Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic (preprint)

Background: COVID-19 vaccination and shielding targeted hypertensive patients in low and middle income countries. We describe the COVID-19 experiences of hypertensive patients in Colombia and Jamaica and discuss factors associated with vaccine acceptance. Methods: A cross-sectional study was conducted between December 2021 and February 2022 in 4 randomly selected primary care clinics in Colombia and 10 primary care clinics in Jamaica. Participants in Colombia were randomly selected from an electronic medical record. In Jamaica consecutive participants were selected on clinic days for non-communicable diseases. Interviewer-administered questionnaires were conducted by telephone. Results: 576 participants were recruited (50% Jamaica; 68.5% female). Jamaica participants were younger (36% vs 23% <60 years) and had a lower proportion of persons with more than high school education (17.2% vs 30.3%, p=0.011). Colombia participants more commonly tested positive for COVID-19 (24.2% vs 6.3%, p<0.001), had a family member or close friend test positive for COVID-19 (54.5% vs, 21.6%; p<0.001), experienced loss of a family member or friend due to COVID-19 (21.5% vs 7.8%, p<0.001) and had vaccination against COVID-19 (90.6% vs 46.7%, p<0.001). Fear of COVID-19 (AOR 2.71, 95% CI 1.20-6.13) and residence in Colombia (AOR 5.88 (95% CI 2.38-14.56) were associated with COVID-19 vaccination. Disruption in health services affecting prescription of medication or access to doctors was low (<10%) for both countries. Conclusion: Health services disruption was low but COVID-19 experiences such as fear of COVID-19 and vaccine acceptance differed significantly between Colombia and Jamaica. Addressing reasons for these differences are important for future pandemic responses.

COVID-19 and Religion: Pandemic Lessons and Legacies

The essay draws on a multiyear project to assess how religious communities worldwide experienced the COVID-19 pandemic and how they have in turn shaped responses to the pandemic. It focuses on religious public health responses, religious gatherings, and practices such as funerals, and the remarkable responses, especially at community level, offering social safety nets to people devastated by lockdowns and economic crises. Stigma, violence against specific groups, effects on women and children, and mental health are central challenges. The pandemic casts new light on contemporary forms of religious practice, community, mobilization, and engagement. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The International Education Index: A global approach to education policy analysis, performance and sustainable development

Before the COVID-19 pandemic, the world struggled to address growing educational inequalities and fulfil the commitment to Sustainable Development Goal 4, which seeks to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. The pandemic has exacerbated these inequalities and changed how education functions, moving to online and hybrid methods. The challenges in global education highlighted and worsened by the pandemic make it necessary to re-evaluate education systems and the policies in place to support access, quality and equal opportunity. This article focuses on analysing education policies at a national level. It tests a pilot policy analysis tool, the International Education Index (IEI), developed as a starting point to begin this reconsideration and create an accessible and comprehensive way to evaluate national education systems to inform decision-making and policies in the new context. This research uses Ireland and Northern Ireland to test the IEI pilot tool. The IEI consists of 54 questions across nine indicators, including institutional frameworks, education strategies, digital skills and infrastructure, twenty-first century skills, access to basic social services, adherence to international standards, legal frameworks, data gathering and availability and international partnerships. Countries can score 108 points to be categorised as having developed, emerging or nascent national education systems. Ireland scored 94 and Northern Ireland 81, indicating that they have developed national education systems.

A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial.

BACKGROUND: Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. OBJECTIVE: This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. METHODS: The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. RESULTS: Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. CONCLUSIONS: Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40713.

Feasibility of Smartphone-Based Physical Activity Tele-Coaching in Lung Transplant Recipients;an Interim Analysis

Purpose: The COVID-19 pandemic has increased the demand for tele-medicine, particularly for lung transplant (LTX) recipients who are immunosuppressed and often live far from transplant centres. We report the feasibility of a 3-month semi-automated tele-coaching intervention in this population. Methods: The intervention consists of a pedometer and smartphone app, allowing transmission of activity data to a platform (Linkcare v2.7) that provides feedback, activity goals, education and contact with the researcher as required. Remote assessment pre- and post-intervention included patient acceptability using a project specific questionnaire, physical activity using accelerometry (Actigraph GT3X), HADS and the SF-36 questionnaire. Results: So far, all eligible patients approached were willing to be randomised to the intervention or usual care (n=14;COPD=4, ILD=7;CF=1;PH=2). For the intervention, usage of the pedometer was excellent, with patients wearing it for 6.9±0.1 days/week and rating the pedometer and telephone contact (9±2 out of 10) as the most vital aspects. Patient feedback has been positive, with 80% of patients responding that they ‘liked’ taking part and that it ‘helped them a lot’ to increase their activity levels. Daily steps and VMU are presented in Figure 1 and SF-36 scores in Figure 2. There were no changes in HADS scores between groups. Conclusion: Tele-coaching appears feasible in LTX recipients, with patients showing excellent adherence and providing positive feedback after 3 months. This is promising, with the on-going need to develop and evaluate ways of supporting patients remotely.

The Impact of Physical Distancing on the Evacuation of Crowds

One of the key implications of COVID-19 is the adoption of physical distancing provisions to minimise the risk of virus transmission. Physical distancing can have significant consequences on crowd movement both in normal conditions and during emergencies. The impact of physical distancing is discussed in this chapter by first presenting an overview of its implications on crowd dynamics and space usage. This is followed by an assessment of expected changes in crowd behaviour, including changes in the fundamental walking speed/density and flow/density relationships. Findings from an experiment investigating the impact of physical distancing on flow rates through doors are presented. In addition, a set of recommendations concerning modifications of the hand calculations currently used for evacuation design (e.g. hydraulic models) are presented alongside a discussion on possible modifications to agent-based crowd models. A verification test to evaluate the results produced by crowd evacuation modelling tools considering physical distancing is also presented. This chapter highlights the importance of considering the increased movement time due to physical distancing in evacuation design and provides insights on how to account for this issue in crowd modelling. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

'passing the surgical torch'-a review of appropriate surgical handover protocol on the acute surgical take

Aim: Effective handover between shifts is vital to protect patient safety. The Royal College of Surgeons has detailed the necessary information needed for each patient at handover. We aimed to assess compliance with this handover protocol. Method: Weekday surgical handover was reviewed over an 8-week period of time. Data was collected on documentation of diagnosis, up to investigations/bloods, clinical state of patient, management plan and resuscitation status/ceiling of care and COVID status. Results: 210 patients were reviewed. Of these, a clear diagnosis was documented for 152 patients. Up to date imaging results if applicable was documented in 111 of 153 patients. Up to date bloods were included in 140 of 210 patients. COVID status was only noted in 31 of 210 patients and DNAR status in only 24. After re-audit of 197 a clear diagnosis was seen in 183 patients, COVID status was documented in 170 patients and DNAR status in 169. Conclusions: Surgical handover is hugely crucial for provision of patient care. Following clear guidance from the royal college of surgeons, better compliance with handover was noted, including a critical improvement in COVID and DNAR status.

Feasibility of smartphone-based physical activity tele-coaching in lung transplant recipients

S21 Figure 1Daily steps using accelerometry (Actigraph GTX3), at baseline (hospital discharge), 3 months and 6 months for lung transplant recipients assigned to the intervention group (n=5)[Figure omitted. See PDF]ConclusionTele-coaching appears feasible in lung transplant recipients, with patients wearing the pedometer and interacting well with the app over 3 months. This is promising in the current climate, with the need to develop and evaluate innovative ways of supporting patients remotely.

Adolescent Levers for a Diet and Physical Activity Intervention Across Socioecological Levels in Kenya, South Africa, Cameroon, and Jamaica: Mixed Methods Study Protocol.

BACKGROUND: The increasing burden of noncommunicable diseases that are prevalent in low- and middle-income countries (LMICs) is largely attributed to modifiable behavioral risk factors such as unhealthy diets and insufficient physical activity (PA). The adolescent stage, defined as 10 to 24 years of age, is an important formative phase of life and offers an opportunity to reduce the risk of noncommunicable diseases across the life course and for future generations. OBJECTIVE: The aim of this paper is to describe a protocol for a study using a convergent mixed methods design to explore exposures in the household, neighborhood, school, and the journey from home to school that may influence diet and PA behaviors in adolescents from LMICs. METHODS: Male and female adolescents (n≥150) aged between 13 and 24 years will be recruited from selected high schools or households in project site countries to ensure the socioeconomic diversity of perspectives and experiences at the individual, home, and neighborhood levels. The project will be conducted at 5 sites in 4 countries: Kenya, Cameroon, Jamaica, and South Africa (Cape Town and Johannesburg). Data on anthropometric measures, food intake, and PA knowledge and behavior will be collected using self-report questionnaires. In addition, a small number of learners (n=30-45) from each site will be selected as citizen scientists to capture data (photographs, audio notes, text, and geolocations) on their lived experiences in relation to food and PA in their homes, the journey to and from school, and the school and neighborhood environments using a mobile app, and for objective PA measurements. In-depth interviews will be conducted with the citizen scientists and their caregivers to explore household experiences and determinants of food intake and foodways, as well as the PA of household members. RESULTS: The study described in this protocol paper was primarily funded through a UK National Institute for Health Research grant in 2017 and approved by the relevant institutional ethics review boards in the country sites (South Africa, Cameroun, and Jamaica in 2019, and Kenya in 2020). As of December 23, 2020, we had completed data collection from adolescents (n≥150) in all the country sites, except Kenya, and data collection for the subgroup (n=30-45) is ongoing. Data analysis is ongoing and the output of findings from the study described in this protocol is expected to be published by 2022. CONCLUSIONS: This project protocol contributes to research that focuses on adolescents and the socioecological determinants of food intake and PA in LMIC settings. It includes innovative methodologies to interrogate and map the contexts of these determinants and will generate much-needed data to understand the multilevel system of factors that can be leveraged through upstream and downstream strategies and interventions to improve health outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26739.

Exploring the Impact of Home-Schooling on the Psychological Wellbeing of Irish Families During the Novel Coronavirus (COVID-19) Pandemic: A Qualitative Study Protocol

Background: The COVID-19 pandemic has placed severe restrictions on people’s behavior worldwide with school closures in many countries. These closures have shifted education from the classroom to the home. This change is unprecedented, and home-schooling has placed substantial stress on families across the world. As of 9 April 2020, 1.57 billion children were being educated by families that had little or no experience of protracted home-schooling. An essential but neglected issue related to COVID-19 is the psychological impact of home-schooling on family wellbeing, especially considering the other stressors they are experiencing including social isolation, fears of infection, frustration, boredom, inadequate information, and financial stress. This study explores the impact of home-schooling on family psychological wellbeing during COVID-19. These findings will help develop supports and interventions for this population. Methods: An exploratory qualitative study will be conducted using semi-structured interviews with a convenience sample of families (at least one parent and one child). Participants will be recruited using social media outlets, contacts of academic members and snowball sampling. Interviews will take place using Microsoft Teams and via telephone and recorded for transcription purposes. These transcripts will be analyzed using interpretative phenomenological analysis (IPA). Ethical approval has been granted by the Social Research Ethics Subcommittee (SRESC) Maynooth University (2407411). The Science Foundation Ireland (SFI) has funded the research with the COVID-19 rapid response grant. The dissemination of findings will be through open access journal publications, distribution of lay summaries, press release and policy papers. Discussion: The research findings will discuss the impact that home-schooling has had on family psychological wellbeing. It will examine how parents are managing their children’s education and learning while handling the other stresses associated with COVID-19. A deeper understanding of the impact of school closures and home-schooling on family processes is essential if the psychological wellbeing of families is to be protected and supported during challenging times such as health-related disasters. © The Author(s) 2020.