ABSTRACT
BACKGROUND AND AIM: To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and intensive care units (PICU). METHOD(S): We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries. RESULT(S): We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. There was a significant decline reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. CONCLUSION(S): SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. Continual effort and research into the subject should be essential for us to protect the well-being of children.
ABSTRACT
Background and Aims: Medical management alone is insufficient to reduce secondary stroke risk. Supervised exercise combined with behaviour change support may facilitate increased physical activity and help adequately address stroke recurrence risk. This early analysis of the ENAbLE Pilot Trial aimed to test the feasibility of a supervised aerobic exercise package delivered via telehealth. Method(s): A 4-arm, assessor blinded RCT was piloted during the COVID-19 Pandemic. The remotely delivered trial included people 3 months to 10 years post stroke or TIA. The intervention involved 12 weeks of twice weekly telehealth-supervised aerobic exercise and support sessions. Feasibility data including recruitment, adherence, adverse events and ability to collect clinical outcomes to support a Phase III trial (blood pressure [primary outcome], physical activity, fatigue, and quality of life) was collected and analysed. Result(s): Thirty people participated (exercise intervention n=14, control n=16) between April 2020 and July 2021. Session attendance was 80%. Three participants (10%) withdrew or were lost to follow-up, all in the experimental group. Mean exercise intensity during supervised sessions was in the target range (moderate to vigorous). Mean number of systolic BP measures recorded over 7 days was 27 (SD 2.2) of a maximum of 28, at baseline. One non-serious adverse event occurred during supervised exercise sessions. However, outside exercise sessions adverse events were higher in the experimental group who were more frequently monitored. Conclusion(s): A remotely delivered program of supervised aerobic exercise delivered via telehealth was feasible. Learnings from the remote delivery of an exercise pilot trial will be shared. Acknowledgements: Stroke Foundation Australia.