Sanitary Emergencies Research Articles

Quality of life and associated factors for community health workers in the context of the COVID-19 pandemic in northeastern Brazil

In this study, we evaluated the quality of life (QoL) and associated factors of community health workers (CHWs) in different urban settings as a contributor to the preparedness of Brazilian primary care for future sanitary emergencies. The sample included 1935 CHWs from 4 state capitals and 4 inland municipalities in northeastern Brazil. Information was collected on QoL (WHOQOL-BREF), work routines, sociodemographics, direct and indirect exposure to violence, general self-efficacy, social support (MSPSS), mental health (SRQ-20) and coronavirus anxiety. The data were subjected to multiple linear regression analysis (α = 5%). In the state capitals, the factors associated with loss of QoL were poor mental health, lack of training, uncertainty about occupational biosafety, and lack of adaptation of services to tend to patients diagnosed with COVID-19. Among the inland municipalities, the main factors were coronavirus anxiety, poor mental health, lack of adaptation of services, lack of training, and lack of personal protective equipment (PPE). A high MSPSS (family and friends) score and self-efficacy had positive impacts on QoL in both urban settings. Our results highlight the need for investment in permanent education, PPE, social support, and mental health care for CHWs.

Improved protocol for Bst polymerase and reverse transcriptase production and application to a point-of-care diagnostics system.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised awareness in the scientific community about the importance of being prepared for sanitary emergencies. Many measures implemented during the COVID pandemic are now being expanded to other applications. In the field of molecular and immunological diagnostics, the need to massively test the population worldwide resulted in the application of a variety of methods to detect viral infection. Besides gold standard reverse transcription quantitative polymerase chain reaction (RT-qPCR), the use of reverse transcription loop-mediated isothermal amplification (RT-LAMP) arose as an alternative and sensitive method to amplify and detect viral genetic material. We have used openly available protocols and have improved the protein production of RT-LAMP enzymes Bst polymerase and HIV-reverse transcriptase. To optimize enzyme production, we tested different protein tags, and we shortened the protein purification protocol, resulting in reduced processing time and handling of the enzymes and, thus, preserved the protein activity with high purity. The enzymes showed significant stability at 4 °C and 25 °C, over 60 days, and were highly reliable when used as a one-step RT-LAMP reaction in a portable point-of-care device with clinical samples. The enzymes and the reaction setup can be further expanded to detect other infectious diseases agents.

The status of water access, sanitation, and hygiene in schools: A cross sectional survey to identify capacities and assess coverage in Garoua, North Cameroon

There has been an increasing global interest in understanding, documenting, and monitoring water, sanitation, and hygiene (WASH) services in schools. This study is the first to identify existing WASH-in-school capacities and understand the magnitude of the gaps in WASH coverage in schools in the Northern Cameroon, a region of the country marked by recurrent sanitary emergencies, the highest prevalence of acute malnutrition, and representing the largest and heaviest focus of food and water insecurity. Using a cross-sectional design, relevant authorities of 176 schools in Garoua, were interviewed. The survey guide included core questions for monitoring WASH in schools from recommended guidelines. Eleven indicators-related variables were extracted from data to calculate the WASH-in-school indicators composite score, which could be used as a more reliable and useful tool for comparison across settings and can contribute to harmonize data with WASH in schools related indicators applied in national surveys. The results of this research showed suboptimal drinking water supply systems and sanitation facilities whereas most schools had hand washing points available. However, activities that aimed to promote and sustain a WASH positive environment among children still need to be put in place. The WASH-in-school indicators composite score predictive value corroborated the disparities related to WASH access in schools located in Garoua. This score hence provides an assessment of the spatial dimensions of reduced access to water in schools, improper hygiene practices, and inadequate sanitation facilities. Such a score could be used to identify hotspots lacking WASH infrastructural facilities and strategize optimal interventions to reduce the incidence of WASH related diseases in schools.

The Individual- and Organization-Related Stressors in Pandemic Scale for Healthcare Workers (IOSPS-HW): Development and Psychometric Properties of a New Instrument to Assess Individual and Organizational Stress Factors in Periods of Pandemics.

The validation and psychometric properties of the Individual and Organization related Stressors in Pandemic Scale for Healthcare Workers (IOSPS-HW) were presented. This is a new measure to assess individual factors related to the health and well-being of individuals, such as family and personal relationships, as well as organizational factors related to the management of the pandemic, including workplace relationships, job management and communication. Across two studies conducted at different time points of the pandemic, psychometric evidence of the IOSPS-HW is presented. In Study 1, through a cross-sectional design, we conducted exploratory and confirmatory factor analysis through which the originally developed 43 items scale was reduced to a 20-item bidimensional scale with two correlated dimensions: Organization-related Stressors (O-S; 12 items) and Individual- and Health-related Stressors (IH-S; 8 items). Internal consistency and criterion validity were also provided by investigating the relationship with post-traumatic stress. In Study 2, we provided evidence for the temporal invariance of the measure and for temporal stability through a Multigroup-CFA through a longitudinal design. We also supported the criterion and predictive validity. The results suggest that IOSPS-HW is a good instrument to simultaneously investigating individual and organizational factors related to sanitary emergencies in healthcare workers.

Dietary Panic under Public Crisis: A Case Study of the COVID-19 Outbreak

Since April 1st, Shanghai had been under a citywide quarantine for two months due to the exponential growth of the new COVID-19 variant, Omicron. Hence, over 25 million people have been confined, leading to drastic changes in residents’ dietary behaviours compared to the preceding period. This study aims to examine the patterns of dietary panic in the situation of public crisis through the case of shanghai confinement based on the method of participant observation. The discussion included perceived changes in food consumption, variety of foodstuff intake and individual culinary practices of inhabitants during the lockdown period. Variables which affected inhabitants’ dietary behaviours had been analysed, as well as the potential factors related to lack of food provisions. Research on the local food system and logistic access reflected the challenging food supply systems were facing as being restricted by anti-contagion policies and emergency public management, resulting in a common trend of irregular dietary habits and negative mental conditions during quarantine. Evaluating the situation may help to understand the relationship between dietary panic and global sanitary emergencies while being referenced further improvements in the method and timing of deploying public policy and societal management in the future.

Nanotechnology-Assisted Biosensors for the Detection of Viral Nucleic Acids: An Overview.

The accurate and rapid diagnosis of viral diseases has garnered increasing attention in the field of biosensors. The development of highly sensitive, selective, and accessible biosensors is crucial for early disease detection and preventing mortality. However, developing biosensors optimized for viral disease diagnosis has several limitations, including the accurate detection of mutations. For decades, nanotechnology has been applied in numerous biological fields such as biosensors, bioelectronics, and regenerative medicine. Nanotechnology offers a promising strategy to address the current limitations of conventional viral nucleic acid-based biosensors. The implementation of nanotechnologies, such as functional nanomaterials, nanoplatform-fabrication techniques, and surface nanoengineering, to biosensors has not only improved the performance of biosensors but has also expanded the range of sensing targets. Therefore, a deep understanding of the combination of nanotechnologies and biosensors is required to prepare for sanitary emergencies such as the recent COVID-19 pandemic. In this review, we provide interdisciplinary information on nanotechnology-assisted biosensors. First, representative nanotechnologies for biosensors are discussed, after which this review summarizes various nanotechnology-assisted viral nucleic acid biosensors. Therefore, we expect that this review will provide a valuable basis for the development of novel viral nucleic acid biosensors.

Stigmatization towards healthcare personnel during the first COVID-19 wave in Central and Northern Mexico.

The evidence all over the world shows an alarming increase in the stigmatization of health personnel during the COVID-19 pandemic. We sought to explore possible psychological factors that help explain the disposition to stigmatize health personnel in the central and northern regions of Mexico. Two studies explore possible psychological factors to explain the disposition to stigmatize healthcare personnel (HP) in Mexico during the COVID-19 pandemic. In study one, 520 participants responded to three instruments that measure the disposition to stigmatize, the perceived contagion risk, and the positive beliefs towards HP. Results showed a generalized low disposition to stigmatization, where only a small percentage obtained high scores. A regression analysis identified that stigmatization towards HP can derive mainly from the perception of risk of contagion, although positive beliefs of HP decrease this disposition. The second study extends this finding by analyzing responses of 286 participants to seven instruments measuring factors hypothesized as predictors towards stigmatization: uncertainty generated by the pandemic, selfish strategies to face off the pandemic, social capital, trust in institutions, perceived vulnerability of contagion, perceived risk of contagion, and positive beliefs towards HP. A path analysis reveals that the main predictor of stigmatization is the perceived risk of contagion, increased by the strategy of selfishness, and the uncertainty generated by the pandemic. These results are discussed emphasizing the importance of cooperation and community ties to prevent the stigmatization of HP in the context of sanitary emergencies generated by contagious diseases.

An Automated Strategy to Handle Antigenic Variability in Immunisation Protocols, Part I: Nanopore Sequencing of Infectious Agent Variants.

Infectious agents often challenge therapeutics, from antibiotics resistance to antigenic variability affecting inoculation measures. Over the last decades, genome sequencing arose as an important ally to address such challenges. In bacterial infection, whole-genome-sequencing (WGS) supports tracking pathogenic alterations affecting the human microbiome. In viral infection, the analysis of the relevant sequence of nucleotides helps with determining historical variants of a virus and elucidates details about infection clusters and their distribution. Additionally, genome sequencing is now an important step in inoculation protocols, isolating target genes to design more robust immunisation assays. Ultimately, genetic engineering has empowered repurposing at scale, allowing long-lasting repeating clinical trials to be automated within a much shorter time-frame, by adjusting existing protocols. This is particularly important during sanitary emergencies as the ones caused by the 2014 West African Ebola outbreak, the Zika virus rapid spread in both South and North America in 2015, followed by Asia in 2016, and the pandemic caused by the SARS-CoV-2, which has infected more than 187 million people and caused more than 4 million deaths, worldwide, as per July 2021 statistics. In this scenery, this chapter presents a novel fully automated strategy to handle antigenic variability in immunisation protocols. The methodology comprises of two major steps (1) nanopore sequencing of infectious agent variants - the focus is on the SARS-CoV-2 and its variants; followed by (2) mRNA vector design for immunotherapy. This chapter presents the nanopore sequencing step and Chapter 17 introduces a protocol for mRNA vector design.

A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors.

Bangladesh suffered disruptions in the utilization of essential health and nutrition services (EHNS) during the COVID-19 pandemic. The magnitude of the pandemic has been documented, but little is known from the perspectives of health administrators. A rapid qualitative assessment of division-level capacity identified successes and bottlenecks in providing EHNS- and COVID-19-related services during the first months of the pandemic in Bangladesh. Semi-structured interviews were held with the Health and Family Planning Divisional Directors of the Ministry of Health and Family Welfare. The Primary Health Care System Framework guided the content analysis, focusing on (i) service delivery, (ii) communication and community outreach, and (iii) surveillance and service monitoring. Our findings identified low care seeking due to fears of getting infected and unawareness that EHNS were still available. Adaptations to telemedicine were highly heterogeneous between divisions, but collaboration with NGOs were fruitful in reinstating outreach activities. Guidelines were centered on COVID-19 information and less so on EHNS. The inflexibility of spending capacities at divisional and clinic levels hindered service provision. Misinformation and information voids were difficult to handle all around the country. Community health workers were useful for outreach communication. EHNS must be guaranteed during sanitary emergencies, and Bangladesh presented with both significant efforts and areas of opportunity for improvement.

Wastewater-based epidemiology: A Brazilian SARS-COV-2 surveillance experience

Since 2020, developed countries have rapidly shared both publicly and academically relevant wastewater surveillance information. Data on SARS-CoV-2 circulation is pivotal for guiding public health policies and improving the COVID-19 pandemic response. Conversely, low- and middle-income countries, such as Latin America and the Caribbean, showed timid activities in the Wastewater-Based Epidemiology (WBE) context. In these countries, isolated groups perform viral wastewater monitoring, and the data are unevenly shared or accessible to health agencies and the scientific community. This manuscript aims to highlight the relevance of a multiparty effort involving research, public health, and governmental agencies to support usage of WBE methodology to its full potential during the COVID-19 pandemic as part of a joint One Health surveillance approach. Thus, in this study, we explored the results obtained from wastewater surveillance in different regions of Brazil as a part of the COVID-19 Wastewater Monitoring Network ANA (National Water Agency), MCTI (Ministry of Science, Technology, and Innovations) and MS (Ministry of Health). Over the epidemiological weeks of 2021 and early 2022, viral RNA concentrations in wastewater followed epidemiological trends and variations. The highest viral loads in wastewater samples were detected during the second Brazilian wave of COVID-19. Corroborating international reports, our experience demonstrated usefulness of the WBE approach in viral surveillance. Wastewater surveillance allows hotspot identification, and therefore, early public health interventions. In addition, this methodology allows tracking of asymptomatic and oligosymptomatic individuals, who are generally underreported, especially in emerging countries with limited clinical testing capacity. Therefore, WBE undoubtedly contributes to improving public health responses in the context of this pandemic, as well as other sanitary emergencies.

Happy birthday to the Italian Territorial Emergency Service (118): Thirty years of your valuable service

Sunday 27th March 2022 marked 30 years of activity of the Italian Territorial Emergency Service, also known as “118”, which was officially set up in Italy on 27th March 1992 by a presidential decree, with the aim of creating a single number for sanitary emergencies that would operate 24 hours a day, seven days a week, free of charge throughout the country. [...]

A mixed-methods study on the design of Artificial Intelligence and data science-based strategies to inform public health responses to COVID-19 in different local health ecosystems: A study protocol for COLEV.

Background: Artificial Intelligence (AI) and data science research are promising tools to better inform public policy and public health responses, promoting automation and affordability. During the COVID-19 pandemic, AI has been an aid to forecast outbreak spread globally. The overall aim of the study is to contribute to the ongoing public health, socioeconomic, and communication challenges caused by COVID-19. Protocol: COLEV is a five-pronged interdisciplinary mixed methods project based on AI and data science from an inclusive perspective of age and gender to develop, implement, and communicate useful evidence for COVID-19-related response and recovery in Colombia. The first objective is identification of stakeholders' preferences, needs, and their use of AI and data science relative to other forms of evidence. The second objective will develop locally relevant mathematical models that will shed light on the possible impact, trajectories, geographical spread, and uncertainties of disease progression as well as risk assessment. The third objective focuses on estimating the effect of COVID-19 on other diseases, gender disparities and health system saturation. The fourth objective aims to analyze popular social networks to identify health-related trending interest and users that act as 'super spreaders' for information and misinformation. Finally, the fifth objective, aims at designing disruptive cross-media communication strategies to confront mis- and dis-information around COVID-19. To understand stakeholders' perspectives, we will use semi-structured interviews and ethnographic work. Daily cases and deaths of COVID-19 reported from the National Surveillance System (INS) of Colombia will be used for quantitative analysis, and data regarding the online conversation will be obtained from Facebook and Twitter. Conclusions: COLEV intends to facilitate the dialogue between academia and health policymakers. The results of COLEV will inform on the responsible, safe and ethical use of AI and data science for decision-making in the context of sanitary emergencies in deeply unequal settings.

Evaluation of a clinical orientation Call Center during the first months of the COVID-19 pandemic

During sanitary emergencies such as the recent pandemic, health services can collapse. In these cases, remote orientation services such as call centers may help to debottleneck these services. To assess the demand and problem resolution of a clinical guidance telephone service during the COVID-19 pandemic. The call registry between May and August 2020 of an orientation call center for COVID-19 was analyzed. The number of calls, sociodemographic features of callers, type of enquiry and given indications were described. We analyzed 1,278 telephone calls, corresponding to 655 people. Sixty nine percent of queries were resolved during the call and in 31% of calls, users were referred to face-to-face evaluation. Two percent of these referrals were to an emergency service. The call center had a high level of resolution, favoring remote consultation and reducing face-to-face care, improving users'accessibility.

Analysis of investment incentives for power generation based on an integrated plasma gasification combined cycle power plant using municipal solid waste

Municipal solid waste (MSW) high generation rate and final disposal are major issues for societies worldwide. In Colombia, projections warn about potential sanitary emergencies by 2030 due to ∼30% of current landfill short life span (0–3 years). Thus, this work aimed to assess the techno-economic performance of an Integrated Plasma Gasification Combined Cycle power plant (IPGCC) fueled with MSW. The effects of the plasma and reactor temperatures on the IPGCC efficiency were studied. The plant reached the best thermodynamic performance (32.49% efficiency) at a low reactor temperature (2000 °C) and at high plasma temperature (5000 °C) since torch power consumption decreased. At these conditions, the IPGCC power plant, processing 900 t/day, was able to generate ∼56 MWe. In the economic assessment, several financing scenarios were considered for the calculations of the levelized cost of energy (LCOE), which is used as an economic indicator. When the investment structure included 30% green bonds and 70% bank loans, the best LCOE (9.13 ¢US$/kWh) was obtained. Furthermore, if the generation project received a reliability charge of 1.70 ¢US$/kWh, the LCOE would decrease to 7.56 ¢US$/kWh, which could be competitive in the Colombian electricity market, whose 2020 average electricity price was 7.11 ¢US$/kWh.

Effect of the Colombian Renewable Energy Law on the Levelized Cost of a Substitute Gaseous Fuel Produced from MSW Gasification

Colombian municipal solid waste (MSW) production trends indicate that sanitary emergencies could occur in the largest cities of the country by 2030 because of the end of their landfills’ useful life. In this work, the energy recovery from different MSW through the updraft plasma gasification process to produce syngas as a substitute gaseous fuel was assessed from an economic viewpoint. The study was carried out using the results of an implemented model under a thermochemical approach using Aspen Plus. The economic assessment was conducted using the levelized cost of syngas production (LCOS), which was regarded as an economic indicator that considers tax incentives in the context of the Colombian renewable energy regulations (Law 715 of 2014). The combination between operational conditions (air flow and plasma temperature) allowed finding the maximum efficiency by means of a sensitivity analysis. The maximum efficiency ranged from 79,22 to 83,46%, highlighting the flexibility of the plasma gasification process to treat MSW. The lowest levelized syngas production cost reached with tax incentives varied from 13,19 to 22,95 ¢US$/kWh. Therefore, a waste disposal charge was proposed to make these projects feasible, which must range between 11,25 and 23,56 ¢US$/kWh (123-259 US$/t)

Anxiety and Perceived Risk in Red Cross Volunteer Personnel Facing the Coronavirus Disease 2019 Pandemic.

In the current situation of sanitary emergencies, humanitarian organizations and their volunteers are playing an important role in the coronavirus disease 2019 (COVID-19) pandemic. A study is proposed that includes a network of volunteers who perform humanitarian activities during the COVID-19 pandemic to assess anxiety, perceived risk, and response behaviors and to explore their relationship with sociodemographic variables. For data collection, an online questionnaire was developed through the Google Forms® platform, where the perceived risk, anxiety, and behavioral responses of the general population to the Influenza A (H1N1) pandemic were assessed. The survey presented is a modified version of that survey adapted for COVID-19. This adaptation was endorsed by an experts committee made up of the health chief of the Ecuadorian Red Cross, the focus point of operations from the International Federation of the Red Cross in Ecuador, and a member from the Health Unit of the Americas Regional Office of the International Federation of the Red Cross. A significant relationship has been shown between the job situation and perceived risk and anxiety, being the staff who worked full time away from home, which was exposed to greater risk and anxiety. Both perceived risk and perceived anxiety are very high (according to a 5-point Likert scale). Knowing these data from this first-line personnel will allow adopting measures that could be beneficial for stress management and, therefore, contribute to the well-being and support of these humanitarian and volunteer organizations in the worldwide response to COVID-1 9.

La radio indígena ante la pandemia de la Covid-19 en la Amazonía peruana. El caso de Radio Ucamara (Nauta, Loreto, Perú)

The indigenous communities in the Peruvian Amazon region have been harshly impacted by the COVID-19 pandemic. Practically after its arrival, different initiatives arose to provide adequate information in indigenous languages, as well as other directed to help alleviate and reduce the effects of the pandemic. In this article we analyze a project implemented to deal with COVID-19 pandemic and with other sanitary emergencies in general. This project was designed together with the team of indigenous and non-indigenous communicators in Radio Ucamara radio project, located in the city of Nauta (Loreto region), in the northeastern Amazon of Peru. The main objective of this project was to use the radio a communication hub that could allow the flow of information on health issues from the indigenous communities to the regional authorities, and vice versa, in such a way that it could promote timely and culturally relevant primary health interventions.

Frequency of acute stress disorder in health care workers of a tertiary level pediatric hospital during the National Safe Distance Strategy for COVID-19 prevention.

Acute stress disorder (ASD) is one of the most frequent mental illnesses occurring during sanitary emergencies. This study aimed to estimate the frequency of ASD in health care workers of a tertiary level pediatric hospital during the coronavirus disease (COVID-19) pandemic. We conducted a cross-sectional study in which health care workers completed a virtual questionnaire, including sociodemographic information and the ASD scale. We analyzed 206 questionnaires. The population was divided into three groups: attending physicians, medical residents, and nursing personnel. The frequency of health care workers who showed at least nine symptoms of ASD was 88.8%. No significant differences were found between the studied groups. ASD is a frequent condition in health care workers in the context of the COVID-19 pandemic. We need to investigate further and assess risk and protective factors for developing this and other psychopathologies in this population.

Genetic characterization of highly pathogenic avian Influenza H5Nx clade 2.3.4.4b reveals independent introductions in nigeria.

Among recurrent sanitary emergencies able to spread rapidly worldwide, avian influenza is one of the main constraints for animal health and food security. In West Africa, Nigeria has been experiencing repeated outbreaks of different strains of avian influenza virus (AIV) since 2006 and is also recognized as a hot spot in the region for the introduction of emerging strains by migratory wild birds. Here, we generated complete genomes of 20 highly pathogenic avian influenza (HPAI) H5N8 viruses collected during active surveillance in Nigerian live bird markets (LBM) and from outbreaks reported in the country between 2016 and 2019. Phylogenetic analysis reveals that the Nigerian viruses cluster into four separate genetic groups within HPAI H5 clade 2.3.4.4b. The first group includes 2016-2017 Nigerian viruses with high genetic similarity to H5N8 viruses detected in Central African countries, while the second includes Nigerian viruses collected both in LBM and poultry farms (2018-2019), as well as in Cameroon, Egypt and Siberia. A natural reassortant strain identified in 2019 represents the third group: H5N8 viruses with the same gene constellation were identified in 2018 in South Africa. Finally, the fourth introduction represents the first detection in the African continent of the H5N6 subtype, which is related to European viruses. Bayesian phylogeographic analyses confirmed that the four introductions originated from different sources and provide evidence of the virus spread within Nigeria, as well as diffusion beyond its borders. The multiple epidemiological links between Nigeria, Central and Southern African countries highlight the need for harmonized and coordinated surveillance system to control AIV impact. Improved surveillance at the Wetlands, LBMs and early warning of outbreaks are crucial for prevention and control of AIV, which can be potentially zoonotic and be a threat to human health.

Viral surveillance: Governing social isolation in São Paulo, Brazil, during the COVID-19 Pandemic.

In the context of COVID-19 pandemics, Brazilian cities implemented social isolation policies and deployed digital systems to monitor urban mobility. This article addresses the setting of two digital technologies based on massive cell-phone data collection by private companies in São Paulo state. We relied on secondary data from multiple sources (press conferences, interviews, newspaper articles, public documents), complemented by primary data from the authors’ ongoing research. In our analysis of heterogeneous and contingent techniques of pandemic control, we found that although these monitoring technologies seem to be effective in assisting public services and informing society, they also raise issues about performativity and transparency, with relevant consequences for their adoption in sanitary emergencies, and their potential legacy to São Paulo’s public safety management.