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The present study aimed to examine work environment related factors and frontline primary healthcare profes-sionals' mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong. A total of 61 (20%) school health nurses (frontline primary healthcare professionals) participated in a cross-sec-tional online survey from March to June 2020. Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form (14-item scale with three subscales related to emotional, social and psychological wellbeing);the Perceived Stress Scale (10-item scale with two subscales related to perceived help-lessness and lack of self-efficacy;and the Coping Orientation to Problems Experienced Inventory (Brief COPE), a 28-item inventory with two subscales related to adaptive and maladaptive strategies. Almost half (42.6%) of participants experienced mental health problems. Those employed in government subsidized schools had significantly lower scores in mental health wellbeing than those who worked in private schools. Factors relating to increased mental health problems included lack of emotional support, inadequate training relating to infection prevention and control measures, disengagement and self-blame. A variety of factors influencing school health nurses' social, emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported. The mental-emotional wellbeing of school nurses may relate to their subjective feeling of loneliness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic. Study findings provide relevant evidence for management teams to build a culture of psychological and social support into workplace policies and procedures. Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare professionals in school communities as they play a significant role in safeguarding resources during pandemics. © 2023, Tech Science Press. All rights reserved.
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Background Venous thromboembolism (VTE), is associated with significant morbidity and mortality. Inflammation increases the risk of VTE, and it is a well-recognised complication of both inflammatory bowel disease (IBD) and COVID-19. Purpose To compare the risk of VTE among individuals with and without IBD following a positive COVID-19 test. Method Using health administrative data from Ontario, Canada we conducted a retrospective matched cohort study.All Ontario residents with a positive SARS-CoV-2 PCR test between January 1,2020 and December 30,2021 who had been diagnosed with IBD prior to their COVID-19 infection (identified using a validated algorithm) were matched to 5 individuals without IBD based on year of birth, sex, mean neighbourhood income quintile, date of positive COVID-19 test, and rural/urban residence. Individuals with a cancer diagnosis in the 5 years prior to their first COVID-19 positive test were excluded. Individuals were followed from positive COVID-19 PCR test until VTE event, death, migration out of Ontario or March 31, 2022.VTEs were identified from emergency department or hospitalization data using ICD-10 codes. Incidence rate of VTEs among individuals with IBD were assessed at 1, 6 and 12 months. Proportional cause-specific hazards models compared the risk of VTEs in people with and without IBD, treating death as a competing risk and controlling for vaccination status (2nd dose ≥14 days prior to positive COVID-19 test) and a history of VTE (VTE in the 5 years prior to infection). Result(s) There were 4293 people with IBD (44% Crohn's disease, mean age ±SD 46.1±17.2 y) matched to 20,207 with out IBD (mean age 45.3±16.8 y) with a positive SARS-CoV-2 PCR test. Within 1 month of a positive COVID-19 test, the crude incidence rate of VTE in individuals with IBD was 4.77(95%CI, 4.75-4.80) per 100,000 person-days compared to 8.25(95%CI, 8.20-8.30) per 100,000 among people without IBD.Within 6 months, these rates were 1.86(95%CI, 1.86-1.87) and 2.12(95%CI, 2.11-2.12) per 100,000 person-days among people with and without IBD, respectivley. Within 12 months, these rates were 1.59(95% CI, 1.58-1.59) and 1.42(95% CI, 1.42-1.42) per 100,000 person-days among people with and without IBD, respectively.After adjusting for vaccination status and history of VTE there was no difference in the risk of VTE for people with and without IBD (HR 1.08, 95%CI, 0.64 to 1.83). Conclusion(s) IBD patients with COVID-19 were not more likely to experience a VTE infection compared with the general popluation. The risk of VTE was highest soon after COVID-19 and declined thereafter. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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BACKGROUND: Antibiotics are commonly prescribed for respiratory tract infections (RTIs) among older adults in long-term care facilities (LTCFs), and this contributes to the emergence of antimicrobial resistance. The objective of this study was to determine the antibiotic prescribing rate for RTIs among LTCF residents, and to analyse the antibiotic consumption patterns with the AwaRe monitoring tool, developed by the World Health Organization. METHODS: MEDLINE, EMBASE and CINAHL were searched from inception to March 2022. Original articles reporting antibiotic use for RTIs in LTCFs were included in this review. Study quality was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Prevalence Data. A random-effects meta-analysis was employed to calculate the pooled estimates. Subgroup analysis was conducted by type of RTI, country, and study start year. RESULTS: In total, 47 articles consisting of 50 studies were included. The antibiotic prescribing rate ranged from 21.5% to 100% (pooled estimate 69.8%, 95% confidence interval 55.2-82.6%). The antibiotic prescribing rate for lower respiratory tract infections (LRTIs) was higher than the rates for viral and general RTIs. Compared with Italy, France and the USA, the Netherlands had lower antibiotic use for LRTIs. A proportion of viral RTIs were treated with antibiotics, and all the antibiotics were from the Watch group. Use of antibiotics in the Access group was higher in the Netherlands, Norway, Switzerland and Slovenia compared with the USA and Australia. CONCLUSION: The antibiotic prescribing rate for RTIs in LTCFs was high, and AWaRe antibiotic use patterns varied by type of RTI and country. Improving antibiotic use may require coordination efforts.
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Exercise improves mental health and effectively alleviates cognitive and physical declines. Unfortunately, engagement in physical activity decreases as individuals age and this was likely exacerbated by the COVID-19 pandemic. New technologies to deliver live online home-based group exercise classes may help mitigate mental and physical health declines in older adults while maintaining social connectivity. We evaluated the feasibility of an age-appropriate and ability-modified at-home exercise program via live video stream. The impact on loneliness, anxiety, and depression in older adults were exploratory outcomes. In this two-arm pilot RCT, we randomly assigned sedentary community-dwelling adults (65-80 years) to a waitlist control (CON) or an active group (ACTIVE) of thrice-weekly, 8-wk online live exercise program delivered via Zoom by trained exercise professionals. Attendance was recorded, and participant satisfaction to ACTIVE was assessed. Pre- and post-intervention loneliness, anxiety, and depression were collected using the revised UCLA Loneliness Scale (R-UCLA), the Geriatric Anxiety Inventory (GAI), and the Geriatric Depression Scale (GDS). 32 participants were randomized (ACTIVE: n=16, mean age 70 ± 4, 69% women, 30 ± 5 kg/m2;CON: n=16, mean age 71 ± 5;88% women;29 ± 5 kg/m2). Attendance to online classes was >80% and all ACTIVE participants reported being satisfied with the exercise sessions. There was no intervention effect compared to CON on loneliness and anxiety. An effect of the intervention was observed for depression (ACTIVE: -1.94;CON: -0.07;p=0.015). We demonstrated good feasibility, satisfaction, and preliminary efficacy of a live online exercise program on older adults' mental health.
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Study Objective: In the emergency department (ED), chemical restraints are utilized for patients who present imminent danger to self or others. In children and adults, increased restraint has been associated with black males for both chemical and physical restraints. Further although most pediatric ED visits occur in community hospitals, pediatric studies have analyzed only those seen at freestanding children's hospitals. With the rising pediatric behavioral health crisis, we sought to evaluate trends and hospital variation in the use of chemical restraint for pediatric behavioral health patients and assess for any association with race/ethnicity or hospital-level factors. Study Methods: This was a retrospective cohort study of pediatric ED patients ages 8-17 treated at hospitals contributing to the Premier Database between January 1, 2018-December 31, 2020 who had an ED discharge diagnosis associated with a mental health or behavioral condition, identified via the presence of an International Classification of Diseases, Tenth Revision code using the Child and Adolescent Mental Health Disorders Classification System (CAMHD-CS). Hospitals contributing fewer than 50 cases during the study period were excluded. The primary outcome was the proportion of patients with a behavioral health ED diagnosis who underwent chemical restraint. This was defined as receipt of an intramuscular benzodiazepine or antipsychotic medication. We also developed a hierarchical model, adjusting for patient and hospital variables, to compute a median odds ratio (MOR) to quantify the contribution of the individual hospital on the odds of a patient being discharged from the ED. Additionally, we performed a descriptive analysis of medications used and the proportion chemically restrained before or during the COVID-19 pandemic. Result(s): A total of 630,399 patients from 822 hospitals were included in the overall cohort and 29,399 (4.7%) were administered medication associated with chemical restraint. The median age was 15 (IQR 13-16), 54.6% were female, and 59.3% were white. Compared to those who did not receive chemical restraint, those who were chemical restrained were more likely to be older (13-17 years [OR 1.61, 95% CI 1.56-1.67]), privately insured (OR 1.21, 95% CI 1.18-1.25), or have a concurrent ED diagnosis of anxiety disorders (OR 1.72, 95% CI 1.67-1.77), and disruptive mental health diagnosis (OR 1.69, 95% CI 1.61-1.77). There was no difference in chemical restraint for race/ethnicity (Black OR 0.97 [95% CI 0.94-1.01], Hispanic OR 0.99 [95% CI 0.95-1.03], or sex (female OR 0.94 [95% CI 0.92-0.97]). Overall, 4.7% received medications associated with chemical restraint. After adjusting for patient and hospital factors, the influence of the individual hospital on the odds of chemical restraint was 1.44 (MOR;95% CI 1.40-1.47). Overall, chemical restraint rates were similar across hospital covariates except for geographical region, where the median restraint rate was much lower in the Northeast (3.8%;IQR 2.9-5.1). During the COVID-19 pandemic, median rates of chemical restraint were higher (6.0%, 95% CI 5.8-6.1) compared to pre-pandemic (4.4%, 95% CI 4.3-4.4). Conclusion(s): We found that age, but not race/ethnicity or sex, was associated with a higher odds of chemical restraint during ED visits associated with a mental health or behavioral diagnosis. Although hospital-level restraint rates were low, we found that practice varied across hospitals and regions. [Formula presented] [Formula presented] No, authors do not have interests to disclose Copyright © 2022
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We highlight the benefits of a formal preseason in professional football in terms of there being a lower injury rate at the start of the season following a formal preseason. Data Background The 'preseason' is an established period of the professional football season for players to gain fitness and has been demonstrated to subsequently improve player performance following the start of the season. Although players are at greater risk of injury in the preseason period, it is questioned whether a preseason subsequently decreases the risk of injury in the start of the formal season itself. Due to the established nature of the preseason no studies have previously reviewed the effect of the preseason on injury rates in the subsequent season. Our aim was to report the injury rate from post-lockdown professional football games (no preseason programme -NPP) and compare to the start of the season (following a preseason programme -FPP). This would then provide a comparison between the two groups and a determination of the potential beneficial effect of a formal preseason on the injury rates at the start of the formal season. Methods We compared the injuries sustained across 4 European Professional Football Leagues (Premier League, Serie A, Bundesliga, La Liga) from the first 2 games for each team at the start of the 2019-20 season (FPP group) and from the first 2 games for each team after the re-start of football following lockdown (NPP group). We recorded the frequency, injuries per game, contact and soft tissue injuries. An injury was recorded if the player was deemed unable to continue play. Results In total 156 games were reviewed, 78 in the FPP group and 78 in the NPP group. A total of 10 injuries were observed in the FPP group games, 0.13 per game, compared to 30 injuries in the NPP group games, 0.39 per game (p=0.001). The ratio of contact to soft tissue injuries was the same for both groups (1:4). There was no significant difference in the length of downtime between the leagues stopping and restarting (92-103 days) and no correlation between injury rate and length of downtime. Conclusions Injuries in elite professional football were more common in the first 2 games following the restart after lockdown than in the first 2 games of the 2019/20 season. We believe this is due to the beneficial effect of a normal preseason being absent for the restart. We highlight the importance of preseason in reducing injury rates amongst professional footballers.
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During COVID-19 pandemic online shopping gained importance. One aspect of online shopping is customers recommending products to each other. Also named electronic word of mouth (EWOM), this type of marketing is effective in online marketing. Based on a survey of 206 Indonesian customers, this research examined which factors affect customer satisfaction and EWOM. The results show that price value, brand awareness, and country ethnocentricity were significantly affecting customer satisfaction. On the other hand, customer satisfaction had significant effect on EWOM. © 2022 IEEE.
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SESSION TITLE: Late Breaking Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. METHODS: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariate, multivariate, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate, and sPESI. Both lactate and sPESI were included as continuous variables. Our covariates included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. RESULTS: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariate analysis, both sPESI (p=3.4*10
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Introduction: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. Methods: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariant, multivariant, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate elevation, and sPESI. Our covariants included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. Results: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariant analysis, both sPESI (p=3.4∗10∧-6, AUC = 0.74) and lactate (p=1.1∗10∧-7, AUC = 0.71) correlate with mortality. When included in the same multivariant model, both lactate (p=1.3∗10∧-5) and sPESI (p=3.2∗10∧-4) retained their statistical significance with mortality. Conclusion: As in previous studies, our analysis confirms these results (lactate p=1.1∗10∧-7;AUC = 0.71, sPESI p=3.4∗10∧-6, AUC = 0.74). However, we also demonstrate that both lactate and sPESI retain statistical significance when both are included in the same multivariant model (p-value for lactate = 1.3∗10∧-5, p-value for sPESI = 3.2∗10∧-4). Thus, both lactate and sPESI each demonstrate independent statistical significance, contributing to prediction of mortality. This finding makes a compelling case for inclusion of lactate in risk stratification models used by Pulmonary Embolism Response Teams (PERT) across institutions for triaging the management of acute pulmonary embolism in the hospital.
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Biomedical Research , COVID-19 , COVID-19/epidemiology , Global Health , Humans , SARS-CoV-2ABSTRACT
INTRODUCTION: The COVID-19 pandemic necessitated the introduction of revised diagnostic pathways for assessing urgent suspected cancer (USC) referrals. Combinations of faecal immunochemical testing (FIT) and minimal preparation computed tomography (CT) scans (MPCT) were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways across Wales is evaluated in this study. METHODS: All consecutive patients referred from primary care on the USC pathway between 15 March and 15 June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral. RESULTS: A total of 1,050 patients across eight sites in Wales were included. Of these 1,050 patients, 52.6% were female with median age 68 (21-97) years; 50.5% had first-line clinical review, of which 61.1% were virtual consultations; 49.5% had primary investigations; 26.7% of patients had FIT and 13.1% had MPCT. COVID-response pathways achieved a 29.9% reduction in use of colonoscopy as first-line investigation and 79% of patients avoided face-to-face consultations altogether during this first wave of the pandemic. Overall, 6.8% of USC referrals were diagnosed with colorectal cancer (CRC). Median timescale from diagnosis to treatment for CRC was 65 (4-175) days. The negative predictive value (NPV) for FIT in this cohort was 99.6%. MPCT as the first modality had a NPV of 99.2%. CONCLUSION: A modified investigation pathway helped maintain cancer diagnosis rates during the pandemic with improved resource utilisation to that used prepandemic.
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With the world facing a public health emergency due to the Coronavirus disease (COVID-19) in a global pandemic, this paper provides insight about how a simulation model was used to determine the impact of headcount variability during lockdown on fab performance. To create a robust simulation model, operator loading time was introduced as one of the input parameters. An existing and well validated Discrete Event Fab simulation model was extended with operator modelling, and was used to conduct case studies, evaluating the impact of different operator availability scenarios including work disruptions for several shifts within a week. The studies provide implications for operation to derive mitigation strategies, weighing the trade-off between cost demand and speed loss due to operator resources. © 2021 IEEE.
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The IASC Intervention Pyramid (MHPSS) for mental health and psychosocial support in emergencies facilitates the need for a multi-layered system of complementary support that meets the needs of different groups in emergencies. The recommendations here reflect these levels of intervention and provide a network of collective care and mutual aid that integrates the cognitive, emotional, mental and social realities of camp refugees in the context of COVID-19. It focuses on the importance of building, and focusing on (1) Basic services and security, (2) Community and family support, (3) Focused non-specialised supports, (4) Specialised mental health services, and (5) Task-sharing of psychological support.
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The revitalization of the global economy after the COVID-19 era presents Environmental Geotechnics with the opportunity to reinforce the need for a change in paradigm toward a green, circular economy and to promote aggressively the use and development of sustainable technologies and management practices. This paper aims to assist in this effort by concentrating on several thematic areas where sustainability solutions and future improvements are sought. These include the re-entry of construction and demolition waste, excavated material, industrial waste, and marine sediments into the production cycle and the reuse of existing foundations. Despite the recent trend in advanced countries toward recycling and waste-to-energy thermal treatment, landfills still constitute the most common municipal solid waste management practice, especially in low-and-middle-income countries, and technological solutions to improve their environmental footprint are presented. At the same time, remediation solutions are required to address the multitude of contaminated sites worldwide. Advanced developments that incorporate environmental, economic, and social dimensions are expounded, together with sustainable ground improvement solutions for infrastructure projects conducted in soft and weak soils. The topic of thermo-active geostructures concludes this paper, where, apart from their infrastructure utility, these structures have the potential to contribute as a renewable energy source. © 2021 ICE Publishing: All rights reserved.
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Introduction: Revised patient pathways incorporating combinations of FIT and MPCT were introduced to triage USC referrals during the COVID-19 pandemic to replace straight-to- test colonoscopy. This study aims to evaluate the effectiveness of a secondary care diagnostic pathway improvement initiative for colorectal cancer referrals. Method: All consecutive patients referred from primary care on the USC pathway between 15th March -15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations, timelines and patient outcomes up to 90 days following initial referral. Results: 816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 -97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to- face consultations during this first wave of the pandemic. Referred patients required a median of 1 secondary care investigation (0 -6). Overall, 5.6% of USC referrals were diagnosed with CRC, similar to pre-pandemic rates. Median timescale from diagnosis to treatment for CRC was 82 (4 -175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%. Conclusion: A modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.