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1.
Southern Journal of Business and Ethics ; 13:121-132, 2021.
Article in English | ProQuest Central | ID: covidwho-1957962

ABSTRACT

[...]we propose appropriate guidelines for organizations that balance their duty to maintain their employees' privacy and protect other employees and customers. Among these federal statutes are the Health Insurance Portability and Accountability Act of 1996, known as HIPAA14 which pertains to privacy rights for patients and medical record privacy, the Privacy Act of 197415 which pertains to personal information maintained by Federal agencies, and the Americans with Disabilities Act of 1990 (ADA)16 which prohibits employers from inquiring into the medical history or condition of applicants and prevents employers from discriminating against qualified individuals with a disability in regard to the terms, conditions, and privileges of employment. Some state statutes, like Wisconsin's right of privacy statute, explicitly acknowledge a right of privacy with respect to private medical information when the disclosure of such information would be highly offensive to a reasonable person.25 In Marino v. Arandell Corp., the court allowed an employee's privacy claim when his employer conducted prohibited medical inquiries about his condition, chronic Hepatitis C, and intentionally failed to maintain confidentiality with respect to his medical records.26 Nevertheless, some courts strictly construe the right to privacy. In Carter v. Tennant Co.,21 the court interpreted the Illinois Right to Privacy in the Workplace Act which prohibits any employer from inquiring into whether a prospective employee has ever filed a claim for benefits under the Illinois Worker's Compensation Act or the Illinois Workers' Occupational Diseases Act or received benefits under the Acts.28 Although the court acknowledged that the employer had questioned the prospective employee regarding whether he had suffered prior occupational injuries, lost time from work for a work-related injury or illness, or seen a medical doctor for any work-related injury or illness, the court denied the prospective employee's claim for a violation of the privacy act because the employer did not specifically ask whether the prospective employee had ever filed a workers compensation claim.29 Given the foregoing, an employee's right to privacy with respect to medical information is clear and compelling.

2.
European Journal of Clinical Pharmacology ; 78:S73, 2022.
Article in English | EMBASE | ID: covidwho-1955959

ABSTRACT

Introduction: The use of antidepressants seems to be increasing in most countries worldwide, probably due to the increasing burden of stressful life (1). Apart from their therapeutic application, antidepressants are sometimes used as lifestyle drugs. Monitoring antidepressant usage is crucial to prevent unnecessary consumption and avoid adverse effects and additional costs (2). Objectives: The aim of this work was to study trends in antidepressants utilization in various European countries, and to note changes in their usage between the years 2013 and 2019, before the outbreak of COVID 19 pandemic. Methods: Data on antidepressants consumption in 20 European countries were collected from the Organization for Economic Cooperation and Development (OECD) data bases. Antidepressants consumption was expressed in Defined Daily Doses (DDDs) per 1,000 inhabitants per day, and calculations referred to years 2013 and 2019. Changes in antidepressants use during this six-year period in each European country were assessed. The statistical package SPSS (Chicago, IL, USA) was used for calculations. Results: There was a huge variation in antidepressants usage among the 20 countries of our study. The mean consumption of antidepressants was 52.67 DDDs per 1,000 inhabitants per day in 2013 (range 10.2-113.7 DDDs) and 62.51 DDDs per 1,000 inhabitants per day in 2019 (range 17.6-146.0 DDDs), with a mean increase of 9.84 DDDs per 1,000 inhabitants per day (18.68%) in just six years. The countries with the highest consumption of antidepressants in 2013 were Iceland (113.7 DDDs), Portugal (87.5 DDDs), Sweden (84.3 DDDs), Belgium (72.1 DDDs), Finland (69.4 DDDs) and Spain (65.2 DDDs). The countries with the highest consumption of antidepressants in 2019 were Iceland (146.0 DDDs), Portugal (123.7 DDDs), Sweden (102.7 DDDs), Spain (83.6 DDDs) and Belgium (81.9 DDDs). The countries with the lowest consumption of antidepressants in 2013 were Latvia (10.2 DDDs), Estonia (21.4 DDDs), Lithuania (24.7 DDDs), and Hungary (27,5 DDDs). The countries with the lowest consumption of antidepressants in 2019 were Latvia (17.6 DDDs), Hungary (29.5 DDDs), Estonia (34,8 DDDs) and Lithuania (35,4 DDDs). The use of antidepressants was increased in all European countries in the study period. There was only one exception: Finland, being one the countries with the highest consumption of antidepressants, reduced their use by 13%. In the countries with the lowest consumption of antidepressants (Latvia, Estonia and Lithuania), the increase in antidepressants usage was higher than 40%. A similarly high increase (41.37%) was also observed in Portugal, which was second in antidepressant use in both years studied (2013 and 2019). The Countries with the lowest increase (less than 5%) were Austria, Norway and Luxemburg, which displayed an average consumption of antidepressants in the study period. Conclusion: There was a huge variation in antidepressants use among the 20 European countries of our study. A trend for increase in antidepressants use was observed in almost all countries during the six-year study period.

3.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927745

ABSTRACT

RATIONALE: The discharge of patients from the ICU to the hospital ward is a high-risk period. Previously, we used Human-Centered Design - an iterative, collaborative process for user-focused solutions - to develop a prototype structured ICU-ward transfer communication tool for clinicians by focusing on resident-to-resident communication. We describe here an approach to rapid prototyping with the specific focus on meeting the needs academic Hospitalists. METHODS: In winter 2021, we conducted a voluntary focus group of Hospitalists at the University of Chicago to ensure that a recently developed ICU- ward transfer tool created through prior focus groups with resident also met the needs of hospital medicine clinicians. The focus group was conducted via videoconference due to the COVID-19 pandemic. With participants' consent, we recorded and transcribed the focus group discussions conducted over the Zoom platform. Following transcription, qualitative analysis on the transcript was used to look for common themes and concerns. Coding was performed using both a theory driven (deductive) and data driven (inductive) approach. RESULTS: The focus group identified several main themes around the role, content, and workflows related to an ideal ICU-wards handoff tool: (1) how the tool can communicate the patient course clearly through multiple verbal hand-offs;(2) that the ICU-ward handoff process must balance thoroughness, usability, and reducing the propagation of copy/paste errors;and (3) that design and implementation should provide hand-off communication between providers and patient families. Under these themes, participants identified specific attributes of an ideal handoff tool (Table 1), which coalesced around 3 main goals: (1) to synthesize key details and communicate the ICU team's thought process and follow up tasks (summarized in Table 1A);(2) to integrate the new tool into the EHR that minimizes documentation errors and communicates transfer status in the EHR to help handoffs between shifts (1B);and (3) to serve as a standardized process to ensure communication is bridged between teams and patient families (1C). CONCLUSIONS: Participants valued organization of handoff information, succinct information, EHR integration, and standardization of family communication when modifying a framework. One notable difference is our Hospitalist group focused on brevity while our resident group preferred a longer detailed course. Further work will need to be performed to find balance the needs between these two groups to ensure efficient handoffs.

4.
Obstetrics and Gynecology ; 139(SUPPL 1):5S, 2022.
Article in English | EMBASE | ID: covidwho-1925581

ABSTRACT

INTRODUCTION: Prior to the COVID-19 pandemic, Planned Parenthood of Illinois (PPIL) provided in-clinic contraceptive services to over 10,000 patients/year. At pandemic onset, PPIL rapidly consolidated services to six health centers and launched telehealth. This study aims to understand the disruptions of the pandemic on contraceptive access and to understand the impact of telehealth as measured by changes in time to appointment and method mix. METHODS: Retrospective contraceptive service delivery data were analyzed before (March 2019-March 2020) and during (March- October 2020) the pandemic. Time to appointment was defined as days from date appointment was made to originally scheduled appointment date. Method mix was dichotomized as pill/patch/ring or long-acting reversible contraception (LARC). Other methods were excluded. Descriptive and comparative statistics were generated. Institutional review board approval was received from the University of Chicago. RESULTS: Before the pandemic, median (IQR) time to in-clinic appointment was 5 (2-9) days compared to 11 (5-15) days during the pandemic. Median time to telehealth appointment was 4 (2-8) days. During the pandemic, 6,615 patients received contraceptive services, 1,701 through telehealth and 4,914 in-clinic, with 91.9% choosing pill/patch/ring or LARC methods. When dichotomized, method mix slightly changed with 57.0% of patients, prepandemic, choosing pill/patch/ring methods compared to 54.9% patients during the pandemic (P=.006). During the pandemic, 41.4% of pill/patch/ring visits were through telehealth and 58.6% through in-clinic visit. CONCLUSION: Telehealth appointments were available sooner than in-clinic visits and uptake of telehealth visits for patients obtaining pill/patch/ring was substantial. The small change in method mix is likely not clinically significant.

5.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925444

ABSTRACT

Objective: The aim of this study was to characterize patients hospitalized with COVID-19 and cerebrovascular disease, with a focus on young patients diagnosed with CVST and ICH/SAH. Background: There have been many reported neurologic manifestations of coronavirus disease 2019 (COVID-19) including cerebrovascular events such as ischemic stroke, hemorrhagic stroke including intracerebral hemorrhage/subarachnoid hemorrhage (ICH/SAH) and central venous sinus thrombosis (CVST). However, there has not been much focus on this topic in young adults aged under 50. Design/Methods: Retrospective chart review was used to obtain parameters of patients hospitalized in Chicago area hospitals with COVID-19 and a neurologic diagnosis including acute ischemic stroke, subarachnoid hemorrhage, intracranial hemorrhage, and cerebral venous sinus thrombosis. Data including patients' comorbidities and disease course was entered into a secure database by representatives from 4 different tertiary care centers. Results: A total of 27 patients aged 18 to 50 were hospitalized in Chicago land tertiary care centers from March 30, 2020 to February 1, 2021 with cerebrovascular disease and concurrently tested positive for COVID-19. Of these patients, 2 were found to have venous sinus thrombosis. 9 patients had hemorrhagic strokes, of these, 4 patients with ICH were thought to have had spontaneous hemorrhages. 9 of 27 patients had no past medical history. Conclusions: This population had a large portion, 11 out of 27 patients, with non-ischemic cerebrovascular insults such as CVST, ICH, or SAH while concurrently infected with COVID-19. Unlike most classic patients who develop these conditions, our population did not have traditional risk factors such as smoking or hypertension. Systemic inflammation, hypoxia, platelet dysfunction, or hyper-coagulability due to COVID-19 are theorized as the cause of these cerebrovascular manifestations in the absence of traditional risk factors. Spontaneous cerebrovascular manifestations of COVID-19 continue to be investigated, particularly in younger patients without traditional risk factors.

6.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925346

ABSTRACT

Objective: To determine whether background frequency on encephalogram (EEG) was associated with hospital discharge disposition in COVID-19 patients. Background: Neurological complications, including encephalopathy, have been reported up to 80% of hospitalized COVID-19 patients. It is unclear how encephalopathy during acute illness is related to clinical outcomes in COVID-19 patients. Design/Methods: Subjects were drawn from hospitalized patients who received an EEG at single tertiary center between March 2020 and February 2021. Included were adult subjects with confirmed COVID-19 during hospitalization who were not in the intensive care unit at the time of EEG evaluation. Clinical outcome measured was disposition upon discharge, graded as variables: 0-home, 1-acute rehabilitation, 2-subacute rehabilitation, 3-long term acute care hospital, and 4-death. Background frequency on EEG was used as a measure of encephalopathy severity and was assessed in occipital channels. EEG and medical records were reviewed retrospectively. We used two-independent t test for univariate analysis. Significant variables were then analyzed with multivariate linear regression in SPSS. Study was approved by the University of Chicago IRB. Results: A total of 50 subjects were included. Reasons for EEG were concern for seizure (n=14, 28.0%), altered mental status (n=33, 66.0%), and others (n=3, 6.0%). According to WHO COVID-19 severity scale, on admission 37 (74%) patients had ambulatory disease, 11 (22%) had moderate disease, and 2 (4.0%) severe disease. Thirteen (26.0%) patients received COVID-19 treatment, 4 (8.0%) with steroid. Sodium upon admission, history of epilepsy, cefepime use, intubation, and EEG background frequency were all significant predictors of disposition with univariate analysis (p <0.05). Multivariate analysis showed only intubation (B 1.347, p=0.03) and background frequency on EEG (B -0.282, p <0.001) as independent predictors of disposition. Conclusions: EEG background frequency was a predictor of discharge disposition in COVID-19 patients, and patient with low background frequencies were less likely to be discharged home.

7.
Obstetrics and Gynecology ; 139(SUPPL 1):38S, 2022.
Article in English | EMBASE | ID: covidwho-1925245

ABSTRACT

INTRODUCTION: Initial COVID-19 vaccine trials excluded pregnant individuals, making eventual vaccine recommendations nongeneralizable. After noninferiority was established, the Centers for Disease Control and Prevention, World Health Organization, and American College of Obstetricians and Gynecologists supported vaccination of this group. However, only 31% of pregnant patients accepted vaccination. This study aims to assess COVID-19 vaccine hesitancy in reproductive-aged females. METHODS: We developed a REDCap survey using a validated COVID-19 vaccine hesitancy survey tool. From August to November 2021, women aged 18-50 years were recruited from inpatient and outpatient obstetrics and gynecology services at the University of Illinois Hospital. We performed t tests and ANOVA statistics using SPSS. RESULTS: A total of 51 patients partially or fully completed the survey. The results revealed that Black individuals are more hesitant than Hispanic and White individuals (F2,44=3.45, P<.50). Specifically, Black women differed in the belief that the COVID-19 vaccine is safe overall (F2,44=5.62, P<0.01) and in pregnancy (F2,46=4.95, P<0.01). Pregnant patients were less confident that the COVID-19 vaccine is safe overall (F2,45=7.44, P<0.01) as well as in pregnancy (F2,47=6.26, P<0.01) compared to those recently pregnant or not pregnant. Individuals who declined the flu vaccine were more likely to be vaccine hesitant (t46=-4.49, P<.001). Participants' age, occupation, and contraception status were not associated with vaccine hesitancy. CONCLUSION: Existing vaccine hesitancy highlights the need to study misconceptions regarding the safety of the COVID-19 vaccine.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925199

ABSTRACT

Objective: This research aims to characterize stroke awareness in homeless individuals of Chicago while providing guidance on stroke recognition and response. Additionally, we aim to assess the effects that the COVID-19 pandemic and social isolation have on stroke risk factors. Background: Strokes occur every 40 seconds in the United States and are one of the leading causes of preventable death and debilitation for both men and women. Higher stroke mortality rates occur in neighborhoods with larger proportions of Black residents and lower median incomes. Some physicians are concerned that risk factors for stroke such as physical inactivity and poor diet have worsened in the setting of the COVID-19 pandemic and have led to an even higher risk stratification in these populations. Design/Methods: A 53-item stroke survey along with health and wellness questionnaires were administered to 40 residents at A Safe Haven, a social enterprise serving the homeless. Participants were recruited at random from a booth on-site. Results: The majority of participants were Black (n=36/40) with most being between the ages 30-44. Participants identified as male (n=18) or female (n=22). Those surveyed endorsed decreased physical activity levels (m=2.2/5) and increased screen time (m=4.0/5) since the beginning of the pandemic. Subjectively worse dietary changes were reported in 78% of participants since the pandemic began. Stroke symptom and risk factor awareness was poor in 29%, fair in 40%, and good in 31% of participants. Among those surveyed, 45% agreed they would not be able to recognize a stroke and 55% agreed they would not know what to do if they witnessed a stroke. Conclusions: These data suggest that poor stroke awareness, decreased physical activity levels, and worsening dietary habits have become more prevalent among homeless populations in Chicago during the ongoing pandemic. Our goals of promoting healthy lifestyles and raising stroke awareness are particularly important during this time.

9.
Open Access Macedonian Journal of Medical Sciences ; 10:1143-1147, 2022.
Article in English | EMBASE | ID: covidwho-1917904

ABSTRACT

BACKGROUND: Cancer patients may be susceptible to COVID-19 infection due to decreased immune status. Breast cancer is the most common cancer in Indonesia, still has high admission, which increasing the risk of exposure to COVID-19. AIM: Thus, this study aimed to identify hospitalized breast cancer patients diagnosed with COVID-19 infection 1 year after the pandemic. METHODS: This is a cross-sectional study that was conducted in the Adam Malik General Hospital in Medan, Sumatera Utara, Indonesia. The enrolled subjects were those who previously histopathologically confirmed with breast cancer and having laboratory-confirmed COVID-19 infection The sources of baseline, clinical, and laboratory data were retrieved from the electronic medical records. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA). RESULTS: A total of 17 female breast cancer subjects with COVID-19 infection were enrolled in this study. Mostly subjects were multiparity, highest education was junior high school, housewife, menopause, diagnosed in Stage IV, had metastasis in lung, and categorized luminal B with invasive cancer of non-special type. Most subjects showed mild clinical and radiological severity of COVID-19 infection. Low leukocyte, high neutrophil-to-lymphocyte, and high platelet-to-lymphocyte counts were significantly differed between alive and death outcome in the subjects. CONCLUSION: The baseline and clinical characteristics of female breast cancer subjects with COVID-19 infection were similar to general characteristics in the population. The parameters of leukocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte counts could be a valuable predictive parameters of mortality outcomes.

10.
Nephrology Dialysis Transplantation ; 37(SUPPL 3):i655-i656, 2022.
Article in English | EMBASE | ID: covidwho-1915777

ABSTRACT

BACKGROUND AND AIMS: SARS-CoV-2 represents a challenge for hemodialysis (HD) patients due to their diminished immune defenses in the setting of kidney disease, multiple comorbidities and older age. COVID-19 vaccines have brought hope but these patients' reduced response to immunization with the hepatitis B and influenza vaccination raised concerns about a lower efficacy of the new vaccines. This study aimed at quantifying IgG in sequential samples from HD patients and compare its titers with those of a non-HD healthy population, after vaccination. METHOD: We compared IgG titers using Abbott SARS-CoV-2 IgG II Quantitative Antibody Assay on the Alinity i system (Abbott Diagnostics, Chicago, US), 3-4 months after the Pfizer-BioNTech COVID-19 vaccine in 54 HD patients and 59 non-HD controls. This method is a two-step chemiluminescent microparticle immunoassay used for the quantitative determination of IgG antibodies to the receptor binding domain of the S1 subunit of the spike protein of SARS-CoV-2. HD patients performed their treatments at the HD unit of Felgueiras, a municipality in the district of Porto, Portugal, and were vaccinated in January/February 2021. The controls were healthcare workers from the hospital of Gaia. All HD patients received 2 vaccine doses even if they had previously had COVID-19 (N = 8) whereas controls only received 1 dose of the vaccine if they had been infected (N = 28). For 48 of the HD patients, we reassessed IgG levels 8 months after vaccination and compared it with the first measurements. Statistical analysis used SPSS ® . Parametric variables were described with mean ± standard deviation and compared using independent and paired-samples t-tests. Non parametric variables were described with median ± interquartile range (IQR) and compared using Mann-Whitney U and Wilcoxon tests. RESULTS: HD patients were older (67.6 ± 15.8 years of age) when compared to the healthy controls (42.4 ± 12.1 years of age). Only 1 HD patient had IgG below the positive cutoff after vaccination, all others seroconverted. Median values were significantly lower among HD patients compared to the controls (973 IQR 387-3306 versus 4809 IQR 2557-7746 AU/mL;p < 0.001). This difference remained significant even if those who had COVID-19 were removed from the analysis (p < 0.001). Those who had had COVID-19 before vaccination, showed significantly increased IgG levels compared to those who had not (6956 IQR 4810-13 101 versus 1520 IQR 554-3950 AU/mL;p < 0.001), a similar finding among HD and non-HD individuals. In HD patients for whom this data was available, IgG levels decayed from month 4 to month 8 (973 IQR 387-3306 versus 382 IQR 168-2071 AU/mL;p < 0.001). CONCLUSION: HD patients seem to have an impaired immune response after the COVID-19 vaccines, similar to what happens with vaccines against other viruses. After the Pfizer-BioNTech COVID-19 vaccine 98% of the patients seroconverted. Although they were older which may have played a role, a limitation to the analysis, IgG titers were lower in HD-patients than in the control group. Antibodies declined over the next months. This decline may be associated with loss of neutralizing antibodies, cellular responses to SARS-CoV-2 and risk of reinfection.

11.
YC Young Children ; 77(2):64-66, 2022.
Article in English | ProQuest Central | ID: covidwho-1905099

ABSTRACT

[...]when I started having regular nightmares and was scared to go to school, my parents-my biggest champions and protectors-not only spoke with the school administration but also took me to a child psychologist. Later, she worked part time in a child care setting-perhaps spurring my interest in early learning. With the field still being ignored by federal investments and still not being funded in the necessary ways to create an equitable system, it is no surprise that early childhood educators are leaving. Look to this column and NAEYC's other resources for updates and opportunities to join me in the unabashed and unapologetic work with and for young children and our field.

12.
et Cetera ; 78(1/2):8-38, 2021.
Article in English | ProQuest Central | ID: covidwho-1887781

ABSTRACT

On December 2, 2020, Lance Strate, who was at the time President of the New York Society for General Semantics (NYSGS), convened a virtual session in place of the monthly sessions he had coordinated, until the time of COVID-19, at The Players Club in New York City. One of the unforeseen benefits of holding virtual sessions during COVID times was that local organizations like the NYSGS were able to spread their net much wider in terms of both presenter-participants and audience. For this particular occasion, Lance invited a group ofjazz composer-musicians from Chicago and the San Francisco Bay area who he discovered while surveilling the Internet for mentions of general semantics. The group, the Geof Bradfield/Ben Goldberg/Dana Hall Trio, had just released, in September 2020, an album entitled General Semantics (Delmark DE5035 ©2020 Delmark Records LLC). The driving question of the session was of course: "Why General Semantics as a title for your album?" The following is an edited transcript of the conversation that took place on that evening.

13.
Topics in Antiviral Medicine ; 30(1 SUPPL):299, 2022.
Article in English | EMBASE | ID: covidwho-1880591

ABSTRACT

Background: People who use unregulated drugs (PWUD) in Canada and the United States (US) are contending with the intersection of two simultaneous health crises: the COVID-19 pandemic and the longstanding drug poisoning crisis. However, the possible contributions of COVID-related factors to increases in overdoses during the pandemic are not well understood. Our study objectives were to assess the prevalence of non-fatal overdose and identify factors associated with overdose among participants in nine prospective cohorts of PWUD in urban centers in Canada (Vancouver, BC) and the US (Baltimore, MD;Miami, FL;Chicago, IL;Los Angeles, CA) during the COVID-19 pandemic. We further sought to examine the prevalence of and identify factors associated with reporting being highly impacted day-to-day by COVID-19. Methods: Data were derived from the nine cohorts in the NIDA-funded C3PNO consortium between May, 2020 and April, 2021. Multivariable logistic regression was used to identify factors associated with nonfatal overdose and day-to-day impact among participants who had used unregulated drugs in the past month. Results: Among 885 participants, 253 (28.6%) were female and 41 (4.6%) had reported experiencing a non-fatal overdose. Most of the sample reported being worried and approximately half reported being highly impacted day-to-day by the pandemic. In multivariable analyses, individuals who had experienced an overdose were more likely to be female (Adjusted Odds Ratio [AOR]=2.18;95% Confidence Interval [CI]:1.10-4.30);unstably housed/homeless (AOR = 2.16;95% CI: 1.11-4.26);engaged in medications for opioid use disorder (MOUD) (AOR = 2.45;95% CI: 1.19-4.97);and highly impacted day-to-day by COVID-19 (AOR = 2.42;95% CI: 1.22-5.10). In a second multivariable model, highly-impacted individuals were more likely to report higher levels of COVID-related worry (AOR = 1.30;95% CI: 1.23-1.37) and stocking up on drugs (AOR = 1.59, 95% CI: 1.09-2.32) due to the pandemic. Conclusion: Our findings indicate a need for a multi-level approach involving the spectrum of care services to meet the elevated risks of overdose in the context of the dual crises, particularly among women, those unstably housed/homeless and those who reported being highly impacted day-to-day by the pandemic. Efforts to prevent overdose, however, should prioritize addressing the root causes of the drug poisoning crisis, such as the continuous exposure to toxic and contaminated unregulated drug supplies among PWUD.

14.
Topics in Antiviral Medicine ; 30(1 SUPPL):377-378, 2022.
Article in English | EMBASE | ID: covidwho-1880557

ABSTRACT

Background: During the COVID-19 pandemic, HIV care providers urgently adopted telemedicine as an alternative to routine in-person person visits to ensure continuity of care. We examined how introducing televisits at a community and an academic outpatient HIV clinic during the COVID-19 pandemic affected technical quality of care for persons with HIV (PWH). Methods: The study included all non-pregnant adult PWH who had at least two visits for HIV care in the 18 months prior to 3/13/2020 at the Howard Brown Health Centers (HB) and Northwestern University Infectious Disease Center (NU-IDC) and in Chicago, Illinois. HIV care quality indicators (described in Table) were calculated using data extracted from electronic medical records during 4 different time periods: 1. pre-pandemic (1/1/19-3/1/2020), 2. early pandemic (7/1/2019-9/1/2020), 3. mid-pandemic (1/1/2020-3/1/2021), and 4. current (7/1/2020-9/1/2021). Measures were compared between intervals 2-4 and interval 1 (pre-pandemic) using generalized linear mixed models to estimate differences in indicators across intervals within each site while controlling for multiple observations of individuals. Differences by age group, race, and sex at birth were also compared. Results: 6,447 PWH were included in the analysis. The proportion of televisits peaked between April-June 2020 (71-75% at HB 53-89% at NU-IDC) then declined by July-September (33-35%at HB, 10-15% at NU). Changes in quality care measures are shown in Table 1. There were significant declines in care utilization and disease monitoring measures in intervals 2,3 &4 compared to interval 1. The largest declines were observed in STI screening. Measures of HIV virologic suppression, BP control, and HbA1C <7% (in both persons with and without diabetes) were stable with no significant differences noted in these measures between interval 4 and 1. Similar trends were observed across all age, race and sex subgroups. Conclusion: During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and disease monitoring decreased compared to pre-pandemic levels. Despite these reductions, proportions with virologic, BP, and glycemic control remained stable among PWH. The effect of televisits as well as other patient factors on HIV quality indicators and their changes over time during COVID-19 need to be further examined.

15.
Topics in Antiviral Medicine ; 30(1 SUPPL):302-303, 2022.
Article in English | EMBASE | ID: covidwho-1880351

ABSTRACT

Background: The greater Chicagoland area has recorded over 10,000 COVID-related deaths and nearly 600,000 cases since the start of the COVID-19 pandemic in March of 2020. SARS-CoV-2, the causative agent of COVID-19, has continually changed over that time, with some variants evolving to become more transmissible or more resistant to neutralizing antibody responses. Methods: To better understand how viral genetic variation has contributed to differences in COVID-19 pathogenesis and patient outcome, we established a biobank of residual diagnostic samples from adult patients who tested positive for COVID-19 in a PCR-based test at Northwestern Memorial Hospital. Thus far, we have collected samples from 6448 out-patients and 632 in-patients. Of these, we have performed whole genome sequencing and viral load calculations on 1373 samples. Clinical and demographic information, including composite measures of disease severity, were extracted from available electronic health records. These data were assessed for longitudinal patterns and for specific association with viral lineage. Results: We found that the early epidemic in March of 2020 was defined by three distinct lineages reflecting the outbreaks in China (19B/A), Washington state (19B/A.1), and New York state (19A/B.1). By November of 2020, we saw a large increase in the number of confirmed cases, dominated by the 20G clade. This lineage remained predominant until March of 2021, when the Alpha and Gamma variants of concern became more established. These were recently supplanted by the Delta variant, which now accounts for over 90% of Chicago cases. At the height of the pandemic in November of 2020, case counts peaked at over 5000 cases per day, but hospitalizations, ICU admissions, and deaths over this period remained flat. Statistical testing revealed that the predominant clade at that time, 20G, was associated with better outcomes and less severe disease as measured by clinical measures of patient deterioration, even when controlling for patient demographics. These results suggest that a viral variant associated with less severe disease was predominant in late 2020 before the emergence of the more transmissible variants of concern. Conclusion: Current work is being done to determine if the less severe outcomes associated with this clade also contributed to more asymptomatic transmission, potentially contributing to the high case counts recorded over this period. These data emphasize the need for continued genomic surveillance of SARS-CoV-2 to character.

16.
Topics in Antiviral Medicine ; 30(1 SUPPL):380, 2022.
Article in English | EMBASE | ID: covidwho-1880225

ABSTRACT

Background: The potential impact of COVID-19 pandemic on the US HIV epidemic remains unclear. Characterizing the scope and main drivers of the impact of COVID-19 on HIV incidence can inform future HIV policy. Methods: We characterized the impact of COVID-19 pandemic and attendant lockdowns on HIV epidemiology via reductions in sexual transmission (0-50%) from March 1st, 2020 to July 4th, 2021, plus reductions in viral suppression (0-40%), HIV testing (0-50%), and pre-exposure prophylaxis use (0-30%) from March 1st to February 4th, 2022. Using the Johns Hopkins Epidemiologic and Economic Model (JHEEM) of HIV transmission, we projected HIV infections from 2020 to 2025 across 32 high-priority US cities and compared these to projections if COVID-19 had not emerged. Results: Across all 32 cities, 80% of simulations projected a decline in HIV incidence in 2020 (median decrease of 15% from 2019), before rebounding in 2021 (96% of simulations, median increase of 13% from 2020)-see Figure, panel B. Projections of the impact of the COVID-19 pandemic on cumulative HIV incidence from 2020-2025 varied by city, ranging from a median of 3% fewer incident cases in Las Vegas to 9% more incident cases in Boston (Figure, panel A). At the MSA level, reductions in sexual transmission had the strongest impact on incidence, followed by reductions in viral suppression. Among simulations that incorporated large (>25%) reductions in viral suppression due to COVID-19, adverse impacts on HIV incidence were greater where pre-pandemic levels of viral suppression were higher (ranging from a median 1% increase in cumulative incidence 2020-25 in Chicago with 52% pre-pandemic suppression, to a 24% increase in Seattle with 86% pre-pandemic suppression-Figure, panel C). Conclusion: The effects of COVID-19 on HIV transmission remain uncertain and differ substantially at the local level. Disruptions to HIV care and viral suppression due to the COVID-19 pandemic may have greater impact in increasing HIV incidence in settings where pre-existing suppression levels are higher.

17.
Fertility and Sterility ; 116(3 SUPPL):e33, 2021.
Article in English | EMBASE | ID: covidwho-1880166

ABSTRACT

OBJECTIVE: To assess Telehealth services offered by Society for Assisted Reproductive Technology (SART) member clinics and provider experiences with incorporating Telehealth into reproductive endocrinology and infertility practices. MATERIALS AND METHODS: A 16-question web-based survey on use of Telehealth was distributed to SART member reproductive endocrinology and infertility clinics. Clinic demographic data, Telehealth descriptive data and provider satisfaction with use of Telehealth were assessed. Results were collected via Survey Monkey. RESULTS: A total of 330 SART clinics were reached via email. 38 clinics responded (11.5%), representing 17 unique states, with California, NewYork, and Illinois most commonly represented. 22 clinics (59.5%) were private, 12 (32.4%) were university-affiliated and 3 (8.11%) were health system-based. 25 clinics (67.6%) were described as suburban and 12 (32.4%) were urban. All 38 clinics surveyed offer Telehealth visits. The most common Telehealth platform was Zoom (58.6%), followed by use of telephone or landline (41.4%), and Telehealth service through electronic medical platform (31%). New patient consultations and return visits were offered by 36 (94.7%) and 35 (92.1%) of clinics, respectively. The most common types of consultations offered were related to fertility (100%), reproductive endocrinology (94.7%) and reproductive surgery (73.7%). Only 13 clinics (34.2%) offered Telehealth services before the COVID-19 pandemic;most of these clinics estimated that 25-50% of visits were done via Telehealth before the pandemic. Half of the clinics estimated that>75% of visits were done via Telehealth during the pandemic. The majority of clinics (89.5%) anticipate they will offer Telehealth visits after the COVID-19 pandemic. 63.2% of clinics anticipate fewer Telehealth visits after the pandemic because of logistics (28.6%) and patient preference (25.7%). Most providers (73.7%) stated that they are ''very satisfied'' with Telehealth overall. CONCLUSIONS: Telehealth enabled safe patient-provider interactions throughout the COVID-19 pandemic for all clinics that responded to this survey, most commonly performed via Zoom. While only few clinics offered Telehealth services before COVID-19, the majority of clinics anticipate that they will continue to offer Telehealth after the pandemic. There is ongoing research assessing patient satisfaction with Telehealth, and future research can focus on ways to overcome logistical issues to widen use of a service that is considered satisfactory for providers and patients alike. IMPACT STATEMENT: Telehealth is a method of care delivery that reduces risk of cross-contamination caused by close contact (1), critical during pandemics and convenient under other routine circumstances as well. All clinics surveyed used Telehealth during the COVID-19 pandemic. Most providers express great satisfaction with Telehealth and anticipate they will offer Telehealth services henceforth.

18.
Estudos Históricos ; 35(76):208-223, 2022.
Article in English | ProQuest Central | ID: covidwho-1879352

ABSTRACT

An interview with American sociologist Howard Becker is presented. Among other things, Becker shares his memories of Gilberto Velho and his visits to Brazil. He also talks about his training as sociologist in Chicago and the sociological perspective.

19.
Emerg Infect Dis ; 28(6): 1281-1283, 2022 06.
Article in English | MEDLINE | ID: covidwho-1862553

ABSTRACT

Bars and restaurants are high-risk settings for SARS-CoV-2 transmission. A multistate outbreak after a bar gathering in Chicago, Illinois, USA, highlights Omicron variant transmissibility, the value of local genomic surveillance and interstate coordination, vaccination value, and the potential for rapid transmission of a novel variant across multiple states after 1 event.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Chicago/epidemiology , Disease Outbreaks , Humans , Illinois/epidemiology , SARS-CoV-2/genetics
20.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-337493

ABSTRACT

Background. Monitoring the emergence and spread of SARS-CoV-2 variants is an important public health objective. Travel restrictions, aimed to prevent viral spread, have major economic consequences and unclear effectiveness despite considerable research. We investigated the introduction and establishment of the Gamma variant in New York City (NYC) in 2021. Methods. We performed phylogeographic analysis on 15,967 Gamma sequences available on GISAID and sampled between March 10th through May 1st, 2021, to identify geographic sources of Gamma lineages introduced into NYC. We identified locally circulating Gamma transmission clusters and inferred the timing of their establishment in NYC. Findings. We identified 16 phylogenetically-distinct Gamma clusters established in NYC (cluster sizes ranged 2-108 genomes). Most of the NYC clusters were introduced from Florida and Illinois;only one was introduced from outside the United States (US). By the time the first Gamma case was reported by genomic surveillance in NYC on March 10th, the majority (57%) of circulating Gamma lineages had already been established in the city for at least two weeks. Interpretation. Despite the expansion of SARS-CoV-2 genomic surveillance in NYC, there was a substantial gap between Gamma variant introduction and establishment in January/February 2021, and its identification by genomic surveillance in March 2021. Although travel from Brazil to the US was restricted from May 2020 through the end of the study period, this restriction did not prevent Gamma from becoming established in NYC as most introductions occurred from domestic locations.

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