Training during the COVID-19 pandemic: the experience of public health registrars in the London and Kent, Surrey, Sussex training programme.

BACKGROUND: Public Health registrars (SpRs) were an important component of the workforce that contributed to the COVID-19 response. This study explores their contribution and the impact the early stages of the pandemic had on their learning and training. METHODS: Data were collected from SpRs in the London and Kent, Surrey, Sussex training programme between July and September 2020 through a mixture of questionnaires and semi-structured interviews. A thematic analysis of interview transcripts was undertaken to identify themes. RESULTS: 35/128 SpRs responded to the survey and 11 were interviewed. SpRs were placed across a range of organizations and made a significant contribution to the COVID-19 response. Overall, SpRs learned important skills but working on the response may for some have impacted negatively on training. A number of facilitators and barriers to learning were identified. CONCLUSION: The study findings highlight the opportunities for learning created by the pandemic. However, changing projects and the desire of SpRs to contribute to the response meant the impacts on training were mixed. Future deployment of SpRs should consider the balance of responsibility and pace when delegating work, as well as the need to supervise effectively and support remote working to maintain good mental wellbeing.

Pregnancy-associated listeriosis in England and Wales.

Listeriosis is a rare but severe foodborne disease with low morbidity and high case-fatality rates. Pregnant women, unborn and newborn babies are among the high-risk groups for listeriosis. We examined listeriosis cases reported to the enhanced surveillance system in England and Wales from 1990 to 2010 to identify risk factors influencing outcome. Cases were defined as pregnancy-associated if Listeria monocytogenes was isolated from a pregnant woman or newborn infants aged <28 days. Of the 3088 cases reported, pregnancy-associated listeriosis accounted for 462 (15%) cases and 315 cases resulted in a live birth. Several factors were identified as affecting the severity and outcome of listeriosis in pregnancy in both mother and child including: presence or absence of maternal symptoms, gestational age at onset of symptoms, and clinical presentation in the infant (meningitis or septicaemia). Deprivation, ethnicity and molecular serotype had no effect on outcome.

Salmonella enterica serovar Enteritidis phage type 4 outbreak associated with eggs in a large prison, London 2009: an investigation using cohort and case/non-case study methodology.

In September 2009, an outbreak of Salmonella enterica serovar Enteritidis affected 327 of 1419 inmates at a London prison. We applied a cohort design using aggregated data from the kitchen about portions of food distributed, aligned this with individual food histories from 124 cases (18 confirmed, 106 probable) and deduced the exposures of those remaining well. Results showed that prisoners eating egg cress rolls were 26 times more likely to be ill [risk ratio 25.7, 95% confidence interval (CI) 15.5-42.8, P<0.001]. In a case/non-case multivariable analysis the adjusted odds ratio for egg cress rolls was 41.1 (95% CI 10.3-249.7, P<0.001). The epidemiological investigation was strengthened by environmental and microbiological investigations. This paper outlines an approach to investigations in large complex settings where aggregate data for exposures may be available, and led to the development of guidelines for the management of future gastrointestinal outbreaks in prison settings.

Developing best practice response to carbon monoxide incidents: a toolkit for health protection frontline staff.

OBJECTIVES: Carbon monoxide (CO) poisoning represents a significant public health burden. CO incidents require multiple responders, including the Health Protection Agency (HPA). However, best practice guidance does not yet exist in the UK for chemicals. Since CO is a good template for chemical incidents, the authors aimed to develop an electronic 'best practice' CO incident response toolkit which could serve as a blueprint for chemicals in general, and have compatibility with HPZone, the electronic decision support system being implemented across the HPA. STUDY DESIGN: Public health guidance development. METHODS: (1) Literature review of CO incidents, risk management, public health, toxicology and environmental guidance; (2) expert opinion; (3) synthesis of information; (4) writing the toolkit; and (5) consultation and toolkit testing. RESULTS: The draft toolkit was designed integrating a best practice algorithm, risk assessment, links to CO guidance, and template incident forms. The risk assessment model is in development but key intermediate outcomes of this were proposed case definitions for CO exposure. CONCLUSION: The toolkit has been successfully piloted and further consultation and refinement will follow. It provides a platform for the expansion of electronic decision support tools in chemical incidents management with the potential for HPZone functionality.

Assessing public health risk in the London polonium-210 incident, 2006.

OBJECTIVES: Mr Alexander Litvinenko died in a London hospital on 23 November 2006, allegedly from poisoning with the radionuclide polonium-210 ((210)Po). Associated circumstances required an integrated response to investigate the potential risk of internal contamination for individuals exposed to contaminated environments. STUDY DESIGN: Descriptive study. METHODS: Contaminated locations presenting a potential risk to health were identified through environmental assessment by radiation protection specialists. Individuals connected with these locations were identified and assessed for internal contamination with (210)Po. RESULTS: In total, 1029 UK residents were identified, associated with the 11 most contaminated locations. Of these, 974 were personally interviewed and 787 were offered urine tests for (210)Po excretion. Overall, 139 individuals (18%) showed evidence of probable internal contamination with (210)Po arising from the incident, but only 53 (7%) had assessed radiation doses of 1mSv or more. The highest assessed radiation dose was approximately 100mSv. CONCLUSIONS: Although internal contamination with (210)Po was relatively frequent and was most extensive among individuals associated with locations judged a priori to pose the greatest risk, a high degree of assurance could be given to UK and international communities that the level of health risk from exposure to the radionuclide in this incident was low.

Care of the ear canal and mastoid.

Zinc sulfate has been used for therapy of granulations of the trachea and ear that have not responded to usual treatment. This paper will report on current indications for zinc sulfate and the resulting success in managing granulomata of the ear canal and mastoid bowl. Some mastoid bowls have been large and hard to clean, especially in the posterior and lateral parts. A method of cleaning using indirect otoscopy and curved aspirators in conjunction with adequate lubrication will be described. Treatment of otalgia in both the ear canal and mastoid bowl due to otitis externa sicca and results of proper lubrication and avoidance of patient instrumentation to restore the normal wax will also be discussed.

Zinc therapy in otology.

At a recent panel on Otology, I asked the audience for a show of hands of those using Zinc for delayed healing and granulations. It was surprising to note that not more than 4 physicians out of 100 had tried Zinc. The need to report our encouraging results was apparent. From 1971 to 1975, 544 tympanoplasties and 122 mastoidectomies were studied for delayed healing due to granulations. Forty-six patients were found to have resistant granulations. Thirty-three of these healed within two weeks of therapy, 10 more required a total of four weeks for healing, and three did not respond well. Sixteen patients had recurrence when the medication was terminated as soon as healing had occurred but responded well when the medication was continued for four weeks after healing was complete. Five patients had nausea, which subsided when the dosage was reduced from the usual 200 mg. of Zinc Sulfate, three times daily with meals to 100 mg., t.i.d. or b.i.d. One patient developed mild urticaria. Zinc therapy is apparently indicated in granulomata of the ear when healing does not occur with conventional therapy, especially in the post-operative patient; however, it will not suffice when there is massive involvement of the mastoid or middle ear, where surgical removal is indicated.