ABSTRACT
Background Due to climate change, the likelihood of an extreme infectious disease events-similar to the COVID-19 pandemic-is very likely to increase. Anticipating and preparing for such events Is therefore essential. A setting of high risk in such an event are long-term care facilities (LTCF), which accounted for 30-60 % of all COVID-19 related deaths in most high-income countries (HIC). To prevent, mitigate, and avoid potential adverse consequences of future outbreaks of viral respiratory pathogens with pandemic potential (e.g., SARSCoV-2, SARS, MERS, influenza) in LTCFs, a systematic review will analyze which non-pharmacological interventions (NPI) are effective in LTCFs. Methods We conducted literature searches in Medline, Embase, CINAHL, and two comprehensive specialized registries focused on COVID-19-related literature. We included experimental, quasi-experimental, and specific observational studies assessing the effect of NPIs implemented in LTCFs regarding the outcomes: infections, outbreaks, hospitalizations and deaths due to the viral pathogens of interest and adverse consequences. Screening for eligibility and risk-of-bias (RoB) assessment was done in duplicate. For RoB assessment, we used the RoB2 and ROBINS-I tool. We synthesized findings narratively, focusing on the direction of effect. The certainty of evidence was evaluated using GRADE. Results We included 16 observational studies, 14 of which focused on intervention effectiveness. All were conducted in HIC and most focused on SARSCoV-2 (n = 14). There were serious concerns regarding RoB in almost all studies. We found low/very low certainty of evidence for the effectiveness of entry regulation measures (n = 1), regular testing of residents/staff (n = 5), combined outbreak control measures (n = 2), and for combinations of multiple NPIs (n = 3) in preventing outbreaks or mitigating their consequences. The evidence on the effectiveness of hand and surface hygiene interventions showed mixed results (n = 4). We found mixed results regarding adverse mental health outcomes due to visiting restrictions. Conclusion This review indicates a number of measures which could be effective in protecting residents and staff in LTCFs in upcoming extreme infectious disease epidemics, which are expected to become more likely in the future. Furthermore, we can point out several gaps in the evidence which require further research and specific study designs to improve pandemic preparedness in LTCFs.
ABSTRACT
For decades, the public health service in Germany (PHS) experienced shortages of young professionals and challenges in recruiting qualified personnel. To sustainably counteract this challenge, it is necessary to understand the reasons of the perceived low attractiveness of PHS as a potential employer among students and young professionals. Two cross-sectional online surveys were conducted to assess the attitudes of medical, public health, and health science students towards the PHS as a potential employer. Wave 1, conducted from 2019-12 to 2020-04, focused on factors associated with high and with low interest in working for the PHS. Wave 2 was conducted from 2020-06 to 2020-09 to capture changes that may have resulted from the newfound attention of the PHS during the SARS-CoV-2 pandemic. Participants in both waves were asked about opportunities to increase the attractiveness of the PHS, which were analyzed using qualitative content analysis. In total 3040 students participated. Low interest in the PHS was associated with limited knowledge about public health, primary interest in clinical medicine, and a negative image of the public service. The qualitative analysis indicated as major obstacles: low visibility of and low awareness about the PHS, a perception of hierarchical and bureaucratic workplaces, and perceptions of repetitive occupations, among others. The participants suggested: improving awareness about the PHS in the population, including PHS in curriculum, and reducing entry barriers for non-medical students. The results of the largest survey of students on the attractiveness of the ÖGD in Germany provide valuable insights for ongoing reform processes. In addition to approaches to increase external visibility, existing processes and procedures within the ÖGD should be considered. Key messages • To counteract the shortage of skilled workers, the PHS must become more attractive to young professionals. This requires both, greater external visibility and modernization of internal structures. • Successful inclusion of the perspective of young professionals in the current modernization processes introduces opportunities to increase the attractiveness of the PHS in the long-term.
ABSTRACT
Einleitung The Public Health Service in Germany (PHS, German: ÖGD) has been suffering from a significant shortage of young professionals for decades. An issue likely to intensify in the coming years due to demographic processes. This applies not only, but especially, to the municipal level. The reasons for the perceived low attractiveness of the PHS as a potential employer have been widely discussed, but so far, no empirical data is available. Therefore, the German Network of Young Professionals in Public Health (German: NOEG), has set up a study to analyze the attractiveness of the PHS as a potential employer for young professionals. Methoden We conducted two cross-sectional surveys to assess the requirements and expectations of students in PHSrelevant fields of study with regard to their future employers. The first survey (wave 1) was conducted from December 2019 to April 2020 and focused on wishes and expectations of medical, public health, and health science students regarding their prospective jobs and employers. It was postulated that the various roles and activities of the public health workforce within the PHS are of interest to many students but are not considered as potential fields of employment for a variety of reasons. The second survey (wave 2) was conducted from June to September 2020 to be able to address any changes that may have resulted from the newfound attention on the PHS during the coronavirus crisis, to identify changes in the evaluation of the PHS as a potential employer form a young professional perspective. Ergebnisse In the wave 1, 2456 students participated, with an additional 584 taking part in wave 2. Medical students were less likely to report interest in working for the PHS in comparison with public health students and students of other health sciences. The vast majority of those medical students that considered the PHS as a potential employer reported their main interest as working in primary health care. Public health students and other students have experienced barriers when seeking jobs in the PHS. The respondees reported on a number of domains contributing to a low attractiveness of the PHS as an employer, such as the PHS being perceived as antiquated, inefficient and slow, the occupations consisting of too much braucracy, and limited career opportunities. Suggestions for improvement included a stronger occupational focus on prevention, health promotion and public health impact, modernization and digitalization, as well as providing attractive job offers for candidates without a professional training in medicine. Schlussfolgerung The results of this largest survey regarding the attractivenss of the German PHS among students provide valuable insights for the reform of the German PHS. We synthesized a number of suggestions for reform, among others regarding training and education, occupation in the PHS, adminstrative processes, and career opportunities.
ABSTRACT
Background During the Corona pandemic, many countries implemented restrictions on daily life to contain the spread of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). These measures varied by country, depending on the region and the rate of infections. A group of Stanford University researchers led by Prof. John Ioannidis concluded, based on an analysis of existing data from 10 countries, that a hard lockdown, compared with less restrictive measures, did not offer significant benefits in reducing infection rates. The publication of the study (Bendavid et al.) is being used in social media as evidence that lockdowns have no significant benefit in containing the spread of SARS-CoV-2. Methods Six researchers independently assessed the methodological quality of the study. The internationally accepted assessment tool ROBINS-I (Risk Of Bias in Non-randomized Studies of Interventions) was applied, which is divided into seven domains. Conflicts in the evaluation were resolved by consensus. Risk of bias in results was graded as low, moderate, or high using an adapted three-tiered scheme. Results The study by Bendavid et al. has serious methodological flaws. The study was rated as having high risk of bias in four of seven domains. One of the most serious shortcomings related to confounding factors: the countries that were compared applied measures at different intensities, and the effectiveness of those measures varied depending on the baseline situation. Crucial information on the criteria used to select the countries included in the study, as well as a clear definition of the interventions, were missing. Conclusions The results of the study have a high potential for bias and should not be used as a basis for decision-making. © Deutscher Ärzteverlag.
ABSTRACT
In response to the SARS-CoV-2 pandemic, a strong focus on the control of infectious disease has shaped policymaking and public life in Germany since March 2020. In this article, we discuss some observations with respect to evidence production and evidence use during the early weeks of the pandemic, highlighting current challenges and outlining opportunities for a stronger Health in All Policies approach in Germany.
ABSTRACT
In this article, members of the German Network of Young Professionals in Public Health, discuss the opportunities and challenges of the Health in All Policies (HiAP) approach, in view of the current COVID-19 pandemic. It outlines various perspectives, from the interaction and cooperation of different policy areas to the national Public Health Service.