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"Townsend, John"
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Impact of COVID-19 on Pediatric Primary Care Visits at Four Academic Institutions in the Carolinas
We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0–18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.
Journal Article
Temperature and time of host-seeking activity impact the efficacy of chemical control interventions targeting the West Nile virus vector, Culex tarsalis
West Nile virus (WNV) is the leading mosquito-borne disease causing-pathogen in the United States. Concerningly, there are no prophylactics or drug treatments for WNV and public health programs rely heavily on vector control efforts to lessen disease incidence. Insecticides can be effective in reducing vector numbers if implemented strategically, but can diminish in efficacy and promote insecticide resistance otherwise. Vector control programs which employ mass-fogging applications of insecticides, often conduct these methods during the late-night hours, when diel temperatures are coldest, and without a-priori knowledge on daily mosquito activity patterns. This study’s aims were to 1) quantify the effect of temperature on the toxicity of two conventional insecticides used in fogging applications (malathion and deltamethrin) to Culex tarsalis , an important WNV vector, and 2) quantify the time of host-seeking of Cx . tarsalis and other local mosquito species in Maricopa County, Arizona. The temperature-toxicity relationship of insecticides was assessed using the WHO tube bioassay, and adult Cx . tarsalis , collected as larvae, were exposed to three different insecticide doses at three temperature regimes (15, 25, and 35°C; 80% RH). Time of host-seeking was assessed using collection bottle rotators with encephalitis vector survey traps baited with dry ice, first at 3h intervals during a full day, followed by 1h intervals during the night-time. Malathion became less toxic at cooler temperatures at all doses, while deltamethrin was less toxic at cooler temperatures at the low dose. Regarding time of host-seeking, Cx . tarsalis , Aedes vexans , and Culex quinquefasciatus were the most abundant vectors captured. During the 3-hour interval surveillance over a full day, Cx . tarsalis were most-active during post-midnight biting (00:00–06:00), accounting for 69.0% of all Cx . tarsalis , while pre-midnight biting (18:00–24:00) accounted for 30.0% of Cx . tarsalis . During the 1-hour interval surveillance overnight, Cx . tarsalis were most-active during pre-midnight hours (18:00–24:00), accounting for 50.2% of Cx . tarsalis captures, while post-midnight biting (00:00–06:00) accounted for 49.8% of Cx . tarsalis . Our results suggest that programs employing large-scale applications of insecticidal fogging should consider temperature-toxicity relationships coupled with time of host-seeking data to maximize the efficacy of vector control interventions in reducing mosquito-borne disease burden.
Journal Article
Eternals
\"The Eternals, a super-race, are now scattered and forgetful of their powers and immortality, living mortal human lives of supreme normalcy. Meanwhile their age-old enemies, the Deviants, stalk the earth with nefarious intentions, and at least one of the super-duper-race Celestials (who created both Deviants and Eternals eons ago) may be returning to Earth. The source of all this forgetfulness and strife appears to be the eternally 11-year-old Sprite, who desires to be allowed to age like an actual human.\"--Provided by publisher.
Book
Before I kick the bucket, I want to say thank you
Because the bowel cancer was growing more slowly, they decided to remove the oesophageal cancer first, and 13 months later when my body had recovered I went back in for the bowel operation. [...]I had to retire because of the cancer I had worked for 27 years without a single day off sick.
Journal Article
Defining the roles of local precipitation and anthropogenic water sources in driving the abundance of Aedes aegypti, an emerging disease vector in urban, arid landscapes
Understanding drivers of disease vectors’ population dynamics is a pressing challenge. For short-lived organisms like mosquitoes, landscape-scale models must account for their highly local and rapid life cycles.
Aedes aegypti
, a vector of multiple emerging diseases, has become abundant in desert population centers where water from precipitation could be a limiting factor. To explain this apparent paradox, we examined
Ae. aegypti
abundances at > 660 trapping locations per year for 3 years in the urbanized Maricopa County (metropolitan Phoenix), Arizona, USA. We created daily precipitation layers from weather station data using a kriging algorithm, and connected localized daily precipitation to numbers of mosquitoes trapped at each location on subsequent days. Precipitation events occurring in either of two critical developmental periods for mosquitoes were correlated to suppressed subsequent adult female presence and abundance. LASSO models supported these analyses for female presence but not abundance. Precipitation may explain 72% of
Ae. aegypti
presence and 90% of abundance, with anthropogenic water sources supporting mosquitoes during long, precipitation-free periods. The method of using kriging and weather station data may be generally applicable to the study of various ecological processes and patterns, and lead to insights into microclimates associated with a variety of organisms’ life cycles.
Journal Article
A conceptual framework for measuring community health workforce performance within primary health care systems
Background
With the 40th anniversary of the Declaration of Alma-Ata, a global effort is underway to re-focus on strengthening primary health care systems, with emphasis on leveraging community health workers (CHWs) towards the goal of achieving universal health coverage for all. Institutionalizing effective, sustainable community health systems is currently limited by a lack of standard metrics for measuring CHW performance and the systems they work within. Developed through iterative consultations, supported by the Bill & Melinda Gates Foundation and in partnership with USAID and UNICEF, this paper details a framework, list of indicators, and measurement considerations for monitoring CHW performance in low- and middle-income countries.
Methods
A review of peer-reviewed articles, reports, and global data collection tools was conducted to identify key measurement domains in monitoring CHW performance. Three consultations were successively convened with global stakeholders, community health implementers, advocates, measurement experts, and Ministry of Health representatives using a modified Delphi approach to build consensus on priority indicators. During this process, a structured, web-based survey was administered to identify the importance and value of specific measurement domains, sub-domains, and indicators determined through the literature reviews and initial stakeholder consultations. Indicators with more than 75% support from participants were further refined with expert qualitative input.
Results
Twenty-one sub-domains for measurement were identified including measurement of incentives for CHWs, supervision and performance appraisal, data use, data reporting, service delivery, quality of services, CHW absenteeism and attrition, community use of services, experience of services, referral/counter-referral, credibility/trust, and programmatic costs. Forty-six indicators were agreed upon to measure the sub-domains. In the absence of complete population enumeration and digitized health information systems, the quality of metrics to monitor CHW programs is limited.
Conclusions
Better data collection approaches at the community level are needed to strengthen management of CHW programs and community health systems. The proposed list of metrics balances exhaustive and pragmatic measurement of CHW performance within primary healthcare systems. Adoption of the proposed framework and associated indicators by CHW program implementors may improve programmatic effectiveness, strengthen their accountability to national community health systems, drive programmatic quality improvement, and plausibly improve the impact of these programs.
Journal Article
Forecasting the relative abundance of Aedes vector populations to enhance situational awareness for mosquito control operations
Aedes -borne diseases represent a major public health threat and mosquito control operations represent a key line of defense. Improving the real-time awareness of mosquito control authorities by providing reliable forecasts of the relative abundance of mosquito vectors could greatly enhance control efforts. To this aim, we developed an analytical tool that forecasts Aedes aegypti relative abundance 1 to 4 weeks ahead. Forecasts were validated against mosquito surveillance data (2,760 data points) collected over multiple years in four jurisdictions in the US. The symmetric absolute percentage error was in the range 0.43–0.69, and the 90% interquantile range of the forecasts had a coverage of 83–92%. Our forecasts consistently outperformed a reference “naïve” model for all analyzed study sites, forecasting horizon, and for periods with medium/high Ae . aegypti activity. The developed tool can be instrumental to address the need for evidence-based decision making.
Journal Article
Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach
Background
There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients’ health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems – the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated.
Methods
We explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component.
Results
We identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring system incorporating data from communities and the health system.
Conclusions
We believe that strategic partnership between communities and health systems on a minimum package of simultaneously implemented strategies offers the potential for accelerating progress in improving CHW performance at scale. Comparative, retrospective and prospective research can confirm the potential of these strategies. More experience and evidence on strategic partnership can contribute to our understanding of how to achieve sustainable progress in health with equity.
Journal Article