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1.
J AAPOS ; 27(3): 137.e1-137.e6, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-2319472

ABSTRACT

PURPOSE: To study the effect of the pandemic-related lockdown (physical distance measures and movement restrictions) on the characteristics and management of retinopathy of prematurity (ROP). METHODS: In this controlled, multicenter cohort study, the medical records of patients born prematurely and screened for ROP in the neonatal intensive care unit during four time periods were reviewed retrospectively: (1) November 1, 2018, to March 15, 2019; (2) March 16, 2019, to August 2, 2019 (lockdown control period); (3) November 1, 2019, to March 15, 2020; and (4) March 16, 2020-August 2, 2020. RESULTS: A total of 1,645 patients met inclusion criteria. Among the 1,633 patients with complete data, mean gestational age (GA) at birth was 28.2, 28.4, 28.0, and 28.3 weeks across time periods 1 to 4, respectively (P = 0.16). The mean birth weight of all patients was 1079.1 ± 378.60 g, with no significant variation across time periods (P = 0.08). There were fewer patients screened during the lockdown period (n = 411) compared with the period immediately before (n = 491) and the same period in the prior year (n = 533). Significantly more patients were screened using indirect ophthalmoscopy, compared to digital imaging (telemedicine), during the lockdown (P < 0.01). There were 11.7%, 7.7%, 9.0%, and 8.8% of patients requiring treatment in each time period, respectively (P = 0.42), with a median postmenstrual age at initial treatment of 37.2, 36.45, 37.1, and 36.3 weeks, respectively (P = 0.32). CONCLUSIONS: We recorded a decrease in the number of infants meeting criteria for ROP screening during the lockdown. The GA at birth and birth weight did not differ. Significantly more infants were screened with indirect ophthalmoscopy, compared to digital imaging, during the lockdown.


Subject(s)
COVID-19 , Retinopathy of Prematurity , Infant, Newborn , Infant , Humans , United States/epidemiology , Birth Weight , Infant, Premature , Cohort Studies , Retrospective Studies , Retinopathy of Prematurity/diagnosis , Retinopathy of Prematurity/epidemiology , Retinopathy of Prematurity/therapy , COVID-19/epidemiology , Communicable Disease Control , Gestational Age , Neonatal Screening/methods , Risk Factors
2.
Open Forum Infectious Diseases ; 9(Supplement 2):S924, 2022.
Article in English | EMBASE | ID: covidwho-2190038

ABSTRACT

Background. Vaccination strategies that provide enhanced immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are needed. We evaluated the safety and immunogenicity of a bivalent omicron containing vaccine, mRNA-1273.214 (50 mug), administered as a second booster dose in adult participants. Methods. In this ongoing phase 2/3 trial, 50 mug of the bivalent vaccine mRNA-1273.214 (25 mug each ancestral Wuhan-Hu-1 and omicron BA.1 spike mRNAs) or 50 mug of the authorized mRNA-1273 were administered as second boosters in adults who previously received a 2 dose (100 mug) primary series and a first booster (50 mug) dose of mRNA-1273 (>= 3 months prior). Primary objectives were safety and reactogenicity and immunogenicity 28 days post-booster dose. Results. In participants with no prior SARS-CoV-2 infection who received booster doses of mRNA-1273.214 (n=334) or mRNA-1273 (n=260), neutralizing antibody (nAb) geometric mean titers (GMTs [95% confidence interval (CI)]) against omicron BA.1 were 2372.4 (2070.6-2718.2) and 1473.5 (1270.8-1708.4), respectively. The model-based GMT ratio (GMR [97.5% CI]) of mRNA-1273.214 compared to mRNA-1273 was 1.75 (1.49-2.04), meeting the pre-specified superiority criterion against omicron BA.1. The pre-specified criterion for non-inferiority against the ancestral SARS-CoV-2 strain was also met. Additionally, mRNA-1273.214 elicited higher GMTs (727.4 [632.8-836.1]) than mRNA-1273 (492.1 [431.1-561.9]) against omicron subvariants BA.4/BA.5 [GMR (95% CI) 1.69 [1.51-1.90])]. Binding antibody responses against alpha, beta, gamma, delta, and omicron were numerically higher in the mRNA-1273.214 group compared to mRNA-1273. mRNA-1273.214 GMTs were consistently higher across age (18-< 65 and >= 65 years) and pre-booster SARS-CoV-2 infection subgroups (Figure). Safety and reactogenicity were similar for both vaccine groups. Conclusion. The bivalent omicron containing mRNA-1273.214 elicited superior nAb responses against omicron 28 days post-immunization compared to mRNA-1273 regardless of age and prior SARS-CoV-2 infection;no new safety concerns were identified. (Figure Presented).

3.
Journal of Adolescent Health ; 70(4):S47-S48, 2022.
Article in English | EMBASE | ID: covidwho-1936675

ABSTRACT

Purpose: The COVID-19 pandemic has led to widespread expansion of telehealth services for adolescent and young adult patients, including contraceptive care. However, many young people lack awareness of telehealth services or how to use them. Our aim was to develop and conduct formative testing of an educational tool to increase young people’s knowledge of telehealth for contraception. Methods: We developed a youth-friendly visual tool on how to access contraception through video and phone visits and online birth control platforms. In July 2021, we recruited 35 young people aged 18-25 of all gender identities in California through social media and outreach at community colleges to inform tool development. Participants completed pre and post surveys after reviewing the tool, and we measured changes in telehealth knowledge using McNemar’s statistical testing. We also conducted semi-structured interviews to understand the survey responses, their perceptions of the educational tool, and their experiences and challenges using telehealth for contraception. We used a modified form of grounded theory to analyze the interview data. Results: Participants included diverse sexual orientations, with 51% straight, 26% bisexual and 18% gay/lesbian or queer. 80% were sexually active and 63% wanted birth control. Most of the participants (86%) identified as a woman, 11% man, and 3% genderqueer/gender non-binary. Participants largely identified as Latinx (57%), with 14% Asian, 14% White, 11% Mideastern, and 9% Black. Telehealth knowledge increased universally after viewing the educational tool. The percentage who knew what telehealth is increased from 60% to 100% (p< 0.001), and knowledge of how to get contraception without going to a clinic in person increased from 37% to 97% (p< 0.001). After viewing the telehealth information, most participants correctly identified which contraceptive methods are available through telemedicine visits, including the pill (100%), patch (100%), vaginal ring (86%), and emergency contraception (86%). Acceptability was high, with all participants agreeing that the tool was useful, taught them new things, and that they would share the information with friends. One participant commented, “I liked seeing what methods you can get through telehealth.” The interview data revealed areas where participants need additional education about telehealth for contraception. Many participants shared concerns about the cost and insurance coverage of telehealth services, confidentiality, and the safety and legitimacy of online birth control prescription companies. Many were unsure how to find a health center that offers telemedicine visits. Most participants wanted to know more about birth control methods available through telehealth, such as their effectiveness and how to use them. Conclusions: This youth-friendly tool helped to improve young people’s knowledge of telehealth for contraception. The next stage will involve community advisory board review and testing a revised version with a larger and more representative sample to ensure acceptability and effectiveness among all young people. As the use of telehealth continues to grow, educational materials are necessary to help address the low levels of telehealth knowledge and barriers to health care among young people. Sources of Support: The JPB Foundation, The William and Flora Hewlett Foundation.

4.
Contraception ; 104(4):466, 2021.
Article in English | EMBASE | ID: covidwho-1408751

ABSTRACT

Objectives: To examine disparities in access to telemedicine visits for contraception during the COVID-19 pandemic by young people's experiences of basic needs insecurity. Methods: We collected data from May 2020 to March 2021 from people at risk of pregnancy aged 18–28 in an ongoing study of community college students in California and Texas (n=1,352). Multivariate logistic regression analyses, adjusted for clustering by site, were conducted to examine differences in access to contraceptive services through telemedicine by food and housing insecurity, controlling for age, race/ethnicity, health insurance, and other key sociodemographic characteristics. Results: Only 9% of participants received their birth control method through a phone or video visit. One quarter (24%) reported it would be difficult to have a telemedicine visit for birth control. Perceived barriers to telemedicine included lacking privacy at home (42%), not knowing how to do a telemedicine visit (25%), lacking a device or Internet connection (23%), clinics not offering telemedicine (16%), and insurance not covering telemedicine (13%). Half (51%) stated they needed to get their method in person, while 36% would not feel comfortable using telemedicine, and 78% preferred in-person visits. Participants experiencing food insecurity (adjustedOR [aOR], 2.14;95% confidence interval [CI], 1.59–2.88) and housing insecurity (aOR, 1.66;95% CI, 1.16–2.38) were significantly more likely to report that they would have difficulty using telemedicine for birth control. Conclusions: Efforts are needed to remove barriers to telemedicine, particularly for young people facing basic needs insecurity, and to ensure that safe, high-quality in-person contraceptive services also remain accessible.

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