ABSTRACT
Background: The Covid pandemic and subsequent lockdown had implications on the population's mental health, particularly amongst society's most vulnerable members. We looked at the impact of the Covid pandemic on both generalised anxiety and health anxiety in women living with HIV (WLHIV). This research aimed to examine any increases in anxiety, what caused these increases, and how WLHIV dealt with them. Method(s): 12 WLHIV, aged 31-62 years old, completed recognised anxiety questionnaires (General Anxiety Disorder (GAD-7) and Health Assessment Questionnaire (HAQ)) to ascertain levels of anxiety and health anxiety respectively. Participants also responded to two open-ended questions: what made you most anxious during Covid lockdown and how did you deal with it? Results: Pre-covid GAD-7 scores averaged 6.3 indicating mild anxiety throughout the sample compared to postcovid scores of 12.9, which indicated moderate anxiety. Average HAQ scores were 21.3 indicating moderate health anxiety throughout the sample. Lack of self-advocacy skills (in relation to health) and isolation were commonly reported as being causes of anxiety;additional reasons included preexisting health issues and inability to access medical appointments and support. Participants reported using exercise, watching TV, sleep and prayer as coping mechanisms. Conclusion(s): The results of this research demonstrated that the Covid pandemic played a major part in raising anxiety, health anxiety and health worries in our sample. This was largely caused by increased isolation and decreased self-advocacy skills. Participants used individualised tools to manage their anxiety. Isolation: Isolation increased women's anxiety and health anxiety as they had no one to talk issues through with and social and organisational support was reduced due to lockdown. Lack of self-advocacy: Many participants reported that during the lockdown they found it difficult to identify and communicate their health concerns, advocate for themselves medically and subsequently negotiate help and support. Recommendations include future programmes to assist WLHIV to improve their self-advocacy skills and increase their attendance at groups/be actively involved with peers to reduce isolation. Supporting and improving advocacy helps women to gain more knowledge about their rights in relation to health care and empowers them to seek answers and negotiate treatment for themselves.
ABSTRACT
Farming occupations are, in the Global North, generally solitary, and a growing body of research identifies this as one of the factors that underpins low levels of wellbeing and poor mental health amongst farmers. The primary public health response to the coronavirus disease 2019 (COVID-19) pandemic focused on reducing transmission of the virus by limiting interactions of people. This article seeks to assess the impact of these restrictions on farmer's experience of isolation and how it shaped their wellbeing. Applying a broad socio-ecological framework, we analyse change, continuity and shifts in social and economic relations and their spatial reconfiguration during the COVID-19 pandemic as recounted in semi-structured, qualitative interviews. We found that while COVID-19 has disrupted socio-spatial relations, including key sites of socialisation for farmers and rural communities, occupational isolation was viewed as a positive feature of farming as was working in nature. Familial and informal networks of support were important throughout the pandemic, while novel engagements with communication technologies facilitated both change and continuity of social and economic interaction. Whilst these findings are broadly positive, the reconfiguration of, particularly, economic relations is viewed as accelerating the turn towards service delivery using technology and, consequently, further reducing opportunities for social interaction.
ABSTRACT
Farming occupations are, in the Global North, generally solitary, and a growing body of research identifies this as one of the factors that underpins low levels of wellbeing and poor mental health amongst farmers. The primary public health response to the coronavirus disease 2019 (COVID-19) pandemic focused on reducing transmission of the virus by limiting interactions of people. This article seeks to assess the impact of these restrictions on farmer's experience of isolation and how it shaped their wellbeing. Applying a broad socio-ecological framework, we analyse change, continuity and shifts in social and economic relations and their spatial reconfiguration during the COVID-19 pandemic as recounted in semi-structured, qualitative interviews. We found that while COVID-19 has disrupted socio-spatial relations, including key sites of socialisation for farmers and rural communities, occupational isolation was viewed as a positive feature of farming as was working in nature. Familial and informal networks of support were important throughout the pandemic, while novel engagements with communication technologies facilitated both change and continuity of social and economic interaction. Whilst these findings are broadly positive, the reconfiguration of, particularly, economic relations is viewed as accelerating the turn towards service delivery using technology and, consequently, further reducing opportunities for social interaction. © 2023 The Authors. Sociologia Ruralis published by John Wiley & Sons Ltd on behalf of European Society for Rural Sociology.
ABSTRACT
Background. Uncertainty and continuously changing guidance for COVID-19 response has taken a toll on the mental health of all individuals. Growing uncertainty within a healthcare system can create stress and confusion, ultimately affecting patient care. We designed an evidence-based, data-driven, decision matrix for healthcare operations that adapts COVID-19 mitigation measures in a predictable fashion according to the CDC community risk level and wastewater positivity data. Methods. A multidisciplinary team reviewed mitigation measures, published and internal data on the value and yield of these measures, and different operational aspects of a major healthcare system that are affected by COVID-19. The team also reviewed publicly available community risk metrics to then a create a decision matrix that adjusts mitigation measures and operational aspects in a predictable fashion according to COVID-19 risk in the community. Results. When COVID-19 rates were low during the pandemic the yield of temperature and symptom screening was 0.19% people screening out and the yield of preprocedure testing was 0.17% patients testing positive. Taking that into account, as well as published literature and public health guidance, we built the COVID-19 decision matrix shown in the figure, with adaptations for in-patient, out-patient, long-term care sites. The decision matrix was then posted online with a qualification that the enterprise COVID-19 status would only change with sustained changes ( > 2 weeks) in CDC Community risk level or wastewater positivity. The enterprise COVID-19 status is inserted in all enterprise communications for operational awareness. The response to the COVID-19 decision matrix has been overwhelmingly positive by staff and visitors, with no safety or operational problems in the first month of implementation. Conclusion. An evidence-based, data-driven, decision matrix provides predictable mitigation measures and operational responses to changes in the COVID-19 community risk levels and alleviates workforce uncertainty.
ABSTRACT
Objectives: To evaluate the effectiveness of face mask mandates in four suburban communities in the metropolitan Boston area during the SARS-CoV2 Omicron surge. Background(s): Face mask mandates have been implemented by local, state and national governments to limit the transmission of illness during the SARS-CoV2 pandemic. Method(s): A retrospective review of state reported, PCR positive cases of SARS-CoV2 and vaccination rates in four communities during the Omicron surge from 01/11/21- 01/31/22. Data was analyzed using descriptive statistics. Result(s): Two communities had a face mask mandate in place for all indoor public spaces throughout the study period, and two communities did not. Brookline (population 59,180, fully vaccinated rate per capita 62%) and Newton (population 88,593, vaccination rate 87%) implemented face mask mandates prior to the surge on 08/27/21 and 09/02/21, respectively, that remained in place through 02/18/22. Needham (population 31,248, vaccination rate 93%) and Framingham (population 72,308, vaccination rate 76%) issued mask recommendations but not a mask mandate. SARS-CoV2 percent positive rate per 100,000 population, reported weekly for each community is shown in Figure 1. Prior to Omicron, on 10/14/21 percent positive rates were 1% or less in all four communities. Percent positivity at the peak of Omicron was lower in Newton (13.18%) and Brookline (12.28%) than in Needham (14.92%) and Framingham (22.38%). Brookline had the lowest peak positivity rate and the lowest vaccination rate. Percent positivity also peaked and declined earlier in both communities with mask mandates. Conclusion(s): In this study, suburban communities with mask mandates had a lower SARS-CoV2 peak percent positivity rate and an earlier peak than communities without mask mandates. Face mask requirements in indoor public spaces may reduce transmission of SARS-CoV2 during variant surges, and may be particularly effective in communities with lower vaccination rates. (Figure Presented) .
ABSTRACT
To bring the wave energy sector to full commercialisation, the laboratory and small-scale testing, TRL 3 – TRL 6, must progress to full scale, long-term testing, TRL 7 – TRL9. The cost of testing at full-scale grows exponentially in early stages of scale-up. The high costs make gathering as much knowledge as possible from each test vital. The TRL 6 deployment of the Ocean Energy OE35 buoy, with the Siemens HydroAir Turbine at the US Navy Wave Energy Test Site (WETS) in Kāne‘ohe Bay, O’ahu, Hawai’i is the largest floating oscillating water columns (OWC) deployment to date. The buoy has been fabricated and delivered to O’ahu for deployment, but final deployment, like so many aspects of life, has been delayed due to the COVID-19 pandemic. This paper aims detail the some of the expected important outcomes from the 12-month deployment at WETS, and the learning from the project so far. © European Wave and Tidal Energy Conference 2021.
ABSTRACT
As the COVID-19 pandemic roiled the global economy, significant disruptions to the flow of goods and raw materials between countries emerged. Serious medical product shortages exposed the degree to which the United States relies on foreign suppliers of active pharmaceutical ingredients (API), finished pharmaceuticals, and other indispensable medical products and components. Concern about the fragility of medical product supply chains has generated rare bipartisan consensus, as policymakers of all stripes have called for measures to reduce the country's heavy dependence on foreign manufacturers. This Article begins by briefly discussing the root causes that have led many drug companies, API manufacturers, and device makers to move their operations abroad. It then outlines the potential national security and public health risks posed by the nation's significant dependence on foreign pharmaceutical and medical device suppliers. The Article also reviews measures taken during the COVID-19 pandemic to address medical product shortages, and how the pandemic has highlighted the need for comprehensive, long-term solutions to overreliance on foreign medical product manufacturing. The Article then addresses both the Trump and Biden administrations' approaches to strengthening domestic medical product manufacturing. It concludes by considering whether the current level of scrutiny and funding to address supply chain fragility will continue after COVID-19 is no longer an immediate threat.
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Background: Point of care lung ultrasound (LUS) has become an integral part in the clinical care and evaluation of patients presenting with respiratory complaints in the setting of COVID-19 infection. Since the start of the COVID-19 pandemic, LUS has been used not only to help identify possible COVID-19 infection, but also to help prognosticate and risk stratify patients with known, or highly suspicious for, COVID-19 infection 24. Study Objective: To determine if point-of-care LUS can be used to risk stratify patients presenting under suspicion of COVID-19 infection. Methods: 118 patients were scanned using 8-point LUS score method looking at 4 lung fields on each side in order to evaluate the diagnostic and prognostic value of LUS in COVID-19 patients. Scores were assigned to each field based on presence of B-lines, pleural abnormalities, and subpleural consolidations. All lung ultrasounds were performed in the emergency department on persons under investigation (PUI) for COVID-19 respiratory infections. Result: There is a clear trend of increasing mean total LUS score with increasing severity of illness. The increasing severity was defined in ascending order as patients discharged, admitted to floor, admitted to ICU, and death in hospital. The mean total LUS score for each was: discharged (5.18 ±1.47 [95% CI 3.71-6.65]), admitted to floor (9.82 ± 1.57 [95% CI 8.25-11.4]), admitted to ICU (10.83 ± 1.99 [95% CI 8.84-12.8] ), and death in hospital (13.14 ± 4.64 [95% CI 8.5-17.8]). One of the deaths was a patient with a means total LUS score of 3 who was placed on comfort care and then terminally extubated in the setting of metastatic lung disease. If this patient is removed, the mean LUS score associated with death in hospital is 14.83 ± 3.83 [95% CI 11-18.7]. Overall, patient’s that tested positive for COVID-19 had a higher mean LUS score (8.71 ± 1.3 [95% CI 7.41-10) than those that tested negative (7.24 ± 1.86 [95% CI 5.38-9.1). A SpO2 greater than or equal to 90% was associated with a lower average LUS score (7.76 ± 1.24 [95% CI 6.52-9), than an SpO2 less than 90% (12.24 ± 2.24 [95% CI 10-14.5). Patient’s requiring high flow nasal cannula, non-invasive positive pressure ventilation, or intubation had a mean LUS score of 12.75 ± 2.05 [95% CI 10.7-14.8], while those who only required nasal cannula or no supplemental oxygen had mean LUS score of 8.76 ± 1.5 [95% CI 7.26-10.3]. Conclusion: Our results show that by using an 8 zone lung ultrasound protocol not only are we able to identify those patients more likely to test positive for COVID, but also to risk stratify those patients under suspicion of a COVID infection.
ABSTRACT
INTRODUCTION: At our institution we utilize an Open Access Colonoscopy (OAC) program that allows patients to self-refer for colorectal cancer (CRC) screening and polyp surveillance. Patients are offered the choice of optical colonoscopy or CT colonography (CTC) and the submission is the reviewed for appropriateness. Open access procedures account for approximately 20% of the endoscopic procedures performed at our institution. Following the directive to postpone elective procedures due to the COVID-19 pandemic, our department had 202 OAC patientswhose CRC screening would be delayed. We utilized fecal immunochemical testing (FIT) to provide timely CRC screening to appropriate patients. FIT is a top tier, stool based, CRCscreening test for average risk patients. METHODS: This was an observational study which assessed all patients previously scheduled for CRC screening through a pre-existing OAC program. The rates of FIT eligibility, patient acceptance, patient completion, and results were tracked. RESULTS: A physician reviewed the 202 OAC patient request forms for FIT eligibility. We found 143 patients that were eligible for FIT with the primary exclusions being a personal history of polyps or a significant family history. Our eligibleOAC patients were proactively notified of delays and offered FIT by a nurse. Of the eligible patients, 100 (70%) accepted, 41 (29%) declined and 2 (1%) were unable to be reached. Nine weeks into our initiative, 64 eligible patients (64%) hadcompleted screening with 8 positive and 56 negative tests. Patients with positive FITs received scheduling precedence. Two advanced adenomas were detected in the first six weeks. CONCLUSION: FIT has been used for programmatic CRC screeningby healthcare systems due to low cost and ease of participation.Still, FIT is not widely utilized in many medical systems where patients are often screened opportunistically after presenting forcare via self-referral or referral from their primary care provider. Our findings suggest that the majority of our patients prioritizedtimely CRC screening over a specific modality of screening in a self-referral system. We propose that the utilization of FIT in OAC programs can decrease wait times for screening, particularly during periods of limited resources. This highlightsthe feasibility of FIT in a self-referral OAC program forproviders and health systems working to maintain access to care through streamlining of CRC screening. (Figure Presented) .
ABSTRACT
In this time of Covid-19, life in healthcare has changed immeasurably. It has rapidly been injected with an 'all hands-on deck' approach, to facilitate the necessary adaptations required to reduce the spread of the virus and deliver frontline clinical care. Inevitably aspects of these changes have disrupted the delivery of medical education, notably clinical placements have been cancelled and social distancing guidelines prohibit face-to-face teaching. The training of future doctors is an essential part of this effort. Indeed, the emergence of a global health threat has underlined its continued importance. For medical educators and students alike, we have been presented with a challenge. Concurrently, this presents us with an impetus and opportunity for innovation. For some time now, a transformation in medical education has been called for, with an increasing recognition of the need to prepare students for the changing landscape of healthcare systems. This has included a focus on the use of technology-enhanced and self-directed learning. As a team of educators and clinicians in psychiatry, working in the School of Medicine and Medical Sciences (SMMS) in University College Dublin (UCD), we will share how we have responded. We outline the adaptations made to our 'Psychiatry' module and consider the influence this may have on its future delivery. These changes were informed by direct student input.