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1.
Am J Public Health ; 113(1):96-104, 2023.
Article in English | PubMed | ID: covidwho-2162732

ABSTRACT

Objectives. To assess the effectiveness of vaccine-induced immunity against new infections, all-cause emergency department (ED) and hospital visits, and mortality in Indiana. Methods. Combining statewide testing and immunization data with patient medical records, we matched individuals who received at least 1 dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines with individuals with previous SARS-CoV-2 infection on index date, age, gender, race/ethnicity, zip code, and clinical diagnoses. We compared the cumulative incidence of infection, all-cause ED visits, hospitalizations, and mortality. Results. We matched 267 847 pairs of individuals. Six months after the index date, the incidence of SARS-CoV-2 infection was significantly higher in vaccine recipients (6.7%) than the previously infected (2.9%). All-cause mortality in the vaccinated, however, was 37% lower than that of the previously infected. The rates of all-cause ED visits and hospitalizations were 24% and 37% lower in the vaccinated than in the previously infected. Conclusions. The significantly lower rates of all-cause ED visits, hospitalizations, and mortality in the vaccinated highlight the real-world benefits of vaccination. The data raise questions about the wisdom of reliance on natural immunity when safe and effective vaccines are available. (Am J Public Health. 2023;113(1):96-104. https://doi.org/10.2105/AJPH.2022.307112).

2.
Journal of Head Trauma Rehabilitation ; 37(6):E518-E519, 2022.
Article in English | EMBASE | ID: covidwho-2161226

ABSTRACT

Introduction Annually around 40 000 children and young people (CYP) in the United Kingdom sustain an acquired brain injury (ABI). Many experience significant, lifelong impairments that impact on physical and psychological development, health-related quality of life (HRQoL), educational achievement, and social participation. We aimed to explore the longer-term needs of CYP with ABI aged 5 to 18 years and their families in one region of the United Kingdom. Patients and Methods Mixed-methods study. CYP aged 5 to 18 years with ABIs and their parents were recruited through a regional specialist pediatric neurorehabilitation service. A cross-sectional survey consisting of demographic questions and standardized measures of pediatric HRQoL (PedsQL) and participation (CASP), parental HRQoL and family functioning (PedsQLFIM), and parental anxiety and depression (Parental Health Questionnaire-4) was completed by the parent or CYP. Additional free-text questions captured parent and CYP goals and impact of COVID-19 lockdowns. Qualitative interviews were completed with a 20% subsample to gain more indepth understanding of CYP and parental unmet needs, as well as facilitators and barriers to participation. Survey data were analyzed using descriptive statistics, and interviews were transcribed verbatim and analyzed using Framework analysis. Ethical approval was gained (REC-20/EM/0258) from the UK Health Research Authority. Results Ninety-five survey responses (response rate 30%) were received from 49 parents, 41 CYP, and 5 parent-proxy, representing 51 families. Forty-five percent of CYP respondents had had a brain tumor. Sixty-seven percent of CYP had impaired HRQoL (PedsQL median =64.17;IQR =43.33-78.33;range, 18.75-93.33), and the CASP indicated 72% had severely impaired social participation (CASP median =80.63;IQR = 61.25-94.44;range, 35-100). More than half of parents (53%) reported reduced parental HRQoL and family functioning (PedsQL-FIM median =56.25;IQR =39.58-74.31;range, 16.67-100). According to PHQ-4 cutoff values, 37% of parents were at risk of anxiety, depression, or both (PHQ-4 median = 4;IQR =2-6;range, 0-12). Parent and CYP goals were mapped to the International Classification of Functioning, Disability and Health: Child and Youth version (ICF-CY). Most goals mapped to Activity and Participation domains, with 93% for CYP and 83% for parents. Recreation and leisure goals were the top priority for both parents and CYP. Ten interviews were conducted with CYP-parent dyads. Preliminary key themes are the need for long-term key-worker support, support to identify new or unrecognized needs, reaccess to rehabilitation services, and specific needs around transition to adult services. Conclusion Preliminary findings highlight the long-term impact of ABI on CYP and family HRQoL and CYP social participation. Recreation and leisure activities are important goals for CYP with ABI and their parents. Rehabilitation should address both participation goals and the psychological well-being of CYP with ABI and their parents and access to services should be lifelong.

3.
The Breast ; 2022.
Article in English | ScienceDirect | ID: covidwho-2158530

ABSTRACT

Purpose In March 2020, a 1-week adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was adopted to reduce the risk of COVID19 for staff and patients. This study quantifies acute toxicity rates and the effect on linac capacity. Materials and methods This is a report of consecutive patients receiving ultrafractionated breast radiotherapy ( ± sequential boost) Mar–Aug 2020. Virtual consultations assessed acute skin toxicity during treatment and weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. The number of linac minutes saved was estimated accounting for boost and DIBH use. Results In total,128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (Grade 3). 41/128 (32%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2), 62/128 (48%) reported faint erythema or dry desquamation (Grade 1) as their worst skin toxicity, with the remaining 20% reporting no skin toxicity. The highest prevalence of grade 2 toxicity occurred week 1 following treatment (20%), reducing to 3% by week 4. There was no difference in toxicity between those who received a boost versus not (p = 1.00). Delivering this schedule to 135 patients over six months saved 21,300 linac minutes and 1485 hospital visits compared to a 3-week schedule. Conclusion Rapidly implementing ultrahypofractionated breast radiotherapy is feasible and acute toxicity rates are acceptable even when followed by boost.

4.
Pilot Feasibility Stud ; 8(1):245, 2022.
Article in English | PubMed | ID: covidwho-2153699

ABSTRACT

BACKGROUND: Dental caries in childhood is a burden on the daily lives of children and their families, and associated with poor oral health in adulthood. In England, dental caries is the most common reason for young children to be admitted to hospital. It is believed that most tooth extractions (due to decay) for children aged 10 years and under, could be avoided with improved prevention and early management. National public health policy recommendations in England include specific oral health initiatives to tackle tooth decay. One of these initiatives is delivered as part of the Healthy Child Programme and includes providing workforce training in oral health, integrating oral health advice into home visits, and the timely provision of fluoride toothpaste. This protocol seeks to assess the delivery of the First Dental Steps intervention and uncertainties related to the acceptability, recruitment, and retention of participants. METHODS: This study seeks to explore the feasibility and acceptability of the First Dental Steps intervention and research methods. First Dental Steps intervention will be delivered in local authority areas in South West England and includes oral health training for health visitors (or community nursery nurses) working with 0-5-year-olds and their families. Further, for vulnerable families, integrating oral health advice and the provision of an oral health pack (including a free flow cup, an age appropriate toothbrush, and 1450 ppm fluoride toothpaste) during a mandated check by a health visitor. In this study five local authority areas will receive the intervention. Interviews with parents receiving the intervention and health visitors delivering the intervention will be undertaken, along with a range of additional interviews with stakeholders from both intervention and comparison sites (four additional local authority areas). DISCUSSION: This protocol was written after the start of the COVID-19 pandemic, as a result, some of the original methods were adjusted specifically to account for disruptions caused by the pandemic. Results of this study will primarily provide evidence on the acceptability and feasibility of both the First Dental Steps intervention and the research methods from the perspective of both families and stakeholders.

5.
North American Journal of Psychology ; 24(4):585-596, 2022.
Article in English | Scopus | ID: covidwho-2125483

ABSTRACT

Vaccinations, conspiracy theories, and celebrities are all popular topics in contemporary society. Anti-vaccination attitudes and conspiratorial beliefs, especially, have emerged as more prevalent against the backdrop of the 2020 election and Covid-19 pandemic. Martinez-Berman et al. (2020), collected data on these topics prior to the emergence of the Covid-19 pandemic and found a positive relationship between anti-vaccination attitudes and celebrity admiration. Further, there were positive relationships between conspiratorial beliefs and dimensions of celebrity admiration. In this study, we replicated and extended this work to a university-aged sample, to document anti-vaccination attitudes and conspiratorial beliefs at a different time of the Covid-19 pandemic, and to conduct a validity check of the single-item Belief in Conspiracy Theories scale with a more sophisticated measure of conspiratorial belief, the General Conspiratorial Belief (GCB) scale. We discovered overall attitudes toward vaccinations to be similar to those in the prior study. However, participants in our study reported lower mistrust of vaccinations and greater concern for future effects of vaccinations than participants in the previous study. In contrast to the results of the prior study, we found that interest in celebrities was not a significant predictor of vaccination attitudes. We discussed the results in the context of the replication and extension nature of the project and present goals for future research into the relationships among the key variables. © NAJP.

6.
Journal of the American Society of Nephrology ; 33:35, 2022.
Article in English | EMBASE | ID: covidwho-2125032

ABSTRACT

Background: Renal (acute kidney injury, AKI) involvement in COVID-19 patients is associated with high mortality and morbidity. Critically ill COVID-19 patients are at twice the risk of in hospital mortality compared to nonCOVID AKI patients. The cell types that succumb to direct or indirect damage and the associated abnormal biological responses are unclear. New generation single cell technologies have the potential to provide insights into physiological states and molecular mechanisms in COVID-AKI. One of the key limitations is that biopsies are not routinely performed and the risks of procuring an additional research core is indeterminate making it difficult to get direct insights into the landscape of COVID-AKI disease in the kidney at genome wide and cellular scale. Method(s): We developed an innovative method that used remnant kidney biopsy tissue from OCT-embedded frozen diagnostic pathology biopsy core and generated single nucleus transcriptome (snRNAseq) of COVID-AKI from as little as 1 mm3 of tissue. Comparative analysis of snRNAseq of 4 COVID-AKI and 4 control cortical biopsies was done in conjunction with urine transcriptomics to find overlapping genes in these two datasets representing COVID-AKI-enriched genes and the corresponding cell types in the kidney. Result(s): snRNAseq of COVID-AKI remnant or control frozen kidney biopsies (15659 and 15604 nuclei passing QC, respectively) identified all major and minor cell types. Differential expression analysis of COVID-AKI biopsies showed pathways enriched in viral response, kidney regeneration, WNT signaling, cancer, kidney development and cytokines in several nephron epithelial cells including kidney injury markers and fibrosis indicating robust remodelling in various cell types. Ten genes were also detected in urine cells of COVID-AKI patients as potential biomarkers. Two of these genes, LRP1B and PDE3A, have been recently implicated in driving fibrosis in COVID-AKI model systems. Conclusion(s): snRNAseq is feasible on leftover kidney biopsy tissue using minimum amount of sample and enabled identification of altered kidney cell types and states with several novel genes associated with tissue injury, remodelling and fibrosis.

7.
Asia-Pacific Journal of Clinical Oncology ; 18(Supplement 3):212-213, 2022.
Article in English | EMBASE | ID: covidwho-2136603

ABSTRACT

Aims: Vaccination uptake is the principal focus of the world-wide response to the COVID-19 pandemic. Vaccine hesitancy remains a critical issue. Our aim was to ascertain rates and reasons for vaccine hesitancy in people with breast cancer (BC) in Australia. Method(s): Between June and October 2021, an anonymous online survey was conducted among people with solid organ cancer treated at nine Australian treatment centres. Data collected included demographics and clinical characteristics. Vaccine hesitancy and related beliefs were assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale (OCVCCS), and the Disease Influenced Vaccine Acceptance Scale-Six. Descriptive statistics, chi-squared and linear regression were used. Results for the BC subgroup are reported. Result(s): The BC subgroup (N = 986, mean age 58.4 years, 99% female) comprised 36.6% of the responses in the solid cancer population (N = 2691). Most (76%) were treated at metropolitan centres and 64% were receiving ongoing treatment. Early BC was more commonly reported than metastatic BC (77% vs. 23%). Overall, 82% self-reported at least one COVID-19 vaccine dose. Unvaccinated participants were more likely to diagnosed with BC for a shorter time (<2 years (22.1%) vs >=2 years (14.5%), p = 0.003). Participants with metastatic BC were more likely to be unvaccinated and report greater disease-related vaccine concerns and hesitancy, when compared with participants with early BC (all p < 0.05). When compared with participants with all other solid cancers, participants with BC reported more negative attitudes towards COVID-19 vaccine side-effects (OCVCCS Side-Effects subscale mean scores: 5.19 (SD 1.91) vs. 5.46 (SD 1.82), p < 0.001). Conclusion(s):Despite a relatively high rate of self-reported vaccination, people with BC reported lower vaccine confidence when compared with all other solid cancers. A better understanding of these inequalities, and strategies to address vaccine confidence in people with BC, particularly those with metastatic BC, should be developed.

8.
Bulletin of the American Meteorological Society ; 103(8):E1796-E1827, 2022.
Article in English | Web of Science | ID: covidwho-2123275

ABSTRACT

During spring 2020, the COVID-19 pandemic caused massive reductions in emissions from industry and ground and airborne transportation. To explore the resulting atmospheric composition changes, we conducted the BLUESKY campaign with two research aircraft and measured trace gases, aerosols, and cloud properties from the boundary layer to the lower stratosphere. From 16 May to 9 June 2020, we performed 20 flights in the early COVID-19 lockdown phase over Europe and the Atlantic Ocean. We found up to 50% reductions in boundary layer nitrogen dioxide concentrations in urban areas from GOME-2B satellite data, along with carbon monoxide reductions in the pollution hot spots. We measured 20%-70% reductions in total reactive nitrogen, carbon monoxide, and fine mode aerosol concentration in profiles over German cities compared to a 10-yr dataset from passenger aircraft. The total aerosol mass was significantly reduced below 5 km altitude, and the organic aerosol fraction also aloft, indicative of decreased organic precursor gas emissions. The reduced aerosol optical thickness caused a perceptible shift in sky color toward the blue part of the spectrum (hence BLUESKY) and increased shortwave radiation at the surface. We find that the 80% decline in air traffic led to substantial reductions in nitrogen oxides at cruise altitudes, in contrail cover, and in resulting radiative forcing. The light extinction and depolarization by cirrus were also reduced in regions with substantially decreased air traffic. General circulation-chemistry model simulations indicate good agreement with the measurements when applying a reduced emission scenario. The comprehensive BLUESKY dataset documents the major impact of anthropogenic emissions on the atmospheric composition.

9.
American Journal of Clinical Pathology ; 158(SUPP 1):S126-S127, 2022.
Article in English | Web of Science | ID: covidwho-2122088
10.
European journal of public health ; 32(Suppl 3), 2022.
Article in English | EuropePMC | ID: covidwho-2102823

ABSTRACT

Obesity is a complex multifactorial disease defined by excessive adiposity and is linked to an increased risk for many noncommunicable diseases (NCDs). Overweight and obesity affect almost 60% of adults and nearly one in three children in the WHO European Region. Recent estimates suggest that overweight and obesity is the fourth most common risk factor for NCDs in the Region, after high blood pressure, dietary risks and tobacco. It is also the leading risk factor for disability and obesity is linked to greater morbidity and mortality from COVID-19. And obesity is considered a cause of at least 13 different types of cancer including cancers of the breast, colorectum, kidney, liver and ovary, multiple myeloma and meningioma. None of the countries in the Region are on track to achieve the obesity related target set in 2013. Early studies from a number of countries in the Region indicate that the prevalence of overweight and obesity and/or mean body mass index has increased in children and adolescents during the COVID-19 pandemic. This latest WHO European report on obesity examines the growing challenge and impact of obesity in the Region, building on past publications and aligning with initiatives to tackle cancer. The report focuses on managing obesity throughout the life course and tackling obesogenic environments;it also considers more recent challenges, including problematic digital marketing to children and the impact of the COVID-19 pandemic on obesity prevalence. Policy options to prevent obesity are outlined for consideration by Member States together with a suite of population-level approaches. The report highlights the importance of including prevention and control of obesity within measures to build back better in the wake of the COVID-19 pandemic. Whilst highlighting that single intervention will not be sufficient in any country, it examines the challenges faced by countries to implement known interventions to tackle obesity.

11.
Department of Veterans Affairs ; 11:11, 2021.
Article in English | MEDLINE | ID: covidwho-2102797

ABSTRACT

As both the largest integrated health system and largest provider of telehealth in the country, the Veterans Health Administration (VHA) has a particular interest in understanding how best to implement and utilize virtual care. VHA has long embraced virtual care as part of its mission to "serve all who have served" regardless of their socioeconomic and geographic circumstances. Having begun conducting "virtual care" in the 1960s when doctors first communicated with patient's via TV screens,1 VHA has since provided over 2.6 million episodes of care to more than 900,000 Veterans in 20192 and has distributed over 50,000 data- and video-enabled iPads for Veterans throughout the country.3 Virtual care within VHA includes services such as MyHealtheVet secure messaging, the Home Telehealth program that combines case management principles with remote monitoring to improve access and coordinate care, and the VA Video Connect (VVC) video platform for synchronous visits within both specialty and primary care.4 Increasing Veteran access to care via virtual care has been an integral part of VHA's strategy for improving chronic disease management for a population that is on average older and sicker than their civilian counterparts.5,6 Given the importance that virtual care has for Veteran care even beyond the COVID-19 pandemic, understanding the strengths and limitations associated with synchronous virtual care will be critical in shaping how VHA utilizes virtual care going forward.

13.
Embodied Environmental Risk in Technical Communication: Problems and Solutions Toward Social Sustainability ; : 40-58, 2022.
Article in English | Scopus | ID: covidwho-2100163

ABSTRACT

The troubling era of COVID-19 has highlighted that various audiences align with media sources that support and confirm their own beliefs, oftentimes to the detriment of fact-based reasoning. To counter the lack of reliable news sources in a critical time such as a global pandemic, we offer the Anticipatory Model of Crisis Management’s (AMCM’s) five major components and how crisis teams and practitioners can apply this model to inherent risks as well as the many audiences that are stakeholders. After we discuss the AMCM in depth, we show the crucial role that technology plays during a state of crisis, especially pertaining to community-based crisis communication centers;as such, we explore the embodiment of media and self-salient behavior that media platforms can often facilitate. The final third of our chapter discusses the actions that technical communicators should take in order to minimize “alternative facts” and maximize the dissemination of science-based facts. Learning objectives for this chapter are to: (1) familiarize our readers with AMCM and how to apply it to their own ends;(2) recognize how media can manipulate intended messages for their own agendas;and (3) explore best practices for the technical communicator during a time of crisis. © 2022 Taylor and Francis.

14.
PLoS Global Public Health ; 2(9), 2021.
Article in English | CAB Abstracts | ID: covidwho-2098662

ABSTRACT

The COVID-19 pandemic has affected job satisfaction among healthcare workers;yet this has not been empirically examined in sub-Saharan Africa (SSA). We addressed this gap by examining job satisfaction and associated factors among healthcare workers in Ghana and Kenya during the COVID-19 pandemic. We conducted a cross-sectional study with healthcare workers (N = 1012). The two phased data collection included: (1) survey data collected in Ghana from April 17 to May 31, 2020, and (2) survey data collected in Ghana and Kenya from November 9, 2020, to March 8, 2021. We utilized a quantitative measure of job satisfaction, as well as validated psychosocial measures of perceived preparedness, stress, and burnout;and conducted descriptive, bivariable, and multivariable analysis using ordered logistic regression. We found high levels of job dissatisfaction (38.1%), low perceived preparedness (62.2%), stress (70.5%), and burnout (69.4%) among providers. High perceived preparedness was positively associated with higher job satisfaction (adjusted proportional odds ratio (APOR) = 2.83, CI [1.66,4.84]);while high stress and burnout were associated with lower job satisfaction (APOR = 0.18, CI [0.09,0.37] and APOR = 0.38, CI [0.252,0.583] for high stress and burnout respectively). Other factors positively associated with job satisfaction included prior job satisfaction, perceived appreciation from management, and perceived communication from management. Fear of infection was negatively associated with job satisfaction. The COVID-19 pandemic has negatively impacted job satisfaction among healthcare workers. Inadequate preparedness, stress, and burnout are significant contributing factors. Given the already strained healthcare system and low morale among healthcare workers in SSA, efforts are needed to increase preparedness, better manage stress and burnout, and improve job satisfaction, especially during the pandemic.

15.
J Am Acad Child Adolesc Psychiatry ; 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2095534

ABSTRACT

OBJECTIVE: To examine whether racial disparities in access to pediatric mental health care were affected during the COVID-19 telemedicine transition at both The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH). METHOD: Electronic health records were queried for all unique outpatient visits from a pre-pandemic period in 2019 and a within-pandemic period in 2020. Changes in the proportion of patients were compared based on insurance status, clinic location, and racial identification. Hypotheses were tested via logistic regression analyses. RESULTS: At CHOP, from 2019 to 2020, the proportion of racially minoritized patients significantly declined within a 1-month period from 62% to 51%, whereas the proportion of White-identifying patients increased from 38% to 49% (ß = 0.47; z = 3.60; p =.0003), after controlling for insurance status and clinic location. At BCH, the proportion of racially minoritized patients significantly declined within a longer 6-month period between 2019 and 2020, from 62% to 59%, whereas the proportion of White-identifying patients increased from 38% to 41% (ß = 0.13; z = 2.8; p = .006), after controlling for insurance status. CONCLUSION: At CHOP and BCH, the COVID-19 telemedicine transition exacerbated pre-existing racial disparities in pediatric mental health services. Our findings suggest that racially minoritized patients receiving services in urban areas may be particularly at risk for losing access when telemedicine is implemented. Although there are limitations to this racial dichotomization, examining differences between White and racially minoritized patients can highlight ways in which White-identifying individuals have disproportionately received enhanced access to healthcare resources.

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17.
Journal of Clinical Oncology ; 40(16):E18807-E18807, 2022.
Article in English | Web of Science | ID: covidwho-2092270
18.
Pharmacoepidemiology and Drug Safety ; 31:623-624, 2022.
Article in English | Web of Science | ID: covidwho-2083890
20.
Telemed J E Health ; 28(10): 1525-1533, 2022 10.
Article in English | MEDLINE | ID: covidwho-1733626

ABSTRACT

Introduction: Cost studies of telehealth (TH) and virtual visits are few and report mixed results of the economic impact of virtual care and TH. Largely missing from the literature are studies that identify the cost of delivering TH versus in-person care. The objective was to demonstrate a modified time-driven activity-based costing (TDABC) approach to compare weighted labor cost of an in-person pediatric clinic sick visit before COVID-19 to the same virtual and in-person sick-visit during COVID-19. Methods: We examined visits before and during COVID-19 using: (1) recorded structured interviews with providers; (2) iterative workflow mapping; (3) electronic health records time stamps for validation; (4) standard cost weights for wages; and (5) clinic CPT billing code mix for complexity weighs. We examined the variability in estimated time using a decision tree model and Monte Carlo simulations. Results: Workflow charts were created for the clinic before COVID-19 and during COVID-19. Using TDABC and simulations for varying time, the weighted cost of clinic labor for sick visit before COVID-19 was $54.47 versus $51.55 during COVID-19. Discussion: The estimated mean labor cost for care during the pandemic has not changed from the pre-COVID period; however, this lack of a difference is largely because of the increased use of TH. Conclusions: Our TDABC approach is feasible to use under virtual working conditions; requires minimal provider time for execution; and generates detailed cost estimates that have "face validity" with providers and are relevant for economic evaluation.


Subject(s)
COVID-19 , Telemedicine , Ambulatory Care , Ambulatory Care Facilities , COVID-19/epidemiology , Child , Humans , Pandemics , Telemedicine/methods
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