APCDs can Provide Important Insights for Surveilling the Opioid Epidemic, With Caveats

State-level all-payer claims databases (APCDs) are a possible new public health surveillance tool, but their reliability is unclear. We compared Colorado’s APCD with other state-level databases for use in monitoring the opioid epidemic (Colorado Hospital Association and Colorado’s Prescription Drug Monitoring Program database for 2010–2017), using descriptive analyses comparing quarterly counts/rates of opioid-involved inpatient and emergency department visits and counts/rates of 30-day opioid fills between databases. Utilization is lower in the Colorado APCD than the other databases for all outcomes but trends are parallel and consistent between databases. State APCDs hold promise for researchers, but they may be better suited to individual-level analyses or comparisons of providers than for surveillance of public health trends related to addiction.

A Decisive Review to Understand the Basic Fundamentals of Novel Corona Viruse Disease

With the development and spread of 2019 novel coronavirus (2019-nCoV), also known as the severe acute respiratory syndrome coronavirus 2, a new public health disaster is threatening the world (SARS-CoV-2). In December 2019, the virus was discovered in bats and transmitted to humans via unidentified intermediary species in Wuhan, Hubei Province, China. To date (05/03/2020), there have been roughly 96,000 recorded cases of coronavirus disease 2019 (COVID-2019) and 3300 documented deaths. The disease is spread through inhalation or contact with contaminated droplets, with a 2 to 14-day incubation period. Fever, cough, sore throat, dyspnea, weariness, and malaise are common symptoms. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it can lead to pneumonia, ARDS (acute respiratory distress syndrome), and multi-organ failure. A large number of persons are asymptomatic. The case fatality rate is expected to be between 2 and 3%. Specimen collection, assay collection, serology, nucleic acid testing or molecular testing, and target selection for RT-PCR are all examples of laboratory diagnosis. Home isolation of suspected cases and those with mild illnesses, as well as tight infection control measures in hospitals, including contact and droplet precautions, are all part of the prevention strategy. The virus has a lower fatality rate than its two ancestors, SARS-CoV and Middle East respiratory sickness coronavirus (MERS-CoV). The global consequences of this new epidemic are still unknown.

CBOs’ Capacity and Resilience on Serving Older AA and NHPI Adults During the Pandemic

Community-based organizations (CBOs) are essential settings for older Asian American (AA) and Native Hawaiian Pacific Islander (NHPI) adults for accessing culturally and linguistically appropriate services and connecting with and support each other. This study examined the impact of the COVID-19 pandemic on CBOs’ ability to serve older AA & NHPI adults. This mixed methods study (survey and semi-structured interviews) used a sequential exploratory design. We recruited 65 leaders and staff members from 40 CBOs serving older AA & NHPI adults nationally. Descriptive analysis was conducted with the survey data followed by thematic analysis of the interview data. Many CBOs were impacted by the increased demands for services (80%) and created new services (75%) while experiencing programming disruption (69%), decreased staffing (55%), and loss of revenue (38%). Some CBOs temporarily closed their organizations (38%), while others closed permanently (3%). To remain in operation, many CBOs (65%) increased their online presence, hired staff (52%), and recurred to financial reserves (20%). The semi-structured interviews identified four themes: 1) CBOs resourcefulness to acquire and share resources, 2) technology as a connector for CBOs and an isolator for older adults, 3) heightened racial discrimination against Asians, and 4) emergence of multi-level resilience (personal/ community/organizational). CBOs experienced disruption in their operation, and heightened racial discrimination during the pandemic. Yet, CBO’s ability to remain resilient was critical to continue to provide key programs for older adults. Future studies may want to examine evolving needs of CBOs as they adjust to new public health challenges during the pandemic.

Emerging Human Coronaviruses: Molecular Biology and Vaccine Challenges

COVID-19 is a new public health crisis caused by the novel respiratory pathogen SARS-CoV-2. It is one of the most significant pandemic events in recent history. The SARS-CoV-2 Beta corona virus was transmitted to humans in the end of 2019 by unknown intermediary host from bats in Wuhan, Hubei province (China). It marked the third major coronavirus source of disaster in the 21stcentury.The three last severe respiratory tract infections caused by the SARS-CoV-1, MERS-CoV and SARS-CoV-2 caused high human mortality. Viral genomic sequencing and investigations and the development of advanced vaccine strategies are expected to give us more information on these emerging pathogens and controlling them in the future. The aim of this review is to summarize updated information regarding these emerging human coronaviruses to understand their molecular and structural biology, transmissions and potential vaccine approaches actually developed against the SARS-CoV-2.

COVID-19, chronic conditions and structural poverty: A social psychological assessment of the needs of a marginalized community in Accra, Ghana

In the African region COVID-19 infection and death rates are increasing (writing in May 2020), most deaths have occurred among individuals with chronic conditions, and poor communities face higher risks of infection and socio-economic insecurities. We assessed the psychosocial needs of a chronic illness support group in Accra, Ghana, within the context of their broader community. The community lives in structural poverty and has a complex burden of infectious and chronic non-communicable diseases (NCDs). Between March and May 2020, we conducted interviews, group discussions, and surveys, with members of the support group and their caregivers, frontline healthcare workers, and religious and community leaders. Data was analysed through the social psychology of participation framework. Community members understood COVID-19 as a new public health threat and drew on eclectic sources of information to make sense of this. Members of the support group had psychosocial and material needs: they were anxious about infection risk as well as money, food and access to NCD treatment. Some community members received government food packages during the lockdown period. This support ended after lockdown in April and while anti-poverty COVID policies have been unveiled they have yet to be implemented. We discuss the impact of these representational, relational and power dynamics on the community’s access to COVID-19 and NCD support. We argue that strategies to address immediate and post-COVID needs of vulnerable communities have to focus on the politics and practicalities of implementing existing rights-based policies that intersect health, poverty reduction and social protection.

Association Between Subjects with Newly Diagnosed Rheumatoid Arthritis and Dental Caries

Alterations in saliva, temporomandibular joint disorders, dysphagia, Sjogren's syndrome, dental caries, periodontal disease, and tooth loss have been identified in patients with Rheumatoid Arthritis. The aims of this research were 1) to study the association between newly diagnosed rheumatoid arthritis and dental caries and 2) to identify most frequent teeth with caries in study groups. A descriptive pilot study was performed. A total of 620 participants were evaluated, 29 met the selection criteria. The subjects were divided into 2 groups: 13 subjects with newly diagnosed rheumatoid arthritis and 16 subjects without rheumatoid arthritis. Salivary parameters, DMFT index, care index, FS-T index and Treatment Needs Index were evaluated in all participants. The Fisher’s Exact test and Mann-Whitney U test we used to establish the differences between groups. Low mean in all salivary parameters and a high caries frequency were observed in subjects with newly diagnosed rheumatoid arthritis compared to a control group (p<0.01). The right maxillary second premolar (n=6, 46%, p=0.0100); right mandibular second premolar (n=7,54%, p=0.0462) and left mandibular second molar (n=10,77%, p=0.0001) were the most frequent teeth with caries. Early diagnosis and early treatment of rheumatoid arthritis can improve the prognosis in most of patients. The development of new public health policies and care based on the prevention are necessary to improve the quality of patient's lives.

Exempting the state and responsibilizing individuals during pandemic governance: Analyzing the health minister’s responses to the Covid-19 pandemic in Turkey

The COVID-19 pandemic pushed the governments of the world to implement different regulative and protective measures. Although these measures required serious re-considerations of public health strategies, they were still grounded on pre-existing contexts of countries’ health systems, namely the “new public health” paradigm. Turkey’s neoliberal health reforms since 2003 coincide with the principles of this paradigm’s trends toward marketizing services and responsibilizing individuals; yet the Turkish context of the pandemic also stands out due to its mixed and unique form of governance. Utilizing the tweets of the Turkish Health Minister between March 13th and October 1st, 2020, we conducted a thematic qualitative analysis investigating the Turkish state’s response to the COVID-19 pandemic. Our analysis revealed that state responsibility was framed around building new pandemic hospitals, informing the public, and building trust. Conversely, his tweets assigned Turkish individuals an active role in shaping pandemic outcomes through their “informed” and “empowered” agency. Finally, he coined “togetherness,” referring to the sum of individual actions, as an indispensable goal in assuring public compliance with precautions. The Minister’s tweets reflect the unique nature of pandemic governance in Turkey with a relatively imposing and swift response of centralized power but a primary focus on “responsibilized” individuals’ collective actions.

A SARS-CoV-2-járvány hatása a kórházon kívüli és belüli szívmegállásra

Összefoglaló. A koronavírus-betegség (COVID–19) okozta közvetlen mortalitáson túl, a járvány közvetett úton is hatással lehet a hirtelen szívhalálra. Egyre növekvő számú közlemény foglalkozik a járványnak a hirtelen szívhalálra kifejtett közvetett hatásával. A kijárási korlátozások és az egészségügyi rendszerek átszervezése hozzájárulhatott ahhoz, hogy a járvány alatt mind a kórházon kívüli, mind a kórházon belüli szívhalál előfordulása megemelkedett. Közegészségügyi intézkedések, mint a korlátozások és a kórházak átszervezése, megváltoztathatják az egészségügyi szolgáltatásokhoz való hozzáférést, ezért hozzájárulhattak az elmúlt évben tapasztalt emelkedett számú szívmegálláshoz. Közleményünk célja a SARS-CoV-2-járvány hirtelen szívhalálra kifejtett hatására vonatkozó, a nemzetközi irodalomban jelenleg megtalálható tanulmányok összefoglalása, melyek a kórházon kívüli szívmegállás előfordulásának háromszoros emelkedéséről számoltak be a járványt megelőző évhez képest. Általánosságban elmondható, hogy a kórházon kívüli szívmegállás a járvány ideje alatt nagyobb gyakorisággal járt nem sokkolandó ritmussal, hosszabb idő telt el a mentők kiérkezéséig, alacsonyabb volt a szemtanú által megkezdett újraélesztés, a spontán keringés visszatérésének, valamint a kórházi elbocsátásnak a gyakorisága. A járványnak a kórházon belüli szívmegállásra kifejtett hatása kevésbé vizsgált az irodalomban. Míg a hirtelen szívhalált követő mortalitás néhány kutatásban jelentős emelkedést mutatott, addig máshol nem volt különbség a járványt megelőző időszakhoz képest. A COVID–19-pandémia ideje alatt jelentősen megnövekedett kórházon kívüli és belüli szívmegállás hátterében a járványnak közvetett úton is szerepe lehet, a fertőzés közvetlen hatása mellett. A túlélési lánc megbomlását számos helyen tapasztalták, ami hozzájárulhatott a kedvezőtlen kimenetelhez. Mind a prehospitális, mind pedig a hospitális ellátás gyakorlatában bekövetkező jelentős változások magyarázhatják a világ különböző pontjain megfigyelt eltéréseket. Orv Hetil. 2021; 162(46): 1831–1841. Summary. The direct effect of COVID-19 on mortality through acute respiratory failure is well-established. However, there are a growing number of publications suggesting that the prevalence and outcome of sudden cardiac death may also be indirectly affected by the pandemic. Public health measures, such as lockdowns and reorganisation of hospitals, can alter the access to healthcare services and therefore might have contributed to the excess number of cardiac arrests which were seen over the last year. Our aim was to review the currently available publications regarding the impact of the COVID-19 pandemic on out-of-hospital and in-hospital cardiac arrests. A recent study reported a 3-fold growth in the incidence of out-of-hospital cardiac arrests during the 2020 COVID-19 period compared to the year before. In general, the number of non-shockable rhythms increased, bystander-witnessed cases and bystander-initiated cardiopulmonary resuscitation were reduced and ambulance response times were significantly delayed during the pandemic. Return of spontaneous circulation and survival to discharge substantially decreased compared to the time before the pandemic. The difference between the rate of mortality following in-hospital cardiac arrest during and before the pandemic is controversial according to published data. The incidence of out-of-hospital and in-hospital cardiac arrests significantly increased during the pandemic compared to previous years suggesting direct effects of COVID-19 infection and indirect effects from new public health measures. The disruption of the chain of survival could have contributed to the increased mortality following out-of-hospital cardiac arrest. Orv Hetil. 2021; 162(46): 1831–1841.

Co-Design and Evaluation of the Feasibility and the Efficacy of a Multiple-Targeted Adapted Physical Activity Intervention to Promote Quality of Life, Well-Being and Physical Activity Levels in Pregnant Women: The “WELL-DONE!” Study Protocol

Background: Regular physical activity (PA) practice during pregnancy offers health and fitness benefits for both mother and baby. Therefore, healthy pregnant women with no contraindications to exercise should be encouraged to perform PA. Nevertheless, their levels of PA are generally low. The aim of the WELL-DONE! Study is to co-design an adapted physical activity intervention (APAI) for pregnant women to include in childbirth preparation classes (CPCs) evaluating its feasibility and efficacy on quality of life (QoL), PA levels and other outcomes. Methods: A quasi-experimental study was divided in two progressive stages. First, APAI was developed in collaboration with pregnant women and midwives using focus groups; second, APAI’s efficacy was evaluated comparing two groups: the experimental group engaged in the CPCs integrated with 1 h/week of the APAI administered by midwives and the control group participating in the standard CPCs. Pre-post evaluation was carried out in three stages through questionnaires and tests. Data analysis involved the combination of qualitative and quantitative methodologies. Discussion: Findings from the WELL-DONE! Study will help to assess the feasibility, sustainability, and efficacy of incorporating APAI inside CPCs as a new public health strategy oriented to QoL, well-being, and PA level improvements.

From health education to digital health literacy – building on the past to shape the future

Health education has continuously evolved and taken several distinctive forms over the decades. The emergence of new concepts such as health promotion and health literacy have helped to shape and refine our understanding of how the purpose, content and methods of health education can adapt with to new public health methods and priorities. Viewing health education through the lens of health literacy has been particularly helpful in differentiating between traditional task-focused health education, and skills-focused health education designed to develop more generic, transferable skills. The advent of digital media has enabled unprecedented access to health information but brought with it new challenges. Managing the volume of available information, and assessing its quality and reliability have become essential digital health literacy skills in the information age. As health educators we need to continue to adapt our practices to these new opportunities and understand the challenges that come with them.