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Background Cardiac rehabilitation is accessed by only ~50% of eligible patients. Virtual options have become more important since Covid. The Our Hearts Our Minds (OHOM) programme used wearable technology (Fitbit) for virtual physical activity monitoring. Aim To examine whether a Fitbit smartwatch/dashboard component was an acceptable option to improve physical activity levels in the absence of supervised exercise classes. Methods Initial multidisciplinary assessments were conducted via telephone/video as per patient preference. Patients were offered a Fitbit, if they did not have their own smartwatch and to synchronise to a cloud based dashboard visible to the clinical team. Using behaviour change techniques, tailored physical activity advice was provided including personalised notifications pushed to the patient's Fitbit app. Patients also received coaching calls and virtual group education sessions. Average daily step count and active minutes (over a 7 day period) were calculated at the start and end of programme. Results 1066 referrals were received from 01/04/20 to 30/ 03/22, of which 1043 patients (98%) had an initial assessment. Of these, 407 wore a Fitbit device (33% provided by programme, 6% own Fitbit) and synchronised to OHOM Fitbit dashboard (39% uptake). 6% had their own non-Fitbit smartwatch. 55% declined Fitbit (5% didn't own a smartphone for app download or access the internet, 3% weren't interested in technology, 2% medical reasons, 2% didn't collect, 43% weren't interested in virtual monitoring). Physical activity outcomes pre and post programme are shown in table 1. Conclusion Fitbit (and other) smartwatches coupled with centralised monitoring provided a viable alternative to supervised exercise classes in approximately half of those attending cardiac rehabilitation with evidence of increased physical activity.
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This study aims to examine the specific health challenges experienced by cancer patients and survivors during the COVID-19 crisis. It's a descriptive mixed-methods study with 317 participants recruited from multiple sources. Participants were asked to complete an online anonymous 35-question semi-structured questionnaire. Data was analyzed both quantitatively and qualitatively. During the COVID-19 pandemic, 56% of the participants felt their medical care was disrupted or delayed. About 85% believed healthcare providers were taking the necessary measures to address COVID-19, yet, 50% of the participants felt they had received adequate information from healthcare providers. Participants had 49% satisfaction with general healthcare provided through telehealth, while only 33% were satisfied with telehealth cancer care. Common themes of challenges confronted by cancer patients during COVID-19 also include, delays in testing and treatment leading to cancer metastasis;lack of family and general support in hospitals/office visits, and feelings of isolation as a result of the quarantine;limited access to mental healthcare services;limited communication with medical personnel. There is an urgent need for medical and oncological institutions to create streamlined protocols for cancer treatment, appointments, and communication to minimize the number of challenges endured by cancer patients during a health pandemic. Copyright©2022 by authors, all rights reserved.
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Background. In February 2021 Kazakhstan began offering COVID-19 vaccines to adults. Breakthrough SARS-CoV-2 infections raised concerns about real-world vaccine effectiveness. We aimed to evaluate effectiveness of four vaccines against SARS-CoV-2 infection. Methods. We conducted a retrospective cohort analysis among adults in Almaty using aggregated vaccination data and individual-level breakthrough COVID-19 cases (>=14 days from 2nd dose) using national surveillance data. We ran time-adjusted Cox-proportional-hazards model with sensitivity analysis accounting for varying entry into vaccinated cohort to assess vaccine effectiveness for each vaccine (measured as 1-adjusted hazard ratios) using the unvaccinated population as reference (N=565,390). We separately calculated daily cumulative hazards for COVID-19 breakthrough among vaccinated persons by age and vaccine month. Results. From February 22 to Sept 1, 2021 in Almaty, 747,558 (57%) adults were fully vaccinated (received 2 doses) and 108,324 COVID-19 cases (11,472 breakthrough) were registered. Vaccine effectiveness against infection was 78% (sensitivity estimates: 74-82%) for QazVac, 77% (72-81%) for Sputnik V, 71% (69-72%) for Hayat-Vax, and 69% (64-72%) for CoronaVac. Among vaccinated persons, the 90-day follow-up cumulative hazard for breakthrough infection was 2.2%. Cumulative hazard was 2.9% among people aged >=60 years versus 1.9% among persons aged 18-39 years (p< 0.001), and 1.2% for people vaccinated in February-May versus 3.3% in June-August (p< 0.001). Conclusion. Our analysis demonstrates high effectiveness of COVID-19 vaccines against infection in Almaty similar to other observational studies. Higher cumulative hazard of breakthrough among people >60 years of age and during variant surges warrants targeted booster vaccination campaigns. (Figure Presented).
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Purpose: The COVID-19 pandemic resulted in a dramatic decrease in living kidney donation (LKD) in the U.S. This study investigated the effect of the COVID crisis on characteristics of LKD recipients in the U.S. Methods: We used OPTN transplant and LKD data to compare proportions of LKD recipients' race, SES (neighborhood income), sex, dialysis status, age, and recipient/ donor sex match during 3 eras: Pre-COVID (1/1/20-3/12/20, n=1294);COVID Shutdown (3/13/20-5/9/20, n=173);and COVID Stabilization (5/10/20-11/15/20, n=2331;Table 1). Results: Contrary to our expectations, LKD recipients' race, neighborhood income, and dialysis status at transplant did not differ by era (Figure 1a-c;Table 2). We did, however, find a significant relationship between recipient sex and era, with a higher proportion of male recipients in the COVID Shutdown and COVID Stabilization eras than in the Pre-COVID era (Figure 1d). We found a related significant association between recipient/donor sex match and era, with a higher proportion of male-recipient/female-donor transplants and a lower proportion of female-recipient/ female-donor transplants in the COVID Shutdown and COVID Stabilization eras than in the Pre-COVID era (Figure 1e). There was a marginally significant relationship between recipient age at transplant and era, with a higher proportion of younger recipients in the COVID Shutdown era than in the Pre-COVID and COVID Stabilization eras (Figure 1f). Conclusions: While we did not find expected differences in areas of current disparities such as LKD recipient race or SES, we did find that the drop in living donation caused by the COVID crisis exacerbated previously existing disparities in recipient sex and recipient/donor sex match, suggesting that COVID has not had an equal effect on all candidates. (Table Presented).
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Purpose: The OPTN temporarily suspended follow-up reporting requirements on 4/3/20 (retroactive to 3/13/20) in response to the COVID-19 crisis. We assessed the policy's impact on living donor follow-up form (LDF) and lab data submission for donors who have historically been disadvantaged in the transplant system. Methods: We analyzed OPTN data as of 1/22/20 for all 6-, 12-, and 24-month LDFs expected between 3/13/20-12/31/20 (“COVID”) vs 3/13/19-12/31/19 (“pre-COVID”). We assessed status of COVID forms by donor demographics. We also compared proportions of validated forms with complete lab data by era and donor demographics. Results: 15.6% of kidney and 10.8% of liver LDFs were in amnesty status, with substantial variation by center. Kidney: We found significant differences in form status by race/ethnicity (p<0.001), gender (p=0.007), age group (p<0.001), neighborhood income quartile (p=0.001), and relationship to recipient (p<0.001), with greater proportions of forms in amnesty status for Black (Black: 19.3%;White: 15.6%;Hispanic: 13.7%;Other: 14.6%), male (male: 16.7%;female: 15.0%), younger (age 18-34: 16.9%;35-49: 16.4%;50-64: 13.9%;65+: 13.7%), lower-income (Q1: 18.3%;Q2: 15.6%;Q3: 15.9%;Q4: 14.6%), biologically related and paired donors (biologically related: 16.8%;paired: 17.6%;spousal: 12.1%;unrelated: 14.5%) (Table 1). Liver: Younger donors had greater proportions of forms in amnesty status (age 18-34: 12.9%;35-49: 10.0%;50-64: 6.4%;p=0.056). Pre-COVID demographic differences in forms with complete lab data persisted during COVID, compounded by amnesty forms (Figure 1). Conclusions: Centers have voluntarily submitted over 80% of expected LDFs under this emergency policy. However, our finding that a disproportionate number of forms are missing for donors who are Black, male, younger, lower SES, and biological relatives of their recipient is concerning. These groups are at greater risk of long-term complications after donation, and may have limited access to health services during the pandemic and risk being lost to follow-up. Centers should consider targeted follow-up efforts for at-risk groups. (Table Presented).
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This article explores how the asymmetric institutionalization of the United Kingdom’s multinationality interacted with the COVID-19 pandemic. The UK’s political elite has traditionally accepted the country’s multinational character, but democratic institutionalization of it occurred relatively recently and in a remarkably asymmetric manner. Only the UK’s minority nations possess devolved governments, while the largest nation, England, is governed directly from the center. This framework has consequences for the pandemic response. It has clarified the relevance of devolved legislatures, but also highlights continued resistance of the UK’s governing elite to acknowledge the multi-level character of the state. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.