Social Determinants of Health and Their Impact on Families of Children with Sickle Cell Disease during Covid-19 Pandemic

Background: According to national prevalence data, SCD has an estimated economic burden of $2.98 billion per year in the United States and caring for a child with sickle cell disease (SCD) carries its own financial burden, resulting in higher healthcare costs and unintended days lost from employment. Social experiences are known to impact health outcomes in the general pediatric population. These experiences can be examined through the construct of social determinants of health (SDOH), the "condition in which people are born, grow, work, live and age" that impact their health. Since the WHO has designated COVID-19 a pandemic in January 2020, many families in the US have suffered financially, and during the shutdowns, there was a record number of jobs lost. The objective of this study was to determine the impact of the COVID-19 pandemic on financial and employment status of SCD Families Methods: This study was part of the larger CNH Sickle Cell Disease Social Determinants of Health study that was IRB approved. Caregivers of children with SCD completed a 30-question survey reporting their experiences with SDOH that included Demographics, USDA Food Security Scale, the We Care housing screening tool, and the validated COVID-19 Employment Status/COVID-19 related household finances survey in RedCap during clinic visits and hospitalizations Results: 99 caregivers of SCD patients responded to our survey (82.5% Female, 17.5% Male) (N=97). 93.9% identified as African-American, 3% identified as Hispanic or Latinx, 1% identified as "other". Of respondents, 66% were insured through on Medicaid and 33% had private insurance. Twenty-six percent endorsed food insecurity and 2724% relied on low-cost food. Thirty-one percent lived in an apartment, 67.768% lived in a home, 1% lived in shelter or transitional housing. Sixteen percent lived in subsidized or public housing. Thirty-seven (36.8%) percent reported at least once they were being unable to pay the mortgage or rent on time at least once, 9% (8.5%) reported living with other people because of financial difficulties, 55.2% reported their home not being heated, 7.2% reported being evicted from their home and 3.1% lived in an emergency shelter or transitional housing. 6.1% had an educational level of high school graduation or less, 42.2% were college graduates or completed additional post-graduate education (N=98). Two weeks prior to the pandemic, 61.5% worked full time, 13.5% worked part time, 6.3% were unemployed with only 2.1% working from home of the 96 caregivers who responded to this question. 15.5% (N=12 of 77) reported losing their job or were furloughed during the pandemic;34.4% (N=33 of 96) reporting at least one household member losing a job or a significant amount of income. Twenty-five percent (N=21 of 83) reported it was difficult to get work/school done because of the home environment. 36.4 % (N=35 of 96) reported household income was significantly less since February 2020. 53% (N=52 of 97) worried their household income has been or will be negatively impacted by the COVID-19 pandemic. Additionally, 48.9% (N=47 of 96) worried the value of their assets (housing, savings, other financial assets) has been or will be negatively impacted by COVID-19 and its effects. Since February 2020, 9.8% (N= 9 of 97) received unemployment insurance, 30.9% (N=29 of 94) received SNAP or food stamps, 16.5% (N= 15 of 91) received from the food pantry, 6.6% (N=6 of 90) applied for temp ass.

Differentiating infectious from non-infectious respiratory disease in the cat and dog

This paper describes the clinical signs and use of differential laboratory diagnostic techniques (computed tomography, cytology, histopathology, antigen/antibody detection and polymerase chain reaction) for infectious (viral, bacterial, fungal and parasitic) and non-infectious (inflammatory/immune mediated, neoplastic, cardiac, malformation, foreign body, smoke inhalation, aspiration of caustic material, non-cardiogenic, pulmonary oedema, traumativ, pneumothorax, pulmonary contusions and idiopathic) causes of respiratory diseases in cats and dogs in Ontario, Canada.

The reach and benefits of a digital intervention to improve physical activity in people with a musculoskeletal condition delivered during the COVID-19 pandemic in the UK.

AIM: To evaluate a digital intervention to improve physical activity in people in the UK with a musculoskeletal condition delivered during movement restrictions brought about because of the COVID-19 pandemic. METHOD: Service evaluation data collected from 26,041 participants over 5 months was assessed against national datasets to understand the reach and representativeness of the digital physical activity intervention. Measures to restrict the movement and interaction of people were in place during these 5 months. Cross-sectional data from 2752 participants across different stages of the 12-week programme assessed levels of physical activity and the components of behaviour as defined by the COM-B model (Capability, Opportunity, Motivation = Behaviour). Regression analysis investigated the relationship between programme stage and physical activity and the components of behaviour. RESULTS: In comparison to the UK population of people with a musculoskeletal condition, the intervention participants were over-represented by females, White, and inactive people. A cross-sectional analysis suggested that the number of participants regularly active increased by programme stage. Scores for the behavioural components of automatic and reflective motivation, physical and psychological capability, and physical opportunity were also improved by programme stage. CONCLUSION: The service evaluation suggests that the digital intervention, designed to improve physical activity in people with a musculoskeletal condition, could be beneficial during measures to restrict movement to slow the spread of infectious disease in those who are already motivated to become or stay active.

PATIENT EXPERIENCE OF OSTEOPOROSIS TELEPHONE CONSULTATIONS

Background/Aims The COVID-19 pandemic resulted in a rapid change to the use of virtual consultations in both primary and secondary care. Since April 2020, our osteoporosis clinic appointments have predominantly been undertaken by telephone. We wanted to assess our patients' experience of telephone consultations. Methods A patient feedback questionnaire was developed by the osteoporosis team which was validated by the Patient Advice and Liaison Service team (PALS) at the Royal United Hospital Bath. A questionnaire consisting of 15 questions was sent to patients following their telephone consultation. Patient consent to receive the questionnaire was requested by the consulting clinician for each participant. The patients were provided with a stamped addressed envelope to return the completed anonymous questionnaire. Thematic analysis was used to identify themes in the qualitative data. Results A total of 39 questionnaires were completed. More than 86% of patients reported that their telephone consultation definitely met their needs. Over 89% answered 'yes definitely' to questions regarding understanding of the reason for their appointment, opportunities for questions, clear understandable answers, feeling listened to, and treatment plans. 59% of patients responded 'yes definitely' that they were given information prior to the appointment about what would happen in the consultation, 10% reported they hadn't, with 31% responding they had but to some extent only. 72% of respondents reported that it was clear who they should contact if they had any further questions following the consultation. Regarding preference for future appointments, 47% of patients indicated that they would prefer a mixture of telephone, face to face and video consultations;24% preferred telephone, 16% preferred hospital face to face, and 3% preferred video. 11% reported that they had no preference. Thematic analysis of individual comments identified positive themes such as flexibility, good communication with clinicians and convenience. Areas for development are around communication with regard to physical barriers such as hearing and telephone signal problems. There are also limitations around both physical examination and the transmission of implicit information (non-verbal communication). Conclusion Virtual consultations provide an opportunity to safely assess patients whilst meeting social distancing requirements and minimising patient flow through the hospital. Questionnaire analysis indicates an overall positive experience of telephone consultations. However, most patients would prefer a mixture of face to face, video and telephone consultations in future. There are a number of areas for improvement including: a review of the information provided to patients prior to the consultation, review of contact information for patients following the consultation, and mechanisms for identifying patients with physical/ sensory limitations. The information gained through this small review will help us improve the overall telephone consultation experience for our patients.

Frailty Assessment of Transcatheter Aortic Valve Replacement Patients: Contemporary Practice and Future Directions

Frailty is a multi-system clinical syndrome characterized by reduced physiological reserve and increased vulnerability to stressors. There is now established evidence recognizing its incremental value as a predictor of suboptimal outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) beyond conventional surgical risk scores and objective frailty assessment is integrated in major guidelines. Several frailty assessment tools have been developed and validated for use in patients undergoing TAVR with varying complexity, clinical pragmatism and outcomes assessed. In contemporary TAVR practice, frailty assessment guides patient selection, informs care requirements, and identifies those who may require supplemental treatment. Further opportunities to improve patient care in this area include identification of interventions that can mitigate the deleterious impact of frailty, evaluation of the role of frailty assessment in low surgical risk patients, and development of frailty management models that can be delivered virtually. In this review, we aim to provide an overview of the concept of frailty, the available assessment tools, peri-procedural considerations in frail patients undergoing TAVR and future directions.

Climate emergency: lessons from the COVID-19 emergency? (Special Issue: Climate change, COP26 and the crucible of crisis.)

The COP-26 United Nations Climate Change meeting, scheduled to be held in Glasgow in 2021, is an important step in the world's attempt to deal with the climate emergency arising from increasing greenhouse gas emissions. Here we look at how society has responded to the Covid-19 emergency and compare it with the response to the climate change emergency, the latter based on our experience of a Royal Society of Edinburgh Inquiry on climate change published nearly ten years ago (RSE, 2011). With reference to Covid-19, civil society's response to the lockdown showed the power of clear political leadership and also the willingness of people to work together. On the negative side, the UK national test and trace system struggled because of a disconnect between national and regional activities. In our climate change report, we identified similar organisational barriers that were impeding a move towards a low-carbon future, especially the lack of responsibilities and powers at a city regional scale. If Scotland is to reduce emissions seriously, the focus needs to be on transport (30% of emissions), heating and agriculture. Without more responsibility and power at a city regional scale, Scotland will not achieve its emissions targets.

Learning in lockdown: A case study in rapid transition to remote teaching

Disruption is the by-word for 2020. Across the globe organisations have been affected by the COVID-19 pandemic and consequent lockdowns, which accelerated new ways of working and learning. In this article, I share my experience of transitioning from a face-to-face model of delivering post-graduate education to a remote learning model. I reflect on how the corporate sector might learn from my experience as it considers re-skilling and up-skilling the workforce to meet the demands faced by a changing jobs landscape. © The Author(s) 2021.