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1.
Journal of Gastroenterology and Hepatology ; JOUR:163, 37(Supplement 1).
Article in English | EMBASE | ID: covidwho-2088258

ABSTRACT

Background and Aim: Inflammatory bowel disease (IBD) commonly affects men and women during their reproductive years. Misconceptions surrounding the impact of IBD and associated therapies on the peripartum period contributes to increased rates of voluntary childlessness. Navigating IBD and obstetric-related decisions during pregnancy can be challenging. We established a monthly multidisciplinary clinic comprising a gastroenterologist, IBD nurse, and obstetric fellow, in addition to dietetic and psychological referral pathways, to optimize care for women with IBD in the peripartum period.We aim to describe the patient cohort and associated pregnancy-related outcomes. Method(s): Between January 2021 and May 2022, 43 women were referred to the multidisciplinary pregnancy in IBD clinic for the indications of preconception counseling or IBD care during pregnancy and postpartum. The consultations were conducted face-to-face or via telehealth due to the impact of the COVID-19 pandemic. Nutritional and psychological screening occurred before clinic review, while intestinal ultrasound (IUS) was done as needed;however, the latter was limited due to COVID-19-related clinical restrictions. A review of prospectively collected patient records, including the use of Crohn's Colitis Care (CCCare), was performed to obtain demographic data, medical and surgical history, and obstetric outcomes. Patients referred for preconception counseling were prospectively assessed using the decisional conflict scale (DCS) and Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow). Result(s): Of the 43 women (mean age, 30.9 years) who received care in our clinic, 14 were at preconception stage, and 29 were pregnant. Twenty-one patients had a diagnosis of ulcerative colitis, 19 had Crohn's disease, and one had IBD-unclassified. Two additional patients with pregnancy-onset IBD did not yet have a confirmed diagnosis, as their endoscopic assessment was deferred until after delivery. The mean DCS score for women referred for preconception counseling was 39.1 (>37.5 being associated with decision delay and difficulty with implementation). The median CCPKnow score at baseline was 7/18 (range, 3-11), suggesting poor IBD and pregnancy-related knowledge. The median score improved to 9/18 (range, 4-11) at 1 month follow-up and to 11/18 (range, 4-13) at 3 months. Nineteen patients (44.2%) were prescribed 5-aminosalicylates alone, eight (18.6%) thiopurines, and 21 (48.8%) biologic therapy (antitumor necrosis factor agents, 12;ustekinumab, 6;vedolizumab, 3). Eleven of 29 patients (37.9%) had active disease at conception, as assessed through symptomatic, biochemical, and radiological assessment. Two patients (4.7%) were prescribed oral budesonide during pregnancy. Five of 29 patients (17.2%) were assessed using IUS, while none required endoscopic assessment during pregnancy. Fifteen of 29 patients (51.7%) have given birth to date, with 12 (80%) having an uncomplicated vaginal delivery and three (20%) having a caesarean section, temporally compared with a caesarean section rate of 32.5% in the general South West Sydney Local Health district population. None were indicated for known perianal Crohn's disease. There have been no cases of preterm birth or pregnancy. The mean birth weight was 3.53 kg (range, 2.67-4.29). Two of 15 women (13.3%) experienced a postpartum flare. Nine of 15 women (60%) breastfed, while three (20%) formula-fed, and the remaining three (20%) mixed-fed their infants. Conclusion(s): Establishment of a multidisciplinary clinic has enabled provision of IBD care in the reproductive stage of life, with the ongoing aim to minimize the impact of voluntary childlessness through the delivery of dedicated clinic sessions for preconception counseling and the negative impact of active disease on obstetric and maternal outcomes.

2.
NeuroQuantology ; 20(11):3622-3625, 2022.
Article in English | EMBASE | ID: covidwho-2081050

ABSTRACT

Introduction: COVID-19, a deadly infectious disease, had caused the implementation of the Movement Control Order (MCO) in Malaysia. After the end of the first MCO, there was a decrease in the number of infections. However, the resurgence of cases prompted the government to reimplement the MCO. This was thought to be caused by people flaunting the SOPs due to lack of awareness of this disease. Therefore, this cross sectional study aims to evaluate the awareness of COVID-19 and the compliance of social distancing among medical students of UOC. Material(s) and Method(s): The data was collected through an online google form questionnaire. that was distributed to the medical students with a sample size of 248 through the students' email and through the Whatsapp messaging application. Result(s): Analysis of the data showed that almost all medical students of University of Cyberjaya have a good awareness status of COVID-19 at 100.0% and good social distancing compliance status at 99.5%. The data also showed that the majority obtained their information about COVID-19 from the Ministry of Health website Conclusion(s): The study shows that there is a good awareness status of COVID-19 and a good compliance of social distancing status among medical students. Copyright © 2022, Anka Publishers. All rights reserved.

3.
BMJ Open ; 12(10): e066777, 2022 10 17.
Article in English | MEDLINE | ID: covidwho-2078991

ABSTRACT

OBJECTIVES: Sexual harassment among adolescent girls and young women (AGYW) is a prevalent and understudied form of gender-based violence (GBV) with negative impacts on health and well-being. The COVID-19 pandemic raised global concern about GBV within homes; less is known about how it affected GBV in public spaces. METHODS: Present analyses use cross-sectional data from a cohort of adolescents and young adults residing in Nairobi, Kenya, restricted to female participants. Data were collected August-October 2020 via phone after implementation of COVID-19 restrictions. Prevalence of past-year sexual harassment and harassment relative to COVID-19 restrictions were calculated for overall sample, and by individual, household, and pandemic-related factors. Multivariate negative binomial regression models examine correlates of (1) past-year sexual harassment and (2) increases in sexual harassment relative to COVID-19 restrictions. RESULTS: Overall, 18.1% of AGYW experienced past-year sexual harassment at the 2020 survey. Among this group, 14.6% experienced sexual harassment pre-COVID-19 only, 18.8% after only and 66.6% at both time points. Among the latter group, 34.9% reported more occurrences following COVID-19 restrictions, 20.5% reported less occurrences and 44.7% reported no change in occurrence. Overall, 42.0% of AGYW experienced an increase in sexual harassment while 58.0% experienced no increase since COVID-19. In adjusted models, past-year sexual harassment was associated with higher educational attainment (adjusted risk ratio, aRR 2.11; 95% CI 1.27 to 3.52) and inability to meet basic financial needs (aRR 1.67; 95% CI 1.05 to 2.66). Increased sexual harassment since COVID-19 was associated with having full control to leave the home (aRR 1.69; 95% CI 1.00 to 2.90). CONCLUSIONS: Sexual harassment among AGYW in Nairobi, Kenya was prevalent before and during COVID-19 restrictions. Safety in public spaces remains a highly gendered issue that impacts women's safety and ability to participate in public life. Prevention and support services to address sexual harassment remain an important element in ensuring safe, sustainable public spaces.


Subject(s)
COVID-19 , HIV Infections , Sexual Harassment , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Humans , Kenya/epidemiology , Pandemics , Sexual Behavior , Young Adult
4.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P169-P170, 2022.
Article in English | EMBASE | ID: covidwho-2064402

ABSTRACT

Introduction: The objective of this study is to determine the likelihood of diagnosis and accuracy of treatment of various conditions via use of telemedicine services within an academic, multisubspecialty otolaryngology practice located in a COVID-19 hot spot. At the conclusion of this presentation, the participants should be able to understand the role that virtual care can play in otolaryngology, both in terms of diagnosis and management. Method(s): This retrospective cohort study included all telemedicine patient encounters with an otolaryngologist or advanced practice provider between March 17 and August 30, 2020. Pediatric and adult patients who completed a synchronous virtual visit (VV) were included. Patient demographics, new vs return patients, known and unknown visit diagnoses, treatment given and/or surgery scheduled, and recommended in-person follow-up were extracted. If in-person follow-up occurred, the diagnosis, whether scope was performed, and if in-person follow-up changed the diagnosis were extracted. A t test and chi2 analysis were utilized. Result(s): A total of 758 patients completed a VV;388 were new and 370 return patients. New patients were significantly younger than return patients (44.3 vs 48.2 years, P=.014). New patients with a known diagnosis were treated more often than return patients (80.6% vs 67.2%, P=.008). There was no significant difference between new and return patients in treatment given, recommendation for in-person follow-up, rate of in-person follow-up, rate of patients scoped, and if recommendations were made for surgery. Treatment was recommended in 71.1% of encounters, and surgery was recommended in 10.8% of encounters. The endocrine subgroup had the highest rate at 60.6% (CI, 42.1, 77.1) of recommending surgery. Conclusion(s): Telemedicine is an effective tool when used for diagnosis, as well as to recommend treatment and surgery when in-person visits are difficult or not possible.

5.
Anaesthesia ; 77:75, 2022.
Article in English | EMBASE | ID: covidwho-2032355

ABSTRACT

Paracetamol has great potential environmental savings due to its ubiquitous peri-operative use. The Welsh Anaesthesia Audit Research and Engagement Network (WAAREN) and Australian Trainee-Led Research and Audit in Anaesthesia for Sustainability in Healthcare (TRA2SH) group collaborated in an audit of peri-operative paracetamol use. We present the Welsh data, alongside survey results assessing anaesthetists' opinions on paracetamol use. Methods We conducted retrospective note reviews of patients aged ≥ 5 years and over having elective surgery for a 1-week period prior to the COVID-19 pandemic. Data were collected on the timing, route, administration, brand, cost and weight of paracetamol preparations. A survey of attitudes was sent to all Welsh anaesthetists as an anonymised Google Form. Results Data were collected from seven hospitals on 678 patients aged 5-96 years (Fig. 1). Ninety per cent received paracetamol peri-operatively. Of 52 patients prescribed per oral (PO) paracetamol pre-operatively, 67% received it. Eighty per cent received intravenous (IV) paracetamol intra-operatively. Glass and plastic bottles were used in four and three hospitals, respectively. The 'dry' weight of IV paracetamol packaging was 82-113 g.g-1. The cost of IV paracetamol was 19-104 times that of PO. Of 216 anaesthetists responding to our survey, 88% would be comfortable replacing intra-operative IV with pre-operative PO paracetamol for appropriately screened elective patients. Common concerns were the efficacy of PO paracetamol, dose timing, logistical challenges and double dosing. (Figure Presented) Discussion Full life-cycle analyses (LCAs) of pharmaceuticals are resource intensive and scarce [1]. No LCA is currently available for paracetamol, but our calculations, accounting only for primary material production and material disposal, show that PO paracetamol generates 1/ 68th and 1/45th the emissions of IV paracetamol in glass and plastic bottles, respectively. A recent review demonstrated equivalent efficacy between PO and IV paracetamol [2]. We propose an all-Wales approach to changing practice;developing resources for distribution via the Welsh Anaesthetic Green Network (WAGN) to support Trusts with the aim to replace a proportion of IV paracetamol with PO nationally. The resulting environmental 'savings' would be complemented by financial savings, without negatively impacting on patient care.

7.
BMJ Military Health ; 2022.
Article in English | ProQuest Central | ID: covidwho-2020235

ABSTRACT

ObjectiveThe selection process to the British Army’s Brigade of Gurkhas is rigorous, demanding and competitive. The ethos of recruitment to the Gurkhas is grounded in an overarching tenant: that selection is free, fair and transparent. The aim of this study was to retrospectively review reasons for potential recruits (PRs) to be deemed medically unsuitable or deferred suitability on medical grounds for selection to the Brigade of Gurkhas.MethodsA retrospective review was conducted by extracted data from published post-exercise reports for the past four years to ascertain numbers of PRs deemed medically fit, medically unsuitable or deferred suitability on medical grounds. The International Classification of Disease version 11 (ICD-11) codes were retrospectively assigned to code medical reasons for non-progression. Rates of medical non-progression were compared by year.ResultsA total of 3154 PRs were analysed between 2018 and 2021. There was no significant difference between PRs deemed medically fit and those deemed medically suitable or deferred on medical grounds over the study period (p=0.351). There was a significant difference in the ratio of PRs deferred on medical grounds and those deemed medically unsuitable over the study period (p<0.05).ConclusionSelection to the Gurkhas is extremely competitive. These data demonstrate that, overall, reasons for medical deferral or unsuitability have remained constant despite the impact of a global pandemic. These data reinforce the central tenant of Gurkha selection;that it continues to be free, fair, and transparent.

8.
Int J Environ Res Public Health ; 19(17)2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2010021

ABSTRACT

INTRODUCTION: Suicide is a key issue impacting children and young people. Helplines offer unique benefits, such as anonymity, varied communication avenues and low cost, which help to promote help-seeking behaviour. The aim of this study was to explore the views and experiences of helpline organisations of identifying, assessing, and managing suicide risk among children and young people. METHODS: Thirteen professionals from three UK-based helplines and online counselling services took part in semi-structured interviews between November 2020 and January 2021 via Zoom. Interviews were transcribed verbatim and analysed using Thematic Analysis. RESULTS: Three superordinate themes were identified: (i) Starting conversations about suicide; (ii) Identifying and responding to "imminent" suicide risk; and (iii) Responses to suicide risk in relation to safeguarding. LIMITATIONS: Recruitment was limited by COVID-19 due to the demands needed from helplines at this time. CONCLUSIONS: Our findings highlight not only the different types and range of services helpline organisations offer to young people who might be at risk of suicide, but most importantly the distinct role they have in young people's help-seeking pathway.


Subject(s)
COVID-19 , Suicide , Adolescent , COVID-19/epidemiology , Child , Communication , Counseling , Humans , Qualitative Research , Suicide/prevention & control
9.
Industrial Marketing Management ; 106:166-182, 2022.
Article in English | ScienceDirect | ID: covidwho-2004152

ABSTRACT

This research explores the underlying roles of effectuation and causation logic as they impact upon firm resilience in Small and Medium Sized Enterprises (SMEs) in the unprecedented disruption caused by Covid-19. Because Covid-19 provides a unique and powerful discontinuance to internal and external environments, it requires firm adaptation in a wide variety of areas, as they seek to find a new “normal”. Our study contributes to the literature by applying effectuation to understand how an SME can experiment and learn in the face of disruption, and then subsequently causally adapt their resources and networks to achieve resilient outcomes. It adds to knowledge about the interaction between effectual and causal logic, leading to a more nuanced explanation of how and why an SME might apply each logic when responding to disruption caused by Covid-19.

10.
Veterinary Evidence ; 7(2), 2022.
Article in English | EMBASE | ID: covidwho-1928966

ABSTRACT

Objective: To assess outcomes of a limited period (7 months) of remote video consultation with prescribing of prescription-only (POM) or prescription-only-veterinary (POM-V) medications by Royal College of Veterinary Surgeons (RCVS) registered veterinary surgeons to UK clients via a veterinary telemedicine smartphone application. Background: Objective evidence is needed to inform the veterinary profession on the impact that remote prescribing, without physical examination in person, has on animal health and welfare. During the COVID-19 pandemic, the RCVS allowed remote prescribing temporarily. Methods: Clinical records from all veterinary video consultations from 1 April-31 October 2020 were reviewed. Details were assessed pertaining to: signalment, body system/disease categories managed, referrals into practice, medication classes prescribed and outcomes following POM-V/POM medications. Records of adverse events and antimicrobial prescribing were reviewed. Results: 16.6% (3,541/21,383) of video consults had a POM-V/POM prescribed;with a (mild) adverse event rate of 0.8% (30/3541). Antibacterials were prescribed in 5.88% of all consultations (1,258/21,383), 99.3% (1249/1258) being first line. Follow-up on prescribing was available in 67.7% (2,399/3541) of cases. 89% (2135/2399) of all known treatment outcomes were complete or had an expected response to treatment. Dermatological disease was the most common body system/disease category seen and prescribed for. Conclusion: Low prescribing rates (including antibacterials) were recorded, treatments were efficacious and no harm was done by prescribing remotely via a veterinary video consult app. Application: Veterinary surgeons and governing bodies are invited to use the information provided in this clinical audit to inform decisions on the suitability of remote consultations and prescribing in veterinary medicine.

11.
International Journal of Agricultural and Statistical Sciences ; 18(1):141-152, 2022.
Article in English | Scopus | ID: covidwho-1898144

ABSTRACT

The COVID-19 pandemic is wreaking havoc on society and the current situation the country is in now clearly shows the failure of predicting the second wave in India. Several variants of the coronavirus responsible for COVID-19 have been detected around the world. With several mutations, some are said to be more contagious than the original strain;the recent one is the Indian variant. This necessitates a wholesome study for modeling and forecasting COVID-19 cases in India, which will help us to be prepared. The bottleneck underlines here is the very nature of the virus, which is continuously mutating and unavailability to real-time and precise data for the purpose. This paper is an effort in this regard to the model and forecast the second wave in India. The dataset covers the period 2021-01-16 to 2021-05-16, where different models were used. SARIMA modeling was used for forecasting the cases, deaths and vaccinations using the best-fitted model. The results depict that the prediction was good as the predicted figures were found to be close to the observed values. In this context, we tried to study the pattern of propagation of this variant in India by modeling and forecasting the new deaths, new cases, total deaths, total cases and the total vaccination. Findings are alarming, especially, in the context of the difficulties of the health system in India. © 2022 DAV College. All rights reserved.

12.
Fertility and Sterility ; 116(3 SUPPL):e220, 2021.
Article in English | EMBASE | ID: covidwho-1880552

ABSTRACT

OBJECTIVE: To compare trends in and rates of elective egg freezing (EF) cycles before and during the COVID-19 pandemic. MATERIALS AND METHODS: We retrospectively identified all appointments for EF from June 2019-February 2020 (group 1, pre-pandemic) and June 2020-February 2021 (group 2, post-pandemic) for comparison. Total numbers of EF consultation appointments and retrievals, time to first EF cycle after initial consultation, as well as patient demographics were collected. Growth rates in EF cycles from pre- to post-pandemic were calculated as a whole, by time to first EF cycle from initial consultation, as well as by age group (<30, 30-34.9, 35-39.9, 40-44.9 and >45). RESULTS: Post-pandemic retrieval volume for EF increased by 39% compared to pre-pandemic despite only a 3% increase in new consultation appointments seen over the same timeframe. Demographics in patients pursuing EF between the two timeframes were similar (average age 36.8 years pre-pandemic vs 36.6 years post-pandemic). There was 44% growth in patients pursuing EF cycles in 90 days or less, primarily driven by increased numbers of EF cycles in the 30-34.9 year-old age group. CONCLUSIONS: Despite stable numbers of patients presenting for EF consultation pre- and post-pandemic, more EF retrieval cycles were observed post-pandemic, notably occurring at earlier timepoints from initial consultation and in patients <35. This may represent pandemic-related reevaluation of life goals, changes in financial status, and/or alterations in workplace flexibility. Qualitative survey data will provide further insight into the motivators and drivers of EF, particularly during a time of national crisis. Research focused on what factors were most responsible for the increase in EF cycles may enable providers and patients to make accommodations in the future. IMPACT STATEMENT: Following the COVID-19 pandemic, we observed growth in EF cycle volume and the rates at which EF cycles were initiated after EF consultation. (Table Presented).

13.
Wellcome Open Research ; 6(11), 2021.
Article in English | CAB Abstracts | ID: covidwho-1780281

ABSTRACT

Background: New data collection in established longitudinal population studies provides an opportunity for studying the risk factors and sequelae of the novel coronavirus disease 2019 (COVID-19), plus the indirect impacts of the COVID-19 pandemic on wellbeing. The Extended Cohort for E-health, Environment and DNA (EXCEED) cohort is a population-based cohort (N>11,000), recruited from 2013 in Leicester, Leicestershire and Rutland. EXCEED includes consent for electronic healthcare record (EHR) linkage, spirometry, genomic data, and questionnaire data.

14.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-330665

ABSTRACT

Early identification of symptoms and comorbidities most predictive of COVID-19 is critical to identify infection, guide policies to effectively contain the pandemic, and improve health systems' response. Here, we characterised socio-demographics and comorbidity in 3,316,107persons tested and 219,072 persons tested positive for SARS-CoV-2 since January 2020, and their key health outcomes in the month following the first positive test. Routine care data from primary care electronic health records (EHR) from Spain, hospital EHR from the United States (US), and claims data from South Korea and the US were used. The majority of study participants were women aged 18-65 years old. Positive/tested ratio varied greatly geographically (2.2:100 to 31.2:100) and over time (from 50:100 in February-April to 6.8:100 in May-June). Fever, cough and dyspnoea were the most common symptoms at presentation. Between 4%-38% required admission and 1-10.5% died within a month from their first positive test. Observed disparity in testing practices led to variable baseline characteristics and outcomes, both nationally (US) and internationally. Our findings highlight the importance of large scale characterization of COVID-19 international cohorts to inform planning and resource allocation including testing as countries face a second wave.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S126, 2021.
Article in English | EMBASE | ID: covidwho-1746755

ABSTRACT

Background. The SARS-CoV-2 pandemic has spotlighted respiratory infections and the value of effective vaccines. The SARS-CoV-2 vaccine has been remarkably effective;however, influenza vaccine effectiveness has been reported to be lower among active duty military populations than in the general public (18% vs 36%). The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study compares 3 FDA-licensed influenza vaccine types (egg-based, cell-based, and recombinant) to assess differences in immunogenicity and effectiveness in adults. Methods. Participants in the 3rd year of PAIVED (2020/21 influenza season) were enrolled from October 2020 through January 2021. Participants received weekly surveys about influenza-like-illnesses (ILI) experienced in the past week;if they reported an ILI, they were queried about symptom duration and severity, and asked to self-collect a nasal swab and dried blood sample. Four weeks later, more information about symptom duration and illness burden was obtained via telephone interview, and the participant collected a second blood sample. Results. PAIVED year 3 enrolled 3,269 participants (Table 1). 278 participants reported 1 ILI , while 60 reported 2 ILIs, and 18 reported 3 ILIs. No pathogen was identified for most processed ILI samples (78%);the most common viruses were SARS-CoV-2 (25, 12%), rhinovirus (24, 12%), and seasonal coronaviruses (4, 2%). No influenza has been identified thus far. Among those participants who had convalescent ILI visits (275), the median duration of the reported ILIs was 9 days (IQR 5, 15), with a median of 4 days (IQR 2, 7) of limited activity, and 2 days (IQR 0, 3) with fever. Three individuals were hospitalized. Conclusion. There have been relatively low rates of ILI identified in this study during this season, with only 11% of the participants reporting an ILI so far, consistent with low rates of non-COVID-19 ILI reported elsewhere during the current pandemic. We anticipate some influenza cases may be identified as more samples are processed. Planned analyses include calculating comparative influenza vaccine effectiveness to inform future vaccine purchasing decisions, as well as comparing serological response to the different vaccines.

16.
Open Forum Infectious Diseases ; 8(SUPPL 1):S344, 2021.
Article in English | EMBASE | ID: covidwho-1746511

ABSTRACT

Background. We sought to describe the range of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children. Methods. Patients < 18 years of age who had a positive nasopharyngeal polymerase chain reaction (PCR) for SARS-CoV-2 at a single health system in central Pennsylvania from 3/19/2020-12/31/2020 were identified. Using a random number generator, 150 additional patients < 18 years of age who had a negative PCR test were also identified. Asymptomatic patients and those without clinical data in the electronic medical record were excluded from analysis. Demographic characteristics, symptoms present at the time of testing, and outcomes were compared between PCR-positive and negative patients. Odds ratios were calculated using univariable and multivariable logistic regression models to patients with positive vs. negative PCR tests. Results. We included 544 patients in analysis, 412 (76%) of which had a positive SARS-CoV-2 PCR. PCR-positive patients were statistically more likely to have a known contact, no comorbidities, and to present with cough, cold-like symptoms, headache, or loss of taste and smell. All patients who presented with loss of taste and smell were PCR positive at time of presentation. Positive patients were statistically less likely to present with fever or emesis than negative patients. Multivariable regression identified increased age, cough, cold symptoms, headache, and non-white race as predictive of PCR positivity. Patients who tested positive were statistically less likely to be admitted to the hospital and less likely to require respiratory support than negative patients. Conclusion. Loss of taste and smell is a specific, though uncommon, indicator of SARS-CoV-2 infection in the pediatric population. Headache, cough, and cold-like symptoms are also suggestive of SARS-CoV-2 infection, while fever and gastrointestinal symptoms appear less common. This data suggests that screening questions developed for adults may be less applicable in children. Future research, including more dedicated and prospective studies, is warranted to identify patients in whom a positive SARS-CoV-2 test is sufficiently likely to warrant isolation and testing.

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S756-S757, 2021.
Article in English | EMBASE | ID: covidwho-1746296

ABSTRACT

Background. The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) is a multicenter study assessing influenza vaccine effectiveness in active duty service members, retirees, and dependents. PAIVED recently completed its third year and offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospective, well-defined cohort. Methods. During the 2018-19, 2019-20, and 2020-21 influenza seasons, PAIVED enrolled DoD beneficiaries presenting for annual influenza vaccination. After collecting baseline demographic data, participants were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Weekly throughout the influenza season of enrollment, participants were surveyed electronically for ILI, defined as (1) having cough or sore throat, plus (2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection. Results. Over the three seasons, there were 10,656 PAIVED participants: 1514 (14.2%) in 2018-19, 5876 (55.1%) in 2019-20, and 3266 (30.6%) in 2020-21. The majority were male (68-73% per year) with a mean age of 34±14.8 years at enrollment. 2266 participants reported a total of 2673 unique ILIs. The highest percentage of participants with ILI was in 2019-20 (28.2%), versus 19.6% in 2018-19 and 9.6% in 2020-21. Figure 1 depicts the percent of individuals reporting ILI by week of the season for each of the PAIVED seasons. Notably, after March 21, 2020, the weekly incidence of participants reporting ILI never exceeded 1%. Figure 1. Percent of PAIVED participants reporting ILI by week of season. Conclusion. The low incidence of reported ILI in PAIVED participants during the COVID-19 pandemic is consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that mitigation measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses.

18.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-329400

ABSTRACT

Background: The majority of U.S. reports of COVID-19 clinical characteristics, disease course, and treatments are from single health systems or focused on one domain. Here we report the creation of the National COVID Cohort Collaborative (N3C), a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative U.S. cohort of COVID-19 cases and controls to date. This multi-center dataset supports robust evidence-based development of predictive and diagnostic tools and informs critical care and policy. Methods and Findings: In a retrospective cohort study of 1,926,526 patients from 34 medical centers nationwide, we stratified patients using a World Health Organization COVID-19 severity scale and demographics;we then evaluated differences between groups over time using multivariable logistic regression. We established vital signs and laboratory values among COVID-19 patients with different severities, providing the foundation for predictive analytics. The cohort included 174,568 adults with severe acute respiratory syndrome associated with SARS-CoV-2 (PCR >99% or antigen <1%) as well as 1,133,848 adult patients that served as lab-negative controls. Among 32,472 hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March/April 2020 to 8.6% in September/October 2020 (p = 0.002 monthly trend). In a multivariable logistic regression model, age, male sex, liver disease, dementia, African-American and Asian race, and obesity were independently associated with higher clinical severity. To demonstrate the utility of the N3C cohort for analytics, we used machine learning (ML) to predict clinical severity and risk factors over time. Using 64 inputs available on the first hospital day, we predicted a severe clinical course (death, discharge to hospice, invasive ventilation, or extracorporeal membrane oxygenation) using random forest and XGBoost models (AUROC 0.86 and 0.87 respectively) that were stable over time. The most powerful predictors in these models are patient age and widely available vital sign and laboratory values. The established expected trajectories for many vital signs and laboratory values among patients with different clinical severities validates observations from smaller studies, and provides comprehensive insight into COVID-19 characterization in U.S. patients. Conclusions: This is the first description of an ongoing longitudinal observational study of patients seen in diverse clinical settings and geographical regions and is the largest COVID-19 cohort in the United States. Such data are the foundation for ML models that can be the basis for generalizable clinical decision support tools. The N3C Data Enclave is unique in providing transparent, reproducible, easily shared, versioned, and fully auditable data and analytic provenance for national-scale patient-level EHR data. The N3C is built for intensive ML analyses by academic, industry, and citizen scientists internationally. Many observational correlations can inform trial designs and care guidelines for this new disease.

19.
AIDS Behav ; 26(8): 2746-2757, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1706377

ABSTRACT

We examined PrEP use, condomless anal sex (CAS), and PrEP adherence among men who have sex with men (MSM) attending sexual health clinics in Wales, UK. In addition, we explored the association between the introduction of measures to control transmission of SARS-CoV-2 on these outcomes. We conducted an ecological momentary assessment study of individuals in receipt of PrEP in Wales. Participants used an electronic medication cap to record PrEP use and completed weekly sexual behaviour surveys. We defined adherence to daily PrEP as the percentage of CAS episodes covered by daily PrEP (preceded by ≥ 3 days of PrEP and followed by ≥ 2 days). Sixty participants were recruited between September 2019 and January 2020. PrEP use data prior to the introduction of control measures were available over 5785 person-days (88%) and following their introduction 7537 person-days (80%). Data on CAS episodes were available for 5559 (85%) and 7354 (78%) person-days prior to and following control measures respectively. Prior to the introduction of control measures, PrEP was taken on 3791/5785 (66%) days, there were CAS episodes on 506/5559 (9%) days, and 207/406 (51%) of CAS episodes were covered by an adequate amount of daily PrEP. The introduction of pandemic-related control measures was associated with a reduction in PrEP use (OR 0.44, 95%CI 0.20-0.95), CAS (OR 0.35, 95%CI 0.17-0.69), and PrEP adherence (RR = 0.55, 95%CI 0.34-0.89) and this may have implications for the health and wellbeing of PrEP users and, in addition to disruption across sexual health services, may contribute to wider threats across the HIV prevention cascade.


Subject(s)
Anti-HIV Agents , COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , Sexual and Gender Minorities , Anti-HIV Agents/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Medication Adherence , Pandemics/prevention & control , SARS-CoV-2 , Sexual Behavior , Wales/epidemiology
20.
Journal of Social Inclusion ; 12(2):57-66, 2021.
Article in English | Web of Science | ID: covidwho-1695313

ABSTRACT

The use of digital technology has become increasingly commonplace within the United Kingdom, with many public services, including healthcare, becoming 'digital by default' in response to COVID-19 pandemic and pledged government objectives. Digital healthcare delivery has shown to be a beneficial mode of delivery, yet it is unclear whether the benefits of digital healthcare are experienced evenly throughout society. Individuals from lower income households, individuals residing in areas with poor digital infrastructure, and individuals without adequate digital skills are at risk of being excluded from digital healthcare. It is imperative that the determinants of digital inequality are addressed to ensure that vulnerable members of society can assess healthcare that is increasingly being delivered digitally. To achieve this, stakeholders spanning many sectors should collaborate to understand and address the impact that digital inequality has upon health inequality.

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