European Surveillance and History of the COVID-19 Pandemic: Updated Epidemiological Assessment.

BACKGROUND: COVID-19 surveillance plays a crucial role in monitoring the pandemic's progression and comprehending its impact on diverse regions. In this study, we build upon our initial research published in 2020 by incorporating an additional two years of data for Europe. We assess whether COVID-19 had shifted from pandemic to endemic in the region when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. OBJECTIVE: First, we measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provide the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. METHODS: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study Post et al. (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a one-sided t-test for whether regional weekly speed was greater than an outbreak threshold of ten. We ran the test iteratively with six months of data across the sample period. RESULTS: Speed for the region had remained below the outbreak threshold for four months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1- and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively). The shift parameters for the two weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December of 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t-test of speed equal to ten became insignificant for the first time in April 2023. CONCLUSIONS: While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for four months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggest COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer pandemic in Europe at the time is unclear.

Documentation of Screening for Firearm Access by Healthcare Providers in the Veterans Healthcare System: A Retrospective Study.

INTRODUCTION: Presence of a firearm is associated with increased risk of violence and suicide. United States military veterans are at disproportionate risk of suicide. Routine healthcare provider screening of firearm access may prompt counseling on safe storage and handling of firearms. The objective of this study was to determine the frequency with which Veterans Health Administration (VHA) healthcare providers document firearm access in electronic health record (EHR) clinical notes, and whether this varied by patient characteristics. METHODS: The study sample is a post-9-11 cohort of veterans in their first year of VHA care, with at least one outpatient care visit between 2012-2017 (N = 762,953). Demographic data, veteran military service characteristics, and clinical comorbidities were obtained from VHA EHR. We extracted clinical notes for outpatient visits to primary, urgent, or emergency clinics (total 105,316,004). Natural language processing and machine learning (ML) approaches were used to identify documentation of firearm access. A taxonomy of firearm terms was identified and manually annotated with text anchored by these terms, and then trained the ML algorithm. The random-forest algorithm achieved 81.9% accuracy in identifying documentation of firearm access. RESULTS: The proportion of patients with EHR-documented access to one or more firearms during their first year of care in the VHA was relatively low and varied by patient characteristics. Men had significantly higher documentation of firearms than women (9.8% vs 7.1%; P < .001) and veterans >50 years old had the lowest (6.5%). Among veterans with any firearm term present, only 24.4% were classified as positive for access to a firearm (24.7% of men and 20.9% of women). CONCLUSION: Natural language processing can identify documentation of access to firearms in clinical notes with acceptable accuracy, but there is a need for investigation into facilitators and barriers for providers and veterans to improve a systemwide process of firearm access screening. Screening, regardless of race/ethnicity, gender, and age, provides additional opportunities to protect veterans from self-harm and violence.

The Interplay Between Policy and COVID-19 Outbreaks in South Asia: Longitudinal Trend Analysis of Surveillance Data.

BACKGROUND: COVID-19 transmission rates in South Asia initially were under control when governments implemented health policies aimed at controlling the pandemic such as quarantines, travel bans, and border, business, and school closures. Governments have since relaxed public health restrictions, which resulted in significant outbreaks, shifting the global epicenter of COVID-19 to India. Ongoing systematic public health surveillance of the COVID-19 pandemic is needed to inform disease prevention policy to re-establish control over the pandemic within South Asia. OBJECTIVE: This study aimed to inform public health leaders about the state of the COVID-19 pandemic, how South Asia displays differences within and among countries and other global regions, and where immediate action is needed to control the outbreaks. METHODS: We extracted COVID-19 data spanning 62 days from public health registries and calculated traditional and enhanced surveillance metrics. We use an empirical difference equation to measure the daily number of cases in South Asia as a function of the prior number of cases, the level of testing, and weekly shifts in variables with a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Traditional surveillance metrics indicate that South Asian countries have an alarming outbreak, with India leading the region with 310,310 new daily cases in accordance with the 7-day moving average. Enhanced surveillance indicates that while Pakistan and Bangladesh still have a high daily number of new COVID-19 cases (n=4819 and n=3878, respectively), their speed of new infections declined from April 12-25, 2021, from 2.28 to 2.18 and 3.15 to 2.35 daily new infections per 100,000 population, respectively, which suggests that their outbreaks are decreasing and that these countries are headed in the right direction. In contrast, India's speed of new infections per 100,000 population increased by 52% during the same period from 14.79 to 22.49 new cases per day per 100,000 population, which constitutes an increased outbreak. CONCLUSIONS: Relaxation of public health restrictions and the spread of novel variants fueled the second wave of the COVID-19 pandemic in South Asia. Public health surveillance indicates that shifts in policy and the spread of new variants correlate with a drastic expansion in the pandemic, requiring immediate action to mitigate the spread of COVID-19. Surveillance is needed to inform leaders whether policies help control the pandemic.

Adolescent Firearm Homicides in Chicago, 2013-2017.

PURPOSE: This study aims to describe how firearm homicides among adolescents change over a five-year period. METHODS: This serial cross-sectional analysis uses surveillance data collected by the Illinois Violent Death Reporting System. Decedent selection criteria included the following: manner of death was homicide, weapon type was firearm, age was 15-19 years, and location of fatal injury was Chicago. Data collected between 2013 and 2017 were used. Multiyear rates per 100,000 and rate ratios were calculated by sex and race/ethnicity. Joinpoint regression analysis and chi-squared tests of linear-by-linear association were used to identify trends over time (by year, month, and weekday). Geographic Information System mapping was used to visualize data. RESULTS: There were 509 victims of firearm homicide aged 15-19 years in Chicago between 2013 and 2017. Overall rates were significantly higher in 2016 than in all other years. Victims were disproportionately black males, comprising 75.6% of total adolescent homicides and increasing by 87.8% across the five years. The rate ratio for black males versus all other adolescents peaked in 2015 at 19.4 (95% confidence interval, 10.9-34.6). For black males, the percentage of fatal injuries occurring on Saturdays and Sundays decreased significantly (p = .048). Among all victims, firearm deaths became less dispersed throughout Chicago, and "hot spots" shifted from the South Side to the West Side. CONCLUSIONS: Adolescent firearm homicides are increasing over time, however, in Chicago, a more accurate narrative would portray their consolidation with regard to spatial and racial/ethnic variances across the city. Such analyses define Chicago's firearm homicide epidemic and can shape targeted and effective interventions.

Management of Atopic Dermatitis in Children Younger Than Two Years of Age by Community Pediatricians: A Survey and Chart Review.

OBJECTIVES: To characterize primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children <2 years old and determine the need for AD guidelines for PCPs focused on this age group. STUDY DESIGN: This is a mixed-methods study consisting of a survey and a retrospective medical record review of PCP practices in the Chicago metropolitan area. The survey was analyzed using both quantitative and qualitative methods. RESULTS: In the survey (n = 52 respondents), PCPs reported management of AD is different in children <2 years compared with older children (88%). They were more likely to refer to a specialist (65%) and less likely to use high-potency topical corticosteroids (64%). In the chart review, PCP visits for children 2-5 years old (n = 50 914) vs those <2 years old (n = 71 913) for AD, older children had medium- and high-potency topical corticosteroids prescribed more frequently than younger children (0.66% vs 0.37%, P < .01 and .15% vs 0.05%, P < .01, respectively). In the subset of children <2 years of age who also were evaluated by a specialist (n = 109), medium- and high-potency topical corticosteroids were prescribed disproportionately at visits to providers in dermatology (57%) vs allergy (30%) vs pediatrics (15%) (P < .01). PCPs suggested that guidelines for this age group should include recommendations for preferred corticosteroids (39%), allergy management (35%), referral criteria (22%), and assessment of disease severity (11%). CONCLUSIONS: PCP management of AD in children <2 years is different from older children, with possible underuse of medium/high-potency topical corticosteroids. Clear guidelines for this age group are needed.

Physical activity of fifth to sixth graders during school hours according to school race/ethnicity: Suburban Cook County, Illinois.

BACKGROUND: We compared moderate-to-vigorous intensity physical activity (MVPA) and inactivity levels among fifth and sixth graders during school hours according to school-level race/ethnicity and income attributes to inform school-based obesity interventions in Illinois Suburban Cook County (SCC). METHODS: Fifth- and sixth-grade students (N = 591) in 14 SCC public schools were asked to wear an accelerometer during school hours for 4 consecutive school days. School-level race/ethnicity was assigned based on the majority (≥ 70%) race/ethnicity of the student population: white (N = 4), black (N = 2), Hispanic (N = 5), or "mixed" (N = 3). All minority schools (N = 7) fell within a low-income category. RESULTS: A total of 538 students (91%) had valid accelerometry data. Average MVPA time during school hours was 20 minutes/day for boys and 11 minutes/day for girls. Multilevel linear regression models showed that compared to peers in white schools, boys, and girls in Hispanic schools engaged in 14 and 10 minutes less MVPA, respectively (p < .01). Girls in black and Hispanic schools had greater inactivity time than girls in white schools (p < .01). CONCLUSIONS: Objectively measured physical activity (PA) data support the need for school-level PA interventions during school hours, particularly in predominantly Hispanic schools.

Working with community partners to implement and evaluate the Chicago Park District's 100% Healthier Snack Vending Initiative.

BACKGROUND: The objective of this case study was to evaluate the acceptability, sales impact, and implementation barriers for the Chicago Park District's 100% Healthier Snack Vending Initiative to strengthen and support future healthful vending efforts. COMMUNITY CONTEXT: The Chicago Park District is the largest municipal park system in the United States, serving almost 200,000 children annually through after-school and summer programs. Chicago is one of the first US cities to improve park food environments through more healthful snack vending. METHODS: A community-based participatory evaluation engaged community and academic partners, who shared in all aspects of the research. From spring 2011 to fall 2012, we collected data through observation, surveys, and interviews on staff and patron acceptance of snack vending items, purchasing behaviors, and machine operations at a sample of 10 Chicago parks. A new snack vending contract included nutrition standards for serving sizes, calories, sugar, fat, and sodium for all items. Fifteen months of snack vending sales data were collected from all 98 snack vending machines in park field houses. OUTCOMES: Staff (100%) and patrons (88%) reacted positively to the initiative. Average monthly per-machine sales increased during 15 months ($84 to $371). Vendor compliance issues included stocking noncompliant items and delayed restocking. INTERPRETATION: The initiative resulted in improved park food environments. Diverse partner engagement, participatory evaluation, and early attention to compliance can be important supports for healthful vending initiatives. Consumer acceptance and increasing revenues can help to counter fears of revenue loss that can pose barriers to adoption.

Partnering with community institutions to increase access to healthful foods across municipalities.

BACKGROUND: Low-income and minority communities have higher rates of nutrition-related chronic diseases than do high-income and nonminority communities and often have reduced availability to healthful foods. Corner store initiatives have been proposed as a strategy to improve access to healthful foods in these communities, yet few studies evaluating these initiatives have been published. COMMUNITY CONTEXT: Suburban Cook County, Illinois, encompasses 125 municipalities with a population of more than 2 million. From 2000 through 2009, the percentage of low-income suburban Cook County residents increased 41%; African-American populations increased 20%, and Hispanic populations increased 44%. A 2012 report found that access to stores selling healthful foods was low in several areas of the county. METHODS: Beginning in March 2011, the Cook County Department of Public Health recruited community institutions (ie, local governments, nonprofit organizations, faith-based institutions) who recruited corner stores to participate in the initiative. Corner stores were asked to add new, healthful foods (May-June 2011) to become eligible to receive new equipment, marketing materials, and enhanced community outreach (July 2011-February 2012). OUTCOMES: Nine community institutions participated. Of the 53 corner stores approached, 25 (47%) participated in the trial phase, which included offering 6 healthful foods in their stores. Of those, 21 (84%) completed the conversion phase, which included expansion of healthful foods through additional equipment and marketing and promotional activities. INTERPRETATION: Community institutions can play a key role in identifying and engaging corner stores across jurisdictions that are willing and able to implement a retail environment initiative to improve access to healthful foods in their communities.

"I know what CBPR is, now what do i do?": Community perspectives on CBPR capacity building.

BACKGROUND: Community-based participatory research (CBPR) offers a promising approach for combating health disparities. CBPR capacity must be developed among academics and communities. Most published CBPR capacity development work focuses on general guidance or individual partnership development. OBJECTIVES: Herein we have reported community perspectives on community capacity-building efforts involving multiple community partners, including capacity-building outcomes and identification of facilitators and challenges. METHODS: We have presented a case study using qualitative and quantitative data from community-based organization (CBO) members of a committee guiding a university-based CBPR initiative. A survey measuring 11 CBPR capacity domains was fielded at two points. Three rounds of interviews were conducted. RESULTS: Community CBPR capacity increased over time, although there remains room for improvement. Leader commitment, CBPR resources, and hands-on CBPR experiences were identified as key facilitators. Resource limitations, difficulty integrating CBPR into organizational operations, lack of specific information, and institutional inequities were identified as challenges. Recommendations offered include continued and expanded support for sharing/co-learning with academic partners and capacity-building activities and services. CONCLUSIONS: Results will inform future efforts and contribute to the understanding of capacity-building outcomes for initiatives supporting multiple CBPR partnerships.

A novel program trains community-academic teams to build research and partnership capacity.

The Community-Engaged Research Team Support (CERTS) program was developed and tested to build research and partnership capacity for community-engaged research (CEnR) teams. Led by the Northwestern University Clinical and Translational Sciences Institute (NUCATS), the goals of CERTS were: (1) to help community-academic teams build capacity for conducting rigorous CEnR and (2) to support teams as they prepare federal grant proposal drafts. The program was guided by an advisory committee of community and clinical partners, and representatives from Chicago's Clinical and Translational Science Institutes. Monthly workshops guided teams to write elements of NIH-style research proposals. Draft reviewing fostered a collaborative learning environment and helped teams develop equal partnerships. The program culminated in a mock-proposal review. All teams clarified their research and acquired new knowledge about the preparation of NIH-style proposals. Trust, partnership collaboration, and a structured writing strategy were assets of the CERTS approach. CERTS also uncovered gaps in resources and preparedness for teams to be competitive for federally funded grants. Areas of need include experience as principal investigators, publications on study results, mentoring, institutional infrastructure, and dedicated time for research.

Learning from state surveillance of childhood obesity.

Data on childhood obesity collected by the Centers for Disease Control and Prevention helped reveal the nation's epidemic of overweight and obese children. But more information is needed. Collecting body mass index (BMI)-the widely accepted measurement of childhood weight status-at the state and local levels can be instrumental in identifying and tracking obesity trends, designing interventions to help overweight children, and guiding broader policy solutions. Approximately thirty states have enacted or proposed BMI surveillance laws and regulations. Arkansas stands out as the state with the highest-quality surveillance data. Innovative strategies being pursued in a number of other states should be explored for broader dissemination.

Measuring food availability and access in African-American communities: implications for intervention and policy.

Obesity is a major public health concern in the U.S. As compared to whites, minority populations are disproportionately at risk, with the highest prevalence rates of overweight and obesity occurring among African American women. Although researchers and policymakers argue that environmental approaches have the greatest potential to reverse the rising prevalence of obesity, critical gaps remain in our understanding of the complex mechanisms that underlie the associations between neighborhood food environments and weight status. A major challenge has been the need for reliable and valid measures to assess aspects of the neighborhood food environment that encourage or inhibit healthful eating behaviors and weight management. Investigators have made considerable gains in the development of tools and approaches to measure neighborhood food environments overall, but few studies focus on the specific challenges and issues associated with characterizing neighborhood food environments in communities of color. This paper highlights important considerations for measuring food environments in African-American neighborhoods and their implications for developing programmatic and policy solutions to reduce racial disparities in overweight.