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Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.
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Background: People who inject drugs (PWID) may be at a greater risk of SARS-CoV-2 infection and COVID-19 due to socio-structural inequities, high-risk behaviors and comorbidities;however, PWID have been underrepresented in case-based surveillance due to lower access to testing. We characterize temporal trends and correlates of SARS-CoV-2 seroprevalence among a community-based sample of current and former PWID. Method(s): A cross-sectional study was conducted among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of adults with a history of injection drug use in Baltimore, Maryland. Participants' first serum sample collected at routine study visits between December 2020 and July 2022 was assayed for antibodies to the nucleocapsid (N) (past infection) and spike-1 (S) (past infection and/or vaccination) proteins using the MSD V-Plex Panel 2 IgG SARS-CoV-2 assay. For each correlate, we estimated adjusted prevalence ratios (PR) via separate Poisson regression models adjusted for calendar time, age, sex and race. Result(s): Of 561 participants, the median age was 59 years (range=28-77), 35% were female, 84% were Black, 36% were living with HIV (97% on ART), and 55% had received >=1 COVID-19 vaccine dose. Overall, anti-N and anti-S prevalence was 26% and 63%, respectively. Prevalence of anti-N increased from 23% to 40% between December 2020-May 2021 and December 2021-July 2022, with greater increases in the prevalence of anti-S from 34% to 86% over the same period (Figure). Being employed (PR=1.53 [95%CI=1.11-2.11]) and never being married (PR=1.40 [0.99-1.99]) were associated with a higher prevalence of anti-N, while female sex (PR=0.75 [0.55-1.02]) and a history of cancer (PR=0.40 [0.17-0.90]) were associated with a lower prevalence of anti-N. Younger age, female sex (PR=0.90 [0.80-1.02]), and homelessness (PR=0.78 [0.60-0.99]) were associated with a lower prevalence of anti-S. Although HIV infection was not associated with anti-N, it was associated with a higher prevalence of anti-S (PR=1.13 [1.02-1.27]). Substance use was not associated with anti-N or anti-S. Conclusion(s): Anti-N and anti-S levels increased over time, suggesting cumulative increases in SARS-CoV-2 incidence of infection and vaccination among PWID;however, disparities in seroprevalence remain. Younger and female PWID and those experiencing homelessness were less likely to be anti-S positive, suggesting programs should aim to improve vaccination coverage in such vulnerable populations.
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Background and objective Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. Methods Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. Results A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019–2020 and 2020–2021) were not associated to poorer health outcomes compared to 2018. Conclusions The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.
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The use of the internet and in particular social networks have altered social interaction, even increased with COVID-19. In the case of children and adolescents, considered early users, they have remained exposed to negative virtual environments. The purpose of this study is to identify the knowledge that children and adolescents have about the implications in the use of social networks to reduce the risk of sexual harassment online, in the face of the pedophilic deception known as grooming. A survey was applied to 251 boys, girls and adolescents between the ages of 10 and 14, who are in the fifth and sixth year of primary school in four public educational centers in the municipality of Zapopan, Jalisco-Mexico. It is evident that the students are unaware of the term grooming;however, 8.76% have been exposed to a situation of online sexual harassment;boys 10.86%, while girls 6.19%. Girls show greater vigilance in the use of the Internet and social networks (26.79%), compared to boys with 15.94%. It is concluded that the prevalence of risk in the school zone analyzed is strictly linked to the plans of the educational centers and in the training of teachers, parents and the community © 2023, Revista de Ciencias Sociales.All Rights Reserved.
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Background: The immune system is highly susceptible to changes of zinc levels and this might imply a different response against infection. Prior evidence suggests some benefit on viral infection prognosis after zinc supplementation. We aim to study the efficacy of zinc supplementation in SARS-CoV-2 infection outcomes. Method(s): This is an unicenter prospective, randomized cliinical trial where unvaccinated individuals with moderate SARS-CoV-2 infection without endorgan failure were randomized to standard of care+oral zinc for 15 days (three times per day a tablet of 83mg of Zn acetate equals to 75 mg of Zn element) (zSoC) (n =37) or standard of care alone (SoC) (n = 34). The primary combined outcome was death due to SARS-CoV-2 or intensive care unit (ICU) admission. Secondary outcomes included length of hospital stay (LoS) and time to clinical stability (defined as: oxygen saturation >94% [FiO2 21%], normalized level of consciousness [baseline], HR < 100rpm, systolic BP >90mm Hg,Temperature < 37.2degreeC). Wilcoxon-Mann-Whitney test generalized Odds ratio (ORs) and 95% confidence intervals (CIs) for differences in outcomes between SoC and zSoC. A logistic regression model was fitted adjusted by age, sex, severity and comorbidity to compare the primary outcome between SoC and zSoC. Result(s): Seventy-one participants were recruited. No significant differences in terms of age, gender and comorbidities nor in SoC were found between groups (Table 1). 14-day Mortality was 2.90 % (2 participants) in the SoC group and none in zSoC. ICU admission rates were, respectively, 8 (23%) and 1 (2.7%) (OR: .098;95% CI .013-.766). The principal combined outcome occurred in 8 participants (23%) in SoC and in 2 (5.4%) in zSoC (OR: 0.18;95% CI .03-.946). In a logistic regression model adjusting by age, sex, comorbidity and severity the OR for the combined outcome in those in zSoC was 0.091 (95% CI: 0.007-0.913;p=0.045). LoS was shorter in zSoC (6.9 days (SD 6.1) vs 12.7 (SD 11.6);p=0.013) respectively. Time to clinical stability was significantly shorter in zSoC (5 days (SD 6.1)) compared to SoC (11.9(SD 9.1));p=0.005. No significant differences in changes in inflammatory markers were found among groups. No severe adverse events were observed during the study. Conclusion(s): Daily zinc supplementation with 240 mg of zinc acetate for 14 days during the acute phase of SARS-CoV-2 infection resulted in lower rates of severity (less death and ICU admission) and faster clinical recovery along with shorter hospital stay.
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Introduction: The North Metropolitan Primary Care Direction of the Institut Catala de la Salut created the Centralized Liaison Unit for anti-COVID19 vaccination (UECeV) to solve queries from users and/or health professionals related to vaccination against the SARS-CoV-2 virus. The main objective of the present analysis was to describe the activity of UECeV. Method: We carried out a retrospective observational study based on the registry of consultations attended from the UECeV between April 31st and October 31, 2021. We have an equal or above 18 years old reference population of 1,139,411 inhabitants. The UECeV was set up in three territorial offices, each attended by two Primary Care pharmacists/pharmacologists (FAP) and one administrative staff member. The telephone service was full-time and could be adapted according to activity. The main variable of the analysis was the number and types of queries attended. Absolute values and percentages, medians and standard deviation were calculated for the quantitative variables and a descriptive analysis was performed for qualitative variables. Results: 3,103 queries were managed out of 3,030 users;2,180 (70.25%) were answered by the FAP. Most frequent consultation was: vaccine compatibility according to pathology/basic medication 1,008 (32.5%). 2,830 (93.4%) users were vaccinated after the consultation (2,210 consulted before the first dose and 618 before the second). The majority vaccine was Comirnaty (R) Conclusions: The UECeV coordinated by the FAP with direct attention to users and/or health professionals constitutes a support element for primary care vaccination teams for the expert management of AntiCOVID19 vaccination consultations.
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BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.
Subject(s)
COVID-19 , Cardiologists , General Practitioners , Remote Consultation , Humans , COVID-19/epidemiology , Pandemics , Referral and ConsultationABSTRACT
Background and Importance In 2020 Spain was involved in the SARS-CoV-2 pandemic. This situation entailed in the dispensing of drugs from pharmacy services to patients' homes. This way of reaching the patient facilitated the access to antiretroviral treatment (ART) in this difficult situation. However, due to the social stigmas, certain patients did not consent to access this dispensing system. Aim and Objectives The objective is to study how adherence to antiretroviral treatment was affected in HIV-positive patients during the months of the first alarm state in Spain (March 14 to June 21 2020);because during those period ART was home dispensation. Material and Methods Observational retrospective study, included patients HIV-positive who received ART during the first alarm state in Spain during COVID-19 pandemic and in the same period of 2019. Collected data were: sex, age and variables related to pharmacological treatment (ART in the selected periods, number of dispensations made, galenic units dispensed). To measure adherence, an indirect method was used, comparing the dispensations made in the hospital pharmacy of the hospital of Leon during the studied period and the same dates of the previous year. % adherence = [dispensed galenic units/planned galenic units] x100 Results We analyse 444 patients with a median age of 54 years (45-59) being 77.93% (n=346) men. During the study period 83 patients (18.69%) changed their ART. 38.55% (n=32) carried out a simplification of ART in 2020 (from a treatment based on several pharmaceutical forms to a treatment based on a single one). The mean adherence in the periods studied in 2019 and 2020 was 91.89% (CI 90.44-92.90) and 90.25% (CI 87.61- 92.90), respectively. In 2019, 67.12% (n=298) of patients had adherence greater than 95%, compared to 86.71% (n=385) in 2020. For 38 patients there are no medication dispensations during the 2020 period. Of the majority (n=27) the reason for the absence is unknown;6 were not disposed of from the hospital of Leon for spending the confinement outside the city;4 have died and 1 did not accept home dispensation. Conclusion and Relevance The implementation of home dispensing could have positively influenced adherence in HIVpositive patients. It is necessary to evaluate in the future that the implementation of new telepharmacy programmes can have a positive influence on adherence.
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An inquiry-based teacher training proposal concerning covid-19 was implemented during lockdown with Pre-Primary Education Degree students. The objective was to analyse how the workshop changed the students' emotions and their knowledge linked to the pandemic. To this end, the participants responded to an open-ended questionnaire passed out before and after the workshop, and to a Likert-type questionnaire on emotions when they handed in their responses. The results show that, in the case of learning, the students modified their covid-19 literacy to a greater or lesser extent and, in the case of emotions, they felt less fear, anger, concern, and insecurity, and greater tranquillity and optimism. In conclusion, an emotional modulation is perceived in which scientific literacy participates. © 2023 Eskisehir Osmangazi University. All rights reserved.
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The article aims to analyze the socio-economic panorama of the countries that make up the Latin American and Caribbean region, whose main source of study focuses on the predominant multiculturalism in native and indigenous peoples seen from a health crisis approach in full swing of the COVID-19. Thus, despite the current policies to deal with and consolidate the overthrow of the history of oppression and capitalist exploitation in minority communities, the disconnection between the literal nature of the current policies and their implementation by virtue of protection can still be evidenced. and support for the collective and social rights of indigenous populations. In this sense, this research is developed from a qualitative approach under the methodology of grounded theory in an exploratory and descriptive framework of the phenomenal situation of indigenous peoples marginalized as a result of an imposing current neoliberal model. © Encuentros (Maracaibo). All rights reserved.
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The concept of Artificial Intelligence (AI), born as the possibility of simulating the human brain's learning capabilities, quickly evolves into one of the educational technology concepts that provide tools for students to better themselves in a plethora of areas. Unlike the previous educational technology iterations, which are limited to instrumental use for providing platforms to build learning applications, AI has proposed a unique education laboratory by enabling students to explore an instrument that functions as a dynamic system of computational concepts. However, the extent of the implications of AI adaptation in modern education is yet to be explored. Motivated to fill the literature gap and to consider the emerging significance of AI in education, this paper aims to analyze the possible intertwined relationship between students' intrinsic motivation for learning Artificial Intelligence during the COVID-19 pandemic;the relationship between students' computational thinking and understanding of AI concepts;and the underlying dynamic relation, if existing, between AI and computational thinking building efforts. To investigate the mentioned relationships, the present empirical study employs mediation analysis based upon collected 137 survey data from Universidad Politécnica de Madrid students in the Institute for Educational Science and the School of Naval Architecture and Marine Engineering during the first quarter of 2022. Findings show that intrinsic motivation mediates the relationship between perceived Artificial Intelligence learning and computational thinking. Also, the research indicates that intrinsic motivation has a significant relationship with computational thinking and perceived Artificial Intelligence learning. © 2023
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Purpose: This paper aims to explore the perceptions of preservice teachers regarding their learning during the teaching practicum (TP) period in the context of the pandemic. Specifically, the objectives of this study are to analyze the difficulties and the learning consequences perceived by student teachers and also to identify proposals with which to improve the initial teacher education (ITE) during the TP period in times of uncertainty and crisis. Design/methodology/approach: This study used a mixed-methods approach. The participants consisted of 89 preservice teachers (student teachers). An online questionnaire was used to collect data during January 2022 in two rounds. The data analysis was carried out from an integrative perspective and used both a descriptive approach and the content analysis of the participants' narratives. Findings: The results show the differences, adjustments and adaptations that have had to be implemented in schools as a whole. The findings also highlight the difficulties that the pandemic context has caused for the TP period in schools and the relevant implications that it has had on ITE during these past two academic years. Originality/value: This research is relevant for a better understanding of the challenges faced during the pandemic in the field of early childhood and primary education. More specifically, this paper gives important clues to higher education institutions on how to carry out TP, especially in times of uncertainty and crisis. © 2022, Emerald Publishing Limited.
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What is anticipated from the European Digital Identity project is being able to prove possession of a COVID-19 vaccination certificate without submitting any personal data. The introduction of this project through the draft amendment of the Regulation on electronic identification and trust services (eIDAS) has established for the first time the creation of a Digital Identity Wallet that could be used as a means of identification and a container of identity credentials, without depending on centralised files or tracking who they are presented to, with the premise of security and privacy of personal data by design as a fundamental objective. This vision, which is strongly influenced by the self-sovereign identity movement, together with the creation of the European Blockchain Services Infrastructure (EBSI) on which the European Self-Sovereign Identity Framework (ESSIF) depends, is reflected in the amendment of the eIDAS Regulation, and, indirectly, in the EU Digital COVID Certificate. As a result of the pandemic, the need to create a reliable, secure, interoperable system with full respect for the General Data Protection Regulation (GDPR) to certify health in relation to the disease led to the adaption of the European Digital Identity project to the COVID certificate. The opportunity presented by the study of the technical functioning of the certificate means that the assessment of improvements to be introduced can be transferred to the European Digital Identity project, including the blockchain resource as an alternative to the traditional public key infrastructure (PKI). In this respect, the certificate represents a firm step towards a decentralised digital identity model to ensure that individuals have full control over their data. © 2022, Escola d'Administracio Publica de Catalunya. All rights reserved.
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Introduction: The design and first results of a transcutaneous electrical stimulator of the vagus nerve for the treatment of Refractory Epilepsy are discussed. Method(s): The device developed is based on the STM32L073CZ microcontroller and can generate fully configurable monopolar or bipolar stimuli, so that the electrical therapy can be adjusted to each patient following the therapeutic strategy designed by their doctor. The start time and duration of each therapeutic session are stored in an internal memory of the device, as well as the instants in which the contact of the electrodes is poor, or the therapeutic session is aborted. In this way, the doctor in charge can review what happened once the information is downloaded to a personal computer. Using 3D printing techniques, a plastic support for the electrodes was developed that allows the automatic adjustment of these to the left ear of the subject undergoing treatment;this ensures placement of the electrodes on the correct ear and proper contact of the electrodes with the skin. The operation of the device is easy, each session starts by pressing a button and ends automatically when the programmed time expires, the intervention of the subject undergoing treatment is minimal and thus stress is avoided. Result(s): 20 prototypes were built and passed technical tests in accordance with IEC 60601-1 and IEC 60601-2-10 standards. The results were satisfactory and thus it is guaranteed that the proposed solution is safe for patients and the techniques used are in the state of the art within this medical technology. The Cuban regulatory body approved a trial with 18 humans to test the effectiveness of the device developed;each patient will be under treatment for nine months, but not all began simultaneously due to restrictions put in place by the COVID-19 pandemic. Electrical stimulation was set as follows: bipolar square pulses of 200 microseconds duration at 25 Hz;three 60-minute sessions per day. A patient is considered as treatment's responder monthly crisis frequency decrease more than 50% that he suffered before starting treatment. To date, six patients have completed the trial, five with significant improvement. The other twelve patients are in treatment and after the third month the Monthly Seizure Frequency has decreased in all of them. Conclusion(s): The proposed solution has been effective in the first six patients ending the trial. Without concluding the study, the proposed solution seems an outstanding therapeutic solution. Copyright © 2022
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Loneliness in older adults with visual impairment was explored to gain a better understanding of the phenomenon. A collective case study explored 3 participants' occupational performance histories, functional visual performance, and loneliness. Seven themes emerged: pride in employment;adaptation to visual impairment through devices and environmental modifications;engaging and participating in meaningful occupations;enjoying companionship;engaging and delegating home maintenance tasks appropriately;engaging in routines;and engaging in preventive care. A significant finding at P =.05 (r =-0.998) was found between the overall scores on the Revised Self-Report Assessment of Functional Visual Performance and the UCLA Loneliness Scale (Version 3) using Pearson's correlations. The findings support addressing loneliness in older adults with visual impairment as the levels of functional impairment correlate with loneliness. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.
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Background The social and economic impacts that have occurred during the pandemic can disproportionally affect those already experiencing poverty. The social determinants of health aggravate inequalities and can adversely affect wellbeing. This study aims to gain rich insight into Australian adults’ experiences of the social determinants of health and the impact on their wellbeing during the COVID-19 pandemic. Methods A descriptive qualitative study using purposive sampling to recruit participants for semi-structured interviews, conducted via videoconferencing between March-August 2021. Thematic analysis was performed with the support of NVivo 12. Results Participants included 20 Australian adults from various socioeconomic areas ranging in age from 21 to 65 years. Three main themes emerged from the analysis of the data: Food-related concerns;Housing outcomes;and Psychological and emotional impact. Accessing food, during the COVID-19 pandemic, for most participants who resided in low socioeconomic areas, was described as stressful and challenging. Along with the burden of food security, many participants from low socioeconomic areas expressed emotional distress in relation to securing and maintaining adequate housing. Conclusions The pandemic has amplified existing social determinants of health experienced by those within low socioeconomic areas, particularly those who are female and from migrant communities. The wellbeing of participants from low socioeconomic areas decreased in response to their experiences and challenges with food insecurity and housing instability, highlighting the need for housing affordability strategies and funding of emergency food relief initiatives. Food access for those in areas with high socioeconomic disadvantage, can be improved to address some of the barriers associated with food security by providing supermarket meal vouchers, access to community gardens, and school food programs. Key messages • The housing and food insecurity experienced by participants in this study during the pandemic has influenced their overall wellbeing. • The pandemic has amplified existing social determinants of health experienced by those in low socioeconomic areas.
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The teaching scenarios in the context of the health pandemic generated by COVID-19 have forced the development of a change in the academic paradigm in higher education that has not only had repercussions on the development of the contents of the subjects, but also on the way the different agents involved (teachers and students) interact with each other. This is a participatory research in context on a subject of the teaching degree at the University of Cadiz where the challenge of improving academic results from previous years and changing the attitude of students, very unfavourable due to low success rates, is faced. After the creation of the participatory scenario and a specific plan for the subject, the academic results and attitudes showed a change in the students’ formative conception, focusing on the main finding of the new methodological design. In this way, this research can be replicated in other contexts as it is considered a good educational practice that integrated the communicative, informational, interactive and collaborative potential of virtual environments to face the challenge of teaching a subject with low academic success rates in an emergency situation. Thus, the results show a change in the learning culture that aims to be institutionalised in normalised contexts. © 2022. Educacao e Pesquisa. All Rights Reserved.
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The COVID-19 pandemic has profoundly impacted the way general practice is run and this is expected to have had a knock-on effect upon GP training. A questionnaire-based study was designed to investigate what was happening to GP trainees 16 months into the pandemic in terms of opportunities to develop clinical experience and clinical decision-making. We also asked trainers and trainees for ideas on how we might mitigate for the effects of COVID-19. In particular, there has been decreased exposure to clinical examination during the pandemic and there appear to be gaps in opportunities to learn from urgent and unscheduled care settings and to develop skills in rapid clinical decision-making. It is interesting to consider what general practice will look like when the pandemic is over and how this will this affect the GP training curriculum going forwards. Although response rates were low, we were able to determine some emerging themes for national, local and educational review going forwards to help shape and improve GP training for the future.