Original Mixed Methods Research Experiences, Service Needs, and Impacts of Workplace Safety and Insurance Board (WSIB) processes on injured and ill workers: evidence from the city and district of Thunder Bay (Ontario, Canada)

Introduction: Individuals experience negative physical, social and psychological ramifications when they are hurt or become ill at work. Ontarios Workplace Safety and Insurance Board (WSIB) is intended to mitigate these effects, yet the WSIB process can be difficult. Supports for injured workers can be fragmented and scarce, especially in underserved areas. We describe the experiences and mental health needs of injured and ill Northwestern Ontario workers in the WSIB process, in order to promote system improvements. Methods: Community-recruited injured and ill workers (n=40) from Thunder Bay and District completed an online survey about their mental health, social service and legal system needs while involved with WSIB. Additional Northwestern Ontario injured and ill workers (n=16) and community service providers experienced with WSIB processes (n=8) completed interviews addressing similar themes. Results: Northwestern Ontario workers described the impacts of workplace injury and illness on their professional, family, financial and social functioning, and on their physical and mental health. Many also reported incremental negative impacts of the WSIB processes themselves, including regional issues such as "small town" privacy concerns and the cost burden of travel required by the WSIB, especially during COVID-19. Workers and service providers suggested streamlining and explicating WSIB processes, increasing WSIB continuity of care, and region-specific actions such as improving access to regional support services through arms-length navigators. Conclusion: Northwestern Ontario workers experienced negative effects from workplace injuries and illness and the WSIB process itself. Stakeholders can use these findings to improve processes and outcomes for injured and ill workers, with special considerations for the North.

DIARRHEA, ELEVATED AST, AND ELEVATION OF INFLAMMATORYRELATED BIOMARKERS IS A PREDICTOR FOR MORTALITY IN MINORITY HOSPITALISED COVID-19 PATIENTS

Background and Aims: Initial reports on US COVID-19 showed different outcomes in different races. In this study, we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. Methods: We analyzed data from hospitalized COVID- 19 patients (n=5,852) from 8 hospitals. Demographics, comorbidities, symptoms and laboratory data were collected. Results: The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and dead patients' mean ages were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, and EA were 14.8%, 7.3%, and 16.3%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation, respiratory failure, shortness of breath (SOB) (p<0.01), fatigue (p=0.04), diarrhea (p=0.02), and increased AST (p<0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had a higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables were age (over 45 years old), male sex, EA, patients hospitalized in Indiana, Michigan, Georgia, and District of Columbia. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP, and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID- 19 death in our cohort. Conclusion: Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, predictors of mortality include male gender, diarrhea, elevated AST, comorbidities, respiratory symptoms and failure, and elevation of inflammatory- related biomarkers. These findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to a high frequency of comorbidities and older age among AA.

COVID19 PATIENTS IN A TERTIARY HOSPITAL IN WASHINGTON DC: EFFECTS OF COMORBIDITIES AND GASTROINTESTINAL SYMPTOMS ON OUTCOME

Background: Coronavirus disease 2019 (COVID19) disproportionately struck minority populations.It is important to find out the determinants of such differences in outcomes. Methods:We collected data on 403 hospitalized COVID19 patients at Howard University Hospital.Statistical analysis of symptoms, comorbidities, and lethality was performed using SPSS.Results: There were 257 (63.7%) African Americans (AAs), 102 (25.3%) Hispanics, and 26(6.45%) Whites. The mean age was 55.6 years old (+/-18.5). However, the Hispanic's meanage was the lowest (43.66 years vs. 61.23 for Whites vs. 60 for AAs). 64 (15.8%) patientsdied. Age and race were risk factors for poor outcomes. Elevated Creatinine, Ferritin, CRPand D-dimers were associated with death (35.75% vs. 2.61%), (24.72% vs. 9.9%), (22.7%vs. 7.8%), and (21% vs. 0%), respectively. Hydroxychloroquine treatment did not associatewith a better prognosis (25.92% vs. 14.23%). Abdominal pain, anorexia, diarrhea, nausea,and vomiting did not have any effect on the outcome. Elevated liver enzymes associatedwith poor outcome. There was more mortality in patients with cardiac diseases (25.67%vs. 14.33). Immunocompromised patients had a higher mortality rate (40% vs. 15.31%).Cough and fever were the top symptoms in our patients, but they were unrelated to theoutcome. As for treatment, patients receiving glucocorticoid displayed higher mortality(39.1% vs. 11.8%). Also, patients with shortness of breath (21.6 vs. 7.3%), those undergoingIntubation (66.6% vs. 14.5%), and mechanical ventilation (70.1% vs. 5.1%) had a highmortality rate. Conclusion: Overall, elevated liver enzymes, ferritin, CRP, and D-dimers arerobust markers of poor prognosis. The African Americans in our study displayed the highestmortality as they consisted of an older population when compared to the Hispanic group.GI symptoms did not correlate with outcome, however, they are likely important to followas the virus persists within the GI system, even after clearing from the respiratory system.

Clinical Characteristics, Gastrointestinal Manifestations And Outcomes Of Covid-19 Patients Among Minorities In The Usa

Background: It Is Well Known That Minorities Have Lower Access To Healthcare And At The Same Time Are Widely Affected By Many Comorbidities. This Predisposes Them To Worse Outcomes Compared To Others In The Current Pandemic. We Aimed To Study The Gastrointestinal (Gi) Symptoms, Comorbidities, And Clinical That Associate Covid-19 Outcomes In These Populations. Methods: We Analyzed Prospective And Retrospective Data From Sars-Cov-2 Positive Hospitalized Patients (N=5,932) From 9 Hospitals Including New York (3 Hospitals), Indiana, Rhode Island, District Of Columbia, Georgia, Michigan, And Maryland Between March And September 2020. Demographics, Comorbidities, Clinical Symptoms, And Median Laboratory Values Were Collected. The Primary Outcome Was The Rate Of In-Hospital Death. Secondary Outcomes Included Frequency And Duration Of Invasive Mechanical Ventilation, Frequency Of Treatment, And Liver Function Following Admission. Statistical Analysis Of Symptoms, Comorbidities, And Lethality Was Performed By Using Spss. Results: There Were 3713 With (62.7%) African Americans (Aa), 294 (5%) Hispanics, 1,418 (23.9%) Whites, 94 (1.5%) Asian, And 187 (3.2%) Others, 64 (1.1%) Decline, 150 (2.5%) Unknown. From 5,631 Known Ethnicity, The Average Age For Alive And Dead Was, 58 And 68 For Aa, 58 And 77 For Whites, 44 And 61 For Hispanic, And 51 And 63 Years For Asians. Males Were 47%, 41%, 47%, And 43% Among Aas, Hispanics, Whites, And Asians, Respectively. Lethality Rates Were 14.3%, 6.4%, 15.6%, Among Aas, Hispanics, And Whites, Respectively. In Chi-Squared Analysis, An Association With Lethality Was Found For Elevated Bun 14 (21.10%), Creatinine 14 (21.10%), Ferritin, Crp 304 (16.20%), D-Dimers 267 (18.00%), Ast 264 (21.10%), Prc, Troponin, Low Hemoglobin, Coronary Artery Disease, Cancer, Cardiac Disease, Hypertension (18.8%), Copd, Diabetes 281(17.20%), Diarrhea14 (21.10%), Fatigue 14 (21.10%). Use Of Glucocorticoid, Intubation, Mechanical Ventilation, Respiratory Failure, Shortness Of Breath Correlated With Death In A Significant Manner. Male Gender 311 (18.00%) And White And African Races Have A Higher Rate Of Death. These Symptoms And Commodities Were Seen Across The Board In All Races, However, Diarrhea Was Among The Most Common Gi Symptom In African Americans 50 (21.90%). Conclusion: Our Study Is Among The Largest Minority Covid-19 With Gi Manifestation That Shows Diarrhea And Elevated Liver Enzyme Ast Is Associated With Death. High Lethality Rate In African Americans In Comparison With Hispanics Is Likely Related To High Frequencies Of Comorbidities Such As Cardiovascular (Hypertension), And Diabetes. Prospective Investigations Will Likely Help A Better Characterization Of Minority Covid-19 Patients And A Better Understanding Of Factors Underlying The Observed Disparities

Facteurs associés à la durée d’hospitalisation des patients hospitalisés pour pneumopathie à COVID-19 dans le service de pneumologie du CH Chauny

Introduction La corona virus disease 19 (COVID-19) sévit dans le monde depuis décembre 2019. Ses principaux facteurs de risque sont : un âge avancé, les maladies pulmonaires et rénales chroniques, le diabète, l’hypertension artérielle, l’obésité et les néoplasies [1], [2]. Ce travail a pour but de décrire les aspects cliniques, paracliniques, thérapeutiques, évolutifs des patients hospitalisés pour COVID-19 dans le service de pneumologie du centre hospitalier (CH) Chauny et les facteurs associés à leur durée d’hospitalisation. Méthodes Il s’agit d’une étude prospective, descriptive et analytique qui s’est déroulée dans le service de pneumologie du CH Chauny du 1er février au 30 avril 2021. Tous les patients admis pour infection à COVID-19 diagnostiquée soit par le test antigénique, soit RT-PCR ou par un scanner thoracique ont été inclus. Résultats Au total, 87 patients soit 63,9 % de l’ensemble des admissions dans le service durant la période d’étude ont été inclus. Il y avait une prédominance masculine avec un sex-ratio de 1,2. L’âge moyen était de 71,8±15 ans avec des extrêmes de 32 et 97 ans. Les principaux antécédents médicaux étaient l’hypertension artérielle 60 % (52/87), le diabète 29 % (25/87) et la BPCO 15 % (13/87). Les patients admis en USIR représentaient 17 % des cas (15/87). La rentabilité diagnostique était de 96 % (73/76) pour le scanner thoracique, 93 % (54/58) pour le RT-PCR et 71 % (32/45) pour le test antigénique. L’oxygénothérapie a été administrée à 72 patients (82,8 %) et dans 8 cas, l’oxygène a été délivré par le système d’Optiflow. L’évolution a été favorable dans 80,5 % (70/87) des cas et défavorable dans 19,5 % (17/87). Il a été noté 13 décès (14,9 %) dont 11 dans les 15 premiers jours suivants l’hospitalisation et 4 patients (4,6 %) ont été transférés en réanimation. En analyse multivariée, un âge supérieur ou égal à 65 ans était associée à une durée d’hospitalisation plus longue (p=0,0003) et une saturation pulsée en oxygène haute à une plus courte durée d’hospitalisation (p=0,002). Conclusion Les facteurs associés à la durée d’hospitalisation des patients atteints de la pneumopathie à COVID-19 sont à prendre en compte afin d’optimiser leur prise en charge.

Dosage de la vitamine D chez les patients hospitalisés pour pneumopathie à Covid-19 dans le service de pneumologie du CH Chauny, France

Introduction La Covid-19 est un problème de santé publique dans le monde. C’est une affection qui présente encore des zones d’ombre. Il n’existe à ce jour aucun traitement curatif d’où les nombreuses recherches. La vitamine D, hormone immunomodulatrice, semble avoir un effet anti-inflammatoire dans les infections respiratoires et la Covid-19 [1], [2]. La présente étude a pour objectif d’évaluer l’impact de la vitamine D sur l’infection à Covid-19. Méthodes Nous avons réalisé une étude prospective, descriptive et analytique qui s’est déroulée dans le service de pneumologie du centre hospitalier de Chauny (France) du 1er février au 30 avril 2021. Nous avons inclus tous les patients hospitalisés pour infection à Covid-19 durant cette période et chez qui le dosage de la vitamine D avait été réalisé. Résultats Nous avons inclus 49 patients sur un ensemble de 87 patients admis pendant la période soit 56,32 % de cas. Le sex-ratio était de 1,3. L’âge moyen était de 75±14 ans. Les antécédents étaient l’hypertension artérielle 53,06 % (26/49), le diabète 26,53 % (13/49) et la BPCO 10,2 % (5/49). Les symptômes fréquemment retrouvés sont la dyspnée et la fièvre dans respectivement 75,51 % (37/49) et 44,9 % (22/49) des cas. Le surpoids était retrouvé dans 32,65 % (16/49) suivie de l’obésité 26,53 % (13/49). Le diagnostic de l’infection à Covid-19 était fait par le test antigénique 57,7 % (15/26), la RT- PCR 90,9 % (30/33) et le scanner thoracique 97,7 % (42/43). L’insuffisance en vitamine D était retrouvée dans 67,34 % des cas (33/49). L’évolution était favorable dans 85,7 % des cas. Nous avons noté 7 décès dont 5 chez des patients avec insuffisance de vitamine D. L’existence d’une insuffisance en vitamine D n’était pas statistiquement liée au sexe, à l’âge, à la durée de séjour, à l’existence d’une comorbidité, à la positivité des tests et à l’évolution de la maladie. Conclusion La supplémentation en vitamine D permet de prévenir les infections respiratoires aiguës en modulant la réponse inflammatoire. Il apparaît nécessaire d’approfondir les recherches concernant son impact sur la Covid-19.

[Impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital]. / Impact de la pandémie de COVID-19 sur les activités du service de cardiologie de l'hôpital national Ignace Deen du CHU de Conakry.

The new coronavirus pandemic (COVID-19) is the main global health crisis of our time and the greatest threat we have faced in this century. According to the National Health Security Agency (ANSS), which is the national body responsible for managing epidemics and pandemics, 1927 cases of COVID-19 were confirmed, 11 deaths with more than 4000 contact subjects. The objective of this study was to assess the impact of the COVID-19 pandemic on the activities of the cardiology department of the Ignace Deen National Hospital at the Conakry University Hospital. This was a descriptive retrospective study from January 2020 to April 2020, focusing on consultation and hospitalisation activities in the cardiology department of Ignace Deen National Hospital at Conakry University Hospital. The study consisted of assessing the impact of the pandemic on patient use of the service during the first weeks of the pandemic. We recorded the frequency of consultations and hospitalisations from March to April 2020, which we compared to the frequency of consultations and hospitalisations in January and February 2020. During this study from March to April 2020, we identified 130 patients in consultation against 450 patients for the two months preceding the official declaration of the pandemic in Guinea, a drop of 71.1% (320 patients). The same remark was made in hospitalisation with a drop of 75% (35 patients against 140 for the two months preceding the pandemic). At the start of the COVID-19 pandemic in Guinea, it is clear that there has been a rapid and significant drop in the effective use of the cardiology service.