Digitalization of Professional Regulation Commission (PRC) Process of Accreditation of Nutritionist and Dietetics

With the recent global COVID-19 pandemic and lockdowns, accreditation delays have become inevitable in lieu of the strict travel restrictions. The usual accreditation inspection process conducted face-To-face was affected. Organizations are shifting to a reliance on technology to adapt to the national emergency. The study aims to bridge the gap by digitalization Professional Regulation Commission's (PRC) monitoring and accreditation system to conduct a virtual inspection and monitoring. With all of these said, the specific objectives of the researchers and developers are to develop an efficient digitized system that captures the original one. In developing the proposed accreditation and monitoring system and document management system (website) for PRC, the group will adapt and take inspiration from the Agile Development Lifecycle methodology, which will help the modification and other functionality of the system by using the iterative style in the development of the system. The proposed digital monitoring system undergoes a cross-browser test, and performance test, i.e., Requirements Traceability Matrix (RTM). These tests show that the proposed system passed the compatibility for commonly used browsers like Chrome, Edge, Mozilla, and many more. The Final Test in Performance Testing showed that the system RTM functions had passed all final testing. © 2023 IEEE.

Self-Medication in Medical Students during Covid-19 Pandemic

Introduction: Self-medication is one of the most common health maintenance practices in the world, and has been observed more frequently after the emergence of the Covid-19 pandemic. In this context, responsible self-medication is very important to ensure public health and to alleviate health systems. Medical students are referents in society in terms of medication knowledge and therefore are promoters of medication use behaviors.Objective: evaluate self-medication practices among medical students in the context of non-specific symptoms associated or not with SARS-COV-2 infection at a university in Barranquilla, Colombia. Methods: Cross-sectional study conducted in a population of 2285 medical students. A sample of 350 randomly selected students was taken, and a self-administered survey was applied to inquire about aspects related to self-medication practices.Results: The prevalence of self-medication was 100%, and non-responsible self-medication practices were identified in 70.1% of the participants. The academic level of clinical sciences was associated with a high level of knowledge of medication (OR: 1.91;95%CI: 1.1-3.6);however, these variables did not show an association with responsible self-medication practices. Additionally, 48% indicated that they would be willing to self-medicate without seeking medical assistance in case of symptoms probably related to COVID-19. Conclusions: A high frequency of non-responsible self-medication was found. Further studies are needed to facilitate effective interventions.

The Influence of Serious Games and Gamification in University Students of English as a Foreign Language

Many careers have changed since COVID-19 appeared. In education in particular, the use of ICT tools increased in quite a disorderly manner, and the expansion of these tools opened new opportunities to update the ways of teaching and learning. ICT tools have been used for a long time in education, but they have often been used just as support tools without any academic purpose and without achieving their full potential. If we focus on teaching foreign languages, ICT has given us the opportunity to see and experience other cultures, as well as to live experiences close to a real-life immersion, facilitating the understanding of the use of language and giving everyone a chance to learn in context. This does not only include videos or music;nowadays, we can use and connect many resources including videogames, social media, and blogs, among others. And here is where we can find great potential for development. In this context, the purpose of this paper is to present the plan for a doctoral thesis and its status, as well as some notes on the context, main motivation, literature, and methodology to be used for creating resources that help improve the 21st-century teaching and learning experience. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Increasing polio coverage with safer vaccines: a pressing need in Latin America

Given the actual risk of poliomyelitis outbreaks in the region due to poliovirus derived from the Sabin vaccine or the importation of wild poliovirus, the Latin American Society of Pediatric Infectious Diseases commissioned an ad hoc group of experts from the institution's Vaccines and Biologicals Committee, to draft an official position paper on the urgent need to increase immunization levels against the disease in the region and incorporate inactivated polio vaccine exclusive schedules in all national immunization programs. This publication discusses the main conclusions and recommendations generated as a result of such activity.Copyright © 2022, Sociedad Chilena de Infectologia. All rights reserved.

Dengue/Covid-19, Epidemiological and Clinical Interactions

COVID-19 pandemic is an important public health concern in dengue endemic areas due to overlapping of clinical and laboratory features, representing a significant challenge for health care providers that often hampers a correct diagnosis and management of both diseases. Therefore, during the COVID-19 pandemic, healthcare providers in areas where dengue is endemic or who treat patients with recent travel history to these areas, need to consider dengue and COVID-19 in the differential diagnosis of acute febrile illnesses. Global Implications and Opportunities and COVID-19 have mild illness and do not require hospitalization, both diseases can cause severe illness that may result in death. Indeed, clinical management for people with severe illness due to either of these two diseases is quite different, often requiring hospital-based care. High index of suspicion is necessary in handling COVID-19 cases in tropical setting where dengue is endemic. Acute febrile cases with leucopenia and thrombocytopenia should be screened for dengue. Since false positive dengue serology or cross-reactivity with SARS-Cov-2 infections are known to occur, and have a potential impact on clinical outcome, or else, result in delay in COVID-19 or dengue appropriate treatment, the risk of occurrence of complications and death is increased.Copyright © 2023

ANALYSIS OF EPITOPE-SPECIFIC T CELLS IN SARS-CoV-2 INFECTION AND VACCINATION

Background: T cells play a critical role in the adaptive immune response to SARS-CoV-2 in both infection and vaccination. Identifying T cell epitopes and understanding how T cells recognize these epitopes can help inform future vaccine design and provide insight into T cell recognition of newly emerging variants. Here, we identified SARS-CoV-2 specific T cell epitopes, analyzed epitope-specific T cell repertoires, and characterized the potency and cross-reactivity of T cell clones across different common human coronaviruses (HCoVs). Method(s): SARS-CoV-2-specific T cell epitopes were determined by IFNgamma ELISpot using PBMC from convalescent individuals with mild/moderate disease (n=25 for Spike (S), Nucleocapsid (N) and Membrane (M)), and in vaccinated individuals (n=27 for S). Epitope-specific T cells were isolated based on activation markers following a 6-hour peptide stimulation, and scRNAseq was performed for TCR repertoire analysis. T cell lines were generated by expressing recombinant TCRs in Jurkat cells and activation was measured by CD69 upregulation. Result(s): We identified multiple immunodominant T cell epitopes across S, N and M proteins in convalescent individuals. In vaccinated individuals, we detected many of the same dominant S-specific epitopes at similar frequencies as compared to convalescent individuals. T cell responses to peptide S205 (amino acids 817-831) were observed in 56% and 59% of individuals following infection and vaccination, respectively, while 20% and 19% of individuals responded to S302 (a.a. 1205-1219) following infection and vaccination, respectively. For S205, a CD4+ T cell response, we confirmed 8 unique TCRs and determined the minimal epitope to be a 9mer (IEDLLFNKV). While TCR genes TRAV8-6*01 and TRBV30*01 were commonly utilized across the TCRs, we did identify TCRs with unique immunogenetic properties with different potencies of cross-reactivity to other HCoVs. For S302, a CD8+ T cell response, we identified two unique TCRs with different immunogenetic properties that recognized the same 9mer (YIKWPWYIW) and cross-reacted with different HCoV peptides (Figure 1). Conclusion(s): These data identify immunodominant T cell epitopes following SARS-CoV-2 infection and vaccination and provide a detailed analysis of epitope-specific TCR repertoires. The prospect of developing a vaccine that broadly protects against multiple human coronaviruses is bolstered by the identification of conserved immunodominant SARS-CoV-2 T cell epitopes that cross react with multiple other HCoVs.

Return to exercise after COVID-19. Statement of the Mexican Society of Cardiology / Retorno al ejercicio después de COVID-19. Posicionamiento de la Sociedad Mexicana de Cardiología

The coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020; one consequence has been the increase in sedentary lifestyle and reduction of sports activity. Exercise benefits the immune defense system especially in older adults; it is recommended to keep a distance of 1.5 meters between people, and if walking or jogging is carried out, the space must be up to 5 and 10 meters respectively. The reported cases are mostly mild up to 80% and can be critical in up to 4.7%; the risk factors are well known, hypertension, diabetes and previous heart disease. Severe or critical cases present as symptoms of acute respiratory distress syndrome, and in the case of cardiovascular disease, they mainly occur as myopericarditis, acute coronary syndromes, cardiogenic shock, thrombotic events, among others. Returning to exercise after recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is always recommended, however it will depend on the clinical picture what measures should be taken prior to its onset, and it is in moderate cases and especially in the severe ones where the evaluation and prescription prior to returning to exercise or sport should be guided by medical personnel experts in cardiopulmonary rehabilitation, especially in athletes.

La enfermedad por coronavirus 2019 (COVID-19) fue declarada pandemia el 11 de marzo de 2020; una consecuencia ha sido el incremento en el sedentarismo y la reducción de la actividad deportiva. El ejercicio beneficia el sistema inmunitario de defensa, especialmente en adultos mayores. Se recomienda guardar distancia de 1.5 metros entre personas, y si se realiza caminata o trote, el espacio debe ser de hasta 5 y 10 metros respectivamente. Los casos reportados son en su mayoría leves hasta en un 80%, y pueden ser críticos hasta en 4.7%; los factores de riesgo son bien conocidos: hipertensión, diabetes y enfermedad cardiaca previa. Los casos graves o críticos se presentan como cuadros de síndrome de distrés respiratorio agudo y ante afección cardiovascular cursan principalmente como miopericarditis, síndromes coronarios agudos, choque cardiogénico y eventos trombóticos, entre otros. El ejercicio después de la recuperación de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) siempre está recomendado, sin embargo, dependerá del cuadro clínico qué medidas se deben tomar previo a su inicio, y es en casos moderados y especialmente en los graves donde la evaluación y prescripción previa al retorno al ejercicio o deporte debe ser guiada por personal médico experto en rehabilitación cardiopulmonar, en especial en deportistas.

Lessons from Co-Occurring Disasters: Covid-19 and Eight Hurricanes

Changing climate dynamics have resulted in a confluence of disaster events to which Louisiana government leaders and emergency managers have never before had to respond simultaneously: a global pandemic and an "epidemic" of landfalling hurricanes during the 2020 season (eight cones over Louisiana) with challenging, unusual characteristics: (1) two hurricanes passing over the same location within 36 hours, a fujiwhara - Hurricanes Marco and Laura, (2) 150 mile-per-hour winds inadequately forecasted and of an almost unprecedented speed, (3) a difficult to forecast surge magnitude that led to incorrect immediate response, (4) delayed long-term recovery efforts from responders outside of the area because of initial reporting errors regarding surge heights and wind speed, and (5) a storm, Zeta, that passed directly over a densely populated area that would have been hard hit by rain if the storm had slowed. In addition, the number and closeness in dates of storm occurrences led to lengthy coastal highwater levels. To these co-occurring threats forecasters, state and local officials and residents responded with expertise and commitment, adhering to close collaboration, modifying evacuations and undertaking protective measures, all contributing to a low death rate from storms and a modest death rate from COVID. More just outcomes were supported by the general capacity of the responders, commitment to keep the residents informed about both risks and appropriate responses to them and the provision of special services, calculated for the new situation of the pandemic and the storm epidemic, for those without the means to respond adequately to both.

Maxillofacial emergency's care during the COVID-19 pandemic, Granma 2021

Introduction: during the COVID-19 pandemic, new safety measures were implemented in all sectors. However, the Maxillofacial Surgery specialty kept on, where emergency patients were not left unattended. Background: to characterize the maxillofacial emergencies attended at the Hospital Clinico Quirurgico Docente "Celia Sanchez Manduley" in Manzanillo, during the COVID-19 related epidemiological situation. Methods: an observational, descriptive, and cross-sectional study was applied on 358 patients in the period between September 2020 and April 2021. The variables studied were as follow: age groups, sex, month when patients were attended, maxillofacial emergency's motive, therapeutic behavior and patients with COVID-19 related symptoms. Results: the most affected age group was 60 (22.6%), with predominance in male sex (54.2%). Most patients were attended in November and December (20.3%), the predominated maxillofacial emergencies were those associated to maxillofacial trauma (31.8%), followed by facial cellulitis (23.7%). In terms of treatment, the highest percentage of conservative treatment was associated with the medicamentation (88.3%), while wound suturing practice predominated in surgical treatment (18.2%). The symptom with the highest incidence was fever (3.4%). The 61.5% of the maxillofacial surgeons were infected with COVID-19. Conclusions: maxillofacial emergencies are more frequent in males;maxillofacial trauma and facial cellulitis predominate. The maxillofacial surgery service is vulnerable to the coronavirus infection.

Clinical Findings and Outcomes from 1306 Patients with Covid-19 Pneumonia in an Intermediate Respiratory Care Unit: A Prospective, Observational Study

Background: An intermediate respiratory care unit (IRCU) may be a valuable tool for optimizing patient care, allowing to implement standardized algorithm management to decrease clinical failure and mortality. We aimed to describe the practice of noninvasive respiratory strategies (NRS) in a novel facility fully dedicated to COVID-19 and to establish outcomes of these patients Methods: Prospective, observational study performed at one hospital in Spain. We included consecutive patients admitted to IRCU due to COVID-19 requiring NRS between December 2020 and September 2021. Data collected included mode and usage of NRS, endotracheal intubation and mortality to day 30. A multivariable Cox proportional hazards method was used to assess risk factors associated with clinical failure and mortality Findings: 1306 patients with COVID-19 were included. Of them, 64.6% were men and mean age was 54.7 years. During IRCU stay, 345 patients presented a clinical failure, (89.6% intubated;14.5% died). Cox model showed a higher clinical failure in IRCU when time between symptoms onset and hospitalization < 10 days (HR 1.59;95% CI 1.24-2.03;p<0.001) and PaO2/FiO2 <100 (HR 1.59;95% CI 1.27-1.98;p<0.001). Conversely, these variables were not associated with an increased mortality to day 30 Interpretation: IRCU may be a useful option for the multidisciplinary management of COVID-19 patients requiring NRS;thus, reducing ICU overcharge. Men gender, gas-exchange and blood chemistry at admission are associated with worse clinical outcomes, while older age, gas-exchange and blood chemistry are associated with 30-day mortality.

Prevalence of SARS-CoV-2 infection in Baja California, Mexico: Findings from a community-based survey in February 2021 in the Mexico-United States border

Between March 2020 and February 2021, the state of Baja California, Mexico, which borders the United States, registered 46,118 confirmed cases of COVID-19 with a mortality rate of 238.2 deaths per 100,000 residents. Given limited access to testing, the population prevalence of SARS-CoV-2 infection is unknown. The objective of this study is to estimate the seroprevalence and real time polymerase chain reaction (RT-PCR) prevalence of SARS-CoV-2 infection in the three most populous cities of Baja California prior to scale-up of a national COVID-19 vaccination campaign. Probabilistic three-stage clustered sampling was used to conduct a population-based household survey of residents five years and older in the three cities. RT-PCR testing was performed on nasopharyngeal swabs and SARS-CoV-2 seropositivity was determined by IgG antibody testing using fingerstick blood samples. An interviewer-administered questionnaire assessed participants' knowledge, attitudes, and preventive practices regarding COVID-19. In total, 1,126 individuals (unweighted sample) were surveyed across the three cities. Overall prevalence of SARS-CoV-2 infection by RT-PCR was 7.8% (95% CI 5.5–11.0) and IgG seroprevalence was 21.1% (95% CI 17.4–25.2). There was no association between border crossing in the past 6 months and SARS-CoV-2 prevalence (unadjusted OR 0.40, 95%CI 0.12–1.30). While face mask use and frequent hand washing were common among participants, quarantine or social isolation at home to prevent infection was not. Regarding vaccination willingness, 30.4% (95% CI 24.4–3 7.1) of participants said they were very unlikely to get vaccinated. Given the high prevalence of active SARS-CoV-2 infection in Baja California at the end of the first year of the pandemic, combined with its low seroprevalence and the considerable proportion of vaccine hesitancy, this important area along the Mexico-United States border faces major challenges in terms of health literacy and vaccine uptake, which need to be further explored, along with its implications for border restrictions in future epidemics.

SARS-CoV-2 and Stroke in a New York Healthcare System

Background and Purpose: With the spread of coronavirus disease 2019 (COVID-19) during the current worldwide pandemic, there is mounting evidence that patients affected by the illness may develop clinically significant coagulopathy with thromboembolic complications including ischemic stroke. However, there is limited data on the clinical characteristics, stroke mechanism, and outcomes of patients who have a stroke and COVID-19. Method(s): We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 15, 2020, and April 19, 2020, within a major health system in New York, the current global epicenter of the pandemic. We compared the clinical characteristics of stroke patients with a concurrent diagnosis of COVID-19 to stroke patients without COVID-19 (contemporary controls). In addition, we compared patients to a historical cohort of patients with ischemic stroke discharged from our hospital system between March 15, 2019, and April 15, 2019 (historical controls). Result(s): During the study period in 2020, out of 3556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke. Cryptogenic stroke was more common in patients with COVID-19 (65.6%) as compared to contemporary controls (30.4%, P=0.003) and historical controls (25.0%, P<0.001). When compared with contemporary controls, COVID-19 positive patients had higher admission National Institutes of Health Stroke Scale score and higher peak D-dimer levels. When compared with historical controls, COVID-19 positive patients were more likely to be younger men with elevated troponin, higher admission National Institutes of Health Stroke Scale score, and higher erythrocyte sedimentation rate. Patients with COVID-19 and stroke had significantly higher mortality than historical and contemporary controls. Conclusion(s): We observed a low rate of imaging-confirmed ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased. Studies are needed to determine the utility of therapeutic anticoagulation for stroke and other thrombotic event prevention in patients with COVID-19.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.

Social Media and Its Importance in Digital Communication, Before, during and after the COVID Era: Case of Panama

In the last two years, there has been an abrupt change in the use of the Internet and Social Media. For many, these digital media have become the foundation of our lives and we rely on them without giving too much thought to what makes them work or who makes them possible. Its stability gives us stability, allowing people from almost every continent to move seamlessly between their offline and online lives. And yet, billions of peoplemust also navigate this abrupt change without reliable access to the Internet and digital media. This article presents a sample of the role played by social media in the harshest part of the Covid-19 pandemic, in the very particular case of Panama. © 2022 IEEE.

Treatment outcome of tofacitinib dose reduction to 5 mg BID vs remaining on 10 mg BID in patients with Ulcerative Colitis who were in stable remission on 10 mg BID: Updated 30-month data from the double-blind, randomised RIVETING study

Background: Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis. The long-term, Phase 3b/4 RIVETING study (NCT03281304) assessed the efficacy and safety of tofacitinib dose reduction from tofacitinib 10 mg twice daily (BID) maintenance therapy to 5 mg BID in patients (pts) in stable remission. 1 We present a final analysis of the RIVETING study after >=30 months of treatment. Method(s): RIVETING was a double-blind, randomised, parallelgroup study with a 42-month (M) duration. Eligible pts had received tofacitinib 10 mg BID for >=2 consecutive years in an open-label, long-term extension study (NCT01470612), had been in stable remission for >=6 months and corticosteroid-free for >=4 weeks prior to baseline. The primary efficacy endpoint was remission at M6 based on modified Mayo (mMayo) score (endoscopic and stool frequency subscores of <=1 and rectal bleeding subscore of 0).1 RIVETING was terminated (primary objective met) when all pts had passed M30 (or discontinued);some pts had already completed all visits up to M42. Here, we assess efficacy at M30 and safety throughout. Result(s): Overall, 140 pts were randomised (1:1) to tofacitinib 5 or 10 mg BID;50.0% and 62.9% were in remission based on mMayo score at M30 in the 5 and 10 mg BID dose groups, respectively, with consistent findings observed for other secondary efficacy endpoints (Table 1). At M30, observed differences for mMayo remission between tofacitinib 10 and 5 mg BID were generally greater in the subgroup with a baseline endoscopic subscore of 1 vs 0 and in the subgroup with vs without prior tumour necrosis factor inhibitor (TNFi) failure (Table 1). The percentage of pts who experienced loss of remission by M30, as estimated from Kaplan-Meier curves, was numerically higher in the 5 vs the 10 mg BID dose group (28.1%;95% confidence interval [CI], 17.68-39.49 vs 21.7%;95% CI, 12.21-32.95, respectively). Table 2 shows adverse events of special interest, by dose group. One death occurred due to fatal coronavirus disease 2019 pneumonia (10 mg BID). Conclusion(s): These long-term data showed that most pts in stable remission on tofacitinib 10 mg BID maintenance therapy maintained mMayo score remission through M30 after dose reduction to 5 mg BID. Dose group difference in remission at M30 was consistent with that at M6.1 Differences in remission between the tofacitinib 5 and 10 mg BID groups were greater in subgroups with an endoscopic subscore of 1 vs 0 and in subgroups with vs without prior TNFi failure. Overall, safety findings were consistent with tofacitinib's known safety profile;incidence of serious infections and herpes zoster was numerically higher in the tofacitinib 10 vs 5 mg BID group. (Table Presented).

Prevalence of Depression and Anxiety before and during the COVID-19 Pandemic in Puerto Ricans with Inflammatory Bowel Disease

Background: A higher rate of anxiety and depression is present in patients with inflammatory bowel disease (IBD). The COVID-19 pandemic has negatively impacted mental health in the general population. This study aims to compare the prevalence of depression and anxiety in patients with IBD during the pre-pandemic period and the pandemic period, and to explore trends in patients' specific IBD-related needs during the pandemic era. Method(s): Data was collected from subjects with IBD in two different timepoints: 2016 and 2021-2022. Self-administered questionnaires were given to adults with confirmed IBD attending an academic IBD Clinic. Data collected included demographic information, Patient Health Questionnaire-9 (PHQ-9) for major depressive disorder (MDD), General Anxiety Disorder-7 (GAD-7) questionnaire and subject's need for referrals to other services such as nutrition, pain management, mental health services. Scores of 10 or more in the GAD-7 or PHQ-9 indicate need for professional evaluation. Statistical analysis was performed using R Studio v.4.2.1. This study is approved by the UPR MSC-IRB. Result(s): Two hundred-fifty-two questionnaires were collected in 2016 and 196 during the 2021-22 pandemic period. The majority of subjects were male (54.6%) and had Crohn's disease (69.9%). Mean +/- SD age was 40.2 +/- 14.6. In the PHQ-9, 33.7% (n=91) during 2016, and 16.33% (n=32) during 2021-22 screened positive for MDD. For the GAD-7, 30.7% (n=83) during 2016, and 12.76% (n=25) during 2021- 22 screened positive for generalized anxiety disorder (GAD). Sex and age differences were not detected for MDD and GAD screening, with exception for age differences in MDD during 2021-2022. The most frequent needs for referrals during 2021-2022 were nutrition evaluation (n = 74), access to IBD education (n = 73), psychology services (n = 71) and participation in research for IBD studies (n = 66) Conclusion(s): The frequency of depression and anxiety in Puerto Ricans with IBD during the pandemic period was lower than pre-pandemic. Possible factors related to this include active use of telemedicine providing regular follow-up, integrated psychological support as part of the regular clinic services, and access to information regarding COVID-19 and IBD. (Figure Presented).

A GRASP-VND algorithm to solve the multi-objective fuzzy and sustainable Tourist Trip Design Problem for groups

The design and planning of group tourist itineraries is a current trend. Group planning should be done according to the maximum capacity of the site under current COVID-19 conditions, the transport flow, and the benefits associated with individual preferences. Tourists commonly express the benefits and limitations of travel in vague and imprecise linguistic terms. In this paper, a hybrid algorithm is presented that combines Greedy Randomized Adaptive Search Procedure, Variable Neighborhood Descendent, and Pareto optimality to solve the multi-objective problem of planning sustainable group tourists itineraries under uncertainty. A set of experiments is performed with real-world tourism data from Sucre, Colombia and benchmark instances from the literature to validate the algorithm's performance. The results are compared with optimal solutions obtained by CPLEX and other algorithms from previous works. Our approach demonstrates superior performance to different multi-target algorithms and builds more realistic routes.(c) 2022 Elsevier B.V. All rights reserved.

COVID 19 Incidence rates were not different among high risk health-care workers and non-health workers after SARS-CoV-2 vaccination: a prospective study in Cali-Colombia

Background. The seroprevalence of COVID-19 among health-care workers (HCWs) is still not well characterized in Latin America and the Caribbean. The objective of this study was to compare incidence rates (IR) during the COVID-19 pandemic among HCWs vs. non-HCWs in a university hospital in Cali, Colombia. (Table Presented) Methods. A prospective study was performed. The study included two groups: HCWs with high-risk contact of SARS-CoV-2 infections vs. administrative hospital workers (non-HCW). Seroprevalence of SARS-CoV-2 antibodies between both groups was compared according to vaccination history and confirmed SARS-CoV-2 infection during follow-up (March 6th, 2020, to February 28th, 2022). The study was developed in three phases according to the infection waves in Colombia, measuring antibodies anti-nucleocapsid and anti-spike serum concentration in each one. A descriptive analysis was done to compare both groups and IR per month (Figure 1). Results. 480 participants were included, 291 (60.6%) were HCWs, and 189 (39.4%) were non-HCWs. After the second wave and before vaccination, the accumulative seroprevalence was 40.6%: 49.1% of HCWs vs. 27.5% of non-HCWs (p< 0.001). 9.2% of HCWs and 7.9% of non-HCWs seropositive individuals had an asymptomatic infection (p=0.447). Of the 51.9% of susceptible HCWs and 72.5% of susceptible non-HCWs before the third wave, the risk of developing SARS-CoV-2 infection was 9.2% and 12.8%, respectively. After 24 months, the infection rate was higher in HCWs and non-HCWs (55.6% vs. 41.9%, p< 0.001) (Figure 2). The total IR was 31.4/1,000 person-month, with an IR difference of 21/1,000 person-month being higher in HCWs comparing non-HCWs (40.7 vs. 19.8, p< 0.001), but after vaccination (April 2021), the IR difference was not significative (IR difference 5%, p=0.1605). The asymptomatic disease was 9.8% of HCWs vs. 10.2% of non-HCWs. Since vaccination, 93.6% of workers had positive anti-S antibodies after 2 doses;and 100% had them after 3rd dose. SARS-CoV-2 Omicron variant increased cases during the fourth wave, more in non-HCWs. Conclusion. Before vaccination, HCWs had higher infection rates, mainly after the second wave. However, after the immunization, the IR in both groups significantly decreased and equalized in both groups.

Achieving equitable access to cancer care and clinical trials in regional Australia: A networked approach to expand capacity and implement COSA teletrials model

Aim: Peoplewith cancer living in regional Victoria are less likely to participate in a clinical trial than metropolitan patients.We established a new geographically based trials network with the gaol of increasing the number of regional cancer patients recruited to clinical trials. Method(s): Initially six regional services and Cancer Trials Australia (CTA) collaborated to form Regional Trials Network Victoria (RTNV). Two more sites, Latrobe Regional Hospital and Mildura Public Hospital were added in 2021. This network represents a population of 1.9 million people and approximately 8000 new cancer diagnoses each year. Access to cancer clinical trials at regional sites was achieved by: Building capacity of regional clinical trial units Improving the efficiency of clinical trial conduct Implementing the COSA teletrial framework Investing in the capability of staff Increasing the number of clinical trials Results: In 2017, the CCV Clinical Trial Management Scheme (CTMS) recorded 1587 Victorians recruited to cancer clinical intervention trials. 428 resided in regional Victoria, but only 81 of these participated at a regional site, with others needing to travel. In 2017, 135 patients were recruited to RTN sites (regional plus Geelong) across 55 trials. By 2021, despite the impacts of the COVID19 pandemic the number of recruiting clinical trials increased by 54% and the number of regional patients recruited to CTMS studies in the network increased to 179. Driven by uptake of teletrials and registry trials total recruitment increased to 620 patients. RTNV leveraged funding to sustain core activity and was awarded $18.5 million from the Medical Research Future Fund to conduct health services research over the next 5 years. Conclusion(s): The RTNV is a successful implementation of a regionally based clinical trials network, improving access and participation of regional patients. Much of the increase was driven by the use of COSA Teletrials methodology.