Health Care Provider Knowledge and Attitudes Regarding Reporting Diseases and Events to Public Health Authorities in Tennessee

Compliance of Healthcare Providers With the Notifiable Diseases Surveillance System in Riyadh, Saudi Arabia

Introduction Though reporting notifiable diseases is obligatory in Saudi Arabia, and the Saudi Ministry of Health establishes guidelines, there are concerns about healthcare providers' compliance, and studies evaluating the notifiable diseases surveillance system (NDSS) are lacking, underlying the urgent need to assess the compliance of healthcare providers with the NDSS in Saudi Arabia. Methods This cross-sectional study involved doctors, nurses, and epidemiologists working in healthcare facilities in Riyadh, Saudi Arabia. The data collection was done using a self-administered questionnaire. SPSS version 27 software (IBM Corp., Armonk, NY) was used for statistical analyses. Results We included 420 participants enrolled in our study, and 63.1% were female. Of 51.4% of participants who worked in private healthcare facilities, 75.7% of them were nurses, while the majority of those working in governmental facilities were doctors (69.1%). The age range was 20-62 years, and the dominant age group was 31-40 years (63.8%). Most participants had no training in epidemiology (79.7%) and of those trained, 64% had a certificate training level. Most notifiable diseases worked were detected in governmental health facilities (35.6% vs. 18.8%). Of those who identified notifiable diseases, 84.3% notified them. COVID-19, measles, and hepatitis A, B, and C were the most notified diseases. The lack of knowledge of the notification system was the most common barrier to the notification among 81 nurses, 39 doctors, and one epidemiologist. There was a significant relationship between being a doctor in the governmental institution and notification timeline (p = 0.024). Conclusion This study showed that identifying notifiable diseases was poor despite good compliance among those who identified them. This study showed the lack of proper training of participants, explaining poor knowledge. The findings highlight the differences in notification practices between private and governmental facilities and the need for educational interventions to tackle the knowledge barrier reported.

Perceptions and Beliefs About Preconceptional Care Among Primary Healthcare Workers in Jeddah City, Saudi Arabia: An Analytical Cross-Sectional Study

Introduction Preconception care (PCC) is one of the important aspects of reproductive health and family planning, from the preventive aspect as primordial prevention for future offspring and primary prevention for females before pregnancy. However, there is no written protocol about PCC and it is not routinely practiced in Saudi Arabia. This study aimed to assess the perceptions and beliefs among care workers regarding PCC. Methods A cross-sectional study was conducted on general practitioners (GP), family physicians (FP), practitioner nurses (PN), and midwives (MW) in primary healthcare centers (PHC) in Jeddah City using a validated questionnaire that assesses their preconception practices, perceptions, and beliefs. Results This study included 201 participants, of whom 98.5% were Saudi nationals and 80.1% were female. Most (64.7%) were 30-39 years old, followed by 40-49 years old (21.9%). The majority (67.7%) were married and had one or two children (37.3%). Most (36%) were practitioner nurses, followed by family physicians (31%), and had 11-15 years of experience (32%), followed by six to 10 years of experience. The majority (44%) reported providing PCC one to five times last month. Of all participants, 72.63% agreed that PCC affected pregnancy outcomes, and 83% agreed that PCC is important. However, 51.7% agreed there is not enough time to provide PCC services. The service rated as the highest priority was providing advice regarding smoking cessation (82.1%), alcohol cessation (84.6%), control of chronic diseases (85.1%), and information about drug use (86.6%). Most participants rated rubella screening as highly important (89.9%), followed by hepatitis screening (88.6%). Family physicians and practitioner nurses perceived PCC as more important than general practitioners and midwives (p=0.026) and were more likely to perceive hospitals as the optimal setting for PCC (p=0.015). General practitioners were more likely to believe in the insufficient evidence base for PCC (p < 0.001). Conclusion The study found that healthcare workers had good perceptions, knowledge, and attitudes toward the PCC, but their practice was poor. Most lacked formal training and had differing perspectives on PCC, depending on their professions. The findings could inform strategies and measures to improve PCC practice among healthcare workers and raise awareness as well as capacity building by enhancing the training of healthcare workers.

Foodborne and Waterborne Illness

Safe water and food are impactful public health measures that improved significantly during the past century in the United States. But waterborne and foodborne illnesses continue to cause significant morbidity and mortality despite existing public health control measures and regulations. It was estimated that each year in the United States, 31 pathogens caused 37.2 million illnesses, with 36.4 million domestically acquired. Of those, 9.4 million were foodborne: 59% were caused by viruses, 39% by bacteria, and 2% by parasites. The pathogens that caused the most foodborne illnesses were norovirus (58%), nontyphoidal Salmonella species (11%), Clostridium perfringens (10%), and Campylobacter species (9%). Unspecified agents caused an estimated 38.4 million episodes of domestically acquired foodborne gastroenteritis, 258,033 hospitalizations, and 3,574 deaths. The estimate for illnesses caused by waterborne transmission was 7.15 million. The diseases that caused the greatest number were otitis externa (n = 4.67 million), norovirus (n = 1.33 million), giardiasis (n = 415,000), and cryptosporidiosis (n = 322,000). An important aspect of management and prevention is health-care provider reporting of foodborne and waterborne illnesses. Health-care provider reporting of reportable diseases has been inconsistent, infrequent, and delayed. Education efforts concerning reporting need to be enhanced, and physicians should report suspected cases before laboratory confirmation to enhance the timeliness of outbreak investigation and possibly prevent subsequent cases.

Improving Collaboration Between Public Health and Medicine: A Timely Survey of Clinician Public Health Knowledge, Training, and Engagement

Objective

To assess the core knowledge of health indicators, federal health programs, and public health functions in practicing clinicians along with perceptions of their education and engagement with public health.

Patients and Methods

A paper survey in booklet form was administered to attendees at 2 general medical conferences in May 2019. The survey was divided into 5 sections: knowledge of health systems and policy, knowledge of public health concepts and function, public health engagement, public health education, and demographics.

Results

One hundred two surveys were received from 402 attendees (response rate, 24.3%). Most were male (56%), older than 50 years (51%), and physicians (86%). Respondents had a fairly good knowledge of federal health programs (77%) and public health functions (84%), but less than half had a personal interaction with public health in the past 2 years (45%) or were aware of how to work with public health organizations in their community (46%). Only a few respondents rated their public health training as good or excellent during their primary degree (7%) or graduate medical education (15%), and most (75%) were interested in learning more about public health and health policy.

Conclusion

Respondents had generally good foundational knowledge of federal health programs and public health functions, although some gaps were identified. Inclusion of health policy and public health topics in continuing medical education would be well received by clinicians. To improve collaboration between public health and medicine, public health should personally engage clinicians more and explain how they can work together to improve population health.

Social Media Survey and Web Posting Assessment of the COVID-19 Response in China: Health Worker Attitudes Toward Preparedness and Personal Protective Equipment Shortages

BACKGROUND

Understanding health worker awareness, attitudes, and self-confidence in the workplace can inform local and global responses toward emerging infectious threats, like the coronavirus disease 2019 (COVID-19) pandemic. Availability of accessible personal protective equipment (PPE) is vital to effective care and prevention.

METHODS

We conducted a cross-sectional survey from February 24 to 28, 2020, to assess COVID-19 preparedness among health workers. In addition, we assessed trends from search engine web crawling and text-mining data trending over the Sina Weibo platform from January 1 to March 3, 2020. Data were abstracted on Chinese outbreak preparedness.

RESULTS

In the survey, we engaged 6350 persons, of whom 1065 agreed to participate, and after an eligibility logic check, 1052 participated (16.6%). We accessed 412 internet posts as to PPE availability. Health workers who were satisfied with current preparedness to address COVID-19 were more likely to be female, to obtain knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak from government organizations, and to consider their hospital prepared for outbreak management. Health workers with more confidence in their abilities to respond were those with more faith in their institution's response capacities. Elements of readiness included having airborne infection isolation rooms, visitor control procedures, and training in precautions and PPE use. Both survey and web post assessments suggested that health workers in need were unable to reliably obtain PPE.

CONCLUSIONS

Health workers' self-confidence depends on perceived institutional readiness. Failure to maintain available PPE inventory for emerging infectious diseases preparedness suggests a failure to learn key lessons from the 2003-2004 SARS outbreak in China.

Public Health Surveillance for Zika Virus: Data Interpretation and Report Validity

Zika virus provides an example for which public health surveillance is based primarily on health care provider notifications to health departments of potential cases. This case-based surveillance is commonly used to understand the spread of disease in a population. However, case-based surveillance is often biased-whether testing is done and which tests are used and the accuracy of the results depend on a variety of factors including test availability, patient demand, perceptions of transmission, and patient and provider awareness, leading to surveillance artifacts that can provide misleading information on the spread of a disease in a population and have significant public health practice implications. To better understand this challenge, we first summarize the process that health departments use to generate surveillance reports, then describe factors influencing testing and reporting patterns at the patient, provider, and contextual level. We then describe public health activities, including active surveillance, that influence both patient and provider behavior as well as surveillance reports, and conclude with a discussion about the interpretation of surveillance data and approaches that could improve the validity of surveillance reports.

Characteristics of Laws Requiring Physicians to Report Patient Information for Public Health Surveillance: Notable Patterns from a Nevada Case Study

Laws across the globe require healthcare providers to disclose patient health information to public health entities for surveillance and intervention purposes. Physicians play a unique role in such mandatory reporting regimes. However, research reveals consistent under-reporting and points to limited knowledge of mandates, perceived burdens of reporting, misaligned incentives and penalties, and a lack of streamlined processes as significant reporting barriers. These barriers suggest that how legal mandates are structured may impact compliance; yet little research systematically examines their characteristics. Law-based reporting requirements differ across jurisdictions. Thus, we conducted a case study in the U.S. State of Nevada to characterize its physician mandatory reporting laws using legal mapping methodology. Nevada is a useful case study because it has few local jurisdictions and its legislature meets biennially. First, we searched key terms to find relevant state mandates and screened them using inclusion criteria. We then scanned near included provisions for additional requirements and incorporated requirements known a priori. We also searched relevant local regulations. Next, we analyzed all included provisions. Our findings indicate wide, intra-jurisdictional variation in reporting requirements across conditions. Variability extends to physician discretion, information reported, timing, recipient agencies, reporting processes, and implications of non-compliance. Local-level variation adds further complexity. Some relevant state requirements apply only to physicians and nearly one-third were absent from our searches. Our findings support exploring the hypothesis that reporting requirements' characteristics may impact compliance and call for empirically testing such relationships to enhance compliance and public health surveillance and intervention efforts.