Search

Skilled nursing facilities (SNFs) are focal points of the coronavirus disease 2019 (COVID-19) pandemic, and asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19, among SNF residents and health care personnel have been described (1-3). Repeated point prevalence surveys (serial testing of all residents and health care personnel at a health care facility irrespective of symptoms) have been used to identify asymptomatic infections and have reduced SARS-CoV-2 transmission during SNF outbreaks (1,3). During March 2020, the Detroit Health Department and area hospitals detected a sharp increase in COVID-19 diagnoses, hospitalizations, and associated deaths among SNF residents. The Detroit Health Department collaborated with local government, academic, and health care system partners and a CDC field team to rapidly expand SARS-CoV-2 testing and implement infection prevention and control (IPC) activities in all Detroit-area SNFs. During March 7-May 8, among 2,773 residents of 26 Detroit SNFs, 1,207 laboratory-confirmed cases of COVID-19 were identified during three periods: before (March 7-April 7) and after two point prevalence surveys (April 8-25 and April 30-May 8): the overall attack rate was 44%. Within 21 days of receiving their first positive test results, 446 (37%) of 1,207 COVID-19 patients were hospitalized, and 287 (24%) died. Among facilities participating in both surveys (n = 12), the percentage of positive test results declined from 35% to 18%. Repeated point prevalence surveys in SNFs identified asymptomatic COVID-19 cases, informed cohorting and IPC practices aimed at reducing transmission, and guided prioritization of health department resources for facilities experiencing high levels of SARS-CoV-2 transmission. With the increased availability of SARS-CoV-2 testing, repeated point prevalence surveys and enhanced and expanded IPC support should be standard tools for interrupting and preventing COVID-19 outbreaks in SNFs.

Older buildings in the United States often contain lead paint, and their demolition poses the risk of community lead exposure. We investigated associations between demolitions and elevated blood lead levels (EBLLs) among Detroit children aged &lt, 6 years, 2014&ndash, 2018, and evaluated yearly variation given health and safety controls implemented during this time. Case-control analysis included incident EBLL cases (&ge, 5 &micro, g/dL) and non-EBLL controls from test results reported to the Michigan Department of Health and Human Services. Exposure was defined as the number of demolitions (0, 1, 2+) within 400 feet of the child&rsquo, s residence 45 days before the blood test. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), and test effect modification by year. Associations between demolition and EBLL differed yearly (p = 0.07): 2+ demolitions were associated with increased odds of EBLLs in 2014 (OR: 1.75, 95% CI: (1.17, 2.55), 2016 (2.36, 1.53, 3.55) and 2017 (2.16, 1.24, 3.60), but not in 2018 (0.94, 0.41, 1.86). This pattern remained consistent in sensitivity analyses. The null association in 2018 may be related to increased health and safety controls. Maintenance of controls and monitoring are essential, along with other interventions to minimize lead exposure, especially for susceptible populations.

Since the decriminalisation of abortion in 2006, women in Colombia have continued to seek clandestine abortions, endangering their health and contributing to maternal mortality and morbidity. The goal of this study was to explore physicians' opinions towards and knowledge about legal abortion in Bogotá, Colombia, and key barriers to the legal abortion access. We conducted 13 key informant interviews followed by a survey with a probability sample of 49 doctors working in public hospitals in Bogotá. Interview and survey data showed lack of technical experience in the provision of abortion and nuanced opinions towards its practice. Key informants described ignorance and lack of abortion training in medical schools as key barriers to provision. In the survey, 16/49 respondents had performed an abortion, 24/49 had referred a woman for an abortion and only 33/49 showed correct knowledge of the law.

In 2006, the Colombian Constitutional Court partially decriminalized abortion. However, barriers to access, including improper use of conscientious objection, remain.To explore conscientious objection from the objectors' perspectives, in-depth interviews were conducted in 2014 with 13 key informants and with 15 Colombian physicians who self-identified as conscientious objectors. Recruitment included snowball and purposive sampling techniques. Analysis was conducted in tandem with data collection and focused on objectors' attitudes, beliefs and behaviors related to abortion and referral.Objectors had varied perspectives. Three types of objectors were evident: extreme, moderate and partial. Extreme objectors refused to perform abortions or make referrals, and often lectured their patients; they also provided misleading or false medical and legal information, preventing women from accessing abortions to which they were legally entitled. Moderate objectors would not perform abortions, but respected their patients and viewed referral as a way to save "one out of two" lives. Partial objectors performed some abortions but refused to do others on the basis of gestational age or case-by-case circumstances. Across the typology, objectors linked conscientious objection with medical ethics, and many described a duty to protect the fetus, which they conceptualized as a patient.Conscientious objectors exhibit diverse opinions and behaviors. Potential areas for future investigation include identifying factors that lead objectors to refer and estimating the prevalence of each type of objector. Results suggest potential interventions that could reduce the role of conscientious objection as a barrier to care.RESUMEN Contexto: En 2006, la Corte Constitucional de Colombia descriminalizó parcialmente el aborto. Sin embargo, aún existen barreras al acceso, incluido el uso inapropiado de la objeción de conciencia. Métodos: Con el fin de explorar la objeción de conciencia desde las perspectivas de los objetores, en 2014 se llevaron a cabo entrevistas en profundidad con 13 informantes clave y 15 médicos colombianos que se autoidentificaron como objetores de conciencia. El reclutamiento incluyó técnicas de muestreo por bola de nieve e intencional. El análisis se llevó a cabo conjuntamente con la recolección de datos y se focalizó en las actitudes, creencias y conductas de los objetores en relación con el aborto y las referencias a otros proveedores. Resultados: Los objetores tienen perspectivas diversas. Fueron evidentes tres tipos de objetores: extremos, moderados y parciales. Los objetores extremos rechazaron realizar abortos o hacer referencias y, con frecuencia, sermonearon a sus pacientes; también proporcionaron información médica y legal engañosa o falsa, para evitar que las mujeres tuvieran acceso a abortos a los cuales legalmente tenían derecho. Los objetores moderados no realizaron abortos, pero respetaron a sus pacientes y consideraron las referencias como una forma de salvar “una de dos” vidas. Los objetores parciales realizaron algunos abortos pero rechazaron practicar otros en base a la edad gestacional o circunstancias relacionadas con cada caso. A lo largo de esta tipología, los objetores vincularon la objeción de conciencia con la ética médica y muchos describieron un deber de proteger el feto, el cual conceptualizaron como paciente. Conclusión: Los objetores de conciencia exhiben diversas opiniones y conductas. Algunas áreas con potencial para futuras investigaciones incluyen la identificación de factores que conducen a los objetores a referir a otros proveedores y la estimación de la prevalencia de cada tipo de objetor. Los resultados sugieren intervenciones potenciales que podrían reducir el rol de la objeción de conciencia en tanto una barrera a la hora de recibir atención.RÉSUMÉ Contexte: En 2006, le Tribunal constitutionnel de Colombie a décriminalisé partiellement l'avortement. Des obstacles d'accès, notamment l'invocation abusive de l'objection de conscience, persistent cependant. Méthodes: Afin d'explorer l'objection de conscience dans la perspective des intéressés, des entretiens en profondeur ont été menés en 2014 avec 13 informateurs clés et 15 médecins colombiens qui s’étaient dits objecteurs de conscience. Le recrutement a été effectué selon les techniques d’échantillonnage en boule de neige et par choix raisonné. Parallèlement à la collecte de données, l'analyse s'est concentrée sur les attitudes, croyances et comportements des objecteurs concernant l'avortement et l'orientation vers un prestataire. Résultats: Différentes perspectives expliquent la position des objecteurs. Trois grands types d'objection se sont révélés: absolue, modérée et partielle. Les objecteurs absolus refusent toute pratique de l'avortement ou orientation afférente, faisant souvent la leçon à leurs patientes; ils fournissent aussi une information médicale et légale trompeuse ou fausse, empêchant les femmes d'accéder aux procédures d'avortement auxquelles elles ont légalement droit. Les objecteurs modérés refusent de pratiquer l'avortement mais ils respectent leurs patientes et voient dans leur orientation vers un prestataire un moyen de «sauver une vie sur deux». Les objecteurs partiels pratiquent certains avortements mais en refusent d'autres en fonction de l’âge gestationnel ou de circonstances considérées au cas par cas. Dans les trois types, les objecteurs lient l'objection de conscience à l’éthique médicale. Beaucoup parlent d'une obligation de protection du fœtus, qu'ils conceptualisent tel un patient.Les objecteurs de conscience présentent des opinions et des comportements divers. Les points potentiels de recherche future comprennent l'identification des facteurs qui amènent les objecteurs à l'orientation vers un prestataire et l'estimation de la prévalence de chaque type d'objecteur. Les résultats laissent entendre de potentielles interventions aptes à réduire le rôle de l'objection de conscience parmi les obstacles aux soins.