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1.
J Gen Intern Med ; 2022.
Article in English | PubMed | ID: covidwho-2035271

ABSTRACT

BACKGROUND: During the first wave of the COVID-19 pandemic physicians worked on the front lines, immersed in uncertainty. Research into perspectives of frontline physicians has lagged behind clinical innovation throughout the pandemic. OBJECTIVE: To inform ongoing and future efforts in the COVID-19 pandemic, we conducted a qualitative exploration of physician perspectives of the effects of policies and procedures as well as lessons learned while caring for patients during the height of the first wave in the spring of 2020. DESIGN: A confidential survey was emailed to a convenience sample. Survey questions included demographic data, participant role in the pandemic, and geographic location. Eleven open-ended questions explored their perspectives and advice they would give going forward. Broad areas covered included COVID-19-specific education, discharge planning, unintended consequences for patient care, mental health conditions to anticipate, and personal/institutional factors influencing workforce well-being amid the crisis. PARTICIPANTS: We received fifty-five surveys from May through July 2020. Demographic data demonstrated sampling of frontline physicians working in various epicenters in the USA, and diversity in gender, race/ethnicity, and clinical specialty. APPROACH: Inductive thematic analysis. KEY RESULTS: Four themes emerged through data analysis: (1) Leadership can make or break morale;(2) Leadership should engage frontline workers throughout decision-making processes;(3) Novelty of COVID-19 led to unintended consequences in care delivery;and (4) Mental health sequelae will be profound and pervasive. CONCLUSIONS: Our participants demonstrated the benefit of engaging frontline physicians as important stakeholders in policy generation, evaluation, and revision;they highlighted challenges, successes, unintended consequences, and lessons learned from various epicenters in the first wave of the COVID-19 pandemic. There is much to be learned from the early COVID-19 pandemic crisis;our participants' insights elucidate opportunities to examine institutional performance, effect policy change, and improve crisis management in order to better prepare for this and future pandemics.

2.
Surgery ; 2022.
Article in English | ScienceDirect | ID: covidwho-2031699

ABSTRACT

Background The Coronavirus pandemic outbreak in 2019 and the saturation of healthcare system led to an increased use of digital tools for surveillance. In this study we describe our experience using telemedicine to follow-up IPMN patients during Covid-19 era and analyze those factors associated to patients’ satisfaction. Methods This one-year retrospective observational study enrolled IPMN patients followed-up by telemedicine during COVID-19 outbreak. Patients with high-risk features needing on-site physical examination or declining remote follow-up were excluded. A 13-question survey was conducted;demographic, geographic and employment information was collected. Univariate and multivariate analysis were performed to evaluate those factors associated to patients’ satisfaction. Results Out of 287, a total of 177 IPMN patients were included: mean age was 69 (44-87) years, male/female ratio was 0.78. Eighty (45.2%) patients had previously experienced abdominal pain. Most patients (85.3%) were satisfied with telemedicine: at univariate analysis, age ≥ 70 years (p=0.007), retirement (p=0.001) and absence of previous abdominal pain (p=0.05) were significantly associated with patient satisfaction. At multivariate analysis, absence of previous abdominal pain was the only factor independently associated with patient satisfaction (OR 5.964, 95%CI 2.21-16.11, p<0.001). Conclusions Telemedicine allows a new follow-up strategy that can be used in selected patients with IPMN. Absence of previous abdominal pain is associated with patient satisfaction during follow-up. Further studies are needed to evaluate safety of remote follow-up in IPMN patients.

3.
Medicina-Buenos Aires ; 82(3):332-337, 2022.
Article in Spanish | Web of Science | ID: covidwho-2030820

ABSTRACT

Coronavirus 2 infection has spread rapidly throughout the world. Most of the current publications describe different behavior between an adult and pediatric population, this last one is associated with less clinical severity. The purpose of this study was to analyze the process of care, the epidemiological and clinical features, the evolution and the use of resources in pediatric patients with SARS-Cov-2 infection, treated during the first pandemic wave, at the beginning of 2020. An observational and retrospective study was carried out in the pediatric population with SARS-CoV-2 infection, treated in a highly complex pediatric hospital from April 1 to August 31, 2020. A total of 333 patients were included, 175 (53%) residents of the Metropolitan area of Buenos Aires (AMBA). The median age was 5.47 years (IQR 1.1-10.9) and 177 (53%) were women. A total of 209 (63%) patients required hospitalization and 152 (46%) had an underlying disease. Most of the patients (n 295, 89%) had mild/asymptomatic disease and the main symptom was fever (N169, 65%). In the univariate analysis, neurological disease (OR 4.5, IC95% 1.9-11, p 0.002), chronic respiratory disease (OR 3.9, IC95%1.5-10.3, p 0.002) and genetics (OR 11, IC95%3.4-34.4, p < 0.001), as well as neurological symptoms (OR 2.8, IC95%1.1-6.6, p 0.035) and respiratory (OR 20.2, IC95%8.5-48.2, p 0.001) were associated with more severe disease. Active surveillance of pediatric patients with underlying diseases should continue to define the pandemic's impact on this specific population.

4.
Journal of Public Health Research ; 11(3):22799036221107062, 2022.
Article in English | MEDLINE | ID: covidwho-2029668

ABSTRACT

To verify if lethality and diffusivity of Covid-19 correlated with percentage of people vaccinated in different countries and whether results on these indicators were comparable under different types of vaccines. A linear regression analysis was conducted between vaccines/inhabitant, new cases/inhabitants and ratio deaths/cases. A comparison between the three indicators was carried out in countries subdivided by kind of vaccine. The proportion of vaccinations/inhabitants correlates negatively with proportion of deaths x 100 cases (R = -3.90, p < 0.0001), but didn't on incidence of new cases. Countries with prevalence of mRNA vaccines were similar to others on incidence of new cases;but a lower lethality of Sars-Cov2 was found than in countries with prevalence of viral vehicle vaccines (F = 6.064, p = 0.0174) but didn't against countries with prevalence of inactivated vaccines. The higher is the proportion of vaccine/inhabitant in a given country, the less is the fraction of infected people who die.

5.
Genes Immun ; 2022.
Article in English | PubMed | ID: covidwho-2016684

ABSTRACT

IgG3 would play an important role in the immune adaptive response against SARS-CoV-2, and low plasma levels might increase the risk of COVID-19 severity and mortality. The IgG3 hinge sequence has a variable repeat of a 15 amino acid exon with common 4-repeats (M) and 3-repeats (S). This length IGHG3 polymorphism might affect the IgG3 effector functions. The short hinge length would reduce the IgG3 flexibility and impairs the neutralization and phagocytosis compared to larger length-isoforms. We genotyped the IGHG3 length polymorphism in patients with critical COVID-19 (N = 516;107 death) and 152 moderate-severe but no-critical cases. Carriers of the S allele had an increased risk of critical ICU and mortality (p < 0.001, OR = 2.79, 95% CI = 1.66-4.65). This adverse effect might be explained by a less flexibility and reduced ability to induce phagocytosis or viral neutralization for the short length allele. We concluded that the IgG3 hinge length polymorphism could be a predictor of critical COVID-19 and the risk of death. This study was based on a limited number of patients from a single population, and requires validation in larger cohorts.

6.
Service Business ; 2022.
Article in English | Scopus | ID: covidwho-2014442

ABSTRACT

This paper studies networking in rural tourism from a gender perspective comparing pre and post Covid period. The empirical study consisted of a questionnaire answered by 154 tourism promoters. Results showed a higher percentage of promoters belonging to an association during the Covid-19. There was a link between receiving training and belonging to an association and a significant relationship between participation in associations and receiving public funds, this relationship being found more among male promoters. On the other hand, a higher score was given by women for the advantages of networking, and mainly for the following: ‘Simplifies the management of booking’. © 2022, The Author(s).

7.
Annals of Nutrition & Metabolism ; 78:46, 2022.
Article in English | ProQuest Central | ID: covidwho-2012322

ABSTRACT

Introduction: COVID-19 has seriously affected the quality of life of children due to the restrictions imposed to control the pandemia. Objectives: To analyse healthy lifestyle levels during the course of the pandemic in the city of Madrid in 20 schools with a representative sample of children aged 8 to 12. Methods: Body composition was measured by BIA (TANITA DC-240MA, Japan). Diet quality, physical activity (PA), sleep measurements, and emotional well-being were measured by validated questionnaires (KIDMED Index, PAU-7S, BEARS9/SHSA8 and KIDSCREEN-10, respectively). Data were collected twice, 1 year apart, winter 2020/21 and winter 2021/22. Results: Excess weight according to the International Obesity Task Force (IOTF) affected 32% (22.4% overweight and 9.6% obese) of children in 2021 and 35.3% (19.1% overweight and 16.2% obese) in 2022. Compliance with WHO PA recommendations for moderate/vigorous PA were 32.8% in 2021 and 31.6% in 2022. Children fulfilling recommendations for screen use were 36.2% and 31.4% during the week, for 2021 and 2022, respectively;however, screen use was higher at weekends (71.8% vs 67.7%, respectively) in 2022 than in 2021. While in 2021, 72% of school children met the recommended hours of sleep, there was a slight decrease (70.5%) in 2022. Adherence to the Mediterranean diet decreased between 2021 and 2022 periods both in those at medium and low adherence profile (48.2% vs 43.9% and 8.9% vs 5.7%, respectively). Emotional well-being and quality of life were within reference values over the two years, although 49% reported feeling sad in 2021 compared to 52% in 2022. Conclusions: A tendency to worsening was observed in all analysed parameters except for weekly screen use. Urgent public health measures are needed to reduce the impact of the pandemic on children's health.

8.
Annals of Nutrition & Metabolism ; 78:53, 2022.
Article in English | ProQuest Central | ID: covidwho-2012132

ABSTRACT

Introduction: The COVID-19 pandemic has brought major changes in children's lifestyle and nutrition. In this sense, children have resulted as the most vulnerable group. Objectives: To analyze the adherence to the Mediterranean Diet (MD) in a representative sample of children during the COVID-19 pandemic in the City of Madrid. Methods: This is a cross-sectional study conducted in 20 schools of Madrid which completed evaluations during COVID19 pandemic between November 2021 and February 2022. The Mediterranean Diet Quality Index for children and adolescents (KIDMED) was performed to measure the adherence to MD. Low, medium, and high adherence groups were established. Results: Participants were 471 children (48.4% girls;mean age 9.36±1.19 years). Our results showed that mean KIDMED score was 7.51±2.14 and 7.21±2.46 in girls and boys, respectively. Furthermore, low, medium and high adherence to MD was 3.9%, 42.5% and 53.5% in girls, respectively vs. 7.4%, 45.3% and 47.3% in boys, respectively. Regarding breakfast, 89.2% consumed dairy products, 69.4% ate cereals and 35.2% consumed industrial pastries. Furthermore, 22% consumed fast food weekly and 19.7% had sweets >1/day. The percentage of children who ate fruits and vegetables was 81.1% and 70.3%, respectively;while those having them >1/day decreased until 66.0% and 39.3%, respectively. More than 70% ate legumes >1/week and fish regularly, and the intake of pasta or rice ≥5/week and nuts 2-3/week was lower than 50%. Conclusions: Our results suggest that adherence to MD is high during the COVID-19 pandemic, especially in girls;however, consumption of fast food could be reduced. The acquisition of healthy habits during childhood is essential for adulthood and to prevent chronic diseases.

9.
Therapeutic Advances in Drug Safety ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2009328

ABSTRACT

Pharmacovigilance (PV) came suddenly into the spotlight when several new vaccines, developed as a response to the COVID-19 pandemic, received emergency authorisation and were rolled out on a large scale in late 2020. The vaccines underwent stringent clinical trials and evaluation from regulatory authorities, but with the use of novel technology and an anticipated rapid and vast deployment of the vaccines, the importance of a well-functioning international post marketing safety surveillance system was stressed. International PV stakeholders were faced with several challenges due to the extent of the global vaccination campaign. The unprecedented volume of reports of suspected adverse events following immunization has led to the development and use of new tools. Furthermore, the collaboration between various PV stakeholders was encouraged and strengthened. PV rose to the challenges posed by the currently ongoing global COVID-19 vaccination campaign and successful adaptations were made in a short period of time. However, the pandemic has not ended yet, the vaccination campaign is far from being completed, and further challenges are anticipated. Advances made during the pandemic will be important to strengthen PV in future and ensure to advance medicines’ safety together. Plain Language Summary: Global safety monitoring of the COVID-19 vaccines: challenges, preparations, and outlooks Pharmacovigilance (PV) is the umbrella term for all sciences and activities relating to the detection, assessment, understanding, and prevention of adverse effects relating to medicines or vaccines. PV came into the spotlight when several new vaccines were authorised and rolled out as a response to the COVID-19 pandemic. The anticipated extent of the global vaccine rollout stressed the importance of a well-functioning safety surveillance system and international collaborations between patients, health care workers, vaccine producers, regulatory authorities, and PV centres. The identification and communication of potential safety concerns showed that adaptations to PV processes made in a short period of time as well as international collaborations were successful. However, it is important to learn from experiences made so far and to make sure the positive advances are maintained in the future to advance medicines’ safety together.

10.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005657

ABSTRACT

Background: Combined-modality treatments are bladder-preserving alternatives for patients (pts) who are not candidates for radical cystectomy by medical reasons, refusal, or patientś choice. Immune therapies seem to potentiate tumor-specific immune response induced by radiotherapy (RT). Combination of RT with anti-PD-1/PD-L1 therapy appears safe and there are signs of promising activity. The aim of this study is to assess the efficacy and safety of atezolizumab (ATZ) concurrent with external beam radiotherapy (EBRT) for the treatment of muscle-invasive bladder cancer (MIBC) with bladder preservation intent. Here we present an interim analysis. Methods: This is an open, multicenter, and phase II trial, sponsored by SOGUG, in pts with confirmed diagnosis of MIBC in clinical stages cT2-T4a N0 M0 who are not candidates for radical cystectomy. Treatment consists of 6 doses of ATZ 1200 mg IV every 3 weeks, starting on day 1 of EBRT, and 60 Gy of RT in 30 fractions over 6 weeks at 2 Gy/day. The primary endpoint of the study is pathological complete response (pCR) defined as a response of grade 5 according to Miller and Payne criteria, 1 to 2 months after the last dose of ATZ. A planned interim analysis has been performed (data cut-off date: November 2021) on the primary endpoint to avoid exposure to ineffective treatment according to the minimax two-stages Simon's design (stopping rule: 9 out of the first 13 evaluable pts should achieve pCR). Incidence of adverse events (AE) and serious AE (SAE) has been also secondarily assessed. Results: From September 2019 to November 2021, 39 pts were screened, of whom 13 were excluded due to non-compliance with eligibility criteria. Thus, the evaluable population consisted of 26 pts. The safety analysis was performed in 22 pts who had received at least one dose of ATZ. 14 pts were assessed pathologically and, thus, included in interim efficacy analysis (median age: 78.6 years;clinical stage: 71.4% T2a, 14.3% T2b, 7.1% T3a, 7.1% T3b). All 14 pts had achieved pCR at the cut-off date. 20/22 (91%) pts experienced at least one AE, with asthenia (11 pts), diarrhea (9 pts), and urinary tract infection (4 pts) being the most common. 9 SAEs were reported in 7 (32%) pts (bacteriemia, COVID-19 infection, depressed LVEF, unknown origin fever, hepatic toxicity, kidney failure, rectorrhagia, respiratory infection, and urinary sepsis). 6 (27%) pts suffered AEs leading to treatment discontinuation. No AEs leading to death occurred. 17 pts with available data on survival were alive at the cut-off date. Conclusions: Interim results suggest that ATZ combined with EBRT is a feasible and effective treatment in terms of pCR, with a manageable safety profile. The final results from this trial will provide information about its effects on clinical outcome, including survival and updated safety findings.

11.
Journal of Public Health Research ; 11(2), 2022.
Article in English | Web of Science | ID: covidwho-2005594

ABSTRACT

Background: This study aimed to evaluate the respect for users' rights, job satisfaction, and well-being between mental health workers (MHWs) compared to non-mental health care workers (nMHWs) from the same Italian region. Methods: The sample was recruited from community mental health and non-mental health outpatient centers in Sardinia. Participants fulfilled the WellBeing at work and respect for human-rights questionnaire (WWRR). The sample included 240 MHWs and 154 nMHWs. Results: MHWs were more satisfied with their work and workplace compared to nMHWs. MHWs had stronger beliefs that users were satisfied with the care received, and both workers and users' human rights were respected in their workplace. MHWs reported to need more rehabilitation therapists and psychologists in their services, while nMHWs needed more nurses and professionals for users' personal care. Italian MHWs are more satisfied with their work and workplace, and more convinced that users are satisfied with the care received and that users' and staff human rights are respected in their workplaces, compared to nMHWs. Conclusions: The historic link between the community mental health network and other support networks in Italy and the consequent perception of proximity to the citizens of the care network may be the reason for this optimal situation of Italian MHWs.

12.
Human reproduction (Oxford, England) ; 37(Suppl 1), 2022.
Article in English | EuropePMC | ID: covidwho-1998469

ABSTRACT

Study question Do the different types of vaccines against SARS-CoV-2 influence the results of an Assisted Reproduction treatment? Summary answer The type of vaccine administered against SARS-CoV-2 does not affect the results in women performing an Assisted Reproduction treatment. What is known already Since the COVID-19 pandemic was declared, the search for vaccines has become the priority, so its development has represented a step towards herd immunity in a short period of time. Despite this encouraging advance, vaccine hesitancy in reproductive-aged women has been heightened because of the spread of misinformation stating that COVID-19 vaccines will cause sterility. Due to the lack of information and the clinical relevance, the objective of this work was to evaluate the impact of the different types of vaccines on women’s fertility. Study design, size, duration Retrospective and observational study during January-October 2021 in women vaccinated against SARS-CoV-2 and performing an Assisted Reproductive treatment in any of the 11 clinics belonging to the IVIRMA group in Spain. The Control group included patients performing a treatment during the same study period but who had not yet been vaccinated. The study was approved by an Institutional Review Board (2109-MADR-084-AR) Participants/materials, setting, methods All women, those who had received the complete vaccination schedule, regardless of the type of vaccine administered mRNA or viral vector, and women from the control group underwent the same ovarian stimulation protocol. The Assisted Reproduction treatment was performed with their own oocytes in all cases. Statistical analyses were performed using the Statistical Package for Social Sciences 19.0 (IBM Corporation, Armonk, NY, USA). Main results and the role of chance We included 510 patients distributed as follows: 13.5% (n = 69) received a viral vector vaccine either the adenovirus serotype 26 vector vaccine (Ad26.CoV2.S;Johnson & Johnson;n = 31) or the chimpanzee adenovirus vector vaccine (ChAdOx;AstraZeneca;n = 38). The remaining 86.5% (n = 441) received an mRNA vaccine from either Pfizer-BioNTech (n = 336) or Moderna (n = 105). Sample size for control group was n = 1190 Our results showed that women vaccinated with Johnson & Johnson have a higher average age (39.7 ± 4.3) than the other groups, although no statistical difference was observed (p = 0.072);that is, AstraZeneca (36.8 ± 1.7), Moderna (35.7 ± 1.5), Pfizer (34.6 ± 1.6) and the control group (37.8 ± 2.7). This circumstance did not affect other parameters such as the days of stimulation (p = 0.336) or the doses of FSH administered (p = 0.392), where no statistical differences were recorded between the vaccinated and the control group. Finally, the number of oocytes were as follows, Johnson & Johnson (9.2 ± 2.6), AstraZeneca (7.7 ± 1.2), Moderna (11.3 ± 1.8), Pfizer (12.6 ± 1.0), and the control group (10.2 ± 1.5), p = 0.06. Limitations, reasons for caution This is an observational study, and thus possible confounders cannot be excluded entirely. More data are needed to draw firm conclusions, and it will be critical to increase the sample size to check if the results observed in this work remains in the general population Wider implications of the findings This is the first study to assess whether the type of vaccine administered against SARS-CoV-2, mRNA, or viral vector, affects ovarian function in ART. These early findings suggest no measurable detrimental on ovarian response regardless of vaccine received. Trial registration number not applicable

13.
Journal of General Internal Medicine ; 37:S653, 2022.
Article in English | EMBASE | ID: covidwho-1995807

ABSTRACT

SETTING AND PARTICIPANTS: Structural racism is defined as the cumulative effects of policies, institutional practices, cultural representations, and other norms that work together to perpetuate racial inequity. This phenomenon extends to academic medicine and is exposed through how we teach, learn, and evaluate patients, students, trainees, and faculty physicians. Thus, the authors created a faculty development series to establish a knowledge of structural competency as a framework for teaching and to change participants' attitudes and confidence. Our participants consisted of clinician-educators (N=122) including internal medicine (generalists and subspecialists), pediatrics, psychiatry, and surgery who participated in sessions rooted in structural competency. The authors developed and facilitated the sessions over Zoom. DESCRIPTION: In the wake of Black Lives Matter protests following the killing of George Floyd, and in light of alarming health disparities uncovered in the COVID-19 pandemic, our institution, like many across the country, realized the importance of actively training providers to address racism and its downstream effects. Despite this, there are few examples of curricula for clinician-educators. Structural competency offers a framework for practicing anti-racism in medical education. We developed a faculty development workshop series consisting of four 90-minute workshops administered in the spring and summer of 2021 and developed or adapted associated tools that could be directly applied to teaching. Session Developed Tools Introduction to Structural Competency & Revising Existing Curricula Structurally competent and anti-racist rubric for revising existing didactics Transforming Resident Report and Case-Based Presentations Using the Structural Differential Step by step guide for building a structural differential with learners Ambulatory Teaching: The Structurally Competent Preceptor Structurally competent adaptations of the One Minute Preceptor and SNAPPS precepting models Inpatient Teaching: Structurally Competent Hospital-Based Medicine Structurally competent inpatient discharge checklist EVALUATION: Preliminary results showed significant improvements in overall faculty attitudes and confidence on pre-and post-intervention surveys (M=1.92, SD=2.29, p= 0.01;M=4.36, SD=3.32, p=.0.00) respectively. Additional results will evaluate whether there are improvements in faculty knowledge and behavior by tracking faculty use of the structural competency rubric and comparing faculty clinical documentation practices before and after the curriculum. DISCUSSION / REFLECTION / LESSONS LEARNED: The potential next step is to integrate into a faculty development program aimed to bolster structurally competent communication with diverse patients, strengthen efficiencies in clinical data gathering, and deepen patient trust in treatment plans. Future investigations will center on the validation of a survey tool to assess anti-racism within an institution's teaching faculty and apply the workshop to various institutional settings.

14.
Journal of General Internal Medicine ; 37:S620, 2022.
Article in English | EMBASE | ID: covidwho-1995751

ABSTRACT

SETTING AND PARTICIPANTS: In response to the need for innovative community engagement and pre-medical education, the COVID-19 STEM Community Education and Empowerment Internship program (CCEEI) was developed as a collaboration between six New York City medical schools and Mentoring in Medicine, a non-profit organization. This virtual program was attended by 1045 underrepresented in medicine (UriM), first-generation, and disadvantaged college and gap year students who were interested in medical and health careers, over the first three cohorts. Participants learned about COVID-19 and disparities, vaccine science, the roles of medicine and public health, and strategies for community education and empowerment. 1045 U.S. based students participated over three cohorts as well as additional students from around the world. DESCRIPTION: 4-8 sessions, each 2-4 hours long, each of which consisted of lectures (e.g. virology and pandemics, COVID-19 biology and prevention, how vaccines work, etc.) followed by interactive discussions. Learner assessment included mid-point survey, end of program survey, and post-30 day survey, and capstone projects presented during the final session of the program;capstones were intended to raise awareness of COVID-19 safety measures and vaccines to a lay audience. Examples included Tik Tok videos, infographics, PowerPoint presentations, etc. Each student received a certificate of acknowledgment for their participation in the COVID-19 STEM Education and Empowerment Internship. EVALUATION: Recruiting efforts were successful in providing this premedical program available to students from URiM backgrounds, 55% identified as Black or Latino and 97% were interested in health professional careers. Program evaluation consisted of aggregate learner assessments and administration of a mixed-method survey seeking participant perspectives. Program participants applied knowledge they gained and self-reported outreach to at least 13,499 people in their communities on COVID-19 and COVID-19 vaccination. Most frequent modes of communication included: TikTok, YouTube, and Instagram. DISCUSSION / REFLECTION / LESSONS LEARNED: Program adjustments including curriculum changes were made based on mid-point, end-of-course, and post-surveys. There was an overwhelming response from students wanting to gain knowledge and be a part of outreach efforts to impact their communities. In the first session, many students shared in their e-poster personal impacts of COVID, ranging from loss of family and friends, and isolation experienced. There is much promise in reaching pre-medical students through a virtual education program as students reported gaining communication skills to address myths and vaccine hesitancy and felt empowered to use technology to share knowledge gained from the program with their networks.

15.
Journal of General Internal Medicine ; 37:S568, 2022.
Article in English | EMBASE | ID: covidwho-1995673

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: In early 2021, only 14% of vaccine eligible patients of two academic outpatient practices had received at least one COVID-19 vaccine dose;Black patients comprised 16% of all vaccine eligible patients, but only 10% of those vaccinated, while Hispanic patients comprised 13% of all vaccine eligible patients, but only 7% of those vaccinated. DESCRIPTION OF PROGRAM/INTERVENTION: The objective of this study was to rapidly develop and implement an equity-focused outreach intervention that facilitated COVID-19 vaccine appointments in patients who qualified for a vaccine. The intervention aimed to contact Black and Latino adults ≥65 years old, or ≥18 years old with qualifying chronic conditions, who had at least one visit at the practices within the past three years and who had not received or scheduled a COVID-19 vaccination per electronic health records. Using the Plan-Do-Study-Act model, we developed and executed a multipronged outreach intervention consisting of (1) a mailed letter from the patient's physician endorsing the COVID-19 vaccine, (2) a phone call/recall system to remind patients about their eligibility to receive the vaccine, (3) discussions with a vaccine ambassador to answer questions or address hesitancies regarding the vaccines, and (4) real-time facilitation with scheduling a vaccine appointment and information about where in the community to receive or schedule a vaccine. Volunteer callers were recruited and trained in executing all components of the intervention. MEASURES OF SUCCESS: Bi-weekly focus groups were held with callers to identify challenges with implementation. The number of calls made, patients reached and vaccinations scheduled were analyzed weekly. FINDINGS TO DATE: From March 15 to May 28, 2021, 38 callers were recruited and 5058 calls were made as part of our outreach intervention. Of 2794 total patients attempted, 1519 were successfully reached, 746 of whom had already scheduled or received a vaccine (without documentation in the electronic health record). Of the 750 patients who were reached and eligible for the intervention, 129 (17.2%) had a vaccine scheduled by the caller, 72 (9.6%) planned to self- schedule a vaccine and were instructed on how to do so by the callers, and 549 (73.2%) did not want nor planned to have the vaccine scheduled. The weekly proportion of eligible patients scheduled for vaccine decreased over time, starting at 30% and ending at 0% in the 11th week of the intervention, at which point the intervention was stopped. “Low confidence in the vaccine” and “Still contemplating whether to receive the vaccine” were the two reasons most cited for declining or being unsure about receiving the vaccine. KEY LESSONS FOR DISSEMINATION: An equity-focused outreach program to facilitate vaccination scheduling can be rapidly developed and implemented in outpatient primary care practices, but may need to further consider inaccuracies in vaccination status as documented in the electronic records and increase access to accessible vaccinations sites.

16.
Conference on Global Medical Engineering Physics Exchanges/Pan American Health Care Exchanges (GMEPE/PAHCE) ; 2022.
Article in English | Web of Science | ID: covidwho-1985447

ABSTRACT

Stress index is a useful indicator in mechanical ventilation to assess improper ventilation settings. It can indicate tidal overdistension or tidal recruitment, which are two major mechanisms of ventilator-induced lung injury. However, it's implementation require dedicated hardware and software and is not a widespread parameter used in commercial ventilators. In this work, an alternative, simple way to visually inspect the concavity of the pressure-time curve during mechanical ventilation is presented, by calculating the pressure difference of the pressure-time curve. This proves useful when implemented in low-cost emergency devices, such as those designed to cope with the COVID-19 pandemic, because of the reduced computational load required to perform its calculation. The method was implemented in a low-cost emergency mechanical ventilator and tested with an artificial lung for a proof-of-concept. Results show that this alternative method can be effectively used to qualitatively assess the concavity of the pressure-time curve.

18.
Medicina (Argentina) ; 82(4):487-495, 2022.
Article in Spanish | EMBASE | ID: covidwho-1965451

ABSTRACT

Introduction: the information regarding characteristics and ventilatory results comparing the first (W1) and the second wave (W2) in Argentina are limited. The main objective of this study was to describe general characteristics and ventilatory variables in COVID-19 patients who required invasive mechanical ventilation (IMV) and compare differences between waves. Secondarily, factors associated with mortality in intensive care unit (ICU) were studied. Methods: We conducted a prospective observational cohort study that included patients older than 18 years infected with SARS-CoV-2 consecutively admitted to ICU with IMV between August 1, 2020, and June 30, 2021. We included 412 patients. Results: We found statistically significant differences (p < 0.001) in age [W1 64(55-72) vs W2 59 (50-66) years], presence of COPD [W1 n = 42 (19.8%) vs. W2 n = 13(6.3%)], plateau pressure [W1 27(25-30) cm H2 O vsW2 24 (22-27) cmH2O], driving pressure (ΔP) [W1 15 (13-17) cmH2 O vs. W2 12 (11-14) cm H2O] compliance [W1 40 mL/cmH2O (32-46) vs. W2 = 33 mL/cm H2O (27-40)];reintubation [W1 30.4% (n = 63/207) vs. W2 13.7% (n = 28/205)]. We identified as independent factors associated with mortality the following variables: age [OR 1.07(95% CI 1.05-1.09)], the ΔP in the first 24 hours [OR 1.19(95% CI 1.10-1.28)] and W2 [OR 1.81 (95% IC1.12-2.93);p = 0.015. Discussion: During W2 the patients were younger. It was possible to achieve ventilatory mechanics more adjusted to a protective ventilation strategy. In conclusion, in the patients studied, age and ΔP were independent predictors of mortality.

19.
Revista Colombiana de Ciencias Quimico-Farmaceuticas(Colombia) ; 51(1):470-492, 2022.
Article in Spanish | Scopus | ID: covidwho-1964772

ABSTRACT

Introduction: The COVID-19 pandemic caused human losses, tensions in medical care, the economy and other social systems. Objective: To collect information on food safety and fortification of foods based on coffee pulp, considering that good nutrition counteracts infections. Methodology: Literature in SciELO and SCOPUS bases was analyzed, restricting search terms to food safety, COVID-19, block chain technology, food supply, micronutrients, regulation, iron fortification with emphasis on coffee pulp-based products. Results: In times of pandemic and other disasters, one of the factors that affect the response of a host to the virus is nutrition. The importance of food security is recognized with proposals especially in countries with high rates of malnutrition and anemia, for the fortification of common foods to contribute to guaranteeing nutritional adequacy as part of the governments’ responses, especially in impoverished rural and urban areas, considering food supply systems with block or Block Chain technology. Conclusion: The fortification of food products based on coffee pulp and their supply using block chain could be a response strategy to the consequences of the pandemic. © 2022. Revista Colombiana de Ciencias Quimico-Farmaceuticas(Colombia). All Rights Reserved.

20.
Open Public Health Journal ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1957130

ABSTRACT

Introduction: The study of seasonal influences on the COVID-19 pandemic can take advantage of the unique position of Chile and its different climatic profiles in the north-south extension. The purpose is to verify the influence of seasonal climate changes on the COVID-19 in the temperate and sub-arctic areas of Chile. Methods: We monitored the evolution of CFR in temperate versus sub-boreal regions, reporting from the John Hopkins University COVID-19 Center on the CFR in each province in midwinter, spring, and early summer. Results: CFR worsened from mid-winter to mid-spring in the temperate zone of Chile, while in the sub-boreal area the CFR improves in the same period, (Kruskal Wallis Test, p=0.004). In the temperate zone after the increase in late winter-early spring, CRF tends to stabilize;on the contrary in the sub-boreal zone, there is a more marked tendency to worsen the CFR at the same time (Kruskal Wallis Test, p=0.010). The temperate zone of Chile shows a CFR increasing until spring-like temperate Europe, unlike Europe CFR does not decrease in summer, but the mean minimum temperature in temperate Chile is lower in summer than in temperate Europe. In Patagonian, CFR remains stable or drops from winter to spring but increases in early summer. Conclusion: The temperate and sub-boreal zones of Chile have a markedly different CFR variation profile during the COVID-19 pandemic.

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