Implementation of Electronic Disease Reporting Systems by Local Health Departments

Background: Electronic disease reporting systems (EDRSs) are imperative for local health departments (LHDs) operating in the post-H1N1 and evidence-based public health practice era. Studies regarding functionality and factors responsible for variation in implementation are important but rare. Purpose: This primary objective for this study was to provide evidence regarding the level to which LHDs have implemented electronic disease reporting systems and factors associated with variation in implementation of electronic disease reporting systems. Methods: A quantitative analysis was performed of the 2013 Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials (NACCHO). The Profile study used a nationally representative sample of 625 LHDs and received an 81% response rate. Using a Multinomial Logistic Regression model, significant factors explaining variation were examined. Results: Significant factors associated with the implementation of EDRSs were experienced (tenure) top executive, jurisdiction population size, region of geographic location, presence of Local Board of Health, type of governance, presence of health information specialist on staff, and number of clinical services performed. Implications: For the advancement of public health surveillance in the 21st century, LHDs need the capacity for real time surveillance data collection and use, as well as, interoperable and integrated disease surveillance systems. Policies aimed at advancing disease surveillance in the United States might benefit from our findings on modifiable factors associated with the difference in EDRS implementation

Nucleotide identity and variability among different Pakistani hepatitis C virus isolates

<p>Abstract</p> <p>Background</p> <p>The variability within the hepatitis C virus (HCV) genome has formed the basis for several genotyping methods and used widely for HCV genotyping worldwide.</p> <p>Aim</p> <p>The aim of the present study was to determine percent nucleotide identity and variability in HCV isolates prevalent in different geographical regions of Pakistan.</p> <p>Methods</p> <p>Sequencing analysis of the 5'noncoding region (5'-NCR) of 100 HCV RNA-positive patients representing all the four provinces of Pakistan were carried out using ABI PRISM 3100 Genetic Analyzer.</p> <p>Results</p> <p>The results showed that type 3 is the predominant genotypes circulating in Pakistan, with an overall prevalence of 50%. Types 1 and 4 viruses were 9% and 6% respectively. The overall nucleotide similarity among different Pakistani isolates was 92.50% ± 0.50%. Pakistani isolates from different areas showed 7.5% ± 0.50% nucleotide variability in 5'NCR region. The percent nucleotide identity (PNI) was 98.11% ± 0.50% within Pakistani type 1 sequences, 98.10% ± 0.60% for type 3 sequences, and 99.80% ± 0.20% for type 4 sequences. The PNI between different genotypes was 93.90% ± 0.20% for type 1 and type 3, 94.80% ± 0.12% for type 1 and type 4, and 94.40% ± 0.22% for type 3 and type 4.</p> <p>Conclusion</p> <p>Genotype 3 is the most prevalent HCV genotype in Pakistan. Minimum and maximum percent nucleotide divergences were noted between genotype 1 and 4 and 1 and 3 respectively.</p

Report from the Annual Conference of the British Society of Echocardiography, November 2016, Queen Elizabeth II Conference Centre, London.

Peer reviewedPublisher PD

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Implementation of Electronic Disease Reporting Systems by Local Health Departments

Background: Electronic disease reporting systems (EDRSs) are imperative for local health departments (LHDs) operating in the post-H1N1 and evidence-based public health practice era. Studies regarding functionality and factors responsible for variation in implementation are important but rare. Purpose: This primary objective for this study was to provide evidence regarding the level to which LHDs have implemented electronic disease reporting systems and factors associated with variation in implementation of electronic disease reporting systems. Methods: A quantitative analysis was performed of the 2013 Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials (NACCHO). The Profile study used a nationally representative sample of 625 LHDs and received an 81% response rate. Using a Multinomial Logistic Regression model, significant factors explaining variation were examined. Results: Significant factors associated with the implementation of EDRSs were experienced (tenure) top executive, jurisdiction population size, region of geographic location, presence of Local Board of Health, type of governance, presence of health information specialist on staff, and number of clinical services performed. Implications: For the advancement of public health surveillance in the 21st century, LHDs need the capacity for real time surveillance data collection and use, as well as, interoperable and integrated disease surveillance systems. Policies aimed at advancing disease surveillance in the United States might benefit from our findings on modifiable factors associated with the difference in EDRS implementation

Implementation of Electronic Disease Reporting Systems by Local Health Departments

Background: Electronic disease reporting systems (EDRSs) are imperative for local health departments (LHDs) operating in the post-H1N1 and evidence-based public health practice era. Studies regarding functionality and factors responsible for variation in implementation are important but rare. Purpose: This primary objective for this study was to provide evidence regarding the level to which LHDs have implemented electronic disease reporting systems and factors associated with variation in implementation of electronic disease reporting systems. Methods: A quantitative analysis was performed of the 2013 Profile of Local Health Departments Survey conducted by the National Association of County and City Health Officials (NACCHO). The Profile study used a nationally representative sample of 625 LHDs and received an 81% response rate. Using a Multinomial Logistic Regression model, significant factors explaining variation were examined. Results: Significant factors associated with the implementation of EDRSs were experienced (tenure) top executive, jurisdiction population size, region of geographic location, presence of Local Board of Health, type of governance, presence of health information specialist on staff, and number of clinical services performed. Implications: For the advancement of public health surveillance in the 21st century, LHDs need the capacity for real time surveillance data collection and use, as well as, interoperable and integrated disease surveillance systems. Policies aimed at advancing disease surveillance in the United States might benefit from our findings on modifiable factors associated with the difference in EDRS implementation

Race-Related Disparities in Infant Mortality in the United States

Objective: The purpose of this research is to describe race-related disparities in infant mortality rates, their geographic variation and trends, and to highlight the contributory factors for existence and persistence of disparities. Methods: We used data from secondary sources, with infant mortality data from CDC Wonder. Results: Despite efforts in the United States at local, state, and federal levels to lower the rates of infant mortality and eliminate the subgroup differences, there is little success in reducing the disparities. Our research suggests that race-related differences in infant mortality not only exist presently, they have persisted for years, and the gaps among different race/ethnicity groups are not narrowing. Conclusions: Disparities among black and white infants continue to persist, and cannot be narrowed to a small set of determinants. Instead, a multitude of factors seem to be interconnected, preserving the gaps in infant mortality rates among different race/ethnicity groups. Consequently, Healthy People 2020 objectives still seek to reduce LBW, VLBW, total preterm births, and overall infant mortality rates

Nature of Local Health Departments Partnerships With Hospitals for Community Health Needs Assessment and Other Mutual Needs

Introduction: Healthcare and public health industries have history of working in siloes, but those silos are beginning to give way to collaborations, due to community health needs assessment (CHNA) conducted by hospitals requiring hospitals to use perspectives of a broad range of community stakeholders. Purpose: The purpose of this research included assessment of the level of collaboration between Local Health Departments (LHDs) and non-profit hospitals for hospitals’ recent CHNA and impact of such collaboration on LHD best practices (accreditation, community health assessment etc.). Methods: Chi-square and descriptive analysis were performed using data from the 2016 Profile of LHDs Survey, administered to all 2,533 LHDs and completed by 1930. Results: LHD partnerships arrangements with hospitals included sharing personnel/resources (15.6%), having written agreements (25.0%) regularly scheduling meetings (47.5%), and exchanging information (70.4%). Over 75% of all LHDs had one or more non-profit hospitals in their jurisdiction. Of these LHDs with at least one non-profit hospital in their jurisdiction, 76% collaborated with one or more non-profit hospitals on the most recent CHNA. The most frequent roles played by LHD s in CHNA completed by hospitals included: (a) sharing local data resources regarding health status –performed by 61.7% (b) providing input on strategies to improve community health (60.4%), and (c) conducted joint assessment with non-profit hospital. LHD partnerships with non-profit hospitals on CHNA conducted by hospitals was positively and significantly (p\u3c0.001) associated with LHDs’ accreditation engagement, and completion of community health assessment, community health improvement planning, and strategic planning. Implications: LHDs-hospital partnerships on CHNA can be mutually beneficial. In their collaborative role, LHDs can assist hospitals to align community benefit-expenditures with the communities’ health needs