Association between the Covid-19 Pandemic and Icu Utilization for Children with Hyperglycemic Crisis

INTRODUCTION: Admissions to the intensive care unit (ICU) for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic, possibly from social distancing resulting in decreased or delayed health care access. We sought to determine if severity of illness for HGC changed from pandemic year 1 to year 2 as social distancing restrictions lightened. METHOD(S): Retrospective study of children <= 18 y/o hospitalized from 3/2017 to 3/2022 in the Pediatric Health Information System for HGC. PreCOVID years (3/2017- 3/2020), COVID-19 year 1 (3/2020-3/2021), and COVID-19 year 2 (3/2021-3/2022). The primary outcome was ICU admission. Secondary outcomes included ICU length of stay (LOS) >3 days, use of therapies for neurologic compromise, and cost. RESULT(S): From 42 hospitals, 46,220 patients were admitted with HGC, of these, 19,889 patients were admitted to the ICU. There was a decrease in ICU admissions from COVID-19 year 1 (47.4%) to year 2 (44.6%) but both remained higher than PreCOVID (40.7%). Median admission cost remained elevated in year 1 ($11,134 [IQR $6,412, $13,060) and year 2 ($11,057 [IQR $7,974, $15,997]) compared to PreCovid ($9,206 [IQR $7,741, $16,069]). In multivariable analysis, when compared to PreCOVID, ICU admissions for HGC were higher in COVID-19 year 1 (OR 1.31 [95%CI 1.25-1.37], p< 0.01) and year 2 (OR 1.16 [95% CI 1.10-1.22], p< 0.01) after controlling for confounding variables. However, ICU admissions were higher in year 1 than year 2 (OR 1.13, 95% CI [1.075-1.20], p=< 0.01). ICU LOS >3days increased when compared to PreCOVID years (COVID-19 Year 1: OR 1.70, [95% CI: 1.38-2.09], p< 0.01, Year 2: OR: 1.6 [95% CI 1.3-1.97], p< 0.001) but there was no difference between year 1 and 2 (p=0.6). Therapies for neurologic compromise increased in COVID-19 year 1 (p< 0.01) and year 2 (p < 0.01) in comparison to PreCOVID years but there was no change between COVID-19 years (p=0.15). CONCLUSION(S): During the COVID-19 pandemic, children with HGC were admitted with a higher severity of illness than pre-COVID. This pattern continued during Covid-19 year 2 despite reduction in social distancing although need for ICU admission was higher in COVID-19 Year 1 than Year 2.

Digital Challenges and Strategies in a Post-Pandemic World

The Covid-19 pandemic has not only affected the health and life of people around the world but also many areas such as the economy, the way of doing business, working life, the education sector, the urban life, and consumer consumption habits. Digital technologies and solutions also played an important role in the changes brought about by the pandemic. Digitization has brought its own challenges in this context. Being aware of this issue, Turkish-German University (TGU) hosted a conference on "Digital Challenges and Strategies in a Post-Pandemic World” in cooperation with Bielefeld University of Applied Sciences in Istanbul. The conference offered a platform for academicians as well as practitioners to discuss the current issues related to new digital applications, the impact of digitization, digital challenges, and necessary measures, as well as strategies to overcome these challenges in a post-pandemic world. The academic papers presented in the conference constitute the chapters of this book. © Peter Lang GmbH.

Factors Affecting Work-Family Conflict in the Digital Work Environment

Remote work, which has become widespread in today's digitalized world, has gained pace globally. Especially with the effect of the pandemic, many institutions in different sectors have had to quickly adapt to this new order. Remote working is now at an irreversible point in today's working life, and therefore, the need to carry out studies that will increase the effectiveness of remote working, as well as that will help to eliminate the situations that will reduce the success of remote working, has gained vital importance in providing competitive advantage for institutions. The virtualization of business practices, increasing virtual teams and virtual meetings can force the employees to be available at any time, which can lead to work-family conflicts and as a result to employee burnout and poor performance. In today's digital business world, both employees and employers have important responsibilities to prevent work-family conflict, which has a significant impact on both employee and company success. The aim of this study is to determine the factors that have either a positive or negative effect on the work-family conflict experienced by the employees in their digitally supported remote working life, based on a literature review of recent relevant studies. © Peter Lang GmbH.

Intellectual property versus health care

There are various challenges that must be overcome before the COVID-19 epidemic may be contained on a worldwide scale. The protection of one's intellectual property is of the utmost importance. Instead of ultimately addressing this issue in the current health emergency, many actors in industry and politics are persistently refusing to accept any modification of patent rights. This is despite the fact that the issue is a public health emergency. This article discusses the role that patents play in the health care industry and how they have become a barrier to the widespread protection of public health during a pandemic emergency, particularly in the development of vaccines.

COVID-19 vaccination intent and associated factors in healthcare workers: cross-sectional study : Ana Zhelyazkova

Background Considering the vaccine hesitancy recorded among healthcare workers (HCW) during the 2009/10 influenza pandemic, we aimed to examine the COVID-19 vaccination intent of HCW at one of the largest hospitals in Germany and to identify associated factors. Methods We conducted a cross-sectional anonymous survey at LMU University Hospital in Munich, Germany, between February 25 and March 20, 2021. Data was collected on COVID-19 vaccination intent as main outcome and on potential associated factors. Results In total, 2555 HCW completed the survey;48,3% (n = 1325) of them had already received at least one COVID-19 vaccine dose. Of those not yet vaccinated 51,7% (n = 1320), 83,6% (n = 1104) reported intention to get vaccinated, while 10,2% (n = 134) were undecided and further 6,2% (n = 82) reported refusal. Disagreeing that everyone should receive the generally recommended vaccines was associated with refusal (RR = 529,500, p = 0,000) while being vaccinated against influenza in the 2020/21 season was linked with lower likelihood of refusal or indecisiveness (RR = 0,124, p = 0,000;RR = 0,182, p = 0,000). Low or partial conviction of the effectiveness and safety of COVID-19 vaccines were linked to refusal (effectiveness;RR = 485,471, p = 0,000;RR = 9,247, p = 0,000;safety: RR = 116,829, p = 0,000;RR = 5,423, p = 0,025). Feeling ill informed about COVID-19 vaccines was associated with refusal and indecisiveness (RR = 25,900, p = 0,000;RR = 21,104, p = 0,000). Conclusions At the beginning of the vaccination campaign in Germany, a small proportion of HCW at LMU University hospital was hesitant on receiving a COVID-19 vaccine. Factors associated with refusal or indecisiveness were a sceptical attitude towards vaccines in general as well as feeling ill informed about COVID-19 vaccines, especially regarding their effectiveness and safety. Having received an influenza vaccine was associated with COVID-19 vaccination intent. Key messages • The presented results provide insight into the reasons for hesitancy of HCW against COVID-19 vaccines, indicating a pattern-like behaviour in the acceptance of novel vaccines by HCW. • The evidence from our analysis can help inform the communication aims and emphases of vaccination campaigns among HCW within similar organizational contexts or in future outbreak scenarios.

Timing of elimination of hepatitis C virus in Canada's provinces

BACKGROUND: Infection with chronic hepatitis C virus is a global public health concern. A recent study concluded that Canada is on track to achieve hepatitis C elimination goals set by the World Health Organization if treatment levels are maintained. However, recently a falling temporal trend in treatments in Canada was observed, with most provinces seeing a decrease before the global coronavirus pandemic. This study assesses the timing of elimination of hepatitis C in the 10 provinces of Canada. METHODS: Previously published disease and economic burden model of hepatitis C infection was populated with the latest epidemiological and cost data for each Canadian province. Five scenarios were modelled: maintaining the status quo, decreasing diagnosis and treatment levels by 10% annually, decreasing diagnosis and treatment levels by 20% annually, increasing them by 10% annually, and assuming a scenario with no post-coronavirus pandemic recovery in treatment levels. Year of achieving hepatitis C elimination, necessary annual treatments for elimination, and associated disease and economic burden were determined for each province. RESULTS: If status quo is maintained, Manitoba, Ontario, and Quebec are off track to achieve hepatitis C elimination by 2030 and would require 540, 7,700, and 2,800 annual treatments, respectively, to get on track. Timely elimination would save 170 lives and CAD$122.6 million in direct medical costs in these three provinces. CONCLUSIONS: Three of Canada's provinces-two of them most populous in the country-are off track to achieve the hepatitis C elimination goal. Building frameworks and innovative approaches to prevention, testing, and treatment will be necessary to achieve this goal.

Improving Immunization Rates in Underserved Neighborhoods

Background: Immunization refusal rates in the United States are increasing. Ohio is below the national average for immunization rates, with even lower rates among children who are publicly insured. Our two hospital-based pediatric primary care offices serve 25,000 children from urban, underserved neighborhoods, with 90% publicly insured and 75% Black. Our immunization refusal rate is 2%, but nearly 10% of families refuse select immunizations or request alternative schedules. The drivers of local immunization rates are unknown. Our objective was to explore families' immunization beliefs and perspectives through interviews to allow for development of tailored information. The secondary objective was to evaluate caregiver impression of the newly developed educational information and measure the acceptability of these materials. Methods: This content analysis took place at a large, urban pediatric hospital's primary care offices. Caregivers of patients were recruited for interviews. We developed semi-structured interview guides after conducting a literature review and holding informal discussions with families at community meetings. The interview script included eight questions related to educational materials, desired topics, preferred learning format and reasons for vaccine refusal. Interviews were audio recorded, transcribed, and coded by one team member, then collectively analyzed by three team members to identify initial codes. The entire team discussed codes and resolved any discrepancies and then created categories. Educational materials were created based on the results of these interviews. Finally, caregivers at well child visits were approached to review the educational materials and provide written feedback, through pre- and post-surveys, to assess acceptability and impression of the materials. Results: Eighteen family were initially interviewed. Key educational topics identified by families included vaccine ingredients, side effects, and general benefits of immunizations. Reasons for vaccine refusal included concerns that vaccines cause disease, adverse side effects, and a fear of developing autism (Table 1). Written materials and videos were the preferred educational format, and families reported wanting these materials in conjunction with inperson discussions with the health care providers. Several educational resources were created: 1) a timeline displaying a typical vaccine schedule with descriptions of each vaccine, 2) a brochure addressing common concerns, and 3) a testimonial video with clinicians and caregivers describing “Why I Vaccinate.” The educational information was piloted with 51 families, and the majority of caregivers reported their questions were answered and they would likely share the information with family and friends (Table 2). Conclusion: Caregivers indicated preferences for written and digital materials to augment vaccinerelated discussions with healthcare providers. Educational materials tailored to address family concerns and learning preferences may enhance quality of conversations and ultimately decrease immunization refusal in our community. Next steps include distributing educational materials more broadly within primary care and evaluating impact on immunization rates. Similar approaches could be considered for newer vaccines, including COVID-19.

Coronavirus disease 2019 (COVID-19) and international media-issues, challenges, and opportunities Introduction

Providing a rich overview of COVID in the media, the volume's four main sections explore relationships among media, culture, government agencies, and technology. COVID-19 in International Media: Global Pandemic Responses is one of the first books uniting a diverse international team of scholars to investigate how media address critical social, political, and health issues connected to the 2020-2021 COVID-19 outbreak. The book evaluates unique civic challenges, responsibilities, and opportunities for media worldwide, exploring pandemic social norms that media promote or discourage, and how media serve as instruments of social control and resistance (Frankfort School), or of cooperation and representation (media sociology and community structure theories). Hailing from continents across the globe, the authors provide deep insights into media representations of COVID, from individual nations or specific social media platforms to transnational and even global contexts.

Socioeconomic status and school absenteeism: A systematic review and narrative synthesis

School absenteeism is detrimental to life course outcomes and is known to be socioeconomically stratified. However, the link between socioeconomic status (SES) and school absence is complex given the multidimensional nature of both family SES (e.g., income, education, occupational status) and absenteeism (e.g., truancy, sickness, suspension). Despite the vast literature on socioeconomic inequalities in school attendance, no systematic review on SES and school absenteeism exists. This study systematically reviewed and provides a narrative synthesis of journal articles (n = 55) published between 1998 to 2019 on the association between SES dimensions and forms of absenteeism. The majority of studies from high-income contexts found an association between SES and absenteeism in the expected direction, albeit on average with small effect sizes. Studies largely confirmed these findings among populations at risk of school absence and those from low- and middle-income countries. There was greater evidence for an association between absenteeism and SES measured at the family than the school level. Studies using SES measures of financial resources (e.g., free or reduced-price lunch) provided more evidence for this association than studies measuring sociocultural resources (e.g., parental education). We found limited evidence that socioeconomic gaps in absenteeism vary by the reasons for absence. Research on the mediating pathways between SES and absenteeism is sparse. A key implication is that attempts to address inequalities in educational outcomes must include tackling SES gaps in school attendance. Context and implicationsRationale for this studyOur narrative review synthesised the literature on socioeconomic status (SES) and school absenteeism. Why the new findings matterInequalities in school absenteeism may partly account for socioeconomic disparities in children’s academic achievement. We found that lower SES is associated with higher levels of absenteeism in most of the studies we reviewed, including among disadvantaged groups.Implications for policy-makers and practitionersGiven robust evidence that school absences are detrimental to children’s academic achievement, policy-makers and practitioners need to place an explicit focus on addressing socioeconomic disparities in school attendance in order to close SES achievement gaps. This will be particularly important in tackling the consequences of Covid-19 related school closures around the world. An intersectional approach that addresses multiple disadvantages should be adopted to tackle inequalities in school attendance. Researchers should address several gaps, such as directly comparing SES effects across different reasons for absenteeism and examining the mechanisms by which SES leads to absenteeism. © 2021 The Authors. Review of Education published by John Wiley & Sons Ltd on behalf of British Educational Research Association.

COVID-19 and damage to the olfactory system causing anosmia

Objective: To list studies that show the relationship of long-term damage to the sense of smell in adult patients with COVID-19 (coronovirus disease), in order to facilitate access to information on the management of this sequel and thus address the problem. COVID-19, caused by SARS-CoV-2, emerged in the East Asian region and became a pandemic causing the death of millions of individuals. Fever, dyspnea, cough, arthralgia, myalgia, headache, rhinorrhea and diarrhea are the most prevalent symptoms, in addition to olfactory and taste changes, which commonly cause anosmia and dysgeusia. This literature review aims to list the relationships between long-term damage to smell in patients with Covid-19 and its possible treatment. Thus, we carried out a narrative review of the literature in the PUBMED database with the following keywords: "smell of loss";"Covid-19";"Chronic damage". Thus, we found seven articles, and two articles were discarded, the first for relating olfaction loss by COVID-19 in children only, a rare fact in this age group. And the second, for escaping the topic.

Myopia and damage due to excessive use of screens in the middle of the COVID pandemic -19: literature review

Myopia is an ophthalmological abnormality prevalent among human beings, it is characterized by the formation of an image anteriorly to the retina, with the ciliary muscle at rest. We can list genetics and environment as conditioning factors of this pathology;in the meantime, this last factor has acquired great importance nowadays, in view of the growing exponential increase in the use of electronic screens. This literature review aims to list the relationships between myopia and the overuse of screens. In this context, it is necessary to review the main international publications on this health problem in children under 4 years of age. Thus, we carried out a literature review in the PUBMED database with the following keywords: "Myopia";"Use of Digital Devices";"children", "computer", "covid". Although the relationship between the pandemic and the repercussions for ophthalmic health proposed in this work is an extremely relevant topic, it is known that there is still a need for further studies.

Automatically Selecting Striking Images for Social Cards

To allow previewing a web page, social media platforms have developed social cards: visualizations consisting of vital information about the underlying resource. At a minimum, social cards often include features such as the web resource's title, text summary, striking image, and domain name. News and scholarly articles on the web are frequently subject to social card creation when being shared on social media. However, we noticed that not all web resources offer sufficient metadata elements to enable appealing social cards. For example, the COVID-19 emergency has made it clear that scholarly articles, in particular, are at an aesthetic disadvantage in social media platforms when compared to their often more flashy disinformation rivals. Also, social cards are often not generated correctly for archived web resources, including pages that lack or predate standards for specifying striking images. With these observations, we are motivated to quantify the levels of inclusion of required metadata in web resources, its evolution over time for archived resources, and create and evaluate an algorithm to automatically select a striking image for social cards. We find that more than 40% of archived news articles sampled from the NEWSROOM dataset and 22% of scholarly articles sampled from the PubMed Central dataset fail to supply striking images. We demonstrate that we can automatically predict the striking image with a Precision@1 of 0.83 for news articles from NEWSROOM and 0.78 for scholarly articles from the open access journal PLOS ONE. © 2021 ACM.

Telehealth in primary care: Meeting patient and family needs

Background: Telehealth is a novel way to provide care to patients and families and may be especiallyimportant for families with transportation challenges. The COVID-19 pandemic with social distancingrequirements further accelerated the need for the utilization and expansion of telehealth services. Objective:To evaluate the feasibility of rapidly scaling primary-care telehealth and its impact on families' location of careand associated transportation costs. Methods: A retrospective study was conducted at a large, urban,academic primary care center consisting of 6 primary care sites, with approximately 85% of patients coveredby Medicaid. In February 2020, just prior to the COVID-19 pandemic, telehealth was launched for routinefollow-up of chronic medical conditions (e.g., ADHD, asthma) and acute complaints (e.g., rashes) two half-daysper week. Due to COVID-19, rapid escalation of telehealth was necessary and during these telehealth visits,families were asked the location of care they would have chosen if telehealth was not available (in-personprimary care, Emergency Department (ED), Urgent Care (UC), or opt for no care). Miles saved (measured bydistance from family residence zip code to the hospital main campus where the ED, UC, and most primary care sites are located) and cost saved (as measured by federal reimbursement amounts for mileage) weredetermined from demographic information in the electronic health record. Results: Five physicians trained anadditional 16 clinicians over 2 weeks, providing the ability to expand telehealth to six days per week. FromFebruary-March 2020, 245 unique telehealth encounters were completed. Providers asked 60% (n=147) offamilies where they would have sought in-person care if telehealth was not available, with the largest percent(68.7% (n= 101)) indicating a primary care visit. In addition, 14.2% (n= 21) of families reported intent to visit theED, 4.8% (n=7) an UC and 12.2% (n=18) would have opted for no care. Regarding savings related to distance toan alternative location of care, families saved an average of 16 miles ($9.30) for an in-person primary care visit,13 miles ($7.19) for an ED visit, and 11.4 miles ($6.23) for an urgent care visit. Families who would have optedfor no care lived the farthest, with an average 21 miles. A substantial percent of families (19%;n=28) reportedthat they would have sought more costly care options (ED or UC). Conclusion: Rapid scaling of primary carebased telehealth was feasible serving a mostly publically insured population. The majority of families reportedthat without telehealth, they would have sought in-person visits, but those who lived farthest would not havesought care. Telehealth appears to be a cost saving alternative for families and the medical system. Next stepsinclude a trial of social risk and mental health screening during telehealth visits.

Ethical guides, criteria for admission in intensive care, palliative care. Multi-society recom mendations for allocation of resources during the covid-19 pandemic

Guidelines on resource allocation, ethics, triage processes with admission and discharge criteria from critical care and palliative care units during the pandemia are here presented. The interdisciplinary and multi-society panel that prepared these guidelines represented by bioethicists and specialists linked to the end of life: clinicians, geriatricians, emergentologists, intensivists, and experts in palliative care and cardiopulmonary resuscitation. The available information indicates that approximately 80% of people with COVID-19 will develop mild symptoms and will not require hospital care, while 15% will require intermediate or general room care, and the remaining 5% will require assistance in intensive care units. The need to think about justice and establish ethical criteria for allocation patients arise in conditions of exceeding available resources, such as outbreaks of diseases and pandemics, with transparency being the main criterion for allocation. These guides recommend general criteria for the allocation of resources relies on bioethical considerations, rooted in Human Rights and based on the value of the dignity of the human person and substantial principles such as solidarity, justice and equity. The guides are recommendations of general scope and their usefulness is to accompany and sustain the technical and scientific decisions made by the different specialists in the care of critically ill patients, but given the dynamic nature of the pandemic, a process of permanent revision and adaptation of recommendations must be ensured.