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Weiqi Huang,* Yingxin Wang,* Nan Meng, Kexin Wang, Long Yin, Hongyu Li, Qunhong Wu, Huan Liu* Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huan Liu, Department of Social Medicine, School of Health Management, Harbin Medical University, 157 health Road, Nangang District, Harbin, Heilongjiang Province, 150081, People’s Republic of China, Tel + 86-451-87502851, Fax + 86-451-87502853, Email liuhuan00813@163.comPurpose: China’s fever clinics succeeded during the Coronavirus Disease 2019 pandemic but revealed operational deficiencies. This study explores multiparty coordination mechanisms in fever clinics to improve collaborative management and efficiency in epidemic control.Patients and Methods: A tripartite evolutionary game model was constructed, involving “primary healthcare institutions—non-primary healthcare institutions—government” to analyze the evolutionary stable strategies among these entities in different scenarios. We implemented a simulation of evolutionary processes and conducted sensitivity analyses of government subsidies, punishments, and public supervision.Results: Four evolutionarily stable strategies were identified: B4(0,0,1), B5(1,1,0), B6(1,0,1), and B7(0,1,1). The government gradually tended to be passive in emergency scenarios of the epidemic during the evolution process. Primary and non-primary healthcare institutions chose to participate in the coordinated response for epidemic prevention and control in transition scenarios. In addition, increased government subsidies and punishments resulted in the active participation of primary and non-primary healthcare institutions in the coordinated response for epidemic prevention and control. However, excessive subsidies and punishments led to lenient supervision when they exceeded a certain threshold. Meanwhile, the collaborative participation of non-primary healthcare institutions fluctuates in response to variations in government supervision. Under normal scenarios, public supervision had an obvious effect on driving primary healthcare institutions to participate in coordinated responses for epidemic prevention and control, thereby sharing the role of government supervision to a certain extent.Conclusion: Government subsidies and punishments under a certain threshold effectively promoted the participation of primary and non-primary healthcare institutions in pandemic prevention and control. Additionally, participation in public supervision gradually increased with the gradual evolution of the pandemic. Therefore, our results suggested that the government should actively explore reasonable, dynamic thresholds for subsidies and punishments, promote public participation through diversified means, and explore diverse operation types of fever clinics to address the challenges of emerging infectious diseases in the future.Keywords: fever clinics, public health emergency, coordination, evolutionary game model, simulation

ObjectiveTo analyze the epidemiological characteristics of infectious disease-related public health emergencies in Guangdong Province from 2014 to 2023, for the development of effective infectious disease prevention and control strategies and rational allocation of health resources. MethodsData on infectious disease public health emergencies reported in Guangdong province from 2014 to 2023 were obtained from the Public Health Emergency Management Information System of the Chinese Center for Disease Control and Prevention. Descriptive data analysis was performed using WPS 2019 and R 4.0.3. ResultsExcluding COVID-19 outbreaks, a total of 3 783 infectious disease-related public health emergencies were reported in Guangdong province from 2014 to 2023, of which 2 369 (62.62%) occurred in schools. The top five infectious diseases causing these public health emergencies were influenza (accounting for 18.82% of all reported emergencies), other infectious diarrheal diseases (17.42%), dengue fever (17.23%), varicella (17.00%), and hand, foot, and mouth disease (6.93%). The highest proportion of events (61.80%) were reported in the Pearl River Delta region. Among the events reported in the the Eastern Wing region, 66.09% were caused by vector-borne and zoonotic diseases and the proportion was significantly different from those in other regions. Among the four major categories of infectious diseases causing these events, vector-borne and zoonotic diseases had the highest proportion (33.10%). ConclusionsThere were regional differences in the epidemiological characteristics of infectious disease-related public health emergencies in Guangdong Province from 2014 to 2023, suggesting that region- and disease-specific measures should be developed for the prevention and control of infectious disease-related public health emergencies in the province.

Abstract Background Evidence suggests that PTSD symptoms following public health emergencies are influenced by many factors. The aim of this study was to investigate the relationship between perceived social support and Post-traumatic stress disorder symptoms and to explore the chain-mediated role of resilience and positive coping style, among medical staff in Hubei Province, China, during a public health emergency. Methods Convenience sampling was used to select medical staff from two general hospitals in Hubei Province in July 2022 for this study. A total of 2,751 medical staff were included in the study. Multidimensional Scale of Perceived Social Support, 10- itemConnor- Davidson resilience scale, Simplified Coping Style Questionnaire and The Post-traumatic stress disorder Checklist for DSM-5 were used to assess the levels of perceived social support, resilience, coping style and Post-traumatic stress disorder symptoms of medical staff two years after the public health emergency. Statistical descriptions were conducted using SPSS, and a structural equation model was established using AMOS to analyze the chain-mediated roles of resilience and positive coping style between perceived social support and Post-traumatic stress disorder symptoms. Results Structural equation modeling results showed a standardized total effect of perceived social support on Post-traumatic stress disorder symptoms of -0.416 (95%CI [-0.456, -0.374], P

ObjectiveTo improve the standardization of health emergency equipment at the scene of major public bioterrorism events and to establish a health emergency equipment system for such events. MethodsBased on domestic laws and regulations, domestic and international literature on health emergencies from 2004 to 2023, and survey data on the equipment configuration of domestic health emergency equipment enterprises and relevant emergency response teams, this study first used scenario analysis to explore the functional requirements of health emergency equipment from three aspects: the environment in which bioterrorism events occur, the survival and task requirements of personnel at the scene, and the methods of emergency response. Second, with reference to national standards for the allocation of health emergency equipment, a preliminary plan for the equipment system was determined through literature analysis and market research. Finally, the Delphi method was used to revise and improve the plan. ResultsThe positive coefficient of expert consultation in both rounds was 100%, and the mean coefficient of expert authority was 0.855. The coordination coefficients of the expert opinions were 0.226 and 0.258, respectively (both P < 0.001), indicating a good degree of coordination among the expert opinions. Ultimately, 32 functional units were constructed, including five aspects: investigation, testing, decontamination, protection, and treatment, and a health emergency equipment system for major public bioterrorism events was constructed, consisting of 162 units/sets of instruments or equipment. ConclusionThe constructed medical emergency equipment system has a certain degree of pertinence and reliability and can serve as a reference for the construction of medical emergency team equipment systems and the use of medical emergency equipment at the scene of bioterrorism events.

IntroductionDuring the COVID-19 pandemic, vaccines and specific drugs are seen as indispensable solutions to ending or responding to the pandemic, and pharmaceutical enterprises are in the spotlight. The Chinese government has made active efforts to guide pharmaceutical enterprises to make appropriate social contribution during the public health emergency. This study explores how government-enterprise relationship promotes this process.MethodsUsing the financial and textual data of China's listed pharmaceutical companies and policy data from the official website of the Chinese health-related government departments, this study drew the social contribution through text analysis, and established the response index of pharmaceutical companies to the government—the government-enterprise alignment index (GE_Ali) based on the formula of elasticity for reference. Then a series of regressions are used to do the empirical tests.ResultsThis study found the more responsive pharmaceutical companies were to government, the greater their contribution to society during the pandemic, mainly through increasing the intensity of drug R&D, production and promotion, and the good communication mechanism between the two formed a mediating effect.DiscussionThe nature of state ownership, the presence of embedded party organizations, and the location in the provincial capital city had significant effects on the realization of a high level of government-enterprise alignment positively affecting the social contribution. This study confirms that the Chinese government has made enterprises a part of social governance, which is a global hotspot, through the embedding of party organizations. It also indicates that the government needs to re-recognize its key role in shaping social contribution, especially in distinguishing its responsibilities between normal and emergency situations.

The United States Centers for Disease Control and Prevention (CDC) Laboratory Response Network for Chemical Threats (LRN-C) is a network of more than 50 primarily local public health laboratories covering all states and regions of the United States. It is managed by the CDC and is responsible for collecting, shipping, and analyzing clinical specimens from large-scale and local chemical threat events. The U.S. CDC Chemical Threat Laboratory Response Network establishes a hierarchical network framework, standard specimen collection, packaging, and transport procedures, laboratory testing methods, and related support facilities to achieve rapid collection, shipment, and laboratory analysis of large numbers of specimens following large-scale chemical threat events and to provide local laboratory response capabilities for chemical threat and public health services. The framework design, capability requirements, and event response workflow of the CDC Chemical Threat Laboratory Response Network in the United States provide a reference for the establishment of relevant domestic network laboratories.

Abstract Introduction COVID-19 has demonstrated the importance of competent staff with expertise in public health emergency preparedness and response in the civil aviation system. The civil aviation system is a critical sentinel and checkpoint to prevent imported cases and slow the spread of communicable diseases. Understanding the current competencies of staff to deal with public health emergencies will help government agencies develop targeted training and evidence-based policies to improve their public health preparedness and response capabilities. Methods This cross-sectional pilot study was conducted from November 2022 to October 2023, involving 118 staff members from various positions within China’s civil aviation system. A 59-item questionnaire was translated and developed according to a competency profile. Data were collected using the self-report questionnaire to measure the workforce’s self-perceptions of knowledge and skills associated with public health emergency proficiency, categorized into (1) general competency, (2) preparedness competency, (3) response competency, and (4) recovery competency. KMO & Bartlett test and Cronbach’s α reliability analysis were used to test the reliability and validity of the questionnaire. Descriptive statistics, independent sample T-test, ANOVA, and linear regression models were performed to analyze the competencies. Results A total of 107 staff members from the aviation system were surveyed in this study. The KMO & Bartlett test, (KMO = 0.919, P

ObjectivePublic health emergencies pose a serious challenge to the ability of medical personnel to respond. We aimed to establish a scientific and effective resilience capability assessment scale for grassroots medical workers and explore the way to improve resilience.Research designDeveloped a resilience ability assessment scale and applied it on the medical personnel who worked in community health service centers for more than 1 year. Related indicators were identified through literature review and the Delphi method. The established scale was given weight using the attribute analytic hierarchy process, and the evaluation model was built through the grey correlation analysis.Principal findingsA three-level indicator scale was established, which included three first-level indicators [professional quality (weight 0.346), psychological capital (weight 0.614), and emergency attitude (weight 0.040)]. The second-level indicators had 13 contents and were further subdivided into 46 three-level indicators. The overall resilience ability assessment score of 347 medical workers in Guangzhou was only 0.787. However, steady scientific-exercise habits and relative training can help improve their public health emergency resilience ability (p

At the beginning of the COVID-19 pandemic, an ad hoc organisational framework was established between academic, local government and community partners to implement the “Sentinella – Identify, Trace and Prevent” screening programme in Verona, north-east Italy. Between September 2020 and May 2021, key populations not covered by any screening policies at the local and national level were screened for SARS-CoV-2. Target populations were: older adult residents (males >65 years and females >75 years), bus and taxi drivers, social workers, supermarket employees, hospital cleaning and catering staff, researchers working in the local hospitals, students, and people experiencing homelessness (PEH). Five dedicated swab clinics, home testing facilities, and one mobile clinic were activated to collect nasopharyngeal swabs. Molecular analysis was performed for all the subjects; an antigen-rapid diagnostic test (Ag-RDT) was also implemented as a point-of-care test for PEH. Medical follow-up, psychological support, and quarantine facilities were organised for subjects who tested positive for SARS-CoV-2. Overall, 2075 subjects participated in the surveillance programme. Amongst these, 1,572 were residents/workers, whilst 503 were PEH. A total of 127 (6.2%) participants tested positive for SARS-CoV-2. Sixty-nine were residents, 58 PEH. The incidence rate was 4 per 10.000 person/day (95% CI 3.1–5.0). The highest prevalence and incidence rates were found amongst supermarket employees (9.7% and 8.5 per 10.000 person/day, 95% CI 3.81–18.86, respectively), followed by hospital cleaning staff (8.1%, 7.6 per 10.000 person/day, CI 95% 4.9–11.7). Regarding PEH, the prevalence of SARS-CoV-2 was 11.5%. All PEH identified as positive were isolated in dedicated shelter facilities. Amongst the 69 residents/workers who were quarantined, 53 were reached for initial psychological support for assessing the presence of any psychological distress or psychiatric pathology. Amongst the subjects evaluated, 10 (18.9%) presented clinically significant psychological discomfort and accessed the stepped-care psychological intervention. The community partnerships played a pivotal role in optimising early case detection. Promotion of testing helped to prevent and contain more efficiently potential clusters through strategic planning, especially for PEH. Insights from the study highlight the importance of community partnerships in public health emergencies, particularly in the context of highly transmissible diseases pathways.

ABSTRACT Introduction The COVID‐19 pandemic was a public health emergency (PHE) of unprecedented magnitude and impact. It provided the possibility to investigate the Dutch citizens' understanding and perception of the actors involved in the Dutch pandemic response as a PHE unfolded. Methods Three focus groups (FGs) were held with 16 Dutch citizens in June 2020. Citizens were recruited using the Dutch Health Care Consumer Panel. During the FGs, participants were asked to fill in a table with actors they thought were involved in the management of the COVID‐19 pandemic. They also received information on actors involved in Dutch outbreak responses. Then, the actors named and omitted by the participants were discussed. Results An analysis of the FGs suggests that the Dutch citizens participating in the study were not fully aware of the scope of actors involved in the Dutch COVID‐19 pandemic response. Some participants would have appreciated more information on the actors involved. This would help them have an informed opinion of the actors involved in the decision‐making process, and accept non‐pharmaceutical interventions implemented. Lastly, most participants recognised that they played a role in limiting the spread of the COVID‐19 pandemic. Yet, very few spontaneously mentioned themselves as actors within the COVID‐19 pandemic response. Conclusion This study suggests that early in the COVID‐19 pandemic, the Dutch citizens participating in this study's FG did not have a complete understanding of the scope of actors involved in the Dutch COVID‐19 pandemic response, or the potential role of the citizen. Future research can build on these results to explore the citizen's perception of their role during PHEs of another origin, as well as other geographical and historical contexts. Patient or Public Contribution The public participated in the focus groups and received a non‐expert report summarising the outcomes of the focus groups.

With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.

Although all walks of life are paying less attention to COVID-19, the spread of COVID-19 has never stopped. As an infectious disease, its transmission speed is closely related to the atmosphere environment, particularly the temperature (T) and PM2.5 concentrations. However, How T and PM2.5 concentrations are related to the spread of SARS-CoV-2 and how much their cumulative lag effect differ across cities is unclear. To identify the characteristics of cumulative lag effects of environmental exposure under city differences, this study used a generalized additive model to investigate the associations between T/PM2.5 concentrations and the daily number of new confirmed COVID-19 cases (NNCC) during the outbreak period in the second half of 2021 in Shaoxing, Shijiazhuang, and Dalian. The results showed that except for PM2.5 concentrations in Shaoxing, the NNCC in the three cities generally increased with the unit increase of T and PM2.5 concentrations. In addition, the cumulative lag effects of T/PM2.5 concentrations on NNCC in the three cities reached a peak at lag 26/25, lag 10/26, and lag 18/13 days, respectively, indicating that the response of NNCC to T and PM2.5 concentrations varies among different regions. Therefore, combining local meteorological and air quality conditions to adopt responsive measures is an important way to prevent and control the spread of SARS-CoV-2.

Abstract Background Public health emergencies are characterized by uncertainty, rapid transmission, a large number of cases, a high rate of critical illness, and a high case fatality rate. The intensive care unit (ICU) is the “last line of defense” for saving lives. And ICU resources play a critical role in the treatment of critical illness and combating public health emergencies. Objective This study estimates the demand for ICU healthcare resources based on an accurate prediction of the surge in the number of critically ill patients in the short term. The aim is to provide hospitals with a basis for scientific decision-making, to improve rescue efficiency, and to avoid excessive costs due to overly large resource reserves. Methods A demand forecasting method for ICU healthcare resources is proposed based on the number of current confirmed cases. The number of current confirmed cases is estimated using a bilateral long-short-term memory and genetic algorithm support vector regression (BILSTM-GASVR) combined prediction model. Based on this, this paper constructs demand forecasting models for ICU healthcare workers and healthcare material resources to more accurately understand the patterns of changes in the demand for ICU healthcare resources and more precisely meet the treatment needs of critically ill patients. Results Data on the number of COVID-19-infected cases in Shanghai between January 20, 2020, and September 24, 2022, is used to perform a numerical example analysis. Compared to individual prediction models (GASVR, LSTM, BILSTM and Informer), the combined prediction model BILSTM-GASVR produced results that are closer to the real values. The demand forecasting results for ICU healthcare resources showed that the first (ICU human resources) and third (medical equipment resources) categories did not require replenishment during the early stages but experienced a lag in replenishment when shortages occurred during the peak period. The second category (drug resources) is consumed rapidly in the early stages and required earlier replenishment, but replenishment is timelier compared to the first and third categories. However, replenishment is needed throughout the course of the epidemic. Conclusion The first category of resources (human resources) requires long-term planning and the deployment of emergency expansion measures. The second category of resources (drugs) is suitable for the combination of dynamic physical reserves in healthcare institutions with the production capacity reserves of corporations. The third category of resources (medical equipment) is more dependent on the physical reserves in healthcare institutions, but care must be taken to strike a balance between normalcy and emergencies.

Previous research has identified social isolation as a significant detriment to the wellbeing of older adults. However, studies that consider endogenous issues are scarce. The present paper examines the impact of the recent exogenous shock, the COVID-19 pandemic on the wellbeing of the older adult population using a longitudinal dataset from China for the period 2016–2020. The results of this study indicate that the life satisfaction of Chinese older adults was negatively affected, e particularly in regions where social distancing measures were more strictly enforced. Declines in physical and mental health were found to be attributable to declines in life satisfaction. Those who experienced greater exposure to the pandemic were more likely to suffer from chronic disease, illness, and insomnia, and many found it challenging to complete tasks during the lockdown. Furthermore, heterogeneity estimation shows that these effects are stronger among the rural older adult, females, those without a spouse, and those with less education.

Abstract Background The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic. Methods This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects. Results Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing. Conclusion It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies.

Hengqin, located at the southern end of Zhuhai city and connected to Macao by a bridge and a river, serves as a key platform for promoting Macao's moderately diversified economic development, leveraging the inherent advantages of Guangdong-Macao cooperation. To enhance the capability of responding to public health emergency is very important for the development of cultural tourism and exhibition industries in the Guangdong-Macao In-Depth Cooperation Zone in Hengqin due to high population mobility in the region. In this article, we briefly discussed the role, strength and future development of community engagement-based public health emergency response in the in-depth cooperation zone.

Abstract The ability of the public to remain psychologically resilient in the face of public health emergencies and disasters (such as the COVID-19 pandemic) is a key factor in the effectiveness of a national response to such events. Community resilience and social capital are often perceived as beneficial and ensuring that a community is socially and psychologically resilient may aid emergency response and recovery. This review presents a synthesis of literature which answers the following research questions: How are community resilience and social capital quantified in research?; What is the impact of community resilience on mental wellbeing?; What is the impact of infectious disease outbreaks, disasters and emergencies on community resilience and social capital?; and, What types of interventions enhance community resilience and social capital? A scoping review procedure was followed. Searches were run across Medline, PsycInfo, and EMBASE, with search terms covering both community resilience and social capital, public health emergencies, and mental health. 26 papers met the inclusion criteria. The majority of retained papers originated in the USA, used a survey methodology to collect data, and involved a natural disaster. There was no common method for measuring community resilience or social capital. The association between community resilience and social capital with mental health was regarded as positive in most cases. However, we found that community resilience, and social capital, were initially negatively impacted by public health emergencies and enhanced by social group activities. Several key recommendations are proposed based on the outcomes from the review, which include: the need for a standardised and validated approach to measuring both community resilience and social capital; that there should be enhanced effort to improve preparedness to public health emergencies in communities by gauging current levels of community resilience and social capital; that community resilience and social capital should be bolstered if areas are at risk of disasters or public health emergencies; the need to ensure that suitable short-term support is provided to communities with high resilience in the immediate aftermath of a public health emergency or disaster; the importance of conducting robust evaluation of community resilience initiatives deployed during the COVID-19 pandemic.

Abstract Background The abject uncertainty and unpredictability of public health emergencies have plagued various countries. Global health governance and international communities are facing long-term and arduous challenges. The self-rescue ability of individuals in a public emergency may be the most powerful trait to improve the survival rate outside the hospital. The study explores the cognitive ability and attitudes of urban residents in China towards self-rescue in response to public health emergencies. It provides appropriate evidence for improving the self-rescue ability of urban residents in China. Methods Sixteen urban residents were selected using the purposive sampling method for semi-structured interviews. Theme analysis was used to collate and analyse the interview data. Results Two themes and five sub-themes were analysed. The two themes included cognition and attitude of Chinese urban residents for self-rescue in an emergency. Urban residents believed that their knowledge and skills for self-rescue in an emergency were low. The ability for emergency self-rescue is affected by multiple factors, with relatively limited options for improvement. Nonetheless, the respondents expressed a desire to accept interventions under psychological crisis and a strong willingness to acquire knowledge and skills required for emergency self-rescue. Conclusion This study investigated the perceptions and attitudes of Chinese urban residents towards emergency self-rescue. The results support enhanced ability of urban residents to respond to public health emergencies, thereby diminishing the negative outcomes. The findings suggest the need for strategies to address the factors affecting emergency self-rescue.

Facing with the growing health demands of the people, governments of all countries would promote national health to the level of national strategy, with the national health strategies of the United States and the United Kingdom being the most representative. Based on the theoretical framework of the political systems theory in this paper, we analyze policy texts relevant to health strategies of the two countries in recent years; we also conduct analyses on the semantic network, word frequency of the policy texts in different periods and co-word matrix of the policy documents to interpret the shift of health strategic priorities and the adjustment of measures in the United Kingdom and the United States under the impact of public health emergencies, and then deduce future development direction of the health strategies of the two countries. The study is intended to provide a reference for achieving the strategic goal of Healthy China Initiative.

Abstract Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014. Methods We reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it. Results Despite the adoption of the IDSR framework, Liberia failed to secure the resources—human, logistical, and financial—to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease. Conclusion Our findings suggest that post-war, Liberia’s health system intended to prioritize epidemic preparedness and response with the adoption of IDSR. However, insufficient investment and systems development meant IDSR was not well implemented, leaving the country vulnerable to the devastating impact of the Ebola epidemic.

ObjectiveThis study aimed to analyze the population characteristics of apheresis platelet donors in Chongqing Province and provide a scientific basis for the development of precise and efficient recruitment strategies. The ultimate goal is to increase the number of regular platelet donors in preparation for public health emergencies.MethodsThis study involved 53,089 blood donors who donated apheresis platelets to the Chongqing Blood Center from 2020 to 2022. Data regarding age, sex, blood type, education level, occupation, and frequency of blood donation were collected and analyzed to identify factors influencing platelet donation.ResultsBetween 2020 and 2022, the majority of apheresis platelet donors in Chongqing were aged 25–35 years, with a male-to-female ratio of 2.6:1. The ABO blood group distribution was O > A > B > AB. The apheresis platelet donors mainly consisted of college students, and the donors who had donated only once accounted for the greatest proportion.ConclusionBased on the population characteristics of apheresis platelet donors in Chongqing, blood collection and supply organizations must refine emergency blood collection and supply plans during public health emergencies. This study underscores the importance of developing precise and efficient recruitment strategies for apheresis platelet donors and expanding the pool of regular apheresis platelet donors. These measures are essential to ensure the timely, safe, and effective use of clinical blood resources during public health emergencies.

BackgroundThe integration of disparate emergency resources and the improvement of emergency response teamwork are the underlying trends and shared requirements for building resilience in an era of multiple global public health crises.ObjectiveThis study investigated the emergency response with emergency collaboration networks of each functional module and the overall Joint Epidemic Prevention and Control Mechanism (JPCM) network in China’s COVID outbreak prevention and control.MethodsThe study employed a scholarly framework of “the integration of JPCM coordination and emergency collaborative modularization” to explore the attributes of JPCM using social network analysis. The data were obtained from administrative records from JPCM’s official website, spanning January 2020 to December 2022.ResultsThe study examined the JPCM coordination and found several functional working modules of JPCM, such as Interrupt Spread, Manage Supply, Medical Rescue, Restore Work and Production, and Implement Responsibility modules. The network structure indicators showed that the Manage Supply module had the most extensive network connectivity, the shortest communication distance, and the most consistent collaboration. The E-I index of the overall JPCM network and the Manage Supply network were − 0.192 and − 0.452, respectively (at p

ObjectiveTo establish a set of indicators for assessing the public health emergency response capacity at county/district level in China. MethodsAn indicator system for evaluating public health emergency response capacity at county/district level was initially formulated based on theoretical research and literature review. Three rounds of Delphi consultation were conducted among 18 senior professionals to determine the indicators and their weights of the system using hierarchical analysis method. ResultsFor the 3 rounds of expert consultation, the positive coefficients of the were 100.0%, 88.9%, and 88.9%; the expert authority coefficients were 0.87, 0.84, and 0.87; and the coordination coefficients of expert opinions were 0.207, 0.210, and 0.295 (all P < 0.001), indicating a good coordination of the experts′ opinions. The finally established indicator system for assessing public health emergency response capacity at county/district level included 5 first-, 19 second-, and 61 third-level indicators. For the third round of Delphi consultation, the experts′ mean scores and ranges of coefficients of variance for importance/feasibility of all the indicators were 4.83 ± 0.13/4.48 ± 0.21 and 0.00 – 0.18/0.07 – 0.22, respectively. The weights for the first-, second-, and third-level indicators ranged from 0.094 to 0.290, 0.011 to 0.119, and 0.001 to 0.087, respectively. ConclusionThe established indicator system could be used to develop tools for evaluating public health emergency response capacities at county/district level, while the reliability and validity of the indicator system need to be assessed further.

Abstract Objective The coronavirus disease 2019 was a global public health emergency in later years (from 2020 to early 2022), and androgens have been associated with infection and prognostic outcomes. However, the relationship between low serum testosterone levels and prognostic outcomes remains inconclusive. This systematic review aimed to investigate the relationship between serum testosterone levels and prognostic outcomes in patients with COVID-19. Methods We searched PubMed, MEDLINE, EMBASE and Web of Science electronic databases for all literature from January 1, 2020, to September 1, 2022. In addition, we also searched literature manually. The search terms were COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), androgens, and testosterone. There were no language restrictions for retrieval. Results Our search identified 2285 articles, resulting in a full-text analysis of 16 studies, including 12 cohort studies and four case-control studies. Low serum testosterone levels were observed to be statistically associated with a higher probability of intensive care unit (ICU) admission in seven studies. In eight studies, higher hospital mortality was associated with lower serum testosterone levels. Six studies found that low serum testosterone levels were associated with a statistically significant difference in lung function impairment. Only four studies found that among living patients, those with lower serum testosterone levels had longer hospital stays. All but one of the included studies had a low risk of bias. Conclusions Based on available data, low serum testosterone levels are associated with higher rates of ICU admission, hospital mortality, risk of lung failure, inflammatory markers, and longer hospital stays in patients with COVID-19 compared with those having normal serum testosterone levels.

As an important part of the emergency management system for public health emergencies, health emergency preparedness has been highly valued by the World Health Organization (WHO) and various countries and regions. Public health emergency preparedness (PHEP) has been defined as the capability of the public health and health care systems/communities/individuals to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those with the scale, timing, or unpredictability exceeding conventional capabilities. In this paper, we summarize and compare the health emergency preparedness frameworks proposed by the World Health Organization and issued in the United States and the United Kingdom, and draw on the relevant experience of the above-mentioned organizations and national health emergency preparedness frameworks, and proposes a set of systematic health emergency preparedness frameworks composed of three major system modules (functional subsystem, management mechanism and resource support) covering the preparation, response and recovery phases of public health emergencies. This study puts forward corresponding suggestions to provide support for improving China's health emergency preparedness framework.

BackgroundChina faces various public health emergencies, and emergency responders at the Centers for Disease Control and Prevention (CDC emergency responders) are a mainstay in responding to public health emergencies. Career resilience can help CDC emergency responders to effectively respond to and recover from public health emergencies, but there is no specific measurement instrument available. In this study, we aimed to develop and conduct an initial validation of the career resilience instrument for CDC emergency responders in China within the context of public health emergencies from a process perspective.MethodsBased on a survey conducted in Shanghai, interpretive phenomenological analysis (IPA), which is a qualitative research approach to describing and analyzing individual experiences, was used to analyze the interview texts to develop the initial career resilience instrument for CDC emergency responders. The initial career resilience instrument was revised through two rounds of expert consultation. Cronbach’s α coefficient and exploratory factor analysis were used to test the reliability and validity of the revised career resilience instrument.ResultsThe initial career resilience instrument for CDC emergency responders contained three first-level measurement dimensions, 9 second-level measurement dimensions, and 52 measurement items. After expert consultation, the first-level and second-level measurement dimensions were not revised, 13 measurement items were deleted or revised, and six measurement items were added, resulting in 48 measurement items. The revised career resilience instrument was tested for good reliability and validity.ConclusionCareer resilience for CDC emergency responders can be regarded as a set of protective factors and dynamic processes that can be cultivated and intervened in cognitive, affective, and behavioral dimensions to improve their ability to respond to and recover from public health emergencies.

Abstract Background During public health emergencies, online community users can obtain social support and assistance through information interaction in the online community. This study takes the COVID-19 pandemic as the context and aims to analyze the influence of user information interaction in online communities on the acquisition of social support during this public health emergency. Methods Data collected from help-seeking posts in the “COVID-19 Patients Help-Seeking Dialog” subforum on China’s Sina Weibo were used as the research sample. The influence of the frequency of interaction and responsiveness on help seekers’ receipt of online social support was analyzed, and the moderating effect of help seekers’ identity type and intensity of online community use was explored. Results The results reveal that the frequency of interaction positively impacts informational support (β = 0.367, p

Background The competencies of medical staff in the public health emergency system and evaluated the effects of system-based professional training were investigated. Material and Methods A competency model for individuals in a public health emergency management system was developed, which contained 33 items with 5 domains. A competency-based intervention was performed. A total of 68 participants from 4 health emergency teams in Xinjiang, China were recruited and randomly divided into 2 groups: the intervention (N = 38) and control groups (N = 30). Participants in the intervention group received competency-based training, while those in the control group received no training. All participants responded to the COVID-19 activities. The competencies of medical staff in the 5 domains were then analyzed in the pre-intervention, post-first training, and post-COVID-19 intervention using a self-designed questionnaire. Results Participants’ competencies were at the middle level at baseline. After the first training, competencies in the 5 domains significantly improved in the intervention group; in the control group, there was a significant increase in professional quality compared in the pre-training. After the response to COVID-19, the mean scores of competencies in the 5 domains significantly increased in both the intervention and control groups compared with those in the post-first training. Psychological resilience scores were higher in the intervention group than in the control group, whereas no significant differences in competencies were found in other domains. Conclusions Competency-based interventions provided practice and showed a positive effect on improving the competencies of medical staff in public health teams. Med Pr. 2023;74(1):19–26

Abstract Granted by the U.S. Food and Drug Administration, an Emergency Use Authorization (EUA) can only be utilized upon declaration that a specialized set of circumstances exist which justify the authorization. In 2020, the COVID-19 pandemic demanded rapid communication strategies to promote treatment options available through EUA. Despite the authorizations of available monoclonal antibody (mAb) treatments in November 2020, their rate of adoption among health care providers in the U.S. remained low well into 2021. This study examines the accelerators and barriers to provider adoption of COVID-19 treatment so that future adoption of treatments in emerging public health emergencies may be better communicated and hastened. We established a framework informed by adoption accelerators and barriers identified by Diffusion of Innovations (DoI) Theory and conducted a study during the rapidly evolving COVID-19 public health emergency. Most DoI public health research focuses on chronic health issues and has yet to be applied to provider adoption of new treatment under EUA. Through a series of guided interviews with health care providers, primarily physicians or nurse practitioners that were responsible for referring COVID-19 patients, we extracted tools, processes, or other mechanisms (accelerators) and barriers to validate against our DoI framework and fill the gap regarding emergency situations. Our research found that providers supported by large health systems were more inclined to adoption, due to many contributing factors such as the availability of collaborative support and availability of information. Further, communicating evidence-based summaries of treatment options and related processes was also critical to adoption.

BackgroundThe COVID-19 pandemic has disrupted the healthcare and public health sectors. The impact of working on the frontlines as a healthcare or public health professional has been well documented. Healthcare organizations must support the psychological and mental health of those responding to future public health emergencies.ObjectiveThis systematic review aims to identify effective interventions to support healthcare workers’ mental health and wellbeing during and following a public health emergency.MethodsEight scientific databases were searched from inception to 1 November 2022. Studies that described strategies to address the psychological impacts experienced by those responding to a public health emergency (i.e., a pandemic, epidemic, natural disaster, or mass casualty event) were eligible for inclusion. No limitations were placed based on study design, language, publication status, or publication date. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal tools. Discrepancies were resolved through discussion and a third reviewer when needed. Results were synthesized narratively due to the heterogeneity of populations and interventions. Outcomes were displayed graphically using harvest plots.ResultsA total of 20,018 records were screened, with 36 unique studies included in the review, 15 randomized controlled trials, and 21 quasi-experimental studies. Results indicate that psychotherapy, psychoeducation, and mind–body interventions may reduce symptoms of anxiety, burnout, depression, and Post Traumatic Stress Disorder, with the lowest risk of bias found among psychotherapy interventions. Psychoeducation appears most promising to increase resilience, with mind–body interventions having the most substantial evidence for increases in quality of life. Few organizational interventions were identified, with highly heterogeneous components.ConclusionPromoting healthcare workers’ mental health is essential at an individual and health system level. This review identifies several promising practices that could be used to support healthcare workers at risk of adverse mental health outcomes as they respond to future public health emergencies.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=203810, identifier #CRD42020203810 (PROSPERO).

Introduction. During the early phase of the COVID-19 pandemic, some infection control measures were implemented to keep people safe and control the spread of the virus. These measures however were observed to cause significant delay or interruption in the delivery and utilization of healthcare services. Objective. The purpose of this study was to determine the impact of the COVID-19 pandemic on the utilization and delivery of healthcare services by outpatients in Nigeria during the early phase of the pandemic Methods. We sampled 373 outpatients who had received healthcare services before and during the pandemic in the University College Hospital, Ibadan using convenience sampling. Descriptive and inferential statistics (t-test) were carried out and the level of significance was set as P0.05. Results. Healthcare utilization was significantly impacted by the pandemic as there was a reduction in hospital visits by patients during the pandemic (p 0.0003). Restriction of movement and fear of contracting the virus was identified as reasons for the reduction in healthcare services utilization in about 59% of the participants. Patients rated the quality healthcare services delivered to them as “average” during the pandemic as opposed to “good” before the pandemic. Conclusion. The findings of this study showed that the COVID-19 pandemic had a significant impact on patients’utilization of healthcare services as well as the delivery of adequate healthcare services in the hospital during the early phases of the pandemic. Therefore, we recommend that efforts be made to improve hospitals and nationwide preparednessfor future pandemics to prevent healthcare interference and delay.

Abstract Background Emergency-use-authorization (EUA) is the representative biodefense policy that allows the use of unlicensed medical countermeasures or off-label use of approved medical countermeasures in response to public health emergencies. This article aims to determine why the EUA policies of the United States and South Korea produced drastically different outcomes during the COVID-19 pandemic, and how these outcomes were determined by the originations and evolutionary paths of the two policies. Method Historical institutionalism (HI) explains institutional changes—that is, how the institution is born and how it evolves—based on the concept of path dependency. However, the HI analytical narratives remain at the meso level of analysis in the context of structure and agency. This article discusses domestic and policy-level factors related to the origination of the biodefense institutions in the United States and South Korea using policy-learning concepts with the Event-related Policy Change Model. Results The 2001 anthrax letter attack (Amerithrax) and the 2015 Middle East Respiratory Syndrome (MERS) outbreak prompted the establishment of biodefense institutions in the United States and South Korea, respectively. Due to the different departure points and the mechanism of path dependency, the two countries’ EUAs evolved in different ways—the United States EUA reinforced the Post-Exposure Prophylaxis (PEP) function, while the South Korea EUA strengthened the Non-Pharmaceutical Intervention (NPI) function. Conclusions The evolution and outcomes of the two EUAs are different because both policies were born out of different needs. The United States EUA is primarily oriented toward protecting homeland security against CBRN (chemical, biological, radiological, and nuclear) threats, whereas the South Korea EUA is specifically designed for disease prevention against infectious disease outbreak.

ObjectiveTo examine current situation of internet sentiment on public health emergencies and strategies for coping with the situation in China to provide evidence for administrative agencies′ effective response to the public sentiment. MethodsPublished studies relevant to internet sentiment on public health emergency published in Chinese or English up to October 30th, 2021 were retrieved through comprehensively searching Chinese National Knowledge Infrastructure (CNKI), Wanfang Database and PubMed. Content analysis, co-word clustering and significance assessing were used to sort out and categorize the characteristics of internet sentiment on public health emergencies and strategies and problems in administrative agencies′ response to the sentiment. Ordinal ranking was adopted to evaluate the importance and severity of the strategies and problems in the agencies′ responses. Results Based on content analysis on 116 literatures included into the study, 29 features were identified in terms of public health emergency-related internet sentiment′s ontology, subject, content, development, communication, society, space and time. Also according to the analysis, 25 problems and 26 strategies in the responses to the internet sentiments were revealed at four stages of prevention, preparation, response and recovery in dealing with a public health emergency. The ordinal ranking for the importance/severity of the 25 problems and 26 response strategies were basically consistent in the 4 stages of public health emergency management; the top serious problems in each stage were delayed management and prevalence of rumors due to the lack of initiative in response stage, without theoretical guidance owing to imperfect laws and regulations in preparation stage, lacking post-event evaluation and accountability as a result of imperfect systemic infrastructure in recovery stage, and too much information noise due to the absence of serial theme propaganda in prevention stage, with the severity/importance index score of 0.1263, 0.0982, 0.0355, and 0.0305; the top important strategies in each stage included dispelling rumors actively in mass media in response state, establishing a mechanism to deal with the internet sentiment in preparation stage, establishing regulations for rapid evaluation and accountability about the internet sentiment in recovery stage, and constructing a media-wide communication system for carrying out positive publicity actively in preparation stage, with the severity/importance index score of 0.1062, 0.1016, 0.0360, and 0.0257, respectively. Conclusion The response to public health emergency-related internet sentiment should be integrated into the whole process responding to public health emergencies and should be addressed in each of the four stages: prevention, preparation, response and recovery. Such considerations should be aligned with risk communication strategies for public health emergency response, for better resolving of social contradictions and satisfying of public needs.

Severe circumstance of global public health has posed higher requirements for rapid response to public health emergencies in port cities, especially at border ports, and it is urgent to construct a rapid decision-making mechanism for the response to public health emergency in port city in China. In this paper, the basic elements of public health emergency management decision-making, the structure of decision-making system, as well as the experience of port cities in responding to public health emergencies, are summarized. Specific problems in decision-making mechanism for the response to public health emergency in port city were also discussed in the paper, including the risk identification and screening of infectious diseases, novel model for comprehensive risk management of public health event, the application of artificial intelligence technology to construct rapid response infrastructure, and the structure and operation mode of the early-warning decision-making system.

Abstract Background In the present study, we attempted to develop and validate a participatory competency model for medical workers and then evaluate the current status of competency characteristics of Chinese medical workers. Methods The competency model was constructed in a multistage process, including literature review, expert consultation, critical incident and focus group interview. A pilot study was conducted to refine the initial model among 90 participators and the viability and reliability were evaluated by a questionnaire survey among 121 medical workers. Then, the current status of competency characteristics was measured based on the final version of competency model. Results In the pilot study, ten questionnaires were dropped for the poor quality and thus the eligible rate was 92% (138/150). KMO value was 0.785 and Bartlett test showed that the χ2 = 6464.546 (df = 903) and p value

ObjectiveTo study emotional reactions to and behavior intentions about sufferers′ privacy leakage among internet users in China during public health emergencies (PHE) and to provide references for improving government supervision capability and risk communication strategy. MethodsTotally 54 blogs and 6 946 comments relevant to two events of PHE sufferers′ privacy leakage were retrieved from Sina Weibo during March 2021 using Octoparse software. High-frequency words were extracted from the retrieved corpus with ROST Content Mining software and a grounded theory-based textual analysis was performed after open, spindle and selective coding with NVivo12.0. ResultsFinally 25 initial and 11 main categories were identified; a 'situation-perception-reaction' theoretical model was constructed; and a logical framework was formed for the internet users′ emotional response and coping behaviors to the incidents of PHE sufferers′ privacy leakage. Conclusion Influenced by personal characteristics, risk information and other factors, the self-perception on sufferers′ privacy leakage would occur among internet users in public health emergencies; based on the self-perception, the internet users may produce corresponding emotional reactions, and finally make behavioral response choices.

Tao Li School of Law, Hebei University of Economics and Business, Shijiazhuang, Hebei, People’s Republic of ChinaCorrespondence: Tao Li, School of Law, Hebei University of Economics and Business, Xuefu Road No. 47, Shijiazhuang, 050061, People’s Republic of China, Tel +86 18034167013, Fax +86 311 87655560, Email lawyerlitao@126.comAbstract: In the occurrence of public health emergency events, such as the ongoing COVID-19 pandemic, the most severely affected areas may face various problems due to insufficient medical staff and materials. These problems can be solved by the adequate supply of trans-regional medical support. However, due to the Chinese government’s hierarchical and segmented administrative system, the provision of such support to fight against the COVID-19 epidemic in China met several challenges, including insufficient coordination and weak integration. This article summarizes four aspects of fragmentation related to the holistic management of this situation: cooperation from local government officials, supply of medical resources, support from logistical services, and incentive mechanisms. Furthermore, suggestions for improving the holistic management of trans-regional medical support are provided.Keywords: public health emergency, COVID-19, trans-regional medical support, holistic management

IntroductionEmergency Medical Language Services (EMLS) have played a crucial role in the COVID-19 pandemic. Research on the quality and its influencing factors of EMLS is necessary.MethodsThis study used the SERvice QUALity (SERVQUAL) model to determine factors affecting the quality of EMLS during the pandemic. An online questionnaire was completed by 206 participants who received the service in 2021–2022. Structural Equation Modeling (SEM) indicated that the service provider and service process significantly influenced the Service Results.ResultsIn the service process, the evaluation of service content and responsiveness were highly correlated, and both factors significantly affected user satisfaction. In the service provider, tangibility and reliability were highly correlated. The key factors for user willingness to recommend the service were service content and tangibility.DiscussionBased on the results of the data analysis, it can be inferred that EMLS should be improved and upgraded in terms of service organization, talent cultivation, and service channel expansion. To enhance service organization, an emergency medical language team should establish a close collaboration with local medical institutions and government departments, and an EMLS center should be established with the support of hospitals, government, or civil organizations.

ObjectiveTo evaluate key node issues in the process of community resilience construction to deal with public health emergencies in China and to provide a reference for the construction and improvement of community resilience. MethodsA list of problems in the construction of community resilience in response to public health emergencies was determined after literature studies and professional group discussions. The severity and the urgency of intervention for each of the problems were assessed through a consultation among 40 senior professionals engaged in emergency response or community management. Technique for order performance by similarity to ideal solution (TOPSIS) method was adopted to rank the importance of the problems. ResultsFor the expert consultation, the positive coefficient was 95.0% and the authority coefficient was 0.774; and the coordination coefficients were 0.387 and 0.428 for the experts’ scores of evaluation on the severity and intervention urgency of the 16 items in the problem list of community resilience construction, indicating significant coordination of the experts′ evaluation (both P < 0.05). The results of the TOPSIS analysis revealed that the five key node issues in the construction of community resilience include: the absence of the multi-agent community resilience system, the lack of communication and coordination mechanism among participants of the resilience construction, the prevalence of traditional top-down management model for local governments and other stakeholders due to the lack of community-based disaster management concepts among administrative staff, poor engagement of community residents in public health emergency management with predominate role of governments and health institutions, and insufficient emergency response resources supported by local governments to communities and health institutions, with the weight indexes of 0.514, 0.487, 0.467, 0.454, and 0.437, respectively. ConclusionEfficient coordination mechanism among community participants, appropriate community management model, the participation of community residents, and relevant resources support are among the key node issues needing to be concerned in the construction of community resilience system to cope with public health emergency in China.

It is urgent to improve communities′ response and resilience against various disasters frequently posing serious threats to the safety of people′s lives and property. With literature researches and based on complex system analysis, the study summarizes constituent elements of a community resilience system for coping with public health emergencies; the study also analyzes general characteristics and main loop logic of the resilience system′s four subsystems: social capital, community′s basic characteristics, disaster management, and community′s development capability. Then, a logical model of community resilience system for public health emergencies was constructed to provide a policy simulation tool for the development of community resilience. Among a community resilience system′ four subsystems, the social capital subsystem involves residents′ participation, community norms, relationship networks, and trust; the community basic characteristics includes a community′s physical environment, economic and demographic characteristics; the disaster management covers emergency organization management, disaster prevention and mitigation activities, disaster risk assessment, and residents′ awareness and skills for disaster reduction; the community development capability involves community innovation potential, information communication and public services. The constructed logical model for community resilience system to cope with public health emergencies could provide a certain reference for theoretical research and practical cultivation of community resilience.

IntroductionWith the new coronavirus (COVID-19) pandemic across the world, it is critical to propose effective strategies for stigma governance in public health emergencies in order to reduce negative effects caused by stigma. However, no known research has focused on the essential role of events in understanding stigma phenomenon from the perspective of external dynamic changes.MethodsBased on the event system theory, this paper analyzes the evolution mode and characteristics of specific events in the process of stigmatization from strength, space and time aspects, and taking COVID-19 event as an example, 1202 questionnaires and empirical analysis were conducted.Results and discussionOur results reveal that event strength directly affects the results of stigmatization, and such impact appears to be more prominent with a novel, disruptive and critical event. In addition, spatial and temporal attributes represent the dynamic development of an event, and they can interact with event strength to regulate the relationship between event strength and outcomes. Finally, stigma governance strategies under public health emergencies from three aspects of event strength, space, and time were put forward.

Early in the pandemic, pre-print servers sped rapid evidence sharing. A collaborative of major medical journals supported their use to ensure equitable access to scientific advancements. In the intervening three years, we have made major advancements in the prevention and treatment of COVID-19 and learned about the benefits and limitations of pre-prints as a mechanism for sharing and disseminating scientific knowledge.

Fei Zuo,1 Shaoguo Zhai2 1Department of Finance, Economics and Management School, Northwest University, Xi’an, Shaanxi Province, People’s Republic of China; 2Department of Social Security, Public Management School, Northwest University, Xi’an, Shaanxi Province, People’s Republic of ChinaCorrespondence: Fei ZuoDepartment of Finance, Northwest University, No. 1, Xuefu Road, Xi’an, Shaanxi Province, People’s Republic of ChinaTel +86 153-3907-9756Email grace.fiz@nwu.edu.cnBackground: While past experiences show that a health system financing mechanism can support resilience to shocks, the impact on the sustainability of the financing system is exceptionally important considering the magnitude of the COVID-19 pandemic. The role of Social Health Insurance (SHI) in responding to the pandemic brings about an influence on insurance system sustainability. This study investigates the impact of China’s COVID-19 treatment policy on the sustainability of its SHI system, explores influences of the policy on Wuhan’s system, and discusses the effects of an assumed equivalent emergency on SHI funds for five other provincial capital cities in China.Methods: The study was conducted using pay-as-you-go actuarial models of Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) funds, which constitute China’s basic health insurance system. Current and accumulated balances of the funds in 2020 are predicted and utilized to measure the sustainability of health insurance funds during emergencies.Results: The findings suggest a disparity in the capacities of insurance schemes and localities. If the surplus before 2018 is not considered, it is likely that the URRBMI fund of Wuhan would suffer a deficit, whereas the UEBMI would retain a considerable surplus. To maintain the current actuarial balance of the URRBMI fund, coverage for ordinary inpatient and outpatient expenses would have to be significantly reduced in Wuhan, potentially affecting enrollees’ wellbeing. A similar situation may occur in three other cities, some with underdeveloped economies and lower per capita income are likely to be encountered with worse situation than Wuhan.Conclusion: Concerning fragmentation of China’s SHI system, to strengthen longer-term preparedness to manage future emergencies, this study suggests the integration of insurance schemes and provincial pooling, fund balance adjusting and an emergency safety net are also advised. All options call for more public health investments.Keywords: public health emergency, COVID-19 pandemic, public health insurance, sustainability, disparity

Inconsistent training programs for public health emergency (PHE) have been criticized as a contributing factor in PHE's managerial weak points. In response, to analyze the relevant discrepancies among the medical students in the class of 2021 from Xiangya School of Medicine of Central South University, the present study conducted an online questionnaire survey using convenience sampling. The questionnaire comprised four sections, including the basic information, the subjective cognition in PHE, the rescue knowledge and capabilities of PHE, and the mastery of PHE regulations and psychological intervention abilities. To compare the abovementioned aspects, related data were collected from 235 medical students divided into two groups, namely, clinical medical students (Group A) and preventive medical students (Group B). We found a more positive attitude in PHE (P = 0.014) and a better grasp of the PHE classification (P = 0.027) and the reporting system in group B compared with group A. In addition, even if group B showed the same response capability in communicable diseases as group A, the former had less access to clinical practice, resulting in poorer performance in the noncommunicable diseases during a fire, flood, and traffic accidents (P = 0.002, P = 0.018, P = 0.002). The different emphasis of each training program contributed to the uneven distribution of abilities and cognition. Meanwhile, the lack of an integrated PHE curriculum led to unsystematic expertise. Hence, to optimize the PHE management system, equal attention should be paid to medical students with diverse majors along with a complete integrated PHE curriculum.

ObjectiveAs life with COVID-19 became a norm in 2022, the public's demand for and perception of COVID-19-related information has changed. This study analyzed the performance and responses of Healthy China and the public at various stages of COVID-19 normalization using the crisis and emergency risk communication (CERC) theory.MethodsThis study was based on the 2022 Shanghai COVID-19 outbreak and data from “Healthy China,” the official TikTok account of the National Health Commission of the People's Republic of China (NHCC). First, we divided the Shanghai lockdown into five stages in accordance with the CERC. Second, the videos released by Healthy China were open-coded. Third, to understand the distribution of strategies across the stages, we used counts and percentages to summarize the categorical variables. Fourth, we investigated the distribution of public participation indicators using descriptive statistical analysis. Finally, the relationship between stage and communication strategy was examined using the chi-square test and negative binomial regression.Results(1) Healthy China adopted a more flexible approach to communication strategies; (2) new cases per day was the commonly used substrategy for uncertainty reduction; (3) there was a significant difference in the strategies used by Healthy China at different stages; (4) public participation was highest in the pre-crisis period; and (5) the stage had a significant positive impact on the number of views, favorites, likes, and shares.ConclusionsThis research provides insight into effective communication strategies for the government or public health agencies to employ during COVID-19 normalization.

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a “trauma-informed lens,” which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or “lens” to minimize compounding trauma for First Nations communities.

Kelin Chen,1 Yuni Luo,1 Anyang Hu,2 Ji Zhao,3 Liwei Zhang4 1Institute of Urban Governance, Shenzhen University, Shenzhen, 518060, People’s Republic of China; 2School of Government, University of Chinese Academy of Social Science, Beijing, 102488, People’s Republic of China; 3School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, 200030, People’s Republic of China; 4School of Public Administration, Jilin University, Changchun, 130012, People’s Republic of ChinaCorrespondence: Liwei ZhangSchool of Public Administration, Jilin University, 2699 Qianjin Street, Changchun, 130012, People’s Republic of ChinaEmail zhanglw@jlu.edu.cnBackground: During a public health emergency, social media is a major conduit or vector for spreading health misinformation. Understanding the characteristics of health misinformation can be a premise for rebuking and purposefully correcting such misinformation on social media.Methods: Using samples of China’s misinformation on social media related to the COVID-19 outbreak (N=547), the objective of this article was to illustrate the characteristics of said misinformation on social media in China by descriptive analysis, including the typology, the most-mentioned information, and a developmental timeline.Results: The results reveal that misinformation related to preventive and therapeutic methods is the most-mentioned type. Other types of misinformation associated with people’s daily lives are also widespread. Moreover, cultural and social beliefs have an impact on the perception and propaganda of misinformation, and changes in the crisis situation are relevant to the type variance of misinformation.Conclusion: Following research results, strategies of health communication for managing misinformation on social media are given, such as credible sources and expert sources. Also, traditional beliefs or perceptions play the vital role in health communication. To sum up, combating misinformation on social media is likely not a single effort to correct misinformation or to prevent its spread. Instead, scholars, journalists, educators, and citizens must collaboratively identify and correct any misinformation.Keywords: health misinformation, social media, public health emergency, health communication, COVID-19, China

BackgroundThe COVID-19 pandemic is affecting the care of patients with colorectal cancer worldwide, resulting in the postponement of many colorectal cancer surgeries. However, the effectiveness and safety of performing colorectal cancer surgery during the COVID-19 pandemic is unknown. This study evaluated the impact of the COVID−19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery.MethodsWe retrospectively identified patients undergoing colorectal cancer surgery in January 21, 2019, to April 1, 2019, vs. January 21, 2020, to April 1, 2020. Data regarding perioperative outcomes (postoperative complications, conversion rate, duration of surgery, intraoperative blood loss, transfusion, reoperation, intensive care, histological examination, morbidity, and length of hospital stay) were retrieved and compared between the two cohorts. A meta-analysis of 14 studies was also conducted to assess the impact of the COVID−19 pandemic on surgical outcomes in patients undergoing colorectal cancer surgery.ResultsThe sample included 68 patients who underwent surgery in 2020 and 136 patients who underwent surgery in 2019. No patient was converted from laparoscopy to laparotomy or required reoperation. R0 resection was completed in all patients in both groups. There was no significant difference in postoperative complications (p = 0.508), duration of surgery (p = 0.519), intraoperative blood loss (p = 0.148), transfusion (0.217), intensive care (p = 0.379), mean lymph node yield (p = 0.205), vascular positivity rate (p = 0.273), nerve invasion rate (p = 0.713), anastomosis leak rate (p = 1), morbidity (p = 0.478), and length of hospital stay (p = 0.623) between the two groups. The meta-analysis also showed no significant difference in short-term outcomes between the two groups.ConclusionsOur study shows that the COVID-19 pandemic has not led to a deterioration in the surgical outcomes of colorectal cancer surgery or reduction in the quality of cancer removal. Therefore, we do not recommend postponing elective colorectal cancer surgery during the COVID-19 pandemic.

The COVID-19 outbreak makes up a major public health emergency, and each country has adopted different epidemic prevention policies and measures. Since the control of COVID-19 in 2020, China has gradually developed a “Dynamic Clearing” epidemic prevention policy of “external input prevention and internal rebound prevention”. The policy has been effective in protecting people's lives and health and developing the country's economy as much as possible, but it has also faced some challenges, such as slowing economic development, huge prevention, and control costs, and expanding secondary disasters and risks. Reviewing China's current “dynamic clearing” policy, it is still the overall policy to continuously improve guiding policies, construct scientific prevention measures, and promote digital governance at the grassroots level.