Policy implementation challenges and the ritualization of public health emergency plans: An investigation of urban communities in Jiangsu Province, China.

Introduction: The COVID-19 pandemic has been a global public health emergency, and countries worldwide have responded to it through a vast array of pre-planned, adaptively devised and ad-hoc measures. In China, public health emergency plans - the plans expected to drive the response to epidemics or pandemics - demonstrated a concerning tendency towards "ritualization." "Ritualization" denotes the practice of public health emergency plans to be reliably developed so that a formal requirement is met, while being implemented selectively or not at all in the emergency response. Methods: This study explored the phenomenon of ritualization by analyzing data from 1485 questionnaires, 60 in-depth interviews and 85 actual public health emergency plans. It used the Smith Policy-Implementation-Processing pattern as its conceptual framework. Results: The study found that the infeasibility of plans, their ineffective implementation by emergency management agencies, the obstructive behaviors of community residents, and the lack of an appropriate policy environment all contributed to the practice of ritualization. Discussion: As China seeks to better respond to COVID-19 and accelerate the recovery of its health system, it is essential to ensure that its public health emergency plans are effectively developed and implemented.

"We need to talk to each other": Crossing traditional boundaries between public health and occupational health to address COVID-19.

Introduction: This study examined how public health (PH) and occupational health (OH) sectors worked together and separately, in four different Canadian provinces to address COVID-19 as it affected at-risk workers. In-depth interviews were conducted with 18 OH and PH experts between June to December 2021. Responses about how PH and OH worked across disciplines to protect workers were analyzed. Methods: We conducted a qualitative analysis to identify Strengths, Weakness, Opportunities and Threats (SWOT) in multisectoral collaboration, and implications for prevention approaches. Results: We found strengths in the new ways the PH and OH worked together in several instances; and identified weaknesses in the boundaries that constrain PH and OH sectors and relate to communication with the public. Threats to worker protections were revealed in policy gaps. Opportunities existed to enhance multisectoral PH and OH collaboration and the response to the risk of COVID-19 and potentially other infectious diseases to better protect the health of workers. Discussion: Multisectoral collaboration and mutual learning may offer ways to overcome challenges that threaten and constrain cooperation between PH and OH. A more synchronized approach to addressing workers' occupational determinants of health could better protect workers and the public from infectious diseases.

PERCEPTIONS OF THE PEOPLE RECRUITED ABOUT THE STRATEGIC ACTION “O BRASIL CONTA COMIGO” (BRAZIL COUNTS ON ME)

Objective: to analyze the perceptions of academics and supervisors about the strategic action “O Brasil Conta Comigo”(Brazil counts on me). Method: cross-sectional study conducted in Mato Grosso do Sul-Brazil, from December 2020 to March 2021, in two stages: 1) Exploratory (quantitative), via analysis of reports of the 33 supervisors and 90 academics convened, application of an online questionnaire;2) In-depth (qualitative), using the remote focus group technique, with convenience sampling. Descriptive and content analysis was performed. Results: the reasons for joining and remaining with the action (scholarship, internship hours, and social responsibility), the pedagogical aspects (training, evaluation, and support from educational institutions, and management), and the contributions of the action (assistance and professional training) were identified. Conclusion: the general perceptions of the recruits are positive. Pedagogical aspects related to the evaluation of academics and support from higher education institutions should be reviewed, for more assertive actions in times of health crisis. © 2022, Universidade Federal do Parana. All rights reserved.

Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

BACKGROUND: Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe. OBJECTIVES: The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic. METHODS: A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome. RESULTS: The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78). CONCLUSION: This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.

Improving equitable access to care via telemedicine in rural public libraries.

OBJECTIVE: Rural public libraries have been proposed as ideal locations from which individuals can access a telemedicine visit, but limited adoption of this practice suggests significant barriers remain. The purpose of this study was to determine rural public librarians' perspectives on the benefits and barriers to offering patrons the ability to use their public library for a telemedicine video visit, and to suggest strategies for moving this practice forward. DESIGN: Qualitative content analysis. SAMPLE: Fifteen rural US librarians and library directors. MEASUREMENTS: Individual interviews were conducted to determine perspectives on the benefits of and barriers to implementing telemedicine in public libraries. RESULTS: We identified four themes from the data: rural public libraries increase healthcare access in a trustworthy location, librarians are supportive of telemedicine, but have concerns, limited resources drive barriers to telemedicine implementation in rural libraries, and small rural libraries continued in-person service during the COVID-19 pandemic. CONCLUSION: Rural public libraries can be an important part of achieving equitable access to care, particularly with regard to chronic disease management in rural populations. Rural public health nurses can be instrumental in promoting collaborations between local libraries and regional health systems that may help libraries overcome financial barriers to this practice.

Associations Between Compliance With Non-pharmaceutical Interventions and Social-distancing Policies in Korea During the COVID-19 Pandemic.

OBJECTIVES: This study explored changes in individuals' behavior in response to social distancing (SD) levels and the "no gatherings of more than 5 people" (NGM5) rule in Korea during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using survey data from the COVID-19 Behavior Tracker, exploratory factor analysis extracted 3 preventive factors: maintenance of personal hygiene, avoiding going out, and avoiding meeting people. Each factor was used as a dependent variable. The chi-square test was used to compare differences in distributions between categorical variables, while binary logistic regression was performed to identify factors associated with high compliance with measures to prevent transmission. RESULTS: In men, all 3 factors were significantly associated with lower compliance. Younger age groups were associated with lower compliance with maintenance of personal hygiene and avoiding meeting people. Employment status was significantly associated with avoiding going out and avoiding meeting people. Residence in the capital area was significantly associated with higher compliance with personal hygiene and avoiding venturing out. Increasing SD levels were associated with personal hygiene, avoiding going out, and avoiding meeting people. The NGM5 policy was not significantly associated with compliance. CONCLUSIONS: SD levels, gender, age, employment status, and region had explanatory power for compliance with non-pharmaceutical interventions (NPIs). Strengthening social campaigns to inspire voluntary compliance with NPIs, especially focused on men, younger people, full-time workers, and residents of the capital area is recommended. Simultaneously, efforts need to be made to segment SD measures into substrategies with detailed guidance at each level.