Transmission dynamics: Data sharing in the COVID-19 era

Problem: The current coronavirus disease 2019 (COVID-19) pandemic underscores the need for building and sustaining public health data infrastructure to support a rapid local, regional, national, and international response. Despite a historical context of public health crises, data sharing agreements and transactional standards do not uniformly exist between institutions which hamper a foundational infrastructure to meet data sharing and integration needs for the advancement of public health. Approach: There is a growing need to apply population health knowledge with technological solutions to data transfer, integration, and reasoning, to improve health in a broader learning health system ecosystem. To achieve this, data must be combined from healthcare provider organizations, public health departments, and other settings. Public health entities are in a unique position to consume these data, however, most do not yet have the infrastructure required to integrate data sources and apply computable knowledge to combat this pandemic. Outcomes: Herein, we describe lessons learned and a framework to address these needs, which focus on: (a) identifying and filling technology gaps ; (b) pursuing collaborative design of data sharing requirements and transmission mechanisms; (c) facilitating cross-domain discussions involving legal and research compliance; and (d) establishing or participating in multi-institutional convening or coordinating activities. Next steps: While by no means a comprehensive evaluation of such issues, we envision that many of our experiences are universal. We hope those elucidated can serve as the catalyst for a robust community-wide dialogue on what steps can and should be taken to ensure that our regional and national health care systems can truly learn, in a rapid manner, so as to respond to this and future emergent public health crises

Assessment of the impact of the COVID-19 pandemic on health services use

OBJECTIVES: The coronavirus disease of 2019 (COVID-19) pandemic declared by the World Health Organization on March 11, 2020 impacted healthcare services with provider and patient cancellations, delays, and patient avoidance or delay of emergency department or urgent care. Limited data exist on the population proportion affected by delayed healthcare, which is important for future healthcare planning efforts. Our objective was to evaluate the impact of the COVID-19 pandemic on healthcare service cancellations or delays and delays/avoidance of emergency/urgent care overall and by population characteristics. STUDY DESIGN: This was a cross-sectional study. METHODS: Our sample (n = 2314) was assembled through a phone survey from 8/12/2020-10/27/2020 among non-institutionalized St. Louis County, Missouri, USA residents ≥18 years. We asked about provider and patient-initiated cancellations or delays of appointments and pandemic-associated delays/avoidance of emergency/urgent care overall and by participant characteristics. We calculated weighted prevalence estimates by select resident characteristics. RESULTS: Healthcare services cancellations or delays affected ∼54% (95% CI 50.6%-57.1%) of residents with dental (31.1%, 95% CI 28.1%-34.0%) and primary care (22.1%, 95% CI 19.5%-24.6%) being most common. The highest prevalences were among those who were White, ≥65 years old, female, in fair/poor health, who had health insurance, and who had ≥1 medical condition. Delayed or avoided emergency/urgent care impacted ∼23% (95% CI 19.9%-25.4%) of residents with a higher prevalence in females than males. CONCLUSIONS: Healthcare use disruptions impacted a substantial proportion of residents. Future healthcare planning efforts should consider these data to minimize potential morbidity and mortality from delayed care

Leveraging CD4 cell count at entry into care to monitor success of human immunodeficiency virus prevention, treatment, and public health programming in the greater St Louis area between 2017 and 2020

CD4 cell count at entry into human immunodeficiency virus (HIV) care is a useful indicator of success of multiple steps in HIV public health programming. We demonstrate that CD4 cell count at care initiation was stable in St Louis between 2017 and 2019 but declined in 2020. Missouri efforts in the Ending the HIV Epidemic plan should focus on rapidly identifying individuals with undiagnosed HIV infection

Quantifying inequities in COVID-19 vaccine distribution over time by social vulnerability, race and ethnicity, and location: A population-level analysis in St. Louis and Kansas City, Missouri

BACKGROUND: Equity in vaccination coverage is a cornerstone for a successful public health response to COVID-19. To deepen understanding of the extent to which vaccination coverage compares with initial strategies for equitable vaccination, we explore primary vaccine series and booster rollout over time and by race/ethnicity, social vulnerability, and geography. METHODS AND FINDINGS: We analyzed data from the Missouri Department of Health and Senior Services on all COVID-19 vaccinations administered across 7 counties in the St. Louis region and 4 counties in the Kansas City region. We compared rates of receiving the primary COVID-19 vaccine series and boosters relative to time, race/ethnicity, zip-code-level Social Vulnerability Index (SVI), vaccine location type, and COVID-19 disease burden. We adapted a well-established tool for measuring inequity-the Lorenz curve-to quantify inequities in COVID-19 vaccination relative to these key metrics. Between 15 December 2020 and 15 February 2022, 1,763,036 individuals completed the primary series and 872,324 received a booster. During early phases of the primary series rollout, Black and Hispanic individuals from high SVI zip codes were vaccinated at less than half the rate of White individuals from low SVI zip codes, but rates increased over time until they were higher than rates in White individuals after June 2021; Asian individuals maintained high levels of vaccination throughout. Increasing vaccination rates in Black and Hispanic communities corresponded with periods when more vaccinations were offered at small community-based sites such as pharmacies rather than larger health systems and mass vaccination sites. Using Lorenz curves, zip codes in the quartile with the lowest rates of primary series completion accounted for 19.3%, 18.1%, 10.8%, and 8.8% of vaccinations while representing 25% of the total population, cases, deaths, or population-level SVI, respectively. When tracking Gini coefficients, these disparities were greatest earlier during rollout, but improvements were slow and modest and vaccine disparities remained across all metrics even after 1 year. Patterns of disparities for boosters were similar but often of much greater magnitude during rollout in fall 2021. Study limitations include inherent limitations in the vaccine registry dataset such as missing and misclassified race/ethnicity and zip code variables and potential changes in zip code population sizes since census enumeration. CONCLUSIONS: Inequities in the initial COVID-19 vaccination and booster rollout in 2 large US metropolitan areas were apparent across racial/ethnic communities, across levels of social vulnerability, over time, and across types of vaccination administration sites. Disparities in receipt of the primary vaccine series attenuated over time during a period in which sites of vaccination administration diversified, but were recapitulated during booster rollout. These findings highlight how public health strategies from the outset must directly target these deeply embedded structural and systemic determinants of disparities and track equity metrics over time to avoid perpetuating inequities in healthcare access

Fe control in soil solutions in hydromorphic soils by equilibrium with the "fougerite" green rust mineral

National audienc

Control of iron activity in soil solutions in hydromorphic soils by equilibrium with the "fougerite" green rust mineral

National audienc

Postpartum diabetes screening among low income women with gestational diabetes in Missouri 2010–2015

Abstract Background Gestational diabetes increases risk for type 2 diabetes seven-fold, creating a large public health burden in a young population. In the US, there are no large registries for tracking postpartum diabetes screening among women in under-resourced communities who face challenges with access to care after pregnancy. Existing data from Medicaid claims is limited as women often lose this coverage within months of delivery. In this study, we aim to leverage data from electronic health records and administrative claims to better assess postpartum diabetes screening rates among low income women. Methods A retrospective population of 1078 women with gestational diabetes who delivered between 1/1/2010 and 10/8/2015 was generated by linking electronic health record data from 21 Missouri Federally Qualified Health Centers (FQHCs) with Medicaid administrative claims. Screening rates for diabetes were calculated within 12 weeks and 1 year of delivery. Initial screening after the first postpartum year was also documented. Results Median age in the final population was 28 (IQR 24–33) years with over-representation of black non-Hispanic and urban women. In the final population, 9.7% of women had a recommended diabetes screening test within 12 weeks and 18.9% were screened within 1 year of delivery. An additional 125 women received recommended screening for the first time beyond 1 year postpartum. The percentage of women who had a postpartum visit (83.9%) and any glucose testing (40.6%) in the first year far exceeded the proportion of women with recommended screening tests. Conclusions Linking electronic health record and administrative claims data provides a more complete picture of healthcare follow-up among low income women after gestational diabetes. While screening rates are higher than reported with claims data alone, there are opportunities to improve adherence to screening guidelines in this population

Rôle du sol sur la circulation et la qualité des eaux au sein de paysages présentant un domaine hydromorphe. Incidences sur la teneur en nitrate des eaux superficielles d'un bassin versant armoricain.

National audienc

Rôle du sol sur la circulation et la qualité des eaux au sein de paysages présentant un domaine hydromorphe

International audienceLa qualité des eaux de paysages présentant des sols hydromorphes dépend notamment des modes de circulation de l'eau à travers ces paysages et de l'extension spatiale et temporelle des zones humides en raison de leurs fonctionnements hydrologique et biogéo-chimique particuliers. L'incidence de ces cheminements sur la teneur en nitrate des eaux superficielles a été analysée par une approche pluridisciplinaire sur un bassin versant de 1 200 ha (Coët Dan, Morbihan). Le modèle d'organisation spatiale des sols correspond à un système pédologique associant un nombre limité d'horizons liés génétique-ment. Le moteur de la différenciation pédologique étant l'hydromorphie, qui, sur ce bassin, est contrôlée principalement par la topographie, un modèle prédictif de la distribution des sols hydromorphes combinant deux indices topographiques a pu être établi. Les propriétés hydrodynamiques des horizons de ce système permettent de les regrouper en familles présentant un même comportement. En fonction de ces familles d'horizons et du modèle d'organisation des sols, le bassin versant peut être divisé en deux domaines : un domaine amont, homogène et très perméable où les transferts d'eau et de solutés sont principalement verticaux ; et un domaine aval, multicouche, peu perméable présentant deux niveaux de nappes. Ce dernier domaine est le siège de transferts latéraux dans le sol et d'un ruissellement superficiel dont l'importance est fonction de l'extension spatiale et temporelle des surfaces saturées et de leur connectivité. L'étude biogéochimique du domaine mal drainé montre l'importance des phénomènes de dénitrification dans la nappe perchée subsu-perficielle et l'existence d'un composé du fer (rouille verte) qui peut à certains moments concurrencer la dénitrification. Au plan hydrologique, les variations de la qualité de l'eau au cours de la crue sont bien rendues par la décomposition de l'hydrogramme de crue à partir d'un modèle de mélange à 4 compartiments, cohérent avec le modèle de fonctionnement proposé. Ce modèle montre que l'eau venant de la zone dénitrifiée représente 15 à 30 % de l'écoulement de crue. A l'échelle annuelle, la concentration moyenne en nitrate de différents sous-bassins décroît lorsque la proportion de sols hydromorphes croît. Ces résultats montrent que les zones hydro-morphes ont un effet sur les transferts de nitrate, mais que cet effet est limité par l'importance des chemins de l'eau court-circuitant les zones épuratrices. Un modèle conceptuel combinant les transferts d'eau et de nitrate à l'échelle du bassin versant est proposé qui prend en compte les principaux processus identifiés ici