BACKGROUND: The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long-term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non-pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear.
METHODS: We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE.
RESULTS: We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems.
CONCLUSIONS: Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics.
BACKGROUND: CRD42022344149.

Background: People living in long-term care facilities (LTCF) are at high risk to develop active tuberculosis primarily as a result of reactivation of a latent TB infection, or endemic transmission between residents. Current national guidelines in Canada are to use a posterior-anterior and lateral chest X-ray to screen for TB for those over 65 years old, upon admission to a LTCF. Objective: To assess the available evidence for cost benefits of universal chest X-ray screening for new LTCF residents. Methodology: We conducted a search for all articles published until September 2018, in PubMed and WorlCat databases, in English, using a combination of key words: chest X-ray, chest radiography or CXR, long-term care, elderly, screening, and tuberculosis. We also reviewed publicly available guidelines for screening new residents to LTCF from across Canada. We report on a qualitative synthesis of the evidence in the documents retrieved. Results: The final review yielded four cost-effectiveness studies (2 of 4 conducted in countries with low incidence), one systematic review, one recommendation/editorial, and one cohort study. We found that in a tuberculosis low-incidence country the CXR cost per identified case was $672,298 CAD. Enacting a more targeted screening program, perhaps one that tests only those who previously had TB, or other high-risk medical conditions may enhance the cost-effectiveness. Recommendations: We suggest reviewing the screening policy for active TB in people entering LTCF, which is based on a CXR. The results indicate that a targeted search for active TB in people with symptoms or other high-risk medical conditions may be more cost-effective.

BACKGROUND: The optimal cardiovascular preparticipation screen is debated. The purpose of this study was to perform a systematic review/meta-analysis of evidence comparing screening strategies.
METHODS: PRIMSA guidelines were followed. Electronic databases were searched from January 1996 to November 2014 for articles examining the efficacy of screening with history and physical exam (PE) based on the American Heart Association (AHA) or similar recommendations and electrocardiogram (ECG). Pooled data was analyzed for sensitivity, specificity, false positive rates and positive and negative likelihood ratios. Secondary outcomes included rate of potentially lethal cardiovascular conditions detected with screening and the etiology of pathology discovered.
RESULTS: Fifteen articles reporting on 47,137 athletes were reviewed. After meta-analysis the sensitivity and specificity of ECG was 94%/93%, history 20%/94%, and PE 9%/97%. The overall false positive rate of ECG (6%) was less than that of history (8%), or physical exam (10%). Positive likelihood ratios were ECG 14.8, history 3.22 and PE 2.93 and negative likelihood ratios were ECG 0.055, history 0.85, and PE 0.93. There were a total of 160 potentially lethal cardiovascular conditions detected for a rate of 0.3% or 1 in 294. The most common pathology was Wolff-Parkinson-White (67, 42%), Long QT Syndrome (18, 11%), hypertrophic cardiomyopathy (18, 11%), dilated cardiomyopathy (11, 7%), coronary artery disease or myocardial ischemia (9, 6%) and arrhythmogenic right ventricular cardiomyopathy (4, 3%).
CONCLUSIONS: The most effective strategy for screening for cardiovascular disease in athletes is ECG. It is 5 times more sensitive than history, 10 times more sensitive than physical exam, has higher positive likelihood ratio, lower negative likelihood ratio and a lower false positive rate. 12-lead ECG interpreted using modern criteria should be considered best practice in screening for cardiovascular disease in athletes while the use of history and physical alone as a screening tool should be reevaluated.

A new funding instrument has been introduced into residential aged care known as the Aged Care Funding Instrument. As part of these requirements the assessment of depression for all residents admitted to an Australian aged care facility has been implemented using the Cornell Scale of Depression in Dementia. This literature review was undertaken on the depression prevalence for residents, the Cornell Scale of Depression in Dementia as the assessment tool being utilised and its application for residents who may or may not have dementia. The use of the assessment tool and its reliability and validity are dependent on the assessor\'s education and ability to understand depressive symptoms that are often complicated by other co morbidities. There is a serious lack of qualified nursing staff in residential aged care facilities in Australia, and the review and conclusions question whether the information collected through this tool will be of value for the accurate assessment of the presence of depression in residents.

In 2005, a federal advisory committee recommended that the number of disorders in state newborn screening programs be expanded from 9 to 29. In view of this recommendation, state leaders will need to make cogent decisions regarding the expanse of their state newborn screening programs. They must consider several factors, including the costs and outcomes of the screening program. The expense of the initial screening test can be misleading because it does not include the cost of the entire program (testing, tracking, notifying, retesting, confirmatory testing, and follow-up). Also, outcomes such as false positive findings can be costly to newborn screening programs, result in additional testing for infants, and lead to parental concern and worry. This article examines some of the policy issues related to newborn screening and specifically focuses on three disorders recommended for newborn screening, cystic fibrosis (CF), medium-chain acyl CoA dehydrogenase Deficiency (MCADD), and beta-ketothiolase (BKT).

BACKGROUND: The increased prevalence of HIV infection in women is leading to a rising number of children born to HIV-infected mothers. As therapeutic possibilities for HIV/AIDS increase, the detection of undiagnosed HIV infections in pregnant women, followed by adequate management, is of crucial interest. Therapeutic protocols are being updated and increasingly applied in most European countries, but there is no structured information on policies and strategies with regard to antenatal HIV screening as such.
METHODS: In order to identify national policies with regard to antenatal HIV screening, a structured questionnaire was sent to key-informants within the ministries of health and national institutes for public health in each of the 25 EU Member States.
RESULTS: Information was obtained from all EU Member States with the exception of Cyprus and Luxembourg. Eighteen countries issued a national policy with regard to antenatal HIV screening, 16 opted for a system in which HIV testing is offered to all women attending antenatal services while only two opted for selective screening. None of the 18 countries with a national policy supports a mandatory screening strategy. The voluntary testing strategies are of two types: opting in versus opting out. In almost all EU countries with antenatal HIV screening policies, screening conditions are defined.
CONCLUSIONS: Policies are in place in most EU countries. Nevertheless, there is a need for more integrated European policies and region-specific recommendations on the performance of antenatal HIV screening as an opportunity for comprehensive HIV/AIDS service delivery. This would enable the different aspects of prevention to be linked and also address both the needs of pregnant women and mothers as well as that of their infants.

In December 2006, the Mandatory Blood Testing Act, 2006 passed third reading in the Legislative Assembly of Ontario. When this new Act comes into force, it will replace the existing administrative system for forced blood testing, currently operating under Ontario\'s public health law. Responsibility for forced blood testing will shift from the Minister of Health and Long-Term Care to the Minister of Community Safety and Corrections.

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This paper reviews the changing role of the ethical value of autonomy in law and policy relating to AIDS in a number of European jurisdictions. In the early years of the epidemic the autonomy of infected and at-risk persons, and of social groups was promoted as a means of reducing the spread of HIV in the general population. Accordingly, autonomy was deemed worthy of respect for instrumental reasons. This means-end calculation was premised on the lack of medical therapies, as well as the need to avoid discrimination in order to prevent at-risk persons from \"going underground\". In law, this instrumentalisation of autonomy was reflected in a specific application of the proportionality test applied in administrative and human rights law, that is, imposing coercive or discriminatory measures would be disproportionate, or even inimical, to the goal of reducing the spread of HIV. This was a contingent analysis, strongly informed by the state of medical knowledge at the time, as well as by the relative power of professionals, health bureaucrats and lay activists. With the introduction of effective therapies such as the Highly Active Retroviral Therapy and Zidovudine, the terms of the proportionality analysis have changed decisively. As a result, it is now more likely than before that coercive measures will be implemented.

OBJECTIVE: Critical review of worldwide legislation on HIV/AIDS, with a focus on the issue of HIV testing, mainly in a military context.
METHODS: Analysis of health legislation on HIV/AIDS among 121 of the 191 member states of the World Health Organization (WHO), representing 85% of the world\'s population.
METHODS: The WHO Directory of Legal Instruments Dealing with HIV Infection and AIDS has been the main source consulted. Relevant findings of two global surveys were used to examine HIV testing in the military.
RESULTS: AIDS cases are reportable in 60% of the 121 countries, whereas HIV infections in no more than 26%. Notifications are kept confidential by law in 20% of countries. Only 17% have developed HIV-specific legislation against social discrimination, whereas 10% have passed legislation establishing financial reimbursement to those who have acquired HIV infection after injection of HIV-contaminated biologic material, support for occupational risk, and/or social protection for patients. Only 42% of the 121 countries report having legal instruments that require screening of donated blood. Legislative measures that address, generally in a prescriptive but sometimes also in a protective way, vulnerable groups, such as commercial sex workers, men who have sex with men, injecting drug users, and recipients of multiple transfusions of blood or blood-derivatives, are reported in 27% of countries. Other categories considered potentially vulnerable, for which specific legislation has been passed, include immigrants (17% of countries), prisoners (5%), and health personnel (14%). Further legislative measures for HIV prevention address testing pregnant women in the prenatal period (7% of countries), supporting condom promotion (11%), measures requiring quarantine, isolation, or coercive hospitalization of HIV-infected people or AIDS patients (9%), or imposing penal sanctions for HIV-infected people who deliberately expose others to the risk of transmission (10%). A National AIDS Committee responsible for addressing issues related to HIV/AIDS has been established by law in 39% of the 121 countries. Global surveys show that 27 countries carry out compulsory HIV screening on recruitment of military personnel.
CONCLUSIONS: These data represent a useful tool to make governments aware of the problem of underreporting of legal instruments to the WHO and of the need to promote legislation in line with the idea that public health and human rights are complementary, not conflicting, goals.