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1.
International Journal of Engineering Education ; JOUR(5):1562-1576, 38.
Article in English | Web of Science | ID: covidwho-2101488

ABSTRACT

Research suggests that online learning should be more engaging and collaborative to provide a compatible alternative to in-person learning. Many educators have implemented active learning in their in-person classrooms, while only a few assess how effective similar techniques are in virtual environments. The authors hypothesize that virtual learning, including active learning components, can improve student learning in virtual environments. Furthermore, the authors hypothesize that learning in virtual settings would be affected by students' gender, ability, and familiarity with the topic. The authors conducted a quasi-experimental study involving eighty-seven students from two institutions who participated in an online workshop covering fundamental concepts in construction scheduling. They were split into two groups: one group had no prominent active learning component, while the other was exposed to an active learning component. All participants completed pre and post-workshop surveys to assess their learning of the workshop outcomes and explore the effectiveness of virtual workshops and active learning components in online course delivery. The results of this study suggest that virtual workshops are effective in teaching construction scheduling, while active learning in the form of virtual pair-work does not have a significant positive impact on student learning. Furthermore, student performance in virtual workshops significantly differs based on gender, ability, and familiarity with the topic. Therefore, instructors need to be aware of significant student performance challenges, particularly for males and those with some familiarity with the topics covered in virtual workshops. Since this study was conducted during the COVID-19 pandemic, the authors present further challenges and recommendations for educators and institutions under similar emergency circumstances.

2.
Clin Infect Dis ; 2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2087755

ABSTRACT

BACKGROUND: Social determinants of health (SDOH) have been associated with COVID-19 outcomes. We examined differential patterns in COVID-19-related mortality by SDOH accounting for confounders and compared these patterns to those for non-COVID-19 mortality. METHODS: Residents of Ontario, Canada aged ≥20 years were followed from March-01-2020 to March-02-2021. COVID-19-related death was defined as death within [-7,30] days of a positive COVID-19 test. Area-level SDOH from 2016 Census included: median household income; proportion with diploma or higher educational-attainment; proportion essential workers, racially-minoritised groups, recent immigrants, apartment buildings, and high-density housing; and average household size. We examined associations between SDOH and COVID-19-related mortality using cause-specific hazard models, treating non-COVID-19 mortality as competing risks, and vice-versa. RESULTS: Of 11,810,255 individuals, we observed 3,880(0.03%) COVID-19-related deaths and 88,107(0.75%) non-COVID-19 deaths. After accounting for individual-level demographics, baseline health, and other area-level SDOH, the following area-level SDOH were associated with increased hazards of COVID-19-related death (hazard ratios[95% confidence intervals]: lower income (1.30[1.04-1.62]), lower educational-attainment (1.27[1.07-1.52]), higher proportions essential workers (1.28[1.05-1.57]), racially-minoritised groups (1.42[1.08-1.87]), apartment buildings (1.25[1.07-1.46]), and large vs. medium household size (1.30[1.12-1.50]). In comparison, areas with higher proportion racially-minoritised groups were associated with a lower hazard of non-COVID-19 mortality (0.88[0.84-0.92]). CONCLUSIONS: Area-level SDOH are associated with COVID-19-related mortality after accounting for demographic and clinical factors. COVID-19 has reversed patterns of lower non-COVID-19 mortality among racially-minoritised groups vs. their counterparts. Pandemic responses should include strategies (e.g., 'hotspot' and risk-group tailored vaccination) to address disproportionate risks and inequitable reach of, and access to, preventive interventions associated with SDOH.

3.
Embase; 28.
Preprint in English | EMBASE | ID: ppcovidwho-346617

ABSTRACT

BACKGROUND There were increased SARS-CoV2 hospitalizations and deaths noted during Omicron (B.1.1.529) variant surge in the UK despite decreased cases, and the reasons are unclear. METHODS In this retrospective observational study, we analyzed reported SARS-CoV2 cases, hospitalizations, and deaths during the COVID-19 pandemic in the UK. We also analyzed variables that affect the outcomes (including ethnicity, deprivation score, vaccination disparities, and pre-existing conditions). We also analyzed the vaccine effectiveness among those >=18 years of age (from August 16, 2021 to March 27, 2022). RESULTS Of the total cases (n= 22,072,550), hospitalizations (n=848,911), and deaths (n=175,070) due to COVID-19 in the UK;51.3% of cases (n=11,315,793), 28.8% of hospitalizations (n=244,708), and 16.4% of deaths (n=28,659) occurred during the Omicron variant surge as of May 1, 2022. During the latter part of the Omicron variant surge (February 28 - May 1, 2022 period), we observed a significant increase in the proportion of cases (23.7% vs 40.3%;RR1.70 [1.70-1.71];p<0.001) and hospitalizations (39.3% vs 50.3%;RR1.28 [1.27-1.30];p<0.001) among >=50 years of age, and deaths (67.89% vs 80.07%;RR1.18 [1.16-1.20];p<0.001) among >=75 years of age compared to the earlier period (December 6, 2021-February 27, 2022) during the Omicron variant surge. Using the available data from vaccine surveillance reports, we compared the Omicron variant surge (December 27, 2021-March 20, 2022) with the Delta variant surge (August 16-December 5, 2021). Our comparative analysis shows a significant decline in case fatality rate (all ages [0.21% vs 0.39%;RR 0.54 (0.52-0.55);p<0.001], over 18 years of age [0.25% vs 0.58%;RR 0.44 (0.43-0.45);p<0.001], and over 50 years of age [0.72% vs 1.57%;RR 0.46 (0.45-0.47);P<0.001]) and the risk of hospitalizations (all ages [0.62% vs 0.99%;RR 0.63 (0.62-0.64);p<0.001], over 18 years of age [0.67% vs 1.38%;RR 0.484 (0.476-0.492);p<0.001], and over 50 years of age [1.45% vs 2.81%;RR 0.52 (0.51-0.53);p<0.001]). Both the unvaccinated (0.41% vs 0.77%;RR 0.54 (0.51-0.57);p<0.001) and vaccinated (0.25% vs 0.59%;RR 0.43 (0.42-0.44);p<0.001) populations of over 18 years of age showed a significant decline in the case fatality rate during the Omicron variant surge when compared to the Delta variant surge. In summary, a significant decline in the risk of hospitalizations was observed both among the unvaccinated (1.27% vs 2.92%;RR 0.44 (0.42-0.45);p<0.001) and vaccinated (0.65% vs 1.19%;RR 0.54 (0.53-0.55);p<0.001) populations of over 18 years of age during the same period. We observed negative vaccine effectiveness (VE) for the third dose since December 20, 2021, with a significantly increased proportion of SARS-CoV2 cases hospitalizations, and deaths among the vaccinated;and a decreased proportion of cases, hospitalizations, and deaths among the unvaccinated. The pre-existing conditions were present in 95.6% of all COVID-19 deaths. We also observed various ethnicity, deprivation score, and vaccination rate disparities that can adversely affect hospitalizations and deaths among the compared groups based on vaccination status. CONCLUSIONS There is no discernable optimal vaccine effectiveness among >=18 years of age and vaccinated third dose population since the beginning (December 20, 2021) of the Omicron variant surge. Other data including pre-existing conditions, ethnicity, deprivation score, and vaccination rate disparities need to be adjusted by developing validated models for evaluating VE against hospitalizations and deaths. Both the vaccinated and unvaccinated populations showed favorable outcomes with a significant decline in case fatality rate and risk of hospitalizations during the Omicron variant surge. The suboptimal vaccine effectiveness with an increased proportion of cases among the vaccinated population was associated with a significantly increased proportion of hospitalizations and deaths during the Omicron variant surge. This underscores the need to prevent infections, especially in the elderly vaccinated population irrespective of vaccination status by employing uniform screening protocols and protective measures. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.

4.
Front Public Health ; 10: 875198, 2022.
Article in English | MEDLINE | ID: covidwho-2080281

ABSTRACT

Background: Worldwide, the Coronavirus pandemic has had a major impact on people's health, lives, and livelihoods. However, this impact has not been felt equally across various population groups. People from ethnic minority backgrounds in the UK have been more adversely affected by the pandemic, especially in terms of their physical health. Their mental health, on the other hand, has received less attention. This study aimed to explore the mental health experiences of UK adults from ethnic minorities during the Coronavirus pandemic. This work forms part of our wider long-term UK population study "Mental Health in the Pandemic." Methods: We conducted an exploratory qualitative study with people from ethnic minority communities across the UK. A series of in-depth interviews were conducted with 15 women, 14 men and 1 non-binary person from ethnic minority backgrounds, aged between 18 and 65 years old (mean age = 40). We utilized purposefully selected maximum variation sampling in order to capture as wide a variety of views, perceptions and experiences as possible. Inclusion criteria: adults (18+) from ethnic minorities across the UK; able to provide full consent to participate; able to participate in a video- or phone-call interview. All interviews took place via MS Teams or Zoom. The gathered data were transcribed verbatim and underwent thematic analysis following Braun and Clarke carried out using NVivo 12 software. Results: The qualitative data analysis yielded seven overarching themes: (1) pandemic-specific mental health and wellbeing experiences; (2) issues relating to the media; (3) coping mechanisms; (4) worries around and attitudes toward vaccination; (5) suggestions for support in moving forward; (6) best and worst experiences during pandemic and lockdowns; (7) biggest areas of change in personal life. Generally, participants' mental health experiences varied with some not being affected by the pandemic in a way related to their ethnicity, some sharing positive experiences and coping strategies (exercising more, spending more time with family, community cohesion), and some expressing negative experiences (eating or drinking more, feeling more isolated, or even racism and abuse, especially toward Asian communities). Concerns were raised around trust issues in relation to the media, the inadequate representation of ethnic minorities, and the spread of fake news especially on social media. Attitudes toward vaccinations varied too, with some people more willing to have the vaccine than others. Conclusion: This study's findings highlight the diversity in the pandemic mental health experiences of ethnic minorities in the UK and has implications for policy, practice and further research. To enable moving forward beyond the pandemic, our study surfaced the need for culturally appropriate mental health support, financial support (as a key mental health determinant), accurate media representation, and clear communication messaging from the Governments of the UK.


Subject(s)
Coronavirus Infections , Coronavirus , Adult , Male , Female , Humans , Adolescent , Young Adult , Middle Aged , Aged , Pandemics , Mental Health , Ethnicity , Minority Groups , Ethnic and Racial Minorities , United Kingdom/epidemiology
5.
Biomedicines ; 10(10)2022 Oct 12.
Article in English | MEDLINE | ID: covidwho-2071216

ABSTRACT

Although there is strong evidence that SARS-CoV-2 infection is associated with adverse outcomes in certain ethnic groups, the association of disease severity and risk factors such as comorbidities and biomarkers with racial disparities remains undefined. This retrospective study between March 2020 and February 2021 explores COVID-19 risk factors as predictors for patients' disease progression through country comparison. Disease severity predictors in Germany and Japan were cardiovascular-associated comorbidities, dementia, and age. We adjusted age, sex, body mass index, and history of cardiovascular disease comorbidity in the country cohorts using a propensity score matching (PSM) technique to reduce the influence of differences in sample size and the surprisingly young, lean Japanese cohort. Analysis of the 170 PSM pairs confirmed that 65.29% of German and 85.29% of Japanese patients were in the uncomplicated phase. More German than Japanese patients were admitted in the complicated and critical phase. Ethnic differences were identified in patients without cardiovascular comorbidities. Japanese patients in the uncomplicated phase presented a suppressed inflammatory response and coagulopathy with hypocoagulation. In contrast, German patients exhibited a hyperactive inflammatory response and coagulopathy with hypercoagulation. These differences were less pronounced in patients in the complicated phase or with cardiovascular diseases. Coagulation/fibrinolysis-associated biomarkers rather than inflammatory-related biomarkers predicted disease severity in patients with cardiovascular comorbidities: platelet counts were associated with severe illness in German patients. In contrast, high D-dimer and fibrinogen levels predicted disease severity in Japanese patients. Our comparative study indicates that ethnicity influences COVID-19-associated biomarker expression linked to the inflammatory and coagulation (thrombo-inflammatory) response. Future studies will be necessary to determine whether these differences contributed to the less severe disease progression observed in Japanese COVID-19 patients compared with those in Germany.

6.
Frontiers in Education ; 7, 2022.
Article in English | Web of Science | ID: covidwho-2071076

ABSTRACT

The COVID-19 pandemic forced higher education into emergency remote instruction in 2020. Impacts of this modality shift on undergraduates of different identities are important to document, for both current students who need support now and future students who may face other crises. A large survey in the United States asked students in science, technology, engineering, and mathematics (STEM) to report the impact of emergency remote instruction on their confidence to succeed and sense of belonging in STEM. Using those data, we find that the impact varies by gender, race/ethnicity, and socioeconomic status (SES). For instance, 63.3% of lower SES women identifying as underrepresented racial/ethnic minorities (URM) reported a decrease in their confidence to succeed, compared to 38.9% of non-URM, higher SES men who reported a decrease. On the other hand, 35.3% of URM, lower SES men reported that emergency remote instruction increased their sense of belonging, compared to 15.9% of non-URM, higher SES women. The large percentage reporting increased belonging was unexpected and adds to calls for more research into the experiences of URM men. Our results suggest researchers, instructors, and administrators working to mitigate shocks to higher education must consider multiple identities and take an intersectional view, because impacts of these crises are not neutral with respect to gender, race/ethnicity, and SES.

7.
J Clin Med ; 11(19)2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-2066190

ABSTRACT

Racial disparities in incidence and outcomes of acute kidney injury (AKI) are pervasive and are driven in part by social inequities and other factors. It is well-documented that Black patients face higher risk of AKI and seemingly have a survival advantage compared to White counterparts. Various explanations have been advanced and suggested to account for this, including differences in susceptibility to kidney injury, severity of illness, and socioeconomic factors. In this review, we try to understand and further explore the link between race and AKI using the incidence, diagnosis, and management of AKI to illustrate how race is directly related to AKI outcomes, with a focus on Black and White individuals with AKI. In particular, we explore the effect of race-adjusted estimated glomerular filtration rate (eGFR) equation on AKI prediction and discuss racial disparities in the management of AKI and how this might contribute to racial differences in AKI-related mortality among Blacks with AKI. We also identify some opportunities for future research and advocacy.

9.
BMC Med ; 20(1): 386, 2022 10 10.
Article in English | MEDLINE | ID: covidwho-2064797

ABSTRACT

BACKGROUND: Regular vaccination against SARS-CoV-2 may be needed to maintain immunity in 'at-risk' populations, which include healthcare workers (HCWs). However, little is known about the proportion of HCWs who might be hesitant about receiving a hypothetical regular SARS-CoV-2 vaccination or the factors associated with this hesitancy. METHODS: Cross-sectional analysis of questionnaire data collected as part of UK-REACH, a nationwide, longitudinal cohort study of HCWs. The outcome measure was binary, either a participant indicated they would definitely accept regular SARS-CoV-2 vaccination if recommended or they indicated some degree of hesitancy regarding acceptance (probably accept or less likely). We used logistic regression to identify factors associated with hesitancy for receiving regular vaccination. RESULTS: A total of 5454 HCWs were included in the analysed cohort, 23.5% of whom were hesitant about regular SARS-CoV-2 vaccination. Black HCWs were more likely to be hesitant than White HCWs (aOR 2.60, 95%CI 1.80-3.72) as were those who reported a previous episode of COVID-19 (1.33, 1.13-1.57 [vs those who tested negative]). Those who received influenza vaccination in the previous two seasons were over five times less likely to report hesitancy for regular SARS-CoV-2 vaccination than those not vaccinated against influenza in either season (0.18, 0.14-0.21). HCWs who trusted official sources of vaccine information (such as NHS or government adverts or websites) were less likely to report hesitancy for a regular vaccination programme. Those who had been exposed to information advocating against vaccination from friends and family were more likely to be hesitant. CONCLUSIONS: In this study, nearly a quarter of UK HCWs were hesitant about receiving a regular SARS-CoV-2 vaccination. We have identified key factors associated with hesitancy for regular SARS-CoV-2 vaccination, which can be used to identify groups of HCWs at the highest risk of vaccine hesitancy and tailor interventions accordingly. Family and friends of HCWs may influence decisions about regular vaccination. This implies that working with HCWs and their social networks to allay concerns about SARS-CoV-2 vaccination could improve uptake in a regular vaccination programme. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN11811602.


Subject(s)
COVID-19 , Influenza, Human , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Cross-Sectional Studies , Health Personnel , Humans , Influenza, Human/prevention & control , Longitudinal Studies , SARS-CoV-2 , United Kingdom/epidemiology , Vaccination
10.
J Nurs Scholarsh ; 2022 Oct 11.
Article in English | MEDLINE | ID: covidwho-2063817

ABSTRACT

PURPOSE: The COVID-19 pandemic, now in its third year, has served as a magnifying glass, exposing the inequitable impact of the outbreak. The study aims to analyze the relationships between the socioeconomic and ethnic characteristics of the population and COVID-19 testing, infection, and vaccination throughout the first five pandemic waves. DESIGN: A secondary analysis of an existing national database was conducted in Israel from March 2020 to May 2022. During the study period, Israel underwent 5 pandemic peaks or waves (March-April 2020, September-October 2020, January-February 2021, September 2021, and January-February 2022). METHODS: Data on tests performed, confirmed COVID-19 cases, and uptake of vaccine doses one through four during the study period, were analyzed by the socioeconomic (SE) cluster (scale of 1 to 10) and ethnicity (Jewish, Arab, mixed Jewish- Arab ethnicity) of the residents' local authority. RESULTS: COVID-19 testing rate gradually increased from the lowest to the highest SE clusters, with rates 3.2 times higher in the second highest, compared with the lowest cluster. People living in Jewish localities were tested twice more than those in Arab or mixed localities. The rate of confirmed cases was 1.9, 3.0, 6.3, and 4.3 times higher, respectively, among cluster 1 (the lowest) compared with cluster 9 (second highest) in the first, second, third, and fourth pandemic waves, respectively. Rates among people living in Arab or mixed localities were higher compared with those living in Jewish localities in 3 of the 5 waves. Vaccine uptake revealed a clear social gradient, with the percentage of the population being vaccinated gradually increasing from cluster 1 (the lowest) to the higher clusters. The relative difference between the lowest and highest SE clusters increased from 2.4 in the first vaccine dose to 5.5 in the third and fourth doses. Ethnic disparities also grew with vaccine dose, with a Jewish to an Arab rate ratio of 1.1, 1.2, 1.6, and 4.5 for vaccine doses 1,2,3, and 4, respectively. CONCLUSIONS: Covering 26 consecutive months of the COVID-19 pandemic at the national level, the current study demonstrates that despite high accessibility of tests and vaccines to the entirety of the population and tailored outreach efforts, socioeconomic, and ethnic disparities not only failed to diminish, but they even widened along the five pandemic waves. CLINICAL RELEVANCE: The pandemic exposed the vulnerability of the weakest segments of the population. Therefore, the combined action of the Ministry of Health, health providers, and local authorities is required to further adapt health messages to the cultural characteristics of diverse populations, to equip the health professionals with practical tools to promote healthy choices among the vulnerable populations, and to build communities that promote healthy lifestyles. The pandemic has highlighted the importance of reducing health disparities and building trust between vulnerable populations and the healthcare system during "normal" or routine times, to better prepare for times of emergencies, such as the current pandemic.

11.
Pharmaceutical Journal ; 307(7951), 2022.
Article in English | EMBASE | ID: covidwho-2064987
12.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P127-P128, 2022.
Article in English | EMBASE | ID: covidwho-2064495

ABSTRACT

Introduction: Pediatric epistaxis is highly prevalent, yet patient characteristics, frequency of office cauterizations, and outcomes have been minimally described. This study examined the epidemiology and prevalence of epistaxis and potential impact by COVID-19. Method(s): A retrospective summary was performed on all patients (0-18 years) seen/treated for epistaxis by pediatric otolaryngologists within a single health care system across northeast and southeast United States between January 1, 2013, and October 31, 2021. Demographics, geographics, medical history, and office and operating room cauterization were reviewed. Data were analyzed using chi2 and logistic regression. Result(s): Of 9770 unique patients, with 26,699 epistaxis encounters, 62% were male. Median age at first encounter was 8.5 years;50% of patients were White. Encounters were most frequent during the fall (September-November) and least frequent during winter (December-February) with no significant differences. The incidence of epistaxis has significantly increased since the onset of the COVID-19 pandemic (P<.001). Overall, 27% received a procedural intervention, 54% required more than a single visit. Logistic regression revealed age, ethnicity, and geographical region as independent predictors of receiving a procedure on the first encounter, with a model receiver-operating characteristic (ROC) curve with area=0.75 (95% CI, 0.73-0.76). Similarly, procedural intervention, history of allergies, and nasal steroid use were independent predictors of recurrent visits, with a model ROC curve with area=0.79 (95% CI, 0.78-0.80). Conclusion(s): The incidence of pediatric epistaxis is not significantly correlated with seasonality. However, there has been a significant increase in epistaxis encounters during the COVID-19 pandemic. Recurrent visits for pediatric epistaxis were significantly predicted by procedural intervention, allergies, and nasal steroid use.

13.
Obstetric Medicine ; 15(1 Supplement):33-34, 2022.
Article in English | EMBASE | ID: covidwho-2064395

ABSTRACT

Background: During the COVID-19 pandemic, the model of care for gestational diabetes mellitus (GDM)management at Bankstown-LidcombeHospital was adapted to include telehealth consultations to minimise unnecessary face to face interactions and mitigate contagion risk. Aim(s): Assessment of pregnancy outcomes before and during the COVID-19 pandemic. Method(s): We analysed prospectively collected data of singleton GDM pregnancies (International Association of the Diabetes and Pregnancy Study Groups (IADPSG)/WHO2013 criteria). The pre-COVID period defined as March 2016 to February 2020 and COVID period from March 2020 to March 2021. Baseline characteristics evaluated included age, ethnicity, pre-pregnancy body mass index (BMI), gestational age at GDM diagnosis, diagnosis of GDM <20 weeks, HbA1c and 75 g OGTT result. Outcomes assessed were need for insulin therapy, number of medical reviews, incidence of excessive weight gain (EGWG) during pregnancy (per IOM), pre-term delivery (<37 weeks) and caesarean section. Neonatal outcomes included infant gender, birthweight, small for gestational age (SGA, <10th percentile) and large gestational age (LGA, >90th percentile), shoulder dystocia, neonatal hypoglycaemia and jaundice. Independent sample t-tests and chi-square/Fisher's exact tests were used for continuous and categorical data, respectively. P < 0.05 indicated statistical significance. Result(s): A total of 1896 GDM women were included in this study, 292 (15.4%) during COVID and 1604 (84.6%) pre-COVID. During COVID, there was lower mean 1 h glucose (p < 0.0001), 2 h glucose (p < 0.001), HbA1c (p < 0.001), later diagnosis of GDM (p < 0.001) and a lower proportion diagnosed before 20 weeks (p < 0.05) compared to pre-COVID. There were no other differences in baseline characteristics. During the COVID period, there were similar rates of insulin use (48.6% vs. 43.0%), number of medical reviews (7.0 vs. 6.9 episodes), rates of EGWG (39.4% vs. 36.0%), pre-term delivery (6.2 vs. 6.1), caesarean section (37.0% vs. 34.6%), SGA (8.6% vs. 8.4%), LGA (14.4% vs. 11.4%), shoulder dystocia (1.0% vs. 0.2%), neonatal hypoglycaemia (9.2% vs. 10.2%) and neonatal jaundice (3.8% vs. 5.0%) compared to pre-COVID (all outcomes, p =NS). Conclusion(s): Increased use of teleconferencing during the initial 12 months of the COVID pandemic lead to similar pregnancy outcomes compared to the pre-COVID period. A model of care involving teleconferencing is likely to be retained as the 'new-normal' in a post-COVIDworld. Future audits will ascertain whether comparable outcomes are maintained.

14.
Obstetric Medicine ; 15(1 Supplement):35-36, 2022.
Article in English | EMBASE | ID: covidwho-2064392

ABSTRACT

Introduction: The use of metformin in the treatment of gestational diabetes mellitus (GDM) is variable in Australia and worldwide. There is strong evidence that metformin is safe and efficacious during pregnancy in the short term.1 During the COVID-19 pandemic, Fiona Stanley Hospital offered women metformin as an alternative to insulin where clinically appropriate. Aim(s): The aim of this study was to describe the clinical characteristics of the women receiving different treatments, and assess the efficacy and safety of metformin therapy in women with GDM. Method(s): We retrospectively analysed the medical records of 157 women with GDM requiring pharmacotherapy at our site over nine months. Women were allocated to four treatment groups: metformin monotherapy (Group A), insulin monotherapy (Group B), metformin added to insulin (Group C) and insulin added to metformin (Group D). Result(s): There was no difference in the mean age (p =0.30) and ethnicity (p =0.75) of the four treatment groups. Women commenced on insulin therapy (Group B) had higher body mass index (BMI) (p =0.03) and were more likely to have previous history of GDM (p<=0.01). Eighty-three women with GDM were treated with metformin monotherapy during the study period. However, 60% of them needed addition of insulin to achieve glucose control. Sixty-six percent of women reached optimal blood sugar control with less than maximum dose of metformin. Thirteen percent of the women experienced gastrointestinal side effects, however, there were no unplanned reviews or unplanned admissions noted during the study period. This group was commenced on therapy later in the pregnancy leading to shorter mean treatment duration (6.42 weeks) compared to other groups (11.16, 11.58 and 14.62 weeks for Groups B, C and D, respectively) Group D was able to avoid insulin for a mean duration of 3.58 weeks when on metformin alone. Among the four groups there were no significant difference in neonatal complications (p=0.47), birth weight (p=0.80) and neonatal intensive care unit (NICU) (p=0.92) admissions. Fewer total maternity complications (p<=0.01) were noted in Group A but this was driven by lower postpartum haemorrhage rates. Conclusion(s): The metformin treated group had lower BMI and were at later gestational stage when metformin was commenced and there were no significant differences in neonatal outcomes as compared to the insulin group. However, 60% of women required addition of insulin and 13% had gastrointestinal side effects.

15.
Archives of Disease in Childhood ; 107(Supplement 2):A292-A293, 2022.
Article in English | EMBASE | ID: covidwho-2064036

ABSTRACT

Aims The COVID-19 pandemic triggered a national lockdown to be imposed in the UK in March 2020. Social restrictions resulted in children being isolated within their homes with little to no contact with teachers, social workers, or health services. These measures decreased the opportunity to detect children suffering from abuse.1 Nationally, social restrictions contributed to 8,500 fewer referrals to children's services during COVID-19.2 Increased financial strain3 alongside domestic violence4 is suggested to have potentiated an increase in child abuse during the COVID-19 pandemic. This study therefore aimed to assess how COVID-19 affected child protection referrals in Leeds and evaluate the concern that the COVID-19 pandemic resulted in more child abuse yet fewer child abuse referrals. 2,5-7 Methods Referrals to Leeds Community Paediatric Department between 1st March and 30th September 2019 and 2020 were collated using electronic patient records and in total 426 referrals were evaluated. The source, reason and outcome of referrals was recorded as well as the age, sex, ethnicity, number of siblings, and socioeconomic status of each child. The presence of domestic violence in the household as well as any prior interactions with children's services was recorded. Results There were 22.5% fewer referrals in 2020 during the pandemic when compared to 2019, with a reduction in referrals from every source. The percentage of children with domestic violence in their household rose significantly from 44.58% in 2019 to 58.60% in 2020. The age of children referred differed significantly between 2019 and 2020. The modal age of children referred in 2019 was four years whereas in 2020 it was one year. Conclusion The number of referrals for suspected child abuse decreased in Leeds during COVID-19. It is therefore likely that child abuse became less visible rather than less prevalent during this pandemic.

16.
Archives of Disease in Childhood ; 107(Supplement 2):A121, 2022.
Article in English | EMBASE | ID: covidwho-2064022

ABSTRACT

Aims Post COVID-19 condition is defined by the WHO as a 'condition (which) occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis and generally have an impact on everyday functioning [1].' South Tees' Paediatric Post COVID-19 Assessment Clinic is one of fifteen tertiary paediatric clinics commissioned in England for the multidisciplinary assessment of children and young people (CYP) with suspected post COVID-19 condition. To assess patient data from clinic to identify any patterns of susceptibility and contextualise data in terms of the national picture. Methods Data was obtained from the referral form, clinic notes and service evaluation tool. Results In the period from July 2021 to February 2022, twelve CYP completed assessment. (See figure 1 for referral and assessment pathway). Of the assessed patients, eleven were of white and one of mixed ethnicity, seven were female and five male, three were between 6-11 years, six between 12-15 years and three between 16-18 years. Four were classified as being from a deprived location defined by living in a postcode that was classed as quintile 1 or 2 in the indices of multiple deprivation. Chronic fatigue and 'brain fog' were the two most common symptoms. However, symptoms like tinnitus (one child) and chronic chesty cough with wheeze (one child) were also noted. Four patients have still not managed full-time return to school. Two of these have attendance below 25%. Conclusion Though our experience was in line with national figures in terms of symptom profile, increased prevalence in females and teenagers [2], total number of referrals for assessment is significantly lower than expected. From the local area CYP population estimates [3] and most recent Office for National Statistics 'self-reported long COVID survey' results [2], we would have expected to see significantly higher numbers of patients with post COVID-19 condition (~150-250 patients under 16 years of age at the lowest estimate) but this is not the case. It is possible that symptoms reported in the survey are not severe enough to have significant impact on daily living warranting referral. The reduced referral numbers could also be due to reduced awareness (clinicians and community) or symptoms being attributed to other causes resulting in non-referral to appropriate services. Despite small numbers, one third of CYP seen in clinic continue to have multiple symptoms and have not been able to return to full-time education. This would have significant impact on long-term health and wellbeing of these CYP. There is an urgent need for research to find rehabilitation and therapeutic strategies for these CYP. 1. 'A clinical case definition of post COVID-19 condition by a Delphi consensus'. (2021) World Health Organization. 2. 'Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK'. (2022) Office for National Statistics. 3. 'Local population diversity'. (2018) Middlesbrough Council.

17.
Archives of Disease in Childhood ; 107(Supplement 2):A57-A58, 2022.
Article in English | EMBASE | ID: covidwho-2064013

ABSTRACT

Aims The London Post COVID Syndrome Pathway was set up in October in 2020 in order to meet the needs of children affected by persistent symptoms after SARS-CoV-2 infection. The UK CLoCk study (1), 11-17 years, showed high symptom prevalence, increasing from time of testing to 3 months (35.4% to 66.5% in SARS-CoV-2 positive cases and 8.3% to 53.3% in controls). ONS (2) data from a large, randomly selected population survey (April 2020 to August 2021) reported symptom prevalence 4-8 weeks after infection of 3.3% in primary aged children (vs 3.6% in negative controls) and 4.6% (vs 2.9%) in secondary aged. The Zoe Kings study (3) showed 1.8% of children had symptoms beyond 8 weeks after infection. The COVID pandemic has affected ethnic minorities and those in deprived communities the most. Here, we aimed to describe referral patterns and ascertain factors influencing inequalities in access to care. Methods We collected demographic and clinical data from our Post COVID clinics, from October 2020 to January 2022. Deprivation deciles were based on the Index of Multiple Deprivation (IMD 2019). Decile 1 represents the most deprived 10% (decile) in England and Decile 10 represents the least deprived 10%. Analyses were descriptive. Results A total of 86 patients were referred with persistent symptoms (median age 14, range 7-18). The female:male ratio was 1.5:1 (52:34). Ethnicity data was available for n=74. Of those 5% identified from Black backgrounds (expected 13.30%);9% Asian (vs 18.50%);12% Other Ethnic Groups (vs 3.40%), 7% Mixed Ethnic Groups (vs 5%) and 53% White (vs 59.80%). Median IMD score was 6, with mode =7 (London mean 3, mode =1). Conclusion Our data suggests children from more affluent (less deprived) areas are accessing the service, with an underrepresentation of males. A small number of patients were referred compared to those reporting persistent symptoms in national surveys. This may be due to a relatively lower number having impairment and/or a lack of awareness amongst professionals. Ethnicity data shows a lower number than expected Black (40% less) and Asian (50% less) backgrounds are accessing support. Since schools re-opened in September 2021 reduced school attendance has been reported for many children. Persistent symptoms are common post viral infection, and most children recover. However, for some these can be debilitating. If children have reduced school attendance due to persistent symptoms they need prompt access to care. Our study raises concern about access to Post COVID services for all children (particularly males and those from minority backgrounds), raising lack of awareness amongst GPs and schools as a possibility. Proactive case finding is needed, particularly in hardly-reached groups. NHS England has recommended a lead for supporting equality to help this and is in post. The numbers of children accessing care is smaller than the number reporting symptoms, an area that requires further study.

18.
American Journal of Transplantation ; 22(Supplement 3):776, 2022.
Article in English | EMBASE | ID: covidwho-2063545

ABSTRACT

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

19.
American Journal of Transplantation ; 22(Supplement 3):639, 2022.
Article in English | EMBASE | ID: covidwho-2063507

ABSTRACT

Purpose: Despite the large numbers of reports on patient risk factors for poor clinical outcomes with COVID-19, little is known about how these risks may differ for solid organ transplant (SOT) recipients versus non-SOT (NSOT) patients. Method(s): We reviewed demographic and comorbid conditions in a cohort of SOT (n=129) and NSOT patients (n=708) admitted to our center for COVID-19 between December 2019 and February 2021. Patient characteristics were compared between groups using the t-test or chi-square test. Univariable and multivariable (stepwise reduced) logistic regression models were constructed for our outcomes of interest. Result(s): Patient age and sex were similar between SOT and NSOT cohorts. However, SOT patients were more likely to be of Hispanic ethnicity (64% v. 39%, p<0.001). Both SOT and NSOT had similar incidence of neurologic conditions (23% and 21%, p=0.476), but SOT patients were more likely to have comorbid conditions including diabetes mellitus, cardiovascular condition, or lung disease (all p<0.001). Several clinical factors were associated with ICU admission in NSOT patients, including patient age, diabetes, cardiac disease, neurologic disease, obesity, and hepatobiliary disease (all p < 0.05). In contrast, only cardiac disease was associated with ICU admission for SOT patients (p=0.010). Multivariable analysis of factors associated with increased mortality revealed that neurologic condition (OR 3.0, 95% CI 0.8-11.4) and lung disease (OR 3.5, 95% CI 0.7-18.2) were significant for SOT patients in a model including age, sex, and other comorbid conditions. In contrast, for NSOT patients, history of a neurologic condition (OR 2.3, 95% CI 1.3-4.0) and age >65 (OR 4.2, 95% CI 2.1-8.7) were significantly associated with death in a multivariate analysis. Conclusion(s): It has been previously unclear whether risk factors associated with poor outcomes in NSOT patients with COVID-19 will be similarly important in SOT recipients. Our analysis demonstrated different risk associations in contemporaneous patient cohorts at a single academic center. This observation suggests that SOT-specific approaches for risk stratification would be beneficial for patient evaluation and triage.

20.
American Journal of Transplantation ; 22(Supplement 3):765, 2022.
Article in English | EMBASE | ID: covidwho-2063490

ABSTRACT

Purpose: The purpose of the study was to examine the clinical course, outcomes, and complications of COVID-19 in pediatric solid organ transplant patients from a single institution, with special attention to thrombotic complications, multiple inflammatory syndrome in children (MIS-C), and new rejection. Method(s): The medical record at our institution was retrospectively queried for all solid organ transplant patients up to 21 years old diagnosed with COVID-19 from March 2020 to September 2021. This cohort was compared in a 1:1 fashion with age, sex, and ethnicity-matched controls with COVID-19 infection, but no history of transplant. Categorical variables were analyzed with Chi-square or Fisher's exact test, and continuous variables were analyzed with Mann-Whitney test. Result(s): 44 solid organ transplant patients met study inclusion criteria. Six patients were excluded from analysis due to insufficient documentation of COVID-19 diagnosis or course. The cohort was composed of 17 kidney, 11 heart, six liver, two lung, one liver-kidney, and one multivisceral transplant patients. Median age at COVID-19 diagnosis was 15 years (IQR 9). Median time from transplant to COVID-19 diagnosis was 2.5 years (IQR 3.4). Of the 38 patients, 17 were white non-Hispanic/Latino (44.7%), 12 were Hispanic/Latino (31.6%), three were Black (7.9%), two were Asian (5.3%), three were other (7.9%), and one was unknown (2.6%). 19 patients (50%) were male. 12 transplant patients were asymptomatic (31.6%), compared to five controls (13.2%, p=0.054). Of the symptomatic patients, the most common symptoms in the solid organ transplant group were fever (26.3%) and headache (18.4%), with few patients experiencing shortness of breath (5.3%). Hospital (15.8%) and ICU (5.3%) admission rates were equal in both groups, with a median length of stay of 4.5 days for the transplant group (IQR 5.25) versus 4 days (IQR 5.75) for controls (p=0.59). 32 patients in each group received supportive care as outpatients (84.2%). A minority of transplant patients received monoclonal antibody (6.3%), convalescent plasma (6.3%), steroids (6.3%), and remdesivir (3.1%). There was one case of MIS-C in the transplant group (2.6%) versus three in the control group (7.9%) (p=0.62). One transplant patient developed COVID-associated microangiopathy (2.6%), but there were no thrombotic complications among controls (p > 0.99). There were no new cases of cellular or antibody-mediated rejection following COVID-19. There was one death in the transplant cohort, but no deaths in the control group. Conclusion(s): We report the largest multi-organ cohort of pediatric solid organ transplant recipients with COVID-19 to date. Our findings suggest pediatric solid organ transplant patients fare similarly to healthy children, without elevated risk of complications.

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