ABSTRACT
STATEMENT OF PROBLEM/QUESTION: The COVID-19 pandemic has caused marked declines in cancer screenings and exacerbated preexisting disparities in cancer screening among vulnerable patient populations. DESCRIPTION OF PROGRAM/INTERVENTION: Despite the availability of robust quantitative data reporting disparities in cancer screening during the COVID-19 pandemic, there is a dearth of patient-reported data available describing prevalence and drivers of patient hesitancy towards cancer screening and patient willingness to resume cancer screening. Additionally, as health systems continue to experience pandemic-related bandwidth strain, there is an urgent need to develop innovative models of re-engaging patients in preventive screening that can successfully be implemented in the current healthcare environment. To address this issue, we developed a medical student-led, high- touch outreach model to re-engage primary care patients of the Brookside Community Health Center (BCHC) in cancer screening. We iteratively optimized semi-structured call scripts and surveys in English and Spanish to contact patients overdue for mammography screening. Student callers consisted of medical students and premedical students with native Spanish fluency. Call script language allows students to identify patient-reported barriers and facilitates re-scheduling of mammograms for consenting patients. For consenting patients, student callers input a telephone encounter with a pended screening mammogram order in the electronic medical record;the note is then routed to the patient's PCP for signing. Patients additionally receive reminder calls from students the week of their mammography appointment. MEASURES OF SUCCESS: Primary outcomes include screening consent rates, rates of mammogram scheduling and completion, and screening results. Patient response to survey prompts and student call summaries were securely recorded and analyzed utilizing the REDCap survey platform. FINDINGS TO DATE: 198 patients eligible for the intervention have been identified, of which 60% are primarily Spanish-speaking and 81% are enrolled in MassHealth (MA Medicaid). 145 patients (73%) have successfully been contacted, of which 129 (89%) consented for mammogram screening. 74 (57%) of the consenting patients have scheduled their mammogram, and 38 (29%) have completed their mammogram. Of note, 6 patients had abnormal mammograms requiring subsequent diagnostic imaging, and one patient was diagnosed with ductal carcinoma in situ requiring establishment of oncologic care. A preliminary qualitative analysis of patient surveys has found that primary barriers to screening included factors associated with the COVID-19 pandemic, lack of awareness of overdue status, and patient unavailiability (e.g. temporarily out of the country), and miscommunication between patients and the clinic. KEY LESSONS FOR DISSEMINATION: In this single-center quality improvement study, we found willingness to engage in cancer screening during the pandemic remains high and trainees can play a vital role in mitigating screening disparities during the pandemic.
ABSTRACT
Objective: To determine the bioequivalence of two oral formulations of paracetamol 500 mg/ibuprofen 200 mg. Tolerability of both formulations of paracetamol/ ibuprofen were evaluated descriptively. Material and/or methods: Twenty-four healthy volunteers were enrolled at this random, single-dose, crossover, two-period design, open-label, bioequivalence study. After overnight fasting, two formulations (test and reference) of paracetamol/ibuprofen (paracetamol 500 mg/ ibuprofen 200-mg film coated tablets), were administered as a single dose on two treatment days separated by a 72 h (minimum) washout period. After dosing, blood samples were drawn for a period of 12 h. Pharmacokinetic parameters were determined from plasma concentrations for both formulations. The coronavirus disease 2019 (COVID-19) pandemic was declared a public health emergency of international concern by the WHO. Extraordinary safety measures were implemented at different levels that intended to preserve the clinical trial activities as far as possible, protecting the safety and preserving the traceability while no vaccine was available. These measures, locally, consisted of: information about the importance of the measures, PCR test for COVID-19 at the screening visit (if IgG serology was positive) and PCR test at every period of admission to Trials Unit, the subject came into the Unit only after a negative result. Results: The highest effort made to assure the safety of participants led to a regular development of the study, with only two cases excluded primarily and one excluded after the first dose administration. Regarding pharmacokinetics, the results found for Paracetamol: Ln (Cmax) ng/ml Ratio 92.83% (CI90: 83.73%-102.94%);Ln (AUClast) h∗ng/ml Ratio: 96.14% (CI90: 93.24%-99.13%);for Ibuprofen: Ln (Cmax) ng/ml Ratio: 93.78% (CI90: 85.43-102.96%), Ln (AUClast) h∗ng/ml Ratio: 96.06% (CI90: 93.75%-98.42%). No drug-related safety concerns appeared. Conclusions: The clinical development of the BE clinical trial was made available by the extraordinary safety measures adopted. The pharmacokinetics results comply with the regulatory requirements for bioequivalence. No significant findings concerning safety were found.
ABSTRACT
Introduction: Concern about becoming infected is a particularly relevant psychological aspect in the context of a pandemic, as it is associated with social reactions and behavioral changes. Objectives: The present study sought to determine some sociodemographic and health factors associated with concern about COVID-19 infection in Cuban patients with type 2 diabetes mellitus. Methods: 203 patients with type 2 diabetes mellitus, who attended nine primary care areas of four Cuban provinces belonging to different regions of the country (65.52% female, mean age 57.5, SD=19.2), selected through non-probabilistic sampling, participated in the study. A sociodemographic questionnaire, the COVID-19 contagion concern scale (PRE-COVID-19) and an evaluation of blood glucose level were applied. Bivariate associations were examined with a series of analyses of variance (ANOVA). Adjusted (multiple) regression with all predictors running simultaneously was also used. Results: Bivariate analyses showed that age, sex, education, occupation, having comorbidities, and having a family member or friend who had COVID-19 were significantly related to COVID-19 contagion concern. However, when all variables were included simultaneously, only age, technical education, having comorbidities, and having a friend or family member who had COVID-19 remained significant predictors of concern about COVID-19 infection. Conclusions: Male patients, with a technical level of education, with comorbidities and those who had infected family members or friends presented greater concern for the contagion of COVID-19. The public health policies should develop strategies to assess the mental health of people belonging to vulnerable groups and provide interventions to promote mental health in those who show concern about infection.
ABSTRACT
The current health crisis has led to an international economic crisis that has caused great social uncertainty that puts national governments in check. The Covid-19 places an enormous burden on health systems that poses a social and political challenge leading to a call for collective action by economic actors. However, in an industry 4.0 context, it allows for improved conditions of detection, economic recovery, flexibility, among others. In this sense, artificial intelligence allows the redefinition of its theoretical foundations, improving the efficiency of the health system.
ABSTRACT
Background: Literature evaluating the effect of SARS-CoV-2 infection in exposed newborns during pregnancy is still scarce. Although a 3% rate of perinatal transmission has been described, there is not enough evidence of viral transmission in biological samples through microbiological techniques. Our aim is to describe perinatal transmission in newborns exposed to SARS-CoV-2 during pregnancy and their follow up. Methods: The study period is from March 15 to November 30, 2020. Exposed newborns of SARS-CoV-2 infected mothers (with microbiologically confirmed COVID-19 disease during pregnancy or delivery) were included at 13 hospitals in Spain. Demographic, clinical and microbiological data were collected. Biological samples including nasopharyngeal swab, blood, urine, and meconium from newborns and blood, placenta, and breast milk from mothers were collected for reverse transcription polymerase chain reaction (RT-PCR) analysis. Results: 282 exposed to SARS-CoV-2 neonates were recruited;130 cases during the first wave (March 15-July 31) and 152 during the second one (August 1- November 30). The prematurity birth-rate was 20% and 13% respectively. Overall, eleven newborns were positive for RT-PCR in nasopharyngeal swab, eight of them during the first 24-48 hours after birth. Three of them presented viral load in urine sample and another three in meconium sample. Only one RT-PCR was positive in maternal blood samples (1/115) and placenta (1/81). All newborns blood samples collected at delivery were negative for RT-PCR (0/70). There was no viral load either in breast milk samples (0/79). Placental immuno-histochemistry performed for SARS-CoV-2 showed no virus (0/16). Two newborn death were described none of them related to SARS-CoV-2. Those newborns exposed to SARS-CoV-2 were asymptomatic and with normal weight and psychomotor development at 6-months follow-up. Conclusion: Intrauterine SARS-CoV-2 transmission seems unlikely, describing a 3.9% rate of neonatal infection after delivery. A high rate of prematurity is described, mostly during the first wave. SARS-CoV-2 can be detected by RT-PCR in urine and meconium of neonates with positive nasopharyngeal RT-PCR, whereas it has not been detected in any newborn blood. The detection in maternal blood and placenta was anecdotal and it was not detected in breast milk samples. Except for the complications derived from prematurity, exposed newborns evolution was satisfactory.
ABSTRACT
The COVID-19 pandemic led to the temporary closures of higher education institutions in most countries. In this scenario of uncertainty, it is important to begin to draw the fundamental lines of the way out of this crisis and it is necessary to ensure the highest possible degrees of inclusion and equity. The objective of this article is to develop a procedure to carry out the defense of the diploma thesis via virtual and deliver professionals to the business system. For this, a methodology is designed that uses the groups and channels of the main social networks used in Cuban territory in the pandemic period belonging to the 2019-2020 school year. The result is the culmination of study of a university career via "online" of 45 students. The annual objectives are met with the quality and rigor required and the satisfaction of the interested parties is achieved.