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1.
Environmental Reviews ; 31(1):76-94, 2023.
Article in English | Academic Search Complete | ID: covidwho-2270994

ABSTRACT

In response to the coronavirus (COVID-19) pandemic, there has been an increased need for personal and environmental decontamination to aid in curbing transmission of the SARS-CoV-2 virus. Products used for this purpose include sanitizers for hands and disinfectants for surfaces. The active chemical ingredients used in these products, termed antimicrobials, can enter waste streams after application and may be emerging as more prominent environmental contaminants. Even prior to COVID-19, there was recognized need to examine their implications for aquatic biota, which is now made more pressing due to their exaggerated use in response to the pandemic. Our objectives were to identify current antimicrobial active ingredients, quantify their increased use, and determine which may be candidates for further consideration as possible aquatic contaminants. By consulting multiple sources of publicly available information in Canada, we identified current-use antimicrobials from the lists of sanitizers and surface disinfectants approved for use against SARS-CoV-2 by Health Canada and the drug registration database. To estimate the use of sanitizers and disinfectants, we evaluated import quantities and grocery store retail sales of related compounds and products (Statistics Canada) and both lines of evidence supported increased use trends. The list of identified antimicrobials was refined to include only candidates with potential to reach aquatic ecosystems, and information on their environmental concentrations and toxicity to aquatic biota was reviewed. Candidate antimicrobials (n = 32) fell into four main categories: quaternary ammonium compounds (QACs), phenols, acids, and salts. Benzalkonium chloride, a QAC, was the most prominent active ingredient used in both nonalcohol-based hand sanitizers and surface disinfectants. Four QACs followed in prevalence and the next most used antimicrobial was triclosan (hand sanitizers only), an established and regulated environmental contaminant. Little information was found on environmental concentrations of other candidates, suggesting that the majority would fall into the category of emerging contaminants if they enter aquatic systems. Several were classified as acutely or chronically toxic to aquatic biota (Globally Harmonized System), and thus we recommend empirical research begin focusing on environmental monitoring of all candidate antimicrobials as a critical next step, with detection method development first where needed. (English) [ABSTRACT FROM AUTHOR] En réponse à la pandémie de coronavirus (COVID-19), un besoin accru de décontamination personnelle et environnementale s'est manifesté pour aider à freiner la transmission du virus SRAS-CoV-2. Les produits utilisés à cette fin comprennent des assainisseurs pour les mains et des désinfectants pour les surfaces. Les ingrédients chimiques actifs utilisés dans ces produits, appelés antimicrobiens, peuvent entrer dans les systèmes des eaux usées après leur application et peuvent devenir des contaminants environnementaux plus importants. Avant même l'avènement de la COVID-19, on reconnaissait qu'il était nécessaire d'examiner leurs implications pour le biote aquatique, ce qui est aujourd'hui rendu plus urgent en raison de leur utilisation exagérée en réponse à la pandémie. Nos objectifs consistaient à identifier les ingrédients actifs antimicrobiens actuels, à quantifier leur utilisation accrue et à déterminer ceux qui pourraient être considérés comme des contaminants aquatiques potentiels. En consultant de multiples sources d'information publiquement accessibles au Canada, nous avons pu identifiéer les antimicrobiens utilisés actuellement à partir des listes d'assainisseurs et de désinfectants de surface dont l'utilisation contre le SRAS-CoV-2 a été approuvée par Santé Canada, et de la base de données sur les produits pharmaceutiques. Pour estimer l'utilisation des assainisseurs et des désinfectants, nous avons évalué les quantités importées et les ventes au détail dans les épiceries de composés et de produits connexes (Statistique Canada) et les deux sources de données ont confirmé les tendances à l'augmentation de l'utilisation. La liste des antimicrobiens identifiés a été affinée pour n'inclure que les candidats susceptibles d'atteindre les écosystèmes aquatiques, et les informations sur leurs concentrations environnementales et leur toxicité pour le biote aquatique ont été examinées. Les antimicrobiens candidats (n = 32) se répartissent en quatre grandes catégories: les composés d'ammonium quaternaire (CAQ), les phénols, les acides et les sels. Le chlorure de benzalkonium, un CAQ, était l'ingrédient actif le plus utilisé dans les désinfectants non alcoolisés pour les mains et les désinfectants de surface. Quatre CAQ suivaient en prévalence et l'antimicrobien le plus utilisé ensuite était le triclosan (uniquement dans les désinfectants pour les mains), un contaminant environnemental avéré et réglementé. Peu d'informations sur les concentrations environnementales des autres candidats étaient accessibles, ce qui suggère que la majorité d'entre eux entreraient dans la catégorie des contaminants émergents s'ils pénètrent dans les systèmes aquatiques. Plusieurs d'entre eux ont été classés comme présentant une toxicité aiguë ou chronique pour le biote aquatique (Système général harmonisé de classification et d'étiquetage des produits chimiques, SGH). Les auteurs recommandent donc que la recherche empirique commence à se concentrer sur la surveillance environnementale de tous les candidats antimicrobiens comme prochaine étape critique, en commençant par le développement de méthodes de détection si nécessaire. Le texte intégral de l'article en français est disponible parmi les documents supplémentaires. (French) [ABSTRACT FROM AUTHOR] Copyright of Environmental Reviews is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

2.
AIDS Patient Care STDS ; 37(4): 199-204, 2023 04.
Article in English | MEDLINE | ID: covidwho-2268516

ABSTRACT

HIV and other sexually transmitted infections (STIs) are on the rise nationally and internationally. The coronavirus 2019 (COVID-19) pandemic drove a shift toward telemedicine and prioritization of symptomatic treatment over asymptomatic screening. The impact in safety-net settings, which faced disproportionate baseline STI/HIV rates rooted in structural inequities, and where many patients lack telemedicine resources, is not yet known. This study describes the impact of COVID-19 on STI/HIV testing at an urban safety-net hospital. We used descriptive statistics to compare hospital-wide chlamydia, gonorrhea, syphilis, and HIV testing volume and positivity rates in the following periods: prepandemic (July 1, 2019-February 29, 2020), peak-pandemic (March 1, 2020-May 31, 2020), and postpeak (June 1, 2020-August 31, 2021). STI and HIV test volume dropped sharply in March 2020. STI testing during the peak-pandemic period was 42% of prepandemic baseline (mean 1145 vs. 2738 tests/month) and nadired in April 2020 (766 tests/month). Similarly, peak-pandemic HIV testing was 43% of prepandemic baseline (mean 711 vs. 1635 tests/month) and nadired in April 2020 with 438 tests/month, concentrated in emergency department and inpatient settings. STI and HIV testing rates did not return to baseline for a full year. STI and HIV test positivity rates were higher in the peak-pandemic period compared with the prepandemic baseline. Given the precipitous decline in STI and HIV testing during the pandemic, safety-net settings should develop low-barrier alternatives to traditional office-based testing to mitigate testing gaps, high positivity rates, and associated morbidity.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , HIV Infections , Sexually Transmitted Diseases , Syphilis , Humans , HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Infections/prevention & control , Safety-net Providers , COVID-19/diagnosis , COVID-19/epidemiology , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control , Gonorrhea/diagnosis , Syphilis/diagnosis , HIV Testing , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Mass Screening
3.
J Dev Behav Pediatr ; 44(2): e73-e79, 2023.
Article in English | MEDLINE | ID: covidwho-2232261

ABSTRACT

OBJECTIVE: The aim of this study was to identify barriers and improve access to services for children diagnosed with autism spectrum disorder (ASD) during the COVID-19 pandemic. METHODS: Sixty-two patients diagnosed with ASD between March 23 and June 30, 2020, at a large urban safety net hospital were identified by chart review. Patients were called from January to March 2021 and queried regarding access to services. Brief interventions were provided as part of a modified Plan-Do-Study-Act approach. A second chart review was conducted between April and May 2021 to determine whether families accessed any additional services. RESULTS: At the time of initial evaluation, 12 patients (19%) had been able to access all recommended services, 32 (52%) had been able to access some recommended services, and 9 (15%) were not able to access any services. Service levels for 9 families (15%) were undetermined. Sixteen patients (26%) lacked any follow-up with their developmental behavioral pediatrician since their initial evaluation. Thirty patients (48%) reported changes to their individualized educational program or early intervention services, and 17 patients (27%) were receiving in-home applied behavior analysis. After the brief intervention, 13 patients had accessed new services, and 9 patients previously lost to follow-up had completed an appointment. CONCLUSION: Patients diagnosed with ASD in the spring of 2020 had significant difficulty accessing community services. The transition to telemedicine exacerbated this hospital's difficulty contacting patients for follow-up. Additional research is needed to fully characterize the disruptions to services experienced by patients diagnosed with ASD during the pandemic and to increase accessibility and equity of care.


Subject(s)
Autism Spectrum Disorder , Autistic Disorder , COVID-19 , Child , Humans , Autism Spectrum Disorder/diagnosis , Pandemics , Quality Improvement , Health Services Accessibility , COVID-19 Testing
4.
Environmental Reviews ; 2022.
Article in English | Web of Science | ID: covidwho-2214013

ABSTRACT

In response to the coronavirus (COVID-19) pandemic, there has been an increased need for personal and environmental decontamination to aid in curbing transmission of the SARS-CoV-2 virus. Products used for this purpose include sanitizers for hands and disinfectants for surfaces. The active chemical ingredients used in these products, termed antimicrobials, can enter waste streams after application and may be emerging as more prominent environmental contaminants. Even prior to COVID19, there was recognized need to examine their implications for aquatic biota, which is now made more pressing due to their exaggerated use in response to the pandemic. Our objectives were to identify current antimicrobial active ingredients, quantify their increased use, and determine which may be candidates for further consideration as possible aquatic contaminants. By consulting multiple sources of publicly available information in Canada, we identified current-use antimicrobials from the lists of sanitizers and surface disinfectants approved for use against SARS-CoV-2 by Health Canada and the drug registration database. To estimate the use of sanitizers and disinfectants, we evaluated import quantities and grocery store retail sales of related compounds and products (Statistics Canada) and both lines of evidence supported increased use trends. The list of identified antimicrobials was refined to include only candidates with potential to reach aquatic ecosystems, and information on their environmental concentrations and toxicity to aquatic biota was reviewed. Candidate antimicrobials (n = 32) fell into four main categories: quaternary ammonium compounds (QACs), phenols, acids, and salts. Benzalkonium chloride, a QAC, was the most prominent active ingredient used in both nonalcohol-based hand sanitizers and surface disinfectants. Four QACs followed in prevalence and the next most used antimicrobial was triclosan (hand sanitizers only), an established and regulated environmental contaminant. Little information was found on environmental concentrations of other candidates, suggesting that the majority would fall into the category of emerging contaminants if they enter aquatic systems. Several were classified as acutely or chronically toxic to aquatic biota (Globally Harmonized System), and thus we recommend empirical research begin focusing on environmental monitoring of all candidate antimicrobials as a critical next step, with detection method development first where needed.

5.
Subst Use Misuse ; 58(4): 585-589, 2023.
Article in English | MEDLINE | ID: covidwho-2212477

ABSTRACT

BACKGROUND: The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care. METHODS: Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures. RESULTS: Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed. CONCLUSIONS: Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.


Subject(s)
COVID-19 , Opioid-Related Disorders , Telemedicine , Adult , Humans , Male , Female , Pandemics , Telephone
6.
J Addict Med ; 16(6): 678-683, 2022.
Article in English | MEDLINE | ID: covidwho-2119193

ABSTRACT

OBJECTIVES: People who inject drugs (PWID) may experience high human immunodeficiency virus (HIV) risk and inadequate access to biomedical HIV prevention. Emerging data support integrating HIV post-exposure and pre-exposure prophylaxis (PEP, PrEP) into services already accessed by PWID. We describe PEP/PrEP eligibility and receipt in a low-barrier substance use disorder bridge clinic located in an area experiencing an HIV outbreak among PWID at the onset of the COVID-19 pandemic. METHODS: Retrospective chart review of new patients at a substance use disorder bridge clinic in Boston, MA (January 15, 2020-May 15, 2020) to determine rates of PEP/PrEP eligibility and prescribing. RESULTS: Among 204 unique HIV-negative patients, 85.7% were assessed for injection-related and 23.0% for sexual HIV risk behaviors. Overall, 55/204 (27.0%) met CDC criteria for HIV exposure prophylaxis, including 7/204 (3.4%) for PEP and 48/204 (23.5%) for PrEP. Four of 7 PEP-eligible patients were offered PEP and all 4 were prescribed PEP. Thirty-two of 48 PrEP eligible patients were offered PrEP, and 7/48 (14.6%) were prescribed PrEP. Additionally, 6 PWID were offered PrEP who lacked formal CDC criteria. CONCLUSIONS: Bridge clinics patients have high rates of PEP/PrEP eligibility. The majority of patients with identified eligibility were offered PEP/PrEP, suggesting that upstream interventions that increase HIV risk assessment may support programs in initiating PEP/PrEP care. Additional work is needed to understand why patients declined PEP/PrEP. PrEP offers to PWID who did not meet CDC criteria also suggested provider concern regarding the sensitivity of CDC criteria among PWID. Overall, bridge clinics offer a potential opportunity to increase biomedical HIV prevention service delivery.


Subject(s)
Anti-HIV Agents , COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , Substance Abuse, Intravenous , Humans , Substance Abuse, Intravenous/epidemiology , COVID-19/prevention & control , Retrospective Studies , Pandemics/prevention & control , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/drug therapy
7.
J Contin Educ Health Prof ; 2022 Aug 09.
Article in English | MEDLINE | ID: covidwho-1985135

ABSTRACT

ABSTRACT: The COVID-19 pandemic has exacerbated pre-existing health inequities in vulnerable and marginalized patient populations. Continuing professional development (CPD) can be a critical driver of change to improve quality of care, health inequities, and system change. In order for CPD to address these disparities in care for patient populations most affected in the health care system, CPD programs must first address issues of equity and inclusion in their education development and delivery. Despite the need for equitable and inclusive CPD programs, there remains a paucity of tools and frameworks available in the literature to guide CPD and broader education providers on how best to develop and deliver equitable and inclusive education programs. In this article, we describe the development and application of a Health Equity and Inclusion (HEI) Framework for education and training grounded in the Analyze, Design, Develop, Implement, and Evaluate model for instructional design. Using a case example, specifically a hospital-wide trauma-informed de-escalation for safety program, we demonstrate how the HEI Framework can be applied practically to CPD programs to support equity and inclusion in the planning, development, implementation, and evaluation phases of education program delivery. The case example illustrates how the HEI Framework can be used by CPD providers to respect learner diversity, improve accessibility for all learners, foster inclusion, and address biases and stereotypes. We suggest that the HEI Framework can serve as an educational resource for CPD providers and health professions educators aiming to create equitable and inclusive CPD programs.

9.
J Addict Med ; 15(6): 448-451, 2021.
Article in English | MEDLINE | ID: covidwho-967523

ABSTRACT

The Grayken Center for Addiction at Boston Medical Center includes programs across the care continuum for people with substance use disorders (SUDs), serving both inpatients and outpatients. These programs had to innovate quickly during the COVID-19 outbreak to maintain access to care. Federal and state regulatory flexibility allowed these programs to initiate treatment for people experiencing homelessness and maximize patient safety through physical distancing practices. Programs switched to telehealth with high levels of acceptability and patient retention. Some programs also maintained some face-to-face clinic visits to see patients with complex problems and to provide injectable medications. Text-messaging proved invaluable with adolescent and young adult clients, and a mobile-health outreach program was initiated to reach mother/child dyads affected by SUDs. A 24-hour hotline was implemented to support seamless access to treatment for hundreds released from incarceration early due to the pandemic. Boston Medical Center also launched the COVID Recuperation Unit to allow patients experiencing homelessness to recover from mild to moderate COVID-19 infection in an environment that took a harm-reduction approach to SUDs and provided rapid initiation of medication treatment. Many of these innovations increased access to treatment and retention of patients during the pandemic. Maintaining the revised regulations would allow flexibility to provide telehealth, extended prescriptions, and remote access to buprenorphine initiation to support and engage more patients with SUDs.


Subject(s)
Buprenorphine , COVID-19 , Substance-Related Disorders , Telemedicine , Adolescent , Child , Humans , Pandemics , SARS-CoV-2 , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Young Adult
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