The COVID-19 Pandemic and Daily Steps in the General Population: Meta-analysis of Observational Studies.

BACKGROUND: The COVID-19 pandemic has the potential to accelerate another pandemic: physical inactivity. Daily steps, a proxy of physical activity, are closely related to health. Recent studies indicate that over 7000 steps per day is the critical physical activity standard for minimizing the risk of all-cause mortality. Moreover, the risk of cardiovascular events has been found to increase by 8% for every 2000 steps per day decrement. OBJECTIVE: To quantify the impact of the COVID-19 pandemic on daily steps in the general adult population. METHODS: This study follows the guidelines of the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) checklist. PubMed, EMBASE, and Web of Science were searched from inception to February 11, 2023. Eligible studies were observational studies reporting monitor-assessed daily steps before and during the confinement period of the COVID-19 pandemic in the general adult population. Two reviewers performed study selection and data extraction independently. The modified Newcastle-Ottawa Scale was used to assess the study quality. A random effects meta-analysis was conducted. The primary outcome of interest was the number of daily steps before (ie, January 2019 to February 2020) and during (ie, after January 2020) the confinement period of COVID-19. Publication bias was assessed with a funnel plot and further evaluated with the Egger test. Sensitivity analyses were performed by excluding studies with low methodological quality or small sample sizes to test the robustness of the findings. Other outcomes included subgroup analyses by geographic location and gender. RESULTS: A total of 20 studies (19,253 participants) were included. The proportion of studies with subjects with optimal daily steps (ie, ≥7000 steps/day) declined from 70% before the pandemic to 25% during the confinement period. The change in daily steps between the 2 periods ranged from -5771 to -683 across studies, and the pooled mean difference was -2012 (95% CI -2805 to -1218). The asymmetry in the funnel plot and Egger test results did not indicate any significant publication bias. Results remained stable in sensitivity analyses, suggesting that the observed differences were robust. Subgroup analyses revealed that the decline in daily steps clearly varied by region worldwide but that there was no apparent difference between men and women. CONCLUSIONS: Our findings indicate that daily steps declined substantially during the confinement period of the COVID-19 pandemic. The pandemic further exacerbated the ever-increasing prevalence of low levels of physical activity, emphasizing the necessity of adopting appropriate measures to reverse this trend. Further research is required to monitor the consequence of long-term physical inactivity. TRIAL REGISTRATION: PROSPERO CRD42021291684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291684.

The prospective relations of substance use frequency to social distancing behaviors and intentions during the COVID-19 pandemic: the role of social distancing self-efficacy.

To identify factors that increase risk for nonadherence to recommended health protective behaviors during pandemics, this study examined the prospective relations of substance use frequency to both adherence to social distancing recommendations and social distancing intentions during the COVID-19 pandemic, as well as the role of social distancing self-efficacy in these relations. A U.S. community sample of 377 adults completed a prospective online study, including an initial assessment between March 27 and April 5, 2020, and a follow-up assessment one-month later. Results revealed a significant direct relation of baseline substance use frequency to lower adherence to social distancing recommendations one-month later. Results also revealed significant indirect relations of greater substance use frequency to lower levels of both social distancing behaviors and intentions one-month later through lower social distancing self-efficacy. Results highlight the relevance of substance use and social distancing self-efficacy to lower adherence to social distancing during the COVID-19 pandemic.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions.

BACKGROUND: Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS: This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS: Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS: This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

The impact of stay-at-home orders on vulnerability assessments and precautionary intentions during a pandemic.

In 2020, a novel emerging infectious disease - COVID-19 - became a global pandemic and prompted unprecedented social distancing measures. We examined the associations of voluntary stay-at-home (SAH) orders during the COVID-19 pandemic with vulnerability assessments and precautionary intentions (e.g. social distancing, hand washing). A quasi-experimental study using an online adult sample was conducted in U.S. states with and without voluntary SAH orders during the COVID-19 pandemic. Self-report surveys assessed vulnerability assessments and precautionary intentions. Participants living in states with SAH orders showed inflated vulnerability assessments for contracting COVID-19, and this association was stronger for affect-laden than cognitively-based assessments. Moreover, only affect-laden vulnerability assessments were uniquely associated with precautionary intentions and accounted for the relationship between SAH orders and precautionary intentions. Our study was among the first to explore the impact of voluntary SAH orders on vulnerability assessments and precautionary intentions. Results are discussed in terms of their implications for health behavioral models and applications for promoting self-protective actions during a pandemic.

Narcolepsy due to a medical condition

"Narcolepsy due to a medical condition” (symptomatic or secondary narcolepsy) results from a specific underlying medical or neurological condition. Common causes are inherited disorders, tumors, head trauma, demyelinating diseases and stroke. Similar to idiopathic narcolepsy, aberrant T cell mediated cytotoxicity to host antigens in hypocretin neurons might be the underlying pathophysiology. Secondary narcolepsy cases have varying ages of onset, typically following a specific underlying medical or neurological disorder. Primary sleep disorders, mental disorders, or drug/substance use needs to be ruled out. Although the main treatment should be controlling underlying pathologic processes, use of wake promoting medications are often warranted. © 2023 Elsevier Inc. All rights reserved

Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults.

BACKGROUND: Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. OBJECTIVE: Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). METHODS: Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0-53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. RESULTS: Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. DISCUSSION: These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.

Elevated day-time PTSD symptom severity (PTSS) and more frequent intrusive memories were generally associated with subjectively reported disruptions in sleep and vice versa, but not with objective measures of sleep.While longer subjective sleep duration predicted reductions in PTSS and shorter sleep onset latency predicted reduced numbers of intrusions the next day, reduced daytime PTSS was only associated with reductions in distress associated with nightmares during the following night.Exploratory analyses showed that sex (men vs. women) moderated the bi-directional relationships between night-time sleep and day-time PTSD symptoms with longer sleep onset latency and lower sleep efficiency being related to worse PTSD symptoms the next day in women, but was not associated with men.

Advances in understanding the formation and fate of B-cell memory in response to immunization or infection.

Immunological memory has the potential to provide lifelong protection against recurrent infections. As such, it has been crucial to the success of vaccines. Yet, the recent pandemic has illuminated key gaps in our knowledge related to the factors influencing effective memory formation and the inability to predict the longevity of immune protection. In recent decades, researchers have acquired a number of novel and powerful tools with which to study the factors underpinning humoral memory. These tools have been used to study the B-cell fate decisions that occur within the germinal centre (GC), a site where responding B cells undergo affinity maturation and are one of the major routes for memory B cell and high-affinity long-lived plasma cell formation. The advent of single-cell sequencing technology has provided an enhanced resolution for studying fate decisions within the GC and cutting-edge techniques have enabled researchers to model this reaction with more accuracy both in vitro and in silico. Moreover, modern approaches to studying memory B cells have allowed us to gain a better appreciation for the heterogeneity and adaptability of this vital class of B cells. Together, these studies have facilitated important breakthroughs in our understanding of how these systems operate to ensure a successful immune response. In this review, we describe recent advances in the field of GC and memory B-cell biology in order to provide insight into how humoral memory is formed, as well as the potential for generating lasting immunity to novel pathogens such as severe acute respiratory syndrome coronavirus 2.

Prevalence and Motivators of Getting a COVID-19 Booster Vaccine in Canada: Results from the iCARE Study.

Studies have shown that the protection afforded by COVID-19 vaccines against hospitalization and death decreases slowly over time due to the emergence of new variants and waning immunity. Accordingly, booster doses remain critical to minimizing the health impacts of the pandemic. This study examined the prevalence rate, sociodemographic determinants, and motivators of getting a COVID-19 booster vaccine within the Canadian population. We recruited a representative sample of 3001 Canadians aged 18+ years as part of the iCARE study using an online polling form between 20 January and 2 February 2022. Participants self-reported their booster status and were dichotomized into two groups: those who did vs. did not receive at least one booster dose. A total of 67% of participants received a booster dose. Chi-square analyses revealed that older age (p < 0.001) and having a chronic disease diagnosis (p < 0.001) were associated with being more likely to get a booster. Boosted individuals reported motivators tied to efficacy and altruism, whereas non-boosted individuals reported motivators tied to efficacy and safety. Results suggest that messaging will require careful tailoring to address the identified behavioral motivators among non-boosted individuals who emphasize safety and efficacy of additional vaccine doses.

RSV-associated Hospitalizations in Adults Aged >=18 Years and the Impact of the COVID-19 Pandemic in the United States, October 2018 - February 2022

Background. Respiratory syncytial virus (RSV) is a significant cause of hospitalizations in older adults and typically circulates during the fall and winter in the United States. The COVID-19 pandemic and implementation of nonpharmaceutical interventions (NPIs) including masking, improved handwashing, and social distancing likely impacted RSV circulation. To explore the pandemic's impact on RSV seasonality and hospitalizations in adults aged >=18 years, we analyzed laboratory-confirmed RSV-associated hospitalizations through the RSV Hospitalization Surveillance Network (RSV-NET) across four seasons. Methods. RSV-NET is a population-based surveillance system that collects data on RSV-associated hospitalizations across 75 counties in 12 states. An RSV-NET case is a resident of a defined catchment area who tests positive for RSV through a clinician-ordered test within 14 days prior to or during hospitalization. Surveillance was conducted October-April for the 2018-19 and 2019-20 pre-pandemic seasons and October 2020-September 2021 (2020-21 season). Available data October 2021-February 2022 (ongoing 2021-22 season) are presented. Results. 2,536, 3,195, 618, and 1,758 laboratory-confirmed hospitalizations were identified in adults >=18 years in 2018-19, 2019-20, 2020-21, and 2021-22, respectively;case counts were 4.1 and 5.2 times higher in 2018-19 and 2019-20, respectively, than in 2020-2021. Hospitalizations peaked in January for pre-pandemic and 2021-22 seasons and in September for 2020-21 (Figure). For all years combined, 16.2%, 23.4%, 33.3%, and 27.1% of all RSV-associated hospitalizations were among those aged 18-49, 50-64, 65-79 and >=80 years, respectively. Laboratory-confirmed RSV-associated hospitalizations in adults >=18 years, October 2018 - February 2022 Conclusion. Laboratory-confirmed RSV-associated hospitalizations in adults were lower during the 2020-21 and 2021-22 seasons compared with pre-pandemic seasons, with a marked change in seasonal patterns in 2020-21, likely because of NPIs implemented during the pandemic. Continued monitoring of RSV-associated hospitalizations will be critical to understand ongoing changes in RSV circulation that resulted from the COVID-19 pandemic and associated NPIs. (Figure Presented).

Telehealth education and training in entry-to-practice physiotherapy programs in Australian universities: A qualitative study with university educators.

BACKGROUND: To explore attitudes to telehealth education and experiences incorporating telehealth education into entry-to-practice physiotherapy programs in Australia, from the perspective of university educators. METHODS: Qualitative design based on a constructivist paradigm and a phenomenological approach. Sixteen university educators (who had a responsibility for telehealth curriculum or oversight of the broader curriculum in an entry-to-practice physiotherapy programme at an Australian university) were recruited. Individual semi-structured interviews were conducted via Zoom. Interviews were recorded, transcribed verbatim, and analysed thematically using an inductive approach. RESULTS: Three themes (with associated subthemes) were identified: (i) telehealth education has a role in contemporary physiotherapy practice (COVID-19 pandemic was a driver for telehealth education, acknowledgement that telehealth is here to stay and identified areas of focus for telehealth education and training); (ii) telehealth education and training vary substantially (content delivered and assessment of telehealth competency is ad hoc and student exposure to telehealth on clinical placements is inconsistent); (iii) challenges in telehealth education (finding space and time in the curriculum, as well as insufficient knowledge and expertise of staff, are challenges for implementation of telehealth education, however, course and subject development and/or reviews provide opportunities for implementing telehealth education and training). CONCLUSION: Current content and volume of telehealth education and training in entry-to-practice physiotherapy programs across Australia varies substantially. Although educators believe telehealth is an important component of contemporary physiotherapy practice, many barriers exist for including telehealth training into the curriculum.

Sex and Gender Impact Mental and Emotional Well-Being During COVID-19 Pandemic: A European Countries Experience.

Objective: The COVID-19 pandemic influences mental health drastically. Therefore, our aim was to investigate whether biological sex and gender-related factors are associated with mental health during the COVID-19 pandemic. Materials and Methods: The International COVID-19 Awareness and Responses Evaluation Study is an international multiwave cross-sectional observational cohort study of public awareness, attitudes, and responses to public health policies (www.mbmc- cmcm.ca/covid19). The study is led by the Montreal Behavioural Medicine Centre in collaboration with 200 international collaborators from 42 countries. It has received research ethics board approval from the Comité d'éthique de recherche du CIUSSS-NIM (Centre intégré universitaire de santé et de services sociaux du Nord- de-l'île-de-Montréal), approval no.: 2020-2099/25-03-2020. Recruitment began on March 27, 2020, and the survey is available in 34 languages. The associations between biological sex, sociocultural gender, and mental health were assessed in multivariate logistic regression models only for the European population (n = 12,300). Results: Positive correlations were found between female sex and "feeling nervous, anxious or worried" (OR = 3.2, p < 0.001, 95% CI 1.87-5.63) and "feeling sad, depressed or hopeless" (OR 1.8, p = 0.031, CI 1.05-3.05). Male sex was related to more frequently "feeling irritable, frustrated, and angry" (OR = 1.8, p = 0.04, 95% CI 1.03-2.99). Concerning gender, a negative correlation between being employed and "feeling lonely or isolated" (OR = 0.26, p < 0.001, 95% CI 0.11-0.59) was observed in the female cohort. Conclusion: Sex and gender differences exist in the emotional responses during the COVID-19 pandemic. Especially, within the female cohort, unemployment is negatively associated with mental health. Therefore, this study suggests more targeted psychological and social support for females during the pandemic.

How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses.

COVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study ( www.icarestudy.com ). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended.

INTERSECTIONS OF TELEMEDICINE / TELEHEALTH AND CYBERSECURITY: THE AGE OF RESILIENCE AND COVID-19

The telemedicine and telehealth industry regenerates to fasttrack the COVID-19 pandemic. Preliminary 2020 data suggests a 2,532 % surge in healthcare aid provided equated to the 2019 March through June timeframe. While telemedicine technology offers a variety of benefits, it is vulnerable to cyber threats. Countrywide stayput mandates swiftly intensified telemedicine/telehealth from an auspicious novelty to becoming fundamental precedence. The industry is consistently besieged by a deluge of convalescents, restrained supplies, allotting, and additional encounters because of COVID-19. Cybersecurity leaders and healthcare establishments had to promptly change their IT resources, timetables, and work ranges to leverage prevailing technologies and propel healthcare providers and convalescents, adapted to the novel healthcare delivery services and enhanced changes. Telehealth, an integral part of delivering convalescent care, has multiplied healthcare offerors' digital traces and cybersecurity hacks, as evidenced through endpoint security and the amplification of conclusions per telemedicine/telehealth sphere. COVID-19 reveals the junctions of cybersecurity and telehealth as a worst-case scenario for modernistic interpretations regarding healthcares' cybersecurity guidance. The findings of this research provides awareness to understand if leaders at all levels aid in preventing cyber-attacks, thwarting ransom attacks, and indicating that healthcare organizations must adopt a cyber resilience plan.

Impacts of the COVID-19 Pandemic on a Community-Based, Palliative Care Lay Advisor Project for Latinos with Cancer

The COVID-19 pandemic posed challenges to a community-based participatory research (CBPR) project for rural-dwelling adults with cancer in eastern North Carolina. This project trained Latino community leaders as palliative care lay advisors (PCLAs) to deliver information on cancer symptom management and advance care planning (ACP). Pandemic impacts were assessed using data from team meetings and fieldnotes, journal memos, online booster sessions, participant encounter forms and digital correspondence. Three key results were: 1) the disproportionate effects of COVID -19 on PCLAs and their communities;2) the need for a major study redesign that extended the recruitment region and changed the mode of intervention delivery;and 3) the adoption of new channels of communication. Online discussions and in-person meetings with PCLAs sustained engagement, resulting in a two-year, 73 percent retention rate, and addressed community concerns about COVID-19. Applied outcomes included the selection by the regional cancer center of a 2022 goal to improve cultural care for Latinos and the empowerment of PCLAs as community advocates. The challenges created by COVID-19 were met by the study team's ongoing commitment to CBPR principles, flexible adaptations to a changing environment, and strong relationships forged with community members and advocacy groups.

Effect of motion control versus neutral walking footwear on pain associated with lateral tibiofemoral joint osteoarthritis: a comparative effectiveness randomised clinical trial.

OBJECTIVES: To determine if motion control walking shoes are superior to neutral walking shoes in reducing knee pain on walking in people with lateral knee osteoarthritis (OA). DESIGN: Participant-blinded and assessor-blinded, comparative effectiveness, superiority randomised controlled trial. SETTING: Melbourne, Australia. PARTICIPANTS: People with symptomatic radiographic lateral tibiofemoral OA from the community and our volunteer database. INTERVENTION: Participants were randomised to receive either motion control or neutral shoes and advised to wear them >6 hours/day over 6 months. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was change in average knee pain on walking over the previous week (11-point Numeric Rating Scale (NRS), 0-10) at 6 months. The secondary outcomes included other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity. RESULTS: We planned to recruit 110 participants (55 per arm) but ceased recruitment at 40 (n=18 motion control shoes, n=22 neutral shoes) due to COVID-19-related impacts. All 40 participants completed 6-month outcomes. There was no evidence that motion control shoes were superior to neutral shoes for the primary outcome of pain (mean between-group difference 0.4 NRS units, 95% CI -1.0 to 1.7) nor for any secondary outcome. The number of participants experiencing any adverse events was similar between groups (motion control shoes: n=5, 28%; neutral shoes: n=4, 18.2%) and were minor. CONCLUSIONS: Motion control shoes were not superior to neutral shoes in improving knee pain on walking in symptomatic radiographic lateral tibiofemoral joint OA. Further research is needed to identify effective treatments in this important but under-researched knee OA subgroup. TRIAL REGISTRATION NUMBER: ACTRN12618001864213.

Exploring experiences with telehealth-delivered allied healthcare services for people with permanent and significant disabilities funded through a national insurance scheme: a qualitative study examining challenges and suggestions to improve services.

OBJECTIVES: In people with a disability, or their caregivers, who reported suboptimal experiences, the objectives were to explore: (1) challenges with telehealth-delivered allied health services during the COVID-19 pandemic and (2) suggestions to improve such services. DESIGN: Qualitative study based on an interpretivist paradigm and a phenomenological approach. SETTING: Participants who accessed allied healthcare via telehealth during the pandemic. PARTICIPANTS: Data saturation was achieved after 12 interviews. The sample comprised three people with permanent or significant disabilities, and nine carers/partners/family members of people with permanent or significant disabilities, who were funded by the Australian National Disability Insurance Scheme and had suboptimal experiences with telehealth. Semistructured one-on-one interviews explored experiences with telehealth and suggestions on how such services could be improved. An inductive thematic analysis was performed. RESULTS: Six themes relating to the first study objective (challenges with telehealth) were developed: (1) evoked behavioural issues in children; (2) reliant on caregiver facilitation; (3) inhibits clinician feedback; (4) difficulty building rapport and trust; (5) lack of access to resources and (6) children disengaged/distracted. Five themes relating to the second study objective (suggestions to improve telehealth services) were developed: (1) establish expectations; (2) increase exposure to telehealth; (3) assess suitability of specific services; (4) access to support workers and (5) prepare for telehealth sessions. CONCLUSIONS: Some people with permanent and significant disabilities who accessed allied healthcare via telehealth during the pandemic experienced challenges, particularly children. These unique barriers to telehealth need customised solutions so that people with disabilities are not left behind when telehealth services become more mainstream. Increasing experience with telehealth, setting expectations before consultations, supplying resources for therapy and assessing the suitability of clients for telehealth may help overcome some of the challenges experienced.

TELEHEALTH ACCESS IN A MULTI-LINGUAL, UROGYNECOLOGY POPULATION

Introduction: The Covid 19 pandemic led to a rapid adoption of telehealth. But challenges include technology literacy1 and access to technology (i.e. smartphones) 2. Since our institution's implementation of the Epic Systems (Verona, WI) electronic health record, Epic MyChart (EPIC) is the patient-facing, mobile portal application. It is the primary mode for televideo visits (televisit) endorsed by the institution. However, the platform is in English, requires downloads and passwords, site navigation, and requires over 20 clicks to setup. In a non-English speaking (55%), and digital elderly (50 + yrs old)3 patient population, this may be difficult. Doximity (Doximity, Inc, San Francisco, CA) is a text message based application without passwords and takes 4 clicks to start a televisit. This population successfully utilized Doximity for 76% of the televisits prior to EPIC. Objective: This quality improvement project is to assess the type of application needed for a televisit. If an EPIC televisit does not connect, then a Doximity televisit text was sent to the patient's cell phone. If this is not successful, it is then converted to a phone visit. The secondary purpose is to assess for factors that would predict who would be successful utilizing EPIC for their televisit. Methods: All televisits scheduled from August 1-Dec 31, 2021 was deidentified to create the dataset. ed data include televisit application, age, language, the need for login help, and zip code. Statistical analysis is conducted using SAS Studio Software. Descriptive statistics are used to summarize patient and visit data. Logistic regression is utilized for binary outcomes. Chisquare, and Fischer's used for categorical variables. Results: See Table 1. 93% (n = 208) of the scheduled televisits (n = 224) were completed. No login help was needed for 27% of scheduled televisits via EPIC (average age(age): 50 years old (yo), 87% speaking English), with an additional 24% via Doximity (age: 60yo, 67% speaking English). Login help was needed for a smaller proportion of Doximity visits (29%;age 69yo, 41% speak English) compared to EPIC (35%;age: 68yo, 36% speak English). If Doximity was still unable to connect, a phone visits was initiated 17% of the time (age: 71 yo, 24% speaking English). Factors for independent televisits include EPIC (p = 55yo (OR 0.089, P < 0.0001) are associated with a decreased likelihood that a patient will access an EPIC televisit without help. Conclusions: In this non-English speaking and older patient population, only a minority of telehealth visits are accessible via EPIC. Despite selecting out younger and English speaking patients, due to the step-wise utilization of the televisit applications (EPIC, then Doximity), older (average 60 yo) and non-English speaking patients are able to independently login for a Doximity telehealth visit. These factors decrease access to care when only utilizing the EPIC application. To improve health equity and minimize barriers for care, a televisit application's ease of use, needs to be considered when deciding on which televisit application should be utilized by an institution. And a choice of televisit applications should be offered for access to care (Table Presented).

The effect of COVID-19 on prostate cancer testing in Australia

Introduction & Objectives: The effects of the COVID-19 pandemic on healthcare in Australia have yet to be fully determined. There are well documented decreases in the rates of screening & diagnostic testing for many cancers in 2020, with commensurate stage migration of cancers when they are eventually detected. Early evidence from overseas has suggested decreased levels of PSA testing in highly impacted communities, & many Australian urologists fear that there are men with potentially curable prostate cancers will have missed their opportunity for cure because of decreased uptake of screening tests. We aimed to determine whether there was a decrease in the rate of prostate Cancer screening & testing in Australia in 2020. Methods: Using the Medicare Statistics Reports tool, the Medicare Benefit Schedule number for screening & diagnostic tests for prostate cancer were analyzed over a 6-year period (2015 - 2020). The items numbers covered prostate biopsies (37219) PSA testing for men without an existing diagnosis of prostate cancer (66655), & MRIs performed in men without a diagnosis of cancer (63541, data available for 2019-2020). Sub group analysis were conducted for Victoria & the rest of the country excluding Victoria (to account for the Victorian lock-downs of 2020) Results: Data was extracted for 2015- 2020, these are shown in Table 1. As can be seen, the difference between 2020 & the preceding years is relatively modest. A modelling exercise was also performed in order to estimate test usage in 2020 based on population. The predicted test usage was similar to the average use, & the actual testing rate fell within the Predictive Interval. A subgroup analysis for Victoria only did show a statistically significant difference with regards to PSA tests (8% less than average, p = 0.002), however an analysis of testing by month shows that the vast majority of this reduction coincided with the first Melbourne lockdown (March to May 2020). Conclusions: On the available evidence, the rates of testing for prostate cancer in 2020 did not differ significantly from previous years with the exception of prostate biopsies & MRI conducted within Victoria, & this may be at least partly artifactual. As such there is no basis to believe that there will be a stage migration in prostate cancer in Australia owing to the COVID pandemic.