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Perrotta, Carla
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Perrotta, Carla
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Perrotta, Carla
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- PublicationCOVID-19 prevention and control measures in workplace settings: a rapid review and meta-analysis(MDPI, 2021-07-24)
; ; ; ; ; ; ; ; ; ; ; ; ; ; Workplaces can be high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. The included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, environmental adjustments, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-one studies from healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ~280,000 employees based in Europe, Asia, and North America. Meta-analyses showed that combined IPC measures resulted in lower employee COVID-19 positivity rates (0.2% positivity; 95% CI 0–0.4%) than single measures such as asymptomatic PCR testing (1.7%; 95% CI 0.9–2.9%) and universal masking (24%; 95% CI 3.4–55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning can effectively prevent workplace outbreaks. Masking alone should not be considered sufficient protection from SARS-CoV-2 outbreaks in the workplace.414Scopus© Citations 68 - PublicationCOVID19 in Irish Workplaces and Communities - Modelling Outbreaks from Infection data(University College Dublin, 2022)
; ; ; ; During 2020-2021, the government of Ireland in line with international recommendations imposed the closure of non-essential trades, services, and commerce. Food plant factories, meat processing plants among others were deemed essential and remained open. During that time, many workers were exposed to outbreaks in their workplaces. Some of the questions arising included if workers will adapt to new safety measures, if those measures could prevent and mitigate workplace outbreaks and, if an outbreak occur in a closed facility, if it will impact community transmission. The most vulnerable workplaces were typically front-line industries, with healthcare and food processing facilities among the hardest hit by Covid-19 infections. To complete the core aims, statistical models were developed for WP1. These models could accurately predict the scale of an outbreak in a meat processing plant based on the infection transmission in the community in the weeks preceding the outbreak and account for patterns in infection spread in both Ireland and worldwide using a ‘behavioural response’ mechanism. In addition to this, vaccine effectiveness was calculated using a method that made use of surveillance data. This demonstrated the strength and limitations of surveillance data. One clear aspect of behaviour in the COVID-19 pandemic has been people’s focus on, and response to, reported or observed infection numbers in their community. WP1 developed a simple model of infectious disease spread in a pandemic situation where people’s behaviour is influenced by the current risk of infection and where this behavioural response acts homeostatically to return infection risk to a certain preferred level. Analysis of worldwide COVID-19 data confirmed the model predictions at both an overall and an individual country level. Building on the findings of the infectious disease spread model, the research team aimed to investigate how individuals adapted their behaviours throughout the pandemic at an individual level, using the number of community cases and the number of contacts reported by cases to the contact-tracing program as a proxy for behavioural response. This work is ongoing at this time. In addition to this, estimations on vaccine effectiveness were calculated using a method that made use of surveillance data. This demonstrated the strength and limitations of surveillance data. There were significant challenges in completing WP1, primarily caused by a difficulty in accessing the required data, however, the primary aims and goals of the work package were achieved and a meaningful body of research was produced on disease spread in specific, controlled environments and among the general population. Our work will certainly inform future pandemics. The main messages are 1) that community transmission can predict the occurrence of outbreaks -suggesting that managers and Public Health officials should work together to reinforce surveillance during peaks of community transmission and 2) high risk settings -like meat factories- can reduce or mitigate outbreaks if they introduce timely protective measures.41 - Publication‘Communication, that is the key’: a qualitative investigation of how essential workers with COVID-19 responded to public health information(BMJ, 2022-07-07)
; ; ; ; ; ; ; ; ; ; ; ; Objectives: To understand how essential workers with confirmed infections responded to information on COVID-19. Design: Qualitative analysis of semistructured interviews conducted in collaboration with the national contact tracing management programme in Ireland. Setting: Semistructured interviews conducted via telephone and Zoom Meetings. Participants: 18 people in Ireland with laboratory confirmed SARS-CoV-2 infections using real-time PCR testing of oropharyngeal and nasopharyngeal swabs. All individuals were identified as part of workplace outbreaks defined as ≥2 individuals with epidemiologically linked infections. Results: A total of four high-order themes were identified: (1) accessing essential information early, (2) responses to emerging ‘infodemic’, (3) barriers to ongoing engagement and (4) communication strategies. Thirteen lower order or subthemes were identified and agreed on by the researchers. Conclusions: Our findings provide insights into how people infected with COVID-19 sought and processed related health information throughout the pandemic. We describe strategies used to navigate excessive and incomplete information and how perceptions of information providers evolve overtime. These results can inform future communication strategies on COVID-19.129Scopus© Citations 2 - PublicationIt's the Destination and the Journey—A Mapping of the Challenges in Transport and Referral for Maternal and Newborn Health in Pandemics and BeyondThere has been an abundance of work in the last few years highlighting the importance of high-quality health systems as foundational to achieving better health outcomes (1). Quality provision of care is particularly critical for women and newborn during the perinatal and the immediate postpartum period (2). Transport issues are generally considered as important for access to care, but the quality of these transport and referral systems is equally essential. Recent systematic reviews related to the provision of intrapartum and postnatal care found that women were unlikely to accept referral if they had negative perceptions of the health facility (3) and were generally unsatisfied with delays in referral processes (4). Other studies have noted poor capacity at referring facilities (5), as well as challenges with coordination, communication, documentation, and adherence to referral protocols, especially for newborns (6). The World Health Organization standards for quality of maternal and newborns care and for care of small and sick newborns include that women and newborns must be assessed and treated with available resources or appropriately referred, without delay at any time. Functional referral systems are thus integral at each stage: initial transport to the facilities, referral between facilities, and transportation whenever follow-up is required (7, 8). The COVID-19 pandemic has stretched the limits of health systems, including transport and referral pathways (9); the question of how women and their newborns reach these facilities becomes ever more urgent in this current pandemic.
15Scopus© Citations 1 - PublicationAssessment of Environmental and Occupational Risk Factors for the Mitigation and Containment of a COVID-19 Outbreak in a Meat Processing Plant(Frontiers Media, 2021-10-27)
; ; ; ; ; ; ; Throughout the COVID-19 pandemic, meat processing plants have been vulnerable to outbreaks of SARS-CoV-2 infection. Transmission of the virus is difficult to control in these settings because of a combination of factors including environmental conditions and the specific nature of the work. This paper describes a retrospective outbreak investigation in a meat processing plant, a description of the measures taken to prevent or contain further outbreaks, and insights on how those with specific knowledge of the working environment of these plants can collaborate with public health authorities to ensure optimal outbreak control. The plant experienced 111 confirmed positive asymptomatic cases in total with an estimated attack rate of 38% during a five-week period. 4 weeks after the first case, mass screening of all workers was conducted by the public health authorities. Thirty-two workers tested positive, of which 16 (50%) worked in one particular area of the plant, the boning hall (n = 60). The research team prepared and carried out semi-structured interviews with the plant personnel who were charged with COVID control within the plant. They carried out assessments of operational risk factors and also undertook air quality monitoring in the boning hall and abattoir. The air quality measurements in the boning hall showed a gradual build-up of carbon dioxide and aerosol particles over the course of a work shift, confirming that this poorly ventilated area of the plant had an environment that was highly favorable for aerosol transmission of SARS-CoV-2. Assessment of operational conditions incorporated visual surveys of the plant during the working day. Prior to and during the first 2 weeks of the outbreak, multiple measures were introduced into the plant by management, including physical distancing, provision of educational material to workers, visitor restrictions, and environmental monitoring. After the implementation of these measures and their progressive refinement by plant management, the factory had no further linked cases (clusters) or outbreaks for the following 198 days. The tailored approach to risk mitigation adopted in this meat processing plant shows that generic risk mitigation measures, as recommended by public health authorities, can be successfully adapted and optimized by designated plant emergency response teams.16Scopus© Citations 14 - PublicationHomelessness and health-related outcomes in the Republic of Ireland: a systematic review, meta-analysis and evidence mapAim: To map existing research on homelessness and health in the Republic of Ireland, and to synthesize the evidence on housing-related disparities in health. Methods: Peer-reviewed articles and conference abstracts published in English between 2012–2022 were retrieved from 11 bibliographic databases if they contained empirical data on homelessness and health in Ireland, and – in a subsequent screening stage – at least one measure of health disparity between the homeless and general populations. Reviewers extracted relative risks (RR), 95% confidence intervals (CI), and calculated pooled RR of comparable health disparities using pairwise random-effects meta-analyses. Results: One hundred four articles contained empirical data on the health of homeless individuals residing in Ireland, addressing primarily substance use, addiction and mental health. Homelessness was associated with increased risk of illicit drug use (RR 7.33 [95% CI 4.2, 12.9]), reduced access to a general practitioner (GP) (RR 0.73 [CI 95% 0.71, 0.75]), frequent emergency department (ED) presentation (pooled RR 27.8 [95% CI 4.1, 189.8]), repeat presentation for self-harm (pooled RR 1.6 [95% CI 1.2, 2.0]) and premature departure from hospital (pooled RR 2.65 [95% CI 1.27, 5.53]). Conclusions: Homelessness in Ireland is associated with reduced access to primary care and overreliance on acute care. Chronic conditions amongst homeless individuals are understudied.
Scopus© Citations 4 36 - PublicationCaesarean birth in public maternities in Argentina: A formative research study on the views of obstetricians, midwives and traineesObjectives: To explore obstetricians', midwives' and trainees' perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services: Setting We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants: Results Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS: Conclusions Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
13Scopus© Citations 6 - PublicationPriority healthcare needs amongst people experiencing homelessness in Dublin, Ireland: A qualitative evaluation of community expert experiences and opinions(Public Library of Science (PLoS), 2023-12-14)
; ; ; ; In light of evidence that housing-related disparities in mortality are worsening over time, this study aimed to explore the perspectives of experts working in homeless health and addiction services on priority healthcare needs amongst people experiencing homelessness in Dublin, Ireland, a city facing problematic increases in homelessness. As part of a larger qualitative study, a series of semi-structured interviews were carried out with 19 community experts followed by inductive thematic framework analysis to identify emergent themes and sub-themes relating to priority healthcare needs. At the societal level, community experts identified a need to promote a culture that values health equity. At the policy level, accelerating action in addressing health inequalities was recommended with an emphasis on strategic planning, Housing First, social support options, interagency collaboration, improved data linkage and sharing, and auditing. At the health services level, removing barriers to access will require the provision of more and safer mental health, addiction, women-centred, and general practice services; resolved care pathways in relation to crisis points and multi-morbidity; expanded trauma-informed education and training and hospital-led Inclusion Health programmes; and outreach programmes and peer support for chronic disease management. The voices of people experiencing homelessness, including representatives from specific homeless groups such as migrants, youth, and the elderly, must be thoroughly embedded into health and social service design and delivery to facilitate impactful change.20Scopus© Citations 1 - PublicationTeaching design thinking as a tool to address complex public health challenges in public health students: a case studyBackground: Developing a public health workforce that can understand problems from a population perspective is essential in the design of impactful user-centred responses to current population health challenges. Design Thinking, a user-driven process for problem-defining and solution-finding, not only has utility in the field of public health but stands as a potential mechanism for developing critical skills -such as empathy, creativity and innovation- amongst future professionals. Though the literature reflects the use of DT across many health sciences disciplines, less research has been published on how students apply learned concepts using real-world challenges of their choice and what difficulties they face during the process. Methods: This case study evaluates achieved learning outcomes after the introduction of a design thinking block into post-graduate public health curriculum at the University College Dublin. Two independent assessors evaluated student learning outcomes and observed difficulties during the process by assessing group presentations to identify and understand any learning difficulties using an ad-hoc designed tool. The tool consisted of twelve items scored using a 5-point Likert scale. Student feedback, in the form of an online survey, was also analysed to determine their level of enjoyment, perceived learning outcomes and opinions on the course content. Results: The assessors evaluated thirteen DT group presentations and reports from 50 students. The groups chose a range of topics from socialization of college students during Covid-19 to mental health challenges in a low-income country. Independent assessment of assignments revealed that the highest scores were reached by groups who explored a challenge relevant to their own lives (more than 80% of total possible points versus 60% class average). The groups that explored challenges more distant to themselves struggled with problem finding with a mean score of 2.05 (SD ± 1.2) out of 5 in that domain. The greatest difficulties were observed in problem finding and ideation. Though most students found the design thinking block enjoyable and relevant to their education, they recommended that the DT block be a stand-alone module. Students recognized that groups who chose a familiar topic experienced fewer difficulties throughout the process. Conclusion: The study showed that DT learning outcomes were best achieved when students focused on challenges, they had either personally experienced or were familiar with. These findings provide insight for future iterations of DT workshops and support the teaching of user-centred approaches to future public health practitioners.
174Scopus© Citations 5 - PublicationDevelopment and validation of a multi-lingual online questionnaire for surveying the COVID-19 prevention and control measures used in global workplaces(Elsevier, 2022-01)
; ; ; ; ; ; ; Introduction: There is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to the global workforce. Material and Methods: A 44-item QualtricsXM survey was developed, translated, and validated for face, content, and cross-cultural validity according to literature review, expert consultation, and pre-testing. The survey was piloted with 890 workers from diverse industries and countries. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing and Pearson correlation coefficients verified construct validity (i.e., known-groups technique, discriminant validity), and criterion validity. Results: EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥ 0.60). Hypothesis testing confirmed construct validity (p < 0.001), criterion validity (p ≤ 0.03), and discriminant validity (r = -0.45). Conclusions: The occupational IPC measures survey showed strong validity and reliability. It can be used by decision makers in the distribution of IPC resources, and to guide occupational health and safety (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.264