Health Care Utilization During the COVID-19 Pandemic Among Individuals Born Preterm.

Importance: Limited data exist on pediatric health care utilization during the COVID-19 pandemic among children and young adults born preterm. Objective: To investigate differences in health care use related to COVID-19 concerns during the pandemic among children and young adults born preterm vs those born at term. Design, Setting, and Participants: In this cohort study, questionnaires regarding COVID-19 and health care utilization were completed by 1691 mother-offspring pairs from 42 pediatric cohorts in the National Institutes of Health Environmental Influences on Child Health Outcomes Program. Children and young adults (ages 1-18 years) in these analyses were born between 2003 and 2021. Data were recorded by the August 31, 2021, data-lock date and were analyzed between October 2021 and October 2022. Exposures: Premature birth (<37 weeks' gestation). Main Outcomes and Measures: The main outcome was health care utilization related to COVID-19 concerns (hospitalization, in-person clinic or emergency department visit, phone or telehealth evaluations). Individuals born preterm vs term (≥37 weeks' gestation) and differences among preterm subgroups of individuals (<28 weeks', 28-36 weeks' vs ≥37 weeks' gestation) were assessed. Generalized estimating equations assessed population odds for health care used and related symptoms, controlling for maternal age, education, and psychiatric disorder; offspring history of bronchopulmonary dysplasia (BPD) or asthma; and timing and age at COVID-19 questionnaire completion. Results: Data from 1691 children and young adults were analyzed; among 270 individuals born preterm, the mean (SD) age at survey completion was 8.8 (4.4) years, 151 (55.9%) were male, and 193 (71.5%) had a history of BPD or asthma diagnosis. Among 1421 comparison individuals with term birth, the mean (SD) age at survey completion was 8.4 (2.4) years, 749 (52.7%) were male, and 233 (16.4%) had a history of BPD or asthma. Preterm subgroups included 159 individuals (58.5%) born at less than 28 weeks' gestation. In adjusted analyses, individuals born preterm had a significantly higher odds of health care utilization related to COVID-19 concerns (adjusted odds ratio [aOR], 1.70; 95% CI, 1.21-2.38) compared with term-born individuals; similar differences were also seen for the subgroup of individuals born at less than 28 weeks' gestation (aOR, 2.15; 95% CI, 1.40-3.29). Maternal history of a psychiatric disorder was a significant covariate associated with health care utilization for all individuals (aOR, 1.44; 95% CI, 1.17-1.78). Conclusions and Relevance: These findings suggest that during the COVID-19 pandemic, children and young adults born preterm were more likely to have used health care related to COVID-19 concerns compared with their term-born peers, independent of a history of BPD or asthma. Further exploration of factors associated with COVID-19-related health care use may facilitate refinement of care models.

Hybrid Opto‐Thermocycler for RT‐qPCR Detects SARS‐CoV‐2

Although real‐time quantitative reverse transcription polymerase chain reaction (RT‐qPCR) is the gold standard for detecting the virus severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) and other pathogens, the coronavirus disease 2019 (COVID‐19) pandemic has highlighted the scarcity of instruments, devices, and reagents for polymerase chain reaction (PCR) testing in constrained settings. At least for under‐resourced countries, it has become critical to deploy instruments that can be rapidly constructed and satisfy this demand. Instead of separating the optical system from the thermal module (typical of qPCR thermocyclers), we report a portable Hybrid Opto‐Thermocycler—dubbed HybOT Cycler—that takes advantage of the high‐temperature tolerances (>100 °C) of electronic and optical components to combine thermal control, illumination, and fluorescence detection into a highly integrated hybrid module. This simple configuration allowed us to reduce the overall number of components, thus simplifying its assembly and reducing the instrument size. The HybOT Cycler is wirelessly controlled from an application installed in a tablet. PCR assays are carried out in a bubble‐free microfluidic device that can be easily replicated from an acrylic mold. Using the HybOT Cycler, down to 100 copies/µL of genetic material of the virus SARS‐CoV‐2 with 95% sensitivity and 100% specificity is detected. The HybOT Cycler can assist in diagnosing SARS‐CoV‐2 and other pathogens in resource‐poor settings. [ FROM AUTHOR] Copyright of Advanced Materials Technologies is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Lessons Learned: Community Engagement in Emergencies in Puerto Rico.

OBJECTIVE: To describe the importance of community engagement from research projects and research centers in times of disasters or emergencies, using the case of Puerto Rico in recent years (2017 - 2022) as an example. METHODS: First, research participants and stakeholders from local community and health organizations were contacted via email and phone calls after each emergency to assess their immediate needs. Second, needs were classified in categories (materials, educational resources, service referrals, and collaborations). Finally, delivery of support was coordinated in a timely manner whether in person or online. RESULTS: Activities were conducted such as handing out materials, providing educational resources, contacting participants, and stakeholders, as well as coordinating collaboration with community and organizations. CONCLUSION: Several lessons were learned from our experiences related to Puerto Rico's recent emergencies as well as some relevant recommendations for future disasters. The efforts presented illustrate the importance of community engagement from academic institutions in disasters. Research centers and research projects, particularly those with community engagement components, should consider providing support in the preparedness phase as well as the recovery phase if necessary. Community engagement in emergencies is crucial to recovery efforts as well as fostering empowerment and making an impact on individual and societal levels.

Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program.

OBJECTIVE: We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic. STUDY DESIGN: Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes. RESULTS: Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life. CONCLUSION: In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic. KEY POINTS: · COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..

Impact of COVID-19 on the surgical volume of general surgery residents as main surgeons in a National Training Program in Costa Rica: A cross-sectional study.

ABSTRACT: To quantify the impact of coronavirus disease 19 (COVID-19) on the surgical volume of residents' medical practice in Costa Rica's General Surgery Residency Program.The COVID-19 pandemic has caused a significant disruption in people's lives. Health systems worldwide have been forced to adapt to the new normal, which has posed a challenge for medical residency programs, especially in the surgical field.This transversal study includes the surgical records of all residents of the General Surgery program who worked as main surgeons at the Mexico Hospital of the Costa Rican Social Security between December 23, 2019, and June 25, 2020.As main surgeons, a total of 10 residents performed 291 pre-pandemic surgeries and 241 pandemic surgeries.When comparing the distribution of procedures performed by residency levels, it is observed that the postgraduate year -2 increased the number of procedures performed during the pandemic period (pre-pandemic 19% vs pandemic 27%, P = .028). There was no statistically significant difference between the pre-pandemic and pandemic periods in the remaining levels.When comparing the procedures by unit, a statistically significant decrease was observed in the Endocrine-Abdominal Wall Unit (pre-pandemic 18.3% vs pandemic 5.4%, P < .001). Conversely, a statistically significant increase was identified in Surgical Emergencies Unit procedures (40.0% vs post 51.7%, P = .007). No statistically significant differences were observed in the remaining the Units.The COVID-19 pandemic had no statistically significant effect on surgeries performed by residents of the General Surgery Residency Program as main surgeons in a national training center in Costa Rica. The Department's timely measures and pro-resident attitude were the key reasons for the above results.

Hybrid Opto‐Thermocycler for RT‐qPCR Detects SARS‐CoV‐2

Although real‐time quantitative reverse transcription polymerase chain reaction (RT‐qPCR) is the gold standard for detecting the virus severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) and other pathogens, the coronavirus disease 2019 (COVID‐19) pandemic has highlighted the scarcity of instruments, devices, and reagents for polymerase chain reaction (PCR) testing in constrained settings. At least for under‐resourced countries, it has become critical to deploy instruments that can be rapidly constructed and satisfy this demand. Instead of separating the optical system from the thermal module (typical of qPCR thermocyclers), we report a portable Hybrid Opto‐Thermocycler—dubbed HybOT Cycler—that takes advantage of the high‐temperature tolerances (>100 °C) of electronic and optical components to combine thermal control, illumination, and fluorescence detection into a highly integrated hybrid module. This simple configuration allowed us to reduce the overall number of components, thus simplifying its assembly and reducing the instrument size. The HybOT Cycler is wirelessly controlled from an application installed in a tablet. PCR assays are carried out in a bubble‐free microfluidic device that can be easily replicated from an acrylic mold. Using the HybOT Cycler, down to 100 copies/µL of genetic material of the virus SARS‐CoV‐2 with 95% sensitivity and 100% specificity is detected. The HybOT Cycler can assist in diagnosing SARS‐CoV‐2 and other pathogens in resource‐poor settings. [ FROM AUTHOR]

U.S. bound journey of migrant peoples InTransit across Dante's Inferno and Purgatory in the Americas.

Rapid rise of population migration is a defining feature of the 21st century due to the impact of climate change, political instability, and socioeconomic downturn. Over the last decade, an increasing number of migrant peoples travel across the Americas to reach the United States seeking asylum or cross the border undocumented in search of economic opportunities. In this journey, migrant people experience violations of their human rights, hunger, illness, violence and have limited access to medical care. In the 'Divine Comedy', the Italian poet Dante Alighieri depicts his allegorical pilgrimage across Hell and Purgatory to reach Paradise. More than 700 years after its publication, Dante's poem speaks to the present time and the perilious journey of migrant peoples to reach safehavens. By exploring the depths and heights of the human condition, Dante's struggles resonate with the multiple barriers and the unfathomable experiences faced by migrant peoples in transit across South, Central, and North America to reach the United States. Ensuring the safety of migrant peoples across the Americas and elsewhere, and attending to their health needs during their migratory paths represent modern priorities to reduce social injustices and achieving health equity.

SARS-CoV-2 infection and e-cigarette use, binge drinking, and other associated risk factors in a college population.

In the summer of 2020, SARS-CoV-2 infection rates among the U.S. population aged 20-39 years exceeded other age groups, with the largest increases occurring in the southern US. As many colleges reopened for in-person instruction in August and September, these trends continued among campuses across the country. Our study aimed to identify risk factors (demographic and behavioral) associated with SARS-CoV-2 infection among college students. We used data from a survey administered to students at a southern university in the US. The survey had a total of 765 respondents and this study included the 679 (88.8%) who responded about their SARS-CoV-2 infection status. We examined associations between population characteristics and reported SARS-CoV-2 infection and calculated prevalence ratios along with 95% confidence intervals. SARS-CoV-2 infection was 2.5 times more likely among current users of electronic nicotine delivery systems (ENDS) compared to those who do not use ENDS (95% confidence interval [CI]: (1.76-3.4)) and 2.8 times more likely among those who reported a high frequency of binge drinking compared to those who did not report binge drinking (95% CI: (1.81-4.36)). Current high frequency ENDS users were 2.76 (1.79-4.25) more likely to report SARS-CoV-2 infection than non-users. Current low frequency users of ENDS were 2.27 (1.53-3.37) times more likely to report SARS-CoV-2 infection than nonusers. A trend analysis among ENDS use frequency and SARS-CoV-2 infection was statistically significant, showing a significant dose response with increasing ENDS use. The results of this analysis may assist in providing guidance on policies as well as may serve as a steppingstone for future research concerning SAR-CoV-2 infection among university populations.

A high-throughput multiplexed microfluidic device for COVID-19 serology assays.

The applications of serology tests to the virus SARS-CoV-2 are diverse, ranging from diagnosing COVID-19, understanding the humoral response to this disease, and estimating its prevalence in a population, to modeling the course of the pandemic. COVID-19 serology assays will significantly benefit from sensitive and reliable technologies that can process dozens of samples in parallel, thus reducing costs and time; however, they will also benefit from biosensors that can assess antibody reactivities to multiple SARS-CoV-2 antigens. Here, we report a high-throughput microfluidic device that can assess antibody reactivities against four SARS-CoV-2 antigens from up to 50 serum samples in parallel. This semi-automatic platform measures IgG and IgM levels against four SARS-CoV-2 proteins: the spike protein (S), the S1 subunit (S1), the receptor-binding domain (RBD), and the nucleocapsid (N). After assay optimization, we evaluated sera from infected individuals with COVID-19 and a cohort of archival samples from 2018. The assay achieved a sensitivity of 95% and a specificity of 91%. Nonetheless, both parameters increased to 100% when evaluating sera from individuals in the third week after symptom onset. To further assess our platform's utility, we monitored the antibody titers from 5 COVID-19 patients over a time course of several weeks. Our platform can aid in global efforts to control and understand COVID-19.

Outpatient treatment of COVID-19 with steroids in the phase of mild pneumonia without the need for admission as an opportunity to modify the course of the disease: A structured summary of a randomised controlled trial.

OBJECTIVES: The aim of this study is to explore the effectiveness and safety of oral corticosteroids (prednisone) in the treatment of early stage SARS-Cov-2 pneumonia in patients who do not yet meet hospital admission criteria. TRIAL DESIGN: Randomized clinical trial, controlled, open, parallel group, to evaluate the effectiveness of steroids in adult patients with confirmed COVID-19, with incipient pulmonary involvement, without hospital admission criteria. Patients will be stratified by the presence or not of radiological data on pneumonia. PARTICIPANTS: We will include patients with early stage SARS-Cov-2 pneumonia who do not meet hospital admission criteria from the reference hospital, the Hospital Universitario de Burgos, in the region of Castilla y León, Spain. Patients will be followed-up by specialist physicians and Primary Health Care professionals. INCLUSION CRITERIA: - Men and women. - Age between 18 and 75 years old. - Diagnosed SARS-CoV-2 infection, by PCR and/or IgM+ antibody test and/or antigen test. - Clinical diagnosis of lung involvement: (respiratory symptoms +/- pathological auscultation +/- O2 desaturation) - Chest X-ray with mild-moderate alterations or normal. - Patients who give their verbal informed consent in front of witnesses, which will be reflected in the patients' medical records. EXCLUSION CRITERIA: - Oxygen desaturation below 93% or P02 < 62. - Moderate-severe dyspnea or significant respiratory or general deterioration that makes admission advisable. - Chest X-ray with multifocal infiltrates. - Insulin-dependent diabetes with poor control or glycaemia in the emergency room test greater than 300 mg/ml (fasting or not). - Other significant comorbidities: Severe renal failure (creatinine clearance < 30 mL/min); cirrhosis or chronic liver disease, poorly controlled hypertension. - Heart rhythm disturbances (including prolonged QT). - Severe immunosuppression (HIV infection, long-term use of immunosuppressive agents); cancer. - Pregnant or breast-feeding women. - Patients under use of glucocorticoids for other diseases. - History of allergy or intolerance to any of the drugs in the study (prednisone, azithromycin or hydroxychloroquine). - Patients who took one or more of the study drugs in the 7 days prior to study inclusion. - Patients taking non-suppressible drugs with risk of QT prolongation or significant interactions. - Patients unwilling or unable to participate until study completion. - Participation in another study. INTERVENTION AND COMPARATOR: Eligible patients will be randomized to receive standard outpatient treatment only (group 1) or standard outpatient treatment plus prednisone (group 2). - Group 1: paracetamol 1 g/8 h (on demand) + hydroxychloroquine 400 mg/12h the first day, 200 mg/12 h for 4 days + azithromycin 500 mg/24h for 5 days. - Group 2: paracetamol 1 g/8 h (on demand) + hydroxychloroquine 400 mg/12h the first day, 200 mg/12 h for 4 days + azithromycin 500 mg/24h for 5 days + prednisone 60 mg / 24 h for 3 days, 30 mg / 24 h for 3 days and 15 mg / 24 h for 3 days. MAIN OUTCOMES: If the patient requires ambulatory observation, according to the protocol established in this respect in the Emergency Department, meets all the criteria for inclusion and none for exclusion, data will be taken by the person responsible on the data collection sheet. The main result is admission after 30 days. Secondary outcomes are 30-day ICU admission and hospital stay. The safety variable will be the occurrence of clinical symptoms or delirium related to the steroids. Also, the possible decompensations of diabetes will be measured. All tests will be on an intention-to-treat basis. RANDOMISATION: Treatment will be assigned according to stratified randomization by the presence or absence of radiological data of lung involvement (previously performed by random sequence 1:1 generated with Epidat and kept hidden by opaque, sealed envelopes, which will only be opened after inclusion and basal measurement). BLINDING (MASKING): Participants, caregivers and personnel responsible for outcomes measurement will not be blinded to group assignment, once the patient is included and the basal measurement performed, as per protocol design. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The percentage of patients with incipient lung involvement is unknown, but given that pulmonary involvement already exists it is estimated to be around 20%. We consider that the intervention could reduce this percentage to 5%, so the necessary sample size would be 200 subjects (100 per group), with a power of 80% and an estimated loss percentage of 10%. TRIAL STATUS: The protocol with code TAC-COVID-19, version 2.0 on date: April 16, 2020 is approved by the Spanish Drug Agency (AEMPS) and the local Ethics Committee. The trial is in the recruitment phase. Recruitment began 19 April, 2020 and is anticipated to be complete by April 2021. TRIAL REGISTRATION: The trial was registered under the title "OUTPATIENT TREATMENT OF EARLY PULMONARY COVID19 WITH CORTICOSTEROIDS AS AN OPPORTUNITY TO MODIFY THE COURSE OF THE DISEASE" with EudraCT number 2020-001622-64 , registered on 3 April 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.