Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study.

BACKGROUND: During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS: Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS: Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS: The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.

Are health care assistants part of the long-term solution to the nursing workforce deficit in Kenya?

This commentary article addresses a critical issue facing Kenya and other Low- and Middle-Income Countries (LMIC): how to remedy deficits in hospitals' nursing workforce. Would employing health care assistants (HCAs) provide a partial solution? This article first gives a brief introduction to the Kenyan context and then explores the development of workforce roles to support nurses in Europe to highlight the diversity of these roles. Our introduction pinpoints that pressures to maintain or restrict costs have led to a wide variety of formal and informal task shifting from nurses to some form of HCA in the EU with differences noted in issues of appropriate skill mix, training, accountability, and regulation of HCA. Next, we draw from a suite of recent studies in hospitals in Kenya which illustrate nursing practices in a highly pressurized context. The studies took place in neo-natal wards in Kenyan hospitals between 2015 and 2018 and in a system with no legal or regulatory basis for task shifting to HCAs. We proffer data on why and how nurses informally delegate tasks to others in the public sector and the decision-making processes of nurses and frame this evidence in the specific contextual conditions. In the conclusion, the paper aims to deepen the debates on developing human resources for health. We argue that despite the urgent pressures to address glaring workforce deficits in Kenya and other LMIC, caution needs to be exercised in implementing changes to nursing practices through the introduction of HCAs. The evidence from EU suggests that the rapid growth in the employment of HCA has created crucial issues which need addressing. These include clearly defining the scope of practice and developing the appropriate skill mix between nurses and HCAs to match the specific health system context. Moreover, we suggest efforts to develop and implement such roles should be carefully designed and rigorously evaluated to inform continuing policy development.

Caspase-8 mediates caspase-1 processing and innate immune defense in response to bacterial blockade of NF-κB and MAPK signaling.

Toll-like receptor signaling and subsequent activation of NF-κB- and MAPK-dependent genes during infection play an important role in antimicrobial host defense. The YopJ protein of pathogenic Yersinia species inhibits NF-κB and MAPK signaling, resulting in blockade of NF-κB-dependent cytokine production and target cell death. Nevertheless, Yersinia infection induces inflammatory responses in vivo. Moreover, increasing the extent of YopJ-dependent cytotoxicity induced by Yersinia pestis and Yersinia pseudotuberculosis paradoxically leads to decreased virulence in vivo, suggesting that cell death promotes anti-Yersinia host defense. However, the specific pathways responsible for YopJ-induced cell death and how this cell death mediates immune defense against Yersinia remain poorly defined. YopJ activity induces processing of multiple caspases, including caspase-1, independently of inflammasome components or the adaptor protein ASC. Unexpectedly, caspase-1 activation in response to the activity of YopJ required caspase-8, receptor-interacting serine/threonine kinase 1 (RIPK1), and Fas-associated death domain (FADD), but not RIPK3. Furthermore, whereas RIPK3 deficiency did not affect YopJ-induced cell death or caspase-1 activation, deficiency of both RIPK3 and caspase-8 or FADD completely abrogated Yersinia-induced cell death and caspase-1 activation. Mice lacking RIPK3 and caspase-8 in their hematopoietic compartment showed extreme susceptibility to Yersinia and were deficient in monocyte and neutrophil-derived production of proinflammatory cytokines. Our data demonstrate for the first time to our knowledge that RIPK1, FADD, and caspase-8 are required for YopJ-induced cell death and caspase-1 activation and suggest that caspase-8-mediated cell death overrides blockade of immune signaling by YopJ to promote anti-Yersinia immune defense.

Still the last great open secret: Sexual harassment as systemic trauma.

Despite being illegal for more than half a century, sexual harassment remains today the most pervasive form of violence against women, often encompassing other forms of violence in its ambit. This stubborn and pernicious persistence rests largely on (1) a pervasive system of attitudes and beliefs, accruing over centuries and embedded in a variety of cultural institutions, that denies and rationalizes systemic abuse of women; and (2), the organizational and institutional actors that serve to maintain this system, a phenomenon that has come to be known as institutional betrayal. These phenomena, the attitudinal aspects of "rape culture" combined with the iatrogenic features of organizations, institutions, make clear that sexual harassment and the cultural system in which it is embedded is best understood as "systemic trauma" requiring multilevel prevention and intervention systems that are yet to be fully identified or understood.

Exploring the accessibility of primary health care data in Europe's COVID-19 response: developing key indicators for managing future pandemics (Eurodata study).

BACKGROUND: Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC's clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC's role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics. METHODS: A mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. ANALYSIS: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development. DISCUSSION: While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC's role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants' involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments' daily dashboards in Europe, often overlooked in media and public debates.

The evaluation of sexual harassment litigants: reducing discrepancies in the diagnosis of posttraumatic stress disorder.

Relatively few targets of sexual harassment cope with the psychological sequelae of their experiences by engaging in litigation. Those who do are often subjected to forensic examination to evaluate their history of psychological distress or disorder and to determine whether such a condition could be reasonably attributed to the alleged harassment, as opposed to some other cause. An unbiased approach to such examinations is critical to all parties, as well as to the profession itself. This study investigates the relationship between the clinical and restructured clinical scales of the Minnesota Multiphasic Personality Inventory-2, the Trauma Symptom Inventory subscales, the Crime-Related Posttraumatic Stress Disorder (CR-PTSD) scale, and an American Psychiatric Association diagnosis (APA, Diagnostic and statistical manual of mental disorders; DSM-IV-TR; 4th ed., text rev., 2000, Washington, DC, Author) of PTSD in a sample of sexual harassment plaintiffs. All measures performed well independently, but together provided improved predictive accuracy, suggesting that the use of multiple validated measures as well as structured diagnostic interviews may help us better understand litigants' experiences and reduce bias in evaluations.

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study.

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study).

BACKGROUND AND AIM: Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. METHODS: Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. RESULTS: Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC. CONCLUSION: PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.

Gastric neuroendocrine tumours.

BACKGROUND: Gastric neuroendocrine tumours (NETs) are increasingly recognised, and management decisions may be difficult due to an incomplete understanding of aetiology, natural history and optimum therapy. This article presents a current understanding based on recent advances in epidemiology, classification, molecular profiling, and treatment. METHODS: Relevant medical literature was identified from searches of PubMed and references cited in appropriate articles identified. Selection of articles was based on peer review, journal and relevance. RESULTS: Gastric NETs may be divided into three clinical prognostic groups: type I is associated with autoimmune atrophic gastritis and hypergastrinaemia, type II is associated with Zollinger-Ellison syndrome, and type III lesions are gastrin-independent, have the greatest metastatic potential and poorest prognosis. There has been an increased frequency of gastric NETs reported. Management approaches have evolved in parallel with advances in endoscopic staging and surgery, as well as improved understanding of the biology and natural history of NETs. CONCLUSIONS: Gastric NETs present a spectrum of activity from indolent tumours to metastatic malignancy. Treatment decisions for patients must be individualised and are best managed by a multidisciplinary team approach. The current evidence base is limited to small series and efforts to treat patients within clinical networks of expertise are warranted.

Creating fairer futures for sustainability transitions.

Futures thinking is an expanding interdisciplinary field which is seen as a key element of transitioning towards a more sustainable planet and society. Developing fairer futuring is increasingly urgent in the context of the radical reconfiguration of current systems needed to meet complex global sustainability challenges. However, explicit consideration of uneven power and participation and the nature-society relations that feature in contemporary futuring processes has been given little explicit attention to date. This deficit is addressed in this paper through a critical review of dominant futuring approaches and outlining insights from critical perspectives which (a) identify limitations of current futuring approaches and (b) provide important perspectives to help shape fairer futuring in geographical research.

No magic targets! Changing clinical practice to become more evidence based.

This article focuses on the diffusion and adoption of innovations in clinical practice. The authors are specifically interested in underresearched questions concerning the latter stages of the creation, diffusion, and adoption of new knowledge, namely: What makes this information credible and therefore utilized? Why do actors decide to use new knowledge? And what is the significance of the social context of which actors are a part? This article first appeared in Health Care Management Review, 27(3), 35-47.

Neuroimaging provides relevant clinical information in patients with burn injuries.

INTRODUCTION: Neurological assessment of patients with burn injuries may be complicated by a variety of factors including artificial ventilation and sedation, cerebral hypoxia and intoxication. Medically unstable intubated patients present logistical challenges for radiological imaging. The role of neuroimaging as an adjunct to clinical assessment of burn injured patients has not yet been determined. AIM: This study aims to investigate the indications, findings and outcomes of neuroimaging studies performed for burn injured patients. METHODS: A retrospective case series study of adult burn patients admitted over an 8 year period was completed in the National Burns Centre at St James's Hospital, Dublin. Neuroimaging studies carried out for patients admitted during the study period were reviewed by a Consultant Radiologist and Consultant Stroke Physician. Outcomes included neuroimaging findings, prevalence of white matter disease (Fazekas scale), length of stay, discharge destination, predicted and observed mortality. RESULTS: 1328 consecutive patients with burn injuries were admitted during the study period. 56 patients underwent neuroimaging studies with computerised tomography, magnetic resonance imaging or both. 46 out of 56 neuroimaged patients (82.1%) had significant radiological findings, including 14 patients (25%) with acute findings. There was a high prevalence of white matter disease (mean total Fazekas score: 3.59) and acute cerebral infarction (7 patients). Patients with radiological findings required additional in-patient rehabilitation and had increased length of stay (Median 47.0 days vs. 27.5 days, p < 0.027). Patients with resuscitation burns or associated inhalation injury were significantly more likely to undergo neuroimaging (p < 0.0001) and to have positive radiological findings. Predicted mortality was higher in patients with positive neuroimaging findings compared to patients with normal neuroimaging studies, although there was no significant difference in observed mortality between these two groups. CONCLUSION: Neuroimaging is used appropriately in patients admitted with burns and provides valuable applicable clinical information when indicated.

Correlates of joining a sexual harassment class action.

Researchers have proposed a variety of factors that influence the decision to seek legal relief in response to sexual harassment, but have generally failed to test these proposals empirically. The present study aims to address this gap by investigating the decision to join a class-action lawsuit. Participants were female professionals at a nationally based financial services firm, who either participated in or opted out of a sexual harassment class-action proceeding against the company. Five variables emerged as significant correlates of joining the class: organizational climate, turnover, financial dependence, PTSD, and primary appraisal. Dominance analysis identified contextual factors as the most important correlate. Theoretical and practical implications for the role of these factors in joining a class action are discussed.

Effects of racial and sexual harassment on work and the psychological well-being of African American women.

Research on workplace harassment has typically examined either racial or sexual harassment, without studying both simultaneously. As a result, it remains unknown whether the co-occurrence of racial and sexual harassment or their interactive effects account for unique variance in work and psychological well-being. In this study, hierarchical linear regression analyses were used to explore the influence of racial and sexual harassment on these outcomes among 91 African American women involved in a sexual harassment employment lawsuit. Results indicated that both sexual and racial harassment contributed significantly to the women's occupational and psychological outcomes. Moreover, their interaction was statistically significant when predicting supervisor satisfaction and perceived organizational tolerance of harassment. Using a sample of African American women employed in an organizational setting where harassment was known to have occurred and examining sexual and racial harassment concomitantly makes this study unique. As such, it provides novel insights and an important contribution to an emerging body of research and underscores the importance of assessing multiple forms of harassment when examining organizational stressors, particularly among women of color.

Change capacity: the route to service improvement in primary care.

BACKGROUND: This paper draws on data from five English primary care trust (PCT) case studies which formed part of a larger research project that explored the roles and relationships of clinical managers and their colleagues in periods of change within different healthcare organisations. AIMS: This article uses empirical data to further our understanding of how primary care organisations can successfully implement service improvements. METHOD: Qualitative methods were used to compare across multiple cases. Three methods were utilised comprising semi-structured interviews, document analysis and observation at meetings. Through an iterative process of data coding using the NVivo data analysis software, final conclusions developed and became more explicit. Data were collected between mid-2002 and 2005. RESULTS: Our analysis demonstrates the important influence of context on the change process. The case studies provide evidence of the nature of the relationships between context and progress in organisational change. We identified three interrelated dimensions of organisational context that played a crucial role in the progress or otherwise of service improvement. CONCLUSION: We conclude that primary care organisations need to have three key features in combination to successfully implement service improvements. These are (i) the presence of change leaders, at several levels throughout the organisation; (ii) a coherent change strategy; and (iii) a sound foundation of relationships between managers and clinical professional groups.

Knowledge translation in tri-sectoral collaborations: An exploration of perceptions of academia, industry and healthcare collaborations in innovation adoption.

With the aging population and increase in chronic disease conditions, innovation to transform treatment pathways and service delivery will be necessary. The innovation adoption process however, can take 15 years before widespread adoption occurs in most healthcare systems. Current UK government policies to increase the facilitation of innovation adoption are under way. The aim of this study is to explore perceptions of tri-sectoral collaborations in the healthcare sector. The data in the study are drawn from a cross-sectional survey conducted in 2015 of professionals in academia, industry and the healthcare sectors in England, focusing on Diabetes care. Academia and healthcare respondents had the least work experience outside of their sectors compared to the industry respondents. Healthcare and academia respondents rated the industry sector less trustworthy, unethical, having different goals and less understanding of the other sectors. Industry respondents had a more positive perspective towards potential collaborators. The results from the study demonstrate greater potential challenges to tri-sectoral collaborations and the government's knowledge translation policy, due to pre-conceived notions and lack of understanding of other sectors. The purely structural approach of establishing government mandated translational networks may be insufficient without active attempts to improve collaborative relationships. Mechanisms to facilitate trust building and collaboration are proposed.

New workforce roles in health care: exploring the longer-term journey of organisational innovations.

PURPOSE: This paper seeks to present findings from a longitudinal action research study aimed at exploring one such innovation. Little is known about the micro-level impact of health service innovations over time. DESIGN/METHODOLOGY/APPROACH: The paper shows that action research is a participatory approach ideally suited to monitoring the process and outcomes of change. Over 20 months, an action researcher studied the work of four interprofessional care co-ordinators (IPCCs), whose role was intended to speed patient through-put within a London teaching hospital general medical directorate. The action researcher kept regular participant observation field notes and supplemented these data with a profile of IPCC patients (n = 407), in-depth interviews (n = 37) and focus groups (n = 16) with staff. Throughout the study, findings were regularly fed back to participants to inform practice developments. FINDINGS: The findings in this paper show that, in spite of the original intention for this role to provide clerical support to the multidisciplinary team, over time the role shifted beyond its implementation into practice to take on more complex work from registered nurses. This raised actual and potential governance issues that were not attended to by service managers. A complex and turbulent context disrupted managers' and practitioners' abilities to reflect on and respond to these longer-term role shifts. ORIGINALITY/VALUE: This paper argues that the complex nature of the innovation and the setting in which it operated account for the role shift and the lack of attention to issues of governance. Current innovation literature suggests that implementation into routine practice represents the end-point of an innovation's journey. These findings suggest that certain innovations may in fact continue to shift in nature even after this "end-point". The conclusions drawn are likely to be of global interest to those interested in complex health service innovations.

How reliable is the vomer flap in early hard palate repair?

Hard palate closure with a vomer flap at the time of lip repair has been widely adopted. A recent study by Deshpande et al. showed a high rate of failure of the vomer flap and led the authors to abandon the technique. We conducted a retrospective study of vomer flap healing in a consecutive series of cases performed by the senior author (D.O.). The case records of 71 patients who underwent repair of unilateral cleft lip and palate with a vomer flap at the time of lip repair were studied. Vomer flap healing was assessed and documented by the senior author at the time of definitive palate closure, and this was recorded. Adequate records were available for 66 cases. Twelve patients (18%) had associated syndromes and were included in the analysis. The median age at the time of lip and vomer flap repair was 3.5 months, and that at the time of palate repair was 8 months. At definitive palatoplasty, the vomer flap was intact in 62 patients (94%). Four patients (6%) had partial or complete failure of the vomer flap. All failures occurred in cases where the vomer flap was sutured directly to the nasal mucosa, a technique since abandoned in favour of double-breasting the flap to the raw surface of the oral mucosa. Five patients had incomplete healing of the palate following definitive palatoplasty, two of whom had a previous vomer flap failure. Contrary to Deshpande et al., we found the vomer flap to be highly reliable in closing the hard palate at the time of primary lip repair.

The effects of sexual harassment on turnover in the military: time-dependent modeling.

Sexual harassment has consistently negative consequences for working women, including changes in job attitudes (e.g., lower satisfaction) and behaviors (e.g., increased work withdrawal). Cross-sectional evidence suggests that harassment influences turnover intentions. However, few studies have used actual turnover; rather, they rely on proxies. With a sample of 11,521 military servicewomen with turnover data spanning approximately 4 years, the authors used the appropriate method for longitudinal turnover data--Cox's regression--to investigate the impact of harassment on actual turnover. Experiences of harassment led to increased turnover, even after controlling for job satisfaction, organizational commitment, and marital status. Among officers, harassment also affected turnover over and above rank. Given turnover's relevance to organizational bottom lines, these findings have important implications not only for individual women but also for organizations.