Disruptions in Health Care among Mwccs Participants during the Covid-19 Pandemic

Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.

AAA WORKFORCE CHALLENGES AND THEIR IMPACT ON OLDER ADULTS: RESULTS FROM A NATIONAL POLL AND AGENCY INTERVIEWS

Area Agencies on Aging (AAAs) play a critical role in addressing social needs that enable older adults to live independently. In 2022, over 90% of AAAs reported that the number of consumers seeking services and the complexity of consumer needs have increased. At the same time, the nation faces a shortage of direct care workers. Existing AAAs workforce challenges, such as worker shortages and staff burnout, have been exacerbated by the COVID-19 pandemic. We will share the results of a USAging poll of AAAs on the challenges facing their agency and provider workforce, reductions in volunteer staffing, and the impacts of workforce shortages on clients and services provided. Top impacts include clients not receiving the frequency of services needed, if at all. Services most impacted include personal care, respite, and transportation. Presenters will conclude by sharing innovative solutions that AAAs have developed to address these challenges.

"NO TIME TO OVERTHINK IT, JUST DO IT'': AREA AGENCIES ON AGING AND INCLUSIVE COMMUNITY ENGAGEMENT

AAAs have always been deeply engaged in addressing the health-related social needs of older adults from historically marginalized and underserved communities. As a confluence of COVID and social injustices moved issues of racial equity and inclusion to the forefront of national conversation, AAAs refocused their efforts to identify and address health inequities related to the social determinants of health (SDOH). One result of the COVID-19 pandemic and the urgency to reach and vaccinate older adults was that AAAs quickly formed new partnerships with culturally specific organizations. These relationships have developed and resulted in expanding culturally responsive service delivery. Presenters will describe this and other findings from a mixed methods study about AAA initiatives that seek to improve access and equity, such as inclusive community needs assessments, equity analyses that leverage census data to identify areas of greatest SDOH disparities, and dashboards to compare service recipients with community demographics.

Differences in Emergency Department Sepsis Care: Do Race, Sex, and Language Matter?

Study Objectives: Sepsis accounts for half of hospital deaths and is a priority area of quality measurement and improvement by the Centers for Medicare and Medicaid Services (CMS). Social determinants of health have been associated with sepsis outcomes, with racial and ethnically minoritized patients experiencing higher mortality rates and worse outcomes. Standardization of emergency department (ED) sepsis-care protocols and quality measurement have improved sepsis outcomes and are closely tracked. However, it is unknown whether there are differences in ED sepsis care protocol adherence or outcomes by race, sex, or primary language spoken. The Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure is a CMS quality measure used to bundle and track multiple elements of sepsis care that are shown to improve sepsis outcomes. This measure includes obtaining blood cultures and serum lactate measurements and timely administration of intravenous fluid and antibiotics, if indicated. In this study, we hypothesized there would be a difference in 3- hour bundle compliance based on differences in race, sex, and/or language spoken. Method(s): We conducted a retrospective chart review of adult ED patients who met SEP-1 reporting guidelines for severe sepsis, septic shock, or sepsis with organ failure, from April 8, 2019 to January 21, 2022 at a large health system in Rhode Island with over 150,000 annual ED visits. We included patients who had 3-hour bundle compliance reported to CMS. Statistical analysis was completed using univariate descriptive analyses and bivariate analyses with a chi-square test of independence. We conducted logistic regression to identify factors associated with 3-hour sepsis bundle compliance and differences in sepsis treatment by race, ethnicity, sex, primary language spoken, and use of an interpreter, adjusting for emergency severity index (ESI), disposition, inpatient department, and COVID test results. Result(s): The study population included 3,182 patients of which 44.6% (1418/3182) were female, 78.4% (2495/3182) white, and 11.3 % (360/3182) were Hispanic or Latino. The majority (85.5%, 2722/3182) spoke English. Among people who spoke a language other than English, over two-thirds (66.3%, 305/460) received an interpreter. Less than a quarter 23.5% (749/3182) had severe sepsis, over a third (35.5%, 1131/3182) had septic shock, and 40.9% (1302/3182) had sepsis with organ failure. Overall compliance with the SEP-1 bundle was low at 44.9% (1430/3182). There were no significant differences in sepsis bundle compliance by patient sex, race, ethnicity, or language spoken. Logistic regression showed a lower likelihood of compliance with the sepsis bundle among patients with severe sepsis compared to sepsis patients with organ failure (aOR 0.77 [95% CI: 0.65-0.90]). Conclusion(s): Our study did not identify a disparity in SEP-1 bundle compliance by sex, race, ethnicity, or language spoken. These findings support the hypothesis that using standardized ED sepsis protocols and measures are important tools to mitigate and/or prevent disparities in ED sepsis care. We also found low compliance with the SEP-1 bundle, with higher compliance noted among individuals with more severe disease, potentially diluting differences that may exist between demographic groups. Future studies are needed in populations with higher SEP-1 compliance to determine whether there are differences by sex, race, or language spoken. No, authors do not have interests to disclose Copyright © 2022

Stigma and Intentions to Seek Psychotherapy Among Primary Care Providers During the COVID-19 Pandemic: A Mediational Analysis.

BACKGROUND: Medical personnel have reported increases in psychological distress and depression during the COVID-19 pandemic. Additionally, many providers, including primary care providers (PCPs), face significant stigma related to personal mental healthcare. However, the process by which stigma affects help-seeking among PCPs is unclear. METHOD: Between January and May 2020, 112 PCPs completed a survey of perceived public stigma, self-stigma, attitudes, intentions to seek psychotherapy for depression, and a clinical vignette on patient referrals to psychotherapy. RESULTS: Self-stigma and attitudes toward psychotherapy sequentially mediated the relationship between perceived public stigma and intentions to seek psychotherapy. PCPs were more likely to refer a depressed patient to psychotherapy than seek personal psychotherapy, but lower personal help-seeking intentions were associated with lower referral intentions. CONCLUSION: These results clarify processes by which stigma hinders PCPs' psychotherapy use and highlight interventions to encourage their help-seeking. Addressing cultural and practical barriers in the medical field is needed to reduce stigma.

Improving HIV Pre-Exposure Prophylaxis (PrEP) Uptake During the COVID-19 Pandemic

Background: Acute HIV cases have doubled during the COVID-19 pandemic. We implemented a quality improvement (Ql) project to standardize PrEP telehealth at a large metropolitan medical center in a HIV hotspot to ensure PrEP access and uptake. Methods: A 2-arm recruitment approach was implemented from August 31st, 2020-December 16th, 2020 targeting (1) patients through weekly social medial outreach and (2) providers in high-volume departments through educational in-services and dedicated chart reviews. Results: Provider referrals from the Emergency and Primary Care Departments increased 460% (p=0.03). PrEP users shifted to a majority<35 years old (n=12, 38.7%), but remained mostly Black (n=16, discontinuation during the pandemic. The low percentage of PrEP users may be related to COVID-19 on clinic follow-up. The younger demographic shift may translate to a larger decrease in HIV transmission given the relative risk of different cohorts. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.

Applying Principles and Methods of Risk Analysis: A Case Example of Northern Spotted Owl Research in a Dynamic Pandemic Landscape

This report presents considerations of potential hazards and mitigation measures associated with conducting field research in the context of a pathogenic epidemic or pandemic situation. We use an example of a specific risk assessment developed for advising decisions on initiating or continuing field activities (in this case, mark-resight and passive acoustic monitoring) associated with ongoing research of northern spotted owls (Strix occidentalis caurina) in the Pacific Northwest region of the United States under conditions imposed by the COVID-19 (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) global pandemic. We review the structure of a risk assessment procedure that follows USDA Forest Service policy in general and has specifically been applied to owl research during the current pandemic. The risk assessment framework we used included listing job objectives, job tasks, and potential hazards associated with each task. For each task, we evaluated the severity of the hazard (negligible, moderate, critical, or catastrophic) and the probability of a mishap if the hazard was present (rare, unlikely, possible, likely, or almost certain) and assigned a risk assessment code that identified risks as low, moderate, high, or extremely high. We then described mitigation and abatement measures that we posited would reduce the risk severity or probability, and then scored the residual (decreased) severity, probability, and risk level. We briefly review other potential considerations for a job hazard risk assessment under conditions of pathogenic outbreaks, including considerations for additional costs and administrative duties, working in proximity and unexpected encounters in field situations, and changes in behavior of wildlife. © 2020, USDA Forest Service. All rights reserved.

MENTAL HEALTH & ALCOHOL USE in PEOPLE with & WITHOUT HIV before & during COVID-19

Background: Increases in the prevalence of mental health symptoms during global pandemics have been observed. We hypothesized that people with HIV (PWH) and without HIV (HIV-) would experience an increase in mental health symptoms and alcohol use after the onset of the COVID-19 pandemic and that PWH would experience a greater increase than HIV-individuals. Methods: Participants were recruited from two established cohorts of PWH and HIV-adults in Omaha, Nebraska for whom baseline data including mental health and alcohol use assessments had been collected prior to the pandemic. Participants were excluded from the original cohorts if they had any known psychiatric diagnosis or were taking antipsychotics or anticonvulsants. Participants were reassessed utilizing the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Identification Test (AUDIT), and Pittsburgh Sleep Quality Index (PSQI) between February and April 2021. All outcomes were evaluated using generalized linear mixed models. Results: Of the 95 participants who completed all questionnaires, 50 were PWH and 45 HIV-. Groups did not statistically differ in age, sex, race or ethnicity (mean: 45.67 years;69.5% male;74% non-Hispanic white). Pre-pandemic mean BDI-II, BAI, AUDIT and PSQI scores were higher in PWH versus HIV-. After the onset of the pandemic, mean BDI-II and AUDIT scores increased significantly in both groups (see Table;P<.001 and P=0.003, respectively) and AUDIT scores were significantly higher in males than females (P=.002). Measures of binge drinking and alcohol misuse as well as mean BAI and PSQI scores increased numerically intra-pandemic. Intra-pandemic mean BDI-II and AUDIT scores increased more among HIV-than PWH, but not significantly so. The percentage of PWH and HIV-participants who moved into a more severe category of depression as measured by the BDI-II (eg, from minimal to moderate) after the onset of the pandemic was identical (18%). Conclusion: Measures of depression and alcohol use increased significantly after the onset of the COVID-19 pandemic in people with and without HIV. Although there were no significant differences in the changes between the groups, PWH had higher baseline scores so the increases in this group may have more clinical impacts. Screening for symptoms of mental health and alcohol use is critical, especially in PWH during a pandemic. Future work will explore the longer-term impact of the pandemic on mental health symptoms and alcohol use.

Comparison of Hospital Resource Allocation Associated With CTCA for Intermediate-Risk ACS as Inpatient vs Expedited Outpatient

Background: Pre-COVID, intermediate risk ACS accounted for ∼50% of our local cardiac medical assessment unit (MAU) admissions and followed an inpatient pathway for further investigation. During COVID, a new protocol was established with the aim to reduce the burden on inpatient cardiac and imaging resources, where intermediate-risk ACS patents were discharged direct from ED with arrangements made for an expedited outpatient CTCA. Aim: The current study aim was to compare the allocation of hospital resources, completion, and timing of CTCA in the two models of care. Methods: Retrospective cohort study comparing the characteristics and resource allocation of consecutive intermediate-risk ACS patients who went onto undergo CTCA pre- and post-COVID. The decision to investigate with CTCA was made at the discretion of the treating Cardiologist. ED and total inpatient length of stay and the cost in National Weighted Activity Units (NWAU), which is a common unit for measuring hospital activity, were compared. Results: 78 consecutive patients were included (Table). All 39 patients in Group 1 had inpatient CTCA. 36/39 patients attended their arranged CTCA (2 patients failed to attend, 1 patient represented to hospital). Conclusion: An expedited outpatient protocol for investigation of Intermediate-risk ACS was associated with significant reduction in total inpatient length of stay and associated costs, albeit with a significant delay in the time to diagnosis. Further examination into associated patient outcomes is warranted. [Formula presented]

Student Opinion on Teaching Thermodynamics through Synchronous and Asynchronous Distance Learning

This Evidence-Based Practice paper describes the shift of a third-year biological and agricultural engineering thermodynamics course into 100% distance delivery including both synchronous and asynchronous elements. Public health restrictions on in-person gatherings due to the global COVID-19 pandemic shifted many courses that were previously not considered appropriate candidates for e-Learning to an online platform. This was one of those courses. Anecdotal evidence from the teaching team suggested that students preferred this online approach to the more traditional class setting. Written reflections and Likert scale survey data were collected from students in the class that transitioned from in-person to online-delivery to determine their course preference, and indicated positive attitudes towards the online-delivery mode. Additionally, test scores from two previous years were compared to current exams to determine if the change in lecture delivery mode had a significant impact on students' performance. It was found that the asynchronous lectures did not harm student learning outcomes. © American Society for Engineering Education, 2021

Use of a Research as Intervention Approach to Explore Telebehavioral Health Services During the COVID-19 Pandemic in Southeastern Idaho.

INTRODUCTION: Since the inception of the COVID-19 pandemic, telebehavioral health services have been a key contributor to continuation of care in rural and underserved areas of southeastern Idaho. Providers of telebehavioral health services faced numerous challenges as they navigated rapidly shifting regulations, variable access to internet and their own personal understandings of practice. OBJECTIVE: This study aimed to characterize provider experiences, generate policy- and practice-level recommendations, and raise awareness among community stakeholders regarding telebehavioral health in southeastern Idaho. METHODS: Using a newly developed conceptual/analytical framework, a research-as-intervention strategy was employed to conduct and analyze semi-structured interviews, short writings, and photographs from 7 primary care and behavioral health providers in the region. RESULTS: Providers shared examples from practice that addressed technology and training, access-to-care, safety, changing provider roles, payment for services, treatments that are not well suited to telehealth and the nuances of living and working in newly forged spaces of care. CONCLUSIONS: Providers found promise in telebehavioral health's utility as a hybrid model of care, but it must be supported by flexible legislation and policy. For example, it would help to make reimbursement expansions permanent and to simplify inter-jurisdictional practice options. Cross-sharing of information between licensing boards could help providers from various disciplines understand the parameters within which their colleagues must work.

COVID-19 diagnosis by SARS-CoV-2 Spike protein detection in saliva using an ultrasensitive magneto-assay based on disposable electrochemical sensor.

The outbreak of the COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome of Coronavirus 2 (SARS-CoV-2), has fueled the search for diagnostic tests aiming at the control and reduction of the viral transmission. The main technique used for diagnosing the Coronavirus disease (COVID-19) is the reverse transcription-polymerase chain reaction (RT-PCR) technique. However, considering the high number of cases and the underlying limitations of the RT-PCR technique, especially with regard to accessibility and cost of the test, one does not need to overemphasize the need to develop new and less expensive testing techniques that can aid the early diagnosis of the disease. With that in mind, we developed an ultrasensitive magneto-assay using magnetic beads and gold nanoparticles conjugated to human angiotensin-converting enzyme 2 (ACE2) peptide (Gln24-Gln42) for the capturing and detection of SARS-CoV-2 Spike protein in human saliva. The technique applied involved the use of a disposable electrochemical device containing eight screen-printed carbon electrodes which allow the simultaneous analysis of eight samples. The magneto-assay exhibited an ultralow limit of detection of 0.35 ag mL-1 for the detection of SARS-CoV-2 Spike protein in saliva. The magneto-assay was tested in saliva samples from healthy and SARS-CoV-2-infected individuals. In terms of efficiency, the proposed technique - which presented a sensitivity of 100.0% and specificity of 93.7% for SARS-CoV-2 Spike protein-exhibited great similarity with the RT-PCR technique. The results obtained point to the application potential of this simple, low-cost magneto-assay for saliva-based point-of-care COVID-19 diagnosis.

Learnings from the commission’s initial state aid response to the covid-19 outbreak

Against the background of the COVID-19 outbreak and the effects of public health mea-suresonMemberStateeconomies,theCommissionhasactedimpressivelyquicklytopre-ventStateaidrulesbecomingablocktonecessaryinterventions.TheCommissionhaspub-lished a Temporary Framework under Article 107(3)(b) TFEU, which has been amended twiceincludingtoallowforrecapitalisationoffirmsinreturnforStateparticipation.Aid under this Temporary Framework along with a wide range of measures approved under Article107TFEUhasallowedbillionsinaidtobegranted,ensuringthatliquidityisavail-able to companies. This liquidity has avoided mass bankruptcies but comes with the risk of distortions of competition across the internal market;a risk augmented by the differ-encesinapproachoftheMemberStates.AsMemberStatesexittheinitialphaseofthere-sponsetothecrisisfocusedonliquidity,andmovetomorestructuralmeasuressuchasre-capitalisations,wecanexpectthedesignofaidtobemonitoredevenmorecloselytomin-imise market distortions. The Commission’s initial response has been flexible, swift and pragmaticandistobelaudedbutmanypotentialpitfallsremainasthecrisismovestothe next phase. © 2020, Lexxion Verlagsgesellschaft mbH. All rights reserved.

The COVID-19 pandemic and organ donation and transplantation: ethical issues.

BACKGROUND: The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. METHOD: To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. RESULTS: This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates. CONCLUSION: This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.

Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic.

The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed. METHODS: Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks. RESULTS: The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of "no recommendation." CONCLUSIONS: SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.

Thermodynamics online: A multi-method exploration of student perception

Public health restrictions on in-person gatherings due to the global COVID-19 pandemic have shifted many courses to an online platform that were previously not considered appropriate candidates for distance education. This paper focuses on the shift of a third-year biological and agricultural engineering thermodynamics course that in the past was taught in-person with two lectures and one lab/recitation session per week. In response to the pandemic, the course was delivered via two asynchronous lectures and one required synchronous lab/recitation each week. Both pre- and post-COVID courses consisted of online homework, weekly worksheet assignments, four total exams, and a semester-long humanitarian engineering team project. Student perceptions were evaluated using end-of-semester course evaluation comments and a Likert-style survey based on the Survey of Attitudes Towards Statistics that was modified by replacing “statistics” with “thermodynamics” in the survey’s questions. The results from these different methods were triangulated in order to better understand the effect of transitioning this thermodynamics course to a wholly online delivery mode and to inform future curricular innovations with the goal of enhancing student success. © American Society of Agricultural and Biological Engineers Annual International Meeting, ASABE 2021. All Rights Reserved.