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As global COVID-19 pandemic response has moved from full lockdowns and partial lockdowns in most parts of the world to a post-COVID era, an interesting new phenomenon that has emerged is the increased prevalence of hybrid meetings with a mixture of online and in-person attendees. The opportunity for remote participants to observe the responses and interactions of others in the meeting is generally accepted as being limited. An experimental prototype system, called Wedge Video, has been constructed as an attempt to improve the experience of remote participants in hybrid in-person/remote meetings. Wedge Video uses standard screen and camera equipment with existing video conferencing software (Zoom). An evaluation of the prototype system was conducted based on three simple games that each required players to interact rapidly and with some use of body language or gaze direction. Encouraging results led to the examination of the geometry of screen and camera placement in detail. A system that has a somewhat 'virtual reality' feeling to it has now been developed. The remote user is given a view of the in-person part of the meeting with participants at the same scale and location as they would be if the remote user were at the table themselves. Similarly, the local participants see the remote person in place at their table, at a realistic scale and with close to accurate gaze direction. A very preliminary evaluation of these concepts has been promising.
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The world is currently experiencing a crisis, caused by SARS-CoV-2 and a viral mutation. Given this, the mechatronic system is proposed that allows disinfecting contaminated surfaces. This device makes it possible to disinfect polyethylene terephthalate (PET) bottles by applying short-wave UVC rays from 200 to 280 nm, which generates a germicidal effect. The machine consists of a UVC chamber, transport, and a control system. For this, the methodology of the Association of German Engineers (VDI 2206) was used, taking into account the Inventor, TIA Portal, and Factory IO software, managing to develop the system whose light-emitting diodes inside the camera project type C ultraviolet light, camera protected by strips of plastic sheet (ABS) acrylonitrile butadiene styrene anti-ultraviolet light that blocks the projection wave up to 98% of the radiation;the recycled PET bottles are moved through a linear conveyor belt that supports a maximum weight of 200 kg, controlled by a control panel. Obtaining the results in this research focused on the design of the prototype, with a feasible structural system thanks to its maximum efficiency in the disinfection process. It is concluded that it is feasible to design a machine that projects ultraviolet rays to disinfect recycled PET bottles to eliminate viruses, parasites, fungi, and bacteria. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background: COVID-19 has been reported to cause cardiac injury. It can be detected by an electrocardiogram (ECG), which may show markers that may predict clinical outcome. Robust data on the ECG abnormalities among COVID-19 patients affected by the alpha, beta, and gamma variants have been reported, but there is paucity of data among patients affected by the delta and omicron variants. Purpose(s): This study aims to describe the cardiovascular profile, ECG findings, and clinical course of adult patients with COVID-19, and to determine the association between certain ECG findings and clinical outcomes among these patients. Method(s): We evaluated 547 COVID-19 patients admitted from June 2021 to June 2022. Clinical profiles were extracted from electronic records. Admission ECGs were independently read and adjudicated by three cardiologists. Logistic regression analysis was done to determine the association between ECG abnormalities and adverse outcomes, including in-hospital mortality, ICU admission, need for mechanical ventilation, acute respiratory distress syndrome (ARDS), shock, acute kidney injury (AKI), myocardial infarction (MI), myocarditis, venous thromboembolism (VTE), and stroke. Result(s): A Total of 547 COVID-19 patients (mean age 54;men 51.2%) were included. The most common comorbidities were hypertension, diabetes, and dyslipidemia. Majority of patients had severe COVID-19 infection (36%). On admission, 6.4% needed intubation and 14.6% died. The most common ECG abnormalities were non-specific ST-T wave changes (41.1%) and sinus tachycardia (25.6%). Other findings were ST segment depression (3.3%), T wave inversion (1.6%), and ST segment elevation (1.3%). On logistic regression analysis, intraventricular conduction delay (IVCD), T wave inversion, and poor R wave progression were significantly associated with mortality;sinus tachycardia, atrioventricular (AV) block, ST segment elevation, and T wave inversion were significantly associated with the development of VTE;left axis deviation, ST segment elevation, and T wave inversion were significantly associated with the development of ARDS;sinus tachycardia, ST segment depression, and T wave inversion were significantly associated with the development of shock;and sinus tachycardia, ST segment elevation, and early repolarization changes were significantly associated with ICU admission. No associations were established for AKI, MI, myocarditis, and need for mechanical ventilation due to the low prevalence of these outcomes. Conclusion(s): A baseline ECG in patients with COVID-19 may help predict patients who may warrant hospitalization or even intensive care monitoring. In our cohort, certain ECG abnormalities, especially sinus tachycardia, left axis deviation, ST segment elevation, ST segment depression, T wave inversion, AV block, IVCD, poor R wave progression, and early repolarization changes, were associated with adverse clinical outcomes, including in-hospital mortality.
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Background: Mono(ethylhexyl) phthalate (MEHP) is the main metabolite of Di(2-ethylhexyl) phthalate (DEHP), a chemical worldwide used as a plastic softener to increase the malleability, flexibility, and durability of several types of plastic, including those employed in bottled water, medical devices, and food wrapping, among others. Importantly, the consumption of these products has dramatically increased during the COVID-19 pandemic. MEHP has been classified as an endocrine disruptor chemical (EDC) and its involuntary intake has been associated with pregnancy complications such as preeclampsia and miscarriages. The placenta is a transitory organ that provides sustainability to the fetus, as well as the transportation of nutrients, hormones, and oxygen. Recent studies have proposed that MEHP may impair placental development and functionality. Nevertheless, little is known about its molecular mechanisms and effects on the placenta. Recent data has suggested that Sirtuin 1 (SIRT1) might be a molecular target. The aim of this study was to analyze the toxic and transcriptomic effects of MEHP in the human trophoblastic cell line HTR-8/svneo, focusing on the SIRT1-related pathways. Methods and Results: The HTR-8/svneo cell line was used as an extravillous trophoblast model to investigate MEHP effects. MEHP concentrations employed in this study were 0.5, 5, 50, 100, and 200 microM. Cell viability was evaluated by two methods: fixable viability staining, using eFluor 780, and MTT assay. Only the MTT assay suggested a significant decrease in cell viability at 48 hours with MEHP treatments of 5, 50, 100, and 200 microM. Mitochondrial biogenesis was analyzed by qPCR amplifying a region of the MT-ND1 mitochondrial gene. GAPDH promoter was used as a reference control. The results suggested a decrease in mitochondrial DNA at 48 hours. The transcriptomic analysis was performed in an Illumina Next-seq 500 with a coverage of 10 million reads. Doses of 5 and 200 microM of MEHP at 48 hours were analyzed. The results show that 41 and 341 genes were differentially expressed, respectively. These genes are involved in trophoblast function and pathophysiology and, according to previous reports, a portion of them are regulated by SIRT1. Finally, the effect of MEHP on SIRT1 was explored at both protein and mRNA levels by western blot and RT-qPCR, respectively. The results for mRNA levels exhibited a significant decline at 24 hours for all treatments, while protein levels were significantly reduced by 200 microM MEHP treatment at 48 hours. Conclusion(s): The present study demonstrates that MEHP treatments promote mitochondrial dysfunction in HTR-8/svneo cells. Moreover, the transcriptome analysis showed that MEHP modifies important signals for placental function and pathophysiology. The decline in SIRT1 levels correlates with the mitochondrial alterations as well as a portion of the transcriptomic changes, suggesting that SIRT1 may have an important role in MEHP effects in trophoblastic cells. Copyright © 2022 Elsevier B.V.
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This study aimed: 1) to investigate sources of information used by students to learn about COVID-19, 2) to investigate levels of knowledge about COVID-19 and about conditions for the treatment of patients during the COVID-19 lockdown, and 3) to evaluate students' perceptions of safety regarding their return to in-person activities at the School of Dentistry. Dental students answered a questionnaire (29 items;n=371) that explored the aims of the study, based on a Likert scale (Cronbach's alpha, 0.778). Data were tested with the Mann-Whitney U test and Kendall's Tau-c. Dental students received information about COVID-19 from the Mexican Health Ministry as their first source (45.28%). Students had good knowledge about the main characteristics of COVID-19, and 59.3% of students had excellent knowledge about the factors relevant to dental treatment of patients. Half of the students said they felt safe regarding a possible return to in-person activities at the dental school, while the other half did not. Statistically significant differences were noted between the students' scholar year and their level of knowledge (P<0.001) and between their perception of safety (very unsafe, unsafe, safe, and very safe) and scholar year (P=0.000). Dental students had good knowledge about COVID-19 and about the dental care for patients during the lockdown. Half of the dental students felt unsafe about a possible return to in-person school activities. © 2023, Universidad de Costa Rica. All rights reserved.
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Introduction: The design and first results of a transcutaneous electrical stimulator of the vagus nerve for the treatment of Refractory Epilepsy are discussed. Method(s): The device developed is based on the STM32L073CZ microcontroller and can generate fully configurable monopolar or bipolar stimuli, so that the electrical therapy can be adjusted to each patient following the therapeutic strategy designed by their doctor. The start time and duration of each therapeutic session are stored in an internal memory of the device, as well as the instants in which the contact of the electrodes is poor, or the therapeutic session is aborted. In this way, the doctor in charge can review what happened once the information is downloaded to a personal computer. Using 3D printing techniques, a plastic support for the electrodes was developed that allows the automatic adjustment of these to the left ear of the subject undergoing treatment;this ensures placement of the electrodes on the correct ear and proper contact of the electrodes with the skin. The operation of the device is easy, each session starts by pressing a button and ends automatically when the programmed time expires, the intervention of the subject undergoing treatment is minimal and thus stress is avoided. Result(s): 20 prototypes were built and passed technical tests in accordance with IEC 60601-1 and IEC 60601-2-10 standards. The results were satisfactory and thus it is guaranteed that the proposed solution is safe for patients and the techniques used are in the state of the art within this medical technology. The Cuban regulatory body approved a trial with 18 humans to test the effectiveness of the device developed;each patient will be under treatment for nine months, but not all began simultaneously due to restrictions put in place by the COVID-19 pandemic. Electrical stimulation was set as follows: bipolar square pulses of 200 microseconds duration at 25 Hz;three 60-minute sessions per day. A patient is considered as treatment's responder monthly crisis frequency decrease more than 50% that he suffered before starting treatment. To date, six patients have completed the trial, five with significant improvement. The other twelve patients are in treatment and after the third month the Monthly Seizure Frequency has decreased in all of them. Conclusion(s): The proposed solution has been effective in the first six patients ending the trial. Without concluding the study, the proposed solution seems an outstanding therapeutic solution. Copyright © 2022
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Background: COVID-19 has impacted several areas of oncology patient care, most notably the reduction of patient visits for treatments. Standard treatment of multiple myeloma (MM) involves a combination of intravenous (IV) and oral therapies. Objective(s): The purpose of this study is to assess the impact COVID-19 had on IV and oral medication prescribing patterns pre and during the COVID-19 pandemic among MM patients. Method(s): This is a retrospective review of adult MM patients insured by a large commercial and Medicare health plan in the United States who started a new IV or oral MM agent during the study period. To assess the impact of COVID-19 on IV and oral medication prescribing patterns, we compared a pre-COVID period (1 March-31 August 2019) to a COVID period (1 March-31 August 2020). We utilized medical and pharmacy claims to identify patients and calculated new therapy starts per newly diagnosed patient (defined as the number of patients starting a new IV or oral medication for MM divided by the total number of patients with a first indication date of MM within the study timeframe). We compared rates using a Chi-square test;p-values <=.05 were considered statistically significant. Result(s): 1754 patients were enrolled in the study;there were no significant differences in demographic characteristics pre and during COVID-19 between the two groups with respect to age (67.05 vs. 66.64;p=.45), gender (p=.80), insurance plan type (p=.17), geographical region (p=.26) and medication (p=.59). During COVID-19, the number of newly diagnosed MM patients decreased by 22% (9657-7560) and the total number of new therapy starts decreased by 11% (930-824). When looking at rates of new therapy starts per newly diagnosed patient, both IV (11%;p=.03) and oral (51%;p=.03) medication rates significantly increased. Additionally, there were significant increases in new therapy start rates by region in the Northeast for oral (157%;p=.08). Conclusion(s): While the total count of new therapy starts, a proxy for new diagnoses, decreased during COVID-19, the rate of new starts for both IV and oral therapies for patients diagnosed with MM significantly increased. These increased start rates may be explained by a remarkable 22% drop in the total number of newly diagnosed MM patients during COVID-19. As the pandemic continues, further study is warranted to understand how COVID-19 may impact IV vs. oral usage in MM.
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Background: CVS Health recently developed a best-in-class mobile app and website that enables oncology patients to start and stay on therapy. While digital patient engagement is relatively new, identifying and estimating the frequency of its use and the impact of COVID-19 on adherence are critical for planning strategies to mitigate the effects of the pandemic on cancer patient outcomes. Objective(s): This study examined the impact of COVID-19 on adherence to oral oncolytic agents in a large health plan with a significant digital health platform. Method(s): This retrospective cohort study included adult patients with chronic myelogenous leukemia (CML), ovarian cancer or prostate cancer initiating oral oncolytics between 3/1/19 and 3/ 1/2021. Patients were divided into two groups: pre-COVID oral oncolytic initiators before 3/1/20 and COVID initiators after 3/1/ 20 and were followed for 1 year after therapy initiation. The primary outcome was optimal adherence to oral oncolytic agents as defined by a medication possession ratio (MPR)>=0.8. Percent of digital engagement, defined as the number of times a patient interacted with the CVS digital platform, was examined as a secondary endpoint and was considered as a binary and categorical endpoint (none, low (<28), moderate (28-105) and high (>105)). Descriptive statistics and logistic regression modeling were performed;p-values <.05 were significant. Result(s): In total, 15,494 patients were included in the study, with 8067 (52.07%) in the pre-COVID initiator group. Patient demographics were similar across study groups, with the exception of pre-COVID initiators who were less likely to be male (75.32 vs. 77.34%;p<.01) and receive copay assistance (38.37 vs. 41.70%;p<.01). No difference in digital engagement pre and during COVID was noted (74.55 vs. 73.60%;p=.18). Pre-COVID initiators were less likely to be optimally adherent than COVID initiators (84.75 vs. 85.96%;p=.04). Therapy persistence was more common among COVID initiators, with greater number of fills (Median [quartile (Q) Q1-Q3]: 10 [4-12] vs. 9[4-12];p<.01) and less changes to therapy (8.87 vs. 9.95%;p=.02). After regression, COVID initiation of oral oncolytics was not associated with optimal adherence (odds ratio (OR) = 1.06 [95% (confidence interval (CI) 0.96-1.16]). Adherence increased as digital engagement increased (low: OR 0.64 [95% CI 0.56-0.72];moderate: OR 0.67 [95% CI 0.56-0.76];high: OR 1.71 [95% CI 1.48-1.99]). Other factors associated with increased adherence were copay assistance, male gender and age between 65 and 84 (all p<.05). Factors associated with decreased adherence were therapy change, CML and age <50 years (all p<.05). Conclusion(s): The onset of the COVID-19 pandemic did not significantly impact optimal adherence for new-to-therapy oral oncology patients. Patients with high digital engagement during the pandemic experienced significantly improved adherence than those not engaged. Additionally, persistence and number of fills were slightly improved in COVID initiators, suggesting that the current pandemic may have influenced adherence behaviors.
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Background: COVID-19 has had an unprecedented impact on the healthcare system. During the pandemic, cancer patients experienced delayed diagnoses, interruptions in care and suboptimal care. This study aimed to understand the impact of COVID-19 on breast, lung, colon and prostate cancer patients' diagnoses, treatment and utilization during the pandemic. Methods: This is a retrospective cohort study of breast, lung, colon and prostate cancer patients insured by a large Commercial and Medicare health plan in the United States. To assess the impact of COVID-19 on newly diagnosed treatment and utilization rates, we compareda pre-COVID period (March 1 to December 31, 2019) to a COVID period (March 1 to December 31, 2020) to assess how COVID-19 impacted diagnoses and treatment. We defined a new cancer diagnosis as a patient with medical insurance but no paid claim for cancer for at least six months before the initial claim with a cancer diagnosis. We utilized both medical and pharmacy claims to identify utilization patterns. The newly diagnosed rate and cancer diagnosis claims were normalized by total membership in the given year by line of business. Results: This study included 113,795 patients in 2019 and 112,837 patients in 2020. The newly diagnosed rate decreased by 4% (2.2 to 2.1 per 1000 patients) (p = 0.0014) for Commercial and 3% (16.2 to 15.8 per 1000 patients) (p < 0.001) for Medicare patients. Patients with infused chemotherapy treatments, among patients with cancer diagnoses, increased by 4% (9.6% to 10%) (p = 0.02) for Medicare patients but not for Commercial patients. Among patients with infused treatments, there were no significant changes in average number of infusions per patient for Commercial and Medicare patients (all p > 0.05). In 2020, there was a 2% decrease in infused treatments in the hospital setting (52% to 50%;p < 0.01) for Medicare patients;it remained stable for Commercial patients. There was also a switch from infused drugs to oral drugs for Commercial (2.4%, p < 0.001) and Medicare patients (2.0%, p < 0.001). From March to May 2020, there was a 31-35% decrease (p < 0.001) in new cancer diagnoses for Commercial and Medicare patients with a rebound in the last six months of 2020. There was an 18-21% decrease (p < 0.001) in the percentage of existing cancer patients with cancer claims during this time, reflecting a decrease in utilization. Conclusions: During the COVID-19 pandemic, we observed significant decreases in cancer diagnoses and utilization rates among new and existing Commercial and Medicare patients;however, chemotherapy treatments increased for Medicare patients during this time. We observed site of care changes in patients undergoing infused treatments. While new cancer diagnoses and utilization rates declined during the pandemic's height, both rates quickly rebounded in the last months of 2020. As the COVID-19 pandemic continues to evolve, care for patients with cancer will need to evolve as well.
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Background: COVID-19 has impacted several areas of oncology patient care, most notably the reduction of patient visits for treatments. Standard treatment of multiple myeloma (MM) involves a combination of intravenous (IV) and oral therapies. The purpose of this study is to assess the impact COVID-19 had on IV and oral medication prescribing patterns pre and during the COVID-19 pandemic among MM patients. Methods: This is a retrospective review of adult MM patients insured by a large commercial and Medicare health plan in the United States who started a new IV or oral MM agent during the study period. To assess the impact of COVID-19 on IV and oral medication prescribing patterns, we compareda pre-COVID period (March 1-August 31, 2019) to a COVID period (March 1-August 31, 2020). We utilized medical and pharmacy claims to identify patients and calculated new therapy starts per newly diagnosed patient (defined as the number of patients starting a new IV or oral medication for MM divided by the total number of patients with a first indication date of MM within the study timeframe). We compared rates using a Chi-square test;p-values ≤ 0.05 were considered statistically significant. Results: 1,754 patients were enrolled in the study;there were no significant differences in demographic characteristics pre and during COVID-19 between the two groups with respect to age (67.05 vs. 66.64;p=0.45), gender (p=0.80), insurance plan type (p=0.17), geographical region (p=0.26) and medication (p=0.59). During COVID-19, the number of newly diagnosed MM patients decreased by 22% (9,657 to 7,560) and the total number of new therapy starts decreased by 11% (930 to 824). When looking at rates of new therapy starts per newly diagnosed patient, both IV (11%;p=0.03) and oral (51%;p=0.03) medication rates significantly increased. Additionally, there were significant increases in new therapy start rates by region in the Northeast for oral (157%;p<0.01) and West for IV (32%;p=0.02) medications. There were no significant differences in new start rates by insurance plan type (all p>0.08). Conclusions: While the total count of new therapy starts, a proxy for new diagnoses, decreased during COVID-19, the rate of new starts for both IV and oral therapies for patients diagnosed with MM significantly increased. These increased start rates may be explained by a remarkable 22% drop in the total number of newly diagnosed MM patients during COVID-19. As the pandemic continues, further study is warranted to understand how COVID-19 may impact IV vs. oral usage in MM.
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Background: COVID-19 has substantially decreased cancer screening, management visits and surgeries. CVS Health recently developed a best-in-class mobile app and website that enables oncology patients to start and stay on therapy. This study examined the impact of COVID-19 on adherence to oral oncolytic agents in a large health plan with a significant digital health platform. Methods: This retrospective cohort study included adult patients with chronic myelogenous leukemia (CML), ovarian cancer or prostate cancer initiating oral oncolytics between 3/1/19 and 3/1/2021. Patients were divided into two groups: pre-COVID oral oncolytic initiators before 3/1/20 and COVID initiators after 3/1/20 and were followed for 1 year after therapy initiation. The primary outcome was optimal adherence to oral oncolytic agents as defined by a medication possession ratio (MPR) ≥ 0.8. Percent of digital engagement, defined as the number of times a patient interacted with the CVS digital platform, was examined as a secondary endpoint and was considered as a binary and categorical endpoint (none, low (< 28), moderate (28-105) and high (> 105)). Descriptive statistics and logistic regression modeling were performed;p-values < 0.05 were significant. Results: In total, 15,494 patients were included in the study, with 8,067 (52.07%) in the pre-COVID initiator group. Patient demographics were similar across study groups, with the exception of pre-COVID initiators who were less likely to be male (75.32% vs. 77.34%;p < 0.01) and receive copay assistance (38.37% vs. 41.70%;p < 0.01). No difference in digital engagement pre and during COVID was noted (74.55% vs. 73.60%;p = 0.18). Pre-COVID initiators were less likely to be optimally adherent than COVID initiators (84.75% vs. 85.96%;p = 0.04). Therapy persistence was more common among COVID initiators, with greater number of fills (Median [quartile (Q) Q1-Q3]: 10 [4-12] vs. 9[4-12];p < 0.01) and less changes to therapy (8.87% vs. 9.95%;p = 0.02). After regression, COVID initiation of oral oncolytics was not associated with optimal adherence (odds ratio (OR) = 1.06 [95% (confidence interval (CI) 0.96-1.16]). Adherence increased as digital engagement increased (low: OR 0.64 [95% CI 0.56-0.72];moderate: OR 0.67 [95% CI 0.56-0.76];high: OR 1.71 [95% CI 1.48-1.99]). Other factors associated with increased adherence were copay assistance, male gender and age between 65 and 84 (all p < 0.05). Factors associated with decreased adherence were therapy change, CML and age < 50 years (all p < 0.05). Conclusions: The onset of the COVID-19 pandemic did not significantly impact optimal adherence for new-to-therapy oral oncology patients. Patients with high digital engagement during the pandemic experienced significantly improved adherence than those not engaged. Additionally, persistence and number of fills were slightly improved in COVID initiators, suggesting that the current pandemic may have influenced adherence behaviors.
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Introduction: Viral pneumonia is the main complication of SARSCov- 2 infection. Many patients require prolonged invasive mechanical ventilation and subsequent tracheostomy [1]. There is no standard recommendation about the optimal timing for the procedure [2,3]. The aim of this study was to describe the clinical outcomes in COVID-19 patients who underwent early versus late tracheostomy. Methods: A retrospective single-center observational descriptive study was performed at a fourth level hospital on patients with confirmed diagnosis of COVID-19 and admission to the ICU who required mechanical ventilation and subsequent tracheostomy between January and July of 2021. Group analysis by the timing of tracheostomy since the start of mechanical ventilation was done in two sets: until day 14 (group 1) and from day 15 onward (group 2). The measured outcomes were hospital length of stay (LOS), ICU length of stay (ICLOS) and overall mortality. Results: 151 patients were included, almost all patients required ICU due to respiratory failure (96%). 42 patients conformed group 1 and 109 patients were included in group 2. Baseline characteristics are shown in Table 1. Mortality (50% vs 56,8%;p = 0.4) was not statistically different between groups. However, LOS (33.5 IQR 27.3 vs 43 IQR 20;p = 0.003) and ICLOS (25 IQR 19 vs 32 IQR 19;p < 0.001) were shorter in group 1. Conclusions: Optimal timing for tracheostomy in critically ill COVID- 19 patients is still undefined. Our study showed similar results found in other populations [4,5]. ICLOS and LOS seem to be shorter in early tracheostomy group. Other outcomes such as morbidity, time to decannulation and the possibility of early pulmonary rehabilitation should be included in future studies. (Table Presented).
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Purpose: We partnered with a local Federally Qualified Health Center (FQHC) to test implementation of evidence-based interventions (EBI) promoting Fecal Immunochemical Test (FIT) CRC screening in an environment in which colonoscopy has been the prevailing screening strategy. We report on implementation adaptations and preliminary results. Background: Sociocultural and medical concerns are barriers to colonoscopy uptake in some populations. An additional barrier to CRC screening is system level capacity for colonoscopy that results in a back log of cases and long wait times. With Covid-19, the additional backlog in overdue CRC screening has underscored the need to expand FIT testing capacity to address screening needs and to pre-empt further racial/ethnic and SES disparities in CRC outcomes. This trial tests the unique and additive value of multiple EBIs for increasing CRC screening (primarily through FIT testing, but also colonoscopy when indicated) while evaluating the success of implementing these approaches. EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and assistance from community health workers. Methods: Participants (3500), ages 45-75, were identified from a large FQHC in New Haven, CT and determined to be overdue for CRC screening. Participants were randomly assigned to one of the four arms of the study: 1) Provider reminder (overdue for CRC screening) only;2) Provider Reminder + SDOH short message and one-size-fits all link to resources;3) Provider Reminder + SDOH short message and offer for individualized navigation (trained navigators from local community) to address SDOH and other barriers;4) Provider Reminder + offer to participate in a CRC educational program as phase 2 of the NCI's Screen to Save program (not an EBI). Preliminary data on uptake of CRC screening will be presented. Results: With input from stakeholders, we have: 1) lowered age eligibility from 50 to 45 to align with new guidelines;2) expanded the target population to 2 additional satellite clinics, more than doubling the proposed study enrollment;3) incorporated design changes in the patient reminders. The collaboration between research team and clinician stakeholders has been critical in minimizing disruptions to clinical workflow while assuring fidelity to the evidence-based interventions. Preliminary outcomes (within one month of intervention) on uptake of intervention across the 4 arms of the study, i.e., referral for CRC screening and test completion will be presented. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx and/or low socioeconomic status individuals stem from the disproportionate burden of SDOH barriers. Findings will inform primary care setting implementation of EBIs to address the anticipated increase in disparities in CRC screening, exacerbated by COVID-19 changes in health care access and utilization, as well as the increased demand associated with the change in guidelines.
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Since its molecular isolation on January 7, 2020, the new SARS-CoV-2 coronavirus has spread rapidly, affecting regions such as Latin America. Ecuador received the worst outbreak globally if we count excess mortality per capita. This study describes the clinical, epidemiological and therapeutic characteristics of 89 patients admitted to an intensive care unit (ICU) in a second-level hospital in Quito, Ecuador. Methods: We conducted a retrospective cohort study. We collected data from health records of adult patients with severe COVID-19 admitted to an ICU in Quito, Ecuador, during the first five months of the SARSCoV-2 outbreak. We used the Chi-square test or Fisher's exact statistics to analyze risk and associations between survivors and non-survivors. We used ROC curve analysis to predict mortality and determine cut-off points for mechanical, analytical, and cytometric ventilation parameters. We used the Wald test to evaluate the categorical predictors of the model at the multivariate level during the regression analysis. Results: 89 patients were recruited. The mean age of the patients was 54.72 years. Men represented 68.54% (n=61) and women 31.46% (n=28). Significant differences in mortality were observed (men 40.98% vs. women 17.76%). LDH and IL-6 at 24 hours after hospital admission were higher among non-survivors than survivors. Persistent hypercapnia (PaCO2 >45 mmHg), a PaFiO2 ratio of less than 140 mmHg, and positive end-expiratory pressure (PEEP) titration >9 mmHg were also associated with increased mortality. Conclusions: Elevated levels of LDH at 24 hours, IL-6 at 24 hours, lymphocyte and platelet count at 48 hours, neutrophil count at 48 hours and NLR are factors associated with higher motility, higher risk of failed extubation and reintubation in patients with acute respiratory distress syndrome due to COVID-19. © 2022 by the authors.
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Objective: Assess consumer experience and health impact among under-resourced individuals who were enrolled into longitudinal navigation to address social determinants of health (SDOH) needs and health goals related to cancer primary and secondary prevention. Background: The Yale Cancer Disparities Firewall Project is a multi-tiered initiative to address the social determinants of health (SDOH) and other challenges that prevent at-risk communities from receiving the full benefit of the many available cancer prevention and cancer screening options. A communityfacing health navigation program, staffed by community members who have received extensive multidisciplinary training is a central component of this program. Methods: Of the 61 currently enrolled individuals (all of whom are either African American/Black or Hispanic/Latinx), we collected questionnaire data from 24 individuals (39% response rate). In general, participants are enrolled for a minimum of 1 year, but most have been followed for 2 years. Respondents were similar to non-respondents with respect to race (60% were Black/African American vs 61.2%, respectively) and age (mean = 44.8 vs 47.2 years, respectively). Respondents were more likely to be female (85% vs 71.4%, p =.009), Hispanic/Latinx (35% vs 42%), but significantly less likely to be foreign-born (15% vs 26.5 %, p = .021). We assessed satisfaction with assigned navigator(s), uptake of referred services, knowledge gained, health behavior change, and self-rated health (SRH). Results: Per self-report, 79.2% of participants agreed and a further 12.5% somewhat agreed that they were overall satisfied with their experience with the health navigation program. Importantly, two-thirds (66.7%) agreed and a further 20.8% somewhat agreed that they changed their behavior to improve their health and well-being because of the program. Of the 5 health focused services offered, the most commonly reported uptake was physical activity (87.5%), followed by learning how to eat healthier and losing weight. Additionally, one third (33.3%) of participants received assistance with reducing or stopping smoking. In terms of secondary prevention, 62.5% of clients received assistance with cancer screening. Of the 5 SDOH focused services offered, the most common was assistance with finding food to eat (66.7%) followed by assistance with paying utilities (45.8%), a shift from the priority needs at baseline (40% needing food assistance, and 35% with housing concerns), presumably reflecting the additional strains associated with the COVID-19 pandemic. Conclusions: Against the backdrop of COVID-19, these findings suggest that addressing SDOH barriers through individual navigation is an important add-on service when facilitating access to services to maintain healthy lifestyle and adhere to cancer screening guidelines. Although this was a pilot program, we foresee the opportunity to utilize trained non-clinical navigators and/or community health workers and to promote cancer prevention in at risk communities.
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In recent years, the Dominican Republic has experienced a significant reduction in vaccination coverage;cases of tetanus and diphtheria that have recently emerged are a result of this situation. In order to identify barriers to immunization and determine the impact of COVID-19 on vaccination adherence, 2,584 Dominicans completed an online survey on personal vaccination history and reasons for not getting vaccinated. In addition, they answered questions about the acceptance of the COVID-19 vaccine and the influence of the pandemic on their perception/ adherence to vaccination. Most of those surveyed were not vaccinated during the pandemic, the main reason being: “I had no vaccination scheduled for this year.” This indicates that even though the pandemic made it difficult to access vaccination services, this was not the main barrier to immunization in the Dominican Republic in 2020. Despite the fact that most of the participants are in favor of vaccination, of the vaccines included in our study, the only one that reached the goal of the Global Vaccine Action Plan of achieving 90% vaccination coverage by 2020 was measles, mumps and rubella in children. The main barrier to immunization is forgetting to get vaccinated. It is necessary to adopt an effective reminder system to increase adherence and improve immunization rates. © 2021, Finlay Ediciones. All rights reserved.
ABSTRACT
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a main public health problem;it is estimates that is the most frequent hepatic disease. In Mexico, MAFLD is prevalent in nearly 30% of its population. In the same way, it is calculated that MAFLD is going to become the first cause of cirrhosis and hepatic cancer worldwide. MAFLD, unlike non-alcoholic fatty liver disease (NAFLD) definition, focus on metabolic dysregulation as the root of the condition. Given the implication of MAFLD on immune regulation and its association with other comorbidities associated with more severe COVID-19 disease, it is plausible that MAFLD could impact the clinical outcomes of COVID-19 in-patients. The study of this association could help us to understand the higher mortality rates by COVID-19 observed in countries with great prevalence of acquired metabolic disease. The objective of this work was to evaluate the association of NAFLD and MAFLD with mortality in hospitalized patients by COVID-19 in Mexico. Methods: All the patients admitted to Central Military Hospital (SEDENA) located in México city with a positive SARS-Cov-2 PCR test from 4 April to 24 June 2020 were analysed. Three groups were formed. 1. Control, 2. NAFLD and 3. MAFLD. MAFLD was defined according to the criteria of international group of experts. Additionally, other variables associated with severity in COVID-19 were obtained, including gender, age, and comorbidities (T2D, hypertension and obesity) to be included in an adjusted model. An unadjusted and adjusted Cox Proportional-Hazard Regression was performed to obtain the mortality Hazard-Ratio among the groups. Results: We studied a total of 348 patients, the mean age was 54.4 (SD 14.7) years, 250 (71.8%) were male, and 182 patients died (52%). The results of the Cox Regression is shown in Figure 1. NAFLD was not statically associated with mortality (adjusted HR 1.62 CI 95% 0.97-2.65, p = 0.06), on the other hand MAFLD was statically associated with mortality (adjusted HR 1.63 CI 95% 1.02-2.59, p = 0.03) Conclusion: In the studied population, MAFLD was associated with increased risk of mortality despite the setting to age, sex, and main comorbidities of the population.
ABSTRACT
Background: Regardless of the initial measures implemented by LA countries in early 2020, the COVID-19 pandemic spread rapidly and by December 31, there were 15 million confirmed cases, and 500,000 deaths. Given the overload of healthcare systems and the need for resource reallocation, a decrease in liver transplantation (LT) activity was expected in most LA countries. However, the real magnitude of this situation has not been described. The aim of this sudy is provide an overview of the impact of the pandemic on LT activity in LA countries. Methods: During 2020, LA countries were invited to nominate representatives to this special interest group (ALEH). Online meetings were arranged to fill a survey on LT activity. Some data was also obtained from the Global Observatory on Donation and Transplantation (GODT). Results: 20 LA countries participated (representing 640 million inhabitants). In 2019, there were 3,847 LT in LA, performed in 14/20 countries (total LT rate:5.96 pmp) with 12% of them (n= 482) with living donors (7/20 countries) (LDLT rate:0.73 pmp). In 2020, there were 2,817 LT (total LT rate:4.4), with 278 LDLT (LDLT rate:0.43 pmp). The pandemic was associated to a decrease of 26% in the LT rate (p < 0.01), and 41% in the LDLT rate (p<0.01). 6/20 countries not performing LT in 2019, kept no LT activity in 2020. When considering countries with LT rates > 5 ppm in 2019 (5/20), there was a decrease of 23% in the LT rate (from 10.63 to 8.16 pmp;p < 0.01) and 43% in the LDLT rate (from 1.41 to 0.79 pmp;p<0.01). When analyzing countries with a lower total LT rate (0,2-5 pmp in 2019) (9/20), there was a decrease in 62% in the total LT rate (from 1.3 to 0.45 pmp, p < 0.01) and of 21% in the LDLT rate (from 0.06 to 0.047 pmp;p NS). COVID-19 cases and deaths (raw data and rates), give biased comparisons between countries, which also depends on the strategies implemented, on the testing rates, and timing of the 1st and 2nd wave peaks Conclusion: The COVID-19 pandemic, had a major impact on LT activity in LA countries, with a 26% decrease in total LT rate (p <0.01) and a 41% decrease in LDLT rates (p < 0.01). The impact was greater in countries with more limited resources and initial lower total LT rates (decrease of 62% in 2020) as compared to countries with initial higher LT rates (decrease of 23%, p < 0,01)). This situation may be related to a longstanding tradition in LT with a more consolidated systems of donation and procurement in countries with higher LT rates. Abbreviations:Pop: Population;Mill: Millions;Dom. Rep.: Dominican Republic;LT: Liver Transplantation;DDLT: Deceased donor LT;LDLT: Living donor LT;LT Rates: per million population (pmp) COVID-19 cases (per 100.000 population).