ABSTRACT
BACKGROUND AND AIM: Pediatric Early Warning Systems (PEWS) are evidence-based interventions that improve early identification of deterioration in resource-limited hospitals. While PEWS can be successfully implemented in these settings, little is known about their sustainability postimplementation. This study evaluates staff perspectives on the importance of, and challenges to, sustaining PEWS. METHOD(S): We conducted semi-structured interviews of PEWS implementation leaders and hospital directors at 5 pediatric oncology centers sustaining PEWS in Latin America. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed combining a priori and inductively derived codes. Transcripts were independently coded by 2 coders achieving a kappa of 0.8-0.9. Thematic content analyses explored staff perceptions on PEWS sustainability. RESULT(S): We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefit. However, participants reported a range of challenges sustaining PEWS, including fluctuations in human and material resources needed for PEWS, staff turnover and insufficient training, difficulty achieving new leadership buy-in, lack of internal systems to promote ongoing monitoring of PEWS, and the COVID-19 pandemic (Table 1). Together, these challenges resulted in multiple impacts, ranging from a small reduction in PEWS quality to complete disruption of PEWS use resulting in loss of benefits to patient outcomes in some units. CONCLUSION(S): While sustainability of evidence-based interventions like PEWS is valued by staff in resourcelimited hospitals, participants reported multiple challenges to sustainability resulting in reduced patient benefit. Future work should focus on identifying factors that promote intervention sustainability in these settings. (Table Presented).
ABSTRACT
BACKGROUND: We aim to use intermarriage as a measure to disentangle the role of exposure to virus, susceptibility and care in differences in burden of COVID-19, by comparing rates of COVID-19 infections between immigrants married to a native and to another immigrant. METHODS: Using data from the Norwegian emergency preparedness, register participants (N=2 312 836) were linked with their registered partner and categorized based on own and partner's country of birth. From logistic regressions, odds ratios (OR) of COVID-19 infection (15 June 2020-01 June 2021) and related hospitalization were calculated adjusted for age, sex, municipality, medical risk, occupation, household income, education and crowded housing. RESULTS: Immigrants were at increased risk of COVID-19 and related hospitalization regardless of their partners being immigrant or not, but immigrants married to a Norwegian-born had lower risk than other immigrants. Compared with intramarried Norwegian-born, odds of COVID-19 infection was higher among persons in couples with one Norwegian-born and one immigrant from Europe/USA/Canada/Oceania (OR 1.42-1.46) or Africa/Asia/Latin-America (OR 1.91-2.01). Odds of infection among intramarried immigrants from Africa/Asia/Latin-America was 4.92. For hospitalization, the corresponding odds were slightly higher. CONCLUSION: Our study suggests that the excess burden of COVID-19 among immigrants is explained by differences in exposure and care rather than susceptibility.