The Negative Impact of the New Coronavirus Pandemic on the Trend of Breast Biopsies and Their Direct Costs: Interrupted Time Series Analysis.

OBJECTIVES: The overload of health services because of the COVID-19 pandemic has reduced the population's access to treatment and prevention of other diseases. This study aimed to identify whether there was a change in the trend of breast biopsies and their direct costs during the COVID-19 pandemic in a developing country's public and universal healthcare system. METHODS: This was an ecological time series study of mammograms and breast biopsies in women aged 30 years or older from an open-access data set of the Public Health System of Brazil from 2017 to July 2021. RESULTS: In 2020, there was a reduction of -40.9% in mammograms and -7.9% in breast biopsies compared with the prepandemic period. From 2017 to 2020, there was an increase in the breast biopsies ratio per mammogram (1.37%-2.55%), the percentage of Breast Imaging-Reporting and Data System (BI-RADS) IV and V mammograms (0.79%-1.14%), and the annual direct cost of breast biopsies (Brazilian Real 3 477 410.00 to Brazilian Real 7 334 910.00). In the time series, the negative impact of the pandemic was lower on BI-RADS IV to V mammograms than on BI-RADS 0 to III. There was an association between the trend of breast biopsies and BI-RADS IV to V mammography. CONCLUSIONS: The COVID-19 pandemic harmed the increasing trend of breast biopsies, their total direct costs, BI-RADS 0 to III and IV to V mammograms, observed in the prepandemic period. Furthermore, there was a tendency to screen women at a higher risk for breast cancer during the pandemic.

The trend and direct costs of screening and chemotherapy treatment of breast cancer in the new coronavirus pandemic: total and interrupted time series study.

BACKGROUND: The COVID-19 pandemic has overloaded the healthcare systems of many countries and reduced the population's access to treatment and prevention of other diseases. This study aims to assess whether the COVID-19 pandemic has negatively interfered with the trend and the direct costs of screening and chemotherapy treatment of breast cancer in a public and universal healthcare system. METHOD: This was an ecological time series study using an open database of a public and universal health system from 2017 to 2021. RESULTS: In 2020, there was a 41% reduction in the coverage rate of breast cancer screening in women aged 50 to 69 years (about 1 million mammograms missed). The total direct cost of breast cancer screening reduced proportionally to the number of tests (BRL 67 million). On the other hand, the cost of chemotherapy treatment was higher in 2020, both in advanced (BRL 465 million) and localized (BRL 113 million) diseases. In the time series, mammograms' trend and direct costs changed from stationary to decreasing after the COVID-19 pandemic. The trend of direct costs with chemotherapy treatment for the advanced disease has been increasing and has not changed after the COVID-19 pandemic. On the other hand, in the case of localized disease, there was a trend toward reducing direct costs after the pandemic. CONCLUSION: After COVID-19, there was a downward trend in breast cancer screening and its direct costs, an upward trend in chemotherapy costs for advanced disease, and a downward trend in chemotherapy costs for localized disease.

Roads to Health: Infrastructure and Urban Wellbeing in Later Medieval Italy: by Guy Geltner, Philadelphia, University of Pennsylvania Press, 2019, 259 pp., $65.00 (cloth)

Second, in retrieving archival records of the activity of the civic offices responsible for maintenance, Geltner also joins the call of other medieval public health historians to expand the scope of health histories beyond the activity of medical personnel. I Roads to Health i was published just a few months before the outbreak of the Covid-19 pandemic and the subsequent re-emergence into public consciousness of how health issues may impact all of society. Third, Geltner demonstrates that public health has a longer history than claimed by much modern historiography and that the Black Death, the plague of 1348, was not the watershed of public health measures as it is often claimed to have been. [Extracted from the article] Copyright of European Legacy is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

P141 Where Do We Go From Here? California Local Health Departments Navigate School-based SNAP-Ed During COVID-19

COVID-19 forced California Supplemental Nutrition Assistance Program Education (SNAP-Ed) to suddenly shift planned strategies to meet SNAP-eligible population needs. K-12 schools, important SNAP-Ed partners for reaching children and families, were profoundly affected. Most (77%) local health departments (LHDs) reported they were unable to accomplish previously planned activities at school sites in 2020. To understand pandemic-related changes to school-based SNAP-Ed and identify areas of opportunity. We conducted secondary mixed-methods analyses of California LHDs' school-based SNAP-Ed activity and needs assessment data from fiscal years 2020-2021. Outcomes include number and type of SNAP-Ed programs that were halted or newly implemented, number of participants reached, policies, systems, and environmental change strategies (PSEs) adopted, new methods of education delivery, and extent to which schools implemented nutrition and physical activity (Nut-PA) best practices. Qualitative analysis examined COVID-19-related barriers and facilitators to SNAP-Ed implementation. In 2020, 270 PSE interventions were initiated in schools;21% were discontinued and 12% were created in response to COVID. New opportunities included using school meal distributions to provide free groceries, home gardening kits, and brief face-to-face nutrition education. Many LHDs transitioned to virtual Nut-PA education, increasing SNAP-Ed participant reach. In Fall 2020, as schools adjusted to alternative learning models, school-level assessments of Nut-PA practices indicated the most common area of opportunity was nutrition education. Over 75% of schools reported that PSE strategies requiring on-site/in-person implementation, such as improving lunchroom facilities, were not feasible. Facilitators of SNAP-Ed implementation included community support and strong partnerships between schools, community-based organizations, and SNAP-Ed implementing agencies;barriers included regulations and staff turnover. SNAP-Ed programs nationwide can continue to serve SNAP-eligible children and families during crises like COVID-19 by partnering with schools and other community organizations. These partners identified the nutrition and physical activity needs of a community and the best practices to address them. Supplemental Nutrition Assistance Program - Education

Identifying Value-Added Population Health Capabilities to Strengthen Public Health Infrastructure.

Policy Points While the coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in delivery systems. The results of our study suggest that the public health system structure can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities can help communities efficiently use limited time and resources and identify the most effective pathways for building a stronger public health system and improving health outcomes over time. CONTEXT: While the novel coronavirus pandemic has underscored the important role of public health systems in protecting community health, it has also exposed weaknesses in the public health infrastructure that stem from chronic underfunding and fragmentation in public health delivery systems. Information about the relative value in the implementation of recommended population health capabilities can help communities prioritize their use of limited time and resources and identify the most effective pathways for building a stronger public health system. METHODS: We used a longitudinal cohort design with data from the National Longitudinal Survey of Public Health Systems to examine longitudinal and geographic trends in the delivery of population health capabilities and their impact on system strength across communities in the United States. We used linear probability models to ascertain whether the delivery of certain capabilities added value to public health system strength. FINDINGS: Those communities with the strongest classification of public health system structure in both urban and rural areas implemented the largest set of population health capabilities. Results from the linear probability model indicate that a set of population health capabilities are associated with increased public health system strength. Key activities include allocating resources based on a community health plan, surveying the community for behavioral risk factors, analyzing the data on preventive services use, and engaging community stakeholders in health improvement planning (p < 0.01). CONCLUSIONS: The results of this study suggest that public health systems can be strengthened through the targeted implementation of high-value population health capabilities. Prioritizing the delivery of value-added population health capabilities may help communities increase their public health system's capacity and improve health outcomes.

An analysis of China's strategy in combating the coronavirus pandemic with the 3H framework

Purpose - This paper attempts to theorise about China's strategy in combating the coronavirus pandemic with an embryonic framework - 3H (Heart-Head-Hand) framework. By adopting a descriptive approach, the paper introduces the case of coronavirus outbreak in China and how the public health administration coped with it The 3H framework has been applied to analyse China's strategy, and the framework's assumptions are initially tested. Design/methodology/approach - The pandemic case is created based on credible reports, press releases from different respected sources, World Health Organization (WHO) statistics, interview transcripts and broadcasting stations' video clippings. Interpretive analysis with pragmatism approach has been conducted in analysing the data and information collected. Triangulation, wherever possible, has been done to validate the data and information. Findings - As an exploratory study, its findings show that 3H framework distinguishes the effectiveness of a country's strategy and practice for combating the pandemic. Countries, which failed to observe the assumed principles of 3H domains tend to have much more infected cases and deaths. Originality/value - The 3H framework conceptualised a holistic management approach and its assumptions have been initially tested with this pandemic case. The framework shows its predictability value for a country's pandemic management effectiveness.

An Introduction to Socioeconomic Dynamics of the COVID-19 Crisis: Global, Regional, and Local Perspectives

This edited volume on the socioeconomic dynamics of the COVID-19 crisis covers a wide spectrum of topics, such as reallocation of economic resources, financial markets, government policy response to COVID-19 crisis, stock market return, social relief packages, spread of the disease in polluted cities, public health strategies and biopolitics, donation efficiencies, global hegemony, psychological perspectives, mental health outcomes, cultural challenges, and organization and management research in the post-COVID-19 era, as well as entrepreneurial universities, entrepreneurial frugality, and the international entrepreneurship future. Through each chapter, the authors, who are experts in this area of study, have tried to unfold an emerging aspect in the COVID-19 crisis which could benefit not only academic readers but also institutional, economic, social, and developmental policymakers, as well as health managers and practitioners on the ground. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The pandemic knocks on the occupational health acute accent s door

The pandemic caused by SARS-CoV-2 has tested our current National Occupational Safety and Health System. The pandemic, managed from the public health Administration sector, has directly affected the world of work. Therefore, the management of this contingency has demanded a joint and agile response from two areas, public health and occupational health, and has proved its indissoluble nature. This article analyzes the main activities carried out in the labor context to fight against COVID-19 in order to identify the best tools to integrate the measures defined by the competent public health authorities in the occupational safety and health management. Likewise, this article shows the vision of the main international organizations about the relationship between the pandemic and the safety and health at work.

Unmasking Scientific Expertise

In early Feb 1976, two cases of swine flu were discovered at Fort Dix NJ. The Center for Disease Control (CDC) identified the virus as Hsw1N1, similar to the one that caused the 1918 pandemic. Serologic testing indicated that the virus had spread to more than 200 recruits. The CDC's Advisory Committee on Immunization Practices soon recommended "an immunization program be launched to prevent the effects of a possible pandemic." After consulting with a group of scientific experts and public representatives, President Gerald Ford launched a nationwide vaccination program to immunize "every man, woman, and child." The National Swine Flu Immunization Program, which cost $137 million and received bipartisan support from Congress, soon met with controversy. The president's critics accused him of politicizing science during an election year, while skeptics questioned the safety of the vaccine. Reports of severe adverse effects--specifically, cases of Guillain-Barré syndrome--began ricocheting across the media. As public health experts and the administration grappled with a growing public backlash and the complex logistics of a mass immunization program, they learned something shocking: no new cases of Hsw1N1 had been detected outside the Fort Dix cluster.

Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada.

This commentary explores public health (PH) investments in Quebec and underlines the challenge of tracking PH resources across Canada. We analyzed governmental data to compare investments across all health and social programs in Quebec from 2004-2005 to 2017-2018. The province's PH budgets suffered from disproportionately low investments and abrupt cuts. These cuts were the largest among all health programs in 2015-2016 (- 7.1%). PH budgets did not keep up with inflation and, in constant dollars, have declined over the last decade. Furthermore, their evolution over the span of 14 years significantly differed from other health programs. On average, programs providing direct services experienced overall budget increases of 81%, whereas PH budgets had the lowest increase of all such programs at only 46%. PH suffers from serious erosion of its capacity. Unfortunately, there is a dire lack of comparable data for provincial, national, and international PH budgets, which further complicates the monitoring of PH erosion. We contend that systematic tracking of PH budgets remains profoundly inadequate across Canada. We recommend (1) regular, comprehensive, and publicly reported analyses of PH budgets; (2) in-depth comparisons of PH investments across Canadian jurisdictions; and (3) a strong PH systems and services research agenda for Canada.

Stay-at-Home Orders and the Common Good.

COVID-19, also known as SARS-CoV-2, began in Wuhan, China, late November or early December, 2019 and has since spread rapidly throughout the globe, being declared a health emergency of international concern a month later and a pandemic on March 11, 2020. It is highly contagious with a death rate up to twelve times that of the flu, even higher where the healthcare systems have been strained. To reduce the spread, states have implemented stay-at-home declarations, limiting social gatherings, and closing churches. However, some have argued that churches are an "essential service" and should be reopened in order that the faithful to be able to receive the sacraments, in particular the Eucharist. I will argue that this goes against the Catholic doctrine of the common good and care for the poor and vulnerable. Summary: COVID-19 has caused a pandemic strained health care resources. In response, the US instituted stay-at-home orders which included the closing of places of worship. Within reason, this falls under the Catholic doctrine of the common good and caring for the poor and vulnerable.

Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study.

BACKGROUND: As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required. Personal health records (PHRs) are suitable for the daily management of physical conditions. Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19. Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items. Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19. To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app. OBJECTIVE: This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs. METHODS: We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center. At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers). Email addresses are used by the app when a health observer sends data to the public health center. Each health observer downloads the app and installs it on their smartphone. Self-observed health data are entered daily into the app. These data are then sent via the app by email at a designated time. Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers. RESULTS: We used the app as part of an active epidemiological investigation executed at a public health center. During the investigation, 72 close contacts were discovered. Among them, 57 had adopted the use of the health observation app. Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours. After the introduction of the app, a single epidemiological officer can carry out health observations. The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan. Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities. CONCLUSIONS: Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases. Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases. Ultimately, similar actions may help to prevent the spread of COVID-19.

[Development and improvement of Chinese oral public health system].

The pandemic of COVID-19 in early 2020 is a big challenge to the mechanism of major epidemic prevention and control, the national public health management system, as well as medical and health resources in China. Going through the COVID-19 crisis, we should fully understand the problems and vulnerabilities of the current public health system in China, and it is imperative to deepen and strengthen the public health system which should be throughout whole life cycle and whole process. Oral cavity is the first portal of human body, while illness finds its way in by the mouth. Oral health is highly related to general health and quality of life. The outbreak has drawn the public's attention to the public health system. The establishment and improvement of the oral public health system with the concept of "public health with Chinese characteristics" should also attract people's attentions and thoughts. Furthermore it is urgent to recognize the importance of oral public health.