Still using MS Excel? Implementation of the WHO Go.Data software for the COVID‐19 contact tracing

In the fight against the current epidemic of COVID‐19, contact tracing has been used with success in China, as part of a series of containment efforts.1 Historically, data collection has been done through paper forms and, over time, this data collection has been digitalized, usually using the tools at hand, which are typically spreadsheets and custom‐made databases, and in some cases, specialized software.2 Throughout the world, many agents, from regional public health agencies to hospitals of all levels, have to choose a platform to record cases, determine exposures, register contacts, and manage their follow‐up assessments, that is, document all the events in the chains of transmission. Although in small outbreaks the management of this information is not overwhelming, and spreadsheets or small ad‐hoc databases can be used, in an outbreak of the scale of COVID‐19, with a high number of cases and around 36 contacts for each one,3 these traditional solutions may not be scalable to the required levels. Needless to say, the speed and effectiveness of contact tracking are critical elements for this tool to help contain the COVID‐19 epidemic

Monitoring the COVID-19 epidemic in the context of widespread local transmission.

Coronavirus disease 2019 (COVID-19) is a novel viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first detected in Wuhan, China, in December, 2019.1 Given the fast spread, the severity of disease, the increasing number of cases outside China, and the number of affected countries, WHO declared the rapid spread of SARS-CoV-2 a pandemic on March 11, 2020.2 The availability of reliable surveillance platforms is crucial to monitor the COVID-19 epidemic in a timely manner and to respond with adequate control measures. Since the beginning of the outbreak, different countries have used different testing approaches and criteria, depending on their resources and capacity

Perceptions of Covid-19 maternal vaccination among pregnant women and healthcare workers and factors that influence vaccine acceptance: a cross-sectional study in Barcelona, Spain

COVID-19 is associated with poor maternal and pregnancy outcomes. COVID-19 vaccination is recommended in Spain, yet vaccination rates in pregnancy are suboptimal. This study investigates the perceptions of pregnant women and healthcare workers (HCW) regarding COVID-19 vaccination. A web-based cross-sectional quantitative study was conducted in 2021-2022 among 302 pregnant women and 309 HCWs in the Catalan public health system. Most pregnant women (83%) and HCWs (86%) were aware of COVID-19 maternal vaccines. The recommendation of the COVID-19 vaccination by an HCW was identified as the greatest facilitator for maternal vaccine uptake, while the fear of harming the foetus was the most significant barrier reported for rejecting vaccination. HCWs recognised they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations. This study highlights that information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake

The social network around influenza vaccination in health care workers: a cross-sectional study

Background: Influenza vaccination coverage remains low among health care workers (HCWs) in many health facilities. This study describes the social network defined by HCWs’ conversations around an influenza vaccination campaign in order to describe the role played by vaccination behavior and other HCW characteristics in the configuration of the links among subjects. Methods: This study used cross-sectional data from 235 HCWs interviewed after the 2010/2011 influenza vaccination campaign at the Hospital Clinic of Barcelona (HCB), Spain. The study asked: “Who did you talk to or share some activity with respect to the seasonal vaccination campaign?” Variables studied included sociodemographic characteristics and reported conversations among HCWs during the influenza campaign. Exponential random graph models (ERGM) were used to assess the role of shared characteristics (homophily) and individual characteristics in the social network around the influenza vaccination campaign. Results: Links were more likely between HCWs who shared the same professional category (OR 3.13, 95% CI = 2.61–3.75), sex (OR 1.34, 95% CI = 1.09–1.62), age (OR 0.7, 95% CI = 0.63–0.78 per decade of difference), and department (OR 11.35, 95% CI = 8.17–15.64), but not between HCWs who shared the same vaccination behavior (OR 1.02, 95% CI = 0.86–1.22). Older (OR 1.26, 95% CI = 1.14–1.39 per extra decade of HCW) and vaccinated (OR 1.32, 95% CI = 1.09–1.62) HCWs were more likely to be named. Conclusions: This study finds that there is no homophily by vaccination status in whom HCWs speak to or interact with about a workplace vaccination promotion campaign. This result highlights the relevance of social network analysis in the planning of health promotion intervention

'Maternal vaccination greatly depends on your trust in the healtcare system': a qualitative study on the acceptability of maternal vaccines among pregnant women and healthcare workers in Barcelona, Spain

The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women's lives that required risk-benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs

SARS-CoV2 hospital surveillance and control system with contact tracing for patients and health care workers at a large reference hospital in Spain during the first wave: An observational descriptive study

Background and Aims During the first peak of the COVID-19 pandemic, the Preventive Medicine Department and the Occupational Health Department at Hospital Clinic de Barcelona (HCB), a large Spanish referral hospital, developed an innovative comprehensive SARS-CoV2 Surveillance and Control System (CoSy-19) in order to preserve patients' and health care workers' (HCWs) safety. We aim to describe the CoSy-19 and to assess the impact in the number of contacts that new cases generated along this time. Methods Observational descriptive study of the findings of the activity of contact tracing of all cases received at the HCB during the first peak of COVID-19 in Spain (February 25th-May 3rd, 2020). Results A team of 204 professionals and volunteers performed 384 in-hospital contact-tracing studies which generated contacts, detecting 298 transmission chains which suggested preventive measures, generated around 22¿000 follow-ups and more than 30¿000¿days of work leave. The number of contacts that new cases generated decreased during the study period. Conclusion Coordination between Preventive Medicine and Occupational Health departments and agile information systems were necessary to preserve non-COVID activity and workers safety.Peer ReviewedPostprint (published version

Promoció de la vacunació antigripal en els professionals sanitaris

[cat] Es fa necessari parlar de promoció de la vacunació antigripal entre professionals sanitaris perquè l'adhesió a la recomanació és baixa. L'estratègia de vacunació de la grip vol protegir sobretot les persones més vulnerables a patir complicacions i els professionals sanitaris estan inclosos en aquesta perspectiva. En aquesta tesi presentem dues campanyes de promoció amb la seva avaluació a l'Hospital Clínic de Barcelona i dos treballs de recerca vinculats a les campanyes: l'anàlisi de la validesa de les cobertures declarades respecte les cobertures registrades i l'anàlisi de la xarxa social al voltant de la campanya de promoció. Les campanyes de promoció que presentem es donen en un context on la vacunació és voluntària i gratuïta. En una primera campanya (2008-09) es va voler visualitzar un compromís més gran de la institució i dels càrrecs amb la campanya i la vacunació, millorar en l'accessibilitat pel que fa a la planificació i disponibilitat als professionals i enviar missatges clars sobre la vacunació alhora que atractius de cara a fomentar la conversa entre els professionals sobre la vacunació. Va usar, per això últim, fotos de treballadors vacunats a la intranet, dos sorteigs i l'ús del correu electrònic corporatiu de forma més intensiva. La campanya es va consensuar amb els treballadors a través dels seus representants. La campanya 2008-09 va aconseguir augments significatius en la cobertura respecte l'anterior. Va resultar també una campanya més ràpida pel que fa a la velocitat de vacunació. La campanya de 2010-11 va voler avaluar els objectius estratègics plantejats per aquella temporada, això és, l'augment de la informació sobre la grip i la vacunació, la major percepció de risc sobre la malaltia i la implicació dels professionals com a promotors entre els seus col·legues. L'avaluació, amb una enquesta abans i després de la campanya en una mostra aleatoritzada de treballadors de l'hospital, va mostrar un impacte a l'alça en les tres objectius estratègics i una bona acceptació de la campanya sense impacte en la cobertura, cosa que mostra que l'increment de la informació i de la percepció de risc no augmenta necessàriament l'acceptació de la vacunació. Quan es parla de cobertures es parla de xifres obtingudes manera molt diversa. Es va considerar adient avaluar si les cobertures declarades són un bon succedani («proxy» en anglès) de les cobertures que consten al registre i si el comportament vacunal influeix en la declaració. Els professionals van ser preguntats per el seu comportament vacunal les tres campanyes anteriors i es va creuar amb el registre del centre. La declaració va resultar ser un bon succedani per dues temporades però es va veure un major nombre de casos discordants en no vacunats que en vacunats. Per últim, atès que s'havia recollit en diversos estudis transversals que l'opinió dels col·legues sobre la vacunació és important de cara a l'acceptació de la pròpia vacunació, es va voler fer una anàlisi de la xarxa generada a partir de les converses entre professionals sobre una campanya de vacunació. Es van enquestar dues unitats completes de l'hospital i es va detectar que les converses es donaven en la mateixa categoria laboral, sexe, edat i servei però no entre treballadors que compartien el comportament vacunal. Els professionals de més edat i vacunats eren més citats. Sembla, per tant, que una campanya de promoció és un tema de conversa entre els treballadors sanitaris i que la xarxa social juga un paper actiu en la campanya. Descriure una xarxa social real té interès en la planificació i implementació de campanyes de promoció de la salut, especialment per conèixer el paper de l'estat de salut en qüestió en la xarxa de relacions. Cal ser cautelós a l'hora de dissenyar intervencions basant-se en aquestes troballes, atès que la xarxa social entre professionals és un capital del centre que cal tractar amb cura.[eng] It is necessary to talk about the promotion of influenza vaccination among healthcare workers because the adherence to the recommendation is low. The influenza vaccination strategy aims at protecting, especially, those most vulnerable to complications, and this strategy includes healthcare professionals. The vaccination promotion campaigns presented in this thesis occur in a context where vaccination is voluntary and free. In the first campaign (2008-09) we wanted to improve the visibility and the commitment of the institution and those holding officers with the vaccination campaign, improve accessibility in terms of planning and availability to healthcare workers and send clear messages about vaccination. We wanted these messages to be attractive in order to foster the conversation among professionals about vaccination. We posted photos of vaccinated healthcare workers in the intranet, organized two raffles and used corporate email more intensively. The campaign was agreed with workers through their representatives. The 2008-09 campaign got significant increases in coverage compared to the previous one. The 2010-11 campaign wanted to evaluate the strategic goals set for that season, that is, increased information about influenza and vaccination, a greater perception or risk about the disease and the involvement of professionals as promoters among their colleagues. The evaluation, conducted through a before-after survey of the campaign in a randomized sample of hospital employees, showed an increase on the three strategic objectives and was well accepted without having an impact on coverage. This shows that the increase of information and perception of risk does not necessarily increase the acceptance of vaccination. The ways vaccination coverage are obtained can be very diverse. We considered it relevant to assess whether the declared coverage is a good proxy of the coverage according to the register and if the vaccine status affects the declaration of vaccination. The professionals were asked about their behavior in the previous three vaccination campaigns and matched to the register of the hospital. Self-declaration turned out to be a good proxy for the two previous seasons but the number of discordant non vaccinated professionals was larger than the number of vaccinated and discordant cases

Maternal educational level and preterm birth: Exploring inequalities in a hospital-based cohort study.

Preterm birth has been related to inequalities in maternal educational level, but the causal mechanism is not entirely known. Some factors associated with preterm birth and low educational level such as chronic medical conditions, pregnancy complications and related-health behaviours could have a mediation role in the pathway. This study aimed to evaluate the association between maternal educational level and preterm birth, analysing the mediation role of these factors. We performed a retrospective cohort study based on hospital electronic records of 10467 deliveries that took place in the Hospital Clínic of Barcelona between 2011 and 2017. Poisson regression was used to obtain crude and adjusted relative risk of preterm birth in women with different educational level and the percentage of change in relative risk was calculated when mediation variables were included in the model. Women with a lower educational level had a higher risk of preterm birth (RR 1.57, 95% CI 1.21, 2.03). The loss of association after the inclusion of body mass index in the model suggests an important mediation role of maternal overweight. Other variables such as smoking, drug use, preeclampsia and genitourinary infections also appear to play a role in the observed inequality between women with different levels of education. Efforts to promote health literacy and to improve preventive interventions, before and during pregnancy, could decrease preterm birth rates and perinatal health inequalities