Prostate Cancer Screening during the Covid-19 Pandemic across Demographic Groups

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic led to the delay of routine medical care, including cancer screening, beginning in March of 2020. While screening rates for several cancers, including prostate cancer, rapidly recovered after the first wave of the COVID-19 pandemic, the degree to which this recovery was realized in different populations remains unknown. We sought to determine the association of the COVID-19 pandemic with prostate cancer screening, particularly for traditionally underserved patients. METHOD(S): We performed a retrospective cohort study using electronic health records (EHR) data from the Optum EHR database for male patients between the ages of 55-69 eligible for prostate cancer screening from quarter 1 (Q1) of 2016 through Q2 of 2021. We excluded men with a prior diagnosis of prostate cancer. We performed multivariable analysis to estimate screening over time, adjusting for patient age, race, ethnicity, Census division of residence, and insurance status. RESULT(S): A total of 7,361,765 patients were included. After adjusting for patient demographics, the percentage of eligible patients with prostate cancer screening decreased from 2.2% in Q4 of 2019 to 1.3% in Q2 of 2020. There was a rebound in screening to 2.4% in Q3 of 2020, which is similar to baseline levels, and a subsequent decline to 1.6% in Q2 of 2021. This trend was seen even after stratifying based on age, race, ethnicity, division, and insurance status (Figure 1). CONCLUSION(S): A 40% decline in prostate cancer screening in Q2 of 2020 was observed during the first wave of the pandemic. This returned to baseline by Q3 of 2020. Subsequent decline was seen again through Q2 of 2021, which also coincides with the second wave of COVID-19. This trend was unaffected by patient characteristics, such as age, race, insurance status, or division of residence. While these data suggest that the peak of the pandemic impacted prostate cancer screening trends similarly across different patient demographic groups, further study is required to breakdown if this was due to social distancing, decreased clinic volumes, or other factors.

COVID-19 Not a Risk Factor of Alopecia Areata: Results of a National Cohort Study in South Korea

Background. There have been approximately 158 million coronavirus disease 2019 (COVID-19) pandemic survivors worldwide by June 9, 2021. As a result, concerns about hair loss in COVID-19 patients have emerged among dermatologists. However, most of extant literature have limited implications by relying on cross-sectional studies with restricted study subjects without control group. Therefore, our study aims to investigate the risk of developing alopecia areata (AA) among COVID-19 patients in South Korea using adequate control based on national representative data. Methods. We used the National Health Insurance Service (NHIS) COVID-19 cohort database, comprising COVID-19 patient and control group, all of whom were diagnosed from January 1, 2020 to June 4, 2020. Patients were defined as individuals who were confirmed as COVID-19 positive, regardless of disease severity. Controls were defined as whom confirmed as COVID-19 negative. People with a history of AA during the period 2015-2019 were excluded. The primary endpoint was a new diagnosis of AA (ICD-10-CM-Code: L63). Adjusted incidence rate ratio (IRR) of developing AA was estimated using log-link Poisson regression model based on incidence density of case and control group. The model adjusted for (1) age and sex (2) demographic variables (age, sex, place of residence, and income level). Statistical significance was set at p< 0.05. Results. A total of 226,737 individuals (7,958 [3.5%] cases and 218,779 [96.5%] controls) were included in the final analysis. There were more females than males, both in test positives and negatives at 59.9% and 52.3%, respectively. The largest test positive population was those in age group 20 to 29 years (25.5%),. The test negatives had the largest population in age group 30 to 39 years (17.1%). The ratio of newly diagnosed AA was 18/7,958 (0.2%) in cases and 195/218,779 (0.1%) in controls. IRRs of COVID-19 patients having newly diagnosed AA compared to controls were 0.78 (0.48-1.27) when age and sex were adjusted for, and 0.60 (0.35-1.03) when all demographic variables were adjusted for. Flowchart of study subject selection Conclusion. Diagnosis of COVID-19 was not significantly associated with development of AA even after appropriately adjusting for covariates.

New-Onset Diabetes as an Acute Complication of COVID-19: A National Population Cohort Analysis

Background. Diabetes is emerging as one of the complications of coronavirus disease 2019 (COVID-19), but this is hard to be revealed with cross-sectional studies since it is also known as the major predisposing factor for high-risk COVID-19. Therefore, this study aimed to estimate the risk of new-onset diabetes after COVID-19 through a population follow-up study. Methods. All COVID-19 confirmed cases in Korea from January 20 to June 4, 2020, were matched with national health insurance data and their health screening data, both provided by the National Health Insurance Service of Korea. Controls were selected as the people who received the PCR test for COVID-19 and showed negative results in the same period and followed up until July 19, 2020. We selected the outcome as the diagnosis of diabetes according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10, E10 - E14). People who were diagnosed with diabetes in the past five years were excluded from both groups. After performing a log-rank test between groups, adjusted incidence rate and hazard ratio were estimated using Cox proportional hazard modeling. Demographic characteristics (age, sex, region, family histories of hypertension/diabetes, and income) and underlying health conditions such as hypertension, dyslipidemia, heart disease, alcohol consumption, cigarette smoking, and BMI were adjusted. Proportional assumptions were tested by the zph test and the sensitivity analysis by excluding each factor in turn and comparing results. Results. A total of 6,247 COVID-19 patients and 143,594 controls without diabetes in the past were included for the analysis. The number of new-onset diabetes were 759 (12.15%) in COVID-19 patients and 3,465 (2.41%) in controls (P < 0.01). The adjusted incidence of diabetes was 15.34 (95% confidence interval, CI: 14.10 - 16.66) and 11.18 (95% CI: 10.67 - 11.72) per 100 person-year, respectively, with the mean follow-up time as 46.31 (standard deviation: 16.37) days. The adjusted hazard ratio of diabetes in COVID-19 cases was 2.97 (95% CI: 2.44 - 3.63). Conclusion. Since COVID-19 patients showed a higher incidence of new-onset diabetes in a short-time follow-up, we should consider diabetes as one of the possible complications of COVID-19.

Re-estimation of basic reproduction number of COVID-19 based on the epidemic curve by symptom onset date.

Previous studies have reported the basic reproduction number (R0) of coronavirus disease from publicly reported data that lack information such as onset of symptoms, presence of importations or known super-spreading events. Using data from the Republic of Korea, we illustrated how estimates of R0 can be biased and provided improved estimates with more detailed data. We used COVID-19 contact trace system in Korea, which can provide symptom onset date and also serial intervals between contacted people. The total R0 was estimated as 2.10 (95% confidence interval (CI) 1.84-2.42). Also, early transmission of COVID-19 differed by regional or social behaviours of the population. Regions affected by a specific church cluster, which showed a rapid and silent transmission under non-official religious meetings, had a higher R0 of 2.40 (95% CI 2.08-2.77).

Organizational culture and social climate in Kazakhstani higher education institutions during the COVID-19 crisis: KazNU case study

The purpose of this study is to analyze the current characteristics of organizational culture and climate in Kazakhstani higher educational institutions during the COVID-19 crisis. Materials for the study were collected from interviews and online discussions published on the website of Al-Farabi Kazakh National University (KazNU). In addition, results from the social monitoring systems of the university's educational activities as well as an official survey have been used. The study offers details of how Kazakhstani universities dealt with the crisis by presenting KazNU case study. The paper presents the responsible actions developed at the university as well as the problems faced by students and teachers. One important lesson to be learnt is that educational organization needs to be more comprehensive, caring for appropriate technical equipment, helping develop skills for staff and students, and include vulnerable groups of the population. © 2020 Lippincott Williams and Wilkins. All rights reserved.