Background
Influenza viruses pose significant disease burdens through seasonal outbreaks and unpredictable pandemics. Existing surveillance programs rely heavily on reporting of medically attended influenza (MAI). Continuously monitoring cause‐specific school absenteeism may identify local acceleration of seasonal influenza activity. The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS; Oregon, WI) implements daily school‐based monitoring of influenza‐like illness‐specific student absenteeism (a‐ILI) in kindergarten through Grade 12 schools and assesses this approach for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities.
Methods
Starting in September 2014, ORCHARDS combines automated reporting of daily absenteeism within six schools and home visits to school children with acute respiratory infection (ARI). Demographic, epidemiological, and symptom data are collected along with respiratory specimens. Specimens are tested for influenza and other respiratory viruses. Household members can opt into a supplementary household transmission study. Community comparisons are possible using a pre‐existing and highly effective influenza surveillance program, based on MAI at five family medicine clinics in the same geographical area.
Results
Over the first 5 years, a‐ILI occurred on 6634 (0.20%) of 3,260,461 student school days. Viral pathogens were detected in 64.5% of 1728 children with ARI who received a home visit. Influenza was the most commonly detected virus, noted in 23.3% of ill students.
Conclusion
ORCHARDS uses a community‐based design to detect influenza trends over multiple seasons and to evaluate the utility of absenteeism for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities.
Background and Objectives: Resident physicians experience a high level of stress. Mindfulness meditation has been shown to offer medical students and physicians a healthier way to relate to daily stressors. We developed and pilot tested a mindfulness training program and assessed its impact on resident physician burnout and resilience.
Methods: The residency program offered 17 family medicine residents a 10-hour mindfulness training over the course of 2 months in 2016. Residents were encouraged, but not mandated, to attend. Experienced Mindfulness-Based Stress Reduction teachers and a family physician/integrative health fellow cotaught the program. A research team qualitatively assessed deidentified, postintervention resident interviews. Residents completed four quantitative questionnaires preintervention, immediately postintervention, and 3 months postintervention. A t score was calculated to assess for statistical significance.
Results: Three residents (18%) attended all five training sessions, seven residents (41%) completed at least four sessions, and 16 residents (94%) completed either one or two sessions. Eight residents completed the postintervention interview. Twelve, nine and 14 residents completed the four questionnaires at the three time points, respectively. Qualitative results identified multiple personal/professional benefits of participating in mindfulness training, and we found a statistically significant decrease in perceived stress and increase in mindful awareness from pre- to postintervention (P<.05).
Conclusions: A resident physician mindfulness training program can be reasonably integrated into the residency schedule as part of the wellness curriculum required by the Accreditation Council for Graduate Medical Education. Preliminary results show potential for personal growth and positive changes in patient relationships.
Background
Schools are primary venues of influenza amplification with secondary spread to communities. We assessed K-12 student absenteeism monitoring as a means for early detection of influenza activity in the community.
Materials and methods
Between September 2014 and March 2020, we conducted a prospective observational study of all-cause (a-TOT), illness-associated (a-I), and influenza-like illness–associated (a-ILI) absenteeism within the Oregon School District (OSD), Dane County, Wisconsin. Absenteeism was reported through the electronic student information system. Students were visited at home where pharyngeal specimens were collected for influenza RT-PCR testing. Surveillance of medically-attended laboratory-confirmed influenza (MAI) occurred in five primary care clinics in and adjoining the OSD. Poisson general additive log linear regression models of daily counts of absenteeism and MAI were compared using correlation analysis.
Findings
Influenza was detected in 723 of 2,378 visited students, and in 1,327 of 4,903 MAI patients. Over six influenza seasons, a-ILI was significantly correlated with MAI in the community (r = 0.57; 95% CI: 0.53–0.63) with a one-day lead time and a-I was significantly correlated with MAI in the community (r = 0.49; 0.44–0.54) with a 10-day lead time, while a-TOT performed poorly (r = 0.27; 0.21–0.33), following MAI by six days.
Discussion
Surveillance using cause-specific absenteeism was feasible and performed well over a study period marked by diverse presentations of seasonal influenza. Monitoring a-I and a-ILI can provide early warning of seasonal influenza in time for community mitigation efforts.
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