Psychological impact and implementation of preventative measures in hemodialysis centers during the COVID-19 pandemic: a provincial questionnaire survey in China.

OBJECTIVES: This study investigated the psychological status of patients and staff, and the implementation of preventative measures in hemodialysis centers in Guangdong province, China, during the 2019 novel coronavirus disease (COVID-19) pandemic. METHODS: An electronic questionnaire survey was carried out anonymously between March 28 and April 3, 2020. All of the 516 hemodialysis centers registered in Guangdong province were invited to participate in the survey. The questionnaires were designed to investigate the psychological status of hemodialysis patients and general staff members (doctors, nurses, technicians, and other staff), and to address the implementation of preventative measures for administrators (directors or head nurses) of the hemodialysis centers. RESULTS: A total of 1782 patients, 3400 staff, and 420 administrators voluntarily participated in this survey. Patients living in rural areas reported a higher incidence of severe anxiety compared to those living in other areas (in rural areas, towns, and cities, the incidence rate was 17.0%, 9.0%, and 8.9%, respectively, P < 0.001). Medical staff were less likely to worry about being infected than non-medical staff (13.1% vs 30.3%, respectively, P < 0.001). With respect to the implementation of preventative measures, hemodialysis centers in general hospitals outperformed stand-alone blood purification centers, while tertiary hospitals outperformed hospitals of other levels. However, restrictions regarding the admission of non-resident patients were lower in tertiary hospitals than in other hospitals. In this situation, only one patient imported from Hubei province was diagnosed with COVID-19. CONCLUSIONS: COVID-19 did not significantly affect the psychological status of most patients and medical staff members. Due to the implementation of comprehensive preventative measures, there were no cluster outbreaks of COVID-19 in hemodialysis centers. This provincial-level survey may provide referential guidance for other countries and regions that are experiencing a similar pandemic.

Coordination during Cholera Outbreak Response: Critical Insights from Yemen.

Within the humanitarian arena and since the introduction of the humanitarian reform process in 2005, the cluster approach was introduced to strengthen the cooperation and accountability between agencies working in the same field. Such an integrated approach is particularly needed and relevant in emergencies like cholera, especially in countries undergoing internal conflicts like Yemen. Several areas of concern have been identified during the past field experiences, which include dysfunctional cooperation as a result of different mandates as well as the relationship between nongovernmental organizations and their donors. Control of environmental health services is, for instance, the responsibility of several clusters/agencies and stakeholders, which usually results in a complicated and sometimes confusing approaches to address gaps and barriers. As far as the drinking water quality monitoring and surveillance are concerned, sampling and testing and compilation of data are usually carried out by many agencies included in the health and water sanitation and hygiene (WASH) clusters. We believe that the cluster theoretical approach for emergency response remains a turning point for the humanitarian arena. However, lessons from the recent past, especially in the management of a cholera outbreak in fragile settings, may serve as a serious reflection on roles and dynamics within the blurred border between health and WASH. Specifically, cluster leads in the field have the responsibility for ensuring that humanitarian actors working in their sectors remain actively engaged in addressing crosscutting concerns such as the environment.

Iran COVID-19 Epidemiology Committee: A Review of Missions, Structures, Achievements, and Challenges.

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee. STUDY DESIGN: A rapid review . METHODS: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study. RESULTS: The efforts of the committee's working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling. CONCLUSION: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education.

Women's Health and Gender-Specific Considerations.

Women's health is largely influenced by cultural beliefs, local traditions, and access to care across the world. Immigrant and refugee women experience health in varied ways; prior experiences with health care and beliefs about health should be explored with women on their arrival to the United States. Topics that should be discussed include menstrual practices, contraception and beliefs about family planning, prior screening for preventable diseases, pregnancies and experiences with childbirth, sexual assault and trauma, and history of traditional practices, including female genital mutilation (dependent on area of origin).

Preventive Care and Management of Chronic Diseases in Immigrant Adults.

Immigrants may have variable access to chronic disease screening and treatment in their countries of origin and host country, often limited by their immigration status. Immigrants face barriers to chronic disease management and preventive care, including health insurance access, linguistic challenges, lack of culturally sensitive care, limited records, and acculturation. Health care providers should prioritize chronic disease screening and follow up regularly to encourage preventive care and self-management of chronic disease.

Preventive Care in Children and Adolescents.

This article describes the current state of migration of immigrant children into the United Sates and the various categories of immigrant children, including refugees, asylum seekers, unaccompanied minors, adoptees, and Special Immigrant Visa holders, hereafter called immigrant children. It focuses on guidelines for medical screening and management of newcomer immigrant children and adolescents and their ongoing preventive care. This article also addresses challenges unique to immigrant children and adolescents and the importance of culturally sensitive anticipatory guidance.

The Relationships Among the Organizational Factors of a Tertiary Healthcare Center for Type 2 Diabetic Patients in Palestine.

BACKGROUND: Diabetes prevalence at Palestine was 10%, with a rising fund crisis, and diabetes healthcare problems. There was a limited research concerning diabetes healthcare dimensions including organizational factors and their predictors. OBJECTIVE: This study described patient characteristics and organizational factors, and assessed relationships among organizational factors of type 2 diabetes health care in Palestine. METHODS: This study is a retrospective cross sectional study, recruited by convenience sampling method in 330 participants from a type 2 diabetes patients list. It was carried out at Ramallah, Palestine. The Statistical Package for Social Sciences (SPSS v 19) was used to analyze data on patient characteristics and organizational factors collected from personal interview and medical records review. RESULTS: The results showed that 51.2% were males, and 88.5% had additional chronic diseases. Preventive healthcare and patient-healthcare professionals' relationship were the most prominent organizational factors in statistically significant relationships among organizational factors. CONCLUSION: This study reflected the need for reviewing prescription mode, and educational programs that emphasize the diabetes self-care management and the health care providers' role that would be of great benefit in health outcomes further.

Optimizing preventive medicine to bridge the gap between clinical medicine and public health for disease control in China: A lesson from COVID-19.

The pandemic of Coronavirus Disease 2019 (COVID-19) highlights the importance of early detection of disease outbreaks, taking swift and decisive public health actions, and strengthening public health systems. Preventive medicine, as a specialty of medicine, trains students on both clinical medicine and public health and is of a particular need in battling against this pandemic. In China, preventive medicine plays a unique role in the disease control system where preventive medicine graduates represent a large share of the workforce. However, there is a shortage of qualified staff in the Chinese disease control system. The reasons for such a shortage are multifaceted. From the human resource perspective, the undergraduate preventive medicine curricula and exclusive public health training for preventive medicine postgraduates limit their clinical capacities. A series of disease control and public health education reforms may further incapacitate preventive medicine graduates' clinical skills, unintentionally widening the gap between public health and clinical medicine and thus posing threats to effective disease detection and control. The authors call for reforming and optimizing preventive medicine to bridge the gap between clinical medicine and public health by strengthening curricula on clinical medicine, diversifying curricula on public health, enhancing preventive medicine residency programs, and rectifying regulations that restrict preventive medicine graduates from practicing curative medicine.

Expanding the genetic toolbox.

Knowledge of canine genetics has advanced rapidly in recent years. Researchers say even deeper understanding is ahead, and that it could support a shift to more preventative veterinary care. But the involvement of a wide group of people will be vital in progressing towards that future.

[Feedback on ophthalmologic telemedicine in a nursing home]. / La télé-ophtalmologie en EHPAD : retour d'expérience.

INTRODUCTION: Ophthalmologic care needings increase whereas the numbers of ophthalmologist decrease. Oldest people who are often vulnerable and dependent populations are particularly affected in difficulty to access to health services. To resolve the problem, the use of telemedicine in ophthalmology could be an alternative. MATERIALS AND METHODS: From June 2018 to November 2018, patients from Janzé Hospital (Ille et Vilaine) did an ophthalmologic teleconsultation during their stay. Teleconsultation was based on visual acuity, intraocular pressure measurement, wild-field retinophotography and optical coherence tomography performed by an orthoptist and a videoconference with an ophthalmologist. RESULTS: Sixty-seven patients underwent teleconsultation (60 % women, 40 % men). Mean age was 83 (standard deviation±8). Fifty-four percent (36) of consultations were complete. Retinophotography was missing in 45 % of cases (30) and optical coherence tomography in 53 % of cases (35). Ophtalmologic pathologies were detected in 37 patients (55 %) and we start medical care in 14 (38 %) of the patients. We gave glasses prescription to 45 % (30) of the patients. Eighteen percent (10) of the patients required a physical consultation. LogMar distance visual acuity was significantly improved from 0.67 (±0.76) to 0.52 (±0.72) (P<0.0001) and LogMar near visual acuity was significantly improved from 0.68 (±0.84) to 0.53 (±0.76) (P<0.0001). Low vision proportion was significantly decreased from 54 % to 39 % (P=0.02; OR=1.86; IC95 % [1.06-3.28]) after our intervention. DISCUSSION: This experiment gives the opportunity to old, vulnerable and dependent population that has no longer access to classical consultation to access eye care. At the same time, consultation informs the nursing home caregivers about the visual health status and provides environment improvement. CONCLUSION: Teleconsultation is an alternative to classical consultation especially in dependent population. This experiment could be a starting point to the development of this solution in social health-care institutions.

Inclusion of Evidence-Based Breast Cancer Control Recommendations and Guidelines in State Comprehensive Cancer Control Plans.

INTRODUCTION: Each US state, territory, and tribe/tribal organization is supported by the Centers for Disease Control and Prevention to develop and implement a comprehensive cancer control (CCC) plan. The objective of this study was to inform areas for improvement of those plans. METHODS: To show how CCC plans can be improved, we used the example of breast cancer, which has a long public health history and an established, broad spectrum of prevention and control activities. We evaluated the inclusion of evidence-based breast cancer prevention topics as provided by guidelines from the Centers for Disease Control and Prevention (CDC) and recommendations of the US Preventive Services Task Force (USPSTF) in each state's CCC plan. From January through March 2019, we downloaded CCC plans from each state and the District of Columbia and abstracted and quantified the content of plans for 1) discussion of data on breast cancer mortality, breast cancer incidence, uptake of mammography; 2) statement of objective to reduce the burden of breast cancer; and 3) review of CDC guidelines and USPSTF recommendations. RESULTS: The discussion of breast cancer-relevant topics and specification of objectives was incomplete. Of 51 plans, data on breast cancer mortality and incidence and uptake of mammography were reported in 53% (n = 27) to 76% (n = 39) of plans. CDC and USPSTF recommendations for breast cancer-specific interventions were discussed in only 6% (n = 3) to 37% (n = 19) of plans. Discussion of general cancer prevention topics relevant to breast cancer ranged from 10% (n = 5) to 61% (n = 31) of plans. CONCLUSION: Our findings inform areas for quality improvement of state CCC plans and may contribute to other areas of public health planning.

Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities.

BACKGROUND: Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities. METHODS: Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US). RESULTS: Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146 256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%-13.2%) in Seattle and 54.4% (CI, 37.6%-73.9%) in Miami. Incidence reduction reached 16.1%-75.5% at ideal scale. CONCLUSIONS: Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.

Prevention of mother-to-child transmission activities after one-off clinical mentorship training in selected health facilities, Zimbabwe: 2014-2018.

This was a cross-sectional study describing HIV testing uptake and ART initiation for pregnant women and HIV-exposed infants after one-off clinical mentorship training in 2013 for nurses in 56 peripheral health-facilities, Zimbabwe. Between 2014-2018, 92% of 106411 pregnant women were HIV tested and 98% of HIV-positive women initiated antiretroviral therapy (ART). There were 15846 HIV-exposed infants, of whom 96% had dried blood spots collected for virologic diagnosis and 51% of those diagnosed HIV-positive initiated ART. In conclusion, this one-off clinical mentorship training in 2013 was associated with consistently high HIV testing and ART initiation in pregnant women and their children.

La importancia de identificar factores intrínsecos modificables de riesgo de caídas para implementar precozmente medidas preventivas / The importance of identifying intrinsic and modifiable risk factors for falls in order to act early prevention measures

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A Clinical Informatics Program Directors' Proposal to the American Board of Preventive Medicine.

In 2013, the American Board of Preventive Medicine (ABPM) and the American Board of Pathology (ABPath) offered the first board certification examination in Clinical Informatics to eligible physicians in the United States. In 2022, the Practice Pathway will expire and in 2023 only candidates eligible through the Fellowship Pathway will be eligible for the board certification. To date, Clinical Informatics as a specialty has not had a regular match process and used a controlled offer-acceptance process that does not meet candidates' or programs' needs. Fellows may not be offered a position with their top choice program initially, and they may accept offers from other programs to avoid risk by ensuring that they have a fellowship position. Programs have to consider losing an applicant in the first round in the ranking of applicants. The process is open to manipulation including early agreements between program directors and candidates. In this open letter to the ABPM, program directors make the case for a third-party match and are calling on the ABPM to leverage its status as the Clinical Informatics certifying body and its existing infrastructure to implement a Clinical Informatics match.

Health Care for Refugee and Immigrant Adolescents.

This article describes the current scope of immigration to the United States, defines the different categories of immigrants, and describes the Centers for Disease Control and Prevention-mandated overseas and postarrival medical assessment of adolescent refugees. Guidelines for primary care physicians who care for refugee youth are provided, including diagnosis and treatment of common medical and mental health conditions. Special considerations in caring for this vulnerable population include acknowledging prior traumas, acculturation and challenges to education such as bullying, and adjustment to a new health care system that emphasizes preventive care in addition to curative medical care.

Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial.

OBJECTIVE: Clinical practice guidelines recommend that community mental health services provide preventive care for clients' chronic disease risk behaviours; however, such care is often not routinely provided. This study aimed to assess the effectiveness of offering clients an additional consultation with a specialist clinician embedded within a community mental health service, in increasing client-reported receipt of, and satisfaction with, preventive care. METHOD: A randomised controlled trial was undertaken in one Australian community mental health service. Participants (N = 811) were randomised to receive usual care (preventive care in routine consultations; n = 405) or usual care plus the offer of an additional consultation with a specialist preventive care clinician (n = 406). Blinded interviewers assessed at baseline and 1-month follow-up the client-reported receipt of preventive care (assessment, advice and referral) for four key risk behaviours individually (smoking, poor nutrition, alcohol overconsumption and physical inactivity) and all applicable risks combined, acceptance of referrals and satisfaction with preventive care received. RESULTS: Analyses indicated significantly greater increases in 12 of the 18 preventive care delivery outcomes in the intervention compared to the usual care condition from baseline to follow-up, including assessment for all risks combined (risk ratio = 4.00; 95% confidence interval = [1.57, 10.22]), advice for all applicable risks combined (risk ratio = 2.40; 95% confidence interval = [1.89, 6.47]) and offer of referral to applicable telephone services combined (risk ratio = 20.13; 95% confidence interval = [2.56, 158.04]). For each component of care, there was a significant intervention effect for at least one of the individual risk behaviours. Participants reported high levels of satisfaction with preventive care received, ranging from 77% (assessment) to 87% (referral), with no significant differences between conditions. CONCLUSION: The intervention had a significant effect on the provision of the majority of recommended elements of preventive care. Further research is needed to maximise its impact, including identifying strategies to increase client uptake.