[Impact of COVID-19 on Japanese municipal public health nurses and public health practices related to communication with community residents]

Objective　This study analyzed the impact of COVID-19 on municipal public health nurses and public health practices related to communication with community residents.Method　A self-administered questionnaire survey targeted 474 public health nurses working in 40 municipalities in Japan's Aomori Prefecture. Participants were asked about the following basic attributes: whether they provided care for people who were COVID-19 positive or were in close contact with infected people; physical or mental impacts; how each work area was impacted; how mask-wearing affected their communication with community residents; positive and negative aspects of current infection-control measures; how they communicated and shared information with residents as they provided care; challenges and initiatives; and creative work efforts. We conducted the survey from September 23 to October 7, 2020, and analyzed the data using SPSS and KH Coder.Results　We received 228 responses (48.1% valid responses); 11.4% reported that they provided care or were in close contact with people who were COVID-19 positive. At least 60% of respondents had been impacted mentally. Mask-wearing hindered communication with community residents, however, it did not significantly impact trust-building. COVID-19 measures had a positive impact on respondents' public health work as infection-prevention awareness increased and infection-control measures advanced. Meetings, including online conferences, became more efficient, and nurses had opportunities to reexamine their work performance. Negative consequences included weakened communication with residents, slander against infected people, increased stress among residents, repercussions from not going out, and difficulty implementing necessary public health services. Most of the interaction, information sharing, and support for residents were carried out over the phone. Responses regarding new challenges and initiatives were classified into six categories: public health services that consider infection-control measures; various preventive measures; efforts to establish new lifestyles; review of methods for conducting group-health check-ups; review of operations and implementation of creative efforts in providing health guidance; and review of meetings, training sessions, and online conferences.Conclusion　The survey revealed that COVID-19 affected most public health nurses mentally. Challenges in providing in-person care were reported. Nurses faced significant obstacles communicating with residents; however, they reported that services incorporating infection-control measures were progressively gaining traction. Nurses are exploring new communication methods based on established community trust. Furthermore, it is necessary to explore public health services that fulfill both the current and future community requirements.

Canadian Cancer Centre Response to COVID-19 Pandemic: A National and Provincial Response

Background: COVID-19 has spread rapidly, requiring health delivery systems to undertake dramatic transformations. To evaluate these system changes, we undertook one of the first Canadian health delivery system reviews and the first Canadian cancer centre evaluation of pandemic system modifications. Methods: Questionnaires were distributed to the Canadian Association of Provincial Cancer Agencies (CAPCA) members in order to assess changes to cancer centre services and patient management. Documentation relating to COVID-19 from the CAPCA electronic space was accessed, and all publicly available cancer centre documentation related to COVID-19 was reviewed. Results: Seven provinces completed the questionnaire and had documentation available from the CAPCA electronic space. All screening programs across Canada were suspended. In most provinces surveyed, ≥50% of outpatient appointments were occurring virtually, with <25% using video platforms. Generally, the impact on diagnostic imaging and new patient referrals correlated with the impact of COVID-19. Most provinces had a reduction in operating room availability, with chemotherapy and radiation treatments continuing. Public health modification, including personal protective equipment and screening staff, varied across the country. Conclusion: Canadian cancer centres underwent a rapid and aggressive transformation of services in response to COVID-19, with many similarities and differences across provinces. In part, this response was facilitated by communication under a national association, which in Canada remains unique to cancer. This response may serve to inform changes in other jurisdictions or disease states now and in future waves of the pandemic, as well as a record of changes for future health services and patient outcome research.

Adapting a health equity tool to meet professional needs (Québec, Canada)

While numerous tools are available to better incorporate equity into population health actions, they are limited mainly by their lack of adaptation to professional practices and organizational realities. A study was conducted in Québec to identify and understand, from the perspective of future users, conditions that would facilitate use of a tool (Reflex-ISS) targeted at supporting collaborative action to improve consideration of social inequalities in health (SIH) within population health actions. Concept mapping and focus groups were implemented as complementary methods for investigating the conditions. Significant results that emerged were strong participant interest in the tool and the need for resources to better take SIH into account. The conditions for use that were identified referred to the tool itself (user-friendliness and literacy) and to resources for appropriating the tool, competency development, as well as the role and responsibilities of organizations and policies in promoting use of the tool in daily activities and more fundamentally in acting against SIH in general. Models for organizational innovation give an idea of the dimensions that need to be considered to strengthen the integration of equity into organizations and to support the changes in practice that result from using the tool. They provide a reminder that a health equity tool cannot be the cornerstone of an organizational strategy to fight against SIH; rather, it must be incorporated as part of a systemic strategy of professional and organizational development.

Mass-gathering Events: The Public Health Challenge of the Kumbh Mela 2013

Mass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of unsanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.