Awake Prone Positioning in Acute Hypoxemic Respiratory Failure from COVID-19: A Randomized Clinical Trial

Background: The efficacy and safety of awake prone positioning (APP) in hypoxemic patients with coronavirus disease 2019 (COVID-19) is unclear. Aim(s): To evaluate the efficacy and safety of APP in non-intubated adults with COVID-19. Method(s): We performed a pragmatic, international, randomized trial at 21 centers in Canada, Saudi Arabia, Kuwait, and the United States between May 19, 2020, and May 18, 2021. Eligible patients were hospitalized adults with COVID-19 requiring >40% oxygen. Patients were randomized to APP (n=205) or usual care (n=195). The primary outcome was intubation by day 30. Secondary outcomes included mortality at 60 days, ventilation-free days at 30 days, intensive care unit (ICU) and hospital-free days at 60 days, adverse events, and serious adverse events. Result(s): Patients in the APP group proned for a median of 4.8 hours per day (IQR 1.8 to 8.0) in the first 4 days. By day 30, 70/205 patients (34.1%) in the APP group and 79/195 (40.5%) in the control group were intubated (hazard ratio [HR] 0.81;95% confidence interval [CI] 0.59 to 1.12). APP did not reduce mortality at 60 days (HR 0.93;95% CI 0.62 to 1.40) and had no effect on days alive invasively or noninvasively ventilated at 30 days, or days out of ICU or hospital at 60 days. There were no serious adverse events in either group. A prespecified subgroup analysis suggested that APP reduced intubation among patients with SpO2:FiO2 >150 (HR of 0.44, 95% CI 0.23 to 0.87) but not among patients with SpO2:FiO2 <150 (HR 1.02;95% CI 0.70 to 1.48;P-interaction= 0.03). Conclusion(s): APP did not significantly reduce intubation at 30 days or mortality at 60 days overall, but may be effective in patients with SpO2:FiO2 >150.

WHEN AND WHERE: LESSONS LEARNED ABOUT TECHNOLOGY FROM AN INTERVENTION FOR CAREGIVERS OF PERSONS WITH HEART FAILURE

Use of technology in older adult populations is growing, therefore it is important to understand opportunities for healthcare initiatives that support older adults using technology. The aim of the pilot study was to test Caregiver Support, a self-care and social support intervention, for caregivers of persons living with heart failure (N=24). Originally, the protocol was designed with in-person visits. We expected this option to reduce participant burden: the caregiver would not have to travel, and the interventionist would gain more insight about the home context to aid with intervention delivery. However, due to the COVID-19 pandemic, it became necessary to conduct the visits virtually. All participants completed the 5-component intervention via virtual meeting and there were no dropouts related to technology use. When asked about the virtual modality, participants emphasized the flexibility of virtual meetings. In summary, the intervention visits conducted virtually were perceived as a caregiver-centered approach.

Role and Utility of COVID-19 Laboratory Testing in Low-and Middle-Income Countries: A Systematic Review of Diagnostic Test Accuracy Studies (preprint)

Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate management of COVID-19 patients. As such, robust evidence regarding diagnostic accuracy and costs of available tests would inform policy and practice especially in resource-limited settings. We aimed to determine the diagnostic test accuracy, costs and utility of laboratory test strategies for COVID-19 in LMICs.Methods This was a multi-staged protocol-driven systematic review conducted in line with PRISMA guidelines for diagnostic test accuracy studies (PRISMA-DTA). We searched for relevant literature in six databases including: PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science, and the WHO Global Index Medicus. Studies were screened and coded in pairs. We conducted a structured narrative and quantitative synthesis of the results guided by Fryback and Thornbury framework. The primary outcome was COVID-19 diagnostic test accuracy. The results were reported following the PRISMA-DTA.Results Thirteen articles were from studies in China and one from Turkey. All studies included used the Real-time polymerase chain reaction test (RT-PCR) as their reference test. 21.4% (n = 3) of articles were determining the diagnostic accuracy of the PCR test. The remaining studies (n = 11) used other COVID-19 tests as the index tests. It is generally observed that the tests were more specific than sensitive pooled sensitivity and specificity was 87.6%, (95% CI: 82.2% − 93%), 98.1% (95% CI: 96.4%-100%) respectively. The Reverse-transcription loop-mediated isothermal amplification (RT-LAMP) tests had the highest sensitivity as compared to RT-PCR, serological and chemiluminescent immunoassays (CLIA). The specificity and sensitivity of the tests were highest when bronchial lavage samples were used and lowest with the use of serum specimens/sample. No study documented cost of the diagnostic test used.Conclusion The evidence on COVID-19 testing in LMICs is summarized in this systematic review. The RT-PCR was used as the reference test in all studies. The diagnostic assays' combined sensitivity and specificity were 87.55% and 98.10%, respectively. In the reviewed literature, no study reported on the cost and cost effectiveness of diagnostic tests. Finally, no studies were carried out on the African continent.Registration: This review was registered in PROSPERO No. CRD42020209528. And the protocol published here https://bmjopen.bmj.com/content/11/10/e050296

Linkage to care and treatment among men with reactive HIV self-tests after workplace-based testing in Uganda: A qualitative study

Introduction HIV self-testing at workplaces has the potential to reach men at risk of HIV infection with lower access to HIV testing services. While several studies have reported high uptake of HIV self-testing, linkage to HIV care following a positive result remains a challenge. This study, therefore, explored the motivators for and barriers to linkage to HIV care and treatment among men who returned positive results following workplace-based HIV self-testing. Methods A qualitative descriptive study, among men in private security services in Kampala district, Uganda. The men were eligible to participate if they were aged 18 to 60 years and had worked at the company for more than 6 months. Following HIV self-testing, participants with reactive (positive) self-test results were purposively sampled and engaged in key informant interviews. Inductive content analysis was employed to identify the motivators and barriers to the men's linkage to HIV treatment and care. Results Overall, 12 men participated in the study, of whom 9 (75%) were security guards, and the rest held management positions. The motivators for linkage to care coalesced under five categories. (i) Communication (open communication, phone reminders, consistent communication) (ii) Navigating health facility systems and processes (enabling health facility environment, easy access to health care, employing ART clinic counselors as part of the study team, health workers) (iii) Linkage support (linkage companions, referral forms, linkage facilitation, individualized linkage plan, pre-arranged clinic appointments) (iv) Psychosocial support (counseling sessions, family support, online and social media support, peer support) (v) workplace environment (employer's support, work schedules and policies). The barriers to linkage to HIV care included (i) Inflexible work schedules, (ii) Far distances to travel to access ART (iii) mandatory work transfers, (iv) disruptive effects of the COVID-19 pandemic, (v) Denial of HIV-positive results and (vi) fear of stigma and discrimination at health facilities. Conclusion The findings suggest the need for innovative interventions to facilitate regular follow-up and open communication with workplace-based HIV self-testers, to improve linkage to HIV care and treatment. Furthermore, initiating linkage plans during pre-test counseling and working in collaboration with health facilities and clinics may improve linkage to care.

Is flushing necessary during building closures? A study of water quality and bacterial communities during extended reductions in building occupancy

Drinking water stagnation can lead to degradation of chlorine residual, bacterial growth (including of opportunistic pathogens and nitrifiers), and metals release from plumbing materials;however, few studies have characterized building water quality and bacterial communities during the extended stagnation periods that occurred during COVID-19 pandemic-related building closures. Additionally, despite a lack of evidence-based guidance, flushing fixtures has been recommended to restore building water quality. We aimed to evaluate the impacts of reduced building occupancy (>2 months) and weekly restorative flushing on drinking water quality, bacterial communities, and the occurrence of undesirable microorganisms in three university buildings. Reduced occupancy led to diminished chloramine and elevated intact cell counts, but values remained stable after additional weeks of limited water use. Flushing temporarily improved water quality, with chlorine and cell counts remaining stable for at least 1 day but returning to levels measured prior to flushing within 1 week. Alpha diversity was lower under more stagnant conditions, and fixture identity, not flushing, was the most influential factor on bacterial community composition, suggesting a strong influence from local biofilm. Although Mycobacterium, Legionella, Pseudomonas, Nitrosomonas, and Nitrospira were detected in samples via amplicon sequencing, concentrations measured via qPCR of M. avium complex, L. pneumophila, P. aeruginosa, and ammonia-oxidizing bacteria were very low or were undetected, supporting that stagnation alone did not lead to high occurrence of undesirable microorganisms. Findings from this study contribute to our understanding of the effects of stagnation on building water microbiomes and the efficacy of flushing to improve water quality. Under the conditions of this case study, repeated flushing on a weekly timescale during low occupancy periods was not sufficient to maintain chlorine residual and prevent bacterial growth in fixtures. Building managers need to weigh the temporary water quality benefits of flushing against the labor and water resources required considering local context.

National organization addresses multidisciplinary oncology team burnout and resiliency through multifaceted presidential theme education initiative

Background: The 2021-2022 Association of Community Cancer Centers (ACCC) President's Theme centered on strengthening a work culture that supports professional well-being and workforce resilience. To support this theme and help ensure sustainable high quality cancer care delivery, ACCC -an education and advocacy organization for the multidisciplinary oncology care team (MDT)-designed a multifaceted professional development initiative. Educational interventions were designed to address team member burnout and building resilience, critical issues facing members of today's oncology workforce. Methods: ACCC designed a collaborative and bi-directional peer-support educational initiative to drive the mission of the 2021-2022 ACCC President's Theme. Professional Development opportunities included: 1) Expert-led mindfulness meditation series of 10 guided exercises tailored to help MDT members manage through social, emotional, physical, and mental health challenges. 2) Professional development themed virtual meetings, styled as “Coffee Chat Learning Sessions,” facilitated by the ACCC President, addressing emergent challenges and opportunities facing MDT members. 3) Podcast series featuring timely topics related to MDT well-being and resiliency amid the COVID-19 Pandemic. Podcast topics include a) The Business Case for Hiring Oncology Social Workers. b) Leading with Gratitude. c) Coping with Pandemic Grief. d) A Summer of Disconnect for Cancer Professionals. e) COVID-19 Self-Care. f) Real-World Lessons from COVID-19. Results: The education initiative reached a diverse cohort of oncology care community members. 76 unique professionals participated in the small group “Coffee Chat Learning Sessions” from 25 states and represented 72 unique cancer care programs, practices, and institutions. The meditation series engaged more than 1,100 users and the podcast series garnered 1,870 learners. The podcast episode titled “COVID-19 Self Care” was the third most accessed ACCC Podcast episode of all time with more than 680 views. Over 2,900 learners accessed and engaged with the ACCC President's Theme resources across the dedicated webpage from March 2021-January 2022. Conclusions: Anecdotal learner feedback has been overwhelmingly positive regarding this professional development educational initiative. In a climate of high burnout and health care worker fatigue, the ACCC 2021-2022 President's Theme Education program has served as a unique lifeline and resource to members of the oncology community to restore and develop resiliency, enhance well-being, and advance professional connections and peer-to-peer support to meet continued challenges. Lessons learned from these activities will guide and inform future professional development opportunities.

COVID-19 VACCINATIONS AMONG VETERANS WITH MENTAL ILLNESS

BACKGROUND: Patients with mental illness have high COVID-19 infection rates and mortality. Equitable vaccination strategies have prioritized outreach for high-risk medical conditions, racial/ethnic groups, and social groups (e.g., experiencing homelessness). Despite calls to ensure adequate access for persons with mental illness, COVID-19 vaccination disparities have not been systematically evaluated in this population. A recent study demonstrated that Veteran's Administration (VA) systems can deliver equitable vaccine access for traditionally marginalized racial/ethnic groups.We sought to evaluate whether there are disparities in COVID-19 vaccination rates for veterans with mental illness. METHODS: We conducted a retrospective cohort study among Veterans assigned to primary care at the VA Puget Sound with >1 visit recorded in the past two years. We used logistic regression to determine the association between diagnosis of serious mental illness (SMI) (bipolar disorder or schizophrenia), post-traumatic stress disorder (PTSD), depression or anxiety, and substance use disorder (SUD) and COVID-19 vaccination using three separate models. Covariates were age, sex, race/ethnicity, marital status, Gagne comorbidity score, socioeconomic status index, rurality based on home address, homelessness, number of primary care and mental health visits in the past 12 months, and percentage without a high school degree. RESULTS: We identified 103,025 veterans with no mental health diagnoses, 1,467 with SMI, 15,329 with PTSD, depression or anxiety, and 5,110 with SUD. Those with mental health diagnoses were younger, had higher Gagne scores, higher primary care and mental health utilization, were more likely to experience homelessness, and to live in urban settings. In adjusted analysis the odds ratio of vaccine receipt was higher in all three groups compared to those without mental health diagnoses: 1.58 (95% CI 1.38, 1.82) for SMI, 1.26 (1.2, 1.32) for PTSD/Depression/Anxiety, and 1.24 (1.15, 1.34) for SUD. CONCLUSIONS: After adjusting for clinical and sociodemographic covariates, we found that diagnoses of SMI, SUD, PTSD, depression or anxiety were associated with a slightly higher predicted probability of vaccination compared to no mental health diagnoses among Veterans receiving primary care within the VA. No other published analysis reports vaccination rates in persons with mental health conditions, so we are unable to assess whether this is a trend nationally or specific to the VA system, where vaccination efforts were conducted using a clear equity framework, strong data sources, and heavy outreach campaigns. Study limitations include unclear generalizability to other geographic areas, and exclusion of veterans with mental health diagnoses not enrolled in primary care, due to lack of adequate clinical covariate information. Nevertheless, our results provide initial evidence that disparities in COVID-19 vaccination rates for persons with mental illness can be prevented.

Pilot Outcomes of A Multi-component Support Intervention for Caregivers of Persons with Heart Failure

Background: Caregivers of persons with heart failure must manage high levels of patient health care utilization, treatment complexity and often unpredictable stressors associated with intermittent symptom exacerbations and mortality. Interventions have often focused on the needs of the person with HF, not the caregiver. Therefore, we developed an intervention using human-centered design to provide caregiver-targeted support for this population. Objective: Pilot test the feasibility and gauge initial effect size of the Caregiver Support intervention to improve quality of life (mental and physical), caregiver burden, and self-efficacy among family caregivers from baseline to 16 weeks. Methods: The intervention includes five individualized, nurse-led sessions over 10 weeks conducted remotely (due to COVID-19). Intervention components focus on 1) nature of caregiving, 2) life purpose, 3) co-development of an action plan to address caregiver goals to reduce caregiver burden and improve caregiver well-being, 4) exploration of social and community resources to support unmet needs, and 5) building a sustainability plan for addressing future caregiver needs. We tested our approach in a randomized waitlist control pilot trial (N=35) from August 2020 through March 2022. We calculated enrollment and retention rates, described acceptability, and computed intervention effect sizes from baseline to 16 weeks. Results: 35 out of 101 (35%) eligible caregivers enrolled and were majority female (93.3%), White (60%) and spousal caregivers (63.3%). Average age was 59.4 ± 16.6 years. Overall retention was 69%. All intervention participants completed the five core components, reporting high levels of satisfaction and acceptability of activities. Between-group effect sizes (n=21) at 16 weeks suggest improvement in the mental health component of quality of life, caregiver burden, and self-efficacy (effect sizes 0.88, 0.31, and 0.63, respectively). Conclusion: Caregivers found Caregiver Support acceptable and study methods were feasible, despite challenges to engaging during the COVID-19 pandemic. Findings provide foundational evidence that this person-centered behavioral intervention can contribute to enhanced caregiver outcomes.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis.

BACKGROUND: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

User Characteristics of Unique Men's Health Website

Introduction: Covid-19 has helped drive all forms of medicine away from traditional brick and mortar medical interactions. Given the availability of online services to obtain treatments for ED, we developed a website to facilitate patient education, triage and men's health appointment scheduling. Objective: We sought to assess characteristics of men who utilized a novel website to treat their ED. Methods: We report on 50 patients who ultimately booked and attended appointments (video or in person) for erectile dysfunction. Patients found our website through our institution's main informational ED pages or through youtube links from our men's health video playlist library. Patients create an institutional account and are then asked a series of MD created questions designed to streamline patient triage and complete the majority of chart documentation ahead of the appointment. Patients are then sent videos relevant to their condition and future appointment options. Results: 2300 users investigated the ED portion of the website with 1.8% of patients ultimately following through with an appointment. 13% of patients who explored the ED portion of the site created a user account that allows a questionnaire to be taken. 90% of men who began the ED questionnaire completed with a mean time of 11 minutes. 52% of men offered an appointment based on their responses completed the patient scheduling form. 71% of traffic was on mobile devices with 29% on desktop/tablet. Site use by time of day is shown in figure 1. Mean age of patients was 53. 92% of patients had ED that occurred > 6 months. Mean SHIM score was 8.2 (IQR 4-12). 80% of participants had both desire and opportunity for sexual activity, 20% did not meet both criteria and thus SHIM scores were less valid for these men. Of the users 28% had never tried pde5s, 32% had partial success with pde5s, 24% could not tolerate or afford pde5s and 42% had unsatisfactory results with pde5s. PDE5 naïve patients were seen by an internal medicine MD specializing in men's health, 10 were seen by surgeons as they requested IPPs and the rest were seen by a combination of men's health APPS and urology attendings for second line treatments and penile doppler. Interestingly, 66% of men were interested in undergoing penile doppler to better understand the etiology of their ED. Hypertension (40%) and diabetes (22%) were the most common medical comorbidities. 36% of the cohort had a strong family history of cardiac disease. Conclusions: Men with ED can be effectively triaged through a website application. Most men with pde5 refractory ED wish to pursue penile doppler. The majority of patients seen had watched educational video material ahead of time, facilitating a more sophisticated and streamlined patient interaction. Disclosure: No

Learning to think critically about health using digital technology in Ugandan lower secondary schools: A contextual analysis.

INTRODUCTION: The world is awash with claims about the effects of health interventions. Many of these claims are untrustworthy because the bases are unreliable. Acting on unreliable claims can lead to waste of resources and poor health outcomes. Yet, most people lack the necessary skills to appraise the reliability of health claims. The Informed Health Choices (IHC) project aims to equip young people in Ugandan lower secondary schools with skills to think critically about health claims and to make good health choices by developing and evaluating digital learning resources. To ensure that we create resources that are suitable for use in Uganda's secondary schools and can be scaled up if found effective, we conducted a context analysis. We aimed to better understand opportunities and barriers related to demand for the resources, how the learning content overlaps with existing curriculum and conditions in secondary schools for accessing and using digital resources, in order to inform resource development. METHODS: We used a mixed methods approach and collected both qualitative and quantitative data. We conducted document analyses, key informant interviews, focus group discussions, school visits, and a telephone survey regarding information communication and technology (ICT). We used a nominal group technique to obtain consensus on the appropriate number and length of IHC lessons that should be planned in a school term. We developed and used a framework from the objectives to code the transcripts and generated summaries of query reports in Atlas.ti version 7. FINDINGS: Critical thinking is a key competency in the lower secondary school curriculum. However, the curriculum does not explicitly make provision to teach critical thinking about health, despite a need acknowledged by curriculum developers, teachers and students. Exam oriented teaching and a lack of learning resources are additional important barriers to teaching critical thinking about health. School closures and the subsequent introduction of online learning during the COVID-19 pandemic has accelerated teachers' use of digital equipment and learning resources for teaching. Although the government is committed to improving access to ICT in schools and teachers are open to using ICT, access to digital equipment, unreliable power and internet connections remain important hinderances to use of digital learning resources. CONCLUSIONS: There is a recognized need for learning resources to teach critical thinking about health in Ugandan lower secondary schools. Digital learning resources should be designed to be usable even in schools with limited access and equipment. Teacher training on use of ICT for teaching is needed.

Information-seeking behaviour of students at a Caribbean University during the COVID-19 pandemic

Purpose: This study investigated how students of the Faculties of Humanities and Education and Social Sciences at a Caribbean University sought information during the COVID-19 pandemic, identified challenges they experienced in seeking information for academic tasks and how satisfied they were with the Library's provision of electronic resources and services during this period. Design/methodology/approach: A quantitative survey design was adopted for this study. Data were collected using an online questionnaire. Descriptive and inferential statistics were used to analyse the data. Findings: This study revealed that undergraduates relied upon lecture notes to complete assignments during the COVID-19 pandemic. Undergraduate students have developed a definite information-seeking pattern, which did not change during the pandemic. They tend to use information channels that require the least effort. Postgraduate students used a variety of Library information channels but primarily used electronic journals. On the whole, students experienced challenges while seeking information via the channels provided by the Library. Students were neither satisfied nor dissatisfied with the Library's provision of electronic resources and services. Research limitations/implications: The study used non-probability sampling and only included students from two faculties at one university. As a result, the findings may not be generalized to the entire student population or all Caribbean universities. Practical implications: The results of this study can be used to identify the difficulties students are having in accessing information from the Library and gauge service delivery. Originality/value: This paper contributes to the scholarship from the Caribbean written to show whether students' information-seeking behaviour changed during the COVID-19 pandemic. © 2022, Emerald Publishing Limited.

Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.

IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES: Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.

Knowledge, preparedness, and attitude towards COVID-19 among health profession students in Sub-Saharan Africa: A cross-sectional survey.

Objective: We assessed the knowledge, preparedness, and attitude of health profession students towards COVID-19 outbreak in Sub-Saharan Africa. Methods: This cross-sectional study used convenience sampling to recruit participants from institutions under African Forum for Research and Education in Health (AFREhealth). The survey was developed in QuestionPro software covering the participants' socio-demographic characteristics, knowledge, attitude, and preparedness towards the COVID-19 outbreak. Data were analysed and the association between variables was tested. Results: The mean age of the 336 students was 25•75 (±7•88) years. Most (99•7%) knew the cause of COVID-19 which could be transmitted via droplets (97•3%). Several participants vowed to adhere to preventive measures (92•3%) and claimed their curriculum equipped them with skills addressing infectious disease outbreaks (63•6%). Nursing students were better prepared than other students (p=0•001). Students from West African regions were more prepared (p=0•001) and aware they could contract COVID-19 if they cared for infected persons (p=0•001). Conclusion: Students are knowledgeable about COVID-19, adequately prepared to handle epidemics, have a positive attitude towards infection prevention, and their training institutions and government have taken adequate measures to address the COVID-19 outbreak. Funding: AFREhealth.

Innovative electronic sleep mitigation tool for medical trainees

Introduction: The ACGME (Accreditation Council for Graduate Medical Education) has been advocating for training of medical learners in sleep and fatigue mitigation, in attempt to enhance their wellbeing. While some educational programs include a one-time sleep didactic, prone to being overlooked, there is need for an educational resource which can be accessible to the learners throughout their training span. The trainees' needs and readiness to learn may vary from time to time, therefore, continued access to educational resources can be very beneficial. Methods: An electronic tool was created on Coggle, comprising of educational resources and content on the basic tenets of sleep quality, regulation, effects of deprivation and strategies to mitigate these effects. Links to free resources made available by AASM, such as 'Choose Sleep,' were also included. The sleep resources were then incorporated in the overall continuum of Graduate Medical Education (GME) resources available to trainees, and was advertised in newsletters, incorporated in orientations (n=324) and wellness sessions (n=254). The GME Institutional Quality of Life data was obtained in 2018-2019 and in 2020 to ascertain baseline and post-intervention measures of wellness, workload and burn-out in trainees. Results: Data collected in 2020, after introduction of Coggle, demonstrated: 1) A 4% increase of residents (n=1041) would rate their workload as 'just right.' 2) A 9% increase of residents (n=1040) said their personal health and wellbeing was 'very good' and 'good.' 3) A 12% decrease of residents (n=1040) said they felt burned out at work. 4) A 5% decrease of residents (n=1037) said they felt they had become more calloused towards people since they first started training. Conclusion: The analysis of learners' feedback demonstrated that access to sleep training resources on a continuous, on-demand basis improved trainees' personal health and wellbeing. The positive impact was sustained despite unprecedented stress caused by the COVID- 19 pandemic. Future steps include: 1) Moving the electronic tool to a more advanced platform with analytical capabilities. 2) Obtaining longitudinal data to assess the impact of the electronic tool on medical trainees' sleep parameters. 3) Sharing the electronic tool with other organizations to improve wellbeing of all medical trainees and health professionals.