ABSTRACT
OBJECTIVES: To evaluate the effectiveness, use, and implementation of telehealth for women's preventive services for reproductive healthcare and interpersonal violence (IPV), and to evaluate patient preferences and engagement for telehealth, particularly in the context of the coronavirus (COVID-19) pandemic. DATA SOURCES: Ovid MEDLINE R, CINAHL R, Embase R, and Cochrane CENTRAL databases (July 1, 2016, to March 4, 2022);manual review of reference lists;suggestions from stakeholders;and responses to a Federal Register Notice. REVIEW METHODS: Eligible s and full-text articles of telehealth interventions were independently dual reviewed for inclusion using predefined criteria. Dual review was used for data ion, study-level risk of bias assessment, and strength of evidence (SOE) rating using established methods. Meta-analysis was not conducted due to heterogeneity of studies and limited available data. RESULTS: Searches identified 5,704 unique records. Eight randomized controlled trials, one nonrandomized trial, and seven observational studies, involving 10,731 participants, met inclusion criteria. Of these, nine evaluated IPV services and seven evaluated contraceptive care, the only reproductive health service studied. Risk of bias was low in one study, moderate in nine trials and five observational studies, and high in one study. Telehealth interventions were intended to replace usual care in 14 studies and supplement care in 2 studies. Delivery modes included telephone (5 studies), online modules (5 studies), and mobile applications (1 study), and was unclear or undefined in five studies. There were no differences between telehealth interventions to supplement contraceptive care and comparators for rates of contraceptive use, sexually transmitted infection, and pregnancy (low SOE);evidence was insufficient for abortion rates. There were no differences between telehealth IPV services versus comparators for outcomes measuring repeat IPV, depression, post-traumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). The COVID-19 pandemic increased telehealth utilization. Barriers to telehealth interventions included limited internet access and digital literacy among English-speaking IPV survivors, and technical challenges and confidentiality concerns for contraceptive care. Telehealth use was facilitated by strategies to ensure safety of individuals who receive IPV services. Evidence was insufficient to evaluate access, health equity, or harms outcomes. CONCLUSIONS: Limited evidence suggests that telehealth interventions for contraceptive care and IPV services result in equivalent clinical and patient-reported outcomes as in-person care. Uncertainty remains regarding the most effective approaches for delivering these services, and how to best mobilize telehealth, particularly for women facing barriers to healthcare.
ABSTRACT
Clinical manifestations of infection with the novel SARS-CoV-2 in humans are widely varied, ranging from asymptomatic to COVID-19 respiratory failure and multiorgan damage. Profound inflammation is the hallmark of severe COVID-19 disease, and commonly does not occur until the second week of infection. Although risk factors for this late hyperinflammatory disease have been identified, most notably age and pre-existing co-morbidities, even within high-risk groups the specific factors leading to severe COVID-19 illness remain elusive. Acquired somatic mutations in hematopoietic stem and progenitor cells (HSPCs), termed clonal hematopoiesis (CH), are associated with advanced age, and loss of function (LOF) mutations in certain genes, most commonly DNMT3A and TET2, have been linked to a marked hyperinflammatory phenotype as well as clonal expansion of mutant HSPCs. Given the similar age range of frequent CH and severe COVID-19 disease, the presence of CH could impact the risk of severe COVID-19. Several human cohort studies have suggested this relationship may exist, but results to date are conflicting. Rhesus macaques (RM) have been established as a model for SARS-CoV infection and are being utilized to test therapies and vaccine development, but up to now, macaques have not been reported to develop late hyperinflammatory COVID-19 disease. We have created a robust RM model of CH by introducing LOF TET2 mutations into young adult HSPC via CRISPR/Cas9 followed by autologous transplantation, recapitulating the clonal expansion and hyperinflammatory phenotype. Thus, we hypothesized that macaques with CH could develop severe late COVID-19 disease and be utilized as a model to study disease pathophysiology or test therapeutic approaches. Macaques with either engineered (n=2) or natural CH (n=1) along with age-matched transplanted controls (n=3) were inoculated with SARS-CoV-2 and monitored clinically and via laboratory studies until 12 days post-inoculation (dpi). Macaques normally clear infection and symptoms within 3-5 days of infection. No significant differences in clinical symptoms and blood counts were noted, however, an aged animal with natural DNMT3A CH died on 10 dpi. IL-6 levels were somewhat higher in sera of the CH animals until 12 dpi, and in BAL, mean concentrations of MCP-1, IL-6, IL-8 and MIP-1b were consistently higher in CH macaques compared to controls. Interestingly, we found the median copy number of subgenomic SARS-CoV-2 RNA was higher at every timepoint in the CH group as compared with the control group, in both upper and lower respiratory samples. Lung sections from euthanasia at 10 or 12 dpi showed evidence of mild inflammation in all animals. However, in the immunohistochemical analysis, the viral antigen was detected in the lung tissues of all three animals in the CH group even at the time of autopsy, whereas only one animal of three controls had detectable viral antigen. Although the striking inflammation and serious disease have not been observed, data so far provide evidence of potential pathophysiological differences with or without CH upon SARS-CoV-2 infection. We continue to expand sample size and conduct further analyses to draw a solid conclusion, but we believe this model may be of benefit to understand the relationship between COVID-19 disease and CH. Disclosures: No relevant conflicts of interest to declare.
ABSTRACT
The COVID-19 pandemic has forced supply chain management researchers and practitioners to question many of our firmly held assumptions about the discipline. Perhaps the most interesting question is, where does supply chain management go from here? This issue of the Journal of Supply Chain Management begins to answer that question via a combination of invited essays and a regular submission. We consider this issue as only a starting point, and we hope to see its impact on future research on mega-disruptions in supply chains. © 2020 Wiley Periodicals LLC