Collecting Data During the COVID-19 Pandemic: Lessons From an In-Person Survey of People Who Use Opioids

Objectives: In response to the COVID-19 pandemic, much in-person data collection has been suspended or become tele-remote. However, tele-remote methods often exclude marginalized groups, including people who use drugs, many of whom lack the technology to participate. To inform future surveillance and research during the pandemic and other public health disasters, we report methods and lessons learned from an in-person survey of people who use opioids conducted by the New York City Department of Health and Mental Hygiene (DOHMH) during the COVID-19 pandemic. Materials and Methods: This public health surveillance was a component of the Centers for Disease Control and Prevention Overdose Data to Action initiative and aimed to inform overdose prevention efforts. Survey domains inquired about participants’ drug use patterns, risk behaviors, overdose history, and service use. Results: From June 16 through September 9, 2020, DOHMH staff members conducted 329 surveys with participants from 4 syringe service programs (n = 148, 44.9%) and via street intercept (n = 81, 55.1%). To survey participants safely and effectively, it was important to build rapport upfront so that requests to maintain distance were not perceived as stigmatizing. DOHMH staff members offered all participants, regardless of survey eligibility, Narcan and hygiene products, including face masks and soap. Practice Implications: Surveys administered outdoors during the COVID-19 pandemic should be limited to 30 minutes. Although conducting in-person surveys poses unique challenges, this method should be considered so marginalized populations are included in data collection and public health responses.

Fast-track hospital end-of-life discharge pathway: is it actually fast? National clinical audit

ObjectivesTo determine adherence to Department of Health and Social Care target of fast-track pathway discharge for end-of-life care within 48 hours.MethodsMulticentre audit in England using retrospective analysis of patient records for fast-track pathway tools submitted between 1 March 2019 and 31 March 2019.ResultsMost patients (72%) were not discharged within the 48-hour target. There was significant variability in success between hospital sites. Delays in discharge were most frequently considered to be secondary to delays in sourcing packages of care and 24-hour care facility placements. Involvement of specialist discharge nurses in paperwork submission improved rates by Commissioning Care Groups. Patients who died in hospital had significantly longer admissions than those who were discharged (discharged 19 days (IQR 11–28) vs died 28 days (IQR 18–42); p=0.039). This was entirely accounted for by increased numbers of days between admission and first suggestion of fast-track pathway discharge in those who died in hospital (discharged 9 days (IQR 5–19), died 15 days (IQR 9–33); p=0.003).ConclusionsWe demonstrated a delay in the fast-track pathway discharge process with significant variation in success of the discharge process at different geographical locations.

An Assessment of the Philippine Hospital Resources as Predictors of the Case Fatality Rate of COVID – 19

In the heightened effects of the pandemic, health resources have been in constant limbo as supplies and availability of hospital resources take a toll as COVID-19 cases surge, resulting in shortages. Thus, health systems are overwhelmed, resulting in a higher fatality rate since the capacity to provide medical attention is diminished. In this paper, hospital resources refer to mechanical ventilators, ICU, isolation, and ward beds which are the critical factors of the case fatality rate (CFR) of COVID-19 in the Philippines. Data were retrieved from the Department of Health (DOH) Case Bulletins from October 26, 2020, to June 30, 2021, with 248 total observations. This research used the Ordinary Least Squares (OLS) Multiple Regression to determine if hospital resources are the predictors of the case fatality rate of COVID-19. Furthermore, the results show a significant relationship between the hospital resources and the case fatality rate of COVID-19 in the Philippines. This study can become a framework for further research concerned about hospital resources as the predictors of case fatality rates of different diseases in a pandemic.

Disparities in Outcomes Among Patients Diagnosed With Cancer in Proximity to an Emergency Department Visit

A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This study is a case-control analysis of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases were patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no recent ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4% vs 7.4%, P<.0001) and more were low income (36.4%. vs 29.3%). The top 3 ED-associated cancer diagnoses were lung (18.4%), breast (8.9%), and colorectal cancers (8.9%), whereas the controls were breast (17%), lung (14.9%), and prostate cancers (10.1%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9% for cases vs 9.0% for controls (P<.0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95% CI 3.72-4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.

Developing the Women’s health strategy: The British Menopause society’s recommendations to the department of health and social care’s call for evidence

In the early part of 2021, the government launched a call for evidence to inform the development of the Women’s Health Strategy with the objective of better understanding women’s experiences of the health and care system and to help improve the health and wellbeing of women. The British Menopause Society Medical Advisory Council and the BMS Board of Trustees recommendations specific to the menopause and post reproductive health in relation to all six core themes included in the call for evidence assessing the different areas of women’s health are discussed in this document

Human parasitism by the exotic tick Dermacentor variabilis (Parasitiformes: Ixodida) in Brazil: report of an imported case

In June 2012, a tick was found parasitizing a man in the city of São Paulo, who had recently returned from a visit to Pennsylvania, in the northeast of the United States. The tick was removed and sent to the São Paulo State Department of Health, where it was identified as a male of the species Dermacentor variabilis (Say, 1821), according to the literature and taxonomic keys. The tick was subjected to a PCR test to search for rickettsiae, but the result was negative. The fact that a human entered Brazilian territory unaware that he was parasitized by a hard tick not belonging to the national tick fauna is significant because of the possibility that an exotic species could be introduced and take hold in this country. Another major risk to public health is that this arthropod could be infected with the bacterium Rickettsia rickettsii, as this ectoparasite is the main vector of Spotted Fever on the East Coast of North America.

Donors' Participation in Iran's Health System: Challenges and Solutions

Background: Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions. Methods: This qualitative study was performed using semi-structured interviews with 38 donors and 26 policymakers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research. Results: Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers’ support, weak legal support and poor monitoring were the most important challenges for donors’ participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors’ participation in healthcare. A conceptual model was developed to strengthen donors’ participation in the health system. Conclusion: Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policymakers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors’ needs are necessary for successful philanthropy initiatives in the health sector.

Lagged effects of rainfall on malaria: a case study of Meghalaya

Background: Meghalaya contributes about twenty per cent of India's total malaria death and is one of the high malaria endemic states in India, very susceptible to malaria transmission mainly due to favorable climatic conditions that mostly facilitate the transmission. In the relationship between malaria and meteorological factors, existing studies mainly focus on the interaction between different climatic factors, while interaction within one specific climatic predictor at different ag times has been largely neglected. This paper aims to explore the interaction of lagged rainfalls and their impact on malaria incidence. Methods: The district monthly malaria records from Jan 2005 to December 2017 was collected from the Department of Health Services (Malaria), Government of Meghalaya. The district monthly meteorological records from Jan 2005 to December 2017 was collected from the Directorate of Agriculture, Government of Meghalaya, in which average temperature (℃), humidity (%) and rainfall (mm) had been recorded. Monthly malaria cases and three climatic variables of 4 districts in Meghalaya from 2015 to 2017 were analysed with the varying coefficient-distributed lag non-linear model. The missing climatic values were imputed using Kalman Smoothing on structural time series using the package imputeTS in R. Results: During the period 2005-2017, a total of 309133 malaria cases were reported in all the districts under study. The monthly average rainfall ranges from a minimum of 181.79 mm in South Garo to a maximum of 367.87 in Jaintia. Also, South Garo and East Khasi are the hottest and the coolest place understudy with 26.96 and 16.86 degrees Celsius respectively. Rainfall levels in the first-month lag affect the non-linear patterns between the incidence of malaria and rainfall at each lag time. The low rainfall level at the first-month lag may promote malaria incidence as rainfall increases. However, for the high rainfall level at the first-month lag, malaria incidence decreases as rainfall increases. Conclusion: The interaction effect between lagged rainfalls on malaria incidence was observed in this study, and highlights its importance for future studies to better understand and predict malaria transmission.

Effectiveness of different booster regimens for preventing infection and adverse outcomes in Puerto Rico

Recent laboratory and observational studies have demonstrated that the COVID-19 vaccine effectiveness wanes over time. In response, several jurisdictions have authorized the administration of booster doses. Since August 13, 2021, Puerto Rico has administered 540,140 booster shots. We used data collected and made public by the Puerto Rico Department of Health (PRDH) to evaluate the effectiveness of four different booster regimens at preventing SARS-CoV-2 laboratory confirmed infections and adverse COVID-19 outcomes. Specifically, we analyzed data from all 115,995 SARS-CoV-2 infections occurring since the vaccination process commenced on December 15, 2020. We combined vaccination status, SARS-CoV-2 test results, and COVID-19 hospitalizations and deaths data, and fit a statistical model that adjusted for time-varying incidence rates and age group, to estimate time-varying vaccine effectiveness against infection and adverse outcomes. We find that, after 6 months, the mRNA-1273 and BNT162b2 effectiveness against infection wanes substantially to 61% (58%-63%) and 36% (34%-39%), respectively, while the Ad26.COV2.S wanes to 35% (31%-39%) after two months. However, after a booster shot of the corresponding initial vaccine manufacturer, effectiveness increased to 87% (83%- 91%) and 82% (79%- 85%) for mRNA-1273 and BNT162b2, respectively. The effectiveness for Ad26.COV2.S followed by either a mRNA-1273 or BNT162b2 booster increased to 88% (71%-100%), substantially higher than 65% (59%-70%), the peak effectiveness reached with just one shot. We also found that heterologous booster regimens restored effectiveness. Furthermore, we did not observe waning after two months of the booster shot. Finally, we found that all booster regimens provided increased protection against COVID-19 hospitalizations and deaths. Code and data to reproduce the analyses are provided here: https://github.com/rafalab/booster-eff-pr.

The Quality of Yellow Fin Tuna Powder (Thunnus Albacores) as a Natural Flavoring Alternative

Flavoring is already commonly used by the community, but on the market, flavoring generally contains monosodium glutamate (MSG). Alternative processed yellow fin tuna (Thunnus albacores) into natural flavoring fish powder without MSG becomes interesting and very useful for reducing MSG intake in the people of North Maluku. This type of research is experimental research conducted in September - November 2018 in the SIG Laboratory, Bogor for chemical quality testing (sodium, water, protein, and total fat) and Food Organizing Laboratory for Nutrition Department of Health Ministry of Ternate for making fish powder and organoleptic quality tests (color, texture, aroma, and taste). Chemical test results obtained sodium content of 3204.79 mg / 100 g of sample, moisture content of 6.08%, protein of 48.76%, and total fat of 3.28%; and the organoleptic test results obtained a mean ± SD of the color aspect of 4.0 ± 0.7, texture of 3.5 ± 0.9, aroma of 4.1 ± 0.8, and taste of 3.7 ± 1, 0. It was concluded that the heating process (roasted and oven-dried) affected the chemical quality of yellow fin tuna powder, and obtained sodium 3204.79 mg / 100 g, Water content 6.08%, protein content 48.76%, and total fat 3.28%; and in terms of organoleptics, the average panelist likes color and aroma, while aspects of taste and texture are only part of the panelists who say they like.