Post-pandemic American travelers' behavior given a chikungunya outbreak

Introduction: Mosquito-borne diseases have historically affected communities, especially in tropical areas where mosquitoes and illnesses are endemic. Globalization, climate change, and increased travel have created ideal conditions for outbreaks of mosquito-borne diseases that could threaten the American health system and place a burden on the national economy, especially in southern states. Methods: The study adopts a quantitative cross-sectional design with a retrospective survey carried out using the Pollfish platform in June 2022. The data were analyzed using descriptive statistics and hierarchical multiple regression to assess the three hypotheses: (H1) Chikungunya awareness is related to sociodemographic factors;(H2) Wearing long sleeves and pants is related to (a) Chikungunya awareness and (b) information-seeking behaviors, when controlling for sociodemographic variables;(H3) Use of insect repellents is related to (a) Chikungunya awareness and (b) information-seeking behaviors when controlling for sociodemographic variables. Results: The results highlight the relationships between chikungunya's awareness, information-seeking behavior, and willingness to engage in protective behaviors. 45.91% of the participants mentioned not having heard about chikungunya, and 67.07% of respondents had sought information about mosquito-borne illnesses in the past, 55.9% have looked at the U.S. State Department's website for mosquito-borne diseases, 38.32% have visited the U.S. CDC website for information specifically about chikungunya. Conclusions: The results of this study show that most American travelers are unaware of chikungunya and its mode of transmission. Travel could likely introduce the chikungunya virus to the United States. Despite increased health information-seeking behavior among U.S. residents after the Covid19 pandemic, Chikungunya awareness is low.

Battling Burnout: Utilising Our Hospice Complementary Therapy Team to Support Postpandemic Colleague Wellbeing

Motivation Healthcare workers were under extreme pressure during the COVID-19 pandemic, which proved detrimental to staff wellbeing. In their research paper, Petrella et al. (2021. Gen Psychiatr. 34: e100458) concluded that 'In order to mitigate the risk of burnout and post-traumatic stress, long-term, effective strategies that facilitate staff accessing support are urgently required.' Purpose Kilbryde Hospice's Complementary Therapists recognised the importance of utilising their skills to address the physical and emotional wellbeing of colleagues. The Complementary Therapy (CT) Team therefore established formal methods of support, available to all colleagues regardless of role. Given the considerable costs associated with staff absence, the CT Team sought to demonstrate how an existing service can be extended to provide effectual and cost-effective in-house support. Methods The hospice CT Team (comprising 2.5 WTE and 1 volunteer therapist) provided support to colleagues over the period 01/04/21 to 31/03/22, in addition to all existing patient/carer services. Staff received CT input dependant on individual needs, identified following a holistic assessment. Range of CT interventions included: * Provision of hands-on therapy. * Preparation of bespoke aromatherapy products. * Demonstration of self-management techniques. * Provision of relaxation music and guided meditation CDs. Written instructions accompanied all items provided. Results CT support was available to 88 contracted and 21 flexi-bank staff. A total of 108 aromatherapy products were issued to staff over the period. Results show the top reasons for receipt of a product were: stress/anxiety;pain;skin problems. The CT Team also delivered 45 hands-on therapies, predominantly to address stress/anxiety, and pain. These results show a high level of need and demand for CT support. Conclusions This poster outlines a cost-effective solution to maintaining the health/wellbeing of the staff body by utilising an existing resource (requiring investment of staff time but no additional budget). Direct staff feedback would have provided an interesting adjunct to these results. Staff evaluations will therefore be collected going forward.

COVID vaccines - therapeutic errors reported to the UK National Poisons Information Service (NPIS)

Objective: The first COVID-19 vaccine was administered in the UK on the 8 December 2020. Since then, the UK has authorised four vaccines for use against COVID-19 (Pfizer/BioNTech, Oxford/ AstraZeneca, Moderna and Janssen). Serious adverse effects, including fatalities, have been linked to COVID-19 vaccines [1]. We reviewed all enquiries to the UK National Poisons Information Service (NPIS) related to COVID-19 vaccines. Methods: We conducted a retrospective analysis of enquiries relating to COVID-19 vaccines to the NPIS from 1 March 2020 until 31 July 2021. Enquiries were identified from the UK Poisons Information Database (UKPID) and filtered to identify those relating specifically to COVID-19 vaccines. Results: The NPIS received 34 enquiries about COVID-19 vaccines during the study period (Oxford/AstraZeneca: 13, 38.2%;Pfizer/ BioNTech: 9, 26.5%;Moderna: 1, 2.9%). Two enquiries were seeking information about two different vaccines (Pfizer/BioNTech and Oxford/AstraZeneca) and in nine enquiries the manufacturer was unknown. Of these enquiries, 29 (85.3%) were specifically patient-related while five (14.7%) were for information only and were excluded from further analysis. The majority of patientrelated enquiries were from NHS 111 (17, 58.6%) with the remaining from hospitals (6, 20.7%) or primary care (6, 20.7%). All enquiries were regarding adult patients;21 enquiries were regarding female patients (72.4%) with 8 regarding male patients (27.6%). The most common enquiries were regarding patients who had received three doses instead of 2 (7, 24.1%), dosing errors due to incorrect dilution/reconstitution of the vaccine (5, 17.2%), doses administered outside the recommended timeframe of 8-12 weeks (5, 17.2%), adverse reactions (4, 13.8%) and patients receiving 2 doses in the same day (4, 13.8%). Nineteen patients (65.5%) were asymptomatic at the time of the enquiry. Four patients had symptoms (13.8%) but these were all deemed to be minor. In 6 enquiries (20.7%) it was unknown if the patient had symptoms. No moderate or severe symptoms were recorded and there were no fatalities. Conclusion: Serious adverse effects have been rarely associated with COVID-19 vaccines [1]. Enquiries to the NPIS regarding COVID-19 vaccines were generally related to administration or dosing errors. Reassuringly, in this patient population, most patients had no symptoms or mild symptoms only.

COVID testing kits - A new source of accidental poisoning in the UK?

Objective: Self-testing kits for COVID-19 are available to the public and commonplace in households. Kits consist of nasal/throat swabs, absorbent testing strips (including a desiccant sachet) and bottles of extraction liquid. Once samples are collected swabs are placed in the liquid to create a sample for lateral flow (LFT) or polymerase chain reaction (PCR) testing. The liquid is a mixture of water, transport mediums, buffers, preservatives and animal proteins and although not intended for human contact, is considered to be low toxicity. Our objective was to analyse enquiries to the UK National Poisons Information Service (NPIS) regarding COVID-19 test kits to investigate potential toxicity. Methods: We conducted a retrospective analysis of enquiries from 1 March 2020 until 31 July 2021. Enquiries were identified from the UK Poisons Information Database (UKPID) and filtered to identify those relating specifically to COVID-19 test kits. Results: In the study period 126 enquiries were received about COVID-19 test kits. One enquiry was regarding ingestion of the desiccant (LFT kit) with all others regarding the extraction liquid. The majority of enquiries (86, 68.3%) related to LFT kits with 9 (7.1%) enquiries regarding PCR kits. In 31 enquiries (24.6%) the test type was not specified. NHS telephone services (NHS 111/ Direct/24) accounted for the majority of enquiries (94, 74.6%), with the remaining from hospitals (12, 9.5%), primary care (10, 7.9%), and other sources (10, 7.9%) including ambulance services and nursing homes. Adults accounted for 69 (54.8%) enquiries with 55 (43.7%) regarding children. Age was not specified in 2 (1.6%) enquiries. Most adult exposures were accidental (67, 97.1%) with only 2 (2.9%) intentional exposures. Accidental exposures were due to the liquid being mistaken for eye drops (24, 35.8%), swabs dipped in liquid before taking samples (21, 31.3%), ingestion of liquid (19, 28.4%), spill of liquid onto skin (2, 3%) and liquid mistaken for ear drops (1, 1.5%). Patients were either asymptomatic (48, 69.6%) or reported mild symptoms only (20, 29%). In 1 enquiry the symptoms were unknown. Paediatric exposures were also accidental with only one intentional ingestion. Enquiries included ingestion of liquid or desiccant (45, 83.3%), liquid mistaken for eye drops (6, 11.1%), and swab dipped in liquid before taking sample (3, 5.5%). Patients were asymptomatic (48, 87.3%) or reported mild symptoms only (7, 12.7%). Conclusion: Almost all exposures to COVID-19 test kits were accidental with the extraction liquid most commonly being mistaken for eye drops. Reassuringly, serious toxicity has not been reported.

Adapting provision of structured diabetes education from face-to-face to virtual during the COVID-19 pandemic

In Bedfordshire, individuals newly diagnosed with type 2 diabetes are referred to the diabetes education team for either a group or one-to-one structured education session. The DESMOND Newly Diagnosed Programme is delivered to groups to support people to self-manage their condition through lifestyle modification and behaviour change. Prior to the COVID-19 pandemic, all options for structured education were in-person only. However, when the pandemic hit in March 2020, all face-to-face patient education sessions were immediately cancelled. As the initial three-week lockdown became an extended period, the Bedfordshire diabetes education team had to think how to continue to provide diabetes education and support to its patients whilst working within government guidelines and restrictions. This article describes how the team successfully moved its educational options from an entirely face-to-face provision to a virtual service and details the service’s post-pandemic plans. © 2022 SB Communications Group. All rights reserved.

WHO DO WE RISK LEAVING BEHIND? A SURVEY OF DIGITAL ACCESS AND E-HEALTH LITERACY IN PEOPLE WITH INFLAMMATORY CONDITIONS

Background/Aims The COVID-19 pandemic led to an overnight shift in healthcare delivery and rapid uptake of digital technology. Such approaches risk digital exclusion for people without access to or not confident in their use of technology. We sought to examine digital access and e-health literacy in people with inflammatory conditions. Methods People (n=2,024) were identified from their electronic health record and invited to participate in a survey, using SMS and postal approaches. Data were collected on age, gender, self-reported arthritis diagnosis (RA, PsA, AS, SLE and other), access to an internet-enabled device and frequency of internet access, health literacy (single-item literacy screener) and self-perceived e-health literacy (eHEALs). Ethical approval was obtained (Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed it online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. 98.3% were white. Approximately 20% of people did not have access to an internet enabled device (Table). 93 (15.3%) of patients reported never accessing the internet, this proportion was higher in people with RA. Approximately 19% had low health literacy. In those reporting internet use, eHealth literacy was moderate. The most Conclusion Low health literacy, lack of digital access and low reported internet use was common, especially in people with RA, leading to high use of telephone advice and rheumatology appointments. Digital roll-out needs to take account of people requiring extra support to enable them to access care or risks excluding many patients with inflammatory conditions.

IMPACT OF COVID-19 ON PHYSICAL AND MENTAL HEALTH OF PEOPLE WITH INFLAMMATORY CONDITIONS: THE ICEPAC SURVEY

Background/Aims Concerns about the risk of COVID-19 infection led to guidelines advocating shielding for many people with inflammatory conditions. We aimed to assess the impact of the pandemic on the self-reported physical and mental health of people with inflammatory conditions. Methods 2024 patients with inflammatory conditions (RA, PsA, AS, SLE and other) were randomly selected from electronic health records. Survey invites were sent (August 2021 to coincide with relaxation of COVID restrictions) using a combination of SMS and postal approaches. Data collected included demographics, COVID infection and shielding status, physical (MSK-HQ) and mental health (PHQ8 and GAD7) and global impact on physical or mental health (4 options: none-severe). Ethical approval was obtained (REC Ref 21/PR/0867). Results 639 people completed the survey, of whom 287 (44.9%) completed online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. The majority of people had RA although 57 (9%) reported more than one inflammatory condition. 349 (57.9%) of people were advised to shield. Rates of COVID infection were relatively low across the groups (Table 1). 254 (41.2%) reported moderate or severe impact of the pandemic on physical health, which impacted least in people with RA. 244 (39.4%) reported moderate or severe impact of the pandemic on mental health with 175 (28.7%) reporting moderate depression (PHQ8>10) and 138 (22.6%) moderate anxiety (GAD-7≥10). Conclusion Reported COVID infections were low in our cohort. The pandemic had significant effects on physical and mental health, which appeared less in people with RA than other inflammatory conditions.

AUDIT OF THE RHEUMATOLOGY PIFU PATHWAY AT THE UHMB TRUST

Background/Aims Patient initiated follow up (PIFU) is an initiative that allows patients to access follow-up when required by initiating their own appointments. The disruptive impact of the COVID-19 pandemic has created significant capacity constraints on many services that were already experiencing pressures prior to the pandemic, piquing interest in PIFU as a sustainable model of care. The BSR has produced draft PIFU guidance to support rheumatology units to develop and deliver safe, robust and sustainable PIFU care models. We audited our PIFU pathway in line with the BSR's recommended standards to establish its safety and efficacy since its implementation in 2018. Methods This was a retrospective analysis of patients transferred to an active PIFU access plan within UHMBT between February 2018 and November 2019. Patients were identified by the informatics team from the active PIFU access plans. We captured data to include treatments used. The electronic case notes were reviewed to establish reasons for appointment triggers in those who contacted the service, analyse waiting times for clinical review further to making contact and assess subsequent outcomes. Data were entered and analysed in Microsoft Excel 2016. Results We had a total of 420 patients on PIFU. We audited 100 of these. 56 were female. Mean age was 63.4 years (24-96). The most common diagnosis was inflammatory arthritis (n=78). The majority of patients (n=53) were on a single disease-modifying anti-rheumatic drug (DMARD). 17 patients were on>1 DMARD and 5 patients were on prednisolone monotherapy, mean steroid dose 4.9mg daily. 25 patients were not on any treatment. Of those on DMARDS, 63% (44) were on methotrexate, either as monotherapy or in combination with other DMARDs. 68% (30) of those on methotrexate were on a dose of ≤15mg weekly. Of the 100 patients, 9 triggered a review within the follow up period. This was usually via the nurse helpline (n=7). Occasionally the GP triggered a review on behalf of the patient via the advice and guidance line (n=2). The most common reason for a trigger was a flare of inflammatory arthritis (n=7) and the remaining two appointments were due to side effects of DMARDs. Patients were contacted via nurse telephone call back within 48 hours of contacting the helpline (n=8). One patient required an urgent face-to-face consultant review and was seen within 7 days. After contacting the service, all nine patients were reverted to regular follow-up. Conclusion Our results confirmed a robust PIFU pathway with appropriate safety nets ensuring prompt access to clinician input when needed. The use of PIFU pathway did not compromise care or result in any worsening clinical outcomes. After validation at 2 years, the majority of our patients on this pathway were onwardly managed through the PIFU model.

Lab Every Day!! Lab Every Day? *&%#ing Lab Every Day!? Examining Student Attitudes in a Core Engineering Course Using Hands-on Learning Every Day of Class

The author's Control Systems and Instrumentation course is a four credit, core course combining topics traditionally taught across several courses including electrical theory, instrumentation, signal processing, and controls. To meet this challenge, the authors took a student centered approach to the course design as well as active learning pedagogy. From this approach the course was structured where students work through theory and hands-on labs each class period. This infused basic electrical theory and instrumentation with Arduino-based sensors and control algorithms, and has allowed alignment of every day of the course with multiple student learning outcomes. In this work the authors present student outcomes of the approach. These are informed by methods of formative and summative assessment as well as evidence of achievement through regular informal student feedback, course evaluations, observations, and focus groups. The assessment strategy has included formative assessment of daily concept check points. Every week the next week's activities are adjusted to ensure the material stayed within the cohort's zone of proximal development, towards mastery of the content. Projects were designed to reinforce learning outcomes achieved at check points throughout the semester. Summative assessment included project deliverables, homework based on theoretical problem solving, as well as a midterm and final that included a take-home portion, a partnered practical lab-based exercise, and a problem solving section. The primary challenges faced included how to facilitate better connections students made across the content and how to assist students in the cognitive shifts necessary in a fast-paced and pedagogically very different environment than they are used to. The authors have worked towards this by creating more connection opportunities through improved theoretical content, alignment of reading quizzes and structured outside of class work. Mid-term and final course evaluations as well as facilitated focus groups have been conducted for three semesters. Three semesters of classroom observations made through the Classroom Observation Protocol for Undergraduate STEM (COPUS) have also been completed. From these, mixed results with regards to student attitudes towards the hands-on nature of the course have been reported. While most students have enjoyed the hands-on work, less were convinced of the connections they were making to the theory. Some students went so far as to request more lectures and less lab time. Student attitudes towards working with their partner and peer-to-peer learning were positive across cohorts and semesters. In light of this the authors describe methods of scaffolded opportunities for independent as well as peer-to-peer learning. While student preferences varied, data is also presented on student behavior and achievement. Class attendance remained over 90% throughout all three semesters (including the COVID Spring 2020 semester). Student feedback has indicated a sense of obligation to their lab partners and perceived value of the in-class activities to be the primary motivators of attendance. Further, data on student achievement of summative assessments across topics has been summarized. This data suggests that topics students spent more hands-on time with resulted in better performance. © American Society for Engineering Education, 2021

Investigating the transmission risk of infectious disease outbreaks through the Aotearoa Co-incidence Network (ACN): a population-based study.

BACKGROUND: The emergence and re-emergence of infectious diseases presents a significant challenge to public health and broader society. This study utilises novel nationwide data to calculate the transmission risk and potential inequity of infectious disease outbreaks through use of network analysis. METHODS: Nationwide employment and education microdata (∼4.7 million individuals in Aotearoa New Zealand) were used to develop the Aotearoa Co-incidence Network (ACN). The ACN considers connections generated when individuals are employed at the same workplaces or enrolled at the same schools. Through forms of network analysis, connections between geospatial areas can be established and provide proxy measures of infectious disease transmission risk. The ACN was also overlayed with nationwide population vulnerability data based on the number of older adults (>65 years) and individuals with long-term health conditions. FINDINGS: We identify areas that have both high potential transmission risk (i.e., highly connected) and high vulnerability to infectious diseases. Community detection identified geographic boundaries that can be relevant to the application of regional restrictions for limiting infectious disease transmission. INTERPRETATION: Integrating novel network science and geospatial analytics provides a simple way to study infectious disease transmission risk and population vulnerability to outbreaks. Our replicable method has utility for researchers globally with access to such data. It can help inform equitable preparation for, and responses to infectious disease outbreaks. FUNDING: This project was funded by the Health Research Council of New Zealand (20/1442) and from the NZ Government via Ministry for Business Innovation and Employment and Department of Prime Minister and Cabinet.

Prognostic value of the initial chest computerised tomography scan at one year following infection in an ethnically diverse cohort of patients admitted to hospital for COVID-19

P130 Figure 1Features of COVID-19 on the CT were very common in hospitalised patients and were related to all-cause mortality one year following hospitalisation[Figure omitted. See PDF]ConclusionEvidence of COVID-19 pneumonia on CTT is more common and severe in patients from ethnic minority groups and is independently associated with worse prognosis following hospitalisation.

Ethics and equity in the time of coronavirus

Government responses and lockdowns, even done well, have also caused increased morbidity and mortality by a reduction in patients seeking treatment for non-COVID-19 conditions, and the postponement of therapy such as surgery and preventive screening. This opportunity cost of the lockdown also includes the morbidity and mortality induced by unemployment and mental health issues. Whether these risks of lockdown are outweighed by the projected lives saved from dying of COVID-19 has still to be adequately analysed both here and overseas, but such analyses are essential in understanding the circumstances under which such measures are ethically justified. Equity of information-provision has been problematic. There have been issues of access to digital information and telehealth, especially for people who are poor or homeless.29 Understanding the risks, benefits and ethics of virtual healthcare is evolving concurrently with its widescale implementation.

Life during lockdown: a qualitative study of low-income New Zealanders' experience during the COVID-19 pandemic

AIM: This research explores the experience of low-income New Zealanders during the COVID-19 pandemic lockdown and their advice to the Government about addressing future pandemics. New Zealand had a rapid and effective lockdown that meant the virtual elimination of community transmission. METHOD: Twenty-seven semi-structured interviews were undertaken with low-income people in June-July 2020 immediately after lockdown was lifted. RESULTS: Life during lockdown was challenging for study participants. They were fearful of the virus and experienced mental distress and isolation. Most participants felt safe at home and reported coping financially while still experiencing financial stress. Participants were resourceful and resilient. They coped with lockdown by using technology, self-help techniques and support from others. New Zealand's welfare state ensured participants had access to health services and welfare payments, but there were challenges. Welfare payments did not fully meet participants' needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government's response and advised the Government to take the same approach in the future. This is a particularly reassuring finding from some of the most vulnerable New Zealanders. CONCLUSIONS: An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful lockdown for the low-income people in this study. Research of the experience of low-income people during pandemics is critical to ensuring inequities in pandemic impact are mitigated.

COVID-19 outbreaks in Aotearoa New Zealand: urgent action is required to address systematic causes and consequences of border failures

Between August and November 2020, Aotearoa New Zealand experienced eight known failures of the COVID-19 border control system. Multiple introductions of this highly transmissible virus into New Zealand's almost completely susceptible population present a high risk of uncontrollable spread, threatening New Zealand's elimination strategy. In this editorial, we propose that, although steps are being taken reactively in response to these known breaches, systematic underestimation of risk across the pandemic response makes future failures inevitable. We present an epidemiological framework for identifying and addressing risk, giving examples of actions that can be taken to reduce the probability of further outbreaks and enable New Zealand to benefit from sustained elimination of COVID-19.