COVID-19 vaccine hesitancy among Ethiopian healthcare workers

Introduction COVID-19 poses significant health and economic threat prompting international firms to rapidly develop vaccines and secure quick regulatory approval. Although COVID-19 vaccination priority is given for high-risk individuals including healthcare workers (HCWs), the success of the immunization efforts hinges on peoples’ willingness to embrace these vaccines. Objective This study aimed to assess HCWs intention to be vaccinated against COVID-19 and the reasons underlying vaccine hesitancy. Methods A cross-sectional survey was conducted among HCWs in Addis Ababa, Ethiopia from March to July 2021. Data were collected from eligible participants from 18 health facilities using a pre-tested semi-structured questionnaire. Data were summarized using descriptive statistics and multivariable logistic regression was performed to explore factors associated with COVID-19 vaccine hesitancy. A p<0.05 was considered statistically significant. Results A total of 614 HCWs participated in the study, with a mean age of 30.57±6.87 years. Nearly two-thirds (60.3%) of HCWs were hesitant to use the COVID-19 vaccine. Participants under the age of 30 years were approximately five times more likely to be hesitant to be vaccinated compared to those over the age of 40 years. HCWs other than medical doctors and/or nurses (AOR = 2.1; 95%CI; 1.1, 3.8) were more likely to be hesitant for COVID-19 vaccine. Lack of believe in COVID-19 vaccine benefits (AOR = 2.5; 95%CI; 1.3, 4.6), lack of trust in the government (AOR = 1.9; 95%CI; 1.3, 3.1), lack of trust science to produce safe and effective vaccines (AOR = 2.6; 95%CI; 1.6, 4.2); and concern about vaccine safety (AOR = 3.2; 95%CI; 1.9, 5.4) were also found to be predictors of COVID-19 vaccine hesitancy. Conclusion COVID-19 vaccine hesitancy showed to be high among HCWs. All concerned bodies including the ministry, regional health authorities, health institutions, and HCWs themselves should work together to increase COVID-19 vaccine uptake and overcome the pandemic.

Covid-19 and Surgery

The severe acute respiratory syndrome (SARS) caused by the super-infectious, super-spreading, super-mutating novel coronavirus-2 (Covid-19) is responsible for the worldwide overwhelming panic and pandemic with a huge burden of suffering patients at a time. It has been causing alarming morbidity and unexpected mortality, shortening life span of many people that hadn’t happened since the second world war. It was first identified in Wuhan, China in the last months of 2019. The clinical scenario presents in the form of asymptomatic, mild, moderate and severe illnesses. More than 80% patients are either asymptomatic who transmit it to others and have a mild influenza-like illness clinically not different from common cold. The moderate and severe cases commonly need supervised home or institutional treatment. Many of the latter need intensive therapy that includes non-invasive and invasive ventilation along with other measures and medications. The treatment is principally conservative, HDU- and ICU-dependent. Surgery has no role as its primary treatment. But protection of surgical team and non-infected patients remains as a challenge to surgeons and hospital authorities. Many of the mutant variants now show resistance to antibodies generated by spike protein based and m-RNA based vaccines. The threat of infection still persists making surgeons overwhelmingly concerned while performing emergency, elective and cancer surgeries. This article describes some guidelines to be followed by the operating surgeons, hospital and regional health authorities to minimize the risks of spreading the disease and to protect the surgical team and other non-infected people from being infected. KYAMC Journal. 2021;12(3): 172-181

Persuasion Tactics in the Implementation of Large-Scale EHR Suites in Public Healthcare

Large-scale electronic health record (EHR) suites have the potential to cover a broad range of use needs across various healthcare domains. However, a challenge that must be solved is the distributed governance structure of public healthcare: Regional health authorities regulate hospitals, municipalities are responsible for first-line healthcare services, and general practitioners (GPs) have an independent entrepreneurial role. In such settings, EHR program owners cannot enforce municipalities and GPs to come on board. Thus, we examine what tactics owners of large-scale EHR suite programs apply to persuade municipalities to participate, how strongly these tactics are enforced, and the consequences. Empirically, we focus on the Health Platform program in Central Norway where the goal is to implement the U.S. Epic EHR suite in 2022. Theoretically, the paper is positioned in the socio-technical literature.

Halting the pandemic outside ‘CORTINA2021’ alpine world ski championships: a challenge for sport and public health in times of COVID-19

Background In February 2021 the “Cortina2021” Alpine World Ski Championships took place in the mountain town of Cortina d'Ampezzo (Italy), thus gaining the definition of “first sporting event of global significance in the time of covid-19 pandemic”. Though the event took place behind closed doors and in a context of national public health restrictive measures, it counted almost 6,000 participants. Methods A rigorous “Covid-19 Prevention and Hygiene Protocol” was drawn up by the local and regional health authorities together with the organizing committee, in order to contain the risk of viral circulation within the venue. Results Overall about 20,000 rapid antigen nasal swabs were performed to screen-detect sars-cov2 cases: only 22 of these were found positive, whereas 25 people were quarantined as close contacts. Conclusions The experience of “Cortina2021” proves that mass gatherings can take place even in times of epidemic threats, if adequately planned and by providing public health recommendations tailored on the viral circulation foreseen by the time the event is due. If new epidemics should arise in the future, hopefully the public health management of “Cortina2021” may be a template for next mass gatherings to be held, as far as possible, despite the viral circulation.

Assessing the Removal of Regional Health Authorities in Ontario

A little more than a decade ago, a series of regional bodies were introduced throughout Ontario to help resolve difficulties with the province’s health care system. The Local Health Integration Networks, the name given to the new health entities, sought to create a connected set of health services and to achieve more effective control and distribution of health care finances. A third intent was to engage the community when setting priorities for health care. Recently, the new government of Ontario replaced the LHINs with a single health authority. It asserted that the single authority was better equipped to handle the many problems that still prevailed. An assessment of this decision offers some grounds for disbanding the LHINs. However, the findings offer stronger support for the alternative of keeping the regional authorities and providing them with greater autonomy.

Evolution-revolution-devolution

From 1993 to 2009 the University of Manitoba (UM), the Regional Health Authorities of Manitoba (RHAM), and the Manitoba Health Department signed affiliation agreements that changed the access to knowledge-based information for health professionals. These agreements transferred the management and delivery of library service from the home organizations to the UM Libraries. This three-part paper describes the events that led to the evolution of change in health information access in Winnipeg, subsequent revolutionary changes in the nature of the services, and their eventual devolution due to a significant array of unexpected challenges.

Trends in survival from myeloma, 1990–2015: a competing risks analysis

Background Myeloma survival has greatly increased over past decades. We investigated trends in survival over time in New Zealand by age, ethnicity, and geography and thus examined potential inequalities among these population subgroups. Methods From data supplied by the New Zealand Ministry of Health, all new diagnoses of multiple myeloma (ICD-10 code C90) between 1990 and 2016 were extracted, as well as their matched mortality data. Cox’s proportional hazards regression and competing risks regression were used to estimate multivariable survival functions. Results Between 1 January 1990 and 1 December 2015, 6642 myeloma cases were registered by the New Zealand Cancer Registry. Although survival from myeloma increased substantially from 1990–1994 to 2010–2015, 5-year survival was still only about 60% in 2010–2015. The greatest improvement in survival was for people aged 60–69 years at diagnosis. Using Cox’s proportional hazards regression, Māori showed an increased risk of myeloma death but this was predominantly due to differences in competing risks among ethnic groups. Competing risks analysis found the greatest improvement in myeloma survival in Pacific Islanders, and in 2010–2015 Māori had better survival than other ethnicities. Myeloma survival improved significantly over time in all regional health authorities but in all time periods the Central and Southern regions had significantly poorer survival than the Midland region. Conclusions Improvements in myeloma survival have been unequal across subgroups and regions in New Zealand. Detailed information about utilization of chemotherapeutic agents and transplantation in New Zealand is not available. This information, as well as more detailed hematological data, is essential to further explore the relationships and reasons for differing myeloma survival in population subgroups of New Zealand.

Fundamental privacy rights in a pandemic state

Faced with the emergence of the Covid-19 pandemic, and to better understand and contain the disease’s spread, health organisations increased the collaboration with other organisations sharing health data with data scientists and researchers. Data analysis assists such organisations in providing information that could help in decision-making processes. For this purpose, both national and regional health authorities provided health data for further processing and analysis. Shared data must comply with existing data protection and privacy regulations. Therefore, a robust de-identification procedure must be used, and a re-identification risk analysis should also be performed. De-identified data embodies state-of-the-art approaches in Data Protection by Design and Default because it requires the protection of direct and indirect identifiers (not just direct). This article highlights the importance of assessing re-identification risk before data disclosure by analysing a data set of individuals infected by Covid-19 that was made available for research purposes. We stress that it is highly important to make this data available for research purposes and that this process should be based on the state of the art methods in Data Protection by Design and by Default. Our main goal is to consider different re-identification risk analysis scenarios since the information on the intruder side is unknown. Our conclusions show that there is a risk of identity disclosure for all of the studied scenarios. For one, in particular, we proceed to an example of a re-identification attack. The outcome of such an attack reveals that it is possible to identify individuals with no much effort.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

Prevalence and factors associated with depression, anxiety and stress among healthcare workers of Trinidad and Tobago during COVID-19 pandemic: a cross-sectional study

ObjectivesTo determine the prevalence and factors associated with depression, anxiety and stress among healthcare workers (HCWs) during COVID-19 pandemic.DesignCross-sectional online survey.SettingHCWs from four major hospitals within the Regional Health Authorities of Trinidad and Tobago.Participants395 HCWs aged ≥18 years.Main outcome measuresDepression, anxiety and stress scores.ResultsAmong the 395 HCWs, 42.28%, 56.2% and 17.97% were found to have depression, anxiety and stress, respectively. In the final stepwise regression model, contact with patients with confirmed COVID-19, p<0.001 (95% CI 3.072 to 6.781) was reported as significant predictors of depression. Further, gender, p<0.001 (95% CI 2.152 to 5.427) and marital status, p<0.001 (95% CI 1.322 to 4.270) of the HCWs were considered to be correlated with anxiety. HCWs who had contact with patients with suspected COVID-19 had lower depression, p<0.001 (95% CI −5.233 to −1.692) and stress, p<0.001 (95% CI −5.364 to −1.591).ConclusionsThis study has depicted the prevalence and evidence of depression, anxiety and stress among HCWs during the COVID-19 pandemic. The findings of the study will serve as supportive evidence for the timely implementation of further planning of preventative mental health services by the Ministry of Health, for frontline workers within the public and private health sectors.