Average Monthly Number Research Articles

Factors Affecting the Utilization of Information & Communication Technology (ICT): A Case of Badulla & Nuwara Eliya Potato Farming Community, Sri Lanka

ICT upgrades farmer knowledge thus, enhances overall production and marketing aspects in agricultural systems. However, transferring traditional farmer into new technologies in developing countries is a significant challenge. At present, there have been many ICT tools which introduced to farmers in Sri Lanka. Thus, the central question is whether agro-community is utilizing these different ICT tools in a productive way. Therefore, the objective of this study is to explore the factors which affect the overall usage of ICT tools of potato farmers in Sri Lanka and their perception on future use of ICT. Primary data was collected from 241 farmers randomly in Badulla and Nuwara Eliya Districts using a pre-tested questionnaire. Correlation analysis was deployed to elicit the relationship between selected socio-economic factors of the farmer and the number of ICTs those farmers have utilized. Results revealed education level (p<0.05, r=0.659), average monthly farm income (p<0.1, r=0.352) and number of crops cultivated (p<0.05, r=0.851) by farmer were positive and significant with the number of ICT appliances used by the potato farmer. Age (p<0.05, r=-0.7432) and years of experience engaged in agricultural activities (p<0.05, r=-0.254) were negative and significant with the number of ICT appliances used by the potato farmer. Further, 60% farmers have used internet once a week to gather agriculture related information. Another, 13% have used GPS and only 1% have used e-mail. Even though there have been numerous ICT tools, still ICT literacy of local farmers were not up to the satisfactory level. This implied Sri Lankan agriculture sector is not fully utilizing ICT in agriculture. Perhaps changing the way or mode of delivering of ICT tools may cause positive influence in agriculture. Rather than focusing advanced ICT appliances and tools, it is recommended to exploit the full potential of current ICT appliances and tools to disseminate vital information. Consideration of farmer accessibility of different ICT appliances and tools are much important to decide the next step of agriculture modernization in Sri Lanka.

Analysis of the meteorological situation in the conditions of icing and ice

The article is devoted to the study of the problem of ensuring the safety of aircraft on the territory of the Republic of Belarus and, directly, on the territory of the Minsk airfield. Icing and ice are some of the most dangerous meteorological phenomena for aviation. In order to prevent accidents related to these phenomena, it is necessary to have a clear idea of the laws of their occurrence and distribution, as well as their relationship to each other. To study the spatial and temporal patterns of ice distribution, the actual meteorological data of Belhydromet for 1989–2016 were processed at all meteorological stations of the Republic of Belarus. Also, charts of the chronological progress of the average monthly number of days with ice and the average annual number of days with ice at all meteorological stations on the territory of the Republic of Belarus for the above period were constructed and analyzed. The tendency to change the average annual number of days with ice over the period from 1989 to 2016 is analysed. The icing analysis for 2014–2018 was also carried out according to the data of the Civil Aviation Meteorological Station «Minsk». The accompanying meteorological elements, such as the shape of the clouds, the direction and strength of the wind, air temperature, as well as the synoptic situation, are analysed. The map of the spatio-temporal distribution of ice is constructed using ArcGIS by the method of equal intervals.

Estimating Maternal Mortality Rates During The 1918 Flu Using Birth to Death Linkage

IntroductionThe Digitising Scotland project (https://digitisingscotland.ac.uk/) has transcribed all Scottish birth, death, and marriage certificates from 1855 to 1974. The linkage of these data will provide formidable challenges for linkage experts and a multitude of opportunities for health and social science researchers.&#x0D; Objectives and approachWe linked birth between November 1916 and December 1923 to death of women aged 15 to 49 who died between January 1917 and December 1923. We only linked a death up-to 42 days after a birth. We compared parent names with those of the deceased and her spouse, as well as their address, using string matching functions. Given the lack of ground truth data, we conducted a sensitivity analysis using different similarity thresholds to classify birth linked to death as matches (if their similarity was at least a given threshold), or otherwise as non-matches. We then calculated the maternal mortality rate (MMR) on a monthly basis for January 2017 to July 2018 (the pre-flu period), and October 1918 to March 1919 (the flu period) as the number of matched birth to death certificates divided by the average monthly number of birth in the month of death and the previous month.&#x0D; ResultsPuerperal risk of death during this period was much higher than for the comparable female age group during the different phases of the 1918 flu. During the October 1918 wave, puerperal women were at greater risk than women of the same age, while the risk dropped below the expected in the summer of 1919. We carried out a sensitivity analysis by linking with different similarity thresholds and found our findings were robust to these decisions.&#x0D; ConclusionsWe have shown how a large and complex data collection can be successfully linked, resulting in new opportunities for various studies in the health and socialsciences.

The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: a quasi-experimental study

BackgroundPoor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers’ strikes in rural Kenya.MethodsThe study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods.ResultsThe monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3.ConclusionsThe findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

Pneumonia and the role of dentistry on ICU Staff

Ventilator-associated pneumonia (VAP) is one ofthe most prevalent healthcare-associated infections (HAI) andcauses of death in intensive care units (ICUs), and studies haveshown its relation to oral health. Aim: To report the impact ofthe incorporation of dental professionals into multidisciplinaryICU staff on the incidence of VAP. Methods: A retrospectiveobservational study was carried out to collect and analyzehealth indicators of patients in the ICUs from 2011 to 2018 andto differentiate these indicators between the periods beforeand after the participation of dental staff in the ICU. This studywas approved by the Research Ethics Committee. Results:The average number of monthly ICU admissions was 105.89 ±169.72, and the discharge was 105.21 ± 168.96, with a monthlyaverage number of deaths within 24 h of 38.61 ± 62.27. Theaverage number of monthly HAI-related deaths decreasedfrom 2011 to 2018, followed by a reduction in cases of HAIper month. The average monthly number of HAIs relatedto mechanical ventilation (MV) decreased, and the samewas observed for the infection density of HAIs related to MV(p &lt; 0.001). In multivariate analysis, there was a significantdecrease in the number of HAIs related to MV (p = 0.005).Conclusion: Although a reduction in the number of admissionsor complexity of cases was not observed in the study period,multidisciplinary staff practices were essential for controllingHAIs and the presence of dental professionals can assist in thecontrol of HAIs related to MV.

Restricted mean survival time analysis in heart failure clinical trials

Abstract Background The hazard ratio (HR) is the most common measure used to quantify treatment effects in heart failure (HF) clinical trials. However, the HR is only valid when the proportional hazards assumption is plausible, and the HR may be difficult to interpret for clinicians and laypeople. Restricted mean survival time (RMST), defined as the average time-to-event before a specific timepoint, is an intuitive summary of group-wise survival. The difference between two RMSTs measures treatment effects without model assumptions and may communicate more clinically interpretable results. Purpose To evaluate statistical and clinical properties of RMST-based statistics applied to clinical trial data for treatments of HF with reduced ejection fraction. Methods Patient time-to-event data was reconstructed from the published primary and secondary outcome Kaplan-Meier curves from landmark HF clinical trials. We estimated the RMST-differences between treatment groups as a measure of treatment effect with published data, and compared statistical testing results and effect size values to HR analysis results. Results We analyzed 7 HF clinical trials, including data from a total of 27,845 patients (Table 1). RMST should be interpreted as the average number of months that the outcome is avoided over the study period. As examples: On average, treatment with enalapril for 12 months extended each patient's life by 2.2 months compared to placebo, and treatment with spironolactone for 34 months extended each patient's life by 2.2 months compared to placebo. Conclusions RMST-difference test statistic has identical statistical conclusions as HRs but provided an intuitive estimate of each treatment effect. RMST-based data can potentially be used to better communicate treatment effects to patients, to assist in patient-preference discussions and shared decision-making Funding Acknowledgement Type of funding source: None

Peer Comparison Intervention to Improve Antibiotic Prescribing in Dentistry

Background: Dentists prescribe an estimated 13% of outpatient antibiotic courses, many of which may be unnecessary. Health departments are in a unique position to support implementation of antibiotic stewardship across healthcare facilities, including in dental offices. A customized peer comparison message with feedback regarding prescribing frequencies was effective in reducing inappropriate prescribing among primary care physicians in Massachusetts and California. We tested the effect of a peer comparison message for antibiotic prescribing on dentists in the Massachusetts Medicaid program. Methods: We analyzed data from September 2018 to July 2019 for prescriptions of antibiotic courses by dentists to identify the highest prescribing dentists. We used their national provider identifier (NPI) to deduplicate providers and we searched for addresses using the CMS online database. On March 25, 2019, the high prescribers were sent a hard copy letter from the Massachusetts Department of Public Health stating that they were “among the 1% of frequent prescribers.” In addition, the letter provided citations to professional guidelines and prescribing best practices and invited participation in health department–sponsored training for continuing education credits. We tracked the monthly number of antibiotics prescribed by provider before and after the mailing and compared those who received the letter (intervention) to those whose address was either out of state or undeliverable (comparison). Results: Prescribing records for 3,008 dentists were available from September 2018 through July 2019. Most (67%) prescribed &lt;10 antibiotic courses in the 11-month period; the mean monthly antibiotic courses prescribed ranged from 1.2 to 1.6, and the median monthly prescriptions was 0. However, 33% prescribed 10–199 antibiotics, and 1% prescribed &gt;200. Of these 28 comprising the highest 1% , 15 received the intervention letter. The others were either out of state (N = 3) or the letter was returned undelivered (N = 10). The average monthly number of antibiotic courses prescribed before the intervention was similar in the intervention and comparison groups (25.0 and 24.2, respectively). In the 4 months after the intervention, the average did not change in the intervention group but increased slightly in the comparison group (25.2 and 26.2, respectively). The intervention had no significant effect (P = .80). Conclusions: We observed no effect of this peer comparison message among a small sample of dentists in the Massachusetts Medicaid program. This finding may be due to multiple factors, including the small number of the targeted prescribers, the use of a relatively friendly message for communicating with the high prescribers, and the possibility that other forms of communication would be more effective.Funding: NoneDisclosures: None

The performance of routine immunization in selected African countries during the first six months of the COVID-19 pandemic.

following the declaration of the COVID-19 pandemic on 11 March 2020, countries started implementing strict control measures, health workers were re-deployed and health facilities re-purposed to assist COVID-19 control efforts. These measures, along with the public concerns of getting COVID-19, led to a decline in the utilization of regular health services including immunization. we reviewed the administrative routine immunization data from 15 African countries for the period from January 2018 to June 2020 to analyze the trends in the monthly number of children vaccinated with specific antigens, and compare the changes in the first three months of the COVID-19 pandemic. thirteen of the 15 countries showed a decline in the monthly average number of vaccine doses provided, with 6 countries having more than 10% decline. Nine countries had a lower monthly mean of recipients of first dose measles vaccination in the second quarter of 2020 as compared to the first quarter. Guinea, Nigeria, Ghana, Angola, Gabon, and South Sudan experienced a drop in the monthly number of children vaccinated for DPT3 and/or MCV1 of greater than 2 standard deviations at some point in the second quarter of 2020 as compared to the mean for the months January-June of 2018 and 2019. countries with lower immunization coverage in the pre-COVID period experienced larger declines in the number of children vaccinated immediately after the COVID-19 pandemic was declared. Prolonged and significant reduction in the number of children vaccinated poses a serious risk for outbreaks such as measles. Countries should monitor coverage trends at national and subnational levels, and undertake catch-up vaccination activities to ensure that children who have missed scheduled vaccines receive them at the earliest possible time.

Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment.

ObjectivesThe main objective was to determine the trajectory of instrumental activities of daily living (iADL) decline in persons with mild cognitive impairment (MCI) who progressed towards dementia relative to persons with MCI who remained stable.Methods/DesignAt study entry, 121 participants met criteria for MCI. Based on the follow‐up, 47 participants later converted to dementia and were identified as progressors. Sixteen participants, identified as decliners, presented a significant cognitive decline but did not reach the criteria for dementia within the study timeframe. Stable MCI remained cognitively stable during the 5‐year follow‐up; n = 58. Participants completed a yearly assessment using clinical tests/questionnaires, neuropsychological measures, and functional autonomy assessment until they met criteria for dementia. The average number of months for the follow‐up was 34.ResultsMany years of stable performance followed by an accelerated decline just prior to diagnosis, was observed for complex activities for progressors. No change was found for stable MCI and a gradual linear decline characterized decliners. The housekeeping‐related activities component showed a linear decline in progressors and did not change in stable and decliner MCI. We found a predictive model that includes significant predictors of dementia conversion with a high diagnostic accuracy the following year (area under the curve = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]).ConclusionsIt is critical to assess iADL that reflect complex activities in the evaluation of MCI individuals as their impairment, combined with change on cognitive markers, indicates a higher risk of dementia progression 1 or 2 years later.

IKLIM DAN POTENSI TEGAKAN SENGON (Falcataria moluccana) DI HUTAN RAKYAT DESA JATI BALI KABUPATEN KONAWE SELATAN

This study aims to determine the climatic conditions that occur at Sengon cultivation sites and determine the standing potential number of trees, base area, and volume of sengon stands in community plantation forests that follow the people's seed garden program. Data collection is carried out in August to November 2018. The location of this village is at the coordinates of 04° 5'12 '' - 04°3'15'' LS and 122° 24'00'' - 122° 23'00'' BT and at altitude of 108 m above sea level. The population in this study is the sengon stand with an area of 5.8 ha. The sample area is determined with an intensity of 6.2% and the area of 1 plot is 0.04 ha, so the number of plots is 9 units. The results showed that 1) climatic conditions in the study location are classified as type B climate or wet (Schmidth-Ferguson method) including the category of tropical rain forests with an average number of wet months (BB) 9.2 and dry months (BK) 1.5 with a Q value of 0.16. Average annual rainfall is 2 662.6 mm, the monthly average rainfall of the highest in May was 347.4 mm with an average number of rainy days by 22.5 days and the lowest in September was 83.0 mm with an average rainy day of 11 days, while the longest rainy day occurred in April during 22.6 days with rainfall reaching 262.1 mm and the fastest occurred in October for 10.3 days with rainfall reaching 101.7 mm. The average annual temperature is around 230C with an 320C, with the lowest monthly average of 25.3oC (August) - 28.1oC (December). This fact indicates that the climatic conditions in Jati Bali Village South Konawe District are suitable for the development of sengon plants. 2) the potential of sengon stands in the village of Jati Bali South Konawe Regency, namely the number of trees 866 btgha-1, base area of 9.76 m2ha-1, volume of stands of 94.15 m3ha-1.

Informing Rift Valley Fever preparedness by mapping seasonally varying environmental suitability

BackgroundRift Valley Fever (RVF) poses a threat to human and animal health throughout much of Africa and the Middle East and has been recognized as a global health security priority and a key preparedness target. MethodsWe combined RVF occurrence data from a systematic literature review with animal notification data from an online database. Using boosted regression trees, we made monthly environmental suitability predictions from January 1995 to December 2016 at a 5 × 5-km resolution throughout regions of Africa, Europe, and the Middle East. We calculated the average number of months per year suitable for transmission, the mean suitability for each calendar month, and the “spillover potential,” a measure incorporating suitability with human and livestock populations. ResultsSeveral countries where cases have not yet been reported are suitable for RVF. Areas across the region of interest are suitable for transmission at different times of the year, and some areas are suitable for multiple seasons each year. Spillover potential results show areas within countries where high populations of humans and livestock are at risk for much of the year. ConclusionsThe widespread environmental suitability of RVF highlights the need for increased preparedness, even in countries that have not previously experienced cases. These maps can aid in prioritizing long-term RVF preparedness activities and determining optimal times for recurring preparedness activities. Given an outbreak, our results can highlight areas often at risk for subsequent transmission that month, enabling decision-makers to target responses effectively.

The Association between the Frequency of Rhegmatogenous Retinal Detachment and Atmospheric Temperature

Rhegmatogenous retinal detachment (RRD) frequency was observed to be higher with an increase in the daily temperature range. This showed that a wide daily range of temperature, rather than the absolute value of the temperature, is associated with the occurrence of RRD. Purpose. To investigate the association between the frequency of rhegmatogenous retinal detachment (RRD) and the atmospheric temperature. Method. A retrospective review of consecutive eyes that had undergone primary RRD surgery from 1996 to 2016 at Chungbuk National University Hospital was conducted. Temperature data (highest, lowest, and mean daily temperatures and daily temperature range) in Chungbuk Province were obtained from the Korean Meteorological Administration database. We investigated the relationship between the daily temperature range and the frequency of RRD surgery. We also analyzed the association between various temperature data and the frequency of RRD surgery. Result. There were 1,394 RRD surgeries from 1996 to 2016. Among them, 974 eyes were included in this study. The monthly average number of RRD operations showed a bimodal peak (in April and October) throughout the year. With the same tendency as the frequency of RRD, the monthly average of the daily temperature range over 1 year also showed a bimodal peak in April and October. There was a significant positive correlation between the monthly average of the daily temperature range and the number of RRD surgeries (r = 0.297, P < 0.001). However, there were no associations between RRD frequency and the mean temperature, highest temperature, and lowest temperature. Conclusion. The higher the daily temperature range, the higher was the RRD frequency observed. We speculated that dynamic changes in temperature during the day may affect degrees in chorioretinal adhesion and liquefaction of the vitreous, which may eventually result in retinal detachment. Therefore, further experimental studies on the correlation between temperature changes and retinal detachment are needed.

Impact of the Closure of a Large, Urban Safety-Net Hospital on a Neighboring Academic Center: A Philadelphia Case Study.

We examined how the closure of 496-bed Hahnemann University Hospital (HUH), a level I trauma and stroke center and safety-net hospital in Philadelphia, Pennsylvania, impacted the emergency department (ED) and radiology workflow in our neighboring hospital (Thomas Jefferson University Hospital) located <1 mile away. On June 30, 2019, HUH announced its imminent closure and began diverting trauma patients, with its ED officially closing in mid-August. Trends of our ED and radiology workflow were analyzed using QlikView analytics software for 3 months before and after the closure. Data were compared to workflow from the same time period in2018. The average monthly number of patients presenting to our ED after the closure increased 20.2% with a corresponding 16% increase in ED imaging studies, primarily in radiographs (+16%) and CT (+20%). Radiology orders by advanced practice providers increased 74%. Turnaround time from imaging order placed to final diagnostic radiology report did not change substantially after the closure. Workflow in our ED and radiology department was significantly impacted by the closure of HUH. This study provides insight into how our practice patterns changed and compensated after the closure of a neighboring, large, urban safety-net hospital; it is important for radiologists to be aware of citywide practice patterns to adapt to acute change.

Knowledge and Attitudes of Chinese Oncology Nurses Regarding Cancer Pain Management-a Cross-Sectional Study.

To measure the knowledge and attitudes of Chinese oncology nurses regarding cancer pain management and explore related factors. A cross-sectional survey was conducted. A convenience sample of 505 Chinese oncology nurses from 20 provinces, 4 municipalities, and 4 autonomous regions was recruited between April and October 2018. A Chinese version of the Knowledge and Attitudes Survey Regarding Pain (KASRP) was used. Socio-demographic characteristics were also measured by a multi-item questionnaire. The mean accuracy of KASRP in all participants was 56.11% ± 11.05%. According to univariate analysis, oncology nurses' cancer pain knowledge and attitudes were positively correlated with age, region, education level, years of oncology nursing, clinical practice of cancer pain management, average monthly number of patients with cancer pain, and the experience of cancer pain-related training. The results of multiple linear regression revealed that nurses' age, education level, experience of cancer pain-related training and clinical practice of cancer pain management were independent influencing factors (all p < 0.05). Most Chinese oncology nurses had misconceptions about cancer pain management and lacked relevant knowledge. We should assign importance to targeted cancer pain training and develop training methods that closely relate to clinical practices.

Exploring the cost-effectiveness of child dental caries prevention programmes. Are we comparing apples and oranges?

Exploring the cost-effectiveness of child dental caries prevention programmes. Are we comparing apples and oranges?

Reducing the Volume of Low-Value Outpatient MRI Joint Examinations in Patients ≥55 Years of Age.

Magnetic resonance imaging (MRI) is not beneficial in patients with joint pain and concomitant osteoarthritis (OA). We attempt to determine whether evaluation of OA via X-rays can reduce inappropriate MRI and computed tomography (CT) arthrogram use. In our jurisdiction, CT arthrograms are used as surrogate tests because of MRI wait times. Our intervention required patients ≥55 years of age scheduled for outpatient MRI of the knee/hip/shoulder at an urban hospital to have X-rays (weight bearing when appropriate) from within 1 year. Red flags (ie, neoplasm, infection) were identified for which MRI would be indicated regardless. Through review of radiographs on picture archiving and communication system/digital media and use of the validated Kellgren-Lawrence (KL) OA scale, radiologists assessed the presence and degree of OA. A finding of significant OA (KL > 2) without red flags would preclude MRI. Monthly averages of MRI and CT arthrogram examinations were measured 33 months before and 23 months following introduction of the intervention. The proportion of protocoled MRI requisitions that were avoided was 21%. If extrapolated to the province of British Columbia, 2419 of 11 700 examinations could have been prevented in the past year. The average monthly number of knee/hip/shoulder MRI examinations as a percentage of total MRI examinations decreased from 4.9% to 4.3% (P < .02) following the intervention. The average monthly number of knee/hip/shoulder CT arthrogram examinations decreased from 20.6 to 12.1 (P < .0001). We were able to decrease the number of MRI and CT arthrogram examinations in patients ≥55 years of age with joint pain by implementing an evaluation for OA via recent X-ray imaging.

Burns in the Emergency Department: A One-Year Single Center Analysis on 355 Cases

Background: Burns are common reasons for emergency department presentations. While extensive or special burns require treatment in a specialized center, the majority are amenable to ambulatory treatment or hospitalization in a surgical ward. Romania has a national data collecting mechanism regarding all hospitalized patients, but there are no available statistics concerning non-hospitalized burn cases. This study aims to explore the amplitude of burn trauma by analyzing data from an Emergency Department at a major Romanian regional trauma center. Methods: This is a retrospective single-center 1-year study of all burn-related emergency department presentations at the trauma referral center for Romania's North-East region, in 2015. Included in the study were all cases of burns, indiscriminate of their etiology. Results: A total of 355 burn cases were analyzed. The average monthly number of cases was 29.58, with a maximum of 54 and a minimum of 18. There were 206 males and 149 females and 57.7% urban residents. Only 134 cases have been hospitalized during this period. Conclusions: Almost two-thirds of cases have not been hospitalized, thus missing from national statistics. Precise epidemiological data is paramount for a successful national burn management strategy. Creation of a national burn registry is suggested.

The performance of routine immunization in selected African countries during the first six months of the COVID-19 pandemic

Introductionfollowing the declaration of the COVID-19 pandemic on 11 March 2020, countries started implementing strict control measures, health workers were re-deployed and health facilities re-purposed to assist COVID-19 control efforts. These measures, along with the public concerns of getting COVID-19, led to a decline in the utilization of regular health services including immunization.Methodswe reviewed the administrative routine immunization data from 15 African countries for the period from January 2018 to June 2020 to analyze the trends in the monthly number of children vaccinated with specific antigens, and compare the changes in the first three months of the COVID-19 pandemic.Results:thirteen of the 15 countries showed a decline in the monthly average number of vaccine doses provided, with 6 countries having more than 10% decline. Nine countries had a lower monthly mean of recipients of first dose measles vaccination in the second quarter of 2020 as compared to the first quarter. Guinea, Nigeria, Ghana, Angola, Gabon, and South Sudan experienced a drop in the monthly number of children vaccinated for DPT3 and/or MCV1 of greater than 2 standard deviations at some point in the second quarter of 2020 as compared to the mean for the months January-June of 2018 and 2019.Conclusioncountries with lower immunization coverage in the pre-COVID period experienced larger declines in the number of children vaccinated immediately after the COVID-19 pandemic was declared. Prolonged and significant reduction in the number of children vaccinated poses a serious risk for outbreaks such as measles. Countries should monitor coverage trends at national and subnational levels, and undertake catch-up vaccination activities to ensure that children who have missed scheduled vaccines receive them at the earliest possible time.

Comparison of naloxone prescribing patterns due to educational outreach conducted by full-time and part-time academic detailers at the U.S. Veterans Health Administration

ObjectiveTo examine the impact of full-time equivalent employee (FTEE) allocation to academic detailers on naloxone prescribing at the U.S. Veterans Health Administration (VA). DesignLongitudinal nonequivalent control group posttest-only design using a random effects model. Setting and participantsClosed cohort of primary care providers exposed to academic detailing between September 1, 2016, and September 20, 2018, at VA. Outcome measuresPrevious analysis identified a cutoff of 0.40 FTEE was associated with a greater return on investment. We evaluated whether this level of FTEE allocation was associated with increases in naloxone prescribing rates and compared providers who had an interaction with an academic detailer allocated 0.4 FTEE or greater (high FTEE) to providers who interacted with an academic detailer allocated less than 0.4 FTEE (low FTEE). ResultsAmong VA primary care providers who received academic detailing, 1770 (68%) had interactions with a high FTEE academic detailer. There were no differences in demographics between providers who interacted with high FTEE and low FTEE academic detailers except for the distribution of provider classes (P = 0.004) and geographic districts (P < 0.001). Providers who interacted with high FTEE academic detailers had a greater average monthly number of naloxone prescriptions prescribed compared with low FTEE academic detailers (0.60 vs. 0.53; P = 0.005). In the random effects model, there was a 65% greater increase in the average monthly number of naloxone prescriptions prescribed among providers who interacted with a high FTEE academic detailer compared with providers who interacted with low FTEE academic detailers (P = 0.027). We also observed a dose-dependent relationship between the number of naloxone prescribed and the amount of FTEE allocated. ConclusionThis observational study highlights the potential benefits (e.g., increased naloxone prescribing) of academic detailers having more FTEE allocated. Hence, implementation of academic detailing needs to consider the amount of dedicated time for academic detailers, given competing VA priorities.

The association between the referendum for withdrawal from the EU and the health-care workforce in England: an interrupted time series

BackgroundAfter the referendum for withdrawal of the UK from the EU, uncertainty about the rights of EU citizens is driving doctors from Europe to seek jobs outside the UK. This study aimed to evaluate the effect of the referendum on changes in total numbers of health-care staff. MethodsFrom National Health Service (NHS) Digital, we obtained a dataset of national NHS hospital and community health service (HCHS) staff groups in trusts and Clinical Commissioning Groups in England (excluding primary care staff). This dataset includes information about the monthly numbers of full-time equivalents. The study covered 108 months (September, 2009, to August, 2018). We used an interrupted time series analysis (ITS) to evaluate the association between the referendum and the total number of health-care staff and subgroups. FindingsDuring the study period, the average monthly number of NHS staff varied between 963 000 and 1 067 000. More than half of the NHS workforce were professionally qualified clinical staff (varying between 527 000 and 575 000), of which around 26% were nurses and health visitors. There was no evidence that the referendum was associated with changes in the total number of NHS staff (with relative change of 3·9%, 95% CI 0·0 to 7·9). However, looking at each subgroup separately, a significant decrease in relative change was estimated for midwives by –4·0% (95% CI –5·5 to –2·4), representing 22 412 fewer midwives during the 26 post-referendum months on the basis of trends in the pre-referendum period. A significant increase in relative change was estimated for HCHS doctors (2·8%, 95% CI 1·8 to 3·8%) and NHS infrastructure support workers (14·7%, 3·7 to 25·6). InterpretationOur findings show that overall there was no significant association between the referendum and the health-care workforce. Increases were found for several groups, although many of them had an increasing trend before the referendum. However, a significant decrease was observed for midwives, which might be caused by the uncertainty of the rights of EU citizens. Continued surveillance is necessary to monitor changes in NHS staff, specifically for midwives, and further research is needed to evaluate any adverse clinical outcomes. The main strength of the study is the use of ITS, which is the most robust quasi-experimental research design, and the main limitation is unavailable data on the nationality of NHS staff. FundingNone