Cancer risk factors and access to cancer prevention services for people experiencing homelessness.

Cancer is one of the most pressing global health issues, and populations with complex needs, such as people experiencing homelessness, have higher cancer incidence and mortality rates compared with the housed population. We mapped the evidence on cancer risk factors as well as barriers and facilitators to cancer prevention services among people experiencing homelessness, which is key to localising research gaps and identifying strategies for tailored interventions adapted to people experiencing homelessness. The results of 40 studies contribute to an understanding of the dynamic, interactive factors at different levels that determine access to cancer prevention services: socioeconomic, psychological, and physical factors (individual level); practical support and relational loops between health-care providers and people experiencing homelessness (interpersonal level); housing and regular medical care (system level); and interventions to facilitate access to cancer prevention (policy level). Furthermore, studies reported higher prevalence of various cancer-associated risk factors among people experiencing homelessness with the most common being tobacco use, ranging from 26% to 73%. The results show the importance of interventions to facilitate cancer prevention services through social support and low-threshold interventions (eg, navigation programmes), and training health-care staff in creating supportive and trusting environments that increase the likelihood of the continuity of care among people experiencing homelessness.

Cancer risk factors and access to cancer prevention services for people experiencing homelessness: a scoping review protocol.

INTRODUCTION: Homelessness is a complex social issue that significantly impairs the health of those affected. People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes, including premature mortality, compared with the general population, with cancer being the second-leading cause of death. The objective of this scoping review is to map the evidence to assess the exposure of PEH to known cancer risk factors and identify barriers and facilitators PEH experience in accessing cancer prevention services. METHODS AND ANALYSIS: This scoping review will be conducted in line with the Joanna Briggs Institute guidelines for scoping reviews. For a time window from the date of database establishment until 20 February 2023, the research team will create a detailed search strategy and apply it to the following databases: CINAHL, Embase, Global Index Medicus, PubMed, Scopus and Web of Science. In addition, we will search OpenGrey and Google for grey literature and contact non-governmental organisations to request relevant reports. In the first stage, eligibility criteria will be assessed through a blinded title/abstract assessment, and following this assessment, a full-text screening will be performed. Subsequently, the research team will perform the data extraction and synthesise all relevant information in relation to the scoping review question. ETHICS AND DISSEMINATION: As this protocol does not involve gathering primary data, ethical approval is not necessary. The results of this review will be published in a peer-reviewed journal and on institutional websites.

SARS-CoV-2 infections in "less visible" hospital staff: The roles and safety of environmental services and allied health professionals.

BACKGROUND: During the early SARS-CoV-2 pandemic, all healthcare workers had specific and essential functions. However, environmental services (e.g., cleaning staff) and allied health professionals (e.g., physiotherapists) are often less recognised inpatient care. The aim of our study was to evaluate SARS-CoV-2-infection rates and describe risk factors relevant to workplace transmission and occupational safety amongst healthcare workers in COVID-19 hospitals before the introduction of SARS-CoV-2-specific vaccines. METHODS: This cross-sectional study (from May 2020 to March 2021, standardised WHO early-investigation protocol) is evaluating workplace or health-related data, COVID-19-patient proximity, personal protective equipment (PPE) use, and adherence to infection prevention and control (IPC) measures, anti-SARS-CoV-2-antibody status, and transmission pathways. RESULTS: Out of n = 221 HCW (n = 189 cleaning/service staff; n = 32 allied health professionals), n = 17 (7.7 %) were seropositive. While even SARS-CoV-2-naïve HCW reported SARS-CoV-2-related symptoms, airway symptoms, loss of smell or taste, and appetite were the most specific for a SARS-CoV-2-infection. Adherence to IPC (98.6 %) and recommended PPE use (98.2 %) were high and not associated with seropositivity. In 70.6 %, transmission occurred in private settings; in 23.5 %, at the workplace (by interaction with SARS-CoV-2-positive colleagues [17.6 %] or patient contact [5.9 %]), or remained unclear (one case). CONCLUSIONS: Infection rates were higher in all assessed 'less visible' healthcare-worker groups compared to the general population. Our data indicates that, while IPC measures and PPE may have contributed to the prevention of patient-to-healthcare-worker transmissions, infections were commonly acquired outside of work and transmitted between healthcare workers within the hospital. This finding emphasises the importance of ongoing education on transmission prevention and regular infection screenings at work.

The Association of Time of Day of ChAdOx1 nCoV-19 Vaccine Administration With SARS-CoV-2 Anti-Spike IgG Antibody Levels: An Exploratory Observational Study.

Data from human and animal studies are highly suggestive of an influence of time of day of vaccine administration on host immune responses. In this population-based study, we aimed to investigate the effect of time of day of administration of a COVID-19 vector vaccine, ChAdOx1 nCoV-19 (AstraZeneca), on SARS-CoV-2 anti-spike S1 immunoglobulin (IgG) levels. Participants were 803 university employees who received their first vaccine dose in March 2021, had serology data at baseline and at 3 weeks, and were seronegative at baseline. Antibody levels were determined in binding antibody units (BAU/mL) using enzyme-linked immunosorbent assay (ELISA). Generalized additive models (GAM) and linear regression were used to evaluate the association of time of day of vaccination continuously and in hourly bins with antibody levels at 3 weeks. Participants had a mean age of 42 years (SD: 12; range: 21-74) and 60% were female. Time of day of vaccination was associated non-linearly ("reverse J-shape") with antibody levels. Morning vaccination was associated with the highest (9:00-10:00 h: mean 292.1 BAU/mL; SD: 262.1), early afternoon vaccination with the lowest (12:00-13:00 h: mean 217.3 BAU/mL; SD: 153.6), and late afternoon vaccination with intermediate (14:00-15:00 h: mean 280.7 BAU/mL; SD: 262.4) antibody levels. Antibody levels induced by 12:00-13:00 h vaccination (but not other time intervals) were significantly lower compared to 9:00-10:00 h vaccination after adjusting for potential confounders (beta coefficient = -75.8, 95% confidence interval [CI] = -131.3, -20.4). Our findings show that time of day of vaccination against SARS-CoV-2 has an impact on the magnitude of IgG antibody levels at 3 weeks. Whether this difference persists after booster vaccine doses and whether it influences the level of protection against COVID-19 needs further evaluation.

Vulnerability and One Health assessment approaches for infectious threats from a social science perspective: a systematic scoping review.

Vulnerability assessments identify vulnerable groups and can promote effective community engagement in responding to and mitigating destabilising events. This scoping review maps assessments for local-level vulnerabilities in the context of infectious threats. We searched various databases for articles written between 1978 and 2019. Eligible documents assessed local-level vulnerability, focusing on infectious threats and antimicrobial resistance. Since few studies provided this dual focus, we included tools from climate change and disaster risk reduction literature that engaged the community in the assessment. We considered studies using a One Health approach as essential for identifying vulnerability risk factors for zoonotic disease affecting humans. Of the 5390 records, we selected 36 articles for review. This scoping review fills a gap regarding vulnerability assessments by combining insights from various approaches: local-level understandings of vulnerability involving community perspectives; studies of social and ecological factors relevant to exposure; and integrated quantitative and qualitative methods that make generalisations based on direct observation. The findings inform the development of new tools to identify vulnerabilities and their relation to social and natural environments.

Occupational challenges of healthcare workers during the COVID-19 pandemic: a qualitative study.

OBJECTIVES: To address structural determinants and healthcare workers' (HCWs) physical, mental, emotional and professional challenges of working during the COVID-19 pandemic. DESIGN: Exploratory qualitative study with semistructured interviews. Collected data were analysed using thematic analysis. SETTING: This qualitative study was undertaken with HCWs who mainly worked in intensive care units in six non-profit hospitals in Vienna, Austria. Data were collected from June 2020 to January 2021. PARTICIPANTS: A total of 30 HCWs (13 medical doctors, 11 qualified nursing staff, 2 nurse assistants, 2 physiotherapists and 2 technical/cleaning staff) who were in direct and indirect contact with patients with COVID-19 were included. RESULTS: Three overall themes resulted as relevant: challenges due to lack of preparedness, structural conditions, and physical and mental health of HCWs. Lack of preparedness included delayed infection prevention and control (IPC) guidelines, shortages of personal protective equipment combined with staff shortages (especially of nursing staff) and overworked personnel. Physical and mental strains resulted from HCWs being overworked and working permanently on alert to face medical uncertainties and the critical conditions of patients. HCWs lacked recognition on multiple levels and dealt with stigma and avoidance behaviour of colleagues. CONCLUSION: To mitigate HCWs' occupational health risks and staff turnover, we propose context-specific recommendations. The number of available essential workers in care of patients with COVID-19, especially nursing staff, should be carefully planned and increased to avert chronic work overload. Timely training and education in IPC for all HCWs is important. Providing supportive supervision is as essential as appropriate recognition by higher level management and the public.

Vulnerability assessment tools for infectious threats and antimicrobial resistance: a scoping review protocol.

INTRODUCTION: This protocol will guide and explain the working process of a systematic scoping review on vulnerability assessment tools in the field of infectious disease outbreaks and antimicrobial resistance (AMR) crises. The scoping review will appraise existing tools or methodologies to identify local level vulnerabilities in the context of infectious disease outbreaks and AMR. Due to this focus on infectious threats and AMR, the review also considers articles using a 'One Health' approach to assess the vulnerability of individuals, groups and practices in human-animal-environment interactions. Given the broad nature of vulnerability, we aim to allocate studies discerning the process of identifying vulnerable or at-risk groups during a crisis, instead of studies taking vulnerability only as a starting point. Because considerable research has been conducted on vulnerability, disasters and climate change, we will also assemble tools developed from these fields. To our knowledge, this is the first planned systematic scoping review of vulnerability assessment tools for disease outbreaks and AMR, taking into account practices at the human-animal-environment interface that can lead to increased risk of exposure of individuals to infections, pathogen spillovers or epidemics. METHODS AND ANALYSIS: To develop the protocol, we used the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist (PRISMA-P 2015) in compliance with the PRISMA Extension for Scoping Reviews Explanation and Elaboration. With the assistance of an experienced research librarian, we developed the search strategy, which targeted the following databases: Medline, Global Health database, Web of Science and Embase. A second strategy was developed for Epistemonikos, African Journals Online and Global Index Medicus because these databases do not provide the infrastructure for an advanced search. We consider studies published between 1978 and 2019 and include articles, book chapters, websites and grey literature from selected non-governmental organisations and non-profit organisations working in the health field. We contact them directly regarding whether they are working with or have developed a vulnerability assessment tool. To address the dynamic nature of our investigation, we develop a flow diagram which we continually update to reflect the selection process. Two reviewers (MJ and LL) independently screen the literature and resolve conflicts through discussion rounds. Data extraction will be conducted by four researchers (MJ, LL, EJ and RK) through inductive and deductive coding. Extracted data will be systematically compared and divergences highlighted. ETHICS AND DISSEMINATION: Ethical approval is not required because this study does not involve collection of primary data. The purpose of this review is to disseminate a catalogue of vulnerability assessment tools and a brief summary of key results and recommendations for SoNAR-Global partners in Bangladesh, Ukraine and Uganda. The catalogue will be made publicly available. On the basis of our results, SoNAR-Global partners will pilot one of these tools.