Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review.

BACKGROUND: The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups). OBJECTIVE: We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance. METHODS: Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. RESULTS: We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability. CONCLUSIONS: A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-https://doi.org/10.1136/bmjopen-2021-053962.

The social organization of opioid policies and their implications for people with chronic pain and clinicians: An institutional ethnography.

BACKGROUND: Opioid use and related harms have been of growing concern in North America and elsewhere. In Canada, while policies and programs intended to mitigate opioid-related harms have been introduced by public health agencies, the medical profession, and different levels of government, there remains a paucity of evidence regarding the unintended consequences of these initiatives, including their impacts on people with chronic pain, a population often treated with opioids. METHODS: This institutional ethnography investigated how opioid-related policies and programs are developed, deployed, and translated into practice in Ontario, Canada. Semi-structured interviews were conducted with people with chronic pain and practitioners to trace the institutional relations organizing opioid prescribing and use. Data analysis proceeded through an iterative process of identifying and mapping social relations, as well as textual analysis. RESULTS: Participants identified two policies that have been particularly impactful for people with chronic pain and clinicians: Ontario's Narcotics Monitoring System and the 2017 Guideline for Opioids for Chronic Non-Cancer Pain. Both interventions have contributed to fear among physicians that they will be investigated and disciplined by their licensing college for 'overprescribing' opioids. In the face of pressure to adhere to more conservative opioid prescribing practices, physicians have taken up strategies including rapidly tapering patients' doses and refusing to prescribe opioids. These changing work practices have had significant repercussions for people with chronic pain, such as increased pain, reduced quality of life, greater risks of harm, and the erosion of the physician-patient relationship. CONCLUSIONS: Policies intended to mitigate opioid-related harms by reducing the number of opioids prescribed have had repercussions for people with chronic pain and for practitioners. There is an urgent need to investigate the unintended and unanticipated impacts of drug policies, which may only be uncovered through explorations of people's everyday lives and experiences.

An investigation of media reports of digital surveillance within the first year of the COVID-19 pandemic.

Introduction: The COVID-19 pandemic prompted a surge in digital public health surveillance worldwide, with limited opportunities to consider the effectiveness or impact of digital surveillance. The news media shape public understanding of topics of importance, contributing to our perception of priority issues. This study investigated news media reports published during the first year of the pandemic to understand how the use and consequences of digital surveillance technologies were reported on. Methods: A media content analysis of 34 high- to low-income countries was completed. The terms "COVID-19," "surveillance," "technologies," and "public health" were used to retrieve and inductively code media reports. Results: Of the 1,001 reports, most were web-based or newspaper sources on the development and deployment of technologies directed at contact tracing, enforcing quarantine, predicting disease spread, and allocating resources. Technology types included mobile apps, wearable devices, "smart" thermometers, GPS/Bluetooth, facial recognition, and security cameras. Repurposed data from social media, travel cards/passports, and consumer purchases also provided surveillance insight. Media reports focused on factors impacting surveillance success (public participation and data validity) and the emerging consequences of digital surveillance on human rights, function creep, data security, and trust. Discussion: Diverse digital technologies were developed and used for public health surveillance during the first year of the COVID-19 pandemic. The use of these technologies and witnessed or anticipated consequences were reported by a variety of media sources worldwide. The news media are an important public health information resource, as media outlets contribute to directing public understanding and shaping priority public health surveillance issues. Our findings raise important questions around how journalists decide which aspects of public health crises to report on and how these issues are discussed.

Use of digital technologies for public health surveillance during the COVID-19 pandemic: A scoping review.

Throughout the COVID-19 pandemic, a variety of digital technologies have been leveraged for public health surveillance worldwide. However, concerns remain around the rapid development and deployment of digital technologies, how these technologies have been used, and their efficacy in supporting public health goals. Following the five-stage scoping review framework, we conducted a scoping review of the peer-reviewed and grey literature to identify the types and nature of digital technologies used for surveillance during the COVID-19 pandemic and the success of these measures. We conducted a search of the peer-reviewed and grey literature published between 1 December 2019 and 31 December 2020 to provide a snapshot of questions, concerns, discussions, and findings emerging at this pivotal time. A total of 147 peer-reviewed and 79 grey literature publications reporting on digital technology use for surveillance across 90 countries and regions were retained for analysis. The most frequently used technologies included mobile phone devices and applications, location tracking technologies, drones, temperature scanning technologies, and wearable devices. The utility of digital technologies for public health surveillance was impacted by factors including uptake of digital technologies across targeted populations, technological capacity and errors, scope, validity and accuracy of data, guiding legal frameworks, and infrastructure to support technology use. Our findings raise important questions around the value of digital surveillance for public health and how to ensure successful use of technologies while mitigating potential harms not only in the context of the COVID-19 pandemic, but also during other infectious disease outbreaks, epidemics, and pandemics.

Digital technology and disease surveillance in the COVID-19 pandemic: a scoping review protocol.

INTRODUCTION: Infectious diseases pose a risk to public health, requiring efficient strategies for disease prevention. Digital health surveillance technologies provide new opportunities to enhance disease prevention, detection, tracking, reporting and analysis. However, in addition to concerns regarding the effectiveness of these technologies in meeting public health goals, there are also concerns regarding the ethics, legality, safety and sustainability of digital surveillance technologies. This scoping review examines the literature on digital surveillance for public health purposes during the COVID-19 pandemic to identify health-related applications of digital surveillance technologies, and to highlight discussions of the implications of these technologies. METHODS AND ANALYSIS: The scoping review will be guided by the framework proposed by Arksey and O'Malley and the guidelines outlined by Colquhoun et al and Levac et al. We will search Medline (Ovid), PsycInfo, PubMed, Scopus, CINAHL (EBSCOhost), ACM Digital Library, Google Scholar and IEEE Explore for relevant studies published between December 2019 and December 2020. The review will also include grey literature. Data will be managed and analysed through an extraction table and thematic analysis. ETHICS AND DISSEMINATION: Findings will be disseminated through traditional academic channels, as well as social media channels and research briefs and infographics. We will target our dissemination to provincial and federal public health organisations, as well as technology companies and community-based organisations managing the public response to the COVID-19 pandemic.

Content analysis of chronic pain content at three undergraduate medical schools in Ontario.

Background: It has been well documented that interdisciplinary, comprehensive pain education can foster positive pain beliefs among medical students, in addition to improving students' abilities to diagnose and treat pain. Though some work has been done to quantify the number of hours of pain education students receive, the content itself has received little attention. Aims: This study seeks to identify what medical students learn about chronic pain throughout an undergraduate medical degree program in Ontario. Methods: Three undergraduate medical schools in Ontario were selected on the basis of variety in curricular structure and instructional methods. Written documents comprising the formal curriculum were analyzed through qualitative and quantitative content analysis. These findings were compared with promising practices from the pain education literature. Results: The three curricula studied here dedicate the bulk of pain education to three topics: pain mechanisms, pain management, and opioids and addiction. The curricula vary considerably in organization of content and hours of pain training. All three curricula were found to contain negative pain beliefs that characterize pain patients as difficult, overwhelming, and unrewarding to work with. Two of the medical schools studied here do not have a pain curriculum. Conclusions: The results of this study indicate a need for medical schools to develop comprehensive, interdisciplinary pain curricula. Though increasing the number of hours of pain training is crucial, equally imperative is a consideration of what, and how, students learn about pain.

Contexte: Il est bien documenté que l'enseignement interdisciplinaire et global de la douleur en médecine peut favoriser une modification positive à l'égard des croyances positives chez les étudiants en médecine, en plus d'augmenter leur capacité à diagnostiquer et à traiter la douleur. Bien que certains travaux aient été menés pour quantifier le nombre d'heures prodiguées en éducation sur la douleur le contenu des cursus a reçu peu d'attention.But: Cette étude cherche à déterminer ce que les étudiants en médecine dans la province de l'Ontario apprennent au sujet de la douleur chronique tout au long de leurs études.Méthodes: Trois curriculums de médecine de premier cycle de l'Ontario ont été choisies de manière à refléter la diversité des structures et des méthodes d'enseignements. Les documents écrits comprenant le programme ­ plan cours officiel ont été scutés par une analyse de contenu qualitative et quantitative. Les observations ont été comparées à des pratiques prometteuses décrites dans la littérature sur l'éducation médicale de la douleur.Résultats: Les trois curriculums étudiés consacrent la majeure partie de l'éducation à la douleur à trois sujets: les mécanismes de la douleur; la gestion de la douleur; et les opioïdes et la dépendance. Le contenu des curriculum varient considérablement en ce qui concerne le cursus de formation et le nombre d'heures qui y sont consacrées. Les trois curriculums contenaient des croyances négatives sur la douleur décrivant les patients souffrant de douleur comme étant des sujets difficiles, exigeants et avec lesquels il est peu gratifiant de travailler.Conclusions: Les résultats de cette étude révèlent la nécessité pour les Facultés de médecine d'élaborer des curriculums interdisciplinaires et globaux sur la douleur. Bien qu'il soit primordial d'augmenter le nombre d'heures de formation, il est tout aussi impératif d'examiner le contenu de ce que les étudiants apprennent au sujet de la douleur et surtout la façon dont ils l'apprennent.