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1.
JAMA health forum ; 3(1), 2022.
Article in English | EuropePMC | ID: covidwho-1738058

ABSTRACT

This cross-sectional analysis examines changes in health service use among community-dwelling persons with dementia, persons with Parkinson disease, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Key Points Question Was the COVID-19 pandemic associated with changes in health service use and mortality among community-dwelling persons with dementia and Parkinson disease compared with older adults? Findings In this population-based repeated cross-sectional analysis, large declines in hospital use and nursing home admission were experienced across all cohorts. After the first wave, most services returned to historical levels, with physician visits elevated and mostly virtual, nursing home admissions reduced, and excess all-cause mortality. Meaning The pandemic was associated with meaningful health service disruptions for persons with dementia and Parkinson disease, highlighting that continued support for virtual care is needed to ensure optimal health outcomes. Importance Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services. Objective To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic. Design, Setting, and Participants Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada. Exposures COVID-19 pandemic as of March 1, 2020. Main Outcomes and Measures Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels. Results Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466;mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606;73.7 [10.2] years) and older adults (n = 2 363 742;74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10;95% CI, 0.07-0.15;RR for PD: 0.03;95% CI, 0.00-0.21;RR for older adults: 0.11;95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45;95% CI, 0.41-0.48;RR for PD: 0.40;95% CI, 0.34-0.48;RR for older adults: 0.45;95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07;95% CI, 1.05-1.09;RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts. Conclusions and Relevance In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.

2.
JAMA Pediatr ; 176(4): e216298, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1669341

ABSTRACT

Importance: Public health measures to reduce the spread of COVID-19 have heightened distress among children and adolescents and contributed to a shift in delivery of mental health care services. Objectives: To measure and compare physician-based outpatient mental health care utilization before and during the COVID-19 pandemic and quantify the extent of uptake of virtual care delivery. Design, Setting, and Participants: Population-based repeated cross-sectional study using linked health and administrative databases in Ontario, Canada. All individuals aged 3 to 17 years residing in Ontario from January 1, 2017, to February 28, 2021. Exposures: Pre-COVID-19 period from January 1, 2017, to February 29, 2020, and post-COVID-19 onset from March 1, 2020, to February 28, 2021. Main Outcomes and Measures: Physician-based outpatient weekly visit rates per 1000 population for mental health diagnoses overall and stratified by age group, sex, and mental health diagnostic grouping and proportion of virtual visits. Poisson generalized estimating equations were used to model 3-year pre-COVID-19 trends and forecast expected trends post-COVID-19 onset and estimate the change in visit rates before and after the onset of COVID-19. The weekly proportions of virtual visits were calculated. Results: In a population of almost 2.5 million children and adolescents (48.7% female; mean [SD] age, 10.1 [4.3] years), the weekly rate of mental health outpatient visits was 6.9 per 1000 population. Following the pandemic onset, visit rates declined rapidly to below expected (adjusted relative rate [aRR], 0.81; 95% CI, 0.79-0.82) in April 2020 followed by a growth to above expected (aRR, 1.07; 95% CI, 1.04-1.09) by July 2020 and sustained at 10% to 15% above expected as of February 2021. Adolescent female individuals had the greatest increase in visit rates relative to expected by the end of the study (aRR, 1.26; 95% CI, 1.25-1.28). Virtual care accounted for 5.0 visits per 1000 population (72.5%) of mental health visits over the study period, with a peak of 5.3 visits per 1000 population (90.1%) (April 2020) and leveling off to approximately 70% in the latter months. Conclusions and Relevance: Physician-based outpatient mental health care in Ontario increased during the pandemic, accompanied by a large, rapid shift to virtual care. There was a disproportionate increase in use of mental health care services among adolescent female individuals. System-level planning to address the increasing capacity needs and to monitor quality of care with such large shifts is warranted.


Subject(s)
COVID-19 , Physicians , Adolescent , COVID-19/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Mental Health , Ontario/epidemiology , Pandemics
3.
Small Methods ; 5(5): e2001108, 2021 05.
Article in English | MEDLINE | ID: covidwho-1599126

ABSTRACT

During the global outbreak of COVID-19 pandemic, "cytokine storm" conditions are regarded as the fatal step resulting in most mortality. Hemoperfusion is widely used to remove cytokines from the blood of severely ill patients to prevent uncontrolled inflammation induced by a cytokine storm. This article discoveres, for the first time, that 2D Ti3 C2 Tx MXene sheet demonstrates an ultrahigh removal capability for typical cytokine interleukin-6. In particular, MXene shows a 13.4 times higher removal efficiency over traditional activated carbon absorbents. Molecular-level investigations reveal that MXene exhibits a strong chemisorption mechanism for immobilizing cytokine interleukin-6 molecules, which is different from activated carbon absorbents. MXene sheet also demonstrates excellent blood compatibility without any deleterious side influence on the composition of human blood. This work can open a new avenue to use MXene sheets as an ultraefficient hemoperfusion absorbent to eliminate the cytokine storm syndrome in treatment of severe COVID-19 patients.


Subject(s)
COVID-19/immunology , Cytokine Release Syndrome/drug therapy , Hemoperfusion/methods , Nanostructures/administration & dosage , SARS-CoV-2/immunology , Titanium/administration & dosage , Adsorption , COVID-19/transmission , COVID-19/virology , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/virology , Humans , Interleukin-6/immunology , Nanostructures/chemistry , SARS-CoV-2/isolation & purification , Titanium/chemistry
4.
Alzheimer's & Dementia ; 17(S10):e055623, 2021.
Article in English | Wiley | ID: covidwho-1589222

ABSTRACT

Background Little has been quantified, at a population-level, about the magnitude of heath service disruption to persons living with dementia in community settings during the COVID-19 pandemic. Sustained access to health care services is particularly important for persons with dementia and other neurodegenerative diseases as they are vulnerable to decline. Method Health administrative data from Ontario, Canada were used to examine patterns of health service use among all persons with Alzheimer disease and related dementias (dementia) who were alive and living in the community. This cohort was compared to persons with Parkinson?s disease (PD) as well as all older adults (age 65+ years) without neurodegenerative diseases. Rates of all-cause hospital admissions, emergency department visits, primary care and specialist physician visits and home care visits were analyzed for all individuals alive and eligible for provincial health insurance at the start of each weekly period from March 1, 2020 to September 20, 2020 (pandemic period) and from March 3, 2019 to September 22, 2019 (pre-pandemic period). Rates of health service use during specific weeks in the pandemic period (i.e., lowest week, last available week) were compared to corresponding weeks in the pre-pandemic period within each cohort using percent changes. Results On March 1, 2020, 128,696 persons with dementia, 30,099 with PD and 2,460,358 older adults were eligible for provincial health services. Across cohorts and services, dramatic declines in use of health services were observed at the lowest week: hospitalization (-38.7% dementia, -72.3% PD, -44.2% older adults);emergency department (-54.9% dementia, -57.7% PD, -53.6% older adults);home care (-14.8% dementia, -19.4% PD, -7.4% older adults). Health services varied in how quickly they rebounded to pre-pandemic levels within cohorts;notably, by the end of the study period, emergency department visits had increased to a level higher than corresponding 2019 weekly rates (24.2% dementia, 15.2% PD, 7.4% older adults). Conclusions The first wave of the COVID-19 pandemic meaningfully and immediately disrupted use of health care services for persons living with dementia and PD and may have resulted in long-term consequences that should be monitored.

5.
CMAJ Open ; 9(4): E1149-E1158, 2021.
Article in English | MEDLINE | ID: covidwho-1575519

ABSTRACT

BACKGROUND: There were large disruptions to health care services after the onset of the COVID-19 pandemic. We sought to describe the extent to which pandemic-related changes in service delivery and access affected use of primary care for children overall and by equity strata in the 9 months after pandemic onset in Manitoba and Ontario. METHODS: We performed a population-based study of children aged 17 years or less with provincial health insurance in Ontario or Manitoba before and during the COVID-19 pandemic (Jan. 1, 2017-Nov. 28, 2020). We calculated the weekly rates of in-person and virtual primary care well-child and sick visits, overall and by age group, neighbourhood material deprivation level, rurality and immigrant status, and assessed changes in visit rates after COVID-19 restrictions were imposed compared to expected baseline rates calculated for the 3 years before pandemic onset. RESULTS: Among almost 3 million children in Ontario and more than 300 000 children in Manitoba, primary care visit rates declined to 0.80 (95% confidence interval [CI] 0.77-0.82) of expected in Ontario and 0.82 (95% CI 0.79-0.84) of expected in Manitoba in the 9 months after the onset of the pandemic. Virtual visits accounted for 53% and 29% of visits in Ontario and Manitoba, respectively. The largest monthly decreases in visits occurred in April 2020. Although visit rates increased slowly after April 2020, they had not returned to prerestriction levels by November 2020 in either province. Children aged more than 1 year to 12 years experienced the greatest decrease in visits, especially for well-child care. Compared to prepandemic levels, visit rates were lowest among rural Manitobans, urban Ontarians and Ontarians in low-income neighbourhoods. INTERPRETATION: During the study period, the pandemic contributed to rapid, immediate and inequitable decreases in primary care use, with some recovery and a substantial shift to virtual care. Postpandemic planning must consider the need for catch-up visits, and the long-term impacts warrant further study.


Subject(s)
COVID-19/epidemiology , Pediatrics/statistics & numerical data , Primary Health Care/statistics & numerical data , Adolescent , Age Distribution , Ambulatory Care/statistics & numerical data , COVID-19/virology , Child , Child, Preschool , Cross-Sectional Studies , Databases, Factual , Emigrants and Immigrants , Female , Humans , Infant , Infant, Newborn , Male , Manitoba/epidemiology , Ontario/epidemiology , Outcome Assessment, Health Care , Pandemics , Population Surveillance , Rural Population
6.
Dis Markers ; 2021: 6803510, 2021.
Article in English | MEDLINE | ID: covidwho-1443673

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the most significant public health threat worldwide. Patients with severe COVID-19 usually have pneumonia concomitant with local inflammation and sometimes a cytokine storm. Specific components of the SARS-CoV-2 virus trigger lung inflammation, and recruitment of immune cells to the lungs exacerbates this process, although much remains unknown about the pathogenesis of COVID-19. Our study of lung type II pneumocyte cells (A549) demonstrated that ORF7, an open reading frame (ORF) in the genome of SARS-CoV-2, induced the production of CCL2, a chemokine that promotes the chemotaxis of monocytes, and decreased the expression of IL-8, a chemokine that recruits neutrophils. A549 cells also had an increased level of IL-6. The results of our chemotaxis Transwell assay suggested that ORF7 augmented monocyte infiltration and reduced the number of neutrophils. We conclude that the ORF7 of SARS-CoV-2 may have specific effects on the immunological changes in tissues after infection. These results suggest that the functions of other ORFs of SARS-CoV-2 should also be comprehensively examined.


Subject(s)
COVID-19/metabolism , Chemotaxis , Monocytes/pathology , Neutrophils/pathology , Open Reading Frames/physiology , Pneumonia/pathology , Viral Proteins/metabolism , A549 Cells , Chemokine CCL2/metabolism , Humans , In Vitro Techniques , Monocytes/immunology , Monocytes/metabolism , Neutrophils/immunology , Neutrophils/metabolism , Pneumonia/immunology , Pneumonia/metabolism , SARS-CoV-2/metabolism , Viral Proteins/genetics
7.
J Am Med Dir Assoc ; 22(11): 2258-2262.e1, 2021 11.
Article in English | MEDLINE | ID: covidwho-1440152

ABSTRACT

OBJECTIVE: To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata. DESIGN: Population-based time series analysis. SETTING AND PARTICIPANTS: Community-dwelling adults with dementia in Ontario, Canada, from January 2019 to September 2020. METHODS: We used health administrative databases (Ontario Registered Persons Database and Home Care Database) to measure home care services used by participants. Poisson regression models were fit to compare weekly rates of home care services during the pandemic to historical trends with rate ratios (RRs) and 95% confidence intervals (CIs) stratified by service type (nursing, personal care, therapy), sex, rurality, and neighborhood income quintile. RESULTS: During the first wave of the pandemic, personal care fell by 16% compared to historical levels (RR 0.84, 95% CI 0.84, 0.85) and therapies fell by 50% (RR 0.50, 95% CI 0.48, 0.52), whereas nursing did not significantly decline (RR 1.02, 95% CI 1.00, 1.04). All rates had recovered by September 2020, with nursing and therapies higher than historical levels. Changes in services were largely consistent across sociodemographic strata, although the rural population experienced a larger decline in personal care and smaller rebound in nursing. CONCLUSIONS AND IMPLICATIONS: Personal care and therapies for individuals with dementia were interrupted during the early months of the pandemic, whereas nursing was only minimally impacted. Pandemic responses with the potential to disrupt home care for individuals living with dementia must balance the impacts on individuals with dementia, caregivers, and providers.


Subject(s)
COVID-19 , Dementia , Home Care Services , Adult , Dementia/epidemiology , Dementia/therapy , Humans , Independent Living , Ontario/epidemiology , Pandemics , SARS-CoV-2
8.
Med Sci Monit ; 27: e931467, 2021 Oct 06.
Article in English | MEDLINE | ID: covidwho-1344552

ABSTRACT

BACKGROUND Effective identification of patients with suspected COVID-19 is vital for the management. This study aimed to establish a simple clinical prediction model for COVID-19 in primary care. MATERIAL AND METHODS We consecutively enrolled 60 confirmed cases and 152 suspected cases with COVID-19 into the study. The training cohort consisted of 30 confirmed and 78 suspected cases, whereas the validation cohort consisted of 30 confirmed and 74 suspected cases. Four clinical variables - epidemiological history (E), body temperature (T), leukocytes count (L), and chest computed tomography (C) - were collected to construct a preliminary prediction model (model A). By integerizing coefficients of model A, a clinical prediction model (model B) was constructed. Finally, the scores of each variable in model B were summed up to build the ETLC score. RESULTS The preliminary prediction model A was Logit (YA)=2.657X1+1.153X2+2.125X3+2.828X4-10.771, while the model B was Logit (YB)=2.5X1+1X2+2X3+3X4-10. No significant difference was found between the area under the curve (AUC) of model A (0.920, 95% CI: 0.875-0.953) and model B (0.919, 95% CI: 0.874-0.952) (Z=0.035, P=0.972). When ETLC score was more than or equal to 9.5, the sensitivity and specificity for COVID-19 was 76.7% (46/60) and 90.1% (137/152), respectively, and the positive and negative predictive values were 75.4% (46/61) and 90.7% (137/151), respectively. CONCLUSIONS The ETLC score is helpful for efficiently identifying patients with suspected COVID-19.


Subject(s)
COVID-19/diagnosis , Diagnosis, Computer-Assisted/methods , Primary Health Care/methods , Body Temperature , COVID-19/epidemiology , Humans , Leukocyte Count , Logistic Models , SARS-CoV-2 , Tomography, X-Ray Computed
9.
Clin Lab ; 67(1)2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1045292

ABSTRACT

BACKGROUND: The COVID-19 outbreak, which began in late 2019, continues to ravage the globe and has become the greatest threat to human health. As nucleic acid test is the primary means of screening for COVID-19, this makes the laboratory the most important node in the epidemic prevention and control system. METHODS: As a small laboratory in the hospital, we can meet a large number of demands for nucleic acid test by optimizing staff process, strictly disinfecting experimental batches and changing experimental methods. RESULTS: Through the improvement of the above aspects, our daily maximum detection quantity has been increased from 256/day to 1,012/day. Besides, none of the medical staff has been infected. And there have been no nosocomial infections. CONCLUSIONS: Nucleic acid laboratories, especially small laboratories, should promptly adjust their strategies in the face of unexpected outbreaks and conduct risk assessment in accordance with laboratory activities.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , COVID-19/virology , Health Services Needs and Demand/organization & administration , Mass Screening/organization & administration , Specimen Handling , Workflow , Workload , Humans , Infection Control/organization & administration , Occupational Health , Predictive Value of Tests
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