Public coping discourse in response to government health crisis communication

Purpose: This study aims to explore public coping strategies with government-imposed lockdown restrictions (i.e. forced compliance) due to a health crisis (i.e. COVID-19). This directly impacts the public's power, as they may feel alienated from their environment and from others. Consequently, this study explores the relationships between the public's power, quality of life and crisis-coping strategies. This is important to help governments understand public discourse surrounding perceived government health crisis communication, which aids effective policy development. Design/methodology/approach: An online questionnaire distributed via Qualtrics received 371 responses from the South African public and structural equation modelling was used to test the hypotheses. Findings: The results indicate the public's experience of powerlessness and resulting information-sharing, negative word-of-mouth and support-seeking as crisis coping strategies in response to government-imposed lockdown restrictions. Originality/value: The public's perspective on health crisis communication used in this study sheds light on adaptive and maladaptive coping strategies that the public employs due to the alienation they feel during a health crisis with government-forced compliance. The findings add to the sparse research on crisis communication from the public perspective in a developing country context and provide insights for governments in developing health crisis communication strategies. The results give insight into developing policies related to community engagement and citizen participation during a pandemic. © 2023, Melanie Wiese and Liezl-Marié Van Der Westhuizen.

Programmatic impacts of utilizing various staffing options for COVID-19 contact tracers: recommendations and lessons learned

Background: The rapidly expanding COVID-19 pandemic created an immediate demand for the Department of Health in Hillsborough County (DOH-Hillsborough) Epidemiology Program to supplement its contact tracing workforce;and, because of the long duration of the response, a sustained workforce was needed. The DOH-Hillsborough Epidemiology Program's COVID-19 response, broadly referred to as "contact tracing", included case investigations, outbreaks, and identification and notifications to exposed individuals. To meet contact tracing staffing needs, several staffing options were utilized, including Core Epidemiology Staff, Reassigned DOH-Hillsborough staff (Reassigned Staff), Contracted staffing agency hires (Contract Staff), State of Florida hires (State Level Hires), County hires (DOH-Hillsborough Hires), and college and university faculty and students (University Partners). Purpose: To understand the differences in work output and efficiency across staffing groups (quantitative analysis) and to understand Core Epidemiology Staff recommendations when hiring temporary staff as contact tracers (qualitative analysis). Methods: A mixed-methods approached was used to assess each staffing group hired in Hillsborough County. Quantitative data was analyzed from 3/1/2020 through 1/31/2021, and included data from the state's personnel management system and the state's reportable disease database to represent work output. Qualitative interviews with DOH-Hillsborough Core Epidemiology Staff were conducted and analyzed to understand Core Epidemiology Staff recommendations when hiring surge staffing in the future. Results: During the evaluation period, 199 staff across the staffing groups worked a collective 132,252.50 hours. The number of hours worked per case and contact ranged from 10.16 in Core Epidemiology Staff to 0.67 in University Partners. During qualitative interviews with the Core Epidemiology Staff, five common themes emerged as ideal characteristics for temporary contact tracing staff. These included: communication skills, professionalism, public health knowledge, following official guidance, and flexibility. Two groups who emerged as the "best hires" for their seamless transition into their roles included University Partners and the State Level hires. Discussion: These mixed methods data can be used to develop best practices to inform future surge staffing needs.

Implementation of an Institutional Simulation Curriculum to Teach Team Leadership Skills, Management of Critically Ill Patients, and Emergent Procedures to Pediatric Residents

Background: Simulation in medical training is effective at increasing clinical knowledge, improving comfort with procedures, and teaching crisis resource management skills. Uniquely, simulation can also expose trainees to standardized cases independent of available clinical experience. This is especially important at a time when the COVID-19 pandemic has paradoxically led to decreased emergency department visits and hospitalizations, and, consequentially, decreased clinical opportunities for trainees. We developed and piloted a formal, longitudinal, high-fidelity simulation curriculum for pediatric residents, led by pediatric emergency medicine fellows in a unique, near-peer training program. The project goal was to assess the efficacy of this curriculum at increasing resident selfreported comfort in leading a team, managing critically ill patients, and performing essential emergent procedures. Methods: Six cases were designed by pediatric residents and emergency medicine fellows for the curriculum. Cases were reviewed by faculty members, focused on a critically ill pediatric patient, and included an associated emergent procedure. Three of the cases were used for the study, which was conducted over a four-month period in the 2021 academic year. Study participation was voluntary, and 27 pediatric residents participated, completing up to three cases each. Data was collected as self-reported Likert scales for questions regarding leadership, individual medical knowledge, and comfort with procedures. Surveys were completed prior to the curriculum implementation, following each case, and at study conclusion. To account for expected improvements during traditional residency training, data was also collected for two control cases not used in the study. Wilcoxon Signed-Rank test was used to compare pre- and post-intervention assessments. For significant results, the Dwass-Steel-Chritchlow-Fligner method was used to examine pair-wise comparisons by trainee post-graduate year. Results: Results are summarized in Table 1 and Table 2. There was a significant improvement in self-reported ability to function as team leader, identify and designate roles, effectively organize and minimize noise in the room, effectively use closed loop communication, and access additional resources. There was also an increase in self-reported comfort level with both medical knowledge and performing emergent procedures. There was no significant difference between responses based on trainee year. As expected, residents also reported an improvement in medical knowledge about control cases, although the improvement was less than with the implemented cases. When the size of this effect was compared between implemented and control cases, there was a trend towards significance favoring the simulated cases, suggesting that statistical significance may be achieved with a larger sample size. Conclusion: The implementation of a simulation curriculum can lead to improvements in pediatric resident's self-reported comfort with crisis resource management, team leadership, clinical knowledge, and emergent procedures. The effect on medical knowledge and comfort with procedures may be significantly different than the gains expected naturally over time in pediatric residency training.

The relationship Between Glycemic Control and Food Insecurity in People with Diabetes Mellitus and Comorbid Psychosis

Background/Significance: In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease (CVD) (Olfson 2015). Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses (Mangurian 2018). Little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis. Food insecurity has been shown to be an independent risk factor for poor glycemic control (Seligman 2012). Methods: This IRB-approved cross-sectional survey aims to describe the prevalence and correlates of food insecurity among adults with DM and co-morbid psychosis who receive primary care through 12 clinics affiliated with a large academic healthcare system in Washington state. Administrative data was utilized to identify eligible patients: age 18-65;one inpatient or two outpatient diagnoses of schizophrenia (F20-29), bipolar disorder (F31), or major depressive disorder with psychotic features (F32.3;F33.3) and one inpatient or two outpatient diagnoses of DM (E08-E13.9). Patients with diagnoses of dementia or intellectual disability were excluded. All eligible patients were sent a letter with a unique link to a survey in Research Electronic Data Capture. The survey included questions related to diabetes clinical characteristics, self-care behaviors, and psychosis symptom severity in addition to demographics. Food insecurity was measured with the validated USDA’s Food Security Survey Module. Consistent with previous studies, participants will be considered food-insecure if two or more responses are affirmative. We compared food insecure and food secure particpants with level of social support and frequency of psychiatry symptoms. •Regression analysis was applied to examine the associations between food security status, social support, and mental health symptoms. Results: 624 patients with diabetes and psychosis were identified. 156 patients responded, giving a response rate of 26%. 25% of respondents were found to be food insecure. 16% of respondents demonstrated low social support while 43% showed moderate social support and 41% showed high social support. Mean CSI was 19.36, which suggests participants experienced symptoms several times per month (versus daily or weekly). Significantly lower social support was found in participants with food insecurity compared to those without (p=0.008). This relationship was driven by lower social support from family (p<0.001) compared to friends (p=0.61) or significant others (p=0.192). Additionally, greater psychiatric symptom severity was found in people with food insecurity (p <0.001). Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms. Discussion: This study showed that food insecurity was significantly associated with both low perceived social support and more frequent psychiatric symptoms. However, no evidence of a moderating effect of social support on the relationship between food insecurity and psychiatric symptom severity was found. Rate of food insecurity was found to be lower than previous studies, which showed approximately 50% of individuals who used public mental health services faced food insecurity (Adams et al., 2021). The study sample was not limited to public mental health service users, which is the likely cause of this lower rate. Conclusion/Implications: Food insecurity is associated with poorer mental health outcomes, which have been associated with poorer health outcomes. The presence of perceived social support does not mitigate the need for addressing food insecurity. There is a need for both medical and mental health providers who care for people with co-morbid diabetes and psychosis to specifically address food insecurity. References: 1. Adams WE, Rogers ES, Edwards JP, Lord EM, McKnight L, Barbone M. Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey. Psychiatr c Services. 2021 Jun 23:appi-ps. 2. Coleman-Jensen AJ. US food insecurity status: toward a refined definition. Social Indicators Research. 2010 Jan 1;95(2):215-30. 3. Hammami N, Leatherdale ST, Elgar FJ. Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study. Nutrition journal. 2020 Dec;19(1):1-1. 4. Mangurian CV et al. Diabetes and prediabetes prevalence by race and ethnicity. Diabetes care. 2018 Jul 1;41(7):e119-20. 5. Na M, Miller M, Ballard T, Mitchell DC, Hung YW, Melgar-Quiñonez H. Does social support modify the relationship between food insecurity and poor mental health? Evidence from thirty-nine sub-Saharan African countries. Public health nutrition. 2019 Apr;22(5):874-81. 6. Olfson M et al. Premature mortality among adults with schizophrenia in the United States. JAMA psychiatry. 2015 Dec 1;72(12):1172-81. Seligman HK et al. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes care. 2012 Feb 1;35(2):233-8. Stubbs B, Vancampfort D, De Hert M, Mitchell AJ.Acta Psychiatr Scand. 2015 Aug;132(2):144-57. Regression analysis showed that social support did not significantly moderate the relationship between food security and frequency of psychiatric symptoms.

SUS AND SOCIAL PROTECTION: CHALLENGES FOR FAMILIES IN FRONT OF THE COVID-19 PANDEMIC

The aim of this paper is to demonstrate the impact of the COVID-19 pandemic on families through their relation with social protection, focusing especially on health policy. The importance of Sistema Unico de Saude - SUS for working-class families in the face of the pandemic is indubitable, even as the federal government continually neglects and dismantles Brazil's social protection system. The pandemic comes to further unveil the country's profound social inequality, which turns families socially vulnerable to COVID-19. It would be salubrious for health services to be preserved and enlarged so that they could cater for the social needs of the families, both before the COVID-19 pandemic as well as other health-related issues. Resuming the State's central role as the leader in the fight of the pandemic, together with a strengthening and extension of Brazil's social protection through social security, is imperative.