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1.
JAMA Netw Open ; 4(11): e2132923, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1516695

ABSTRACT

Importance: Seroprevalence studies inform the extent of infection and assist evaluation of mitigation strategies for the COVID-19 pandemic. Objective: To estimate the prevalence of unidentified SARS-CoV-2 infection in the general population of Hong Kong. Design, Setting, and Participants: A prospective cross-sectional study was conducted in Hong Kong after each major wave of the COVID-19 pandemic (April 21 to July 7, 2020; September 29 to November 23, 2020; and January 15 to April 18, 2021). Adults (age ≥18 years) who had not been diagnosed with COVID-19 were recruited during each period, and their sociodemographic information, symptoms, travel, contact, quarantine, and COVID-19 testing history were collected. Main Outcomes and Measures: The main outcome was prevalence of SARS-CoV-2 infection. SARS-CoV-2 IgG antibodies were detected by an enzyme-linked immunosorbent assay based on spike (S1/S2) protein, followed by confirmation with a commercial electrochemiluminescence immunoassay based on the receptor binding domain of spike protein. Results: The study enrolled 4198 participants (2539 [60%] female; median age, 50 years [IQR, 25 years]), including 903 (22%), 1046 (25%), and 2249 (53%) during April 21 to July 7, 2020; during September 29 to November 23, 2020; and during January 15 to April 18, 2021, respectively. The numbers of participants aged 18 to 39 years, 40 to 59 years, and 60 years or older were 1328 (32%), 1645 (39%), and 1225 (29%), respectively. Among the participants, 2444 (58%) stayed in Hong Kong since November 2019 and 2094 (50%) had negative SARS-CoV-2 RNA test results. Only 170 (4%) reported ever having contact with individuals with confirmed cases, and 5% had been isolated or quarantined. Most (2803 [67%]) did not recall any illnesses, whereas 737 (18%), 212 (5%), and 385 (9%) had experienced respiratory symptoms, gastrointestinal symptoms, or both, respectively, before testing. Six participants were confirmed to be positive for anti-SARS-CoV-2 IgG; the adjusted prevalence of unidentified infection was 0.15% (95% CI, 0.06%-0.32%). Extrapolating these findings to the whole population, there were fewer than 1.9 unidentified infections for every recorded confirmed case. The overall prevalence of SARS-CoV-2 infection in Hong Kong before the roll out of vaccination was less than 0.45%. Conclusions and Relevance: In this cross-sectional study of participants from the general public in Hong Kong, the prevalence of unidentified SARS-CoV-2 infection was low after 3 major waves of the pandemic, suggesting the success of the pandemic mitigation by stringent isolation and quarantine policies even without complete city lockdown. More than 99.5% of the general population of Hong Kong remain naive to SARS-CoV-2, highlighting the urgent need to achieve high vaccine coverage.


Subject(s)
COVID-19 Testing , COVID-19/epidemiology , Pandemics , Population Health , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Viral/blood , COVID-19/diagnosis , COVID-19/virology , Communicable Disease Control , Cross-Sectional Studies , Female , Hong Kong , Humans , Immunoglobulin G/blood , Male , Middle Aged , Population Surveillance , Prevalence , Prospective Studies , RNA, Viral , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Seroepidemiologic Studies , Young Adult
3.
Int Nurs Rev ; 68(4): 557-562, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1483903

ABSTRACT

AIM: To discuss the virtual learning strategies used in population health nursing course during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: The School of Nursing faculty in a South Central University in the United States quickly combined innovation with digital resources and transitioned a course in population health during the COVID-19 pandemic. Nursing faculty were challenged to develop student nursing objectives in assessment, planning, intervention and evaluation of vulnerable populations in the community through a virtual environment. REFLECTIONS OF POPULATION HEALTH NURSING CLINICAL EDUCATION: The experiences of five clinical groups are described, covering adults with disabilities, older people, patients with COVID-19 and youth populations. DISCUSSION: The course objectives were met through use of a digital environment. Collaborative interventions were designed and implemented with community stakeholders while maintaining social distancing policies. Successes included increased frequency of communication and learning opportunities for students and the community, and student satisfaction. Barriers to student learning were not related to the digital learning environment, although the older adults required modifications to use electronic devices. CONCLUSION: Virtual classrooms are a viable platform to teach population health nursing and to benefit vulnerable populations. IMPLICATIONS FOR NURSING PRACTICE: Virtual learning offers benefits within academia and the community. Technology offers the possibility to improve mental health among older people and enhance knowledge among the general population. Students are better able to connect with clinical faculty and stakeholders through digital platforms. IMPLICATIONS FOR NURSING POLICY: Nurses play a vital role in improving population health and can collaborate with community stakeholders to implement innovative and sustainable solutions to nursing education, practices and policy. Digital platforms can enhance the involvement of students through these collaborations during and after the pandemic.


Subject(s)
COVID-19 , Education, Distance , Population Health , Students, Nursing , Adolescent , Aged , Humans , Pandemics/prevention & control , SARS-CoV-2 , United States
4.
Int J Equity Health ; 20(1): 214, 2021 09 26.
Article in English | MEDLINE | ID: covidwho-1477425

ABSTRACT

BACKGROUND: COVID-19 has caused almost unprecedented change across health, education, the economy and social interaction. It is widely understood that the existing mechanisms which shape health inequalities have resulted in COVID-19 outcomes following this same, familiar, pattern. Our aim was to estimate inequalities in the population health impact of COVID-19 in Scotland, measured by disability-adjusted life years (DALYs) in 2020. Our secondary aim was to scale overall, and inequalities in, COVID-19 DALYs against the level of pre-pandemic inequalities in all-cause DALYs, derived from the Scottish Burden of Disease (SBoD) study. METHODS: National deaths and daily case data were input into the European Burden of Disease Network consensus model to estimate DALYs. Total Years of Life Lost (YLL) were estimated for each area-based deprivation quintile of the Scottish population. Years Lived with Disability were proportionately distributed to deprivation quintiles, based on YLL estimates. Inequalities were measured by: the range, Relative Index of Inequality (RII), Slope Index of Inequality (SII), and attributable DALYs were estimated by using the least deprived quintile as a reference. RESULTS: Marked inequalities were observed across several measures. The SII range was 2048 to 2289 COVID-19 DALYs per 100,000 population. The rate in the most deprived areas was around 58% higher than the mean population rate (RII = 1.16), with 40% of COVID-19 DALYs attributed to differences in area-based deprivation. Overall DALYs due to COVID-19 ranged from 7 to 20% of the annual pre-pandemic impact of inequalities in health loss combined across all causes. CONCLUSION: The substantial population health impact of COVID-19 in Scotland was not shared equally across areas experiencing different levels of deprivation. The extent of inequality due to COVID-19 was similar to averting all annual DALYs due to diabetes. In the wider context of population health loss, overall ill-health and mortality due to COVID-19 was, at most, a fifth of the annual population health loss due to inequalities in multiple deprivation. Implementing effective policy interventions to reduce health inequalities must be at the forefront of plans to recover and improve population health.


Subject(s)
COVID-19 , Health Status Disparities , Pandemics , Population Health , COVID-19/epidemiology , Disabled Persons/statistics & numerical data , Humans , Quality-Adjusted Life Years , Scotland/epidemiology
5.
J Manag Care Spec Pharm ; 27(10-a Suppl): S2-S13, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1471241

ABSTRACT

BACKGROUND: Despite therapeutic advances for patients with schizophrenia, improving patient outcomes and reducing the cost of care continue to challenge formulary decision makers. OBJECTIVES: To (1) understand the perspectives of formulary decision makers on challenges to optimal schizophrenia population management and (2) identify best practices and recommendations for mitigating these challenges. METHODS: This mixed-methods study, conducted in a double-blind manner, comprised in-depth telephone interviews with formulary decision makers from February through May 2020, and a web-based follow-on survey that was sent to all participants in October 2020. US-based formulary decision makers were recruited if they were directly involved in schizophrenia drug formulary or coverage decision making for national or regional payers, health systems, or behavioral health centers. Formulary decision makers' perceptions of challenges, policies, and programs related to schizophrenia population health management were assessed generally and in the context of the COVID-19 pandemic. RESULTS: 19 formulary decision makers participated in the interviews and 18 (95%) completed the survey. Participants reported a spectrum of patient- and payer-driven challenges in schizophrenia population health management, including medication nonadherence, high pharmacy and medical costs, and frequent hospitalizations and emergency department visits. Participants noted that COVID-19 had worsened all identified challenges, although patient unemployment (mean score of 2.00 on a scale of 1 [made much worse] to 5 [made much better]) and reduced access to psychiatric care (mean score, 2.12) were most negatively affected. The most common strategies implemented in order to improve schizophrenia population health management included case management (89%), telemedicine (83%), care coordination programs (72%), strategies to mitigate barriers to accessing medication (61%), and providing nonmedical services to address social determinants of health (56%). Participants noted that, ideally, all treatments for schizophrenia would be available on their formularies without utilization management policies in place in order to increase accessibility to medication, but cost to the health plans made that difficult. Whereas 61% of respondents believed that long-acting injectable antipsychotics (LAIs) were currently underused in their organizations, only 28% represented organizations with open access policies for LAIs. Participants believed that among patients with schizophrenia, LAIs were most beneficial for those with a history of poor or uncertain adherence to oral medications (mean score of 4.50 on a scale of 1 [not at all beneficial] to 5 [extremely beneficial]) and those with recurring emergency department visits and inpatient stays (mean score, 3.94). Study participants reported slightly increased use of LAIs (mean score of 3.17 on a scale of 1 [negatively impacted] to 5 [positively impacted]) among their patients with schizophrenia in response to the COVID-19 pandemic; 29% of participants reported easing access restrictions for LAIs. CONCLUSIONS: Participants described persisting challenges and various approaches intended to improve schizophrenia population health management. They also recommended strategies to optimize future health management for this population, including expanding programs to address social determinants of health and mitigating barriers to accessing treatment. DISCLOSURES: This study was funded by Janssen Scientific Affairs, LLC. Roach, Graf, Pednekar, and Chou are employees of PRECISIONheor, which received financial support from Janssen Scientific Affairs, LLC, to conduct this study. Chou owns equity in Precision Medicine Group, the parent company of PRECISIONheor. Lin and Benson are employees of Janssen Scientific Affairs, LLC. Doshi has served as a consultant, advisory board member, or both, for Acadia, Allergan, Boehringer Ingelheim, Janssen, Merck, Otsuka, and Sage Therapeutics and has received research funding from AbbVie, Biogen, Humana, Janssen, Novartis, Merck, Pfizer, PhRMA, Regeneron, Sanofi, and Valeant.


Subject(s)
COVID-19/prevention & control , Clinical Decision-Making/methods , Health Personnel , Population Health Management , Population Health , Schizophrenia/therapy , Antipsychotic Agents/therapeutic use , COVID-19/epidemiology , Double-Blind Method , Female , Follow-Up Studies , Humans , Interviews as Topic/methods , Male , Medication Adherence , Schizophrenia/diagnosis , Schizophrenia/epidemiology
6.
Perspect Public Health ; 141(5): 255-257, 2021 09.
Article in English | MEDLINE | ID: covidwho-1430325
8.
Can J Public Health ; 111(6): 912-920, 2020 12.
Article in English | MEDLINE | ID: covidwho-1389876

ABSTRACT

Over the past few months, our fellow citizens have heard more about public health than ever before. The SARS-CoV-2 pandemic has shed light on the vital role played by public health for health protection and provided telling evidence about current public health capacity as well as the corrective measures to be taken and milestones to be achieved in the future. To this end, we identify several ways forward to re-empower public health in Québec and thus ensure that it can significantly contribute to population health. In particular, we propose that although reforms must continue to bolster health protection, substantial efforts are required to strengthen surveillance systems, prevention systems, health promotion systems, and accessible, effective, and overarching primary care systems.


Subject(s)
COVID-19/epidemiology , Pandemics , Population Health , Public Health , Data Analysis , Health Promotion , Humans , Leadership , Population Surveillance , Primary Health Care , Quebec/epidemiology
9.
Popul Health Manag ; 24(4): 439-441, 2021 08.
Article in English | MEDLINE | ID: covidwho-1369038
10.
Health Commun ; 36(10): 1155-1162, 2021 09.
Article in English | MEDLINE | ID: covidwho-1366903

ABSTRACT

The U.S. Healthy People 2030 health objective-setting process has taken place in an inequitable social structure with significant implications for health literacy, health equity, and population health. The draft 2030 objectives have greatly reduced the number of digital health and health literacy objectives, meaning our national agenda is poised to capture only a fraction of what will evolve in digital and health literacy between 2020 and 2030. This paper synthesizes two decades of Healthy People data on health literacy and digital health objectives, highlights the digital health and health literacy trends and disparities that persist and proposes remedies to ensure that health literacy and digital health issues receive the attention they deserve in the next decade. These remedies can inform policies, research, and interventions that touch health communication and digital health issues.


Subject(s)
Health Equity , Health Literacy , Population Health , Health Status , Humans , Policy
12.
JAMA Netw Open ; 4(8): e2119621, 2021 08 02.
Article in English | MEDLINE | ID: covidwho-1359743

ABSTRACT

Importance: In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level. Objective: To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties. Design, Setting, and Participants: In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020. Exposures: Hosting NFL or NCAA games. Main Outcomes and Measures: The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance. Results: A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median (IQR) daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day. The treatment effect size ranged from -5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games, and the daily treatment effect trend remained relatively steady during this period. Conclusions and Relevance: This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/statistics & numerical data , Population Health/statistics & numerical data , Sentinel Surveillance , Sports and Recreational Facilities/statistics & numerical data , COVID-19/prevention & control , COVID-19/transmission , Communicable Disease Control/methods , Cross-Sectional Studies , Football , Humans , Organizations, Nonprofit , SARS-CoV-2 , Societies , United States/epidemiology , Universities
13.
Prev Chronic Dis ; 18: E79, 2021 08 12.
Article in English | MEDLINE | ID: covidwho-1357594
14.
Med Sci Monit ; 27: e934171, 2021 Aug 02.
Article in English | MEDLINE | ID: covidwho-1337822

ABSTRACT

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) commonly presents with pneumonia. However, COVID-19 is now recognized to involve multiple organ systems with varying severity and duration. In July 2021, the findings from a retrospective population study from the National COVID Cohort Collaborative (N3C) Consortium were published that included analysis by machine learning methods of 174,568 adults with SARS-CoV-2 infection from 34 medical centers in the US. The study stratified patients for COVID-19 according to the World Health Organization (WHO) Clinical Progression Scale (CPS). Severe clinical outcomes were identified as the requirement for invasive ventilatory support, or extracorporeal membrane oxygenation (ECMO), and patient mortality. Machine learning analysis showed that the factor most strongly associated with severity of clinical course in patients with COVID-19 was pH. A separate multivariable logistic regression model showed that independent factors associated with more severe clinical outcomes included age, dementia, male gender, liver disease, and obesity. This Editorial aims to present the rationale and findings of the largest population cohort of adult patients with COVID-19 to date and highlights the importance of using large population studies with sophisticated analytical methods, including machine learning.


Subject(s)
COVID-19 , Machine Learning , Adult , COVID-19/classification , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/mortality , Diagnosis, Computer-Assisted , Female , Humans , Male , Middle Aged , Models, Statistical , Population Health , Risk Factors , SARS-CoV-2 , Severity of Illness Index
16.
Ethn Dis ; 31(3): 407-410, 2021.
Article in English | MEDLINE | ID: covidwho-1318484

ABSTRACT

Purpose: Enhancing the bidirectional benefit of precision medicine research infrastructure may advance equity in research participation for diverse groups. This study explores the use of research infrastructure to provide human-centered COVID-19 resources to participants as a part of their research participation. Design: The All of Us New England (AoUNE) consortium research team developed standardized check-in telephone calls to ask participants about their well-being and share COVID-19 resources. Participants: A total of 20,559 participants in the AoUNE consortium received a COVID-19 check-in call. Methods: Research assistants called participants during March-April 2020, distributed COVID-19 resources to interested participants, and subsequently rated call tone. Results: Of the total cohort participants called, 8,512 (41%) spoke with a research team member. The majority of calls were rated as positive or neutral; only 3% rated as negative. African American and Black as well as Hispanic populations requested COVID-19 resources at higher rates than other groups. Conclusions: Calls made to AoUNE participants were received positively by diverse groups. These findings may have implications for participant-centered engagement strategies in precision medicine research.


Subject(s)
COVID-19 , Population Health , Humans , Precision Medicine , SARS-CoV-2
17.
Front Public Health ; 9: 697515, 2021.
Article in English | MEDLINE | ID: covidwho-1302134

ABSTRACT

This report arises from the intersection of service learning and population health at an academic medical center. At the University of California, San Francisco (UCSF), the Office of Population Health and Accountable Care (OPHAC) employs health care navigators to help patients access and benefit from high-value care. In early 2020, facing COVID-19, UCSF leaders asked OPHAC to help patients and employees navigate testing, treatment, tracing, and returning to work protocols. OPHAC established a COVID hotline to route callers to the appropriate resources, but needed to increase the capacity of the navigator workforce. To address this need, OPHAC turned to UCSF's service learning program for undergraduates, the Patient Support Corps (PSC). In this program, UC Berkeley undergraduates earn academic credit in exchange for serving as unpaid patient navigators. In July 2020, OPHAC provided administrative funding for the PSC to recruit and deploy students as COVID hotline navigators. In September 2020, the PSC deployed 20 students collectively representing 2.0 full-time equivalent navigators. After training and observation, and with supervision and escalation pathways, students were able to fill half-day shifts and perform near the level of staff navigators. Key facilitators relevant to success reflected both PSC and OPHAC strengths. The PSC onboards student interns as institutional affiliates, giving them access to key information technology systems, and trains them in privacy and other regulatory requirements so they can work directly with patients. OPHAC strengths included a learning health systems culture that fosters peer mentoring and collaboration. A key challenge was that, even after training, students required around 10 h of supervised practice before being able to take calls independently. As a result, students rolled on to the hotline in waves rather than all at once. Post-COVID, OPHAC is planning to use student navigators for outreach. Meanwhile, the PSC is collaborating with pipeline programs in hopes of offering this internship experience to more students from backgrounds that are under-represented in healthcare. Other campuses in the University of California system are interested in replicating this program. Adopters see the opportunity to increase capacity and diversity while developing the next generation of health and allied health professionals.


Subject(s)
COVID-19 , Internship and Residency , Population Health , Humans , SARS-CoV-2 , San Francisco , Workforce
18.
BMC Public Health ; 21(1): 1312, 2021 07 05.
Article in English | MEDLINE | ID: covidwho-1296589

ABSTRACT

BACKGROUND: Although existing studies have described patterns of social media use in healthcare, most are focused on health professionals in one discipline. Population health requires a multi-disciplinary approach to ensure diversity and to include diverse stakeholders. To date, what is known about using social media in population health is focused on its potential as a communication tool. This study aims to investigate patterns of use and perceived value of social media usage among stakeholders in population health practice, policy, or research. METHODS: We conducted a web-based survey of delegates attending the Singapore Population Health Conversations and Workshop. We designed a 24-item questionnaire to assess 1) social media use in terms of type of platform and frequency of use; 2) perceptions of social media relevance and impact on population health; and 3) top three areas in population health that would benefit from social media. We used descriptive and logistic regression analyses to assess the relationships between variables. RESULTS: Of the 308 survey respondents, 97.7% reported that they use social media in some form. Messaging (96.8%) was the most dominant activity when using social media. Challenges in implementing social media for population health were time investment by health care professionals (56.2%) and patient adoption (52.9%). The top three population health areas that would benefit most from using social media were the promotion of healthy behaviors (60.7%), community engagement (47.7%), and preventive care (40.6%). Older respondents (> = 40 years) were less likely to view social media as useful for the promotion of healthy behaviors (OR = 0.34; 95% CI: 0.19-0.60). Non-social/healthcare professionals were more likely to consider social media to be useful for community engagement (OR = 1.74; 95% CI: 1.10-2.76). For preventive care, older respondents (OR = 0.51; 95% CI: 0.32-0.82) and non-social/healthcare professionals were less likely to view social media as useful (OR = 0.61; 95% CI: 0.38-0.97). CONCLUSIONS: Our findings suggest that it may be important to select the specific care areas that would benefit most from using social media. The time investment needed by population health professionals should be fully addressed in planning to maximize the application and potential value of social media.


Subject(s)
Population Health , Social Media , Cross-Sectional Studies , Health Personnel , Humans , Singapore , Surveys and Questionnaires
19.
Folia Med (Plovdiv) ; 63(3): 315-320, 2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1291421

ABSTRACT

In 2019, the world faced another of the potentially deadly viruses affecting humanity. The new virus, COVID-19, was extremely virulent when it first appeared, with aggressive behaviour toward people unprepared at the time to deal with the infection.Months later, we already know much about its pathophysiology, but new and unknown pathophysiological aspects of the disease are revealed in time. The clinical picture is not unequivocal at times, with symptoms quite unlike those we have previously considered normal in respiratory infections tending to appear. There have been reports of an increase in the frequency of neoplasms or disease progression due to delayed treatment. Treatment of COVID-19 is still a mirage, and people are struggling with the implications for recovery, the health and economic crisis, and the psychological effects of traumatic stress.


Subject(s)
COVID-19 , Population Health , Epidemics , Humans , SARS-CoV-2
20.
Front Public Health ; 9: 676750, 2021.
Article in English | MEDLINE | ID: covidwho-1290176
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