Responding to COVID-19 related mental health impacts among elite athletes

The COVID-19 pandemic has impacted considerably on elite athletes' performance. In this paper, we aim to examine how the psychosocial effects of COVID-19 may impact on athletes. First, mental health problems are as common among elite athletes as among the general population. Second, the mental health effects of COVID-19 are common in adolescents and young adults. Third, there are recognised gender differences in mental health related help-seeking behaviour. There is emerging evidence that these issues may be exacerbated by the pandemic. While there is little evidence on what interventions may help to address this problem, it is possible that optimising the identification and treatment of mental health problems (in an appropriate and acceptable manner) and promoting team cohesion and interaction may be effective. Addressing this issue is important for all team doctors and healthcare professionals associated with sports teams (both elite and non-elite).

Impact of the COVID-19 pandemic on urologic care delivery in the United States

Introduction & Objectives: The impact of the COVID-19 pandemic on health care access and delivery in the US has been reported for hospital admissions and in the outpatient setting for a few selected health conditions. However, the impact on specialty care has not been adequately characterized. We therefore aimed to determine trends in outpatient urologic care visit and procedural volume in 2020, using a specialty-wide, community-based registry. Materials & Methods: The American Urological Association Quality (AQUA) Registry collects data via automated extraction from electronic health record systems at 157 urology practices representing 3,165 providers (roughly one-quarter of US urologists) across 48 US states and territories. We analyzed trends in care delivery from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features. The primary outcomes were mean visit volume and procedure volume per practice per week, and we compared each week to the corresponding week in 2019. Results: There were 2,750,001 patients in our cohort, accounting for 8,953,832 outpatient visits and 1,570,161 procedures. We found large (>40%) declines in outpatient visits from March to April 2020 across all demographic groups and US states, regardless of timing of stay-at-home orders. Visits recovered through May and early June, but began falling again by early July (see Figure). Non-urgent visits and procedures decreased more (39–47%) than visits for urgent diagnoses (29–43%);surgical procedures for non-urgent conditions also decreased more (37–53%) than those for potentially urgent conditions (13–21%). African American and Hispanic patients had smaller decreases in visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients (mostly over 65 years old) had the steepest declines (50%) while those on Medicaid (generally low-income) had among the lowest percentage of recovery to baseline (84.4%). Practices in zip codes with lower median incomes, higher poverty levels, and lower urologist to population ratios had smaller decreases in outpatient visits. (Figure Presented) Conclusions: This study provides timely, real-world evidence on the magnitude of decline in the provision of urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses.

Worker adaptation behaviours and mental health impacts in Irish workplaces arising from COVID-19 – observations of OSH professionals

Introduction: Workers quickly adapted during the COVID-19 pandemic to comply with updated work arrangements, control measures and policies. Understanding adaptation difficulties/fatigue and mental health issues among workers is crucial for OSH professionals to plan for future emergencies. Materials and Methods: As part of a larger COVID-19 workplace study, 16 two-hour focus groups (4-6 participants each) were conducted with OSH professionals (n=60) in Ireland, covering four predetermined themes (organisational preparedness;organisational impacts;worker adaptation behaviour;and the future of OSH post-pandemic). Thematic analysis was conducted using Nvivo. Results: OSH professionals observed many workers rapidly adapted and became involved in organisational COVID-19 outbreak prevention and long-term adaptation, in contrast to some workers that exhibited mental health problems as they struggled to adapt. Adaptation fatigue was observed when staff were sent home to work due to a range of factors: 1) isolation at home 2) no boundary between work and life;and 3) inability to disconnect from negative media coverage. The situation can be alleviated by 1) increasing informal communication to cope with isolation;2) Employee Assistance Programmes;and 3) additional consultation regarding their COVID-19 concerns. Conclusion: Most Irish workplaces focused more on employees’ physical safety rather than their mental wellbeing. The experiences shared by OSH professionals in this study illustrate their agility and ability to apply their risk management and control skills to any unanticipated public/occupational health crisis that arises.

Development and validation of a multi-lingual online questionnaire for surveying the COVID-19 prevention and control measures used in global workplaces

Introduction: There is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to the global workforce. Material and Methods: A 44-item QualtricsXM survey was developed, translated, and validated for face, content, and cross-cultural validity according to literature review, expert consultation, and pre-testing. The survey was piloted with 890 workers from diverse industries and countries. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing and Pearson correlation coefficients verified construct validity (i.e., known-groups technique, discriminant validity), and criterion validity. Results: EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥ 0.60). Hypothesis testing confirmed construct validity (p < 0.001), criterion validity (p ≤ 0.03), and discriminant validity (r = -0.45). Conclusions: The occupational IPC measures survey showed strong validity and reliability. It can be used by decision makers in the distribution of IPC resources, and to guide occupational health and safety (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

COVID-19 and its impact on Irish workplaces – OSH professionals experience and observations of preparation and adaptation

Introduction: An investigation of Irish workplace adaptation to COVID-19 was conducted to assess impact to workers, their organisations and to develop new OSH adaptation mechanisms for future health emergencies. Materials and Methods: As part of the study, OSH professionals (n=60), each representing their workplace, took part in a series of semi-structured online focus groups. Each focus group incorporated twenty quantitative questions (covering four themes: organisational preparedness;organisational impacts;worker impacts;and the future of OSH) that were answered anonymously via a poll function. Results: 59 participants completed the questions. 58% of workplaces began pandemic preparations prior to COVID-19 emerging in Ireland. 66% of workplaces remained open while 27% were partially closed. 34% of workplaces had more than half their workforce working from home (5% pre-pandemic). 37% of workplaces had a working from home policy with 54% of workplaces having risk assessments for infectious diseases in place prior to the pandemic. 41% of workplaces had identified a viral pandemic scenario as part of its emergency planning prior to COVID-19. OSH professionals indicated that the majority (63%) of their colleagues understood the control measures instigated as a response to COVID-19 with a greater majority (90%) more willing to accept future workplace changes if they know it is to keep them safe and healthy. Conclusion: Irish workplaces adapted well to the changing OSH landscape that emerged in response to COVID-19. Irish workplaces are now more likely to be able to adapt and respond well to future public health emergencies.

Quantifying the impact of regional variations in COVID-19 infections and hospitalizations across Ireland.

BACKGROUND: As most COVID-19 transmission occurs locally, targeted measures where the likelihood of infection and hospitalization is highest may be a prudent risk management strategy. To date, in the Republic of Ireland, a regional comparison of COVID-19 cases and hospitalizations has not been completed. Here, we investigate (i) the variation in rates of confirmed infection and hospital admissions within geographical units of the Republic of Ireland and (ii) frequency of deviations in risk of infection or risk of hospitalization. METHODS: We analyzed routinely collected, publicly available data available from the National Health Protection and Surveillance Centre and Health Service Executive from nine geographical units, known as Community Health Organization areas. The observational period included 206 14-day periods (1 September 2020-15 April 2021). RESULTS: A total of 206 844 laboratory-confirmed cases and 7721 hospitalizations were reported. The national incidence of confirmed infections was 4508 [95% confidence interval (CI) 4489-4528] per 100 000 people. The risk of hospital admission among confirmed cases was 3.7% (95% CI 3.5-3.9). Across geographical units, the likelihood that rolling 14-day risk of infection or hospitalization exceeded national levels was 9-86% and 0-88%, respectively. In the most affected regions, we estimate this resulted in an excess of 15 180 infections and 1920 hospitalizations. CONCLUSIONS: Responses to future COVID-19 outbreaks should consider the risk and harm of infection posed to people living in specific regions. Given the recent surges of COVID-19 cases in Europe, every effort should be made to strengthen local surveillance and to tailor community-centred measures to control transmission.

Impact of the COVID-19 pandemic on urology care delivery in The United States

INTRODUCTION AND OBJECTIVE: We determined the national impact over time of the COVID-19 pandemic on outpatient urology visits and procedural volume. METHODS: We examined temporal changes in urologic care delivery in the United States from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features using real-world data from the American Urological Association Quality (AQUA) Registry, which is a Qualified Clinical Data Registry. Data are collected via automated extraction from practices' electronic health record systems. RESULTS: There were 2,750,001 unique patients represented in our study cohort, accounting for 8,953,832 total outpatient visits and 1,570,161 procedures;data represented 157 outpatient urologic practices and 3,165 providers across 48 US states and territories. We found large (>40%) declines in outpatient visits from March 2020 to April 2020 across all patient demographic groups and across states, regardless of timing of state stay-at-home orders. Visits recovered through May and early June, but began falling again by early July. Non-urgent outpatient visits decreased more across various non-urgent procedures (39e47%) than for procedures performed for urgent diagnoses (29e43%);surgical procedures for non-urgent conditions also decreased more (37e53%) than those for potentially urgent conditions (13e21%) (Table). African American and Hispanic patients had smaller decreases in outpatient visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (50%) while those on Medicaid had among the lowest percentage of recovery to baseline (84.4%). Practices in zip codes with lower median incomes, higher poverty levels, and lower urologist to population ratios had smaller decreases in outpatient visits. CONCLUSIONS: This study provides timely, real-world evidence on the magnitude of decline in the provision of specialty care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses.

The national impact of the COVID-19 pandemic on us prostate cancer community care

INTRODUCTION AND OBJECTIVE: We used data from a specialty-wide, community-based urology registry to determine trends in outpatient prostate cancer (PCa) care during the COVID-19 pandemic. METHODS: 3,165 (w 25%) of US urology providers, representing 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry, which collects data via automated extraction from electronic health record systems. We analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. Risk stratification was based on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage, and we used a natural language processing algorithm to determine Gleason and Tstage from unstructured clinical notes. The primary outcome was mean weekly visit volume by PCa patients per practice (visits defined as all MD and mid-level visits, telehealth and face-to-face), and we compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019. RESULTS: There were 267,691 PCa patients in AQUA who received care between 2019 and 2020. From mid-March to early November, 2020 (week 10 - week 44) the magnitude of the decline and recovery varied by risk stratum, with the steepest drops for lowrisk PCa (Table). For 2020, overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks (w25). Visits declined to week 14 (18.19;a 31% drop from 2019), recovered to 2019 levels by week 23, and declined steadily to 11.89 (a 58% drop from 2019) as of week 44, the cut off of this analysis. CONCLUSIONS: Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November. This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely.

PUK19 DATA Quality Considerations for Determining the IMPACT of the COVID-19 Pandemic on Outpatient Visits and Procedures in the United States

Objectives: To use real-world data to better understand the temporal impact of COVID-19 on frequency of outpatient visits in urology clinics and apply a data quality framework to identify and resolve issues that could influence the validity of analyses. Methods: We examined visit trends from 157 outpatient urologic practices and 3,165 providers included in the American Urological Association Quality (AQUA) Registry, a national Qualified Clinical Data Registry designed to measure, report and improve healthcare quality and patient outcomes. As of December 2020, 50 million patient visits from 7.3 million unique patients exist in the database. We used a data quality framework to assess issues related to data completeness and timeliness. Past data lag trends were assessed to determine a temporal cutoff point that minimized lag. To account for missing data, a comprehensive visit definition that went beyond E/M (Evaluation and Management) coding was applied and compared to results using the E/M-only definition. Results: Correlating with the onset of the COVID-19 pandemic in the US in mid-March 2020, outpatient visits declined for five weeks, resulting in a 47.7% drop from the February 2020 baseline, followed by an 83.1% recovery back to baseline by July 31. Based on timeliness scores, which consider the average time between visit date and the visit data processing date from the selected practices, a 90-day buffer between data cutoff and the end of the analysis’s observation period was necessary to minimize data lag. Total patient encounters increased by more than 20% when using a more comprehensive visit definition Conclusions: The COVID-19 pandemic contributed to a reduction in outpatient visits, followed by a recovery close to baseline. Our data quality framework identified and informed key study design decisions to account for inadequate data timeliness and completeness. These methods prevented an overestimation of the true decline in patient encounters and missed patient encounters.