Disability Evaluations: Common Questions and Answers

Disability is a physical or mental impairment that substantially limits at least one major life activity. Family physicians are often asked to assess patients with disabling conditions that can impact insurance benefits, employment, and ability to access needed accommodations. Disability evaluations are needed for short-term work restrictions following a simple injury or illness and for more complex cases involving Social Security Disability Insurance, Supplemental Security Income, Family and Medical Leave Act, workers' compensation, and personal/private disability insurance claims. Using a stepwise approach built on awareness of the biologic, psychological, and social elements of disability assessment may facilitate this evaluation. Step 1 establishes the role of the physician in the disability evaluation process and the context of the request. In Step 2, the physician assesses impairments and establishes a diagnosis based on findings from an examination and validated diagnostic tools. In Step 3, the physician identifies specific participation restrictions by assessing the patient's ability to perform specific movements or activities and reviewing the employment environment and tasks. Steps 4 and 5 ensure proper documentation, billing, and coding. In complex cases, consultants such as psychiatrists and physical therapists may assist by providing insight into a patient's mental and physical impairments, activity limitations, and response to treatment. (Am Fam Physician. 2023;107(5):490–498. Copyright © 2023 American Academy of Family Physicians.)

Patient-reported respiratory outcome measures in the recovery of adults hospitalised with COVID-19: A systematic review and meta-analysis

Background: The morbidity associated with recovery from COVID-19 is huge with apparent persisting respiratory limitation. Aims and objectives: We investigate the persisting respiratory symptomatic and functional recovery of patients initially hospitalised with COVID-19 in a systematic review and meta-analysis using patient-reported outcome measures (PROMs). Method(s): Comprehensive database searches in accordance with the PRISMA statement were carried out up till 31/05/2021 where data exists for patients >8 weeks after hospital discharge, according to PROSPERO (1). Data were narratively synthesized, and meta-analyses were performed using the random-effects inverse variance method. Result(s): Of 49 studies, across 14 countries with 2-12 months follow up, fatigue was the most commonly reported persisting symptom at 2-4 months (36.6%, 95 % CI 27.6 to 46.6, n=14), and at >4 months (32.5%, 95% CI 22.6 to 44.2, n=15). Modified MRC dyspnoea score >=1 was reported in 48% (95% CI 30 to 37, n=5) at 2-4 months and 32% (95% CI 22 to 43, n=7) at >4 months. Persisting sick leave, change in their scope of work and increased healthcare usage was also reported. Conclusion(s): Persisting respiratory symptoms are experienced by survivors of COVID-19 hospital admission with associated impact on work and healthcare usage.

Profile of healthcare workers who contracted COVID-19 after vaccination against SARS-CoV-2

Introduction: Being at high-risk for COVID-19, healthcare workers (HCW) were prioritized in the beginning of vaccination campaigns in Tunisia. The emergence of several variants raises the issue of resistance and postvaccination infection. Aim(s): To study epidemiological and clinical characteristics of COVID-19 infection in HCW who previously had COVID19 vaccine. Method(s): Retrospective descriptive study focusing on Rabta hospital's HCW who presented themselves for a reinstatement visit after post-vaccination COVID-19 infection, from 15 March to 31 December 2021. Result(s): There were 122 HCW with a mean age of 42.8 years, a sex ratio of 0.5, and an average professional seniority of 13.8 years. 32% worked full-time in COVID-19 wards and13.1% had a history of COVID-19 before vaccination. Half had received two doses of vaccine. They were vaccinated mainly with mRNA (66.4%), viral vector (19.9%) or attenuated virus (12.3%). Symptoms appeared, on average, 35 days after the last dose of vaccine and the disease was confirmed by RT-PCR after 3 days of the symptom's onset. The main symptoms described were asthenia (66.4%), cough (66.4%), headache (62.3%), anosmia (64.8%), ageusia (55.7%), fever (52.2%), diarrhea (40.2%) ans dyspnea (21.3%). They were mainly put on symptomatic treatment and home rest for 11 days. However, 15% had an extension of their sick-leave and 2.5% presented a severe form requiring hospitalization. On return to work, 59.8% reported the persistence of symptoms including cough (18.9%), asthenia (11.5%), dyspnea (9.8%), anosmia and ageusia (7.4%). Conclusion(s): Vaccinated HCW presented mainly a mild form of COVID-19. Vaccination is an important and promising means to end this pandemic.

Twenty months follow-up in non-hospitalised adults with post COVID-19 condition: a preliminary longitudinal cohort study

Background: Persistent symptoms and impairments occur after both severe and mild COVID-19 infection. Studies have focused on follow-up after hospitalisation, however studies in non-hospitalised people are warranted. Aim(s): To evaluate long-term impact on physical function and health-related quality of life (HRQoL) in non-hospitalised adults with post COVID-19 condition. Method(s): Preliminary results from assessment in non-hospitalised adults (n=51), with >= 3 months of persistent symptoms after infection, was performed at Karolinska University Hospital. Baseline assessment was in median 9 months after illness onset and follow-up 20 months after illness onset. Assessments consisted of dynamic spirometry, maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), mMRC dyspnoea scale (0-4) and HRQoL (EQ5D VAS: 0-100). Result(s): Mean age was 42 years (SD:10,8) and 92 % were women. Prior to infection 82 % worked and at baseline 47 % were on full-time sick leave compared to 33 % at follow-up. Median BMI was 25 (IQR: 5,6), 16 % had asthma and 35 % were smokers or former smokers. Improvements between baseline and follow-up were seen in 6MWT (75 % vs 82 % of predicted distance, p<0.05), MIP (81 % vs 95 % of predicted, p<0.05) and mMRC (3 vs 2, p<0.05). HRQoL was impaired and unchanged (mean EQ VAS: 34 vs 39). Lung function, expressed as % of predicted, was normal and unchanged (FEV1: 85 % vs 88 %, FVC: 88 vs 89 %). Conclusion(s): The results indicate that although physical function improve to some degree, impairments in physical function and HRQoL remained 20 months after COVID-19 infection. Finding causes and rehabilitation to improve these impairments are urgently needed.

Employment status of referrals to a regional Long COVID service in the United Kingdom

Introduction: Long COVID is a new phenomenon characterised by multiple physical and psychological symptoms, all of which can affect a person's ability to work. There has been evidence that Long COVID disproportionately affects healthcare professionals (HCPs). Aim(s): We analysed the employment status of referrals to the Cheshire and Merseyside Long Covid assessment service. Method(s): Retrospective case note review of referrals received between 01/03/21-30/09/21. Result(s): 1285 referrals analysed, of which: 59.2% (761) currently working 19.7% (253) long term sick leave . 10.3% (111) retired 0.7% (9) students, of these 33.3% (3) were on placement within hospitals. . 8.6% (132) were unemployed, of these 15.2% (20) contributed this to Long COVID syndrome 1.48% (19) had no record of employment 20.2% (259) worked for the National Health Service (NHS). Table 1 shows the breakdown by sector. Conclusion(s): The results show the ongoing socio-economic impact of COVID-19. Almost 1/3 of the cohort were unemployed or on long-term sick leave. Furthermore, NHS HCP made up the largest proportion of the long-term sick group. Further work could evaluate the occupational risk associated with Long COVID syndrome, especially in healthcare settings.

Prevalence and Severity of COVID-19 and Missed Job Opportunities among Healthcare Workers in Mazandaran Province, February-June 2020

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Materials and methods: In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Results: The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion: COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease.

Prevalence and Severity of COVID-19 and Missed Job Opportunities among Healthcare Workers in Mazandaran Province, February-June 2020.

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Material(s) and Method(s): In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Result(s): The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion(s): COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease. Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

American College of Radiology Paid Family/Medical Leave Policy: A Call to Action for the House of Medicine.

The American College of Radiology (ACR) passed a historic paid family/medical leave (PFML) resolution at its April 2022 meeting, resolving that "diagnostic radiology, interventional radiology, radiation oncology, medical physics, and nuclear medicine practices, departments and training programs strive to provide 12 weeks of paid family/medical leave in a 12-month period for its attending physicians, medical physicists, and members in training as needed." The purpose of this article is to share this policy beyond radiology so that it may serve as a call to action for other medical specialties. Such a PFML policy (1) supports physician well-being, which in turn supports patient care; (2) is widely needed across American medical specialties; and (3) should not take nearly a decade to achieve, as it did in radiology, especially given increasing physician burnout and the ongoing COVID-19 pandemic. Supported by information on the step-by-step approach used to achieve radiology-specific leave policies and considering current and normative policies at the national level, this article concludes by reviewing specific strategies that could be applied toward achieving a 12-week PFML policy for all medical specialties.

Changes in sick leave utilization at an academic medical center during the COVID-19 pandemic

Purpose: The coronavirus disease 2019 (COVID-19) pandemic drastically changed work arrangements, but COVID-19's impact on employee leave utilization is unclear. The authors sought to understand how sick leave and vacation leave utilization changed during the pandemic among clinical and non-clinical departments at an academic medical center (AMC). Design/methodology/approach: Clinical departments were defined as work units with a primary mission of providing direct patient care. Per-person, per-month leave utilization data were obtained from the AMC's time-keeping system for 3 clinical departments and 4 non-clinical departments in the first 12 months of the pandemic and the preceding 12 months. Monthly data for each department were analyzed with mixed-effects regression. Finding(s): Available data represented 402 employees from 3 clinical departments and 73 employees from 4 non-clinical departments. The authors found no statistically significant change in sick leave utilization among either clinical or non-clinical departments. Vacation leave utilization decreased during the pandemic by 5.9 h per person per month in non-clinical departments (95% confidence interval [CI]: -8.1, -3.8;p < 0.001) and by 3.0 h per person per month in clinical departments (95% CI: -4.3, -1.7;p < 0.001). Originality/value: Among employees in clinical departments, the authors found no increase in sick leave utilization and a decrease in vacation utilization. These findings are concerning for presenteeism, risk of burnout or understaffing resulting in workers' inability to take time away from work in clinical departments. Copyright © 2023, Emerald Publishing Limited.

Paid sick leave among U.S. healthcare personnel, April 2021

Background. Healthcare personnel (HCP) are at risk for acquiring and transmitting coronavirus disease 2019 (COVID-19), influenza, and other respiratory infections in the workplace. An important strategy to prevent workplace transmission, paid sick leave benefits allow workers to stay home and visit a healthcare provider when ill. Our objectives were to quantify the percentage of HCP reporting paid sick leave, identify differences across occupations and settings, and determine factors associated with having paid sick leave. Methods. In a national nonprobability Internet panel survey ofHCP in April 2021, respondents were asked, "Does your employer offer paid sick leave?" We weighted responses to the U.S. HCP population by age, sex, race/ethnicity, work setting, and census region. We calculated the weighted percentage of HCP who reported paid sick leave by occupation, healthcare setting, and type of employment. Using multivariable logistic regression, we identified factors associated with having paid sick leave (i.e. an adjusted prevalence ratio (aPR) with a 95% confidence interval that excludes 1). Results. In April 2021, 71.4% of 1,652 responding HCP reported having paid sick leave, a slight increase from 68.1% in April 2020. The percentage of HCP reporting paid sick leave varied by occupation, ranging from 54.3% (physicians) to 88.8% (nurse practitioners/physician assistants), and by work setting, ranging from 59.7% ("other" clinical settings) to 82.4% (hospitals). In multivariable analyses, factors associated with having paid sick leave included age between 30-44 years (aPR:1.20) and 45-59 years (aPR:1.22) and male sex (aPR:1.19). HCP working as physicians (aPR:0.74), as contract employees (aPR:0.71), and those working in the Midwest (aPR:0.78) and South (aPR:0.87) regions and in rural settings (aPR:0.86) were less likely to report having paid sick leave. Conclusion. The majority of HCP from all occupational groups and healthcare settings reported having paid sick leave. However, differences by age, sex, occupation, type of work arrangement, and region exist and highlight disparities. Increasing HCP access to paid sick leave may decrease presenteeism and subsequent transmission of infectious diseases in healthcare settings.

Depression among frontline medical and paramedical staff during the coronavirus pandemic

Introduction: The current coronavirus pandemic is a unique and unusual situation. It is putting the general population under severe strain. However, frontline medical and paramedical staff remain particularly vulnerable to depression because of its close contact with patients. Objective(s): The aim of this work was to screen and evaluate depression in the frontline professionals during the pandemic and to study their associated factors . Method(s): In this study , we conducted a national descriptive and analytical cross-sectional study over a 2-month period from September to October 2020. We used "Beck Depression Inventory" to assess depression and "Brief Cope Scale" to detect a possible correlation between depression and coping mechanisms. Result(s): We collected 78 professionals. The mean age was 29.86 years. 2/3 of workers were women. 67.9% of the staff were residents. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 56.4% of the staff worked daily and 76.9% of them provided direct care to patients with Coronavirus. 52.6% of workers did not receive adequate training of protection against Covid-19. The staff reported 66.7% of death among their patients. 42.3% suffered from minor depression and only 2.3% suffered from severe depression. During this period we objectified an increase of 14.1% in the psychoactive substances use. Stigma affected 57.7% of professionals. We didn't objectify a significant correlation between Depression and coping mechanisms . Conclusion(s): Screening depression among healthcare professionals should be considered in order to prevent it, ensure continuity of care and avoid sick leaves.

THE IMPACT of the COVID-19 PANDEMIC on WORK PRODUCTIVITY in PATIENTS with SPONDYLOARTHRITIS: RESULTS from the DUTCH SPA-NET REGISTRY

Background: Since early 2020, governments have initiated local and nationwide measures to contain the spread of the coronavirus disease 2019 (COVID-19). In the Netherlands, people were strongly recommended to work from home, and several work sectors were shut down. In addition, hospitals had to reduce regular care. These changes, together with the risk of contracting COVID-19 and becoming ill, could have affected people's employment perspectives and work productivity. It is unknown to what degree this affected persons with chronic disorders, such as spondyloarthritis (SpA). Objectives: To investigate whether work productivity in patients with SpA changed following the onset of the pandemic and the associated government-initiated containment measures in the Netherlands. Methods: Data from the Dutch eHealth monitoring system SpA-Net were used. Since 2016, patients in SpA-Net completed outcome measurements when they attended outpatient rheumatology visits. Employment and work productivity were assessed with the Work Productivity and Activity Impairment questionnaire (WPAI, work productivity loss range 0-100%), capturing both sick leave and reduced at-work productivity. Covariables of interest were age, gender, education (high vs. low) and disease activity (ASDAS, BASDAI, patient global). The proportions of patients employed and their work productivity losses were compared during a 1-year period before and after the onset of the pandemic (March 2020). Generalized Estimating Equations (GEE) analysis of all assessments over time explored if work productivity in employed patients had changed with the onset of the pandemic, adjusting for potential confounders. Similar analyses with disease activity as outcome were used to facilitate interpretation of work productivity results. Results: Of 238 patients, data were available during the 1-year period both before and after onset of the pandemic. Pre-pandemic, 128 (54%) patients were employed. These employed patients had a mean age of 49.0 (SD 10.2) years, 66 (54%) were male and the mean ASDAS was 2.1 (0.9). After the onset of the pandemic, 7 (5.5%) were no longer employed. In addition, 8 out of 110 (7.3%) originally unemployed patients had become employed by this time. Work productivity loss (0-100%) was worse after the onset of the pandemic (37.0) compared to the pre-pandemic year (27.0) (p<0.01). In multivariable GEEs with work productivity loss as outcome (and stratifed by education due to interaction), patients with low education had work productivity losses that were almost 10% (absolute) higher after onset of the pandemic compared to pre-pandemic (B = 9.57, 95%CI 5.63-13.51) (Table 1). This was independent of ASDAS and other confounders. In patients with high education, however, no such association between pandemic onset and work productivity was seen. Analyses adjusting for other measures of disease activity (BASDAI, patient global) showed similar results. In GEEs with disease activity as outcome, disease activity before and after pandemic onset did not differ (B =-0.05, 95%CI-0.15 to 0.06 for ASDAS, model not shown). Conclusion: Work productivity has worsened in patients with SpA since the onset of the pandemic, especially in patients with lower educational attainment, while disease activity remained stable. Care should be taken to support patients in their work role during the pandemic, and thereafter.

THE OPPORTUNITIES OF TELEMEDICINE IN BULGARIA IN THE CONDITIONS OF COVID-19 – A SURVEY

In times of global pandemic, telemedicine is emerging as an effective and sustainable solution to stop the spread of COVID-19. The aim of this article is to study the public attitudes towards the application of telemedicine in Bulgaria in the conditions of the COVID-19 pandemic. Material and methods: To study the public attitudes for the application of telemedicine in a pandemic, 253 people were interviewed voluntarily and anonymously. We used our own tools – a questionnaire distributed online. Statistical data processing was performed using IBM SPSS v. 23. Results: Respondents with higher education and healthcare workers were more distrustful of health information on the Internet. Over 75% of the respondents stated that they would use remote medical services for consultation with a medical professional in case of a health problem, and nearly 59% of them would pay for remote medical services for consultation and/or monitoring of treatment. The issuance of an electronic referral, an electronic sick leave form and an electronic prescription could limit the spread of COVID-19 according to 77.4% of them. Almost ¾ of our respondents would install a mobile application to contact a doctor in case of emergency. The preferred means of consulting a medical professional in the current pandemic is a telephone conversation. Conclusion: Telemedicine is essential to ensure that patients have access to medical care. In times of global public health emergency, health systems must rely on remote medical examinations and electronic prescriptions to deal with the further spread of the disease.

VA Employee Engagement in Pilot Employee Whole Health Well-Being Labor- Mapping Program

Methods: Employees were enrolled at three VA medical centers. Self-report data was collected at baseline, six months, and will be collected again at twelve months, to assess changes over time in measures of perceived wellness culture, resiliency, stress, self-efficacy, and flourishing. Objective metrics of overtime and sick leave use were collected. An activity survey was administered every two weeks to assess engagement in WBP. Pilot WBP activities included education, health coaching, and complementary and integrative health modalities for well-being. Qualitative data was collected from supervisors at six months. Results: Employees inmultiple departments within each medical center were offered protected time. Pilot enrollment was from March-April 2021. A total of n=312 employees and n=135 supervisors enrolled. At sixmonths, 40 (29%) supervisors provided feedback on pilot impact. Supervisors expressed appreciation and observable benefits for employees and/or themselves. However, given the pandemic and competing demands, workload was identified as an ongoing barrier. Preliminary analyses from surveys indicated statistically significant improvements in wellness culture, resiliency, goal setting, and flourishing. Background: EmployeeWhole Health (EWH) empowers VA employees to take charge of their health by integratingwell-being skills-building programming (WBP) at work. During the COVID response, there was a pronounced increase in WBP;however, employees cite lack of time to participate in self-care as a barrier to utilization. To support participation,EWHembarked on a 12- month pilot to protect 60 minutes of time per week via a new labor mapping category in support of employee self-care. Conclusion: The pilot is ongoing;results of the six-month quantitative and qualitative evaluations will be presented. The use of a new labor mapping category to support employee well-being on an ongoing basis is expected to meet the need for building a more resilient workforce. Early results show perceived benefits of a regular, routine self-care allotment, however challenges to full utilization remain.

IMPACT OF THE SARS-COV PANDEMIC ON THE TRAINING OF HOSPITAL PHARMACY RESIDENTS

Background and importance The Pharmacy Service is committed to resident training. The residency programme in the Hospital Pharmacy Service covers all areas of the training programme. The high hospital demand and the weekly updates of the pharmaceutical protocols made it necessary to dedicate almost the entire working day to the hospital pharmacy residents. Aim and objectives To evaluate the impact of the SARS-CoV pandemic on the training period of resident pharmacist interns. Material and methods A survey was conducted among all hospital pharmacy residents in Spain. It was carried out by the Teaching and Hospital Pharmacy units. The survey was anonymous, voluntary and disinterested. Data collected: place of residence, year of training, hospital level, resident supervision, internal and external rotations missed, emotional impact and sick leave. Results The survey was completed by 122 hospital pharmacy residents. The completion period was from 15 March to 15 April 2021. The geographic distribution of the residents was: Andalusia (48.3%), Madrid (11.7%), Catalonia (10%), Valencia (8.3%), Murcia (8.3%), Castilla y León (3%), Galicia (3%), Asturias (1.7%), Cantabria (1.7%) and the Basque Country (1.7%). The year of residence of the respondents was: 4th year (56.7%), 2nd year (18.3%), 1st year (13.3%) and 3rd year (11.7%). With respect to supervision and concern for the work: 65.6% felt adequately supervised, while 27.9% said they were deficient in the process. Regarding rotations in other services and/or hospitals: 50.8% stated that they had missed some type of rotation, of which 13.1% were irrecoverable. 63.9% recognized that the pandemic has had some emotional impact on their lives, while 34.4% stated that it has had a great impact. Of the residents, 50.81% said they had been on sick leave due to SARS-CoV. Conclusion and relevance Pharmacy services met the demand of the hospital and associated residences with increased activity. Despite the situation, residency in a crucial stage of professional training, therefore changes must be faced in order to find the best way to meet the goals.

Double-blind placebo-controlled randomized clinical trial to assess the efficacy of montelukast in mild to moderate respiratory symptoms of patients with long COVID: E-speranza COVID-19 Project study protocol

Objective: To evaluate the efficacy of 10-mg oral montelukast every 24 h for 28 days versus placebo in improving health-related quality of life in patients with long COVID and mild to moderate respiratory symptoms measured with the COPD Assessment Test (CAT) questionnaire. The secondary objectives will evaluate the effect of montelukast versus placebo on improving: exercise capacity and oxygen desaturation;COVID-19 related symptoms (asthenia, headache, mental, brain fog, ageusia and anosmia);functional status;and mortality. Material and/or methods: Phase III, randomized, double-blind clinical trial. We will include 18 to 80 year old patients with SARS-CoV-2 infection and mild to moderate respiratory symptoms lasting between 4 weeks and 12 months after the onset of infection. Participants will be randomly allocated in a 1:1 ratio to the experimental treatment with 10-mg/day montelukast or the placebo group, during a 28-day treatment. Follow-up will finish 56 days after starting of the treatment. The study will be carried out in primary healthcare centres in four health areas of Catalonia and Aragon, Spain, from 1 August 2021 to 1 March 2023. The primary outcome will be health-related quality of life associated with respiratory symptoms according to the COPD Assessment Test, assessed at 4 weeks after finishing of the treatment. Secondary outcomes: (a) Exercise capacity and oxygen saturation (1Min Sit-to-Stand test);(b) Post-COVID-19 Functional Status scale;(c) other symptoms: asthenia, headache, mental confusion (brain fog), ageusia and anosmia (Likert scale);(d) use of healthcare resources;(e) sick leave duration in days;(f) side effects of montelukast;(g) mortality. Ethics and dissemination: This study has been approved by the AEMPS and Clinical Research Ethics Committee of the IDIAPJGol (reference number 21/091-C). EudraCT number 2021-000605-24. ClinicalTrials.gov Identifier: NCT04695704.It is currently under peer-review process for publication. Results: Ongoing clinical trial. Conclusions: Ongoing clinical trial.

Paid Leave and Beyond: The Urgency and Feasibility of Addressing Structural Inequalities Across Race, Gender, and Class

HOW GAPS IN PAID LEAVE WORSEN INEQUALITIES These gaps have had profound consequences;while home to only 4% of the global population, the United States has accounted for 16% of COVID-19 deaths to date,1 with Black, Latinx, and Indigenous Americans twice as likely to die from COVID-19 as White Americans.2 Drivers of these disparities include higher rates of exposure and infection linked to working conditions.3 The enactment of emergency paid sick leave during the pandemic, despite not covering all workers, markedly reduced cases until Congress let it lapse at the end of 2020.4 Furthermore, even in nonpandemic years, paid sick leave has been shown to increase access to preventive care and treatment, reduce job loss, and increase return to work. [...]had a robust, fully inclusive paid sick leave policy been in place when COVID-19 began to spread and for its duration, the United States could have avoided innumerable infections and deaths that occurred because people had to go to work when they were sick or send children to school sick, while also helping people keep jobs critical to their long-term well-being. [...]we are even farther behind than that: 181 countries around the world guarantee paid sick leave at the national level.7 Similarly, 186 countries guarantee paid maternity or parental leave.8 While the US provides unpaid leave through the Family and Medical Leave Act (FMLA), because of racial wealth gaps-which stem from a long history of exclusionary policymaking, compounded by ongoing discrimination9-when the only leave available is unpaid, Black and Latinx workers are far less likely to be able to afford it. [...]the FMLA eligibility criteria for even unpaid leave exclude many part-time workers, the self-employed, workers starting a new job, and those working for small businesses, widening racial and gender disparities in access. [...]when Congress considers new legislation-including new social policies-it should routinely assess who will be affected and how.

Adaptation and development of IR services in response to the COVID-19 pandemic: preliminary results of a focused survey

Purpose: The cyclic nature of active and recovery phases of the COVID-19 pandemic, has demanded fast adaptations and preparation for health care workers world-wide. We aimed to assess how interventional radiologists are handling the pandemic during active and recovery phases with regard to work and team structures, as well as mental health and how the pandemic could have increased the awareness of minimally-invasive therapies as alternatives to postponements of non-urgent procedures. Material and methods: 7125 CIRSE members were invited to participate. For this interim report, responses were collected between 23 November 2021 and 17 December 2021. Results: 114 responses were obtained for this preliminary report, of which 102 were complete. 94% (n=99) of respondents were interventional radiology specialists. Most respondents reported having established a routine to handle different waves of the pandemic (89.5%;n=102). Compared to active phases, fewer respondents indicated at least one pandemic-associated measure in their department during recovery phases (46%-71% vs 13%). 56% reported an increase in ambulatory care patients either during active and/or recovery phases. 54% reported more referrals during active and/or recovery phases. 25% reported increased hours at the hospital during recovery phases, 52% indicated increased sick leave, care leave, quarantine, and burn-out of team members and only 39% reported to get enough time to rest during recovery phases. Conclusion: While the COVID-19 pandemic is continuing to burden IR departments and the mental health of IRs, more than half of respondents reported an increase in referrals for minimally-invasive therapies and ambulatory care.