Dementia Care under COVID-19 and Infectious Disease Pandemic Restrictions

Abstract Emergency measures including social distancing and program restrictions during COVID-19 has reduced supports for people living with dementia and family/friend caregivers in the community. Consequently, these reductions in dementia services and resources have added to existing challenges and (in)equities for this stigmatized population. The objectives of this study were to identify how community-based resources and services for people with dementia and their caregivers are impacted by public health emergency measures enacted during COVID-19 and other infectious pandemics and secondly, use an intersectional health equity perspective to explore how supports for people and families living with dementia are affected by social determinants of health. A scoping review using JBI methodology was conducted. Academic databases searched included Embase, Medline, CINAHL and PAIS. Grey literature was searched using the CADTH tool. English articles published after 2000 in high-income countries were included. Data was extracted by two reviewers using an adaptation of the Health Equity Impact Assessment tool to explore factors related to health equity. Findings included articles discussing the COVID-19 pandemic (N=15). Most alterations to dementia services included switching to telehealth platforms with some advantages/disadvantages of this method discussed. Limited information on how different populations experienced service changes was identified and more research is needed to address issues of (in)equities for people living with dementia and their caregivers during public health emergencies. Information on how health emergency responses affects dementia services and their users will provide important information on resources for current and future efforts to analyze and assess their impacts.

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Managing Borders During Public Health Emergencies of International Concern: A Proposed Typology of Cross-border Health Measures

10.21203/rs.3.rs-278629/v1 ◽

2021 ◽

Author(s):

Kelley Lee ◽

Karen A Grépin ◽

Catherine Worsnop ◽

Summer Marion ◽

Julianne Piper ◽

...

Keyword(s):

Public Health ◽

Research Policy ◽

Grey Literature ◽

World Health ◽

Border Health ◽

Policy And Practice ◽

Public Health Emergencies ◽

Cross Border ◽

Health Measures ◽

Starting Point

Abstract BackgroundThe near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. ResultsBased on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – type of movement (travel and trade), policy goal, level of jurisdiction, use by public versus private sector, stage of journey, and degree of restrictiveness. These categories are then be brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. The typology facilitates evidence-informed decision-making which takes account of policy complexity including trade-offs and externalities. Finally, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). ConclusionsThe widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

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Assessing National Antimicrobial Resistance Campaigns Using a Health Equity Assessment Tool (HEAT)

Antibiotics ◽

10.3390/antibiotics8030121 ◽

2019 ◽

Vol 8 (3) ◽

pp. 121 ◽

Cited By ~ 1

Author(s):

Hood ◽

Toleikyte ◽

Ashiru-Oredope

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Health Equity ◽

Assessment Tool ◽

Significant Proportion ◽

Cost Effective ◽

Health Campaigns ◽

Quality Healthcare ◽

Public Health Campaigns ◽

Global Threat

It has been widely recognised that a significant proportion of the world’s population suffer inequalities in accessing high quality healthcare and wider services. Within healthcare, antimicrobial resistance (AMR) is a global threat to public health affecting all healthcare systems and growing at an alarming pace. To ensure that national AMR campaigns developed by Public Health England are inclusive of all populations within the target audience a health equity assessment tool (HEAT) was used. The project leads for each campaign completed the HEAT independently with a follow up meeting with the study team to discuss and clarify the responses. A trend analysis was carried out with common themes being used to provide recommendations. The campaigns have demonstrated equality and diversity based on the requirements of the Equality Act 2010, particularly age, sex, and race protected characteristics. Some notable results include the translation of website materials in over 30 languages and reaching individuals in 122 countries. It was however noted that several of the protected characteristics were not applicable. The continuous development of resources with collaboration from a variety of diverse user groups would be advantageous towards aiding future campaign reach. The use of the HEAT has demonstrated the ease and cost-effective way to assess any health inequalities and would be a useful addition to antimicrobial stewardship and public health campaigns.

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Rapid urban health security assessment tool: a new resource for evaluating local-level public health preparedness

BMJ Global Health ◽

10.1136/bmjgh-2020-002606 ◽

2020 ◽

Vol 5 (6) ◽

pp. e002606 ◽

Cited By ~ 1

Author(s):

Matthew R Boyce ◽

Rebecca Katz

Keyword(s):

Public Health ◽

Urban Health ◽

Assessment Tool ◽

Local Level ◽

Local Health ◽

Security Assessment ◽

Direct Function ◽

Health Security ◽

Public Health Emergencies ◽

Sustainable Capacity

Urbanisation will be one of the defining demographic trends of the 21st century—creating unique opportunities for sustainable capacity development, as well as substantial risks and challenges for managing public health and health emergencies. Plans and policies for responding to public health emergencies are generally framed at higher levels of governance, but developing, improving and sustaining the capacities necessary for implementing these policies is a direct function of local-level authorities. Evaluating local-level public health capacities is an important process for identifying strengths and weaknesses that can impact the preparedness for, detection of and response to health security threats. However, while various evaluations and assessments exist for evaluating capacities at other levels, currently, there are no readily available health security assessments for the local-level. In this paper, we describe a tool—the Rapid Urban Health Security Assessment (RUHSA) Tool—that is based on a variety of other relevant assessments and guidance documents. Assessing capacities allow for local-level authorities to identify the strengths and weaknesses of their local health security systems, create multiyear action plans and prioritise opportunities for improving capacities, effectively engage with development partners to target resources effectively and develop compelling narratives and a legacy of leadership. While the RUHSA Tool was not designed to be used in the midst of a public health emergency, such as the ongoing COVID-19 pandemic, it may also be adapted to inform a checklist for prioritising what capacities and activities a city needs to rapidly develop or to help focus requests for assistance.

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Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services

BMJ Open ◽

10.1136/bmjopen-2020-043966 ◽

2021 ◽

Vol 11 (6) ◽

pp. e043966

Author(s):

Connor O'Rielly ◽

Joshua Ng-Kamstra ◽

Ania Kania-Richmond ◽

Joseph Dort ◽

Jonathan White ◽

...

Keyword(s):

Public Health ◽

Scoping Review ◽

Grey Literature ◽

Healthcare Systems ◽

Emergency Department Visits ◽

Secondary Outcome ◽

Surgical Capacity ◽

Public Health Emergencies ◽

Surgical Services ◽

The Impact

ObjectivesTo understand how surgical services have been reorganised during and following public health emergencies, particularly the first wave of the COVID-19 pandemic, and the consequences for patients, healthcare providers and healthcare systems.DesignA rapid scoping review.SettingWe searched the MEDLINE, Embase and grey literature sources for documents and press releases from governments and surgical organisations or associations.ParticipantsStudies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems were included.Primary and secondary outcome measuresPrimary outcomes were strategies implemented for the reorganisation of surgical services. Secondary were the impacts of reorganisation and resuming surgical services, such as: adverse events (including morbidity and mortality), primary care and emergency department visits, length of hospital and ICU stay, and changes to surgical waitlists.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganisation of surgical services, 55 described the consequences of reorganising surgical services; and 6 reported actions taken to rebuild surgical capacity in public health emergencies. Reorganisations of surgical services were grouped under six domains: case selection/triage, personal protective equipment (PPE) regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganisations led to large reductions in non-urgent surgical volumes, increases in surgical wait times and impacted medical training (ie, reduced case involvement) and patient outcomes (eg, increases in pain). Strategies for rebuilding surgical capacity were scarce but focused on the availability of staff, PPE and patient readiness for surgery as key factors to consider before resuming services.ConclusionsReorganisation of surgical services in response to public health emergencies appears to be context dependent and has far-reaching consequences that must be better understood in order to optimise future health system responses to public health emergencies.

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Characterization of National Immunization Programs in the Context of Public Health Emergencies: A Case Study of 13 Countries in the WHO Africa Region

Frontiers in Public Health ◽

10.3389/fpubh.2021.736532 ◽

2021 ◽

Vol 9 ◽

Author(s):

Viola Chepkurui ◽

Edina Amponsah-Dacosta ◽

Eposi Christiana Haddison ◽

Benjamin Mugo Kagina

Keyword(s):

Public Health ◽

Disease Outbreaks ◽

Immunization Coverage ◽

World Health Organisation ◽

Armed Conflicts ◽

World Health ◽

Limited Information ◽

Immunization Programs ◽

Public Health Emergencies ◽

National Immunization

Multiple public health emergencies (PHEs) experienced annually in the World Health Organisation (WHO) Africa region affect the provision of health services, including immunization. However, there is limited information on the performance of national immunization programs (NIPs) in WHO Africa countries that experience PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs using global and regional immunization targets outlined for the Decade of Vaccines. Thirteen beneficiary countries of PHE mitigation funds from the African Public Health Emergency Fund were used as case studies. Data on PHEs and immunization indicators between 2010 and 2019 in selected countries were extracted from different PHE databases and the WHO/UNICEF immunization database, respectively. The data were stratified by country and summarized using descriptive statistics. Mann-Whitney U test was done to determine the association between the frequency of PHEs and the performance of NIPs. There were 175 disease outbreaks, 288 armed conflicts, and 318 disasters in the examined countries between 2010 and 2019. The Democratic Republic of Congo had the highest total PHE count (n = 208), while Liberia had the lowest (n = 20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunization coverage. Higher counts of armed conflict and total PHEs were associated with not meeting immunization targets for national DTP3 coverage of ≥90% and Maternal and Neonatal Tetanus elimination, p < 0.01. It was clear that in the WHO Africa region, PHEs are prevalent, irrespective of a country’s level of immunization maturity, and have the potential to derail the progress of NIPs in the absence of effective interventions. As we transition toward the Immunization Agenda 2030, we recommend that the WHO Africa region prioritizes interventions to mitigate the impacts of PHEs on NIPs.

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Meeting Needs of Diverse Older Adults and Caregivers During Public Health Emergencies: What Can We Learn From COVID-19?

Innovation in Aging ◽

10.1093/geroni/igab046.893 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 233-233

Author(s):

Alycia Bayne ◽

Rachel Singer ◽

Candace Spradley ◽

Lauren Isaacs ◽

Eva Jeffers ◽

...

Keyword(s):

Public Health ◽

Older Adults ◽

News Media ◽

Limited English Proficiency ◽

Technical Assistance ◽

Grey Literature ◽

Health Interventions ◽

Computer Assisted ◽

Public Health Interventions ◽

Public Health Emergencies

Abstract With support from the CDC Foundation and technical assistance from the Centers for Disease Control and Prevention, NORC at the University of Chicago conducted studies to examine the needs and concerns of older adults and unpaid caregivers during COVID-19, including their trusted sources of COVID-19 information and available public health interventions. Methods included a nationally representative survey of 1,030 adults aged 50+ years using computer-assisted telephone and web interviewing; online focus groups with older adults and caregivers in Spanish and English; a survey and interviews with stakeholder organizations; secondary analysis of U.S. caregiver surveys; analysis of public social media posts; and searches of peer-reviewed and grey literature in Spanish and English to identify interventions. Results suggest that needs and concerns differed among older adult subpopulations, including racial and ethnic minority populations, people with lower incomes, rural and tribal populations, people with limited English proficiency, and people with disabilities as well as caregivers. Older adults perceived news media, the internet, and healthcare providers as important resources for COVID-19 information, although trusted sources varied by race and ethnicity, urbanicity, and income. Findings suggested the need to increase awareness of existing public health interventions and resources to support older adults and caregivers during public health emergencies like COVID-19. Strategies for tailoring communication for diverse older adults and caregivers include partnering with national organizations, leveraging community-level infrastructure, and disseminating information through trusted sources. Studying the needs of older adults and caregivers during COVID-19 can inform future public health emergency response priorities.

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Managing borders during public health emergencies of international concern: a proposed typology of cross-border health measures

Globalization and Health ◽

10.1186/s12992-021-00709-0 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Kelley Lee ◽

Karen A. Grépin ◽

Catherine Worsnop ◽

Summer Marion ◽

Julianne Piper ◽

...

Keyword(s):

Public Health ◽

Research Policy ◽

Grey Literature ◽

World Health ◽

Border Health ◽

Policy And Practice ◽

Public Health Emergencies ◽

Cross Border ◽

Health Measures ◽

Starting Point

Abstract Background The near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. Results Based on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently – policy goal, type of movement (travel and trade), adopted by public or private sector, level of jurisdiction applied, stage of journey, and degree of restrictiveness. These categories are then brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. Addressing the current gaps in evidence about travel measures, including how different jurisdictions apply such measures with varying effects, in turn, enhances the potential for evidence-informed decision-making based on fuller understanding of policy trade-offs and externalities. Finally, through the adoption of standardized terminology and creation of an agreed evidentiary base recognized across jurisdictions, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). Conclusions The widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

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Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies

BMC Public Health ◽

10.1186/s12889-021-11495-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rita Henderson ◽

Ashley McInnes ◽

Leslee Mackey ◽

Myles Bruised Head ◽

Lindsay Crowshoe ◽

...

Keyword(s):

Public Health ◽

Substance Use ◽

Health Systems ◽

Scoping Review ◽

Scientific Journal ◽

Grey Literature ◽

Opioid Use Disorder ◽

Nominal Group ◽

Opioid Use ◽

Public Health Emergencies

Abstract Background During public health emergencies, people with opioid use disorder (PWOUD) may be particularly impacted. Emergent disasters such as the COVID-19 pandemic disrupt already-strained harm reduction efforts and treatment availability. This study aims to answer three research questions. How do public health emergencies impact PWOUD? How can health systems respond to novel public health emergencies to serve PWOUD? How can the results of this scoping review be contextualized to the province of Alberta to inform local stakeholder responses to the pandemic? Methods We conducted a scoping review using the 6-stage Arksey and O’Malley framework to analyse early-pandemic and pre-pandemic disaster literature. The results of the scoping review were contextualized to the local pandemic response, through a Nominal Group Technique (NGT) process with frontline providers and stakeholders in Alberta, Canada. Results Sixty one scientific journal articles and 72 grey literature resources were included after full-text screening. Forty sources pertained to early COVID-19 responses, and 21 focused on OUD treatment during other disasters. PWOUD may be more impacted than the general population by common COVID-19 stressors including loss of income, isolation, lack of rewarding activities, housing instability, as well as fear and anxiety. They may also face unique challenges including threats to drug supplies, stigma, difficulty accessing clean substance use supplies, and closure of substance use treatment centres. All of these impacts put PWOUD at risk of negative outcomes including fatal overdose. Two NGT groups were held. One group (n = 7) represented voices from urban services, and the other (n = 4) Indigenous contexts. Stakeholders suggested that simultaneous attention to multiple crises, with adequate resources to allow attention to both social and health systems issues, can prepare a system to serve PWOUD during disasters. Conclusion This scoping review and NGT study uncovers how disasters impact PWOUD and offers suggestions for better serving PWOUD.

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Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies

10.1101/2020.12.03.20243592 ◽

2020 ◽

Author(s):

Connor M O’Rielly ◽

Joshua S Ng-Kamstra ◽

Ania Kania-Richmond ◽

Joseph C Dort ◽

Jonathan White ◽

...

Keyword(s):

Public Health ◽

Scoping Review ◽

Grey Literature ◽

Healthcare Systems ◽

List Type ◽

Surgical Capacity ◽

Public Health Emergencies ◽

Surgical Services ◽

Competing Interests ◽

The Impact

ABSTRACTBackgroundHealthcare systems globally have been challenged by the COVID-19 pandemic, necessitating the reorganization of surgical services to free capacity within healthcare systems.ObjectivesTo understand how surgical services have been reorganized during and following public health emergencies, and the consequences of these changes for patients, healthcare providers and healthcare systems.MethodsThis rapid scoping review searched academic databases and grey literature sources to identify studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems. Recommendations and guidelines were excluded. Screening was completed in partial (title, abstract) or complete (full text) duplicate following pilot reviews of 50 articles to ensure reliable application of eligibility criteria.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganization of surgical services, 55 described the consequences of reorganizing surgical services and six reported actions taken to rebuild surgical capacity in public health emergencies. Reorganizations of surgical services were grouped under six domains: case selection/triage, PPE regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganizations led to large reductions in non-urgent surgical volumes, increases in surgical wait times, and impacted medical training (i.e., reduced case involvement) and patient outcomes (e.g., increases in pain). Strategies for rebuilding surgical capacity were scarce, but focused on the availability of staff, PPE, and patient readiness for surgery as key factors to consider before resuming services.ConclusionsReorganization of surgical services in response to public health emergencies appears to be context-dependent and has far-reaching consequences that must be better understood in order to optimize future health system responses to public health emergencies.ARTICLE SUMMARYStrengths and limitations of the studyThis rapid scoping review provides an exhaustive and rigorous summary of the academic and grey literature regarding modifications to surgical services in response to public health emergencies, especially COVID-19.This study did not limit studies based on location or language of publication to ensure a worldwide pandemic had contributions from worldwide voices.Both quantitative and qualitative outcomes were included, with a mix of inductive and deductive data abstraction approaches to provide a comprehensive understanding of surgical services during public health emergencies.Studies with potential relevance to this question are emerging at an unprecedented rate in response to the COVID-19 pandemic and as such, some may not be included in the current review.Original protocol for the studyAs requested, the original unpublished protocol for this study is included as a supplementary file.Funding statementThis study did not receive grant from any funding agency in the public, commercial or not-for-profit sectors.Competing interest statementAll authors declare that they have no competing interests in accordance with the International Committee of Medical Journal Editors uniform declaration of competing interests.

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Core Capacities for Public Health Emergencies of International Concern at Ground Crossings: A Case Study from North India

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2019.46 ◽

2019 ◽

Vol 14 (2) ◽

pp. 214-221

Author(s):

Rahuldeep Singh ◽

Kumar Sumit ◽

Shaikh Shah Hossain

Keyword(s):

Public Health ◽

Assessment Tool ◽

International Health ◽

North India ◽

World Health ◽

Public Health Emergencies ◽

Point Of Entry ◽

Health Organization ◽

Implementation Status ◽

And Control

ABSTRACTObjective:International airports, ports, and ground crossings are required to have health units for undertaking public health measures during routine times and specific measures during the time of public health emergency of international concern (PHEIC). This study was conducted at a ground crossing of North India to assess the implementation status of International Health Regulations (IHR) (2005) at a ground crossing in the prevention and control of public health emergencies and to assess the risk of imported infections from a ground crossing.Methods:A qualitative study was conducted at the selected point of entry. The World Health Organization (WHO) core capacity assessment tool and in-depth interviews were used for data collection in the form of meetings and visits to isolation sites, and general observations were conducted regarding facilities on routine and other infrastructure and equipment that can be used during emergencies. Respondents were recruited using purposive methods.Results:The findings reveal that there is lack of awareness among the travelers, which increases the risks of spreading diseases. The overall implementation status at the ground crossing according to the assessment conducted using WHO Tool was 76%. It showed the need for further strengthening of the implementation at the site. Gaps were identified regarding the local capacity for handling chemical, radiological and nuclear hazards, and shortage of regular staff through stakeholders.Conclusion:The findings from this study, as well as the suggestions and recommendations given by stakeholders, should help revise the current strategies of action. Hence, the gaps identified should be fulfilled to better respond to PHEIC at the ground crossings.

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