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Objectives: Site-specific wastewater surveillance could potentially control COVID-19 outbreaks more effectively at long-term care facilities (LTCF). It could identify the presence of pre-symptomatic and asymptomatic COVID-19 infections in the facility and therefore initiate timely outbreak control measures. Besides, compared to repetitive screenings of residents and staff using diagnostic tests, screenings based on positive wastewater test results incur fewer costs and less discomfort. We evaluated the effectiveness of LTCF-site-specific wastewater surveillance in preventing COVID-19 outbreaks, by comparing the scenario where more diagnostic tests were initiated due to positive wastewater test results and the base case of no action. Method(s): We built a susceptible-infected-cases-recovered model to study COVID-19 transmission at LTCF under the base-case and wastewater surveillance scenario. We used data from an outbreak during the Omicron wave in one LTCF in Edmonton, Canada (December 2021 - March 2022), where wastewater data did not initiate actions. We fit base-case model parameters with daily cases and testing data using the nonlinear least-squares method. We hypothesized 10%-50% more diagnostic tests in the wastewater scenario. We compared the outbreak size, i.e., predicted numbers of infections, to measure the effectiveness. We used the Mann-Whitney U test to identify whether the outbreak size in the wastewater scenario was significantly smaller. Result(s): Results reported are subject to minor changes as modelling work is ongoing. The number of infections peaked on day 25 in the base case, with 23.8% of individuals being infected. In the wastewater scenario, all hypothesized values resulted in a significantly smaller outbreak size;only 10% more diagnostic tests could lead to 5.4% fewer infections (p=0.03) at the peak. Conclusion(s): This pilot study demonstrates the potential effectiveness of LTCF-site-specific wastewater surveillance to prevent COVID-19 outbreaks. Future works include engaging policymakers in analyzing specific wastewater-based actions and estimating the costs of controlling COVID-19 to explore the cost-effectiveness of wastewater surveillance.Copyright © 2023
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INTRODUCTION: The COVID-19 pandemic has revealed the weakness of the internet as a resource for medical information. YouTube is a common source patients search, especially regarding surgeries. YouTube and the National Academy of Medicine (NAM) have collaborated to accredit videos from reputable sources to identify them as trustworthy resources. It remains undefined whether high quality resources are available to inform patients pending cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), In this study, YouTube search results for HIPEC are critically appraised for the quality of information and visual aids presented to patients seeking information online. METHOD(S): The first 100 YouTube search results for HIPEC less than 10 minutes long in English with audio and/or text were transcribed. The Flesch-Kincaid score defined the reading grade level. High content quality videos were accredited by the National Academy of Medicine (NAM) or mentioned the standard components necessary for a surgical consent. The Anderson-Lau score is a composite of these criteria ranging from 0-8. The simplicity of videos for patient education was graded from poor to high quality by the DISCERN tool. The quality of audiovisual aids was evaluated using the Patient Education Materials Assessment Tool (PEMAT) which is graded from 0-100%. RESULT(S): A total of 96 videos met the inclusion criteria. The threshold of 100 videos was not reached because the remaining videos were all over 10 min or not in English. The median number of views was 798. The most common video publishers were Academic or Research Centers (37.5%) and News or Media Outlets (30.2%). The most common intended audiences were Patients (73%) and Physicians (16.7%). Over half of the videos (53.1%) did not have NAM accreditation. The median Anderson-Lau, PEMAT understandability and DISCERN scores were 2, 56.4%, and Poor respectively. Only 1 video scored as high quality by DISCERN metrics. Only 11.5% of the videos were at a 6-8th grade reading level, which is considered the reading level for average Americans. Higher Anderson-Lau, PEMAT, or DISCERN scores were not associated with NAM accreditation. CONCLUSION(S): CRS/HIPEC is a treatment option for advanced metastatic cancers. Using the Anderson-Lau, DISCERN, and PEMAT scores, most internet videos are poor quality regardless of NAM accreditation. These three tools could be used in a concerted effort to design higher quality resources about CRS/HIPEC to better educate patients on such a consequential operation.
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Case report Cytomegalovirus (CMV) causes latent asymptomatic infection in most adults worldwide. Immunodeficiency or immune activation can disrupt viral suppression and lead to viral reactivation, occasionally causing a mononucleosis-like illness in otherwise healthy immunocompetent people. A 37-year- old female presented with a 10-day history of fevers, chills, right-sided neck tenderness, rapidly expanding rash, as well as myalgia, arthralgia, and weakness. She had received her first dose of tozinameran (Pfizer-BioNTech COVID-19 mRNA vaccine) 11 days prior to symptom onset. She was admitted to hospital for further investigations, and was seen by an allergy/clinical immunology specialist, with the diagnosis initially felt to be a delayed serum sickness-like reaction to the vaccine. On admission to hospital, the patient was febrile (37.8C) and tachycardic (122 beats/min). Her physical examination was remarkable for right-sided submandibular tenderness, diffuse blanchable, nonpruritic, erythematous, maculopapular rash, and mild facial swelling. There were no effused joints, lymphadenopathy, nor splenomegaly. Bloodwork showed pancytopenia and mild liver transaminase elevation. Blood cultures were negative. Multiple PCR tests for COVID-19 were negative. Monospot and serology for HBV, HIV, and B. burgdorferi were negative. CMV serology was positive, but unavailable until after discharge. ANA and rheumatoid factor were negative. CT head demonstrated nonspecific edema in the right submandibular area without abscess. On outpatient follow-up, the patient reported symptom resolution over two months. Repeat CMV titres two months post hospitalisation showed strongly elevated IgG, which upon consultation with infectious diseases was felt to represent CMV reactivation (Table 1). CMV viral load was negative. Pancytopenia resolved and transaminases normalized. She received her second dose of tozinameran 4 months post first dose with prophylactic valacyclovir 1g once daily for 1 week prior to and 1 week post vaccination as recommended by infectious diseases and remained asymptomatic. This case is the first known description of CMV reactivation secondary to COVID-19 vaccination. It may be underdiagnosed due to nonspecific symptomatology, as CMV seropositivity ranges from 60-100% of all adults. While causality has yet to be established, recognition of this condition may allow appropriate treatment and prophylaxis in order to facilitate safe COVID-19 vaccination in affected individuals. The patient has provided verbal consent through the telephone for the publication of this case report due to the current COVID-19 pandemic, with written consent to follow.
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Objective: There are limited studies on the safety and efficacy of high flow nasal cannula (HFNC) utilization in pediatric critical care transport (CCT). This 15-month retrospective study was designed to describe HFNC utilization by our transport team and to track escalations in respiratory support within 24 hours of hospital admission including increased liter flow, non-invasive ventilation (NIV), or intubation. Method(s): This study was conducted at a large quaternary free standing children's hospital with a dedicated pediatric transport team that completes an average of 5,500 transports per year. Data was collected from January 1, 2019, to March 31, 2020. A total of 6,279 pediatric transports were completed during the study period. Inclusion criteria: >30 days and <18 years old, required HFNC >=4 L/min during transport, and admitted to our pediatric facility. Our institutions HFNC pediatric floor (Peds) criteria: <2 years of age, no comorbidities, suspected respiratory viral illness, max 2 L/kg and/or 15 L/min, <=40% FiO2. All patients used the standard HFNC equipment in our department. No new equipment was trialed during this study. We did not include SARS-COVID-19 patients given the initial variability in non-invasive respiratory support. Result(s): A total of 382 charts reviewed;358 patients met inclusion criteria. Median age 0.7 years old, with an interquartile range (IQR) of 0.3-1 year of age. Median weight 8.4 kilograms (kg), IQR 6.2-11 kg. Median transport time 80 minutes (min), IQR 69-115 min. Most of our HFNC volume was initiated by the referral (279, 78%) and we initiated the remainder (79, 22%). The majority of our HFNC patients were transported from the (ER) (184, 51%) and Peds (119, 33%) with the remainder being from urgent care (UC) (42, 12%), and Pediatric Intensive Care Unit (PICU) (13, 4%). We transported (210, 41%) back to the PICU versus (148, 41%) to Peds. Of the 279 patients that were on HFNC started by the referral, 42 (15%) had their flow weaned by the transport team. Median HFNC 10 L/min with an IQR of 6-15 L/min appreciated at drop-off regardless of HFNC status (initiated by transport, weaned by transport, or continued referral settings) (p-value 0.122). Escalations of care were tracked up to 24 hours after patient drop-off. A total of 118 patients (33%) had an escalation of care;90 (76%) required an increase in flow, 28 (24%) required NIV, and 0 (0%) required intubation within 24 hours. Escalations of care typically occurred within the first 6 hours after patient drop-off, 96 (27%), with a median HFNC 10.25 L/min, IQR 8-14 L/min (p-value range <=0.310). Conclusion(s): Our data suggests HFNC utilization in pediatric patients during CCT is a safe modality for non-invasive oxygen delivery with minimal risk of escalation requirement and no need for intubation. The number of escalations in liter flow after patient drop-off (~25% of high flow volume) was likely due to inpatient protocol to place all HFNC patients on 2 L/kg or max of 15 L/min. In the future, we plan to implement a HFNC protocol for management guidelines during CCT while conducting further research and review.Copyright © 2022
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The COVID-19 pandemic has negatively affected the tourism and services sector. Using the example of Airbnb's recent layoff of 25% of its workforce, we focused on the role of organizational justice in mitigating the negative psychological impacts of layoffs. Based on a unique survey of Airbnb employees who survived the layoffs, as well as those who left, we employed an ordinary least squares regression to show that employees' perceptions of organizational justice were positively related to their job satisfaction and trust in management, while being negatively related to their emotional exhaustion and cynicism. We discovered the crucial importance of interactional justice (i.e., interpersonal and informational justice). The respect, dignity, and politeness shown by management (i.e., interpersonal justice), as well as truthful and adequate communication about the procedure (i.e., informational justice) were pivotal to successfully conducting layoffs, especially during unprecedented economic uncertainty. © 2023 by the authors.
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This paper presents a computational approach designed to construct and query a literature-based knowledge graph for predicting novel drug therapeutics. The main objective is to offer a platform that discovers drug combinations from FDA-approved drugs and accelerates their investigations by domain scientists. Specifically, the paper introduced the following algorithms: (1) an algorithm for constructing the knowledge graph from drug, gene, and disease mentions in the biomedical literature;(2) an algorithm for vetting the knowledge graph from drug combinations that may pose a risk of drug interaction;(3) and two querying algorithms for searching the knowledge graph by a single drug or a combination of drugs. The resulting knowledge graph had 844 drugs, 306 gene/protein features, and 19 disease mentions. The original number of drug combinations generated was 2,001. We queried the knowledge graph to eliminate noise generated from chemicals that are not drugs. This step resulted in 614 drug combinations. When vetting the knowledge graph to eliminate the potentially risky drug combinations, it resulted in predicting 200 combinations. Our domain expert manually eliminated extra 54 combinations which left only 146 combination candidates. Our three-layered knowledge graph, empowered by our algorithms, offered a tool that predicted drug combination therapeutics for scientists who can further investigate from the viewpoint of drug targets and side effects. © 2022 IEEE.
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Despite appearing positive, the model minority myth (MMM), or the perception that Asian Americans are "problem-free" minorities, maintains unfair racial hierarchies and discredits the pervasiveness of systemic racism faced by Asian Americans and other Black, Indigenous, and people of Color. This study investigated the role of internalized MMM in Asian/Asian Americans' (A/AA) experiences during the syndemic of COVID-19 and our society's racial reckoning. Using a mixed methods approach, we analyzed A/AA college students' open-ended responses to a query about their experiences as A/AA during COVID-19, which resulted in qualitative themes of Personal and Vicarious Discrimination, Vigilance, Safety due to Ethnicity, Safety due to Environment, and No Difference during COVID-19. We then conducted a series of logistic and linear regression models to examine how internalized MMM and sociodemographic factors (i.e., ethnic group, gender, and generational status) were associated with qualitative themes and quantitative measures of COVID-related discrimination. Overall, findings demonstrated that greater internalized MMM, as well as identifying as South Asian, male, and an international/first-generation immigrant student, were linked to fewer qualitative and quantitative reports of vicarious discrimination. We conclude with implications for research and practice in community psychology that further examine the racialized experiences among A/AA college students and ultimately seek to challenge the MMM and racial hierarchies perpetuating systems of oppression.
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The clinical severity of coronavirus disease 2019 (COVID-19) in children is usually mild. Most of the affected patients completely recovered from COVID-19 before being released from approximately 7-day quarantine. However, children with comorbidities are at risk of more severe disease and adverse outcomes. We report three cases of COVID-19-affected adolescents with underlying chronic respiratory difficulty due to neurologic diseases who showed sudden clinical aggravations at the time of discharge, even after full clinical improvement. Patient 1 is a 17-year-old boy with Ullrich congenital muscular dystrophy who had cardiopulmonary arrest 9 days after the initial COVID-19 symptoms. Patient 2 is a 17-year-old girl with intracerebral hemorrhage with infarction in bed-ridden status who had cardiopulmonary arrest 11 days after the initial symptoms. Patient 3 is a 12-year-old boy with intraventricular hemorrhage with hydrocephalus in bed-ridden status who showed multiorgan failure 10 days after the initial symptoms. Remdesivir, dexamethasone, and empirical antibiotics were administered with mechanical ventilation and intensive unit care. Among the three patients, two (patients 1 and 3) were alive, and one (patient 2) expired. Clinicians caring for adolescents with chronic neurologic and/or pulmonary disease should keep in mind that these patients could have sudden deterioration after recovery from the acute phase of COVID-19 around or after the time of discharge. © 2022 The Korean Society of Pediatric Infectious Diseases.
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Background: The widespread of the newly emerged infectious human disease labeled coronavirus 2019 (COVID-19) has caused a prolonged public health crisis of pandemic proportions. The emergence and severe consequences of COVID-19 heightened anxieties and concerns. The Fear of COVID-19 Scale (FCV-19S) was developed recently to specifically measure the fear sensed by an individual about COVID-19. This study aimed to establish the factor structure, reliability, and validity of the Korean version of the FCV-19S (KF-COVID-19S) in the context of a Korean university. Methods: Data were collected from 402 university students enrolled in undergraduate degree programs at a private university in the central region of South Korea. The sample was randomly bifurcated to execute exploratory factor analysis (EFA, N = 201) and confirmatory factor analysis (CFA, N = 201). Cronbach's alpha reliability coefficient was also applied to assess consistency. Results: Both the EFA and CFA supported a two-factor model: factor 1 (somatic symptoms) and factor 2 (emotional fear) were significantly correlated. Additionally, the two-factor model exhibited a superior fit to the data compared to the unidimensional and bifactor models. Cronbach's alpha revealed acceptable internal consistency. Conclusion: Our results suggest that the Korean version of the FCV-19S can multidimensionally assess the severity of fear of COVID-19. However, we recommend using the single FCV-19S total score for practical purposes, given the high correlation among factors, the robust reliability of the total scale, and items implying a higher order factor of the fear sensed by individuals toward COVID-19. © 2022 Lee and Kim.
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Korea's late nineteenth and early twentieth-century Chosŏn Dynasty is marked by evidence of climate change. A distinctive feature of this period was the frequent outbreak of plagues such as cholera, dysentery, and typhoid, especially among the less privileged. There was, consequently, a large-scale discontentment among the poor. In this milieu, some local Confucian scholars, dismayed by the prevailing corruption in the central government, withdrew themselves from government business, focused on studying imported Catholic texts from China, and converted to Catholicism. The emergence of indigenous religious movements also reflected this social reality. This paper explores the correlation among climate anomalies, decline in agricultural productivity, competition for limited common resources, heightened social inequality, and frequent plagues, and how Catholicism, an indigenous religious movement, and Protestant Christianity impacted and were impacted by these processes in Korea's late Chosŏn Dynasty. It also suggests missional implications of this in the post-Covid-19 era.
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According to the World Health Organization, Artificial Intelligence (AI) technology may assist in COVID-19 management. However, existing image segmentation using AI suffers from a lack of accuracy and explainability, which prevents its adoption in actual clinical practice. In this paper, we investigated an attention-based image segmentation method for COVID-19 CT imaging with enhanced interpretation capabilities. Specifically, we developed U-Net architecture-based for segmentation with attention coefficients to produce a salient feature map. We use the DICE score and accuracy to perform a comprehensive model evaluation. We compared to other well-known methods such as Light U-Net, COPLE-Net, and Res U-Net and demonstrated that attention U-Net is superior for COVID-19 segmentation tasks in terms of performance and explainability. We also developed the tool as a web-application with a graphic user interface with the goal to translate this AI-driven clinical decision-support system for real-world clinical use. © 2022 IEEE.
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Background. Children <=5 years of age have the highest rates of pneumococcal colonization and play an important role in the spread of pneumococcus. Our objective was to determine whether the public health measures (physical distancing, masking, and shelter-in-place orders) implemented to slow the spread of SARS-CoV-2 pandemic had an impact on pneumococcal colonization rates among children aged <=5 years with and without respiratory symptoms during the first year of SARS-CoV-2 pandemic (4/1/20 to 3/31/21). Methods. This is a single center retrospective cohort study. The study period was divided in 3 four-month periods to represent the initial period of strict adherence to public health measures (period 1: Apr-Jul), relaxation of some of these measures (period 2: Aug-Nov) and Northern hemisphere winter season (period 3: Dec-Mar). We used salvaged mid-turbinate samples obtained as part of routine care from patients without respiratory symptoms but screened for SARS-CoV-2 prior to surgery or aerosol generating procedures (asymptomatic) or from patients with respiratory symptoms tested for SARS-CoV-2 and/or other respiratory viruses (symptomatic). Samples were evaluated for pneumococcal colonization by real-time PCR using CDC lytA primers. Sample size was calculated based on the assumption of lower colonization rates in period 1 and gradual increase (10-15%) in the following study periods. Results. A total of 311 patients were included (185 asymptomatic and 126 symptomatic). Demographics, SARS-CoV-2 PCR and pneumococcal colonization results are shown in Table 1. Pneumococcal colonization rates for asymptomatic and symptomatic children were 14% and 22% (p=0.06), respectively. The odds of colonization of asymptomatic children were similar during period 2 (OR 0.96 [95%CI 0.34-2.67]) and period 3 (OR 0.53 [95%CI 0.17-1.62]), using period 1 as reference and after adjusting for age, sex, and SARS-COV-2 results. The odds of colonization of symptomatic children were also similar across the 3 study periods (period 2 OR 1.28 [95%CI 0.41-4.01] and period 3 OR 0.73 [95% CI 0.24-2.18]). Table 1. Characteristics of asymptomatic and symptomatic groups Conclusion. Pneumococcal colonization rates were not significantly impacted by public health measures implemented during the first year of the SARS-CoV-2 pandemic and did not correlate with SARS-CoV-2 positivity.
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Background. WW surveillance enables real time monitoring of SARS-CoV-2 burden in defined sewer catchment areas. Here, we assessed the occurrence of total, Delta and Omicron SARS-CoV-2 RNA in sewage from three tertiary-care hospitals in Calgary, Canada. Methods. Nucleic acid was extracted from hospital (H) WW using the 4S-silica column method. H-1 and H-2 were assessed via a single autosampler whereas H-3 required three separate monitoring devices (a-c). SARS-CoV-2 RNA was quantified using two RT-qPCR approaches targeting the nucleocapsid gene;N1 and N200 assays, and the R203K/G204R and R203M mutations. Assays were positive if Cq< 40. Cross-correlation function analyses (CCF) was performed to determine the timelagged relationships betweenWWsignal and clinical cases. SARS-CoV-2 RNA abundance was compared to total hospitalized cases, nosocomial-acquired cases, and outbreaks. Statistical analyses were conducted using R. Results. Ninety-six percent (188/196) of WW samples collected between Aug/ 21-Jan/22 were positive for SARS-CoV-2. Omicron rapidly supplanted Delta by mid-December and this correlated with lack of Delta-associated H-transmissions during a period of frequent outbreaks. The CCF analysis showed a positive autocorrelation between the RNA concentration and total cases, where the most dominant cross correlations occurred between -3 and 0 lags (weeks) (Cross-correlation values: 0.75, 0.579, 0.608, 0.528 and 0.746 for H-1, H-2, H-3a, H-3b and H-3c;respectively). VOC-specific assessments showed this positive association only to hold true for Omicron across all hospitals (cross-correlation occurred at lags -2 and 0, CFF value range between 0.648 -0.984). We observed a significant difference in median copies/ ml SARS-CoV-2 N-1 between outbreak-free periods vs outbreaks for H-1 (46 [IQR: 11-150] vs 742 [IQR: 162-1176], P< 0.0001), H-2 (24 [IQR: 6-167] vs 214 [IQR: 57-560], P=0.009) and H-3c (2.32 [IQR: 0-19] vs 129 [IQR: 14-274], P=0.001). Conclusion. WWsurveillance is a powerful tool for early detection andmonitoring of circulating SARS-CoV-2VOCs.Total SARS-CoV-2 andVOC-specificWWsignal correlated with hospitalized prevalent cases of COVID-19 and outbreak occurrence.
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Purpose - This paper analyzes all possible issues that need to be considered in case disputes occur with regard to force majeure in international commercial contracts through the comparative study between English and Korean during COVID-19. Design/methodology - This paper belongs to the field of explanatory legal study, which aims to explain and test whether the choice of law is linked to the conditions that occur in the reality of judicial practice. The juridical approach involves studying and examining theories, concepts, legal doctrines, and legislation that are related to the problem. Findings - English law does not permit general economic impracticability to qualify as a valid force majeure event. If a party asserts that they were prevented from performing the contract, the courts will examine this strictly. Many commercial contracts in a broad range of sectors and industries are chosen by parties to be governed by English law. With COVID-19, there have been discussion of parties being released from performance as a result of force majeure. Meanwhile, under Korean law, a force majeure event should be unforeseeable and beyond a party's control. Since COVID-19 is a known event for future contracts, to avoid the risk that a similar situation in the future is deemed foreseeable and under a party's control, parties must ensure that such a risk is properly addressed in a contract. Therefore, it is necessary to have a new clause to cover a pandemic. Originality/value - In light of the ongoing unexpected and uncertain economic impacts COVID-19 is expected to bring to the world, it is anticipated that companies will experience an increased number of claims involving force majeure around the world, including English and Korea. As such, taking proactive steps to assess the applicable legal principles, including the concept of force majeure of contract, will help companies be prepared for the financial or legal implications of COVID-19. In this regard, it would be advisable for companies and businesses to take specific actions.
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BACKGROUND: People experience higher levels of psychological distress during times of crisis, such as the current COVID-19 pandemic. Resilience is a psychological resource that helps people to recover from adverse events. OBJECTIVE: The purpose of this study was to determine the effects of resilience on COVID-19-related stress and worry about job loss in people with chronic conditions and disabilities (PwCID). METHODS: The Perceived Stress Questionnaire -8 (PSQ-8) and the Brief Resilience Scale were used to measure COVID-19-related stress and resilience, respectively. Demographics were also assessed. A two-step hierarchical regression and binary regression analyses were conducted. RESULTS: A moderate amount of perceived stress and resilience with mean scores of 2.45 (SD = 0.69;range 1-4) and 3.17 (SD = 0.98;range 1-5), respectively, were found among the 269 participants. Resilience (beta=-0.44, p < 0.001) was significantly associated with COVID-19-related stress after controlling for demographic variables. Results also revealed that those with higher resilience scores had lower probability to worry about job loss. CONCLUSION: PwCID who have higher scores on resilience reported lower levels of COVID-19-related stress. Resilience can be cultivated among PwCID for better psychological outcomes during times of crisis. Vocational rehabilitation counselors can implement strategies to improve resilience in PwCID.
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A global pandemic presents challenges and opportunities especially for artists with disabilities. Connect2Abilities is an inclusive intercultural collaboration project between an inclusive dance company, Restless Dance Theatre in Australia, and SNU MUSIC in Korea. This project employed the philosophy of Deleuze and Guattari's rhizomatic thinking with a belief that when creating “people-to-people” connections, different individuals' particular abilities interconnect, multiply, and grow as networks with no explicit center. Connect2Abilities was originally initiated as a face-to-face performing arts intercultural collaboration, yet due to the global pandemic, COVID-19, it had to pivot to virtual collaboration. Dialogue for Six Strings, a digital performing arts piece created for an online global public viewing, was developed by artists of all abilities, multiplying their separate creativities. A critical outcome from the experience underscores that the unforeseen pandemic motivated a technology-enabled collaboration based on shared skills and social engagement between heterogeneous groups, extending the borders of the aesthetic sphere. This project is evidence that opportunities outweigh challenges in a time of crisis, especially in terms of audience outreach, boosting morale, and creating positive social impact through the arts. © 2023 selection and editorial matter, Amanda Cachia;individual chapters, the contributors.
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OBJECTIVE: To address health disparities in the perinatal period (i.e., during pregnancy and through one year after birth) by exploring the intersectional experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women during the COVID-19 pandemic. In this study, participants were asked if and how COVID-19 had impacted their experiences of receiving healthcare, whether they had faced any challenges during this time, how they had navigated these challenges, and what recommendations they had for improving perinatal healthcare. METHODS: Between November 2021 and March 2022 our team conducted eight virtual focus groups comprising perinatal BIPOC women. A semi-structured interview protocol was used, and interviews were voice recorded and transcribed verbatim. The data were analyzed using reflexive thematic analysis. RESULTS: Three major themes common in BIPOC perinatal healthcare experiences during COVID-19 were generated through engaging in reflexive thematic analysis: (1) an overwhelming lack of support from providers, (2) experiences of blame and shame, and (3) difficulties navigating institutional policies that were unclear or ever-changing during the COVID-19 pandemic. Recommendations from participants included greater empathic communication from providers in the face of uncertainty during COVID-19, greater access to information and guidance for caring for themselves and their babies, and an overall request for greater compassion while navigating an exciting and busy time. RELEVANCE: These findings have implications for trauma-informed and inclusive perinatal care that can reduce the impacts of systemic inequalities for perinatal BIPOC women. This study offers a discussion of implications for future training for maternal health providers and implications for community-based programs.
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COVID-19 , Pregnancy , Female , Humans , COVID-19/epidemiology , Pandemics , Skin Pigmentation , Parturition , Qualitative Research , Delivery of Health CareABSTRACT
Background: The coronavirus disease 2019 pandemic has remarkably challenged preschool teacher candidates, triggering concerns for their psychological well-being and mental health. Valid and reliable instruments to assess elements of mental health are thus required. The self-rating Hospital Anxiety Depression Scale demonstrates promise as an instrument for the identification and quantification of the states of anxiety and depression in non-psychiatric patients. The Hospital Anxiety Depression Scale is widely applied in both clinical and research contexts. However, no psychometric evaluations have been performed for this instrument with non-clinical samples such as preschool teacher candidates in South Korea. This study purposed to establish the factor structure of the Hospital Anxiety Depression Scale and to validate its Korean version and was conducted online with a sample of preschool teacher candidates during the peak of the coronavirus disease 2019 lockdown. Methods: Data were collected from 359 undergraduates currently enrolled in a 4-year early childhood education degree program at a private university in Korea. The sample was randomly split to perform exploratory factor analysis and then confirmatory factor analysis respectively to test competing models hypothesized to reflect the factor structure of the Hospital Anxiety Depression Scale. Results: Supplemental revisions based on confirmatory factor analysis modification indices demonstrated that a correlated 2-factor model with 1 cross-loaded item offered the best fit to the data with adequate internal reliability estimates. Conclusion: Overall, this study confirms the validity and factor structure of the Korean version of the Hospital Anxiety Depression Scale, which is deemed an acceptable instrument that can be used to measure the symptoms of depression and anxiety in Korean preschool teacher candidates. © 2022, AVES. All rights reserved.
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Background: Delays in acute care for diabetic ketoacidosis, appendicitis and malignancy resulted in more severe initial presentations for these problems during the COVID-19 pandemic. It is unknown whether the pandemic also caused delays in care for more common problems such as pediatric acute otitis media (AOM). Delays in presentation for AOM may have secondarily resulted in decreased delayed prescribing or watchful waiting (WW). We hypothesized that there was a greater time to presentation for AOM in 2020 (during the pandemic) with an increased percentage of patients presenting outside of the delayed antibiotic prescribing window compared to those who presented in 2019 (pre-pandemic). Methods: This is a retrospective secondary analysis of data collected for a national quality improvement project across 24 institutions with freestanding pediatric urgent care sites conducted in calendar years 2019 and 2020. 2020 data collection began after the pandemic was declared in the US. We included all submitted records with a diagnosis of AOM. Records were excluded if they had a codiagnosis for which an antibiotic is almost always required. The primary outcome compared the median time to presentation measured in days between 2019 and 2020 using the Wilcoxon rank-sum test. Pearson's chi-square test was used to compare categorical factors between 2019 and 2020. Results: Our analysis included 1,983 and 402 encounters diagnosed with AOM in 2019 and 2020. There was no significant difference in time to presentation for AOM between 2019 and 2020 (p=0.761). Similarly, the rate of delayed antibiotic prescriptions for eligible encounters was not different (p=0.419). Among patients without associated fever, the median time to presentation was shorter in 2019 compared to 2020, (2 days vs 3 days, p=0.02). However, when fever was present, the directionality was changed (3 days in 2019 and 2 days in 2020 p=0.04). Conclusion: Despite a growing body of evidence of delayed pediatric care during the COVID-19 pandemic, there was no difference in time to presentation, albeit many fewer diagnoses, for AOM in a national pediatric urgent care database. Both time periods had a median time to presentation of 2 days;however, children with fever had a shorter time to presentation during the pandemic. Only a small percentage of AOM encounters were eligible for delayed antibiotics due to presentation after 2 days of symptoms.