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Background: Following the declaration of the COVID-19 national emergency, screening mammograms (SM) abruptly dropped across the United States. Stay-at-home orders discourage cancer patients from seeking care, and cancer screenings and surgeries were postponed. Upon resumption of screening services, rates of screening were slow to recover. At Baylor St. Luke's CHI (BSL), one of the largest tertiary care centers providing comprehensive cancer screening in Houston, we investigated patient level predictors, including comorbidities and area deprivation index (ADI), and the risk of skipping SM in the first year of the COVID-19 Pandemic. Method(s): We used the local PENRAD database to retrieve the monthly gross number of SM performed at all BSL sites from 02/2018 to 01/2021. We obtained patient level data through EPIC, including address and demographics, comorbid conditions e.g., diabetes, hypertension, obesity (BMI 30), chronic kidney disease and cardiovascular diseases (CVD). We identified ADI associated with patient addresses. We included patient who received at least one SM between 02/2018 to 01/2020. We compared patients did not get a mammogram in the first year of the pandemic;02/2020 to 01/2021, to those who maintained screening during the pandemic. We performed a logistic regression analysis to assess the influence of age, 0 to +3 comorbid conditions, and ADI in quartiles on the odds ratio of skipping SM in the first year of the pandemic. Statistical significance was set at p< 0.05. The study was IRB approved. Result(s): Out of the 4591 women that screened in 2018 and/or 2019, only 1628 came back for SM in 2020 (35.5%). Women who obtained SM during the pandemic vs those who did not were slightly older, mean age 58 vs 56 (P< 0.001), were less likely to be living in the most deprived neighborhood, Q4 of ADI, 23.8% vs. 25.6%, more likely to be obese 39% vs. 35% (P< 0.001), more likely to have diabetes 48% vs. 41% (P< 0.001), more likely to have CVD, 16% vs. 13% (P< 0.001), and more likely to have hypertension 80% vs. 71% (P< 0.001). On multivariate logistic regression, living in Q4 ADI was associated with 22% higher risk of skipping SM in 2020 (95% CI 1.02-1.42), having one vs. two vs. three comorbid conditions increased the likelihood of obtaining SM in 2020 by 25% (95% CI 0.62- 0.91) vs. 30% vs (95% CI 0.58-0.85), 42% (95% CI 0.48-0.7) compared to no comorbid conditions. Conclusion(s): Women living in Q4 of the ADI (most deprived neighborhood) were more likely to miss 2020 screening when compared with the Q1 women (least deprived neighborhood). The more chronic diseases women had, the less likely they were to skip 2020 screening when compared with those that had no chronic disease. This could because women with many health issues have to frequent health facilities at higher rates and thus less likely to miss mammograms. VIEW LARGE VIEW LARGE.
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Background and objective: COVID-19 as an unknown disease could have been able to increase the anxiety of the patients. The objective of this study is to analyze if the anxiety of patients with severe COVID-19 in the first wave of COVID-19 was higher than in the second wave. Method(s): We collected data from patients with severe COVID-19 who required intensive care and were later reviewed in a COVID-19 monographic consultation. They were classified according to the time of illness in the first wave (03/01/2020-07/31/2020) and second wave (08/01/2020-11/30/2020). The HADS (Hospital Anxiety and Depression Scale) questionnaire was analyzed. It is considered depression if the value of HADS-D is 7 or higher and anxiety if the value of HADS-A is 8 or higher. Result(s): 53 patients were included, 37 from the first wave of COVID-19 and 16 from the second;38 men and 15 women, mean age of 60.83+/-10 years and global mean BMI 30+/-5.56 kg/m . The HADS for anxiety in the first wave was 3.41+/-3.25 and in the second wave 6.38+/-4.73 (p<0.05). On the first wave, 18,9% of patients had anxiety (HADS-A>=8), while on the second wave 50% of the patients had anxiety, with a statistically significant difference (p<0.05). The HADS of depression in the first wave was 4.30+/-3.56 and in the 2 second wave 6.75+/-3.46 (p<0.05). On the first wave, 18.9% of patients had depression (HADS-D>=7), while on the second wave 50% of the patients had depression, with a statistically significant difference (p<0.05). Conclusion(s): Anxiety and depression were higher in patients of the second wave, so uncertainty does not appear to play a role. The study would have to be expanded to confirm that the finding holds on larger groups.
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We frame our research on future teachers' need for accompani-ment during their formative process. Until 2019, most profes-sional trainings were face-to-face in the Practice Centers and UCSH's workshop activities. Derived from the COVID-19 pan-demic, a new form of educational accompaniment appeared in 2020, online work with students. As references to this study, we established aspects we learned during the health crisis, such as collaborative work, adaptation, and flexibility. The UCSH For-mative Model considers the three fundamental pillars: identity, quality, and responsibility. The dimensions of Salesian accompa-niment are anthropological, educational, and theological. Final-ly, the relevant competencies proposed by CASEL are considered from the socioemotional area. Our work methodology follows participatory action research, which considers the review of background information related to the research topic, the elabo-ration, and application of questionnaires, and online interviews, to then continue analyzing comparative and qualitative data. We aim to arrive at the proposal of pedagogical accompaniment and the evaluation phase that would correspond once implemented. Our main results show that there has been an evolution of the student's perceptions about professional practice since 2019, where this instance was associated with stress, insecurity, and even failure. During the years 2020 and 2021, the students value the accompaniment and feedback positively from both the col-laborating teachers (guides) and the internship teachers (super-visors).
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Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022
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Background: The third most populous county in the United States, the Harris Country, has some of the worst outcomes of breast cancer in the country. In this county, 27% of mammogram eligible women, ages 40-64 are uninsured, compared to about 11% the national average. Harris Health (HH) is a state funded network of SafetyNet hospitals and clinics that provide comprehensive care, including breast cancer screening to the uninsured and underinsured residents of the Harris county. The population who receives care at the HH sites is majority of racial and ethnic minorities and generally lower socioeconomic status than the county average. The number of screening mammograms abruptly dropped by 94% across the United States following the declaration of the COVID-19 national emergency. Currently there is no data on how breast cancer screening rates have been affected during the pandemic across Houston, and specifically in Harris County where health disparities gap already existed. We hypothesized that the population across HH sites have lower rates of screening mammograms following the COVID-19 pandemic declaration compared to the rest of the population across Houston who visit Baylor St. Luke's Health- Texas (SLH) catchment area. Methods: We retrieved the monthly gross number of screening mammograms performed at all HH sites and SLH sites from February to October for both 2019 and 2020 on the PENRAD database. We then used the Independent-Samples Mann-Whitney U Test to assess differences in the distribution of percent change in mammogram between HH sites and SLH sites. First, we compared the total mammogram numbers for February to October (2020 vs. 2019). We then compared only the numbers for each month (e.g., May 2020 vs. May 2019). Beyond basic descriptive counts, statistical analysis was limited to mammogram among women ages 40 - 69. Statistical significance was set at p<0.05. Results: Overall, across both health care systems, HH and SLH, and for all ages, there was a drastic drop (53.96%) in screening mammogram between 2019 (N=32,968) and 2020 (N=17,788). For women ages 40 - 69, the drop in screening mammogram at SLH sites during 2020 (February to October) was significantly less than the drop at HH sites during the same period. When screening mammogram was compared between 2019 and 2020 for each month separately, it was only in May and September that the % change in mammogram were similar for SLH and HH. For the remaining months, SLH site had significantly less drop in screening mammograms. Conclusion: The population that normally receives care at HH site had significantly lower rates of screening mammograms following the pandemic compared to the population who receives care at SLH sites. This will likely widen the already present disparity gap in breast cancer outcomes for the city of Houston.
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In this paper, we present a new methodology for the assessment of Programming and Data Structures courses in conditions of Covid-19. The study is carried out at the Catholic University of Temuco, based on the suggestions received at the beginning of the pandemic, by students of the Computer Engineering career. The proposal consists of redirecting the assessment to freely accessible online programming platforms. As part of the study, a mapping of the contents to be evaluated in both subjects with problems available on platforms such as LeetCode and CodinGame is carried out. We manage to cover all the content to be evaluated using these platforms. An analysis of the results of the course, applying this new methodology, is made. Through a survey, applied at the end of the semester, we collected information about the perception of students, concerning aspects related to the changes in the assessment of the course. The results of the survey are analyzed qualitatively and quantitatively, perceiving improvements in the promotion indicators and the motivation of the students. © 2021 IEEE.
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Introduction: The COVID-19 pandemic produced a health crisis affecting countries' vaccination coverage statistics. Objective: To describe the coverage of recommended vaccines during the pre-pandemic (2015-2019) and pandemic (2020-2021) periods in Paraguay. Materials and Methods: This was a descriptive, observational cross-sectional study, comprising children from 0 to 5 years of age, from the Country's 18 Health Regions. The vaccination coverage of the National Expanded Immunization Program, pre-pandemic (2015-2019) and pandemic (2020-201) periods were analyzed. The recommended vaccinations included were: BCG, DTP1, DTP3, IPV1 and bOPV3, MMR1, MMR2 and yellow fever vaccine (AA), the calculation of vaccination coverage at the country level was carried out through the analysis of the weekly electronic report of doses of vaccines administered by Health Region. The comparison of vaccination coverage by recommended vaccine was established, by periods and age range. Results: During the pandemic, a decrease in vaccination coverage of the recommended vaccines was observed, for BCG: 4% (2020), 15% (2021);DTP1: 5% (2020), 13% (2021);DTP3: 9% (2020), 22% (2021);IPV1: 5% (2020), 16% (2021);bOPV3: 7% (2020), 19% (2021);MMR1: 9%, MMR2: 13% (2020), MMR1: 17%, MMR2: 16% (2021) and AA: 7% (2020), 15% (2021). Conclusion: During the Covid-19 pandemic, vaccination coverage of all recommended vaccines decreased, a similar decrease was found in other countries in the Americas, there is a risk of outbreaks of vaccine-preventable diseases due to the accumulation of susceptible populations.
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Introduction: The information regarding IBD patients with COVID-19 suggests that the factors related to bad outcome are older age and comorbidity whereas immunosuppressants do not have a significant impact worsening the disease evolution. Aims & Methods: Aims: To assess if there are differences in epidemiological, demographical, and clinical characteristics between infected and non-infected IBD patients. Methods: Case-control study in IBD patients with COVID-19 (cases) compared to IBD without COVID-19 (controls) in the period March-July/2020 within the ENEIDA registry (promoted by GETECCU and with more than 60.000 IBD patients included). Cases were matched 1:2 by age (±5y), type of disease (CD/UC), gender, and centre. All controls were selected from only one investigator blind to other clinical characteristics of the patients to avoid selection bias. Results: 482 cases and 964 controls from 63 Spanish centres were included. No differences were found within the basal characteristics including CD location, CD behaviour, extraintestinal manifestations, family history of IBD or smoking habits. Cases had ≥ 1 comorbidities (cases:43%vs. controls: 35%, p=0.01) and occupational risk (cases:27% vs. controls:10.6%, p<0.0001) in a higher proportion. Strict lock-down was the only measure demonstrating protection against COVID-19 (cases:49% vs. controls:70%, p<0.0001). There were no differences in the use of systemic steroids (p=0.19), immunosuppressants (p=0.39) or biologics (p=0.28) between cases and controls. Cases were more often treated with aminosalycilates (42% vs.34%, p=0.003). Having ≥ 1 comorbidities (OR:1.6, 95%CI: 1.2-2.1), occupational risk (OR:1.95, 95%CI:1.39-2.7) and the use of aminosalycilates (OR:1.4, 95%CI: 1-1.8) were risk factors for COVID-19. On the other hand, strict lockdown was a protective factor (OR:0.38, CI:0.29-0.49). Conclusion: Comorbidities and epidemiological risk factors are the most relevant aspects for the risk of COVID-19 in IBD patients. This risk of COVID- 19 seems to be increased by aminosalycilates but not by immunosuppressants or biologics. The attitude regarding treating IBD patients with aminosalicylates during COVID-19 pandemic deserves a deeper analysis. (Table Presented).
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Background: SARS-CoV-2 infection has bimodal distribution in Europe with a 1st wave in March-June 2020 and a 2nd in September 2020-February 2021. In cancer patients (pts) the lethality of COVID- 19 infection was 25%>35% in the 1st wave. Comparison on impact of COVID-19 infection in the 1st vs. 2nd waves have not been performed in ALL. Aims: We compared the frequency, clinical characteristics and outcome of adults with ALL and COVID-19 infection in the 1st vs. 2nd waves in Spain. Methods: Between March 1, 2020-May 31, 2020, and between September 12, 2020- January 12, 2021 (date of vaccination onset in Spain), a registry from the PETHEMA (Programa Espa.ol de Tratamientos en Hematologia) and GETH (Grupo Espa.ol de Trasplante Hematopoyético y Terapia Celular) groups prospectively recruited adult ALL pts with COVID-19 infection confirmed by PCR. Demographic and clinical characteristics of ALL and COVID-19 infection, comorbidities, treatment and outcome were collected and compared in the two periods. In addition, prognostic factors for survival were analyzed. Results: Fifty-six patients were collected in 82 centers contacted, 4 of them being excluded (COVID infection >3 yr. after end of ALL therapy [n=3] and Burkitt lymphoma [n=1]). Twenty-eight pts were collected in the 1st wave and 24 in the 2nd. Median age was 46 (range 20-83), (34 pts [65%] >40 yr). Comorbidities were present in 18 pts (35%). ALL was of B-cell precursors in 38 pts (74%) (Ph+ in 8, 15%). Thirtyone pts (60%) were under frontline treatment, 16 (31%) in rescue, 1 (2%) palliative and 4 (7%) had recently finished the therapy. Eight pts had received allogeneic HSCT (5 of them at COVID-19 infection diagnosis), CAR T (n=1, 2 yr prior to COVID-19 infection) or received immunotherapy (inotuzumab, n=6, 2 at COVID-19 infection, and blinatumomab, n=1, prior to COVID-19 infection). Eleven pts were receiving immunosuppressive drugs at COVID infection (fludarabine in 6, among others). No significant differences were observed in ALL characteristics in the two COVID-19 waves, except for a significantly higher number of patients on first line therapy in the second wave, and a higher frequency of severe neutropenia and lymphocytopenia in the first wave. COVID19 therapy was different in the two periods, with significantly higher use of hydroxychloroquine, remdesivir and lopinavir-ritonavir in the first wave and corticosteroids in the second wave. No significant differences were observed in need of oxygen support (12 vs. 8 pts), ICU requirement (7 vs. 4 pts), days in ICU (medians 16 vs. 21) and time to COVID infection recovery (medians 17 vs. 13 days). Seventeen patients (33%) died (11 vs. 6), being death attributed to COVID infection in 15 (29%), without significant differences in the 100-day survival probabilities (Figure 1). By multivariable analysis only comorbidities at COVID-19 infection had a negative impact on survival (HR: 5.358 [95% CI: 1.875;15.313]). Summary/Conclusion: COVID-19 infection was frequent in ALL pts, especially in those with advanced age and under ALL frontline or rescue therapy. The frequency of severe COVID-19 infection and mortality were high, with negative impact of comorbidities on survival. No significant differences were observed in ALL characteristics, response to therapy and outcome in the two waves of COVID infection. The poor outcome of COVID infection makes vaccination a priority for ALL patients in this pandemic period. Supported in part by 2017 SGR288 (GRC) Generalitat de Catalunya and "la Caixa" Foundation.
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The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.
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In front of the sanitary situation that you confront the world and Cuba, for the new coronavirus's presence, the psychologists began to offer psychological help to the population, using the most various roads: You consult phone, you program television and radial, as well as the platform WhatsApp, in dependence of the requests of the population attended in point. The work presents the general strategy implemented by the Cathedra of the Older Adult of the University Carlos R. Rodriguez of Cienfuegos, to attend the older, considered people a vulnerable population. Present the organizational and functional aspects of the work in group using the Plataforma WhatsApp, others fact-finding roads about the older people's well-being, as well as some reflections to go into the new normality.