ABSTRACT
Background. COVID-19 has caused over 6 million deaths worldwide. While testing was initially centered in healthcare facilities with automatic reporting to health departments, it is increasingly being performed in the home with rapid antigen testing. Many at-home tests are self-interpreted and not typically reported. In December 2021, nirmatrelvir/ritonavir and molnupiravir were authorized for the treatment of COVID-19 in high-risk patients. In New York City (NYC), these antivirals are available for free via pickup or home delivery, allowing for early expanded access. We sought to identify if prescribing of antivirals might act as an early indicator of increasing COVID-19 incidence in the setting of decreased case reporting. Methods. Confirmed and probable COVID-19 tests are reported to the NYC Health Department. All pharmacies participating in the federal COVID-19 therapeutics program are required to report daily utilization data, which are made available to jurisdictions through the Tiberius platform. From December 27, 2021 to April 18, 2022, we analyzed citywide weekly case counts, using patients 65 years and over as a proxy for high-risk eligible patients, and weekly oral therapeutic prescription fills. We calculated weekly case rates and prescribing rates per 100,000 residents. Weekly case rates and prescription fill rates were trended to assess for concordance over time. Results. During this period, 17,522 prescriptions were filled. Prescription fills and case rates were concordant until the weeks of February 28 and March 7, when an increase in fill rate was noted from the week prior (1.76 to 2.34 to 4.10), while reported case incidence continued to decrease (6.16 to 5.08 to 4.61). This discordance coincided with the emergence of the BA.2 subvariant in NYC. After these weeks, an uptick in case incidence was noted for the remainder of the study period, in concordance with prescription data. Conclusion. Increasing rates of oral therapeutic prescribing could be an early indicator of increasing COVID-19 transmission. Limitations include the unclear impact of public and prescriber education efforts on prescribing trends. Next steps include exploring the addition of prescription data into modeling to predict trends in transmission as reported cases becomes a less reliable indicator.
ABSTRACT
Since the coronavirus disease outbreak, older adults have been isolated from family, as in-person contact declined, and many turned to digital contact to stay in touch. This form of contact, consisting of texting, email, and social media, is labeled digital solidarity. A key advantage of digital communication over in-person contact is that it requires less investment of time and no geographic proximity. However, it is unclear whether digital solidarity represents a separate dimension of intergenerational solidarity, and whether it compensates for low in-person contact. In this paper, we examined traditional and digital types of intergenerational communication between older parents and adult children, and their associations with older adults' perceived quality of communication and closeness with children. We used the 2016 wave of the Longitudinal Study of Generations to generate a sample of 580 older parents who reported on relationships with 1,489 adult children. Adopting a three-step latent class approach, we identified four classes of intergenerational communication: all-type contact, no contact, digital contact, and traditional contact. Older adults in both no contact and digital contact classes were less likely to report being emotionally close with their adult children when compared to those in the traditional contact class. No difference in perceived quality of communication was found between contact classes. Our findings indicate that digital solidarity is a distinct dimension of intergenerational solidarity and can compensate for reduced in-person contact with children. Discussion centers on the implications of these results for pandemic times and a replication using recently collected data from 2021-22.
ABSTRACT
Introduction: Two prospective randomized trials, TARGIT-A and ELIOT, have shown intraoperative radiationtherapy (IORT) to be a safe alternative with a low-risk of local recurrence compared to whole breast radiationtherapy following breast conserving surgery for selected low-risk patients. We report the first 1200 tumors treatedwith this modality at our facility. Methods: 1200 distinct breast cancers in 1169 patients (31 bilateral) were treatedwith breast conserving surgery and X-ray IORT, using the Xoft Accent System from June 2010 to November 2018.Patients were enrolled in an IORT registry trial and data were collected at 1 week, 1 month, 6 months, 1 year, andyearly thereafter. The primary endpoint was local recurrence. Results: To date, there have been 61 events in 54patients: 50 ipsilateral local recurrences (14 DCIS and 36 invasive), 7 regional nodal recurrences and 4 distantrecurrences. Of local recurrences, 9 were within the IORT field, 21 outside of the IORT field but within the samequadrant as the index cancer, and 20 were new cancers in different quadrants. There has been no breast cancerrelated deaths and 27 non-breast cancer deaths. Currently, with a median follow-up of 52 months, Kaplan Meieranalysis projects 5.2 % local recurrence rate at 5 years. In the table below, the five-year probability of localrecurrence is analyzed by quadrant and/or type of recurrence (all recurrences or just invasive). Using the 2017,ASTRO Categories, 520 patients (43%) were suitable for IORT, 415 (35%) were cautionary, and 265 (22%) wereunsuitable for IORT after final histopathology was evaluated. Conclusion: IORT is profoundly convenient. Whenused as the only adjuvant breast irradiation, it eliminates approximately 15-35 outpatient visits. This has become increasingly important during the current COVID-19 pandemic. In the group of patients described here, more that100,000 patient-hours were saved. The local, regional, and distant recurrence rates observed in this trial wereslightly higher than those of the prospective randomized TARGIT-A and ELIOT Trials. This may be explained by22% of our patients being considered unsuitable for IORT by ASTRO Criteria. The low complication rates previouslyreported by our group as well as the low recurrence rates reported in this study support the cautious use andcontinued study of X-ray IORT in women with low-risk breast cancer.
ABSTRACT
This report describes COVID-19 patients treated during March–May 2020 at an urban safety-net hospital serving predominantly low-income racial/ethnic minority populations.