ABSTRACT
Objective: Telehealth has been an integral part of ensuring continued general practice access during the COVID-19 pandemic. Whether telehealth was similarly adopted across different ethnic, cultural, and linguistic groups in Australia is unknown. In this study, we assessed how telehealth utilisation differed by birth country. Methods: In this retrospective observational study, electronic health record data from 799 general practices across Victoria and New South Wales, Australia between March 2020 to November 2021 were extracted (12,403,592 encounters from 1,307,192 patients). Multivariate generalised estimating equation models were used to assess the likelihood of a telehealth consultation (against face-to-face consultation) by birth country (relative to Australia or New Zealand born patients), education index, and native language (English versus others). Results: Patients born in Southeastern Asia (aOR: 0.54; 95% CI: 0.52-0.55), Eastern Asia (aOR: 0.63; 95% CI: 0.60-0.66), and India (aOR: 0.64; 95% CI: 0.63-0.66) had a lower likelihood of having a telehealth consultation compared to those born in Australia or New Zealand. Northern America, British Isles, and most European countries did not present with a statistically significant difference. Additionally, higher education levels (aOR: 1.34; 95% CI: 1.26-1.42) was associated with an increase in the likelihood of a telehealth consultation, while being from a non-English-speaking country was associated with a reduced likelihood (aOR: 0.83; 95% CI: 0.81-0.84). Conclusions: This study provides evidence showing differences in telehealth use associated with birth country. Strategies to ensure continued healthcare access for patients, whose native language is not English, such as providing interpreter services for telehealth consultations, would be beneficial. Perspectives: Understanding cultural and linguistic differences may reduce health disparities in telehealth access in Australia and could present an opportunity to promote healthcare access in diverse communities.
ABSTRACT
Background At least 80% of new cervical cancer cases and deaths occur in low- and middleincome countries. Vietnam is a middle-income country where cervical cancer is the second most common and the deadliest gynecologic cancer. Cervical cancer incidence in Southern Vietnam has been shown to be 1.5-4 times higher than that in Northern Vietnam. However, less than 10% of Southern Vietnamese women have received the Human papillomavirus (HPV) vaccine and only 50% have ever been screened for cervical cancer. No study has examined the perceptions toward cervical cancer prevention and screening in Southern Vietnamese women. Hence, this study aimed to explore cervical cancer awareness, barriers to screening, and acceptability of HPV self-sampling for cervical cancer screening among rural and urban women in Southern Vietnam. Methods In October-November 2021, three focus groups were conducted in the rural district of Can Gio (n=21 participants) and three were conducted in the urban District Four (n=23 participants) in Ho Chi Minh City, Southern Vietnam. All participants were cervical cancer-free women aged 30-65 years. Awareness of, attitudes toward, and experience with cervical cancer prevention and screening were explored using audio-recorded, semi-structured discussions in Vietnamese. During the focus groups, participants also watched four short videos with Vietnamese subtitles and voiceover about cervical cancer screening methods and discussed their views on each. The recordings were transcribed, translated into English, and coded and analyzed using Dedoose 9.0.46. Results Four main themes emerged. First, women showed low awareness, but high acceptance of cervical cancer screening and HPV vaccination. Second, screening barriers were related to logistics (e.g., cost, time, travel distance), psychology (e.g., fear of pain, embarrassment, fear of the test revealing they had cancer), and healthcare providers (e.g., doctors' impolite manners, male doctors). Third, women were concerned about self-sampling incorrectly and pain, but believed HPV self-sampling to be a feasible screening tool in some circumstances (e.g., during the COVID-19 pandemic, those living in remote areas). Fourth, women related cervical cancer prevention to COVID-19 prevention;they believed strategies that have been successful for COVID-19 control in Vietnam could be applied to cervical cancer. No differences in themes emerged by rural/urban areas. Conclusions Southern Vietnamese women showed low awareness but high acceptance of cervical cancer screening despite barriers. Strategies for successful COVID-19 control in Vietnam, including campaigns to increase public awareness, advocacy from the government and doctors, and efforts to increase access to screening and vaccination, should be applied to cervical cancer control. Health education programs to address HPV self-sampling concerns and promote it as a cervical cancer screening tool are warranted given its potential to improve screening uptake in this low-resource setting.
ABSTRACT
Background. WW surveillance enables real time monitoring of SARS-CoV-2 burden in defined sewer catchment areas. Here, we assessed the occurrence of total, Delta and Omicron SARS-CoV-2 RNA in sewage from three tertiary-care hospitals in Calgary, Canada. Methods. Nucleic acid was extracted from hospital (H) WW using the 4S-silica column method. H-1 and H-2 were assessed via a single autosampler whereas H-3 required three separate monitoring devices (a-c). SARS-CoV-2 RNA was quantified using two RT-qPCR approaches targeting the nucleocapsid gene;N1 and N200 assays, and the R203K/G204R and R203M mutations. Assays were positive if Cq< 40. Cross-correlation function analyses (CCF) was performed to determine the timelagged relationships betweenWWsignal and clinical cases. SARS-CoV-2 RNA abundance was compared to total hospitalized cases, nosocomial-acquired cases, and outbreaks. Statistical analyses were conducted using R. Results. Ninety-six percent (188/196) of WW samples collected between Aug/ 21-Jan/22 were positive for SARS-CoV-2. Omicron rapidly supplanted Delta by mid-December and this correlated with lack of Delta-associated H-transmissions during a period of frequent outbreaks. The CCF analysis showed a positive autocorrelation between the RNA concentration and total cases, where the most dominant cross correlations occurred between -3 and 0 lags (weeks) (Cross-correlation values: 0.75, 0.579, 0.608, 0.528 and 0.746 for H-1, H-2, H-3a, H-3b and H-3c;respectively). VOC-specific assessments showed this positive association only to hold true for Omicron across all hospitals (cross-correlation occurred at lags -2 and 0, CFF value range between 0.648 -0.984). We observed a significant difference in median copies/ ml SARS-CoV-2 N-1 between outbreak-free periods vs outbreaks for H-1 (46 [IQR: 11-150] vs 742 [IQR: 162-1176], P< 0.0001), H-2 (24 [IQR: 6-167] vs 214 [IQR: 57-560], P=0.009) and H-3c (2.32 [IQR: 0-19] vs 129 [IQR: 14-274], P=0.001). Conclusion. WWsurveillance is a powerful tool for early detection andmonitoring of circulating SARS-CoV-2VOCs.Total SARS-CoV-2 andVOC-specificWWsignal correlated with hospitalized prevalent cases of COVID-19 and outbreak occurrence.
ABSTRACT
Background: Metformin-associated lactic acidosis occurs very infrequently;however, with the significantly greater comorbidity burden and acuity of patients with diabetes undergoing coronary angiography/angioplasty (CA), the inherent risk of metformin-associated lactic acidosis may be significantly increased. Additionally, significant variations in contemporary practice pattern around peri-CA metformin use still continue to exist. Methods and Results: This is a pilot, single-center, open-labelled, randomized comparison of metformin continuation or 48-hour interruption following CA (Saskatoon, Clinical Trials.gov 03980990). All patients had metformin continued to the time of the angiogram. Patients presenting with cardiogenic shock, cardiac arrest, history of chronic liver disease, severe chronic kidney disease (eGFR<30 or on dialysis) or requiring coronary artery bypass graft surgery following CA were ineligible for inclusion. Planned enrollment of 500 patients had been anticipated for the calendar year (June 2019-June 2020), and stratified at randomization by in/out-patient status. The primary outcome included lactic acidosis (lactate ≥5mmol/L ± bicarbonate <18mmol/l) at 48-72 hours after CA. Key secondary outcomes included: absolute lactate levels, acute kidney injury (AKI, ≥25% or 27μmol/L rise at 48-72 hours) and all-cause mortality at 1-week. Continuous variables are expressed as medians (25th, 75th percentile) and categorical variables as frequency (%). At study interruption (March 12/20, COVID-19) 312 patients had been randomized, of whom 52% presented with an acute coronary syndrome (n= 161/312;STEMI 11%). Baseline characteristics were balanced across the two groups, including the proportion treated with PCI (Table 1). Follow up lactate levels were available in: continued arm 71% (n=112/157), interrupt arm 67% (n=104/155). No patients in either arm had serum lactate ≥5mmol/L, however, metformin continuation compared with a 48-hour interruption had significantly higher median lactate levels (1.70 [1.15, 2.2] vs. 1.40 [1.2, 1.8], p=0.02);no between-group differences were evident for serum bicarbonate (26.0 [24, 28] mmol/L vs. 25.0 [24, 27] mmol/l, p=0.15). No differences were evident in the rates of AKI (7.7% vs. 8.3% p= 1.0). No patients died in either treatment arm at 1-week (vital status available for all 312 patients). Conclusion: Conclusion: In this interim analysis of contemporary treated patients with diabetes, all of whom had metformin continued up to CA, metformin continuation compared with a 48-hour interruption was not associated with clinically relevant lactic acidosis. Continued metformin use however appears to associate with higher 48-72-hour lactate levels, without differences in AKI or all-cause mortality at 1-week. Trial completion is anticipated with COVID-19 pandemic resolution. [Formula presented] Royal University Hospital Foundation