Incidence of COVID-19 Infection in Nurses and their Families: A Prospective Cohort Study in Lahore

Background: Nurses, as frontline workers, are at a higher risk of contracting COVID19 and serve as a potential source of transmitting this infection to their family members. Estimating risk in this population is critical for controlling the rate of secondary attack rate among their families.Objective: To measure the incidence of COVID-19 in nurses and their families with associated risk factors for transmission of infection.Methods: A prospective cohort study was conducted in Akhtar Saeed Medical and Dental college, Lahore and associated three hospitals. A cohort of 176 nurses was identified in March 2020 by using non-probability convenience sampling technique and was followed till September 2021. During this tenure of one and a half year, incidence was observed by following the cohort and using a self-structured questionnaire. With SPSS 23, Chi square test was applied and p value of < 0.05 was considered significant.Results: In a cohort of 176 nurses, followed for one and a half year, incidence of COVID-19 was 37(21%). Secondary attack rate among household members of these nurses was 3%. A significant association was observed between the nursing staff and exposure to their family members (p = 0.002). Vaccination rate in nurses at the start of the study was only 26%. Nurses who worked directly with COVID-19 patients reported high incidence (p = 0.009). Nurses who used Personal protective equipment (PPE) were less affected (p = 0.003). Nurses with comorbidities showed higher incidence (p =0.02). Rate of psychological distress was high (p =0.007).Conclusion: Incidence of COVID-19 among nurses was 21% with secondary attack rate of 3% in families. Protective use of N 95 mask and comorbidities were associated with incidence.

Paediatric Residents' Perception of Breastfeeding amidst Covid 19

Objective: This study was conducted to determine paediatric residents' perception, beliefs, and attitudes towards breastfeeding particularly by COVID positive mothers and to assess the need for a breastfeeding teaching program. Study Design: A descriptive cross-sectional study Place and Duration of Study: This study was conducted over 1 months (15 October 2021-15 November 2021) among the paediatric residents from different hospitals in Rawalpindi/ Islamabad. Materials and Methods: A total of 70 paediatric residents were included in the study. A self-Administered online questionnaire was sent via email, comprising 19 items related to breastfeeding and its implications during the COVID 19 pandemic. Results were analysed on SPSS 20. Results: Out of 70 residents, 63 (90%) responses were obtained. Most of the residents were supportive of breastfeeding and had a good perception as 100% of participants supported that breast milk is an ideal food for babies. However, huge uncertainty was noted in the answers to questions regarding breastfeeding in mothers with COVID-19 infection as only a few (12.7%) residents believed that mothers with active COVID 19 infection can breastfeed their baby. There was no difference among first and second year residents and third and fourth year residents (0.5) Conclusion: The participants' perception, beliefs, and overall knowledge about breast feeding is satisfactory but regarding breastfeeding in mothers who had COVID-19 infection is inadequate. The authors' recommendation is to have more emphasis on support & promotion of breastfeeding in paediatric residency programs across Pakistan. © 2022 Journal of Islamic International Medical College. All rights reserved.

Factors of Learning towards Creating Blended Learning Curriculum Using Learning Management System in Higher Education during Covid-19

Blended learning is a mix of online and face-to-face instruction. It refers to a variety of possibilities made available by integrating the internet and streaming media with traditional educational formats that necessitate the physical co-presence of teachers and students. While the Covid-19 pandemic is being referred to as the greatest challenge facing education systems around the world, it has prompted authorities to issue a drastic order requiring institutions to switch from face-to-face teaching to online teaching and virtual education for students. This present study aims to determine the model of integration between learning style and active learning towards enhancing blended learning curriculums among higher education students. A total of 208 students at a selected Malaysian higher education institution were selected randomly in this study. For data collection, this study used the quantitative approach and random sampling technique. The instrument was developed based on the literature review, and expert validation was obtained from various universities. The survey forms were distributed using an online medium (Google forms). Pearson Coefficient correlation (r) was employed to examine the relationship between variables, while Structural Equation Modelling (SEM) was utilized to examine the effect of the mediator variable. By dopting a two-stage method, the measurement model was first tested, followed by the structural model. Confirmatory Factor Analysis (CFA) is to test whether the data is compatible with the hypothesized measurement model as well as for the purpose of validation and construct reliability. The results show that the measurement model was a good fit for the data, and that the constructs were reliable and valid for testing the hypotheses based on the results. The assessment of the structural model, on the other hand, involved testing the hypothesized relationships about the direct effects. Four hypothesized direct paths were found to be statistically significant. © 2022 Eskisehir Osmangazi University. All rights reserved.

Problems associated with usage of PPE Kits during COVID19 pandemic: Experience of Healthcare workers of a tertiary care center from Eastern India

Background: Frontline healthcare workers play a critical role in the containment of the coronavirus disease-2019 (COVID-19) pandemic, and as they are wearing personal protective equipment to minimize cross-transmission and acquire confidence in fighting the pandemic (PPE) they face health problems and discomfort as well because of long duty hours. Objectives: To explore the health issues associated with use of PPE among healthcare front liners and to find out the possible solutions for the identified problems. Methodology: A cross sectional observational study involving a group of medical staff was done using a pre tested semi structured questionnaire using google forms at a tertiary care teaching hospital. Results: Maximum people said that Goggles and gowns are the most uncomfortable part of the PPE and the problems/health conditions faced most frequently was fog in goggles/shield and feeling hot and suffocating. Females, Intern Doctors and those with indefinite/not fixed duty were mostly unsatisfied with the PPE that was given. Conclusion: To alleviate healthcare workers’ burnout and job pressures, effective strategies for increasing comfort at workplace is required. More training regarding donning /doffing and comfortable and adequate supply of PPE is needed in order to get uninterrupted and quality service from the healthcare workers.

ORAL HEALTH KNOWLEDGE, ATTITUDE AND PRACTICE AMONG PEOPLE IN MONITORING DURING COVID-19 PANDEMIC IN MAKASSAR

Introduction: Oral health maintenance is essential in the immune system against corona virus disease (COVID)-19 infection due to the presence of IgA in saliva. Oral health is affected by knowledge, attitudes, and practices. This study aimed to investigate the oral health knowledge, attitudes and practices among PiM (People in monitoring) during the covid-19 pandemic in Makassar. Materials and methods: The population of this study was Makassar citizens who have been identified as people in monitoring (PiM). Online questionnaire was sent via Google form to assess the knowledge, attitudes, and practice. Results: In the category level of oral health knowledge, attitudes and practices among 72 PiM in Makassar, 25%, 50%, and 25% respondents were categorized as having poor, moderate and good knowledge, respectively. In the category of oral health attitude variable, 40.3%, 34.7% and 25% respondents were categorized as poor, moderate and good, respectively. In the category of oral health practices, there were 26.4%, 38.9% and 34.7% of respondents with low, moderate and good oral health practices, respectively. Conclusion: Most PiM in had low oral health knowledge, low oral health attitude and medium oral health practices. © 2021 Medicinski fakultet Niš. Klinika za stomatologiju Niš. Sva prava zadržana. All Rights Reserved.

Epidemiological and Clinical factors associated with mortality of confirmed COVID-19 cases admitted and treated in a tertiary care hospital of Patna, Bihar

Background: A significant proportion of the individuals having the illness of moderate to severe nature due to COVID-19 infection require immediate critical care. High incidence of mortality among elderly population or those with comorbid conditions were reported. Objectives: The study was carried out with objectives to assess the epidemiological and clinical factors associated with mortality among the COVID-19 cases admitted and treated in AIIMS, Patna. Methods: This was a hospital -based cross-sectional analytical study of epidemiological and clinical features of COVID-19-positive patients admitted and treated during the outbreak from March 20, to August 31, 2020. Results: The median age of COVID-19 cases was 51.5 years (IQR : 37-62 years) which was significantly higher (p-value = 0.001) as compared to females. Male-female ratio of cases was 2.88:1. Out of 1696 cases, the case fatality rate was 309 (18.22%). The mean age of cases who died due to COVID-19 was significantly higher (pvalue=0.001) as compared to those who survived. The odds of mortality was significantly higher in males as compared to females (Adjusted OR = 1.534, 95% CI = 1.10 - 2.13, p=0.011). The odds of mortality showed a significant increasing trend with increasing age (Mantel-Hanszel p-value for trend = 0.015). The covariates like gender, age groups 45-59, 60-74 and 75>=, breathlessness and CKD were found to be significantly associated with mortality after controlling for the confounders. Conclusions: Factors like gender, higher age, lower oxygen saturation causing breathlessness and chronic kidney diseases could be attributed to high risk of mortality in COVID-19 patients.

Socio-economic inequality in national incidence and mortality rates of COVID-19 in India: An Ecological Study

Background: There are sufficient evidences on the association of epidemiological and clinical features of the patients with COVID-19 but still there are paucity of evidences on socio-economic aspects of this disease. An ecological study has been carried out with aim to assess the associations of the Human Development Index (HDI) and its components of each states and Union territories in India with incidence and mortality from COVID-19. Methods: Information on confirmed cases and deaths have been extracted from the data on the website of Covid India Organization and the data on HDI and its components have been extracted from various national and international agencies. Regression analysis was performed which showed a direct significant association (p-values<0.05) of incidence and mortality rates with HDI and its components at the national level. Concentration index was estimated to measure socio-economic inequality in COVID-19 incidence and mortality rates with 95% confidence interval (CI), which were 0.41 (0.27-0.54) and 0.42 (0.26-0.58) for incidence and mortality rates of COVID-19 respectively. Results: The high incidence and mortality rates of COVID-19 in states and union territories of India with high HDI and its components warrant priority for interventions by the national health policy-makers. Cases detection and screening facilities need to be scaled up in states and UTs with low incidence and mortality rates to minimize the under-reporting of the cases.

Resuming elective hip and knee arthroplasty in the COVID-19 era: a unique insight into patient risk aversion and sentiment.

INTRODUCTION: There has been guidance from the government and orthopaedic community on how best to ensure the safety of our patients and colleagues as we recommence elective surgery in the UK. The primary aim was to determine what proportion of patients feel they should proceed with their elective hip and knee arthroplasty surgery during the COVID-19 climate. The secondary aim was to investigate what variables affected this decision. METHODS: Patient information from a single surgeon's waiting list in a district general hospital were recorded. A standardised telephone discussion was had with all the patients noting the severity of pain and the potential reasons for not wanting to proceed with surgery. RESULTS: A total of 70.6% (96/136) of patients wished to proceed with surgery; 29.4% (40/136) did not wish to proceed. The decision to proceed with surgery was not correlated with sex, American Society of Anesthesiologists grade or COVID-19 risk. Those who wished to proceed with surgery had a mean age of 68.5 years while those who did not had a mean age of 72.4 years (P = 0.03). Within the matched subgroups, patients under the age of 70 years were more willing to proceed with primary hip arthroplasty surgery (87.9%) compared with primary knee arthroplasty surgery (57.1%; P = 0.007); 75% of the patients who did not wish to proceed with surgery expressed concerns about perioperative COVID-19 infection. CONCLUSION: There is a significant proportion of arthroplasty patients on waiting lists who would be willing to accept the increased risks associated with COVID-19 to undergo surgery on an urgent basis. The subgroup of younger patients awaiting hip arthroplasty is more willing than those awaiting knee arthroplasty to proceed with surgery.

Is india ready to address covid-19 like pandemics: A perspective from existing public health acts

Background: There were three influenza pandemics during the 20th century (in 1918, 1957 and 1968) before 2019 the first of which killed at least 40 million people worldwide, exceeding the 8.3 million military deaths during World War I. Novel Coronavirus Outbreak (COVID-19) pandemic was a call for immediate action to be taken on by all countries in terms of stepping up treatment, detection, and reduction of transmission. Objectives: To review various existing public health acts in India. Methodology: The existing public health acts in the country was reviewed thoroughly from various sources and a summary was formed after review. Feedback about the existing public health acts from experts of different fields was also sought and incorporated into the review and finally components for a model public health act was summarized. Conclusion: The Pandemic responses would require strong community engagement using trusted individuals, inter-sectoral collaboration, the involvement of private health care providers, build on existing disease surveillance systems, and link with India’s existing crisis management frameworks.