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The current study aimed to identify the impact of positive thinking on the anxiety of Coronavirus infection through the lockdown among UNRWA staff in Jordan. To achieve the objectives of the study, three measures were developed, the Positive Thinking Scale, the anxiety level of Coronavirus Infection Scale, and the lockdown Scale. A sample of (2036) employees responded to the measures. The results showed that the level of anxiety for COVID -19 infection among the sample was high, and statistically significant differences were found in the level of Covid-19 infection anxiety according to the sex variable for females, also statistically differences were found in the level of anxiety in COVID-19 infection according to age in favor of (31-40), and statistically differences for the social status in favor of married couples. Results also showed a direct negative impact of positive thinking variable on the level of anxiety associated with COVID-19 infection, and an effect of positive thinking on the level of anxiety during activating the lockdown. The study recommends designing training programs for employees to help them adapt to different circumstances and enable them to continue performing their assigned work. [ FROM AUTHOR] Copyright of An-Najah University Journal for Research, B: Humanities is the property of An-Najah National University 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.)
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Objectives: Social determinants of health (SDoH) including income, education, employment, and housing are known to affect health outcomes;while use in real-world database studies are limited. This study assessed socioeconomic differences in burden of disease and utilization of COVID-19 specific medications in a large cohort of patients in the US. Method(s): A total of 17,682,111 patients having a COVID-19 diagnosis between 4/1/2020 and 4/30/2022 were identified in the IQVIA longitudinal medical and pharmacy claims databases of >277 million patients. For SDoH, a 3-digit zip code median Area Deprivation Index (ADI) (v2.0 University of Wisconsin School of Medicine and Public Health 2015) was calculated for each patient, maintaining patient privacy. The ADI is a validated tool ranking neighborhoods by socioeconomic disadvantage. Medical and pharmacy utilization was assessed and stratified by ADI pentiles, where 0-20 was the least disadvantaged, and 81-100 was the most disadvantaged. Result(s): The proportion of patients having a claim with COVID-19 diagnosis was higher in the most disadvantaged (7.75%) compared to the least disadvantaged group (5.94%) (US overall: 6.37%). Medical claims prior to COVID-19 diagnosis were highest in the least disadvantaged, while prior pharmacy utilization was highest in the most-disadvantaged group. There was sparse use of COVID-19 medications overall;the least disadvantaged patients had the lowest use of COVID-19 specific medications. Casirivimab/imdevimab use was highest in the 61-80 (2.01%) and 81-100 (1.79%) ADI groups, and remdesivir use was highest in the moderately disadvantaged (ADI 41-60 and 61-80) groups (both 2.33%). Utilization of hydroxychloroquine (unapproved for COVID-19) increased from 0.91% in the least to 2.13% in the most disadvantaged groups. Conclusion(s): This study shows unequal burden of COVID-19 prevalence by SDoH, with the most disadvantaged having a higher disease burden and utilization of certain approved and unapproved COVID-19 medications, highlighting the need for further study of the reasons for these disparities.Copyright © 2023
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Objectives: COVID-19 infected over 150 million people and caused over 1 million deaths in the US. This study evaluates several variables thought to be associated with mortality risk in the COVID-19 population. Method(s): The IQVIA longitudinal medical and pharmacy claims databases identified 17,682,111 patients with a COVID-19 diagnosis between 4/1/2020-4/30/2022 from a population of >277 million patients in the US. Patients were linked to Veritas Data Research fact-of-death records (90% complete compared to CDC reporting) and confirmed deaths were flagged. Confirmed mortality rates (CMR) were evaluated by age group, socioeconomic status (SES) using the Area Deprivation Index (v2.0, University of Wisconsin, 2015), co-morbidities and COVID-specific (approved and unapproved) treatments. Result(s): Of the 563,744 patients (3.2%) identified as dead (3.67% in men, 2.85% in women overall), CMR was lowest in patients aged 0-17 (0.08%), highest in age 65-75 (5.92%) and >75 (16.40%). Patients in the lowest 40% of SES had CMR of 4.43% while in the highest 20% was 1.56%. Respiratory failure, pneumonia and sepsis were the most common acute diagnoses accompanying COVID-19 deaths in all SES. In patients with comorbid dementia or Alzheimer's disease, CMR were 21.62% and 23.40% respectively. Additionally, congestive heart failure (15.79%), atrial fibrillation (15.50%), chronic kidney disease (15.30%) and COPD (12.19%) were associated with high CMR. Among patients receiving approved therapies, casirivimab/imdevimab and remdesivir had CMR of 1.41% and 12.63% respectively, while for those receiving unapproved therapies, ivermectin and hydroxychloroquine had CMR of 2.54% and 2.45%. Conclusion(s): Compared to the 1.1% case-mortality rate (Johns Hopkins 2023) among US COVID-19 patients, we found CMR exceeded 3% among those with a medical claim for COVID-19. Advanced age, dementia, and cardio-renal disease were associated with mortality. Patients with the lowest SES had approximately 3 times the confirmed mortality rate compared to those in the highest SES group.Copyright © 2023
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Background: Coronavirus disease-2019 (COVID-19) poses expectant mothers to a higher risk of serious complications and mortality. Following a risk-benefit review, a number of governmental and professional bodies from across the globe recently approved the COVID-19 vaccination during pregnancy. Aim(s): This study aimed to investigate knowledge, actual acceptance, and concerns about the COVID-19 vaccine among the obstetric population. Material(s) and Method(s): Participants were selected from among the expecting women who came for antenatal checkup during the study period (October 1, 2021-November 30, 2021). About 150 pregnant women who met the inclusion criteria and consented were recruited into the study. Data related to socio-demographic and clinical characteristics as well as knowledge, actual acceptance, and concerns about COVID-19 vaccine were collected through in-person interviews using a prestructured questionnaire. The SPSS version 23 was used to analyze data. The association between the attitude (acceptance and hesitance) of participants toward the COVID-19 vaccine and their sociodemographic and clinical profile was found by Fisher's exact test. Result(s): The actual acceptance of the COVID-19 vaccine among expecting women was 52.0%. The primary motive for accepting COVID-19 immunization was to protect the fetus, followed by the protection of one's own health. A significant association was found between COVID-19 vaccine acceptance and the level of education, socio-economic status, and presence of comorbidities. The leading causes for vaccine reluctance were concerns about the efficacy and safety of the vaccines and lack of awareness about their usage during pregnancy. Conclusion(s): Multifaceted activities are required to promote the effectiveness and safety profile of the COVID-19 vaccine as well as disseminate knowledge about its usage during pregnancy. Clinical significance: Unlike numerous other studies that have investigated the accepting attitude only, the present one has investigated the actual COVID-19 vaccine uptake among the obstetric population.Copyright © The Author(s).
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Objectives: The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. Method(s): The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics' urbanicity classification;and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. Result(s): SDoH data were available for ~95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87);median family income ($98k/$76k/$70k vs. $82k);% of members living in low-income low-food-access tracts (9/14/18 vs. 13);urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. Conclusion(s): We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.Copyright © 2023
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Purpose: The aim of this study was to investigate the relationship between the functionality of disabled children and its effects on parents during the Covid-19 pandemic. Method(s): A total of 168 people, including 84 disabled children and 84 mothers, were included in the study. The Pediatric Disability Assessment Inventory (PEDI) and Gross Motor Function Classification System (GMFCS) were used for children with disabilities. The Zarit Burden Scale (ZBS), Fatigue Severity Scale (FSS) and The Nordic Musculoskeletal Questionnaire (NMQ) were applied to the mothers to question musculoskeletal disorders. Result(s): There was no correlation between care burden score and PEDI, total score, self-care and mobility scores (p>0.05). A moderately negative (r=-0.306;p<0.01) significant linear relationship was found between care burden score and social function score. There was no significant linear relationship between the fatigue severity score and PEDI total score, self-care, mobility and social function scores (p>0.05). No correlation was found between care burden score and fatigue severity score (p>0.05). For the last 12 months, only the pain in the lumbar region of the parents prevented them from doing their usual work. It was determined that the most aching body parts of the parents who complained of musculoskeletal pain during the last 12 months were in the waist, neck, shoulder, back, and knee regions. Conclusion(s): As a result, no relationship was found between the functionality of disabled children and their parents' influences during the Covid-19 pandemic.Copyright © 2022 Turkish Physiotherapy Association. All rights reserved.
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Background: COVID-19-Pandemic Lockdowns initiated online teaching-learning in India. We aimed to assess mental health (MH) of adolescents studying online for academic milestone of matriculation during these circumstances. Material(s) and Method(s): It was a cross sectional study carried out in Western Maharashtra, during 2021. MH of study subjects was assessed by presence and severity of symptoms of depression, anxiety, stress (DAS) and emotional intelligence (EI). They were measured by DAS Scale-42 (DASS-42) and Schutte's self-report EI test (SET) respectively with collection of socio-demographic information maintaining confidentiality. Data were analysed by SPSS-20 software. MH parameters were compared with pre-pandemic pilot and other studies to study effect of online education and overall COVID-19 Pandemic scenario on MH of study subjects. Result(s): Total 1162 adolescents participated, out of which 59 were omitted from the analysis due to incomplete data. Out of remaining 1103 participants, 43% boys & 57 % girls with the mean age of 14.69 (+0.78) years. Majority of them belonged to middle socio-economic-status. Mean DAS and EI scores denoted mild anxiety with no evidence of depression and stress. Mean EI score was in normal range. Mean DAS scores were significantly lower and mean EI score was significantly higher than reported in -pandemic pilot and other studies. Conclusion(s): MH derangement of matriculating adolescents during COVID-19- Pandemic with online education seemed to be less severe than that was in pre-pandemic times with in-class education. Recommendations: MH support at schools needs to be strengthened. During the post-COVID-19 period, online school education may be continued in LMIC like India on the basis of willingness of students and parents but with caution and understanding of socio-cultural background and support.Copyright © 2022 Pravara Institute of Medical Sciences. All rights reserved.
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Aims: Since the onset of the COVID-19 pandemic, a significant rise in mental ill-health has been observed globally in young people, particularly amongst those in their final years of secondary school. The students' negative experiences coincide with a critical transitional period, which can subsequently disrupt milestones in social and educational development. This study aims to use innovative population-level data to map the impact of the pandemic on students entering higher education. Method(s): Tertiary education application data for Victorian students were obtained from the Victorian Tertiary Admissions Centre both pre-pandemic (2019/2020) and pandemic (2020/2021). Prevalence of mental health special considerations were compared between cohorts across geographical areas and applicant demographic subgroups. Relative risk regression models were used to understand the role of different risk factors. Result(s): The rate of mental health special considerations increased by 38% amongst all applications (pre-pandemic: 7.8%, n = 56 916;pandemic: 10.8%, n = 58 260). The highest increases were observed amongst students in areas with severe lockdown experiences and areas impacted by 2019/2020 black summer bushfires. The increases were higher amongst year 12 students and students with other preexisting risk factors (e.g., physical condition, learning disability). However, interestingly slightly higher increases were observed in areas with higher socioeconomic status, which is potentially related to inequality in mental health service access. Conclusion(s): As the consequences of mental health difficulties and academic disruption in youth can be long-lasting, it is critical to establish a mental health supportive framework both in and outside of higher education to facilitate young people's recovery from the pandemic.
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Introduction: Oral cancer is Colombia's 8th most common cancer, with an estimated survival rate of 52%. Lack of knowledge and awareness about oral cancer and its risk factors is associated with a delay in diagnosis. Objective(s): To evaluate adults' oral cancer knowledge through a phone survey in the context of the SARS-COV2 pandemic. Material(s) and Method(s): A cross-sectional questionnaire survey was conducted by phone during the COVID-19 pandemic on 268 patients attending at the dental school of Universidad de Antioquia, years 2020-2021. The collected data were analyzed using SPSS software. Result(s): The mean age was 58.9 years. 58.6% of participants had heard about oral cancer. social media was the primary source of information for 42% of participants, and 96.7% considered the screening important. Most patients did not feel worried (54.5%), fearful (59.7%), or anxious (56.3%) in case they were submitted to a screening for early detection of oral cancer. Lower socioeconomic status and educational level are correlated with lower awareness of oral cancer. The dimensions of experience and attitude towards screening were not associated with sociodemographic variables. Conclusion(s): The knowledge of oral cancer is still poor and is related to low socioeconomic and educational levels. However, this association was not observed in the attitude and experience dimensions toward screening for oral cancer. Therefore, there seems to be a need for more educational programs about knowledge of oral cancer, especially in socially disadvantaged groups, considering that there are no barriers related to screening.
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Background: In 1922 the famous Italian novelist Giovanni Verga died in Catania (Italy). In Verga's works there are many suggestions to the world of medicine, in particular the diseases described in the poor society of southern Italy of that time. One of the most common diseases described by Verga was cholera. Methods: The authors researched and reviewed Verga's works, detecting references to public health. These are topical issues in the current period of the COVID pandemic. In Verga's works the theme of hygiene, epidemiology, and infectious diseases occur. There are many hints related to medicine, especially as far as the typical diseases of poor society and the difficult social environments of the time are concerned. One of the most common diseases described by Verga was cholera but also malaria and tuberculosis occur. Results: It was estimated that 69,000 people died of cholera in Sicily, of whom 24,000 in Palermo. The public health situation in Italy was difficult. Verga denounces people's ignorance and the survival of past beliefs. Conclusion: Verga describes a culturally and economically humble society, in a region characterized by large class gaps. It draws a difficult picture of the public health situation in the second half of the 19th Century and people's daily lives. The authors believe that today it is important that the centenary of Verga's death be an opportunity to read his works, also from a medical historical point of view.
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COVID-19 , Cholera , Humans , SARS-CoV-2 , Public Health , Cholera/epidemiology , Pandemics , SicilyABSTRACT
Introduction: Traditional clinical trials that utilize fixed sites often fail to recruit participants that are representative of the intended use population. Participants, particularly those from minority groups, cite geographical constraints, mistrust, miscommunication, and discrimination as barriers to successful recruitment. A decentralized clinical trial enrollment strategy offers reduced cost, reduced time requirements, and circumvents barriers associated with the recent pandemic outbreak. Method(s): After the mt-sRNA test system entered design-lock, a decentralized clinical trial (CRC-PREVENT) was launched through a digital campaign (https://www.colonscreeningstudy.com/;NCT04739722). Online advertisements were published on multiple social media sites, and engagement with materials directed patients to an online screener. Participants who completed the screener were eligible for enrollment if they met CRC-PREVENT inclusion and exclusion criteria and were willing to complete all clinical trial components, including providing a stool sample before an optical colonoscopy. Result(s): After 12 months of active enrollment, 276,400 individuals engaged with digital advertisements and completed pre-screener surveys to determine eligibility for the clinical trial. In total, 14,264 individuals consented to participate in the CRC-PREVENT clinical trial. Of these individuals, 58% were female (42% were male), and 65% were over 50. Regarding race and ethnicity, eligible individuals directly represented the intended use population: 16% were Black or African American, 0.2% were Native Hawaiian, Pacific Islander, American Indian, or Alaskan Native, and 7% were Hispanic or Latinx. Regarding socioeconomic status, the decentralized approach permitted access to individuals with healthcare inequities: 25% of participants had income under $29,999, 5% of participants were from rural areas (defined as a city center , 10,000 people), and 36.7% of participants were on public insurance. Individuals were derived from 7,644 unique zip codes across all 48 continental United States. (Table) Conclusion(s): A decentralized recruitment strategy permits highly successful enrollment in the face of screening burdens heightened by COVID-19 pandemic. This approach also offered a significantly more diverse population and could mitigate selection bias and attrition bias associated with the cohorts observed in traditional clinical studies.
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Purpose: It is unknown whether certain populations of athletes benefit more from returning to sport following COVID-19 restrictions than others. The purpose of this study was to determine whether socioeconomic status (SES), race, or gender moderate the benefits of returning to sports during COVID-19. Method(s): Adolescents who participated in sports before COVID-19 reported sport participation, anxiety (GAD-7), and depression (PHQ-9) inMay 2021. The interactions of return to sport (yes [PLY], no [DNP]) and (1) sex, (2) race (white, nonwhite), and (3) SES (low vs high county household income) to predict anxiety and depression were evaluated, adjusted for age, school instruction, and concern about COVID-19. Result(s): Four thousand eight hundred seventy-four participants were included (16.1 +/- 1.3 years;52% female;PLY = 4456;DNP = 418). DNP had greater symptoms of anxiety (7.8 60.6 v 5.6+/-0.5, P<0.001) and depression (8.8+/-0.6 v 5.76 0.6, P < 0.001) and had significantly more non-white athletes (36% v 19%, P < 0.001), but no significant differences were identified with respect to gender, instructional delivery method, median county household income, or age. Compared with white athletes, adolescent athletes from racial minority groups who returned to sports had relatively greater decreases in anxiety (interaction estimate (b) = -1.18 +/- 0.6, P = 0.036) and depression (b=-1.19+/-0.6, P=0.045). Similarly, athletes from counties with lower household incomes who returned to sports had relatively greater decreases in anxiety (b= -1.23 +/-0.5, P = 0.017) and depression (b=-1.21+/-0.6, P=0.032). The benefits of returning to sports for female athletes were similar to male athletes with respect to anxiety (b = -0.16 +/-0.5, P = 0.76) and depression (beta = 0.49 +/- 0.6, P = 0.37). Conclusion(s): In this nationwide sample of adolescent athletes, returning to sport during COVID-19 was associated with significant mental health benefits for adolescent athletes. However, the greatest benefits were seen among athletes from racial minority groups and areas of lower household income. No differences in the mental health benefits of returning to sports were identified between male and female athletes. Significance: Restriction from sports may disproportionately impact the mental health of certain groups of adolescent athletes. Expanding access to sports for traditionally underserved groups can potentially provide significant mental health benefits.
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Introduction: In gastroenterology, telemedicine has emerged as a means for improving patient access to medical care while limiting viral transmission during the pandemic. The purpose of this study was to assess patient order compliance in the virtual vs. in-person setting during the COVID-19 pandemic for the initial evaluation of constipation. Method(s): Using natural language processing, we identified outpatient gastroenterology visits (virtual and in-person) for constipation from March 2020 through December 2021. We assessed the number of orders placed for patients during these encounters and determined compliance based on order completion. A generalized linear mixed effects model with fixed effects for visit type and random intercepts for intra-patient correlation was used. A multivariable model was built controlling for age, socioeconomic status, BMI, dementia, stroke, and congestive heart failure. Result(s): Among 4,930 patients who presented for initial constipation evaluation since the start of the pandemic, 3,515 patients were evaluated in-person and 1,415 patients were evaluated virtually. Comparing order compliance in patients seen during the pandemic, patients seen virtually were 66% less likely to complete orders in comparison to patients seen in-person (p < .001). Patients seen in a pandemic virtual setting were 43% less likely to complete imaging orders (p < 0.001), 78% less likely to complete procedure orders (p < 0.001), and 90% less likely to complete lab orders (p < 0.001) (Table). Increased lab compliance was associated with the highest socioeconomic status ($75,000-$200,000) with patients eight times more likely to complete lab orders (p=0.049) and three times more likely to complete orders overall (p=0.021). Conclusion(s): Compared with in-person visits, patients seen virtually for their first presentation of constipation were less likely to complete labs, imaging and procedure evaluation ordered. In-person visits were more successful in leading to patient order completion during the pandemic. These findings suggest that virtual visits for constipation, despite convenience, may compromise care delivery;such visits may thus require additional care coordination to achieve compliance with medical recommendations. (Figure Presented).
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The middle class is usually perceived as a main supporter of innovations, source of political stability, and core consumer of goods and services. As a result, its members are traditionally supposed to have high human potential and make a significant contribution to economic growth both in certain country and all over the world, which permanently generates great interest in the issues concerning middle class. However, the main research questions have changed significantly over the last years. The experts both in Russia and abroad highlight the factors that negatively influence the position of the middle class. These are changes in labor market, price growth that outruns the growth of income, increase of tax burden and problems with access to public goods. During COVID-19 pandemic the income has fallen, the risks of unemployment have increased, and the costs of healthcare also have grown. The scholars in different countries underline similar tendencies: middle-class members, who already had to live in an ambiguous world, faced the risks of falling into poverty during the corona crisis. Using data from the Russian Longitudinal Monitor Survey, we evaluate the tracks of middle-class families during 2014-2020 and demonstrate that the problem of poverty affects a part of this social stratum every year. But the share of middle-class members with the income below the poverty line is relatively low and remains largely unaffected by the current corona crisis. © 2023 National Research University Higher School of Economics. All rights reserved.
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Introduction: Nurses not in exception had considerable mental and physical stress caring for patients with COVID-19. This study is to describe the experience of nurses who diagnosed with COVID-19 infection of the concerns regarding the disease outbreak. Method(s): A cross-sectional study using universal sampling method. A validated self-administered questionnaire on 5 Likert scale was given to the 103 nurses diagnosed with coronavirus infection. Concerns regarding the disease outcomes were assessed using 31 concern statements in five distinct domains. Data was analysed using IBM SPSS version 26. Result(s): The majority of respondents (31.1%) at risk of contracting a COVID-19 infection from family transmitted, 92.2% respondents were completed vaccine during pandemic. The level of concerns has five distinct domains which is self-satisfaction, social status, workplace, infection control, and government. Most nurses have moderate concern (80.6%), followed by high concern which was 15.5% regarding COVID-19 infection. There is association between work years as nurse and concerns among experienced nurses diagnosed of COVID-19 outbreak in HPSF (p=0.012). Conclusion(s): Most nurses have moderate concern level that may be influenced by previous experience of COVID-19 outbreaks and related cultural issues. The concerns of nurses may affect their overall effectiveness in an outbreak and should be addressed by incorporating management strategies in outbreak planning.
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Introduction: Due to lockdown measures associated with the COVID 19 pandemic (1), there were substantial changes to healthcare delivery, including the suspension of face-to-face medical appointments, expansion of telehealth and changes to medication protocols.(2) It is important to learn from the successes and challenges of this period to ensure we adapt and improve how we support people to take medicines in the future. Aim(s): We sought to conduct a systematic review to explore the different approaches used to deliver medicines management services for people living with long term conditions (LTCs) during the pandemic and identify strategies that could be integrated into standard care. Method(s): We conducted a systematic review across 3 large databases: MEDLINE (OVID), EMBASE (OVID) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Our research question and search strategy was developed using the PICO framework (Population: adults with LTCs, Intervention: medicines management during the COVID 19 pandemic;no comparison group. Outcome(s): any aspect relating to medicines management. Search terms relating to 'long term conditions', 'medication management' and 'COVID-19' were used. One reviewer (LM) screened all titles, s, and full texts. We included studies discussing medication management of LTCs, in patients of all ages and healthcare settings, throughout the pandemic. Primary literature sources, feasibility studies and case studies, were included. We excluded studies solely focusing on disease monitoring, or the treatment of COVID/ 'long Covid'. One reviewer performed a thematic analysis, synthesising the findings into themes and sub-themes, which were discussed with a further reviewer (CT). A critical appraisal was performed using the Critical Appraisal Skills Programme checklists. Result(s): The search returned 2365 results. After deduplication, articles were removed at the title (n=1070) (n=813) and full text (n=232) stages. 31 studies were included. Studies were conducted in India (n=6), US (n=5), international (n=4), France (n=2), Italy (n=2), and one each from China, Japan, Jordan, Mexico, Morocco, Nigeria, Romania, Saudi Arabia, Spain, UK, UK and US, and location not specified. Most studies (n=17) employed subjective methods of data collection (surveys/ questionnaires). We identified 6 themes. These were: changes in consultation type, for instance using teleconsultations and smartphone apps to monitor glucose control and diabetic management. Studies described temporary changes to treatment protocols e.g., using oral chemotherapy to reduce the need for in-person appointments and reduce the infection risk associated with intravenous administration. Control of certain conditions for example epilepsy was reduced in some studies. Patients missed doses due to drug shortages associated with disruptions in the medication supply chain, particularly in low-income countries. Finally, we identified prescribing trend changes in certain classes of medicines (e.g. reduced biologic usage due to immunosuppression risk) and an increase in patients self-medicating conditions including anxiety and depression, with associated safety risks. Conclusion(s): This review suggested that certain medical conditions such as diabetes and hypertension were more suited to remote monitoring with technological interventions such as smartphone apps. While other conditions e.g., cancer and epilepsy, demonstrated a greater need for in-person care. Countries of lower socioeconomic status were disproportionately affected by the pandemic.
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Introduction/Aim: Ecological studies indicate ambient particulate matter >=2.5 mm (PM 2.5) air pollution is associated with poorer COVID-19 outcomes. However, these studies cannot account for individual heterogeneity and often lack precision in estimates of PM 2.5 exposure. We summarise evidence relating on individual-level data to determine whether PM 2.5 exposure increases the risk of COVID-19 infection, severe disease and death. Method(s): We conducted a systematic review of relevant case-control and cohort studies, searching Medline, Embase and the WHO COVID-19 databases. Study quality was evaluated using the Newcastle-Ottawa Scale. Result(s): N = 18 studies met the inclusion criteria. Generally, PM 2.5 exposure was significantly associated with higher rates of COVID-19 infection (all 7 studies positive) and severe COVID-19 disease (8 of 9 studies positive, 1 null). The effects on mortality were mixed but indicative of a positive association (4 of 6 studies positive, 2 null). Most studies were rated 'good' quality (13 of 18 studies), though there were still methodological issues;few used individual-level data to adjust for important confounders like socioeconomic status (3 of 18 studies), instead using area-based indicators (12 of 18 studies) or not adjusting for it at all (3 of 18 studies). Most studies with severe disease (9 of 10 studies) and mortality outcomes (5 of 6 studies) were based on people already diagnosed COVID-19, potentially introducing collider bias. Conclusion(s): There is strong evidence that ambient particulate matter air pollution increases the risk of COVID-19 infection, and weaker evidence of increases in risk of severe disease and mortality.