Children in poverty: Time for action to address rising inequalities in the United Kingdom

Children have been disproportionately affected by the response to COVID-19 despite having a negligible risk of morbidity and mortality. Moreover, the response to COVID-19 has magnified the inequalities generated by the decade-long austerity regime imposed by the coalition, and current government. The numbers of children living in poverty are rising: some 30% of children, amounting to over four million children, are living in relative poverty in the United Kingdom. Poverty will deepen due to rising levels of unemployment, and with 25% of private sector workers experiencing a reduction in hours, this will disproportionately affect families with young children. The stage is set for deepening and more entrenched inequalities, superimposed on the pre-existing inequalities of austerity. A comprehensive and radical set of policies is needed to address this and will require full government commitment at the highest level.

Does telemedicine work well to support adolescents with type 1 diabetes?: A qualitative study with parents and diabetes care team members

Introduction: Diabetes clinics have rapidly adopted the use of telemedicine to support ambulatory diabetes care during the COVID-19 pandemic. Objectives: The aim of this study was to explore barriers to and facilitators of the integration of telemedicine in ambulatory diabetes care for adolescents with type 1 diabetes (T1D). Methods: Eight focus groups of parents (n=19) and diabetes care team members (n=18) were conducted in the Seattle, WA metropolitan area. Semi-structured questions were used to elicit views about their experience with telemedicine diabetes clinic visits during the COVID-19 pandemic. Analysis was conducted using an iteratively developed codebook and themes were mapped onto the technology acceptance model (TAM). Results: Barriers (n=5) and facilitators (n=5) were mapped to TAM domains (Table). Facilitators of perceived usefulness and perceived ease of use domains included (1) clinic visit accessibility that aligned with adolescent lifestyle, (2) access to context of daily life at home, and (3) adolescent literacy with videoconferencing technology. Barriers included (1) inability to conduct a physical exam and incorporate findings, (2) inconsistent availability of diabetes technology data, and (3) inability to ensure confidential communication with adolescent. Participant attitudes toward ongoing use of telemedicine were informed by the anticipated level of adolescent engagement in a virtual setting and equity determinants, including the challenges related to attending clinic visits. All participants, especially parents, saw the value in a hybrid model of telemedicine/inperson visits as beneficial for future ambulatory diabetes care. Conclusions: Parents and diabetes care team members report that telemedicine visits are useful and align well with communication and lifestyle needs of adolescents. However, diabetes clinics need to address accessibility issues, improve appointment preparation, and develop techniques for confidential communication. (Table Presented).

Covid-19 and qtc: Is hydroxychloroquine worth the risk? a review of qt prolongation in hospitalised covid-19 patients treated with hydroxychloroquine and azithromycin

Background Hydroxychloroquine (HC) and Azithromycin (AZ) is a novel treatment regimen in the management of Coronavirus disease 2019 (COVID-19). Both HC and AZ are associated with QT prolongation, which can precede malignant arrhythmias such as torsade de pointes (TdP) and ventricular fibrillation. Limited literature exists to establish the incidence of QT prolongation with COVID-19 treatment and its relationship with morbidity and mortality. This study was performed to assess the incidence of QT prolongation secondary to HC and AZ, and how it related to morbidity and mortality. Methods A retrospective chart review was performed of COVID-19 patients treated with HC, with or without concomitant AZ, in our hospital in March and April 2020. Their baseline demographic characteristics and co-morbidities were recorded. The baseline corrected QT interval (QTc) and change in QTc was calculated using Bazett's formula on both electrocardiograms (ECGs) and inpatient cardiac monitors. Results Out of 62 PCR confirmed COVID-19 patients (34% female;mean age 67), 58 patients (93.5%) received both HC and AZ, while 4 patients (6.5%) received HC alone. Hypertension was the most common co-morbidity (33.5%) followed by diabetes mellitus (16%), known ischaemic heart disease (19.4%) and atrial fibrillation (8%). Twenty-three patients (37.1%) were on2 additional QT prolonging medications. Mean baseline QTc was 445.7 msec (SD 30.4). The mean QT peak was 469.3 msec (SD 44.5) with a mean change in QTc of 28.4 msec (SD 31.4). QT prolongation was seen in 62.9% of patients, with increase in QTc60 msec or QT peak500 msec in 24.2% of patients. The mean length of stay was 19.7 days (SD 15.2) (range 3-57 days). Treatment was stopped in 6 patients (9.7%) due to QT prolongation. There were no cases of torsade de pointes (TdP). Mortality was 22.6%, with 16.1% of patients admitted to an intensive care unit (ICU). Patients with QT prolongation had a significantly higher risk of death (33% vs 4.3%), with an increased likelihood of ICU admission (20.5% vs 8.7%), and increased length of stay (24.7 days vs 18.6 days). Conclusions In this study, patients who were treated with HC and AZ were at high risk of QT prolongation. QT prolongation was associated with higher mortality, increased ICU admission and longer length of stay. Close cardiac monitoring and rationalisation of additional QT prolonging drugs are essential to prevent adverse cardiac events with this treatment regimen.