System Preparedness Research Articles

Kidney health for all: preparedness for the unexpected in supporting the vulnerable

As the rate of natural disasters and other devastating events caused by human activities increases, the burden on the health and well-being of those affected by kidney disease has been immeasurable. Health system preparedness, which involves creating a resilient system that is able to deal with the health needs of the entire community during times of unexpected disruptions to usual care, has become globally important. In the wake of the COVID-19 pandemic, there is a heightened awareness of the amplification of negative effects on the renal community. Paradoxically, the complex medical needs of those who have kidney diseases are not met by systems handling crises, often compounded by an acute increase in burden via new patients as a result of the crisis itself. Disruptions in kidney care as a result of unexpected events are becoming more prevalent and likely to increase in the years to come. It is therefore only appropriate that the theme for this year’s World Kidney Day will focus on Kidney Health for All: preparedness for the unexpected in supporting the vulnerable.

An Examination of the Humanitarianism-Disaster Management Nexus in Tanzania’s Policy and Legal Framework

The use of law, the main tool for implementing policy, to regulate and coordinate disaster management, preparedness and response systems features in many jurisdictions. Also, international guidance on the use of effective laws and policies, which emphasize taking on board critical stakeholders, including humanitarian responders is available. Consequently, the government of Tanzania has promulgated a new disaster management law as part of a wider reform of the legal framework to regulate disaster management and response systems which seek to involve stakeholders at all stages. This article analyses the extent to which the restructured legal framework and supporting policy address humanitarian responders who provide informal assistance, often before formal government intervention. The article traces the history of disaster management policies and laws in the country in the context of the humanitarianism – disaster management nexus. It focuses on the aftermath of the earthquake that ravaged Kagera Region in Bukoba district in the northern west part of the country in September 2016. This analysis is supported with field data from Bukoba district. The findings reveal that the legal framework for regulating disaster management and response system does not reflect international and regional clarion calls for engaging informal humanitarian responders. Recommendations on how this gap can be addressed are provided, laying emphasis on incorporating the clarion calls in order to improve the country’s legal and policy framework for disaster response and management systems.

A surge in respiratory syncytial virus infection-related hospitalizations associated with the COVID-19 pandemic: An observational study at pediatric emergency referral hospitals in Tokushima Prefecture.

The outbreak of coronavirus disease (COVID-19) resulted in implementation of social distancing and other public health measures to control the spread of infection and improve prevention, resulting in a decrease in respiratory syncytial virus (RSV) and pediatric respiratory tract infection rates. However, there was a rapid and large re-emergence of RSV infection in Japan. Notably, we were faced with a difficult situation wherein there was a shortage of hospital beds. This study aimed to examine the epidemiological patterns of RSV-related hospitalizations among children before and after the COVID-19 pandemic onset at two pediatric emergency referral hospitals covering the entire Tokushima Prefecture. Data were extracted from electronic medical records of children hospitalized with RSV infection between January 1, 2018, and December 31, 2021. All patients meeting the eligibility criteria were included in this study. The rates of study outcomes were documented annually during 2018-2021 and compared between the 2018-2020 and 2021 periods. In 2020, there was no RSV infection outbreak. Hospitalizations at the peak week in 2021 were 2.2- and 2.8-fold higher than those in 2018 and 2019, respectively. Hospitalizations in 2021 were concentrated within a short period. In addition, there was a significant increase in hospitalizations among children aged 3-5 months and those older than 24 months. The high-flow nasal cannula (HFNC) use rate nearly doubled in 2021. A new pandemic in the future may cause an outbreak of RSV infection that can result in an intensive increase in the number of hospitalizations of pediatric patients requiring respiratory support, especially in infants aged <6 months. There is an urgent need to improve the preparedness of medical systems, particularly in terms of the number of inpatient beds and the immediate availability of HFNC.

COVID-19 challenges, responses, and resilience among rural Black women: a study protocol.

Despite the aggregated burdens and challenges experienced by rural Black women during the COVID-19 pandemic, many likely also demonstrated strength and resilience to overcome challenges. A mixed methodology and a community-based participatory approach will be used to collect multilevel data on challenges, responses, resilience, and lessons during the pandemic from Black women, community health workers, and community leaders in rural areas in South Carolina (SC). Specifically, the unique circumstances and lived experiences of rural Black women during the COVID-19 pandemic will be documented to understand their needs regarding effective management of social, physical, and mental health challenges through focus group discussions and in-depth interviews with Black women, community health workers, and local community leaders recruited from rural SC communities. Barriers, facilitators, and potential impacts of multilevel resilience development will be identified through a survey administered among rural Black women recruited from 11 rural counties (with one as site for a pilot testing of the questionnaire). A report for public health practice will be developed, including recommended strategies to optimize health systems' emergency preparedness and responses through triangulation of qualitative and quantitative data from multiple sources. Findings in the proposed study will provide valuable references in terms of addressing social determinants of health factor challenges during the pandemic, fostering resilience, and informing evidence-based decision-making for policymakers. The study will contribute to the development of public health emergency preparedness plans, which can promote the resilience of women, their families, and local communities as well as optimize effective preparedness and response of health systems for rural Black women and their families during infectious disease outbreaks and other public health emergencies.

Are trauma surgeons prepared? A survey of trauma surgeons’ disaster preparedness before and during the COVID-19 pandemic

ObjectiveUS trauma centers (TCs) must remain prepared for mass casualty incidents (MCIs). However, trauma surgeons may lack formal MCI training. The recent COVID-19 pandemic drove multiple patient surges, overloaded Emergency...

Precision Public Health Opportunity: Heat-Associated Mortality Greater among Pilgrims during Hajj

Precision Public Health Opportunity: Heat-Associated Mortality Greater among Pilgrims during Hajj

An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia.

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.

Health and Social Care System Preparedness for Dementia Care in Mexico: Current Status and Recommendations to Achieve Optimal Care.

In this article, we summarise the findings of the situational analysis of dementia care generated as part of the STRiDE: Strengthening responses to dementia care in developing countries project, including a desk review, a SWOT analysis and views from relevant stakeholders. In addition, the article incorporates the experience of 4years of work within the STRiDE project of FEDMA, Mexico's Federation of Alzheimer's and other dementias and its allied Associations in presenting specific recommendations to optimise dementia care in the country. All the information gathered brings together a detailed understanding of the current dementia care systems of diagnosis, treatment, and support in general and what is lacking, allowing for the generation of general recommendations to enhance the isolated efforts currently available and amplify their impact, as well as strategies to generate new services currently unavailable, but urgently needed.

Disaster Preparedness at the Primary Health Care Level: The Proposal of a New Framework

Introduction:With the publication of the Health Emergency and Disaster Risk Management (H-EDRM) Framework in 2019, the World Health Organization (WHO) emphasized the need for disaster preparedness in all sectors of the health system, including primary health care (PHC). PHC disaster preparedness plays a crucial role in guaranteeing continuity of care and responding to the health needs of vulnerable populations during disasters. While this is universally acknowledged as an important component of disaster management (DM), there is still a severe paucity of scholarship addressing how to practically ensure that a PHC system is prepared for disasters. The objective of this study is to propose a new framework that describes key characteristics for PHC disaster preparedness and lays the groundwork to deliver operational recommendations to assess and improve PHC disaster preparedness.Method:A systematic literature review including the following online scientific databases was performed: Cochrane Library, Embase, Medline, National Library of Medicine, PubMed, Scopus, and Web of Science. Gray literature was also found by searching in: Trove, Mednar, and OpenGray. A total of 145 records were analyzed.Results:Twenty-five characteristics that contribute to a well-prepared PHC system were identified and categorized according to the WHO Health System Building Blocks to form a new PHC disaster preparedness framework.Conclusion:The findings will contribute to the elaboration of a set of guidelines for PHC systems to follow in order to assess and boost their disaster preparedness. This will hopefully help to raise awareness among international policymakers and health practitioners on the importance to design interventions that integrate PHC into overall DM strategies, as well as to assess the preparedness of PHC systems in different political, developmental, and cultural contexts. The proposed framework is currently being used by our research group as groundwork for the creation of an assessment tool for evaluating all-hazards preparedness at the PHC level.

A National Survey of Hospital Cyber Attack Emergency Operation Preparedness

Introduction:Cyberattacks on healthcare systems are increasing in frequency and severity. Hospitals need to integrate cybersecurity preparedness into their emergency operations planning and response in order to mitigate adverse outcomes during increasingly likely cyber events. No data currently exists regarding the level of preparedness of US hospital systems for cybersecurity attacks. We surveyed hospital emergency managers to assess cybersecurity preparedness for these events.Method:Fifty-seven emergency managers representing hospitals across the US participated in an online Qualtrics survey regarding current preparedness and response procedures for cybersecurity hazards.Results:Survey responses between April 2019 and May 2021 demonstrated that a majority of hospital systems surveyed included cybersecurity disasters in their HVA (82.4%, 47/57), and most ranked it as one of their top five priorities (57.4%, 27/47). However, over half denied specifically mentioning cybersecurity in their EOPs (52.6%, 30/57). Fourteen of the 57 hospital systems (24.5%) endorsed previously activating an Emergency Response for a cybersecurity incident unrelated to Information Technology (IT) failure.Conclusion:The survey results suggest that American hospitals are currently underprepared for cybersecurity disasters. We emphasize the importance of prioritizing cybersecurity in HVAs and implementing specific EOP annexes for cybersecurity emergencies.

Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India.

Maternal and child health (MCH) care is one of the essential routine healthcare services, which got affected during the coronavirus disease 2019 (COVID-19) pandemic. Modeled projections had anticipated an 8.3%-38.6% rise in maternal mortality from different countries globally. In view of limited studies pertaining to issues related to accessing MCH services in the event of a pandemic, this study was carried out on pregnant and postnatal mothers in Odisha, India. An explorative qualitative study through 36 in-depth interviews (IDIs) was conducted among 16 (44.4%) antenatal and 20 (55.5%) postnatal mothers in six of thirty districts of Odisha, India, from February to April 2021. The districts and blocks were randomly selected for better representativeness. The IDIs were conducted using a predesigned and pretested guide among mothers who had undergone delivery or availed of antenatal, postnatal, or child health services from October 2020 to April 2021. The IDIs were conducted till data saturation. The data were analyzed using MAXQDA software. The average age of mothers was 27.6 (+/- 2.2) years. Among the participants, 16 (44.4%) were antenatal and 20 (55.6%) were postnatal mothers; 19 (52.8%) were primipara and 17 (47.2%) were multipara. The majority explained that they received enormous support including door-to-door services from the community health workers (CHWs) even during the difficult times of the pandemic. Reduced transportation facility and fear of contracting the infection were reasons behind the unwillingness to visit health facilities and preference for home delivery. Furthermore, the pandemic had physical, mental, social, and financial impacts among pregnant and postnatal women. The unprecedented COVID-19 pandemic has affected access to MCH services by antenatal and postnatal mothers. Health system preparedness and appropriate strategies including better community engagement and participation could avert such challenges in the future.

Social implications of a change in the legal classification of COVID-19: The need for pandemic prevention, preparedness, and healthcare system strengthening.

In Japan, there has been a discussion of the potential reclassification of the novel coronavirus infectious disease 2019 (COVID-19) as an infectious disease under the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases (the Infectious Diseases Control Law), beginning in late 2022. To make an informed decision, the societal impact of COVID-19 needs to be carefully considered to ensure that any reclassification does not negatively impact healthcare or society as a whole. The disease burden of COVID-19 remains considerable and is likely to persist for an extended period of time. Consequently, numerous special measures have been taken in the healthcare system to cope with COVID-19. Several of these measures must be implemented. Thus, the healthcare system needs to be strengthened in the future. This will result in adequate prevention, preparation, and a response to future pandemics.

Factors, health system preparedness, and response strategy for the recent cholera outbreak in Syria

Factors, health system preparedness, and response strategy for the recent cholera outbreak in Syria

Assessing perceptions on the burden and health systems preparedness for snakebite in Odisha, India: a qualitative study

Assessing perceptions on the burden and health systems preparedness for snakebite in Odisha, India: a qualitative study

Resilience-Oriented Scheduling of Shared Autonomous Electric Vehicles: A Cooperation Framework for Electrical Distribution Networks and Transportation Sector

As autonomous electric vehicles and car-sharing services are becoming more popular, the contribution of shared autonomous electric vehicles (SAEVs) to the future of urban transportation is getting more achievable. Like conventional electric vehicles, SAEVs can provide power grids with ancillary services. This article proposes a new scheduling scheme for SAEV fleets within a cooperative plan to let power distribution networks benefit from the energy storage of vehicle batteries in recovering critical loads after a predictable extreme event. According to a long-term contract, the detailed request of the distribution system operator (DSO), together with desired constraints and perquisites, is sent to the SAEVs aggregator (SA) prior to the landfall of a predictable extreme event. Afterward, SA runs a targeted algorithm to schedule trip assignments and charging cycles of SAEVs so that the required constraints of DSO are satisfied. The SAEV participants will continue carrying passengers within the scheduled time horizon in addition to delivering energy to the distribution network at the scheduling deadline declared by DSO. This deadline is the time instant when the capacity of the SAEV fleet may be no more applicable to enhance the system preparedness against the approaching event. Numerical results illustrated that the proposed scheme helps improve the power grid resilience by delivering 2396.1 kWh of energy to the distribution network in addition to increasing the total income of each participant SAEV by about 130%. Thus, it is implied that the proposed method offers a win-win situation for both entities.

Preparedness of healthcare professionals towards a new crisis: a short review of experiences, challenges, and lessons from the covid-19 pandemic

Background: The healthcare professionals have had to adapt their current practices and implement new strategies, to ensure a safe patient care environment during the COVID-19 pandemic. In addition, their training in the new conditions of the pandemic has been challenging. Aim: The aim of this short review is to provide a brief record of the experiences and challenges faced by healthcare professionals and how these can constitute lessons for a new health crisis. Method and Material: We conducted literature research in two electronic databases for the period from 2020 to 2022, using keywords. The collected material was classified based on the objectives set. A selection of literature sources was made, followed by a review with the creation of note cards. Results: The review of the selected sources reveals challenges in the practice of healthcare professionals, the continuation of professional development and research activities, as well as the adoption of digital technologies and tools for communication, information and training. The lack of experience of healthcare professionals from a previous pandemic crisis and the delay in the digital transformation of healthcare are some of the obstacles, which can become lessons for the preparedness of the healthcare systems towards a new health crisis. Conclusions: The findings highlight the essential role of a well-trained and well-informed healthcare workforce, to adequately face a health crisis. The analysis of these findings can contribute to the detection and identification of emerging needs of healthcare professionals, allowing policymakers to implement effective interventions for the continuing development of the workforce.

APPLICATION AND ASSESSMENT OF ARTIFICIAL NEURAL NETWORKS IN MODERN MEDICINE FOR PREDICTING AND CUSHIONING THE EFFECT OF COVID-19 PANDEMIC

COVID-19 pandemic has become the greatest worldwide threat, as it has spread rapidly among individuals in most countries around the world. The study assess artificial neural networks in modern medicine for predicting and cushioning the effect if covid-19 pandemic. The study used artificial neural networks forecasting models to identify nonlinear relationships between the variables. A secondary data from Nigeria Centre For Disease Control (NCDC) related to COVID-19 infection cases in Nigerian states for the period between 28 February 2020 and 26 July 2022 was used for prediction. The study revealed that there was an increasing trend in the number of new COVID-19 infections by the end of June, until 16 July for some states while for the rest of them the ANN model predicted a constant to decreasing trend for the next 30 days. The allocation of medical resources, the management of the pandemic's spread, and the improvement of health care system preparedness would be greatly aided by the prediction to cushion the effect of the pandemic. Keywords: Artificial Neural Networks, COVID-19, Pandemic, Medicine, Prediction, Treatment, Vaccine, Global health crisis, Data analysis, Machine learning. DOI: 10.7176/JNSR/14-6-05 Publication date: April 30 th 2023

Exploring healthcare-seeking behavior of most vulnerable groups amid the COVID-19 pandemic in the humanitarian context in Cox's Bazar, Bangladesh: Findings from an exploratory qualitative study.

The COVID-19 pandemic has raised new concerns about healthcare service availability, accessibility, and affordability in complex humanitarian settings where heterogeneous populations reside, such as Rohingya refugees in Bangladesh. This study was conducted in ten Rohingya camps and four wards of the adjacent host communities in Cox's Bazar to understand the factors influencing healthcare-seeking behavior of the most vulnerable groups (MVGs) during COVID-19 pandemic. Data were extracted from 48 in-depth interviews (24 in each community) conducted from November 2020 to March 2021 with pregnant and lactating mothers, adolescent boys and girls, persons with disabilities, elderly people, and single female-household heads. This study adopted Andersen's behavioral model of healthcare-seeking for data analysis. Findings suggest that the healthcare-seeking behavior of the participants amid COVID-19 pandemic in the humanitarian context of Cox's Bazar was influenced by several factors ranging from socioeconomic and demographic, existing gender, cultural and social norms, health beliefs, and various institutional factors. Lack of household-level support, reduced number of healthcare providers at health facilities, and movement restrictions at community level hampered the ability of many participants to seek healthcare services in both Rohingya and host communities. Most of the female participants from both communities required permission and money from their male family members to visit healthcare facilities resulting in less access to healthcare. In both communities, the fear of contracting COVID-19 from healthcare facilities disproportionately affected pregnant mothers, elderly people, and persons with disabilities accessing health services. Additionally, the economic uncertainty had a significant impact on the host communities' ability to pay for healthcare costs. These findings have the potential to influence policies and programs that can improve pandemic preparedness and health system resilience in humanitarian contexts.

The Association of Acute Watery Diarrhea in Iranian Pilgrims of Iraq with Cholera Cases in Iranians.

Despite the advances in the control of infectious diseases like cholera, they can potentially cause epidemics, especially in mass gathering events. One of the most important countries on the walking way of the Arbaeen religious event is Iran, which requires health system preparedness. The aim of this study was to predict the cholera epidemic in Iran by using the syndromic surveillance system of Iranian pilgrims in Iraq. The data of the Iranian pilgrims with acute watery diarrhea in Iraq during the Arbaeen religious event and the confirmed cholera cases of pilgrims after returning to Iran were analyzed. We used the Poisson regression model of the relationship between the numbers of cases to evaluate acute watery diarrhea and cholera. Spatial statistics and hot spot analysis were used to identify the provinces with the highest incidence. SPSS software Version 24 was used for statistical analysis. The frequency of acute watery diarrhea cases was 2232 and the frequency of cholera in pilgrims after returning to Iran was 641. The results of spatial analysis for acute watery diarrhea cases showed a high number of acute watery diarrhea cases in the Khuzestan and Isfahan provinces, located in hot spots. Using Poisson regression, the relationship between the number of acute watery diarrhea reported in the syndromic surveillance system and the number of cholera cases was confirmed. The syndromic surveillance system is useful to predict the outbreak of infectious diseases in large religious mass gatherings.

Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System.

Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.