The Impact of the COVID-19 Pandemic on Emergency Surgical Operations in State Hospitals in Turkey: A Retrospective and Descriptive Study

Aim: Emergency surgery can be defined as surgical interventions and operations necessary to deal with an acute threat to life, organ, limb, or tissue. Our study examined the impact of the Coronavirus disease-2019 (COVID-19) pandemic on emergency surgical operations (ESOs) performed in state hospitals in Turkey. Materials and Methods: In this national, retrospective, and descriptive study, ESOs performed in 2nd and 3rd-level state hospitals in Turkey in 2021 were recorded for the study. ESOs performed in 2019 were taken as the control group, and the changes between the two groups were examined. Results: A total of 1,822,075 ESOs were included in the analysis. There was a 7.6% decrease in ESOs in 2021 compared to 2019. In both 2019 and 2021, cesarean section, surgical treatment of upper/lower extremity fractures and dislocations, and cholecystectomy were the most frequently performed ESOs. An increase in the number of ESOs in 2021 compared to 2019 was observed only in the urology department (7.1%) and orthopedics and traumatology department (2.7%). The surgical departments with the greatest decreases were neurosurgery (-28.1%), Otolaryngology-Head and Neck Surgery (-27.7%), and thoracic surgery (-20.9%) Conclusion: During the COVID-19 pandemic, the number of ESOs performed in the 2nd and 3rd-level state hospitals in Turkey decreased compared with the previous year.

43 NEED FOR AN ORDINANCE FOR THE REDUCTION OF URBAN PROPERTY TAX IN TULCAN-ECUADOR

The payment of the urban property tax is an obligation with which all citizens who own real estate must comply. The objective of this research is to demonstrate the help that the decrease in the payment of the tax would give to the citizens, due to the fact that the economy of the citizens has been affected by the pandemic, since the city of Tulcan is a border city, its main economic activity is commerce, which due to the pandemic decreased significantly, leaving economic losses. The objective is to demonstrate that such increase is currently unnecessary, since everyone has been economically affected by Covid 19, for this we have used a field and investigative methodology. As a result, we should obtain the solution to this problem, giving a favourable end for the citizens as well as for the personnel of the municipality.

A collaborative approach intended to reduce the duration of short term urinary catheters in adult patients at a tertiary care medical center also significantly reduced the duration of hospitalization.

BACKGROUND: Urinary tract infections are the leading cause of nosocomial infections in the United States. The major contributing factor is the placement of indwelling urinary catheters. METHODS: Following a chart review of adult patients hospitalized at a tertiary care medical center who required the use of a short-term (≤ 2 weeks) indwelling urinary catheter, a collaborative effort was initiated by an Infectious Diseases physician to develop protocols focused on the clinical service involved for the expeditious removal of short-term indwelling urinary catheters. The protocols relied in part on the standards of practice by pertinent medical/surgical subspecialty societies. Usage of urinary catheters and duration of hospitalization following implementation of the protocols was assessed. RESULTS: Based on a multivariate analysis controlling for demographic variables, comorbidities, medical vs surgical service, and indication for the urinary catheterization, the median duration of catheterization was significantly reduced from 6.7 days to 3.6 days after the protocols were initiated (P < .001), and the median duration of hospitalization was significantly reduced from 9.5 days to 5.9 days (P < .001). No patient had to have the urinary catheter reinserted. CONCLUSIONS: Development of collaborative protocols for the removal of short-term indwelling urinary catheters significantly reduced both the duration of catheterization and the duration of hospitalization.

Determination of the human impact on the drop in NO2 air pollution due to total COVID-19 lockdown using Human-Influenced Air Pollution Decrease Index (HIAPDI).

This study investigates the relationship between territorial human influence and decreases in NO2 air pollution during a total COVID-19 lockdown in Metropolitan France. NO2 data from the confinement period and the Human Influence Index (HII) were implemented to address the problem. The relative change in tropospheric NO2 was calculated using Sentinel-5P (TROPOMI) satellite data. Hotspot-Coldspot analysis was performed to examine the change in NO2. Moreover, the novel Human-Influenced Air Pollution Decrease Index (HIAPDI) was developed. Weather bias was investigated by implementing homogeneity analysis with χ2 test. The correlations between variables were tested with the statistical T-test. Likewise, remote observations were validated with data from in-situ monitoring stations. The study showed a strong correlation between the NO2 decrease during April 2020 under confinement measures and HII. The greater the anthropogenic influence, the greater the reduction of NO2 in the regions (R2 = 0.62). The new HIAPDI evidenced the degree of anthropogenic impact on NO2 change. HIAPDI was found to be a reliable measure to determine the correlation between human influence and change in air pollution (R2 = 0.93). It is concluded that the anthropogenic influence is a determining factor in the phenomenon of near-surface NO2 reduction. The implementation of HIAPDI is recommended in the analysis of other polluting gases.

Ozone pollution during the COVID-19 lockdown in the spring of 2020 over Europe, analysed from satellite observations, in situ measurements, and models

We present a comprehensive study integrating satellite observations of ozone pollution, in situ measurements, and chemistry-transport model simulations for quantifying the role of anthropogenic emission reductions during the COVID-19 lockdown in spring 2020 over Europe. Satellite observations are derived from the IASI+GOME2 (Infrared Atmospheric Sounding Interferometer + Global Ozone Monitoring Experiment 2) multispectral synergism, which provides better sensitivity to near-surface ozone pollution. These observations are mainly analysed in terms of differences between the average on 1–15 April 2020, when the strictest lockdown restrictions took place, and the same period in 2019. They show clear enhancements of near-surface ozone in central Europe and northern Italy, as well as some other hotspots, which are typically characterized by volatile organic compound (VOC)-limited chemical regimes. An overall reduction of ozone is observed elsewhere, where ozone chemistry is limited by the abundance of NOx. The spatial distribution of positive and negative ozone concentration anomalies observed from space is in relatively good quantitative agreement with surface in situ measurements over the continent (a correlation coefficient of 0.55, a root-mean-squared difference of 11 ppb, and the same standard deviation and range of variability). An average difference of ∼ 8 ppb between the two observational datasets is observed, which can partly be explained by the fact the satellite approach retrieves partial columns of ozone with a peak sensitivity above the surface (near 2 km of altitude over land and averaging kernels reaching the middle troposphere over ocean).For assessing the impact of the reduction of anthropogenic emissions during the lockdown, we adjust the satellite and in situ surface observations for subtracting the influence of meteorological conditions in 2020 and 2019. This adjustment is derived from the chemistry-transport model simulations using the meteorological fields of each year and identical emission inventories. Using adjustments adapted for the altitude and sensitivity of each observation, both datasets show consistent estimates of the influence of lockdown emission reduction. They both show lockdown-associated ozone enhancements in hotspots over central Europe and northern Italy, with a reduced amplitude with respect to the total changes observed between the 2 years and an overall reduction elsewhere over Europe and the ocean. Satellite observations additionally provide the ozone anomalies in the regions remote from in situ sensors, an enhancement over the Mediterranean likely associated with maritime traffic emissions, and a marked large-scale reduction of ozone elsewhere over ocean (particularly over the North Sea), in consistency with previous assessments done with ozone sonde measurements in the free troposphere.These observational assessments are compared with model-only estimations, using the CHIMERE chemistry-transport model. Whereas a general qualitative consistency of positive and negative ozone anomalies is observed with respect to observational estimates, significant changes are seen in their amplitudes. Models underestimate the range of variability of the ozone changes by at least a factor 2 with respect to the two observational datasets, both for enhancements and decreases of ozone. Moreover, a significant ozone decrease observed at a large hemispheric scale is not simulated since the modelling domain is the European continent. As simulations only consider the troposphere, the influence from stratospheric ozone is also missing. Sensitivity analyses also show an important role of vertical mixing of atmospheric constituents, which depends on the meteorological fields used in the simulation and significantly modify the amplitude of the changes of ozone pollution during the lockdown.

[Decrease in activity and its related factors under COVID-19 crisis in community-dwelling older people].

AIM: To prevent the transmission of the novel coronavirus [COVID-19] and stop its spread, a state of emergency was declared from April to May 2020. People were encouraged to refrain from outings and reduce their contact with people. The purpose of this study was to examine the subjective changes in the amount of activity under COVID-19 crisis among the elderly and the factors related to this decrease in activity. METHODS: This study was part of the SONIC study, an ongoing prospective cohort study targeting community dwelling older people in their 70, 80, 90s, and over 100 years old in different regions (urban and suburban) of Japan. Subjective changes in the amount of activity during the state of emergency were assessed via a mail questionnaire. RESULTS: The percentage decrease in activity for the subjects in their 70s, 80s, and 90s were 68.1% (513/753), 65.3% (324/496), and 56.0% (164/293), respectively. By region, 69.4% in urban, while 57.7% in the suburbs. In the 70- and 80-year-old cohorts, the decrease in activity was more frequent among those in urban areas than in suburban areas. In the 90-year-old cohort, the differences between the regions were attenuated, while the economic status and walking speed were significantly associated with a decrease in activity. CONCLUSIONS: The decrease in activity varied by age group and region, suggesting that approaches to preventing the adverse health effects associated with inactivity due to the COVID-19 crisis are more important in urban areas than in suburban ones.

Improving the resilience of SMEs in times of crisis: The impact of mobile money amid Covid-19 in Zambia.

This study investigates the impact of mobile money (MM) on SMEs' resilience and the associated business outcome in developing countries amid Covid-19. Despite the potential of MM to improve SMEs' resilience, little evidence has been documented. Using Enterprise Survey data in Zambia, we show that SMEs are more likely than large firms to experience catastrophic sales decline, reflecting their inherent vulnerability. Further analysis reveals that this unfavourable effect can be effectively counteracted when SMEs incorporate MM into daily business. An important policy implication is that the use of digital technologies should be a key element of policy responses to Covid-19.

Demographic Development of Russia in the 20th‒21st Centuries: Historical and Geopolitical Dimensions.

Features of demographic development in Russia from the 1940s to 2020 are retrospectively considered. The stages of the country's demographic development are analyzed, including the contribution of various components to the demographic dynamics in certain historical periods. The idea of distinguishing two waves of depopulation is proposed, and it is argued that the second wave of depopulation in Russia is provoked not only by negative modern trends, but is also associated with the historical features of the demographic development of the country, namely, with the age structure of the population, deformed under the influence of various historical events, or with "demographic pitfalls," often referred to in the literature. The contribution of supermortality to depopulation in the 1990s, called the shock stage of Russia's demographic development, is highlighted. The features of the second wave of depopulation are noted, which are associated with a decrease in the number of women of reproductive age and a new round of increase in mortality due to COVID-19. A systematic approach to neutralizing the second wave of depopulation is substantiated on the basis of a comprehensive national demographic program, including a system of measures to create conditions for the birth and upbringing of children, support families with children, develop self-preserving behavior, reduce mortality, increase life expectancy, reduce emigration, and attract migrants of the necessary categories to Russia.

Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has become a global problem, put a heavy burden on the health care system, and resulted in many fatalities across the globe. A reduction in the number of cardiac emergencies, especially ST-segment elevation myocardial infarction (STEMI), is observed worldwide. In this study, we aimed to analyze the trends of cases and presentation of STEMI across several cardiac catheterization centers in Indonesia. Method: This retrospective study was performed by combining medical record data from five different hospitals in Indonesia. We compared data from the time period between February to June 2019 with those between February and June 2020. Patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) procedures were included in the study. Results: There were 41,396 emergency department visits in 2019 compared with 29,542 in 2020. The number of patients with STEMI declined significantly from 338 in 2019 to 190 in 2020. Moreover, the total number of PPCI procedures reduced from 217 in 2019 to 110 in 2020. The proportion of PPCI was not significantly reduced (64.2 vs. 57.9%). The majority of the patients were men, with a mean age of 54 years in 2019 and 55 years in 2020. We observed a significantly longer door-to-balloon time in 2020 than in 2019 (p < 0.001). We also observed a difference in the door-to-balloon time and ischemic time between the two periods. Conclusion: We observed a decline in the number of patients presenting with STEMI to our centers. However, we observed no significant decline in the percentage of PPCI performed across our centers during this pandemic.

Unprepared management decreases education performance in kindergartens during Covid-19 pandemic.

The Covid-19 pandemic has disrupted the education sector, including kindergartens. Kindergarten principals and teachers make extra effort to maintain their education performance. This research aims to identify problems of the "learning from home" policy in kindergarten education and formulate possible solutions to overcome them. It involved 15 respondents from different regions in Indonesia. Data were collected through several methods, including face-to-face interviews, phone interviews, and online interviews through messaging services. The research result showed that many kindergarten management boards encountered difficulties in fulfilling planned education schedules and had the low achievement of objective targets. The problems existed in teachers, parents, and mainly students. Most teachers faced problems in creating interactive education materials and conducting an evaluation. Parents had hard times in assisting their children due to their busy activities and low pedagogical competence. Children had hard times due to limited resources for online learning. This research suggests solutions such as improving the mastery of information and communication technology (ICT), especially for teachers, parents, and children. However, the education system's long-term reform is needed to prepare for facing the possible catastrophe that affects the education system. It may include integrating online learning in the traditional education system and the development of supporting infrastructure and facilities.

COVID-19 and cardiovascular complications - preliminary results of the LATE-COVID study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) may affect many organs and may be responsible for numerous complications including cardiovascular problems. METHODS: We analysed consecutive patients (n = 51) admitted to the cardiology department between 1st October 2020 and 31st January 2021 due to symptoms which might have reflected cardiovascular complications following COVID-19. We collected data concerning clinical characteristics, results of laboratory tests, echocardiography and 24-hour ambulatory ECG recording. RESULTS: The post-COVID-19 complications appeared 1-4 months after disease recovery. Severe cardiovascular complications were observed in 27.5% of hospitalized patients. In comparison to those with mild complications, patients with severe complications had significantly higher prevalence of diabetes (36 vs. 8%; p = 0.01), decrease in ejection fraction (36% vs. 0%, p < 0.001), higher resting heart rate at admission (85 vs. 72 bpm; p < 0.001), and higher levels of C-reactive protein (p = 0.02) and troponin T (17.9 vs. 4.2 pg/ml; p = 0.01). Dyspnoea and exercise intolerance were also more frequent in patients with severe complications. CONCLUSIONS: Diabetes, elevated level of CRP and troponin, heart rate variability parameters and worsening of left ventricular ejection fraction are related to the severity of cardiovascular complications following COVID-19 infection.

Changes in the medical treatment status of Japanese outpatients during the coronavirus disease 2019 pandemic.

Background: The coronavirus disease 2019 (COVID-19) has a tremendous influence in general public's behaviors; however, changes in the status of regularly scheduled outpatient visits in Japan during COVID-19 pandemic are still unknown. Methods: This cross-sectional study was conducted in May 2020. Participants were recruited by an Internet-based survey company. A total of 659 patients (54% male, average age 60 ± 14 years) who had regularly scheduled outpatient visits prior to the onset of COVID-19 were enrolled. Participants answered four questions ("decrease in medical visit frequency," "inability to take regular medication," "deterioration of a chronic disease," and "utilization of telephone/online medical care") and stated whether they had a fear of acquiring infection at a medical facility. The associations between answers, fear of infection, and socio-demographic factors were examined. Results: Among the participants, 37.8% had decreased their medical visits, 6.8% were unable to take regular medications, 5.6% experienced a deterioration of chronic disease, and 9.1% utilized telephone/online medical care. Fear of being infected by COVID-19 at medical facilities was strongly associated with a reduced frequency of medical visits and lack of regular medications even after adjusting for socio-demographic factors and current medical histories. Conclusions: During the first wave of COVID-19, approximately 40% of participants reduced their frequency of medical visits. It is important to continue implementing thorough infection control measures at facilities and educating the public the importance of keeping chronic diseases in good condition, as well as promoting telephone/online medical care.

Assessing the recent impact of COVID-19 on carbon emissions from China using domestic economic data.

The outbreak of coronavirus disease 2019 (COVID-19) has caused tremendous loss to human life and economic decline in China and worldwide. It has significantly reduced gross domestic product (GDP), power generation, industrial activity and transport volume; thus, it has reduced fossil-related and cement-induced carbon dioxide (CO2) emissions in China. Due to time delays in obtaining activity data, traditional emissions inventories generally involve a 2-3-year lag. However, a timely assessment of COVID-19's impact on provincial CO2 emission reductions is crucial for accurately understanding the reduction and its implications for mitigation measures; furthermore, this information can provide constraints for modeling studies. Here, we used national and provincial GDP data and the China Emission Accounts and Datasets (CEADs) inventory to estimate the emission reductions in the first quarter (Q1) of 2020. We find a reduction of 257.7 Mt. CO2 (11.0%) over Q1 2019. The secondary industry contributed 186.8 Mt. CO2 (72.5%) to the total reduction, largely due to lower coal consumption and cement production. At the provincial level, Hubei contributed the most to the reductions (40.6 Mt) due to a notable decrease of 48.2% in the secondary industry. Moreover, transportation significantly contributed (65.1 Mt), with a change of -22.3% in freight transport and -59.1% in passenger transport compared with Q1 2019. We used a point, line and area sources (PLAS) method to test the GDP method, producing a close estimate (reduction of 10.6%). One policy implication is a change in people's working style and communication methods, realized by working from home and holding teleconferences, to reduce traffic emissions. Moreover, GDP is found to have potential merit in estimating emission changes when detailed energy activity data are unavailable. We provide provincial data that can serve as spatial disaggregation constraints for modeling studies and further support for both the carbon cycle community and policy makers.