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Background: The safety profiles of the Ad26.COV2.S and AZD1222 COVID-19 vaccines have not been described in a general population in Malawi. We present self-reported adverse reactions (AE) following receipt of these vaccines in Malawi as part of a phone-based syndromic surveillance survey. Method(s): We conducted phone-based syndromic surveillance surveys among adults (>=18 years) with verbal consent from July 2020 to April 2022. We used secure tablets through random digit dialing to randomly select mobile phone numbers and electronic data collection forms. Survey questions included whether the respondent had received at least one dose of the COVID-19 vaccines, whether they had experienced any AE following vaccination, and the severity of the AE. We used multivariable analysis to identify factors associated with self-reported adverse reactions post-COVID-19 vaccination. Result(s): A total of 11,924 (36.0%) out of 33,150 participants reported receiving at least one dose of either Ad26.COV2.S or AZD1222 between July-December 2021;65.1% were female. An estimated 49.2% of the vaccine recipients reported at least one AE, 90.6% of which were mild, and 2.6% were severe. About 16.9% (n=656) of respondents who received the first dose of AZD1222 had AE, while 50.2% (n=2,823) of those who received the second dose of AZD1222 and nearly all individuals (n=2,385) who received Ad26.COV2.S reported AE. Joint pain (45.5%), fever (26.7%), headache (26.1%), pain at the injection site (24.4%), and fatigue (16.6%) were among the commonly reported AE. Males were less likely to report an AE compared to females [Adjusted Odds Ratio (AOR) 0.81 95% confidence interval (CI) 0.75-0.88]. Older age was associated with reduced odds of an AE compared to those aged 18-24 years: 65 years+ (AOR 0.62, 95% CI 0.50- 0.77). The likelihood of reporting AE increased with education level: tertiary education AOR 2.63 95% CI 1.96-3.53. Respondents who thought COVID-19 vaccines were not safe were more likely to report post-vaccination adverse reactions than those who thought it was very safe (AOR 1.44, 95% CI 1.30-1.61). Conclusion(s): Ad26.COV2.S and AZD1222 vaccines are well-tolerated, with primarily mild and few severe AE among adults living in Malawi. Self-report of AE following COVID-19 vaccine receipt is associated with gender, age, education, and concern about the safety of the vaccines. Recognizing these associations is key when designing and implementing COVID-19 vaccination communication messages to increase vaccination coverage.
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BACKGROUND: Digital devices have represented a fundamental resource for maintaining communication relationships during the period of restrictive measures imposed by the COVID-19 pandemic. However it is evident that this period has contributed to increase the risks connected to the inappropriate use of digital devices. The aim of our study is to demonstrate how the COVID-19 pandemic and the consequent lockdown had an impact on children's use of digital devices. METHOD(S): One hundred and thirty children aged between six and 18 from Montalto di Castro were recruited in the study carried out in November 2020. All participants were asked to fill in two identical questionnaires: questions of the first questionnaire were related to the pre-lockdown period, while questions of the second questionnaire were related to the period between March and November 2020. RESULT(S): The average age of the 130 participants was 11.8+/-2 years. The amount of time spent by using digital devices is significantly lower in the pre-lockdown period than in the lockdown period (P<0.02). The smartphone addiction index is significantly lower in the pre-lockdown period (P<0.001). The analysis of headaches in the early morning hours - considered as one of the effects deriving from the use of the smartphone before sleeping - showed a statistically significant difference between the two groups (P<0.05). There are also significant differences related to physical activity and its frequency, with data showing the increase of children who did not perform physical activity (P<0.0001). CONCLUSION(S): This study does not only show a constant increase over time of the smartphone/tablet use, but also how the pandemic and social restrictions have worsened the phenomenon itself. This is particularly evident for the duration of exposure to screens, the addiction to smartphones, the quality of sleep and the practice of physical activity.Copyright © 2021 EDIZIONI MINERVA MEDICA.
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Purpose: UVC radiation has been proven to kill known pathogens and recent years have seen increased adoption of UVC disinfection technology in healthcare settings in an effort to limit the spread of COVID-19 and other common hospital-acquired infections. European Council Directive 2006/25/EC outlines the maximum permissible exposure (MPE) levels for workers due to artificial optical radiation. Knowing the output of a UVC disinfection system allows us to better quantify the risks however this quantitative information is not readily available to the user for some systems. The purpose of this study was to measure the output of a UVC disinfection system used in a hospital environment using a light meter calibrated for the UVC range. Material(s) and Method(s): The THOR UVC disinfection system (Finsen Technologies Ltd, UK) was used for this study. This system uses 90- watt TUV PL-L mercury lamps (Philips Lighting, UK) which emit UVC light at 254nm. It features 24 bulbs around a central column, and the system is controlled remotely via a tablet interface. An ILT2400 light meter (International Light Technologies, USA) calibrated for the 254nm UVC range was mounted on a tripod. The output was measured under different conditions to determine repeatability, consistency, and variation with height, distance, orientation, and exposure time. Unless stated otherwise the measurements were taken at a distance of 1m and a height of 1.5m. The test area chosen was representative of the maximum size of a patient room with an area of 31m2. Result(s): The mean maximum output of the system was 2.2+/-0.1 mW/ cm2. This was found to be consistent over a period of 25 minutes. These results were used to calculate the time to reach the MPE (T[MPE]). The output at a tower orientation of 0degree and 180degree was found to be 22% higher than those at orientations of 90degree and 270degree. Conclusion(s): Using these quantitative results, it was possible to determine the maximum permissible exposure time for the UVC radiation emitted from this system. The observed variations in system output due to contributions of scattered radiation, system orientation, and height may have implications for the degree of disinfection achieved. The T[MPE] of 2.6 seconds based on these measurements was 20% lower than the value estimated. The orientation of the system was shown to impact the T[MPE]. These results highlight that a multidisciplinary approach which includes Medical Physics should be taken when introducing these systems to a hospital environment. Note: changed to ePoster after submission.Copyright © 2023 Southern Society for Clinical Investigation.
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Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.
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Background: Digital solutions for online monitoring of chronic diseases are increasingly implemented in health care, but not all patients might have access, skills, or interest in using them. Fueled by the COVID-19 pandemic and the urgent need for remote consultations, an online website to enter patient-reported outcomes (PROs) from home (DANBIO-from-home, https://danbio.dk) was implemented on May 15th 2020 for patients with infammatory rheumatic diseases (IRD) followed in the Danish nationwide DANBIO registry. Objectives: To explore the use of DANBIO-from-home during the frst 1/year after launching, with focus on a) characteristics of patients who did versus who did not access the webpage, and b) impact of patient age on time to frst entry. Methods: DANBIO-from-home allows PROs to be entered remotely by computer, tablet, or smartphone after secure log-on. All patients followed in DANBIO were informed about this option by invitations sent through eBoks, a national infrastructure for electronic communication, available to 80-90% of Danish citizens. Patients were encouraged to access DANBIO-from-home before planned rheumatology consultations, or when participating in the voluntary questionnaire survey 'You and your rheumatic disease during times with corona-virus' (on three occasions: May 2020, Nov 2020, June 2021) (ref). Follow-up ended Dec 1st 2021. Characteristics of patients who did/did not access DANBIO-from-home during follow-up are explored by multivariable logistic regression analyses adjusted by clinical factors (gender/age-group/diagnosis/disease duration/use of biologics/HAQ/PASS). Time to frst entry of PRO using DANBIO-from-home is presented as cumulative incidence curves by age group. Results: Among 33,776 patients with infammatory rheumatic diseases followed in DANBIO, 68% used DANBIO-from-home at least once during follow-up (Table 1). Patients who used the system were less frequently below 40 years or above 80 years old, more frequently biologically treated and had lower HAQ-score than patients who did not use it. In logistic regression analyses, factors associated with DANBIO-from-home access were: female gender (odds ratio, OR 1. 2 (1.1;1.3)), age group 40-60 (1.8 (1.6;2.0)) or 61-80 yrs (1.9 (1.7;2.19) and not age >80 yrs (0.6 (0.5;0.7) with age <40 as the reference), biologic treatment (1.4 (1.3;1.5)), higher HAQ (1.3 (0.3;1.4)), scoring PASS 'no' (1.1 (1.02;1.2)) (all p <0.001), whereas disease duration and diagnosis had no impact. Time to frst entry was longest in in patients >80 yrs followed by the <40 yrs group. For all age-groups, and most pronounced for age <40 yrs, the use increased when invitations to questionnaire surveys were sent out. (Figure 1) Conclusion: A web-based system for secure remote entry of PROs was well-received after a nationwide launch. Patient-related factors had a substantial impact on the use. Lower use in the elderly might indicate lack of technical skills or facilities, whereas low use in younger age groups, which improved over time, is likely driven by other factors. Further analyses are planned to explore if lack of use impacts treatment outcomes.
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Aim and background: Due to the resurgence of COVID cases many doctors, medical students, and nurses from varied backgrounds, many a time novice to COVID management are deployed in turn from time to time at different COVID care centers and hospitals across India, before they are properly trained and skilled for effective management of COVID and post COVID syndromes, as the disease is relatively new, leading to non-uniform management and documentation. COVID being a contagious disease with newer symptomatology and ongoing research outputs suggesting new guidelines from time to time, which sometimes are conflicting in nature for novice healthcare workers. For uniform and appropriate management to reduce morbidity and mortality, it mandates a unique and effective solution towards guided and error-free disease management, authentic high volume data capture for future research and to trace patient to post COVID condition in the community outside the hospital, virtual patient counselling cum relative visit, generation of the daily patient bulletin, simultaneous teleround of multiple units, and sharing patient's data across multiple specialities and investigation areas. Objective: To have all these above-mentioned facilities over one platform, we aim to test run a cloud-based dynamic mobile application based dedicated device, the C O V I D Device (Covid Operation Vital Information Delivery device) across many hospitals in India simultaneously for COVID and post COVID syndrome management and data retrieval for research. Materials and methods: Two institutes, namely IMS and SUM Hospital and ITER have collaborated to design a cloud-based device having recent COVID guidelines on the management of adult COVID patients. The software has been incorporated into a dedicated handheld device (tablet or android mobile phone), the COVID Device in a dynamic way (when new symptomatology surfaces and new research outcomes on management are published). The important modules pertaining to this COVID Device are Web-based application for Registration Desk and Device-based application for Doctor's Module/Care-givers Module and Patient's/Patient's relative's module. Results: In a pilot, we have successfully test run the COVID device on virtual patients and 2 actual patients in a secondary level COVID ICU and HDU to examine the different functionality of the cloud-based application, namely error-free and guided patient management without missing any point, daily patient relative's counselling and virtual patient visiting by relatives, generating daily patient bulletin, simultaneous tele round of multiple units, and sharing patient's data across multiple specialities and investigation areas and tracing patient to the community after discharge to enquire about post COVID condition and retrieval of data across all module and incorporation of new guideline in a dynamic way and checking the facilities for incorporating other modules namely pediatric module. Conclusion: COVID Device (Adult module) is a very effective tool for COVID and post COVID condition management and research. It has the potential to incorporate other modules namely obstetric, pediatric, and neonatal modules. If used across all hospital of India, it will be a real boost to digital health mission and centralized COVID data management and research in India.
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Background: Patients with cancer have high rates of healthcare utilization due to complications of disease and treatment. Early identification of patient illness may help reduce acute care use and improve quality of care. Remote patient monitoring (RPM), a type of telemedicine involving collection and transmission of health data from a patient's home to clinicians, has promise to alleviate disparities by providing timely access and early intervention, particularly during the COVID-19 pandemic. Studies of digital interventions in oncology have demonstrated reduction in symptom distress and unplanned hospitalizations but lack focus on minority patients whereas studies of telehealth aiming to address disparities have not focused on patients with cancer. In this pilot study, we aimed to evaluate the feasibility of RPM among patients with cancer at a large urban medical center serving a racially and socioeconomically diverse population. Methods: We partnered with a secure HIPAA-compliant platform and FDA-approved RPM device, Current Health, which monitored heart rate, temperature, respiration, oxygen saturation, and blood pressure. The kit included broadband access and a tablet to provide telehealth services. Oncology Clinicians determined clinical inclusion and exclusion criteria of RPM initiation for patients on the bone marrow transplant service and patients with myeloma and lung cancer. A centralized team of Nurse Practitioners (NPs) monitored alarms. Clinical alarms indicated abnormal vital signs;technical alarms indicated no data transmission for a 12-hour period. We measured feasibility by recruitment and retention, and used descriptive statistics to describe the study population, time enrolled on RPM, and alarms. Results: To date, we enrolled 30 patients on the RPM platform over a 10-month period with a weekly census of 9-10 patients undergoing RPM monitoring. Of the 30 patients, 17 (57%) were white, 7 (23%) Black, and 2 (7%) Asian;2 patients (7%) identified as Hispanic. The average age was 57.4 years. The majority of patients (93%) had hematologic malignancies, all of whom were enrolled on hospital discharge. Of the 2 patients with lung cancer, 1 patient was enrolled from the outpatient setting and 1 following hospital discharge. The mean length of time per patient enrolled with the device was 21.7 days. Over 10 months, there were 393 technical and 62 clinical alarms with an average of 3 clinical alarms per week addressed by NPs by phone, indicating low clinician burden. Conclusions: This pilot study demonstrated the feasibility of RPM monitoring in patients with cancer. Future studies should evaluate patient-reported and healthcare utilization outcomes, as well as barriers to reimbursement. The identification of best practices in telemedicine implementation can accelerate adoption and increase high quality, timely, and equitable cancer care.
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Background: SARS-CoV-2 vaccines have changed the course of the current global pandemic. Cancer patients were identified as highrisk of adverse infection outcomes. We have previously characterised the serological response to SARS-CoV-2 vaccines in 220 cancer patients treated at our institution. In addition these patients were given the possibility to report their symptoms (patient-reported outcomes, PROs) weekly using a digital platform (ePROs). We sought to determine if, in cancer patients, the prospectively recorded post-vaccination ePROs could predict the serological response to SARS-CoV-2 vaccines. Methods: We used a pre-existing digital platform that allows monitoring of PROs using weekly questionnaires sent to patients and available on their desktop computers, tablets or smartphones. Serial serologies were performed at 28, 50 and 115 days after vaccination. Results: We observed that at day 50 after the first vaccination dose, coinciding with three weeks after the second dose, patients could be divided into two groups according to their serological response (low - below 1500 U/ml and high - above or equal 1500 U/ml). A peak in symptom burden could be observed after the second dose, as previously described. Omitting ePRO features decreased prediction performance of all models, whereas omitting baseline symptom scores had inconsistent effects. Among all models and feature constructions, the top performance metrics were given by the nearest centroid model7 with baseline symptoms omitted and 20 features chosen with the aforementioned procedure. The model achieved an accuracy of 0.704, an F1-score of 0.759 and an MCC of 0.398. Conclusions: we were able to identify the patients who achieved higher antibody levels against SARS-COV-2 based on the symptom burden reported through ePROs. This represents the first model showing that symptoms, assessed through ePRO can be predictive of response to vaccines. Our results could also be useful information for patients, as they could assuage their fears about adverse -effects, through the knowledge that toxicity could predict better protection against SARS-COV-2. The same toxicity-based prediction of efficacy has been identified with immunotherapy in cancer and is now a routine part of clinical discussions with patients.
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Education is increasingly being accessed digitally, as demonstrated by the success of e-Learning for Healthcare or e-LfH, a health education England programme developed in partnership with the NHS and professional bodies1. Within digital learning, e-learning is a popular medium as it offers users an opportunity to learn at one’s own pace, at a convenient time and place, revisiting as often as required, giving flexibility, and freedom to continue a professional development journey. A plan was therefore formed to develop e-learning to provide important support for enteral tube feeding for care home staff in a simple, convenient, and easily accessible format. Before development of the e-learning, qualitative and quantitative research was undertaken with key stakeholders to assess the acceptability of e-learning for care home staff in the field of enteral tube feeding. Following launch of the e-learning, views and feedback were analysed. Qualitative interviews were conducted with six care home managers across the UK to understand the challenges faced in providing education on enteral tube feeding for care home staff. Difficulties identified included: releasing staff from day-to-day activities;high turn-over of staff resulting in frequent training required for new employees;access to workplace digital devices, and;staff unable to complete their full duties until training was completed and documented. An online survey was conducted to gain quantitative information from an enteral tube feed companies’ homecare nurse team to evaluate the concept of online e-learning for care home staff. 13 homecare nurses responded, (approx. 10%) and 80% felt online training would be valuable for care home staff. Using these learnings an enteral tube feeding e-learning course was developed by the company’s homecare nurse team consisting of six, short interactive modules. Six Dietitians across the UK in both acute and community settings were consulted on the content, which they reviewed and refined ensuring a balanced view of practices and procedures were included. COVID-19 accelerated the requirement for online learning as face-to-face activity and care home access was restricted and the modules were launched earlier than planned in March 2020. A simple registration process granted access to the modules through a variety of electronic devices such as tablets and laptops. Between March 2020 to July 2021, 5,152 individuals registered and completed at least one module, with 3,661 (71%) completing the introductory course and the first 3 modules. Several NHS Trusts have added the e-learning link to their intranet sites as mandatory training for new starters. Feedback has been positive: “E-learning is going down a treat at the moment”;“11 of my staff completed the training. We found it really useful, the system was easy to navigate, gave us information that we didn’t know and helped us to understand the different types of feeding systems available. I would recommend this training as we all felt it gave us more confidence in supporting a person using a feeding system”. The high uptake of the e-learning and positive feedback demonstrate that these e-learning modules are a popular and acceptable form of education for care home staff and are suitable to be used across a variety of settings. The initial research helped to ensure that the e-learning modules which were developed, fully met the needs of care home staff and therefore provide important support in a simple, convenient, and easily accessible format. References 1. e-Learning for Healthcare.
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Background: During the COVID-19 pandemic the US experienced a dramatic decline in in-person visits due to stay at home orders and social distancing. In May 2020 our health system established a regional pediatric telehealth consortium (RPTC) in response to the pandemic. The program, supported in part by the Federal Communications Commission's COVID-19 Telehealth Program enabled;expansion of an established telehealth platform to support 15 urban, suburban and rural healthcare sites in the DCMaryland-Virginia region;continuity of care for patients while limiting community spread of COVID 19;and remote care to expand region-wide surge capacity. Our objectives were first to establish a virtual telemedicine command center to coordinate and provide care via network technology and broaden regional access to pediatric specialty services. Second to provide connected care services-including remote monitoring, video consults, imaging diagnostics, remote treatment and family presence, maintaining social distancing and protecting healthcare workers and patients from exposure to the coronavirus. Thirdly, to prepare and assist health care providers at regional partner sites to conduct connected care services. Methods: RPTC infrastructure was established with the purchase of hardware, software and other connected devices including telehealth carts, robots, peripherals, digital BP cuffs, pulse ox, thermometers, tablets, telehealth platforms, and innovative AI software. Data plans to provide care for underserved patients, virtual interpreter service platforms and tablets to maintain family presence for inpatients were provided. A dashboard was developed to track program assets, roll out, utilization, patient and provider characteristics and geographic distribution of visits. A project management team coordinated roll out of the program. Results: Between March 1 to August, 31, 2020, the RPTC provided 62,864 DTC telemedicine visits, with 558 providers. Telemedicine patients were 51.7% female, insurance was 45.7% public, 34% private, 8.7% federal and the top 10 diagnoses were behavioral health related. In response to the COVID-19 pandemic, telemedicine patient volume increased 284% across all specialties and subspecialties over the course of March and April 2020. Additionally, the number of providers of direct to consumer telemedicine increased by 38% between February (400 providers pre-COVID) and March, 2020 (554 providers post-COVID). The expanded telehealth infrastructure supported provider-to-patient pediatric care and provider-toprovider consultations through a connected “virtual hospital” model. It is used for ED, ICU and inpatient care to provide access to specialized expertise and DTC care across the 15 regional partner sites. Conclusion: Establishment of the RPTC allowed our health system to shift to a telemedicine first model, treat seriously ill COVID-19 pediatric patients and to continue to provide the highest quality care to patients with acute or chronic health needs via telehealth across a tri-state region.
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Introduction: In recent years, the use of computers, laptops, tablets and smartphones has experienced a constant in-crease, and even more so, the health emergency caused by COVID-19 has caused a significant increase in the amount of connection time to said devices. because the teaching mo-dality changed from face-to-face to virtual. Objective: To determine the prevalence and sociodemo-graphic variables associated with computer visual syndrome (VIS) in Peruvian university students during the COVID-19 health emergency. Materials and methods: The research had a quantitative approach;the design was non-experimental and the tran-sectional descriptive type. The sample was made up of 215 students from the professional career of Education to whom the Computer Syndrome Questionnaire (SVI-Q) was applied, an instrument with acceptable levels of reliability and validity. Subsequently, the responses were systematized and ana-lyzed using the SPSS® software. Results: It was determined that there is a high prevalence of SVI and that some sociodemographic variables such as gender, age group, time of exposure to digital devices, as well as having a pre-existing eye disease were significantly associated with said prevalence (p<0.05). Conclusions: It is necessary to promote the application of preventive strategies, such as the 20-20-20 rule, and to im-prove ergonomic conditions, such as the use of adequate seats, anti-glare screens and brightness adjustment to re-duce the prevalence. and symptoms associated with IVS.
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BACKGROUND: Telehealth can effectively connect patients to clinicians across distance and time, but its accessibility remains limited for rural populations. The Veterans Health Administration (VA), serving 9+ million patients across 50 states, has long championed telehealth use through national initiatives that distribute tablets to patients for video visits and that provide contingency clinician staffing via telehealth for underserved clinics. VA efforts had focused largely on rural populations where disparities in health care access and telehealth use existed but have since expanded more broadly with the onset of the COVID-19 pandemic. This study examines rural-urban differences in telehealth use for primary care services across all VA healthcare systems nationally before and after pandemic onset. METHODS: In an ongoing VA quality improvement (non-research) effort, we conducted a retrospective study on Veterans who received primary care (PC, n= 6,340,167 patients;63,541,577 visits) and mental health integration (PC-MHI, n= 977,243 patients;3,621,653 visits) services from 138 VA healthcare systems, nationwide. For each site, we aggregated monthly counts of telehealth (and specifically, video) visits for PC and PC-MHI separately during 12-months before (March 16, 2019-March 15, 2020) and 21-months after pandemic onset (March 16, 2020-December 16, 2021). We examined whether rurality of VA healthcare system predicted telehealth (and video) use for all primary care related (PC and PC-MHI) encounters over time, adjusting for VA size (number of patients), age/disability (Charlson Comorbidity Index), and racial-ethnic composition (%Black, %Hispanic) in regression analyses. RESULTS: In fully adjusted models, rural VAs initially had higher rates of PC telehealth use than urban VAs (35% vs 29%), which reversed after pandemic onset (56% vs 60%), leading to a 35% reduction in odds of telehealth use over time (CI=0.55-0.76;p<0.001). In comparison, the rural-urban gap grew even larger for PC-MHI services (OR=0.49;CI=0.36-0.68;p<0.001), as rural lagged urban telehealth expansion (before 29% vs 25%;after 77% vs 84%). While video use was low overall, the rural-urban divide was stark for PC (OR=0.28;CI=0.19-0.40;p<0.001) and PC-MHI services (OR=0.34;CI=0.21-0.56;p<0.001). Rural VAs initially had higher rates of PC (2% vs 1%) and PC-MHI video use (8% vs 5%) than urban VAs, which reversed after pandemic onset (PC 4% vs 6%;PC-MHI 21% vs 33%). CONCLUSIONS: Despite initial telehealth gains in rural VAs, the pandemic exacerbated the rural-urban telehealth divide across sites. Compared to urban VAs, telehealth expansion lagged for rural ones, especially in mental health integration services. Video visits still constituted a minority of primary care services delivered. To prevent widening rural-urban divides, telehealth implementation efforts should address persistent disparities in structural capacity (e.g., internet bandwidth) and tailor technology to encourage adoption among rural users.
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BACKGROUND: One strategy to aid patients in managing their diabetes is group visits (GVs) that include group education and individual medical visits with a provider. Though in-person GVs have been shown to benefit patients, few studies have evaluated virtual diabetes GVs. METHODS: In this single-arm trial, adult patients with A1c ≥ 8% from six community health centers were recruited to participate in monthly virtual GVs for 6 months. Patients completed surveys about diabetes self-care, support, distress, and the group visit concept before and after they participated in GVs. Health center staff trained to lead the GVs completed surveys pre and post virtual GVs. Linear mixed effects models were used to adjust cohort-based association and model the survey data over time for the time trend effect. RESULTS: Forty-five patients enrolled in the study and thirty-eight patients completed the baseline survey. The average age was 55 (range of 36-83) and 65% of enrollees were female. 63% were black/African American, 32% were white/Caucasian, and 8% were Hispanic/Latino. Thirty-four patients attended one or more GVs and twenty-one patients completed the post GV survey. Overall satisfaction with the virtual GVs was high with 18/20 (90%) of participants being very satisfied and 20/21 (95%) saying they would attend GVs in the future. Most participants agreed that GVs helped improve diabetes self-management skills (78%), motivated them to achieve health goals (89%), and introduced them to others living with diabetes (78%). Barriers to participation were the timing of the GVs and access to a computer, tablet, phone, and internet. Patients had an increase in their diabetes knowledge (mean (SD): 3.2/ 5 (0.9) to 3.6/5 (0.7), p= 0.02) and diabetes support (3.5/5 (0.64) to 4.1/5 (0.7), p <0.001) as well as decreased diabetes distress (2.9/6 (1.5) to 1.2/6 (0.5), p=0.03) from baseline to 6 months. Thirty-five staff enrolled in the study and seventeen completed a post GV survey. Most staff agreed that GVs provided patients with social support and more frequent contact with medical providers. Staff largely agreed that virtual GVs increased opportunity for teamwork and collaboration (94%), care coordination (82%), and understanding of patients (94%). However, only 5/17 (29%) and 3/17 (18%) staff members agreed that virtual GVs increased provider productivity or led to higher reimbursement, respectively. Staff cited other priorities at the health center, difficulty recruiting patients, and concerns about access to technology as the biggest barriers to implementing virtual GVs. CONCLUSIONS: Virtual GVs show promise as evidenced by high patient satisfaction and improvements in support, distress, and diabetes knowledge in patients. Staff also perceived virtual GV benefits to patients, staff, and health centers despite concerns about logistics such as productivity, reimbursement, and the health center's ability to continue visits virtually.
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In the talk I discuss the sleeping habits and sleep problems before and during the Corona pandemic. An alarming increase in sleep problems from 6-year-old primary school children to adolescents and older adults is shown. Half of the interviewed adult Austrians (N=968) sleep less than 7 hours and only 31% classify themselves as "good sleepers". Changes due to the Corona pandemic and lockdown measures are also found across different cultural groups (Austria/Germany, Brazil, Greece, Cuba, Ukraine) and show, on the one hand, a high level of anxiety due to the pandemic (78% of respondents). In addition, in non-system-relevant jobs we see a consistent later going to bed and an extension of sleep times on working days (13 min daily), which in total lead to a reduced "social jetlag". People in system-relevant jobs also go to bed later and get up later, but show no increase in sleep time on weekdays and even a reduction in sleep time on days off (cf. Florea et al., 2021);overall, they also show a reduction in social jetlag, albeit to a lesser extent. We find cultural differences only of a general nature in the sense that people in Greece and Ukraine go to bed and get up later than the other cultural groups studied. Among children and adolescents (N= 2,232), we find 74.8% less physical activity during the Corona pandemic, 44.2% less exposure to daylight and 85% a strong increase in smartphone/tablet use during the pandemic or lock-downs. In addition, a shift of the sleep-wake rhythm to later times (for 94%) & more bedtime, and yet a subjective deterioration in sleep quality is also evident in that data. An alarming number of 33.3-45.3% depending on the age group now even subjectively report sleep problems during the pandemic (cf. Bothe et al., in preparation).
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Background: WHO recognized COVID-19 a pandemic on March 12, 2020 and National Health Commission officially declared it as a Class-B infectious disease. The technological advancements enabled the teaching staffs to keep their students involved during this period of COVID-19 pandemic. Online classes become the efficient medium to learn by staying at home. Aim: To find out the challenges faced by mothers during online learning in order to devise a systematic plan for smooth and effective learning in case of another crises like COVID-19. Method: It was a cross sectional study carried out at CMH LMC&IOD, in which a user-defined questionnaire was introduced to the participants which were mothers of school going children from all over the city. The questionnaire got 161 responses in total, but two were incomplete so 159 were considered while doing the analysis. The results were analyzed using SPSS25. Results: In this study,46.9% mothers were of age 40 and above and 47.5% were between 31 -40 years of age. Rest were 30 and below 57.5 % children used laptops to study online, while 34.4 % used a mobile. 7% had their own tablets and only 1.1 used desktops. Only 14.4% mothers supervised their children during all this time. 58.7% however managed supervising studies with other tasks and 26.9% said their children could study online unsupervised. Only 20% mothers thought their children are taking interest in online schooling. 54.5% found their children struggling37.5% mothers thought that their children were learning much less through this online mode of education and 43.8% thought that online learning is somewhat less. Conclusion: Among the various the challenges faced by working mothers and housewives during online education of their children the most important challenge was to keep their children focused on study. We discovered that the online study had little effect on grades because most mothers had to take on the role of teacher as well as supervising.
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Introduction: MBBS and nursing students spend a lot of time in near vision activities daily while studying. In the covid and post COVID-19 pandemic era, the emphasis on electronic teaching and studying has increased immensely. Students have started depending more on online studying, teaching and search for study material leading to more time being spent using electronic devices like mobile phones, tabs, PC etc. This can lead to lot of eye strain (digital eye strain) and this predisposes them to develop Non Strabismic Binocular Vision Anomalies (NSBVA) related to accommodation and convergence of eyes. Aim: To study prevalence of NSBVA and report associated ocular symptoms and association of electronic devices (mobile, laptop) use with prevalence NSBVA, in MBBS and nursing students of a teaching hospital in Western Maharashtra. Materials and Methods: This study was a prospective observational study conducted between November 2020 to April 2021at Rajiv Gandhi Medical College and CSM Hospital, Thane, Maharashtra, India. In this study, a total of 110 students including both MBBS and nursing students from all academic years of the hospital were examined for a comprehensive ophthalmic examination and complete binocular vision assessment. The prevalence of NSBVA, associated ocular symptoms, prevalence of refractive errors and duration of electronic device use in the students was documented. Student's t-test was used to compare the total daily duration of electronic devices (mobile, laptop, Computer tablets) use between students with and without NSBVA. Chi-square test was used to find association of variables duration of electronic device use and occurrence of NSBVA. Results: Out of 110 students examined, there were 37.27% (n=41) were males and 62.72% (n=69) females. Age range was 18-30 years with mean age 21.85±2.67 years. Overall, 47 (42.72%) students had NSBVA including 34 MBBS and 13 nursing students. 12 (11%) students had ocular symptoms with NSBVA while 35 (31.8%) students had NSBVA without any ocular symptom. Eye strain was the most common ocular symptom. Average electronic device use was 4.53 hours/day. Most used electronic device was mobile phone. There was no association between NSBVA and electronic device use. Conclusion: The NSBVA is highly prevalent among MBBS and nursing students. Ocular symptoms are absent in many students with NSBVA which may lead to delayed diagnosis and worsening of ocular symptoms due to NSBVA. Older age group of students have higher prevalence of NSBVA. Electronic device exposure is not significantly associated with NSBVA in these students. Screening of such at risk population is important for timely diagnosis and treatment of NSBVA.
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The usage of Artificial intelligence in medical arena has proved to be a game changer in the detection and diagnosis of several medical conditions. In the current digital era, children with stressful medical issues are suffering from Deep Obsessive-Compulsive Disorder (DOCD). This kind of mental stress occurs in children because of the continuous usage of gadgets such as mobile phone, playing games using play stations, watching videos on tablets, etc. In most of the possibilities, single children are the ones affected with several obsessions such as stubborn activities, fighting for selfish priorities and so on. In medical terms, these kinds of complex behavioral changes are identified as DOCD. Genetic behaviors sometimes in a few group of children are also noticed as a modality difference. As symptoms are psychiatric impairment, such a child remains isolated, abnormal silence, being obsessive and repeating irrelevant words, high stress or anxiety. All medical challenges could be treated as healthcare research metrics and the gradual increase in DOCD disorder among children of this generation can be considered too. Early detection of DOCD is essential as it can help in early diagnosis but techniques to do so is unavailable currently. Deep learning-an artificial intelligence method can be utilized to detect DOCD, diagnose and treat it and bring about a positive character in children. Behavior changes in children can be classified and detected using transfer learning algorithms. In COVID-19 pandemic situation, 3% of DOCD has increased to 10-15% as a disorder. This information is retrieved from children by monitoring negative activities, unusual behavior such as nail biting, removing spectacles and placing them in the wrong place, watching tablets, mobile phones and television for more hours. Using Convolutional Neural Networks (CNN), input such as MRI (Magnetic resonance Imaging) is used for experimenting the variations in behavior with the high dimension that are analyzed from the image dataset. Using Transfer Learning with Inception V3-, CNN generalization of misophonia level can be statistically analyzed to avoid overfitting problems. By employing AI techniques, the aggression level can be predicted using data augmentation method with better accuracy and a low error rate than the existing systems. In the research it is observed that using the model employing Inception-V3 transfer learning CNN a better prediction of aggression levels can be achieved in comparison to the existing CNN model used.
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Introduction: In order to halt the progression of COVID-19, governments of many countries including India implemented national lockdown. In view of the sudden closure of educational institutions, remote teaching was implemented with the help of online learning or E-learning. Thus, the aim of the study was assessing the attitudes and perceptions of MBBS students regarding the effectiveness of e-learning and the impact of COVID-19 on the student’s mental wellbeing and learning. Methods: The survey instrument was a self-administered questionnaire consisting of 17 close ended questions and 3 open ended question. It has 3 sociodemographic questions, 13 questions assessing their attitudes and perceptions regarding the effectiveness of e-learning and 4 questions investigating the impact of COVID-19 on the student’s mental wellbeing and learning. The data obtained was analyzed using SPSS (version 20). Results: A total of 404 undergraduate students studying in FMHS, SGT University, Gurugram participated in the survey. A major part of the students (57.1%) was using their Mobile phones for e-learning followed by 24.6% using their Personal computer or Laptop, 12% were using combination of these devices and 6.3% using tablets. Due to inconsistent internet connection, most of the students (71.5%) were facing challenges. 64.9% of the respondents faced distraction during the class such as lack of audio clarity, internet connection problems, lack of environment, concentration issues, notifications and social media, student teacher interactions, practical aspect not covered and lack of physical interaction with the teacher. The continuous screen time posed a major problem for students who suffered from strain in the eyes (58.3%), headache (18.7%), neck pain (8.8%), back pain (6.3%) or all of the above problems (7.7%). Thus, 84.1% of the undergraduate students preferred conventional Classroom learning to e-learning. Conclusions: Implementation of strict social distancing and lockdown in COVID-19 era, has mandated the pedagogy of remote learning which remains the only viable option for teaching and learning in these difficult times. The students should be advised to follow good ergonomic practices to maintain their ocular health and should be motivated to enhance their mental well-being and learning amid COVID-19 pandemic.
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As we look back from a few years in India, OTT's platform subscriber growth rate is raising toward high till the date through this (Covid-19) Pandemic Lockdown as this growth is based upon the great Technological advancements that contributing to the OTT providers to bringing high-quality content to our near screens through the Internet. OTT's providers not only depend on their repository but invest a lot of money in producing their content. Many factors, such as new technologies, a drop in data charges, improved Internet speeds both at home and on the Internet. Mobiles, tablets, laptops, and Smart TVs are now to be made for entertainment and made it easy for the consumption of content provided by the OTT providers. This paper is in a novel approach to understand the user profiles and preferences from an Indian perspective.
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Background: In April 2020, the Montana Geriatric Workforce Enhancement Program (MGWEP) applied for CARES Act funding to use telehealth to prevent, prepare for, and respond to COVID-19. As a GWEP based in a College of Health with limited clinical facilities, MGWEP turned to its community partners to pursue this opportunity. The program ended April 30, 2020, and 18 months later MGWEP queried its partners to determine the sustainability of their projects. Methods: A qualitative scripted telephone interview was used to determine the status of the telehealth projects. Each partner was asked about barriers to continuation, changes in project partners, funding, and individuals served. Results: Five of the six projects are ongoing 18 months after the funding ended. Missoula Aging Services' Lifelong Connections provides wifi-enabled tablets, instruction and support to older adults to engage in telehealth and other uses. Ten participants have been added with plans to expand into rural areas;new partners added funding. Skaggs School of Pharmacy secured additional funding to continue use of a simulated EHR platform, training interdisciplinary student teams in a virtual environment. An additional 99 students and 21 instructors have participated in these events. MGWEP's two CHC partners used the funding to support the successful implementation of telehealth visits in their clinics. While the demand for telehealth medical visits has declined, the technology is still being used in behavioral health. The Montana Alzheimer's Association utilized the funding to engage 5 long-term care communities in Project Vital;each site received 2 wifi-enabled tablets for use by their residents. Three sites continued into a second year, but staffing issues may prevent continuation of the program. Mountain-Pacific Quality Health, Montana's QIO, attempted to recruit and train telehealth patient navigators to assist older adults. MPQH developed training materials but had difficulty recruiting individuals to complete the remote training. The project was discontinued after the MGWEP funding ended. Conclusions: MGWEP had difficulty responding to the funding opportunity on short notice and with no direct access to clinical facilities. Our partners provided such access, but led to the question of sustainability of multiple projects. Four are successful with ongoing funding, one moderately so, and one did not continue. Depending on future opportunities that arise, MGWEP plans to involve its community partners.