ABSTRACT
Introduction: Injectable medicines are increasingly used to manage risk factors for cardiovascular (CV) events, such as PCSK-9 inhibitors in dyslipidaemia and GLP-1 agonists in diabetes. However, there is a paucity of data around the administrative and clinical practicalities when using these injectables, and limited information on patient and healthcare professionals' perceptions. Purpose(s): To identify the facilitators and barriers on the use of injectable therapies with CV benefits by undertaking interviews with patients, caregivers and healthcare professionals (HCPs). Method(s): Interviews were conducted via telephone and using MS Teams due to Covid-19 restrictions in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. Result(s): A total of 56 patients were interviewed: 30 in the U.K. (mean age 66 yrs, 60% male) and 26 patients in Italy (mean age 63 yrs, 80% male) and 11 caregivers (mean age 59 yrs, 73% female). A total of 38 HCPs were interviewed, 19 in each country and composed of physicians (n=18), pharmacists (n=10), nurses (n=9) and pharmacy technician (n=1). Three distinct themes were identified: (i) Organisational and governance issues - relating to prescribing restrictions and availability of the drugs locally (PCSK9i are initiated and supplied from hospitals) and lack of communication between hospital and primary care setting;(ii) Clinical issues around HCPs' skills and experience - including: Lack of experience with these injectables, lack of time to provide education to patients and caregivers, therapeutic inertia (HCPs not adopting a change in practice despite the evidence or due to bureaucratic restrictions) as well as lack of knowledge on long-term effects, and finally (iii) Patient-related issues - relating to behaviours and beliefs such as reluctance about using injectable therapies, and lack of education about these injectables in terms of indications/clinical benefits for use. Despite some differences in the prescribing of these injectables in the two countries, the analysis captured similar facilitators and barriers. Facilitators included prior use of injectables (e.g. insulin), and the ability to reach a clinical target of lower cholesterol by having just a one shot . HCPs stated that access to rapid pathology tests would aid uptake of injectables with CV benefit as well as having educational tools on these injectables in practice. Conclusion(s): This qualitative study identified barriers to initiation, continuation, and adherence with injectable therapies with CV benefits but also highlighted areas where changes can be made especially around education and support for patients and HCPs.
ABSTRACT
Since the COVID-19 pandemic began, there has been a reported surge of ageism toward older adults. Research demonstrates that events perpetuating negative attitudes towards older adults can increase ageism and associated negative outcomes. The purpose of this phenomenological qualitative study was to explore how older adults navigated experiences of ageism and their social relationships during the COVID-19 pandemic. Semi-structured interviews with adults ages 60 and older were conducted between February and April of 2021 over Zoom. Data were coded using an iterative, inductive approach and thematic analysis was performed to draw themes from the data. A total of 24 participants ages 61-80 (mean = 70.6) were interviewed. Most participants identified as white (n = 19) female (n = 14), retired (n = 21) and had at least a bachelor's degree (n = 22). Findings showed that participants experienced ongoing ageism but did not report ageist experiences associated specifically with COVID-19. Ageist experiences, unrelated to COVID-19, as shared by participants included assumptions about older adults' (in)ability to use technology, ageism in professional settings, and feelings that ageism is an inevitable part of growing older. Future research should examine the impact of intersectionality on this topic within more diverse populations and explore potential differences that may have occurred throughout different stages of the pandemic.
ABSTRACT
During the main COVID-19 global pandemic lockdown period of 2020 an impromptu set of pollination ecologists came together via social media and personal contacts to carry out standardised surveys of the flower visits and plants in gardens. The surveys involved 67 rural, suburban and urban gardens, of various sizes, ranging from 61.18° North in Norway to 37.96° South in Australia, resulting in a data set of 25,174 rows, with each row being a unique interaction record for that date/site/plant species, and comprising almost 47,000 visits to flowers, as well as records of flowers that were not visited by pollinators, for over 1,000 species and varieties belonging to more than 460 genera and 96 plant families. The more than 650 species of flower visitors belong to 12 orders of invertebrates and four of vertebrates. In this first publication from the project, we present a brief description of the data and make it freely available for any researchers to use in the future, the only restriction being that they cite this paper in the first instance. The data generated from these global surveys will provide scientific evidence to help us understand the role that private gardens (in urban, rural and suburban areas) can play in conserving insect pollinators and identify management actions to enhance their potential. © 2022 The authors.
ABSTRACT
Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a 'train the trainer' (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre-and post-survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.
ABSTRACT
Background. Early assessments of COVID19 preparedness reported resource shortages, use of crisis capacity strategies, variations in testing, personal protective equipment (PPE), and policies in US hospitals. One year later, we performed a follow-up survey to assess changes in infection prevention practice and policies in our diverse network of community and academic hospitals. Methods. This was a cross-sectional electronic survey of infection preventionists in 58 hospitals within the Duke Infection Control Outreach Network (community) and Duke/UNC Health systems (academic) in April-May 2021 to follow-up our initial survey from April 2020. The follow-up survey included 26 questions related to resource availability, crisis capacity strategies, procedures, changes to PPE and testing, and staffing challenges. Results. We received 54 responses (response rate, 93%). Facilities reported significantly fewer PPE and resource shortages in the follow-up survey compared to our initial survey (Figure 1, P< 0.05). Only 32% of respondents were still reprocessing N95 respirators (compared to 73% in initial survey, P< 0.05). All hospitals performed universal masking, universal symptom screening on entry, and 30% required eye protection. In 2020, most hospitals suspended elective surgical procedures in March-April, and restarted in May-June. Approximately 92% reported in-house testing for SARS-COV-2 by April 2020, at least a third of which had a weekly capacity of >100 tests. Almost 80% performed universal pre-operative testing, while 61% performed universal preadmission testing for SARS-COV-2. Almost all hospitals switched from test-based to time-based strategy for discontinuing isolation precautions, majority in August-September 2020. Twenty-five percent hospitals reported infection prevention furloughs, staffing cuts, and or reassignments, while 81% reported increased use of agency nursing during the pandemic. Conclusion. Our follow-up survey reveals improvement in resource availability, evolution of PPE guidance, increase in testing capacity, and burdensome staffing changes. Our serial surveys suggest increasing uniformity in infection prevention policies, but also highlight the increase in staff turnover and infection prevention staffing shortages.
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Purpose: Cervical cancer is one of the leading causes of cancer deaths among women in some countries in the Region of the Americas.1 Cervical cancer is preventable through HPV vaccination, screening and treatment of precancerous lesions, and can be effectively treated if diagnosed early.2 Methods: Under the framework of the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, the US National Cancer Institute (NCI), the University of Texas MD Anderson Cancer Center (MD Anderson) and the Pan American Health Organization/World Health Organization (PAHO/WHO) partnered to develop ECHO Latin America (ECHO ELA). ECHO ELA is modeled on Project ECHO® (Extension of Community Healthcare Outcomes) a hub-and-spoke knowledge-sharing approach where expert teams lead virtual didactic lectures and case discussions, amplifying the capacity for participants to deliver best practice programs to their regions. ECHO ELA consists of monthly, Spanish-language telementoring conferences about cervical cancer prevention and control. The program targets Ministries of Health, Immunization Program Managers and key cervical Sample output to test PDF Combine only cancer stakeholders in Latin American (LA) countries. Its primary goal is to assist countries in reaching their WHO cervical cancer elimination goals “90-70-90:” vaccinating 90 percent of girls against HPV by the age of 15, screening 70 percent of women for cervical cancer at ages 35 and 45, and treating 90 percent of women diagnosed with preinvasive cervical lesions or cervical cancer. Results: To date, 222 participants from 21 countries have registered. Seven sessions have been held averaging 93 participants per session. 85 participants completed the baseline survey addressing priorities, capacity, and desired outcomes. Baseline, mid-year evaluation results, within the COVID-19 context, and learned lessons will be presented. Conclusion: ECHO ELA is potentially an effective tool to convene participants from multiple countries to enhance collaboration and support countries' progress towards the elimination of cervical cancer in the Americas.
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It is well established within both the scientific literature and social discourse that policing in the United States has a history of racial bias. Black people make up a disproportionate percentage of the prison population in this country-a direct result of policies such as "convict leasing" and the War on Drugs, designed to hyper-police the Black community. In this article, we explain how the development of the U.S. carceral system is inextricably linked to slavery at its foundation, how the late twentieth century saw the development of laws that discriminately impact Black people, and why policing and the carceral system must be viewed through a lens of environmental justice. Using modern case studies, we argue that the U.S. carceral system is fraught with issues of environmental injustice, both historically and in the face of new challenges, such as the COVID-19 pandemic. We aim to show that any path forward must be intersectional in its approach, and highlight that the environmental movement must incorporate social justice to address systemic issues of environmental injustice.
ABSTRACT
Background: The SARS-CoV-2 pandemic has placed a tremendous strain on the U.S. healthcare system leading to personal protective equipment (PPE) and resource shortages. Hospitals have developed contingency and crisis capacity strategies to optimize the use of resources, but, to date, community hospital preparedness has not been described. Methods: We performed a cross-sectional survey of infection preventionists in 60 community hospitals within the Duke Infection Control Outreach Network between April 22 and May 7, 2020 using Qualtrics. The survey included 13 questions related to resource availability, crisis capacity strategies and approaches to testing. Results: We received 50 responses during the study period with a response rate of 83%. Community hospitals reported varying degrees of PPE shortages (Table 1);80% of community hospitals were implementing strategies to extend and reuse N95 respirators, Powered Air-Purifying Respirators, face shields and face masks. Over 70% of facilities reported reprocessing N95 respirators (Figure 1). Almost all facilities reported universal masking at time of this survey with 90% performing daily employee screening at point of entry. Additionally, 8% of facilities restarted elective procedures at the time of this survey, but only 54% of facilities reported that they were performing preoperative testing for SARS-CoV-2. Thirty-seven percent of facilities performed one SARS-CoV-2 test before discharging an asymptomatic patient to skilled nursing facility, while 43% of facilities performed 2 tests. Conclusion: Our findings reveal differences in resource availability, crisis capacity strategies and testing approaches used by community hospitals in preparation for the SARSCOV- 2 pandemic. Lack of harmonization in approaches may be in part due to differences in state guidelines and decentralized federal approach to SARS-CoV-2 preparedness. (Table Presented).
ABSTRACT
Introduction Cervical cancer is the primary cause of cancer among women in Mozambique. There is a shortage of providers trained to deliver cervical cancer screening and manage pre-invasive lesions. We describe a training program to build local capacity to deliver quality cervical cancer prevention services in Mozambique. Methods The program includes training courses led by faculty from the United States (US) and Brazil, and consists of lectures followed by hands-on training stations to practice colposcopy, cervical biopsy, ablation and loop electrosurgical excision procedure (LEEP) using innovative training models. Participants then perform the procedures in clinic with supportive supervision from the international faculty. The courses are complemented by monthly videoconference telementoring sessions, held in Portuguese using the Project ECHO® (Extension for Community Healthcare Outcomes) model. Results From 2016 to 2020, 10 courses were held in the cities of Maputo (n=8), Beira (n=1) and Nampula (n=1). There were 347 participants with an average of 34 participants per course. The courses have recently transitioned from only international faculty to include Mozambican gynecologists, including two fellows from the IGCS Global Curriculum program. A total of 15 ECHO sessions were held with ∼25 participants/ session, 30 patient cases discussed and 14 lectures delivered. Conclusion This collaboration between Mozambique, Brazil and the US is building local capacity to prevent cervical cancer through training, mentoring and support of local providers. Due to the COVID-19 pandemic, the courses are being transitioned to a virtual format led by the Mozambican doctors with the international faculty joining remotely.
ABSTRACT
We have not yet seen the full effect of COVID-19 and the subsequent economic crisis, but this early analysis of the COVID19 module of the Australian Rental Housing Conditions Dataset (ARHCD) suggests that the rental sector will be where many of the upcoming challenges for Australia overlap. • The COVID-19 module captures a 'snapshot' of circumstances for Australian renters. The initial findings, presented here, suggest a policy-important cohort of tenants in Australia are lined up on the brink of a financial precipice. Many renters are currently buffered from the full economic effects of the pandemic by their savings, their superannuation, and rent deferment, as well as temporary government supports in the form of eviction moratoriums, JobKeeper and JobSeeker. • The impacts of COVID-19 across the rental sector are, in many respects, still emerging, and this presents a real challenge for policymakers in developing targeted and effective assistance. While policy responses may, in the short term, focus on protective mechanisms, such as eviction moratoriums, the systemic nature of the challenges faced by renters suggests that long-term recovery will be most effectively realised through system-wide policy shifts. • Challenges for effective policy response include the need to provide targeted assistance quickly, to provide a framework of certainty that enables all stakeholders in the rental sector to plan for the future (e.g. tenants, landlords, housing providers, social services), and to anticipate what issues may evolve in an extended pandemic. • Without control of COVID-19 and the associated health risks, there can be no recovery for the Australian economy. Housing is at the frontline of interventions-and, as such, is a potential weakness in recovery. © Australian Housing and Urban Research Institute Limited 2020