ABSTRACT
BACKGROUND: There are insufficient reports on the immunogenicity and safety of the COVID-19 vaccination after lung transplantation in Korea. METHODS: Between April and September 2021, lung transplant recipients (n = 52) and healthy controls (n = 22) underwent vaccination. The levels of antibodies were assessed prospectively at 4 weeks after priming and second dose. RESULTS: Of a total of 52 lung transplant recipients, there were 84.6% nonresponders, 15.4% second-dose responders, and 0% primary dose responders. Among healthy controls, 63.6% were priming responders, and 18.2% were second-dose responders, and 18.2% were nonresponders. Compared with the control group, lung recipients were less likely to develop antibodies (P < .001). Antibody formation tended to be higher in recipients more than 1 year after transplantation (0 vs 20.5%, P = .076). No major safety events were reported, and the adverse symptoms were mild and consistent with those of the general population. In a multivariate regression analysis, mycophenolic acid levels (µg/mL) (odds ratio 0.25, P = .005) and tacrolimus level (ng/mL) (odds ratio 0.65, P = .035) were significantly associated with antibody formation. CONCLUSIONS: The immunogenicity of the second dose of COVID-19 vaccination with various combinations was substantially low in lung transplants. A booster of the COVID-19 vaccine is warranted in lung transplants, especially a year later.
ABSTRACT
Objectives: The COVID-19 pandemic affected healthcare use globally. However, there have been few studies examining how it affected age-specific healthcare use by patients as related to the locations of healthcare institutions. We explore changes in healthcare use while focusing on age-specific patient groups and facility locations after the COVID-19 pandemic. Methods: We compared two databases of cross-sectional outpatient health-insurance claims that have equivalent time points yearly and quarterly both before and after the COVID-19 pandemic. We categorized patients of healthcare institutions into five age groups and two facility locations. Results: The number of claims in 2020 significantly decreased by about 15% compared to 2019. The greatest reduction was for patients aged under 20 (-43.7%), followed by the 20-39 group (-15.0%) and the 40-59 group (-11.9%). Moreover, the number of claims significantly decreased in both urban and rural areas (p< 0.001); however, the magnitude of this decrease was greater in urban areas (-15.2%) than in rural areas (-10.8%). The annual decrease in healthcare use by age groups and location of facility was still supported even after controlling for institutional covariates, except for the patient group aged 80 or over in rural areas. Conclusions: We found that the COVID-19 pandemic critically affected healthcare use across age-specific population groups and different locations of healthcare institutions. It suggests there is a need for further research and policy implications as to whether the declining healthcare use among those age groups is in core health care, and as to whether there are any unmet healthcare needs.
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Objectives Many small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large hospitals. Design This study adopted a retrospective study design looking back at the healthcare utilisation of medical facilities according to size after the COVID-19 pandemic. The dependent variable was change in the number of outpatient health insurance claims before and after onset of the COVID-19 pandemic. The independent variable was an observation time point of the year 2020 compared with 2019. Setting and participants The study was conducted in Korea having a competitive medical provision environment under the national health insurance system. The units of analysis are hospitals and clinics: tertiary hospitals (42), general hospitals (293), small hospitals (1272) and medical clinics (27 049). This study analysed all the health insurance claim data from 1 January 2019 to 31 December 2020. Results Compared with 2019, in 2020, there were significant decreases in the number of claims (−14.9%), particularly in small hospitals (−16.8%) and clinics (−16.3%), with smaller decreases in general hospitals (−8.9%) and tertiary hospitals (−5.3%). The reduction in healthcare utilisation increased as the size of institutions decreased. The magnitude of decrease was significantly greatest in small hospitals (absolute risk (AR): 0.8317, 0.7758 to 0.8915, p<0.0001;relative risk (RR): 0.8299, 0.7750 to 0.888, p<0.0001) followed by clinics (AR: 0.8369, 0.8262 to 0.8478, p<0.0001;RR: 0.8362, 0.8255 to 0.8470, p<0.0001) even after controlling institutional covariates. Conclusion The external impact of the pandemic increased incrementally as the size of healthcare institutions decreased. Healthcare policy-makers need to keep in mind the possibility that small hospitals and clinics may experience reduced healthcare utilisation in the infectious disease pandemic. This fact has political implications for how healthcare policy-makers should prepare for the next infectious disease pandemic.
ABSTRACT
STUDY HYPOTHESIS: Cardiopulmonary resuscitation (CPR) training can increase the likelihood of patient survival and better neurological outcomes. However, conventional learning (CL) has cost, time, and space constraints. This study aimed to evaluate whether laypersons who completed instructor-led distance learning (DL) acquired a level of CPR skill comparable to that achieved via CL training. METHODS: This randomized controlled study recruited students from 28 Korean high schools who were randomized to complete instructor-led DL or CL training. The CL training involved classroom-based face-to-face training, whereas the instructor-led DL training was provided online using a videoconferencing system. RESULTS: The study enrolled 62 students who were randomized to the CL group (31 participants) or the DL group (31 participants). Relative to the CL group, the DL group achieved remarkably similar results in terms of most CPR variables. In addition, the DL group had a significant improvement in the mean compression depth (before: 46 mm [interquartile range: 37-52 mm] vs. after: 49 mm [interquartile range: 46-54 mm], p<0.001). CONCLUSIONS: Instructor-led DL can be a suitable alternative to CL for providing CPR training to laypersons. In settings like the current COVID-19 pandemic, where face-to-face CL is not practical, DL may be a useful tool for delivering CPR training.