Regional Public Health Services Research Articles

Continuing professional development training needs of allied health professionals in regional and rural Victoria.

The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria. This study was an online cross-sectional design conducted between December 2022 and February 2023. AHPs employed at a large multi-site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia. The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers. The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6-10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self-perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment. CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities.

Preparedness and training needs of a regional public mental health service to support people with intellectual disability.

To explore the preparedness and training needs of a regional public mental health workforce to support people with intellectual disability and mental ill health. Staff from a regional public mental health service in Victoria, Australia. A mixed-methods design comprised a survey, interviews and a focus group to collect data about staff attitudes, confidence, education and professional development regarding supporting people with intellectual disability and mental ill health. Descriptive and thematic analyses were used. Data from 31 survey respondents, seven interviews and one focus group were analysed. Survey descriptive analyses showed participants believed treating people with intellectual disability was part of their role but reported areas of low confidence along with insufficient education and training in intellectual disability mental health. Thematic analyses from interviews showed that underpinning confidence, education and training were the themes (1) need for flexibility, such as having more time and (2) solutions but with challenges, such as limited opportunity to upskill and availability of experts. A need for collaborative problem-solving where staff share skills and information to work towards person-centred solutions was a key theme from the focus group analysis. Professional development in intellectual disability mental health is required for the regional public mental health workforce but needs to account for the challenges experienced and reflect how teams function. Exploration of described preparedness offered a possible learning approach informed by workforce members. Collaborative learning approaches to supporting people with intellectual disability and mental ill health are suggested.

The Influence of Procurement Literacy and Budget Supervision on Regional Public Health Service Agency Budget Absorption of Tugurejo Hospital

Financial planning, management, and control will improve with a greater understanding of procurement literacy and budget monitoring. The regulations about the procurement of government goods and services are currently governed by Presidential Regulation Number 54 of 2010, with the most recent amendment being Presidential Regulation Number 16 of 2018, commonly known as the Presidential Decree on Government Procurement of Goods and Services. These regulations were formulated by the Procurement Policy Institute for Government Goods and Services, also known as LKPP. The urgent/immediate need for goods/services results in the procurement process for goods/services sometimes not complying with the provisions for procurement of goods/services. Therefore, a budget monitoring role is needed, so that budget absorption can be absorbed optimally. This research aims to determine the influence of procurement literacy and budget supervision on the absorption of the BLUD Tugurejo Hospital. This type of research uses quantitative descriptive, using regression testing via the SPSS application. The research results show that procurement literacy and budget supervision have a significant effect on the absorption of the BLUD Tugurejo Hospital. The positive impact that arises is the improvement of existing infrastructure in the village so that national development can continue to move in a better direction. In practice, the BLUD of Tugurejo Regional Hospital requires budget supervision by competent human resources so that the planned budget absorption can be realized perfectly. Competent HR means HR with a high level of financial literacy and procurement literacy

Strengthening Infectious Disease Control and Pandemic Preparedness in The Netherlands

Abstract The COVID-19 pandemic showed the importance of a strong public health system. During the pandemic, infectious disease control departments of Dutch Regional Public Health Services (RPHSs) reached their limits. In preparation for new large outbreaks and pandemics, investments must be made in strengthening infectious disease control departments at RPHSs. In March-May 2022, the 25 RPHSs established a programme to reinforce their infectious disease control departments in 2023-2024. The programme addresses current vulnerabilities and focuses on five pillars: increasing staff capacity (1), improving cross-regional monitoring and surveillance (2), strengthening public health research infrastructure (3), improving cross-regional collaboration (4) and increasing training opportunities for professionals (5). The Dutch Ministry of Health, Welfare and Sport is funding the two-year (2023-2024) national programme, assisting the 25 RPHSs to address regional and cross-regional vulnerabilities with 75 million euro. The programme started in January 2023 and already resulted in the start of new national consultation structures and the employment of many new infectious disease professionals, whilst considering task rearrangement of medical and non-medical professionals. RPHSs are working together with national partners to strengthen cross-regional monitoring and surveillance. A national consortium, together with infectious disease professionals at RPHS, is currently working on scientific knowledge enhancement and innovation in the public health work field. The programme provides national education opportunities and investigates career prospects of public health professionals. The programme provides insight in regional similarities and differences and identifies strengths and needs to improve infectious disease control. Outcomes of the programme are used by RPHSs and their national partners to determine what is needed for structural strengthening of infectious disease control departments. Key messages • The 25 Dutch RPHSs work together to strengthen infectious disease control. • The programme contributes to reinforcement, innovation and further professionalisation of the infectious disease control.

Conditions for professional support of school health promotion implementation in the Netherlands

Abstract Background The Dutch Healthy School Program (‘Programma Gezonde School’; HSP) is a whole school approach including education, stimulating physical and social environment, health services, and school health policies. Implementation support is offered by Healthy School Advisers employed at 25 regional Public Health Services (PHSs). To strengthen this professional support, this study aimed to map conditions for the degree of support offered by PHSs and received by schools. Methods The data collection plan was developed together with a Community of Practice. In 2021 and 2022, two rounds of semi-structured group interviews were conducted in 8 PHSs (N = 1-4 employees and ±3.5 hours in total per PHS). Interviews focused on the degree of support (intensity, quality, context-focus, position in PHS and region) and 24 contextual factors regarding: 1) Healthy School Advisers, 2) PHS organization, 3) collaboration with partners, and 4) broader context. Additional data were collected from public websites, year reports, and the Dutch registry of implementing HSP. Data were analyzed thematically in Nvivo. Preliminary results There is large variation in all aspects of support between PHSs. Main conditions for this variation are related to the PHS organization: its policy, internal support, capacity, and (long-term) allocated budget. Other key conditions are related to collaboration with partners: coordination, division of responsibilities, and communication structure. Prerequisites for all PHSs were cohesive adviser teams, the HSP, and national school health promotion focus. Conclusions In order to strengthen professional support for whole school health promotion implementation, it is essential to: 1) establish strong positioning and (long-term) resources in the organization, 2) establish clear coordination between Healthy School Advisers and partners supporting schools, 3) maintain cohesion among adviser teams, and 4) maintain and intensify national (school) health promotion policy. Key messages • Degree of professional support for whole school health promotion varies substantially. • Positioning in the organization and clear coordination among professionals are key in strengthening support.

S9-2 Dutch national falls prevention program- implementation challenges

Abstract Purpose In the Netherlands, a very ambitious falls prevention program is being implemented in 2023 and 2024. Falls among older adults lead to a high burden on healthcare and high societal costs. This program is therefore part of the current government coalition agreement. Each year one in seven persons over 65 should be screened on fall risk and should be stimulated to reduce fall risk. The whole program includes specific falls prevention programs (FPPs) as well as Physical activity (PA) programs outside these FPPs to keep fall risk restricted. Large responsibility is given to municipalities for implementation at the local level, and to regional public health services at a higher level. Project description At present there is no good organisation of falls prevention. A whole infrastructure has to be set up to be able to carry out the prevention program. This is coordinated by VeiligheidNL. It involves a considerable number of stakeholders and different working packages on FFPs, implementation, and communication. Starting in 2022, a number of sessions have been held to inform municipalities, regional health services, and professionals. Funding frameworks are set up including refunding of FPP participation and support of coordination by municipalities. As part of the process, we evaluated among scientists, PA professionals and municipalities what is needed to organise PA for maintenance after FPPs and for people without increased risk. This includes more available organised PA, increase in frequency and intensity of current group PA, and involving regular sports clubs to increase overall capacity. Most municipalities need to take a much stronger coordinating role, including also a professional with ‘broker’ role, generally the so-called neighbourhood sports coach (NSC). This professional guides older people to suitable PA and is a connector between health, social care and PA professionals. Conclusions The ambitious falls prevention program, supported by considerable financial resources, has the potential to give a large boost to PA in older adults. There are still a lot of challenges at the national as well as local level before implementation is successful, but several locations have already managed to develop a good infrastructure.

Cohort profile: The Corona Behavioral Unit cohort, a longitudinal mixed-methods study on COVID-19-related behavior, well-being and policy support in the Netherlands.

This 'cohort profile' aims to provide a description of the study design, methodology, and baseline characteristics of the participants in the Corona Behavioral Unit cohort. This cohort was established in response to the COVID-19 pandemic by the Dutch National Institute for Public Health and the Environment (RIVM) and the regional public health services. The aim was to investigate adherence of and support for COVID-19 prevention measures, psychosocial determinants of COVID-19 behaviors, well-being, COVID-19 vaccination, and media use. The cohort also examined specific motivations and beliefs, such as for vaccination, which were collected through either closed-ended items or open text responses. In April 2020, 89,943 participants aged 16 years and older were recruited from existing nation-wide panels. Between May 2020 and September 2022, 99,676 additional participants were recruited through online social media platforms and mailing lists of higher education organizations. Participants who consented were initially invited every three weeks (5 rounds), then every six weeks (13 rounds), and since the summer of 2022 every 12 weeks (3 rounds). To date, 66% of participants were female, 30% were 39 years and younger, and 54% completed two or more questionnaires, with an average of 9.2 (SD = 5.7) questionnaires. The Corona Behavioral Unit COVID-19 cohort has published detailed insights into longitudinal patterns of COVID-19 related behaviors, support of COVID-19 preventive measures, as well as peoples' mental wellbeing in relation to the stringency of these measures. The results have informed COVID-19 policy making and pandemic communication in the Netherlands throughout the COVID-19 pandemic. The cohort data will continuously be used to examine COVID-19 related outcomes for scientific analyses, as well as to inform future pandemic preparedness plans.

Time Scales of Human Mpox Transmission in The Netherlands.

Mpox has spread rapidly to many countries in nonendemic regions. After reviewing detailed exposure histories of 109 pairs of mpox cases in the Netherlands, we identified 34 pairs where transmission was likely and the infectee reported a single potential infector with a mean serial interval of 10.1 days (95% credible interval, 6.6-14.7 days). Further investigation into pairs from 1 regional public health service revealed that presymptomatic transmission may have occurred in 5 of 18 pairs. These findings emphasize that precaution remains key, regardless of the presence of recognizable symptoms of mpox.

Impacts of a dispersed unit structure on allied health professionals' experiences in an Australian public hospital setting.

The limited published evidence relating to the experiences and outcomes of a unit dispersement model is generally more negative than positive from an allied health perspective. The perceptions of allied health managers and leaders after the transition to a unit dispersement structure were explored in this study. The objectives were to review the impacts of this type of structure and the factors for health care organizations to consider before incorporating allied health professions into a clinical matrix structure. A qualitative study was conducted in a large regional multisite public hospital and health service located in Australia. Semistructured interviews and focus groups were conducted with 30 allied health frontline managers and leaders. Four negative impacts on the work experience of allied health professionals in a dispersement structure were identified through data analysis as: a negative impact on service delivery to patients, a detrimental effect on professional identity, reduced ability of allied health managers and leaders to do their role effectively, and a negative impact on morale, culture, and emotional well-being. Several key factors for public hospitals to consider before embarking on an organizational structure that includes allied health professionals were identified. The impacts of the unit dispersement structure on allied health professionals working within the organization under study were generally negative and did not deliver on the desired objectives. The findings reinforce the unique requirements pertaining to allied health professionals for optimal functioning. The learnings have implications for administrators in health care organizations embarking on organizational change that incorporates allied health professions in certain settings. The findings recommend that health care organizations consider several important factors before they introduce any structural change that would affect the delivery of allied health services.

Understanding public support for COVID-19 pandemic mitigation measures over time: Does it wear out?

COVID-19 mitigation measures intend to protect public health, but their adverse psychological, social, and economic effects weaken public support. Less favorable trade-offs may especially weaken support for more restrictive measures. Support for mitigation measures may also differ between population subgroups who experience different benefits and costs, and decrease over time, a phenomenon termed "pandemic fatigue." We examined self-reported support for COVID-19 mitigation measures in the Netherlands over 12 consecutives waves of data collection between April 2020 and May 2021 in an open population cohort study. Participants were recruited through community panels of the 25 regional public health services, and through links to the online surveys advertised on social media. The 54,010 unique participants in the cohort study on average participated in 4 waves of data collection. Most participants were female (65%), middle-aged [57% (40-69 years)], highly educated (57%), not living alone (84%), residing in an urban area (60%), and born in the Netherlands (95%). COVID-19 mitigation measures implemented in the Netherlands remained generally well-supported over time [all scores >3 on 5-point scale ranging 1 (low)-5 (high)]. During the whole period studied, support was highest for personal hygiene measures, quarantine and wearing face masks, high but somewhat lower for not shaking hands, testing and self-isolation, and restricting social contacts, and lowest for limiting visitors at home, and not traveling abroad. Women and higher educated people were more supportive of some mitigation measures than men and lower educated people. Older people were more supportive of more restrictive measures than younger people, and support for more socially restrictive measures decreased most over time in higher educated people or in younger people. This study found no support for pandemic fatigue in terms of a gradual decline in support for all mitigation measures in the first year of the pandemic. Rather, findings suggest that support for mitigation measures reflects a balancing of benefits and cost, which may change over time, and differ between measures and population subgroups.

Impact of the COVID-19 pandemic on student supervision and education in health care settings: A state-wide survey of health care workers.

To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID-19 pandemic. Studies on the impact of COVID-19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks. The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi-square tests. Free-text comments were analysed using content analysis. Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well-being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted. This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future-proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic.

Implementing best practice occupational therapist-led environmental assessment and modification to prevent falls: A qualitative study of two regional and rural public health services in Australia.

Occupational therapist-led environmental assessment and modification (EAM) is effective in reducing falls for populations at high risk. Two regional and rural public health services in Queensland devised an implementation strategy to embed best practice occupational therapist-led EAM. A qualitative study was conducted to compare the determinants of implementation success across the different health services, using the COM-B model of behaviour change. Six semi-structured interviews were completed with occupational therapists involved at each site, following 12 months of implementation. Interview data were triangulated with minutes from three combined site steering committee meetings, eight local steering committee meetings, and field notes. Thematic analysis was completed to compare barriers and facilitators to best practice uptake of EAM and differences in outcomes between the two sites. Both sites commenced implementation with similar states of capability and motivation. After 12 months, one site considered that practice change had been embedded as noted in steering committee minutes and comments; however, the other site observed limited progress. According to the COM-B analysis, opportunity (the factors that lie outside the individual's control) had a significant influence on how both sites were able to respond to the practice change and navigate some of the unexpected challenges that emerged, including the COVID-19 pandemic. Existing team structure, multiple responsibilities of key stakeholders, differences in access to resources, and lack of connection between complementary services meant that COVID-19 disruptions were only a catalyst for unveiling other systemic issues. This study highlights the power of external factors on influencing behaviour change for best practice implementation. Learnings from the study will provide deeper understanding of completing implementation projects in regional and rural contexts and support the future implementation of EAM in occupational therapy clinical settings.

The timeliness of COVID-19 testing and tracing in eight public health regions in the Netherlands

Abstract Background Testing and Contact Tracing (TCT) was a core strategy in the fight against the spread of SARS-CoV-2. However, little is known about the real-world effectiveness of TCT for COVID-19. Because time is an important conditional factor, we aim to study timeliness of TCT in the Netherlands, and its determinants. Methods We used routine COVID-19 TCT registry data from all individuals who tested positive for SARS-CoV-2 at 8 Dutch regional public health services from 1-6-2020 to 28-2-2021 (N = 338,066). We calculated median time intervals of TCT stages. Factors associated with the time between test result and completion of TCT, categorised as ≤ 3 days and >3 days, were assessed using logistic regression adjusting for region, testing site, and laboratory. Potential determinants were: gender, age, country of birth, number of close contacts, working in health-care or education, TCT manpower, and the Oxford Covid-19 Government Response Tracker (OxCGRT). Results The median time from symptom onset to TCT completion was 6 days (IQR:3-10). Median times between TCT stages were 1 day (IQR:0-3) for symptom onset to test request, 1 day, (IQR:0-1) for test request to sample collection, 1 day, (IQR:1-1) for sample collection to test result, and 2 days (IQR:1-5) for test result to TCT completion. In 31.7% of tests, time between test result and TCT completion was >3 days. This delay was associated with being older (65+), whereas being younger (0-14), a higher OxCGRT, scaling down TCT, and a higher number of TCT employees were associated with a shorter interval. Conclusions Over fifty percent of interval times from symptom onset to TCT completion exceeded the median SARS-CoV-2 incubation period of 5 days. There seems to be little room for improvement on the side of the index case, but there are some implications for logistics such as increasing TCT manpower, and better integration of digital systems. Key messages

Promoting mental health recovery by design: Physical, procedural, and relational security in the context of the mental health built environment.

The rates of mental health hospitalisations in Australia are rising. This paper presents the findings of a study undertaken in a regional mental health unit. The aim of the study was to obtain user perspectives to inform the redesign of the unit, which provides inpatient mental health services to rural and regional adults. A qualitative descriptive study with data collected via focus groups and in-depth interviews was undertaken with 38 participants, including current inpatients, carers and 27 staff members of a single regional inpatient mental health unit. The 25-bed mental health inpatient unit accommodates adults from 18+ years of age. The mental health unit sits within a referral hospital precinct and is associated with community-based mental health services within a large regional and rural Australian public health service. The analysis of interviews and focus groups with patients, carers and mental health professionals revealed three major themes congruent with the literature These were: Firstly, Theme 1: Rooms should be designed to promote physical security. Next, Theme 2: Purposeful planning to support interactions between users and systems will promote relational security. And finally, Theme 3: Optimizing service integrity should promote procedural security. Based on the themes arising from the study, a list of recommendations was produced to inform the design of a new build for a regional mental health unit. In particular, all users of the space should expect that the built environment will promote their physical security and psychological safety and accommodate a wide range of diversity and acuity. The aesthetics should align with the promotion of recovery in the context of person-centred and trauma-informed models of care. Designers should plan to alleviate boredom and accommodate meaningful wayfinding. Mental health nurses should have spaces that support their work without compromising their relational security with consumers. Building designers should optimize therapeutic environments to facilitate dignified intensive and stabilizing treatments and eliminate vicarious stigma associated with caring for people with mental illness. This study provides valuable insights from a community of users who have experienced receiving and delivering mental health care within a regional and rural mental health unit.

Online information about mammography screening in Italy from 2014 to 2021

BackgroundMany studies have reported that the information women receive about the risk-to-benefit ratio of breast cancer screening is still scarce and biased toward benefit. In a study we conducted in 2014, we analysed online documents about breast cancer screening that were addressed to the general female public. In the present study, we used the same methodology to verify if the information provided to women was improved.MethodsWe evaluated documents addressed to the general female public and posted on the Internet by the Italian national and regional public health services. False-positive and false-negative screening results, biopsy-proven false-positive results, interval cancer, overdiagnosis, radiation exposure, and decrease in risk of mortality were analysed. In addition, quantitative data were searched.ResultsIn 2021, the most frequently reported information was reduction in breast cancer mortality (58.2%). The most frequently reported risk was a false-positive mammogram (42.5%). Similar frequency rates were reported for interval cancer, false-negative result, and radiation exposure (35.8%, 31.3%, and 28.3%, respectively). Overdiagnosis and biopsy-proven false-positive result were the less reported risks (20.1% and 10.4%). Thirteen documents provided quantitative data about reduction of mortality risk (16.7%), and only 19 provided quantitative data about risks or harms (8.4%). Almost all organisations sent letters of invitation to women (92.5%) and provided screening free of charge (92.5%). The most recommended was biennial screening for women aged between 50 and 69 years (48.5%). Compared with the information in 2014, that in 2021 showed some improvements. The most marked improvements were in the numbers of reports on overdiagnosis, which increased from 8.0 to 20.1%, and biopsy-proven false-positive result, which increased from 1.4 to 10.4%. Regarding the benefits of breast cancer screening, reduced mortality risk became increasingly reported from 2014 (34.5%) to 2021 (58.2%). Conversely, quantitative data remained scarce in 2021.ConclusionsModerate improvements in information were observed from 2014 to 2021. However, the information on breast cancer screening in documents intended for women published on Italian websites remain scarce.

География бронхолегочной заболеваемости населения в регионах России: мониторинг 2010–2019 годов

The problem of diseases of the respiratory system is important for many countries of the world. The solution of this problem determines the search for new topical directions for the prevention of nosological and epidemiological threats. The article presents the first results of a nosogeographic study of bronchopulmonary morbidity among the population of Russian regions for the period from 2010 to 2019. The article shows that respiratory diseases are the leading class of diseases in the structure of primary and general morbidity of the Russian population. Monitoring of the nosogeographical situation was performed on the example of three bronchopulmonary diseases (pneumonia; bronchitis; chronic obstructive pulmonary disease). For each disease, the morbidity growth rate was calculated. The resulting data sets became the basis for the development of a series of cartograms. A series of cartograms showed territorial differences in the dynamics of bronchopulmonary morbidity in the regions of Russia. As a result, the general patterns of the prevalence of bronchopulmonary diseases in the regions of Russia were described. The most unfavorable nosogeographical situation in most regions of Russia was revealed by pneumonia. As an example, 36 regions were characterized by high and very high morbidity growth rate of pneumonia. The nosogeographic situation for bronchitis and chronic obstructive pulmonary disease was assessed as less tense situation (in comparison with the situation for pneumonia). High and very high morbidity growth rates for bronchitis were registered in 22 regions, for chronic obstructive pulmonary disease were registered in 8 regions. After that, some risk factors that can influence the distribution of various diseases of the respiratory system were discussed. In conclusion, a need to continue research on the assessment and monitoring of bronchopulmonary morbidity was stressed. The results of these research works are of practical value for improving of regional programs and public health services.

Risk factors of loneliness across the life span

Although loneliness is typically associated with adolescence and old age, research has revealed that it is prevalent across the life span. The present study contributes to the loneliness literature by investigating a broad range of risk factors in a Dutch sample ( N = 52,341) ranging from late adolescence to old age using a cross-sectional survey administered by the regional public health services in the province of Limburg in the Netherlands. Risk factors associated with higher levels of self-reported loneliness across the life span were being male, lower education levels, inadequacy of financial resources, mental health, informal caregiving that is experienced as burdensome, and limited social contact or network type. In addition, in early adulthood, having a non-western migration background and having a physical disability were associated with higher levels of loneliness, whereas living alone, having a non-western migration background, and not having a paid job were risk factors of loneliness in middle adulthood. In late adulthood, living alone and having a physical disability were associated with loneliness. The present study demonstrates that different stages of life are associated with different vulnerability factors of loneliness. Hence, the prevention of loneliness might require different interventions in different age groups.

Spatio-temporal small area surveillance of the COVID-19 pandemic

The emergence of COVID-19 requires new effective tools for epidemiological surveillance. Spatio-temporal disease mapping models, which allow dealing with small units of analysis, are a priority in this context. These models provide geographically detailed and temporally updated overviews of the current state of the pandemic, making public health interventions more effective. These models also allow estimating epidemiological indicators highly demanded for COVID-19 surveillance, such as the instantaneous reproduction number Rt, even for small areas. In this paper, we propose a new spatio-temporal spline model particularly suited for COVID-19 surveillance, which allows estimating and monitoring Rt for small areas. We illustrate our proposal on the study of the disease pandemic in two Spanish regions. As a result, we show how tourism flows have shaped the spatial distribution of the disease in these regions. In these case studies, we also develop new epidemiological tools to be used by regional public health services for small area surveillance.

Analysis of Patient Safety Incidents in Primary Care Reported in an Electronic Registry Application.

Objectives: (1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed. Design: Descriptive analytical study of incidents reported from 1 January to 31 December 2018, on the TPSC Cloud™ platform (The Patient Safety Company) accessible from the corporate website (Intranet) of the regional public health service. Setting: 24 Catalan Institute of Health PC health centres of the Tarragona region (Spain). Participants: Professionals from the PC health centres and a Patient Safety Functional Unit. Measurements: Data obtained from records voluntarily submitted to an electronic, standardised and anonymised form. Data recorded: healthcare unit, notifier, type of incident, risk matrix, causal and contributing factors, preventability, level of resolution and improvement actions. Results: A total of 1544 reports were reviewed and 1129 PS incidents were analysed: 25.0% of incidents did not reach the patient; 66.5% reached the patient without causing harm, and 8.5% caused adverse events. Nurses provided half of the reports (48.5%), while doctors reported more adverse events (70.8%; p < 0.01). Of the 96 adverse events, 46.9% only required observation, 34.4% caused temporary damage that required treatment, 13.5% required (or prolonged) hospitalization, and 5.2% caused severe permanent damage and/or a situation close to death. Notably, 99.2% were considered preventable. The main critical areas were: communication (27.8%), clinical-administrative management (25.1%), care delivery (23.5%) and medicines (18.4%); few incidents were related to diagnosis (3.6%). Conclusions: PS incident notification applications are adequate for reporting incidents and adverse events associated with healthcare. Approximately 75% and 10% of incidents reach the patient and cause some damage, respectively, and most cases are considered preventable. Adequate and strengthened risk management of critical areas is required to improve PS.

Social-life factors associated with participation in screening and further assessment of colorectal cancer: A nationwide ecological study in Japanese municipalities

The burden of colorectal cancer in developed countries is high, and it is a major public health concern in Japan. Improving the quality of evidence on colorectal cancer screening participation and further assessment participation rates is important to reduce this burden. This study examined the social-life factors that influence colorectal cancer screening programs in Japan, particularly the effects of the proportion of elderly people and social capital, using a municipality-level national database and existing health reports. Data from a national municipality-based study were analyzed to identify social-life factors associated with participation in colorectal cancer screening and further assessment. Administrative data on the Japanese municipal screening programs were drawn from the Report on Regional Public Health Services and Health Promotion Services 2017. Available data used as predictors of interest for all 1719 municipalities as of 2017 were from the national census, statistical reports on the land area by prefecture and municipality, municipal financial surveys, a survey of physicians, dentists and pharmacists, and other databases. The mean rate of participation in colorectal cancer screening was 13.8%, and that of further assessment was 73.6%. Multiple linear regression analyses of the two outcomes showed that the proportion of elderly people was most significantly positively associated with colorectal cancer screening programs (β = 0.51 for participation, β = 0.13 for further assessment participation), and the proportion of single-elderly-person households was most significantly negatively associated (β = −0.45 and −0.19, respectively). It is suggested that the health behaviors required for participation in colorectal cancer programs in Japanese elderly populations are greatly affected by family members.