Increased mask adherence after important politician infected with COVID-19

Objectives To quantify changes in adherence to mask and distancing guidelines in outdoor settings in Philadelphia, PA before and after President Trump announced he was infected with COVID-19. Methods We used Systematic Observation of Masking Adherence and Distancing (SOMAD) to assess mask adherence in parks, playgrounds, and commercial streets in the 10 City Council districts in Philadelphia PA. We compared adherence rates between August and September 2020 and after October 2, 2020. Results Disparities in mask adherence existed by age group, gender, and race/ethnicity, with females wearing masks correctly more often than males, seniors having higher mask use than other age groups, and Asians having higher adherence than other race/ethnicities. Correct mask use did not increase after the City released additional mask guidance in September but did after Oct 2. Incorrect mask use also decreased, but the percentage not having masks at all was unchanged. Conclusions Vulnerability of leadership appears to influence population behavior. Public health departments likely need more resources to effectively and persuasively communicate critical safety messages related to COVID-19 transmission.

The awareness of Cervical Cancer Screening among Appalachian Women: Review Article

There is a long tradition of negative experiences with cancer among Appalachian women that manifests as avoidance behaviors in seeking screening and follow up because of fear of a cancer diagnosis. The avoidance is usually seen as ‘passive refusal,’ but also occurs in an active form as refusal to obtain services even when offered. This problem is compounded by poverty, which influences many parts of life and is associated with lack of transportation, child care, and exclusive reliance on public health departments and other safety net health care providers to seek cancer screening. Pap tests have reduced the annual incidence cervical cancers. The study aims to overview cervical cancer methods and recommendations among women in reproductive age.

Promoting Health Equity Through Partnerships

Funded by The John A. Hartford Foundation, Trust for America’s Health’s (TFAH) Healthy Aging initiative has supported states as they develop Age-Friendly Public Health Systems (AFPHS). The goal of this national initiative is to make healthy aging a core function of state and local public health departments. Through this initiative, TFAH is working directly with states as they work to improve the health of older adults, with a particular focus on health equity. Given the increased prevalence of health disparities, prioritizing health equity has become important for many organizations. Through new partnerships and collaboration with aging services providers and health care systems, public health departments have developed innovative ways to improve the health and well-being of older adults from racial/ethnically diverse backgrounds. Areas of collaboration between the public health and aging sectors include sharing data on older adult health and working together to address social isolation.

A Semantic Web Framework for Automated Smart Assistants: A Case Study for Public Health

The COVID-19 pandemic elucidated that knowledge systems will be instrumental in cases where accurate information needs to be communicated to a substantial group of people with different backgrounds and technological resources. However, several challenges and obstacles hold back the wide adoption of virtual assistants by public health departments and organizations. This paper presents the Instant Expert, an open-source semantic web framework to build and integrate voice-enabled smart assistants (i.e., chatbots) for any web platform regardless of the underlying domain and technology. The component allows non-technical domain experts to effortlessly incorporate an operational assistant with voice recognition capability into their websites. Instant Expert is capable of automatically parsing, processing, and modeling Frequently Asked Questions pages as an information resource as well as communicating with an external knowledge engine for ontology-powered inference and dynamic data use. The presented framework uses advanced web technologies to ensure reusability and reliability, and an inference engine for natural-language understanding powered by deep learning and heuristic algorithms. A use case for creating an informatory assistant for COVID-19 based on the Centers for Disease Control and Prevention (CDC) data is presented to demonstrate the framework’s usage and benefits.

The impact of the COVID-19 response on the provision of other public health services in the U.S.: A cross sectional study

Introduction Funding and staff formerly dedicated to routine public health tasks (e.g., responding to communicable and non-communicable diseases, investigating foodborne outbreaks, conducting routine surveillance) and services (e.g., environmental health, substance abuse, maternal-child health) may no longer be available in many public health departments due to the COVID-19 response. The objective of this study was to assess the extent to which staffing for essential public health services has been redirected to the COVID-19 response. Materials and methods This is a cross-sectional study using a survey distributed through the Qualtrics platform. Individuals (N = 298) working in public health across governmental and academic public health departments in the U.S. during the ongoing COVID-19 pandemic response were surveyed. Survey items measured multiple domains including professional experience (i.e., training, years of experience, content expertise, job functions, hours worked), mental and physical health status (i.e., generalized anxiety, depression, burnout), and career plans (i.e., pre-pandemic vs. current career plans). Results The total number of content expertise areas and programmatic functions covered by individual public health workers increased between January and September of 2020, with 26% (73 of 282) of respondents reporting an increase in both. The total number of respondents working in infectious disease and preparedness remained constant, while declines were reported in program evaluation (-36%) and health education (-27%) and increases were reported in disease investigation (+35%). Conclusions The provision of many essential public health functions and tasks have been limited or eliminated while the U.S. public health workforce responds to the COVID-19 pandemic. These findings highlight opportunities for funding and professional development of public health systems, both during and after the COVID-19 response, to help ensure the continuity of essential public health services, staffing sustainability, and preparedness for future public health emergencies in the U.S.

A health literacy analysis of the consumer-oriented COVID-19 information produced by ten state health departments

Objective: The COVID-19 pandemic highlights the public’s need for quality health information that is understandable. This study aimed to identify (1) the extent to which COVID-19 messaging by state public health departments is understandable, actionable, and clear; (2) whether materials produced by public health departments are easily readable; (3) relationships between material type and understandability, actionability, clarity, and reading grade level; and (4) potential strategies to improve public health messaging around COVID-19. Methods: Based on US Centers for Disease Control and Prevention statistics from June 30, 2020, we identified the ten states with the most COVID-19 cases and selected forty-two materials (i.e., webpages, infographics, and videos) related to COVID-19 prevention according to predefined eligibility criteria. We applied three validated health literacy tools (i.e., Patient Education Materials Assessment Tool, CDC Clear Communication Index, and Flesch-Kincaid Grade Level) to assess material understandability, actionability, clarity, and readability. We also analyzed correlations between scores on the three health literacy tools and material types.Results: Overall, COVID-19 materials had high understandability and actionability but could be improved in terms of clarity and readability. Material type was significantly correlated with understandability, actionability, and clarity. Infographics and videos received higher scores on all tools.Conclusions: Based on our findings, we recommend public health entities apply a combination of these tools when developing health information materials to improve their understandability, actionability, and clarity. We also recommend using infographics and videos when possible, taking a human-centered approach to information design, and providing multiple modes and platforms for information delivery.

Establishing Standards for the Assessment and Decontamination Cleanup of Opioid-Contaminated Properties

A case is described where a property was used as a clandestine opioid (fentanyl and carfentanil) processing, handling, pill pressing, and packaging site. These activities resulted in potentially lethal opioid residue contamination which remained after police intervention. This case details the environmental assessment and sampling procedures, findings, and decontamination processes that were used to mitigate the property. A safe re-occupancy criterion was established and used as the basis for adoption of a state standard for residential cleanup in California. Regulatory hurdles and key lessons are presented so that others may consider development of similar public health policy. Involvement of public health departments in the assessment and cleanup of sites contaminated with opioids and other illicit drugs and the development of standards for cleanup and worker protection is an important and yet often overlooked public health measure.

Assessing Robustness of Antimicrobial Stewardship in Colorado Hospitals and Barriers to Improvement

Background: Adherence to core elements of antimicrobial stewardship programs (ASPs) is increasing nationally but the robustness of programs and inclusion of pediatrics is poorly understood. We describe the details of ASP in Colorado hospitals and identify steps by which academic centers and public health departments can assist community ASPs. Methods: We invited ASP leaders at the 102 acute-care hospitals (ACHs) and critical-access hospitals (CAHs) in Colorado to participate in a web-based survey regarding their ASPs. Questions related to adherence to Centers for Disease Control and Prevention (CDC) core elements, barriers to improvement, desired resources, and extension to pediatrics. Enrollment began in August 2020. Hospital types were compared using the Fisher exact test. Results: As of January 1, 2021, 31 hospitals (30% of targeted hospitals) completed the web-based survey including 19 ACH and 12 CAH. Hospitals were distributed across the state. Median number of beds was 52 (range, 11–680). Of the responding hospitals, 87% were adherent to all CDC core elements. However, if action was defined as prospective audit and feedback or prior authorization, tracking was defined as measuring antibiotic use in days of therapy (DOT) or defined daily dose (DDD) quarterly, and reporting was defined as providing unit- or provider-specific antibiotic use reports annually. Overall adherence fell to 35% including 81% for action, 58% for tracking, and 58% for reporting. CAHs were less likely to adhere to these strict criteria than ACHs (Figure 1). In the 27 hospitals (87% of hospitals) caring for pediatric patients, adherence to a strict action for at least 1 pediatric population was 59%. Reported barriers to improved ASP were available time and personnel, information technology support, perceived concerns about provider attitudes, and education gaps (Figure 2). CAHs were less likely to use the NHSN antibiotic use or resistance modules or have a data analyst than ACHs (Figure 3). Pediatric pharmacy expertise and guidelines were often not available in hospitals caring for pediatric patients. Desired ASP resources included assistance with data analysis, access to stewardship expertise and education, and treatment guidelines, including for pediatrics. Conclusions: Adherence to CDC core elements of an ASP was excellent but fell dramatically when stricter criteria were used and was worse in pediatric patients. Academic centers and public health departments can assist community hospitals by providing educational resources, assistance in analyzing data including using the NHSN ED: /AR modules, and ASP expertise and clinical care guidelines including those for pediatrics.Funding: NoDisclosures: None