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1.
Health Soc Care Community ; 2022 Oct 01.
Article in English | MEDLINE | ID: covidwho-2052489

ABSTRACT

The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.

2.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880855
3.
Topics in Antiviral Medicine ; 30(1 SUPPL):350-351, 2022.
Article in English | EMBASE | ID: covidwho-1880844

ABSTRACT

Background: The impact of COVID-19 mitigation measures on STI transmission and racial disparities remains unknown. The objectives were to examine trends in sex and drug risk behaviors, access to sexual health services and STI positivity overall and by race during-compared to pre-pandemic among urban sexual minorities (MSM). Methods: Sexually-active MSM aged 18-45 years were administered a behavioral survey and STI testing at three-month intervals. Participants completing > one during-pandemic (April-December 2020) and one pre-pandemic study visit (before March 13, 2020) occurring < six months apart were included. Generalized estimating equations with modified Poisson regression models compared outcomes during-compared to pre-pandemic visits. Results: Among 231 MSM, reports of > three sex partners declined [adjusted Prevalence Ratio (aPR): pandemic-1(p1) 0.68, 95% CI (0.54-0.86);pandemic-2(p2) 0.65 (0.51-0.84);pandemic-3(p3) 0.57 (0.43-0.75)];similar findings were observed among Black and non-Black MSM. Black, but not non-Black MSM, reported sustained decreases in substance use (aPR: p1 0.90 (0.79-1.03);p2 0.74 (0.62-0.89);p3 0.82 (0.67-0.99)], and increased HIV/PrEP care engagement [aPR: p1 1.20 (1.07-1.34);p2 1.24 (1.11-1.39);p3 1.30 (1.16-1.47)]. Reported STI testing (overall and by race) decreased [aPR: p1 0.68 (0.57-0.81);p2 0.78 (0.67-0.92)], then rebounded [aPR: p3 1.01 (0.87-1.18)]. Overall, neither chlamydia [aPR: p2 1.62 (0.75-3.46);p3 1.13 (0.24-1.27)] nor gonorrhea [aPR: p2 0.87 (0.46-1.62) p3 0.56 (0.24-1.27)] positivity significantly changed during vs. pre-pandemic. Conclusion: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared to pre-pandemic. Findings underscore the urgent need for novel strategies to deliver STI prevention services without in-person interactions among MSM.

4.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1879896
5.
Physiotherapy (United Kingdom) ; 114:e90-e91, 2022.
Article in English | EMBASE | ID: covidwho-1705339

ABSTRACT

Keywords: Simulation;On-call;Respiratory Purpose: Some newly qualified physiotherapists had reported feeling anxious about at being the respiratory physiotherapist on call. While this is a common theme with each year's new starters, this is likely exacerbated by the changes to some of their placements in their final year due to Covid-19. Alongside this, we were aware that there was a great demand on the on-call respiratory physiotherapy team due to Covid-19, and there was also a need to make them familiar with the PPE required for the treatment they may wish to perform;particularly for those physiotherapists working in MSK out-pts for whom this was unfamiliar. We wanted to put something in place to support these new graduates. Methods: A teaching package was designed with teaching in simulation for newly qualified physiotherapists about to go on the respiratory physiotherapy on-call rota focusing on common on-call scenarios. It was delivered by physiotherapists, an ACP and a consultant anaesthetist (who attended virtually). Scenarios were broken down into 3 competents: (1) do I have to go in? How to get the right information over the phone to decide. (2) what do I want done while I am travelling in? What advice to give to stabilise the pt while on route, what equipment to get ready, what PPE to get ready, etc., (3) What do I do when I get there – A–E assessment of the pt, treatment and ongoing management plan. Feedback on the sessions was collected from participants by anonymous questionnaire. In the simulation room attendees scan a QR code which generates a MS teams electronic feedback form. Results: Positive feedback -informative, interesting session, met their learning outcomes, reduced anxiety. ‘We were allowed time to practice in a safe environment and ask anything that may concern us’, increased confidence. Conclusion(s): Provision of simulation for newly qualified physiotherapists is helpful at preparing them for being the on-call respiratory physiotherapist. Impact: Funding is now being sort to make this part of standard induction each year at the Trust for newly qualified physiotherapists. We have liaised with the West Midlands sim lead to see if they will recommend this across the West Midlands. Funding acknowledgements: Not funded.

6.
Sexually Transmitted Infections ; 97(Suppl 1):A175-A176, 2021.
Article in English | ProQuest Central | ID: covidwho-1301725

ABSTRACT

BackgroundCOVID-19 mitigation measures may indirectly impact sexually transmitted infection (STI) transmission. Social distancing may impact number/type of sex partnerships and access to STI testing and treatment. The objective was to compare the number of reported sex partnerships and gonorrhea and chlamydia prevalence pre- and during-pandemic among a cohort of gay, bisexual and other men-who-have-sex-with-men (MSM) in Baltimore, Maryland, a U.S. city with sustained STI epidemics.MethodsThis study was nested in a cohort study of sexually active MSM aged 18–45, and included participants who had at least one study visit after March 13, 2020 (during-pandemic) and ≤ six months between their first during-pandemic and last pre-pandemic visit. Wilcoxon and McNemar tests for paired data were used for statistical testing.ResultsAmong 417 MSM enrolled in the cohort, 220 (52.8%) were included. 213 (96.8%) had a visit between April 6-June 30, 2020 (during-pandemic1);185 (84.1%) had a visit between July 1-September 30, 2020 (during-pandemic2), including seven who missed the during-pandemic1 visit. The majority were Black (73.2%) and aged 24–35 (56.4%);42% were living with HIV. Compared to pre-pandemic, the median number of total and casual male sex partners (past three months) significantly declined during-pandemic1 and during-pandemic2 (Total partners: pre-pandemic: 2.0 (range: 0–75);during-pandemic1: 1.0 (0–25), p<0.0001;during-pandemic2: 1.0 (0–20) p<0.0001;Casual partners: pre-pandemic: 1.0 (0–75);during-pandemic1: 0.0 (0–25) p<0.0001, during-pandemic2: 1.0 (0–20), p=0.004). Among those tested both pre- and during-pandemic2, (n=96) STI prevalence was similar (gonorrhea: 14.1% vs. 15.8%, p=0.847;chlamydia: 7.0% vs. 9.5%, p=0.527).ConclusionsAlthough overall and casual sex partnerships declined significantly during- compared to pre-pandemic, STI prevalence was similar. The observed decreased sex partnerships may not have substantially altered transmission dynamics or were offset by increased prevalence due to limited access to testing/treatment. Improved understanding of how COVID-19 mitigation measures alter STI transmission dynamics is needed.

7.
Nutrition Today ; 56(1):7-18, 2021.
Article in English | CAB Abstracts | ID: covidwho-1153303

ABSTRACT

We, registered dietitian nutritionists (RDNs), could have sat on the sidelines in the early days of the pandemic when many RDNs were not considered "essential" workers. Instead, RDNs used their abilities to innovate and adapt to ensure the public, their patients, and clients received continuous nutrition services. Some of the strategies adopted were possible because of temporary or emergency flexibilities in policies. We present examples primarily from our outpatient practices, with efforts by public health and inpatient RDNs acknowledged. We hope these examples will inspire all to do the work needed to provide increased access to medical nutrition therapy and nutrition education for all.

8.
Hepatology ; 72(1 SUPPL):272A-273A, 2020.
Article in English | EMBASE | ID: covidwho-986162

ABSTRACT

Background: Abnormal serum aminotransferase levels have been observed in up to 60% of patients with coronavirus disease 2019 (COVID-19) Higher serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels have been observed in hospitalized patients with severe disease However, the association between enzyme levels at the time of hospital admission and disease outcomes remains incompletely characterized Studies suggest that the mechanism of liver injury is multifactorial and may involve microvascular thrombosis We aimed to assess the prognostic value of abnormal AST and ALT on admission of patients with COVID-19 and their association with d-dimer in a large urban cohort in the U S Methods: Demographic and clinical data of 532 consecutive patient admissions for COVID-19 in two large, urban tertiary referral hospitals in Washington DC from March 13 to May 21, 2020 were analyzed Independent variables were initial AST and ALT values within 24 hours of presentation Primary outcomes were admission to intensive care unit (ICU) and inpatient mortality Presenting AST and ALT were examined as continuous and as dichotomized (≤2x and >2x upper limit of normal (ULN)) variables with outcomes Secondary analyses included general linear regression between AST/ALT and presenting d-dimer levels Statistical analysis was performed using RStudio (version 4 0 0) Results: Of 532 patients, 50 5% were male, 66 5% were Black, with a mean age of 60 3±16 4 years old Time from symptom onset to presentation was 6 (IQR = 3-8) days Chronic liver disease was observed in 20 patients (3 8%) (Table 1) Ninety-two patients (17 2%) expired and 164 (30 9%) required ICU care Abnormal AST and ALT levels were seen in 368 (70 4%) and 199 (38 0%) patients, respectively The mean presenting AST (95 1 vs 56 1 U/L, p= 0 017) and ALT (66 7 vs 43 9 U/L, p=0 008) levels were higher in patients who required ICU care compared to those who did not Patients with AST >2x ULN (>66 U/L) or ALT >2x ULN (>98 U/L) were more likely to require ICU care (OR 2 10, p=0 001 and OR 2 03, p=0 041, respectively) However, difference in mortality was not observed between those groups Lastly, AST was positively associated with presenting d-dimer (p=0 04) but not ALT (p=0 11) Conclusion: Liver function test should be obtained on admission and elevation in AST and/or ALT should be factored into patient risk stratification, especially when AST >66 U/L and/or ALT >98 U/L. Observed correlation between AST (but not ALT) and d-dimer supports the notion that AST level may reflect the ischemic burden of affected organs as a result of microvascular thrombosis, including but not limited to the liver. However, given the low specificity of d-dimer, its elevation may correlate more so with disease severity rather than true presence of microvascular thrombi within the liver (Table Presented).

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