure, and healthcare worker shortages, this particularly in conflict zones. Mobile clinics are a strategy used to reach populations cut off from local health services, and organizations commonly rely on them during relief and recovery humanitarian efforts to deliver primary healthcare. In this study, we present a multiperiod location-routing problem (MLRP) with benefits for the tactical planning of mobile clinic deployment. Our set-packing formulation was developed and solved as part of a collaboration with Première Urgence Internationale (PUI). The proposed model aims to select communities to be served and design routes to be performed such that health benefits, measured by means of coverage and continuity of care functions, are maximized throughout the planning horizon. Results are presented for an application based on PUI’s operations in Iraq, including sensitivity analyses on the parameters used to model the healthcare benefits. Managerial insights on the impacts of organizational strategic and tactical decisions, such as the number of mobile clinics and the relative importance given to coverage and continuity of care, are presented.

A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia.

The Australian National Preventive Health Strategy 2021-2030 recommended the establishment of evidence-based frameworks to enable local public health services to identify strategies and interventions that deliver value for money. This study aimed to review the cost-effectiveness of preventive health strategies to inform the reorientation of local public health services towards preventive health interventions that are financially sustainable. Four electronic databases were searched for reviews published between 2005 and February 2022. Reviews that met the following criteria were included: population: human studies, any age or sex; concept 1: primary and/or secondary prevention interventions; concept 2: full economic evaluation; context: local public health services as the provider of concept 1. The search identified 472 articles; 26 were included. Focus health areas included mental health (n = 3 reviews), obesity (n = 1), type 2 diabetes (n = 3), dental caries (n = 2), public health (n = 4), chronic disease (n = 5), sexual health (n = 1), immunisation (n = 1), smoking cessation (n = 3), reducing alcohol (n = 1), and fractures (n = 2). Interventions that targeted obesity, type 2 diabetes, smoking cessation, and fractures were deemed cost-effective, however, more studies are needed, especially those that consider equity in priority populations.

Multifamily therapy for adolescent eating disorders: a study of the change in eating disorder symptoms from start of treatment to follow-up

BackgroundThis study aimed to evaluate multifamily therapy (MFT) for adolescents with eating disorders (EDs) in a clinical setting, by presenting the outcome of families participating in this treatment at a specialist ED service. MFT was an adjunct to treatment at local mental health services. In particular, the study aimed to present the change in eating disorder symptoms and psychological distress from before to after treatment and at a 6 months follow-up.MethodsParticipants were 207 adolescents receiving outpatient MFT (10 or 5 months) at Oslo University Hospital in Norway between 2009 and 2022. Adolescents had heterogeneous ED presentations, with a preponderance of anorexia nervosa (AN) and atypical AN. All participants completed pre- and post-treatment questionnaires [The eating disorder examination questionnaire (EDE-Q) and the strengths and difficulties questionnaire (SDQ)]. 142 adolescents additionally completed the same questionnaires at 6 months follow-up. Weight and height were measured at all time points.ResultsLinear mixed model analyses showed that from start of treatment to follow-up, there was a significant increase in BMI percentile (p < 0.001) and a significant decrease in EDE-Q global score (p < 0.001) and SDQ total score (p < 0.001).ConclusionsThe study shows that adolescents with an eating disorder who received adjunct outpatient MFT in a real world clinical setting, experienced reductions in ED symptoms comparable to that found in a randomized controlled trial.Trial registration: The data used in this study was collected as part of routine clinical procedures for quality assurance and trial registration is therefore not required.

Clinicians' perspectives on why young Aboriginal people are not testing for sexually transmissible infections in Western Sydney.

Incidence of sexually transmissible infections (STI) amongst young Aboriginal people in Australia are significantly higher compared to the wider population. Low levels of engagement with public sexual health services also exacerbates health inequity. This study sought to understand the access barriers facing Aboriginal People with local Sexual Health services from the perspective of local clinicians within Western Sydney. Six clinicians (six registered nurses, two medical practitioners) and two social workers, working in a Sexual Health service, were interviewed using a semi-structure questionnaire. Interviews were audio recorded and transcribed verbatim. Interview texts were analysed using NVIVO 12 and a thematic analysis undertaken. Thematic analysis revealed three broad themes: personal, practical, and programmatic. Clinicians believed the involvement of Aboriginal people in service delivery would contribute to greater inclusion and more culturally competent services. Clinicians also considered that young Aboriginal people were unaware of the risks of untreated STIs, and that greater STI-related education regarding risk and prevention may reduce STI incidence and improve participation in services. Clinicians believed that culturally-competent STI education would be more effective if co-designed with the local Aboriginal community. Clinicians identified that Aboriginal young people were concerned about their privacy when accessing services, and that barriers could be reduced by greater community engagement in service delivery design and quality improvement initiatives. The three themes identified in this study provide guidance for service providers about approaches that may enhance the access, participation, and cultural safety sexual health services for Aboriginal clients.

Budget impact analysis of the implementation of a bone tissue bank in a Chilean health service

This research aimed to analyze the costs of bone grafting through a bone tissue bank in a Chilean regional health service. Methods: First, we developed a preliminary epidemiological study to obtain the necessary data for the analysis, specifically on bone graft procedures in a local health service (Servicio Salud Concepción). Next, we performed a budget impact analysis. Results: We analyzed a total of 6,252 cc of bone grafts, with a total cost of USD$156,000 per year. We found a potential recovering capacity of 302 ± 16 femoral heads per year from the total hip replacement procedures. Based on these results, bone tissue banks could save USD$145,000 hospital costs annually. Studying a representative health service from Chile, this analysis revealed a dependency on imported bone substitutes and autografts. These requirements can be supplied sustainably by a bone tissue bank based on donations of femoral heads under the current legislation of the Chilean health authority.

Determinants of province-based health service utilization according to Andersen’ s Behavioral Model: a population-based spatial panel modeling study

ObjectiveThe Andersen’ s Behavioral Model was used to explore the impact of various factors on the utilization of health services. The purpose of this study is to establish a provincial-level proxy framework for the utilization of health services from a spatial perspective, based on the influencing factors of the Andersen’ s Behavioral Model.MethodProvincial-level health service utilization was estimated by the annual hospitalization rate of residents and the average number of outpatient visits per year from China Statistical Yearbook 2010–2021. Exploring the relevant influencing factors of health service utilization using the spatial panel Durbin model. Spatial spillover effects were introduced to interpret the direct and indirect effects influenced by the proxy framework for predisposing, enabling, and need factors on health services utilization.ResultsFrom 2010 − 2020, the resident hospitalization rate increased from 6.39% ± 1.23% to 15.57% ± 2.61%, and the average number of outpatient visits per year increased from 1.53 ± 0.86 to 5.30 ± 1.54 in China. For different provinces, the utilization of health services is uneven. The results of the Durbin model show that locally influencing factors were statistically significantly related to an increase in the resident hospitalization rate, including the proportion of 65-year-olds, GDP per capita, percentage of medical insurance participants, and health resources index, while statistically related to the average number of outpatient visits per year, including the illiteracy rate and GDP per capita. Direct and indirect effects decomposition of resident hospitalization rate associated influencing factors demonstrated that proportion of 65-year-olds, GDP per capita, percentage of medical insurance participants, and health resources index not only affected local resident hospitalization rate but also exerted spatial spillover effects toward geographical neighbors. The illiteracy rate and GDP per capita have significant local and neighbor impacts on the average number of outpatient visits.ConclusionHealth services utilization was a variable varied by region and should be considered in a geographic context with spatial attributes. From the spatial perspective, this study identified the local and neighbor impacts of predisposing factors, enabling factors, and need factors that contributed to disparities in local health services utilization.

Tapping into the power of coproduction and knowledge mobilisation: Exploration of a facilitated interactive group learning approach to support equity-sensitive decision-making in local health and care services.

We report on a study of a facilitated interactive group learning approach, through Collaborative Implementation Groups (CIGs), established to enhance capacity for equity-sensitive evaluation of healthcare services to inform local decision-making: (1) What was the experience of participants of the CIGs? (2) How was knowledge mobilisation achieved? (3) What are the key elements that enhance the process of coproducing equity-sensitive evaluations? A thematic analysis of qualitative data obtained from focus group (FG) discussions and semistructured interviews exploring the experiences of participants. All FGs included representation of participants from different projects across the programme. Interviews were conducted with a member from each of the teams participating in the first cohort after their final workshop. We identified four themes to illustrate how the approach to delivering intensive and facilitated training supported equity-sensitive evaluations of local healthcare services: (1) Creating the setting for coproduction and knowledge mobilisation; (2) establishing a common purpose, meaning and language for reducing health inequalities; (3) making connections and brokering relationships and (4) challenging and transforming the role of evaluation. We report on the implementation of a practical example of engaged scholarship, where teams of healthcare staff were supported with resources, interactive training and methodological advice to evaluate their own services, enabling organisations to assemble timely practical and relevant evidence that could feed directly into local decision-making. By encouraging mixed teams of practitioners, commissioners, patients, the public and researchers to work together to coproduce their evaluations, the programme also aimed to systematise health equity into service change. The findings of our study illustrate that the approach to delivering training gave participants the tools and confidence to address their organisation's stated aims of reducing health inequalities, coproduce evaluations of their local services and mobilise knowledge from a range of stakeholders. The research question was developed collaboratively with researchers, partner organisations and public advisers (PAs). PAs were involved in meetings to agree on the focus of this research and to plan the analysis. N. T. is a PA and coauthor, contributing to the interpretation of findings and drafting of the paper.

Health impairment allegations against doctors: Qualitative analysis and insights for Australian general practitioners.

A thematic analysis was conducted of semistructured interviews with 21 doctor-patients and four doctors' health experts. Doctor-patient participants had experienced a past or family psychiatric history, personal loss or trauma, access to drugs at work, workplace stress or recent patient death or suicide. Many avoided seeking care and were significantly unwell when notified to medical regulators. Regulatory processes caused distress, symptom relapse, suicidality, financial pressures and work difficulties. Doctor-patient participants sought assistance from GPs, doctors' health services, medical defence organisations, recovery groups and benevolent associations. When treating doctor-patients, GPs can consider targeted mental health screening, openly discussing mandatory reporting obligations and accessing advice from their medical defence organisation or local doctors' health service. Trust and clear communication benefits doctor-patients and the wider communities they serve.

A Comprehensive Coalition-Based Regional Approach to Pediatric Disaster Planning

Introduction:Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events. To prepare NYC for a large-scale Pediatric Disaster, NYCPDC has worked with an increasing number of providers that initially included only a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include local public health, emergency management and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.Method:The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through repeated discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.Results:The plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing guidelines and templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments including Pediatric and Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists has been provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This initially included pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.Conclusion:The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.The NYCPDC has responded to real time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (including the National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.

Development of an Enhanced Surveillance and Epidemiology Program to Support the Birmingham 2022 Commonwealth Games in England: Outcomes and Lessons Learned

Introduction:The 2022 Commonwealth Games (B2022) was hosted by Birmingham, United Kingdom (UK) from July, 28 2022 to August 8, 2022. As a major global sporting event and mass gathering, B2022 included over 4,500 athletes (from 72 countries and territories) and attracted 1.5 million spectators. Robust public health surveillance and support for health protection incidents was required from the UK Health Security Agency (UKHSA) to protect the health of both those directly involved in B2022, and the local population.Method:UKHSA surveillance activities in the UK West Midlands region were enhanced, utilizing lessons learned from the response to the London 2012 Olympic and Paralympic Games and the 2021 G7 Summit (hosted in England). Enhancements included: adaptation of existing and development of new methods for the identification of increased activity of a range of pathogens/diseases/conditions of particular concern to a mass gathering; standardized daily situation reporting to inform both public health action and the B2022 organizing committee. Three streams of routine UKHSA surveillance data were assessed each day: a UKHSA health protection/clinical management system, statutory laboratory reports of infection, and syndromic surveillance. Bespoke surveillance was also implemented using B2022 health data sources.Results:Enhanced daily surveillance activities successfully met the need for next-day public health surveillance and reporting during B2022. No outbreaks or incidents of public health significance to the Games were identified. Syndromic surveillance reported an increased impact on local health services due to periods of extremely hot weather before and following the competition period, although these impacts were not unique to the Birmingham area.Conclusion:Surveillance and epidemiology reporting for B2022 provided reassurance there were no incidents/outbreaks of public health significance to the Games. The enhancements made will inform future routine surveillance and reporting activities and will be employed for similar activities during future mass gathering events.