First National Genomic Epidemiological Study of Neisseria gonorrhoeae Strains Spreading Across Sweden in 2016

The increasing transmission and antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global health concern with worrying trends of decreasing susceptibility to also the last-line extended-spectrum cephalosporin (ESC) ceftriaxone. A dramatic increase of reported gonorrhea cases has been observed in Sweden from 2016 and onward. The aim of the present study was to comprehensively investigate the genomic epidemiology of all cultured N. gonorrhoeae isolates in Sweden during 2016, in conjunction with phenotypic AMR and clinical and epidemiological data of patients. In total, 1279 isolates were examined. Etest and whole-genome sequencing (WGS) were performed, and epidemiological data obtained from the Public Health Agency of Sweden. Overall, 51.1%, 1.7%, and 1.3% resistance to ciprofloxacin, cefixime, and azithromycin, respectively, was found. No isolates were resistant to ceftriaxone, however, 9.3% of isolates showed a decreased susceptibility to ceftriaxone and 10.5% to cefixime. In total, 44 penA alleles were found of which six were mosaic (n = 92). Using the typing schemes of MLST, NG-MAST, and NG-STAR; 133, 422, and 280 sequence types, respectively, and 93 NG-STAR clonal complexes were found. The phylogenomic analysis revealed two main lineages (A and B) with lineage A divided into two main sublineages (A1 and A2). Resistance and decreased susceptibility to ESCs and azithromycin and associated AMR determinants, such as mosaic penA and mosaic mtrD, were predominantly found in sublineage A2. Resistance to cefixime and azithromycin was more prevalent among heterosexuals and MSM, respectively, and both were predominantly spread through domestic transmission. Continuous surveillance of the spread and evolution of N. gonorrhoeae, including phenotypic AMR testing and WGS, is essential for enhanced knowledge regarding the dynamic evolution of N. gonorrhoeae and gonorrhea epidemiology.

Impact of the COVID-19 Pandemic on Healthcare Activity in the Regional Hospitals of Andalusia (Spain)

(1) Background: The large global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overloaded the public health systems and reduced the regular healthcare activity, leading to a major health crisis. The main objective of this study was to carry out a comparative evaluation of the healthcare activities in the hospitals of Eastern Andalusia, Spain. (2) Methods: In this study, an observational, multicentered, and retrospective approach was adopted to compare the healthcare activities of the Poniente Hospital (PH) and the Alto Guadalquivir Health Agency (AGHA). Data was collected over a period of 24 months, i.e., from 1 January 2019 to 31 December 2020, and the variables evaluated were: patients seen in the hospital emergency service (HES), X-ray tests performed, patients cited in outpatient consultations, surgical interventions performed, and patients included in the waiting list. (3) Results: The analysis of the above-mentioned variables revealed a significant reduction in the number of patients registered in 2020 at HES as compared to that in 2019 for both PH (p = 0.002) and AGHA (p < 0.001). Moreover, the number of surgical interventions in 2020 was significantly reduced from that in 2019 for both PH (p = 0.001) and AGHA (p = 0.009). Moreover, for PH (p < 0.001), a significant reduction was observed in the waiting list admissions in 2020 compared to that in 2019; however, no significant difference in the waiting list admissions between the years 2020 and 2019 was observed for AGHA (p = 0.446). In 2020, the number of teleconsultations was significantly increased from that in 2019 for both PH (p < 0.001) and AGHA (p = 0.006). (4) Conclusion: The analysis carried out indicates that in 2020, compared to 2019, healthcare activity was significantly reduced in most of the parameters included in this study.

Issues and Challenges of, Factors that Affect, and the Primary Influences of Parents’ Decisions to Vaccinate their Adolescents: A Case of a Local National High School in Cagayan de Oro City, Philippines

Vaccines are considered to be the center of the prevention and management of viral diseases. Even with the wide acceptance that vaccines are safe, vaccine hesitancy is still rampant in various parts of the world. Several historical, social, religious, and moral factors were identified and observed to have influence parent’s vaccine acceptance or hesitance. Parent’s vaccine hesitance or acceptance is crucial since adolescents constitute the ideal group for immunization. This study aims to uncover the issues and challenges of parents on vaccination, the factors that affect their decision to vaccinate their children, and parents' primary influences to vaccinate their children. A descriptive-survey research design utilizing a questionnaire floated to parents of adolescents in a local high school. It was found out that the level of education and type of occupation was significantly associated with parent's decision to vaccinate their children. The major issue and challenge of parents toward vaccination is that they don't find vaccines important and have a high level of distrust towards the government's health agency and medical professionals. The primary factor affecting their decision-making is the negative news on vaccination and vaccine safety. Respondents also reported that even they distrust the government's health agency, they still consider it influential towards their vaccine decision-making. With this, it is recommended that efforts be strengthened in restoring the public's trust towards the government health agency to address vaccine hesitancy.

Journaling among home care workers during the COVID-19 pandemic: A promising method for qualitative data collection

Qualitative methods that capture individual lived experiences throughout rapidly changing circumstances are particularly important during public health emergencies. The COVID-19 pandemic has put home care workers at risk as they provide vital services in homes to individuals with chronic conditions or disabilities. Using a 6-week journaling process in which we enrolled participants at different points, we sought to examine experiences of home care workers ( n = 47) in the United States in New York and Michigan during April–July 2020 of the COVID-19 pandemic. Our methods for data collection and analysis were guided by a general qualitative approach as we aimed to examine the weekly perspectives and lived experiences of home care workers. We asked individuals to respond to our journaling prompts weekly to capture their reflections in “real time.” To better understand home care workers’ perspectives on journaling and the broader external context in which they provided care, we triangulated our data with interviews with home care workers ( n = 19) and home health agency representatives ( n = 9). We explored the feasibility of a rolling journaling process during an unprecedented public health emergency, characterized by rapid changes and uncertainty in day-to-day life, and reflect on lessons learned to guide future research on journaling for data collection, particularly for marginalized workers during public health crises, when events are evolving rapidly.

Lessons from Covid-19: A Plan for Action (Pages 59-67) in Journal of the Harvard Club of India

The need for a National Public Health Agency in India is of crucial relevance today. Along with a responsive public health system, we need to focus on preventive healthcare and the promotion of healthy lifestyles. The country, as it marks its 75th year of Independence, must remember that it is essential to bring in structural change for effective public health governance.

Genomic and Virological Characterization of SARS-CoV-2 Variants in a Subset of Unvaccinated and Vaccinated U.S. Military Personnel

The emergence of SARS-CoV-2 variants complicates efforts to control the COVID-19 pandemic. Increasing genomic surveillance of SARS-CoV-2 is imperative for early detection of emerging variants, to trace the movement of variants, and to monitor effectiveness of countermeasures. Additionally, determining the amount of viable virus present in clinical samples is helpful to better understand the impact these variants have on viral shedding. In this study, we analyzed nasal swab samples collected between March 2020 and early November 2021 from a cohort of United States (U.S.) military personnel and healthcare system beneficiaries stationed worldwide as a part of the Defense Health Agency (DHA) Global Emerging Infections Surveillance (GEIS) program. SARS-CoV-2 quantitative real time reverse-transcription PCR (qRT-PCR) positive samples were characterized by next-generation sequencing and a subset was analyzed for isolation and quantification of viable virus. Not surprisingly, we found that the Delta variant is the predominant strain circulating among U.S. military personnel beginning in July 2021 and primarily represents cases of vaccine breakthrough infections (VBIs). Among VBIs, we found a 50-fold increase in viable virus in nasal swab samples from Delta variant cases when compared to cases involving other variants. Notably, we found a 40-fold increase in viable virus in nasal swab samples from VBIs involving Delta as compared to unvaccinated personnel infected with other variants prior to the availability of approved vaccines. This study provides important insight about the genomic and virological characterization of SARS-CoV-2 isolates from a unique study population with a global presence.

Methodology for the Development of the Australian National Nursing and Midwifery Digital Health Capability Framework

Internationally healthcare organisations and governments are grappling with the issue of upskilling healthcare workforces in relation to digital health. Significant research has been undertaken in relation to documenting essential digital health capability requirements for the workforce. In 2019 the Australian Digital Health Agency funded work by the Australasian Institute of Digital Health to develop a National Nursing and Midwifery Digital Health Capability Framework. This paper describes the methodological approach used in the development of the Framework.

A Multidisciplinary Approach to Screen Deployment-Limiting Health Conditions

ABSTRACT Introduction Disease non-battle injuries (DNBIs) are responsible for the majority of hospital admissions for soldiers in combat since the Vietnam War The U.S. Army prepares soldiers to deploy through a multistage process known as the Soldier Readiness Program (SRP). The current processes are reactive and address deployment-limiting health conditions (DLHCs) and the need for intervention and/or medical waivers late in the SRP process. This may compromise the quality and efficiency of pre-deployment medical clearance and result in DNBI medical evacuation from theater, which is costly and reduces the effectiveness of the unit. Implementation of a proactive and standardized screening process focused on behavioral health-related medical evacuations and psychotropic medication use will facilitate timely and effective interventions to improve readiness. Methodology The primary objective of this proof-of-concept (POC) study was to develop a standardized and sustainable process, known as the deployment-limiting medication (DLM) surveillance process, to screen soldiers for DLHCs that prevent mobilization. The A-3 performance improvement model was utilized to identify the root causes of limitations with the current medical SRP and to develop solutions. This process utilized the DLHC tool, a report created by the Defense Health Agency, as a basis to identify soldiers that require continued chart review based on prescription fill history. The results of the report were further assessed using published deployment eligibility standards and focused on psychotropic medications. Secondary measures [included] validation of the DLHC tool by assessing the accuracy of the DLHC report. This was determined by the proportion of soldiers screened who actually required intervention and/or waivers per deployment policy. This study took place within an Infantry Brigade Combat Team (IBCT). Results From August 2019 to March 2020, 959 soldiers in the IBCT were screened under the DLM surveillance process for DLHCs related to mental health and psychotropic medication use. The percentage of completed screenings of psychotropic-related DLHCs in the IBCT reached 100% after 3 months of implementing this POC study. After thorough chart review, a total of 421 soldiers met criteria for a medical intervention and/or waiver with 8% of these soldiers identified with a preexisting medical profile. The DLHC tool’s ability to use medication history to accurately predict the need for an intervention and/or medical waiver was 59% (654/1,112 medications). Soldiers identified using the DLM surveillance process that did not meet criteria predominately involved antidepressant, anticonvulsant, and central nervous system DLHC categories. If the psychotropic-related DLHC categories are optimized in future reports, the report’s accuracy may be increased to 90% while decreasing the time to complete the monthly review. Conclusion The DLM surveillance measures were successfully incorporated into the SRP process to proactively screen for DLHCs. Early identification of DLHCs allowed for proper identification of medical intervention and/or waiver needs and may decrease deployment complications. This process may help to improve a soldier’s deployability and improve overall readiness of the IBCT.

Rheumatoid Arthritis in Silica-Exposed Workers

Few studies have examined rheumatoid arthritis (RA) risk and severity in Korean workers exposed to silica. We compared the hospitalization risk of RA between silica-exposed workers and the general Korean population. The study cohort consisted of male workers exposed to silica who had undergone at least one silica-associated special medical examination between 1 January 2000 and 31 December 2004 (N = 149,948). The data were from the Korea Occupation Safety and Health Agency. RA morbidity based on hospital admission records was estimated from 2000 to 2005 using the Korea National Health Insurance Service claims data. The standardized admission ratio (SAR) was calculated by dividing the observed number of admissions in silica-exposed workers by the expected number of admissions in the general reference population. For the sum of “Seropositive rheumatoid arthritis” (M05) and “Other rheumatoid arthritis” (M06), the SAR was higher in the silica-exposed group (1.34, 95% CI 1.08–1.64). For M05, workers with <10 years of silica exposure had a significantly higher SAR (2.54, 95% CI 1.10–5.01) than the general population. More silica-exposed workers without a diagnosis of pneumoconiosis were hospitalized for RA than the general population. Our analysis reaffirms the link between silica exposure and RA and suggests that the severity of RA is increased by silica. Further studies of silica-exposed workers with longer follow-up are needed.