ABSTRACT
An accelerated need for effective and accessible therapy for children has become more evident in 2020 by the novel coronavirus SARS-CoV2 (COVID-19) pandemic. This global health crisis has exacerbated an existing mental health care crisis for children, particularly for those of color and low income who have a history of being disproportionately underserved. Teletherapy may address some of the barriers that prevent many children from receiving mental health services. Play-based strategies can be creatively integrated in teletherapy to maintain a relational, developmentally appropriate, and evidence-based approach to working with children in a virtual setting. In this article, creative ways to facilitate virtual play-based strategies are provided. Specific information about set-up, accessibility, selectability, scaffolding technology, developmental and cultural considerations, limit setting, and documentation for virtual sessions is discussed. Access to creative and theoretically informed teletherapy practices will strengthen the mental health response needed to reduce disparities in care.
ABSTRACT
Background: As of August 2021, every region of the world has been affected by the COVID-19 pandemic, with more than 196,000,000 cases worldwide. Methods: We analysed COVID-19 cases among travellers from mainland China to different regions and countries, comparing the region- and country-specific rates of detected and confirmed cases per flight volume to estimate the relative sensitivity of surveillance in different regions and countries. Results: Although travel restrictions from Wuhan City and other cities across China may have reduced the absolute number of travellers to and from China, we estimated that up to 70% (95% CI: 54% - 80%) of imported cases could remain undetected relative to the sensitivity of surveillance in Singapore. The percentage of undetected imported cases rises to 75% (95% CI 66% - 82%) when comparing to the surveillance sensitivity in multiple countries. Conclusions: Our analysis shows that a large number of COVID-19 cases remain undetected across the world. These undetected cases potentially resulted in multiple chains of human-to-human transmission outside mainland China. © 2021 Bhatia S et al.
ABSTRACT
Background and Aim: The correlation between non-invasive fibrosis scores and histological liver fibrosis is well established. As the availability of FibroScan is limited in geographically isolated settings and those impacted by coronavirus disease 2019 (COVID-19), we aimed to demonstrate a correlation between FibroScan median liver stiffness readings of patients with metabolic-associated fatty liver disease (MAFLD) with aspartate aminotransferase (AST) to platelet ratio index (APRI), Fibrosis-4 (FIB-4) score, and Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS). Methods:We conducted a retrospective analysis over 2 years of patients referred to the hepatology service by primary care physicians with deranged liver function test results. Data were obtained from routine clinical investigations in electronic medical records at a single Australian tertiary referral center. Data collected included FibroScan liver stiffness measurements, age, body mass index, glycated hemoglobin level, albumin level, platelet count, AST level, and alanine aminotransferase (ALT) level. The APRI, FIB-4, and NFS scores were calculated. Results: We identified 65 patients, all of whom proceeded to FibroScan and exclusion of causes other than MAFLD. Of the 65 patients, we found correlation between FibroScan and all non-invasive scores. However, as expected, there was an indirect relationship only with multiple outliers beyond the commonly used cut-offs for excluding advanced fibrosis (APRI < 0.5, FIB-4 < 1.45, NFS < -1.45). Of the 48 patients with an APRI score < 0.5, 41 (85.4%) had a FibroScan result of <8.0 kPa. Of the 54 patients with a FIB-4 score < 1.45, 47 (87%) had a FibroScan result of <8 kPa. Of the 43 patients with an NFS score < -1.454, 41 (95%) had a FibroScan result of <8 kPa (Fig. 1). Conclusion: Use of non-invasive measures of fibrosis is accurate for excluding advanced fibrosis in the population with MAFLD. Individual previously published cut-off values all correlate well with a FibroScan reading of <8 kPa;so much so that, when used together, they may be relied upon when FibroScan is unavailable. This has obvious indications in the Australian setting with regional and remote communities that have limited access to FibroScan. This is of particular value in helping to avoid hospital attendance amid the COVID-19 pandemic and is also of value in risk stratification in primary care.
ABSTRACT
Background: Since the start of the COVID-19 epidemic in late 2019, there have been more than 152 affected regions and countries with over 110,000 confirmed cases outside mainland China.
ABSTRACT
Background: COVID-19 has had profound direct and indirect effects on population health to date and long-term effects are anticipated. Vulnerabilities to the most serious consequences of infection include older age, obesity, African American race and the presence of comorbid conditions. African American cancer survivors represent a particularly high-risk group, therefore understanding the impact of the virus and our strategies to prevent its spread on this patient population is important. Methods: The Detroit Research on Cancer Survivors (ROCS) cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. Eligible participants were diagnosed with breast, prostate, colorectal, or lung cancer on or after 1/1/2013, or with endometrial or any other cancer before age 50 on or after 01/01/2016 and were identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. To date, we have enrolled 4173 survivors. Full participation includes completion of a baseline survey, and collection of biospecimens, medical records and tumor tissue, if available. Participants are also followed annually for outcomes and changes in history. A supplemental survey focused on the impact of COVID-19 was offered to enrolled participants beginning in the spring of 2020. The results presented here include data from 890 survivors who also completed the ROCS COVID survey. Results: Nearly all ( > 99%) survivors reported some change in their daily activities in an effort to reduce the risk of infection. At the time of survey, just over 1/3 of participants reported being tested for the virus and among those, 12% reported positive results. More than 40% of survivors reported some disruption in their access to medical care. A substantial ( > 40%) proportion of survivors reported feeling anxious, depressed and/or isolated during the COVID-19 pandemic. Approximately 40% of patients reported changes in health behaviors as a direct result of the pandemic that are known to negatively affect survivorship outcomes (physical inactivity, smoking, alcohol use). Notably, 30% of survivors reported declines in physical activity and these declines were significantly associated with increased anxiety (p = 0.008), depression (p = 0.005) and poorer healthrelated quality of life (p < 0.001). Conclusions: The influence of the COVID- 19 pandemic on African American cancer survivors has been substantial, affecting both their physical and mental health and access to needed medical care. Coupled with changes in health behaviors as a direct result of the pandemic, these factors will likely affect outcomes in this high-risk patient population making further study and interventions necessary to mitigate the long-term impact of the pandemic on cancer outcomes.
ABSTRACT
Purpose: Financial hardship due to cancer is more common among African American than White survivors. The COVID-19 pandemic and its economic fallout have also disproportionately affected African Americans. The purpose of this study is to describe the financial and employment impacts of COVID-19 in a population of African American cancer survivors and to compare those impacts with those experienced after a cancer diagnosis. Methods: Results include survey data from 593 participants in the population-based Detroit Research on Cancer Survivors (ROCS) cohort who completed the ROCS enrollment survey and a supplemental questionnaire related to the impact of the COVID-19 pandemic on their financial wellbeing and employment. Most participants (96%) were not diagnosed with COVID-19 by the time they completed the supplement and reflect the societal impact of the pandemic rather than a personal COVID-19 diagnosis. Analyses compare reports of financial hardship (using assets, borrowing money, experiencing debt, decreases in income) and employment impacts (changes to work schedules, duties, hours, employment status) due to cancer and due to the COVID-19 pandemic. Results: A similar proportion of ROCS participants reported financial hardship (41% vs. 42%) and borrowing money (5% vs. 6%) related to the COVID pandemic and their cancer diagnosis, respectively. Fewer survivors reported borrowing money (9% vs. 17%;p<0.001) or experiencing a decrease in income due to COVID than cancer (20% vs. 28%;p = 0.001);however;more reported debt associated with COVID (30% vs. 17%;p<0.001). Changes to work schedules (44% vs. 36%) and hours worked (44% vs. 28%) related to the COVID pandemic and cancer were common, and not statistically different from one another. More survivors changed their work duties due to the COVID pandemic (20%) than cancer (12%;p = 0.048). Prevalence of changes to employment status were similar for cancer (6%) and COVID (11%). Conclusions: The COVID-19 pandemic was associated with similar levels of overall financial hardship, and higher prevalence of debt and some work changes, than individual cancer experiences. These additional burdens on a financially vulnerable population could exacerbate existing cancer-related inequities.