Your call is important to us: COVID-19 and trends in Public Health Unit call service utilization

ABSTRACT OBJECTIVE Analyze COVID-19 related call data at Metro North Public Health Unit, Brisbane Australia, over the 2020 calendar year to assist surge preparedness. METHODS Call data was retrieved by call category or reference to ‘COVID’ in summaries from the call management system at a large metropolitan public health service. Under a mixed-methods approach, qualitative data (caller, call purpose, and call outcome) was categorized with categories arising de novo. Resulting variables were numerically analyzed to identify trends by categories and time. RESULTS Of the 3,468 calls retrieved, 160 duplicates and 26 irrelevant calls were excluded. Of 3,282 included calls, General Practitioners, followed by the public, contributed the greatest call volumes. Healthcare-related callers and the public made 84.2% of calls. Calls most frequently related to patient testing (40.7%) and isolation/quarantine (23.2%). Education provision accounted for 29.4% of all outcomes. 11.8% of all call outcomes involved applying relevant case definitions. 49.1% of calls were identified as potentially preventable through effective ERC and targeted call-handling. CONCLUSIONS This study identified key drivers of public health unit phone service utilization related to the COVID-19 pandemic throughout 2020. The results highlighted where risk perception influenced call volume and provided important insights for future public health preparedness.

Tuberculin Skin Testing versus Interferon-Gamma Release Assay among Users of a Public Health Unit in Northeast Portugal

The screening of groups with a high risk for developing tuberculosis (TB) is a priority in order to control this disease. Since there is no gold standard for the diagnosis of latent TB infection (LTBI), both the tuberculin skin test (TST) and the interferon-gamma release assays (IGRA) have been used for this purpose. The aim of this study was to determine the proportion of LTBI by using the TST and the IGRA tests, and to assess the risk factors related with discordant results between tests across several risk groups advised for screening in Northeast Portugal. Data were collected from the database of patients with suspected LTBI and advised for the screening in a public health unit (January 2014 to December 2015). The proportion of LTBI was computed using both tests. Logistic regression models assessed risk factors for a positive test and for discordant results between tests. The adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. Out of 367 patients included in the analysis, 79.8% had a positive TST and 46.0% of them had a positive IGRA. In comparison with contacts of active TB cases, healthcare workers and inmates presented higher odds of TST positivity (OR 4.38, 95% CI 1.59–12.09 and OR 4.74, 95% CI 1.45–15.49, respectively), but immunocompromised people presented lower odds of TST positivity (OR 0.14; 95% CI 0.06–0.31). Instead, healthcare workers (OR 0.44, 95% CI 0.24–0.80) and immunocompromised people (OR 0.24, 95% CI 0.10–0.56) presented lower odds of a positive IGRA. There were 42.0% concordant positive results, 16.1% concordant negative results, and 41.9% discordant results, with healthcare workers presenting higher odds of discordant results (OR 3.34, 95% CI 1.84–6.05). The proportion of LTBI estimated by TST and IGRA among people advised for screening in our setting is high, highlighting the need of preventive strategies. Among healthcare workers, TST results should be read with caution as the higher proportion of discordant results with a positive TST suggests the impact of the booster reaction in this group.

Tuberculosis at Public Health Unit of Santa Maria da Feira and Arouca (Portugal)

Introduction In the last decade Portugal has seen a decrease of about 40% in the notification and incidence rate of tuberculosis, with incidence values below 20/100,000 inhabitants since 2015. In 2018, a notification rate estimated at a national level was 16,6/100,000 inhabitants and an incidence rate of 16.4/100,000 inhabitants. With this investigation we intend to I) determine the notification and incidence rate of tuberculosis at the Public Health Unit (PHU) of Santa Maria da Feira and Arouca (Portugal); II) analyze the clinical and sociodemographic characteristics. Methods The confirmed cases of tuberculosis between January 1, 2015 and December 31, 2019 were analyzed. Results 105 cases of tuberculosis were identified, most of them male (67%), aged between the 1 year and 94 years age (median: 52 years). About ⅓ of the patients were retired. Among the co-morbidities that constitute a risk for tuberculosis, we highlight COPD (7.6%), alcohol abuse (5.7%) and HIV (3.8%). The pulmonary location prevailed (81.9%). We emphasize that 52 cases had positive smear microscopy and 42 cases cavitation. From 2017 to 2019 we have a median of 61 days from the onset of symptoms to diagnosis. From 2015 to 2019, 4 cases with poly-resistance to isoniazid and streptomycin were identified. In 2019, the incidence rate tuberculosis was 12.5/100,000 inhabitants and the notification rate of 16.3/100,000 inhabitants. Conclusions The incidence and notification rate like the median between the onset of symptoms and the diagnosis, by the public health unit (PHU), are below the national average. Regarding these results, we recommend that the strategy adopted by the PHU should be maintained. Key messages In the last decade Portugal has seen a decrease of about 40% in the notification and incidence rate of tuberculosis, with incidence values below 20/100,000 inhabitants since 2015. In 2019, the incidence rate tuberculosis at PHU was 12.5/100,000 inhabitants and the notification rate of 16.3/100,000 inhabitants.

Assessing Community Empowerment for an Innovative Epidemiologic Approach

Community empowerment can be a process, but also the result of nursing care. To analyze it as a result there is an instrument that allows to quantify its level in nine domains. According to Melo (2020), health centers can be considered communities, becoming the potential target of community and public health nurses care, especially in the public health unit. One of the main functions of a public health unit is the epidemiological surveillance of the population’s health state. However, traditional epidemiological surveillance is focused on diseases and Melo (2020) proposes a new approach for epidemiology focused on people in what concerns nursing diagnosis. The aim of this research is to identify the level of empowerment of four Portuguese primary healthcare structures, named as ACeS, so as to improve the epidemiological surveillance of nursing diagnoses. As methodology, we developed four focus group with all nursing leaders from all primary care units of the four ACeS, using the Portuguese version of the empowerment assessment rating scale. The results present the level of community empowerment of each ACeS according to the nine domains of the scale. The needs of intervention to improve the ACeS empowerment were also identified in order to develop the epidemiological surveillance of nursing diagnoses.

Public health nursing: regulation and public health policies

ABSTRACT Objective: To analyze regulation and public policies related to nursing and the specialist nurse in community and public health nursing. Methods: Analysis of the legal and normative framework of community and public health nursing in Portugal, as well as current public health policies, regarding the competences and intervention of this nurse, articulated with the attributions of the Public Health Unit. Results: The intervention of this nurse deserves a broad reflection, in the sense of maximizing the activities of community and public health, essential for the implementation of public policies and obtaining health gains. Final considerations: This nurse has competences foreseen in the regulations and standards for public health interventions, in line with the attributions of the Public Health Unit, of the National Health Service, in which specialties are identified for their performance in the current structure.