DISABILITY AND COVID-19 TESTING: A CROSS-SECTIONAL RADx-UP STUDY

Background: Nearly 26% of adults in the U.S. live with disability and are more likely to experience chronic health conditions, barriers to healthcare, and severe COVID-19 illness. Therefore, COVID-19 testing of adults living with disability is important to consider. The purpose of this study was to explore relationships between disability and COVID-19 testing, infection, and related challenges. Method(s): A Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) project in Miami, FL determined disability with a modified version of the Washington Group General Disability Measure. HIV serostatus and COVID-19 vaccination were confirmed with medical records. COVID-19 testing and infection history were self-reported. Statistical analyses included chi-squared tests and multiple binary logistic regression;variance inflation factors were calculated to ensure absence of collinearity. Result(s): A total of 1,689 RADx-UP participants with an average age of 55+/-12.3, 51% male, 49% Black non-Hispanic, 23% living with HIV (86% virally suppressed), and 76% received at least one dose of a COVID-19 vaccine. Nearly 40% were disabled, 37% reported employment disability, and 21% were functionally disabled (disability that interferes with performance of daily activities). Despite recruitment from the same sources, PLWH, compared to those without HIV, were more likely to be disabled (52% vs 36%;p< 0.0001), report employment disability (63% vs 30%;p< 0.0001), and report functional disability (29% vs 18%;p< 0.0001). Those with employment disability were less likely to have ever been tested for COVID-19 compared to those without (81% vs 85%;p=0.026). Employment disability was also associated with lower odds of having ever tested positive for COVID-19 after adjustment for demographics, health insurance, HIV, COVID-19 vaccination, smoking, and lung disease (aOR, 0.62;95% CI, 0.43-0.90;p=0.013). Disability was associated with greater odds of transportation challenges (aOR, 2.33;95% CI, 1.76-3.08;p< 0.0001), illicit drug use (aOR, 1.92;95% CI, 1.49-2.47;p< 0.0001), and smoking (aOR, 1.74;95% CI, 1.39-2.17;p< 0.0001). Compared to those without, those with transportation challenges (14% vs 40%;p< 0.0001) and illicit drug use (18% vs 30%;p=0.001) were more likely to postpone medical care. Conclusion(s): Lower COVID-19 testing rates may contribute to underestimated COVID-19 positivity rates in adults living with disability. Challenges with transportation and substance abuse contribute to less engagement in care.

Thromboprophylaxis and anticoagulation in COVID-19.

The immunological reaction that facilitates the cytokine storm in the infection by the new coronavirus facilitates the appearance of microvascular, endothelial and direct cellular damage, which leads to a prothrombotic state and events of thromboembolism to different apparatus and systems as a complication. Therefore, the need to provide adequate prophylactic therapy or anticoagulant management in time and adequate dosage to these patients, as well as an individualized coagulation and hemostasis study. This document is intended to summarize in a practical way the evidence published to date and provide a broader view of the pathophysiological phenomena that occur in this hyperinflammatory state that has taught us a lot since its arrival.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Dialogic pedagogical gatherings in teaching the history of education: an online training experience

Dialogic Pedagogical Gatherings is a technique that has been previously used in different educational contexts. However, its implementation in virtual environ-ments is not so common. The present paper reflects an experience of this technique applied to the telematic training of Social Education students in a subject linked to the history of education. The results obtained were compared with other similar experiences in face-to-face format, evidencing that the Dialogic Pedagogical Gatherings have had good results in the online format, although there are elements of improvement for future implementations. © GKA Ediciones, authors.

Serenity before the demystification of the scourge by Sars-CoV-2

The Pandemic caused by the SARS-CoV-2 virus generated multiple effects at the general level of the world population. Not only in the lethal implications it has for physical health, but also the psychological and emotional consequences that it has left throughout its evolution, since its appearance and categorization as a pandemic on March 11, 2020. This bibliographic review has In order to make a constructive analysis of the coronavirus, no longer seen as a disease that causes death, but with a view to demystifying that negative vision that was built on Covid-19, which is a disease that brought with it many negative implications and radical changes in our models of daily life, but that through advances in technology, medicine and our iron will to improve, as a species we managed to adapt and learned to go hand in hand with SARS-CoV-2, in a new postcovid society that seeks to regain its balance. For this, an exhaustive search was carried out in the available academic information search engines GoogleAcademic and PubMed, feeding the search engines through the words: Covid-19 and implications for health;SARS-CoV-2 and society;society-covid-health;emotional well-being and pandemic;level of emotional satisfaction and postcovid society;perspectives of the new post-pandemic life. The review allows us to highlight a different vision of the disease, no longer from a fatalistic perspective, but from a new evolutionary vision that has allowed us to overcome the self-imposed barriers of Covid-19 and achieve a more balanced society. © 2022 Instituto de Altos Estudios de Salud Publica. All rights reserved.

Main respiratory sequelae of Covid-19: an exploratory review

Covid-19 is an infectious disease that has caused significant rates of morbidity and mortality in the world population, scientific evidence has sought to describe the pathophysiology of SARS-CoV-2. In the initial phase, an acute inflammatory process occurs that begins to be accentuated in the respiratory tract and affects the lungs first and foremost;which, subsequently, can trigger respiratory dysfunctions that persist even after medical discharge, which is considered a persistent symptom. In accordance with the methodology of the exploratory systematic review, this research was carried out whose purpose was focused on finding bibliographic references that support and identify the main respiratory sequelae of Covid-19;For this, a search of the literature was carried out through the PubMed, Scielo, Medline, Web of Science and Scopus databases. The bibliographic investigation was carried out in January 2022, 70 documents were detected, which were subjected to quality evaluation. 38 observational studies, 3 review articles and 1 meta-analysis were included. So far, no consensus has been reached regarding the most important sequela in the post-COVID respiratory field, fundamentally the following stand out: fatigue, dyspnea, chest pain and cough. In addition, a considerable percentage of patients persist with residual pulmonary function abnormalities, suggestive of pulmonary fibrosis, requiring medical assistance even after hospital discharge. It is recommended to continue with research aimed at assessing the sequelae of Covid-19, to obtain clear foundations related to post-infection respiratory functional capacity. © 2022 Instituto de Altos Estudios de Salud Publica. All rights reserved.

Results of the evolution of COVID-19 pandemic in Ecuador: a comparison with South America.

Objectives: The objective of this research was to demonstrate the evolution of the COVID-19 outbreak in Ecuador and South America during the first eight months after the start of the pandemic in the region. Methodology: In Ecuador, data from the Civil Registry, COVID-19 Ec and Ecuador were used in figures regarding the number of deaths, available beds, and infections of health personnel. The population data was obtained from the UN projection for the year 2020, and for the daily contagion reports, the source Our World in Data was used. The graphs were made in Google Drive spreadsheets. Result(s): The impact of the pandemic has affected the entire world, affecting South America with a high daily increase in cases even months after the first outbreak, in addition to the arrival of the second wave of contagion in Europe. The next few months are expected to lighten the panorama with the help of scientific advances in the development of the vaccine and a better understanding of the diagnosis, clinical manifestations and treatment of the disease. Conclusion(s): Ecuador was seriously affected with a significant increase in mortality rates and a lack of health resources. The comparison between the South American countries revealed that the highest spikes in contagion and mortality during the first wave occurred in July and August. It was recommended to continue complying with the rules of social distancing to prevent the appearance of a second wave during the beginning of 2021. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Maternal and neonatal morbidity for SARS-CoV-2 infection

Objective: to carry out an updated bibliographic review focused on maternal and neonatal morbidity due to SARSCoV-2 infection with the purpose of evaluating the severity that could occur in these risk groups. Methodology: this study consisted of a systematic review between December 2019 and September 2020 using platforms such as: PubMed, Scopus, Digital Library of the Complutense University of Madrid, Google Scholar and Scielo. The data were tabulated according to the recommendations of the PRISMA guide. Result(s): Of 116 pregnant women with a positive diagnosis for COVID 19, 91.3% had a favorable evolution without requiring intensive care;8.62% presented severe pneumonia and mechanical respiratory assistance and none of them died. On the other hand, of 117 neonates, 93.2% had negative results for COVID-19 while 6.8% had positive results and there were three neonatal deaths not related to COVID-19. Conclusion(s): This indicates that SARS-CoV-2 does not generate greater susceptibility in obstetric patients or neonates and usually only manifests with mild to moderate symptoms. Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.

Main neurological sequelae of COVID-19: an exploratory review

The purpose of this study is to carry out an exploratory systematic review that allows us to demonstrate the current panorama of the different neurological sequelae caused by COVID-19 in patients. A literature search was performed through the PubMed, Scielo, Medline, Web of Science and Scopus databases. The bibliographic search was carried out in February 2022.60 articles were identified, 10 were duplicates and in the review phase 9 were excluded due to their methodological design;2 articles were discarded due to inconsistencies in the validity of the data collection instruments, therefore, 39 scientific studies were used to obtain data, analyze the results and were subjected to quality evaluation. 33 observational studies, 2 case studies, 3 review articles and 1 meta-analysis were included. Regarding methodological aspects, 92.4% are observational studies (descriptive or analytical or cut-off prevalence), only 3 of them (7.6%) are assumed to be prospective in the directionality of the design. The following neurological sequelae stand out fundamentally: neurovascular syndrome, encephalopathies, migraines, anxiety, depression, olfactory and/or taste dysfunctions, sensory symptomatology, polyneuropathy and myopathy, neuralgia and facial paralysis, the physiopathogenesis of these neurological affections, are mainly associated with the syndrome of systemic inflammatory response resulting from infection with SARS-CoV-2. It is recommended to continue with research aimed at the sequelae of COVID-19, to guide treatment and avoid serious complications from this disease.

Optimal thromboprophylaxis and anticoagulant strategies in patients with COVID-19 pneumonia. The PROTHROMCOVID Trial

Introduction: Hospitalized patients with COVID-19 are at increased risk of venous and arterial thrombosis, ARDS, and death. The optimal dosage of thromboprophylaxis in patients is unknown. Objective: To evaluate the efficacy and safety of tinzaparin in prophylactic, intermediate and therapeutic doses in non-critical patients admitted for COVID-19 pneumonia.Design, Setting, and Participants: The PROTHROMCOVID multicenter randomized clinical trial enrolled noncritical hospitalized adult patients with COVID-19 pneumonia from February 1, 2021, to September 30, 2021, at 18 centers in Spain. Methods: Patients were randomized to prophylactic tinzaparin 4500IU or intermediate dose 100IU/kg or therapeutic tinzaparin 175IU/kg during hospitalization, followed by 7 days of prophylactic tinzaparin at discharge. The patients were stratified at the time of randomization according to age, sex and the presence or absence of hypertension.The primary efficacy outcome was a composite endpoint of symptomatic systemic thrombotic events, need for invasive or non invasive mechanical ventilation or not, including high-flow nasal cannula oxygen, or death within 30 days. The main safety outcome was major bleeding at 30 days. Data were collected and adjudicated locally by non-blinded investigators through imaging, laboratory, and health record data. Results: Of 311 patients randomized, 300 were included in the analysis (mean [SD]age, 56.7 [14.6] years;men, 182 [60.7%];women, 118 [39.3%]). 106 patients (35.33%) were assigned to the prophylaxis group, 91 patients (30.33%) were allocated to the intermediate dose group and 103 patients (34.33%) were randomized to the anticoagulant dose group. The composite endpoint thrombotic event, need for invasive (IMV) or noninvasive mechanical ventilation (NIV) or HFT via nasal cannula or death at 30 days from randomization occurred in 58 patients (19.3%) of the whole population, 19 patients (17.09%) in prophylactic group, 20 (21.98%) in intermediate group and 19 (18.45%) in therapeutic group (P=0.72). No major bleeding were reported in the trial and non-major bleeding occurred in 5 patients (4.71%) in prophilactic, in 3 patients (3.2%) in intermediate arm and in 3 patients (2.9%) in therapeutic, without significant differences in each group (P=0.31). Conclusions: In non-critically ill patients with COVID 19, intermediate or full-dose of tinzaparin do not appear to offer benefit over standard prophylactic doses IU in the likelihood of thrombotic event, non-invasive ventilation or high-flow oxygen, or death. Funding Acknowledgement: Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Leo Pharma

PSYCHOLOGICAL AND PHYSICAL IMPACT OF THE QUARANTINE PERIOD DURING THE COVID-19 PANDEMIC IN ECUADOR

The pandemic caused by the SARS-CoV-2 virus, forced humanity to initiate a period of quarantine in order to reduce the number of contagions and lethality of the virus, several countries reported that this period of isolation brought emotional and physical consequences in the population evaluated, so the present study seeks to determine the behavior of the Ecuadorian population in the face of quarantine by assessing their psychological and physical health;For this purpose, the standardized questionnaire SF12 in its second version of 2002 was used, which uses a Likert scale to analyze the mental and physical health of the respondents, obtaining as results that the Ecuadorian population’s emotional health was mainly affected, while their physical health did not show significant changes. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

Computational modeling of the effect of five mutations on the structure of the ACE2 receptor and their correlation with infectivity and virulence of some emerged variants of SARS-CoV-2 suggests mechanisms of binding affinity dysregulation.

Interactions between the human angiotensin-converting enzyme 2 (ACE2) and the RBD region of the SARS-CoV-2 Spike protein are critical for virus entry into the host cell. The objective of this work was to identify some of the most relevant SARS-CoV-2 Spike variants that emerged during the pandemic and evaluate their binding affinity with human variants of ACE2 since some ACE2 variants can enhance or reduce the affinity of the interaction between the ACE2 and S proteins. However, no information has been sought to extrapolate to different variants of SARS-CoV-2. Therefore, to understand the impact on the affinity of the interaction between ACE2 protein variants and SARS-CoV-2 protein S variants, molecular docking was used in this study to predict the effects of five mutations of ACE2 when they interact with Alpha, Beta, Delta, Omicron variants and a hypothetical variant, which present mutations in the RBD region of the SARS-CoV-2 Spike protein. Our results suggest that these variants could alter the interaction of the Spike and the human ACE2 protein, losing or creating new inter-protein contacts, enhancing viral fitness by improving binding affinity, and leading to an increase in infectivity, virulence, and transmission. This investigation highlighted that the S19P mutation of ACE2 decreases the binding affinity between the ACE2 and Spike proteins in the presence of the Beta variant and the wild-type variant of SARS-CoV-2 isolated in Wuhan-2019. The R115Q mutation of ACE2 lowers the binding affinity of these two proteins in the presence of the Beta and Delta variants. Similarly, the K26R mutation lowers the affinity of the interaction between the ACE2 and Spike proteins in the presence of the Alpha variant. This decrease in binding affinity is probably due to the lack of interaction between some of the key residues of the interaction complex between the ACE2 protein and the RBD region of the SARS-CoV-2 Spike protein. Therefore, ACE2 mutations appear in the presence of these variants, they could suggest an intrinsic resistance to COVID-19 disease. On the other hand, our results suggested that the K26R, M332L, and K341R mutations of ACE2 expressively showed the affinity between the ACE2 and Spike proteins in the Alpha, Beta, and Delta variants. Consequently, these ACE2 mutations in the presence of the Alpha, Beta, and delta variants of SARS-CoV-2 could be more infectious and virulent in human cells compared to the SARS-CoV-2 isolated in Wuhan-2019 and it could have a negative prognosis of the disease. Finally, the Omicron variant in interaction with ACE2 WT, S19P, R115Q, M332L, and K341R mutations of ACE2 showed a significant decrease in binding affinity. This could be consistent that the Omicron variant causes less severe symptoms than previous variants. On the other hand, our results suggested Omicron in the complex with K26R, the binding affinity is increased between ACE2/RBD, which could indicate a negative prognosis of the disease in people with these allelic conditions.

DISPARITIES IN DIABETES AND HYPERTENSION QUALITY DURING THE COVID-19 PANDEMIC

BACKGROUND: The COVID-19 pandemic changed ambulatory chronic disease care. Our goal was to assess racial, ethnic, and language disparities in diabetes (DM) and hypertension (HTN) quality during the pandemic. METHODS: Our primary outcomes were rates of DM and HTN control among patients attributed to primary care physicians. We fit linear models, with random effects to account for repeated monthly measures on patients, to estimate the absolute differences between the 2020 and 2019 rates in the same months. The models estimated and compared these monthly differences across race/ethnicity groups (ref: White, non-Hispanic), and language groups (ref: English-speaking). We adjusted for age, sex, payor, education, and income. Significance was determined from analogous logistic regression models. RESULTS: We included 32,914 patients with DM and 125,478 with HTN. Overall, performance was better in Jan-March 2020 compared to JanMarch 2019, however this differential reversed by June 2020, falling below June 2019 (Figure). Among patients with DM, Asian and Black patients had a larger decrease in control rates compared to White patients. For example, comparing September 2019 to September 2020 the absolute control rates were 12% lower for Asian patients and 14% lower for Black patients compared to 8.3% for White patients (p<0.001). Non-English-speaking patients had a larger decrease in absolute control rates compared to English-speaking patients. For HTN, Asian, Black, and Hispanic patients had larger decreases in absolute control rates compared to White patients. For example, comparing October 2019 to October 2020, control rates decreased by 13.3% for Asian patients, 15.7% for Black patients, and 13.9% for Hispanic patients compared to 10% for White patients (p<0.001). Non-English-speaking patients had a 14.4% decrease in control rates comparing September 2019 to September 2020 while there was a 10.5% decrease among English-speaking patients (p<0.001). CONCLUSIONS: DM and HTN quality disproportionately worsened among marginalized patients during the pandemic.

DISPARITIES IN CARE FOR CHRONIC KIDNEY DISEASE PATIENTS REFERRED FROM PRIMARY CARE TO NEPHROLOGY

BACKGROUND: Underserved patients, including racial/ethnic minorities, and patients with limited English proficiency, experience worse chronic kidney disease (CKD) outcomes. Appropriate CKD care requires timely attendance upon nephrology referral and primary care co-management with nephrologists. Outcomes in these populations may be impacted by delays in access to subspecialty care and referral timeliness. The goal of our study was to assess the association of language, race, and ethnicity with ambulatory metrics among patients referred to nephrology clinics. METHODS: We used EHR data from an academic hospital in Boston to compare ambulatory metrics among patients referred to in-person nephrology visits between 2019-2021.We examined 1) percentage of no shows among all nephrology visits (new and established) and 2) average new visit delay (calendar days between referral date and scheduled date). We compared outcomes based on patient-reported language preference (non-English vs English), race (Black vs White), and ethnicity (Hispanic vs non-Hispanic). To account for changes over time during the COVID-19 pandemic, metrics were compared visits during three timeframes;10/01/19-12/31/19, 10/01/20-12/31/20, and 10/ 01/21-12/31/21. RESULTS: We identified 12,034 nephrology visits. Subtotals were 10,748 English, 1276 non-English, 7246 White, 2406 Black, 10,081 non-Hispanic, and 1534 Hispanic. We found significant disparities in no show rates which persisted across all three timeframes. In 2019, non-English speaking patients had an 11.6% no show rate compared to 6.6% of English-speaking patients (p=0.001), Black patients had an 11.5% no show rate compared to 5.0% of White patients (p<0.001) and, Hispanic patients 11.8%compared to 6.6% non-Hispanic patients (p=0.002). In 2020, no show rates were 11.8% non-English vs 7.3% English, p=0.008;13.3% Black vs 5.3% White, p<0.001;and, 10.4% Hispanic vs 7.4% non-Hispanic, p=0.019. In 2021, no show rates were 11.9% non-English vs 6.1% English, p<0.001;11.3% Black vs 4.3%White, p<0.001;and, 14.3% Hispanic vs 5.7% non-Hispanic, p<0.001. Average delay for new in-person nephrology referrals were similar across demographics though did fluctuate over time (Q4 2019, 45.1 days;Q4 2020, 38.8 days;Q4 2021, 63.0 days). CONCLUSIONS: Our findings reveal disparities in no show rates for nephrology appointments. We did not find disparities in timeliness of referrals, but did see differences between time periods, presumably from COVID. Results reinforce the need for robust efforts to ensure equitable access and care engagement, taking into account the social determinants and structural inequities which contribute to these disparities. In addition, the impact of COVID on chronic disease management could be lessened by targeted attention to improvements in telehealth and PCP/specialist integration.

USE OF ELECTRONIC COMPUTERS AS A PREDISPOSING FACTOR FOR THE DEVELOPMENT OF ASTHENOPIA

The computer in integral education is a powerful and versatile tool that has become an indispensable element for the popu¬lation worldwide, its use increased as a result of the COVID-19 pandemic which caused the suspension of all academic ac¬tivities forcing students to receive virtual classes;which increased the incidence of asthenopia also known as ocular fatigue, a subjective symptom of vision that is mainly characterized by: Burning, pain, irritation, dry and reddened eye sensation, as a consequence of spending several hours in front of computers. Objectives: To determine the use of electronic computers as a predisposing factor for the development of asthenopia. Methods: Bibliographic review by descriptive study of scientific articles, written in English and Spanish and published between 2015 and 2021, including clinical trials, papers, review, syste¬matic review and meta-analysis. Results: Ergonomics and practical advice for the correct use of electronic devices, decrease the incidence to develop asthenopia. Conclusions: People who spend long periods of time in front of computers, cell phones and tablets are at greater risk of visual problems, including eye fatigue. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

HIGHER COVID-19 POSITIVITY and LOWER VACCINATIONS among PEOPLE WHO USE DRUGS

Background: The COVID-19 pandemic has disproportionately impacted people who use illicit drugs and misuse prescription drugs (PWUD), including increased risk for infection with SARS-CoV-2, clinical COVID-19, and poorer health outcomes. The reasons for this disparity are multifactorial and may include numerous social and structural factors. Yet, little is known about COVID-19 testing and vaccinations among PWUD. Methods: This cross-sectional study was conducted in Miami, Florida, USA between March and September 2021 with the support of the National Institutes of Health Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative. Participants had to be 18 years of age and older and willing to be tested for COVID-19. Recruitment included convenience and snowball sampling. The RADx-UP survey (available at https://radx-up.org/) was administered via telephone. Results: A total of 931 participants were enrolled in the study;median age was 59 (53, 64) years, 65.5% were Black, 32.1% Hispanic, and 69.2% had a household income of less than $15,000 in 2019. Nearly a third of participants (32.6%) used drugs. Additionally, 37.6% smoked cigarettes, and 5.2% consumed alcohol for four or more days per week. Twenty percent of participants had never been tested for COVID-19. Of those who reported ever being tested, 14.1% reported ever being positive for SARS-CoV-2, with 67.2% of those having moderate-to-severe symptoms and 26.7% reporting being hospitalized due to COVID-19. Overall, 19 (2.2%) participants tested positive for SARS-CoV-2 at the time of the study, which was more frequent among PWUD than drug non-users (4.2% vs. 1.2%, respectively;p=0.004). PWUD, compared to drug non-users, were less likely to be vaccinated against COVID-19 (66.7% vs. 75.2% for any one dose, respectively;p=0.006). Compared to drug non-users, PWUD had 3.62 (95% CI: 1.41, 9.30;p=0.008) times higher odds of being positive for SARS-CoV-2 based on rt-PCR testing at the time of interview, and 0.66 (95% CI: 0.49, 0.89;p=0.006) times lower odds of being at least partially vaccinated against COVID-19. Conclusion: People who use drugs may be at increased risk of contracting SARS-CoV-2 and developing COVID-19, which could be in part related to lower vaccination rates in addition to comorbidities and lifestyle factors. Testing and immunization plans are needed that are specific for PWUD, considering the barriers and facilitators of this population.

Covid-19 epidemiology in pediatric patients from Ecuador

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that was first identified in December 2019 in the city of Wuhan, Hubei province in the People’s Republic of China, the virus is transmitted from one person to another in the respiratory secretions that are dispersed when the infected person coughs, speaks or sneezes. With 10.93 deaths per million people from coronavirus as of April 6, 2020, Ecuador has one of the highest mortality rates from COVID-19 in Latin America, with only 7.46 Polymerase Chain Reaction tests. (RT-PCR) per 10,000 people. Pediatric cases were rare in the first days of the COVID-19 outbreak, but with the appearance of family aggregation, they began to appear, registering the first cases on March 27th. The pediatric group is always susceptible to upper respiratory tract infections because their immune system is developing. This report describes the epi-demiological situation of pediatric patients in Ecuador, where it was shown that adolescents aged 15 to 18 years were more susceptible to contracting COVID-19 and the group with the highest mortality was from 0 to 9 years old, it was also shown that of the total diagnostic tests performed, 63.6% were RT-PCR tests and 36.3% were rapid tests.

Association of Race, Ethnicity, Age and Socioeconomic Status with Access to Virtual Visits within the Brigham & Women's Hospital Division of Hematology during the COVID-19 Pandemic

Background: The COVID-19 pandemic prompted an expedited shift towards expanding telemedicine services. Historically, telemedicine has been shown to increase healthcare access for those in rural communities but widen care gaps for other vulnerable populations by exacerbating existing digital divides and clinician biases in offering telemedicine services. The purpose of this study is to understand the demographic and socioeconomic characteristics of patients completing telephone, video, and in-person visits at the Brigham and Women's Hospital Division of Hematology (BWH DOH) during the COVID-19 pandemic. Methods: This was a retrospective chart review of patients who completed clinical encounters within the BWH DOH between March 19, 2020, when the division switched to virtual visits, and December 31 st, 2020 (pandemic). Patients who completed visits between January 1, 2019 and March 18, 2020 (pre-pandemic) served as a comparator group. Differences in socio-demographic composition of patients completing telephone only (TO), video only (VO), or a mix of in-person and telemedicine visits (IPTM) were tested for significance using Kruskal-Wallis and Chi-square tests. Results: A total of 8307 pre-pandemic visits and 5910 pandemic visits were included in analysis. Almost all visits (99.8%) were in-person pre-pandemic compared to 32.4% in-person, 42.6% by telephone, and 25% by video during pandemic. Median age was significantly different between patients who had only pre-pandemic visits, only pandemic visits, and both (55 vs 52 vs 58 years;p=0.003). Otherwise, there was no significant difference in racial and median income distributions pre-pandemic to pandemic. Table 1 shows the socio-demographic characteristics of patients who completed TO (1536), VO (1065), or IPTM (1518) visits during the pandemic. VO patients were significantly younger than TO and IPTM patients (p<0.001). The majority of patients identified as White (61.3%) with Black and Hispanic patients accounting for 13.8% and 11.4% of the pandemic population, respectively. A higher proportion of White patients had VO visits (29.9%) compared to Black (15.2%) and Hispanic patients (13%) who both had a higher proportion of TO visits (34.7% vs 40.4% vs 50.9%, p<0.001). More patients with a college (29.9%) or post-graduate (34.3%) degree had VO visits than patients with a high school (16.3%) or other levels of education (21.5%) who were more likely to have TO visits (p<0.001). Median household incomes approximated from patient zip codes were significantly higher in patients with VO visits than those with TO or IPTM visits (p<0.001). Discussion: This study shows that during the COVID-19 pandemic, there were significant differences in the socio-demographic composition of patients completing VO versus TO versus IPTM visits within the BWH DOH. Overall, individuals from groups that historically experience health inequities in the United States including the elderly, African Americans, Hispanics, and those with lower educational levels and socioeconomic status had fewer VO visits and more TO visits compared to patients who were younger, White, and had higher levels of education and socioeconomic status. These differences have important implications as VO visits may offer better clinical interaction when compared to TO visits. The younger age of patients seen during the pandemic compared to pre-pandemic suggests that some older adults lost access to hematology care altogether during the pandemic. This disparity pre-pandemic to pandemic was not observed in other demographic subsets. Our work reveals a need to focus on digital inclusion efforts centered around device access, internet access, and digital literacy. Additionally, while TO and VO visits are temporarily equally reimbursed as in person visits under the U.S government's COVID emergency declaration, there has already been a return to markedly lower reimbursement for TO visits. Many practices and hospital system have lost significant revenue due to the pandemic and this differential reimbursement may disincentivize provi ing care through TO, even if that is the patient's only means of access. This could pose as a further barrier to telemedicine access for individuals from vulnerable populations and exacerbate structural racism, ageism, and other inequities. Care must be taken moving forward that actions to cope with the pandemic or modernize health care serve all patients. [Formula presented] Disclosures: Neuberg: Pharmacyclics: Research Funding;Madrigal Pharmaceuticals: Other: Stock ownership. Achebe: Fulcrum Therapeutics: Consultancy;Pharmacosmos: Membership on an entity's Board of Directors or advisory committees;Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees.

Affective State-Based Framework for e-Learning Systems

Virtual learning and education have become crucial during the COVID-19 pandemic, which has forced a rethink by teachers and educators into designing online content and the indirect interaction with students. In an face-to-face class, some visual cues help the teacher recognize the engagement level of students, while the main weakness of the online approach is the lack of feedback that the teacher has about the learning process of the students. In this paper, we introduce a novel framework able to track the learning states, or LS, of the students while they are watching a piece of knowledge-based content. Specifically, we extract four learning states: Interested, Bored, Confused or Distracted. Finally, to demonstrate the system's capability, we collected a reduced database to analyze the affective state of the subjects. From these preliminary results, we observe abrupt changes in the LS of the audience when there are abrupt changes in the narrative of the video, indicating that well-structured and bounded information is strongly related with the learning behaviour of the students. © 2021 The authors and IOS Press.