Health Emergency and Disaster Risk Management Workforce Development Strategies: Delphi Consensus Study.

INTRODUCTION: Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM). STUDY OBJECTIVE: The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC). METHODS: A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking. RESULTS: In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were "Human Resources" (n = 15), "Planning and Coordination" (n = 7), and "Community Capacities for Health EDRM" (n = 6) in the LMIC group. "Policies, Strategies, and Legislation" (n = 7) and "Human Resources" (n = 7) were the components with the most recommendations for the HIC group. CONCLUSION: The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.

Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis.

BACKGROUND: There is growing evidence that patients recovering after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have a variety of acute sequelae including newly diagnosed diabetes. However, the risk of diabetes in the post-acute phase is unclear. To solve this question, we aimed to determine if there was any association between status post-coronavirus disease (COVID-19) infection and a new diagnosis of diabetes. METHODS: We performed a systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19. PubMed, Embase, Web of Science, and Cochrane databases were all searched from inception to June 10, 2022. Three evaluators independently extracted individual study data and assessed the risk of bias. Random-effects models estimated the pooled incidence and relative risk (RR) of diabetes compared to non-COVID-19 after COVID-19. RESULTS: Nine studies with nearly 40 million participants were included. Overall, the incidence of diabetes after COVID-19 was 15.53 (7.91-25.64) per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62 [1.45-1.80]). The relative risk of type 1 diabetes was RR=1.48 (1.26-1.75) and type 2 diabetes was RR=1.70 (1.32-2.19), compared to non-COVID-19 patients. At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes: <18 years: RR=1.72 (1.19-2.49), ≥18 years: RR=1.63 (1.26-2.11), and >65 years: RR=1.68 (1.22-2.30). The relative risk of diabetes in different gender groups was about 2 (males: RR=2.08 [1.27-3.40]; females: RR=1.99 [1.47-2.80]). The risk of diabetes increased 1.17-fold (1.02-1.34) after COVID-19 infection compared to patients with general upper respiratory tract infections. Patients with severe COVID-19 were at higher risk (RR=1.67 [1.25-2.23]) of diabetes after COVID-19. The risk (RR=1.95 [1.85-2.06]) of diabetes was highest in the first 3 months after COVID-19. These results remained after taking confounding factors into account. CONCLUSIONS: After COVID-19, patients of all ages and genders had an elevated incidence and relative risk for a new diagnosis of diabetes. Particular attention should be paid during the first 3 months of follow-up after COVID-19 for new-onset diabetes.

The impact of SARS and COVID-19 on major trauma in Hong Kong.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been enormously disruptive and harmful to people around the world, but its impact on other illnesses and injuries has been more variable. To evaluate the ramification of infectious disease outbreaks on major traumatic injuries, we compared changes in the incidence of major trauma cases during the 2003 Severe Acute Respiratory Syndrome (SARS) period with COVID-19 in 2020. METHODS: Data were analyzed from the trauma registry of a major, tertiary-care teaching hospital in Hong Kong. Patients presenting with major traumatic injuries during the first six months of 2001-03 and 2018-20 were retrieved for analysis. Patient characteristics, injury mechanism, admitting service, and emergency department (ED)/hospital lengths of stay (LOS) were recorded. Raw and adjusted survival rates (using the modified Trauma Injury Severity Score (TRISS)) were recorded. RESULTS: The number of trauma cases fell dramatically during 2003 and 2020 compared with previous years. In both 2003 and 2020, the number of trauma registry patients fell by 49% in April (compared to the preceding reference years of 2001/02 and 2018/19, respectively). Patient characteristics, treatments, and outcomes were also different during the outbreak years. Comparing 2003 to 2020 relative to their respective reference baselines, the percentages of injuries that happened at home, patients without co-morbidities, and patients' mean age all increased in 2003 but decreased in 2020. Work-place injuries drastically dropped in 2003, but not in 2020. Average ED LOS dropped in 2003 by 36.4 min (95% CI 12.5, 60.3) but declined by only 14.5 min (95% CI -2.9, 32.1) in 2020. Both observed and expected 30-day mortality declined in 2020 vs. 2003 (observed 4.5% vs. 11.7%, p = 0.001, OR 0.352, 95% CI 0.187, 0.661) (expected 4.5% vs 11.6%, p = 0.002, OR 0.358, 95% CI 0.188, 0.684). CONCLUSION: Major trauma cases dropped by half during both the peak of the 2003 SARS and 2020 COVID-19 pandemics in Hong Kong, suggesting a trend for future pandemic planning. If similar findings are seen at other trauma centers, proactive personnel and resource allocations away from trauma towards medical emergency systems may be more appropriate for future pandemics.