Health Diplomacy in the CARICOM Region

In today's globalized world, with high connectivity and interdependence on other nations, the germs can cross borders within minutes making the Caribbean region more vulnerable. The paramount role of health diplomacy is increasing day by day, especially with the recent COVID-19 pandemic. In 2007, the Caribbean region formulated the "Port of Spain Summit Declaration”, a unique, comprehensive policy addressing chronic non-communicable diseases with a high-level commitment from the head of the states. Health diplomacy is not something new to the region as it has developed many regional initiatives for collective action against HIV/AIDS, other infectious diseases in the past decades but never had a dedicated centre to further the concept or conduct more research. This chapter examines various challenges in the region and emphasizes the region's role in addressing its needs on global platforms to negotiate for more assistance and robust policies to safeguard peace, health, and development. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

The experience of countries in implementing the principles of "one health". Comparative review

Relevance: The global consequences of the COVID-19 pandemic emphasize today the importance of the concept of "One Health" for the health system, which provides for the use of a coordinated, joint, interdisciplinary and intersectoral approach to eliminate potential or existing risks arising at the interface of the "environment-animal-human-ecosystem". The aim of the work is to study the experience of countries in implementing the concept of "One Health". Search strategy: comparative analysis of publications on the research topic, sources indexed in the databases of the electronic library e-Library, Google Academy, Pubmed, Web of Science, Scopus. 26 countries from the European Union, South America and Africa were subject to analysis. The criteria defined are: institutional framework;mechanisms of intersectoral interaction and programs/tools for the implementation of the concept of "One Health". Results: The literature review provides a comparative analysis of the experience of implementing the concept of "One Health" in 26 countries. Realizing the importance of "One Health" in the general concept of public safety, countries have launched an active policy to promote it in the last decade. Characteristic features of country policies are the intersectoral approach with appropriate support from the government of the country, the activity of all participants in promoting the initiative and their investment.

Indoor Air Quality Improvements to Reduce Global Catastrophic Biological Risk

The importance of indoor air quality (IAQ) to reduce infectious disease transmission has become clear during the COVID-19 pandemic. In addition to SARS-CoV-2, other diseases, including RSV and influenza, are spread by airborne transmission, and often indoors-where most people spend over 90% of their lives. Given the importance of indoor environments in the spread of infectious disease, ventilation and filtration to improve IAQ should play a major role in preparing for a global catastrophic biological risk event (GCBR). This study involves performing a review of peer-reviewed literature and reports about improving indoor air quality in public spaces and interviewing technical experts in the fields of indoor air, building ownership, IAQ policy, and disease transmission control. The goal of the study is to identify and develop near and long-term policy actions for improving IAQ aimed to reduce GCBRs and other infectious diseases at various levels, including local and national. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

COVID-19 Waves and Politics in Costa Rica

In 2018, the government that came to power in Costa Rica quickly began to promote socially regressive policies, which directly favored the oligarchic groups, at the expense of the working classes and the middle sectors. The COVID-19 pandemic, instead of stopping this process, accentuated it. After a very moderate first wave of infections (March-May 2020), the disease spread steadily during a second wave (June 2020-February 2021). A third wave (so far May-June 2021) has brought the public health system to the brink of collapse. With the social protests neutralized by health measures to contain COVID-19, authorities took advantage of this situation to promote new reforms that deteriorate labor rights, reduce wages and deepen inequalities. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Telehealth Policy and the Advanced Practice Nurse

Telehealth is an efficient and effective method of care delivery used by advance practice registered nurses (APRNs) nationally, especially in the wake of the coronavirus disease 2019 pandemic. With the ever-changing rules and regulations governing telehealth practice, the APRN may struggle to keep abreast. Telehealth is governed by legislation and regulation in addition to telehealth-specific laws. APRNs delivering care through telehealth must be informed about the crucial aspects of telehealth policy and how their practice is affected. Telehealth-related policy is complex and evolving and varies by state. This article provides APRNs with essential knowledge about telehealth-related policy to support legal and regulatory compliance.

The Role of Policymakers in Potential Strengthening to Improve the Safety of the Vegetable in the Supply Chain: SWOT Analysis during COVID-19

Background: Fresh vegetables can play an important role in health and food security. This study aimed to assess the safety of the vegetable supply chain in Iran during the COVID-19 pandemic by strengths, weaknesses, opportunities, and threats (SWOT) analysis. Methods: A mixed-methods study was conducted in two phases in 2021. First, in the cross-sectional study, 192 staff were randomly selected from five major centers of vegetable retail centers. Then, semi-structured interviews were done with ten stakeholders, and a SWOT analysis was completed. Results: Half of the participants had desirable hygienic practices, 39.6% had acceptable, and 8.9% had weak practice scores. The practice of participants whose educational level was BSc and above was better than that of illiterates (OR =15.38, 95% CI =1.61-14.57, P=0.01). SWOT analysis results identified a poor shelf-life of vegetables, weak technology in planting, harvesting, and distributing vegetables. Conclusion: Policymakers can utilize the practical solutions for taking action in the potential strengthening of vegetable safety in the supply chain to improve public health during the COVID-19 pandemic. © 2023, Journal of Nutrition and Food Security. All Rights Reserved.

Barriers to, and facilitators of, eHealth utilisation by parents of high-risk newborn infants in the NICU: a scoping review protocol.

INTRODUCTION: Parental presence in the neonatal intensive care unit (NICU) has been demonstrated to enhance infant growth and development, reduce parental anxiety and stress and strengthen parent-infant bonding. Since eHealth technology emerged, research on its utilisation in NICUs has risen substantially. There is some evidence that incorporating such technologies in the NICU can reduce parental stress and enhance parent confidence in caring for their infant.Several countries, including China, restrict parental attendance in NICUs, citing infection control challenges, issues of privacy and confidentiality and perceived additional workload for healthcare professionals. Due to COVID-19 pandemic-related shortages of personal protective equipment and uncertain mode of transmission, many NICUs around the world closed to parental visiting and engagement in neonatal care.There is anecdotal evidence that, given pandemic-related restrictions, eHealth technologies, have increasingly been used in NICUs as a potential substitute for in-person parental presence.However, the constraints and enablers of technologies in these situations have not been exhaustively examined. This scoping review aims to update the literature on eHealth technology utilisation in the NICU and to explore the literature on the challenges and facilitators of eHealth technology implementation to inform future research. METHODS AND ANALYSIS: The five-stage Arksey and O'Malley methodological framework and the Joanna Briggs Institute scoping review methodology will serve as the foundation for this scoping review. Eight databases will be searched for the relevant literature published between January 2000 and August 2022 in either English or Chinese. Grey literature will be manually searched. Data extraction and eligibility screening will be carried out by two impartial reviewers. There will be periods of both quantitative and qualitative analysis. ETHICS AND DISSEMINATION: Since all data and information will be taken from publicly accessible literature, ethical approval would not be necessary. A peer-reviewed publication will be published with the results of this scoping review. TRIAL REGISTRATION NUMBER: This scoping review protocol was registered in Open Science Framework and can be found here: https://osf.io/AQV5P/.

Horizon scanning, rapid reviews and living evidence to support decision-making: lessons from the work of the Critical Intelligence Unit in New South Wales, Australia during the COVID-19 pandemic.

The COVID-19 pandemic has seen an increase in rapidly disseminated scientific evidence and highlighted that traditional evidence synthesis methods, such as time and resource intensive systematic reviews, may not be successful in responding to rapidly evolving policy and practice needs. In New South Wales (NSW) Australia, the Critical Intelligence Unit (CIU) was established early in the pandemic and acted as an intermediary organisation. It brought together clinical, analytical, research, organisational and policy experts to provide timely and considered advice to decision-makers. This paper provides an overview of the functions, challenges and future implications of the CIU, particularly the Evidence Integration Team. Outputs from the Evidence Integration Team included a daily evidence digest, rapid evidence checks and living evidence tables. These products have been widely disseminated and used to inform policy decisions in NSW, making valuable impacts. Changes and innovations to evidence generation, synthesis and dissemination in response to the COVID-19 pandemic provide an opportunity to shift the way evidence is used in future. The experience and methods of the CIU have potential to be adapted and applied to the broader health system nationally and internationally.

Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings.

Introduction: We explored priorities and perspectives on health policy and payer strategies for improving HPV vaccination rates in safety-net settings in the United States. Methods: We conducted qualitative interviews with policy and payer representatives in the greater Los Angeles region and state of New Jersey between December 2020 and January 2022. Practice Change Model domains guided data collection, thematic analysis, and interpretation. Results: Five themes emerged from interviews with 11 policy and 8 payer participants, including: (1) payer representatives not prioritizing HPV vaccination specifically in incentive-driven clinic metrics; (2) policy representatives noting region-specific HPV vaccine policy options; (3) inconsistent motivation across policy/payer groups to improve HPV vaccination; (4) targeting of HPV vaccination in quality improvement initiatives suggested across policy/payer groups; and (5) COVID-19 pandemic viewed as both barrier and opportunity for HPV vaccination improvement across policy/payer groups. Discussion: Our findings indicate opportunities for incorporating policy and payer perspectives into HPV vaccine improvement processes. We identified a need to translate effective policy and payer strategies, such as pay-for-performance programs, to improve HPV vaccination within safety-net settings. COVID-19 vaccination strategies and community efforts create potential policy windows for expanding HPV vaccine awareness and access.

Identification of behavioural changes in reporting adverse events early during COVID-19: An ambulatory care perspective in Israel.

This study examined adverse event reporting centred on three significant dates in the months before the pandemic arrived in Israel. On these dates, broad media coverage exposed citizens and health care providers with indications about the forthcoming pandemic. The current study tracked whether parameters related to reporting adverse medical events provided early indications that a large crisis was unfolding. The method for analysing the data was based on a statistical test called Regression Discontinuity Design, which helped identify parameters related to medical reporting patterns which significantly changed. The examination indicated nurses' reports were unique in relation to others and indicated three phases: (1) upon declaration of the upcoming pandemic, there was a rise in reporting; (2) when the disease was named, there was moderation and maintenance in a steady quantity of reports, and finally, (3) when the first case arrived in Israel, a slight decrease in reporting began. Nurses' behaviours manifested as changes in reporting patterns. In this process of increase, moderation and decrease, it can be concluded that these are three stages that may characterise the beginning of a large event. The research method presented reinforces the need for forming tools by which significant events such as the COVID-19 pandemic can be identified quickly, and aid in proper planning of resources, optimise staffing and maximise utilization of the health systems.

A shared agenda for gender and COVID-19 research: priorities based on broadening engagement in science.

While the acute and collective crisis from the pandemic is over, an estimated 2.5 million people died from COVID-19 in 2022, tens of millions suffer from long COVID and national economies still reel from multiple deprivations exacerbated by the pandemic. Sex and gender biases deeply mark these evolving experiences of COVID-19, impacting the quality of science and effectiveness of the responses deployed. To galvanise change by strengthening evidence-informed inclusion of sex and gender in COVID-19 practice, we led a virtual collaboration to articulate and prioritise gender and COVID-19 research needs. In addition to standard prioritisation surveys, feminist principles mindful of intersectional power dynamics underpinned how we reviewed research gaps, framed research questions and discussed emergent findings. The collaborative research agenda-setting exercise engaged over 900 participants primarily from low/middle-income countries in varied activities. The top 21 research questions included the importance of the needs of pregnant and lactating women and information systems that enable sex-disaggregated analysis. Gender and intersectional aspects to improving vaccine uptake, access to health services, measures against gender-based violence and integrating gender in health systems were also prioritised. These priorities are shaped by more inclusive ways of working, which are critical for global health as it faces further uncertainties in the aftermath of COVID-19. It remains imperative to address the basics in gender and health (sex-disaggregated data and sex-specific needs) and also advance transformational goals to advance gender justice across health and social policies, including those related to global research.

Mutant metaphors: Frankenstein in the era of COVID-19.

Since its debut, Mary Shelley's Frankenstein has, fittingly, assumed a life of its own. In today's cultural landscape, the mere mention of 'mutant' evokes the language of Othering, including Frankensteinian metaphors, such as those used to describe the omicron variant of SARS-CoV-2. When scientists referred to omicron as a Frankenstein variant, they demonstrated the inherent mutability of the myth-a myth that is crucial in biomedicine. In this article, the authors examine the shifting nature of Frankenstein metaphors and consider how they function in what Priscilla Wald refers to as outbreak narratives in the context of the USA's COVID-19 policies. The authors point to the ready instatement of travel bans as evidence of how such a potent myth is used to create and sell public policy. In response to such xenophobic policies, the authors apply Donna Haraway's concept of 'boundary breakdowns' in order to reimagine relationships with mutancy. They examine how moving past the idea of mutant is other in contemporary virus narratives may offer a way to reconfigure our relationships of self and other and move beyond the hegemonic and nativist policies of the present.

The shortfalls of vulnerability indexes for public health decision-making in the face of emergent crises: the case of COVID-19 vaccine uptake in Virginia.

Equitable and effective vaccine uptake is a key issue in addressing COVID-19. To achieve this, we must comprehensively characterize the context-specific socio-behavioral and structural determinants of vaccine uptake. However, to quickly focus public health interventions, state agencies and planners often rely on already existing indexes of "vulnerability." Many such "vulnerability indexes" exist and become benchmarks for targeting interventions in wide ranging scenarios, but they vary considerably in the factors and themes that they cover. Some are even uncritical of the use of the word "vulnerable," which should take on different meanings in different contexts. The objective of this study is to compare four vulnerability indexes produced by private, federal, and state institutions to assess the application of these measures to the needs of the COVID-19 pandemic and other emergent crises. We focus on federal, state, and private industries' vulnerability indexes for the Commonwealth of Virginia. Qualitative comparison is done by considering each index's methodologies to see how and why they defined and measured "vulnerability." We also quantitatively compare them using percent agreement and illustrate the overlaps in localities identified as among the most vulnerable on a choropleth map. Finally, we provide a short case study that explores vaccine uptake in the six localities that were identified by at least three indexes as most vulnerable, and six localities with very low vaccine coverage that were identified by two or fewer indexes as highly vulnerable. By comparing the methodologies and index (dis)agreements, we discuss the appropriateness of using pre-existing vulnerability indexes as a public health decision-making tool for emergent crises, using COVID-19 vaccine uptake as a case study. The inconsistencies reflected by these indexes show both the need for context-specific and time-sensitive data collection in public health and policy response, and a critical critique of measured "vulnerability."

A cross-sectional study factors associated with resilience among medical staff in radiology departments during COVID-19, Riyadh, Kingdom of Saudi Arabia.

OBJECTIVES: This study aims to assess the level of resilience of medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia, during the COVID-19 outbreak and to explore associated factors. SETTING: Medical staff, including nurses, technicians, radiology specialists and physicians, working in radiology departments at government hospitals in Riyadh, Saudi Arabia during the COVID-19 outbreak. DESIGN: A cross-sectional study. PARTICIPANTS: The study was conducted among 375 medical workers in radiology departments in Riyadh, Kingdom of Saudi Arabia. The data collection took place from 15 February 2022 to 31 March 2022. RESULTS: The total resilience score was 29.37±6.760 and the scores of each dimension showed that the higher mean score was observed in the domain of 'flexibility', while the lowest was observed in 'maintaining attention under stress'. Pearson's correlation analysis showed that there was a significant negative correlation between resilience and perceived stress (r=-0.498, p<0.001). Finally, based on multiple linear regression analysis, factors affecting resilience among participants are the availability of psychological hotline (available, B=2.604, p<0.050), knowledge of COVID-19 protective measures (part of understanding, B=-5.283, p<0.001), availability of adequate protective materials (partial shortage, B=-2.237, p<0.050), stress (B=-0.837, p<0.001) and education (postgraduate, B=-1.812, p<0.050). CONCLUSIONS: This study sheds light on the level of resilience and the factors that contribute to resilience in radiology medical staff. Moderate levels of resilience call for health administrators to focus on developing strategies that can effectively help cope with workplace adversities.

COVID-19: responding to a pandemic on Operation TORAL.

Operation TORAL was the UK's contribution to NATO's Operation RESOLUTE SUPPORT in Kabul, Afghanistan. Approximately 1000 British troops were deployed in Kabul when the arrival of the COVID-19 pandemic in Afghanistan was declared. This article will describe the challenges faced due to COVID-19 in Kabul.Medical planning considerations, occupational health issues, implementation of behaviour change and operating as part of a multinational organisation are all discussed, with challenges encountered detailed and potential solutions offered. The use of a suggested framework for ensuring the medical estimate process covered all areas relevant to an emerging viral pandemic -the 4Ds and 4Cs approach-proved particularly useful in the early stages of the pandemic in Afghanistan.

Telemental health policies for college students during COVID-19.

Federal and institutional policy changes have accelerated the use of telemental health to care for college students distant from their mental health providers during the early part of the COVID-19 pandemic. Temporary measures have made telemental health more readily available, including relaxing of regulations related to interstate licensure, controlled substance prescribing, patient privacy, and reimbursement. Though early efforts are underway to sustain these changes during and in the wake of the pandemic, there are important areas in which federal and institutional policy are still lacking. Additional steps are needed to successfully implement and sustain telemental health for college students include ensuring student access to technology and Internet; proactive outreach to optimize the student's home environment, addressing concerns about safety and confidentiality; developing the means to track rapidly shifting telemental health policy changes; and developing centralized resources that enable remote providers to become familiar with involuntary commitment laws and emergency protocols.