The COVID-19 pandemic and environmental health: Lessons learned

Environmental health is historically an overlooked and underrated discipline. The COVID-19 pandemic highlighted the value of environmental health and environmental health professionals (EHPs). EHPs have a unique set of skills and knowledge that were, or could have been, signifi cant in controlling the pandemic. This skill set includes a thorough understanding of legislation and regulations; the ability to conduct human health risk assessment and implement effective risk-control measures; enforcement, communication, and education skills; and a signifi cant understanding of their own local communities. The opportunities for applying the skills of EHPs vary across the world depending on several factors, including legislative and regulatory frameworks in each jurisdiction. Here we present our early evaluation of the unique skills and knowledge base of EHPs and lessons that can be learned from EHP engagement in public health protection. We also argue that local knowledge and engagement need to be recognized as valuable tools in emergency preparedness. In our increasingly globalized world, mechanisms to maintain and value local knowledge are needed, which could be achieved by embedding the “value of local” into policy to ensure that the importance and value of local knowledge are captured. We also advocate for raising awareness of the value of public health, and specifi cally, environmental health.info:eu-repo/semantics/publishedVersio

The Remote Learning Experience at Portland State University in Spring 2020

It is an endeavor to understand what we have and will learn about the impact of remote instruction on faculty, students and relevant academic support teams. Simply put: We want to learn from an experiment foisted upon us by a health crisis. We have engaged in an incredibly innovative response. And now, we ask what have we learned? How might we improve? And, most importantly, are there implications from this experiment for the future of instruction at PSU and throughout higher education? The project was organized around two stages in the Spring 2020 term. Stage One: Out of the Gate: Reflections and Lessons Learned (First half of the term) Stage Two: Reaching the Finish Line: Lessons Learned and Recommendations for moving forward (Second half of the term). The project began the week of April 20 and continued through June 12. The original plan called for the following participants: (a) ten undergraduate students to put together a group of 8-10 other students to discuss the questions posed in the study; (b) Three graduate students who would assemble 5-7 fellow graduate students; (c) Three tenured or tenure-track faculty, two non-tenure-track faculty and three adjunct faculty, each of whom would form a chat group of 5-7 other faculty to discuss the questions posed in the study. In addition, Judith Ramaley put together a chat group of a dozen student support unit leaders to explore how each unit adjusted as the university moved quickly to remote learning and remote work and then, in a second round, what lessons each had learned throughout the spring term about ways to support students and assist faculty members who were also seeking to help their students

Equity, diversity, and inclusion at the Global Alliance for Genomics and Health

A lack of diversity in genomics for health continues to hinder equitable leadership and access to precision medicine approaches for underrepresented populations. To avoid perpetuating biases within the genomics workforce and genomic data collection practices, equity, diversity, and inclusion (EDI) must be addressed. This paper documents the journey taken by the Global Alliance for Genomics and Health (a genomics-based standard-setting and policy-framing organization) to create a more equitable, diverse, and inclusive environment for its standards and members. Initial steps include the creation of two groups: the Equity, Diversity, and Inclusion Advisory Group and the Regulatory and Ethics Diversity Group. Following a framework that we call "Reflected in our Teams, Reflected in our Standards," both groups address EDI at different stages in their policy development process. [Abstract copyright: © 2023 The Author(s).

Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45 000 donors

Background: Limits on the frequency of whole blood donation exist primarily to safeguard donor health. However, there is substantial variation across blood services in the maximum frequency of donations allowed. We compared standard practice in the UK with shorter inter-donation intervals used in other countries. Methods: In this parallel group, pragmatic, randomised trial, we recruited whole blood donors aged 18 years or older from 25 centres across England, UK. By use of a computer-based algorithm, men were randomly assigned (1:1:1) to 12-week (standard) versus 10-week versus 8-week inter-donation intervals, and women were randomly assigned (1:1:1) to 16-week (standard) versus 14-week versus 12-week intervals. Participants were not masked to their allocated intervention group. The primary outcome was the number of donations over 2 years. Secondary outcomes related to safety were quality of life, symptoms potentially related to donation, physical activity, cognitive function, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin. This trial is registered with ISRCTN, number ISRCTN24760606, and is ongoing but no longer recruiting participants. Findings: 45 263 whole blood donors (22 466 men, 22 797 women) were recruited between June 11, 2012, and June 15, 2014. Data were analysed for 45 042 (99·5%) participants. Men were randomly assigned to the 12-week (n=7452) versus 10-week (n=7449) versus 8-week (n=7456) groups; and women to the 16-week (n=7550) versus 14-week (n=7567) versus 12-week (n=7568) groups. In men, compared with the 12-week group, the mean amount of blood collected per donor over 2 years increased by 1·69 units (95% CI 1·59–1·80; approximately 795 mL) in the 8-week group and by 0·79 units (0·69–0·88; approximately 370 mL) in the 10-week group (p<0·0001 for both). In women, compared with the 16-week group, it increased by 0·84 units (95% CI 0·76–0·91; approximately 395 mL) in the 12-week group and by 0·46 units (0·39–0·53; approximately 215 mL) in the 14-week group (p<0·0001 for both). No significant differences were observed in quality of life, physical activity, or cognitive function across randomised groups. However, more frequent donation resulted in more donation-related symptoms (eg, tiredness, breathlessness, feeling faint, dizziness, and restless legs, especially among men [for all listed symptoms]), lower mean haemoglobin and ferritin concentrations, and more deferrals for low haemoglobin (p<0·0001 for each) than those observed in the standard frequency groups. Interpretation: Over 2 years, more frequent donation than is standard practice in the UK collected substantially more blood without having a major effect on donors' quality of life, physical activity, or cognitive function, but resulted in more donation-related symptoms, deferrals, and iron deficiency. Funding: NHS Blood and Transplant, National Institute for Health Research, UK Medical Research Council, and British Heart Foundation

Longer-term efficiency and safety of increasing the frequency of whole blood donation (INTERVAL): extension study of a randomised trial of 20 757 blood donors

Background: The INTERVAL trial showed that, over a 2-year period, inter-donation intervals for whole blood donation can be safely reduced to meet blood shortages. We extended the INTERVAL trial for a further 2 years to evaluate the longer-term risks and benefits of varying inter-donation intervals, and to compare routine versus more intensive reminders to help donors keep appointments. Methods: The INTERVAL trial was a parallel group, pragmatic, randomised trial that recruited blood donors aged 18 years or older from 25 static donor centres of NHS Blood and Transplant across England, UK. Here we report on the prespecified analyses after 4 years of follow-up. Participants were whole blood donors who agreed to continue trial participation on their originally allocated inter-donation intervals (men: 12, 10, and 8 weeks; women: 16, 14, and 12 weeks). They were further block-randomised (1:1) to routine versus more intensive reminders using computer-generated random sequences. The prespecified primary outcome was units of blood collected per year analysed in the intention-to-treat population. Secondary outcomes related to safety were quality of life, self-reported symptoms potentially related to donation, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin and other factors. This trial is registered with ISRCTN, number ISRCTN24760606, and has completed. Findings: Between Oct 19, 2014, and May 3, 2016, 20 757 of the 38 035 invited blood donors (10 843 [58%] men, 9914 [51%] women) participated in the extension study. 10 378 (50%) were randomly assigned to routine reminders and 10 379 (50%) were randomly assigned to more intensive reminders. Median follow-up was 1·1 years (IQR 0·7–1·3). Compared with routine reminders, more intensive reminders increased blood collection by a mean of 0·11 units per year (95% CI 0·04–0·17; p=0·0003) in men and 0·06 units per year (0·01–0·11; p=0·0094) in women. During the extension study, each week shorter inter-donation interval increased blood collection by a mean of 0·23 units per year (0·21–0·25) in men and 0·14 units per year (0·12–0·15) in women (both p<0·0001). More frequent donation resulted in more deferrals for low haemoglobin (odds ratio per week shorter inter-donation interval 1·19 [95% CI 1·15–1·22] in men and 1·10 [1·06–1·14] in women), and lower mean haemoglobin (difference per week shorter inter-donation interval −0·84 g/L [95% CI −0·99 to −0·70] in men and −0·45 g/L [–0·59 to −0·31] in women) and ferritin concentrations (percentage difference per week shorter inter-donation interval −6·5% [95% CI −7·6 to −5·5] in men and −5·3% [–6·5 to −4·2] in women; all p<0·0001). No differences were observed in quality of life, serious adverse events, or self-reported symptoms (p>0.0001 for tests of linear trend by inter-donation intervals) other than a higher reported frequency of doctor-diagnosed low iron concentrations and prescription of iron supplements in men (p<0·0001). Interpretation: During a period of up to 4 years, shorter inter-donation intervals and more intensive reminders resulted in more blood being collected without a detectable effect on donors' mental and physical wellbeing. However, donors had decreased haemoglobin concentrations and more self-reported symptoms compared with the initial 2 years of the trial. Our findings suggest that blood collection services could safely use shorter donation intervals and more intensive reminders to meet shortages, for donors who maintain adequate haemoglobin concentrations and iron stores. Funding: NHS Blood and Transplant, UK National Institute for Health Research, UK Medical Research Council, and British Heart Foundation

Challenges and opportunities for conducting a vaccine trial during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom. We encountered and overcame a number of challenges including differences in organisational structures, research facilities available, staff experience and skills, information technology and communications infrastructure, and research training and assessment procedures. We overcame these by setting up a project team that included key members from all three organisations that met at least daily by teleconference. This group together worked to identify the best practices and procedures and to harmonise and cascade these to the wider trial team. This enabled us to set up the trial within 25 days and to recruit and vaccinate the participants within a further 23 days. The lessons learned from our experiences could be used to inform the conduct of clinical trials during a future infectious disease pandemic or public health emergency

Pregnant and Precarious: Canadian Immigration through the Lens of Reproductive Justice

In a context where migration has become a contentious global and national issue, and maternal health and reproductive rights continue to be leading priorities for the Canadian state, there is a disconnect between the ideals of Canadian exceptionalism and the discourses and policies surrounding reproductive rights for non-citizens. While legal rights protections for non-citizens have generally been expansive in many liberal democratic states, the politics governing reproductive rights, however, present a unique tension. In countries like Canada with jus soli citizenship, supporting a non-citizen who is giving birth is not simply about providing services, it’s also about formal membership. Given this, the reproductive rights of migrants are positioned against national sovereignty. A fuller account of reproductive citizenship as it intersects with immigration status is needed. In particular, there is a need for analysis that resists this positioning and takes seriously the realization of sexual and reproductive autonomy as a global human right. Using reproductive justice as an analytic lens, this dissertation contributes to our empirical and theoretical knowledge of how reproductive citizenship is experienced by pregnant people with precarious immigration status. Drawing on 24 narrative interviews with temporary status and non-status women living in Montreal, Canada, 13 key informant interviews with service providers, and a review of relevant policies, this dissertation situates the lived experiences of pregnant precarious status migrants within Canadian immigration and reproductive politics. This analysis reveals how neoliberal notions of choice and the racialized and gendered practices of nation-building intersect in the lives of migrant pregnant people and argues that immigration status is barrier to reproductive justice. In particular, narrative interviews showed how immigration and reproduction strategies are often co-produced; however, who can access these strategies and how they are received when they do is shaped by nationality and highly racialized. Precarious immigration programs are not amenable to the needs of pregnant people, such that migration management on the part of the state is experienced as reproductive management in the lives of precarious status migrants. Specifically, they face challenges maintaining their status and accessing basic public services and protections as they navigate pregnancy, childbirth, and motherhood