ABSTRACT
BACKGROUND: The COVID-19 pandemic impacted local health department clinic availability for routine STI screening. In an effort to improve low CT/GC screening rates observed throughout the Commonwealth, we implemented a limited program to offer athome, self-collection kits to Virginia residents. METHOD(S): We worked with a vendor to procure two options for at-home CT/GC screening: box one included a vaginal swab and box two included a urine collection kit, rectal swab, and pharyngeal swab. We integrated athome CT/GC screening options with the existing at-home HIV screening program. Individuals completing an online survey to determine eligibility for an at-home HIV test were offered the option to also receive a CT/GC test kit. RESULT(S): We distributed 496 CT/GC test kits to Virginia residents. Thirty percent (n=147) of distributed test kits were returned to the laboratory. The positivity rates were highest for rectal CT (5.4%), followed by rectal GC (2.0%) and pharyngeal GC (2.0%). Among participants with a resulted test kit, the majority (42.86%) identified as heterosexual. Forty-two percent reported their last CT/GC test was less than one year ago and 64% reported their last HIV test was less than one year ago. Participants reported that their main motivation for requesting an at-home CT/GC test kit was due to the privacy of screening in their own home (53%), followed by not having time to get screened (14%), and impacts from the COVID- 19 pandemic (13%). CONCLUSION(S): At-home specimen collection presents a novel way to engage individuals in screening. Although the majority report screening within the past year, 20.4% and 10.2% report no screening history for STIs or HIV, respectively. The low rate of returned test kits suggests the need for additional intervention, like reminders or incentives, may be necessary.
ABSTRACT
BACKGROUND: The state legislature modified the Code of Virginia in July 2018 to allow employees of the Virginia Department of Health to provide expedited partner therapy (EPT) in accordance with CDC recommendations with some restrictions. Additional legislative modifications in 2019 and 2020 removed most of these restrictions, and expanded EPT permissibility to include private clinicians. METHOD(S): Using electronic encounter data, we tracked the provision of EPT among patients attending public local health department (LHD) clinics in Virginia from July 2018 through December 2021. We also solicited perspectives on EPT use from a convenience sample of LHD clinicians in April 2019. Finally, we assessed patient-reported EPT from interviews with a random sample of gonorrhea and chlamydia cases diagnosed from 2019-2021. RESULT(S): LHD clinics provided 186 index patients with EPT (62% female, average age of 25 years) for 1-2 partners per case. Clinicians predominantly used EPT for chlamydial infections (86%), with medication dispensed directly to the index patient 83% of the time. The number of index patients provided with EPT increased from 7 in 2018 to 89 in 2020, before declining to 38 in 2021. Meanwhile, the number of annual clinic encounters decreased 58% from 2018 to 2021 (from 111,239 to 46,680). The 49 interviewed clinicians reported general openness to the use of EPT, with some misgivings regarding the administrative burden involved and legal liability. From 2019-20 interviews, 2/126 gonorrhea cases and 15/417 chlamydia cases reported being given EPT. In 2021, 2/205 interviewed gonorrhea cases received EPT. CONCLUSION(S): The initial rollout of EPT in Virginia was limited, but did lead to uptake among LHD clinicians. Expansion of EPT permissibility in Virginia coincided with the COVID-19 pandemic, which hindered needed outreach efforts to private clinicians and pharmacists. Future education efforts should focus on the utility of EPT when clinical STI services are scarce.
ABSTRACT
During the COVID-19 pandemic, neuropsychiatric disorders have been diagnosed both in the acute phase, and in the aftermath of this disease. Inpatients, as well as outpatients recently diagnosed with mild, moderate or severe forms of Coronavirus infection have reported neuropsychiatric manifestations with variable duration, symptoms that could be directly or indirectly related to the viral pathogenic agent. Patients who are recovering from the acute phase of COVID- 19 also may exhibit various psychopathological manifestations, during the so-called "post-COVID-19 syndrome" or "long COVID-19 syndrome". Explanations regarding the onset of this type of clinical manifestations and the SARS-CoV-2 infection are extremely diverse, ranging from biological factors (e.g., direct central nervous system viral activity, cerebral hypooxygenation, high level of inflammatory response) to psycho-social stressors (e.g., isolation, fear of death, anxiety related to possible somatic complications or sequelae). Objectives: The primary objective of this article was to analyze psychiatric manifestations in patients with acute COVID-19 disease and in patients during post-COVID-19 phase. The secondary objective was to propose a conceptual framework for the evaluation and treatment of these patients. Methods: Patients included in this analysis were screened positive for COVID-19 infection in the last 6 months before their first psychiatric examination. These patients were further evaluated to detect any personal history of psychiatric disorders, somatic comorbidities, or significant concomitant pharmacological treatments. Specific scales for the measurement of symptoms severity and functional impairment were administered in all patients. Results: Five patients were included in this analysis, one during the acute phase of COVID-19 infection, and four patients were evaluated after the complete remission of this disease. Hyperactive delirium, mild neurocognitive disorder, major depressive episode, panic disorder with agoraphobia, or acute psychotic disorder were the main diagnoses in these patients. All patients received adequate treatment and they were monitored using psychological scales until symptoms remission or stabilisation. Conclusions: Psychosocial stressors, neurobiological changes, systemic inflammatory reaction, and individual vulnerability factors may contribute to a diathesisstress model for psychiatric disorders onset within the acute phase or after the remission of acute manifestations in COVID-19-diagnosed patients.
ABSTRACT
IntroductionIn the context of COVID-19 pandemic, first-line responders (FLR) are exposed to multiple stress factors, ranging from lack of adequate protective equipment to worries about family health due to work-related exposure to the new coronavirus. Therefore, FLR became themselves a vulnerable population that need prevention strategies for professional stress-related disorders (PSRD).ObjectivesTo explore the literature in order to find evidence-based prevention strategies for PSRD in FLR, strategies resulted from other epidemiological crisis situations (MERS-CoV, H1N1, SARS-CoV) that may be applied in the current pandemic.MethodsA literature review was performed through the main electronic databases (PubMed, CINAHL, SCOPUS, EMBASE) using the search paradigm “professional stress-related disorders” AND “first line responders” AND “prevention”. All papers published between January 2000 and June 2020 were included.ResultsReported prevalence of post-traumatic stress disorder in FLR involved in epidemiological crises was between 10% and 33%. Evidence-based recommendations for PSRD prevention are lacking, and only general advices have been detected. These suggestions were clustered on institutional level (e.g., involving of medical personnel in administrative decisions, encouraging personal initiatives, longer pauses between shifts) and individual level (e.g., training of coping abilities, relaxation techniques, and peer-focused group support). Several guidelines for prevention of mental disorders in workplace exist, but they are not focused on FLR.ConclusionsThe need to elaborate guidelines for prevention of PSRD in FLR can not be overemphasized, especially in the pandemic period, in order to avoid the onset of stress-related complications, and to preserve a good quality of the medical activity.
ABSTRACT
Isolation and quarantine during the Covid-19 pandemic affected the lifestyle and daily functioning of the population around the world, leading to social, psychological, and economic changes which further multiplied the stress related to the threat of coronavirus contagion by adding financial, relational, academic, professional and mental health vulnerabilities. To assess the impact of isolation and quarantine over the quality of life in the Romanian population, we conducted a Web-based survey focused on the evaluation of stress level, perception of lifestyle changes, communication patterns, mental health, major concerns, perception of one's future, but also on the preferred coping strategies that people have used to deal with the isolation stress. The answers were collected during one month and the results for the first 2 weeks of quarantine/isolation were compared with the results after one month of such regimen. Several recommendations based on the survey results analysis were formulated regarding possible strategies for decreasing the impact of stress factors over the general population and specific, vulnerable groups.