Go-Along Interviews as a Method for Social-Ecological Research on Urban Nature

The application of go-along interviews allows an integrated mix of methods, combining qualitative interviews with participant observation. This facilitates linking discourses and practices. The method's particular sensitivity to the spatial embeddedness and reflection of social processes has been evaluated and described in various research contexts. In our article, we highlight the added value of go-along interviews for social-ecological and transdisciplinary research. The COVID-19 lockdowns and their effects on everyday practices of urban residents served as a lens to trace interactions with nature that have been habitualized into everyday walks. Discussing specific episodes from our interviews, we reflect on methodological features of go-along interviews, such as generating narratives, considering material environments and non-human actors, opening up memories and experiences, reconstructing evaluations, and enabling self-reflection. We contrast these potentials with specific challenges in the application of go-along interviews, especially with regard to the accessibility of the interview space, the methodical requirements of the dynamic interview situation, and the altered relationship between interviewer and interviewee. Considering these challenges, conducting go-along interviews can significantly enrich both, the scientific descriptions of urban ecology and the methodological spectrum of research on urban nature. Furthermore, go-along interviews provide a conceptual proximity to transdisciplinary, participatory, and transformative research. © 2023, Institut für Qualitative Forschung,Internationale Akademie Berlin gGmbH. All rights reserved.

Me vs. Us: A health divided

How can we care so much about health care yet so little about public health? Before Covid-19, public health programs constituted only 2.5 percent of all US health spending, with the other 97.5 percent going towards the larger health care system. In fact, the United States spends on average $11,000 per citizen per year on health care, but only $286 per person on public health. It seems that Americans value health care, the medical care of individuals, over public health, the well-being of collections of people. In Me vs. Us, primary care doctor and public health advocate Michael Stein takes a hard, insightful look at the larger questions behind American health and health care. He offers eight reasons why our interest in the technologies and delivery of health care supersedes our interest in public health and its focus on the core social, economic, and environmental forces that shape health. Stein documents how public health has continually "lost out" to medicine--from a loss in funding and resources to how we view our personal priorities--and suggests how public health may hold the solutions to our most concerning crises, from pandemics to obesity to climate change. Me vs. Us concludes that individual and public health are inseparable. In the end, Stein argues, we need to recover and sharpen our sense of health based on a reverent appreciation of both perspectives. © Oxford University Press 2022. All rights reserved.

Dutch public health professionals' perspectives and needs regarding citizen involvement in COVID-19 contact tracing through digital support tools: an exploratory qualitative study.

BACKGROUND: Contact tracing (CT) is an important, but resource-intensive tool to control outbreaks of communicable diseases. Under pandemic circumstances, public health services may not have sufficient resources at their disposal to effectively facilitate CT. This may be addressed by giving cases and their contact persons more autonomy and responsibility in the execution of CT by public health professionals, through digital contact tracing support tools (DCTS-tools). However, the application of this approach has not yet been systematically investigated from the perspective of public health practice. Therefore, we investigated public health professionals' perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools. METHODS: Between October 2020 and February 2021, we conducted online semi-structured interviews (N = 17) with Dutch public health professionals to explore their perspectives and needs regarding the involvement of cases and contact persons in CT for COVID-19 through DCTS-tools, in the contact identification, notification, and monitoring stages of the CT-process. Interviews were audio recorded and transcribed verbatim. A thematic analysis was performed. RESULTS: Four main themes related to Dutch public health professionals' perspectives and needs regarding involving cases and contact persons in CT for COVID-19 through DCTS-tools emerged from the data: 'Distinct characteristics of CT with DCTS-tools'; 'Anticipated benefits and challenges of CT for COVID-19 with DCTS- tools'; 'Circumstances in CT for COVID-19 that permit or constrain the application of DCTS-tools'; and 'Public health professionals' needs regarding the development and application of DCTS-tools for CT'. Public health professionals seem to have a positive attitude towards involving cases and contact persons through DCTS-tools. Public health professionals' (positive) attitudes seem conditional on the circumstances under which CT is performed, and the fulfilment of their needs in the development and application of DCTS-tools. CONCLUSIONS: Dutch public health professionals seem positive towards involving cases and contact persons in CT for COVID-19 through DCTS-tools. Through adequate implementation of DCTS-tools in the CT-process, anticipated challenges can be overcome. Future research should investigate the perspectives and needs of cases and contact persons regarding DCTS-tools, and the application of DCTS-tools in practice.

ADDICTION MEDICINE IS MEDICINE: A REQUIRED TWO-WEEK CLINICAL ROTATION FOCUSED ON SUBSTANCE USE FOR INTERNAL MEDICINE RESIDENTS

SETTING AND PARTICIPANTS: Montefiore Health System is the largest health care provider in Bronx, New York, a community that is disproportionately impacted by substance use disorders (SUDs). To better prepare resident physicians to care for patients with SUDs, we developed a novel addiction medicine rotation required for internal medicine residents. DESCRIPTION: The 2-week rotation includes inpatient and outpatient clinical experiences. During the inpatient week, residents rotate on the Addiction Consult Service, staffed by an addiction medicine attending, a fellow, and a peer navigator. Residents attend a weekly interdisciplinary meeting with the Psychiatry Consult Service to discuss cases. During the outpatient week, residents rotate through an opioid treatment program, an intensive outpatient substance use treatment program, and an addiction medicine “Bridge” clinic, which links patients with SUDs to primary care post- hospitalization. Residents also complete a self-study curriculum that includes addiction-focused readings and podcasts as well as the 8-hour online buprenorphine waiver training. All residents participate in Addiction Medicine Rounds, a weekly case conference and journal club led by addiction medicine faculty and trainees. EVALUATION: Between July and November 2021, 22 internal medicine residents participated in the rotation and 12 (55%) completed formal evaluations. All residents rated the overall rotation to be valuable for their education, with 33% in strong agreement based on a 4-point scale from strongly disagree to strongly agree. All residents also agreed (with 42% strongly agreed) that the rotation increased their knowledge and skills in diagnosing SUDs, and managing medication treatment for SUDs. One resident summarized: “This rotation is one of the best rotations I have experienced during my time as a resident. After completing this rotation, I felt very confident in my ability to diagnose, navigate, and manage the complexities of addiction related illness.” DISCUSSION / REFLECTION / LESSONS LEARNED: The Addiction Medicine Rotation was well-received in its first months of implementation. The experience on the Addiction Consult Service stood out as high-yield training, building on residents' familiarity with hospital-based care and leveraging multidisciplinary partnerships with psychiatry, pharmacy, and nursing departments. Providing rigorous inpatient training in addiction medicine is a unique feature of this rotation, as addiction consult services are not the mainstay in most hospitals. The “Bridge” clinic has also been valuable in training residents to provide medication treatment for SUDs within primary care. However, the outpatient experience in specialty care settings faced many scheduling challenges related to the COVID-19 pandemic, with reduced availability of preceptors, decreased number of in-person visits, and suspended group treatment. Optimizing outpatient addiction medicine training will be an ongoing goal in future rotation iterations. ONLINE RESOURCE URL: Rotation document: https://tinyurl.com/ MontefioreAddMedRotation.

Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study.

Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.

Host Immune-Protein Signature Combining TRAIL, IP-10 and CRP for Early and Accurate Prediction of Severe COVID-19 Outcome

Background. Accurately identifying COVID-19 patients at-risk to deteriorate remains challenging. Dysregulated immune responses impact disease progression and development of life-threatening complications. Tools integrating host immune-protein expression have proven useful in determining infection etiology and hold potential for prognosticating disease severity. Methods. Adults with COVID-19 were enrolled at medical centers in Israel, Germany, and the United States (Figure 1). Severe outcome was defined as intensive care unit admission, non-invasive or invasive ventilation, or death. Tumor necrosis factor related apoptosis inducing ligand (TRAIL), interferon gamma inducible protein-10 (IP-10) and C-reactive protein (CRP) were measured using an analyzer providing values within 15 minutes (MeMed Key®). A signature indicating the likelihood of severe outcome was derived generating a score (0-100). Description of derivation cohort RT-PCR, reverse transcription polymerase chain reaction. Results. Between March and November 2020, 518 COVID-19 patients were enrolled, of whom 394 were eligible, 29% meeting a severe outcome. Age ranged between 19-98 (median 61.5), with 59.1% male. Patients meeting severe outcomes exhibited higher levels of CRP and IP-10 and lower levels of TRAIL (Figure 2;p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The signature's area under the receiver operating characteristic curve (AUC) was 0.86 (95% confidence interval: 0.81-0.91). Performance was not confounded by age, sex, or comorbidities and was superior to IL-6 (AUC 0.77;p = 0.033) and CRP (AUC 0.78;p < 0.001). Clinical deterioration proximal to blood draw was associated with higher signature score. Scores of patients meeting a first outcome over 3 days after blood draw were significantly (p < 0.001) higher than scores of non-severe patients (Figure 3). Moreover, the signature differentiated patients who further deteriorated after meeting a severe outcome from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001;Figure 4). TRAIL, IP-10, CRP and the severity signature score are differentially expressed in severe and non-severe COVID-19 infection Dots represent patients and boxes denote median and interquartile range (IQR) The signature score of patients meeting a severe outcome on or after the day of blood draw is significantly (p < 0.001) higher than the signature score of non-severe patients. Dots represents patients and boxes denote median and IQR Kaplan-Meier survival estimates for signature score bins Conclusion. The derived signature combined with a rapid measurement platform has potential to serve as an accurate predictive tool for early detection of COVID-19 patients at risk for severe outcome, facilitating timely care escalation and de-escalation and appropriate resource allocation.

A systematic literature review on the use of health care resources during pandemic response

Background The COVID-19 pandemic demonstrated the need for better pandemic preparedness and response, and more international collaboration. The H2020 EU-funded PANDEM-2 project aims to prepare Europe for future pandemics. As part of the project, an European dashboard consisting of epidemiological data and insights on available pandemic health care capacity is developed. To model and map the availability of pandemic resources, data on the use of these resources and interdependencies between resources are needed to parametrize the resource model of the PANDEM-2 dashboard. Methods We conduct a systematic literature review. The database Embase.com was searched on articles that include a model, scenario, or simulation of pandemic resources and/or describe resource parameters, for example PPE usage, length of stay on the ICU, or vaccine efficacy. Our search included data from all continents and focuses on infectious diseases that have been declared a pandemic by the WHO in the last twenty years, which are the H1N1 influenza (2009-2010) and COVID-19 (ongoing). Preliminary results The search query and additional sources resulted in 1215 articles, of which 187 are included for the full text eligibility assessment. We identified several pandemic resources in the field of vaccination (vaccine efficacy), contact tracing (apps), general practitioners, the hospital (staff, PPE, ventilators), and national and regional public health institutes. Furthermore, interdependencies between resources and possible resource gaps were found, for example in hospital staff and PPE. Conclusions To be better prepared and to be able to respond fast to a pandemic outbreak, it is important to have insight in the availability of pandemic resources on a national and regional level, their use and mutual dependencies. This makes it possible to anticipate on fast changes and possible shortages by reallocating resources within and between regions.

High adherence to treatment with cladribine tablets for multiple sclerosis during the COVID-19 pandemic: Results from patient support programmes

Introduction: Cladribine tablets (CladT) are taken as 2 short annual courses for the treatment of multiple sclerosis (MS), with treatment indications differing by country. Adveva® is a nurse/ pharmacy-led patient support programme (PSP) that provides drug education and support to patients taking CladT, and collects treatment-related clinical information. Objectives: Evaluate treatment adherence during Year 2 of treatment with CladT in Australia, Canada, and the UK, and whether there was an effect of the COVID-19 pandemic on treatment adherence. Methods: PSP data routinely collected from Australia, Canada, and the UK between 05Dec2017 (launch of CladT in first participating country) and 28Feb2021 (cut-off date) were included in this analysis. Demographics and date of treatment initiation of Year 1 and Year 2 were recorded. Patients were monitored using telephone check-in from treatment initiation until cut-off date, loss to follow-up, or treatment discontinuation. Time to Year 2 of treatment initiation was estimated overall and in two periods (before and during COVID-19) defined by the start date of the pandemic in each country (Australia: 13Mar2020;Canada: 16Mar2020;UK: 23Mar2020). Results: Overall, 3,536 patients initiated CladT during the study period (Australia, n=598;Canada, n=1,973;UK, n=965). Approximately 76% were female in each country. Most had received prior disease-modifying therapy (Australia, 75.6%;Canada, 100%;UK, 44.1%). Among patients with at least 18 months of follow-up since Year 1 initiation, the vast majority had initiated Year 2 of treatment (Australia, n=415 [90.6%];Canada, n=1213 [90.8%];UK, n=578 [88.0%]). The mean time to Year 2 initiation in Australia, Canada, and the UK was 13.02 (standard deviation [SD]: ±2.02), 13.15±1.95, and 14.45±2.71 months, respectively. Mean time (months ±SD) to initiation of Year 2 treatment was similar before and during the COVID-19 pandemic in all countries (Australia: 12.49±1.01 and 13.87±2.81;Canada: 12.79±1.33 and 13.43±2.28;UK: 13.28±1.25 and 15.47±3.19). Among those initiating Year 2 of treatment, a delay of at least 6 months to initiation of dosing was seen for 4.1% of patients in Australia, 2.7% in Canada, and 7.6% in the UK. Conclusions: Treatment adherence to CladT was high and consistent between participating countries, and was not influenced by the COVID-19 pandemic. The existence of a robust nurse/pharmacy- led PSP enables valuable data collection and likely facilitates adherence.

Rapid seroconversion and persistent functional IgG antibodies in severe COVID-19 patients correlates with an IL-12p70 and IL-33 signature.

Despite ongoing efforts to characterize the host response toward SARS-CoV-2, a major gap in our knowledge still exists regarding the magnitude and duration of the humoral response. Analysis of the antibody response in mild versus moderate/severe patients, using our new developed quantitative electrochemiluminescent assay for detecting IgM/IgA/IgG antibodies toward SARS-CoV-2 antigens, revealed a rapid onset of IgG/IgA antibodies, specifically in moderate/severe patients. IgM antibodies against the viral receptor binding domain, but not against nucleocapsid protein, were detected at early stages of the disease. Furthermore, we observed a marked reduction in IgM/IgA antibodies over-time. Adapting our assay for ACE2 binding-competition, demonstrated that the presence of potentially neutralizing antibodies is corelated with IgG/IgA. Finally, analysis of the cytokine profile in COVID-19 patients revealed unique correlation of an IL-12p70/IL33 and IgG seroconversion, which correlated with disease severity. In summary, our comprehensive analysis has major implications on the understanding and monitoring of SARS-CoV-2 infections.

How can electronic health records support intersectoral care of oncology patients?

Background Oncology patients require an interdisciplinary approach to diagnosis and treatment. Therefore, communication structures should be established in order to prevent information gaps between medical partners, particularly in case of larger geographical distances. Objective The article describes different kinds of electronic record systems and emphasizes the differences between electronic case records, managed by medical doctors, and electronic health records (EHR), which will be introduced on January 1, 2021. Some useful applications and experiences in the use of intersectoral health records are presented Materials and methods Communication via EHR must follow current guidelines and approved concepts. As application scenarios in oncologic care or advisory services for COVID-19 patients requiring intensive care or nephrology patients, some experiences of the EHR provider RZV are presented. Finally, a forecast for the period beginning January 1, 2021, describes the linkage of electronic case records with the EHR. Results and discussion The electronic case record has proven its usefulness in several intersectoral settings. In addition to direct integration into primary systems, it enables an entirely digital communication processes. Additional services, e.g., provision of image data or online forms, can increase the acceptance of electronic case records. In the future, it will be important to link electronic case records directly with the EHR, to avoid placing an increased burden on physicians during communication with other service providers and patients.