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

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

Improving Access to Extracranial-Intracranial Bypass Surgery in Border Hispanic Communities Utilizing Collaborative Approach Between Plastics and Neurological Surgery

INTRODUCTION: Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas- Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients;COVID-19 further exacerbated this problem with restriction of elective surgical volume. METHOD(S): A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient. RESULT(S): A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes. CONCLUSION(S): We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.

A feasibility study of a school-based asthma programme in Malaysia conducted during COVID-19 pandemic

Background: Asthma is a common non-communicable disease among children that may require urgent treatment during school hours. We developed a school-based programme to improve children's asthma control. Aim(s): To assess the feasibility of the programme. Method(s): The mixed-methods study was conducted in October 2020 in a Malaysian primary school. Despite COVID19 restrictions we delivered sessions to children with asthma and their parents, and school staff and, measured participation rate and explored views on the programme. Result(s): We identified 34 children with asthma (3.7% of school population). The session for school staff received good participation 55/62 (88.7%) and feedback (>80% scored good/excellent). In mid-October, COVID-19 forced national school closure so sessions for children with asthma and their parents were conducted remotely, and sessions for the whole school were abandoned. Only 14/34 (41.2%) children with asthma attended the remote sessions as 9/34 parents were uncontactable;11/34 of parents declined children's participation because they lacked internet facilities or timing was inconvenient. Children enjoyed the interactive methods (e.g. videos, games) used to deliver messages. Parental participation was minimal (4/14;28.5%). Conclusion(s): The school-based intervention was feasible, though restricted by the pandemic. Although remote health programmes gained popularity during the pandemic, widespread use could disadvantage children from lower socio-economic backgrounds who had limited access to the electronic devices/ and the internet.

The impact of COVID-19 on Tuberculosis diagnosis

Introduction: The impact of COVID-19 on the transmission of M. tuberculosis has not yet been accurately ascertained. In addition to the exposure of contacts in household settings, it will be worth considering the impact of respiratory contacts in the community and health care settings, due to the widespread use of masks. Aims and Objectives: We aimed to know if there is an increase in a local hospital TB diagnosis in the postpandemic period and which causes are associated with that increase. Method(s): We collected data from April 2018 to December 2021 and divided it into two 20 months groups - prepandemic (Apr18'-Jan20') and post-pandemic (Mar20'-Dec21'). We analyzed sociodemographic variables, time to diagnosis and type of tuberculosis. Results and Discussion We notified a total of 41 cases after the pandemic started, a 78% increase from the pre-pandemic period (N=23). This increase happened mainly in patients who worked in the primary sector of the economy (agriculture), showing a 4.6x increase in the number of cases (p<0.05) and is probably related to household transmission in low socioeconomic backgrounds. The mean age was 51 years, and most of the patients (78.5%) were male. Time until diagnosis was 102 days (compared to 82 days before). Increased time until diagnosis was independent of any of the variables studied (p>0.05) and happened across all groups. People with>6 months of symptoms were more frequent after Mar20' (8 vs 2). Conclusion(s): The number of cases and the time to diagnosis increased after the onset of the pandemic. The increase was cross-sectional for all groups of patients. The increase in cases occurred mainly in farmworkers, with 40% of post-pandemic cases (and statistical significance) compared to the pre-pandemic period.

Domestic Violence- A Crying Call for Change

Domestic violence or intimate partner violence, can be defined as a pattern of behaviors which could be physical, sexual, emotional, economic or psychological actions or threats of actions in any relationship that is used to gain or maintain power and control over an intimate weaker partner that influence another person. Domestic abuse can happen to anyone regardless of age, race, gender, sexual orientation, religion or socioeconomic background and education levels. It can occur within a range of relationships and not just those who live with us in our homes. These incidents are seldom isolated and escalate in frequency and severity if not opposed initial stage itself and may harm physically as well as emotionally and at times even endangers lives. Statistics for this is grave be it our country be it abroad and it became more grim covid times when staying home was not always safe. There are various factors involved from genesis to the maintainence of this menace medicolegal aspects and many more. Multidisciplinary approach for awareness that one needs to seek help, that one is not alone and various measures for curbing this grave issue is required at all levels. Domestic violence is the outcome of cumulative irresponsible behaviour which a section of society demonstrates. It is also important to note that solely the abuser is not just responsible but also those who allow this to happen and act as mere mute spectators. In this era of rights-based mental health services, such 'hidden shades' of mental wellbeing form potent challenges, which face unique conditions of demographics, prevalence of mental disorders and awareness related to this grave issue of domestic violence. Human rights are universal and are vital for promoting mental health and dignity. With this premise, this symposium intends to unfold the various factors involved and highlight the intersections of Domestic volence and approaches required to bring about and discuss strategies to curb it in light of the lessons learnt from experiences across the globe.

Socioeconomic Background and Self-Reported Sleep Quality in Older Adults during the COVID-19 Pandemic: An Analysis of the English Longitudinal Study of Ageing (ELSA).

The COVID-19 pandemic negatively impacted sleep quality. However, research regarding older adults' sleep quality during the pandemic has been limited. This study examined the association between socioeconomic background (SEB) and older adults' sleep quality during the COVID-19 pandemic. Data on 7040 adults aged ≥50 were acquired from a COVID-19 sub-study of the English Longitudinal Study of Ageing (ELSA). SEB was operationalized using educational attainment, previous financial situation, and concern about the future financial situation. Sociodemographic, mental health, physical health, and health behavior variables were included as covariates. Chi-squared tests and binary logistic regression were used to examine associations between SEB and sleep quality. Lower educational attainment and greater financial hardship and concerns were associated with poor sleep quality. The relationship between educational attainment and sleep quality was explained by the financial variables, while the relationship between previous financial difficulties and sleep quality was explained by physical health and health behavior variables. Greater financial concerns about the future, poor mental health, and poor physical health were independent risk factors for poor sleep quality in older adults during the pandemic. Healthcare professionals and service providers should consider these issues when supporting older patients with sleep problems and in promoting health and wellness.

Socioeconomic position, worry and psychosomatic problems among students in Sweden in the wake of the COVID-19 pandemic

Background: The COVID-19 pandemic has profoundly affected the lives of young people and increased the risks for deteriorated health and widening health gaps. Aim: The aim is to analyse the associations between socioeconomic position and worry triggered by the pandemic and their associations with psychosomatic problems. Methods: From December 2020 to March 2021, 3068 16-17 years old students in Sweden completed a questionnaire about the impact of the COVID-19 pandemic on their schooling and everyday life. The response rate was 32 %, and the data were therefore weighted based on sociodemographic factors to take account of potential bias caused by the non-responses. During the spring semester of 2020, around two-thirds of the students also responded to questions about their psychosomatic health. Multinomial logistic regression was applied to analyse the associations between socioeconomic position (parental education) and worry about different personal and family issues. Binary logistic regression was used to analyse the association between worry and psychosomatic problems. Results: The association between socioeconomic position and worry showed a consistent pattern. Across almost all worry themes, the odds of experiencing worry often or always was higher for students with lower educated parents compared to higher educated parents. The odds for having to worry often/always about family finances was four times higher among students in the former group than the latter, controlling for sex. The magnitude of the association was about the same for worry about parental unemployment. In addition, also worry about personal and parental illness caused by COVID-19 showed strong associations with socioeconomic position. Worry was also clearly associated with students' psychosomatic health. Students who often or always experienced worry were more likely to report psychosomatic problems. Worries for personal and parental illness and family finances showed the highest odds ratios, controlling sex and parental education. Conclusions: The results demonstrate that worry related to COVID-19 about personal and family issues during the pandemic are socially structured. The socioeconomic position is associated with worry in similar ways that are common for health and health-related behaviors. Negative impacts of the pandemic are more common among students from lower socioeconomic backgrounds compared to higher ones. In addition, the significant associations between different worry themes and psychosomatic problems among students are noticeable. While the current study does not allow for conclusions about causality, the results indicate that experiences of worry during the pandemic may increase the risk of deteriorated mental health and inequalities among young people.

Exploring the impact of school closures on the mental health of children in grades K-12 in the United States during the COVID-19 pandemic

Background and Objectives: In March 2020, approximately 57 million children were affected by massive school closures in the wake of the SARS-CoV-2 pandemic. Many child advocates expressed concerns about the impact of physical school closures and transition to virtual learning on school-aged children's mental health and well-being, particularly those who utilized resources, such as counselling or special education, within the school system. This systematic review was done to identify a) the effect and impact of school closures on the mental health of children in grades K-12, if any, and b) to guide future research on the topic. Methods: A systematic review focused on published articles addressing the effect that COVID-19 related school closures and transition to virtual learning had on school-aged children's and adolescents' mental health. Inclusion criteria included: human studies, scholarly papers, school-aged children, SARS-CoV-2 research, mental health impacts, an article written in English, and research-based in the United States. Exclusion criteria included: not human studies, studies not available in English, individuals over 18 years old, and SARS-CoV or MERS-CoV research. The search was conducted between March 20, 2021, and April 18, 2021. Articles were further screened utilizing the PRISMA flow diagram. Once screened, included articles were reviewed by one member of the research team and a PICO-style analysis was used for each article. After the initial review, a total of 11 articles were included in this systematic review. Learning Points Discussion: We identified several areas of a child's life that school closures limited access to, such as reduced-cost meals, mental health services, and special education. Since the school closures and subsequent transition to online schooling, these resources became unavailable or limited by virtual technology. Children from lower socioeconomic backgrounds and marginalized communities were particularly vulnerable to negative mental health changes due to school closures and decreased access to school-based resources. These individuals belonging to a lower socioeconomic class are more likely to have inadequate computers to utilize in-home learning, have more unstable internet connections, and are less likely to have a caregiver that can stay home to help with their distanced learning. This research will be vital in understanding any adverse effects on children and shaping the future development of school-based programs and their funding.

Prevalence of insomnia in adults received at medical wards of Liaquat university hospital Jamshoro, during the COVID-19 pandemic

OBJECTIVE: To determine the prevalence of insomnia in adults received at medical wards of Liaquat University Hospital, Jamshoro, during the Covid-19 pandemic METHODOLOGY: This cross-sectional retrospective study was conducted from February to July 2020, on 200 patients belonging to various educational and socio-economic backgrounds received at Liaquat University Hospital, Jamshoro. The sampling technique was nonprobability, consecutive. The inclusion criteria were males and females above the age of 18 years while the exclusion criteria were individuals with sleep-disordered breathing, prior history of sleep disturbance, and psychiatric illness. This study was funded by the authors. A questionnaire was designed to record the data, including the demographics, educational and job status, and score on Athens Insomnia Scale. The collected data was analyzed on SPSS 20. RESULTS: The study included 108 males (54%) and 92 females (46%) over the age of 18 years. Seventysix individuals (38%) said their sleep quality has worsened during the pandemic, including difficulty initiating sleep in 29, difficulty staying asleep in 22, and 25 having vivid dreams. Out of these, 68% were females and 32% were males, 124 respondents (62%) did not face the above-mentioned problems but 74 (37%) did confirm going to bed later at night and sleeping for a longer duration, while 50 (25%) did not notice any change in their sleeping pattern. CONCLUSION: The Covid-19 pandemic has upturned lives in several ways, including the disruption of sleeping patterns and increased prevalence of insomnia in patients received at medical wards of Liaquat University Hospital, Jamshoro.

Use of telemedicine in the care of pediatric patients with type 1 diabetes during COVID-19 pandemic in a Public University Hospital in Brazil

Introduction: In March 2020 diabetes outpatient clinics were closed and consultations suspended due to the restrictions imposed by authorities in the context of the COVID-19 pandemic. Telemedicine in Brazil was then urgently officialized. Considering that the majority of our patients come from a low socioeconomic background, the only alternative of communication was through a free mobile app via cell phone. Objectives: The aim of this study was to evaluate patient satisfaction and the effectiveness of care delivered by teleconsultations via cell phone in this population. Methods: This was a questionnaire-based cross-sectional study, completed using Google forms, offered to every patient/carer from the Pediatric Diabetes Outpatient Clinic of Santa Casa de São Paulo who received telemedicine care during this period. Complementary data were obtained from patients' electronic medical records. Results: In 12 weeks (between March and June 2020), from a total of 154 appointments, 83%(n=88) of patients were attended via asynchronous teleconsultations using a mobile app, 16%(n=17) were in-person and 31.2%(n=48) did not attend the consultation. The great majority of patients had their insulin dose adjusted (87.6%;n=85). From those who answered the questionnaire (87%;n=77), 93%(n=72) approved the telemedicine consultation and 59% said that glycemic control improved afterward. There were also economic benefits and less waste of time reported. Only 3 patients declared that they did not feel safe without face-to-face care. 60% declared they would like to continue alternating presential with online consultations after the end of the pandemic. Conclusions: During COVID-19 pandemics, the transition to telemedicine was associated with patients' satisfaction and efficacy in treatment adjustments. Considering the socioeconomic characteristics of this population, telemedicine via mobile app was a good option for offering diabetes care during a period of isolation.