ABSTRACT
Background: For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose(s): The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Method(s): Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive highrisk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Result(s): A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3-80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70-79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion(s): The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible.
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Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.Copyright © The Author(s), 2023. Published by Cambridge University Press.
ABSTRACT
Background: For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose: The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Methods: Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7).After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission.The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Results: A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion: The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible. Funding Acknowledgement: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol
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Introduction: Booster vaccination against SARS-CoV-2 is recommended for patients with multiple sclerosis (pwMS), usually six months after the last vaccination. Objectives and aims: To investigate humoral response after SARS-CoV-2 booster vaccination in pwMS compared to healthy controls (HC), as well as the role of the third vaccination in the primarily seronegative and therefore more vulnerable group of treated pwMS (S1PMs, anti-CD20 mAbs). Method(s): In this prospective multicenter study on 292 pwMS and 46 HC, who had all received two vaccinations, SARS-CoV-2 IgG response was measured in the month before and 2-4 months after booster vaccination. PwMS were categorized as follows: untreated (N-DMT, n=32), receiving disease-modifying therapy (DMT) with expected humoral response (er-DMT: interferon-beta preparations, glatiramer acetate, dimethyl fumarate, teriflunomide, natalizumab, cladribine, alemtuzumab;n=120) or no expected humoral response (nr-DMT: S1PMs, CD20mAb;n=140). Result(s): PwMS on nr-DMT had significantly lower median antibody levels before (12.1 U/ml [0.4-2500]) and after booster vaccination (305 U/ml [0.4-2500]) in comparison to other groups (p<0.001). We did not find differences in antibody levels after homologous (n=281;2500 [0.4-2500]) and heterologous (n=57;2500 [0.4-2500]) vaccination regime regardless of the DMT group. The DMT group (= -0.16;95% CI -34.88, -5.08;p=0.009) were associated with antibody levels after booster vaccination, while time to revaccination(6 months [1-13]) was not. After booster vaccination, seropositivity was reached in 75.8% and 82.2% of pwMS on anti-CD20 mAbs and S1PMs, respectively. Complete B-cell depletion significantly decreased the probability of seroconversion even after the third vaccination (OR 0.14;p=0.021), whereas time interval to last DMT intake and time to revaccination did not. Twenty-three patients reported a SARSCoV- 2 infection (3 N-DMT, 10 er-DMT, 10 nr-DMT), one being asymptomatic and the rest having a mild course. Conclusion(s): Humoral response to SARS-CoV-2 booster vaccination in pwMS is excellent. While reduced by S1PMs and CD20mAb, protective response is still expected in the majority of patients.
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Introduction: IgA vasculitis (IgAV) is a common diagnosis in children and includes purpura, and/or petechiae (without thrombocytopenia or coagulopathy) with at least one of the following: abdominal pain, joint pain, AKI, hematuria, proteinuria, or evidence of IgA deposition. Many cases are preceded by upper respiratory tract infections, including COVID-19. The incidence of cerebral venous sinus thrombosis (CVST) in the pediatric population is low (0.6/100,000 per year). We present a case of a 5 year old boy with IgA vasculitis and COVID-19 infection found to have CVST. Case Description: A previously healthy 5 year old boy transferred to our institution with two weeks of intermittent, severe abdominal pain in the setting of COVID-19 infection with new-onset hematochezia, hypertension, and tachycardia. Abdominal ultrasound, abdominal x-ray, chest x-ray, ANA, C3, C4, ANCA, creatinine, electrolytes, and coagulation factors were normal. Urinalysis was significant for hematuria and a urine protein-to-creatinine ratio (UPC) of 2.02 mg/mg. Purpuric and petechial rash appeared the day after admission. UPC trended up to 4.82 mg/mg and a renal biopsy confirmed the diagnosis of IgA nephropathy. Patient was treated with 30mg/kg/day Solu-Medrol for three days and discharged home on 2mg/kg/day prednisolone daily. He was readmitted two days later with severe left frontal headache. UPC was worse at 5.98 mg/mg and mycophenolic mofetil (MMF) was initiated. Imaging revealed an occlusive thrombus of the left transverse sinus with nonocclusive thrombi in the distal portion of the left lateral sinus and posterior superior sagittal sinus. He started 21mg Lovenox twice daily and had minimal residual thrombosis after three months. His UPC peaked at 20.73 mg/mg and eventually normalized with high-dose steroids, Enalapril, and MMF. Discussion(s): This is the first case, to our knowledge, of CVST in a patient with IgAV associated with COVID-19 infection. Multiple case reports of IgA vasculitis associated with COVID-19 infection have been published in the past two years, and this case may support a more careful approach when it comes to screening for pro-coagulation risk factors.
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The corona pandemic has changed travel. The chair for human geography and transformation research at the University of Augsburg, in cooperation with the knowledge transfer center for innovative and sustainable tourism development at the University of Kempten, examined the possibilities of low-touch tourism. First, the focus is on effective strategies to avoid the formation of groups and crowding effects. Second, potentials for minimizing physical contacts between travellers and tourism providers are identified (e. g., to avoid near-contact services). And third, ways to reduce physical contact with high-traffic surfaces are analysed. The aim is to collect, structure and categorize information, data, and experiences on low touch tourism.
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Background and aims: Booster vaccination against SARSCoV- 2 is recommended for everyone approximately six months after the last vaccination, including for patients with multiple sclerosis (pwMS). Methods: In this prospective single-center study on 171 pwMS and 38 healthy controls (HC), who had all received two vaccinations, SARS-CoV-2 IgG response was measured in the month before and 2-4 months after booster vaccination. PwMS were categorized as follows: untreated (N-DMT, n=17), receiving DMT with expected humoral response (er-DMT: all but S1PM and CD20mAB;n=65) or no expected humoral response (nr-DMT: S1PM, CD20mAb;n=89). Results: Absolute antibody levels (median 253.5 U/ml [range 0.4-2500]) before booster vaccination were similar between HC (516 [49.5-2500]), N-DMT (648 [0.4-2345]) and er-DMT (858.5 [25.6-2500]), while nr-DMT had significantly lower antibody levels (32.8 [0.4-2500];p<0.001). After booster vaccination, the absolute antibody levels were as follows: HC (2500 [2190-2500]), N-DMT (2500 [32.2-2500]), er-DMT (2500 [1951-2500]), and nr-DMT (548 [0.4-2500];p<0.001). We did not find differences in antibody levels after homologous (n=96;2500 [0.4-2500]) and heterologous (n=53;2500 [0.4- 2500]) booster vaccination. Time to revaccination (6 months [1-10] was not associated with antibody level. Four of 13 (30.8%, all CD20mAb) seronegative pwMS remained seronegative after booster vaccination. Seven patients reported a SARS-CoV-2 infection (1 N-DMT, 6 nr-DMT). Efficacy rate for preventing hospitalization or death was 100% in all groups. Conclusion: Humoral response to SARS-CoV-2 booster vaccination in pwMS is excellent. While reduced by immunosuppressive DMT, protective humoral response is still expected in the majority of patients.
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In the current overtourism research discourse and in the wake of the ongoing coronavirus pandemic, the perspective of the residents is becoming more and more important, as it is primarily the locals, who find themselves confronted with increasing overcrowding effects in their hometowns. The direct interaction between tourists and residents, especially in high frequency destinations and popular hotspots, often leads to conflict potentials of diverse magnitude. This paper aims to review the perspective of the locals in the current overtourism research discourse and refer to the related problems. The present case study from the Allg..u region empirically complements the theoretical perspective, intended to provide information about the perception of the local residents concerning crowding effects and overtourism as well as the attitude to local guidance measures and visitor management strategies.
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This case study research aimed to explore risk communication processes and strategies adopted by Institutions of Higher Education (IHEs) in the state of Texas during COVID-19. Because higher learning and interactions with students during the initial stages of the pandemic resided predominantly in virtual space, the study design considered website content analysis as appropriate in addressing risk communications chosen by universities. Markedly, website content analysis was conducted among 43 IHEs accredited by the Southern Association of Colleges and Schools Commission on Colleges and part of a Texas University System. This sampling replicates previous IHE research in the state. The conceptual model entitled “Conceptual Model for Evaluating Emergency Risk Communication (EERC)” developed in public health was used to ground focused risk communication dimensions to (a) review whether or to what degree messaging from IHEs aligned with the components used by experts;(b) record the types of patterns that are found in messaging as well as characteristics that foster a Disaster Resilient University (DRU);and (c) provide insights on areas that may need more focus to ensure greater efficacy in the future. The ERC model yielded the following dimensions used for analysis: (a) accurate/reliable;(b) open/transparent;(c) clear;(d) tailored messages;(e) consistent/timely;(f) sufficient;and (g) actionable. In addition to ERC, content regarding technological solutions was assessed from websites of chosen universities to gauge how universities have responded to tools needed during the pandemic to make informed judgments for the campus and to share information openly for the community. Our findings point to various components that IHEs in Texas targeted when communicating COVID-19 related information. For example, less than 60% of IHE in our sample defined terms, reviewed general COVID-19 information, and identified at risk groups on their respective campuses and only 6% provided an option for translating information. Meanwhile, IHEs fared generally better at providing timely updates regarding campus operations (i.e., 80%). Implications for our finding are discussed within the lens of Disaster Resilient University (DRU). © 2021 WIT Press.
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BACKGROUND AND AIMS: Patients on renal replacement therapy (RRT) pose multiple risk factors that may increase the risk of death from coronavirus disease 2019 (COVID-19). Currently, evidence of incidence, management, and prognosis of COVID-19 in this population are scarce. METHOD: Between May and December 2020, we followed two RRT populations that have the same tertiary hospital in Southern Brazil as its reference hospital for transplantation. Firstly, we monitored eight affiliated dialysis clinics keeping track of COVID-19 incidence and fatality rate in dialysis patients and those on the kidney transplant waiting list. In the same period, we also monitor COVID-19 incidence and mortality among our prevalent population of kidney transplant recipients. RESULTS: We evaluated 1049 patients in RRT in the dialysis centers. COVID-19 occurred in 89 of such patients (8.5%), and 31 died from such condition (35.8% death rate). Fifteen patients (5.45%), among 275 on the kidney transplant waiting list, contracted the virus, with one death (6.6%). Within our prevalent population of 1348 kidney transplant recipients, 113 were diagnosed with COVID19 (incidence: 8.4%), and 17 of them died (mortality rate: 15%). Finally, the number of kidney transplants decreased by 60.4% compared with the same period in the previous year. CONCLUSION: COVID-19 determined a substantial impact on RRT. A high frequency of chronic dialysis patients expired from the disease. The impact on the patients on the transplant waiting list seems to be less pronounced probably due to their better health conditions. The fatality rate in kidney transplant recipients is elevated and probably mostly related to comorbidities. Brazil is currently entering the second wave of the disease and it is crucial to find and provide means to protect such vulnerable populations.