System Preparedness Research Articles

Wicked problems of early-COVID-19 response: A content analysis of public emergent norms

COVID-19 acted as a "Disease X", challenging governments around the world in early 2020. Rightly or wrongly, a local government in China handled the pandemic response with great uncertainty, triggering immediate consequences. While the world has entered the post-COVID era, it is still unknown how residents perceived the governmental responses in aligning policies to the public needs under such a great level of uncertainty. This study reevaluated the public's perception of the earliest Chinese government response to the COVID-19 pandemic using the interpretivist paradigm and content analysis. The qualitative and inductive research design used a snowball sampling method and collected 111 semi-structured questionnaire responses in February 2020. A framework of three themes, eight categories, and forty-five codes was developed from the findings, covering knowledge of the virus, information sources, information reliability, quarantine communication, quarantine support, needs during quarantine, improvement recommendations, and hopes and questions. Built from the lived experiences of the Chinese public during the first COVID-19 lockdowns, the posited framework encapsulated the public's perception of the government's response to this pandemic. To conclude, we drew three policy recommendations based on the three key themes to improve preparedness for future health crises and pandemics—disaster communication, integrated pandemic preparedness system, and hope and uncertainty. In particular, (1) a government-developed public information system can promote two-way communication and reduce information asymmetry; (2) an integrated system can better coordinate resource allocation; (3) the warning messages can correspond to the hope and positive feelings in the public norms.

Hospital-Level COVID-19 Preparedness and Crisis Management in Czechia.

Objectives: The COVID-19 pandemic exposed the inadequacy of pandemic preparedness mechanisms worldwide. This study gathered comprehensive data from Czech hospitals, identified possible weaknesses in important areas of crisis preparedness, and quantified changes performed to enhance crisis resilience of healthcare facilities. Methods: Drawing on literature review on pandemic preparedness and hospital crisis management and detailed interviews with hospital representatives, a questionnaire was designed and distributed by email among quality managers of all Czech hospitals. Statistical analysis of their responses was conducted using EZR software. Fisher's exact test and Kruskal-Wallis test, with post hoc testing, were used to assess statistical significance. Results: Achieving response rate of 31.9%, responses from 65 hospitals were analysed. New crisis management policies were necessary in 72.3% of responding hospitals. Furthermore, a majority of the respondents changes indicated the need for changes in policies on general pandemic, human resources and infrastructure and material preparedness. Conclusion: The COVID-19 crisis required significant alterations to previously established hospital crisis management protocols and establishment of new ones. The absence of a unified system for crisis preparedness was noted at hospital and national levels.

The impact of the COVID-19 pandemic on medical treatment activities in some provinces in Vietnam, 2021

ABSTRACT Objectives: 1) describe medical treatment performance and 2) investigate the changing patterns of medical treatment performance in some provinces in Vietnam during the COVID-19 pandemic in 2021. Methods: A retrospective descriptive study of secondary data was conducted by using secondary data from The District Health Information Software, a reporting platform operated by the Vietnam Ministry of Health. Result: A significantly declining trend in patterns of medical treatment activities was observed during the SARS-CoV-2 outbreak, and most utilization measures have not returned to their pre-outbreak levels as of January 2021. The incidence rate ratio (IRR) was 0.99, that is, if one more COVID case was found in the community /100,000 population, the number of medical treatment activities would be significantly reduced by 0.1% with p<0,01. Conclusion: This study emphasizes the need to strengthen the health system's preparedness capability to cope with the pandemic and future disasters. Keywords: COVID-19, impact, medical treatment activities

P143: New therapies for Alzheimer’s dementia and its implications on healthcare system: are we ready?

Objective:The amyloid hypothesis suggests that errors in production, accumulation, or disposal of beta-amyloid are the primary causes of Alzheimer's disease (AD). Since this was hypothesized, there has been significant effort in developing treatments that prevent the build-up of amyloid beta (Aβ) plaques in the brain. A disease modifying therapy (DMT) changes the clinical progression of AD by interfering in its pathophysiological mechanisms.The aim of this article is to review the current literature regarding the role of new DMTs for Alzheimer’s dementia and assess the preparedness of health care systems to implement these treatment options.Methods:Review of the most recent literature regarding the role of new DMTs for Alzheimer’s dementia and the challenges faced by the health care system to implement these treatment options. The research was carried out through the PubMed and UptoDate databases, using the terms “amyloid hypothesis”, “Alzheimer”, “disease modifying treatments” and “dementia”.Results:Research has been focusing on developing monoclonal antibodies as potential DMTs that target Aβ. Aducanumab, a human antibody, or immunotherapy, is the only disease-modifying medication currently approved to treat AD. It targets the Aβ protein and helps to reduce amyloid plaques and is currently the only FDA approved medication to slow the progression of AD. Lecanemab, a humanized IgG1 monoclonal antibody, binds to Aβ soluble protofibrils with high affinity. Even though there is considerable optimism about its potential, lecanemab will probably be more useful to patients on early stages of the disease.Conclusion:DMTs administration obeys to certain needs such as a vacancy in Day Hospital for infusion and regular monitorization and for lumbar punction. It demands a complex network involving general practitioner, neurologist, psychiatrist, psychologist, and social services. It also involves a genetic study and complementary diagnosis exams such as PET (Positron emission tomography) scans and MRIs (Magnetic resonance imaging), which are expensive. There is an emerging need to develop enhanced and safer treatments.

The effectiveness of facility-based management of children with Severe acute malnutrition and their determinants in Jharkhand, India: A retrospective study.

Children with Severe acute malnutrition (SAM) experience a high risk of disease and developmental delays contributing to large scale morbidity and mortality particularly in the developing world with existing progress inadequate to attain the Sustainable Development Goal for improved nutrition, and the cessation of all forms of undernourishment by 2030.The study objective was to assess the functioning and effectiveness of facility-based management of children with SAM in terms of their recovery (anthropometric indicators), adherence to discharge, and follow-up guidelines. This secondary data analysis obtained data from the physical patient registers of two malnutrition treatment centres (MTCs) located in the Jamtara district of Jharkhand. Information of 245 children admitted to these MTCs from April 2019-April 2020 was obtained consecutively including anthropometric outcome (weight, length, and Mean Upper Arm Circumference) measurements during the period of their admission. The primary outcome was the proportion of children who attained the recommended discharge criterion of greater than 15% weight gain at the time of discharge. The mean (SD) age of the children with SAM was 1.52 (0.73) years including 55.1% females and 44.9% males. There were 38% of children had a MUAC below 11.5 cm, and 62% had a Z score for weight for height below -3SD. The mean (SD) length of admission stay at the MTCs was 17.16 (5.76) days. A statistically significant improvement in the mean weight and MUAC at discharge was found although the effect size was small (0.98 kg). Only 105 (44.3%) (n=237) children with SAM achieved recovery as per the discharge criterion requirement of ≥15% weight gain since the time of admission. The mean (SD) duration of stay of the children who recovered was 20.43 (5.64) days, being significantly higher compared to the children who failed to recover as per the weight guidelines 14.59 (4.4) days (p < 0.001). MTCs were effective in the management of children with SAM although the recovery rate through weight gain criterion was poor due to premature discharge and lack of follow-up suggestive of a high-burden of adverse social determinants and inadequate health system sensitization and preparedness.

Quality of Life Health Outcomes Among People Who Lived in a Nursing Home Prior to and During the COVID-19 Pandemic.

The purpose of the current study was to compare quality of life health outcomes during the year prior to and first year of the coronavirus disease 2019 (COVID-19) pandemic among people who lived in a nursing home. This study used quarterly cross-sectional data from Minimum Data Sets between March 2019 and March 2021 among 96 people who resided in a nursing home. Health outcomes were cognitive function, transfer ability, depression, rejecting care, falls, urinary tract infections, physical conflict, and verbal conflict. Data were analyzed using Stuart-Maxwell test to compare differences in health outcomes in the year prior to and first year of the COVID-19 pandemic. There were statistically significant differences between the two time periods for the worsening of health outcomes related to transfer ability, rejecting care, physical conflict, and verbal conflict. Understanding the influence of the COVID-19 pandemic on health outcomes among people who live in nursing homes is critical for improving individual health and health system preparedness. [Journal of Gerontological Nursing, 49(12), 41-48.].

Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence

BackgroundNatural and human-made public health emergencies (PHEs), such as armed conflicts, floods, and disease outbreaks, influence health systems including interruption of delivery and utilization of health services, and increased health service needs. However, the intensity and types of impacts of these PHEs vary across countries due to several associated factors. This scoping review aimed to synthesise available evidence on PHEs, their preparedness, impacts, and responses.MethodsWe conducted a scoping review of published evidence. Studies were identified using search terms related to two concepts: health security and primary health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines to select studies. We adapted the review framework of Arksey and O’Malley. Data were analyzed using a thematic analysis approach and explained under three stages of PHEs: preparedness, impacts, and responses.ResultsA total of 64 studies were included in this review. Health systems of many low- and middle-income countries had inadequate preparedness to absorb the shocks of PHEs, limited surveillance, and monitoring of risks. Health systems have been overburdened with interrupted health services, increased need for health services, poor health resilience, and health inequities. Strategies of response to the impact of PHEs included integrated services such as public health and primary care, communication and partnership across sectors, use of digital tools, multisectoral coordination and actions, system approach to responses, multidisciplinary providers, and planning for resilient health systems.ConclusionsPublic health emergencies have high impacts in countries with weak health systems, inadequate preparedness, and inadequate surveillance mechanisms. Better health system preparedness is required to absorb the impact, respond to the consequences, and adapt for future PHEs. Some potential response strategies could be ensuring need-based health services, monitoring and surveillance of post-emergency outbreaks, and multisectoral actions to engage sectors to address the collateral impacts of PHEs. Mitigation strategies for future PHEs could include risk assessment, disaster preparedness, and setting digital alarm systems for monitoring and surveillance.

Development of an early alert model for pandemic situations in Germany

The COVID-19 pandemic has pointed out the need for new technical approaches to increase the preparedness of healthcare systems. One important measure is to develop innovative early warning systems. Along those lines, we first compiled a corpus of relevant COVID-19 related symptoms with the help of a disease ontology, text mining and statistical analysis. Subsequently, we applied statistical and machine learning (ML) techniques to time series data of symptom related Google searches and tweets spanning the time period from March 2020 to June 2022. In conclusion, we found that a long-short-term memory (LSTM) jointly trained on COVID-19 symptoms related Google Trends and Twitter data was able to accurately forecast up-trends in classical surveillance data (confirmed cases and hospitalization rates) 14 days ahead. In both cases, F1 scores were above 98% and 97%, respectively, hence demonstrating the potential of using digital traces for building an early alert system for pandemics in Germany.

Strengthening community health worker program in Belize

Community health workers (CHWs) have been identified as effective workforce that can improve access to primary health care particularly for underserved and hard to reach populations. The contributions of CHWs have not been limited to low-income countries. More recently, the use of CHWs has attracted attention in some high-income countries where despite more developed health systems there are large inequities in healthcare access and outcomes amongst different population groups. Belize is an upper middle-income country located in Central America and its health system is based on a primary health care model with community health workers actively involved in health service delivery. A descriptive study through review of grey literature detailing the process for strengthening the community health worker program in the country using the Community Health Worker Assessment and Improvement Matrix (CHW AIM) tool. The results were thematically analysed based on Community Health Worker Assessment and Improvement Matrix (CHW AIM) conceptual framework on factors influencing the performance of community health worker program. Community health workers in Belize are recognized as part of the formal health system with policy and strategy in place that define their roles, tasks, relationship to the health system. They are provided with monthly financial incentives, opportunities for further studies, career advancement and employment opportunities within the health system. The study contributes to the existing literature on strengthening of community health worker program to enhance the primary health care system and build a more resilient health system for better preparedness and response for future pandemics with focus on an upper middle income country.

Emerging Infectious Diseases Are Virulent Viruses-Are We Prepared? An Overview.

The recent pandemic caused by SARS-CoV-2 affected the global population, resulting in a significant loss of lives and global economic deterioration. COVID-19 highlighted the importance of public awareness and science-based decision making, and exposed global vulnerabilities in preparedness and response systems. Emerging and re-emerging viral outbreaks are becoming more frequent due to increased international travel and global warming. These viral outbreaks impose serious public health threats and have transformed national strategies for pandemic preparedness with global economic consequences. At the molecular level, viral mutations and variations are constantly thwarting vaccine efficacy, as well as diagnostic, therapeutic, and prevention strategies. Here, we discuss viral infectious diseases that were epidemic and pandemic, currently available treatments, and surveillance measures, along with their limitations.

Environmental, climatic, anthropogenic features of Filoviruses Disease Outbreak: a systematic review

Abstract Background Filoviruses, including Ebola and Marburg viruses, are a threat to global public health due to their transmission and mortality rates. Despite recent advances in forecasting infectious disease limited knowledge of the ecological niche of Filoviruses still hinders research progress. Studying the ecological context of Filoviruses can provide important information for the development of international preparedness and surveillance systems. Methods We conducted a systematic literature review according to the PRISMA 2020 checklist. A search of relevant articles was performed in PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published in English between 2013 and 2023, discussing environmental, climatic and anthropogenic risk factors of Filovirus disease outbreaks. Results A total of 5818 records were screened, and 41 articles were included. Of the 41 studies analyzed, 21 reported an analysis of risk factors related to Ebola Viruses, 8 of Marburg Virus, and 12 analyzed multiple species of Filoviruses. Of the 41 studies analyzed, 16 also developed risk prediction models aimed at stratifying geographic areas. We collected a total of 19 risk factors divided in 4 categories: environmental risk factors (e.g., forest coverage, cropland coverage), climate risk factors (e.g., annual temperature range, seasonal temporal frequency) population risk factors (e.g., human population density, urban population increase), cultural and behavioral risk factors (e.g., bushmeat trade, use of traditional burial practice). The analyzed models primarily use climate and environmental data, with population and cultural factors being considered to a lesser extent. Conclusions The identification of potential predictors of Filovirus disease outbreak is crucial for geographic mapping of high-risk areas. A multidisciplinary Planetary Health approach is needed to advance research and to develop targeted surveillance systems to prevent pandemic outbreaks. Key messages • Environmental and climate factors play a crucial role in filovirus spillover events, but population and cultural factors should also be considered in future research and risk prediction models. • To improve prediction of pandemic outbreaks more research on disease emergence and transmission dynamics, better surveillance of disease in humans and animals, and better access to data are required.

Power and politics of health system data: how data shape responses and equity during pandemics

Abstract Background Pandemics disproportionately affect vulnerable groups. There are documented socioeconomic, gendered, and racialized differences in the burden of disease during COVID-19 and previous pandemics due to factors such as lack of access to social safety nets, poor quality of housing, and precarious working conditions. Therefore, equity should be a key principle for health system preparedness. However, the monitoring and detection of inequities largely depend on the availability of disaggregated data. Often, such data are not available nor are they utilized to promote equity-based approaches during major public health crises. Methods The article builds on social epidemiology and is conducted as a theoretical review. It uses health monitoring data collected in the Finnish health system and the Finnish response to COVID-19 as case studies to investigate how data shape equity and responses during rapidly unfolding crises. Finland provides an interesting context for the case studies due to its extensive and high-quality health registers and health monitoring data. Results In the article, we present a summary of the Finnish health system monitoring data infrastructure and a review of factors affecting data collection and utilization processes in Finland. We then describe how register data was utilized as a part of the Finnish response to COVID-19. Finally, we present an example of how the utilization of disaggregated vaccination coverage data helped create an equity-based community health promotion response during COVID-19 in Finland. Conclusions The article points out several understudied populations in the Finnish health system monitoring infrastructure, including those with lower incomes, undocumented immigrants, racialized minorities, and LGBT populations. While waiting for national health monitoring systems to “catch up”, smaller-scale community-based responses can be used to tackle inequities during health system crises. Key messages • Critical research approaches to health system data and data gaps are crucial since these data are the product of decisions, prioritization and value judgments made by health system actors themselves. • Revision work of pandemic preparedness plans across Europe needs to acknowledge how health system monitoring shape both responses and equity during crises.

Temporality shaping lessons learned from COVID-19 - Follow-up study of Finnish pandemic governance

Abstract Background Public health crises require and offer unique opportunities for learning. Despite abundant “lessons learned” -literature on the COVID-19, follow-up research designs are scarce. To fill in this gap we analyse how key national level decision-makers in Finland discuss the lessons from COVID-19 at its’ different stages, since they are in key positions to develop health system preparedness and crises response policies based on lessons from past shocks. Methods The qualitative interview study includes unique follow-up data on Finnish national-level decision-makers’ interpretations of the lessons learned from COVID-19. The interviewees represent key ministries, other governmental organisations with responsibilities in pandemic governance, expert organisations and authorities responsible for preparedness. The data were collected from the same informants 1) at the acute stage of the epidemic in Finland (2021, n = 21) and 2) after the vaccination coverage was at high level and the acute stage of the epidemic had passed (2022-2023, n = 16). Analyses included abductive and thematical content analyses. Results The lessons learned from COVID-19 were defined differently at different stages of the pandemic. In addition, the possibilities to assess or implement the lessons or reform the system were hampered by scarce resources and the political agenda already shifting to other crises and challenges. Results further showed the short-term nature of many of the crisis measures taken during the acute stage. Conclusions The follow-up design enabled analysis of the nature of the lessons learned during and after the acute stage of COVID-19. Temporal framing of data illustrated the changing and emergent nature of the lessons learned, highlighting the need for broad ranging analyses across multiple time spots and crisis cycles in the future. Scarce human and financial resources in the health system compel to focus on most topical issues, hampering long-term development. Key messages • Preparation for future crises requires practical measures during normal times. • Comprehensive analyses of lessons learned beyond a single crisis cycle supports continuity of crisis preparedness and management.

Area-level geographic and socioeconomic factors and the local incidence of SARS-CoV-2 infections in Queensland between 2020 and 2022

ObjectiveCalculate the incidence of SARS-CoV-2 (COVID-19) infection notifications and the influence of area-level geographic and socioeconomic factors in Queensland using real-time data from the COVID-19 Real-time Information System for Preparedness and Epidemic Response (CRISPER) project. Design and settingPopulation-level ecological study and spatial mapping of the incidence of COVID-19 infection notifications in Queensland, by postcode, 2020–2022. Main outcome measuresProportions and distribution of COVID-19 infection notifications by year, age-group, socioeconomic disadvantage, and geospatial mapping. Incidence rate ratios (IRRs) were calculated. ResultsBetween 28 January 2020 and 30 June 2022, a total of 609,569 cases of COVID-19 associated with a Queensland postcode were recorded. The highest proportion of cases occurred in 2022 (96.5%), and in the 20- to 24-year age category (IRR = 1.787). In non–Major City areas, there was also a higher incidence of COVID-19 cases in lower socioeconomic areas (IRR = 0.84) than in higher socioeconomic areas (IRR = 0.66). ConclusionsQueensland experienced its highest proportion of COVID-19 cases once domestic and international borders opened. However, geographic and socioeconomic factors may have still contributed to a higher incidence of COVID-19 cases across some Queensland areas. Implications for Public HealthAlthough Australia has moved from the emergency response phase of the COVID-19 pandemic, we need to ensure ongoing prevention strategies target groups and areas that we have identified with the highest incidence.

Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands

BackgroundInvestment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems.MethodsWe undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring ‘standalone, best of breed’ systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems.ResultsOur thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture.ConclusionsAchieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design.

Wastewater-based surveillance identifies start to the pediatric respiratory syncytial virus season in two cities in Ontario, Canada.

Detection of community respiratory syncytial virus (RSV) infections informs the timing of immunoprophylaxis programs and hospital preparedness for surging pediatric volumes. In many jurisdictions, this relies upon RSV clinical test positivity and hospitalization (RSVH) trends, which are lagging indicators. Wastewater-based surveillance (WBS) may be a novel strategy to accurately identify the start of the RSV season and guide immunoprophylaxis administration and hospital preparedness. We compared citywide wastewater samples and pediatric RSVH in Ottawa and Hamilton between August 1, 2022, and March 5, 2023. 24-h composite wastewater samples were collected daily and 5 days a week at the wastewater treatment facilities in Ottawa and Hamilton, Ontario, Canada, respectively. RSV WBS samples were analyzed in real-time for RSV by RT-qPCR. RSV WBS measurements in both Ottawa and Hamilton showed a lead time of 12 days when comparing the WBS data set to pediatric RSVH data set (Spearman's ρ = 0.90). WBS identify early RSV community transmission and declared the start of the RSV season 36 and 12 days in advance of the provincial RSV season start (October 31) for the city of Ottawa and Hamilton, respectively. The differing RSV start dates in the two cities is likely associated with geographical and regional variation in the incidence of RSV between the cities. Quantifying RSV in municipal wastewater forecasted a 12-day lead time of the pediatric RSVH surge and an earlier season start date compared to the provincial start date. These findings suggest an important role for RSV WBS to inform regional health system preparedness, reduce RSV burden, and understand variations in community-related illness as novel RSV vaccines and monoclonal antibodies become available.

Estimates of Current Capacity for Diagnosing Alzheimer’s Disease in Sweden and the Need to Expand Specialist Numbers

BackgroundThe emergence of disease-modifying Alzheimer’s (AD) treatments provides new hope to patients and families but concerns have been raised about the preparedness of healthcare systems to provide timely access to such treatments because of a combination of a complex diagnostic process and a large prevalent pool.ObjectivesWe assess the preparedness of Sweden, a high-income country known for its dementia-friendly policies, to diagnose AD patients eligible for treatment within a six-month window, given current capacity for specialist evaluations and biomarker testing. We calculate the investment requirements for Sweden to achieve this target over a timeframe of 20 years.DesignDesk research to identify data for population, mortality, disease burden, cost of services and current capacity, expert consultation to inform assumptions about patient journey, and use of a Markov model to predict waiting times. The model simulates the patients’ journey through different evaluation stages: initial evaluation by a primary care specialist, neurocognitive testing by an AD specialist, and confirmatory biomarker testing with PET scanning or cerebrospinal fluid (CSF) testing. The model assumes specialist appointments and PET scans are capacity constrained, and patients progress from cognitively normal to MCI and from MCI to dementia in the resulting waiting times.MeasurementsProjected waiting times for diagnosis of eligibility for disease-modifying Alzheimer’s treatment from 2023 to 2042 assuming current capacity, assuming 20% of Swedish residents aged 60 years and above would seek an evaluation for cognitive decline. Investments required to scale capacity up to reach target of providing diagnosis within six months on average.ResultsInitial average waiting times for AD specialist appointments would be around 21 months in 2023 and remain around 55 months through 2042, as demand would continue to outstrip supply throughout the 20-year model horizon. Waiting times for biomarker testing would be stable at less than four weeks, as patients would be held up in the queue for their first specialist consultations, and use of CSF testing is widely accepted in Sweden. An additional 25% of AD specialists would have to be added above the current growth trend to reduce waiting times to less than 6 months at an average annual cost of approximately 805 million SEK. The increased cost of volume of biomarker testing would amount to about 106 million SEK per year.ConclusionsAt current capacity, the Swedish healthcare system is unable to provide timely diagnosis of patients eligible for disease-modifying AD treatment. Although future diagnostic technologies, such as digital cognitive assessments and blood tests for the AD pathology, might decrease demand for capacity-constrained services, substantial investments will be required to meet a target of less than six months of waiting time for a diagnosis.

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions.

Identifying stakeholders' needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers. Cross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals. A total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies. Findings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of all.

Society for Maternal-Fetal Medicine Special Statement: Emergency checklist, planning worksheet, and system preparedness bundle for placenta accreta spectrum

Placenta accreta spectrum is a life-threatening complication of pregnancy that is underdiagnosed and can result in massive hemorrhage, disseminated intravascular coagulation, massive transfusion, surgical injury, multisystem organ failure, and even death. Given the rarity and complexity, most obstetrical hospitals and providers do not have comprehensive expertise in the diagnosis and management of placenta accreta spectrum. Emergency management, antenatal interdisciplinary planning, and system preparedness are key pillars of care for this life-threatening disorder. We present an updated sample checklist for emergent and unplanned cases, an antenatal planning worksheet for known or suspected cases, and a bundle of activities to improve system and team preparedness for placenta accreta spectrum.

How exercises help US communities meet the challenge of climate change: The FEMA National Exercise Division’s innovative exercise tools and resources

The US Federal Emergency Management Agency (FEMA) National Exercise Division (NED) leads the nation in validating the capabilities of the whole community in support of the National Preparedness System. In response to the increased threat of climate change, the NED has developed new resources to help communities increase preparedness for severe weather and natural disasters in the long term. This paper provides an overview of two such resources to help communities identify and prepare for climate-related events: the Long-Term Community Resilience Exercise Resource Guide (ERG) and the Climate Adaptation Exercise Series (CAES). These resources help communities develop and conduct exercises to increase their climate literacy, develop climate adaptation and mitigation plans, and leverage data on future climate conditions to inform decision-making. Exercises provide an opportunity for communities to build resilience by discussing and better understanding climate change and to plan for, adapt to, and mitigate the associated risks and hazards. The ERG provides guidance, tools and resources, and the CAES provides a consistent framework that FEMA regions can tailor to address unique, region-specific climate concerns. The results collected from these exercises, in turn, identify strengths to leverage and areas to improve, informing plans of action for a path forward for the next 20, 30 and 50 years.