Impact of the COVID-19 pandemic on prehospital characteristics and outcomes of out-of-hospital cardiac arrest among the elderly in Japan: A nationwide study.

Aim: To assess the impact of the 2020 coronavirus disease (COVID-19) pandemic on the prehospital characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in the elderly. Methods: In this population-based nationwide observational study in Japan, 563,100 emergency medical service-unwitnessed OHCAs in elderly (≥65 years) patients involving any prehospital resuscitation efforts were analysed (144,756, 140,741, 140,610, and 136,993 cases in 2020, 2019, 2018, and 2017, respectively). The epidemiology, characteristics, and outcomes associated with OHCAs in elderly patients were compared between 3 years pre-pandemic (2017-2019) and the pandemic year (2020). The primary outcome was neurologically favourable one-month survival. The secondary outcomes were the rate of bystander cardiopulmonary resuscitation (CPR), defibrillation by a bystander, dispatcher-assisted (DA)-CPR attempts, and one-month survival. Results: During the pandemic year, the rates of neurologically favourable 1-month survival (crude odds ratio, 95% confidence interval: 1.19, 1.14-1.25), bystander CPR (1.04, 1.03-1.06), and DA-CPR attempts (1.10, 1.08-1.11) increased, whereas the incidence of public access defibrillation (0.88, 0.83-0.93) decreased. Subgroup analyses based on interaction tests showed that the increased rate of neurologically favourable survival during the pandemic year was enhanced in OHCA at care facilities (1.51, 1.36-1.68) and diminished or abolished on state-of-emergency days (0.90, 0.74-1.09), in the mainly affected prefectures (1.08, 1.01-1.15), and in cases with shockable initial rhythms (1.03, 0.96-1.12). Conclusions: The COVID-19 pandemic increased the bystander CPR rate in association with enhanced DA-CPR attempts and improved the outcomes of elderly patients with OHCAs.

COVID-19 vaccine acceptance and its associated factors in Ethiopia: A systematic review and meta-analysis.

Background: COVID-19 vaccination is considered as an effective intervention for controlling the burden of the pandemic. However, vaccine hesitation is increasing and hindering efforts targeting to reduce the burden of the COVID-19 disease. Hence, determining COVID-19 vaccine acceptance and identifying determinants that would hinder people to vaccinate against COVID-19 is crucial to effectively improve COVID-19 vaccine uptake. In Ethiopia, the pooled proportion of COVID-19 vaccine acceptance and its determinants is not well known. Thus, the aim of this study is to estimate the pooled proportion of COVID-19 vaccine acceptance and its determinants in Ethiopia. Methods: A systematic search of articles was conducted from PubMed, Scopus, Web of Science, MEDLINE, CINAHL, Science Direct and Cochrane Library. Data were extracted using a data extraction tool which was adapted from the Joanna Briggs Institute. The quality of each included primary studies was evaluated using the Newcastle-Ottawa scale tool. Data analysis was performed using STATA 14. Heterogeneity in studies was assessed using Cochrane Q and I2 test. Publication bias was assessed using visual inspection of funnel plots and Egger's test. A random effects model was applied to determine the pooled estimates if heterogeneity was exhibited; otherwise, a fixed-effects model was used. Results: A total of 14 studies involving 6373 participants were included for the final analysis. The pooled proportion of COVID-19 vaccine acceptance in Ethiopia was 56.02% (95% CI: 47.84, 64.20). The likelihood of COVID-19 vaccine acceptance was higher among participants who had history of chronic disease (AOR = 1.33, 95% CI: 1.09, 2.97), good knowledge (AOR = 2.13, 95% CI: 1.59, 4.97), positive attitude (AOR = 2.23, 95% CI: 1.21, 4.66), good COVID-19 preventive practice (AOR = 1.97, 95% CI: 1.82, 2.12), and high perceived seriousness of COVID-19 (AOR = 3.21, 95% CI: 2.32, 5.98). Conclusion: More than half participants were willing to accept COVID-19 vaccine. Thus, awareness creation battles about the efficacy and safety of the COVID-19 vaccine should be provided to the community. Besides, policy-makers, health planners and other stakeholders should encourage COVID-19 vaccine uptake behaviors by providing trusted information.Systematic review and meta-analysis registration: PROSPERO CRD42021264708.

Awareness, knowledge and acceptance of COVID-19 vaccine among the people of West Bengal, India: A web-based survey.

Objectives: Rapid vaccination is the only way to fight against COVID-19.Vaccine hesitancy is the major barrier against this strategy. The main objective of this cross-sectional study was to analyze COVID-19 vaccine acceptance in the general population of West Bengal (India), as well as to investigate the factors that were independently associated with people's desire to receive the vaccine. Methods: An online questionnaire was distributed by email, Whatsapp, and other social media platforms, and the responses were analyzed using the SPSS (Version 20) software. Results: We conducted a web-based survey in West Bengal, India (N = 803), and accumulated information on individuals' desire to adopt vaccine against COVID-19, views about the virus's effectiveness, and many knowledge-based socio-demographic factors that potentially impact the overall vaccination efforts. We found that, 12.08% of participants do not believe that vaccination against COVID-19 is necessary, but among the rest of the population, 44.33% of individuals are willing to be vaccinated once the vaccine is available, whereas 39.60% of the population responded that they will not be vaccinated immediately but will do so later. Conclusions: Despite the participants' strong vaccine willingness, our findings revealed a troubling degree of lake of awareness and insignificant scientific knowledge about the COVID-19 pandemic and its associated vaccination programme. Vaccination hesitancy is not a barrier in this survey region, but poor vaccine availability and a lack of awareness campaigns may instill unfavorable beliefs in those who refuse to be vaccinated.

OBJETIVOS: La rapidez de la vacunación es el único modo de luchar contra la COVID-19. Las dudas sobre la vacuna constituyen la mayor barrera contra esta estrategia. El objetivo principal de este estudio transversal fue analizar la aceptación de la vacuna contra la COVID-19 en la población general de Bengala occidental (India), así como investigar los factores asociados de manera independiente al deseo de recibir la vacuna por parte de las personas.Métodos: Se distribuyó un cuestionario online por correo electrónico, Whatsapp, y otras plataformas de redes sociales, y se analizaron las respuestas utilizando el software SPSS (Versión 20). RESULTADOS: Realizamos una encuesta basada en web en Bengala occidental, India (N= 803), y acumulamos la información sobre el deseo de las personas de recibir la vacuna contra la COVID-19, las opiniones sobre la efectividad del virus, y muchos factores sociodemográficos basados en el conocimiento que tienen un impacto potencial en los esfuerzos globales sobre vacunación. Encontramos que el 12,08% de los participantes no creen en la necesidad de la vacunación contra la COVID-19 pero, entre el resto de la población, el 44,33% de los individuos desean ser vacunados una vez que se disponga de la vacuna, mientras que el 39,6% de la población respondió que no se vacunarían de inmediato, aunque lo harían más adelante. CONCLUSIONES: A pesar de la sólida voluntad de los participantes por la vacuna, nuestros hallazgos revelaron un grado preocupante de falta de concienciación y conocimiento científico insignificante acerca de la pandemia de COVID- 19 y su programa de vacunación asociado. Las dudas sobre la vacuna no son una barrera en la región de esta encuesta, pero la poca disponibilidad de la vacuna y la falta de campañas de concienciación puede infundir creencias desfavorables en aquellas personas que rechazan recibir la vacuna.

Willingness to use telemedicine during COVID-19 among health professionals in a low income country.

INTRODUCTION: The coronavirus disease 2019 pandemic has prompted rapid restructuring of the health-care system in an effort to stop the spread of the pandemic. Thus, telemedicine is more preferable in order to prevent the COVID-19 pandemic when face to face meeting is forbidden, allowing provision of health service over a distance. This study aimed to assess willingness to use telemedicine and factors that will determine their extent of willingness during COIVID-19 among healthcare providers working in south west of Ethiopia. METHODS: Institutional based cross-sectional study design was applied to assess willingness to use telemedicine among healthcare providers working at public health hospitals in south west of Ethiopia. Self-administered questionnaires were used. We have used Epi-info for data entry and Analysis of Moment Structure (AMOS) for analysis. A structural equation modeling was performed to identify factors associated with willingness to use telemedicine at 95% confidence interval (CI). RESULT: In this study, less than half of respondents had high willingness to use telemedicine. Ease of use (ß = 0.79, 95% CI: [0.72, 0.86], p < 0.01), attitude (ß = 0.91, 95% CI: [0.87, 0.95], p < 0.01) and patient-physician relationships (ß = 0.67, 95% CI: [0.54, 0.70], p < 0.01) were variables associated with willingness to use telemedicine. Anxiety towards technology (ß = 0.74, 95% CI: [0.69, 0.79], p < 0.01) and patient-physician relationships (ß = 0.87, 95% CI: [0.81, 0.92], p < 0.01) were determinant factors of attitude to use telemedicine. CONCLUSIONS: The overall willingness to use telemedicine during COVID-19 in this setting is 46.5%. Addressing the problem related with ease of use, attitude and patient-physician relationships will help to increase the overall willingness to use telemedicine during COVID-19. An attempt to improving patient-physician relationship, provision of technical training for ease of use and working on healthcare providers' attitude will help to improve the willingness to use telemedicine.

Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes.

STUDY OBJECTIVE: Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients. SETTING/PARTICIPANTS: 245 COVID-19 patients who underwent chest CT at Rush University Health System were included. DESIGN: Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians. INTERVENTIONS/MAIN OUTCOME MEASURES: These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation, in-hospital and 60-day mortality. Secondary endpoints included individual components of the ACO. RESULTS: Aortic calcification was independently associated with an increased risk of the ACO (odds ratio 1.86, 95% confidence interval (1.11-3.17) p < 0.05). Aortic calcification, CAC, abnormal septal position, or IVC reflux of contrast were all significantly associated with 60-day mortality and major adverse cardiovascular events. IVC reflux was associated with in-hospital mortality (p = 0.005). CONCLUSION: Incidental cardiovascular findings on chest CT are clinically important imaging markers in COVID-19. It is important to ascertain and routinely report cardiovascular findings on CT imaging of COVID-19 patients as they have potential to identify high risk patients.

Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. METHODS: We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk. FINDINGS: Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38-0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 - 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17-4.37), p = 0.015. INTERPRETATION: Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk. FUNDING: No funding was obtained for this study.

Impact of the COVID-19 lockdown on weight status and associated factors for obesity among children in Massachusetts.

This study aims to evaluate the impact of the COVID-19 lockdown on weight status, obesity and overweight among US children and identify associated factors. METHODS: At a large safety net health system in Massachusetts, anthropometric measurements of 701 children were analyzed before and after the COVID-19 lockdown. Chi-square and paired t-test were computed for categorical and continuous variables, respectively. Multivariate analyses were performed to identify factors associated with obesity and overweight. RESULTS: Post-lockdown, the overall mean body mass index (BMI) increased from 21.07 to 21.57 kg/m2 (p < .001). The overall obesity (23.2%-27.4%, p < .001) and overweight (41.1%-44.5%, p < .001) burdens increased after the lockdown period. Obesity (40.5%-46.9%, p < .001) was highest among Spanish speakers. The youngest age group (2-5 years) had the greatest obesity rate increase by 26% (19.7%-24.8%, p < .001). Obesity was associated with younger age (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91, 1.00), higher baseline BMI (OR = 1.19, 95% CI = 1.15, 1.23) and Spanish speaking children (OR = 2.19, 95% CI = 1.10, 4.33). CONCLUSIONS: BMI, obesity and overweight increased among children during the COVID-19 lockdown, disproportionately affecting disadvantaged subpopulations. Strategies are needed to counteract the impact of the COVID-19 lockdown on unhealthy weight gain and childhood obesity.