scholarly journals 444. Coronavirus Disease 2019 (COVID-19) Among Healthcare Workers in Southeast Michigan

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S289-S290
Author(s):  
Amit T Vahia ◽  
Zohra Sarfraz Chaudhry ◽  
Allison J Weinmann ◽  
Linoj Samuel ◽  
Robert Tibbetts ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Health Care Organization ◽  
High Volume ◽  
The United States ◽  
Care Organization ◽  
Patient Contact ◽  
Upper Respiratory Tract ◽  
Positive Polymerase Chain Reaction ◽  
Job Category ◽  
The Impact

Abstract Background Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has significantly impacted Michigan, with over 60,000 cases and 5,700 deaths to date. During the surge, Metropolitan Detroit was the epicenter of the outbreak, accounting for 80% of cases and 86% of deaths statewide. Healthcare workers (HCW) are particularly at risk; however, rates of infection based on job category has not been described previously in the United States. We describe the impact of the outbreak on our workforce. Background Michigan COVID Figure 1 Methods This was a retrospective review of employees with COVID-19 at Henry Ford Health System (HFHS), a comprehensive, integrated, health care organization in Southeast Michigan includes 5 hospitals and 9 emergency departments from 3/10/2020–6/10/2020. Employees exhibiting symptoms and/or signs consistent with COVID-19 infection were referred to employee health and tested for SARS-CoV-2. All employees with positive polymerase chain reaction (PCR) of upper respiratory tract were included. Data were obtained from a dedicated analytics dashboard that tracked all testing and results for employees. Rate (number positives/total tested) of infection for each job category was determined. Results A total 5352 (16%) of 33538 employees were tested, of whom 1036 (19%) tested positive. The number of infected workers represents approximately 3.1 % of the workforce. The sharp increase of COVID-19 admissions correlated with the rise in HCW COVID-19 positivity (Figure 1). The number of HCW tested largely correlated with the disease burden at each hospital (Figure2). Table 1 shows total population of symptomatic HCW tested and demonstrates volume of testing and positivity were higher among HCW with close patient contact. The positivity rates in specific clinical support staff are shown in Table 2. Notably, there were high rates of positivity among non-clinical business and management employees tested suggesting community-transmission. Table 1 Table 2 Figure 2 Conclusion COVID-19 risk is highest among HCW in high volume settings with close patient contact. Community exposure may be an important factor that contributes to this risk. Strategies to minimize transmission in healthcare settings should be combined with HCW education emphasizing measures to avoid exposure within the community. Disclosures All Authors: No reported disclosures

scholarly journals Survival analysis of time to SARS-CoV-2 PCR negativisation to optimise PCR prescription in health workers: the Henares COVID-19 healthcare workers cohort study

2021 ◽  
pp. oemed-2020-106903
Author(s):  
Julio González Martin-Moro ◽  
Marta Chamorro Gómez ◽  
Galicia Dávila Fernández ◽  
Ana Elices Apellaniz ◽  
Ana Fernández Hortelano ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Workers ◽  
Cox Regression ◽  
Health Workers ◽  
Upper Respiratory Tract ◽  
Rt Pcr ◽  
Kaplan Meier ◽  
Confounding Variables ◽  
The Impact ◽  
Associated Variables

ObjectivesReverse transcriptase PCR (RT-PCR) is considered the gold standard in diagnosing COVID-19. Infected healthcare workers do not go back to work until RT-PCR has demonstrated that the virus is no longer present in the upper respiratory tract. The aim of this study is to determine the most efficient time to perform RT-PCR prior to healthcare workers’ reincorporation.Materials and methodsThis is a cohort study of healthcare workers with RT-PCR-confirmed COVID-19. Data were collected using the medical charts of healthcare workers and completed with a telephone interview. Kaplan-Meier curves were used to determine the influence of several variables on the time to RT-PCR negativisation. The impact of the variables on survival was assessed using the Breslow test. A Cox regression model was developed including the associated variables.Results159 subjects with a positive RT-PCR out of 374 workers with suspected COVID-19 were included. The median time to negativisation was 25 days from symptom onset (IQR 20–35 days). Presence of IgG, dyspnoea, cough and throat pain were associated with significant longer time to negativisation. Cox logistic regression was used to adjust for confounding variables. Only dyspnoea and cough remained in the model as significant determinants of prolonged negativisation time. Adjusted HRs were 0.68 (0.48–096) for dyspnoea and 0.61 (0.42–0.88) for dry cough.ConclusionsRT-PCR during the first 3 weeks leads to a high percentage of positive results. In the presence of respiratory symptoms, negativisation took nearly 1 week more. Those who developed antibodies needed longer time to negativisate.

scholarly journals International and Russian Experience in Primary Health Care Organization

2018 ◽  
pp. 146-148
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Medical Care ◽  
Health Care Organization ◽  
The United States ◽  
Evidence Base ◽  
Care Organization ◽  
Care Provision ◽  
Primary Health ◽  
Effective Instrument

In this study, they presented the analysis of current views on the important link in medical care provision to the population, namely, primary health care. According to the Alma-Ata Declaration on the organization of primary health care this type of medical assistance has made it possible to carry out reforms within this area in many countries, which has led to effective results (the reduction of infant mortality, the increase of life expectancy and a number of other indicators). In this paper, they performed the analysis of Russian and foreign sources of literature on the topic under study between 1978 and 2018. It has been established that primary health care is regarded as the most effective instrument of health protection than specialized medical care according to the experience of Russian Federation, a number of countries in Europe, Asia and the African continent, Australia and the United States. The performed analysis clearly shows that the experience of some countries demonstrates the correlation between the general coverage of primary health care and the achievement of public health indicative indicators. At the same time, the question is raised about the expediency of certain aspect replacement concerning the provision of specialized medical care by the doctors of general practice, i.e. primary health care. The obtained results can be interpreted as an evidence base for the necessity and an undeniable effectiveness of primary health care as a central link in the health care system.

scholarly journals Comparison of Adjuvanted-Whole Inactivated Virus and Live-Attenuated Virus Vaccines against Challenge with Contemporary, Antigenically Distinct H3N2 Influenza A Viruses

2018 ◽  
Vol 92 (22) ◽  
Author(s):  
Eugenio J. Abente ◽  
Daniela S. Rajao ◽  
Jefferson Santos ◽  
Bryan S. Kaplan ◽  
Tracy L. Nicholson ◽  
...  
Keyword(s):  
Influenza A Virus ◽  
Vaccine Efficacy ◽  
Influenza A ◽  
Rapid Evolution ◽  
The United States ◽  
Upper Respiratory Tract ◽  
Influenza A Viruses ◽  
Partial Protection ◽  
Attenuated Virus ◽  
The Impact

ABSTRACTInfluenza A viruses in swine (IAV-S) circulating in the United States of America are phylogenetically and antigenically distinct. A human H3 hemagglutinin (HA) was introduced into the IAV-S gene pool in the late 1990s, sustained continued circulation, and evolved into five monophyletic genetic clades, H3 clades IV-A to -E, after 2009. Across these phylogenetic clades, distinct antigenic clusters were identified, with three clusters (cyan, red, and green antigenic cluster) among the most frequently detected antigenic phenotypes (Abente EJ, Santos J, Lewis NS, Gauger PC, Stratton J, et al. J Virol 90:8266–8280, 2016,https://doi.org/10.1128/JVI.01002-16). Although it was demonstrated that antigenic diversity of H3N2 IAV-S was associated with changes at a few amino acid positions in the head of the HA, the implications of this diversity for vaccine efficacy were not tested. Using antigenically representative H3N2 viruses, we compared whole inactivated virus (WIV) and live-attenuated influenza virus (LAIV) vaccines for protection against challenge with antigenically distinct H3N2 viruses in pigs. WIV provided partial protection against antigenically distinct viruses but did not prevent virus replication in the upper respiratory tract. In contrast, LAIV provided complete protection from disease and virus was not detected after challenge with antigenically distinct viruses.IMPORTANCEDue to the rapid evolution of the influenza A virus, vaccines require continuous strain updates. Additionally, the platform used to deliver the vaccine can have an impact on the breadth of protection. Currently, there are various vaccine platforms available to prevent influenza A virus infection in swine, and we experimentally tested two: adjuvanted-whole inactivated virus and live-attenuated virus. When challenged with an antigenically distinct virus, adjuvanted-whole inactivated virus provided partial protection, while live-attenuated virus provided effective protection. Additional strategies are required to broaden the protective properties of inactivated virus vaccines, given the dynamic antigenic landscape of cocirculating strains in North America, whereas live-attenuated vaccines may require less frequent strain updates, based on demonstrated cross-protection. Enhancing vaccine efficacy to control influenza infections in swine will help reduce the impact they have on swine production and reduce the risk of swine-to-human transmission.

scholarly journals Co-infection does not predict disease signs in Gopherus tortoises

2017 ◽  
Vol 4 (10) ◽  
pp. 171003 ◽  
Author(s):  
Chava L. Weitzman ◽  
Ryan Gov ◽  
Franziska C. Sandmeier ◽  
Sarah J. Snyder ◽  
C. Richard Tracy
Keyword(s):  
Dna Sequences ◽  
Host Species ◽  
Disease Ecology ◽  
Clinical Signs ◽  
Infection Intensity ◽  
The United States ◽  
Host Immune System ◽  
Disease Dynamics ◽  
Upper Respiratory Tract ◽  
The Impact

In disease ecology, the host immune system interacts with environmental conditions and pathogen properties to affect the impact of disease on the host. Within the host, pathogens may interact to facilitate or inhibit each other's growth, and pathogens interact with different hosts differently. We investigated co-infection of two Mycoplasma and the association of infection with clinical signs of upper respiratory tract disease in four congeneric tortoise host species ( Gopherus ) in the United States to detect differences in infection risk and disease dynamics in these hosts. Mojave Desert tortoises had greater prevalence of Mycoplasma agassizii than Texas tortoises and gopher tortoises, while there were no differences in Mycoplasma testudineum prevalence among host species. In some host species, the presence of each pathogen influenced the infection intensity of the other; hence, these two mycoplasmas interact differently within different hosts, and our results may indicate facilitation of these bacteria. Neither infection nor co-infection was associated with clinical signs of disease, which tend to fluctuate across time. From M. agassizii DNA sequences, we detected no meaningful differentiation of haplotypes among hosts. Experimental inoculation studies and recurrent resampling of wild individuals could help to decipher the underlying mechanisms of disease dynamics in this system.

Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 297-297 ◽  
Author(s):  
Virginia P. Quinn ◽  
Joanne E. Schottinger ◽  
Kelley R. Green ◽  
Craig T. Cheetham
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Health Care Organization ◽  
Medication Possession Ratio ◽  
Care Organization ◽  
Adjuvant Hormonal Therapy ◽  
Kaiser Permanente ◽  
Telephone Reminder ◽  
The Impact ◽  
Recommended Therapy

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.

scholarly journals To The Covid-19 Pandemic Experience: A View from Russia

2021 ◽  
Vol 9 (SPE3) ◽  
Author(s):  
Maksim Maksimov ◽  
Natalia Prodanova ◽  
Anatoliy Kolesnikov ◽  
Aleksandr Melnikov ◽  
Ona Grazyna Rakauskiene ◽  
...  
Keyword(s):  
Health Care ◽  
Performance Indicators ◽  
Health Care Organization ◽  
Care Organization ◽  
Recent Past ◽  
Russian Economy ◽  
The Government ◽  
Restrictive Measures ◽  
The Impact ◽  
Made In

In the presented work, an attempt to assess the correlation between the performance indicators of several sectors of the Russian economy and a set of restrictive measures taken by the Government of our country against the backdrop of the fight against the COVID-19 pandemic is made. In addition, a comparative analysis of the impact of this pandemic on the neighboring countries of Russia, which, in the recent past, were part of the USSR and, therefore, have similar health care organization structures, is carried out.

scholarly journals The Impact of Work Place Stressors on Work Quality of Nurses: Case Study of Private Medical Institutions in the (TRNC)

2017 ◽  
Vol 2 (3) ◽  
Keyword(s):  
Health Care Organization ◽  
Negative Relationship ◽  
Work Place ◽  
Care Organization ◽  
Positive Relation ◽  
Work Quality ◽  
Work Related ◽  
Related Quality ◽  
The Impact

Various studies have been discussed in the past time to predispose the contact of work place stressors on work quality of nurse. Most of the studies focused on the work place stressors and their relationship between work related quality of life of nurses that how stressors can affect the work quality of nurses and what are the reasons or is there any negative or positive relation between stressors and work quality. This study seeks to analyze the impact of work place stressors among nurses in their work quality by acquiring a quantitative testing method of administering questionnaires to the nurses in the health work place in Northern Cyprus. If the stressors that alter the task quality of nurses are low in the work place, there can be a positive relation between them and can make nurses work more comfortable and relaxed. The main findings suggests that there is a symbolic negative relationship of job place stressors with work nature and aspect of nurses. The results discloses that the frequency of job place stressors have a eloquent contact on work quality of nurses and there is a statistically expressive negative linear contingency within job related element of life and Nurses stress. In health care organization, designing and creating work to be more important and meaningful in their performance and in the manner at which their contributions are acknowledged.

scholarly journals Assessing the impact of secondary school reopening strategies on within-school COVID-19 transmission and absences: a modelling study

2021 ◽  
Author(s):  
Trystan Leng ◽  
Edward M. Hill ◽  
Robin N. Thompson ◽  
Michael J. Tildesley ◽  
Matt J. Keeling ◽  
...  
Keyword(s):  
Secondary School ◽  
High Volume ◽  
Rapid Testing ◽  
Repeated Testing ◽  
Positive Polymerase Chain Reaction ◽  
Testing Strategies ◽  
Targeted Testing ◽  
Polymerase Chain ◽  
Lateral Flow Tests ◽  
The Impact

AbstractBackgroundStrategies involving rapid testing have been suggested as a way of reopening schools that minimises absences while controlling transmission. We assess the likely impact of rapid testing strategies using lateral flow tests (LFTs) on infections and absences in secondary schools, compared to a policy of isolating year group bubbles upon a pupil returning a positive polymerase chain reaction (PCR) test.MethodsWe developed an individual-based model of a secondary school formed of exclusive year group bubbles (five year groups, with 200 pupils per year). By simulating infections over the course of a seven-week half-term, we compared the impact of differing strategies on transmission, absences, and testing volume. We also considered the sensitivity of results to underlying model assumptions.FindingsRepeated testing of year-group bubbles following case detection or regular mass-testing strategies result in a modest increase in infections compared to the policy of isolating year-group bubbles, but substantially reduce absences. When combined these two testing strategies can reduce infections to levels lower than would occur under year-group isolation, although such a policy requires a high volume of testing.InterpretationOur results highlight the conflict between the goals of minimising within-school transmission, minimising absences and minimising testing burden. While mass and targeted testing strategies can reduce school transmission and absences, it may lead to a large number of daily tests.

scholarly journals The impact of Coronavirus disease 2019 (COVID-19) on health systems and household resources in Africa and South Asia

2020 ◽  
Author(s):  
Nicholas Davies ◽  
Sedona Sweeney ◽  
Sergio Torres-Rueda ◽  
Fiammetta Bozzani ◽  
Nichola Kitson ◽  
...  
Keyword(s):  
United States ◽  
Health Systems ◽  
Resource Use ◽  
Healthcare Workers ◽  
Addis Ababa ◽  
Severe Disease ◽  
The United States ◽  
Economic Implications ◽  
Hospital Beds ◽  
The Impact

AbstractBackgroundCoronavirus disease 2019 (COVID-19) epidemics strain health systems and households. Health systems in Africa and South Asia may be particularly at risk due to potential high prevalence of risk factors for severe disease, large household sizes and limited healthcare capacity.MethodsWe investigated the impact of an unmitigated COVID-19 epidemic on health system resources and costs, and household costs, in Karachi, Delhi, Nairobi, Addis Ababa and Johannesburg. We adapted a dynamic model of SARS-CoV-2 transmission and disease to capture country-specific demography and contact patterns. The epidemiological model was then integrated into an economic framework that captured city-specific health systems and household resource use.FindingsThe cities severely lack intensive care beds, healthcare workers and financial resources to meet demand during an unmitigated COVID-19 epidemic. A highly mitigated COVID-19 epidemic, under optimistic assumptions, may avoid overwhelming hospital bed capacity in some cities, but not critical care capacity.InterpretationViable mitigation strategies encompassing a mix of responses need to be established to expand healthcare capacity, reduce peak demand for healthcare resources, minimise progression to critical care and shield those at greatest risk of severe disease.FundingBill & Melinda Gates Foundation, European Commission, National Institute for Health Research, Department for International Development, Wellcome Trust, Royal Society, Research Councils UK.Research in contextEvidence before this studyWe conducted a PubMed search on May 5, 2020, with no language restrictions, for studies published since inception, combining the terms (“cost” OR “economic”) AND “covid”. Our search yielded 331 articles, only two of which reported estimates of health system costs of COVID-19. The first study estimated resource use and medical costs for COVID-19 in the United States using a static model of COVID 19. The second study estimated the costs of polymerase chain reaction tests in the United States. We found no studies examining the economic implications of COVID-19 in low- or middle-income settings.Added value of this studyThis is the first study to use locally collected data in five cities (Karachi, Delhi, Nairobi, Addis Ababa and Johannesburg) to project the healthcare resource and health economic implications of an unmitigated COVID-19 epidemic. Besides the use of local data, our study moves beyond existing work to (i) consider the capacity of health systems in key cities to cope with this demand, (ii) consider healthcare staff resources needed, since these fall short of demand by greater margins than hospital beds, and (iii) consider economic costs to health services and households.Implications of all the evidenceDemand for ICU beds and healthcare workers will exceed current capacity by orders of magnitude, but the capacity gap for general hospital beds is narrower. With optimistic assumptions about disease severity, the gap between demand and capacity for general hospital beds can be closed in some, but not all the cities. Efforts to bridge the economic burden of disease to households are needed.

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