Using R programming to inform and improve case notification procedures in a local public health unit

Abstract Issue/Problem COVID-19 was declared a pandemic in March 2020. Information systems, particularly those related to laboratory testing notification, became extremely important as a mechanism of fast identification of cases. In Portugal, any test performed in a professional setting is of mandatory notification. For a local public health unit in northern Portugal, much like in other regions worldwide, challenges related to lack of human and material resources were felt over the course of the pandemic. Description of the problem In 2021, an intensive surveillance strategy was implemented using up to date notification database analysis through R programming, focusing on simplified data availability for contact tracing team members and accuracy of notifications submitted by laboratories, including verification of individual identifying information. Results Some laboratories were identified has having lower data completion rate, which had negative effects on contact tracing timeliness, while others failed to notify tests conducted. Public Health workers warned partners of these failures and worked with them to develop solutions. Interventions included facilitation of access to technologies to notify test results, as well as revision of internal processes to ensure correct patient identification. During the intervention, successful notification rates were increased, and new informal and formal partnerships were developed, leading to faster identification of clusters. Lessons Establishing partnerships with stakeholders and developing support systems is beneficial towards epidemiological surveillance efforts. Adequate analysis of notification procedures was an important step towards standardization and correctness of information required for epidemiological surveillance. Key messages Resilient information systems are important for surveillance, especially during a pandemic. Partnerships with community stakeholders are essential to timely and adequate epidemiological response.


Background:
Religious and cultural beliefs strongly influence people's attitudes and behaviors that, in turn, may positively or negatively affect both individual and public health. In this regard, we aimed to collect and analyze evidence on the impact of religion in the current COVID-19 pandemic.

Methods:
We performed a scoping review investigating both scientific and grey literature available on the topic from the onset of the pandemic to September 2021. Pubmed, Web of Science and Google Scholar were investigated and a hand-search on Google was also performed. Studies dealing with religion and COVID-19 were included and narratively summarized according to topics. Results: 46 articles were included in the review. Predominant topics emerged were 1) religious pilgrimages and rituals worldwide being relevant to COVID-19 outbreaks, especially in the first pandemic wave 2) difficulties to engage the Closed Religious Communities (e.g. Haredi, Amish, etc.) in which community way of life, restrictions in using media and resistance to comply to preventive measures were identified as significant COVID-19 risk 3) COVID-19 unofficial treatments and vaccine hesitancy also supported by concerns on the religious acceptability of vaccine composition or firm interpretation of the Ramadan fasting 4) a fuel of religious discrimination 5) religious communities and leaders strongly trusted in conveying COVID-19 information.

Conclusions:
Our findings highlighted how religion has represented both a risk for the spreading of the virus and a precious opportunity to convey evidence-based and culturally-sensitive COVID-19 information engaging people in fighting the pandemic. To be prepared for similar future challenges, scientists, politicians and health professionals need to acknowledge the role that culture and religion have in influencing people's lives to design specific health policies and strategies to ensure that all people are effectively engaged in health production and protection.

Key messages:
Religion has represented both a risk factor for COVID-19 outbreaks and a resource to convey evidence-based information and overcome resistance to implementing COVID-19 preventive measures.
Health policy should become more sensitive to religious and cultural issues acknowledging the role played by religion in facing complex global health challenges.

Description of the problem:
In 2021, an intensive surveillance strategy was implemented using up to date notification database analysis through R programming, focusing on simplified data availability for contact tracing team members and accuracy of notifications submitted by laboratories, including verification of individual identifying information.
Results: Some laboratories were identified has having lower data completion rate, which had negative effects on contact tracing timeliness, while others failed to notify tests conducted. Public Health workers warned partners of these failures and worked with them to develop solutions. Interventions included facilitation of access to technologies to notify test results, as well as revision of internal processes to ensure correct patient identification. During the intervention, successful notification rates were increased, and new informal and formal partnerships were developed, leading to faster identification of clusters.

Lessons:
Establishing partnerships with stakeholders and developing support systems is beneficial towards epidemiological surveillance efforts. Adequate analysis of notification procedures was an important step towards standardization and correctness of information required for epidemiological surveillance. Lebanese government data indicates that the country hosts 1.5 million displaced Syrians (DS). Providing care for DS is a challenge, especially when barriers and discrimination issues arise in accessing the Lebanese health system. This study therefore aimed to understand the causes of biases, their mechanisms, their forms and their consequences on access and quality of care for DS in Lebanon. A qualitative study using indepth semi-structured interviews was utilized. In 2021, 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16). Six group interviews were conducted with DS (n = 22) in different Lebanese healthcare facilities. The recruitment of participants was based on reasoned and targeted sampling. The interviews were recorded iii322 European Journal of Public Health, Volume 32 Supplement 3, 2022