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1.
PRiMER (Leawood, Kan.) ; 6, 2022.
Article in English | EuropePMC | ID: covidwho-2033930

ABSTRACT

Background In March 2020 with the onset of the COVID-19 pandemic, clinical rotations abruptly ceased, and telemedicine became an alternative to in-person patient care. This study investigates factors associated with long-term adoption of telemedicine during family medicine clerkships. Methods Data were gathered from the 2021 CERA survey of family medicine clerkship directors. Participants answered questions about the use of telemedicine in the clerkship, adequacy of telemedicine resources, how well telemedicine visits helped students meet course objectives, quality of course evaluations, efficiency of students seeing patients using telemedicine, and likelihood of continuing use of telemedicine once in-person visits are reinstated. Results The response rate was 48.8%. While most clerkship directors did not use telemedicine prior to the COVID-19 pandemic with their own patients, most had medical students utilize telemedicine during the pandemic. Clerkship directors were more likely to continue having students use telemedicine in the clerkship if it helped them meet clerkship objectives, if telemedicine visits were efficient, and if course evaluations were positive. Adequacy of resources was not associated with likelihood of retaining telemedicine in the clerkship. Conclusions Family medicine clerkship directors will likely continue to have students see patients via telemedicine, particularly if feedback is positive. Family medicine educators need to develop and evaluate new telemedicine curriculum for learner benefit, patient acceptability, and overall care quality.

2.
Am J Public Health ; : e1-e5, 2022.
Article in English | PubMed | ID: covidwho-2029854

ABSTRACT

The REstarting Safe Education and Testing program for children with medical complexity was implemented in May 2021 at the University of Wisconsin to evaluate the feasibility of in-home rapid antigen severe acute respiratory syndrome coronavirus 2 testing among neurocognitively affected children. Parents or guardians administered BinaxNOW rapid antigen self-tests twice weekly for three months and changed to symptom and exposure testing or continued surveillance. In-home testing was feasible: nearly all (92.5%) expected tests were conducted. Symptomatic testing identified seven of nine COVID-19 cases. School safety perceptions were higher among those opting for symptom testing. Clinical Trials.gov identifier: NCT04895085. (Am J Public Health. Published online ahead of print September 15, 2022:e1-e5. https://doi.org/10.2105/AJPH.2022.306971).

3.
Hospital Pediatrics ; 12(9):e295-e302, 2022.
Article in English | MEDLINE | ID: covidwho-2022087

ABSTRACT

OBJECTIVES: The chronic conditions and functional limitations experienced by children with medical complexity (CMC) place them at disproportionate risk for COVID-19 transmission and poor outcomes. To promote robust vaccination uptake, specific constructs associated with vaccine hesitancy must be understood. Our objective was to describe demographic, clinical, and vaccine perception variables associated with CMC parents' intention to vaccinate their child against COVID-19. METHODS: We conducted a cross-sectional survey (June-August 2021) for primary caregivers of CMC between ages 5 to 17 at an academic medical center in the Midwest. Multivariable logistic regression examined associations between vaccination intent and selected covariates. RESULTS: Among 1330 families, 65.8% indicated vaccination intent. In multivariable models, demographics had minimal associations with vaccination intent;however, parents of younger children (<12 years) had significantly lower adjusted odds of vaccination intent (adjusted odds ratio [95% confidence interval]: 0.26 [0.17-0.3]) compared to parents of older children (>=12 years). CMC with higher severity of illness, ie, those with >=1 hospitalization in the previous year (versus none) or >1 complex chronic condition (vs 1), had higher adjusted odds of vaccination intent (1.82 [1.14-2.92] and 1.77 [1.16-2.71], respectively). Vaccine perceptions associated with vaccine intention included "My doctor told me to get my child a COVID-19 vaccine" (2.82 [1.74-4.55]);and "I'm concerned about my child's side effects from the vaccine" (0.18 [0.12-0.26]). CONCLUSIONS: One-third of CMC families expressed vaccine hesitation;however, constructs strongly associated with vaccination intent are potentially modifiable. Pediatrician endorsement of COVID-19 vaccination and careful counseling on side effects might be promising strategies to encourage uptake.

4.
JQ: Justice Quarterly ; : 1-26, 2022.
Article in English | Academic Search Complete | ID: covidwho-2017227

ABSTRACT

Policies implemented to control the COVID-19 (C19) pandemic have faced public resistance. We examined this issue via an experimental vignette study embedded in a May 2020 national (U.S.) survey conducted by YouGov. Specifically, we explore how the public perceived a local policymaker proposing a C19-related isolation policy, based on the policy’s invasiveness or its punitivity. We find that more intrusive and more punitive policies generally resulted in colder feelings towards, and harsher perceptions of, the policymaker. However, our results suggest that the main driver of public sentiment towards the policymaker was the invasiveness of the proposed policy, with the policy's punitivity being less impactful. We discuss these findings in relation to policymaking, policy support and compliance, and tradeoffs between informal/formal controls, and intrusive/punitive policies. [ FROM AUTHOR] Copyright of JQ: Justice Quarterly is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

5.
Infect Control Hosp Epidemiol ; : 1-18, 2022 May 20.
Article in English | MEDLINE | ID: covidwho-2016422

ABSTRACT

One of six nursing home residents and staff with positive SARS-CoV-2 tests ≥90 days after initial infection had specimen cycle thresholds (Ct) <30. Individuals with specimen Ct<30 were more likely to report symptoms but were not different from individuals with high Ct value specimens by other clinical and testing data.

6.
BMC Pediatr ; 22, 2022.
Article in English | PMC | ID: covidwho-2009367

ABSTRACT

Background: In-home direct antigen rapid testing (DART) plays a major role in COVID-19 mitigation and policy. However, perceptions of DART within high-risk, intellectually impaired child populations are unknown. This lack of research could negatively influence DART uptake and utility among those who stand to benefit most from DART. The purpose of this study was to describe caregivers’ perceptions of an in-home COVID-19 DART regimen in children with medical complexity, including the benefits and limitations of DART use. Methods: This qualitative study was a subproject of the NIH Rapid Acceleration of Diagnostics Underserved Populations research program at the University of Wisconsin. We combined survey data and the thematic analysis of semi-structured interview data to understand caregivers’ perceptions of in-home COVID-19 testing and motivators to perform testing. Caregivers of children with medical complexity were recruited from the Pediatric Complex Care Program at the University of Wisconsin (PCCP). Data were collected between May and August 2021. Results: Among n = 20 caregivers, 16/20 (80%) of their children had neurologic conditions and 12/20 (60%) used home oxygen. Survey data revealed that the largest caregiver motivators to test their child were to get early treatment if positive (18/20 [90%] of respondents agreed) and to let the child’s school know if the child was safe to attend (17/20 [85%] agreed). Demotivators to testing included that the child could still get COVID-19 later (7/20 [35%] agreed), and the need for officials to reach out to close contacts (6/20 [30%] agreed). From interview data, four overarching themes described perceptions of in-home COVID-19 testing: Caregivers perceived DART on a spectrum of 1) benign to traumatic and 2) simple to complex. Caregivers varied in the 3) extent to which DART contributed to their peace of mind and 4) implications of test results for their child. Conclusions: Although participants often described DART as easy to administer and contributing to peace of mind, they also faced critical challenges and limitations using DART. Future research should investigate how to minimize the complexity of DART within high-risk populations, while leveraging DART to facilitate safe school attendance for children with medical complexity and reduce caregiver burden. Supplementary Information: The online version contains supplementary material available at 10.1186/s12887-022-03550-5.

7.
Health Equity ; 6(1):610-615, 2022.
Article in English | ProQuest Central | ID: covidwho-2001180

ABSTRACT

Objectives: We aim to assess the influence of COVID-19 on the social needs of emergency department (ED) patients, and assess patients' access to social services. Methods: We conducted a cross-sectional survey of 175 purposively sampled adult ED patients. Results: Approximately half of participants stated that COVID-19 negatively impacted their social needs with statistically significant differences observed for race, ethnicity, and insurance status. Many participants did not know of available social services, and a majority welcomed assistance from the ED. Conclusion: This study suggests that unmet social needs have risen because of COVID-19, and EDs may be positioned to identify and assist affected patients.

8.
Am J Crit Care ; : e1-e9, 2022 Aug 12.
Article in English | MEDLINE | ID: covidwho-1994279

ABSTRACT

BACKGROUND: Tracheostomies are highly aerosolizing procedures yet are often indicated in patients with COVID-19 who require prolonged intubation. Robust investigations of the safety of tracheostomy protocols and provider adherence and evaluations are limited. OBJECTIVES: To determine the rate of COVID-19 infection of health care personnel involved in COVID-19 tracheostomies under a multidisciplinary safety protocol and to investigate health care personnel's attitudes and suggested areas for improvement concerning the protocol. METHODS: All health care personnel involved in tracheostomies in COVID-19-positive patients from April 9 through July 11, 2020, were sent a 22-item electronic survey. RESULTS: Among 107 health care personnel (80.5%) who responded to the survey, 5 reported a positive COVID-19 test result (n = 2) or symptoms of COVID-19 (n = 3) within 21 days of the tracheostomy. Respondents reported 100% adherence to use of adequate personal protective equipment. Most (91%) were familiar with the tracheostomy protocol and felt safe (92%) while performing tracheostomy. Suggested improvements included creating dedicated tracheostomy teams and increasing provider choices surrounding personal protective equipment. CONCLUSIONS: Multidisciplinary engagement in the development and implementation of a COVID-19 tracheostomy protocol is associated with acceptable safety for all members of the care team.

9.
Journal of Allergy and Clinical Immunology: Global ; 2022.
Article in English | ScienceDirect | ID: covidwho-1983273

ABSTRACT

Background Allergic reactions have been reported with mRNA vaccines for COVID-19 prevention. Patients perceived to be at higher risk for a reaction may be referred to an allergist, though evaluation strategies may differ between allergists. Objective To determine outcomes of COVID-19 vaccinations in patients evaluated by an allergist using different approaches. Methods A retrospective case series of 98 patients seen at the University of Michigan Allergy Clinic for concerns regarding COVID-19 vaccination. 34 of these patients underwent skin testing with PEG2000 with or without PEG3350/Polysorbate 80 testing. Results Skin testing was performed on 34 of 98 patients, 16 prior to vaccination and 18 after a reported vaccine related event. One patient had positive skin testing to PEG-3350 following vaccination reaction and natural infection and was advised against a second dose. One patient with a significant history concerning of anaphylaxis to PEG, had positive testing to PEG- 2000, PEG-3350 and polysorbate 80 and was advised against vaccination. 64 of 98 patients (64%) tolerated COVID-19 vaccination without complication after evaluation by an allergist. Conclusion No significant differences were found between vaccination counseling with and without skin testing to excipients. Patients who presented prior to the first dose of vaccination were more likely to proceed with COVID-19 vaccination and tolerate vaccination without complication.

10.
Preprint in English | bioRxiv | ID: ppbiorxiv-504798

ABSTRACT

We present an integrated immunopeptidomics and proteomics study of SARS-Cov-2 infection to comprehensively decipher the changes in host cells in response to viral infection. Our results indicated that innate immune response in Calu-3 cells was initiated by TLR3, followed by activation of interferon signaling pathway. Host cells also present viral antigens to the cell surface through both Class I and Class II MHC system for recognition by adaptive immune system. SARS-Cov-2 infection led to the disruption of antigen presentation as demonstrated by higher level of HLA proteins from the flow-through of MHC immunoprecipitation. Glycosylation analysis of HLA proteins from the elution and flow-through of immunoprecipitation revealed that the synthesis and degradation of HLA protein was affected by SARS-Cov-2 infection. This study provided many useful information to study the host response to SARS-Cov-2 infection and would be helpful for the development of therapeutics and vaccine for Covid-19 and future pandemic.

11.
Sports Med Open ; 8(1): 94, 2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1957071

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020). METHODS: This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. RESULTS: During the COVID-19 pandemic, 91% (n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% (n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity (n = 33/80, 41%) and safety (n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference (n = 57/71, 80%), physical capacity (n = 35/71, 49%) and access to reliable delivery platforms (n = 27/71, 38%). Zoom (n = 54/71, 76%) and telephone (n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. CONCLUSIONS: During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted.

12.
Clin Infect Dis ; 2022 Jul 20.
Article in English | MEDLINE | ID: covidwho-1948237

ABSTRACT

BACKGROUND: Residents of nursing homes experience disproportionate morbidity and mortality related to COVID-19 and were prioritized for vaccine introduction. We evaluated COVID-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infections among nursing home residents. METHODS: We used a retrospective cohort of 4,315 nursing home residents during December 14, 2020 - November 9, 2021. A Cox proportional hazards model was used to estimate hazard ratios comparing residents with a completed vaccination series to unvaccinated among those with and without prior SARS-CoV-2 infection (identified using positive SARS-CoV-2 tests and/or diagnosis codes), by vaccine product, and by period (before and during Delta variant predominance). VE was estimated as one minus the hazard ratio times 100%. RESULTS: Overall adjusted VE for the completed vaccination series was 58% (95%CI: 44%, 69%) among residents without a history of SARS-CoV-2 infection. During the pre-Delta period, the VE within 150 days of receipt of the second dose of Pfizer-BioNTech (67%, 95%CI: 40%, 82%) and Moderna (75%, 95%CI: 32%, 91%) was similar. During the Delta period, VE measured >150 days after the second dose was 33% (95%CI: -2%, 56%) for Pfizer-BioNTech and 77% (95%CI: 48%, 91%) for Moderna. Rates of infection were 78% lower (95%CI: 67%, 85%) among residents with prior SARS-CoV-2 infection and completed vaccination series compared to unvaccinated residents without a history of SARS-CoV-2 infection. CONCLUSIONS: COVID-19 vaccines were effective in preventing SARS-CoV-2 infections among nursing home residents and history of prior SARS-CoV-2 infection provided additional protection. Maintaining high coverage of recommended doses of COVID-19 vaccines remains a critical tool for preventing infections in nursing homes.

13.
Am J Public Health ; 112(8): 1142-1146, 2022 08.
Article in English | MEDLINE | ID: covidwho-1933449

ABSTRACT

While many higher-education institutions dramatically altered their operations and helped mitigate COVID-19 transmission on campuses, these efforts were rarely fully extended to surrounding communities. A community pandemic-response program was launched in a college town that deployed epidemiological infection-control measures and health behavior change interventions. An increase in self-reported preventive health behaviors and a lower relative case positivity proportion were observed. The program identified scalable approaches that may generalize to other college towns and community types. Building public health infrastructure with such programs may be pivotal in promoting health in the postpandemic era. (Am J Public Health. 2022;112(8):1142-1146. https://doi.org/10.2105/AJPH.2022.306880).


Subject(s)
COVID-19 , COVID-19/prevention & control , Humans , Pandemics/prevention & control , Preventive Health Services , Public Health , Universities
14.
Ann Intern Med ; 175(5): 749-750, 2022 05.
Article in English | MEDLINE | ID: covidwho-1928838
15.
European Stroke Journal ; 7(1 SUPPL):553-554, 2022.
Article in English | EMBASE | ID: covidwho-1928146

ABSTRACT

Background: Prior studies indicated a decrease in the incidences of subarachnoid hemorrhage (SAH) during the early stages of the COVID- 19 pandemic. We evaluated differences in the incidence, severity of SAH presentation, and ruptured aneurysm treatment modality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centers. We recorded volumes for: COVID-19 hospitalizations, SAH hospitalizations, Hunt-Hess Grade, coiling, clipping, and aneurysmal SAH (aSAH) in-hospital mortality. Diagnoses were identified by ICD-10 codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16,247 aSAH admissions, 344,491 COVID-19 admissions, 8,300 coiling and 4,240 aneurysmal clipping procedures. Declines were observed in aSAH admissions (-6.4% [95%CI -7,-5.8];p=0.0001) during the first year of the pandemic compared to the prior year, most pronounced in high-volume SAH and highvolume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentation of aSAH (mild: -5%[-5.9,-4.3], p=0.06;moderate: -8.3%[-10.2,-6.7], p=0.06) but no difference in higher SAH severity. The clipping rate remained unchanged (30.7% vs. 31.2%, p=0.58), whereas coiling increased (53.97%vs.56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%,p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the coiling rate, but no change in clipping rate, nor change in aSAH in-hospital mortality.

16.
iScience ; 25(8): 104739, 2022 Aug 19.
Article in English | MEDLINE | ID: covidwho-1926567

ABSTRACT

Several effective SARS-CoV-2 vaccines have been developed using different technologies. Although these vaccines target the isolates collected early in the pandemic, many have protected against serious illness from newer variants. Nevertheless, efficacy has diminished against successive variants and the need for effective and affordable vaccines persists especially in the developing world. Here, we adapted our protein-protein conjugate vaccine technology to generate a vaccine based on receptor-binding domain (RBD) antigen. RBD was conjugated to a carrier protein, EcoCRM®, to generate two types of conjugates: crosslinked and radial conjugates. In the crosslinked conjugate, antigen and carrier are chemically crosslinked; in the radial conjugate, the antigen is conjugated to the carrier by site-specific conjugation. With AS01 adjuvant, both conjugates showed enhanced immunogenicity in mice compared to RBD, with a Th1 bias. In hACE2 binding inhibition and pseudovirus neutralization assays, sera from mice vaccinated with the radial conjugate demonstrated strong functional activity.

17.
Women's Health Issues ; 2022.
Article in English | ScienceDirect | ID: covidwho-1886127

ABSTRACT

Objective We analyzed the exclusion of pregnant and breastfeeding individuals and those capable of pregnancy in COVID-19 vaccine and clinical treatment trials. Methods Inclusion and exclusion criteria were extracted from all listed COVID-19 vaccine and treatment clinical trials from May 1, 2020 to October 31, 2020 using the U.S. National Library of Medicine database. We report rates of rates of exclusion for pregnant and lactating individuals and requirements for contraception for pregnancy-capable participants in COVID-19 vaccine and treatment clinical trials. Analysis included the association between clinical trial exclusion and vaccine and treatment type, study location, sponsor, and phase. Results Pregnant and lactating individuals were explicitly excluded from most COVID-19 vaccine and treatment clinical trials. Of the 90 vaccine trials, 88 (97.8%) excluded pregnant individuals, 73 (81.1%) excluded lactating individuals, and 56 (62.2%) required contraception use. Of the 495 treatment trials, 350 (70.7%) excluded pregnant individuals, 269 (54.3%) excluded lactating individuals, and 91 (18.4%) required contraception use. Although vaccine type was not associated with pregnancy exclusion, it was associated with lactation exclusion (p=0.01) and contraception requirement (p<0.001). Treatment type was associated with pregnancy exclusion, lactation exclusion, and contraception requirement (all p<0.001). Conclusion COVID-19 vaccination and treatment clinical trials mirrored historical trends restricting participation due to pregnancy, lactation, and contraception non-use despite known safety profiles. People of childbearing potential should be considered for and afforded the same opportunity as males to make informed decisions on study participation, particularly in the setting of a global pandemic.

19.
J Clin Transl Sci ; 6(1): e67, 2022.
Article in English | MEDLINE | ID: covidwho-1867966

ABSTRACT

The African American population of Buffalo, New York experiences striking race-based health disparities due to adverse social determinants of health. A team of community leaders and university faculty determined that a community dialogue was needed to focus research and advocacy on the root causes of these disparities. In response, we organized the annual Igniting Hope conference series that has become the premier conference on health disparities in the region. The series, now supported by an R13 conference grant from NCATS, has been held four times (2018-2021) and has attracted community members, community leaders, university faculty, and trainees. The agenda includes talks by national leaders and breakout/working groups that led to a new state law that has reduced disproportionate traffic-ticketing and drivers' license suspensions in Black neighborhoods; mitigation of the disproportionate COVID-19 fatalities in Black communities; and the launching of a university-supported institute. We describe the key elements of success for a conference series designed by a community-university partnership to catalyze initiatives that are having an impact on social determinants of health in Buffalo.

20.
Nursing Research ; 71(3):S73-S73, 2022.
Article in English | Web of Science | ID: covidwho-1865993
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