scholarly journals Electrophysiology in the time of coronavirus: coping with the great wave

2020 ◽  
Author(s):  
Jia Li ◽  
Patrizio Mazzone ◽  
Lisa WM Leung ◽  
Weiqian Lin ◽  
Giuseppe D’Angelo ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Intervention ◽  
Normal Activity ◽  
Health Intervention ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Interventional Electrophysiology ◽  
Ethical Approval ◽  
The Impact ◽  
Nationwide Program

ABSTRACTAimsTo chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions.MethodsWe reviewed the electrophysiology laboratory records in 3 affected cities: Wenzhou in China, Milan in Italy and London, United Kingdom. We interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members.ResultsThere was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurred within a week of the recognition of widespread community transmission of the virus in each region and shows a striking correlation with the national figures for new diagnoses of COVID-19 in each case. During the period of restriction, work-flow dropped to <5% of normal, consisting of emergency cases only. In 2 of 3 centres, electrophysiologists were redeployed to perform emergency work outside electrophysiology. Among the centres studied, only Wenzhou has seen a recovery from the restrictions in activity. Following an intense nationwide program of public health interventions, local transmission of COVID-19 ceased to be detectable after February 18th allowing the electrophysiology service to resume with a strict testing regime for all patients.ConclusionInterventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity.CONDENSED ABSTRACTCOVID-19 has affected every aspect of life worldwide. In the electrophysiology labs of Wenzhou, Milan and London, activity was suspended as the disease took hold. Only Wenzhou has resumed normal services, facilitated by a monumental nationwide program of public health interventions and supported by stringent testing protocols.WHAT’S NEWWe describe the impact of the COVID-19 pandemic on interventional electrophysiology units in 3 cities: Wenzhou, Milan and London.In all cases, the routine work of the electrophysiology was virtually suspended within a week of the recognition of widespread virus transmission in the area.During the period of restricted activity imposed by the pandemic, centres have dealt with a small number of emergency ablations only, a balanced mix of atrial, ventricular and junctional arrhythmias.In 2 of the 3 centres, electrophysiologists were redeployed to perform other medical duties including in COVID-19 wards.COVID-19 infection occurred in medical and nursaing staff in 2 of the 3 centres.Only in the cases of Wenzhou, China, has a resumption of normal activity been possible; this follows intensive public health intervention and is protected by stringent testing.FUNDINGNoneETHICAL APPROVALNone required from the Research Ethics Committee (REC) London according to the type of study. Institutional ethical approval obtained at the centres of: St. George’s Hospital NHS Foundation Trust, London, UK; Local Health Authority Ethical Approval was obtained in: The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University in Wenzhou, PR China and San Raffaele in Milan, Italy.CONSENTInformed consent was obtained from all participants/interviewees who took part in this study.

scholarly journals How to optimise public health interventions: a scoping review of guidance from optimisation process frameworks

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sam McCrabb ◽  
Kaitlin Mooney ◽  
Benjamin Elton ◽  
Alice Grady ◽  
Sze Lin Yoong ◽  
...  
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Implementation Strategy ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Health Interventions ◽  
Problem Identification ◽  
Key Concepts ◽  
The Common ◽  
The Impact

Abstract Background Optimisation processes have the potential to rapidly improve the impact of health interventions. Optimisation can be defined as a deliberate, iterative and data-driven process to improve a health intervention and/or its implementation to meet stakeholder-defined public health impacts within resource constraints. This study aimed to identify frameworks used to optimise the impact of health interventions and/or their implementation, and characterise the key concepts, steps or processes of identified frameworks. Methods A scoping review of MEDLINE, CINAL, PsycINFO, and ProQuest Nursing & Allied Health Source databases was undertaken. Two reviewers independently coded the key concepts, steps or processes involved in each frameworks, and identified if it was a framework aimed to optimise interventions or their implementation. Two review authors then identified the common steps across included frameworks. Results Twenty optimisation frameworks were identified. Eight frameworks were for optimising interventions, 11 for optimising implementation and one covered both intervention and implementation optimisation. The mean number of steps within the frameworks was six (range 3–9). Almost half (n = 8) could be classified as both linear and cyclic frameworks, indicating that some steps may occur multiple times in a single framework. Two meta-frameworks are proposed, one for intervention optimisation and one for implementation strategy optimisation. Steps for intervention optimisation are: Problem identification; Preparation; Theoretical/Literature base; Pilot/Feasibility testing; Optimisation; Evaluation; and Long-term implementation. Steps for implementation strategy optimisation are: Problem identification; Collaborate; Plan/design; Pilot; Do/change; Study/evaluate/check; Act; Sustain/endure; and Disseminate/extend. Conclusions This review provides a useful summary of the common steps followed to optimise a public health intervention or its implementation according to established frameworks. Further opportunities to study and/or validate such frameworks and their impact on improving outcomes exist.

scholarly journals The assembly effect: the connectedness between populations is a double‐edged sword for public health interventions

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sai Thein Than Tun ◽  
Daniel M. Parker ◽  
Ricardo Aguas ◽  
Lisa J. White
Keyword(s):  
Public Health ◽  
Spatial Scales ◽  
Public Health Intervention ◽  
Human Movement ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Malaria Intervention ◽  
Disease Epidemiology ◽  
Intervention Measures ◽  
The Impact

Abstract Background Many public health interventions lead to disruption or decrease of transmission, providing a beneficial effect for people in the population regardless of whether or not they individually participate in the intervention. This protective benefit has been referred to as a herd or community effect and is dependent on sufficient population participation. In practice, public health interventions are implemented at different spatial scales (i.e., at the village, district, or provincial level). Populations, however defined (i.e., neighbourhoods, villages, districts) are frequently connected to other populations through human movement or travel, and this connectedness can influence potential herd effects. Methods The impact of a public health intervention (mass drug administration for malaria) was modelled, for different levels of connectedness between populations that have similar disease epidemiology (e.g., two nearby villages which have similar baseline malaria incidences and similar malaria intervention measures), or between populations of varying disease epidemiology (e.g., two nearby villages which have different baseline malaria incidences and/or malaria intervention measures). Results The overall impact of the interventions deployed could be influenced either positively (adding value to the intervention) or negatively (reducing the impact of the intervention) by how much the intervention units are connected with each other (e.g., how frequent people go to the other village or town) and how different the disease intensity between them are. This phenomenon is termed the “assembly effect”, and it is a meta-population version of the more commonly understood “herd effect”. Conclusions The connectedness of intervention units or populations is an important factor to be considered to achieve success in public health interventions that could provide herd effects. Appreciating the assembly effect can improve the cost-effective strategies for global disease elimination projects.

scholarly journals The assembly effect: the connectedness between populations is a double-edged sword for public health interventions

2020 ◽  
Author(s):  
Sai Thein Than Tun ◽  
Daniel M. Parker ◽  
Ricardo Aguas ◽  
Lisa J. White
Keyword(s):  
Public Health ◽  
Spatial Scales ◽  
Public Health Intervention ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Herd Effect ◽  
Intervention Coverage ◽  
The Impact ◽  
The Village ◽  
Different Levels

Many public health interventions lead to disruption or decrease of transmission, providing a beneficial effect for people in the population regardless of whether or not they individually participate in the intervention. This protective benefit has been referred to as a herd or community effect and is dependent on sufficient population participation. In practice, public health interventions are implemented at different spatial scales (i.e. at the village, district, or provincial level). Populations, however defined, are frequently connected to other populations and this connectedness can influence potential herd effects. In this research we model the impact of a public health intervention (mass drug administration for malaria), given different levels of connectedness between similar populations and between populations of varying epidemiology (i.e. baseline transmission levels and intervention coverage). We show that the way such intervention units are connected to each other may influence the impact of the focal interventions deployed in both positive (adding value to the intervention) and negative (reducing the impact of the intervention) ways. We term this phenomenon the "assembly effect" which is a meta-population version of the more commonly understood "herd effect". We conclude that public health interventions should consider the connectedness of intervention units or populations in order to achieve success.

scholarly journals Electrophysiology in the time of coronavirus: coping with the great wave

EP Europace ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. 1841-1847
Author(s):  
Jia Li ◽  
Patrizio Mazzone ◽  
Lisa W M Leung ◽  
Weiqian Lin ◽  
Giuseppe D’Angelo ◽  
...  
Keyword(s):  
Public Health ◽  
Disease Transmission ◽  
Public Health Intervention ◽  
Normal Activity ◽  
Staff Members ◽  
Interventional Electrophysiology ◽  
Community Transmission ◽  
The Uk ◽  
The Impact ◽  
Local Transmission

Abstract Aims  To chart the effect of the COVID-19 pandemic on the activity of interventional electrophysiology services in affected regions. Methods and results  We reviewed the electrophysiology laboratory records in three affected cities: Wenzhou in China, Milan in Italy, and London in the UK. We inspected catheter lab records and interviewed electrophysiologists in each centre to gather information on the impact of the pandemic on working patterns and on the health of staff members and patients. There was a striking decline in interventional electrophysiology activity in each of the centres. The decline occurred within a week of the recognition of widespread community transmission of the virus in each region and shows a striking correlation with the national figures for new diagnoses of COVID-19 in each case. During the period of restriction, workflow dropped to &lt;5% of normal, consisting of emergency cases only. In two of three centres, electrophysiologists were redeployed to perform emergency work outside electrophysiology. Among the centres studied, only Wenzhou has seen a recovery from the restrictions in activity. Following an intense nationwide programme of public health interventions, local transmission of COVID-19 ceased to be detectable after 18 February allowing the electrophysiology service to resume with a strict testing regime for all patients. Conclusion  Interventional electrophysiology is vulnerable to closure in times of great social difficulty including the COVID-19 pandemic. Intense public health intervention can permit suppression of local disease transmission allowing resumption of some normal activity with stringent precautions.

scholarly journals A review of the quantitative effectiveness evidence synthesis methods used in public health intervention guidelines

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ellesha A. Smith ◽  
Nicola J. Cooper ◽  
Alex J. Sutton ◽  
Keith R. Abrams ◽  
Stephanie J. Hubbard
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Health Interventions ◽  
Synthesis Methods ◽  
Public Health Interventions ◽  
Guidance Documents

Abstract Background The complexity of public health interventions create challenges in evaluating their effectiveness. There have been huge advancements in quantitative evidence synthesis methods development (including meta-analysis) for dealing with heterogeneity of intervention effects, inappropriate ‘lumping’ of interventions, adjusting for different populations and outcomes and the inclusion of various study types. Growing awareness of the importance of using all available evidence has led to the publication of guidance documents for implementing methods to improve decision making by answering policy relevant questions. Methods The first part of this paper reviews the methods used to synthesise quantitative effectiveness evidence in public health guidelines by the National Institute for Health and Care Excellence (NICE) that had been published or updated since the previous review in 2012 until the 19th August 2019.The second part of this paper provides an update of the statistical methods and explains how they address issues related to evaluating effectiveness evidence of public health interventions. Results The proportion of NICE public health guidelines that used a meta-analysis as part of the synthesis of effectiveness evidence has increased since the previous review in 2012 from 23% (9 out of 39) to 31% (14 out of 45). The proportion of NICE guidelines that synthesised the evidence using only a narrative review decreased from 74% (29 out of 39) to 60% (27 out of 45).An application in the prevention of accidents in children at home illustrated how the choice of synthesis methods can enable more informed decision making by defining and estimating the effectiveness of more distinct interventions, including combinations of intervention components, and identifying subgroups in which interventions are most effective. Conclusions Despite methodology development and the publication of guidance documents to address issues in public health intervention evaluation since the original review, NICE public health guidelines are not making full use of meta-analysis and other tools that would provide decision makers with fuller information with which to develop policy. There is an evident need to facilitate the translation of the synthesis methods into a public health context and encourage the use of methods to improve decision making.

scholarly journals Evaluating the effect of public health intervention on the global-wide spread trajectory of Covid-19

2020 ◽  
Author(s):  
Zixin Hu ◽  
Qiyang Ge ◽  
Shudi Li ◽  
Li Jin ◽  
Momiao Xiong
Keyword(s):  
Public Health ◽  
Policy Making ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Intervention Strategies ◽  
Health Interventions ◽  
Wide Spread ◽  
Public Health Interventions ◽  
Different Levels

As COVID-19 evolves rapidly, the issues the governments of affected countries facing are whether and when to take public health interventions and what levels of strictness of these interventions should be, as well as when the COVID-19 spread reaches the stopping point after interventions are taken. To help governments with policy-making, we developed modified auto-encoders (MAE) method to forecast spread trajectory of Covid-19 of countries affected, under different levels and timing of intervention strategies. Our analysis showed public health interventions should be executed as soon as possible. Delaying intervention 4 weeks after March 8, 2020 would cause the maximum number of cumulative cases of death increase from 7,174 to 133,608 and the ending points of the epidemic postponed from Jun 25 to Aug 22.

scholarly journals Co-creating a tailored public health intervention to reduce older adults’ sedentary behaviour

2017 ◽  
Vol 76 (5) ◽  
pp. 595-608 ◽  
Author(s):  
Calum F Leask ◽  
Marlene Sandlund ◽  
Dawn A Skelton ◽  
Sebastien FM Chastin
Keyword(s):  
Public Health ◽  
Older Adults ◽  
Sedentary Behaviour ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Community Dwelling ◽  
Health Interventions ◽  
Ageing Population ◽  
Public Health Interventions ◽  
Sustainable Solutions

Objective: The increasing health care costs associated with an ageing population and chronic disease burden are largely attributable to modifiable lifestyle factors that are complex and vary between individuals and settings. Traditional approaches to promoting healthy lifestyles have so far had limited success. Recently, co-creating public health interventions with end-users has been advocated to provide more effective and sustainable solutions. The aim of this study was to document and evaluate the co-creation of a public health intervention to reduce sedentary behaviour in older adults. Design: Community-dwelling older adults ( N = 11, mean age = 74 years) and academic researchers attended 10 interactive co-creation workshops together. Setting: Workshops took place on university campus and the co-creators completed fieldwork tasks outside the workshops. Method: Workshops were informed by the Participatory and Appreciative Action and Reflection methodology. Data were collected using field notes, video recording and worksheet tasks. Analysis was conducted using a qualitative content analysis approach. Results: The co-creators developed a tailored intervention delivered through a mode congruent with older adults’ lives. Key elements of the intervention included (1) education on sedentary behaviour, (2) resources to interrupt sedentary behaviour, (3) self-monitoring, (4) action planning and (5) evaluating the benefits of interrupting sedentary behaviour. Conclusion: Co-creation is a feasible approach to develop public health interventions; however, it is limited by the lack of a systematic framework to guide the process. Future work should aim to develop principles and recommendations to ensure co-creation can be conducted in a more scientific and reproducible way. The effectiveness and scalability of the intervention should be assessed.

scholarly journals An example of involving lay people to enhance complex public health intervention evaluations

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Southby ◽  
S Rushworth ◽  
J South ◽  
S Coan ◽  
J Woodward ◽  
...  
Keyword(s):  
Public Health ◽  
Lived Experience ◽  
Public Health Intervention ◽  
Community Based Participatory Research ◽  
Health Intervention ◽  
Community Empowerment ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Research Methodologies ◽  
Intervention Evaluations

Abstract Background Despite growing interest in understanding complex systems and public health interventions, research methodologies that take account of system-wide action are relatively underdeveloped. Community-based participatory research (CBPR) is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of CBPR in complex public health intervention evaluations. The 'Local People' and 'Local Conversations' programmes use a community empowerment approach in 50 communities across the UK experiencing social disadvantage to increase social connections and collective control, improve health and wellbeing, and reduce inequalities (linked to SDG 3 and 11). Methods Evaluation of the programmes followed a mixed-methods design, including qualitative case studies, longitudinal survey, process appraisal, and CBPR. Residents from 10 communities across the programmes each undertook 2 rounds of CBPR. These projects resulted in written reports, which were analysed thematically alongside other data sources. Results There was some variation in the scope and design of the 20 completed CBPR projects. Whilst projects did not generally extend beyond the scope of the overall evaluation, peer research provided information from residents that were inaccessible to other data collection streams. Gathering community (lay) knowledge improved understanding of local priorities and actions within the programmes. However, the utility of CBPR was less consistent for community-researchers and local communities, often failing to support project development. Some community-researchers felt unprepared for the activity despite support from the academic team. Conclusions Conducted appropriately, CBPR can elicit data that would be less accessible through externally led research. This study highlights the value of CBPR in complex programme evaluations, enabling a deeper understanding of social context in which interventions occur. Key messages CBPR complements more traditional research methodologies in complex public health evaluation designs. CBPR can enable a deeper understanding of social processes necessary for the success of complex public health interventions that might be beyond the scope of other methodologies.

scholarly journals Evolution of disease transmission during the COVID-19 pandemic: patterns and determinants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jie Zhu ◽  
Blanca Gallego
Keyword(s):  
Public Health ◽  
Disease Transmission ◽  
Clustering Algorithm ◽  
Health Interventions ◽  
Transmission Model ◽  
Model Parameters ◽  
Public Health Interventions ◽  
Forecasting Accuracy ◽  
Time Lagged ◽  
The Impact

AbstractEpidemic models are being used by governments to inform public health strategies to reduce the spread of SARS-CoV-2. They simulate potential scenarios by manipulating model parameters that control processes of disease transmission and recovery. However, the validity of these parameters is challenged by the uncertainty of the impact of public health interventions on disease transmission, and the forecasting accuracy of these models is rarely investigated during an outbreak. We fitted a stochastic transmission model on reported cases, recoveries and deaths associated with SARS-CoV-2 infection across 101 countries. The dynamics of disease transmission was represented in terms of the daily effective reproduction number ($$R_t$$ R t ). The relationship between public health interventions and $$R_t$$ R t was explored, firstly using a hierarchical clustering algorithm on initial $$R_t$$ R t patterns, and secondly computing the time-lagged cross correlation among the daily number of policies implemented, $$R_t$$ R t , and daily incidence counts in subsequent months. The impact of updating $$R_t$$ R t every time a prediction is made on the forecasting accuracy of the model was investigated. We identified 5 groups of countries with distinct transmission patterns during the first 6 months of the pandemic. Early adoption of social distancing measures and a shorter gap between interventions were associated with a reduction on the duration of outbreaks. The lagged correlation analysis revealed that increased policy volume was associated with lower future $$R_t$$ R t (75 days lag), while a lower $$R_t$$ R t was associated with lower future policy volume (102 days lag). Lastly, the outbreak prediction accuracy of the model using dynamically updated $$R_t$$ R t produced an average AUROC of 0.72 (0.708, 0.723) compared to 0.56 (0.555, 0.568) when $$R_t$$ R t was kept constant. Monitoring the evolution of $$R_t$$ R t during an epidemic is an important complementary piece of information to reported daily counts, recoveries and deaths, since it provides an early signal of the efficacy of containment measures. Using updated $$R_t$$ R t values produces significantly better predictions of future outbreaks. Our results found variation in the effect of early public health interventions on the evolution of $$R_t$$ R t over time and across countries, which could not be explained solely by the timing and number of the adopted interventions.

The Impact of Public Health Interventions on Delaying and Mitigating against Replacement by SARS-CoV-2 Variants of Concern

2021 ◽  
Author(s):  
Jianhong Wu ◽  
Francesca Scarabel ◽  
Bushra Majeed ◽  
Nicola Luigi Bragazzi ◽  
James Orbinski
Keyword(s):  
Public Health ◽  
Health Interventions ◽  
Public Health Interventions ◽  
The Impact
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