SARS-CoV-2 Pandemic Preventive Methods Efficacy - A Simulation Case Study

The world has been facing the SARS-CoV-2, a.k.a. COVID-19, pandemic with different preventive methods including social distancing, face masking, screening tests (a.k.a. active surveillance), and vaccination. There are many publications and studies on the efficacy of each of these preventive methods for the last couple of years. Not all methods are readily available in each country and not all methods are accepted by all people in each society. In this study, we explore the interaction of the three preventive methods: face masking, vaccinations, and screening tests. We study a confined space to represent schools, businesses, or healthcare facilities and we model the spread of the COVID-19 virus for a 60-day period among a sample population while varying the percentage of people adopting one or more of the three preventive methods. To interpret the simulation results, we define a (Health Goal) target, for example achieving <5% infection rate, i.e., protecting 95% or more of the sample population. We then construct a (Decision Tree) that depicts all valid combinations that achieve this goal. Multiple scenarios are derived from the decision tree to guide decision makers in drawing effective policies to contain the virus spread. We demonstrate a ramping vaccination rate scenario, a removal of the face-masking mandate scenario, and a cost-minimizing goal scenario. The study highlights the efficacy of combining the three prevention methods to constrain the virus spread among the sample population. For example, results show that a combination of 0% vaccination rate, 6% daily screening test rate, and 80% face masking rate will achieve the target ≥95 protection rate, which can represent a scenario in which vaccination is not yet readily available. As the vaccination rate ramps up to 80% among the sample population, the screening test rate can be 0%, while the face masking rate can be as low as 5% to still achieve the health target. Many other scenarios are derived from this study to meet the defined health target, which represents the flexibility afforded to policy and decision makers when trying to adopt a combination of these preventive methods to contain virus spread. The study also reveals the higher efficiency of either the vaccination or screening test over face masking under the assumed virus transmissibility rates in the study.

Clinical Guideline Highlights for the Hospitalist: Focused Updates to Pediatric Asthma Management

GUIDELINE TITLE: 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC) Expert Panel Working Group1 RELEASE DATE: Online: December 3, 2020 PRIOR VERSIONS: 1991, 1997, 2002, 2007 DEVELOPER: NAEPPCC Expert Panel Working Group (referred to as “the Expert Panel”) of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health FUNDING SOURCE: NHLBI of the National Institutes of Health TARGET POPULATION: Adults and children with asthma and recurrent wheezing

Key issues in dairy herd health management

Dairy herd health management benefits dairy farmers, the environment, dairy cows and citizens. It is an important part of modern dairy farm veterinary care. Dairy herd health management is assessing, monitoring and improving the health of dairy cows at a population level. Good herd health management takes a holistic approach and is ongoing and cyclical. All members of the dairy farm team and their advisors are involved, decisions are informed by data generated by the herd. These data may come from numerous sources. The data are processed and analysed to monitor cow health, target investigations and evaluate progress. To make lasting change on farms, advisors must communicate appropriately with farm managers to understand behaviour and motivate change. This chapter reviews these aspects of dairy herd health management, giving practical suggestions on how to get started, how to incorporate herd health management into business models and how to maintain momentum.

Influencing factors and determinants of health literacy

Health literacy has demonstrable effects on health status and quality of life and is a prerequisite for health-promoting behavior. Thus, health literacy is naturally an Austrian health target. Actions to strengthen health literacy should specifically address its determinants and influencing factors. To provide the best available knowledge for this goal, we developed an impact model of how influencing factors (indirect influence) and determinants (direct influence) will lead to increased health literacy based on the best available evidence We conducted an umbrella review on systematic, narrative and scoping reviews that deal with concepts, models or definitions of health literacy. The systematic literature search in MEDLINE (Ovid/Epistemonikos) identified 256 relevant abstracts. Two authors checked the abstracts and included 32 in the full text assessment. Fourteen studies were ultimately included in the umbrella review. We extracted influencing factors, determinants, and outcomes and coded, summarized, and renamed them in an inductive approach to ensure uniform terminology. In total, we identified 10 specific influencing factors and 13 measurable determinants. A graphical impact model visualizes the causal relationships between influencing factors and determinants and how they affect the main dimensions of health literacy together: decision, appraisal, access & seek. The impact model illustrates that health literacy is prevalent when decisions are made and implemented and that strengthening health literacy is best achieved through approaches that influence the determinants at the individual and situational level. With the list of specific influencing factors and measurable determinants, the impact model presented differs from all health literacy models available to date. The impact model gives clear recommendations on which concrete influencing factors and determinants programs for strengthening health literacy should be used to aim for positive changes. Key messages Interventions to strengthen health literacy should aim to improve both situational and individual determinants. A key situational determinant is the availability of accessible, understandable and reliable health information.

Outcome monitoring of the Austrian health targets

Background The ten Austrian Health Targets, developed in a Health-in-All-Policies process and adopted in 2012 with a time horizon until 2032, are monitored by a series of indicators. The (interim) results are reported regularly. Methods Indicators were discussed intensively with experts and defined in advance. The outcome monitoring enables to observe developments over time, to analyse differences by gender, education and region, and comparisons with other EU-countries. For each indicator an overall qualitative assessment is done. This makes monitoring very comprehensive. The challenge is to communicate the monitoring results in an easily understandable way. Therefore, besides reports and presentations further in depth-discussions about communication formats with decision makers were required. Results The outcome monitoring shows that there is potential for development in all areas: Between 2006 and 2014 only 25 % of the outcome-indicators developed positively. As far as equal opportunities are concerned, the most improvements were seen in gender differences, significantly less for educational differences and hardly any positive developments in regional differences. In an EU comparison, Austria performs well concerning 15 out of 35 indicators (43 %). However, for some indicators - contrary to the EU trend - no improvements can be observed. Conclusions The results confirm the relevance of the ten health targets and identify whole-of-society areas for action. The monitoring provides steering impulses and information enabling decision-making for politics, administration, the health target plenary, and the intersectoral working groups. Key messages The monitoring contributes to strategic steering, helps optimising strategy and action plans and enhancing the overall process. Stakeholder involvement is important for development of a format to communicate the results in the best comprehensible way.

Invited Commentary: Rethinking Cervical Cancer Elimination in Terms of Lifetime Risk Rather Than Arbitrarily Defined Age-Standardized Incidence Rates

In their accompanying article, Vänskä et al. (Am J Epidemiol. 2020;000(00):000–000) provide us with cohort lifetime risks of cervical cancer attributable to different types of human papillomavirus in Sweden. We argue that a standardized lifetime risk such as those calculated by Vänskä et al. might be a more appropriate public health target for cervical cancer elimination than age-standardized incidence rates. Age standardization to an arbitrary standard age distribution implies an implicit value choice regarding the weight of different age groups for which we find little moral justification. Conversely, a standardized lifetime risk uses standard life expectancy as a weight, corresponding to the likelihood that cervical cancer would impact a woman and prevent her from pursuing opportunities within a standard life span. Based on the data from Vänskä et al., a standardized lifetime risk of 129–250 cervical cancers per 100,000 women born could be an aspirational alternative public health target for cervical cancer elimination as a public health problem, complementary to the World Health Organization’s arbitrary draft target of 4 cervical cancers per 100,000 age-standardized woman-years.

Building a global policy agenda to prioritize preterm birth: A qualitative analysis on factors shaping global health policymaking

Background: Preterm birth, defined as infants born before 37 weeks of gestation, is the largest contributor to child mortality. Despite new evidence highlighting the global burden of prematurity, policymakers have failed to adequately prioritize preterm birth despite the magnitude of its health impacts. Given current levels of political attention and investment, it is unlikely that the global community will be adequately mobilized to meet the 2012 Born Too Soon report goal of reducing the preterm birth rate by 50% by 2025. Methods: This study adapts the Shiffman and Smith framework for political priority to examine four components contributing to policy action in global health: actor power, ideas, political context, and issue characteristics. We conducted key informant interviews with 18 experts in prematurity and reproductive, maternal, newborn, and child health (RMNCH) and reviewed key literature on preterm birth. We aimed to identify the factors that shape the global political priority of preterm birth and to describe policy opportunities to increase its priority moving forward. Results: The global preterm birth community (academic researchers, multilateral organizations, government agencies, and civil society organizations) lacks evidence about the causes of and solutions to preterm birth; and country-level data quality is poor with gaps in the understanding required for implementing effective interventions. Limited funding compounds these challenges, creating divisions among experts on what policy actions to recommend. These factors contribute to the lack of priority and underrepresentation of preterm birth within the larger RMNCH agenda. Conclusion: Increasing the political priority of prematurity is essential to reduce preventable newborn and child mortality, a key target of the 2030 Sustainable Development Goal for health (target 3.2). This study identifies three policy recommendations for the preterm birth community: address data and evidence gaps, clarify and invest in viable solutions, and bring visibility to prematurity within the larger RMNCH agendas.

100 Recent trends in stroke reperfusion in new zealand

IntroductionStroke reperfusion therapy improves patient outcomes. Here we describe recent trends in the stroke reperfusion intervention rates, treatment delays, and complications across New Zealand.MethodAll 20 DHBs enter acute stroke reperfusion treatment information into a compulsory, centralized, Ministry of Health (MoH) approved and funded Stroke Register. The data from 1/1/2018 through 30/9/18 was cleaned and analysed to explore trends in intervention rates, time delays, and complication rates.ResultsIn the nine-month study period there were a total of 544 (320 males, mean (SD) age 70.6 (14.5) years) patients thrombolysed and 193 patients underwent thrombectomy. For the January-June period, for which MoH stroke denominator rates were available, there was a thrombolysis rate of 10.4%. The overall median time (interquartile range, IQR) for onset-to-door was 76 minutes (48–118), door-to-computed tomography (CT) scan was 23 (15–36) minutes and CT-to-needle was 33 (20–51) minutes. The overall median (IQR) time delay from hospital arrival to thrombolysis was 59 (40–85) minutes and onset-to-needle median (IQR) time was 145 (110–196). There were a total of 26 (4.8%) symptomatic intracerebral haemorrhages (sICH) for the nine-month period. This compares with a thrombolysis rate of 9.85% and door-to-needle time median of 64 minutes in 2017.ConclusionThrombolysis rates in New Zealand continue to rise and now surpass the more recent 10% Ministry of Health target. The continued reduction in door-to-needle time is also an indication of continued service improvement resulting in better patient outcome. However, there are still to be opportunities for improvement.

Influence of vitamin D on fracture reduction among older adults: a discussion of recent meta-analysis findings

Recent meta-analyses on vitamin D and fracture reduction have led physicians and patients to question current guidelines on vitamin D. In this review of four recent meta-analyses, we summarize these meta-analyses with regard to target group and relevance to current guidelines. Importantly, two of the recent meta-analyses target adults age 50 years and older without osteoporosis and vitamin D deficiency where trial data is still very limited and does not reflect the target group of older adults age 65 and older vulnerable to both osteoporosis and vitamin D deficiency. One other meta-analysis has a focus on vitamin D plus calcium with significant benefits for both total and hip fractures, and one excludes these trials and shows no benefit plus has been questioned for several limitations with regard to study design. In summary, for older adults at increased risk for fractures and/or vitamin D deficiency, it is still reasonable to take 800 to 1000 IU vitamin D per day, following current recommendations. Reducing the risk of fractures among vulnerable older adults age 65 and older, at risk of vitamin D deficiency and fractures, remains a major public health target.