ABSTRACT
Background: There is an increasing body of literature that suggests a relationship between modifiable dietary behaviors and alcohol use and liver cancer. We designed and implemented a culturally tailored community-based education program to promote liver cancer prevention. Methods: Through NCI funded U54 TUFCCC/HC Cancer Partnership Community Outreach Core program, using CBPR approach, we engaged community-based organizations and community stakeholders serving underserved African, Asian, and Hispanic American communities in the Philadelphia metropolitan area and New York City. The community-based education incorporated in-person and virtual hybrid education workshops to address COVID-19 pandemic barriers. We conducted preeducation surveys and follow-up assessments at 6 months post-education. Participants' dietary behaviors, alcohol use, and sociodemographic characteristics were examined at both time points. Results: 526 participants were recruited including 92 African Americans, 247 Asian Americans, and 187 Hispanic Americans, with an average age of 59. We found that at 6-month follow-up assessment, participants had average decreased intake of red meat (3.148/6 vs. 2.685/6, p < 0.001), and average increased intake of vegetables (4.484/6 vs. 5.044/6, p < 0.001) and fruits (4.327/6 vs. 4.877/6, p < 0.001), compared to their intake at pre-education assessment. Additionally, average change in beer (-0.252) and spirit (-0.905) consumption substantively decreased from pre-intervention to 6-month follow-up assessment. Conclusion: This community-based education showed significant effects in improving healthy dietary behaviors and reducing alcohol intake among community members through CBPR community engagement from the two metropolitan areas. Future efforts are needed to sustain the positive changes in modifiable lifestyle behaviors and liver cancer prevention in these medically underserved communities.
ABSTRACT
Purpose The SARS-CoV-2 outbreak changed healthcare and healthcare delivery around the world. Hospital systems saw a dramatic decline in patient volumes both in the inpatient and outpatient settings. Surveying our center's heart failure (HF) clinic population, we aimed to better understand our patients’ perception of COVID19, their fears, and care delivery preferences in this new era. Methods Consecutive patients with chronic HF presenting to our clinic either in person or virtually were approached to complete a ten question Likert scale survey (Table 1). Acutely decompensated patients and heart transplant recipients were excluded. The survey was anonymous and voluntary. Results 109 patients completed the survey. The average age was 62±14 years, 73 (67%) were male and 64 (59%) had a diagnosis of HF with reduced ejection fraction. Overall, our patients were afraid of contracting COVID19 and getting sicker given their underlying cardiac condition but were not hesitant to call the clinic or come to the emergency department with worsening HF symptoms. Patients responded that virtual appointments are less preferable and less effective than in-person visits. Although the difference did not reach statistical significance, female patients and those with HF with preserved ejection fraction were more concerned. Conclusion Overall, patients with HF are concerned about their increased risk of contracting COVID19. However, they are not likely to avoid healthcare contact and preferred in-person over virtual visits.
ABSTRACT
The global pandemic of COVID-19 has challenged the management of hypoxaemic respiratory failure and strained intensive care unit resources. While prone positioning (PP) is an established therapy in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), its role in conscious patients is less well defined. We retrospectively reviewed our experience of implementing early PP in a cohort of 24 patients with acute hypoxaemic respiratory failure due to COVID-19 who required support with continuous positive airway pressure (CPAP). The use of PP alongside CPAP significantly increased both the ROX index and arterial oxygen pressure:fractional inspired oxygen (PaO2:FiO2) ratio from baseline values (ROX index: 7.0±2.5 baseline vs 11.4±3.7 CPAP+PP, p<0.0001; PaO2:FiO2 ratio: 143±73 mm Hg baseline vs 252±87 mm Hg CPAP+PP, p<0.01), and the changes to both the ROX index and PaO2:FiO2 ratio remained significant 1 hour after cessation of proning. The mean duration of PP in the first 24 hours was 8±5 hours. Few complications were observed and PP was continued for a mean of 10±5 days. From our experience in a dedicated COVID-19 respiratory high care unit, PP alongside CPAP therapy was feasible, tolerated, safe and improved oxygenation. The use of conscious PP in ARDS warrants further investigation in randomised controlled trials.