Impact of COVID-19 epidemic on antihypertensive drug treatment disruptions: results from a nationwide interrupted time-series analysis.

Background: The COVID-19 epidemic has disrupted care and access to care in many ways. It was accompanied by an excess of cardiovascular drug treatment discontinuations. We sought to investigate a deeper potential impact of the COVID-19 epidemic on antihypertensive drug treatment disruptions by assessing whether the epidemic induced some changes in the characteristics of disruptions in terms of duration, treatment outcome, and patient characteristics. Methods: From March 2018 to February 2021, a repeated cohort analysis was performed using French national health insurance databases. The impact of the epidemic on treatment discontinuations and resumption of antihypertensive medications was assessed using preformed interrupted time series analyses either on a quarterly basis. Results: Among all adult patients on antihypertensive medication, we identified 2,318,844 (18.7%) who discontinued their antihypertensive treatment during the first blocking period in France. No differences were observed between periods in the characteristics of patients who interrupted their treatment or in the duration of treatment disruptions. The COVID-19 epidemic was not accompanied by a change in the proportion of patients who fully resumed treatment after a disruption, neither in level nor in trend/slope [change in level: 2.66 (-0.11; 5.42); change in slope: -0.67 (-1.54; 0.20)]. Results were similar for the proportion of patients who permanently discontinued treatment within 1 year of disruption [level change: -0.21 (-2.08; 1.65); slope change: 0.24 (-0.40; 0.87)]. Conclusion: This study showed that, although it led to an increase in cardiovascular drug disruptions, the COVID-19 epidemic did not change the characteristics of these. First, disruptions were not prolonged, and post-disruption treatment outcomes remained unchanged. Second, patients who experienced antihypertensive drug disruptions during the COVID-19 outbreak were essentially similar to those who experienced disruptions before it.

Dynamics of emotion trends in Canadian Twitter users during COVID-19 confinement in relation to caseloads: Artificial intelligence-based emotion detection approach.

Multiple waves of COVID-19 have significantly impacted the emotional well-being of all, but many were subject to additional risks associated with forced regulations. The objective of this research was to assess the immediate emotional impact, expressed by Canadian Twitter users, and to estimate the linear relationship, with the vicissitudes of COVID caseloads, using ARIMA time-series regression. We developed two Artificial Intelligence-based algorithms to extract tweets using 18 semantic terms related to social confinement and locked down and then geocoded them to tag Canadian provinces. Tweets (n = 64,732) were classified as positive, negative, and neutral sentiments using a word-based Emotion Lexicon. Our results indicated: that Tweeters were expressing a higher daily percentage of negative sentiments representing, negative anticipation (30.1%), fear (28.1%), and anger (25.3%), than positive sentiments comprising positive anticipation (43.7%), trust (41.4%), and joy (14.9%), and neutral sentiments with mostly no emotions, when hash-tagged social confinement and locked down. In most provinces, negative sentiments took on average two to three days after caseloads increase to emerge, whereas positive sentiments took a slightly longer period of six to seven days to submerge. As daily caseloads increase, negative sentiment percentage increases in Manitoba (by 68% for 100 caseloads increase) and Atlantic Canada (by 89% with 100 caseloads increase) in wave 1(with 30% variations explained), while other provinces showed resilience. The opposite was noted in the positive sentiments. The daily percentage of emotional expression variations explained by daily caseloads in wave one were 30% for negative, 42% for neutral, and 2.1% for positive indicating that the emotional impact is multifactorial. These provincial-level impact differences with varying latency periods should be considered when planning geographically targeted, time-sensitive, confinement-related psychological health promotion efforts. Artificial Intelligence-based Geo-coded sentiment analysis of Twitter data opens possibilities for targeted rapid emotion sentiment detection opportunities.

Impact Assessment of The Covid-19 Pandemic on Service Performance of Sofia Airport

The main objective of the research presented in the paper is to examine the impact of the COVID pandemic on the volume of passenger and freight traffic and the quality of the services provided by Sofia Airport, as well as to examine the factors influencing the demand for air freight transport and the extent of their impact. The authors focus on using two approaches, namely SERVPERF and SERVQUAL, in studying factors influencing the demand for transport. The study analyses a system of indicators with independent influences on the demand for air transport, but they are all related to the development of macroeconomic indicators at the national level under the influence of the COVID pandemic. The study of the impact of the pandemic on the service performance and quality of services provided by Sofia Airport allows us to predict the volume of transport activity and to plan the activities of airlines and ground operators, their transport capacity, as well as the need for adopting measures for recovery of the airport from the negative impacts of the pandemic and the necessary investments in airport facilities. The authors argue that evaluating the service performance and the quality of services could contribute to developing appropriate measures for recovery. They summarized appropriate measures based on the leading quality indicators for air transport services.

Machine learning model to predict vehicle electrification impacts on urban air quality and related human health effects.

Air pollution is a prevailing environmental problem in cities worldwide. The future vehicle electrification (VE), which in Europe will be importantly fostered by the ban of thermal engines from 2035, is expected to have an important effect on urban air quality. Machine learning models represent an optimal tool for predicting changes in air pollutants concentrations in the context of future VE. For the city of Valencia (Spain), a XGBoost (eXtreme Gradient Boosting package) model was used in combination with SHAP (SHapley Additive exPlanations) analysis, both to investigate the importance of different factors explaining air pollution concentrations and predicting the effect of different levels of VE. The model was trained with 5 years of data including the COVID-19 lockdown period in 2020, in which mobility was strongly reduced resulting in unprecedent changes in air pollution concentrations. The interannual meteorological variability of 10 years was also considered in the analyses. For a 70% VE, the model predicted: 1) improvements in nitrogen dioxide pollution (-34% to -55% change in annual mean concentrations, for the different air quality stations), 2) a very limited effect on particulate matter concentrations (-1 to -4% change in annual means of PM2.5 and PM10), 3) heterogeneous responses in ground-level ozone concentrations (-2% to +12% change in the annual means of the daily maximum 8-h average concentrations). Even at a high VE increase of 70%, the 2021 World Health Organization Air Quality Guidelines will be exceeded for all pollutants in some stations. VE has a potentially important impact in terms of reducing NO2-associated premature mortality, but complementary strategies for reducing traffic and controlling all different air pollution sources should also be implemented to protect human health.

Advancing the prevention and control of zoonoses supported by One Health approach.

With the acceleration of globalization, the sustained increase of mobility, the intensification of global warming and environmental changes, the transmission of diseases has become more diverse. In recent years, the corona virus disease 2019(COVID-19) has caused huge economic losses and social unrest around the world. A single-discipline has been unable to solve such complex public health problems effectively. The proposal and development of the One Health approach is closely related to the issues on veterinary medicine and zoonoses. One Health focuses on intradisciplinary, multi-sectoral, and cross-fields collaboration at three levels, including local, regional and global levels, to explore the humans-animals-environment interface complexity. In this review, the development process of One Health approach was introduced. The relationship between the One Health and zoonoses, the role of the One Health in the prevention and control of zoonoses, and how to effectively implement the One Health approach in the real world were explored, providing references for research on zoonoses prevention and control, anti-microbial resistance, food safety, and the impact of climate change on health.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.

[Impact of COVID-19 on mortality in Peru using triangulation of multiple data sourcesImpacto da COVID-19 na mortalidade no Peru por meio da triangulação de várias fontes de dados]. / Impacto de la COVID-19 en la mortalidad en Perú mediante la triangulación de múltiples fuentes de datos.

An analytic cross-sectional study was conducted to quantify the impact of COVID-19 on mortality in Peru. Total excess mortality due to natural and external causes was calculated. The direct and indirect impact of COVID-19 was estimated at two points: when COVID-19 deaths were confirmed by a laboratory test and when they were confirmed by broader criteria (reclassified deaths). This comparison was made in general and by sex, age, and geographical location. The sensitivity of laboratory testing and of death certificates as criteria for confirmation of a COVID-19 death was calculated using reclassified deaths as the gold standard.From epidemiological week (EW) 10 of 2020 to EW 23 of 2021, 349 756 deaths occurred, for an excess of 183 237 deaths, mainly due to natural causes. A total of 100 955 deaths corresponded to deaths confirmed by laboratory tests; however, the reclassification criterion brought this figure to 188 708. Laboratory tests had 53.3% sensitivity; this was lower at the onset of the pandemic (10.6%) and during the first wave (37.8%). The sensitivity of death certificates was higher than laboratory tests (41.7% vs 23.9%) only during the months when little testing was available. These data showed that the impact of COVID-19 on mortality in Peru was mainly direct. Also, in periods with limited access to laboratory testing, death certificates were a useful source for determining deaths directly caused by COVID-19.

Um estudo transversal analítico foi realizado com o objetivo de quantificar o impacto da COVID-19 na mortalidade no Peru. Foi calculada a sobremortalidade total, por causas naturais e externas. O impacto direto e indireto da COVID-19 foi estimado em dois momentos: quando as mortes por COVID-19 foram confirmadas por teste laboratorial e quando foram confirmadas por critérios mais amplos (óbitos reclassificados). Essa comparação foi feita na população geral, por sexo, idade e geografia. Calculou-se a sensibilidade dos critérios laboratoriais e dos atestados de óbito para a confirmação de morte por COVID-19, utilizando os óbitos reclassificados como padrão-ouro.Da semana epidemiológica 10 de 2020 até a 23 de 2021, ocorreram 349.756 óbitos, o que configura um excesso de 183.237 óbitos, principalmente por causas naturais. Considerando os óbitos confirmados por exames laboratoriais, foram encontrados 100.955 óbitos; no entanto, com os critérios de reclassificação, esse número subiu para 188.708. Os exames laboratoriais tiveram uma sensibilidade de 53,3%, sendo menor no início da pandemia (10,6%) e durante a primeira onda (37,8%). A sensibilidade do atestado de óbito foi maior que a do exame laboratorial (41,7% vs 23,9%) apenas nos meses de baixa disponibilidade de exames. Esses dados evidenciaram que, no Peru, o impacto da COVID-19 na mortalidade foi principalmente direto. Além disso, em períodos com acesso limitado a exames laboratoriais, as declarações de óbito foram uma fonte de informação útil para determinar as mortes causadas diretamente pela COVID-19.

Chronic sleep disturbance among adult Canadians: Associations and implications to the evaluation of noise impacts under Canada's Impact Assessment Act

The Canadian Perspectives on Environmental Noise Survey was completed online by 6647 randomly selected Canadians 18 years of age and older between April 12 and May 25, 2021. The survey objective was to explore attitudes, perceptions, and expectations toward environmental noise in rural and non-rural Canada. The questionnaire assessed self-reported high sleep disturbance (HSD) in the previous year, at home. The prevalence of HSD was 7.8% overall. A list of potential sources of sleep disturbance was provided to the full sample, where 6.1%, 5.2%, and 3.0% reported HSD by noisy neighbors, road traffic noise and indoor noise, respectively. Stress/anxiety or worrying about something was selected most frequently at 12.9%. Finally, 7.6% and 5.5% reported pain/illness and partner's sleep disturbance, respectively, as sources of HSD. Reported HSD was significantly higher among respondents below 55 years of age, females, lower income groups, unemployed respondents, those on paid leave (sick, maternity, disability), and living in an urban area. Expectations of quiet, perceiving nighttime noise to have increased over time, high noise sensitivity, hearing and being highly annoyed by road traffic noise was also associated with an increased prevalence of reporting HSD. In contrast to hearing impairment and heart disease (including high blood pressure);rated physical health, mental health, anxiety/depression, and reporting a sleep disorder, were associated with increased HSD. The perceived affects of the COVID-19 pandemic on health and annoyance toward environmental and indoor noise also influenced HSD. In the fully adjusted multivariate logistic regression model, the effect of age, gender, changes in nighttime noise, road traffic noise annoyance, noise sensitivity and sleep disorder remained statistically significant. The univariate and multivariate models showed a similar prevalence of HSD between Indigenous Peoples and non-Indigenous Canadians. Results are discussed in relation to the provision of advice on sleep and health under Canada's Impact Assessment Act. © 2023

A Public Health Perspective on Wellbeing

This chapter places the promotion of wellbeing in the context of public health practice and explores enduring challenges, practical solu­tions, and synergies with the field of positive psychology and contextual behavioural science. Public health applies multilevel frameworks of health and wellbeing to inform and develop policies and programmes to improve population health and wellbeing outcomes, distinct from individual out­comes. How the concept of wellbeing is translated into policy and practice matters, particularly in the face of recent and emerging political, societal, and public health challenges in the UK such as "Brexit”, the COVID-19 pandemic, and the climate emergency—where the need to protect and promote the population's health and wellbeing and address inequalities have become ever more pressing. Specifically, the chapter provides exam­ples of how public health tools such as Health Impact Assessment (HIA) and Mental Wellbeing Impact Assessment (MWIA) can facilitate upstream multi-sectoral collaboration to integrate wellbeing into policy and programmes. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022, corrected publication 2022

The impact of participation in research for speech and language therapy departments and their patients: A case example of the Big CACTUS multicentre trial of self-managed computerized aphasia therapy.

BACKGROUND: In order to conduct research that is meaningful to speech and language therapy services and their patients, it is often desirable to conduct the research within routine clinical services. This can require considerable time and commitment from speech and language therapists (SLTs). It is therefore important to understand the impact that such participation in research can have. AIMS: To explore the impact of research participation in the Big CACTUS study of self-managed computerized aphasia therapy conducted in 21 UK NHS speech and language therapy departments. METHODS & PROCEDURES: An online survey was sent to SLTs who took the lead role for the study at their NHS Trust to evaluate the impact of study participation in three domains: capacity-building, research development and health services. The questionnaire, based on the VICTOR framework for evaluating research impact, included Likert scale statements and closed and open-ended questions. The results from open-ended questions were coded and analysed using framework analysis in NVivo 12 and the data from closed questions were analysed descriptively. OUTCOMES & RESULTS: A total of 12 SLTs returned the survey. Nine codes were identified from open-ended questions and 20 predefined from the literature. Analysis of the responses demonstrated the perceived impact including improvements in practices and access to therapy, investments in infrastructure, increased SLT profile, and impact on research culture among SLTs. The usefulness of the intervention during the COVID-19 pandemic was also highlighted. CONCLUSIONS & IMPLICATIONS: The results suggest participation in Big CACTUS has resulted in improvements in patient care and SLT research capacity and culture in speech and language therapy departments. WHAT THIS PAPER ADDS: What is already known on the subject Practice-based research is encouraged to assist with the clinical relevance of the research findings. Participation in research can be seen as an activity that is additional to the core business of patient care and it can be difficult to secure time to participate or conduct research in clinical settings. Impact evaluation initiatives of individual trials facilitate early identification of benefits beyond the trial. What this paper adds to existing knowledge This study describes specific examples of the impact on services, staff and patients from SLT participation and leadership in the Big CACTUS speech and language therapy trial in clinical settings. What are the potential or actual clinical implications of this study? Clinical services participating in research may benefit from improved clinical care for patients both during and after the study, an improved professional reputation, and increased research capacity and culture within the clinical settings.

IMPORTANCE OF COMPREHENSIVE HEALTH RISK ASSESSMENT PROCEDURES FOR MODERN WASTE-TO-ENERGY FACILITIES IN COMPLEX GEOGRAPHICAL CONTEXTS ORIENTED TO CIRCULAR ECONOMY

Although circular economy (CE) principles set material circularity, resource efficiency and waste recycling as priority targets to guarantee the sustainable development of future generations, the thermochemical valorisation of municipal solid waste (MSW) still plays a fundamental role in the transition towards the final CE targets. As a matter of fact, the waste-to-energy (WtE) sector allows recovering energy from waste, reducing the pressure on MSW landfills and their related potential environmental impacts;however, recovering material for further uses is not excluded in WtE options. Significant improvements have been achieved in the air pollution control of exhaust gases from direct and indirect MSW combustion during the last decades. The efforts focussed on reducing dioxin emissions especially, and this has let other substances emerge as priority pollutants (e.g., heavy metals). In addition, the location of WtE facilities in certain geographical contexts is still potentially critical from the point of view of human exposure and the related health risk;moreover, the public acceptance of WtE plants is still limited, in spite of their recent role in fighting SARS-CoV-2 risks from waste management. The purpose of the present paper is to underline the importance of implementing correct and complete health risk assessment procedures tailored to the exposed population living in the area of influence of a WtE plant. The paper will present two case studies regarding the projects of two WtE plants in a mountainous region, highlighting the critical issues that arose during the environmental impact assessment procedures. The paper will finally suggest possible options to improve the health risk assessment procedure and alternative measures to reduce the expected impacts of the WtE sector on the environment and human exposure. © 2022 WIT Press.

Assessing the impact of an urgent dental care centre on the oral health-related quality of life of patients during the COVID-19 pandemic

Introduction: An urgent dental care centre (UDCC) was set up at Queen Mary's Hospital in Sidcup, in response to the COVID-19 pandemic. Alongside the reporting of clinical outcomes, it is important to determine the success of a service from a patient's perspective. The aim of this study was to ascertain patient reported outcome measures (PROMs) and patient reported experienced measures (PREMs) of our service. Method(s): The Oral Health Impact Profile 14 (OHIP-14) tool was used to assess the Oral Health-Related Quality of Life (OHRQoL) of patients, and completed before and after attending our UDCC for treatment. Patients were also asked to complete a patient satisfaction questionnaire. Result(s): 146 patients were recruited for our study, with 95 patients completing the OHIP-14 questionnaires pre- and post intervention at our UDCC and 136 patients completing a patient satisfaction questionnaire. A statistically significant reduction in OHIP score when comparing pre- and post-intervention was found across all OHIP-14 domains. The mean positive response rate (strongly agree or agree) for the patient satisfaction questionnaire was 97.1%. Conclusion(s): A significant improvement in OHRQoL was found after treatment at our UDCC, with the majority of patients reporting a positive experience. We conclude that PROMs and PREMs are vital tools to assess service efficacy, help with the planning of service provision and should remain at the forefront even during a crisis such as the COVID-19 pandemic.Copyright © 2021

Impact of Anti-Pandemic Policy Stringency on Firms' Profitability during COVID-19

The coronavirus (COVID-19) pandemic devastated all economies across the world and triggered a deterioration in firms' financial performance. However, some sectors turned out to be more vulnerable while others continued to perform well during the crisis period. Given this fact, we conducted a comprehensive study to estimate the impact of the COVID-19 pandemic on firms' profitability in Europe. We used a dynamic panel data approach and a system generalized method of moment (System-GMM) model to investigate (i) which sectors were affected and what was the magnitude of the impact on firms' profitability, and (ii) whether the stringency of anti-pandemic policies such as workplace closures and travel bans impacted firms unevenly. We find that COVID-19 caused about a 25% decline in the profitability of firms. The most impacted sectors were Consumer Discretionary, Consumer Staples, and Industrials, where profitability declined from 20 to 48%. We also find that firms in countries with high anti-pandemic policy stringency lost about 19% more in profitability than in the rest of the countries in Europe during 2020. © 2023 by the authors.

Ayushman Bharat Pradhan Mantri-Jan Arogya Yojana And Its Crucial Impact On Human Health During The Time Of Covid-19 In India

Covid-19-a heinous event that had left an eternally unforgettable scar of troubles, setbacks and distress on the entire human population across the globe. No country could evade from the unfavorable consequences of it. All countries across the world found themselves engulfed in the hands of Covid-19. It had taken a serious toll on the healthcare system of every country across the world. In the context of India, which is a nation with a poor coverage of public healthcare facilities and annually 3.2% Indians falling below poverty line, made the country and its population the most vulnerable. During that time, the biggest question arose was the survival of the marginalized and disadvantaged section of the society. However, fortunately a tiny hope of survival for the population of India was ensured and extended by the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). Thus, the authors of this research paper have attempted to figure out and critically examine the role played by AB PM-JAY in not only managing but also mitigating the outbreak of the virus in India and how it helped Indians sail through the storm of Covid-19. Besides, this paper tries to put views forward through analysis for the policy makers and healthcare stakeholders to become well-prepared for any such troublesome crisis in future. Moreover, secondary data is used to collect necessary information and critical descriptive analysis has been used to interpret the results of the study.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

The Impact of COVID-19 on Systems of Care for Children and Youth With Special Health Care Needs

Introduction: This article describes the challenges and opportunities that the COVID-19 pandemic presented for providing and coordinating care for children and youth with special health care needs (CYSHCN) who rely on a diverse array of systems to promote their health, education, and well-being. Method(s): Peer-reviewed published literature and reports from the national government and nonprofit organizations that advocate for CYSHCN were examined, particularly concerning systems that impacted CYSHCN during COVID-19. Result(s): Pre-COVID-19, CYSHCN and their families faced challenges accessing and coordinating care across diverse systems. COVID-19 exacerbated these challenges because of disruptions in care and services that negatively impacted CYSHCN. COVID-19 also highlighted opportunities for positive change and care innovations. Discussion(s): Understanding the systems of care that CYSHCN rely on and the effects of COVID-19 on these systems can enhance access to and quality of care. Recommendations are made for practice, leadership, research, and policy.Copyright © 2022 National Association of Pediatric Nurse Practitioners

Impact assessment culture in the European Union. Time for something new?

Current approaches and cultures for the economic evaluations of environmental and health policies may suffer from excessive reliance on a standard neoclassic economic toolbox that neglects alternative perspectives. This may prematurely limit the spectrum of available policy options. Here we show how the inclusion of neglected currents of thought such as non-Ricardian economics, bioeconomics and a set of qualitative-quantitative methods from post-normal science leads to richer perspectives for a more inclusive uses of quantitative evidence, and opens the analysis to more possible futures. We also present some case studies in the energy, water, health and climate domains that highlight the point in a practical context for a more policy-oriented audience. We situate our analysis in the context of recent calls in the EU for the inclusion of more perspectives from the social sciences and the humanities in environmental assessment works.Copyright © 2023 The Authors

Evidence-Based Policymaking during the COVID-19 Crisis: Regulatory Impact Assessments and the Polish COVID-19 Restrictions

The COVID-19 pandemic transformed our understanding of the state's role during a public health crisis and introduced an array of unprecedented policy tools: ever-stricter travel restrictions, lockdowns and closures of whole branches of the economy. Evidence-based policymaking seems to be the gold standard of such high-stakes policy interventions. This article presents an empirical investigation into the regulatory impact assessments accompanying sixty-four executive acts (regulations) introducing anti-pandemic restrictions in Poland over the first year of the pandemic. To this end, the study utilises the so-called scorecard methodology, which is popular in regulatory impact assessment research. This methodology highlights the shallowness of these documents and the accompanying processes, with an absence not only of a sound evidence base behind specific anti-pandemic measures or estimates of their economic impacts, but even of the comparative data on restrictions introduced in other European Union/Organisation for Economic Co-operation and Development (OECD) countries. Overall, the collected data support the hypothesis that the ad hoc pandemic management process crowded out the law-making process through tools such as regulatory impact assessments and consultations. In other words, the genuine decision-making occurred elsewhere (with the exact process being largely invisible to public opinion and scholars) and drafting legal texts simply codified these decisions, with the law-making process becoming mere window-dressing.

Effects of a Multi-Professional Intervention on Mental Health of Middle-Aged Overweight Survivors of COVID-19: A Clinical Trial.

The present study aimed to investigate the effects of a multi-professional intervention model on the mental health of middle-aged, overweight survivors of COVID-19. A clinical trial study with parallel groups and repeated measures was conducted. For eight weeks, multi-professional interventions were conducted (psychoeducation, nutritional intervention, and physical exercises). One hundred and thirty-five overweight or obese patients aged 46.46 ± 12.77 years were distributed into four experimental groups: mild, moderate, severe COVID, and control group. The instruments were used: mental health continuum-MHC, revised impact scale-IES-r, generalized anxiety disorder-GAD-7, and Patient health questionnaire PHQ-9, before and after eight weeks. The main results indicated only a time effect, with a significant increase in global MHC scores, emotional well-being, social well-being, and psychological well-being, as well as detected a significant reduction in global IES-R scores, intrusion, avoidance, and hyperarousal, in addition to a reduction in GAD-7 and PHQ-9 scores (p < 0.05). In conclusion, it was possible to identify those psychoeducational interventions that effectively reduced anxiety, depression, and post-traumatic stress symptoms in post-COVID-19 patients, regardless of symptomatology, in addition to the control group. However, moderate and severe post-COVID-19 patients need to be monitored continuously since the results of these groups did not follow the response pattern of the mild and control groups.

A Multicenter Study about the Population Treated in the Respiratory Triage Stations Deployed by the Red Cross during the COVID-19 Pandemic.

BACKGROUND: Care demand exceeded the availability of human and material resources during the COVID-19 pandemic, which is the reason why triage was fundamental. The objective is to know the clinical and sociodemographic factors of confirmed or suspected COVID-19 cases in triage stations from different Ecuadorian provinces. METHOD: A multicenter study with a retrospective and descriptive design. The patients included were those who accessed the Respiratory Triage stations deployed by the Ecuadorian Red Cross in eight Ecuadorian provinces during March and April 2021. Triage allows for selecting patients that need urgent treatment and favors efficacy of health resources. RESULTS: The study population consisted of a total of 21,120 patients, of which 43.1% were men and 56.9% were women, with an age range between 0 and 98 years old. Severity of COVID-19 behaved differently according to gender, with mild symptoms predominating in women and severe or critical symptoms in men. Higher incidence of critical cases was observed in patients over 65 years old. It was observed that overweight predominated in critical, severe, and moderate cases, while the body mass index of patients with mild symptoms was within the normal range. CONCLUSIONS: The Ecuadorian Red Cross units identified some suspected COVID-19 cases, facilitating their follow-up and isolation. Fever was the most significant early finding.

Cervical cancer prevention program in Mexico disrupted due to COVID-19 pandemic: Challenges and opportunities.

Introduction: The COVID-19 pandemic disrupted the preventive services for cervical cancer (CC) control programs in Mexico, which will result in increased mortality. This study aims to assess the impact of the pandemic on the interruption of three preventive actions in the CC prevention program in Mexico. Methods: This study is a retrospective time series analysis based on administrative records for the uninsured population served by the Mexican Ministry of Health. Patient data were retrieved from the outpatient service information system and the hospital discharge database for the period 2017-2021. Data were aggregated by month, distinguishing a pre-pandemic and a pandemic period, considering April 2020 as the start date of the pandemic. A Poisson time series analysis was used to model seasonal and secular trends. Five process indicators were selected to assess the disruption of the CC program, these were analyzed as monthly data (N=39 pre-pandemic, N=21 during the pandemic). HPV vaccination indicators (number of doses and coverage) and diagnostic characteristics of CC cases were analyzed descriptively. The time elapsed between diagnosis and treatment initiation in CC cases was modeled using restricted cubic splines from robust regression. Results: Annual HPV vaccination coverage declined dramatically after 2019 and was almost null in 2021. The number of positive Papanicolaou smears decreased by 67.8% (90%CI: -72.3, -61.7) in April-December 2020, compared to their expected values without the pandemic. The immediate pandemic shock (April 2020) in the number of first-time and recurrent colposcopies was -80.5% (95%CI:-83.5, -77.0) and -77.9% (95%CI: -81.0, -74.4), respectively. An increasing trend was observed in the proportion of advanced stage and metastatic CC cases. The fraction of CC cases that did not receive medical treatment or surgery increased, as well as CC cases that received late treatment after diagnosis. Conclusions: Our analyses show significant impact of the COVID-19 pandemic with declines at all levels of CC prevention and increasing inequalities. The restarting of the preventive programs against CC in Mexico offers an opportunity to put in place actions to reduce the disparities in the burden of disease between socioeconomic levels.

A method for evaluating population and infrastructure exposed to natural hazards: tests and results for two recent Tonga tsunamis.

Background: Coastal communities are highly exposed to ocean- and -related hazards but often lack an accurate population and infrastructure database. On January 15, 2022 and for many days thereafter, the Kingdom of Tonga was cut off from the rest of the world by a destructive tsunami associated with the Hunga Tonga Hunga Ha'apai volcanic eruption. This situation was made worse by COVID-19-related lockdowns and no precise idea of the magnitude and pattern of destruction incurred, confirming Tonga's position as second out of 172 countries ranked by the World Risk Index 2018. The occurrence of such events in remote island communities highlights the need for (1) precisely knowing the distribution of buildings, and (2) evaluating what proportion of those would be vulnerable to a tsunami. Methods and Results: A GIS-based dasymetric mapping method, previously tested in New Caledonia for assessing and calibrating population distribution at high resolution, is improved and implemented in less than a day to jointly map population clusters and critical elevation contours based on runup scenarios, and is tested against destruction patterns independently recorded in Tonga after the two recent tsunamis of 2009 and 2022. Results show that ~ 62% of the population of Tonga lives in well-defined clusters between sea level and the 15 m elevation contour. The patterns of vulnerability thus obtained for each island of the archipelago allow exposure and potential for cumulative damage to be ranked as a function of tsunami magnitude and source area. Conclusions: By relying on low-cost tools and incomplete datasets for rapid implementation in the context of natural disasters, this approach works for all types of natural hazards, is easily transferable to other insular settings, can assist in guiding emergency rescue targets, and can help to elaborate future land-use planning priorities for disaster risk reduction purposes. Supplementary Information: The online version contains supplementary material available at 10.1186/s40677-023-00235-8.