State Department Of Public Health Research Articles

An Analysis of COVID-19 Statistics in Rivers State, Nigeria: A Study of Demographic Patterns, Geographic Distribution, and Prevalent Symptoms from April 2020 to March 2021

Introduction: Coronavirus disease (COVID-19) is an acute infectious disease caused by the SARS-CoV-2 virus which is characterized mainly by fever and cough and is capable of progressing to severe symptoms and in some cases death. Aims: To analyze COVID-19 statistics in Rivers State, Nigeria, during the specified period to contribute to the broader understanding of the epidemiology of COVID-19 in the region. Methodology: Study Design: A cross-sectional study was conducted involving the retrieval of secondary data. Place and Duration of Study: The study was carried out at the Epidemiology Division of the Rivers State Department of Public Health, Ministry of Health, in December 2022. Participants: A total of 6,299 patients recorded between April 2020 to March 2021 in the Epidemiology Unit were included in the study. Patients with incomplete data were excluded from the analysis. Data Collection and Analysis: Secondary data recorded in Excel format was retrieved from the Epidemiology Unit of the Rivers State Ministry of Health. The data was then exported to IBM Statistical Product and Service Solutions (SPSS) version 25 for analysis. Frequencies were generated and reported in tabular format. Ethical Considerations: Ethical approval for the study was obtained from the Ethics Committee of the State Ministry of Health Board, Port Harcourt, ensuring compliance with ethical standards in research and the University of Port Harcourt Ethics Committee to the State Hospital Board. Results: The mortality rate stood at 1.4%. Port Harcourt Local Government Area (LGA) accounted for approximately two-thirds of all infections, while nearly one-third originated from Obio/Akpor LGA. Among those infected, 17.4% reported a history of travel, while 1% had attended a burial before contracting the virus. Symptomatic presentation was prevalent, with four out of every five confirmed cases (76.9%) experiencing various symptoms, with sore throat emerging as a common presentation alongside fever and other symptoms. Significant disparities were observed concerning the sex and age distribution of infections (p < 0.0001). Males were more affected than females, and individuals within the age groups of 31-40 and 41-50 constituted three-fifths of the total infections. Conclusion: As the COVID-19 pandemic unfolded, a notable shift in infection rates emerged, highlighting a trend where younger demographics, notably women, became increasingly susceptible. Despite initial perceptions of heightened severity and mortality among older males, nuanced analysis revealed diverse vulnerabilities across gender and age spectrums. Occupational exposures, biological variations, and behavioural disparities all contributed to the observed gender discrepancies in infection rates and outcomes. Furthermore, the urban landscape, with its higher population density and increased mobility, served as a catalyst for the rapid spread of the virus, albeit impacting genders in differing proportions. Moreover, the varied presentation of symptoms, with sore throat emerging as a prevalent feature alongside fever and other manifestations, underscores the necessity for tailored public health interventions.

Mortality due to cervical cancer in a capital of the brazilian Amazon

Objective: To analyze mortality from cervical cancer in the city of Belém-Pará-Brazil. Methods: Epidemiological, cross-sectional, descriptive study with data on mortality from cervical cancer for the period 2013-2020, obtained from the Mortality Information System and made available by the Pará State Department of Public Health. All reported deaths of women living in the municipality of Belém were included. Data were obtained in June 2022. A descriptive analysis of the socio-epidemiological profile was carried out; mortality rates were calculated according to the year of occurrence; and trend analysis was performed using simple linear regression. Results: A total of 695 deaths were analyzed, with the highest proportion identified in women aged between 50 and 69 years old (43%; n=149), housewives (59%; n=410), single women (39.9%; n=277) and low education, proportionally. The rates were high and tended to increase in the series studied. The period 2015-2017 stands out as the most significant indices. Conclusion: The evidence obtained points to a higher proportion of deaths from CC among women with low education, housewives, single women, aged between 50 and 69 years old. The findings suggest improving actions to promote women's health and prevent cervical cancer, with improvements in screening actions for the disease.

Tuberculose latente entre pessoas vivendo com HIV e contatos num estado hiperendêmico

Abstract Objective To assess latent tuberculosis among people living with HIV and contacts of people with tuberculosis. Methods This is a cross-sectional, quantitative study, carried out in the state of Pará, based on cases of latent tuberculosis infection reported between 2019 and 2020. Data were extracted from the Latent Tuberculosis Infection Information System, at the State Department of Public Health, from November to December 2021. For analysis, descriptive statistics, chi-square test and G test were used, in addition to prevalence ratio, in Bioestat 5.3, with a significance level of 5%. Results A total of 1,116 cases of latent tuberculosis were studied: 653 in 2019 and 463 in 2020. The outcome indicated a low proportion of complete treatments (n=734). Among the records, 371 were of people living with HIV and 416 were of contacts of tuberculosis cases. An association was observed between latent infection in people living with HIV and contacts with the variables sex, age, origin and termination situation (p<0.0001). Conclusion Latent tuberculosis in people living with HIV and contacts presents different patterns when associated with the sociodemographic profile, making it necessary to prioritize the identification of these groups in order to adopt strategic actions that impact disease management.

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion

Hepatitis C screening in a community pharmacy setting: Patient perspective

BackgroundHepatitis C virus (HCV) is an infection of the liver, which contributes to over 15,000 deaths in the United States annually. When treated, HCV has a 90% or greater cure rate, however testing for HCV remains low. ObjectivesTo assess patient perspectives on HCV screenings in the community pharmacy setting including awareness of screening, willingness to be screened, barriers to screening, and willingness to pay for HCV screening. MethodsThis study used a cross-sectional survey design. The surveys were distributed by staff at an independent community pharmacy participating in an HCV screening initiative through the state department of public health. Eligible patients were born between 1945 and 1965. Descriptive statistics were calculated for survey variables. Open-ended responses were analyzed for additional context. ResultsFifty-seven surveys were returned and analyzed. The majority of the respondents were White (94%), female (56%), and had some college education (26%). Only 7% were aware that a finger-stick point-of-care test was available and 67% were unaware of the Centers for Disease Control and Prevention (CDC) recommendation for testing. The most frequently reported barrier or hesitation to screening was the patient not thinking they were at risk (29%) followed by uncertainty about cost (14%). Over half of respondents (63%) were either somewhat interested or very interested in testing in a community pharmacy, however, the majority (71%) were not willing to pay or only willing to pay less than $20. ConclusionsSurvey respondents were largely unaware of the recommendations and availability of finger-stick HCV screenings at community pharmacies but many were willing to be tested if low-cost. Providing patient education on the importance of HCV screenings and CDC recommendations may bolster interest in screening.

AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis.

In this ecological study, data from 2007 to 2018 were extracted from the Mortality Information System provided by the State Department of Public Health of Pará. For the temporal analysis, the integrated autoregressive model of moving average (ARIMA) and locally weighted polynomial regression (STLF) were used to forecast AIDS mortality from 2019 to 2022. For the spatial analysis, spatial autocorrelation and geographically weighted regression (GWR) analyses were employed. The samples consisted of 6,498 notifications for AIDS-related deaths. From 2007 to 2013, the AIDS mortality rates showed an upward trend, followed by a stabilization until 2018 and an upward forecasted trend from 2019 to 2022. High mortality rates and high-high clusters were found in economic pole municipalities. Furthermore, AIDS mortality risk was directly associated with per capita income and demographic density, except in the southwestern region of Pará, which exhibited an inverse association with population density. Although the policies against HIV may have contributed to the stabilization of AIDS mortality rates from 2013 in Pará, the upward forecasted trend until 2022 raises an alert and concern to health authorities to provide reinforcement of the policies. The geographic variability of AIDS mortality promoted by SDH provides subsidies to health authorities to implement SDH-focused strategies for AIDS mortality reduction.

Incidência de malária entre indígenas associada à presença de garimpos

ABSTRACT Objective: To analyze the incidence of malaria among indigenous people associated with the presence of artisanal miningin the state of Pará. Method: Analytical, cross-sectional study conducted with 20,774 cases of malaria in indigenous people in the state of Pará (2011 to 2020). The data came from the Malaria Epidemiological Surveillance Information System, obtained from the Pará State Department of Public Health. In the analysis, Spearman’s correlation coefficient was used, with a significance of 5% (p < 0.05). Results: Incidence rates were high, especially in the Tapajós River Indigenous Special Health District (372.2/1,000 inhabitants). There was association between the incidence of malaria and the presence of indigenous people in artisanalmining activities on the Tapajós River (p=0.0008). Conclusion: The occurrence of malaria is unequal among the Special Indigenous Health Districts, being more frequent in those with greater mining activity, configuring exposure to the disease. It is necessary to adopt intersectoral measures, especially in areas of vulnerability to illness.

1365. Public Health’s Role in ECHO via the Experiences of a State Department of Public Health

Abstract Background In April 2019, Georgia became the second state department of public health to implement and utilize an ECHO program to unite the Ryan White Part B HIV community. Project ECHO is a global telementoring program used to provide cutting-edge medical techniques and knowledge to medical providers in rural settings with fewer resources. Today, the GA-DPH ECHO program reaches over 300 individuals at the local, state, national, and international levels, providing essential insight to healthcare workers and a forum for discussion in several key fields, including infectious diseases and viral hepatitis. The objective is to reveal via participation and demographical data drawn from ECHO sessions the challenges and successes in implementing and potential expanded utility of this type of program within public health, ultimately demonstrating why public health has an important role within the ECHO community. Image 1Map of United States showing outreach of GA-DPH Project ECHO. The map does not include one user based in Africa. Methods iECHO, a partner relations management tool, was utilized in extracting demographical and participation from all GA-DPH ECHO sessions from 2019 to 2021. Data was chosen based on participation over time for each ECHO in addition to who was attending sessions while determining variations in attendance. Once compiled, data was charted into tables with iECHO software utilization to construct graphs illustrating trends over time for each ECHO to be analyzed for future expansion and evaluate the challenges. Results The data revealed a steady growth of GA-DPH ECHO specifically the pilot infectious disease ECHO in 2019 which has grown from 14 attendees at the time to 20. A large attendance spike coincided with ECHO initiations of acute stroke and cancer registry in January 2021, with March 2021 the most attended month for the three ECHOs existing at the time. Initiated in April 2021, viral hepatitis quickly produced the most didactic sessions than any other program. ECHO Figure 1 Graph of participation in 2021 for all five ECHOs with the highest attendance for three ECHOs during March 2021. Sessions are scheduled monthly or bi-monthly (representing months with 0 attendance) and are 1-hour in length Figure 2Graph of participation for Infectious Disease ECHO from 2019-2021, noted as the first GA-DPH ECHO, starting 21 months prior to other GA-DPH ECHOsTable 1Average and total attendees for each ECHO in addition to the date of initiation and a total number of sessions. Average number of attendees include individuals registered with GA-DPH ECHO as well as anonymous (unregistered) users who join via invitation. Conclusion GA-DPH Project ECHO has grown in attendees with a variety of sessions offered and plans for further growth and initiation of new ECHO topics. While there have been challenges, there have been far more successes with the development of 5-ECHOs. The hope is experiences of GA-DPH ECHO will show how this platform may be utilized in departments of public health across the globe. Disclosures All Authors: No reported disclosures.

Adapting an evidence-based cancer survivor lifestyle program for cancer prevention and control in African American and Hispanic/Latino communities.

10545 Background: Cancer is the second leading cause of death in Wisconsin with higher mortality rates observed for Black/African American (B/AA) and Hispanic/Latino(a) (Hisp/Lat) communities. Affordable lifestyle interventions targeting healthy nutrition and physical activity patterns tailored to the needs/interests of these communities are critically needed to prevent and control cancer. In this project, we adapted the evidence-based Moving Forward lifestyle program for B/AA breast cancer survivors, which included a program workbook, in-person education/supervised exercise classes, and text messages. We sought to address cancer prevention among B/AA and Hisp/Lat community members in the general population by implementing the program within an urban public recreation system for sustainability. Methods: To help guide the adaptation process, project partners included an academic cancer center, an urban public recreation system, the state department of public health, and a community advisory board. Our approach comprised of focus groups with B/AA and Hisp/Lat residents, surveys collected at community events, and an After-Action Review of a 4-week program pilot. Results: One-hundred community members (58 B/AA and 42 Hisp/Lat) participated in the adaptation phase through eight focus groups (N = 27), 48 surveys, and 25 pilot participants. Seven key program content adaptations were targeted: 1) integrate information on basic cancer biology; 2) explain the association between cancer, nutrition and physical activity; 3) address other diseases besides cancer (heart disease, diabetes); 4) provide cooking demonstrations with culturally relevant tips to facilitate dietary changes; 5) update workbook images and content to reflect race/ethnicity of targeted populations; 6) add information on cancer screening; 7) provide information on local healthy eating and exercise resources. Key adaptations related to conducting the program within a public recreation system included: 1) dividing the program into two 8-week sessions to meet the public recreation system program calendar; 2) eliminating the text message component; 3) providing the program workbook/classes in English and Spanish; and 4) integrating different exercise approaches to meet needs/interests of different age groups, genders, and different fitness levels. Conclusions: Community-academic partnerships and ongoing community engagement led to meaningful adaptations to a cancer prevention and lifestyle program to address cancer disparities in the B/AA and Hisp/Lat communities.

Using Surveillance With Near-Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019.

In 2019, Connecticut launched an opioid overdose-monitoring program to provide rapid intervention and limit opioid overdose-related harms. The Connecticut Statewide Opioid Response Directive (SWORD)-a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups-required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients' status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD's near-real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

Changes in COVID-19-Associated Deaths During a Year Among Blacks and Hispanics Compared to Whites in the State of Connecticut.

Background With recent COVID-19 vaccination rates relatively high in the USA, the USA still maintains the most documented cases globally,[1] even though COVID-19 cases, hospitalization, and mortality have been declining. However, the health burden has been largely felt in communities involving racial and ethnic minorities. Thus, in order to provide a clearer picture of what is happening in Black, Indigenous, and people of color communities, we examined the racial/ethnic differences of monthly COVID-19 deaths in Connecticut.MethodsThis is an epidemiological study analyzing mortality data from March 1, 2020, to February 28, 2021, obtained from the Connecticut State Department of Public Health. The data include cause of death (COVID-19 death identified by ICD-10 code U071), race/ethnicity (non-Hispanic White (White), non-Hispanic Black (Black), and Hispanic), sex, and age. Both crude and age-adjusted rates were reported by racial/ethnic groups. To compare age-adjusted rates between racial groups, with estimated age-adjusted death counts as outcomes, between-racial group rate ratios, 95% confidence intervals, and p values significant at < 0.05 were derived from the Poisson regression model.ResultsFrom March 2020 to May 2020 (wave 1) of COVID-19 cases, the COVID-19-related mortality rates were the highest for all three race groups (Whites, Blacks, and Hispanics) with statistical group differences (p < 0.05). Blacks had the highest rates of deaths followed by Hispanics and then Whites. Further, more Whites died in a nursing home when compared to Blacks and Hispanics. From June 2010 to October 2020 (wave 2), COVID-19 mortality declined significantly for all three race groups with no statistical differences between groups. COVID-19 deaths in nursing homes declined for all three racial/ethnic groups. From November 2020 to February 2021 (wave 3), COVID-19 mortality rates were significantly higher compared to wave 2 but lower than wave 1 for all three race groups. The mortality rates for Blacks and Hispanics were higher than Whites. Hispanics had the highest rates of deaths, followed by Blacks, and then Whites (p < 0.05). Whites showed the lowest mortality rates among all three racial/ethnic groups.ConclusionsIn summary, COVID-19 health disparities among Black and Hispanic populations were evident in this study. Blacks and Hispanics had significantly higher mortality rates when compared to Whites. Blacks had the highest mortality rates during wave 1, and in wave 3, Hispanics has the highest mortality rates. Our data are important because they show monthly COVID-19 deaths data by race. Data reported this way gives a better and more accurate understanding of what is really happening in Black, Indigenous, and people of color populations.

Evaluation of a Multisite Safe Infant Sleep Education and Crib Distribution Program.

Rates of sleep-related infant deaths have plateaued in the past few decades despite ongoing infant sleep practice recommendations to reduce risk of sleep-related infant deaths by the American Academy of Pediatrics. The state department of public health trained facilitators at 28 sites across the state to facilitate a group safe sleep educational program. A prospective, matched pre- and post-test cohort design with follow-up was used to evaluate changes in self-reported knowledge, intentions, and practices. The final sample included 615 matched pre- and post-test surveys, and 66 matched follow-up surveys. The proportion of correct responses on all knowledge and intended practice items increased significantly from pre- to post-test. When asked where their babies would have slept if they had not received the portable crib, 66.1% of participants planned to use a recommended sleep location (e.g., crib or bassinet). At post-test, 62.3% planned to change something about their infant’s sleep based on what they learned. At follow-up, knowledge was maintained for all but two items and practices and for half of practice items. The results suggest that participating in the education program was associated with increased knowledge and intended adherence, but that these changes were not maintained at follow-up. These results are in line with the research literature that finds a difference in intentions and actual practices after the baby is born.

Opioid Prescribing After Implementation of Single Click Access to a State Prescription Drug Monitoring Program Database in a Health System's Electronic Health Record.

To determine the effect of one-click integration of a state's prescription drug monitoring program (PDMP) on the number of PDMP searches and opioid prescriptions, stratified by specialty. Our large health system worked with the state department of public health to integrate the PDMP with the electronic health record (EHR), which enabled providers to query the data with a single click inside the EHR environment. We evaluated Schedule II or III opioid prescriptions reported to the Massachusetts PDMP 6 months before (November 15, 2017-May 15, 2018) and 6 months after (May 16, 2018, to November 16, 2018) integration. Search counts, prescriptions, patients, morphine milligram equivalents, as well as prescriber specialty were compared. There were 3,185 unique prescribers with a record of a Schedule II and/or III opioid prescription in both study periods that met inclusion criteria. After integration, the number of PDMP searches increased from 208,684 in the pre-integration phase to 298,478 searches in the post-integration phase (+43.0%). The number of opioid prescriptions dispensed decreased by 4.8%, the number of patients receiving a prescription decreased by 5.1%, and the mean morphine milligram equivalents (MMEs) per prescriber decreased by 5.4%. There were some notable specialty-specific differences in these measures. Integration of the PDMP into the EHR markedly increased the number of searches but was associated with modest decreases in opioids prescribed and patients receiving a prescription. Single click EHR integration of the PDMP, if implemented broadly, may be a way for states to significantly increase PDMP utilization.

The COVID-19 Global Pandemic

INTRODUCTIONThe recent outbreak of a novel coronavirus illness (COVID-19) has grown into a global pandemic. As a response, there have been several treatment recommendations published by international, federal, state, and local governing bodies.METHODSWe performed a comprehensive review of COVID-19 policies and aggregated multi-disciplinary expertise at our quaternary care academic facility to formulate objective criteria for scheduling surgery, providing neurosurgical coverage, and engaging in neurosurgical research during the COVID-19 outbreak. Recommendations from the CDC, WHO, California State Department of Public Health (CDPH), San Francisco Department of Public Health (SFDPH), and the UCSF School of Medicine were collected and reviewed by the expert panel. Treatment algorithms regarding the following issues were drafted: (1) neurosurgical case scheduling, (2) neurosurgical clinic scheduling, (3) contingency plans for neurosurgical staffing and ICU utilization, and (4) staffing neurosurgical research directives.RESULTSHere, we present a neurosurgical treatment algorithm for varying levels of COVID-19 community infection. This algorithm (with an accompanying checklist) is centered around a three-tiered system of viral ‘surge’ quantification, which we use to triage case scheduling, and a paired coverage model for inpatient services.CONCLUSIONCOVID-19 represents a challenge to ongoing practice, however with clear algorithms, checklists, and contingency planning, it is possible to provide focused neurosurgical care during this pandemic.

Association Between Cardiac Surgeons’ Number of Years in Practice and Surgical Outcomes in New York Cardiac Centers

More than half of US cardiothoracic surgeons are older than 55 years, and the association between surgeon number of years in practice and surgical outcomes remains unclear. To assess the association between cardiac surgeons' time in practice and operative outcomes for coronary artery bypass grafting (CABG) and valve surgery. Cross-sectional analysis performed of surgeon-level outcomes data from the 2014-2016 New York State Cardiac Data Reporting System across the 38 New York cardiac surgery centers. Years in practice were characterized as early career (<10 years) and late career (≥10 years). Participants were 120 cardiothoracic surgeons who performed CABG and 112 cardiothoracic surgeons who performed valve procedures between 2014 and 2016. Data were analyzed in April 2020. Surgeons who trained outside of the United States or had unclear training history were excluded. Risk-adjusted operative mortality rate (RAMR). Mortality was defined as all-cause death within 30 days of surgery or within the index hospitalization, whichever was longer. Risk adjustment was performed by a multivariable risk model developed by the New York State Department of Public Health. Restricted cubic spline curve identified the association between risk-adjusted mortality rate and surgeon number of years in practice. Linear regression models adjusted for surgeons' annual case volumes. A total of 112 CABG surgeons and 120 valve surgeons performed 39 436 CABG and 18 596 valve procedures between 2014 and 2016. The median number of surgeon years in practice was 20.0 (interquartile range [IQR], 12.0-28.5) years. The median surgeon annual case volume was 160.0 (IQR, 92.5-245.0) for CABG procedures and 104.0 (IQR, 43.0-210.0) for valve procedures. The median RAMR was 1.3% (IQR, 0.2%-2.2%) for CABG procedures and 3.1% (IQR, 1.7%-5.1%) for valve procedures. Surgeons with less than 10 years of practice had higher RAMR for valve procedures compared with surgeons with more than 10 years of practice (4.0 [IQR, 1.5-7.7] vs 2.9 [IQR, 1.7-4.7]; P = .20), but the finding was not statistically signficant. The RAMR for surgeons with less than 10 years of practice was similar compared with surgeons with more than 10 years of practice for CABG procedures (1.3 [IQR, 0.3-2.1] vs 1.3 [IQR, 0.0-2.2]; P = .73). A lower number of years in practice was significantly associated with higher RAMR for valve procedures (RAMR estimates for linear term: -1.144; 95% CI, -1.955 to -0.332; P = .006; quadratic term: 0.059; 95% CI, 0.015 to 1.102; P = .008; and cubic term: -0.001; 95% CI, -0.002 to 0.000; P = .01). This association was not observed for CABG. In this cross-sectional study, compared with late-career cardiac surgeons, early-career cardiac surgeons were associated with worse risk-adjusted outcomes for valve operations but not for CABG. This finding suggests certain competence deficiency for valve surgery early after finishing training in cardiac surgery.

Covid-19 e o cenário atual da Cidade de Castanhal –PA, Brasil

A COVID-19, doença descoberta em 31 de dezembro de 2019, possui os sintomas semelhantes aos de uma gripe comum, e impacta a vida da população mundial de forma gradativa. Um estudo realizado pela Universidade Federal de Pelotas (UFPEL), apontou 11 cidades situadas na região norte com percentual elevado de contaminações pela COVID-19. O município de Castanhal, localizado no nordeste do Estado do Pará, Amazônia, Brasil, destaca-se entre as cidades brasileiras com uma das maiores taxas de contaminação, estando alocada em terceiro lugar no ranking nacional do índice de prevalência. Desse modo, este artigo tem como objetivo verificar os índices da COVID-19 em Castanhal-Pará, Brasil. Metodologicamente, realizou-se o levantamento de dados no site da Secretaria Estadual de Saúde Pública do Pará (SESPA), além da pesquisa bibliográfica, com abordagem quanti-qualitativa que consiste no envolvimento de métodos mistos. Nos resultados, constatou-se o aumento da taxa de casos confirmados assim como de óbitos e recuperados. De apenas 01 caso confirmado no dia 27 de março de 2020, o município passou para 1.215 confirmações da COVID-19 até o dia 12 de Junho de 2020. Além disso, verificou-se a função estratégica da cidade de Castanhal para o funcionamento de parte significativa de municípios do nordeste paraense. Conclui-se que várias medidas estaduais e municipais foram tomadas, na tentativa de enfrentar a COVID-19, porém são necessários cuidados contínuos, tanto da população, quanto do poder público no combate ao novo coronavírus.

P158 Implementation of an I + PSE Technical Assistance Opportunity to Reduce Childhood Obesity: A Qualitative Evaluation of Facilitators, Barriers, and Outcomes

<h3>Background</h3> Childhood obesity is disproportionately higher among low-income women and children, racial and ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living (HEAL) initiatives are beginning to apply an individual + policy, systems, and environmental (I + PSE) framework for change. <h3>Objective</h3> Development of strategic plans to include I + PSE into 4 states' nutrition programming. <h3>Study Design, Setting, Participants</h3> Four, State Department of Public Health, Title V, maternal and child nutrition leaders participated in a 12-month technical assistance (TA) opportunity to develop strategic plans to include I + PSE into each state's nutrition programming. TA was delivered through a combination of online modules, community of practice group meetings, and individual coaching sessions. <h3>Measurable Outcome/Analysis</h3> Semi-structured, in-depth interviews were conducted post TA delivery with the 4 state nutrition leaders. Interviews were audio-recorded and transcribed verbatim. Two independent coders used qualitative content analysis to analyze the data characterizing themes and sub-themes. <h3>Results</h3> Facilitators to implementing I + PSE in state program planning included having education delivered through online modules, a community of practice to discuss ideas and issues that arose, individual coaching to address local barriers to implementation and supervisor support. Barriers identified were time and funding limitations, working in isolation, and lack of self-efficacy and infrastructure. Co-learning helped TA participants to overcome stagnancy and promote development of creative solutions. Participants recognized relationship-building as integral to systems development. <h3>Conclusions</h3> The TA identified factors that drive improved nutrition programming utilizing I + PSE in the planning process. Inclusion of both upstream and downstream influences is key to achieving optimal impact to improve HEAL in individuals and communities.

Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm.

Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm.

On the Frontlines: Rural Iowa Latino/a Ministries during COVID-19

On the Frontlines: Rural Iowa Latino/a Ministries during COVID-19 Kristy Nabhan-Warren34 This past summer, I had the opportunity to be a part of a conversation about how COVID-19 has impacted Eastern Iowa Catholics among local church leaders. These individuals, who are part of the Diocese of Davenport, have decades of experience ministering to an increasingly diverse community of white, Latino/a, Vietnamese, and Burmese parishioners. Before COVID-19 hit the state in the spring, they met in person each month over coffee and pastries; these days they gather over Zoom and have coffee virtually. Yet the joys and challenges of serving multicultural and multilingual populations remains the focus of their conversations. While Iowa is a predominantly white and rural state, the sizeable and growing number of Latinos/as and their ongoing economic and social precarity are of particular concern for these men and women who are committed to a more just church and society. Three interlocking themes emerged from the Zoom meeting: Work is dangerous; There is so much fear; and Latino/a Catholics want community. Work is Dangerous According to Father Guillermo Treviño, the parochial vicar of St. Joseph parish in West Liberty and St. Patrick parish in Iowa City, Spanish-speaking parishioners have been “living in fear” because of immigration laws, potential ICE raids, and now COVID-19. Most Latinos/as in his parishes work in meatpacking at the turkey processing plant in town, West Liberty Foods, or at nearby Columbus Junction’s Tyson hog processing plant. As we have seen in the news, Latino/a workers have contracted COVID-19 at packing plants across Iowa at an alarming rate, as the slaughterhouses have been slow to respond at [End Page 18] best, negligent at worst, in addressing their workers’ safety.35 What we have not heard about as much, says Father Guillermo, is that Latinos/as and other refugees infected with COVID-19 end up spreading it to their family members, as they tend to live in multi-generational homes.36 What Father Guillermo has learned in working closely with his Spanish-speaking parishioners in West Liberty and Iowa City is that some Latinos/as who work at the meatpacking plants and who have COVID-19 have hid their symptoms and continued to work at the plants because they need the paycheck and are afraid of getting fired. According to Father Guillermo, around 500 workers at West Liberty’s turkey plant have been sickened by COVID-19. Some have died. The other Zoom participants nod in agreement when he mentions that the state has not been fully honest in its reporting of the numbers of COVID-19 cases. “The numbers are higher than they have been reported,” Father Guillermo says with a shake of his head. He continues to shake his head, looking down, as he talks about presiding over three COVID-19 funerals for Spanish-speaking parishioners in the past several months, all of whom were infected by the virus at the turkey processing plant. Father Guillermo is correct in his assessment that COVID-19 cases have been underreported in the state of Iowa. A recent report found that Iowa’s State Department of Public Health had recorded 221 cases of COVID-19 in the Tyson plant, whereas the company has counted 522 cases.37 As we have seen on a national scale in the meatpacking industry, Iowa slaughterhouses have been veritable petri dishes for the virus to develop and spread. Workers perform their jobs side by side, mere inches apart and nowhere near the recommended six feet.38 [End Page 19] Father Guillermo says that almost all of his parishioners who have contracted COVID-19 contracted it from the packing plant, or live with someone who works at a packing plant. He emphasizes that for Latinos/as in particular, the family is the central unit and extended families tend to live together, making is impossible for them to maintain social distancing.39 Father Guillermo’s ministerial relationship with his parishioners was complicated during COVID-19 when the vice president of West Liberty Foods asked him to serve as a translator and go-between for the company and his Spanish...

Crianças belas, sadias e robustas: o futuro da raça brasileira nas políticas de proteção à infância em Santa Catarina nos idos de 1940

O presente artigo analisa a relação entre o discurso médico-higienista, a eugenia e a consolidação de um pensamento racial no atendimento à pequena infância nos anos 1940, em Santa Catarina. Práticas médico-higiênicas são organizadas e difundidas pelo Departamento de Saúde Pública do estado por meio de campanhas em prol da formação de uma raça forte e sadia. Entre elas, o Concurso Infantil de Robustez e Beleza, que premiava as mães das crianças saudáveis e eugenicamente belas. O Concurso Infantil de Robustez e Beleza foi promovido e intensamente divulgado pela imprensa da época, em particular o jornal A Gazeta, que atuava em consonância com o projeto de educação higiênica e eugênica do governo Nereu Ramos. A pesquisa apontou para a evidência de um projeto nacional que visava à regeneração das crianças, especialmente as negras e pobres. Tomamos como fontes para o levantamento de dados os jornais A Gazeta e Republica e relatórios da Legião Brasileira de Assistência, que tratam do concurso, do Centro de Puericultura, Proteção à Infância e à Maternidade, Assistência Profilática, Cozinha Dietética e Serviço de Higiene da capital.