Home care for vulnerable populations with special needs during a disaster in Germany

Abstract Background In Europe, too, the risk of natural, technical, or man-made disasters and public health emergencies has been growing for some time. The situation of vulnerable populations with special needs receiving intensive home care such as people of all ages with oxygen therapy, peritoneal dialysis, parenteral nutrition etc. is rarely considered in this context. This issue is addressed by the sub-project “Safety and Nursing” of the AUPIK consortium on “Maintenance of home care infrastructure in crisis and disasters” funded by the German Federal Ministry of Education and Research. Methods Starting in April 2020, a systematic literature analysis was carried out, focussing on home care of populations with special needs during disasters. This was supplemented by an online survey with nurses and care workers (n = 101) and semi-structured interviews with managers of specialized home care services (n = 8). The survey data were analysed with descriptive statistics, the interview data with content analysis; results were cross-checked with the literature. Results Home care providers are at best prepared for everyday tasks; even minor disruptions have far-reaching consequences. Although the impact of disasters such as large-scale and prolonged power cuts are hard to imagine, the experience with the COVID-19 pandemic and other current events (e.g., floods, heat waves) could at least raise awareness of the problem. However, there is hardly any preparation for disasters in home care yet, but there are high expectations of support from civil protection organisations or local authorities. That these, in turn, are not prepared to deal with populations with special needs in intensive home care, is overlooked. Conclusions Home care infrastructure in Germany is currently inadequately prepared in terms of concept, staff, and equipment to care for vulnerable populations with special needs during disasters. Initiatives to improve disaster preparedness in home and long-term care are overdue. Key messages • The situation of vulnerable populations with special needs during a disaster is a pressing public health and disaster nursing issue which needs to be considered more carefully. • Public health nursing and health services research must contribute substantially to improving disaster preparedness in all health sectors and for all populations.


Background:
Vaccination is a critical intervention in the fight against the coronavirus disease 2019  pandemic. Various levels of COVID-19 vaccination acceptance have been observed around the world. However, a high percentage of the general population and healthcare professionals (HCPs), refuse the COVID-19 vaccination. This study aims to examine the factors influencing COVID-19 vaccine uptake among HCPs and the general population in Cyprus.

Methods:
An online cross-sectional study was conducted, using a selfadministered questionnaire to collect information covering various potential determinants including sociodemographic and health-related characteristics, trust in the healthcare system, satisfaction with it, utilization of preventive healthcare services, COVID-19 vaccination information, and general vaccination knowledge.

Results:
A total of 2582 participants completed the survey, with 53.5% of individuals in the general population, and 70.0% of the HCPs received the COVID-19 vaccination. We found that as the age increases by one year among the general population, the odds of being vaccinated against COVID-19 increase by 1.02 units (95% 1.00-1.03, p-value = 0.035), whilst those with increased trust in national healthcare authorities' guidelines (OR = 3.96, 95% CI: 3.41-4.61) and increased vaccination knowledge scores (OR = 1.11, 95% CI: 1.05-1.18) were significantly more likely to be vaccinated. Furthermore, male HCPs (OR = 1.91, 95% CI: 1.01-3.59), and those who reported increased trust in national healthcare authorities' guidelines (OR = 5.38, 95% CI: 3.65-7.95) were significantly more likely to be vaccinated.

Conclusions:
Public health policymakers can use national campaigns and long-term planning to build public trust in national healthcare authorities and educate and raise awareness about the benefits of vaccination. Such strategies could pave the way for adequate vaccine uptake and prepare the public for unfavorable scenarios, such as future pandemics.

Key messages:
Our results revealed the importance of vaccination knowledge and trust in healthcare system in respect to COVID-19 vaccination uptake. The urgent need for national campaigns and long-term planning to build public trust in national healthcare authorities.

Background:
In Europe, too, the risk of natural, technical, or man-made disasters and public health emergencies has been growing for some time. The situation of vulnerable populations with special needs receiving intensive home care such as people of all ages with oxygen therapy, peritoneal dialysis, parenteral nutrition etc. is rarely considered in this context. This issue is addressed by the sub-project ''Safety and Nursing'' of the AUPIK consortium on ''Maintenance of home care infrastructure in crisis and disasters'' funded by the German Federal Ministry of Education and Research. Methods: Starting in April 2020, a systematic literature analysis was carried out, focussing on home care of populations with special needs during disasters. This was supplemented by an online survey with nurses and care workers (n = 101) and semi-structured interviews with managers of specialized home care services (n = 8). The survey data were analysed with descriptive statistics, the interview data with content analysis; results were cross-checked with the literature.

Results:
Home care providers are at best prepared for everyday tasks; even minor disruptions have far-reaching consequences. Although the impact of disasters such as large-scale and prolonged power cuts are hard to imagine, the experience with the COVID-19 pandemic and other current events (e.g., floods, heat waves) could at least raise awareness of the problem. However, there is hardly any preparation for disasters in home care yet, but there are high expectations of support from civil protection organisations or local authorities. That these, in turn, are not prepared to deal with populations with special needs in intensive home care, is overlooked.

Conclusions:
Home care infrastructure in Germany is currently inadequately prepared in terms of concept, staff, and equipment to care for vulnerable populations with special needs during disasters. Initiatives to improve disaster preparedness in home and longterm care are overdue.

Problem:
Georgia, in terms of Covid-19 attributed mortality, ranks 8th in the World. Description: In Georgia, there are no routinely conducted autopsies of the deceased. The identification of causes of death is based on the physician's clinical decision. Absence of autopsies, lack of experience with Covid-19, are key issues of Covid-19 death certification. Considering COVID-19 as a primary cause of death led to over-reporting of COVID mortality among patients with severe comorbidities. This affects the identification of underlying cause of death (UCOD) and leads to misclassifications. Results: 2021 mortal cases with Covid-19 as the UCOD, were analyzed. Cases were grouped by the interval between testing and death: <1 day -170 cases (1.5%), 2-44 days -9468 cases (83.5%), 45+ days -1694 cases (15%). The group of cases with time intervals of 2-44 days, was sub-grouped according to causes mentioned in death certificates: A -only U07 is indicated, B -U07&any chain-of-event condition (pneumonia, respiratory distress, respiratory failure, etc.), C -U07& 1 or more significant contributing conditions (diabetes, stroke, etc.). According to the analysis in the group, 2-44 days distribution was: A -6%; B -81%; C -13%. U07 cases in groups A and C without any respiratory conditions mentioned were defined as 'unlikely' COVID-19 death (19% of total). From groups with time intervals of < 1 and 45+ days (1864) 72 cases were randomly selected for in-depth analysis by a panel of experts, using additional medical records. Out of these cases, the panel of experts considered 80%, as 'non-COVID-19' deaths.

Lessons:
If 'unlikely' and 'non-COVID-19' deaths aren't counted, the number of deaths is reduced by 29.5%. Lack of duration of a disease represents a limitation. A similar revision of all/2-44 day's interval COVID-19-related deaths is required to get a real number. Conduction of a verbal autopsy is necessary. Training on coding causes of death and existing regulations is important.

Key messages:
There is an over-registration of COVID-19 as a UCOD. The lack of knowledge of death certification of cases with severe comorbidities and accidents leads to over estimates.

Background:
The demographic picture in Bulgaria became worse and worse since the democratic changes at the end of the 20th century.
Our country was at one of the first positions according to the level of death rate and the rate of population decline. The study aims to analyse the effect of the COVID-19 pandemic on the main demographic indicators in Bulgaria.

Methods:
Data from Bulgarian National Statistical Institute were used to analyse population growth and life expectancy and to calculate the death rate, birth rate, infant mortality rate, and the share of people over 65 years of age for 2019 in comparison with 2021.

Results:
In 2019

Conclusions:
The Bulgarian population is very strongly affected by COVID -19 pandemic. The COVID-19 pandemic has caused a significant number of deaths worldwide but Bulgaria ranks first in the world in terms of mortality rates. Life expectancy decline reflects the impact of temporary epidemic mortality. The impact on children from the pandemic is not very significant for the country. Society should be making major and cost-effective efforts to reduce mortality.

Key messages:
The sharp change in demographic realities has significant effects on the country's economy. The deterioration of natural growth exacerbates the need to increase labour productivity in areas with the fastest declining populations.
Abstract citation ID: ckac131.064 Impact of COVID-19 on the essential healthcare services at primary healthcare level

Background:
The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low-and middleincome countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia.

Methods:
We applied a conventional qualitative study design using semistructured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases.