Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation - an exploratory retrospective analysis

Objectives: Unfractionated heparin (UFH) remains the anticoagulation of choice at most centres for patients receiving extracorporeal membrane oxygenation (ECMO). One disadvantage of UFH relies on its individual dosing requirement to achieve target values. In this context heparin resistance has been described, defined as doses exceeding 35,000 IU UFH/d. However, the incidence of heparin resistance and its association with thromboembolic complications despite anticoagulation within target ranges remains unknown. Method(s): This retrospective study included adults receiving venovenous (VV) and venoarterial (VA) ECMO, or extracorporeal CO2-removal (ECCO2R) between 2010 and May 2022. The primary outcome was the incidence of heparin resistance (>35,000 IU of UFH/d). Secondary outcomes were heparin failure (thromboembolic complications despite anticoagulation within target ranges) and survival. A multivariable poisson regression model was fitted to analyse the effect of heparin resistance, COVID-19 and ECMO type on the incidence rate of thromboembolic events. Result(s): Of 197 included patients, 33 (16.8%) had heparin resistance. Patients with COVID-19 (n=51) had a higher rate of heparin resistance compared to nonCOVID-19 patients (37% vs. 9.6%, P<0.001). Thromboembolic complications occurred at a rate of 5.89/100 ECMO days. There was a significant effect of COVID-19 (incidence rate ratio (IRR) 2.12, 95% confidence interval (CI) 1.4 to 3.3, P<0.001) and ECMO type (VA ECMO: IRR 2.35;95% CI 1.43 to 3.87, P<0.001;ECCO2R: IRR 2.63, 95% CI 1.37 to 4.9, P=0.003;reference VV ECMO) on incidence rate of thromboembolic events, but not of heparin resistance (IRR 1.11, 95% CI 0.7 to 1.76, P=0.7). ECMO duration was longer (25d (IQR 11-33) vs. 8d (IQR 4-18), P<0.001) in patients with heparin resistance, but hospital survival did not differ (23 (70%) vs. 91 (57%), P=0.2). Conclusion(s): The study revealed a high incidence of heparin failure in ECMO patients, especially in those with COVID-19. Heparin resistance had no effect on the incidence rate of thromboembolic events, whereas our data suggest an increased risk in patients with COVID19, VA ECMO and ECCO2R.

The impact of COVID-19 on colorectal screening in Puerto Rico

INTRODUCTION: Puerto Rico has endured three major environmental and public health crises (Hurricane Irma, Hurricane Maria, the unprecedented seismic activity of January 2020) and the coronavirus disease 2019 (COVID-19) pandemic during the past 5 years. All these events might lead to an unquestionable deleterious impact in the prevention of cancer and across the cancer continuum, exacerbating cancer health disparities in the future. Cancer screening plays a critical role in early cancer detection. COVID-19 has significantly hampered screening programs in many countries' cancer screening infrastructure and services, affecting adherence. Cancer is the leading cause of morbidity and mortality in Puerto Rico. Limited information is available about the impact the current pandemic on colorectal cancer screening. In this study, we aim to describe the impact of the COVID-19 pandemic on colorectal cancer screening in 2020 and assess if this impact varied by health regions. METHOD(S): This study analyzed administrative data claims from the Public Health System of Puerto Rico which is managed by the Government of Puerto Rico through the Health Insurance Administration. The Current Procedural Terminology (CPT) codes included for this study were (81528, 82270, G0104, G0105, G0121, G0328, G0464). To assess changes in the numbers of colorectal cancer screening claims between the incurred year (2016 and 2020), Poisson regression was used. Initially, we fitted this model with only the incurred year as the predictor and offsetting the model with the annual average of total insured (univariate model). Based on this model, we estimate the magnitude of association between the number of claims and incurred year using the Prevalence Ratio (PR) of claims. Lastly, Poisson univariate regression model were used for each of the seven health regions (Ponce, Bayamon, Caguas, Mayaguez, Metro, Arecibo and Fajardo) to assess potential geographic disparities. RESULT(S): The numbers of colorectal cancer screening claims significantly decreased by 40% (PRcrude: 0.60, 95%CI: 0.59, 0.62) in 2020 when compared to 2016. However, when adjusting for claim incurred month, sex, health region and offsetting the model with the annual average of total insured, the numbers of colorectal cancer screening claims significantly decreased by 34%, (PRadj: 0.66, 95%CI: 0.64, 0.67). The numbers of colorectal cancer screening claims significantly decreased in all health regions in 2020 when compared to 2016 (p<0.05). However, the most impacted region was the Eastern region, Fajardo, with a 64% (PRFajardocrude: 0.36, 95%CI: 0.30, 0.42) significant decrease in numbers of colorectal cancer screening claims. CONCLUSION(S): COVID-19 had a profound negative effect on colorectal screening in Puerto Rico. Moreover, despite the beneficiaries of this governmental health plan sharing similar sociodemographic and socioeconomic background, regional differences were observed.

The Effect of Sociodemographic Factors on COVID-19 Mortality in Costa Rica: A Geographic Approach

Introduction: The coronavirus disease (COVID-19) has spread among the population of Costa Rica and has had a great global impact. However, there are important geographic differences in mortality from COVID-19 among world regions and within Costa Rica.Objective: To explore the effect of some sociodemographic factors on COVID-19 mortality in the small geo-graphic divisions or cantons of Costa Rica.Methods: We used official records and applied a classical epidemiological Poisson regression model and a geographically weighted regression model.Results: We obtained a lower Akaike Information Criterion with the weighted regression (927.1 in Poisson regression versus 358.4 in weighted regression). The cantons with higher risk of mortality from COVID-19 had a denser population;higher material well-being;less population by health service units and are located near the Pacific coast.Conclusions: A specific COVID-19 intervention strategy should concentrate on Pacific coast areas with denser population, higher material well-being and less population by health service units.

Healthcare Utilization Remains Elevated Among People Living with Post-COVID-19 Condition More Than One Year after Acute COVID-19 Illness

Objectives: Healthcare systems require comprehensive data for long-term resource allocation planning to support people living with post-COVID-19 condition (PCC). Limited information is available on long-term PCC-associated healthcare utilization patterns. In this study, we assess healthcare utilization rates six and 12-18 months following acute COVID-19 illness among COVID-19 survivors in British Columbia (BC), Canada by PCC status. Method(s): We used difference-in-difference analysis to assess healthcare utilization by all adult COVID-19 survivors in BC diagnosed with COVID-19 on/before November 18, 2021 during three time periods: (i) 26 weeks after the first 4 weeks of COVID-19 illness, and that exact period (ii) one or two years prior (baseline), and (iii) one year afterwards. PCC/non-PCC patients were matched 1:2 on age, sex, region, comorbidities, vaccination status, and COVID-19 index date +/-14 days. The total number of daily healthcare encounters (medical visit, emergency department visit, hospitalization) per person was calculated. Rate ratios (RR) for PCC-associated healthcare utilization were estimated using weighted Poisson regression. Result(s): The matched cohort (n= 7,092) included 2,364 PCC patients (54.9% female;mean age 39.8 [SD, 13.4] years). Healthcare utilization rates were comparable between the PCC and non-PCC groups at baseline (average: 39.3 vs. 32.7 visits per 1000 patients, respectively), but rose two-fold for the PCC group during the 26-week period post-acute illness (76.1 vs. 33.5). One year later, PCC-associated healthcare utilization rates declined but remained elevated relative to baseline rates (54.6 vs. 34.4). In multivariable Poisson regression models, PCC was associated with a 103% increase in healthcare utilization over 26 weeks post-acute illness (aRR: 2.03, 95% CI 1.71-2.41) and a 24% increase the next year (aRR: 1.24, 95% CI 1.03-1.48). Conclusion(s): The increased healthcare utilization rates noted among PCC patients one year following acute COVID-19 illness highlights the need for adequate planning to provide optimal support for people living with PCC.Copyright © 2023

A Warning on Waning: The Duration of Vaccine-Derived Immunity in Malaysia

Intro: Vaccinations have decreased the case fatality rate of COVID-19. Nonetheless, there appear to be differences in the duration of vaccine efficacy against death across populations.We aim to model the duration between vaccine type and time to death stratified by primary and booster series vaccination in Malaysia. Method(s): Data for all COVID-19 deaths between 1 February 2020 and 31 August 2022 were extracted from the Ministry of Health Malaysia data repository. Information was available on age, sex, nationality, region, vaccine status, vaccine type, and the duration from vaccination to death. The duration between primary or booster vaccination and death was modelled using Poisson regression. Finding(s): A total of 25,759 (77%), 7,421 (20%), and 1,036 (2.9%) unvaccinated, primary series vaccinated, and booster vaccinated COVID-19 deaths were respectively reported between 1 February 2020-31 August 2022 in Malaysia. The median duration between primary series vaccination and death, with AstraZeneca, Pfizer and Sinovac vaccines was respectively 150 (IQR: 73-211), 158 (IQR:88-229) and 105 (65-139) days. The median duration between booster vaccine and death with a Homologous or Heterologous vaccine was 86 (IQR: 59- 139) and 106 (66-139) days, respectively. Individuals with an AstraZeneca and Sinovac primary series had 19% (95% CI: 0.8-0.82) and 33% (95% CI: 66-0.68, p<0.01) shorter duration from vaccination to death than individuals with Pfizer vaccines. Individuals with a heterologous booster vaccination had an 8% (95% CI: 1.07-1.10, p<0.01) longer duration from vaccination to death than individuals receiving a homologous booster dose. Conclusion(s): There appear to be differences in the duration between vaccination and death by vaccine type. This must be considered alongside immune evasive variants and level of naturally acquired immunity when planning for vaccination programmes that are central to keeping COVID-19-associated mortalities low.Copyright © 2023

Prediction of the COVID-19 transmission: a case study of Pakistan.

The world has suffered a lot from COVID-19 and is still on the verge of a new outbreak. The infected regions of coronavirus have been classified into four categories: SIRD model, (1) suspected, (2) infected, (3) recovered, and (4) deaths, where the COVID-19 transmission is evaluated using a stochastic model. A study in Pakistan modeled COVID-19 data using stochastic models like PRM and NBR. The findings were evaluated based on these models, as the country faces its third wave of the virus. Our study predicts COVID-19 casualties in Pakistan using a count data model. We've used a Poisson process, SIRD-type framework, and a stochastic model to find the solution. We took data from NCOC (National Command and Operation Center) website to choose the best prediction model based on all provinces of Pakistan, On the values of log L and AIC criteria. The best model among PRM and NBR is NBR because when over-dispersion happens; NBR is the best model for modelling the total suspected, infected, and recovered COVID-19 occurrences in Pakistan as it has the maximum log L and smallest AIC of the other count regression model. It was also observed that the active and critical cases positively and significantly affect COVID-19-related deaths in Pakistan using the NBR model.

SEXUAL BEHAVIOR AND STI INCIDENCE DURING THE FIRST 4 YEARS OF PrEP USE AMONG MSM

Background: A prospective demonstration project in Amsterdam (AMPrEP) provided pre-exposure prophylaxis (PrEP) to people vulnerable to HIV in 2015- 2020. Data on long-term trends in sexual behavior and incidence of STIs during PrEP use are needed to inform future PrEP programs. Therefore, we assessed sexual behavior and incidence rates of STIs among MSM and transgender women on PrEP over four years. Method(s): AMPrEP participants chose between oral PrEP daily (dPrEP) or event-driven (edPrEP) at baseline and could switch regimens at each 3-monthly study visit. They were tested for STIs at these visits and if necessary in between. Follow-up began at PrEP initiation and continued until 48 months of follow-up or was censored at March 15, 2020 (start COVID-19), whichever occurred first. We assessed changes over time in incidence rates (IR) of chlamydia, gonorrhea, and infectious syphilis using Poisson regression. We estimated the IR of Hepatitis C (HCV) diagnoses per consecutive year. We described the number of HIV diagnoses, and sexual behavior (i.e. number of sex partners, condomless anal sex acts with casual partners [CAS]). Result(s): A total of 367 (365 MSM) started PrEP and contributed 1249 person-years of observation. IRs of any STI was 87[95%CI 82-93]/100PY. There was no change in the IR of any STI and infectious syphilis over time on PrEP. We observed a slight decrease in incident chlamydia and gonorrhea in daily PrEP users (Table). Two incident HIV cases were diagnosed in the first year of follow-up. IRs for HCV were 1.5[0.6-3.6], 2.5[1.3-5.0], 0.7[0.2-2.7], and 0.4[0.1- 2.8]/100PY, per consecutive year on PrEP. Median number of sex partners per 3-month period decreased from 16[IQR 8-34] and 12[6-25] (dPrEP and edPrEP, respectively) at baseline, 15[7-30] and 8[3-16] at 24 months, and 12[6-26] and 5[2-12] at 48 months. Median number of CAS acts with casual partners were respectively 7[3-15] and 4[1-9] at baseline, 14[5-25] and 4[1-12] at 24 months, and 12[4-25] and 4[1-9] at 48 months. Conclusion(s): Over the first 4 years of PrEP use overall STI incidence was high and stable. Chlamydia and gonorrhea incidence declined slightly in daily users. Numbers of sex partners seemed to decrease in both dPrEP and edPrEP users. Number of CAS acts with casual partners appeared to increase first, and then stabilized. Notably, this did not result in increased incidence of STIs. Regular testing and treatment of STIs remain a priority among PrEP users. Biomedical prevention of STIs can be examined in this context.

Functional outcome in patients with ischemic stroke and COVID-19 in Lima, Peru

Introduction: COVID-19 seems to induce ischemic stroke by several potential mechanisms including promoting hypercoagulability, and worse functional outcomes have been reported in patients with stroke and the infection with SARS-CoV-2. Objective(s): Determine the association between functional outcome and COVID-19 in patients with stroke. Patients and Methods: We performed a case control study comparing patients admitted to a neurological reference center in Peru with a diagnosis of stroke before (controls) and after (cases) the onset of the COVID-19 pandemic. There were 31 cases diagnosed with COVID-19 and 62 controls without COVID-19. Bivariate analysis and conditional fixed-effects Poisson regression analysis were used to evaluate the association between the functional outcome of the stroke and COVID-19. Result(s): Cases had higher baseline serum glucose (133.5, IQR: 117.5-174 versus 117, IQR: 101-130, p = 0.033) than controls, higher neutrophil counts (7.91, IQR: 5.93-9.57 versus 5.96, IQR: 4.41-7.79, p = 0.008), lower lymphocyte counts (1.48, IQR: 1.04-1.8 versus 1.83, IQR: 1.26-2.32, p = 0.025), higher neutrophil/lymphocyte ratios (5.44, IQR: 4.0-8.1 versus 3.29, IQR: 2.25-6.02, p = 0.011), higher NIH stroke scale/score (NIHSS) (14, IQR: 9-18 versus 7 IQR: 5-11, p = 0.000), and higher modified Rankin scores at discharge (4, IQR: 4-5 versus 2, IQR: 1-4), p = 0.001). Seven (21.88%) participants died in the group of cases versus 1 (1.56%) in the controls (p = 0.014). The odds ratio of having a bad functional outcome at discharge was 1.344 (CI: 1.079-4.039;p = 0.029), adjusted by NIHSS at admission. Conclusion(s): Our findings suggest that ischemic strokes associated with COVID-19 are more severe, have worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.Copyright © 2023 Sociedad Neurologica Argentina

SARS-CoV-2 SEROPREVALENCE AMONG PEOPLE WHO INJECT DRUGS IN BALTIMORE

Background: People who inject drugs (PWID) may be at a greater risk of SARS-CoV-2 infection and COVID-19 due to socio-structural inequities, high-risk behaviors and comorbidities;however, PWID have been underrepresented in case-based surveillance due to lower access to testing. We characterize temporal trends and correlates of SARS-CoV-2 seroprevalence among a community-based sample of current and former PWID. Method(s): A cross-sectional study was conducted among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of adults with a history of injection drug use in Baltimore, Maryland. Participants' first serum sample collected at routine study visits between December 2020 and July 2022 was assayed for antibodies to the nucleocapsid (N) (past infection) and spike-1 (S) (past infection and/or vaccination) proteins using the MSD V-Plex Panel 2 IgG SARS-CoV-2 assay. For each correlate, we estimated adjusted prevalence ratios (PR) via separate Poisson regression models adjusted for calendar time, age, sex and race. Result(s): Of 561 participants, the median age was 59 years (range=28-77), 35% were female, 84% were Black, 36% were living with HIV (97% on ART), and 55% had received >=1 COVID-19 vaccine dose. Overall, anti-N and anti-S prevalence was 26% and 63%, respectively. Prevalence of anti-N increased from 23% to 40% between December 2020-May 2021 and December 2021-July 2022, with greater increases in the prevalence of anti-S from 34% to 86% over the same period (Figure). Being employed (PR=1.53 [95%CI=1.11-2.11]) and never being married (PR=1.40 [0.99-1.99]) were associated with a higher prevalence of anti-N, while female sex (PR=0.75 [0.55-1.02]) and a history of cancer (PR=0.40 [0.17-0.90]) were associated with a lower prevalence of anti-N. Younger age, female sex (PR=0.90 [0.80-1.02]), and homelessness (PR=0.78 [0.60-0.99]) were associated with a lower prevalence of anti-S. Although HIV infection was not associated with anti-N, it was associated with a higher prevalence of anti-S (PR=1.13 [1.02-1.27]). Substance use was not associated with anti-N or anti-S. Conclusion(s): Anti-N and anti-S levels increased over time, suggesting cumulative increases in SARS-CoV-2 incidence of infection and vaccination among PWID;however, disparities in seroprevalence remain. Younger and female PWID and those experiencing homelessness were less likely to be anti-S positive, suggesting programs should aim to improve vaccination coverage in such vulnerable populations.

SARS-CoV-2 SEROPREVALENCE AND RISKS FACTORS IN AFRICAN WLHIV ON ART AND THEIR INFANTS

Background: SARS-CoV-2 seroprevalence data in women living with HIV (WLHIV), their infants and associated risk factors in this subpopulation remain limited. We retrospectively measured SARS-CoV-2 seroprevalence from 09/2019- 12/2021 among WLHIV and their children in the PROMOTE observational cohort in Uganda, Malawi, and Zimbabwe prior to widespread SARS-CoV-2 vaccination in those countries. Method(s): Sociodemographic, clinical data and blood were collected q6 months. Plasma stored during 3 waves of the COVID-19 pandemic in East/ Southern Africa were tested for SARS-CoV-2 specific IgG antibodies (Ab) using serological assays that detect adaptive immune responses to SARS-CoV-2 spike protein. Modified-Poisson regression models were used to calculate prevalence rate ratios (PRR) and 95% confidence intervals (CI) to identify sociodemographic and clinical risk factors. Result(s): Plasma samples from 979 PROMOTE mothers and 1332 children were analysed. We found no significant differences in baseline characteristics between participants testing positive (+) and negative (-) for SARS-CoV-2 Ab. Overall maternal SARS-CoV-2 seroprevalence was 57.6% (95%CI: 54.5-60.7) and 39.3% (95%CI: 36.7-41.9) for infants. The earliest + result was detected from a sample collected on 09/2019, in Malawi. Factors significantly associated with SARS-CoV-2 seropositivity were country of origin (reference Uganda, aPRR 1.45, 95%CI: 1.24-1.69) and non-breastfeeding mother (aPRR=1.22, 95%CI: 1.02-1.48). Children above 5 years had a 10% increased risk of SARS-CoV-2 seropositivity (aPRR=1.10, 95%CI: 0.90-1.34) when compared to younger children. We found no statistically significant association with sanitation, household density, distance to clinic, maternal employment, ART regimen or viral load. Mother/infant SARS-CoV-2 serostatuses were discordant in 373/865 (43.1%) families tested: mothers+/children- in 51.2%;mothers-/children+ in 12%;child+/sibling+ concordance was 21.4%. Conclusion(s): These SARS-CoV-2 seroprevalence data indicate that by late 2021, about half of mothers and about a third of children in a cohort of HIV-affected families in eastern/southern Africa had been infected with SARS-CoV-2. Breastfeeding was protective for mothers, likely because of the need to stay home for young children. Discordant results between children within same families underscores the need to further understand transmission dynamics within households.

Factors associated with sleep quality in university students

To investigate factors associated with poor sleep quality. A cross-sectional study was conducted in 2019 with random sampling. Information on sleep was obtained using the Mini Sleep Questionnaire (MSQ). Independent variables included sociodemographic, behavioural, academic and psychological health characteristics. Adjusted analyzes were performed using Poisson regression. A total of 996 undergraduate students participated in the study. The poor sleep quality affected 23.1% of the sample (95%CI 20.5-25.9), ranging from 13.4% for those with little concern about violence in the neighbourhood to 36.5% for those with less social support. In the adjusted analysis, female sex [PR] 1.81;(95%CI 1.33-2.45), concern about violence in the neighbourhood [PR] 2.21;(95%CI 1.48-3.28), discrimination at university [PR] 1.42;(95%CI 1.08-1.86) and food insecurity [PR] 1.45;(95%CI 1.11-1.89) were associated with the presence of poor sleep quality, as well as having less social support and income and suffering psychological distress. The results highlight socioeconomic and mental health factors that affect sleep quality and demonstrate the need for reflection and interventions capable of minimizing this problem.Copyright © 2023, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.

Hiv Outcomes after Extended 12-Month Scripts for Art during Covid-19 in South Africa

Background: There is an urgent need for more efficient models of differentiated anti-retroviral therapy (ART) delivery, with the World Health Organization and PEPFAR calling for evidence to guide whether 12-monthly ART prescriptions and clinic review (12M scripts) should be recommended in global guidelines. We assessed the association between 12M scripts (allowed temporarily during the COVID-19 pandemic) and clinical outcomes in South Africa. Method(s): We performed a retrospective cohort study using routine, deidentified data from 59 public clinics in KwaZulu-Natal. We included PLHIV aged >18 years with a recent suppressed viral load (VL), and who had been referred from their clinic into a community ART delivery programme with a standard 6-month prescription and clinic review (6M script) or a 12M script. In the community ART programme, PLHIV collected ART every two months at external pick-up points, before returning to the clinic after 6 or 12 months for a new script. We used multivariable modified Poisson regression, accounting for clinic clustering, to compare 12-month retention-in-care (not >90 days late for any visit) and viral suppression (< 50 copies/mL) between 6M and 12M script groups. Result(s): Among 27,148 PLHIV referred for community ART between Jun-Dec 2020, 42.6% received 6M scripts and 57.4% 12M scripts. The median age was 39 years (interquartile range [IQR] 33-46) and 69.4% were women. Age, gender, prior community ART use and time on ART were similar in the two groups (Table). However, a larger proportion of the 12M script group had a dolutegravirbased regimen (60.0% versus 46.3%). The median (IQR) number of clinic visits in the 12 months of follow-up was 1(1-1) in the 12M group and 2(2-3) in the 6M group. Retention at 12 months was 94.6% (95% confidence interval [CI] 94.2%- 94.9%) among those receiving 12M scripts and 91.8% (95% CI 91.3%-92.3%) among those with 6M scripts. 16.8% and 16.7% of clients in the 12M and 6M groups were missing follow-up VL data, respectively. Among those with VLs, 90.4% (95% CI 89.9%-91.0%) in the 12M group and 88.9% (95% CI 88.3%- 89.5%) in the 6M group were suppressed. After adjusting for age, gender, ART regimen, time on ART and prior community ART use, retention (adjusted risk ratio [aRR]: 1.03, 95% CI 1.01-1.04) and suppression (aRR: 1.02(1.01-1.03) were higher with 12M scripts. Conclusion(s): COVID-19 led to temporary introduction of 12M scripts in South Africa. Wider use could reduce clinic visits without negative impacts on shortterm clinical outcomes.

Impact of COVID-19 pandemic on national cataract surgical rate: An interrupted time-series analysis

Introduction: Elective surgeries were suspended during the national lockdown implemented in March 2020 to curb the spread of the COVID-19 pandemic. Our study aimed to assess the impact of COVID-19 pandemic on national cataract surgical rates. Method(s): We conducted an interrupted time series analysis of cataract surgeries from 2017 to 2021 in Malaysia to evaluate the change in cataract surgical rates before and after the lockdown. Incidence rate ratios were estimated using a seasonally adjusted Poisson regression model. Stratified analyses were performed to establish whether the effect of the lockdown varied by COVID- 19 status of the hospital, sex, and age groups. Result(s): The mean monthly cataract surgical rates before lockdown was 14.1 per 100,000 population with an underlying trend of a 1.0% increase per month. The lockdown was associated with an abrupt 54.0% reduction in monthly rates (95%CI: 0.36-0.60;p<0.001). In May 2020, we observed a gradual recovery in the rates with a peak at 13.8 per 100,000 population in September 2020 although it has not rebounded to its pre-lockdown rate in December 2021. There was no evidence that the effect of the lockdown differed by COVID-status of the hospital, sex, or age groups. Conclusion(s): The initial lockdown period in March 2020 was associated with an immediate reduction in cataract surgical rates to nearly half of its baseline rate. Although cataract surgical rates have marginally trended upward after restrictions were eased, efforts should be taken to restore the delivery of cataract services to its pre-pandemic level to mitigate the negative effects caused by service disruption.

Covid-19 Vaccine Coverage among People with Hiv in the Vaccine Safety Datalink

Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.

Factors Associated with the Intake of Ultra-Processed Cariogenic Foods by Preschoolers During the COVID-19 Pandemic

Objective: To evaluate the characteristics and factors associated with the intake of ultra-processed cariogenic foods (UFC) by preschoolers during the COVID-19 pandemic. Material and Methods: This is a cross-sectional study involving parents of 672 children from two to five years old enrolled at public schools in Curitiba, Brazil. Parents answered a questionnaire about socioeconomic and demographic data, their behavior regarding the dietary education of their children (Parent Mealtime Action Scale-translated and validated for use in Brazil), and children's food intake (qualitative food frequency questionnaire-list of foods based on a report from the Pan American Health Organization). The data were analyzed using Poisson regression analysis (α=0.05). Results: About 43% of parents/guardians reported changes in their children's diet during the pandemic, being that diet got worse and better in 19% and 24% of the cases, respectively. The ultra-processed cariogenic foods with the highest daily intake frequencies were sweetened juices/sweetened drinks (0.52), followed by cookies (0.37), and candies (0.35). Parents with a lower level of education reported a daily frequency of UCF intake 1.36 times higher (PR=1.359;CI 95%: 1.106-1.669) in their children compared to those with a higher level of education. On the other hand, parents'/guardians' report of higher intake and greater offer of fruits and vegetables to children was associated with low UCF intake (PR=0.716;CI 95%: 0.592-0.866). Conclusion: The lower level of formal education of parents/guardians and lower availability of fruits and vegetables were related to higher consumption of ultra-processed cariogenic foods by children. © 2023, Association of Support to Oral Health Research (APESB). All rights reserved.

Comparative study on epidemiological characteristics and public health interventions of COVID-19 among China, South Korea, the United States and France based on the poisson regression model

Objective To analyze the trend of COVID-19 epidemic and to comparatively evaluate effects of economic policies, containment and closure policies and health system policies in China , South Korea, the United States (US) and France. Methods Daily confirmed COVID-19 cases and daily comprehensive policy index, specific indicators in mainland China, South Korea, US and France were collected. Considering the lag effect of policy effects, poisson regression model was established to estimate the daily real-time regeneration (Rt) , and the log-log model with variable coefficient was used to compare the prevention and control effects of policies and measures in different countries. Results Containment and closure policies and health system policies were negatively correlated with Rt, and the cumulative lag effect weakens with the increase of lag time. Economic policies were negatively correlated with Rt only in US and France. The effect of American and French policies on Rt was weaker than that of China and South Korea. Conclusion Containment and closure policies and health system policies have a great effect on reducing Rt and controlling the epidemic, the timely and powerful comprehensive blockade measures at the early stage of the epidemic have better effects than mitigation measures. © 2023, Publication Centre of Anhui Medical University. All rights reserved.

The Digital Divide in End-of-Life Care: Evaluating Health Policies to Bridge the Gap in Virtual Care (FR206B)

1. Identify clinical and sociodemographic disparities associated with virtual end-of-life care and understand the role of physician practice behaviors in such disparities. 2. Recognize potential clinical and health policy initiatives that may help to alleviate disparities in virtual end-of-life care. Virtual care was rapidly expanded in Ontario, Canada, during the COVID-19 pandemic following the introduction of new fee codes on March 14, 2020, that incentivized physician delivery of virtual care, including end-of-life care (EOLC). The objective of this study was to measure the associated impact of these fee incentives on disparities in access to virtual EOLC and the variation in use according to a physician's annual practice volume. This population-based cohort study used linked health administrative data of adults in the last three months of life between January 25, 2018, and December 31, 2022, in Ontario, Canada, with practice data for the 38,282 physicians most responsible for their EOLC. Modified Poisson regression was used to measure the association between the intervention and use of virtual EOLC. Multilevel hierarchical logistic regression was used to measure the association between tertiles of annual physician practice volume (Low-bottom, 25%;Average, 25%-75%;High-top, 25%). There were 14,189 people (12%) who received virtual EOLC before March 14, 2020, and 100,934 people (88%) after that date, representing a 9-fold increase (RR, 9.22;95% CI, 8.92-9.52;p<0.0001). Of the measured sociodemographic variables, 10/51 (19.6%) were associated with a lower probability of receiving virtual EOLC before the policy intervention;7 of these 10 had a RR of ≥1 after the intervention (p<0.05). High annual physician volume accounted for 28%-36% of the variation in receipt of virtual EOLC before March 14, 2020, and 10%-12% after March 14, 2020. The introduction of new physician fee codes to broaden the delivery of virtual EOLC was associated with a substantial increase in virtual EOLC utilization and a leveling of preexisting disparities in use among different demographic groups. Physician-level factors accounted for substantial variation in receipt of virtual care, though these effects were attenuated over time as virtual care was more broadly utilized. [ FROM AUTHOR] Copyright of Journal of Pain & Symptom Management is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 pandemic affects STEMI numbers and in-hospital mortality: Results of a nationwide analysis in Germany

Background: The COVID-19 pandemic led to extensive restrictions in Germany in 2020, including the postponement of elective interventions. We examined the impact on ST-elevation myocardial infarction (STEMI) as an acute and non-postponable disease. Method(s): Using German national records, all STEMI between 2017 and 2020 were identified. Using the number of STEMI cases between 2017 and 2019, we created a forecast for 2020 using poisson regression models and compared it with the observed number of STEMI in 2020. Result(s): From 2017 to 2020, 248,062 patients were treated for a STEMI in Germany. Mean age was 65.21 years and 28.36% were female. When comparing forecasted and observed STEMI in 2020, a correlation can be seen: Noticeably fewer STEMI were treated in those weeks respectively months with an increasing COVID-19 hospitalization rate (monthly percentage decrease in STEMI: March -14.85% April -13.39%, November -11.92%, December -22.95%). At the same time, the risk-adjusted in-hospital mortality increased significantly at the peaks of the first and second waves (monthly in-hospital mortality: April RR=1.11 [95% CI 1.02;1.21], November 1.13 [1.04;1.24], December 1.16 [1.06;1.27]). Conclusion(s): The COVID-19 pandemic led to a noticeable decrease in the number of STEMI interventions in Germany at the peaks of the first and second waves in 2020, corresponding to an increase in COVID-19 hospitalizations. At the same time, in-hospital mortality after STEMI increased significantly in these phases. (Figure Presented).

Prescriptions For Analgesics For The Treatment Of Osteoarthritis During The Covid-19 Pandemic: A Retrospective Analysis

Purpose: Between 2008 and 2014 approximately 32.5 million adults in the United States reported a diagnosis of osteoarthritis (OA). The 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis (OA) of the hand, hip and knee recommend treating pain due to OA with analgesic therapy as part of multi-modal treatment program. A national survey conducted by the Centers for Disease Control found that patients with OA were likely to delay care during the pandemic. Given this new barrier to healthcare, access to analgesic therapy may have become even more limited. This study aimed to evaluate changes in analgesic prescribing practices for OA as a result of the COVID-19 pandemic. Method(s): A retrospective analysis was performed to identify new prescriptions, number of doses per order and refills of 73 topical and oral analgesics from encounters for OA. OA encounters were identified using 206 ICD-10 codes for OA from July 2019 to June 2021 at UC Davis Hospital and affiliated outpatient centers. Pre-pandemic data corresponds to 2019 data and data collected after this occurred during the pandemic. Counts of new prescriptions, number of doses per order and refills by fiscal quarter were analyzed using a two-factor Poisson Regression with an interaction between quarter and year with corresponding contrasts to detect a difference between 2019 and 2020 as well as 2019 and 2021 and quarters between these years. A follow-up Sidak step-down p-value adjustment was used to correct for type I error. All statistical analyses were done with a two-sided alpha of 0.05. The Poisson Regression was performed with SAS software for Windows version 9.4 (SAS Institute Inc., Cary, NC). Result(s): A total of 31,532 encounters with a primary diagnosis of OA occurred from July 2019 to June 2021. There was an increase in the number encounters with a primary diagnosis of OA (Figure 1) but there was no statistical difference in the medications ordered from 2019 to 2020, 2019 to 2021, and the quarters between these years as well. After adjusting for Type I error, there was a significant decrease in medication refills from 2019 to 2020 (p-value 0.0031, adjusted p-value 0.0425) as well as from 2019 to 2021 (p-value <0.0001, adjusted p-value 0.003) (Figure 2), and there was a significant decrease in number of doses of analgesia from 2019 to 2020 and an increase in number of doses from 2019 to 2021 (p-value <0.0001, adjusted p-value 0.003) (Figure 3). Conclusion(s): The COVID-19 pandemic has persistent impacts on the prescribing practices of analgesics for the treatment of OA. Our data suggests that since the COVID-19 pandemic, patients with OA were overall provided with more doses of analgesics and fewer refills. It is likely that barriers imposed by COVID-19 resulted in these changes in the way analgesics are provided for the treatment of OA. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023

Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Background: Telemedicine for adolescent and young adult (AYA) long-acting reversible contraception (LARC) care is understudied, as telemedicine was quickly implemented in response to the COVID-19 pandemic. We compare outcomes of AYA LARC follow-up care via telemedicine vs. in-person visits over 1 year. Method(s): This cohort (IRBP00030775) includes patients who 1) had an intrauterine device (IUD) or implant inserted between 4/1/20-3/31/21 and 2) attended an initial LARC follow-up visit (defined as the first visit within 12 weeks of insertion) at 1 of 4 US Adolescent Medicine clinics. Eligible patients were 13-26 years old with a LARC method inserted without sedation and in situ for at least 12 weeks. We compared outcomes over 1 year between AYAs attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported symptoms, menstrual management, acne management, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of menstrual management. Result(s): Our study included 194 AYAs, ages 13.9-25.7 years, who attended an initial follow-up visit. Most AYAs (86.6%) attended only 1 visit in the first 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site, age, race/ethnicity, prior pregnancy, concurrent medical/mental health diagnoses, and reason for LARC (Table 1). In-person attendees were more likely to have the IUD than telemedicine attendees (Table 1). Patient-reported symptoms over 1 year were similar between groups (Table 2). Menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing than telemedicine attendees (p =.001). However, no positive STI tests were captured in either group. Conclusion(s): Approximately 40% of AYAs attended their LARC follow-up visit via telemedicine. LARC type may have influenced modality of visit. While in-person attendees were more likely to have STI testing, there were no positive STI tests detected in either group during the study period. More research is needed to determine if the decrease in STI testing is clinically significant. Other outcomes were similar between visit modalities, suggesting telemedicine may be useful for AYA LARC care. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-1-ANY.docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-2-ANY.docxCopyright © 2023