The Public Health Response to COVID-19 in the St. Louis Region of Missouri

The Public Health Response to COVID-19 in the St. Louis Region of Missouri documents efforts by St. Louis Missouri’s local public health agencies along with other stakeholders to leverage their partnerships, resources, and expertise to respond to COVID-19. Along with professional stakeholder accounts, the report includes residents’ perspectives and experiences during the COVID-19 response. Professional and resident findings helped identify lessons that could strengthen the public health system’s ability to continue responding to COVID-19 and face future crisis with greater resources, coordination, equitable strategies, modernized infrastructure and public trust. The findings in this report center on the period of the pandemic from March 2020 through May 2021, before the proliferation of the Delta and Omicron variants. The Public Health Response to COVID-19 in the St. Louis Region of Missouri along with The Public Health Response to COVID-19 in the Northeast Region of Missouri and The Public Health Response to COVID-19 in the Southwest Region of Missouri are part of a series of regional reports that were used to inform the state-level recommendations in the report Missouri’s Public Health Response to COVID-19: Key Findings and Recommendations for State Action and Investment

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Missouri’s Public Health Response to COVID-19: Key Findings and Recommendations for State Action and Investment

This report from the study, Strengthening Missouri’s Capacity to Respond to Public Health Crises, summarizes key findings that are relevant to strengthening the state’s and local public health agencies’ (LPHAs) capacity to respond to future public health crises. With funding from Missouri Foundation for Health, a George Washington University study team conducted 138 stakeholder interviews within public health and other sectors involved in the COVID-19 response, revealing several key opportunities for the Missouri Department of Health and Senior Services (DHSS). Missouri, like many other states, faced great challenges in responding to the COVID-19 pandemic. Missouri now has a singular opportunity to build stronger public health agencies at state and local levels with unprecedented amounts of funding from the federal government

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar