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Risky sexual behaviors in adolescents and young adults often result in negative outcomes, such as sexually transmitted infections (STIs) and unwanted pregnancies. This case study compares the experience of implementing a digital app-based platform aimed at reducing adolescent sexual risk behavior in a rural medical clinic and a university-based mental health clinic in an effort to better understand how the cliexa-OPTIONS mobile app can inform care and enhance the overall quality of treatment in very different clinical health settings. Clinicians in charge of the implementation of the digital app report that it opens up more transparent discussions with patients/clients, allowing them to provide better care in both medical and mental health settings. The differences in context provide different demographic-related challenges at the two sites. Challenges in online recruitment and workflow were evident only at the university-based mental health clinic as a result of the COVID-19 pandemic. Implementers at both sites indicated a highly positive overall experience with cliexa-OPTIONS and a desire to use the digital app in the future. Patient/client satisfaction surveys indicate that patients/clients enjoy using the digital app and find it easy to use. © 2023 Taylor & Francis Group, LLC.
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Purpose Stressor events, such as COVID-19, may trigger adaptive or maladaptive pain management strategies among individuals with persistent low back pain (LBP). Emerging research shows individuals with lower fear avoidance, depression and anxiety, and greater positive affect and quality of life can better maintain positive pain management strategies during stressor events. For individuals with persistent LBP, physical activity (PA) has been shown to be a beneficial pain management strategy. This study investigated psychosocial variables of individuals with LBP who demonstrated adaptive pain management strategies during COVID-19, indicated by the maintenance of physical activity. Methods Twenty-five individuals with persistent LBP (age 22.4 (3.4) years, 7m, 18f) from an existing longitudinal cohort participated. Participants completed a baseline survey prior to COVID-19. This survey quantified demographics, pain severity, frequency, and duration. Other baseline measures were the Physical Activity Scale, the WHOQOL-Bref physical, psychological, social, and environmental quality of life subscales, Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, and Trait Affect scale. Participants then completed follow-up surveys for 18 months. During COVID-19 lockdown, the impact of lockdown on PA was assessed. The cohort was dichotomized into individuals reporting the same or more PA (MPA) and those reporting less PA (LPA) and baseline characteristics were compared between groups. Results The LPA group contained 17 individuals and the MPA group contained 8 individuals. There was no significant demographic difference between groups. The MPA group had greater duration of LBP symptoms (p=0.015, d =1.16). The MPA group trended towards higher physical quality of life (p=0.101, d=0.79) and higher environmental quality of life (p=0.057, d=0.96) at baseline. Individuals in the MPA group had lower negative affect (fatigue domain) scores than the LPA group (p=0.038, d=0.86). Depression scores were lower in the MPA group (p=0.006, d=1.12). Conclusions Individuals with persistent LBP who had greater duration of symptoms, better physical and environmental quality of life, lower negative affect, and less depression were more likely to maintain or increase physical activity during COVID-19. These characteristics may facilitate positive adaptation to a stressor event.
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INTRODUCTION AND OBJECTIVE: Prior to the COVID-19 pandemic, an estimated 4.8 billion individuals lacked access to basic surgical care worldwide, with near absence in many low-income/ middle-income countries (LMICs). Global health programs work to advance universal health coverage. The COVID-19 pandemic eliminated in-person surgical care and local training to LMICs provided by these programs. The objective of this study was to project a calculated impact of interrupted International Volunteers in Urology (IVUmed) global health surgical workshops since the start of the COVID-19 pandemic on patient care and training provided to partner LMIC sites. METHODS: Data from the 5 fiscal years (FY - April to March) prior to the COVID-19 pandemic was reviewed. This included metrics of number patients seen and surgical cases performed, local surgeons trained, countries visited, and estimated value of service provided as part of financial impact reporting. The last IVUmed workshop was March 5-15, 2020 and concludes the FY 2020. No surgical workshops were performed for FY 2021 and FY 2022 (through October 31, 2021). The projected FY loss of productivity for each metric was calculated by averaging the 5 FYs prior to FY 2021. The total loss since the COVID-19 pandemic was then calculated by the sum of the projected FY 2021 (this value) and that of FY 2022 thus far (7/12ths of this value). RESULTS: Averaging IVUmed surgical workshops over FY 2016-2020, 23 trips were taken each year to 13 countries. The average number of patients seen was 812, with an average of 564 surgical cases performed. The average number local surgeons involved in each workshop was 296. The FY average value of service was US$4,204,217.60. Projected losses for FY 2021 through October 31, 2021 (FY 2022 thus far) would be in the form of 36 trips to 21 countries. This has impacted 1,286 patients and meant the loss of 893 surgical cases. 469 local surgeons have been impacted by lost in-person training. The estimated value of service lost is US$6,656,677.86. CONCLUSIONS: COVID-19 has negatively impacted the already critically limited global surgical volume in LMICs. A simple calculation of lost surgical workshops thus far attempts to put a number on the impact this pandemic has had on the IVUmed program. This is the estimate of the impact of COVID-19 on only a single global health program, with the impact likely nearly immeasurable with the universal loss of global health services being provided during the pandemic. Such estimates can try to help global health programs prepare for the potential backlog of care and training that will be faced when workshops resume.
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TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus Disease 2019 (COVID-19) has affected over 140 million with over 3 million deaths worldwide. As the virus continues, we face a new challenge;to discern between post COVID syndromes or COVID reinfection. We present a case with this medical dilemma. CASE PRESENTATION: 64 y/o F with Diabetes, Hypertension & history of asymptomatic COVID infection eight weeks prior to presentation with follow-up negative testing, presented with fever & SOB. She initially developed progressive dyspnea on exertion for which bronchodilators were initiated as an outpatient. She then presented to our hospital with fevers & progressive SOB. Her initial workup revealed normal blood work & inflammatory markers, however her COVID RNA test was positive with seronegative COVID antibodies. Imaging revealed increased bilateral ground-glass opacities & inter-septal thickening when compared to imaging one month prior. Her positive COVID tests were attributed to viral shedding & COVID therapy was not initiated. On hospital day 6 she began to decompensate requiring rapid escalation of oxygen supplementation to high flow nasal cannula. At this time high dose steroids were initiated as post COVID syndrome was thought to be the disease pathology. On hospital day 12 retesting revealed seroconversion of COVID antibodies. Her hospital course was complicated by severe hypoxia requiring prolonged steroid taper & oxygen supplementation. She was ultimately discharged on home oxygen with outpatient management. DISCUSSION: Complications of COVID-19 disease include reinfection & post-COVID syndrome. Reinfection was considered in this patient due to repeated negative tests & an asymptomatic period. This remains a rare phenomenon. There are only 5 reported known cases thus far. It was ruled out according to WHO guidelines, since there were <90 days between her 1st & 2nd positive tests. There was no genomic sequencing of both samples to confirm different genetic lineages. Her course was attributed to prolonged shedding of virus which can occur >3 months after infection & despite neutralizing antibodies. We believe she developed severe ARDS due to COVID pneumonitis with possible progression to ILD. Typical disease course is still unclear. There is increasing evidence of fibrotic-like changes in the lung in high rate of patients for up to 6 months. Reversibility of these findings is unknown. Post-mortem evaluation of lung tissue reveals diffuse alveolar damage from chronic inflammation. Obesity, ARDS, prolonged hospitalization & NIMV are reported risk factors. CONCLUSIONS: This case shows the importance of considering COVID reinfection in patients with atypical presentation. It is imperative that we differentiate between viral shedding & reinfection in patients with post-acute COVID symptoms. Both presentations may be similar, therefore it is pivotal that we continue to investigate these two-potentially fatal COVID related processes. REFERENCE #1: Pan American Health Organization / World Health Organization. Interim guidelines for detecting cases of reinfection by SARS-CoV-2. 29 October 2020, Washington, D.C.: PAHO/WHO;2020 REFERENCE #2: Qian Li, Xiao-Shuang Zheng, Xu-Rui Shen, Hao-Rui Si, Xi Wang, Qi Wang, Bei Li, Wei Zhang, Yan Zhu, Ren-Di Jiang, Kai Zhao, Hui Wang, Zheng-Li Shi, HuiLan Zhang, Rong-Hui Du & Peng Zhou (2020): Prolonged shedding of severe acute respiratory syndrome coronavirus 2 in patients with COVID-19, Emerging Microbes & Infections, DOI: 10.1080/22221751.2020.1852058 REFERENCE #3: Han X, Fan Y, Alwalid O, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E186. doi:10.1148/radiol.2021203153 DISCLOSURES: No relevant relationships by Angelica Medina-Pena, source=Web Response No relevant relationships by Anna-Belle Robertson, source=Web Response No relevant relationships by Noura Semreen, source=Web Response no disclosure on file for David Shiu;No relevant relationships by Ro-Kaye Simmonds, source=Web Re ponse No relevant relationships by Jodi-Ann Smith, source=Web Response
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RATIONALE: Patients with COVID-19 may require supplemental oxygen and non-invasive respiratory support devices during pre-hospital aeromedical transport as well as in-hospital intensive care units. It is unclear whether these therapies increase the dispersion of potentially infectious bioaerosols and placing health workers at increased risk. METHODS: The studies were conducted in two environments: (1) fixed-wing air ambulance cruising at 25,000 ft;(2) a simulated critical care unit in hospital. A breathing patient simulator consisting of a medical mannequin exhaling nebulized particles from the lower respiratory tract was connected to a ventilator to simulate a patient with mild-moderate respiratory distress. Aerosolized saline and DNA bacteriophage φX174 were used to model aerosol dispersion in the aeromedical and simulated intensive care unit, respectively. Dispersion of 1.0 μm particles were measured in key locations, due to the three respiratory support modalities including;non-invasive bilevel positive pressure ventilation (BiPAP);high-flow nasal oxygen (HFNO);and nasal prongs. In the simulated intensive care unit study, viability of aerosolized bacteriophage φX174 was quantified using plaque assays (Fig. 1) RESULTS: In both environments, particle concentrations were highest close to the simulator's mouth and declined with distance from the mouth. In the aeromedical environment, nasal prongs (with a surgical mask) were associated with the highest particle concentrations and BiPAP the lowest. In that environment, at a location near the mouth, particle concentrations associated with HFNO with a surgical mask (5.5 × 104 particles/L of sampled air) and BiPAP (7.5 × 103 particles/L) were significantly lower when compared to nasal prongs with a surgical mask (1.2 × 105 particles/L) (each P < 0.05). In the simulated intensive care unit, HFNO was associated with the highest particle concentrations and BiPAP the lowest. In this environment, at a location near the mouth, particle concentrations as well as bacteriophage viability associated with nasal prongs (7.4 × 104 particles/L and 1.6 × 104 PFU/L) and BiPAP (1.1 × 104 particles/L and 1.9 × 102 PFU/L) were significantly lower when compared to HFNO (5.3 × 105 particles/L and 2.6 × 104 PFU/L) (each P < 0.05). CONCLUSIONS: These findings highlight the comparable risk of dispersing particles among respiratory support devices and the importance of appropriate infection prevention and control practices and personal protective equipment for healthcare workers when caring for patients with transmissible respiratory viral infections such as COVID-19. These findings also suggest a comparable risk associated with use of nasal prongs and HFNO in both environments.
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Written by a highly respected team of authors brought together by the Society for the Study of Social Problems (SSSP), this book provides accessible insights into pressing social problems in the United States in the aftermath of the COVID-19 pandemic and proposes public policy responses for victims and justice, precarious populations, employment dilemmas and health and well-being. © Bristol University Press 2020. All right reserved.