Local Public Health Services Research Articles

The implementation of the elective subject "Public Health" in the final year for medical students at Göttingen University Medical Center: results of the UNITE project

International and national frameworks and initiatives call for strengthening the training of health professionals in the public health service (PHS) through cooperation with universities. The German Medical Licensing Regulations of 21st Sep 2021 provides for an integration of PHS into undergraduate medical training in the final year since 1st May 2022. The present study presents the procedure and results of the final year elective Public Health (PH) implementation for medical students at the University Medical Center Göttingen (UMG) in cooperation with the local PHS. In the twelve-month project UNITE (07/21-06/22), the final year elective PH was implemented in seven steps: analysis of the framework conditions, conception of the elective, preparation of a logbook, pilot phase with five students in one-week rotations, public relations for students, introduction of a medical didactic training for staff of the health department and implementation of the elective PHS with students. A cooperation agreement between UMG and the Health Department regulates the training of medical students. Students complete four-week rotations in the areas of public health service and funeral services, paediatric and adolescent medical service, infection control and social psychiatric service. The logbook for students contains learning objectives for individuals specialised in services for self-assessment of the acquired competences. The didactics training was implemented with high learning success of the participating staff. So far three final year students have successfully completed the elective. The implementation of final year elective PHS strengthens the anchoring of public health topics in the education of medical students in Göttingen and makes PHS more visible as a professional perspective. Essential for the successful implementation were the establishment of a continuous cooperation between the university and the health department, student-oriented teaching-learning concept with a logbook suitable for the location, a trained multiprofessional team in the health department, and the evaluation of the elective for quality assurance and further development of the training. The concept presented here can help other locations in establishing the final year elective in PH and can be adapted to specific local conditions.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

Strategic Communication for Local Public Health Services in Portugal: A Delphi Study.

Strategic communication plays a decisive role in public health planning and project implementation. However, Portuguese Local Public Health Units, which are responsible for community interventions, still lack guidance models, tools, specialized resources, and training in health communication. The aim of this study was to develop a conceptual model of strategic organizational communication for local public health services, in Portugal. This study presents a conceptual model of strategic organizational communication for Local Public Health Units, which was developed through a three-round, modified Delphi online panel. Thirty-seven Portuguese specialists in public health, communication, and community members were invited to analyse a proposed framework, based on an up-to-date literature review. High retention rates were observed in all rounds (first = 22 valid participations; second = 21 valid participations; third = 18 valid participations). Most participants believed that Portuguese Public Health Units were not prepared to communicate effectively and that they would benefit from adequate planning and identification of a communication lead or team. Websites and social media were also identified as essential for effective communication. The validated conceptual model integrated different partners in health and in the community, with emphasis on the relationships with the national network of health authorities, other Public Health Units, primary health care units, municipalities, and schools. The preferred channels identified for communicating with these partners included interpersonal relationships, email, and mobile phone. No consensus was obtained for preferred communication channels between Local Public Health Units and the media. Strategic planning based on the proposed conceptual model involving different stakeholders, has potential to improve the effectiveness of internal and external communication and facilitate the implementation of public health programs and projects. The proposed model needs to be validated in Local Public Health Units, considering the potential human, material, and financial constraints.

The Role of Health Care and Health Security in War, Disaster & Crisis Preparedness.

Health care and health security are the fundamental pillars of disaster preparedness and crisis management. An established routine health care is necessary for any society, enabling full access to care and fulfilling the rights of every individual. Health security, on the other hand, is what a society needs to be flexible in managing an unexpected situation. To overcome a disaster with minimal damage or to avert such a critical situation, health care and health security should exist simultaneously. Thus, resilience in disaster preparedness and crisis management requires investment in both health care and health security. This ensures local public health services and infrastructure, local ambulances, both acute and chronic care referral systems, prompt vaccinations, and prevention of communicable diseases to name but a few. These measures which have proven to be the most sensitive evaluation of fair governance are critically absent in several nations, particularly in areas with long-standing conflicts. Strengthening health care and health security measures are paramount to the maintenance of the health system in peace and recovery of health delivery post-conflict and require political and economic considerations.

Shaping Conditions for Recovery: A narrative on a Homeless Man with Severe Mental Illness in a Modern Welfare State

AbstractDespite extensive research, interdependent problems such as severe mental illness and homelessness cause extreme disparities and health inequity. Handling complexity in careseeker–caregiver networks remains challenging. The local public health services in a Dutch city were enriched with a specialized team. An ethnographic policy evaluation was conducted to identify the essentials of an effective approach. We use the narrative of a homeless man who experiences psychoses for an in-depth analysis of the team’s functionality. The narrative data shows the challenges of caregiver networks and underlines the need to integrate care. It demonstrates how normal behavior, personal skills, and a socio-ecological system strategy merge into collaborative networks with the ability to diversify care and keep focus on recovery. This paper demonstrates the failure of the linear handicap model and the costs of overspecialized care systems. Building on socio-ecological recovery literature, it provides insight how care networks successfully can foster recovery.

Workers needed: a needed assessment of the workforce in local public health services in Portugal

Abstract Background Portugal is planning to reform its public health services, which have been struggling with a shortage of professionals, even after hiring more staff during the COVID-19 pandemic. Meanwhile, in 2023, new local health units will be created to reorganize the local public health services (LPHS). Therefore, it is essential to examine and discuss how many and where the professionals in LPHS are in Portugal. Methods A cross-sectional descriptive analysis was conducted using hiring data, in the second trimester of 2023. The number of professionals in LPHS in mainland Portugal was described and compared between the 55 LPHS and the 5 health regions. They were classified into categories, with a special attention given to medical specialists, nurses, and environmental health technicians, who have specific regulations. Results More than 20 different professions can be found in the different LPHS. The total number of professionals in public health services in mainland Portugal was 1720, of which 380 (22.1%) were medical specialists, 304 (17.7%) were nurses, 443 (25.8%) were environmental health technicians. The highest number of professionals was found in ACES Baixo Vouga with 70. The health region with the highest number of professionals was ARS Norte with 635. When considering full-time equivalents, only 18 (32,7%) LPHS have the legally recommended ratio of one medical specialist per 25 000 inhabitants, the ratio of one nurse per 30 000 inhabitants is attained in 18 (32,7%) LPHS, and only 12 (21,8%) have the indicated one environmental health technician per 15 000 inhabitants. Conclusions This study provides a comprehensive overview of the number and distribution of professionals in LPHS in mainland Portugal, at a time of change, with concerning results. These can be useful to plan and evaluate policies and interventions regarding public health personnel recruitment and organization, considering impending the reforms. Key messages • There is a lack of professionals in local public health services in Portugal, with few meeting the legally recommended ratios of medical specialists, nurses, and environmental health technicians. • The incoming changes in public health services organizations are a good opportunity to reorganize and invest in their workforce, which is essential to improve public health in Portugal.

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.

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.

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.

The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation

Abstract Background For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Methods Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Results A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol

A realist approach to understanding alliancing within Local Government public health and social care service provision.

Within the current context of continued austerity and post-pandemic recovery, it remains important that Local Government services address the increasing needs of residents as cost-effectively as possible. Alliancing, whereby services work collaboratively focusing on the 'whole-system', has gained popularity as a tool with the potential to support collaborative whole systems approaches. This synthesis aims to identify how alliancing can be successfully operationalised in the commissioning of public health, wider National Health Service (NHS) and social care-related services. A realist literature synthesis was undertaken in order to identify underlying generative mechanisms associated with alliancing, the contextual conditions surrounding the implementation and operationalisation of the alliancing approach mechanisms, and the outcomes produced as a result. An iterative approach was taken, using a recent systematic review of the effectiveness of Alliancing, online database searches, and grey literature searches. Three mechanistic components were identified within the data as being core to the successful implementation of alliances in public health and social care-related services within Local Government: (i) Achieving a system-level approach; (ii) placing local populations at the heart of the system; and (iii) creating a cultural shift. Programme theories were postulated within these components. The alliancing approach offers an opportunity to achieve system-level change with the potential to benefit local populations. The realist synthesis approach taken within this study has provided insights into the necessary contextual and mechanistic factors of the Alliancing approach, above and beyond effectiveness outcomes typically collected through more conventional evaluation methodologies.

Gauging Public Health Literacy needs through Google Trends: the COVID-19 vaccination example

Abstract Background The rollout of the COVID-19 vaccination program in Portugal was one of the most successful in the world. However, there was still a challenge for Public Health services to determine the health literacy needs of the population in the context of a new vaccine and the uncertainty of the pandemic. The goal of this study was to evaluate the usefulness of Google Trends data to gauge the health literacy needs of the general population during the pandemic. Methods A Google Trends search was performed for Portugal including 5 topics related to health literacy needs of the population (“vaccination”, “scheduling”, “isolation”, “booster dose” and “vaccination certificate” ) between the 28th of december 2019 and the 10th of march 2022. The variation shows the relative popularity of each term referring to the total number of Google searches during that period in a normalized scale of 0-100. The variation was compared to the number of doses administered daily in Portugal and key moments of the vaccination campaign as defined by the Directorate-General for Health in Portugal. Results The terms “vaccination” and “isolation” had a steady rise in popularity from December 2019 to January 2021. The term “vaccination” was the most popular search term with peak popularity in July 2021 and a downward trend followed by an ascent to a lower peak in popularity in January 2022. The terms “scheduling” and “vaccination certificate” both followed a similar pattern, though at lower popularity levels. The term “isolation” was low on popularity since February 2021, with a significant rise and peak in January 2022. This variation relates to key dates during the Portuguese vaccination campaign. Conclusions Google Trends data seems to correlate with key events during the Portuguese COVID-19 vaccination campaign. That data might be incorporated in the planning framework of health literacy activities for national and local Public Health services. Key messages • Google Trends might be an important source of information for public health teams. • There is a need for further research into how Google Trends data can be incorporated with other sources of information to inform health literacy activities.

The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation

Abstract Background For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Methods Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Results A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol

780 Are E-Scooters Safe for Widespread Public Use? A Case Series Examining Severe Facial Injuries Secondary to E-Scooter Accidents

Abstract E-scooter use is becoming commonplace across the UK as an increasing number of towns and cities launch trials with pay-as-you-go e-scooter companies. In addition, e-scooters are cheap method of transport, easily available for an individual to purchase online, without restriction. We present two cases of patients having suffered complex facial injuries secondary to e-scooter accidents. The first is a 38-year-old male, who was thrown from an e-scooter and had associated loss of consciousness. CT facial bones demonstrated extensive fractures to the bilateral maxillary and frontal sinuses, nasal bones, bilateral orbital floors, and mandible. The Le Fort II and mandibular fractures were fixed in two procedures. The patient has ongoing neuropathic pain around the right mandibular condyle and is receiving input from orthognathic specialists. The second patient is a 60-year-old male, who collided with the rear of a car and was thrown forward, hitting his face on the tarmac. CT facial bones showed a Le Fort II fracture pattern and a fractured left inferior orbital rim, with extensive surgical emphysema of the face. He underwent plating of the bilateral Le Fort II fractures and application of intermaxillary fixation wires. With little to no enforcement of personal protective equipment use and safety advice whilst utilising e-scooter services, the number of people suffering serious injuries from using such equipment is set to skyrocket. Increased awareness and education around the danger of e-scooters needs to be addressed and should be prioritised by local authorities and public health services.

Examining a rural Victorian community's knowledge and help seeking behaviour for family violence and the role of the local public health service.

The rates of family violence within some rural communities are higher than that of metropolitan areas. The extent to which these rural communities know about and access family violence support services is not well understood. Local health services often play a role in providing information and support for community members at risk of, or experiencing family violence. For a rural community in Victoria, the study aimed to: (a) determine community members' knowledge of family violence services, (b) explore community members' help seeking behaviour for family violence, (c) identify perceived barriers and enabling factors to accessing family violence services and (d) explore community members' expectations of, and preferences for, family violence support provided by local health services. A cross-sectional, anonymous, mixed-methods online survey. A rural community in Victoria's Western District, Australia. Ninety-nine residents, over 18 years of age. The majority of respondents had been exposed to family violence. There were varying knowledge levels of family violence support services as well as a number of barriers identified that directly impacted community members seeking help. There were clear expectations about the role of the local health service in family violence identification and response. There are particular challenges for rural communities in providing support for family violence. Valuable insights can be gained from local communities about their knowledge of services and help seeking behaviours. Evidence generated by this study will inform future strategic planning for family violence services and the local health service.

Supervision for the Public Health Services for Older Adults Under the Background of Government Purchasing: An Evolutionary Game Analysis Framework.

As an important measure to involve services for older adults, the government procurement practices have become a key link for public health services. However, the information asymmetry between public health service purchasers and public health service undertakers triggers a supervision dilemma. Based on this background, this study uses the evolutionary game theory to analyze the symbiotic evolution between local governments and public health service institutions under different reward and punishment mechanisms, explore game evolution, strategy adjustment, and influencing factors of different game subjects, and analyze the necessity and appropriate intensity of dynamic rewards and punishment mechanisms. The results show that: under the static condition, the penalty can change the strategies of local governments to a certain extent, but it is still difficult to achieve complete self-discipline management of public health service institutions. If local governments implement a dynamic reward or penalty mechanism in the supervision process of public health services for older adults, the equilibrium between them tends to be evolutionary stable. For three dynamic mechanisms, a dynamic reward mechanism is more conducive to adopting a self-discipline behavior of public health service institutions, which is helpful to realize the supervision of public health services for older adults. Also, there is a positive correlation between the proportion of public health service institutions who adopt a “self-discipline behavior” strategy and the maximum punishment intensity, and a negative correlation with the reward intensity. This study provides theoretical and decision-making references for governments to explore the promotion and implementation of public health services in older adults.

Implementation of a national testing policy in Dutch nursing homes during SARS-CoV-2 outbreaks.

BackgroundTo evaluate how a national policy of testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) regardless of symptoms was implemented during outbreaks in Dutch nursing homes in the second wave of the pandemic and to explore barriers and facilitators to serial testing.MethodsWe conducted a mixed‐method study of nursing homes in the Netherlands with a SARS‐CoV‐2 outbreak after 15 September 2020. Direct care staff and management from 355 healthcare organizations were invited to participate in a digital survey. A total of 74 out of 355 (20.9%) healthcare organizations participated and provided information about 117 nursing homes. We conducted 26 in‐depth interviews on the outbreak and the testing strategy used. We also conducted four focus group meetings involving managers, physicians, nurses, and certified health assistants. Recordings were transcribed and data were thematically analyzed.ResultsOne hundred and four nursing homes (89%) tested residents regardless of their symptoms during the outbreak, and 85 nursing homes (73%) tested the staff regardless of their symptoms. However, interviews showed testing was sometimes implemented during later stages of the outbreak and was not always followed up with serial testing. Barriers to serial testing regardless of symptoms were lack of knowledge of local leaders with decisional making authority, lack of a cohort ward or skilled staff, and insufficient collaboration with laboratories or local public health services. Important facilitators to serial testing were staff willingness to undergo testing and the availability of polymerase chain reaction (PCR) tests.ConclusionsSerial testing regardless of symptoms was only partially implemented. The response rate of 21% of nursing home organizations gives a risk of selection bias. Barriers to testing need to be addressed. A national implementation policy that promotes collaboration between public health services and nursing homes and educates management and care staff is necessary.

Albanian Migrants in Cyclades: Contact with Mental Health Services and Implications for Practice

The purpose of this study was to examine the potential differences between Albanian migrants and Greeks in the islands of Paros and Antiparos with regard to seeking help from the local public mental health service, namely the Mobile Mental Health Unit of NE Cyclades Islands (EPAPSY-NGO). The study’s instruments include the Global Assessment of Functioning (GAF) and a questionnaire for recording psychosocial profile data and information concerning contact with the services. The results showed that significantly less Albanian migrants contacted the mental health services in the past in comparison to Greeks. When using the service, the Albanians were more likely to see a psychiatrist in the Unit, rather than a psychologist-psychotherapist, and they more often received prescriptions for medication. There was a significantly higher dropout rate among Albanian migrants. This study highlights the different aspects of access and use of mental health services among Albanian migrants compared with native residents. Further research should focus on the factors related to early dropouts and difficulties accessing mental health services in rural areas, in order to develop more focused and effective interventions and improve the quality of care provided.

Evaluation of a caries prevention programme for preschool children in Switzerland: is the target group being reached?

BackgroundWith the goal of reducing the prevalence of early childhood caries, the city of Zurich, Switzerland, started a specific prevention programme in 2010. All 2-year-olds are invited to a free dental check-up at a local public dental health service before the first legally mandated yearly dental check-up for school children between 4 and 5 years of age (at kindergarten). However, for the success of this prevention programme, it is of particular importance that children at high risk of caries are reached. The objective of our study was to assess the effectiveness of the prevention programme in (1) reaching the children who needed it the most and (2) improving subsequent oral health.MethodsThis retrospective cohort study included all children born between July 1, 2013 and July 15, 2014 who had lived in Zurich between the ages of 23 and 36 months. Socio-economic data were extracted from official school records, and dental health data from public dental clinic records. Binomial and quasi-binomial generalised linear models were used to identify the socio-economic factors associated with toddler check-up attendance and to assess the associations between attendance and caries experience (dmft ge 1) as well as degree of treatment (proportion m+f out of dmft) at the kindergarten check-up, adjusting for socio-economic factors.ResultsFrom a total of 4376 children, 2360 (54%) attended the toddler check-up (mean age 2.4 years) and 3452 (79%) had a dental examination at kindergarten (mean age 5.3 years). Non-Swiss origin of the primary caretaker, presence of older siblings, low amount of savings and allocation to certain public dental clinics were associated with a lower odds of attendance. Factors associated with a higher odds of caries experience were similar to those associated with a lower odds of attendance at the toddler check-up, but additionally included low income. Attendance at the toddler check-up was non-significantly associated with a lower odds of caries experience at kindergarten (adjusted OR 0.84, 95% CI from 0.70 to 1.01), but was significantly associated with a higher degree of treatment at this stage (adjusted OR 2.41, 95% CI from 1.79 to 3.24).ConclusionsOur study suggests that children with a high caries risk are less likely to attend the toddler check-up. Greater effort should be put into reaching these children.

The critical role of Digital Health in Public Health

Digitalization in itself is not simply a means to an end but involves an operational change in workflows that is on the critical-path to the digital transformation of public health. The COVID-19 pandemic has been a unique opportunity to put a shining light on all the different technologies that were available and also consider a large number of new and innovative technologies that were developed in a breath-taking place over a period of one year. These different initiatives also brought relevant advances in public health needs such as epidemiological surveillance, rapid case identification, interruption of community transmission and communication with different audiences. Moreover, social media channels, blogs and websites confirmed to be a fertile ground to find data for research, but also to spread misinformation - and public health professionals should be ready to counter that threat effectively. This presentation aims to provide a comprehensive background on digital tools and strategies that can be used in national and local public health services and how stakeholder alignment across different sectors could propel forward the implementation of digital solutions.