Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: Koplan K [original query] |
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Essential public health functions: the key to resilient health systems
Squires N , Garfield R , Mohamed-Ahmed O , Iversen BG , Tegnell A , Fehr A , Koplan JP , Desenclos JC , Viso AC . BMJ Glob Health 2023 8 (7) On 5 May 2023, the WHO declared an end to the designation of COVID-19 as a public health emergency of international concern.1 While COVID-19 remains a threat to health, the world is ready to move forward from a disease that has dominated life for the past three years. Now is the time to assess whether the commitments made to ‘build back better’2 will incorporate learning from diverse country experiences of responding to COVID-19 and its wider system consequences, and increase the resilience of all countries to future public health challenges. | | Health expenditures and life expectancy in most of the world rose between 2000 and 2019; however, the onset of the pandemic resulted in significant and prolonged disruption to essential health services, delaying progress and even reversing gains in life expectancy. This lack of resilience stems from chronic underfunding of public health capacities, even in relatively advanced economies.3 It is these preventive and promotive public health capacities both within and beyond the health system that are essential if we wish to reduce health risks and the impact of shock events like COVID-19, and thus reduce the burden on secondary and tertiary care that occurs when public health systems fail. Increased mortality and morbidity from non-COVID-related causes were seen in many countries,4 with an estimated 15 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021 alone.5 6 The impact on livelihoods and society has also exacerbated social inequities and negatively impacted on mental health,7 while misinformation has undermined trust in health services.8 |
Health Care Utilization and Clinical Characteristics of Nonhospitalized Adults in an Integrated Health Care System 28-180 Days After COVID-19 Diagnosis - Georgia, May 2020-March 2021.
Hernandez-Romieu AC , Leung S , Mbanya A , Jackson BR , Cope JR , Bushman D , Dixon M , Brown J , McLeod T , Saydah S , Datta D , Koplan K , Lobelo F . MMWR Morb Mortal Wkly Rep 2021 70 (17) 644-650 As of April 19, 2021, 21.6 million COVID-19 cases had been reported among U.S. adults, most of whom had mild or moderate disease that did not require hospitalization (1). Health care needs in the months after COVID-19 diagnosis among nonhospitalized adults have not been well studied. To better understand longer-term health care utilization and clinical characteristics of nonhospitalized adults after COVID-19 diagnosis, CDC and Kaiser Permanente Georgia (KPGA) analyzed electronic health record (EHR) data from health care visits in the 28-180 days after a diagnosis of COVID-19 at an integrated health care system. Among 3,171 nonhospitalized adults who had COVID-19, 69% had one or more outpatient visits during the follow-up period of 28-180-days. Compared with patients without an outpatient visit, a higher percentage of those who did have an outpatient visit were aged ≥50 years, were women, were non-Hispanic Black, and had underlying health conditions. Among adults with outpatient visits, 68% had a visit for a new primary diagnosis, and 38% had a new specialist visit. Active COVID-19 diagnoses* (10%) and symptoms potentially related to COVID-19 (3%-7%) were among the top 20 new visit diagnoses; rates of visits for these diagnoses declined from 2-24 visits per 10,000 person-days 28-59 days after COVID-19 diagnosis to 1-4 visits per 10,000 person-days 120-180 days after diagnosis. The presence of diagnoses of COVID-19 and related symptoms in the 28-180 days following acute illness suggests that some nonhospitalized adults, including those with asymptomatic or mild acute illness, likely have continued health care needs months after diagnosis. Clinicians and health systems should be aware of post-COVID conditions among patients who are not initially hospitalized for acute COVID-19 disease. |
Initial findings from a novel population-based child mortality surveillance approach: a descriptive study
Taylor AW , Blau DM , Bassat Q , Onyango D , Kotloff KL , Arifeen SE , Mandomando I , Chawana R , Baillie VL , Akelo V , Tapia MD , Salzberg NT , Keita AM , Morris T , Nair S , Assefa N , Seale AC , Scott JAG , Kaiser R , Jambai A , Barr BAT , Gurley ES , Ordi J , Zaki SR , Sow SO , Islam F , Rahman A , Dowell SF , Koplan JP , Raghunathan PL , Madhi SA , Breiman RF . Lancet Glob Health 2020 8 (7) e909-e919 BACKGROUND: Sub-Saharan Africa and south Asia contributed 81% of 5.9 million under-5 deaths and 77% of 2.6 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts. METHODS: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhica, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths. FINDINGS: Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. INTERPRETATION: Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. FUNDING: Bill & Melinda Gates Foundation. |
Mortality surveillance methods to identify and characterize deaths in Child Health and Mortality Prevention Surveillance Network sites
Salzberg NT , Sivalogan K , Bassat Q , Taylor AW , Adedini S , El Arifeen S , Assefa N , Blau DM , Chawana R , Cain CJ , Cain KP , Caneer JP , Garel M , Gurley ES , Kaiser R , Kotloff KL , Mandomando I , Morris T , Nyamthimba Onyango P , Sazzad HMS , Scott JAG , Seale AC , Sitoe A , Sow SO , Tapia MD , Whitney EA , Worrell MC , Zielinski-Gutierrez E , Madhi SA , Raghunathan PL , Koplan JP , Breiman RF . Clin Infect Dis 2019 69 S262-s273 Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24-36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia. |
Stronger national public health institutes for global health
Frieden TR , Koplan JP . Lancet 2010 376 (9754) 1721-2 Although strengthening health-care systems is receiving increased attention, strengthening public health systems and institutions could save far more lives at lower cost. Public health institutes monitor, implement, and oversee programmes to prevent disease. Life-saving and cost-saving programmes include immunisations, control of communicable diseases including diarrhoeal disease, reduction of motor-vehicle crashes, and tobacco control. Over the past decade, many countries have considered, strengthened, or created national public health institutes (NPHIs), often following a major event such as the outbreak of severe acute respiratory syndrome.1, 2 | The core function of an NPHI is monitoring and responding to health threats. Monitoring requires reference laboratories and surveillance. Response requires outbreak control and implementation of evidence-based public health actions. NPHIs can include disease-specific control programmes, support to state, provincial, or local public health entities, surveillance and control for non-communicable diseases and injuries, occupational and environmental health, and vital registration (table ).3 These functions can be done by more than one institution in a country, and some countries have collaborated to establish regional institutions. Effective public health responses often require a multidisciplinary team, including skills needed for communicable and non-communicable disease control programmes. For example, the response to biosecurity threats involves expertise in infectious diseases, chemical hazards, engineering, environmental remediation, and risk communication. |
Approaching a perfect storm: responding to new challenges without losing critical core capacities
Kochtitzky C . J Environ Health 2010 72 (8) 30-3 Life expectancy in industrialized countries like the United States increased | 30 or more years in the 20th century, | resulting primarily from public health efforts in areas such as sanitation and immunization. Ensuring availability of clean | water and safe food was a primary contributor to approximately 80% of this impressive improvement in life expectancy | (Koplan & Fleming, 2000). Unfortunately, | the U.S. environmental health (EH) system | and the workforce that is its primary engine may become a victim of its own success—the ratio of public health workers to | population served shrank from an estimated | 220/100,000 in 1980 to 158/100,000 in 2000 | (Merrill, Btoush, Gupta, & Gebbie, 2003); | 10% of these workers are in EH. Given projected resource and demographic trends, this | shrinking per capita public health workforce | is unlikely to be reversed; at best it may only | be stabilized. Because of past successes and | current economic realities, the EH system | may be heading into a perfect storm. |
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