scholarly journals Detection of SARS-CoV-2 RNA and Antibodies in Diverse Samples: Protocol to Validate the Sufficiency of Provider-Observed, Home-Collected Blood, Saliva, and Oropharyngeal Samples

10.2196/19054 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e19054 ◽  
Author(s):  
Patrick Sean Sullivan ◽  
Charles Sailey ◽  
Jodie Lynn Guest ◽  
Jeannette Guarner ◽  
Colleen Kelley ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
The United States ◽  
Alternative Methods ◽  
Nasopharyngeal Swab ◽  
Care Providers ◽  
Public Health Response ◽  
Specimen Collection

Background The response in the United States to the coronavirus disease (COVID-19) pandemic has been hampered by a lack of aggressive testing for the infection. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cornerstone of an effective public health response. However, efforts to test have been hampered by limited reagents, limitations in the availability of swabs used for the collection of nasopharyngeal swab (NPS) specimens, limitations in personal protective equipment (PPE) for health care providers collecting the NPS specimens, and limitations in viral transport media for transporting the specimens. Therefore, more flexible options for screening for SARS-CoV-2 RNA and serologic responses are critical to inform clinical and public health responses. Objective We aim to document the ability of patients to self-collect sufficient specimens for SARS-CoV-2 viral detection and serology. Methods Patient self-collection of samples will be done with observation by a health care provider during a telemedicine session. Participants will be mailed a specimen collection kit, engage in a telehealth session with a provider through a HIPPA (Health Insurance Portability and Accountability Act of 1996)-compliant video meeting, and collect specimens while being observed by the provider. Providers will record whether they are confident in the suitability of the specimen for laboratory testing that would inform clinical decision making. We will objectively assess the sufficiency of biological material in the mailed-in specimens. Results The protocol was approved by the Emory University Institutional Review Board (IRB) on March 30, 2020 (Protocol number 371). To date, we have enrolled 159 participants. Conclusions Defining a conceptual framework for assessing the sufficiency of patient-collected samples for the detection of SARS-CoV-2 RNA and serologic responses to infection is critical for facilitating public health responses and providing PPE-sparing options to increase testing. Validation of alternative methods of specimen collection should include objective measures of the sufficiency of specimens for testing. A strong evidence base for diversifying testing modalities will improve tools to guide public health responses to the COVID-19 pandemic.

scholarly journals Detection of SARS-CoV-2 RNA and Antibodies in Diverse Samples: Protocol to Validate the Sufficiency of Provider-Observed, Home-Collected Blood, Saliva, and Oropharyngeal Samples (Preprint)

2020 ◽  
Author(s):  
Patrick Sean Sullivan ◽  
Charles Sailey ◽  
Jodie Lynn Guest ◽  
Jeannette Guarner ◽  
Colleen Kelley ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
The United States ◽  
Alternative Methods ◽  
Nasopharyngeal Swab ◽  
Care Providers ◽  
Public Health Response ◽  
Specimen Collection

BACKGROUND The response in the United States to the coronavirus disease (COVID-19) pandemic has been hampered by a lack of aggressive testing for the infection. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cornerstone of an effective public health response. However, efforts to test have been hampered by limited reagents, limitations in the availability of swabs used for the collection of nasopharyngeal swab (NPS) specimens, limitations in personal protective equipment (PPE) for health care providers collecting the NPS specimens, and limitations in viral transport media for transporting the specimens. Therefore, more flexible options for screening for SARS-CoV-2 RNA and serologic responses are critical to inform clinical and public health responses. OBJECTIVE We aim to document the ability of patients to self-collect sufficient specimens for SARS-CoV-2 viral detection and serology. METHODS Patient self-collection of samples will be done with observation by a health care provider during a telemedicine session. Participants will be mailed a specimen collection kit, engage in a telehealth session with a provider through a HIPPA (Health Insurance Portability and Accountability Act of 1996)-compliant video meeting, and collect specimens while being observed by the provider. Providers will record whether they are confident in the suitability of the specimen for laboratory testing that would inform clinical decision making. We will objectively assess the sufficiency of biological material in the mailed-in specimens. RESULTS The protocol was approved by the Emory University Institutional Review Board (IRB) on March 30, 2020 (Protocol number 371). To date, we have enrolled 159 participants. CONCLUSIONS Defining a conceptual framework for assessing the sufficiency of patient-collected samples for the detection of SARS-CoV-2 RNA and serologic responses to infection is critical for facilitating public health responses and providing PPE-sparing options to increase testing. Validation of alternative methods of specimen collection should include objective measures of the sufficiency of specimens for testing. A strong evidence base for diversifying testing modalities will improve tools to guide public health responses to the COVID-19 pandemic.

Immigrant Communities and COVID-19: Strengthening the Public Health Response

2021 ◽  
Vol 111 (S3) ◽  
pp. S224-S231
Author(s):  
Lan N. Đoàn ◽  
Stella K. Chong ◽  
Supriya Misra ◽  
Simona C. Kwon ◽  
Stella S. Yi
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Immigrant Communities ◽  
Care Providers ◽  
Public Health Response ◽  
The Public ◽  
Public Health Infrastructure ◽  
Health Infrastructure

The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (Am J Public Health. 2021;111(S3):S224–S231. https://doi.org/10.2105/AJPH.2021.306433 )

Pediatric Collections: Vaping: Effects and Solutions

2020 ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Electronic Cigarettes ◽  
The United States ◽  
Care Providers ◽  
Tobacco Products ◽  
Pediatric Health ◽  
Pediatric Health Care

Electronic cigarettes are the tobacco products most commonly used by youths in the United States. The use of e-cigarettes, also known as vaping or JUULing, is a public health epidemic. This collection offers reviews and research to assist pediatric health care providers in identifying and treating adolescent use and exposure to e-cigarettes. https://shop.aap.org/pediatric-collections-vaping-effects-and-solutions-paperback/

Critical Challenges and Impediments Affecting Rural Physicians During a Public Health Emergency

2012 ◽  
Vol 6 (4) ◽  
pp. 342-348 ◽  
Author(s):  
Gavin J. Putzer ◽  
Mirka Koro-Ljungberg ◽  
R. Paul Duncan
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Rural Areas ◽  
Associated Factors ◽  
The United States ◽  
Public Health Emergency ◽  
Care Providers ◽  
Rural Physicians

ABSTRACTObjective: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.Methods: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.Results: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.Conclusions: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.(Disaster Med Public Health Preparedness. 2012;6:342–348)

New Challenges for Public Health Care: Biological and Chemical Weapons Awareness, Surveillance, and Response

2003 ◽  
Vol 4 (4) ◽  
pp. 244-250 ◽  
Author(s):  
Joseph P. Dudley
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Clinical Symptoms ◽  
The United States ◽  
Public Health Care ◽  
Surveillance Systems ◽  
Care Providers ◽  
First Line ◽  
Nursing Professionals

Recent events in the United States have demonstrated a critical need for recognizing nurses and emergency health care providers as important elements of the nation’s first line of defense and response against terrorist attacks involving biological, chemical, or radiological weapons. The anthrax letter attacks of September/October 2001 demonstrate the importance of vigilance and attention to detail while interviewing and attending patients and when entering, reviewing, and cataloging patient records. Nursing professionals, emergency care responders, and physicians can perform a crucial role in our first-line defense against terrorism by detecting and reporting unusual or anomalous illness(es) consistent with possible exposure to biological or chemical agents. Nursing professionals should become more familiar with the etiology and clinical symptoms of biological agents of greatest current concern (smallpox, anthrax, tularemia, plague) and be alert for potentially anomalous or unfamiliar combinations of symptoms that could point to unwitting exposure to biological toxins, toxic chemicals, or cryptic radiological agents. Public health surveillance systems must be developed that encourage and facilitate the rapid reporting and follow-up investigation of suspect illnesses and potential disease outbreaks that will ensure early identification and response for covert attacks involving biological, chemical, or radiological weapons.

Alternative Medicine and Multiple Sclerosis: An Objective Review from an American Perspective

2000 ◽  
Vol 2 (3) ◽  
pp. 15-28 ◽  
Author(s):  
Allen C. Bowling ◽  
Ragaa Ibrahim ◽  
Thomas M. Stewart
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Alternative Medicine ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Care Providers ◽  
American Perspective ◽  
Conventional Medical Therapy

Abstract The use of complementary and alternative medicine (CAM), or unconventional medicine, may be challenging for health care providers in the United States. There are several definitions of CAM, and therapies that are considered alternative in one country may be conventional in other countries. Unconventional medical practices may be used instead of, or in addition to, conventional medical therapy. It may be difficult for people with multiple sclerosis (MS) to obtain reliable MS-relevant CAM information, and there may be conflicts between the values of patients and those of health care providers. These issues may create problems in the clinical decision-making process. The relevance to MS of some commonly used CAM therapies is discussed: herbal medicine, vitamins and minerals, marijuana, and a histamine and caffeine transdermal gel patch. Current information about the efficacy and safety of CAM therapies is extremely variable. Some therapies appear promising, others are unsafe or ineffective, and nearly all need to be studied further.

scholarly journals Perceptions of adult Arkansans regarding trusted sources of information about the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel S. Purvis ◽  
Don E. Willis ◽  
Ramey Moore ◽  
Cari Bogulski ◽  
Pearl A. McElfish
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Academic Medical Center ◽  
The United States ◽  
Vaccine Uptake ◽  
Local Health ◽  
Care Providers ◽  
Sources Of Information ◽  
Health Messaging

Abstract Background The United States leads the world in confirmed COVID-19 cases; Arkansas ranks fifth in average daily cases per 100,000. Historically, Americans relied on health communications from governmental sources and the news media. However, there has been a documented decline of trust in these sources. The present study seeks to understand trusted sources of information about COVID-19 to improve health messaging because research shows the level of trust is associated with adherence to recommendations. Methods Data were collected using an online survey from participants (N = 1221) who were 18 years of age or older and residing, employed, or accessing health care in Arkansas. A qualitative descriptive design was used to summarize participants’ experiences and perceptions related to trusted sources of COVID-19 information. Results Two primary themes related to participants’ perceptions of sources of information about COVID-19 are reported: 1) trusted sources of information and 2) distrust or lack of trust in sources of information. Several subthemes emerged within each primary theme. Results showed high trust in the academic medical center, federal and state public health agencies, and local health care providers. The study also documents diverging voices of distrust and uncertainty in making sense of contradictory information. Participants reported the main reason for their lack of trust was the rapidly changing information and the lack of consistency in information provided across sources. Conclusions This finding provides insight into the importance of coordination between national, state, and local communications to bolster trust. Personal recommendations and testimonies from trusted health care providers and professionals could inform public health messaging interventions to increase vaccine uptake.

Interdisciplinary Information for Infectious Disease Response: Exercising for Improved Medical/Public Health Communication and Collaboration

2020 ◽  
pp. 1-5
Author(s):  
Saskia Popescu ◽  
Nathan Myers
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Care ◽  
Information Sharing ◽  
Health Care Providers ◽  
Disease Outbreaks ◽  
The United States ◽  
Care Providers ◽  
Disease Response ◽  
Train The Trainer

Abstract Infectious disease threats like the novel coronavirus that emerged in late 2019 continue to demand an increase in preparedness and response capabilities. One capability that is both essential and consistently challenging is information sharing between responding organizations, particularly between public health agencies and health care providers. This policy analysis reviews the threat that infectious diseases continue to pose to the United States, and the role that the Hospital Preparedness Program can play in countering such threats. Current strategies for preparing for, and responding to, infectious disease outbreaks are also reviewed, noting some gaps that need to be addressed. Particular attention is given to challenges in information sharing that continue to hinder effective surveillance and response, despite advances in technology. The study looks at recommendations from biodefense organizations and experts in the field. It concludes with our recommendation that regulatory requirements and funding opportunities for health care institutions emphasize the importance of communication and training in relation to high consequence pathogens. We further recommend that providers in Ebola treatment hospitals be employed to train and educate providers in frontline hospitals in a ‘train-the-trainer’ model.

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

scholarly journals What methods and challenges for taking account of context when transferring complex interventions?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Villadsen ◽  
S Dias
Keyword(s):  
Public Health ◽  
Health Care ◽  
Reproductive Health ◽  
Health Care Providers ◽  
Complex Interventions ◽  
Health Interventions ◽  
Care Providers ◽  
Public Health Interventions ◽  
Reproductive Health Care

Abstract For complex public health interventions to be effective their implementation needs to adapt to the situation of those implementing and those receiving the intervention. While context matter for intervention implementation and effect, we still insist on learning from cross-country comparison of implementation. Next methodological challenges include how to increase learning from implementation of complex public health interventions from various context. The interventions presented in this workshop all aims to improve quality of reproductive health care for immigrants, however with different focus: contraceptive care in Sweden, group based antenatal care in France, and management of pregnancy complications in Denmark. What does these interventions have in common and are there cross cutting themes that help us to identify the larger challenges of reproductive health care for immigrant women in Europe? Issues shared across the interventions relate to improved interactional dynamics between women and the health care system, and theory around a woman-centered approach and cultural competence of health care providers and systems might enlighten shared learnings across the different interventions and context. Could the mechanisms of change be understood using theoretical underpinnings that allow us to better generalize the finding across context? What adaption would for example be needed, if the Swedish contraceptive intervention should work in a different European setting? Should we distinguish between adaption of function and form, where the latter might be less important for intervention fidelity? These issues will shortly be introduced during this presentation using insights from the three intervention presentations and thereafter we will open up for discussion with the audience.

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