Keeping Busy: Activities and Longings of the Elderly After Retirement in Kuching, Sarawak

Retirement is often seen as a pleasant time for the elderly, but successful retirement often entails meaningful use of time. The current study explores activities that the retired elderly of Kuching, Sarawak engage in, and if they long for more. Our results indicate that the retired elderly participate in a wide variety of activities, but still found gaps that need to be filled. Furthermore, COVID-19 was also found to significantly impact activities and longings of the retired elderly. [ FROM AUTHOR]

Child welfare workers satisfaction and wellbeing during the COVID-19 pandemic: Perspectives of agency staff in Ohio.

BACKGROUND: The COVID-19 pandemic has impacted the lives of children and families, created additional stressors, and increased risks for maltreatment. The pandemic has changed the way child welfare agencies operate, requiring changes to policies and practice. Minimal research has considered the effects of the COVID-19 pandemic on child welfare workers wellbeing and job satisfaction. OBJECTIVE: This mixed-methods research study seeks to understand CPS staff satisfaction, variables impacting satisfaction, and challenges that increased since the pandemic began for child welfare workers in Ohio. PARTICIPANTS AND SETTING: A sample of staff members (n = 267) from 50 CPS agencies across Ohio participated in the study. METHODS: This mixed-methods study used logistic regression, chi square analyses, and thematic analysis to analyze the data from a survey sent to child welfare agencies in Ohio. RESULTS: Caring for minor children, primary role at work, and years in child welfare were significantly associated with job satisfaction. Those working in foster care/placement, adoption/permanency, family support/visitation, kinship were 7.57 times more likely than those doing intake/investigation work to be satisfied with their job (p = .007). Thematic analysis of staff issues that increased during the pandemic resulted in six themes: Stress and Anxiety, Feeling Overwhelmed, Burnout, All, Motivation, and Isolation and Disconnection. CONCLUSIONS: The COVID-19 pandemic has created additional stressors for child welfare staff. Practice implications are discussed to help increase job satisfaction, staff wellbeing, and mitigate turnover.

Non-Covid Health Care under the Era of COVID-19: A Study from Rural Bengal

The current corona pandemic divided both the health care service infrastructure and patients into two categories: Covid and non-Covid. Both in the health care system and research world, the COVID-19 cases are given utmost priority for all the right reasons. In this study we attempted to understand the challenges faced by the non-Covid patients, particularly from the poor communities, who suffer from multiple deprivations. This study is based on survey of 88 non-Covid patient households in Murshidabad, West Bengal carried out in June 2020. The results show that the majority of the non-Covid patients were not able to access public health care due to lockdown which, in turn, results in increasing out-of-pocket expenditure (OOPE) on both medical and non-medical heads (like transportation). This OOPE aggravated the plight of the household more intensely when income of the household suffered severely due to the lockdown. To meet the household expenditure including OOPE households had to come under the clutch of money lenders mortgaging their small piece of agriculture land and gold-ornaments, and selling assets, and draining out their savings. Women from poor households tend to become ‘triple-deprived’ due to unequal sharing of poverty and with their meagre assets mortgaged. This piece of work may add to the insights to multi-dimensional deprivations of people during calamity like the COVID-19 pandemic. © 2022 selection and editorial matter, Indranil De, Soumyadip Chattopadhyay, Hippu Salk Kristle Nathan, and Kingshuk Sarkar;individual chapters, the contributors.

The Dichotomies of Management and Governance in the COVID-19 Pandemic: A View from Rawls’ Difference Principle and Political Economy Perspective

This chapter studies the Government’s response to the pandemic in terms of lockdown, provision of health care, and vaccination as a preventive measure. It analyses how these responses were distinct between different segments of society – rich and poor, formal and informal, urban and rural, and well-connected and ill-connected. The chapter uses two theoretical lenses for analysis: ‘Rawls’ Difference Principle’ – social and economic inequality leading to the greatest benefit of the least advantaged members of society;and ‘Elite Capture and Political Clientelism’ – powerful elite influencing public policy and public benefits being privatized in return of political support. A brief analysis of lockdown showed how the Government priorities were skewed against migrant workers and informal economy. Similarly, the provision of COVID-19 health care is bound to be lagging in rural areas considering the shortfalls in health facilities and human resources in rural areas. The vaccination drive in the country also demonstrated Government’s lack of urgency at one end and vaccine hesitancy of the citizens at the other. By bringing in theoretical underpinning to these phenomena, the chapter argues that learnings from these understanding would be helpful in management and governance of the current and future waves of the pandemic or such similar disaster. © 2022 selection and editorial matter, Indranil De, Soumyadip Chattopadhyay, Hippu Salk Kristle Nathan, and Kingshuk Sarkar;individual chapters, the contributors.

Introduction: The COVID-19 Pandemic, Challenges and Policy

This chapter is a prelude to the book. It provides an overview of the book with its approach, theoretical background, and relevance of the chapters. A pandemic constrains human freedom in many ways. The COVID-19 pandemic has jeopardized freedom of movement and access to employment, health care, and basic public services. The different chapters of the book show how the pandemic has adversely affected almost all sectors of the economy, multitude of lives in variety of ways. The findings from different chapters of the book have been discussed in this chapter from the perspective of different unfreedoms or lack of freedoms imposed by the pandemic, and how these unfreedoms feed on to each other. The role of institutions and public policies in unleashing unfreedom, which forms the meat of the book, has also been discussed. Taking a cue from the rest of the chapters, this chapter also discusses the policy implications which may become important knowledge to deal with the pandemic or any similar emergencies in the future. © 2022 selection and editorial matter, Indranil De, Soumyadip Chattopadhyay, Hippu Salk Kristle Nathan, and Kingshuk Sarkar;individual chapters, the contributors.

COVID-19 Pandemic, Public Policy, and Institutions in India: Issues of Labour, Income, and Human Development

This book looks at the institutional and governance issues faced by India during the frst and second wave of the COVID-19 pandemic and its adverse impact on the vulnerable sectors and groups. The book is split into four parts, with preceding chapters informing later ones. Part One outlines the approach of the study, in particular their examination of policy responses and the effect of the pandemic. Part Two delves into the governance challenges in containing the pandemic while giving the theoretical rationale for institutional responses. Part Three looks at how the pandemic affected economically vulnerable households, workers, and small industries. The effect of pandemic on the informal sector is also detailed. Lastly, Part Four examines the impacts and responses of Indian public infrastructure and services to the pandemic, in particular the impact of the COVID-19 pandemic on health care and schooling. It also explores the challenges caused by infrastructure inadequacies in Indian cities. The book closes by looking at how businesses in the private sector have responded to the COVID-19 pandemic, with a focus on Corporate Social Responsibility. The book will be a useful reference to researchers, policymakers, and practitioners who are interested in institutions and development, especially in the context of India. © 2022 selection and editorial matter, Indranil De, Soumyadip Chattopadhyay, Hippu Salk Kristle Nathan, and Kingshuk Sarkar;individual chapters, the contributors.

Comparative Outcomes and Surgical Timing for Operative Fragility Hip Fracture Patients during the COVID-19 Pandemic: A Retrospective Cohort Study.

The COVID-19 pandemic had wide-reaching effects on healthcare delivery, including care for hip fractures, a common injury among older adults. This study characterized factors related to surgical timing and outcomes, length-of-stay, and discharge disposition among patients treated for operative hip fractures during the first wave of the COVID-19 pandemic, compared to historical controls. A retrospective, observational cohort study was conducted from 16 March-20 May 2020 with a consecutive series of 64 operative fragility hip fracture patients at three tertiary academic medical centers. Historical controls were matched based on sex, surgical procedure, age, and comorbidities. Primary outcomes included 30-day mortality and time-to-surgery. Secondary outcomes included 30-day postoperative complications, length-of-stay, discharge disposition, and time to obtain a COVID-19 test result. There was no difference in 30-day mortality, complication rates, length-of-stay, anesthesia type, or time-to-surgery, despite a mean time to obtain a final preoperative COVID-19 test result of 17.6 h in the study group. Notably, 23.8% of patients were discharged to home during the COVID-19 pandemic, compared to 4.8% among controls (p = 0.003). On average, patients received surgical care within 48 h of arrival during the COVID-19 pandemic. More patients were discharged to home rather than a facility with no change in complications, suggesting an opportunity for increased discharge to home.

Niacinamide May Be Associated with Improved Outcomes in COVID-19-Related Acute Kidney Injury: An Observational Study.

Background: AKI is a significant complication of coronavirus disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analogue, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI. Methods: We implemented a quasi-experimental design with nonrandom, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline eGFR <15 ml/min per 1.73 m2 on or off dialysis, with COVID-19-related AKI by Kidney Disease Improving Global Outcomes (KDIGO) criteria, in two hospitals with identical COVID-19 care algorithms, one of which additionally implemented treatment with niacinamide for COVID-19-related AKI. Patients on the niacinamide protocol (B3 patients) were compared against patients at the same institution before protocol commencement and contemporaneous patients at the non-niacinamide hospital (collectively, non-B3 patients). The primary outcome was a composite of death or RRT. Results: A total of 38 out of 90 B3 patients and 62 out of 111 non-B3 patients died or received RRT. Using multivariable Cox proportional hazard modeling, niacinamide was associated with a lower risk of RRT or death (HR, 0.64; 95% CI, 0.40 to 1.00; P=0.05), an association driven by patients with KDIGO stage-2/3 AKI (HR, 0.29; 95% CI, 0.13 to 0.65; P=0.03; P interaction with KDIGO stage=0.03). Total mortality also followed this pattern (HR, 0.17; 95% CI, 0.05 to 0.52; in patients with KDIGO stage-2/3 AKI, P=0.002). Serum creatinine after AKI increased by 0.20 (SEM, 0.08) mg/dl per day among non-B3 patients with KDIGO stage-2/3 AKI, but was stable among comparable B3 patients (+0.01 [SEM, 0.06] mg/dl per day; P interaction=0.03). Conclusions: Niacinamide was associated with lower risk of RRT/death and improved creatinine trajectory among patients with severe COVID-19-related AKI. Larger randomized studies are necessary to establish a causal relationship.

A randomized, controlled, feasibility study of RD-X19 in subjects with mild-to-moderate COVID-19 in the outpatient setting.

The RD-X19 is an investigational, handheld medical device precisely engineered to emit blue light through the oral cavity to target the oropharynx and surrounding tissues. At doses shown to be noncytotoxic in an in vitro three-dimensional human epithelial tissue model, the monochromatic visible light delivered by RD-X19 results in light-initiated expression of immune stimulating cytokines IL-1α and IL-1ß, with corresponding inhibition of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) replication. A single exposure of 425 nm blue light at 60 J/cm2 led to greater than 99% reductions against all SARS-CoV-2 strains tested in vitro, including the more transmissible (Alpha) and immune evasive (Beta) variants. These preclinical findings along with other studies led to a randomized, double-blind, sham-controlled early feasibility study using the investigational device as a treatment for outpatients with mild to moderate coronavirus disease 2019 (COVID-19). The study enrolled 31 subjects with a positive SARS-CoV-2 antigen test and at least two moderate COVID-19 signs and symptoms at baseline. Subjects were randomized 2:1 (RD-X19: sham) and treated twice daily for 4 days. Efficacy outcome measures included assessments of SARS-CoV-2 saliva viral load and clinical assessments of COVID-19. There were no local application site reactions and no device-related adverse events. At the end of the study (day 8), the mean change in log10 viral load was -3.29 for RD-X19 and -1.81 for sham, demonstrating a treatment benefit of -1.48 logs (95% confidence internal, -2.88 to -0.071, nominal p = 0.040). Among the clinical outcome measures, differences between RD-X19 and sham were also observed, with a 57-h reduction of median time to sustained resolution of COVID-19 signs and symptoms (log rank test, nominal p = 0.044).

Cardiac rehabilitation visits have not recovered to pre-pandemic levels

Introduction: The COVID-19 pandemic led to temporary restrictions on in-person cardiac rehabilitation (CR) services to mitigate high-risk exposure. Hypothesis: In order to better understand the impact of COVID-19 restrictions on CR services, we evaluated changes in the frequency and characteristics of CR visits in 2020 compared with 2019 in a commercially-insured population. Methods: We queried the Michigan Value Collaborative statewide claims data registry for outpatient CR visits between 01/01/2019 and 12/31/2020 using CPT codes (93797, 93798) among patients with diagnoses of ischemic heart disease, heart failure, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or heart valve procedure. We described monthly trends in CR visits, and used bivariate analyses to compare changes in the demographics and medical diagnoses for CR visits in 2020 compared with 2019. Results: We identified a total of 45,553 CR visits in 2019 and 30,236 visits in 2020, representing a 33.6% relative decline. Monthly CR visits reached a nadir of 138 visits in April 2020 (96.5% reduction compared with April 2019), recovered to 3072 visits in September (-17.9%), and fell again to 2434 visits in December (-34.7%) (Figure). Relative changes in CR visits from 2019 to 2020 varied by diagnosis (p<0.001):-50.3% for heart failure (2931 to 1456,-37.5% for CABG (10121 to 6329),-35.3% for PCI (19669 to 12729),-28.9% for valve surgery (5621 to 3994), and-20.6% for ischemic heart disease (7211 to 5728). There were no significant differences in patient mean age (68.0 vs. 68.1 years, p=0.62) or gender (39.8% vs. 39.9% female, p=0.839) in 2019 compared with 2020. Conclusions: Total cardiac rehabilitation visits in 2020 were 33.6% lower compared with 2019, with heterogeneity in declines by underlying eligible diagnosis. Continued monitoring is needed to understand the public health impact of reduced CR use due to the COVID-19 pandemic.

Nicotinamide Adenine Dinucleotide Biosynthetic Impairment and Urinary Metabolomic Alterations Observed in Hospitalized Adults With COVID-19-Related Acute Kidney Injury.

INTRODUCTION: Acute kidney injury (AKI) is common in COVID-19 and associated with increased morbidity and mortality. We investigated alterations in the urine metabolome to test the hypothesis that impaired nicotinamide adenine dinucleotide (NAD+) biosynthesis and other deficiencies in energy metabolism in the kidney, previously characterized in ischemic, toxic, and inflammatory etiologies of AKI, will be present in COVID-19-associated AKI. METHODS: This is a case-control study among the following 2 independent populations of adults hospitalized with COVID-19: a critically ill population in Boston, Massachusetts, and a general population in Birmingham, Alabama. The cases had AKI stages 2 or 3 by Kidney Disease Improving Global Outcomes (KDIGO) criteria; the controls had no AKI. Metabolites were measured by liquid chromatography-mass spectrometry. RESULTS: A total of 14 cases and 14 controls were included from Boston and 8 cases and 10 controls from Birmingham. Increased urinary quinolinate-to-tryptophan ratio (Q/T), found with impaired NAD+ biosynthesis, was present in the cases at each location and pooled across locations (median [interquartile range]: 1.34 [0.59-2.96] in cases, 0.31 [0.13-1.63] in controls, P = 0.0013). Altered energy metabolism and purine metabolism contributed to a distinct urinary metabolomic signature that differentiated patients with and without AKI (supervised random forest class error: 2 of 28 in Boston, 0 of 18 in Birmingham). CONCLUSION: Urinary metabolites spanning multiple biochemical pathways differentiate AKI versus non-AKI in patients hospitalized with COVID-19 and suggest a conserved impairment in NAD+ biosynthesis, which may present a novel therapeutic target to mitigate COVID-19-associated AKI.

A randomized, controlled, feasibility study of RD-X19 in patients with mild-to-moderate COVID-19 in the outpatient setting (preprint)

These studies aimed to further understand the antiviral effects of safe, visible light and demonstrate a therapeutic effect of an investigational treatment device for outpatients with mild to moderate COVID-19. RD-X19 is a handheld medical device precisely engineered to emit blue light through the oral cavity to target the oropharynx and surrounding tissues. At doses that are well-tolerated in an in vitro human epithelial tissue model, the monochromatic visible light delivered by RD-X19 results in light-initiated expression of IL-1 and IL-1{beta} cytokines with corresponding inhibition of SARS-CoV-2 replication. A randomized, double-blind, sham-controlled early feasibility study using the investigational device enrolled 31 subjects with a positive SARS-CoV-2 antigen test and possessing at least two moderate COVID-19 signs and symptoms. Subjects were randomized 2:1 (RD-X19 to sham), treated twice daily for four days, and evaluated over one week. Prespecified outcome measures included assessments of SARS-CoV-2 viral load and clinical assessments of COVID-19. There were no local application site reactions and no device-related adverse events. The time-weighted average change in log viral load throughout the study demonstrated a favorable reduction for RD-X19 compared to sham and at the end of study the mean change in log10 viral load was -3.29 for RD-X19 and -1.81 for sham at Day 8, demonstrating a treatment benefit of -1.48 [95% confidence internal (CI), -2.88 to -0.071]. Among the clinical outcome measures, differences between RD-X19 and sham were also observed, with a 57-hour reduction of median time to sustained resolution of COVID-19 signs and symptoms.

Clinical efficacy and cost-effectiveness of postoperative radiographs after total knee arthroplasty.

BACKGROUND: Postoperative radiographs are commonly ordered after primary total knee arthroplasty (TKA), however, there is limited data on how often these films change management over the entire postoperative time course, and what should prompt imaging to maximize clinical utility. METHODS: A retrospective cohort study was conducted of patients ≥ 18 years old who underwent a primary TKA at two level one trauma centers. Postoperative data were collected to determine the frequency of postoperative radiograph series, radiograph findings that did not suggest normal healing or alignment to radiologist and orthopedists, and changes in postoperative management. The total cost and radiation exposure values were calculated for all patient radiographs using estimates from previous literature. RESULTS: From the 1258 patients included, 3831 postoperative radiographs were taken (mean ± 95% confidence interval [CI]: 3.05 ± 0.11 radiographs per patient). Of these 3831 radiographs, 44 (1.1%) contained a positive radiographic finding. Only 13 (0.3% of radiographs) of these positive radiographic findings were positive orthopaedic findings, 11 of which led to changes in management. For all but 1 of these patients (10/11, 91%), these radiographs were taken during a non-routine postoperative visit. Routine postoperative radiographs that did not change management cost $1,008,480 and administered 22.92 mSV of radiation to patients within this study. CONCLUSION: Postoperative radiography obtained after primary TKA were of low clinical utility yet resulted in considerable healthcare costs and unnecessary radiation burden. Radiographs ordered during a non-routine visit, however, were a reliable indicator of when this imaging provided clinical utility.

Delayed Treatment of Acute Myocardial Infarction With Ventricular Septal Rupture Due to Patient Fear During the COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.

Adding Space to Disease Models: A Case Study with COVID-19 in Oregon, USA

We selected the COVID-19 outbreak in the state of Oregon, USA as a system for developing a general geographically nuanced epidemiological forecasting model that balances simplicity, realism, and accessibility. Using the life history simulator HexSim, we inserted a mathematical SIRD disease model into a spatially explicit framework, creating a distributed array of linked compartment models. Our spatial model introduced few additional parameters, but casting the SIRD equations into a geographic setting significantly altered the system’s emergent dynamics. Relative to the non-spatial model, our simple spatial model better replicated the record of observed infection rates in Oregon. We also observed that estimates of vaccination efficacy drawn from the non-spatial model tended to be higher than those obtained from models that incorporate geographic variation. Our spatially explicit SIRD simulations of COVID-19 in Oregon suggest that modest additions of spatial complexity can bring considerable realism to a traditional disease model.

Is it safer at the beach? Spatial and temporal analyses of beachgoer behaviors during the COVID-19 pandemic.

Tourism localities worldwide continue to grapple with how best to sustain coastal visitation during the COVID-19 pandemic. Emerging epidemiological science illustrates the risk of disease transmission is lower outdoors than indoors, and exposure is likely lower in outdoor, coastal environments due to dispersion and dilution of respiratory droplets through regular air flow. That said, it remains unclear how beachgoer behavior affects the likelihood of disease transmission. During summer 2020, we analyzed publicly-available beachcam video data and collected unmanned aerial vehicle (UAV) imagery at the recreational beach oceanfront in Virginia Beach, U.S.A. Data were collected over 24 days, documenting tourists' and recreationists' behaviors related to the public health guidance from the U.S. Centers for Disease Control, Commonwealth of Virginia Department of Public Health and City of Virginia Beach. Specifically, using a sample test area of beach and adjoining boardwalk, we investigated diurnal patterns of beach and boardwalk use, the location and density of use, as well as the presence of face coverings (i.e., masks) on boardwalk users. Results from beachcam analyses indicate a curvilinear trend in beach use, peaking in the mid-afternoon, while boardwalk use remained consistent throughout the day. Beachcam observations were corroborated by UAV photography and spatial analysis, indicating concentrated use of the beach adjoining shoreline above high tide, with onethird of the landward adjacent upper beach vacant. Among boardwalk pedestrians, few (8.7%) were observed wearing facial coverings. These findings point to both indirect and direct strategies coastal managers can implement to communicate when, where, and how to reduce the potential for transmission while accessing beach amenities during the COVID-19 pandemic.

Physical and Emotional Sibling Violence in the Time of COVID -19.

The COVID-19 pandemic has impacted families in a variety of ways with much being written on the potential impact of sheltering in place and quarantining on intimate partner violence and parent-to-child abuse. One area that has received scant attention is that of physical and emotional sibling violence. While physical and emotional sibling violence is a predominant form of family violence, discussion of violence between siblings in the time of COVID-19 has not received the attention it warrants. This article examines the potential for family stress to place siblings at risk for engaging in physical and emotional sibling violence and how this is exacerbated in the time of COVID-19. Also discussed is the the connection between physical and emotional sibling violence and other forms of family violence including intimate partner violence and parent-to-child abuse and neglect which underwrites the need to place physical and emotional sibling violence on the radar of practitioners, policy makers, and researchers. Finally, implications for practice, policy, and research on physical and emotional sibling violence in the context of COVID-19 are discussed.