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Hafez S, Ismail SA, Zibwowa Z, Alhamshary N, Elsayed R, Dhaliwal M, Samuels F, Fakoya A. Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002758. [PMID: 38709792 PMCID: PMC11073720 DOI: 10.1371/journal.pgph.0002758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.
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Affiliation(s)
- Sali Hafez
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharif A. Ismail
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zandile Zibwowa
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nadin Alhamshary
- The Nuffield Centre for International Health and Development, School of Medicine, The University of Leeds, Leeds, United Kingdom
| | - Reem Elsayed
- The University of Western Cape, Cape Town, South Africa
| | - Mandeep Dhaliwal
- HIV and Health Group, United Nations Development Program, New York, United States of America
| | - Fiona Samuels
- Centre for Public Health and Policy, Queen Mary University of London, London, United Kingdom
| | - Ade Fakoya
- Institute for Global Health, University College London, London, United Kingdom
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Cho BH, O'Halloran A, Pike J. Investigation of barriers to county-level seasonal influenza vaccine uptake among Medicare beneficiaries in the United States - 2018-2019 seasonal influenza season. Vaccine X 2023; 14:100326. [PMID: 37577260 PMCID: PMC10422654 DOI: 10.1016/j.jvacx.2023.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction As most public health decisions are made at the local level, public health interventions implemented at the local level may vary by their own unique circumstances, such as demographic composition or the availability of resources. Our objective is to estimate and characterize county-level flu vaccine uptakes among Medicare-covered adults aged ≥65 years. Methods The flu vaccine uptake was estimated from Medicare Fee-for-Service claims for those who continuously enrolled during the 2018-2019 flu season. County-level characteristics were obtained from Centers for Disease Control and Prevention (CDC)'s Minority Health Social Vulnerability Index and Behavioral Risk Factor Surveillance System data as well as Health Resources and Services Administration's Area Health Resources File. A generalized linear regression was used to assess the relationship between selected characteristics and uptake. Results A total of 30,265,047 beneficiaries from 3,125 counties were identified, of which 53% received a flu vaccination during the 2018-2019 flu season. For 3,006 counties with more than 500 Medicare beneficiaries, the mean county-level uptake was estimated to be 47.7%. The mean uptakes in counties designated as a health professional shortage area (HPSA) (42.6% and 48.4%, respectively), were lower than the uptakes for the non-HPSA counties (53.8%). Metro counties (53.2%) showed higher uptakes than non-metro counties (44.2%). Regression analysis results showed that the percent of working adults aged 18-64 years and female were positively associated, while the percent of Black and Hispanic adults were negatively associated. Proportions of persons with limited proficiency of English, college education or above, single parent families, multi-unit housing, and living in group quarters were positively associated and significant. Conclusions The results confirmed that county-level flu vaccine uptakes are low, reflect persistent racial disparities in vaccine uptake, and that Medicare populations in medically underserved communities with lower socioeconomic status need more attention in improving flu vaccine uptake.
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Affiliation(s)
- Bo-Hyun Cho
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jamison Pike
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Naito T, Tomata Y, Otsuka T, Tsuno K, Tabuchi T. Did Children in Single-Parent Households Have a Higher Probability of Emotional Instability during the COVID-19 Pandemic? A Nationwide Cross-Sectional Study in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074239. [PMID: 35409920 PMCID: PMC8998338 DOI: 10.3390/ijerph19074239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
The influence of public health measures against COVID-19 in Japan on child mental health by household type is unknown. This study aimed to investigate whether COVID-19 and the declaration of a state of emergency in Japan affected children's mental health between single-parent and two-parent households disproportionately. A large cross-sectional online survey was conducted from August to September 2020. The study included 3365 parents with children aged 0-14 years old who reported their children's mental status during the declared state of emergency. Emotional instability was reported dichotomously by parents. As the primary result, the probability of emotional instability was higher in single-parent households compared with that in two-parent households after adjustments for potential covariates; the adjusted prevalence ratio (95% CI) was 1.26 (1.07-1.49). Our findings suggest a disproportionate impact on children's mental health due to the pandemic.
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Affiliation(s)
- Takuto Naito
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Yasutake Tomata
- School of Nutrition and Dietetics, Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka 238-8522, Japan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: ; Tel.: +81-046-828-2500
| | - Tatsui Otsuka
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan;
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki 210-0821, Japan;
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan;
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Williams BE, Kondo KK, Ayers CK, Kansagara D, Young S, Saha S. Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions. Health Equity 2022; 5:856-871. [PMID: 35018320 PMCID: PMC8742307 DOI: 10.1089/heq.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.
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Affiliation(s)
- Beth E Williams
- Primary Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Karli K Kondo
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Research Integrity Office, Oregon Health and Science University, Portland, Oregon, USA
| | - Chelsea K Ayers
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Devan Kansagara
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah Young
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
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County Social Vulnerability and Influenza Vaccine Rates: National and Local Estimates for Medicare Recipients. Am J Prev Med 2022; 62:e1-e9. [PMID: 34548222 DOI: 10.1016/j.amepre.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Seasonal influenza vaccination among older adults is well below the recommendation of Healthy People 2020. Although geographic disparities in influenza vaccination are well documented, it remains unclear how community attributes correlate with influenza vaccination rates. Social vulnerability measures play an important role in interventions addressing vaccine equity; however, social vulnerability dimensions as corollaries of vaccination are poorly understood. To inform vaccine equity interventions, this analysis investigates spatially varying associations between county social vulnerability and influenza vaccination rate among Medicare recipients. METHODS County-level 2018 data (N=3,105) from the Centers for Disease Control and Prevention's Social Vulnerability Index were merged with the percentage of Medicare recipients vaccinated against influenza. Multilevel linear regression and geographically weighted regression generated global and local estimates, adjusted for potential confounders. Analyses were conducted in November 2020-April 2021. RESULTS A 10-percentile point increase in the overall Social Vulnerability Index was associated with an 0.87-point decrease in percentage vaccinated (p<0.001) with substantial variation by Social Vulnerability Index theme and geography. A 10-percentile point increase in socioeconomic vulnerability was associated with a 1.6-point decrease in vaccination (p<0.001) with stronger associations in higher Social Vulnerability Index quartiles and in parts of the Midwest, South, and coastal Northeast. Other Social Vulnerability Index themes had smaller associations with mixed directions: household composition and disability estimates were negative, whereas estimates for minority status and language and housing and transportation were positive. CONCLUSIONS Medicare recipients in socioeconomically vulnerable counties have low influenza vaccination rates, particularly in select regions of the country. Best practices to improve vaccine access and uptake should be targeted and should explicitly consider local socioeconomic vulnerability.
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Casillas E, Wu G, Iantorno S, Ning WV, Choi J, Chan P, Lee MM. COVID-19: Highlighting Health Disparities in the Los Angeles Latinx Community. Clin Med Res 2021; 19:161-168. [PMID: 34933948 PMCID: PMC8691427 DOI: 10.3121/cmr.2021.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/25/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022]
Abstract
Objective: Characterization of COVID-19 in the Latinx community is necessary for guiding public health initiatives, health system policy, clinical management practices, and improving outcomes. Our aim was to describe the socioeconomic background and clinical profile of patients with COVID-19 at a large public hospital in Los Angeles to improve health disparities leading to poor outcomes during the pandemic.Design, Setting and Participants: A single center retrospective cross-sectional study of all patients with a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to Los Angeles County (LAC)+University of Southern California (USC) Medical Center between March 15, 2020 and April 30, 2020.Methods: We describe patient characteristics, socioeconomic factors, laboratory findings, and outcomes of the first 278 patients to present to LAC+USC Medical Center with COVID-19.Results: Patients self-identified as Hispanic (82.4%) or non-Hispanic (17.6%). Hispanic patients presented later from symptom onset (6 days vs 3 days, P = 0.027) and had higher post-intubation mortality (40.9% vs. 33.3%, P = 1), intensive care unit (ICU) mortality (31.1% vs. 22.2%, P = 0.87), and overall mortality (11.1% vs 10.2%, P = 1). However, the difference in admission rates, mechanical ventilation rates, and overall mortality rates were not statistically significant. A majority of patients, 275/278 (98.9%), reported residency ZIP codes in areas of higher population density, higher percentage of Latinx, born outside the United States, lower median income, and lower high school graduation rate when compared to the rest of Los Angeles County. Regression analysis within the Hispanic cohort found that age, history of hypertension, history of diabetes, lactate dehydrogenase (LDH), and C-reactive protein (CRP) were predictors of mechanical ventilation and mortality.Conclusion: We show the Latinx community has been disproportionally affected by the pandemic in Los Angeles and we identified multiple socioeconomic and clinical characteristics that predispose this population to COVID-19 infection. This study highlights the need for change in local and national strategies to protect vulnerable communities during public health outbreaks.
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Affiliation(s)
- Ernesto Casillas
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Gloria Wu
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Stefano Iantorno
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Weihuang Vivian Ning
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Joon Choi
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Patrick Chan
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - May M Lee
- Department of Pulmonary and Critical Care Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
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Litz BT, Cummings MH, Grunthal B, McLean CL. A Public Health Framework for Preventing Mental Disorders in the Context of Pandemics. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:519-531. [PMID: 34629840 PMCID: PMC8488184 DOI: 10.1016/j.cbpra.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/21/2020] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic has universally threatened the building blocks of mental health, well-being, and quality of life, namely, expectations of safety, connectedness, hope, and individual and societal efficacy. Consequently, unprecedently large numbers of individuals are significantly stressed and many are at risk for relapse of mental health problems, exacerbations of existing mental and behavioral health problems, and new onset clinical problems. Because of the scope of the problem, a population-based public health perspective is needed, which in the context of disasters has well-established theories and prevention approaches. Public health approaches to disasters and pandemics focus on preventing subclinical problems from becoming clinical disorders, in comparison to clinical care approaches that focus on treating established disorders. Fortunately, specialty care clinicians who typically think about assessing and treating established disorders have the training and clinical competencies to deliver prevention-focused interventions. This paper is designed to help specialty care clinicians who use cognitive-behavioral strategies to understand the biopsychosocial impacts and resource deficits associated with COVID-19-related stressors and the public health perspective to address them. We also provide ways clinicians can help people who are suffering from significant stress and resource deficits bounce back and regain functioning. We describe psychological first aid, stress management, repeated ecological assessment, writing about stressors, problem-solving, and behavioral activation approaches to assist individuals at risk for enduring stress-linked problems.
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Affiliation(s)
- Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System
- Boston University School of Medicine
| | - Mackenzie H Cummings
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System
| | - Breanna Grunthal
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System
| | - Caitlin L McLean
- VA San Diego Healthcare System
- University of California San Diego
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Abstract
To test and explore whether more positive coparenting will significantly predict lower COVID-19-related stress across family configurations and dynamics and across both higher- and lower-income mothers, we developed and circulated an online survey among mothers from the U.S. and Canada. Coparenting was measured using the Coparenting Across Family Structures (CoPAFS) short form (27 items) scale, comprised of factors representing five coparenting dimensions: communication, respect, trust, animosity, and valuing the other parent. Items specific to COVID-19 stressors assessed the types of stressors each parent faced. The sample consisted of 236 North American mothers, mostly white (n = 187, 79.2%) and aged 30–50 years. The surveyed mothers reported a consistent and significant relation between more positive coparenting and less COVID-19-related stressors whether parents were living together or not, married or divorced, and with a lower or higher income level, suggesting the importance and centrality of positive coparenting as a key factor for family well-being. Coparenting was especially predictive among mothers who were never married and those with lower incomes.
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Cong Z, Feng G. Financial Preparedness for Emergencies: Age Patterns and Multilevel Vulnerabilities. Res Aging 2021; 44:334-348. [PMID: 34318726 DOI: 10.1177/01640275211034471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guided mainly by the social vulnerability perspective and life course perspective, this study examined age patterns of financial preparedness for emergencies and how they were contextualized by vulnerabilities at the individual and community levels. We matched data from the Federal Emergency Management Agency 2018 National Household Survey and 15 indicators of the Social Vulnerability Index at the county level. Two-level logistic regressions were conducted with the working sample, which included 4,623 respondents from 958 counties. The results showed that adults aged 18 to 44 were more likely than those aged 65 to 74 to set aside money for emergencies among Hispanics, those with minor children in the household, and in communities with higher levels of poverty, higher percentages of minorities, and higher percentages of no vehicles, but less likely to do so among the White and those with insurance. The findings were discussed within a multilevel layered vulnerability framework.
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Affiliation(s)
- Zhen Cong
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Guanggang Feng
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
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Whytlaw JL, Hutton N, Wie Yusuf JE, Richardson T, Hill S, Olanrewaju-Lasisi T, Antwi-Nimarko P, Landaeta E, Diaz R. Changing vulnerability for hurricane evacuation during a pandemic: Issues and anticipated responses in the early days of the COVID-19 pandemic. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 61:102386. [PMID: 36569576 PMCID: PMC9764852 DOI: 10.1016/j.ijdrr.2021.102386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/16/2021] [Accepted: 05/29/2021] [Indexed: 05/07/2023]
Abstract
Hurricane evacuations during a pandemic require a revised understanding of vulnerabilities within communities and the development of different strategies and policies to accommodate the needs of populations vulnerable to the combined hurricane-pandemic threat. The prolonged COVID-19 pandemic has added economic, psychological, social, health, and workforce stressors to communities across the United States. Using original research data from workshops held in May 2020 involving emergency management, public health, and related experts to support planning efforts for hurricane evacuation and sheltering, we analyze two key issues: (1) shifting sources of vulnerability in a COVID-19 environment and (2) solutions proposed during the post-lockdown/pre-vaccine time frame. We discuss findings in the context of policy integration options to solidify and expand protections for populations in need of evacuation and sheltering assistance. Findings show that vulnerabilities associated with underlying health conditions and socio-economic disparities were of increased concern to evacuation and shelter planners. Non-congregate options were of interest but were not expected to accommodate all populations in need of public assistance. Registries used in some states offer means with which to evaluate vulnerabilities and align individuals and families with appropriate resources and facilities. There remains a need to expand and standardize existing policies based on COVID-19 operating protocols to ensure inclusivity of socio-economically disadvantaged and disabled individuals in hurricane preparation efforts.
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Affiliation(s)
- Jennifer L Whytlaw
- Department of Political Science & Geography, College of Arts and Letters, Old Dominion University, USA
| | - Nicole Hutton
- Department of Political Science & Geography, College of Arts and Letters, Old Dominion University, USA
| | | | | | - Saige Hill
- School of Public Service, Old Dominion University, USA
| | | | - Pamela Antwi-Nimarko
- Graduate Program in International Studies, College of Arts and Letters, Old Dominion University, USA
| | - Eduardo Landaeta
- Graduate Program in International Studies, College of Arts and Letters, Old Dominion University, USA
| | - Rafael Diaz
- Virginia Modeling, Analysis and Simulation Center, Old Dominion University, USA
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Mac-Seing M, Rocha de Oliveira R. Health inequities and technological solutions during the first waves of the COVID-19 pandemic in high-income countries. Glob Health Promot 2021; 28:67-71. [PMID: 33590801 DOI: 10.1177/1757975920984185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has resulted in massive disruptions to public health, healthcare, as well as political and economic systems across national borders, thus requiring an urgent need to adapt. Worldwide, governments have made a range of political decisions to enforce preventive and control measures. As junior researchers analysing the pandemic through a health equity lens, we wish to share our reflections on this evolving crisis, specifically: (a) the tenuous intersections between the responses to the pandemic and public health priorities; (b) the exacerbation of health inequities experienced by vulnerable populations following decisions made at national and global levels; and (c) the impacts of the technological solutions put forward to address the crisis. Examples drawn from high-income countries are provided to support our three points.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive and Medicine, School of Public Health, Université de Montréal; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal; Montreal, Canada
| | - Robson Rocha de Oliveira
- Department of Social and Preventive and Medicine, School of Public Health, Université de Montréal; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal; Montreal, Canada
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Plümper T, Neumayer E. The pandemic predominantly hits poor neighbourhoods? SARS-CoV-2 infections and COVID-19 fatalities in German districts. Eur J Public Health 2021; 30:1176-1180. [PMID: 32818263 PMCID: PMC7454540 DOI: 10.1093/eurpub/ckaa168] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Reports from the UK and the USA suggest that COVID-19 predominantly affects poorer neighbourhoods. This article paints a more complex picture by distinguishing between a first and second phase of the pandemic. The initial spread of infections and its correlation with socio-economic factors depends on how the virus first entered a country. The second phase of the pandemic begins when individuals start taking precautionary measures and governments implement lockdowns. In this phase the spread of the virus depends on the ability of individuals to socially distance themselves, which is to some extent socially stratified. Methods We analyse the geographical distribution of known cumulative cases and fatalities per capita in an ecological analysis across local districts in Germany distinguishing between the first and the second phase of the pandemic. Results In Germany, the virus first entered via individuals returning from skiing in the Alps and other international travel. In this first phase we find a positive association between the wealth of a district and infection rates and a negative association with indicators of social deprivation. During the second phase and controlling for path dependency, districts with a higher share of university-educated employees record fewer new infections and deaths and richer districts record fewer deaths, districts with a higher unemployment rate record more deaths. Conclusion The social stratification of Covid-19 changes substantively across the two phases of the pandemic in Germany. Only in the second phase and controlling for temporal dependence does Covid-19 predominantly hit poorer districts.
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Affiliation(s)
- Thomas Plümper
- Department of Socioeconomics, Vienna University of Economics and Business, Vienna, Austria
| | - Eric Neumayer
- Department of Geography and Environment, London School of Economics and Political Science (LSE), London, UK
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Zou X, Fang Z, Xiong S. A discrete particle swarm optimization method for assignment of supermarket resources to urban residential communities under the situation of epidemic control. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2020.106832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Whittle RS, Diaz-Artiles A. An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City. BMC Med 2020; 18:271. [PMID: 32883276 PMCID: PMC7471585 DOI: 10.1186/s12916-020-01731-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND New York City was the first major urban center of the COVID-19 pandemic in the USA. Cases are clustered in the city, with certain neighborhoods experiencing more cases than others. We investigate whether potential socioeconomic factors can explain between-neighborhood variation in the COVID-19 test positivity rate. METHODS Data were collected from 177 Zip Code Tabulation Areas (ZCTA) in New York City (99.9% of the population). We fit multiple Bayesian Besag-York-Mollié (BYM) mixed models using positive COVID-19 tests as the outcome, a set of 11 representative demographic, economic, and health-care associated ZCTA-level parameters as potential predictors, and the total number of COVID-19 tests as the exposure. The BYM model includes both spatial and nonspatial random effects to account for clustering and overdispersion. RESULTS Multiple regression approaches indicated a consistent, statistically significant association between detected COVID-19 cases and dependent children (under 18 years old), population density, median household income, and race. In the final model, we found that an increase of only 5% in young population is associated with a 2.3% increase in COVID-19 positivity rate (95% confidence interval (CI) 0.4 to 4.2%, p=0.021). An increase of 10,000 people per km2 is associated with a 2.4% (95% CI 0.6 to 4.2%, p=0.011) increase in positivity rate. A decrease of $10,000 median household income is associated with a 1.6% (95% CI 0.7 to 2.4%, p<0.001) increase in COVID-19 positivity rate. With respect to race, a decrease of 10% in White population is associated with a 1.8% (95% CI 0.8 to 2.8%, p<0.001) increase in positivity rate, while an increase of 10% in Black population is associated with a 1.1% (95% CI 0.3 to 1.8%, p<0.001) increase in positivity rate. The percentage of Hispanic (p=0.718), Asian (p=0.966), or Other (p=0.588) populations were not statistically significant factors. CONCLUSIONS Our findings indicate associations between neighborhoods with a large dependent youth population, densely populated, low-income, and predominantly black neighborhoods and COVID-19 test positivity rate. The study highlights the importance of public health management during and after the current COVID-19 pandemic. Further work is warranted to fully understand the mechanisms by which these factors may have affected the positivity rate, either in terms of the true number of cases or access to testing.
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Affiliation(s)
- Richard S. Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, TX USA
- International Space University, Illkirch-Graffenstaden, France
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, TX USA
- International Space University, Illkirch-Graffenstaden, France
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Whittle RS, Diaz-Artiles A. An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City. BMC Med 2020; 18:271. [PMID: 32883276 DOI: 10.1101/2020.04.17.20069823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/04/2020] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND New York City was the first major urban center of the COVID-19 pandemic in the USA. Cases are clustered in the city, with certain neighborhoods experiencing more cases than others. We investigate whether potential socioeconomic factors can explain between-neighborhood variation in the COVID-19 test positivity rate. METHODS Data were collected from 177 Zip Code Tabulation Areas (ZCTA) in New York City (99.9% of the population). We fit multiple Bayesian Besag-York-Mollié (BYM) mixed models using positive COVID-19 tests as the outcome, a set of 11 representative demographic, economic, and health-care associated ZCTA-level parameters as potential predictors, and the total number of COVID-19 tests as the exposure. The BYM model includes both spatial and nonspatial random effects to account for clustering and overdispersion. RESULTS Multiple regression approaches indicated a consistent, statistically significant association between detected COVID-19 cases and dependent children (under 18 years old), population density, median household income, and race. In the final model, we found that an increase of only 5% in young population is associated with a 2.3% increase in COVID-19 positivity rate (95% confidence interval (CI) 0.4 to 4.2%, p=0.021). An increase of 10,000 people per km2 is associated with a 2.4% (95% CI 0.6 to 4.2%, p=0.011) increase in positivity rate. A decrease of $10,000 median household income is associated with a 1.6% (95% CI 0.7 to 2.4%, p<0.001) increase in COVID-19 positivity rate. With respect to race, a decrease of 10% in White population is associated with a 1.8% (95% CI 0.8 to 2.8%, p<0.001) increase in positivity rate, while an increase of 10% in Black population is associated with a 1.1% (95% CI 0.3 to 1.8%, p<0.001) increase in positivity rate. The percentage of Hispanic (p=0.718), Asian (p=0.966), or Other (p=0.588) populations were not statistically significant factors. CONCLUSIONS Our findings indicate associations between neighborhoods with a large dependent youth population, densely populated, low-income, and predominantly black neighborhoods and COVID-19 test positivity rate. The study highlights the importance of public health management during and after the current COVID-19 pandemic. Further work is warranted to fully understand the mechanisms by which these factors may have affected the positivity rate, either in terms of the true number of cases or access to testing.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, TX, USA.
- International Space University, Illkirch-Graffenstaden, France.
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, TX, USA
- International Space University, Illkirch-Graffenstaden, France
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Enablers and Barriers to Community Engagement in Public Health Emergency Preparedness: A Literature Review. J Community Health 2019; 43:412-420. [PMID: 28840421 PMCID: PMC5830497 DOI: 10.1007/s10900-017-0415-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Public health emergency preparedness (PHEP) all too often focusses only on institutional capabilities, including their technical expertise and political influence, while overlooking community capabilities. However, the success of institutional emergency preparedness plans depends upon communities and institutions working together to ensure successful anticipation, response and recovery. Broader community engagement is therefore recommended worldwide. This literature review was carried out to identify enablers and barriers to community and institutional synergies in emergency preparedness. Searches were undertaken across bibliographic databases and grey literature sources. The literature identified was qualitative in nature. A qualitative, ‘best fit’ framework approach using a pre-existing framework was used to analyse the literature, whereby themes were added and changed as analysis progressed. A working definition of community was identified, based on a ‘whole community’ approach, inclusive of the whole multitude of stakeholders including community residents and emergency management staff. Given the diversity in community make-up, the types of emergencies that could be faced, the socio-economic, environmental and political range of communities, there are no set practices that will be effective for all communities. The most effective way of engaging communities in emergency preparedness is context-dependent and the review did draw out some important key messages for institutions to consider.
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Belfroid E, Hautvast JLA, Hilbink M, Timen A, Hulscher MEJL. Selection of key recommendations for quality indicators describing good quality outbreak response. BMC Infect Dis 2015; 15:166. [PMID: 25888491 PMCID: PMC4397715 DOI: 10.1186/s12879-015-0896-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 09/30/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The performance of recommended control measures is necessary for quick and uniform infectious disease outbreak control. To assess whether these procedures are performed, a valid set of quality indicators (QIs) is required. The goal of this study was to select a set of key recommendations that can be systematically translated into QIs to measure the quality of infectious disease outbreak response from the perspective of disaster emergency responders and infectious disease control professionals. METHODS Applying the Rand modified Delphi procedure, the following steps were taken to systematically select a set of key recommendations: extraction of recommendations from relevant literature; appraisal of the recommendations in terms of relevance through questionnaires to experts; expert meeting to discuss recommendations; prioritization of recommendations through a second questionnaire; and final expert meeting to approve the selected set. Infectious disease physicians and nurses, policymakers and communication experts participated in the expert group (n=48). RESULTS In total, 54 national and international publications were systematically searched for recommendations, yielding over 200 recommendations. The Rand modified Delphi procedure resulted in a set of 65 key recommendations. The key recommendations were categorized into 10 domains describing the whole response pathway from outbreak recognition to aftercare. CONCLUSION This study provides a set of key recommendations that represents 'good quality of response to an infectious disease outbreak'. These key recommendations can be systematically translated into QIs. Organizations and professionals involved in outbreak control can use these QIs to monitor the quality of response to infectious disease outbreaks and to assess in which domains improvement is needed.
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Affiliation(s)
- Evelien Belfroid
- Radboud university medical center, Radboud Institute for Health Sciences, Academic Collaborative Centre AMPHI, Department of Primary and Community Care, PO box 9101, 6500 HB, Nijmegen, The Netherlands. .,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands. .,National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
| | - Jeannine L A Hautvast
- Radboud university medical center, Radboud Institute for Health Sciences, Academic Collaborative Centre AMPHI, Department of Primary and Community Care, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Mirrian Hilbink
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Aura Timen
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
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Pandemics and health equity: lessons learned from the H1N1 response in Los Angeles County. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 17:20-7. [PMID: 21135657 DOI: 10.1097/phh.0b013e3181ff2ad7] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pandemic preparedness and response (as with all public health actions) occur within a social, cultural, and historical context of preexisting health disparities and, in some populations, underlying mistrust in government. Almost 200,000 people received H1N1 vaccine at 109 free, public mass vaccination clinics operated by the Los Angeles County Department of Public Health between October 23, 2009, and December 8, 2009. Wide racial/ethnic disparities in vaccination rates were observed with African Americans having the lowest rate followed by whites. METHODOLOGY/PRINCIPAL FINDINGS Demographic information, including race/ethnicity, was obtained for 163 087 of the Los Angeles County residents who received vaccine. This information was compared with estimates of the Los Angeles County population distribution by race/ethnicity. Rate ratios of vaccination were as follows: white, reference; African American, 0.5; Asian, 3.2; Hispanic, 1.5; Native American, 1.9; and Pacific Islander, 4.3. SIGNIFICANCE Significant political challenges and media coverage focused on equity in vaccination access specifically in the African American population. An important challenge was community-level informal messaging that ran counter to the "official" messages. Finally, we present a partnership strategy, developed in response to the challenges, to improve outreach and build trust and engagement with African Americans in Los Angeles County.
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Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. PLOS CURRENTS 2012; 4:e5028b6037259a. [PMID: 23066520 PMCID: PMC3461970 DOI: 10.1371/5028b6037259a] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED BACKGROUND The World Health Organisation's (WHO) sixty-fourth World Health Assembly in May 2011 adopted a resolution on 'strengthening national health emergency and disaster management capacities and resilience of health systems'. Disaster management is a topical issue globally and countries are being encouraged to improve their disaster preparedness, along with growing international commitment to strengthening health systems. Lessons identified from disasters have not been effectively collated; essential experience is forgotten. METHODS This paper describes the analysis of the worldwide experience of disasters through a health systems approach. A systematic search of the core literature from January 2000 to November 2011 was conducted. Components drawn from the WHO's Global assessment of national health sector emergency preparedness and response baseline survey were combined with WHO's six health system building blocks (or levers) to act as the initial analysis anchors, with a further grounded theory qualitative analysis of the literature allowing the identification of emerging themes and insights. The priority areas identified by this literature review were then compared with the topics covered by the new expert-consensus-derived Toolkit for assessing health-system capacity for crisis management developed by the WHO Regional Office for Europe. FINDINGS 143 publications identified from a literature search were analysed and appraised. Themes and examples from the literature demonstrate how health system strengthening should contribute to disaster management. Priority areas under-represented in the WHO Toolkit and identified by the qualitative analysis are discussed. INTERPRETATION Collation and analysis of the disaster management literature identifies how health system strengthening can promote resilience and efficient recovery in the face of disasters. These findings support and complement the WHO Toolkit. Countries can use the literature evidence with the WHO Toolkit to assess their disaster management capacities and identify priorities for strengthening their health system. CITATION Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: A qualitative analysis of the core literature to complement the WHO Toolkit for assessing health-system capacity for crisis management. PLOS Currents Disasters. 2012 Aug 22. doi: 10.1371/5028b6037259a.
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Affiliation(s)
- Claire Bayntun
- WHO Collaborating Centre for Mass Gatherings and Extreme Events, Health Protection Agency, London
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Luckhaupt SE, Sweeney MH, Funk R, Calvert GM, Nowell M, D'Mello T, Reingold A, Meek J, Yousey-Hindes K, Arnold KE, Ryan P, Lynfield R, Morin C, Baumbach J, Zansky S, Bennett NM, Thomas A, Schaffner W, Jones T. Influenza-associated hospitalizations by industry, 2009-10 influenza season, United States. Emerg Infect Dis 2012; 18:556-62. [PMID: 22469504 PMCID: PMC3309704 DOI: 10.3201/eid1804.110337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Certain industries were overrepresented among employed adults with this disease.
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Affiliation(s)
- Sara E Luckhaupt
- Centers for Disease Control and Prevention, Cincinnati, Ohio 45226-1998, USA.
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Yip MP, Ong BN, Meischke HW, Feng SX, Calhoun R, Painter I, Tu SP. The role of self-efficacy in communication and emergency response in Chinese limited english proficiency (LEP) populations. Health Promot Pract 2011; 14:400-7. [PMID: 21460258 DOI: 10.1177/1524839911399427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Failure to engage in emergency preparedness, response, and recovery contributes to the differential outcome experienced by limited English proficiency (LEP) populations. Little is known about how psychosocial factors influence LEP individuals' perception of emergency and their process of understanding, collecting, and synthesizing information. The purpose of this exploratory study is to understand how LEP conceptualize an emergency situation to determine when help is needed. METHODS The authors conducted 4 focus groups with 36 adult Chinese LEP speakers living in Seattle. All discussions were audio-taped, translated, and transcribed. Coded text passages were entered into Atlas.ti for data management and model generation. RESULTS Perception of an emergency situation affects LEP individual's ability to manage the crisis. Self-efficacy may be an important psychological variable that positively shapes an individual's response to an emergency situation by improving their confidence to handle the crisis and ability to connect to resources. Response to emergency resulting from this series of information gathering, synthesis, and utilization may not always result in a positive outcome. DISCUSSION Self-efficacy in risk communication messages should be included to engage LEPs in emergency preparedness. Effective communication can increase LEPs' awareness of emergency situations and connecting LEP individuals with existing community resources may enhance LEPs' level of self-efficacy in emergencies.
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Affiliation(s)
- Mei Po Yip
- University of Washington, Seattle, WA, USA
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Natural history of pandemic H1N1 2009 influenza infection in healthy pediatric outpatients. Acad Pediatr 2011; 11:66-74. [PMID: 21272826 DOI: 10.1016/j.acap.2010.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 12/09/2010] [Accepted: 12/09/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The pandemic influenza H1N1 2009 (pH1N1) virus is expected to remain a prominent circulating strain in the current and subsequent influenza seasons. The objective of this study was to compare the clinical course of infection with laboratory-confirmed pH1N1 and seasonal influenza A and B in a cohort of previously healthy children managed in the outpatient setting without antiviral therapy. METHODS Previously healthy children 17 years of age or younger were prospectively enrolled during the first wave of the 2009 pandemic (May-July 2009) and the 2 preceding influenza seasons from a single primary care physician office and a tertiary children's hospital emergency department. Inclusion criteria were: age ≤17 years; laboratory-confirmed influenza; and not receiving antiviral agents. Follow-up telephone interviews were conducted approximately 2 days and 14 days after presentation to assess symptom duration. RESULTS A total of 251 patients (101 with pH1N1, 90 with seasonal influenza A, 60 with seasonal influenza B) were included. Presenting symptoms and duration of symptoms associated with pH1N1 were similar to those with seasonal influenza. Median fever duration in pH1N1 was 3 days and had resolved within 8 days in 95% of patients. Among patients with pH1N1, abnormalities on chest auscultation (10 of 101), the hospitalization rate (2 of 101), the proportion of children receiving intravenous fluid therapy (1 of 101) or supplemental oxygen (1 of 101) were not significantly different from patients with seasonal influenza. CONCLUSIONS In most children without underlying risk factors for severe influenza, pH1N1 virus causes an uncomplicated respiratory tract illness, no more severe than seasonal influenza.
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One more lesson from the pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2010; 17:1-3. [PMID: 21135654 DOI: 10.1097/phh.0b013e318209869e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES To determine the distribution of influenza vaccine coverage in the United States in 2008. DESIGN Cross-sectional analysis. SETTING The 2008 Behavioral Risk Factor Surveillance Survey, which employs random-digit dialing to interview noninstitutionalized adults in the United States and territories. PARTICIPANTS Two hundred forty-nine thousand seven hundred twenty-three persons aged 50 and older. MEASUREMENTS Participants were asked whether they had had an influenza vaccination during the previous 12 months. RESULTS In 2008, 42.0% of adults aged 50 to 64 and 69.5% of adults aged 65 and older reported receiving an influenza vaccination in the past 12 months. Vaccine coverage generally increased with advancing age (P<.001), higher levels of education (P<.001) and total household income (P<.001), and greater morbidity (P<.001). In participants aged 50 to 64, vaccine prevalence was lower in men (39.9%) than in women (44.1%; P<.001), although no significant differences were observed in older adults. Within each 5-year interval of age, non-Hispanic blacks and Hispanics had significantly lower vaccine prevalence than non-Hispanic whites (P<.001 for all comparisons). For participants aged 65 and older, non-Hispanic blacks and Hispanics were 56% (adjusted prevalence ratio (PR)=1.56, 95% confidence interval (CI)=1.48, 1.64) and 44% (adjusted PR=1.44, 95% CI=1.35, 1.54) more likely, respectively, to be unvaccinated than non-Hispanic whites, adjusting for age and sex. Racial and ethnic disparities in vaccine coverage narrowed with increasing number of diseases, although these disparities remained significant in older adults with two or more diseases (P<.05). CONCLUSION There were large disparities in influenza vaccine coverage in 2008, particularly across race and ethnicity and socioeconomic position. Accordingly, more targeted interventions are needed to improve vaccine delivery to disadvantaged segments of the U.S. population.
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Affiliation(s)
- Shauna T. Linn
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, NIH, Bethesda, Maryland
- Johns Hopkins University, Baltimore, Maryland
| | - Jack M. Guralnik
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, NIH, Bethesda, Maryland
| | - Kushang V. Patel
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, NIH, Bethesda, Maryland
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Hutchins SS, Truman BI, Merlin TL, Redd SC. Protecting vulnerable populations from pandemic influenza in the United States: a strategic imperative. Am J Public Health 2009; 99 Suppl 2:S243-8. [PMID: 19797737 PMCID: PMC4504371 DOI: 10.2105/ajph.2009.164814] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2009] [Indexed: 11/04/2022]
Abstract
Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations.
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Affiliation(s)
- Sonja S Hutchins
- Office of Minority Health and Health Disparities, Office of the Chief of Public Health Practice, Office of the Director, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-67, Atlanta, GA 30333, USA.
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Hutchins SS, Fiscella K, Levine RS, Ompad DC, McDonald M. Protection of racial/ethnic minority populations during an influenza pandemic. Am J Public Health 2009; 99 Suppl 2:S261-70. [PMID: 19797739 PMCID: PMC4504373 DOI: 10.2105/ajph.2009.161505] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2009] [Indexed: 11/04/2022]
Abstract
Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic interventions. Implementation of pandemic interventions could be optimized by (1) culturally competent preparedness and response that address specific needs of racial/ethnic minority populations, (2) improvements in public health and community health safety net systems, (3) social policies that minimize economic burdens and improve compliance with isolation and quarantine, and (4) relevant, practical, and culturally and linguistically tailored communications.
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Affiliation(s)
- Sonja S Hutchins
- Office of Minority Health and Health Disparities, Office of the Chief of Public Health Practice, Office of the Director, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-67, Atlanta, GA 30333, USA.
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