Regional Health Authority Research Articles

Advance care planning towards the end of life.

New national clinical guidelines are now available on advance care planning (ACP). Confidence in communication is important for implementation of the guidelines. This study aims to identify healthcare personnel's self-perceived confidence in communication about future medical care and patients' wishes at the end of life. Healthcare personnel in twelve geriatric units in South-Eastern Norway Regional Health Authority responded to an online questionnaire survey in autumn 2022. The four response alternatives for self-reported confidence - 'unconfident', 'fairly confident', 'very confident' and 'extremely confident'- are combined into two categories: 'limited confidence' ('unconfident' and 'fairly confident') and 'high confidence' ('very confident' and 'extremely confident'). We received responses from 289 of the 470 (61.5%) invited, with an average age of 37.8 ± 11.3 years, of whom 217 out of 289 (75%) had more than five years of professional experience. Of the doctors, 15 out of 67 (22%) reported limited confidence in communication about 'future deterioration of the patient's health condition', 20 out of 67 (30%) about 'life-sustaining treatment' and 13 out of 67 (19%) about 'preferences towards the end of life'. For other healthcare personnel, the corresponding responses were 119 out of 222 (54%), 140 out of 222 (63%) and 109 out of 222 (49%). Self-assessed confidence in communication about future deterioration, future medical care and the patient's own wishes at the end of life varies, and such confidence is limited among many health personnel in geriatric units. Measures appear to be needed to increase confidence in the communication and implementation of ACP in the Norwegian health service.

Comprehensive sexuality education: indicators to evaluate interventions in Italian schools

Abstract Background Comprehensive sexuality education (CSE) is globally acknowledged as the most effective approach to promoting sexual health and preventing Sexually Transmitted Infections (STIs). However, in Italy, CSE is not consistently part of the school curriculum. The EduForIST project, funded by the Ministry of Health, introduced and tested a unique CSE model in a sample of secondary schools across six Italian regions, aiming to develop an evaluation model for potential nationwide implementation. Methods The EduForIST partnership, comprising experts from various institutions, devised a framework for monitoring and evaluating CSE interventions. Through monthly focus group discussions from April 2023 to February 2024, they established indicators for short-, medium-, and long-term evaluation of clinical and behavioral outcomes, as well as process indicators to assess intervention implementation. Results A total of 35 indicators were developed, including clinical and behavioral ones for medium and long-term outcomes, short-term behavioral outcomes, and process indicators. Data for clinical and behavioral indicators can be obtained from administrative sources like the Ministry of Health and Regional Health Authorities. The National Institute of Health provides data from relevant surveillance programs. However, many process indicators require specific data collection and calculations. Challenges such as under-reporting and underestimation persist, especially in regions with limited CSE implementation. Conclusions Creating an effective monitoring system for CSE interventions necessitates integrating diverse data sources, including health records, administrative data, and behavioral assessments. The proposed model’s effectiveness will be fully assessed by comparing pre- and post-intervention after widespread implementation in secondary schools. Meanwhile, the selected indicators serve as a foundation for evaluating baseline status of STIs and behaviors in Italy. Key messages • The EduForIST project establishes a robust framework for evaluating Comprehensive Sexuality Education (CSE) interventions in secondary schools, addressing gaps in nationwide implementation. • By devising indicators encompassing several measures, the project lays the groundwork for a comprehensive monitoring system, vital for assessing the effectiveness of CSE interventions in Italy.

The Norwegian Counties Public Health Survey (NCPHS)

Abstract Effective public health initiatives should be based upon a thorough understanding of important health-related factors. The purpose of The Norwegian Counties Public Health Survey (NCPHS) is to gain insights from the adult population on topics relevant for planning of public health policy, interventions, and action at the county and municipality levels. The survey includes a core questionnaire on public health-related topics such as health behaviour, subjective quality of life, distress, subjective health, social support, social capital, community contexts, and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register. NCPHS was piloted in three counties in 2015 and in one county in 2018. After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400 000. Expedient data analysis and reporting has enabled the Norwegian Institute of Public Health to present comprehensive reports within six weeks after completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment, and assessment of household economy. Tables are also made available at the municipality level. The NCPHS represent a valuable addition to existing health registries and regional health surveys, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions, and for evaluation of policies and interventions. The value of such a system during times of crises was demonstrated during the COVID-19 pandemic. At the Lisbon 2024 European Public Health conference, a few selected examples of use of data from the NCPHS system will be presented. Key messages • Large-scale community surveys provide important insights for planning of public health policies and action. • Strong involvement and collaboration with regional and local public health personnell as well as with media and local people is a prerequisite for succeeding.

The Norwegian Counties Public Health Survey (NCPHS): a design study.

Effective public health initiatives should be founded on a comprehensive and robust understanding of health-related factors including societal and community contexts. The Norwegian Counties Public Health Survey (NCPHS) aims for insights into the adult population on topics relevant for planning public health practices at county and municipality levels. The NCPHS includes a core questionnaire on public health-related topics and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register and 'washed' against the Common Contact Register to retrieve digital contact information and exclude those who cannot be contacted electronically. NCPHS was piloted in 2015 and 2018 (four counties). After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400,000. Expedient data analysis has enabled the Norwegian Institute of Public Health to present comprehensive reports within 6 weeks of completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment and self-reported sufficiency of household income. Tables are also made available at the municipality level. The NCPHS represents a valuable addition to existing data sources, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions and for evaluation of policies and interventions. The value of such a system during times of crisis was demonstrated during the COVID-19 pandemic.

Телемедицина сегодня: тенденции использования телемедицинских консультаций на опыте регионов.

The purpose of this work is to show, using regional experience, the differences in the application and factors affecting the efficiency of using telemedicine technologies in public medicine – both inhibiting and motivating. Using the example of 10 regions using centralized subsystems of telemedicine consultations, the authors analyzed the current level and features of using telemedicine in providing medical care. The article demonstrates the need to create a methodology for using telemedicine for specific nosologies, the importance of a new approach to monitoring the efficiency of using telemedicine. GC "HOST", together with other developers of telemedicine solutions, are ready to join working groups to draw up guidelines and develop quality indicators. The organizational and technical problems voiced in this article must be addressed – and this is the task of the regional health authority. The information presented in the article will be useful to those involved in the processes of integrating telemedicine technologies into the processes of providing medical care, and are ready to share their experience.

“I would have to walk around to find the best Wi-Fi connection…”: qualitatively exploring challenges associated with rapid rollout of telehealth in Canadian long-term care homes

BackgroundEarly in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups.ResultsFrom the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings.ConclusionsThe challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.

Exploring Disparities in Opioid Utilization: An Analysis Comparing Red River Métis to All Other Manitobans

Objective and ApproachTo address the opioid crisis within the Red River Métis (RRM) Community, understanding opioid use is crucial to empower regional health authorities to adapt health programs, services, and policies to meet their unique needs effectively. The investigation utilized focus groups with a Community-Based Participatory Research and Collective Consensual Data Analytics Procedure (CBPR/CCDAP) approach. Additionally, a population-based retrospective cross-sectional study for fiscal years 2006/07–2018/19 was conducted using administrative data from a population research data repository. Rates of prescription opioid dispensing (RPOD) and mean morphine equivalents (MEQ) were compared between RRM and all other Manitobans (AOM) aged 10 years or older. ResultsThe rate of prescription opioid dispensing and MEQ/person were found to be consistently higher among RRM compared to AOM in each study year (p < 0.001). While the RPOD declined among AOM over the study period, it did not change among RRM. Key findings revealed RRM were concerned about how opioids impacted their communities, and felt the need for increased addiction treatment resources, including Red River Métis culture-specific programs. ConclusionThe evidence demonstrates higher RPOD and MEQ among RRM compared to AOM, suggesting elevated risk of opioid-related harms. Focus group feedback reinforces the need for tailored interventions. ImplicationsFuture policies and programs targeting the opioid crisis should prioritize the unique needs of populations like the RRM, requiring tailored, culturally appropriate interventions for effective crisis management.

T cell responses to repeated SARS-CoV-2 vaccination and breakthrough infections in patients on TNF inhibitor treatment: a prospective cohort study

Understanding cellular responses to SARS-CoV-2 immunisations is important for informing vaccine recommendations in patients with inflammatory bowel disease (IBD) and other vulnerable patients on immunosuppressive therapies. This study investigated the magnitude and quality of T cell responses after multiple SARS-CoV-2 vaccine doses and COVID-19 breakthrough infection. This prospective, observational study included patients with IBD and arthritis on tumour necrosis factor inhibitors (TNFi) receiving up to four SARS-CoV-2 vaccine doses. T cell responses to SARS-CoV-2 peptides were measured by flow cytometry before and 2-4 weeks after vaccinations and breakthrough infection to assess the frequency and polyfunctionality of responding cells, along with receptor-binding domain (anti-RBD) antibodies. Between March 2, 2021, and December 20, 2022, 143 patients (118 IBD, 25 arthritis) and 73 healthy controls were included. In patients with either IBD or arthritis, humoral immunity was attenuated compared to healthy controls (median anti-RBD levels 3391 vs. 6280 BAU/ml, p=0.008) after three SARS-CoV-2 vaccine doses. Patients with IBD had comparable quantities (median CD4 0.11% vs. 0.11%, p=0.26, CD8 0.031% vs. 0.047%, p=0.33) and quality (polyfunctionality score: 0.403 vs. 0.371, p=0.39; 0.105 vs. 0.101, p=0.87) of spike-specific T cells to healthy controls. Patients with arthritis had lower frequencies but comparable quality of responding T cells to controls. Breakthrough infection increased spike-specific CD8 T cell quality and T cell responses against non-spike peptides. Patients with IBD on TNFi have T cell responses comparable to healthy controls despite attenuated humoral responses following three vaccine doses. Repeated vaccination and breakthrough infection increased the quality of T cell responses. Our study adds evidence that, in the absence of other risk factors, this group may in future be able to follow the general recommendations for COVID-19 vaccines. South-Eastern Norway Regional Health Authority, Coalition for Epidemic Preparedness Innovations (CEPI), Norwegian Institute of Public Health, Akershus University Hospital, Diakonhjemmet Hospital.

141 Residential Radon Exposure and Lung Cancer: A Feasibility Study in the Interior Health Authority Region of British Columbia, Canada

141 Residential Radon Exposure and Lung Cancer: A Feasibility Study in the Interior Health Authority Region of British Columbia, Canada

Serum proteomic profiling of physical activity reveals CD300LG as a novel exerkine with a potential causal link to glucose homeostasis

Background:Physical activity has been associated with preventing the development of type 2 diabetes and atherosclerotic cardiovascular disease. However, our understanding of the precise molecular mechanisms underlying these effects remains incomplete and good biomarkers to objectively assess physical activity are lacking.Methods:We analyzed 3072 serum proteins in 26 men, normal weight or overweight, undergoing 12 weeks of a combined strength and endurance exercise intervention. We estimated insulin sensitivity with hyperinsulinemic euglycemic clamp, maximum oxygen uptake, muscle strength, and used MRI/MRS to evaluate body composition and organ fat depots. Muscle and subcutaneous adipose tissue biopsies were used for mRNA sequencing. Additional association analyses were performed in samples from up to 47,747 individuals in the UK Biobank, as well as using two-sample Mendelian randomization and mice models.Results:Following 12 weeks of exercise intervention, we observed significant changes in 283 serum proteins. Notably, 66 of these proteins were elevated in overweight men and positively associated with liver fat before the exercise regimen, but were normalized after exercise. Furthermore, for 19.7 and 12.1% of the exercise-responsive proteins, corresponding changes in mRNA expression levels in muscle and fat, respectively, were shown. The protein CD300LG displayed consistent alterations in blood, muscle, and fat. Serum CD300LG exhibited positive associations with insulin sensitivity, and to angiogenesis-related gene expression in both muscle and fat. Furthermore, serum CD300LG was positively associated with physical activity and negatively associated with glucose levels in the UK Biobank. In this sample, the association between serum CD300LG and physical activity was significantly stronger in men than in women. Mendelian randomization analysis suggested potential causal relationships between levels of serum CD300LG and fasting glucose, 2 hr glucose after an oral glucose tolerance test, and HbA1c. Additionally, Cd300lg responded to exercise in a mouse model, and we observed signs of impaired glucose tolerance in male, but not female, Cd300lg knockout mice.Conclusions:Our study identified several novel proteins in serum whose levels change in response to prolonged exercise and were significantly associated with body composition, liver fat, and glucose homeostasis. Serum CD300LG increased with physical activity and is a potential causal link to improved glucose levels. CD300LG may be a promising exercise biomarker and a therapeutic target in type 2 diabetes.Funding:South-Eastern Norway Regional Health Authority, Simon Fougners Fund, Diabetesforbundet, Johan Selmer Kvanes’ legat til forskning og bekjempelse av sukkersyke. The UK Biobank resource reference 53641. Australian National Health and Medical Research Council Investigator Grant (APP2017942). Australian Research Council Discovery Early Career Award (DE220101226). Research Council of Norway (Project grant: 325640 and Mobility grant: 287198). The Medical Student Research Program at the University of Oslo. Novo Nordisk Fonden Excellence Emerging Grant in Endocrinology and Metabolism 2023 (NNF23OC0082123).Clinical trial number:clinicaltrials.gov: NCT01803568.

Canadian Medical Imaging Inventory 2022–2023: Methods

The Canadian Medical Imaging Inventory (CMII) was created in 2015 to track, compare, and map trends over time related to the availability, distribution, technical specifications, and use of advanced imaging equipment in Canada. This is the fourth iteration of the CMII. The CMII collects data about availability and use of CT, MRI, PET-CT, PET-MRI, SPECT, and SPECT-CT through a survey conducted approximately once every 2 years and details the use of strategies for improving appropriate imaging, enhancing system efficiencies, reducing wait lists, and addressing other systemic challenges. Senior medical imaging decision-makers within health ministries and/or regional health authority located in each province and territory were consulted to validate unit and exam counts for consistency. Data are presented using descriptive summaries and graphs of site-level and jurisdiction-level findings. Canada’s ranking among from Organisation for Economic Co-operation and Development countries was reported. The number of units and exams in Canada was projected for the years 2025, 2030, 2035, and 2040 based on the per capita values in 2022–2023 and estimated population growth provided by Statistics Canada.

Urgent Response Needed: Addressing the Dengue Crisis in the Andean and Southern Cone Latin American Regions.

The dengue crisis in the Latin American region is currently intensifying, exacerbated by heavy rains, widespread flooding, and the onset of the El Niño-Southern Oscillation. The indirect consequences of the COVID-19 pandemic, which weakened healthcare systems, have further compounded the situation. Comparing the first 15 weeks of 2023 with the same period in 2024, we observed a significant average increase of 600% in the number of new cases. This translates to a 536% rise in the composite rate per 100,000 inhabitants across all countries. Brazil experienced a staggering surge from 1,425,000 cases in the initial 15 weeks of 2023 to 5,177,989 cases in the corresponding period of 2024. Similarly, Paraguay witnessed a notable escalation, with cases soaring from 12,497 in 2023 to more than 240,000 thus far in 2024, marking an increase of more than 1,825%. Bolivia, however, witnessed a reduction in cases, though the cause remains unclear. Urgent action is imperative to address this escalating crisis. Strengthening surveillance systems, enhancing vector control programs, and implementing effective public health campaigns are critical. Immediate and coordinated action by regional governments and health authorities is essential to mitigate the growing dengue crisis and safeguard public health in the region.

The impact of cancer patient pathway on timing of radiotherapy and survival: a cohort study in glioblastoma patients.

Glioblastoma (GBM) is an aggressive brain tumor in which primary therapy is standardized and consists of surgery, radiotherapy (RT), and chemotherapy. However, the optimal time from surgery to start of RT is unknown. A high-grade glioma cancer patient pathway (CPP) was implemented in Norway in 2015 to avoid non-medical delays and regional disparity, and to optimize information flow to patients. This study investigated how CPP affected time to RT after surgery and overall survival. This study included consecutive GBM patients diagnosed in South-Eastern Norway Regional Health Authority from 2006 to 2019 and treated with RT. The pre CPP implementation group constituted patients diagnosed 2006-2014, and the post CPP implementation group constituted patients diagnosed 2016-2019. We evaluated timing of RT and survival in relation to CPP implementation. A total of 1212 patients with GBM were included. CPP implementation was associated with significantly better outcomes (p < 0.001). Median overall survival was 12.9 months. The odds of receiving RT within four weeks after surgery were significantly higher post CPP implementation (p < 0.001). We found no difference in survival dependent on timing of RT below 4, 4-6 or more than 6 weeks (p = 0.349). Prognostic factors for better outcomes in adjusted analyses were female sex (p = 0.005), younger age (p < 0.001), solitary tumors (p = 0.008), gross total resection (p < 0.001), and higher RT dose (p < 0.001). CPP implementation significantly reduced time to start of postoperative RT. Survival was significantly longer in the period after the CPP implementation, however, timing of postoperative RT relative to time of surgery did not impact survival.

Healthcare Resilience in Trinidad and Tobago: A short report on the Healthy Hospital Initiative at the Sangre Grande Hospital

Objective: To describe the establishment of the Healthy Hospital Initiative (HHI), its activities and accomplishments, challenges and future steps. Methods: The initiative was implemented at the Sangre Grande Hospital in the Eastern Regional Health Authority (ERHA), one of five Regional Health Authorities in Trinidad and Tobago. A review of personal records maintained by members of the Healthy Hospital Initiative was undertaken. These records included descriptions of the activities, accomplishments and obstacles that the team experienced. Results: The Healthy Hospital Initiative was launched in November 2019 with the aim of creating an environmentally sustainable health system and improving the physical and mental health of staff and patients. A senior doctor led the initiative and team members included a range of staff, including both clinical and non-clinical professionals who were all volunteers. This allowed for a multi-directional, inclusive approach and created a sense of ownership amongst the staff. In 2022, several activities were implemented: green spaces, recycling bins, a kitchen garden and staff exercise sessions. In addition, team members participated in training on Pan-American Health Organization (PAHO) Smart hospitals and collaborated with a local non-governmental organisation as well as the University of the West Indies, St. Augustine campus engineering department to develop further projects. Conclusion: Next steps include promoting similar projects in community health facilities, developing a hydroponics system and, assessing the disaster resilience and carbon footprint of the hospital.

Shaping the future of healthcare in British Columbia: Establishing provincial clinical governance for responsible deployment of artificial intelligence tools.

As healthcare embraces the transformative potential of Artificial Intelligence (AI), it is imperative to safeguard patient and provider safety, equity, and trust in the healthcare system. This article outlines the approach taken by the British Columbia (BC) Provincial Health Services Authority (PHSA) to establish clinical governance for the responsible deployment of AI tools in healthcare. Leveraging its province-wide mandate and expertise, PHSA establishes the infrastructure and processes to proactively and systematically intake, assess, prioritize, and evaluate AI tools. PHSA proposes a coordinated approach in AI tool deployment in collaboration with regional health authorities to prevent duplication of efforts and ensure equitable access to existing and emerging AI tools across the province of BC, incorporating principles of anti-Indigenous racism, cultural safety, and humility. The proposed governance structure underscores the identification of clinical needs, proactive ethics review, rigorous risk assessment, data validation, transparent communication, provider training, and ongoing evaluation to ensure success.

Implementation of remote general movement assessment using the in-motion instructions in a high-risk norwegian cohort

BackgroundGeneral Movement Assessment (GMA) is recommended for early detection of risk for cerebral palsy but requires trained clinical experts. We aimed to implement home- and hospital-based filming for remote GMA in a Norwegian high-risk infant cohort, as well as evaluating parents’ experiences in filming their infant at home.MethodsThis knowledge translational study used a prospective cohort design including participants referred to neurodevelopmental follow-up across three sites in the Central Norway Regional Health Authority. Two home films of the fidgety type of general movements were collected between 12+1–14+6 and 15+1–17+6 weeks after term by parents. An additional film was collected at the hospital between 12+1 and 17+6 weeks after term. The instructional guide for all filming was the In-Motion App standards. Videos were transferred to a remote GMA team and classified as either “GMA scorable” or “GMA not scorable” based on Prechtl’s GMA standards. Parents responded to an online survey using a 5-point Likert scale to collect information about their perspectives, experiences, and possible worries by filming their infant at home.ResultsOne-hundred-and-two infants from 95 families participated. Ninety-two (96.8%) families transferred 177 home-based videos. Eighty-four (92%) of these had 95 videos taken in their local hospital. All 177 home-videos were “GMA scorable” and three (3,1%) out of 95 hospital-based videos were classified as “GMA not scorable”. Eight families did not respond to the survey and two families did not receive the survey due to a technical error. Seventy-eight (91.7%) respondents agreed or strongly agreed that it was easy to perform home filming and five (5.9%) agreed that they were more worried about their child`s development after filming at home. Almost 80% of respondents agreed that a video for GMA can be taken at home instead of in hospital.ConclusionsThis study strengthens the clinical implementation of home filming by parents and remote GMA for early detection of CP in high-risk follow-up programs. The implementation of remote GMA has the potential to facilitate early intervention to improve function in children with CP in line with international recommendations.Trial registrationClinicalTrials.gov ID: NCT04287166 Date of registration: 27/02/2020.

Reviving health mediation during the COVID-19 crisis and beyond: an implementation study in deprived neighbourhoods of Marseille, France.

In 2020, during France's COVID-19 response, healthcare professionals from a hospital and an association initiated health mediation interventions in Marseille's vulnerable neighbourhoods, funded by the regional health authorities. This mixed method research evaluates the CORHESAN program that lasted until June 2022. We examined CORHESAN documents and reports, conducted interviews, and analysed activity data, comparing it to the COVID-19 hotspots identified on a weekly basis at the neighbourhood level, using generalised linear mixed models (GLMMs). CORHESAN was implemented by a team of up to nine health mediators, six private nurses hired on an ad hoc basis, supervised by a general coordinator and two part-time medical and nursing coordinators. Multiple partnerships were established with shelters, associations, social-housing landlords and local institutions. The team accompanied 6,253 people affected by COVID-19 or contact in the practical implementation of their isolation and contact tracing. Of the 5,180 nasopharyngeal samples for RT-PCR and 1,875 for antigenic testing: 12% were taken at home and 27% in partner facilities in the targeted neighbourhoods; 32% were taken from symptomatic patients and 30% in the context of contact tracing; and 40% were positive. Multiple awareness sessions on prevention methods and distributions of personal protection kits and self-diagnostic tests were conducted in the streets, in shelters, in associations or at home. A total of 5,929 doses of COVID-19 vaccine were administered in a walk-in vaccination centre, at temporary street vaccination posts, during operations at partner facilities, or during home-visits to patients with limited autonomy. GLMMs showed that the intervention significantly targeted its testing interventions in neighbourhoods with socioeconomic disadvantage and/or past under-testing (adjusted odds ratio (aOR), 2.75 [1.50-5.00]) and those with high hotspot level (aOR for level-3 versus level-0, 1.83 [1.24-2.71]). The pandemic emphasised the potential of health mediation interventions to address health disparities. Building on this, a new program began in July 2022, aiming at enhancing cancer screening and vaccinations in deprived areas of Marseille. Evaluations are ongoing to assess its activities and impact, and provide evidence to future implementation initiatives.

Establishment of a multisite umbrella cohort study protocol to describe the epidemiology and aetiologies of acute undifferentiated febrile illness in Latin America

IntroductionAcute undifferentiated febrile illnesses (AUFIs) impose a large burden in the tropics. Understanding of AUFI’s epidemiology is limited. Insufficient diagnostic capacity hinders the detection of outbreaks. The lack of interconnection...

Primary care doctors in acute call-outs to severe trauma incidents in Norway – variations by rural-urban settings and time factors

BackgroundA severely injured patient needs fast transportation to a hospital that can provide definitive care. In Norway, approximately 20% of the population live in rural areas. Primary care doctors (PCDs) play an important role in prehospital trauma care. The aim of this study was to investigate how variations in PCD call-outs to severe trauma incidents in Norway were associated with rural-urban settings and time factors.MethodsIn this study on severe trauma patients admitted to Norwegian hospitals from 2012 to 2018, we linked data from four official Norwegian registries. Through this, we investigated the call-out responses of PCDs to severe trauma incidents. In multivariable log-binomial regression models, we investigated whether factors related to rural-urban settings and time factors were associated with PCD call-outs.ResultsThere was a significantly higher probability of PCD call-outs to severe trauma incidents in the municipalities in the four most rural centrality categories compared to the most urban category. The largest difference in adjusted relative risk (95% confidence interval (CI)) was 2.08 (1.27–3.41) for centrality category four. PCDs had a significantly higher proportion of call-outs in the Western (RR = 1.46 (1.23–1.73)) and Central Norway (RR = 1.30 (1.08–1.58)) Regional Health Authority areas compared to in the South-Eastern area. We observed a large variation (0.47 to 4.71) in call-out rates to severe trauma incidents per 100,000 inhabitants per year across the 16 Emergency Medical Communication Centre areas in Norway.ConclusionsCentrality affects the proportion of PCD call-outs to severe trauma incidents, and call-out rates were higher in rural than in urban areas. We found no significant difference in call-out rates according to time factors. Possible consequences of these findings should be further investigated.

Health service impacts and extractive industries: Experiences from health service leaders operating in a resource-dependent region

Resource extraction and development projects alter community health and well-being in complex and diverse ways. The extractive industry's impacts on local infrastructure and services are commonly recognized social externalities, yet little detail is available on how these manifest across the healthcare system. This study offers a better understanding of the health service impacts of resource extraction and development. It does this by capturing the observations and experiences of leaders from a rural, regional health authority who have worked with industry to manage impacts on health services during a period of rapid economic development and amidst the COVID-19 pandemic. The study found that impacts from resource extraction and development were experienced first and foremost in emergency departments but were also felt across the entire healthcare system. These pressures were primarily driven by the size of the temporary workforce but also influenced by factors such as the relative size of the workforce to the local community, the local context, and how well impacts were managed at the project level, including the competency of a project's medical service provider.