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Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments.Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other is a more traditional dietetic community service where patients are referred predominantly by the GP or secondary care.In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received less referrals from the GP; 36% vs 67% (p0.001), GP appointments for allergy-related conditions prior to dietetic referral were lower; 3 vs 6 visits (p=0.001) and input from secondary care was also lower; 8 vs 25 patients (p=0.002) compared with dietetic community care. Children referred to dietetic-led care were younger; 78%6 months vs 40% (p0.001) in dietetic community care.Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working; offering a solution to reducing GP workload whilst maintaining or improving patient care. This article is protected by copyright. All rights reserved.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a rapid surge of literature on severe acute respiratory syndrome coronavirus 2 and the wider impacts of the pandemic. Research on COVID-19 has been produced at an unprecedented rate, and the ability to stay on top of the most relevant evidence is top priority for clinicians, researchers, public health professionals and policymakers. This article presents a knowledge synthesis methodology developed and used by the Public Health Agency of Canada for managing and maintaining a literature surveillance system to identify, characterize, categorize and disseminate COVID-19 evidence daily. METHODS: The Daily Scan of COVID-19 Literature project comprised a systematic process involving four main steps: literature search; screening for relevance; classification and summarization of studies; and disseminating a daily report. RESULTS: As of the end of March 2022 there were approximately 300,000 COVID-19 and pandemic-related citations in the COVID-19 database, of which 50%–60% were primary research. Each day, a report of all new COVID-19 citations, literature highlights and a link to the updated database was generated and sent to a mailing list of over 200 recipients including federal, provincial and local public health agencies and academic institutions. CONCLUSION: This central repository of COVID-19 literature was maintained in real time to aid in accelerated evidence synthesis activities and support evidence-based decision-making during the pandemic response in Canada. This systematic process can be applied to future rapidly evolving public health topics that require the continuous evaluation and dissemination of evidence.

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) is an emerging condition that was first identified in paediatrics at the onset of the COVID-19 pandemic. The condition is also known as pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS or PIMS), and multiple definitions have been established for this condition that share overlapping features with Kawasaki Disease and toxic shock syndrome. Methods: A review was conducted to identify literature describing the epidemiology of MIS-C, published up until March 9, 2021. A database established at the Public Health Agency of Canada with COVID-19 literature was searched for articles referencing MIS-C, PIMS or Kawasaki Disease in relation to COVID-19. Results: A total of 195 out of 988 articles were included in the review. The median age of MIS-C patients was between seven and 10 years of age, although children of all ages (and adults) can be affected. Multisystem inflammatory syndrome in children disproportionately affected males (58% patients), and Black and Hispanic children seem to be at an elevated risk for developing MIS-C. Roughly 62% of MIS-C patients required admission to an intensive care unit, with one in five patients requiring mechanical ventilation. Between 0% and 2% of MIS-C patients died, depending on the population and available interventions. Conclusion: Multisystem inflammatory syndrome in children can affect children of all ages. A significant proportion of patients required intensive care unit and mechanical ventilation and 0%–2% of cases resulted in fatalities. More evidence is needed on the role of race, ethnicity and comorbidities in the development of MIS-C.

Background: The coronavirus diseases 2019 (COVID-19) pandemic has presented an unprecedented public health challenge. Prior to vaccination, non-pharmaceutical interventions, including closures, were necessary to help control the epidemic. With the arrival of variants of concern and insufficient population vaccination coverage, ongoing evaluation of transmission risk in settings and the use of non-pharmaceutical interventions are necessary to help control the epidemic. This study aimed to produce a framework for evaluating transmission risk in settings where individuals gather and inform decision-making. Methods: A multi-criteria decision analysis process was used to structure the framework. Fifteen criteria were identified as important to consider for COVID-19 transmission risk based on the literature. This list was ranked by experts and then categorized. The analysis was structured by the consensus list of criteria and relative positioning of each criteria within the list to produce sets of factors to consider when assessing transmission risk at gatherings. Results: Fifteen experts from across Canada participated in ranking the criteria. Strong consensus was found on the relative importance of criteria and this relative consensus was used to create four categories: critical (3 criteria); important (6 criteria); good to consider (5 criteria); and if time permits (1 criterion). Conclusion: The resulting consensus list and categories constitutes a set of important elements that can be applied to any setting as an objective and transparent framework to assess transmission risk in the venue. In conjunction with further consideration of the local epidemiology of COVID-19, an overall risk of transmission assessment can be established and uniformly implemented.

Contexte : Le syndrome inflammatoire multisystémique chez les enfants (MIS-C) associé à la maladie à coronavirus 2019 (COVID-19) est une affection émergente qui a été identifiée pour la première fois en pédiatrie au début de la pandémie de COVID-19. Cette affection est également connue sous le nom de syndrome inflammatoire multisystémique pédiatrique ayant un lien temporel au syndrome respiratoire aigu sévère à coronavirus 2 (SIMP-TS ou SIMP), et de multiples définitions ont été établies pour cette affection qui présente des caractéristiques communes avec la maladie de Kawasaki et le syndrome de choc toxique. Méthodes : Une revue a été menée pour déterminer la littérature décrivant l’épidémiologie du MIS-C, publiée jusqu’au 9 mars 2021. Une base de données établie à l’Agence de la santé publique du Canada avec la littérature sur la COVID-19 a été consultée pour obtenir des articles faisant référence à MIS-C, SIMP ou la maladie de Kawasaki en relation avec la COVID-19. Résultats : Au total, 195 articles sur 988 ont été inclus dans la revue. L’âge médian des patients atteints du MIS-C se situait entre sept et dix ans, bien que des enfants de tous âges (et des adultes) puissent être touchés. Le syndrome inflammatoire multisystémique chez les enfants touche de manière disproportionnée les garçons (58 % des patients), et les enfants noirs et hispaniques semblent présenter un risque élevé de développer le MIS-C. Environ 62 % des patients atteints du MIS-C ont dû être admis dans une unité de soins intensifs, un patient sur cinq nécessitant une ventilation mécanique. Entre 0 et 2 % des patients atteints du MIS-C sont décédés, selon la population et les interventions disponibles. Conclusion : Le syndrome inflammatoire multisystémique chez les enfants peut toucher des enfants de tous âges. Une proportion importante de patients a nécessité une admission à l’unité de soins intensifs et une ventilation mécanique et 0 à 2 % des cas ont été fatals. Il est nécessaire de disposer de plus de données sur le rôle de la race, de l’ethnicité et des comorbidités dans le développement du MIS-C.

Le syndrome inflammatoire multisystémique de l’enfant (MIS-C) est l’une des principales répercussions de la maladie à coronavirus 2019 (COVID-19) qui a été décrite dans la littérature depuis le début de la pandémie. Bien que le MIS-C concerne les enfants, des cas ayant des caractéristiques cliniques semblables ont récemment été décrits chez les adultes. Une description des caractéristiques épidémiologiques et cliniques du syndrome inflammatoire multisystémique de l’adulte (MIS-A) est un point de départ pour une meilleure connaissance et compréhension de cette maladie émergente. Nous avons recensé neuf cas de MIS-A dans la littérature, cinq aux États-Unis, deux en France et deux au Royaume-Uni. Les descriptions de cas ont révélé des similitudes dans les caractéristiques cliniques, y compris l’occurrence au cours de la phase post-aiguë de la maladie, la fièvre, les symptômes digestifs, des atteintes cardiaques et des marqueurs inflammatoires élevés. Tous les patients ont été hospitalisés, trois ont dû être admis à l’unité de soins intensifs et un est décédé. Les traitements les plus courants étaient l’immunoglobuline intraveineuse, la prednisolone et l’aspirine. Ces résultats suggèrent que le MIS-A est une grave complication de la COVID-19 qui peut entraîner la mort. D’autres études visant à améliorer notre compréhension de la pathogenèse du MIS-A, qui contribueront à améliorer les décisions de traitement et à prévenir les séquelles ou la mort.

Background: Research studies comparing antibody response from coronavirus disease 2019 (COVID-19) cases that retested positive (RP) using reverse transcription polymerase chain reaction (RT-PCR) and those who did not retest positive (NRP) were used to investigate a possible relationship between antibody response and retesting status. Methods: Seven data bases were searched. Research criteria included cohort and case-control studies, carried out worldwide and published before September 9, 2020, that compared the serum antibody levels of hospitalized COVID-19 cases that RP after discharge to those that did NRP. Results: There is some evidence that immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in RP cases were lower compared with NRP cases. The hypothesis of incomplete clearance aligns with these findings. The possibility of false negative reverse transcription polymerase chain reaction (RT-PCR) test results during viral clearance is also plausible, as concentration of the viral ribonucleic acid (RNA) in nasopharyngeal and fecal swabs fluctuate below the limits of RT-PCR detection during virus clearance. The probability of reinfection was less likely to be the cause of retesting positive because of the low risk of exposure where cases observed a 14 day-quarantine after discharge. Conclusion: More studies are needed to better explain the immune response of recovered COVID-19 cases retesting positive after discharge.

Contexte : Des études comparant la réponse immunitaire de patients rétablis de la maladie à coronavirus 2019 (COVID-19) dont le résultat à un test subséquent a été positif (TP) en utilisant la réaction en chaîne par polymérase après transcription inverse (RT-PCR) et celle de patients qui ont obtenu un résultat négatif (TN) à un test subséquent ont été utilisées pour étudier une relation possible entre la réponse immunitaire et le statut du nouveau test. Méthodes : Sept bases de données ont été consultées. Les critères de recherche comprenaient les études de cohorte et les études cas-témoins réalisées dans le monde entier et publiées avant le 9 septembre 2020. Ces études comparaient les taux sériques d’anticorps des cas de patients atteints de COVID-19 hospitalisés dont le résultat à un test après leur sortie de l’hôpital a été positif (TP) à ceux dont le résultat au test a été négatif (TN). Résultats : Certaines données indiquent que les taux d’immunoglobuline G (IgG) et d’immunoglobuline M (IgM) étaient plus faibles chez les patients dont le résultat à un test subséquent était positif que chez les patients dont le résultat au nouveau test était négatif. L’hypothèse d’une clairance incomplète cadre avec ces résultats. La possibilité d’obtenir des faux négatifs à l’épreuve d’amplification en chaîne par RT-PCR pendant la clairance virale est également plausible, car la concentration d’acide ribonucléique (ARN) viral dans les écouvillons nasopharyngés et fécaux fluctue en dessous des limites de détection de la RT-PCR pendant la clairance virale. La probabilité d’une réinfection était moins susceptible d’être la cause d’un nouveau résultat positif en raison du faible risque d’exposition lorsque les patients observaient une quarantaine de 14 jours après leur sortie de l’hôpital. Conclusion : D’autres études sont nécessaires pour mieux expliquer la réponse immunitaire des cas de patients rétablis de la COVID-19 dont le résultat à un test est positif après leur sortie de l’hôpital.

Contexte : La Base de données publique internationale sur les éclosions des maladies d’origine alimentaire (Publicly Available International Foodborne Outbreak Database (PAIFOD)) est un répertoire régulièrement mis à jour qui contient des données internationales sur les éclosions recueillies auprès de multiples systèmes de surveillance et de sources. En date de février 2020, la base de données contenait plus de 13 000 entrées couvrant plus de 20 ans. La PAIFOD est la seule base de données connue qui saisit les données internationales sur les éclosions de maladies d’origine alimentaire. Objectif : Explorer les perceptions des utilisateurs et déterminer les orientations possibles pour la PAIFOD et faire des recommandations pour les bases de données contenant des informations sur la sécurité alimentaire. Méthodes : Entre janvier et mars 2020, 16 entretiens téléphoniques semi-directifs ont été menés avec 24 anciens utilisateurs, actuels et potentiels de la PAIFOD. Les répondants ont été interrogés sur leur connaissance et leur expérience de l’utilisation de la PAIFOD ainsi que sur ses forces et ses faiblesses, et sur les recommandations concernant la base de données. Une approche d’analyse thématique inductive a été utilisée pour analyser les données qualitatives et générer des thèmes. Résultats : Quatre thèmes principaux ont été dégagés à partir des témoignages des 24 répondants sur leur expérience et leurs recommandations concernant la PAIFOD : les participants ont considéré que la PAIFOD était un outil utile; ils ne connaissaient pas bien son contenu ni son objectif; ils ont déclaré qu’elle devrait devenir une plateforme en libre accès ou être liée à une autre initiative de partage d’informations; et ils ont estimé que la PAIFOD avait le potentiel pour améliorer la réputation de l’Agence en devenant largement reconnue et utilisée. Conclusion : Ce travail, ainsi que le contexte en constante évolution de la surveillance alimentaire, soutient la nécessité de garantir que la PAIFOD soit mise à jour pour répondre aux exigences actuelles des experts en salubrité alimentaire.

RESUME CONTEXTE: Il faudra prendre des mesures continues contre la transmission communautaire du coronavirus du syndrome respiratoire aigu severe 2 (SRAS-CoV-2) pour prevenir d’autres vagues d’infection. Nous avons explore les effets des interventions non pharmacologiques sur la transmission projetee du SRAS-CoV-2 au Canada. METHODES: Nous avons cree un modele de la population canadienne a base d’agents integrant l’âge qui simule les effets des mesures de sante publique, selon leur intensite actuelle et projetee, sur la transmission du SRAS-CoV-2. Les mesures etudiees sont le depistage et l’isolement des cas, la recherche de contacts et la mise en quarantaine, l’eloignement sanitaire et la fermeture des espaces partages. Nous avons evalue l’effet des mesures prises individuellement et celui des mesures combinees. RESULTATS: En l’absence de mesures, 64,6 % (intervalle de credibilite [ICr] a 95 % : 63,9 %–65,0 %) des Canadiens contracteraient le SRAS-CoV-2 (taux d’attaque global), et 3,6 % (ICr a 95 % 2,4 %–3,8 %) des personnes infectees en mourraient. En poursuivant le depistage et la recherche de contacts a la meme intensite que pendant la periode de reference, sans maintenir l’eloignement sanitaire ou refermer certains endroits, le pays connaitrait un taux d’attaque global de 56,1 % (ICr a 95 % 0,05 %–57,1 %); si ces mesures etaient accrues, le taux d’attaque chuterait a 0,4 % (ICr a 95 % 0,03 %–23,5 %). En combinant ce dernier scenario et le maintien de l’eloignement sanitaire, le taux tomberait a 0,2 % (ICr a 95 % 0,03 %–1,7 %). Ce scenario est le seul qui garderait la demande en soins hospitaliers et intensifs sous la capacite, qui previendrait presque tous les deces et qui mettrait fin a l’epidemie. La prolongation de la fermeture des ecoles aurait un effet minime, mais reduirait la transmission en milieu scolaire. Par contre, la prolongation de la fermeture des lieux de travail et des lieux publics reduirait de maniere marquee le taux d’attaque et mettait habituellement ou toujours fin a l’epidemie, selon les differents scenarios simules. INTERPRETATION: Le controle de la transmission du SRAS-CoV-2 passera par l’amelioration et le maintien des mesures, tant communautaires qu’individuelles. Autrement, il y aura une recrudescence de l’epidemie, et un risque de surcharger le systeme de sante.

Background: Globally, the education of students at primary and secondary schools has been severely disrupted by the implementation of school closures to reduce the spread of coronavirus disease 2019 (COVID-19). The effectiveness of school closures in reducing transmission of COVID-19 and the impact of re-opening schools are unclear. Methods: Research criteria for this rapid review included empirical studies, published or pre-published worldwide before January 25, 2021, that assessed the effectiveness of school closures in reducing the spread of COVID-19 and the impact of school re-openings on COVID-19 transmission. Results: Twenty-four studies on the impact of school closures and re-openings on COVID-19 transmission were identified through the seven databases that were searched. Overall the evidence from these studies was mixed and varied due to several factors such as the time of implementation of public health measures, research design of included studies and variability among the levels of schooling examined. Conclusion: Preliminary findings suggest that school closures have limited impact on reducing COVID-19 transmission, with other non-pharmaceutical interventions considered much more effective. However, due to the limitations of the studies, further research is needed to support the use of this public health measure in response to the COVID-19 pandemic.

The spontaneous death or loss of a fetus during pregnancy is termed a fetal death. In the United States, national data on fetal deaths are available for losses at ≥20 weeks' gestation.* Deaths occurring during this period of pregnancy are commonly known as stillbirths. In 2017, approximately 23,000 fetal deaths were reported in the United States (1). Racial/ethnic disparities exist in the fetal mortality rate; however, much of the known disparity in fetal deaths is unexplained (2). CDC analyzed 2015-2017 U.S. fetal death report data and found that non-Hispanic Black (Black) women had more than twice the fetal mortality rate compared with non-Hispanic White (White) women and Hispanic women. Fetal mortality rates also varied by maternal state of residence. Cause of death analyses were conducted for jurisdictions where >50% of reports had a cause of death specified. Still, even in these jurisdictions, approximately 31% of fetal deaths had no cause of death reported on a fetal death report. There were differences by race and Hispanic origin in causes of death, with Black women having three times the rate of fetal deaths because of maternal complications compared with White women. The disparities suggest opportunities for prevention to reduce the U.S. fetal mortality rate. Improved documentation of cause of death on fetal death reports might help identify preventable causes and guide prevention efforts.

Introduction In 2016, March of Dimes (MOD) launched its Prematurity Collaborative to engage a broad cross section of national experts to address persistent and widening racial disparities in preterm birth by achieving equity and demonstrated improvements in preterm birth. African-American and Native American women continue to have disproportionate rates of preterm birth and maternal death. As part of the Collaborative, MOD created the Health Equity Workgroup whose task was the creation of a scientific consensus statement articulating core values and a call to action to achieve equity in preterm birth utilizing health equity and social determinants of health frameworks. Methods Health Equity Workgroup members engaged in-person and virtually to discuss key determinant contributors and resolutions for disparate maternal and birth outcomes. Workgroup members then drafted the Birth Equity Consensus Statement that contained value statements and a call to action. The birth equity consensus statement was presented at professional conferences to seek broader support. This article highlights the background and context towards arriving at the core values and call to action, which are the two major components of the consensus statement and presents the core values and call to action themselves. Results The result was the creation of a birth equity consensus statement that highlights risks and protections of social determinants based on the prevailing science, and identifies promising solutions for reducing preterm birth and eliminating racial disparities. Conclusion The birth equity consensus statement provides a mandate, guiding the work of March of Dimes and the broader MCH community, for equity-based research, practice, and policy advocacy at local, state, and federal levels. Significance This field report adds to the current knowledge base on racial and ethnic disparities in birth and maternal health outcomes. Research has documented the science behind eliminating health disparities. Scientists and practitioners should continue to explore in practice how the social determinants of birth and maternal health, which manifest historically and contemporarily, can be addressed.

Background Severe acute respiratory syndrome virus 2 (SARS-CoV-2), likely a bat-origin coronavirus, spilled over from wildlife to humans in China in late 2019, manifesting as a respiratory disease. Coronavirus disease 2019 (COVID-19) spread initially within China and then globally, resulting in a pandemic. Objective This article describes predictive modelling of COVID-19 in general, and efforts within the Public Health Agency of Canada to model the effects of non-pharmaceutical interventions (NPIs) on transmission of SARS-CoV-2 in the Canadian population to support public health decisions. Methods The broad objectives of two modelling approaches, 1) an agent-based model and 2) a deterministic compartmental model, are described and a synopsis of studies is illustrated using a model developed in Analytica 5.3 software. Results Without intervention, more than 70% of the Canadian population may become infected. Non-pharmaceutical interventions, applied with an intensity insufficient to cause the epidemic to die out, reduce the attack rate to 50% or less, and the epidemic is longer with a lower peak. If NPIs are lifted early, the epidemic may rebound, resulting in high percentages (more than 70%) of the population affected. If NPIs are applied with intensity high enough to cause the epidemic to die out, the attack rate can be reduced to between 1% and 25% of the population. Conclusion Applying NPIs with intensity high enough to cause the epidemic to die out would seem to be the preferred choice. Lifting disruptive NPIs such as shut-downs must be accompanied by enhancements to other NPIs to prevent new introductions and to identify and control any new transmission chains.

Public health measures applied exclusively within vulnerable populations have been suggested as an alternative to community-wide interventions to mitigate SARS-CoV-2 transmission. With the population demography and healthcare capacity of Canada as an example, a stochastic age-stratified agent-based model was used to explore the progression of the COVID-19 epidemic under three intervention scenarios (infection-preventing vaccination, illness-preventing vaccination and shielding) in individuals above three age thresholds (greater than or equal to 45, 55 and 65 years) while lifting shutdowns and physical distancing in the community. Compared with a scenario with sustained community-wide measures, all age-stratified intervention scenarios resulted in a substantial epidemic resurgence, with hospital and ICU bed usage exceeding healthcare capacities even at the lowest age threshold. Individuals under the age threshold were severely impacted by the implementation of all age-stratified interventions, with large numbers of avoidable deaths. Among all explored scenarios, shielding older individuals led to the most detrimental outcomes (hospitalizations, ICU admissions and mortality) for all ages, including the targeted population. This study suggests that, in the absence of community-wide measures, implementing interventions exclusively within vulnerable age groups could result in unmanageable levels of infections, with serious outcomes within the population. Caution is therefore warranted regarding early relaxation of community-wide restrictions.

Objectives To understand the information needs and experiences with health care and social support among women with confirmed or possible Zika virus infection during pregnancy. Methods We conducted in-depth interviews with 18 women whose pregnancies were part of surveillance efforts in two states, Pennsylvania and Virginia. Using a semi-structured guide available in English and Spanish, we asked women about their experiences. We conducted a thematic analysis using NVivo 11. Results Only one participant reported that her infant had been diagnosed with health problems related to congenital Zika virus infection. Most participants said they received the information they needed about Zika virus and their infant's medical care. Most participants primarily spoke Spanish and described satisfactory experiences communicating with providers, either using a mix of Spanish and English or using an interpreter. Coordination of care and clear communication among different providers was a key factor in participants' satisfaction with health care received. Participants noted high levels of stress around the uncertainty associated with Zika virus exposure during pregnancy. Conclusions for practice Although participants reported satisfaction with care, they also reported high levels of anxiety and challenges coping with the uncertainties along their journeys. Study findings support the need for guidance for providers about how to talk with women about Zika virus infection during pregnancy and specifically how to discuss the uncertainties about diagnosis and outcomes.

In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

COVID-19 research has been produced at an unprecedented rate and managing what is currently known is in part being accomplished through synthesis research. Here we evaluated how the need to rapidly produce syntheses has impacted the quality of the synthesis research. Thus, we sought to identify, evaluate and map the synthesis research on COVID-19 published up to 10 July 2020. A COVID-19 literature database was created using pre-specified COVID-19 search algorithms carried out in eight databases. We identified 863 citations considered to be synthesis research for evaluation in this project. Four-hundred and thirty-nine reviews were fully assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) and rated as very low-quality (n = 145), low-quality (n = 80), medium-quality (n = 208) and high-quality (n = 151). The quality of these reviews fell short of what is expected for synthesis research with key domains being left out of the typical methodology. The increase in risk of bias due to non-adherence to systematic review methodology is unknown and prevents the reader from assessing the validity of the review. The responsibility to assure the quality is held by both producers and publishers of synthesis research and our findings indicate there is a need to equip readers with the expertise to evaluate the review conduct before using it for decision-making purposes.

ObjectivePost COVID-19 condition refers to persisting or recurring symptoms weeks after acute COVID-19 illness which can significantly impact quality of life and health systems. It is important to understand the manifestation and magnitude of this condition. The objective of this living systematic review is to summarize the prevalence of symptoms and sequelae reported by people ≥4 weeks after COVID-19 diagnosis.DesignSystematic review, meta-analysis and narrative synthesis.Data sourcesEmbase, Medline, PsychInfo, Cochrane Central and select grey literature up to April 14, 2021.MethodsWe adapted a previous search strategy used by the U.K. National Institute for Health and Care Excellence and updated it to search for new literature. Two reviewers screened references independently; one extracted data and assessed risk of bias and certainty of the evidence while another verified them. Prevalence data from laboratory-confirmed populations were meta-analyzed using a random effects model and synthesized separately in the short-term (4-12 weeks) and long-term (>12 weeks) periods after diagnosis. Data from clinically-diagnosed populations were synthesized narratively.ResultsOf the 4444 unique citations, 84 observational studies met our inclusion criteria. Over 100 post COVID-19 symptoms and sequelae were reported. Sixty-one percent (95% CI: 44-76%, low certainty) and 53% (95% CI: 41-65%, low certainty) of laboratory-confirmed individuals reported persistence or presence of one or more symptoms in the short- and long-term periods, respectively. The most prevalent symptoms in both periods included: fatigue, general pain or discomfort, shortness of breath, cognitive impairment and mental health symptoms.ConclusionsA substantial proportion of individuals reported a variety of symptoms ≥4 weeks after COVID-19 diagnosis. Due to gaps in the research base, and the low certainty of the evidence currently available, further research is needed to determine the true burden of post COVID-19 condition in the general population and in specific subgroups.PROSPERO registration numberCRD42021231476.

Background: The Publicly Available International Foodborne Outbreak Database (PAIFOD) is a regularly updated repository that contains international outbreak data collected from multiple surveillance systems and sources. As of February 2020, the database contained more than 13,000 entries spanning over 20 years. PAIFOD is the only known database that captures international foodborne outbreak data. Objective: To explore user perceptions and identify potential directions for PAIFOD and make recommendations for databases with food safety information. Methods: Between January and March 2020, 16 semistructured telephone interviews were conducted with 24 previous, current and potential PAIFOD users. Interviewees were asked about their knowledge of and experience of using PAIFOD as well as about its strengths and limitations and recommendations for the database. An inductive thematic analysis approach was used to analyze qualitative data and generate themes. Results: Four main themes were generated based on the 24 interviewees’ accounts of their experience with and recommendations for PAIFOD: participants viewed PAIFOD as a useful tool; they weren’t familiar with its contents or purpose; they stated it should become an open-access platform or linked with another information-sharing initiative; and they considered that PAIFOD had the potential to enhance the Agency’s reputation by becoming widely recognized and used. Conclusion: This work, along with the ever-changing landscape of foodborne surveillance, supports the need to ensure that PAIFOD is updated to meet the modern-day demands of food safety experts.

Background: Eastern equine encephalitis virus (EEEV) is a mosquito-borne virus that is primarily found in North America and the Caribbean. Over the past decade there has been an increase in virus activity, including large outbreaks in human and horse populations. Predicted climate change is expected to affect the range of mosquitoes including vectors of EEEV, which may alter disease risk posing a public health concern. Methods: A scoping review (ScR) was conducted to identify and characterize the global evidence on EEEV. A thorough search was conducted in relevant bibliographic databases and government websites. Two reviewers screened titles and abstracts for relevance and the characteristics of relevant articles were extracted using a uniformly implemented data collection form. The study protocol was developed a priori and described the methods and tools used and this article follows the PRISMA-ScR guidelines for reporting ScRs. Results: The ScR included 718 relevant research articles. The majority of the articles originated from North America (97%) between 1933 and 2019. EEEV has been identified in 35 species of mosquitoes, over 200 species of birds, various domestic animals, wild mammals, reptiles, and amphibians. Articles identified in this ScR primarily covered three topic areas: epidemiology of hosts and vectors (344 articles) including surveillance results (138), pathogenesis of EEEV in hosts (193), and in vitro studies characterizing EEEV (111). Fewer articles evaluated the accuracy of diagnostic tests (63), the efficacy of mitigation strategies (62), transmission dynamics (56), treatment of EEEV in hosts (10), societal knowledge, attitudes, and perceptions (4), and economic burden (2). Conclusion: With the projected impact of climate change on mosquito populations, it is expected that the risk of EEEV could change resulting in higher disease burden or spread into previously unaffected areas. Future research efforts should focus on closing some of the important knowledge gaps identified in this ScR.

Alpha-gal syndrome (AGS) refers to a delayed allergic reaction to galactose-α-1,3-galactose (α-Gal) that occurs following the consumption of mammalian meat or exposure to other animal-based foods and products. Increasing evidence suggests that bites from certain tick species can lead to AGS through sensitization of a person's α-Gal specific IgE levels. This systematic review aimed to summarize the published evidence on this topic to understand post-tick exposure AGS epidemiology and health outcomes. A structured search for literature in eight bibliographic databases was conducted in January, 2020. Grey literature and verification searches were also performed. The exposure of interest was tick bites, and the outcome of interest was AGS. All primary research study designs were eligible for inclusion. References were screened for relevance, and data extraction and risk-of-bias assessment were conducted on relevant studies by two independent reviewers. Data were descriptively and narratively summarized. Of 1390 references screened, 102 relevant articles (103 unique studies) were identified (published from 2009 to 2020). Most studies (76.7 %) were case report or series. These 79 studies reported on 236 post-tick exposure AGS cases from 20 different countries, mostly the United States (33.5 %), Spain (19.5 %), Sweden (18.6 %), and France (12.7 %). The mean case age was 51.3 (SD = 16.7, range 5-85, n = 229), while 68.1 % were male (n = 226). The most commonly reported symptom was urticaria (71.2 %); 51.7 % of cases reported anaphylaxis. Twenty-one observational studies were reported, mostly (95.2 %) among clinical allergy patients. The proportion of AGS cases that recalled tick bites was highly variable across these studies. Three challenge studies evaluating tick exposures and α-Gal levels in α-Gal deficient mice were identified. The existing evidence suggests tick bites lead to α-Gal-specific IgE sensitization, which can cause AGS, but further research is needed to clarify if AGS is only attributable to certain tick species and whether other vectors may trigger AGS. Additional research is needed on risk factors for AGS development, evaluation of diagnostic immunoassays, and the epidemiology and distribution of AGS in different populations. Climate change will likely lead to future cases of AGS in new regions worldwide due to the predicted alteration of suitable tick habitats.

Background: parents commonly ask about food allergy tests, to find a cause for their child's eczema, yet the value of routine testing is uncertain. Objective: To determine whether a clinical trial comparing test-guided dietary advice versus usual care, for the management of eczema, is feasible. Methods: children (>3 months and Results: from 1059 invitation letters sent to carers of potentially eligible children, 84 were randomized (42 per group) with mean age of 32.4 months (SD 13.9) and POEM of 8.7 (4.8). Of the 42, 6 (14%) intervention participants were advised to exclude one or more foods, most commonly egg, peanut or milk. By participant, 1/6 had an oral food challenge (negative); 3/6 were told to exclude until review in allergy clinic; and 6/6 advised a home dietary trial (exclusion and reintroduction of food over 4–6 weeks) – with 1/6 partially completing it. Participant retention (four withdrawals) and data completeness (74%–100%) were acceptable and contamination low (two usual care participants had allergy tests). There were three minor SPT-related adverse events. During follow-up, 12 intervention and 8 usual care participants had minor, unrelated adverse events plus one unrelated hospital admission. Conclusions: it is possible to recruit, randomize and retain children with eczema from primary care into a trial of food allergy screening and to collect the outcomes of interest. Changes to recruitment and inclusion criteria are needed in a definitive trial, to ensure inclusion of younger children from more diverse backgrounds.

Background Babesiosis is a parasitic vector-borne disease of increasing public health importance. Since the first human case was reported in 1957, zoonotic species have been reported on nearly every continent. Zoonotic Babesia is vectored by Ixodes ticks and is commonly transmitted in North America by Ixodes scapularis, the tick species responsible for transmitting the pathogens that also cause Lyme disease, Powassan virus, and anaplasmosis in humans. Predicted climate change is expected to impact the spread of vectors, which is likely to affect the distribution of vector-borne diseases including human babesiosis. Methods A scoping review has been executed to characterize the global evidence on zoonotic babesiosis. Articles were compiled through a comprehensive search of relevant bibliographic databases and targeted government websites. Two reviewers screened titles and abstracts for relevance and characterized full-text articles using a relevance screening and data characterization tool developed a priori. Results This review included 1394 articles relevant to human babesiosis and/or zoonotic Babesia species. The main zoonotic species were B. microti, B. divergens, B. duncani and B. venatorum. Articles described a variety of study designs used to study babesiosis in humans and/or zoonotic Babesia species in vectors, animal hosts, and in vitro cell cultures. Topics of study included: pathogenesis (680 articles), epidemiology (480), parasite characterization (243), diagnostic test accuracy (98), mitigation (94), treatment (65), transmission (54), surveillance (29), economic analysis (7), and societal knowledge (1). No articles reported predictive models investigating the impact of climate change on Babesia species. Conclusion Knowledge gaps in the current evidence include research on the economic burden associated with babesiosis, societal knowledge studies, surveillance of Babesia species in vectors and animal hosts, and predictive models on the impact of climate change. The scoping review results describe the current knowledge and knowledge gaps on zoonotic Babesia which can be used to inform future policy and decision making.

Foodborne disease outbreaks are frequently associated with improper food handling at retail and food service settings, indicating a need to improve food safety practices among food handlers. Many qualitative research studies have been conducted to examine food handlers' opinions, perspectives, and experiences with safe food handling in an effort to understand the factors associated with their use of such practices. The aim of this systematic review was a synthesis of the findings from relevant studies to identify the main across-study themes and develop recommendations for interventions and future research. The following steps used to conduct the review were developed a priori as part of the study protocol: a comprehensive search strategy; relevance screening of abstracts; relevance confirmation of articles; study quality assessment; data extraction; thematic synthesis of results; and quality-of-evidence assessment. We identified 28 relevant articles reporting on 26 unique studies. Behavioural determinants were grouped according to constructs from the Theoretical Domain Framework, and further mapped onto the COM-B model of the Behaviour Change Wheel. A total of 13 categories of determinants of safe food handling were identified. Of these categories, overall confidence ratings were assigned and rated as high (n = 9) and moderate (n = 4). The analysis revealed that: 1) food handlers typically demonstrated good knowledge and had positive attitudes toward training; 2) environmental factors (e.g. policies, resources), reinforcement (e.g. posters, reminders), emotions (e.g. stress), and social influences played a significant role in food handlers' intentions and practices; 3) food handlers were confident in their abilities and showed positive beliefs relating to consequences of unsafe food handling; 4) they demonstrated a lack of motivation to perform safe food handling practices and experienced lapses in concentration; and 5) culturally diverse food handlers had unique barriers such as language and communication. Areas for future research and recommendations for policy and practice are discussed.

Background Powassan virus (POWV), a flavivirus discovered in 1958, causes sporadic but severe cases of encephalitis in humans. Since 2007, the number of human Powassan cases diagnosed each year in the USA has steadily increased. This is in agreement with predictions that Powassan cases may increase in North America as a result of increased exposure to infected ticks. However, the increase may also reflect improved diagnostics and reporting among other factors. Methods A scoping review was prioritized to identify and characterize the global literature on POWV. Following an a priori developed protocol, a comprehensive search strategy was implemented. Two reviewers screened titles and abstracts for relevant research and the identified full papers were used to characterize the POWV literature using a predetermined data characterization tool. Results One hundred and seventy-eight articles were included. The majority of the studies were conducted in North America (88.2%) between 1958 and 2017. Both genotypes of POWV (Powassan lineage 1 and Deer Tick virus) were isolated or studied in vitro, in vectors, nonhuman hosts and human populations. To date, POWV has been reported in 147 humans in North America. The virus has also been isolated from five tick species, and several animals have tested positive for exposure to the virus. The relevant articles identified in this review cover the following eight topics: epidemiology (123 studies), pathogenesis (66), surveillance (33), virus characterization (22), POWV transmission (8), diagnostic test accuracy (8), treatment (4) and mitigation strategies (3). Conclusion The literature on POWV is relatively small compared with other vector-borne diseases, likely because POWV has not been prioritized due to the small number of severe sporadic human cases. With the projected impact of climate change on tick populations, increases in the number of human cases are expected. It is recommended that future research efforts focus on closing some of the important knowledge gaps identified in this scoping review.

Lisa Waddell provides practical advice for nurses dealing with children who suffer from food allergies

Background: Shutdowns are enacted when alternative public health measures are insufficient to control the epidemic and the population is largely susceptible. An age-stratified agent-based model was developed to explore the impact of shutdowns to control SARS-CoV-2 transmission in Canada under the assumption that current efforts to control the epidemic remains insufficient and in the absence of a vaccine. Methods: We estimated the current levels of interventions in Canada to generate a baseline scenario from 7 February to 7 September 2020. Four aspects of shutdowns were explored in scenarios that ran from 8 September 2020 to 7 January 2022, these included the impact of how quickly shutdowns are implemented, the duration of shutdowns, the minimum break (delays) between shutdowns and the types of sectors to shutdown. Comparisons among scenarios were made using cases, hospitalizations, deaths and shutdown days during the 700-day model runs. Results: We found a negative relationship between reducing SARS-CoV-2 transmission and the number of shutdown days. However, we also found that for shutdowns to be optimally effective, they need to be implemented fast with minimal delay, initiated when community transmission is low, sustained for an adequate period and be stringent and target multiple sectors, particularly those driving transmission. By applying shutdowns in this manner, the total number of shutdown days could be reduced compared to delaying the shutdowns until further into the epidemic when transmission is higher and/or implementing short insufficient shutdowns that would require frequent re-implementation. This paper contrasts a range of shutdown strategies and trade-offs between health outcomes and economic metrics that need to be considered within the local context. Interpretation: Given the immense socioeconomic impact of shutdowns, they should be avoided where possible and used only when other public health measures are insufficient to control the epidemic. If used, the time it buys to delay the epidemic should be used to enhance other equally effective, but less disruptive, public health measures.

Consumers often engage in unsafe food handling practices at home, and various psychosocial and health-status constructs have been investigated to attempt to explain the underlying reasons affecting consumers' use of such practices. We conducted a systematic review of these studies to synthesize the associations between psychosocial and health-status constructs and consumer safe food handling behaviours to inform future research and interventions. The review followed standard systematic review procedures including: comprehensive search strategy; relevance screening of references; characterization of articles; data extraction; and risk-of-bias assessment. Meta-analysis was conducted on odds ratio (OR) and Pearson's r measures of association within unique data subgroups that were stratified by eight categories of behavioural determinants, five behavioural constructs, and two outcome types. A total of 66 relevant studies were identified. Knowledge was the most commonly investigated behavioural-determinant category (70%), but was only associated with one of the individual behavioural constructs: prevention of cross-contamination and practicing personal hygiene (adjusted OR = 1.56; 95% CI = 1.17, 2.06; I 2 = 40%; n = 4 studies). In contrast, attitudes and risk perceptions, the second most commonly investigated category (61%), was significantly associated with all constructs (adjusted ORs ranging from 1.84 to 3.63) except for avoiding the consumption of risky foods. Habits, subjective norm, and measures of self-confidence and control were consistently and strongly associated with various outcomes. Behavioural intentions had inconsistent associations with behaviours, while cues to action and the high-risk health status of consumers and their families were not associated with any outcomes. Most studies (77%) only reported measures of association that were unadjusted for confounding variables, resulting in high risk-of-bias ratings for most outcomes. Stratified analyses indicated that adjusted ORs differed from unadjusted measures. The review findings highlight key psychosocial constructs that could be targeted in future research and interventions to improve consumers' safe food handling behaviours.

Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings. We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment. We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; I2 = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases. Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.

The reported incidence of clinical hepatitis E cases is rising in some non‐endemic countries, with concurrent concerns regarding potential hepatitis E virus (HEV) contamination of the blood supply. Therefore, the characterization of major potential sources of human HEV exposure is important to inform risk assessment and public health policy. A systematic review was conducted, including a comprehensive search in six electronic bibliographic databases, verified by hand‐searching reference lists of HEV reviews, and a grey literature search, of the broad research question ‘what is the evidence of the association between predictors of human HEV exposure, and HEV IgG seropositivity, in non‐endemic countries?’ Using forms designed a priori, captured studies were appraised at first‐level screening, second‐level characterization, and third‐level data extraction and risk of bias assessment. Meta‐analysis yielded summary estimates of association between potential predictors and odds of HEV seropositivity. Meta‐analysis and meta‐regression of the odds of HEV seroprevalence in specific groups characterized potential sources of HEV exposure. From 4,163 captured citations, 245 relevant studies underwent data extraction, investigating HEV seroprevalence or predictors in both healthy subjects and targeted patient groups. Across these groups, increasing age was a predictor of HEV IgG seropositivity. Both human immunodeficiency virus patients and haemodialysis patients had significantly increased odds of HEV seropositivity relative to the general population. Working with pigs, in forestry, or in hospitals, was significantly associated with increased odds of HEV seropositivity, as were consumption of meat, pork or game meat, or hunting. Chronological time was not associated with HEV seropositivity within our data sets. Further study of the distribution of potential dietary or behavioural predictors between high and lower prevalence areas within non‐endemic countries could improve our understanding of the relative importance of specific HEV transmission pathways.