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Purpose: The demand for pediatric gender-affirming care has increased throughout the COVID-19 pandemic, highlighting the need for telehealth-based specialist-to-primary care provider (PCP) consultative support. Accordingly, the purpose of this study was to identify PCPs’ perspectives on receiving training and consultation in pediatric gender-affirming care using three telehealth modalities, with the larger goal of informing the development of future consultative support offerings. Methods: PCPs who had previously reached out to the Seattle Children’s Gender Clinic for a gender care consultation were invited to participate in a semi-structured, one-hour Zoom interview. During the interview, three different telehealth modalities (tele-education, electronic consultation, telephonic consultation) were described and participants were asked to share their perspectives on 1) the benefits and drawbacks of each modality, 2) which modality would be most effective in supporting them in providing gender-affirming care in the primary care setting, and 3) factors that would make a consultation platform successful. Interviews were transcribed and analyzed using an inductive thematic analysis framework by two authors using Dedoose qualitative analysis software. All participants provided informed consent and all study procedures were approved by the Seattle Children’s Institutional Review Board. Results: Interviews were completed with 15 PCPs. For the tele-education platform, PCPs most often identified continuing medical education (67%) and the community or network it creates (47%) as benefits and the commitment required (73%) and scheduling difficulties (40%) as drawbacks. For the electronic consultation model, timeliness of response (67%) and convenience (53%) were cited as benefits and electronic medical record system requirements (60%) and difficulty conveying the message electronically (53%) were considered the main drawbacks. For the telephonic consultation, PCPs identified the ability to have a conversation (80%) and the timeliness of response (60%) as the main benefits and phone-tag (87%) and finding time to make the initial call (40%) as the main drawbacks. Regarding the most effective platform, responses were mixed: 27% endorsed the electronic consultation, 27% the tele-education platform, and 20% the telephonic consultation, with the remaining 27% suggesting a hybrid of the three models. Finally, responses regarding what would make a platform successful were much more varied across participants, with the most common responses including being non-judgmental and supportive (33%) and flexible with the ability to pivot to other platforms as needed (27%). Conclusions: With the increasing demand to provide gender-affirming care in the primary care setting, further training and support is necessary for pediatric PCPs to deliver this time-sensitive care. The results of this study indicate the need for a more flexible suite of gender-focused specialist-to-PCP telehealth-based consultative services to facilitate the provision of pediatric gender-affirming care. Sources of Support: This project was supported by the Seattle Children's Research Institute and AHRQ (K12HS026393-03;PI: Sequeira) and a grant from Pivotal Ventures.
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Purpose: Pediatric gender centers have seen a notable increase in demand for gender-affirming care services during the COVID-19 pandemic. This increased need has contributed to delays in youth accessing this time-sensitive care and amplified the importance of primary care providers (PCPs) playing an active role supporting gender diverse youth in the post-pandemic world. To guide interventions to support PCPs in gender-affirming care, we sought to understand how often PCP’s see gender diverse youth in primary care and assess PCP comfort facilitating conversations about gender identity in this setting. The objectives of this study were to (1) understand whether PCPs are routinely discussing pronouns and gender identity with adolescents and (2) explore barriers to and the impact of having such discussions in primary care. Methods: This project integrated data from a needs assessment survey and from semi-structured, qualitative interviews with pediatric PCPs. The 15-item survey was administered to PCPs in a large, hospital-affiliated, pediatric primary care network in the northeastern US to better understand PCPs experiences providing adolescent healthcare. Hour long, semi-structured interviews were conducted with pediatric PCPs in the pacific northwest using an interview guide developed in partnership with two PCP stakeholders. Survey responses were analyzed descriptively. Interviews were transcribed and analyzed by two authors in Dedoose qualitative analysis software via inductive thematic analysis using an iteratively designed codebook that was adjudicated to consensus. Results: Of the pediatric PCPs surveyed (n=85), the majority were pediatricians (67%) and most had been in practice for more than 5 years (75%). Almost all (92%) PCPs reported caring for at least one gender diverse youth in their practice in the last year. However, PCPs reported discussing pronouns (15%) and gender identity (29%) during annual well visits with adolescent patients much less frequently than discussing mood (98%), motor vehicle safety (77%) and sexuality (61%). Relatedly, gender-affirming care (60%) was the topic most frequently selected by PCPs for additional education. In separate PCP interviews, participants (n=15) indicated that while they felt discussions about pronouns and gender identity were important, they experienced specific structural and interpersonal barriers that prevented these conversations from occurring. These barriers included poor health system infrastructure (like forms and electronic health records), staff concerns, uncertainty around language, lack of awareness and fear. PCPs also discussed that when they asked about pronouns and gender identity, it normalized conversations about gender, helped facilitate family support, created welcoming environments in the health system and allowed for earlier identification of youth in need of support. Conclusions: Pediatric PCPs recognize the critical role they play in supporting gender-diverse youth and their families, particularly around normalizing conversations about gender identity. However, multiple individual and clinic-level barriers to asking about pronouns and gender identity remain. These results highlight the continued need to provide resources, education and support to PCPs in discussing these topics in the primary care setting to facilitate access to time-sensitive gender-affirming care. Sources of Support: This project was supported by the Seattle Children's Research Institute Career Development and AHRQ K12HS026393-03 (PI: Sequeira).
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Aims: In response to the covid-19 pandemic remote training for healthcare professionals (HCPs) to maintain and expand the availability of, and access to DAFNE courses for people living with type 1 diabetes, has been developed. It consists of both Open University hosted online modules, and a national DAFNE trainer assessed workshop. The effectiveness of the pilot training and the fully developed remote training and assessment of the Remote DAFNE Educator Programme (RDEP) has been evaluated. Methods: Review of pilot training survey monkey feedback and the numbers of HCPs taking part in training, and their assessment results between July 2020 and October 2021. Results: Pilot trainees (n = 20) confidence scores (out of 10) both for insulin adjustment and carbohydrate counting skills improved from 7.2 and 8.1, to 8.7 and 9.1 respectively, p < 0.005. 85% reported the level of challenge about right. The virtual workshop increased confidence scores in facilitation skills from 6.5 to 8.4, p < 0.0001. The majority, 88%, rated the workshop as excellent, and the pass rate was 92%. Subsequent to the pilot the RDEP insulin adjustment unit and the carbohydrate counting unit has been accessed by over 300 HCPs, with 94% completing the assessments. The pass rate was 93% for the insulin adjustment unit and 100% for the carbohydrate counting unit. Summary: RDEP training has been successfully completed by over 90% of trainees. Confidence scores in all areas of learning increased significantly showing that this blended remote training format has proven to be both acceptable and effective to hundreds of HCPs.
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Aims: The lockdown and ongoing restrictions as a result of covid-19 halted DAFNE face to face (F2F) education, consequently remote DAFNE was developed and began in July 2020. It consists of a blended learning programme, combining online modules with weekly group video support calls facilitated by a trained Remote DAFNE educator. F2F DAFNE is known to decrease HbA1cs by 4-8 mmol/ mol, as well as reducing episodes of severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) by 75-80%. As a quality assured programme, effectiveness, as measured by 12 month biochemical data, must be assessed. Methods: Using the national DAFNE audit database, records of the first 233/1434 remote DAFNE graduates with both baseline and 12 month data were examined: 55% female, baseline mean±SD: age 40.9±14.3, duration of diabetes 15.9±13.1 years. Results: At 1 year HbA1c fell by 3.6mmol/mol (63.4±14.5 to 59.8±12.1, p < 0.00001). In the year following Remote DAFNE, in these 233 participants the number of participants experiencing DKA or SH decreased from 10 and 11, down to 0 and 1 respectively, a reduction of 95%. The target HbA1c of ≤ 58mmol/mol was achieved by 40% of participants at baseline, and increased to 52% at 1 year. In the cohort whose baseline HbA1c was >58mmol/mol, HbA1c reduced by 7.2mmol/mol (71.9±12.3 to 64.7±11.9, p < 0.00001). Conclusions: Remote DAFNE delivers highly significant HbA1c improvements and reductions in SH and DKA episodes at least comparable to traditional F2F DAFNE. More NHS trusts should offer this clinically proven intervention to adults with type 1 diabetes.
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Purpose: The purpose of this paper is to provide a commentary on “Adapted guided self-help booklets for supporting the wellbeing of people with intellectual disabilities during the COVID-19 pandemic” (Jahoda et al.). Design/methodology/approach: This paper considers health and wellbeing for people with intellectual disabilities in the context of public health interventions and public health research. Findings: Consideration is given to the evidence base for self-management, self-help and behavioural change interventions and the need to consider systemic support for promoting the health and wellbeing of people with intellectual disabilities. Originality/value: Guided self-help and self-management techniques have a role in the health promotion of people with intellectual disabilities. Reciprocal sharing between public health researchers and intellectual disability researchers is needed to further the research, policy and service agenda to better promote health and wellbeing for this underserved group. © 2021, Emerald Publishing Limited.
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T1 Figure 1ConclusionsOverall, this largest paediatric single cell COVID-19 study to date showed significant differences in response to SARS-CoV-2 between children and adults, reflecting the changes of the immune landscape over developmental time, which in children are dominated by naïve and innate responses.
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Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.
Subject(s)
Breast Neoplasms , COVID-19 , Uterine Cervical Neoplasms , Breast Neoplasms/diagnosis , Early Detection of Cancer , Ethnicity , Female , Humans , Mass Screening , Medically Uninsured , Minority Groups , New York , SARS-CoV-2 , United States , Uterine Cervical Neoplasms/diagnosisABSTRACT
Biosecurity as a discipline remains largely defined by institutional-level practices unbounded by the guidelines and checklists prevalent in the field of biosafety. The result is a high-level of interpretation at the individual and institutional level of defining and implementing biosecurity. At its core, biosecurity frameworks are largely anchored to a mirrored process of risk assessment and management. Therefore, biosecurity is still rooted in the fields of threat and vulnerability assessment, analysis, and management. The aperture of threat and vulnerability management may at first seem contrary to the overall field of public health where emerging infectious disease, and the negative consequences, are more commonly perceived as risks. However, in the spectrum of threat to vulnerability to risk (see Chaps. “ Redefining Biosecurity by Application in Global Health, Biodefense, and Developing Technologies ” and “ The Biothreat Assessment as a Foundation for Biosecurity ”) infectious disease as an entity emerges as a threat. The ability or inability to respond and defend from infectious disease can be characterized as vulnerabilities. The negative consequences (e.g., spread of, infection, mortality, economic impacts) exist as a probability of occurrence, or simply, a risk. This is increasingly evident at the time of composition of this chapter and this book during the global COVID-19 pandemic. This chapter explores the parallels and distinctions of biosecurity-related concepts as they apply to the COVID-19 pandemic, lessons learned from previous epidemics and pandemics, and offers suggestions of stronger connectivity to threat and vulnerability management concepts as we inevitably prepare for future epidemics and pandemics. © 2021, Springer Nature Switzerland AG.
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Background: The DAFNE Educator Programme (DEP) is a training programme for diabetes specialist nurses and diabetes specialist dietitians, training them to deliver structured education to people living with type 1 diabetes and includes face-face training elements. The restrictions imposed by the covid-19 pandemic have impacted on face-to- face training programmes, so a Remote DEP has been developed. Aims: To provide a Remote DEP that is accessible to both existing educators and new trainees within the pandemic restrictions, maintain confidence in the quality of the programme and enable diabetes specialist teams to continue to provide DAFNE structured education to people living with type 1 diabetes. Methods: Existing educators took part in a half-day virtual workshop. For new educators a Remote DEP was developed in partnership with The Open University. Remote educator training programmes were piloted and evaluated between June and December 2020 and rolled out post-pilot. Results: Most DAFNE centres in the UK, 82 out of 92 (89%) now have educators trained in the delivery of Remote DAFNE. Two thirds, 215 of 323 (66.6%), were previously trained in face-to- face DAFNE courses. One third, 108 of 323 (33.3%) were new educators who learnt via a blended approach of online and remote workshops, and were assessed in a virtual environment, 81% said the training programme was excellent, 19% rated it as good, and 86% rated the assessment feedback as excellent. Conclusions: The Remote DAFNE Educator Programme is an effective way of training diabetes specialist team members to deliver Remote DAFNE courses within the restrictions imposed by the covid-19 pandemic.
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In just a few short weeks, COVID-19 transformed cancer care around the world. The crisis has dismantled how careis delivered and forced providers to make difficult decisions about what types of care are essential and can besustained with the resources and staff available. This presentation will provide an overview of the emerging trendsthat are shaping cancer care and how providers are adapting to these new challenges to continue to safely providenecessary care to those who need it most.