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1.
Archives of Disease in Childhood ; 107(Suppl 2):A11-A12, 2022.
Article in English | ProQuest Central | ID: covidwho-2019814

ABSTRACT

AimsPaediatric emergency departments saw an unusual increased incidence and severity of disease presentation in children with new onset diabetes in the early phase of the COVID-19 pandemic. The DIMPLES study(Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic) aimed to characterise the features of children presenting to Paediatric Emergency Department with new onset diabetes in the COVID-19 pandemic, exploring the incidence and severity of diabetic ketoacidosis (DKA).MethodsThe DIMPLES study is a retrospective multicentre study done across 49 paediatric emergency departments providing a unique perspective of new onset diabetes paediatric diabetes from the frontline.We compared the characteristics of children aged 6 months to 16 years presenting to the Paediatric Emergency Departments across UK and Ireland with new onset diabetes in the pandemic (March 1, 2020 to February 28, 2021) with the children presenting in the same time period over the pre pandemic period (March 1, 2019 to February 28, 2020).ResultsDuring the COVID pandemic year, there were increase from the pre-pandemic year in children with new onset diabetes presenting with DKA (pH <7.3;from 395 to 566;43% rise), severe DKA (pH <7.1;from 141 to 252;a 79% rise), and admissions to intensive care (from 38 to 72;89% rise), suggesting an increase in incidence and severity of new-onset diabetes. An increase in the incidence of new onset diabetes from 1015 to 1176 was noted in the pandemic(16% increase compared to an estimated increase of 2-4% per year).The median age of children who presented with new onset diabetes in the pandemic, the duration of symptoms before presentation and the ethnicity was similar to the pre pandemic period. Delay did not appear to be a significant factor in the pandemic compared to the pre pandemic period in the majority of cases.There was a paucity in testing for COVID-19 antibodies, 37/1176 children with new onset diabetes were tested with n=8 children testing positive for IgG/IgM COVID-19 antibodies. 12 children with new onset diabetes tested positive for SARS-CoV-2 on nasopharyngeal swabs, 7 presented with moderate to severe DKA and 3 presented with mild DKA.ConclusionThe DIMPLES study showed an increase in the number and severity of children presenting to the Paediatric Emergency Department with new onset diabetes and DKA in the COVID -19 pandemic. Proving association or causation was challenging given the small number of children tested for COVID-19 antibodies. When the incidence and severity at presentation is interpreted in the context of high levels of SARS-CoV-2 in the community and a low incidence of other viral infectious triggers it appears that COVID -19 may have a role as an accelerator or possibly even a precipitator of new onset diabetes in a genetically predisposed child.

3.
Ir J Med Sci ; 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-1959120

ABSTRACT

During the COVID-19 lockdown, social isolation from school closures and home visitation restrictions compounded known risk factors for child maltreatment. The aim of our study was to determine the incidence and types of child protection concern (CPC) among inpatients during the COVID-19 lockdown compared to the matched timeframe in 2019. We retrospectively reviewed the CPC assessments performed at Children's Health Ireland at Crumlin and Tallaght from March 13 to August 31, 2020, and the same period in 2019. Eighty-six versus 163 inpatients were assessed for CPC in 2020 versus 2019. Higher proportions of physical abuse concerns (52.3% versus 11% (p < 0.001)) and emotional abuse concerns (7.0% versus 1.2% (p = 0.015)) were observed in 2020. Case complexity, defined as involving two or more types of CPC, increased with 48.8% in 2020 versus 13.5% in 2019 (p < 0.001). In conclusion, there were fewer assessments for CPC during the 2020 lockdown. However, the complexity of the CPC cases was significantly increased in 2020.

4.
Stud Health Technol Inform ; 290: 304-308, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1933558

ABSTRACT

We present an automated knowledge synthesis and discovery framework to analyze published literature to identify and represent underlying mechanistic associations that aggravate chronic conditions due to COVID-19. Our literature-based discovery approach integrates text mining, knowledge graphs and medical ontologies to discover hidden and previously unknown pathophysiologic relations, dispersed across multiple public literature databases, between COVID-19 and chronic disease mechanisms. We applied our approach to discover mechanistic associations between COVID-19 and chronic conditions-i.e. diabetes mellitus and chronic kidney disease-to understand the long-term impact of COVID-19 on patients with chronic diseases. We found several gene-disease associations that could help identify mechanisms driving poor outcomes for COVID-19 patients with underlying conditions.


Subject(s)
COVID-19 , Diabetes Mellitus , Renal Insufficiency, Chronic , Chronic Disease , Diabetes Mellitus/epidemiology , Humans , Pattern Recognition, Automated , Renal Insufficiency, Chronic/epidemiology
5.
Br J Radiol ; : 20220024, 2022 Jul 15.
Article in English | MEDLINE | ID: covidwho-1923636

ABSTRACT

OBJECTIVES: The advent of the COVID-19 pandemic has resulted in periods of nationwide restrictions in Ireland including school and workplace closures. The authors hypothesised that this disruption to society may have led to a change in patterns of suspected physical abuse (SPA) presentations to the paediatric emergency department (ED), whilst ED attendance fell dramatically during the period. We reviewed data to determine whether there was an increase in presentations of SPA during periods of social restrictions. METHODS: The National Integrated Medical Imaging Service was searched for all skeletal survey examinations performed between the dates of the 1 March 2016 and 28 Feb 2021 for studies performed in cases of SPA. Electronic records of attendance were extracted from the emergency department administrative system at the three paediatric emergency departments which serve the 400,000 children regionally. The data were reviewed to determine if SPA presentations increased during restriction periods. RESULTS: 311 individual paediatric patients aged 24 months and under were referred for SPA skeletal survey during the study period. During the 2020/2021 period, 60 children were referred for SPA workup and there was no statistically significant difference between monthly referrals (mean 5, sd 2.92) in this period and matched periods over the preceding 4 years (mean 5.23, sd 2.69). CONCLUSIONS: The incidence of SPA did not increase during the period of national restrictions during the COVID-19 pandemic. ADVANCES IN KNOWLEDGE: Periods of social restrictions taken to protect the public health during a pandemic do not result in short term increases in suspected physical abuse in the regional paediatric population.

6.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-331640

ABSTRACT

Background: To investigate the impact of the COVID-19 pandemic and infection prevention measures on children visiting emergency departments across Europe. Methods Routine health data were extracted retrospectively from electronic patient records of children aged <16 years, presenting to 38 emergency departments (ED) in 16 European countries for the period January 2018 – May 2020, using predefined and standardised data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRR) were used to compare age groups, diagnoses, and outcomes. Findings Reductions in paediatric ED attendances, hospital admissions and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (incidence rate ratio (IRR) 2·62, 95% CI 2·19 to 3·13), and in children aged >12 months (12-<24 months IRR 0·89, 95% CI 0·86 to 0·92;2-<5years IRR 0·84, 95% CI 0·82 to 0·87;5-<12 years IRR 0·74, 95% CI 0·72 to 0·76;12-<16 years IRR 0·74, 95% CI 0·71 to 0·77;vs. age <12 months as reference group). The impact on paediatric intensive care admissions (IRR 1·30, 95% CI 1·16 to 1·45) was not as great as the impact on general admissions. Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1·10, 95% CI 1·08 to 1·12;emergent and very urgent triage IRR 1·53, 95% CI 1·49 to 1·57;vs. non-urgent triage category). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. Interpretation Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317962

ABSTRACT

Background: Hospital avoidance during the COVID-19 pandemic has been reported with a significant decrease in attendance at emergency departments among paediatric populations with potential increased morbidity and mortality outcomes. The present study sought to understand parents’ experiences of healthcare during the initial public health stages of the COVID-19 pandemic. Methods: A cross-sectional survey of parents of children under the age of 16 (N = 1044). The survey collected demographic information to profile parents and children, capture relevant health information such as pre-existing conditions and/or chronic illness or disability, and health service usage during the pandemic. Descriptive statistics, chi-square tests and regression analyses were used to determine the factors that influenced avoidance and hesitancy. Results: 23% of parents stated that they were much more hesitant to access health services upon implementation of the initial public health restrictions. Parents with a higher perception of risk of their children contracting COVID-19 ( χ2 (3) =33.8618, p < 0.000), and stronger levels of concern regarding the effects of COVID-19 ( χ2 (3) =23.9189, p < 0.000) were more likely to be hesitant. Stress also appeared to be a factor in hesitancy with higher than normal stress levels significantly associated with hesitancy (RRR= 2.31, CI: 1.54 - 3.47), while those with severe/extremely severe stress were over three times more likely to be hesitant (RRR:3.37, CI:1.81 - 6.27). Approximately one third of the sample required healthcare for their children during the public health restrictions to delay the spread of COVID-19, however, one in five of these parents avoided accessing such healthcare when needed. Of those that required healthcare, parents who avoided were more likely to report that the services were needed more by others ( χ2 (1) 20.3470, p <0.000). Those who felt that the government advice was to stay away from health services were 1.7 times more likely to be much more hesitant (RRR:1.71, CI;1.10 – 2.67). Conclusion: The misinterpretation of government public health advice, stress and the perception of risk each contributed to parental avoidance of or hesitancy to utilize healthcare services during the public health measures imposed to combat COVID-19.

8.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308722

ABSTRACT

Background: The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system. Methods: Fifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians (n = 5), nursing managerial staff (n=6), social workers (n=2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes. Results: The pandemic and public health restrictions have had an adverse impact on children’s health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care. Conclusions: The spread of COVID-19 and subsequent polices to address the pandemic has had wide-reaching implications for children’s health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.

9.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316762

ABSTRACT

Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims : This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed.   Methods : Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify temporal trends in attendances for emergency care. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences.

10.
Ir J Med Sci ; 191(2): 589-595, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1384595

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic and government-enforced restrictions have impacted medical practices. AIMS: The aim of our study was to investigate the impact SARS-CoV-2 and public health restrictions had on trauma presentations to a regional paediatric emergency service. METHODS: We carried out a multisite retrospective longitudinal study of all paediatric ED attendances from 2018 including 13 March to 7 June 2020. This aligned with the initial government-enforced public health phases: delay phase, mitigation phase and reopening phase 1. RESULTS: There were 7975 total regional attendances during government-enforced restrictions. This represents 17.5% and 15.6% reductions in site attendances when compared with the two previous years. Regional attendances reduced by 52.5% in 2020 compared with 2018 and 50.9% compared with 2019. Following an initial reduction in injury attendances at the beginning of the 'lockdown' (p = 0.076), the number of injuries consistently grew as weeks progressed (p < 0.05), reaching a peak of 44.6% of all attendances. As restrictions eased, the most common location where injuries occurred moved to areas outside the home (p < 0.000). There was a significant change in injury type, final disposition and device-associated injury (p < 0.05). Wheeled recreational devices were associated with over 20% of all injuries by reopening phase 1. CONCLUSIONS: This study reveals that total attendances and total injuries reduced during initial phases of the lockdown. This was followed by a significant increase in injury presentations, which reached a peak of 44.6% of all attendances. We identified potential modifiable characteristics of paediatric trauma which can be addressed by future public health strategies.


Subject(s)
COVID-19 , Public Health , COVID-19/epidemiology , Child , Communicable Disease Control , Emergency Service, Hospital , Humans , Ireland/epidemiology , Longitudinal Studies , Retrospective Studies , SARS-CoV-2
11.
Int J Environ Res Public Health ; 18(16)2021 08 08.
Article in English | MEDLINE | ID: covidwho-1348636

ABSTRACT

The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research.


Subject(s)
COVID-19 , Hospital Design and Construction , Infection Control , Telemedicine , Humans , Inpatients , Intensive Care Units , Pandemics , SARS-CoV-2
12.
BMJ Open ; 11(7): e049680, 2021 07 09.
Article in English | MEDLINE | ID: covidwho-1304231

ABSTRACT

OBJECTIVES: The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported. DESIGN: A prospective online three-part longitudinal survey. SETTING: Acute hospitals in the UK and Ireland. PARTICIPANTS: Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020. PRIMARY OUTCOME MEASURES: Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised. RESULTS: The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10). CONCLUSION: Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care. TRIAL REGISTRATION NUMBER: ISRCTN10666798.


Subject(s)
COVID-19 , Psychological Distress , Cohort Studies , Cross-Sectional Studies , Humans , Ireland/epidemiology , Longitudinal Studies , Pandemics , Prospective Studies , SARS-CoV-2 , United Kingdom/epidemiology
14.
HERD ; 14(3): 34-48, 2021 07.
Article in English | MEDLINE | ID: covidwho-1255871

ABSTRACT

OBJECTIVE: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. BACKGROUND: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies. METHODS: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020. RESULTS: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being. CONCLUSIONS: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.


Subject(s)
COVID-19/therapy , Intensive Care Units/organization & administration , Telemedicine/methods , COVID-19/prevention & control , Facility Design and Construction/methods , Facility Design and Construction/standards , Humans , Infection Control/methods , Israel , Organizational Case Studies , Patient Isolation/methods , SARS-CoV-2 , Telemedicine/organization & administration
15.
Stud Health Technol Inform ; 281: 392-396, 2021 May 27.
Article in English | MEDLINE | ID: covidwho-1247793

ABSTRACT

This paper proposes an automated knowledge synthesis and discovery framework to analyze published literature to identify and represent underlying mechanistic associations that aggravate chronic conditions due to COVID-19. We present a literature-based discovery approach that integrates text mining, knowledge graphs and ontologies to discover semantic associations between COVID-19 and chronic disease concepts that were represented as a complex disease knowledge network that can be queried to extract plausible mechanisms by which COVID-19 may be exacerbated by underlying chronic conditions.


Subject(s)
COVID-19 , Diabetes Mellitus , Kidney Diseases , Data Mining , Humans , Pattern Recognition, Automated , SARS-CoV-2
16.
Emerg Med J ; 38(6): 450-459, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1175182

ABSTRACT

OBJECTIVE: To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland. METHODS: Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020-26 March 2020 and Ireland: 25 March 2020-2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being. RESULTS: 5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role. CONCLUSIONS: Findings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term. TRIAL REGISTRATION NUMBER: ISRCTN10666798.


Subject(s)
COVID-19/epidemiology , Emergency Medicine/statistics & numerical data , Occupational Stress/epidemiology , Physicians/statistics & numerical data , Adult , Aged , Anesthesia/statistics & numerical data , COVID-19/psychology , Critical Care/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Ireland/epidemiology , Male , Middle Aged , Occupational Stress/etiology , Physicians/psychology , Psychological Distress , Surveys and Questionnaires , United Kingdom/epidemiology , Young Adult
17.
BMC Health Serv Res ; 21(1): 279, 2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1154006

ABSTRACT

BACKGROUND: The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children's health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system. METHODS: Fifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians (n = 5), nursing managerial staff (n = 6), social workers (n = 2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes. RESULTS: The pandemic and public health restrictions have had an adverse impact on children's health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care. CONCLUSIONS: The spread of COVID-19 and subsequent policies to address the pandemic has had wide-reaching implications for children's health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.


Subject(s)
COVID-19/prevention & control , Child Health , Emergency Service, Hospital/statistics & numerical data , Health Personnel/psychology , Pandemics/prevention & control , Pediatrics , Adult , COVID-19/epidemiology , COVID-19/psychology , Child , Humans , Interviews as Topic , Qualitative Research , Quarantine , SARS-CoV-2
18.
Information and Organization ; : 100344, 2021.
Article in English | ScienceDirect | ID: covidwho-1116820

ABSTRACT

We live in a technologically advanced era with a recent and marked dependence on digital technologies while also facing increasingly frequent extreme and global crises. Crises, like the COVID-19 pandemic, are significantly impacting our societies, organizations and individuals and dramatically shifting the use of, and dependence on, digital technology. The way digital technology is used to cope with crises is novel and not well understood theoretically. To explore the varied uses and impact of digital technologies during crises, we propose to view crisis as (1) opportunity, (2) disruption, and (3) exposure. Examining crisis as opportunity reveals how digital technologies enable experimentation and accelerate innovation while raising coordination challenges and risky implementation. Viewing crisis as disruption highlights how digital technologies enable the rapid shifting of organizational and occupational practices to new digital spaces, allowing work continuity, yet potentially distorting work practices and raising challenges of over-dependence. Finally, crisis exposes the societal implications in making visible and exposing digital inequalities and producing moral dilemmas for us all. We use these three perspectives to shed light on the varied uses of digital technologies in the COVID-19 crisis and suggest new avenues for research on crises more broadly.

20.
Int J Environ Res Public Health ; 17(24)2020 12 11.
Article in English | MEDLINE | ID: covidwho-971349

ABSTRACT

A decrease in attendance at emergency departments among paediatric populations has been reported during the Coronavirus Disease 2019 (COVID-19) pandemic. The present study sought to understand parents' hesitancy and concerns around accessing healthcare during the pandemic using a cross-sectional survey of parents of children under the age of 16 (N = 1044) in Ireland. Multinomial and logistic regression analyses were used to determine the factors that influenced avoidance and hesitancy. In total, 34% of participants stated that their child required healthcare during the pandemic, of whom 22% decided against seeking healthcare. Parents who reported being much more hesitant about accessing healthcare were more likely to report mild-moderate (Relative Risk Ratio (RRR) = 2.31, CI: 1.54-3.47) and severe-extremely severe stress (RRR: 3.37, CI: 1.81-6.27). Parents who understood government advice to mean avoiding health services were more likely to be hesitant to attend (RRR: 1.71, CI; 1.10-2.67). These effects held when restrictions were beginning to be lifted. Higher levels of stress were associated with a parent believing that the government advice meant that they should not attend health services (OR: 1.66, CI: 1.14-2.41). Public health messaging must ensure parents are reassured on the accessibility and safety of paediatric healthcare services as this public health emergency continues.


Subject(s)
COVID-19 , Pandemics , Parents/psychology , Patient Acceptance of Health Care/psychology , Pediatrics , Adolescent , Adult , Anxiety , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Ireland , Male , Middle Aged , Risk Assessment
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