ABSTRACT
BackgroundThe COVID-19 pandemic triggered serious challenges in the treatment of chronic diseases due to the lack of access to medical attention. Patients with rheumatic diseases (RD) must have adequate treatment compliance in order to reach and maintain remission or low activity of their diseases. Treatment suspension because of non-medical reasons might lead to disease activation and organ damage.ObjectivesIdentify the frequency of biologic treatment (bDMARD) suspension in patients with RD during the COVID-19 pandemic and determine the associated factors for suspension.MethodsIn this study we included all patients registered in the Mexican Biologics Adverse Events Registry (BIOBADAMEX), that started bDMARD before March 2019 and suspended treatment during the COVID-19 pandemic. We used descriptive statistic to analyze baseline characteristics and main treatment suspension causes. We used Chi[2] and Kruskal Wallis tests to analyze differences between groups.ResultsA total of 832 patients patients registered in BIOBADAMEX were included in this study, 143 (17%) suspended bDMARD during the COVID-19 pandemic. The main causes of suspension were inefficacy in 54 (38%) patients, followed by other motives in 49 (34%) patients from which 7 (5%) was loss of medical coverage. Adverse events and loss of patients to follow up were the motive in 16 (11%) and 15 (11%) patients respectively.When we compared the group that suspended bDMARD with the non-suspenders (Table 1), we found statistical differences in patient gender, with 125 (87%) female patients that suspended bDMARD, with a median age of 52 (42-60) years, and a treatment duration of 3.8 years.ConclusionIn our study we found that 17% of patients with RD suspended bDMARD treatment during the COVID-19 pandemic and that non-medical motives such as lack of patients follow up and loss of medical coverage due to unemployment were important motives. These results are related to the effect of the pandemic on other chronic diseases.Table 1.Patients baseline characteristicsPatients that did not suspended bDMARD during pandemic (n = 689)Patients that suspended bDMARD during pandemic (n = 143)pFemale gender, n(%)549 (79.7)125 (87.4)0.02Age, median (IQR)55 (45 – 63)52 (42 – 60)0.04Body mass index, median (IQR)26.4 (23 – 30.4)27.23 (24.2 – 30.46)0.13Social security, n(%)589 (85.5)128 (89.5)0.2Diagnosis0.7- Rheumatoid arthritis444 (64.4)97 (67.8)- Juvenil idiopathic athritis29 (4.2)2 (1.4)- Ankyosing sponylitis93 (13.5)19 (13.3)- Psoriasic arthritis43 (6.2)6 (4.2)- Systemic lupus erithematosus32 (4.6)9 (6.3)- Others48 (6.9)10 (6.9)Disease duration, median (IQR)11 (7 – 19.5)12 (6 - 18)0.95Comorbidities, n(%)305 (44.3)73 (51)0.08Previos biologic, n(%)249 (36.1)60 (42)0.1Treatment at pandemic iniciation, n(%)0.8 - Etanercept a34 (4.9)5 (3.5)- Infliximab a24 (3.5)5 (3.5)- Adalimumab130 (18.9)22 (15.4)- Rituximab a61 (8.9)25 (17.5)- Abatacept76 (11)20 (14)- Tocilizumab82 (11.9)18 (12.6)- Certolizumab92 (13.4)28 (19.6)- Rituximab b7 (1)0- Golimumab36 (5.2)5 (3.5)- Tofacitinib14 (2)1 (0.7)- Infliximab b4 (0.5)2 (1.4)- Etanercept b31 (4.5)6 (4.2)- Baricitinib12 (1.7)1 (0.7)- Belimumab5 (0.7)1 (0.7)- Secukinumb8 (1.2)3 (2.1)Steroids use, n(%):254 (36.9)57 (39.9)0.2Steroids dose (mg), median (IQR)6 (5 – 10)6 (5 – 10)0.47DMARD use, n(%):538 (78.1)118 (82.5)0.1Treatment duration, median (IQR)5.06 (4.04 – 5.78)3.82 (3.35 – 4.95)0.001Suspension motive, n(%)NA- Inefficacy-54 (37.8)- Adverse event-16 (11.2)- Pregnancy-2 (1.4)- Loss of patient-15 (10.5)- Remission-7 (4.9)- Others-49 (34.2)Adverse events, n(%):102 (14.8)24 (16.8)0.3- Severe, n(%)13 (1.9)5 (3.5)0.4a original, b biosimilarREFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsVijaya Rivera Teran: None declared, Daniel Xavier Xibille Friedmann: None declared, David Vega-Morales: None declared, Sandra Sicsik: None declared, Angel Castillo Ortiz: None declared, Fedra Irazoque-Palazuelos: None declared, Dafhne Miranda: None declared, Iris Jazmin Colunga-Pedraza: None declared, Julio Cesar Casasola: None declared, Omar Elo Muñoz-Monroy: None declared, Sandra Carrilo: None declared, Angélica Peña: None declared, Sergio Duran Barragan: None declared, Luis Francisco Valdés Corona: None declared, Estefanía Torres Valdéz: None declared, Azucena Ramos: None declared, Aleni Paz: None declared, ERICK ADRIAN ZAMORA-TEHOZOL: None declared, Deshire Alpizar-Rodriguez Employee of: Scientific Advisor in GSK México.
ABSTRACT
BackgroundSjögren's syndrome (SS) is a chronic, systemic autoimmune disease affecting exocrine glands, primarily the salivary and tear glands, with potentially severe manifestations in multiple organs. No approved disease-modifying therapies exist. Dazodalibep (DAZ) is a biologic antagonist of CD40L.ObjectivesThe objective of this study was to evaluate the efficacy and safety of DAZ therapy in adult SS subjects with moderate-to-high systemic disease activity (NCT04129164).MethodsWe conducted a randomized, double-blind, placebo-controlled, crossover study to evaluate DAZ therapy in adult SS subjects with moderate-to-high systemic disease activity, as defined by a EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score ≥ 5. Eligible subjects were randomized 1:1 to receive intravenous DAZ 1500 mg or placebo (PBO) Q2W x 3 doses, then Q4W x 4 additional doses. Starting on Day 169, subjects initially randomized to DAZ received PBO Q4W x 5 doses and subjects randomized to PBO received DAZ Q4W x 5 doses and were then followed for 12 weeks. The primary endpoint was the change from Baseline in ESSDAI at Day 169. Safety assessments included the incidence of adverse (AEs), serious AEs (SAEs), and AEs of special interest (AESIs).ResultsThe 74 randomized subjects all received ≥1 dose of study medication (DAZ, N=36;PBO, N=38). The baseline demographics and disease characteristics were balanced between the two groups. The change from Baseline to Day 169 in ESSDAI score (LS mean ± SE), was -6.3 ± 0.6 in DAZ-treated subjects compared to -4.1 ± 0.6 in the PBO group, a difference of -2.2 (p = 0.0167). Compared to the PBO group, the DAZ group showed positive trends in the EULAR Sjögren's Syndrome Patient Reported Index score, and Functional Assessment of Chronic Illness Therapy-Fatigue score at Day 169. A post-hoc responder analysis of subjects achieving high levels (5 and 6 points) of improvement on ESSDAI favored DAZ (61.1% and 60.0%) over PBO (35.1% and 34.3%).The reported AEs were generally mild through Day 169 and similar in frequency between treatment groups. The most frequently reported AEs occurring in ≥5% of DAZ-treated subjects and >PBO were COVID-19, diarrhea, dizziness, ligament sprain, upper respiratory tract infection, contusion, device allergy, fatigue, hypertension, and oropharyngeal pain. Two SAEs were reported in a single DAZ-treated subject: this subject was a 59-year-old female who experienced a grade 3 SAE of COVID-19 infection and later died of unknown cause 46 days after last administration of DAZ (12 days after COVID-19 diagnosis). There was a single AESI of herpes zoster in a DAZ-treated subject.ConclusionDAZ is a potential new therapy for the treatment of systemic disease activity in patients with SS. SS subjects with moderate-to-high systemic disease receiving DAZ experienced a statistically significant reduction in disease activity relative to PBO as measured by the improvement in ESSDAI score. Except for a case of severe COVID-19 infection, DAZ therapy in SS subjects appeared to be well tolerated. Larger controlled trials of DAZ therapy for SS are warranted to further explore its safety profile and confirm its clinical efficacy.Table 1.Efficacy and Safety DataPBO N=38DAZ 1500 mg N=36EfficacyΔESSDAI, LS mean (SE) †-4.1 (0.6)-6.3 (0.6)*ΔESSPRI, LS mean (SE) †-1.12 (0.29)-1.80 (0.31)ΔFACIT-Fatigue, LS mean (SE) †5.8 (1.6)8.1 (1.6)AE Summary, n (%)≥1 AE23 (60.5)28 (77.8)≥1 related AE8 (21)10 (27.8)≥1 SAE01 (2.8)≥1 related SAE00≥1 AE leading to discontinuation00≥1 AESI01 (2.8)≥1 Death01 (2.8)Efficacy endpoints as of Day 169;† Analyzed using MMRM;Comparisons vs PBO;*p<0.05;AE summaries based on AEs that occurred through Day 169;AE, adverse event;AESI, adverse event of special interest;ESSDAI, EULAR Sjögren's Syndrome Disease Activity Index;ESSPRI, EULAR Sjögren's Syndrome Patient Reported Index;FACIT-Fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue;PBO, placebo;SAE, serious adverse eventFigure 1.AcknowledgementsFunded by Horizon herapeutics. Medical writing support provided by B Lujan, PhD, an employee of Horizon Therapeutics.Disclosure of InterestsE. William St. Clair Consultant of: Horizon Therapeutics, Bristol Myers Squibb, CSL Behring, Resolve Therapeutics, Sonoma Biotherapeutics. Royalties: UpToDate, Liangwei Wang Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Ilias Alevizos Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, William Rees Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Alan Baer Consultant of: Bristol Myers Squibb, Wan Fai Ng Consultant of: Novartis, GlaxoSmithKline, Abbvie, BMS, Sanofi, MedImmune, Janssen and UCB, Ghaith Noaiseh Consultant of: Novartis, Chiara Baldini Consultant of: GSK, and Sanofi.
ABSTRACT
The Coronavirus (COVID-19) disease is a global pandemic infectious disease caused by a novel coronavirus, which affects all age groups with a higher incidence in the geriatric population and people with chronic diseases. The outbreak of the virus is a serious public health challenge including to nurses at the various health care facilities around the world. The outbreak of the coronavirus has been a huge threat to nursing and nursing care globally. Nurses are experiencing a high level of daily emotional stress in their activities in preventing disease infections, promoting health, and saving lives. Many nurses have lost their lives to the deadly disease in their fight to save their patients, many feel stressed and burnout, and many feeling discouraged because of the protracted effects of the disease. The psychological health of the nurses as frontline health care workers should be safeguarded owing to their crucial roles in mitigating disease pandemics. Thus, adequate training of nurses would better equip them with the necessary information regarding the preventive measures, and management approaches to foster the mitigation of the disease, mitigate the disease burden on healthcare facilities, and enhance the recovery rate of the infected populations. Andfurther better prepare nurses on prioritizing personal psychological health.
ABSTRACT
BackgroundSome individuals may have persistent symptoms after COVID-19, a new condition known as long COVID-19. However, these complaints can be misunderstood with disease activity in patients with immune-mediated rheumatic diseases (IMRD), especially fatigue and mental distress.ObjectivesTo evaluate fatigue, depression, anxiety, and stress in IMRD patients after 6 months of COVID-19, compared with IMRD patients without COVID-19.MethodsThe ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 diagnosis (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, such as age, sex, comorbidities, as well as disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. The FACIT questionnaire (Functional Assessment of Chronic Illness Therapy) and the DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) were applied at 6 months after COVID in both groups.ResultsA total of 606 IMRD patients were included, of whom 322 (53.1%) cases and 284 (46.9%) controls. Most patients were female (85.3%) with mean age 46.1 (13.0) years old. Specific disease activity were similar between cases and controls. There was a significant difference between FACIT scores and 3 domains of DASS-21 comparing cases and controls (Figure 1). The factors associated with FACIT were female gender, diabetes, obesity, no comorbidities, COVID manifestations (skin, joint pain, asthenia, diarrhea, and dyspnea), and chronic oral corticosteroid use. DASS-21 Depression was associated with these same factors. Female gender, COVID manifestations as skin, joint pain, asthenia, cough, dyspnea, and chronic oral corticosteroid use were associated with DASS-21-Anxiety. DASS-21 Stress was associated with female gender, asthenia, diarrhea, dyspnea, cough, chronic oral corticosteroid use, and hospitalization. Table 1 shows the variables that remained in the models after the univariate logistic analysis. A weak correlation between disease activity and FACIT was observed in rheumatoid arthritis (p=0.010;r2 = 0.035) and ankylosing spondylitis patients (p=0.010;r2 = 0.129). No other correlations were observed between the scores results and disease activity (patient's global assessment - PGA), medications or specific IMRD.ConclusionFatigue and mental changes such as depression, anxiety, and stress, occurred more frequently in IMRD patients who had COVID-19 than in those who did not have COVID-19, especially in women, regardless of disease activity score. Fatigue was more related to female gender, diabetes, obesity, and current joint pain. Mental impairment was more associated with severity of COVID-19, including respiratory and non-respiratory symptoms.Figure 1.Comparison between cases and controls of FACIT and DASS-21 depression, anxiety, and stress scoresFACIT (Functional Assessment of Chronic Illness Therapy);DASS-21 (Depression, Anxiety and Stress Scale - 21 Items):Table 1.Final model using binary Logistic Regression analysis to evaluate the preditive factors associated with FACIT and DASS-21 scoresFACIT Score ≤ 37 x score > 37§DASS-21-DEPRESSION Score ≤ 6 (normal/mild) x score > 6 (moderate/severeDASS-21-ANXIETY Score ≤ 5 (normal/mild) x score > 5 (moderate/severe)DASS-21-STRESS Score ≤ 9 (normal/mild) x score > 9 (moderate/severeVariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)Female0.151.83 (1.12-2.98)No comorbidities0.0290.66 (0.46-0.95)Joint pain0.0022.44 (1.39-4.26)Female0.0122.31 (1.20-4.46)Diabetes0.0062.35 (1.28-4.32)Joint pain**0.0012.58 (1.57-4.22)Dyspnea0.0013.61 (2.11-6.19)Dyspnea0.0013.69 (2.09-6.51)Dyspneia0.0012.00 (1.23-3.26)Dyspnea0.0012.82 (1.79-4.44)Oral CE0.0141.55 (1.09-2.21)Joint pain0.0052.20 (1.41-3.43)Oral CE0.0481.41 (1.00-1.99)§Lower scores mean worse fatigue;CE: corticosteroid;OR: odds ratio;CI: confiance intervalAcknowledgementsReumaCoV Brasil researchers, Brazilian Rheumatology Society and National Council for Scientific and Technological Deve opment.Disclosure of InterestsNone Declared.
ABSTRACT
Os desafios enfrentados por pacientes e suas famílias para terem acesso a cuidados médicos referentes a condições de saúde crônicas fazem com que os profissionais de saúde responsáveis por seu atendimento médico se sintam, com elevada frequência, impotentes. Às vezes convém atribuir a reponsabilidade por esses desafios a um ou mais grupos específicos, tais como os formuladores de políticas ou o sistema de seguro-saúde. No entanto, as verdadeiras razões desses desafios são bem mais complexas, existindo múltiplos fatores presentes, com interrelação. Torna-se necessário realizar uma análise sistêmica mais ampla, bem como ter uma visão mais abrangente, de forma a integrar o contexto sociocultural, focando particularmente as populações vulneráveis e aquelas precariamente atendidas, incluindo-se os adultos mais idosos, a população de áreas densamente povoadas e os indivíduos com status socioeconômico de nível inferior, assim como os migrantes e as minorias1. Neste contexto, a equidade e a justiça social constituem fundamentos aplicáveis essencialmente em um estado de utopia, mas estes fundamentos são indispensáveis à implementação de mudanças futuras.A justiça social constitui um apelo bastante significativo como conceito, a ser plenamente reconhecido em todas as profissões relacionadas aos cuidados de saúde2. O conceito afirma que todos devem, independentemente das circunstâncias legais, políticas, econômicas ou outras3, ter acesso igual à riqueza, ao bem-estar, aos privilégios e às oportunidades, bem como à saúde. Além disso, esse conceito é dirigido para dimensões que vão além dos princípios do direito civil ou penal e transcendem, entre os indivíduos e a sociedade, a relação cujo propósito é ter e manter uma vida gratificante. Portanto, a justiça social é de aplicação universal, devendo ser relacionada a propósitos sociais em todas as regiões do mundo.Como região, a América Latina tem muitos países e com numerosos pontos em comum. Antes da pandemia do coronavírus de 2019 (COVID-19), existiam desafios significativos com relação à saúde na América Latina, incluindo a escassez de medicamentos, a falta de acesso a alimentos saudáveis ou a cuidados primários, seja para migrantes ou pessoas desabrigadas. De acordo com o Índice de GINI, a América Latina é a região mais injusta do planeta, com 185 milhões de pessoas auferindo uma renda abaixo do limiar de pobreza, o equivalente a 66 milhões de indivíduos em estado de pobreza extrema4. Para superar essas deficiências, as comunidades precariamente atendidas se apoiam mutuamente, trabalhando em projetos locais, bancos de alimentos e organizações religiosas, mas desafios significativos continuam existindo.A abordagem atual, com respeito aos cuidados de saúde para indivíduos fragilmente representados e que vivem em comunidades mal atendidas, não é mais sustentável. O caminho a adotar deve incluir como base a medicina para uma vida saudável (HLM, na sigla em inglês), promovendo em sua essência atividades físicas, boa alimentação, ter um peso corporal mediano e abster-se de fumar. Em nível sistêmico, essa mudança cultural diz respeito ao estabelecimento de políticas e práticas.Apromessa ou possibilidade de ter uma existência gratificante encontra-se aqui, na América Latina. Essa abordagem precisa abraçar o conceito de justiça social para que todos tenham oportunidades semelhantes com relação a ter um estilo de vida saudável, minimizando-se os efeitos deletérios das doenças crônicas.Alternate :The challenges that patients and their families experience to access care for chronic health conditions often make the health professionals responsible for their care feel powerless. At times, it may be convenient to lay the blame for these challenges on a singular group, such as policymakers or the health insurance system. However, the true reasons such challenges exist are much more complex, multifactorial, and interrelated. A broader systemic analysis and broader visio is needed to integrate the sociocultural context and place a particular focus on vulnerable, underserved populations, including older adults, people living in densely populated areas, people with lower socioeconomic status, migrants, and minorities11 Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, Hanvoravongchai P, Obando C, Petrosyan V, Rao KD, Ruano AL, Shi L, de Souza LE, Spitzer-Shohat S, Sturgiss E, Suphanchaimat R, Uribe MV, Willems S. Health equity and COVID-19: global perspectives. Int J Equity Health 2020;19(1):104.. In this context, equity and social justice are constructs that may only feasible in a Utopia but are essential to effect change moving forward.Social justice as a concept is quite appealing and should be fully embraced by all health care professions22 Arena R, Laddu D, Severin R, Hall G, Bond S, HL-PIVOT Network. Healthy living and social justice: addressing the current syndemic in underserved communities. J Cardiopulm Rehabil Prev 2021;41(3):E5-E6.. The concept professes that all people should have equal access to wealth, well-being, privilege, opportunity, and health regardless of legal, political, economic, or other circumstances33 Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN., Manderscheid R, Troutman A. Health disparities and health equity: the issue is justice. Am J Public Health 2011, 101(Suppl. 1):S149-S155.. Moreover, this concept focuses on dimensions beyond civil or criminal law principles and the relationship between individuals and society to lead fulfilling lives. Therefore, social justice is relatable and universal for all regions in the world.Latin America as a region hosts many countries that share numerous commonalities. Prior to the coronavirus disease 2019 (COVID-19) pandemic, there were significant health related challenges in Latin America, including prescription drug shortages, lack of access to healthy food or primary care for migrants, and homelessness. According to the GINI Index, Latin America is the most inequitable region globally;185 million people's income is below the poverty threshold, of whom 66 million live in extreme poverty44 Garcia PJ, Alarcón A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun R. COVID-19 response in Latin America. Am J Trop Med Hyg 2020;103(5): 1765.. While these underserved communities support each other to supplement these shortcomings by working with local movements, food banks, and religious organizations, significant challenges remain. The current approach to health care in underrepresented individuals who live in underserved communities is no longer sustainable. The way forward must include healthy living medicine (HLM) as a foundation, at its core promoting physical activity, good nutrition, average body weight, and not smoking. On a systemic level, this cultural change refers to the establishment of policies and practices. The promise or possibility of being is here in Latin America. This approach needs to embrace the concept of social justice so that all individuals in the population have similar opportunities to embrace a healthy lifestyle and minimize the deleterious effects of chronic disease.
ABSTRACT
Background. Nurses' high workload can result in depressive symptoms. However, the research has underexplored the internal and external variables, such as organisational support, career identity, and burnout, which may predict depressive symptoms among Chinese nurses via machine learning (ML). Aim. To predict nurses' depressive symptoms and identify the relevant factors by machine learning (ML) algorithms. Methods. A self-administered smartphone questionnaire was delivered to nurses to evaluate their depressive symptoms;1,431 questionnaires and 28 internal and external features were collected. In the training set, the use of maximum relevance minimum redundancy ranked the features' importance. Five ML algorithms were used to establish models to identify nurses' depressive symptoms using different feature subsets, and the area under the curve (AUC) determined the optimal feature subset. Demographic characteristics were added to the optimal feature subset to establish the combined models. Each model's performance was evaluated using the test set. Results. The prevalence rate of depressive symptoms among Chinese nurses was 31.86%. The optimal feature subset comprised of sleep disturbance, chronic fatigue, physical fatigue, exhaustion, and perceived organisation support. The five models based on the optimal feature subset had good prediction performance on the test set (AUC: 0.871–0.895 and accuracy: 0.798–0.815). After adding the significant demographic characteristics, the performance of the five combined models slightly improved;the AUC and accuracy increased to 0.904 and 0.826 on the test set, respectively. The logistic regression analysis results showed the best and most stable performance while the univariate analysis results showed that external and internal personal features (AUC: 0.739–0.841) were more effective than demographic characteristics (AUC: 0.572–0.588) for predicting nurses' depressive symptoms. Conclusions. ML could effectively predict nurses' depressive symptoms. Interventions to manage physical fatigue, sleep disorders, burnout, and organisational support may prevent depressive symptoms.
ABSTRACT
ObjectiveTo explore Young Persons (YP) and healthcare professionals (HCP) experiences of virtual consultations (VC) and establish whether developmentally appropriate healthcare can be delivered virtually.MethodYP and HCP questionnaire surveys were designed and piloted. Electronic questionnaire links were sent by post, email or text message January–April 2021 to YP aged 13–25 years old, with predefined chronic gastrointestinal conditions, attending a gastroenterology/hepatology VC. HCP undertaking VC were invited to complete staff questionnaire. Results were anonymous and collated using Excel version 2302.ResultsFive UK hospital trusts participated, with 35 HCP responses. Of the 100 YP completing the survey 66% were female and 34% male aged between 13 years and 25 years (median: 18 years). 13% were new appointments and 87% follow ups, 29% were by video, 69% by phone and 2% gave no response. 80% of HCP spoke to YP directly but not privately (69%). 87% of YP and 88% HCP found VC useful. 83% of YP want VC again, although 20% preferred face to face. 43% of HCP required improved phone/internet connection. 77% of YP required hospital appointments for tests following VC.ConclusionsOverall respondents were satisfied with VC, finding them useful, convenient and time saving. Successful VC rely on appropriate patient selection and availability of reliable technology. Patient preference is key which may alter with time.
ABSTRACT
BackgroundRestrictions on outdoor movements due to the coronavirus disease (COVID-19) pandemic have led to a decreased physical activity;this can lead to sarcopenia and frailty in older adults. Our recent study has demonstrated a significant decrease in the trunk muscle mass immediately after the pandemic's first wave (April–May 2020) among Japanese community-dwelling older women. In the present study, we further examined whether muscle mass recovery or deterioration occurs after 1 year of the pandemic's first wave by comparing physical measurements among the following assessment periods: before the first wave, immediately after the first wave, and at 1-year follow-up thereafter.MethodsThis study included 77 women (78.0 ± 5.7 years) who underwent physical measurements for muscle mass, grip strength, one-leg stand-up ability (3 s), and oral motor skills and answered questionnaires on sociality (social network, participation, and support) in the three assessment periods.ResultsThe frequency of going out and the subjective vitality were significantly decreased immediately after the first wave;these recovered at the 1-year follow-up (P < 0.001). When comparing muscular measures, the trunk muscle mass index preferentially decreased immediately after the first wave but recovered significantly at the 1-year follow-up (P < 0.001). Conversely, the appendicular skeletal muscle mass index (ASMI) and grip strength continued to decrease until the 1-year follow-up (P < 0.001 and P = 0.03, respectively). The ability to perform a one-leg stand-up for 3 s and the oral motor skills did not change significantly across the assessment periods. The prevalence of pre-sarcopenia and sarcopenia tended to increase during these periods (P = 0.068). The reduction and subsequent recovery patterns for sociality were similar to those observed for the trunk muscle mass.ConclusionsOur findings demonstrated differences in the reversibility of skeletal muscle mass and strength at 1 year after the first wave of the COVID-19 pandemic: the trunk muscle mass declined acutely and recovered rapidly, whereas the ASMI and grip strength declined continuously. These differences in the skeletal muscle recovery and deterioration might help formulate short-term or long-term strategies for COVID-19-related sarcopenia prevention in community-dwelling older adults.
ABSTRACT
None is inconsequential: advancing digital technology, globalization of clinical trials, changes in clinical trial design, the inflow of private equity dollars, fewer sponsors lost to mergers and acquisitions, more CROs, the costs of clinical trials, precision medicine, lack of available talent, and-an under the radar trend-the continuing challenges of chronic disease. A 2020 report called them a "primary factor" in the growth of global CRO services market.2 Casey McTigue, an executive director at SRS Acquiom, an M&A services firm, put it this way: "We have seen record setting volumes for M&A." Market attention In 2019, the life sciences recruiter Pr°Clinical considered the following CROs worthy of close attention from investors and pharma alike: PPD, Medpace, PRA Health Sciences, KCR, ICON, IQVIA, PSI, Parexel.3 Of the eight, three still stand alone;the rest have merged or been acquired. Combined, their network covers 2,800 hospitals, clinics and long-term care facilities, and 200 research and pharmaceutical companies, a press release says. Since the combined R&D outlay of the top pharma houses now hovers at the $100 billion-and that majority of trials have CRO involvement-even the math challenged can appreciate the CRO industry's losses, or gains, depending on the road chosen.6 But the CRO industry has already proved its resiliency. Despite changes in market conditions between 2008 and 2019, SRS Acquiom found that of the 227 private life sciences deals in which it was the shareholder representative, 163 had earnouts, the potential dollar figure more than $37 billion.
ABSTRACT
PurposeThis study aims to identify the dietary patterns of two groups of subjects (with and without COVID-19), and to assess the relationship of findings with the prognosis of COVID-19 and metabolic risk parameters.Design/methodology/approachThis study included 100 individuals in the age range of 19–65 years. The medical history, and data on biochemical, hematological and inflammatory indicators were retrieved from the files. A questionnaire for the 24-h food record and the food intake frequency was administered in face-to-face interviews, and dietary patterns of subjects were assessed.FindingsIn individuals with COVID-19, the hip circumference, the waist-hip ratio and the body fat percentage were significantly higher (p < 0.05), and the muscle mass percentage was significantly lower (p < 0.05). Mediterranean diet adherence screener (MEDAS), dietary approaches to stop hypertension (DASH) and healthy eating ındex-2015 (HEI-2015) scores were low in the two groups. A linear correlation of DASH scores was found with the muscle mass percentage (p = 0.046) and a significant inverse correlation of with the body fat percentage (p = 0.006). HEI-2015 scores were significantly and negatively correlated with body weight, body mass index, waist circumference, hip circumference and neck circumference (p < 0.05). Every one-unit increase in MEDAS, DASH and HEI-2015 scores caused reductions in C-reactive protein levels at different magnitudes. Troponin-I was significantly and negatively correlated with fruit intake (p = 0.044), a component of a Mediterranean diet and with HEI-2015 total scores (p = 0.032).Research limitations/implicationsThe limitation of this study includes the small sample size and the lack of dietary interventions. Another limitation is the use of the food recall method for the assessment of dietary patterns. This way assessments were performed based on participants' memory and statements.Practical implicationsFollowing a healthy diet pattern can help reduce the metabolic risks of COVÍD-19 disease.Originality/valueDespite these limitations, this study is valuable because, to the best of the authors' knowledge, it is the first study demonstrating the association of dietary patterns with disease prognosis and metabolic risks concerning COVID-19. This study suggests that dietary patterns during the COVID-19 process may be associated with several metabolic risks and inflammatory biomarkers.
ABSTRACT
BackgroundCOVID-19 has become a national and an international pre-occupation to all doctors. Dealing with patients with clinical suspicion of COVID-19 is a daily markedly growing professional issue for radiologists. The number of COVID-19 cases we deal with is peaking since last March and so is our experience in recognizing the disease patterns and in assessing its severity. The purpose of this study is to assess the role of CT chest in the diagnosis of COVID-19 based on our experience with 220 Egyptian cases.ResultsA cross-sectional multicenter study involving 220 patients;68 (30.9%) females and 152 (69.1%) males, their age range was 10-92 years (average 49.198 years). Non-contrast MSCT chest was done to patients with clinically suspected COVID-19. Data assessment and analysis for lesions probability, pattern, localization, and severity were done.Bilateral affection was seen in 168/220 cases (76.36%). Multilobar affection was noted in 186/220 cases (84.54%). Lower lobes affection was noted in 179/220 cases (81.36%). Peripheral/subpleural affection was noted in 203/220 cases (92.27%). The common CT patterns (ground-glass opacities, consolidation, crazy paving, vascular thickening, traction bronchiectasis, vacuolar sign, architectural distortion signs, and reversed halo sign) and the uncommon CT patterns (halo sign, masses, nodules, lobar affection, tree in-bud-pattern and cysts) were discussed. Associated extra-pulmonary lesions described. Temporal changes, severity scoring, reporting, and possible pitfalls were all assessed.ConclusionIn our experience, CT plays a basic essential role in diagnosing COVID-19 in the current declared pandemic.
ABSTRACT
This article examines how resistance toward capitalism's temporal bullying is performed in contemporary art and activism. It addresses the relationship between creativity, institutions, and empowerment. Building on the conceptual work of Croatian artist Mladen Stilinović (1947–2016), the article explores several aesthetic presentations of resistive temporalities we identify as non-production. The case studies of non-production herein marshaled affirm a performance of resistance that centers discussion of radicality in self-consciously interdependent care networks, ostensibly available to all disabled and nondisabled individuals. This care ethic claps back at the idea of self-optimization and fiduciary endurance amidst economic regimes of exploitation as virtuous. In the place of 'wellness,' this article affirms new directions in care and mutual aid, as premised on queer, crip, and feminist portrayals of disability praxis and pedagogy.
ABSTRACT
Physical activity and exercise participation among older adults have decreased dramatically because of the physical distancing measures implemented to prevent the spread of COVID-19. However, even in the face of unforeseen environmental changes, physical activity and exercise for older adults must be sustainable. This study aimed to identify the influencing physical activity and exercise participation among older adults in 2020 when varying levels of quarantine were in place as a protective measure against the COVID-19 pandemic to build a foundation for sustainable older adult health strategies. We utilized a large-scale dataset from the 2020 National Survey of Older Koreans conducted in 2020. Twenty survey questions were used as predictors, and logistic regression and decision tree analyses were utilized to identify influencing factors. Through a logistic regression analysis, 16 factors influencing exercise participation were identified. Additionally, through a decision tree analysis, 7 factors that influence exercise participation and 8 rules were derived through a combination of these factors. According to the results of this study, the use of ICT technologies, such as ‘smartphone or tablet PC', can be a useful tool to maintain or promote physical activity and exercise by older adults in a situation like the COVID-19 pandemic. In conclusion, physical activity and exercise intervention strategies should be developed with comprehensive consideration of the influencing factors to ensure that physical activity and exercise among older adults can be sustained uninterrupted in the face of unforeseen circumstances, such as the COVID-19 pandemic.
ABSTRACT
Objectives: This study assessed trends in tobacco use in students of the Third Faculty of Medicine of Charles University in the Czech Republic between academic years 2012/13 and 2019/2020. Methods: Two cross-sectional surveys designed to obtain information on smoking history, smoking status, tobacco products use, and cessation were conducted among 382 students of the 6-year Master's Study Programme (General Medicine) and the 3-year Bachelor's Study Programme (Public Health) in 2012/2013;and among 580 students of General Medicine and of the Bachelor's Study Programmes (Public Health, Dental Hygiene and Nursing) in 2019/2020. Results: Regular/daily smoking was reported by 4.4 ± 2.4% (with 95% CI) of General Medicine students and 4.8 ± 4.1% of Public Health students in 2012/2013, and 1.3 ± 1.1% of General Medicine students and 14.4 ± 4.8% of students of bachelor studies in 2019/2020. The share of regular and occasional smokers was higher among junior students in both academic years (23.9 ± 5.1% and 20.1 ± 4.7%, respectively) compared to senior students (23.6 ± 9.8% and 9.6 ± 5.7%). Cigarettes were the most common products used in both academic years (67.0 ± 4.7% and 45.5 ± 4.0%). There was a significant increase in proportion of students using more tobacco products in the course of the time (from 12.1 ± 3.1% to 53.7 ± 4.1%). The proportion of students who quitted smoking has risen from 11.4 ± 3.2% to 16.1 ± 3.0%. On the contrary, the proportion of students who started smoking has dropped from 15.9 ± 3.7% to 2.9 ± 1.4%. The proportion of non-smokers has risen from 57.6 ± 5.0% to 65.3 ± 3.9%. Conclusions: The study revealed some positive trends concerning tobacco use in students (decline in regular smokers among students of General Medicine, senior students, cigarette smokers, water pipe smokers;rise in non-smokers), but also negative ones (rise in regular smokers among students of Public Health, students who used more tobacco products).
ABSTRACT
Inadequate nutrition as a result of poverty and poor real access to health care due to a lack of financial resources for travel to the doctor or medicines contribute to the unsatisfactory state of health in Roma communities. According to a Dinge study (Dinge 2003), there is a relatively large genetic load in some Roma communities, which is related to a high incidence of congenital (born) diseases. According to the general statistics of the Slovak Republic for the year 2021, there were 2.9 million people who were unable to work due to inhabitants, while in 2012 it was 2.3 million, people, while the average morbidity rate rose to 4.3% of the total population. Roma people have worse health status;higher infant mortality rates;shorter (10-15 years) life expectancy;higher prevalence of chronic diseases than the non-Roma (Sedlakova, 2014).
ABSTRACT
Am J Manag Care. 2021;27(1):9-11. https://doi.org/10.37765/ajmc.2021.88571 _____ Takeaway Points * The policy response to the coronavirus disease 2019 (COVID-19) pandemic has removed barriers inhibiting the delivery of remote health care, serving as an opportunity to directly address the gap in health care underutilization. * Policies that encourage telehealth and remote patient monitoring can directly lead to improved chronic disease management, an area of underutilization and high cost to the health care system. * Prior studies demonstrate the efficacy of telehealth, remote patient monitoring, and community health workers. In 2018, only 18% of doctors practiced medicine with some component of telehealth, compared with nearly 50% now.15 To exemplify the profoundness of this point, at Mount Sinai Faculty Practice in New York, New York, more telehealth visits occurred per average day in April 2020 during the height of COVID-19 than in all of 2019.16 In light of the boom in telehealth use, current evidence suggests a cost-reduction potential for the health care system and insurance providers, not to mention the financial incentives that accompany an increased ability to care for chronic diseases.17 Furthermore, of the 4 areas of spending on chronic disease management that account for two-thirds of all health care costs, both high volume and administration would be directly affected by sustained telehealth expansion.18 The increase in telehealth as a result of the COVID-19 pandemic is a prime opportunity to improve the effectiveness of health care expenditures by filling the void in chronic disease management and increasing access to care overall. Remote patient monitoring (RPM) is another disease management strategy that utilizes and builds upon the expansiveness of telehealth to reach underserved populations and fill an unmet need in American health care.19 RPM is a cost-effective method of engaging patients and promoting continuity in care that can integrate care teams and target high-risk groups through multiple channels.20-22 Effective RPM can improve access to chronic care management and help reduce unnecessary admissions, thereby reducing nonessential expenditures and cost burden from more acutely sick, hospitalized patients.23 CMS has issued a number of changes that tear down prior barriers to RPM as a means of providing care during the pandemic. Prior to COVID-19, CHWs, who served their respective communities through culturally appropriate health promotion and patient education, had demonstrated vast improvements in access for patients by improving care efficiency and reducing the need for emergency and specialty services.28,29 Moreover, incorporation of CHWs—as well as, similarly, care managers and navigators—has been associated with overall cost savings in addition to improved management of chronic disease and successful outreach attempts through multimodal communication efforts such as cell phone messaging.30-33 In light of the COVID-19 pandemic, a response effort that uses established CHW networks for short-term pandemic suppression with text messaging and virtual health outreach programming will also enable long-term amelioration by strengthening established care avenues.34-36 Although national policies promoting CHW telehealth strategies to combat the pandemic have not yet occurred, some states are upregulating CHW involvement as a short-term pandemic suppression strategy.
ABSTRACT
Am J Manag Care. 2021;27(3):123-128. https://doi.org/10.37765/ajmc.2021.88511 _____ Takeaway Points Robust population health management integrates analytics and agile clinical programs and is adaptable to optimize outcomes and reduce risk during population-level crises. * The coronavirus disease 2019 pandemic revealed the tenuousness of care delivery based on fee-for-service reimbursement models. * Population-level data and care management facilitate identification of demographic-based disparities and community outreach. * Telemedicine and integrated behavioral health have ensured primary care and specialty access, and mobile health and postacute interventions shifted site of care and optimized hospital utilization. * Beyond the pandemic, population health is a cornerstone of a resilient health system and can improve public health while mitigating risk in a value-based paradigm. _____ Prior to the coronavirus disease 2019 (COVID-19) pandemic, the US health care system was in the midst of major transformation—shifting away from the inefficiencies of fee-for-service toward value and patient-centeredness. [...]registries for hypertension, diabetes, and chronic kidney disease identified the highest-risk patients to receive laboratory monitoring or medical procedures, prioritizing those who were likely to need dialysis in the near future.5,6 Similarly, a registry of patients with frailty, defined by the Johns Hopkins ACG System, was used to identify patients for augmented home-based care and goals of care outreach.7,8 Care Management: Delivering Public Health to High-risk Patients and Addressing Disparities For the last decade, the integrated care management program (iCMP) has been an essential component of PHS population health to coordinate care, improve outcomes, and reduce cost for high-risk patients by leveraging a dedicated nurse, social worker, or community health worker.9,10 This team was utilized as a public health workforce to provide outreach to patients at increased risk for adverse outcomes, including elderly patients, frail patients, and those with complex health conditions. The Home Hospital program provides inpatient level of care to low-acuity patients in their homes, and the Mobile Integrated Health (MIH) program uses paramedics to further support home-based care delivery.12 During the pandemic, these programs expanded capacity to prevent potential COVID-19 exposure in patients requiring hospital care and to monitor patients with COVID-19 who were recovering at home, reducing inpatient utilization and preserving higher-acuity resources.13 Within the first 46 days of MIH expansion, teams evaluated 102 patients with confirmed or suspected COVID-19, with 92.2% of patients able to continue care at home. Postacute care is critical to identify safe locations for patients with and without COVID-19 to recover and to maintain inpatient hospital capacity.14 PHS mobilized an existing collaborative of long-term acute care hospitals and skilled nursing facilities (SNFs) to address the surge in postacute capacity by creating unified admission plans, creating COVID-19–specific SNFs, and supporting personal protective equipment (PPE) provision to facilities.15 This team's expertise was extended to support the creation of a 1000-bed field facility called Boston Hope Medical Center, with a dual focus on respite care for homeless populations and postacute care for those recovering from COVID-19.16 The University of Washington also collaborated with postacute partners to develop a comprehensive strategy for COVID-19, which included establishing clear criteria for facility admission, providing PPE training, equipping testing supplies, and developing isolation plans.17 Population-based postacute strategies during the pandemic helped prevent delays in discharge, spread of infection, and overwhelmed facilities to mitigate the effects of the public health crisis.14,18 Behavioral Health: Providing Psychological Support at a Time of Great Need COVID-19 has brought numerous mental health challenges due to elevated stress, financial insecurity, and exposure to traumatic events.19 To address these needs, we adapted existing programs in behavioral health management, substance use disorders, and digital health.
ABSTRACT
[...]as we turn to a new year and a new administration, I think my points would be to continue to grow on our bipartisan work, emphasizing that there is more than enough money in the US health care system. [...]it's our hope, particularly with a split government with no major health care policy changes on the horizon, that there will be continued attention to aligning health care costs with the essential nature of clinical services, that not only will barriers be removed for coronavirus disease 2019 (COVID-19) vaccines and COVID-19 treatments, but hopefully this would extend to other high-value services that are particularly used in the area of chronic diseases, and that we could pay for the added generosity of that coverage with the identification and reduction of low-value care, as put forth by Mike and I in a template called VBID X, a benefit design that lowers cost sharing on certain high-value services and is paid dollar for dollar by increasing cost sharing on either specific services or line items of services like high-cost imaging and nonpreferred branded drugs. [...]what we feel is that with the COVID-19 pandemic, lots of pain, lots of hardship, but as colleagues of mine from Tufts and I published in the September issue of AJMC®,1 there might be a silver lining in the fact that the dramatic reduction in both high- and low-value care that Mike and his colleagues from Harvard have continuously updated us on allowed us this ability to really inform all stakeholders that we could realign payment, benefit design, and other levers to increase efficiency, in that, while I've not been overly sympathetic to the provider community over my career, I've written in multiple venues that it's time to start paying clinicians and delivery systems more for some of these high-tech services that provide great value and hold them accountable for the services that might be very expensive and profitable but that don't make Americans any healthier. [...]my affinity for alternative payment models
ABSTRACT
Chronic Illnesses;Covid-19;Mental Health;Systematic Review;Prisma;Life Style Diseases;NonCommunicable Diseases INTRODUCTION The WHO declared COVID-19 as public health emergency of international concern. [27] Results of review done by Dubey et al., 2020 showed that infodemic, xenophobia, and stigmatization are expected to increase mental health issues in vulnerable population, that is, females, youngsters, those with pre-existing physical and mental health conditions, high education status, frontline healthcare workers, and migrant workers. [28] Increased screen time, stress, and anxiety was reported during pandemic thereby increasing risk for hypertension and obesity in children and 30% of young population and parents in future are expected to suffer from mental issues, anxiety, and depression[29-31] thereby family and social support appears important to cope with mental health challenges)34 Singh et al., 2021;Kumar et al., 2020, and Singh et al., 2021, found issues with blood pressure control and both elevated systolic and worsening of blood pressure were reported. [16] Chopra et al., 2020, in cross-sectional study reported improvements in dietary habits, frequency of meals, and consumption of home cooked food and dairy products (slight increase in consumption of healthy food and avoiding junk/oily/fast food) mainly in those belonging to higher socio-economic strata and weight gain was also reported.
ABSTRACT
Limited research has been done on the follow-up and long-term effects of SARS-CoV-2 infection, despite the fact that there is growing evidence to support the idea that many SARS-CoV-2 patients, even those with mild symptoms or those who are asymptomatic, develop either long-term symptoms that negatively impact their quality of life or sequelae that may be fatal or crucial to their survival [1]. According to the guidelines, the acute phase of an infection lasts from the time it first manifests itself until four weeks have passed. In a similar vein, the Spanish Society for General Medicine (SEMG, to give it the Spanish acronym) published data from its survey of individuals with "long COVID," a term the society uses to refer to the collection of symptoms affecting multiple organs in individuals with COVID-19 (with or without a confirmed diagnosis) who continue to experience symptoms after what is thought to be the acute phase of the disease has ended4. 1,834 of the 2,120 patients who took part in the survey had symptoms consistent with long COVID.