Voices From the Community: Maternal Healthcare Experiences During the COVID-19 Pandemic.

Introduction The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on health services around the world. Many hospitals and clinics were overwhelmed by the influx of patients, leading to delays and disruptions in care. The fear of contracting the virus also led to a decrease in the number of people seeking medical care, even for urgent or life-threatening conditions. Various studies have reported a decrease in overall utilization of maternal health services. However, it remains vital to find the reasons for reduced utilization along with the experiences of the women as well as healthcare workers during the pandemic. Objective The objective of this study was to identify the facilitators and barriers to maternal healthcare services utilization during the COVID-19 pandemic. Methods It was a qualitative study conducted in a rural area of Haryana, India. Twelve in-depth interviews (IDIs) were conducted with health workers and four focused group discussions (FGDs) were conducted with pregnant women. Textual analysis was done for both IDIs as well as FGDs. Qualitative analysis was done manually. Results The identified themes were complete cessation of services, no outpatient department (OPD) services for many months, no antenatal care (ANC) services for two months, disruption of supply of medicines, unavailability of drugs, fear of getting COVID-19 infection, mandatory COVID-19 negative report for admission in hospital, and increased referral from government health facilities during the pandemic and lockdown. Conclusion Maternal healthcare services suffered during COVID-19 for various reasons including the closure of health facilities, limited supply of stocks, or fear of the disease among pregnant women. This evidence can be used to prepare as well as manage healthcare services in future.

Association of In-School and Electronic Bullying with Suicidality and Feelings of Hopelessness among Adolescents in the United States.

BACKGROUND: Suicide-related behaviors increasingly contribute to behavioral health crises in the United States (U.S.) and worldwide. The problem was worsened during the COVID-19 pandemic, especially for youth and young adults. Existing research suggests suicide-related behaviors are a consequence of bullying, while hopelessness is a more distal consequence. This study examines the association of in-school and electronic bullying with suicide-related behavior and feelings of despair among adolescents, adjusted for sociodemographic characteristics, abuse experience, risk-taking behaviors, and physical appearance/lifestyles. METHOD: Using Chi-square, logistic regression, and multinomial logistic regression, we analyzed the US 2019 Youth Risk Behavior Surveillance System (YRBSS) national component. The YRBSS includes federal, state, territorial, and freely associated state, tribal government, and local school-based surveys of representative sample middle and high school students in the US. The 2019 YRBSS participants comprised 13,605 students aged 12 to 18 years and roughly equal proportions of males and females (50.63% and 49.37%, respectively). RESULTS: We observed a significant association (p < 0.05) between being bullied and depressive symptoms, and the association was more vital for youth bullied at school and electronically. Being bullied either at school or electronically was associated with suicidality, with a stronger association for youth who experienced being bullied in both settings. CONCLUSION: Our findings shed light on assessing early signs of depression to prevent the formation of suicidality among bullied youth.

A Primer to Traditional Knowledge Protection in India: The Road Ahead.

As India moves ahead in the twenty-first century to be a global player, it must take a balanced and inclusive approach. Marginalized and vulnerable tribal communities make approximately 10% of the massive population, playing a dynamic role in this regard. Their ancestral knowledge can be explored to inculcate the ethos in multiple disciplines. This would most certainly bring the much-needed balance in achieving the United Nations Sustainable Development Goals. Where the world is fast losing its natural resources, promoting traditional knowledge (TK) could become an initiative for its reconstruction in post-COVID 19 scenarios. Apart from reinstating the rights of these indigenous communities, this step would also facilitate the economic benefit of the country through the incorporation of TK in the realm of Intellectual Property. This would be a masterstroke for India to lead the Global South. This would also bring in a balance with the Global North, where significant developments have already taken place, in this regard. TK per se should not necessarily be protectable unless based on scientific evidence.

A Prescription for Internet: Feasibility of a Tablet Loaner Program to Address Digital Health Inequities.

OBJECTIVE: The coronavirus disease 2019 pandemic accelerated the adoption of telehealth technologies. Persistent disparities in telecommunication devices, internet connectivity, and digital literacy, however, undermine the potential for telemedicine to reduce barriers to health care access. Health systems may have a role in addressing these structural inequities. We describe the operationalization and feasibility of an internet-enabled tablet loaner program at a freestanding children's hospital. METHODS: Between October 2020 and October 2021, pediatricians enrolled families through ambulatory clinics at an academic urban freestanding children's hospital. Eligibility criteria included difficulty accessing virtual care due to lack of stable internet or device. Tablets featured an unlimited data package, access to the patient portal, and virtual visit platform. A private technology company managed device configuration and distribution. To characterize program impact, we compared the proportion of completed clinical encounters during the intervention compared with a preintervention period (March 2020-October 2020) and conducted a qualitative survey with program participants. Participant and visit characteristics were obtained from the electronic medical record and summarized with descriptive statistics. RESULTS: A total of 111 families participated in the tablet loaner program, the majority of whom were Hispanic (51.4%) and black, non-Hispanic (26.1%), and publicly insured (64.9%). Between the preintervention and intervention periods, there was a significant increase in completed video- and phone-based virtual visits (75.3 vs. 79.1%, p = 0.038). The proportion of video-based only visits increased from 82.9 to 88.9%. p < 0.001. Families reported that the tablet improved the patient's ability to receive medical care (93.7%) and was easy to use (93.9%). CONCLUSION: The tablet loaner initiative was associated with an improvement in markers of virtual visit engagement and health care experience. Efforts to expand telemedicine equity must consider technological access and digital literacy as well as broad coalitions across industry, government, and community organizations.

COVID-19 vaccine acceptance and coverage among pregnant persons in the United States.

Pregnant persons are at higher risk of severe COVID-19. Although vaccination is recommended, COVID-19 vaccination rates are lower among pregnant persons compared to the non-pregnant population. We aimed to evaluate acceptance of any dose of COVID-19 vaccine during pregnancy. A national online cross-sectional survey of US adults who were pregnant between December 2020 and July 2021 was used to measure COVID-19 vaccine behaviors, attitudes, and beliefs. Post-stratification weighting was used to ensure representativeness to the US population. Marginal log-binomial models were used to estimate adjusted prevalence ratios (aPR) of COVID-19 vaccine acceptance, accounting for sociodemographic factors. Of 5,660 who responded to survey advertisements, 2,213 met eligibility criteria and completed the survey; 55.4% of respondents received or planned to receive COVID-19 vaccine prior to or during pregnancy, 27.0% planned to vaccinate after pregnancy, 8.8% were unsure and 8.7% had no plans to vaccinate. Individuals were more likely to receive or plan to receive COVID-19 vaccine if they had group prenatal care (aPR 1.57; 95% CI 1.40, 1.75), were employed in a workplace with a policy recommending vaccination (aPR 1.15; 95% CI 1.06, 1.26), and believed COVID-19 vaccines are safe (aPR 2.86; 95% CI 2.49, 3.29). Pregnant persons who were recommended COVID-19 vaccination by their healthcare provider less commonly reported concerns about vaccine safety (35.5% vs 55.9%) and were more likely to accept COVID-19 vaccines (aPR 1.52; 95% CI 1.31, 1.76). COVID-19 vaccine acceptance during pregnancy is not universal and public health intervention will be needed to continue to increase vaccine coverage.

A Commentary on the Healthy Community Stores Case Study Project: Implications for Retailers, Policy, and Future Research.

In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as future directions for researchers and policy-makers based on results from the prior cross-case analyses. We organize these strategies using key concepts from the Retail Food Environment and Customer Interaction Model. Several key strategies for store success are presented including the use of non-traditional business models, focus on specific retail actors such as store champions and multiple vendor relationships, and a stores' role in the broader community context, as well as the striking challenges faced across store locations. Further exploration of these store strategies and how they are implemented is needed, and may inform policies that can support these types of healthy retail sites and sustain their efforts in improving healthy food access in their communities.

Effectiveness of an institutional COVID-19 central sampling team during pandemic at a tertiary care centre.

BACKGROUND: An efficient sampling is one of the key methods to identify all those affected by coronavirus disease 2019 (COVID-19). OBJECTIVES: To analyze how efficient setting up of a central sampling team would be to prevent any outbreak within the institution by minimizing the movement of suspected COVID-19 patients admitted in the inpatient wards. The secondary objective was to train maximum resident doctors to collect samples of admitted patients. METHODOLOGY: A central sampling team comprising of resident doctors from various departments was made who did sampling of the suspected COVID-19 inpatients admitted under various specialties. RESULTS: There were a total of 341 patients [209 males (61.29%), 132 females (38.7%)] and 335 patients underwent sampling. There was a positive correlation between: (1) number of calls from a department vs percentage of positive samples in that department [Pearson correlation coefficient (R) = 0.47; P = 0.026], (2) number of samples taken by resident of a particular department from central sampling team vs number of positive samples taken by resident of that department [R = 0.8739, P = 0.01] and (3) number of visits to a department vs number of residents trained in that department [R = 0.93; P = 0.00001]. CONCLUSION: Formulation of a central sampling team led to changes like a separate donning and doffing area in each ward and training of many resident doctors posted in different wards. This made each ward self-sufficient in collection of samples. This venture also ensured minimal movement of suspected COVID-19 patients in the hospital and thus least exposure to the hospital staff.

33. Telemedicine in Pediatric and Adolescent Gynecology

Background Telemedicine is broadly used to define medical care delivered remotely through telecommunication technology. This practice is recognized as an alternative strategy to traditional healthcare delivery with comparable health outcomes, and it has been rapidly expanded further in the context of the COVID-19 pandemic. While our clinicians have found telemedicine to be a helpful and innovative approach to medicine, its use specific to pediatric and adolescent gynecology has not been published. The primary outcome of this study was to determine the feasibility of virtual visits for ambulatory care in pediatric and adolescent gynecology. Methods This was a retrospective study on the use of telemedicine by the gynecology division at a tertiary pediatric hospital from January 1, 2020, to June 1, 2020. Video-based virtual visits through a hospital-supported software were conducted during the eligible time period. Patient demographics, visit diagnoses, and operational characteristics of the completed visits were obtained. The study received IRB approval. Results There were a total of 654 virtual visits for 614 patients. Ninety-one percent of patients were in-state (558/654), and the median age of patients seen was 17 years (range 0 – 37 years). Five hundred and two out of 654 visits were return visits (76.8%), 115/654 were new patient visits (17.6%), and 32/654 (4.89%) were post-operative follow-up. The median duration of a virtual visit was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (N=485), abnormal uterine bleeding (N=225), and pelvic pain (N=82). Visits were further assessed to determine if a follow-up in-person visit was needed within 90 days after the virtual visit. From the 654 virtual visits, 14 follow-up visits were in-person;5 were within 30 days from initial virtual visit, 6 were within 60 days, and 3 were within 90 days. The most common complaints that prompted an in-person follow-up were contraception administration (depot medroxyprogesterone, intrauterine device) (N=4), vulvovaginal symptoms (N=4), congenital anomaly exam (N=1), abnormal uterine bleeding exam (N=1), and an ovarian cyst (N=1). Conclusions Telemedicine is a feasible method for healthcare delivery in pediatric and adolescent gynecology with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up.

Mild COVID-19 infection-predicting symptomatic phase and outcome: A study from AIIMS, New Delhi.

CONTEXT: Comprehensive management of mild COVID infection calls for better understanding of symptomatology in these group of patients as well as early identification and close monitoring of patients at risk, data on which is limited. AIM: To study association between inflammatory markers and clinical presentation with progression of disease and the duration of resolution of symptoms. SETTINGS AND DESIGN: This is a retrospective study that has been conducted at a designated COVID -19 medical ward at AIIMS, New Delhi. METHODS AND MATERIAL: Fifty healthcare workers and their dependents who were admitted with asymptomatic and mild COVID-19 infection were included. Their records were retrospectively reviewed, entered into a predesigned proforma and analyzed. RESULTS: A total of 50 participants were included in the study of which 70% were healthcare workers. The patients were admitted with mild COVID illness out of which 22 (44%) were males. Most common symptom at presentation was fever (72%). Among patients who had mild disease versus those who progressed to moderate illness (n = 3), the patients with moderate illness were older [mean (SD): 57.33 (10.21) vs. 36.13 (14.05); P = 0.014] and had a longer duration of hospital stay [17 (1.41) days vs. 11.20 (3.86) days; P = 0.04]. Inflammatory markers, C-Reactive Protein (CRP) [2.46 vs. 0.20 (P = 0.024)], and Ferritin [306.15 vs. 72.53 (P = 0.023)] were higher in patients with moderate illness. There is also a significant correlation between the number of days taken for symptoms to resolve with Serum Ferritin (P = 0.007), CRP (P = 0.0256), and neutrophil lymphocyte ratio (NLR) (P = 0.044). CONCLUSIONS: Acute phase reactants/Inflammatory markers serve as good indicators of time taken to resolution of symptoms in acute COVID infection. NLR is a simple and inexpensive method to provide insight into symptomatic phase. These may be utility tools for primary care physician in the management in periphery and timely decision.

Risk factors and outcome among COVID-19 exposed and quarantined healthcare workers: A study on the status of existing practices of standard precautions.

CONTEXT: Health care workers (HCWs) are at high risk of COVID-19 infection but data on the risk factors for exposure and infection rate among Indian HCWs are limited. AIMS: Our study aims to identify the risk factors and behavior of HCWs which make them high risk for COVID-19 infection and the infection rate among them. SETTINGS AND DESIGN: This is a retrospective study conducted at All India Institute of Medical Sciences, New Delhi. METHODS AND MATERIAL: Fifty HCWs quarantined at our institute in April and May 2020 following exposure to confirmed or suspected COVID-19 cases, or due to development of Influenza-Like Illness (ILI) were included. Data was collected from medical records in a predesigned proforma and analyzed. RESULTS: Thirty-eight (76%) of the 50 quarantined HCWs had high-risk exposure and there was a significant breach in personal protective measures. N-95 masks were worn by 59.6%, gloves by 61.7%, and goggles or face shields by 2%. Exposures were more common in non-COVID areas of the hospital. Hydroxychloroquine pre-exposure prophylaxis was taken by 7 (14%). 3 (6%) were confirmed to be COVID-19 positive during the quarantine period. CONCLUSIONS: Our study has shown leniency among HCWs in adhering to infection control and personal protective measures resulting in an increased quarantine and infection rate and loss of manpower. The safety of our HCWs must be given paramount importance during this pandemic and should be ensured by educating them about infection control, and persistently reinforcing and strictly adhering to standard precautions.