Quantitative comparison of SARS-CoV-2 nucleic acid amplification test and antigen testing algorithms: a decision analysis simulation model

Background Antigen tests for SARS-CoV-2 offer advantages over nucleic acid amplification tests (NAATs, such as RT-PCR), including lower cost and rapid return of results, but show reduced sensitivity. Public health organizations recommend different strategies for utilizing NAATs and antigen tests. We sought to create a framework for the quantitative comparison of these recommended strategies based on their expected performance. Methods We utilized a decision analysis approach to simulate the expected outcomes of six testing algorithms analogous to strategies recommended by public health organizations. Each algorithm was simulated 50,000 times in a population of 100,000 persons seeking testing. Primary outcomes were number of missed cases, number of false-positive diagnoses, and total test volumes. Outcome medians and 95% uncertainty ranges (URs) were reported. Results Algorithms that use NAATs to confirm all negative antigen results minimized missed cases but required high NAAT capacity: 92,200 (95% UR: 91,200-93,200) tests (in addition to 100,000 antigen tests) at 10% prevalence. Selective use of NAATs to confirm antigen results when discordant with symptom status (e.g., symptomatic persons with negative antigen results) resulted in the most efficient use of NAATs, with 25 NAATs (95% UR: 13-57) needed to detect one additional case compared to exclusive use of antigen tests. Conclusions No single SARS-CoV-2 testing algorithm is likely to be optimal across settings with different levels of prevalence and for all programmatic priorities. This analysis provides a framework for selecting setting-specific strategies to achieve acceptable balances and trade-offs between programmatic priorities and resource constraints.

Key Challenges and Opportunities for Implementing School Located Vaccination Clinics for COVID-19 and Influenza: Roundtables With School Nurses and Immunization Programs

School-located vaccination clinics (SLVs) are an established strategy to offer influenza and routine vaccinations and improve student and community health. The COVID-19 pandemic has led many communities to expand SLVs to include COVID-19 vaccines. However, these SLVs are less documented than in the past due to the fast-paced nature of the pandemic and the additional pressures put on schools and public health organizations. We conducted five virtual roundtables with 30 school nurses and state immunization program managers from across the United States to gain insight into SLVs occurring during the COVID-19 pandemic. Roundtables explored participants’ experiences planning and implementing SLVs, including factors influencing success and available resources. Findings highlighted SLVs as an opportunity to increase access and equity for vaccines. Participants shared strategies for School-located vaccination (SLV) funding, partnership building, vaccine storage and management, consent, data sharing, messaging, and promotion. These shared experiences offer useful insights for those interested in future and sustained SLV implementation.

Communicating a Scientific Story

Public health organizations typically try to raise literacy or counter misinformation with fact sheets and other data-centric messages. Yet research shows that disseminating more information does not necessarily combat myths. Storytelling offers the oral health community another option for engaging audiences and complementing the facts. The early–20th century research into fluoride is one example of an interesting story. Data and stories can complement each other. Using the elements of storytelling to report or summarize research findings could make such findings more relevant to health policy makers, whose decisions are often driven by values and evidence. Although the scientific literature has not produced a definitive template for instilling stories in a study manuscript, I provide several techniques and caveats for oral health researchers to consider.

Understanding healthcare sector organizations from a dynamic capabilities perspective

PurposeDynamic capabilities (DCs) need renewing to respond to changes emerging in the environment, and organizations must build up their capacities to sustain good performance levels. This study aims to identifying and characterizing the DCs existing in public health sector organizations by surveying the DC-related areas in health organizations, contributing to broader and more systematized knowledge in this field.Design/methodology/approachThe authors sent a questionnaire to 245 professionals with leadership and management positions in healthcare organizations in this study. The authors used multivariate methods to validate the variables used to measure the DCs.FindingsIn addition to highlighting the impact of DCs on public health organizations' performance, the study’s results allowed the authors to identify hidden capacities in the organizations of this sector, which only emerge when resource management difficulties occur. These changes and difficulties may interact with users and/or professionals' needs and make organizational management a particular challenge aggravated by quick responses to ensure the organization's survival.Originality/valueThis study contributes to the literature's call for a deeper understanding of the role of DCs and contribute to a greater practical understanding of how these capabilities influence the performance of such organizations.

The Value and Interpretation of Race and Ethnicity Data in the Era of Global Migration: A Change Is in Order

Human migration and travel are leading to increasingly diverse populations throughout the world. Data collection practices need to adapt to these changes to expand our understanding of health disparities and to optimize the efforts to address health equity, particularly during public health emergencies such as the current COVID-19 pandemic. Race and ethnicity classifications in the United States have failed to evolve since the 1970s despite an increasingly diverse population. Current commonly collected categories are inadequate to accurately describe the economic, educational, and sociopolitical circumstances of different groups. Further, these categories lend little practical information to inform health policy. More predictive and actionable variables should be routinely collected to improve appropriateness and timeliness of health interventions. The immediate adoption of the collection of primary/preferred language and country of birth/origin by public health organizations, health systems, and clinical providers would be a concrete and valuable first step.

Factors Influencing Practice of Pesticide Use and Acute Health Symptoms among Farmers in Nakhon Sawan, Thailand

Information on knowledge (K), attitude (A), and practice (P) in terms of pesticide use is essential for an effective exposure control program. The objectives of this study were to survey the level of knowledge, attitude, and practice in terms of pesticide use, and the prevalence of acute health symptoms (AHSs) among farmers in Nakhon Sawan Province, Thailand. The study also tried to identify factors affecting the practice of pesticide use. Data from 680 farmers were collected using a face-to-face interview questionnaire. The relationship between safety practices and related factors was analyzed using ordinal logistic regression. This study found about 40% of the farmers had a good level of practice. Factors affecting practice were education, work experience, level of knowledge, or attitudes. Many participants experienced acute health symptoms in the past 24 h, and these symptoms were significantly associated with poor practice (p < 0.05). Public health organizations should provide farmers with more information, especially on chronic effects of pesticides.

Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health

Since the first reports of novel coronavirus in the 2020, public health organizations have advocated preventative policies to limit virus, including stay-at-home orders that closed businesses, daycares, schools, playgrounds, and limited child learning and typical activities. Fear of infection and possible employment loss has placed stress on parents; while parents who could work from home faced chal-lenges in both working and providing full-time attentive childcare. For pregnant individuals, fear of at-tending prenatal visits also increased maternal stress, anxiety, and depression. Not surprising, there has been concern over how these factors, as well as missed educational opportunities and reduced interaction, stimulation, and creative play with other children might impact child neurodevelopment. Lev-eraging a large on-going longitudinal study of child neurodevelopment, we examined general childhood cognitive scores in 2020 and 2021 vs. the preceding decade, 2011-2019. We find that children born during the pandemic have significantly reduced verbal, motor, and overall cognitive performance com-pared to children born pre-pandemic. Moreover, we find that males and children in lower socioeconom-ic families have been most affected. Results highlight that even in the absence of direct SARS-CoV-2 infection and COVID-19 illness, the environmental changes associated COVID-19 pandemic is signifi-cantly and negatively affecting infant and child development.

Social media use to improve communication on children and adolescent’s health: the role of the Italian Paediatric Society influencers

Background Fake news on children’s and adolescent health are spreading. Internet availability and decreasing costs of media devices are contributing to an easy access to technology by families. Public health organizations are working to contrast misinformation and promote scientific communication. In this context, a new form of communication is emerging social media influencers. Aim of this study is to evaluate the role of paediatric influencers (PI) in communicating information about children and adolescents’ health. Materials and methods A group of PI was enrolled from December 2019 to January 2020 by a scientific commission nominated by the Italian Paediatric Society (SIP). PI were asked to share Facebook messages from the official page of the SIP to their own network. Social media tools have been evaluated across 12 months, from July 28, 2019, to July 11, 2020. For the purposes of clarity, we schematically divided the study period as follows: the period of PIs activity (January 6, 2020, to July 11, 2020) and the period when PIs were not yet active (July 28, 2019, to January 4, 2020). Information on Facebook page (lifetime total likes, daily new likes, daily page engaged, daily total reach) and on published post (lifetime post total reach, lifetime post organic reach, lifetime engaged users) were evaluated. Results A significant increase in Facebook daily new likes, page engagement and total reach, as well as in lifetime post total and organic reach was evidenced. As for PI, they reported a positive experience in most cases. Discussion In the digital era, communication strategies are becoming more important, so that the scientific community has to be actively involved in social media communication. Our pilot study demonstrated that the recruitment of paediatric influencers has increased communication and interaction of the SIP Facebook page. Conclusion Our study shows the potential role of influencers: spreading health messages via PI seems to be a successful strategy to promote correct communication about children’s and adolescents’ health.

Analysis of Financing Practice of the State Healthcare System in the Kyrgyz Republic

Health care in the Kyrgyz Republic is financed from the following sources: the national budget, the funds of the Compulsory Health Insurance Fund and the local budget of the city of Bishkek, as well as co-payments of patients. Financial resources received from the state budget to finance the State Guarantee Program do not meet its real needs. The Kyrgyz Republic maintains a residual principle of health financing. Finding potential sources of resources for health and identifying ways to distribute and use them effectively requires better funding for public health organizations. In this regard, it is relevant to develop a mechanism to attract additional sources of funding and their effective use. The article assesses the sources of funding for public health organizations and examines potential sources of the public health system.