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1.
Investigative Ophthalmology and Visual Science ; 63(7):2155-A0183, 2022.
Article in English | EMBASE | ID: covidwho-2058317

ABSTRACT

Purpose : The effect of coronavirus disease 2019 (COVID-19) on ophthalmic surgical case numbers in Australia and globally remains poorly characterised. Increased incidence of COVID-19 in Australia between March and April 2020 led to a national lockdown and elective surgery restrictions. The aim of this population-based study was to quantify the early impact of COVID-19 on ophthalmic surgery in Australia, comparing surgical service rates in 2019 and 2020. Methods : Retrospective analysis of the number of ophthalmic surgical services in 2019 and 2020 in all Australian States and Territories, as recorded by Medicare (Australian Government-funded universal health insurance scheme subsidising healthcare costs for Australian residents). Monthly surgical service rates were calculated and Poisson regression was used to compare the change in service rates between months. Results : Between March and April 2020, surgical service rates decreased for: cataract surgery (by 71%, 95% CI: 70-72%), cataract surgery with minimally invasive glaucoma surgical device insertion (by 71%, 95% CI: 65-75%), pterygium removal (by 67%, 95% CI: 60- 72%), corneal transplantation (by 31%, 95% CI: 9-48%), and collagen crosslinking for corneal ectasias (by 35%, 95% CI: 18-48%). Comparatively, service rates for these surgeries did not differ or decreased less between March and April 2019. Interestingly, glaucoma filtration surgery rates decreased between March and April in 2020 (by 44%, 95% CI: 29- 56%) and also in 2019 (by 45%, 95% CI: 31-55%), whilst retinal detachment surgery rates were unchanged between these months in 2020 (crude decrease 9%, 95% CI: -28 to 16%) and 2019 (crude decrease 11%, 95% CI: -26 to 9%). Conclusions : Despite relatively low rates of COVID-19 community transmission in Australia in 2020, ophthalmic surgical service rates decreased during months in lockdown and with restrictions, largely for non-time-critical conditions. These data may have health planning implications as the pandemic continues, with future lockdowns and restrictions possible, especially as COVID-19 variants emerge.

2.
Investigative Ophthalmology and Visual Science ; 63(7):2139-A0167, 2022.
Article in English | EMBASE | ID: covidwho-2058118

ABSTRACT

Purpose : Pandemic era restrictions on non-essential travel, redistribution of healthcare resources, and nursing shortages have impacted the ability of ophthalmologists to deliver care. California had among the strictest 2020 restrictions during the pandemic with reallocation of non-essential surgical resources. This study assesses changes in surgical volume of common ophthalmic procedures in California since the COVID-pandemic. Methods : The California Health and Human Services Agency (Office of Statewide Health Planning & Development) maintains ambulatory and emergency room procedural databases. Common ophthalmic procedures and surgical volumes were extracted for 29 CPT codes from 2014-2020. Procedures with fewer than 100 cases were excluded. Results : Overall, ophthalmology surgical volume decreased by 19% from 2019 to 2020. Greatest declines were for anterior lamellar corneal transplant (39%) and pterygium with graft (38%). Simple cataract surgeries declined by 29% in 2020, compared to an average annual decline of 3% from 2014-2019. Volume increased only for two surgeries: aqueous shunt with graft (2%) and complex retinal detachment (0.2%). Temporal artery biopsies, historically stable with 0.2% average change from 2014-2019, declined by 28% in 2020. Retinal detachment repairs declined by 20% and 17% (with and without vitrectomy, respectively). In comparison, laparoscopic appendectomy only declined by 2% in 2020. Limitations of this study include role of population changes and changes in annual coding practices. Conclusions : COVID era declines were noted across almost all ophthalmic surgeries with steep drops in perceived non-urgent procedures such as pterygium and cataract. However, delays in cataracts and other conditions can result in increased disease burden and morbidity for patients. Uniquely, tube shunt procedures increased, perhaps due to progression of glaucoma from delayed routine care. For vision-preserving surgeries such as retinal detachment repair, lack of accessible care during the pandemic is especially concerning.

3.
Journal of the Intensive Care Society ; 23(1):150, 2022.
Article in English | EMBASE | ID: covidwho-2042963

ABSTRACT

Introduction: The aim of the audit was to assess the frequency of Emergency Department (ED) attendances before and after Intensive care and correlate this with functional decline and worsening comorbidities. Though the Covid 19 pandemic has highlighted this more starkly1 the implications of prolonged ICU care and increased long term care needs is well established.2 Objectives: A well-structured, comprehensive, multidisciplinary rehabilitation program during and after discharge from the hospital could improve outcomes and prevent further hospital/ED visits. Method: Data was collected using the ITU admission data base for all > 72 hour ITU patient stays over a two year period of 2017-2018 and 2018-2019 in a district general hospital in the UK. Each individual patient's number of same hospital ED attendances for twelve months before and after their ITU admission were reviewed and the causes for them assessed, in addition survival data over a two year period was also reviewed. Results: During 2017-2018 and 2018-2019 a total of 414 and 425 patients were admitted respectively to ITU for more than 72 hours (median= 133.5 hours). Of the total 839 ITU admissions 700 (83.4%) survived ICU stay. 165 (23.6%) of the 700 patients died in subsequent 2 years of ITU discharge. The two year survival rate was 65%. The most common ITU admissions reason was postoperative monitoring (20%) followed by Type 1 respiratory failure (18%) and Type 2 respiratory failure (15%). The median ED attendance was 0 (Range 0 to 29, mean 0.985, S.D 3.985) in the 17-18 and 0 (Range 0 to 24, mean 1.153, SD 2.154) in the 18-19 cohort in the 12 months prior to ITU admission while the median ED attendance was 0 (Range 0 to 15, mean 0.980, S.D 4.4) in the 17-18 and 0 (Range 0 to 15, mean 1.19, SD 2.0) in the 18-19 cohort in the 12 months following the ITU admission. 98% for 17-18 and 72% for 18-19 of ED reattendances following prolonged ITU stay were due to reasons similar to ITU care. Of the 445 patients with no prior ED attendance in 1 year, 168 or 38% (range 1 to 14) had at least one ED attendance in the 12 months following ITU discharge. The remaining 394 patients with at least one ED attendance prior to ICU, 185 or 47% (1 to 15 Range) had ED attendance 12 months following their ITU discharge. Conclusion: The results show that ITU admitted patients consume significant health resources before and after their ITU stay. Patients with no prior ED attendances before ITU admission also reattended in substantial numbers. Most of these attendances were related to their initial reason for ITU admission. A comprehensive rehabilitation program both in hospital and following discharge could improve patients' outcomes, reduce stress on emergency services and improve patient experience. A rehab service was implemented. The need for rehab program for Covid 19 patients during the pandemic has grown immense because of evolving evidence of Long Covid.3.

4.
Journal of the American Academy of Dermatology ; 87(3):AB170, 2022.
Article in English | EMBASE | ID: covidwho-2031394

ABSTRACT

Introduction: Hand dermatitis causes significant physical, psychosocial, and economic burden. The internet is a major source of health education for patients. Here, we evaluate the readability, quality, and comprehensiveness of online health resources on hand dermatitis. Methods: On July 27th 2021, a Google search was conducted with terms “hand dermatitis” and “hand eczema” and the first 40 items were evaluated. Articles that were advertisements, blogs, intended for professionals, scientific papers, or irrelevant were excluded. Contents of articles were evaluated using several validated grading tools/criteria for readability and quality and Pearson’s correlation assessed the relationship between readability and quality. Results: Twenty-three articles met inclusion criteria. Average readability was at the 11th-grade level (range 7.7-15.6). University-level reading comprehension (≥13th grade) was required for 5/23 websites. The highest quality website based on the Discern instrument was Medical News Today (55.5);nearly half of the websites (48%, 11/23) rated as poor or very poor. The average JAMA benchmark score was only 1.4/4. Nineteen websites contained images (83%) and only 4 websites (21%) included images representing hand dermatitis in skin of color (SOC). Quality and readability of the articles were significantly correlated (P =.02). Conclusion: Our results demonstrate that generally, articles were too difficult to read, have low quality, and lack representation of SOC images. With increases in hand dermatitis in the setting of frequent hand-hygiene practices during the COVID-19 pandemic, it is important for online health information to improve in readability, quality, and inclusion of SOC images to optimize online patient education.

5.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003279

ABSTRACT

Background: Immunization refusal rates in the United States are increasing. Ohio is below the national average for immunization rates, with even lower rates among children who are publicly insured. Our two hospital-based pediatric primary care offices serve 25,000 children from urban, underserved neighborhoods, with 90% publicly insured and 75% Black. Our immunization refusal rate is 2%, but nearly 10% of families refuse select immunizations or request alternative schedules. The drivers of local immunization rates are unknown. Our objective was to explore families' immunization beliefs and perspectives through interviews to allow for development of tailored information. The secondary objective was to evaluate caregiver impression of the newly developed educational information and measure the acceptability of these materials. Methods: This content analysis took place at a large, urban pediatric hospital's primary care offices. Caregivers of patients were recruited for interviews. We developed semi-structured interview guides after conducting a literature review and holding informal discussions with families at community meetings. The interview script included eight questions related to educational materials, desired topics, preferred learning format and reasons for vaccine refusal. Interviews were audio recorded, transcribed, and coded by one team member, then collectively analyzed by three team members to identify initial codes. The entire team discussed codes and resolved any discrepancies and then created categories. Educational materials were created based on the results of these interviews. Finally, caregivers at well child visits were approached to review the educational materials and provide written feedback, through pre- and post-surveys, to assess acceptability and impression of the materials. Results: Eighteen family were initially interviewed. Key educational topics identified by families included vaccine ingredients, side effects, and general benefits of immunizations. Reasons for vaccine refusal included concerns that vaccines cause disease, adverse side effects, and a fear of developing autism (Table 1). Written materials and videos were the preferred educational format, and families reported wanting these materials in conjunction with inperson discussions with the health care providers. Several educational resources were created: 1) a timeline displaying a typical vaccine schedule with descriptions of each vaccine, 2) a brochure addressing common concerns, and 3) a testimonial video with clinicians and caregivers describing “Why I Vaccinate.” The educational information was piloted with 51 families, and the majority of caregivers reported their questions were answered and they would likely share the information with family and friends (Table 2). Conclusion: Caregivers indicated preferences for written and digital materials to augment vaccinerelated discussions with healthcare providers. Educational materials tailored to address family concerns and learning preferences may enhance quality of conversations and ultimately decrease immunization refusal in our community. Next steps include distributing educational materials more broadly within primary care and evaluating impact on immunization rates. Similar approaches could be considered for newer vaccines, including COVID-19.

6.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003008

ABSTRACT

Background: The Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project was launched to improve access to oral health care by integrating the interprofessional oral health core clinical competencies into primary care. The competencies, described in the Health Resources and Services Administration's (HRSA's) report Integration of Oral Health and Primary Care Practice, facilitate change in the clinical practice of primary care health professionals (PCPs) working in safety net settings.1 Health professionals providing primary care include family physicians, pediatricians, obstetricians, nurse midwives, nurse practitioners, and physician assistants. The PIOHCPC project was funded by the Maternal and Child Health Bureau and supported by the National Maternal and Child Center for Oral Health Systems Integration and Improvement (COHSII). COSHII, led by the National Maternal and Child Oral Health Resource Center, worked with the National Network for Oral Health Access to provide technical assistance to the PIOHCPC project teams. Methods: The PIOHCPC project teams were selected from five states-Georgia, Illinois, Maryland, Michigan, and Rhode Island. Each team consisted of a state Title V maternal and child health (MCH) program or oral health program that was addressing the Title V national performance measure (NPM) on oral health, NPM 13, as well as a local primary care setting. The PIOHCPC project targeted pregnant women, children, and adolescents at high risk for oral disease. It was implemented from January 2019 through June 2021. Results: The PIOHCPC projects had several accomplishments related to integrating oral health care into primary care, even amid the COVID-19 pandemic that ushered in changes in direct patient care and primary care setting foci. Accomplishments at the primary care setting level included educating PCPs about oral health using Smiles for Life: A National Oral Health Curriculum and in-person trainings;incorporating oral health risk assessment into clinical workflows;implementing current dental terminology (CDT) codes and dot phrases in electronic health records to document oral health care;establishing effective systems for oral health referrals;and integrating oral health education and self-management goal setting into primary care visits. Additionally, state Title V MCH programs or oral health programs and primary care settings established strong partnerships to support and expand upon the success of their work in other settings across the states. Conclusion: The PIOHCPC projects had notable accomplishments. Findings from the project will contribute to the field's understanding of integrating oral health care into primary care. More work is needed at federal, state, and local levels to ensure that oral health is an integral component of primary care visits to ultimately improve oral health and reduce oral health disparities and inequities for pregnant women, children, and adolescents. 1. Health Resources and Services Administration. 2014. Integration of Oral Health and Primary Care Practice. Rockville, MD: Health Resources and Services Administration.

7.
Frontiers in Psychiatry ; 13, 2022.
Article in English | EMBASE | ID: covidwho-1987558
8.
BMJ Global Health ; 7:A22, 2022.
Article in English | EMBASE | ID: covidwho-1968267

ABSTRACT

Objective During the last decades a vast body of literature has emerged on how to promote fair resource allocation of health resources (1-5). Accordingly, a broadly held view stresses the importance of achieving legitimacy in health prioritization to build trust, including processes based on reasonable values, transparency and inclusion (6). In this piece, we discuss how the reverse also holds, i.e, already established trust in existing institutions promotes conferred legitimacy in health resource allocation. As a consequence, we argue for a shift of perspective on what is required to justify fair priorities;from promoting legitimacy through fair processes to establish trust based on mitigation of unjustly distributed and implemented use of powers. Method This paper is based on theoretically and empirically informed reflections. Results Findings from the Comparative Covid Response study, suggest that not only is ' trust in a nation's public health system. contingent on the specifics of each country's institutional arrangements', but also that '(t)rust in official advice correlates with trust in government'(7). These observations support our argument that placing in trust in difficult health priority settings to be fair, depends on the country's institutions and correlate with existing, supportive trust in government. When such trust is lacking, policymakers can establish it by mitigating unjust use of powers. Based on an analytical approach to power, we suggest a reconceptualization of fair priority-setting that can promote this crucial trust. Discussion Our conclusion has substantive implications for health priority-settings and health technology assessments: When trust in decision-making authorities and/or institutions is absent, organizing decisions-making processes according to frameworks for achieving legitimacy 'in isolation' from how the society is otherwise organized, is not sufficient for decision- making authorities to achieve fair priority settings. Policy- makers must also address and mitigate socially unjust implementation of powers to justify health priorities as 'fair'.

9.
BMJ Global Health ; 7:A6, 2022.
Article in English | EMBASE | ID: covidwho-1968249

ABSTRACT

Introduction Given the devastating effects COVID-19 has had, many may think it is obvious that more should have been spent on pandemic preparedness and mitigation measures. But this would have required investment to be taken away from existing health problems to be put towards a problem that may arise in the future at an uncertain time. When the resources available for health are finite, priorities need to be determined. How does pandemic preparedness fit into current approaches to determining health priorities? Methods Conceptual analysis of how pandemic preparedness work compares against other global health priorities, using a framework of three common factors in discussion of the ethics of health-priority setting: scale, cost-effectiveness and justice. Outcome The present-orientation of standard conceptions of burden of disease estimates omits the potential burden from new pandemics, and the uncertainty of pandemics makes it difficult to include them in projections of global disease burden. The use of high discount rates and relatively short time horizons may lead cost-effectiveness estimates to under-value pandemic preparedness work. Whether pandemic preparedness is considered a priority from the perspective of equity depends on how well-off we expect future generations to be relative to the present, and the scale of future pandemic events. Finally, many of the actions to reduce pandemic risks happen outside of the healthcare system. This suggests a need for increased focus on approaches to priority-setting outside of healthcare, including in health research and government and institutional attention. Conclusion The uncertainty and future-orientation of pandemic preparedness activities mean that this area of work doesn't easily fit into traditional approaches to determining global health priorities. Approaches to determining global health priorities need to adapt to enable comparison of stochastic, future-oriented issues to problems of existing health burden.

10.
Gastroenterology ; 162(7):S-109-S-110, 2022.
Article in English | EMBASE | ID: covidwho-1967241

ABSTRACT

Introduction Screening for colorectal cancer (CRC) varies significantly by sociodemographic factors. The Health Resources and Services Administration (HRSA) provides primary care services, including CRC screening, to over 30 million medically underserved individuals at Federally Qualified Health Centers (FQHCs) in the United States (US). Given known disparities in CRC screening utilization and the national decline in screening due to the COVID- 19 pandemic, we aimed to determine the change in screening rates in FQHCs between 2019 and 2020 and factors associated with changes in rates. Methods This repeated cross-sectional analysis was conducted using 2019 and 2020 data from the Uniform Data System (UDS), which includes FQHC quality data for all US FQHCs. We ed CRC screening rates for each FQHC and for each state (FQHCs only) for patients age 50-75 for the years 2019 and 2020. We then calculated the change in screening (2020 rate minus 2019 rate) for each FQHC and for each state. To compare FQHC characteristics, we separated FQHCs into quartiles based on the 2020 screening rate and used ANOVA to compare FQHC characteristics between quartiles. Lastly, we performed a multivariable logistic regression to determine FQHC-level characteristics (2020 data) associated with an increase vs. decrease in screening rate from 2019 to 2020. Results In the 50 states, there were 1308 FQHCs and 7,132,411 FQHC patients eligible for CRC screening in 2020. Change in screening rates by state ranged from -11.1% (North Carolina) to +6.71% (Alaska) (mean= -3.55%) (Figure). The mean change in screening rates in FQHCs was -3.6% (range -62% to +58%) (Table). FQHCs with the lowest screening rates in 2020 (quartile 1, Table) had higher percentages of Black (p<0.001), male (p=0.018), homeless (p<0.001), uninsured (p<0.001), and low-income (p<0.001) patients, and were more likely to be in urban settings (p<0.001). FQHCs with the highest screening rates (quartile 4, Table) had a higher percentage of White (p<0.001) patients. When controlling for FQHC characteristics (including number of patients and 2019 CRC screening rate), each one point increase in the percentage of White patients served in a FQHC was associated with lower odds (aOR 0.71;95%CI=0.56-0.91) of experiencing a decrease in CRC screening rates in 2020 compared to 2019 (data not shown). Discussion FQHCs in the US have below-average CRC screening rates and saw notable declines in CRC screening utilization during the COVID-19 pandemic. Extent of decline varied broadly by state and FQHC, and declines were greater in FQHCs that served a higher proportion of (Figure Presented) Figure. Percent change in colorectal cancer (CRC) screening rate among adults age 50 to 74 at Health Resources and Services Administration-funded FQHCs between 2019 and 2020, by US state. (Table Presented) Table. FQHC characteristics (2020 data) and CRC screening rates (2019 and 2020) for HRSA-funded FQHCs in the US overall and by 2020 CRC screening rate quartiles.

11.
Neuro-Oncology ; 24:i74-i75, 2022.
Article in English | EMBASE | ID: covidwho-1956572

ABSTRACT

INTRODUCTION: High-grade gliomas account for <5% of all pediatric brain tumors with a 20% 5-year overall survival even with maximal safe resection followed by concurrent radiotherapy and chemotherapy. Patients in low-and middle-income countries already face delays and barriers to the treatment they require. The current COVID pandemic has added unique challenges to the delivery of complex, multidisciplinary health services to these patients. METHODOLOGY AND RESULTS: We retrospectively reviewed the records of four patients, ages 2-18 years old, with histologically confirmed high-grade glioma managed in a tertiary government institution from 2020-2021. Three of the patients had a supratentorial tumor and one patient had multiple tumors located in both supra-and infratentorial compartments. Neurosurgical procedures performed were: gross total excision (1), subtotal excision (2), and biopsy (1). The tissue diagnoses obtained were glioblastoma (3) and high-grade astrocytoma (1). Two patients survived and are currently undergoing adjuvant radiotherapy and chemotherapy. The remaining two patients expired: one from hospital-acquired pneumonia and the other from COVID-19 infection. DISCUSSION: Decreased mobility due to lockdowns, the burden of requiring negative COVID-19 results before admission for surgery, reduced hospital capacity to comply with physical distancing measures, the postponement of elective surgery to minimize COVID-19 transmission, physician and nursing shortages due to infection or mandatory isolation of staff, cancellation of face-to-face outpatient clinics, and hesitation among patients and their families to go to the hospital for fear of exposure were found to be common causes of delays in treatment. Also, the redirection of health resources and other government and hospital policies to handle the COVID-19 pandemic resulted in an overall delay in the delivery of health services. In particular, the management of pediatric patients with cancers, especially high-grade gliomas, was significantly disrupted.

13.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927748

ABSTRACT

RATIONALE The COVID-19 pandemic has disrupted national spirometric surveillance of active and former U.S. coal miners since March 2020. Consequently data collected by the Health Resources and Services Administration (HRSA)-funded Black Lung Clinics Program (BLCP) represents the only major source of recent health data on U.S. former coal miners. Using the first available year of national BLCP data we examined associations between mining region and radiographic disease and lung function impairment. METHODS We analyzed pre-bronchodilator spirometry and International Labour Office chest radiograph classifications from miners seen across 15 BLCP grantees from July 1 2020 to June 30 2021. We calculated percent predicted (PP) and lower limits of normal (LLN) for forced expiratory volume in one second (FEV1) forced vital capacity (FVC) and FEV1/FVC ratio. We determined prevalence of patterns of spirometric abnormality (restrictive obstructive/mixed) and moderate to severe impairment (FEV1<70PP). We classified miners who worked the majority of their coal mining career in Kentucky Virginia or West Virginia as Central Appalachian miners. We examined associations between region worked and lung function impairment using logistic regression. RESULTS The 2,891 miners were predominantly non- Hispanic white (98.1%) and male (99.4%) with mean age 66 years (SD9.3). Mean coal mining tenure was 26 years (SD10.7) and 66% (n=1,900) were Central Appalachian miners. Thirty-seven percent had never smoked. Among those with chest radiographs (n=2,464 85%) Central Appalachian miners had a significant three-fold increase in progressive massive fibrosis (PMF) prevalence compared to miners who worked elsewhere in the U.S. (9% vs 3% p<.0001). Smoking history and spirometry were available in 66% (n=1,918). Of these 40% of never-smokers had abnormal spirometry (obstruction/mixed 10%;restriction 30%);among ever-smokers, 54% had abnormal spirometry (obstruction/mixed 27%;restriction 27%). Abnormal FEV1 was present in 30% of never smokers and 42% of ever-smokers. Mean FEV1PP was significantly lower among Central Appalachian miners compared to miners from other regions. Controlling for age, tenure, and pack-years, Central Appalachian miners had significantly elevated odds of having FEV1 impairment compared to non-Central Appalachian miners (OR 1.31, 95%CI 1.06,1.62). A subanalysis controlling for category of radiographic disease showed that odds of impairment remained elevated among Central Appalachian miners (OR 1.24, 95%CI 0.97,1.60). CONCLUSIONS Controlling for smoking, age, and tenure, former miners who worked most of their career in Central Appalachia have significantly increased odds of disabling impairment. These findings highlight the important role of HRSA-funded black lung clinics in understanding work-related lung disease among U.S. coal miners.

14.
African Journal of Infectious Diseases ; 16(2):1-12, 2022.
Article in English | EMBASE | ID: covidwho-1918238

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected over 100 million individuals worldwide with diverse impacts on nations. The rising cases of new strains and resultant infection waves create an urgent need to assess the readiness of countries especially in Africa to mitigate the impact on community transmission. This paper delivers a brief synopsis of the novel SARS-CoV-2, emerging cases of new variants reported worldwide, and implications for genetic surveillance of disease transmission in low-and middle-income countries (LMICs) especially Africa. Materials and Methods: Literature search used keywords like SARS-CoV-2;COVID-19 epidemiology;pandemic waves;corona outbreak, clinical syndromes, treatments, prevention and control. Cross-sectional and observational studies published on COVID-19 from 2019 till date of study provided main information sources. Databases such as Web of Science, Embase, PubMed and Google Scholar were utilised. Main findings: Over 220 countries have documented COVID-19 cases with varied severity till date. Before the spikes in resurgence, a highly virulent mutated (>90% fatality rate) novel strain of COVID-19 had been documented. There is very little data to ascertain the impact of the COVID-19 infection waves in LMICs. Discussion: LMICs especially African countries still grapple with significant challenges like inefficient surveillance mechanisms, inadequate vaccination coverage, inadequate enforcement of environmental health strategies, poor health systems etc. Hence, Africa’s fate remains dicey in the face of the dynamic evolution of the SARS-CoV-2 and other identified challenges. Conclusion: The adoption of a multidisciplinary approach to mitigate the impact of emergence of mutant SARS-CoV-2 variants and resurgence of infection spike is recommended.

15.
SpringerBriefs Public Health ; : 79-90, 2022.
Article in English | EMBASE | ID: covidwho-1913907

ABSTRACT

Disease infections rise to epidemic threshold in local communities from which they spread spatially. Spatial diffusion within metropolitan regions enables hierarchical diffusion among metropolitan regions. Thus, preventing pandemics requires containing infection rates within local communities. Culturally isolated communities and those targeted with discriminatory policies and practices remain most vulnerable to high rates of infection. Because of long-term abuse and neglect by governmental agencies and the economic powers behind government, these communities often disobey edicts from health departments. Local health departments must engage with all communities and community components to effect pandemic prevention and response. Chapter 7 lists tactics of engagement and of organizing an efficacious pandemic response planning board. Health departments must have emergency pandemic powers. Elected executives (mayors, county executives, governors) have proven the Achilles’ heel of pandemic response. Elected executives depend on big donors and befriend ascendant capitalists, favoring them with policies and governmental funds, aka corrupt cronyism.

16.
Journal of Mental Health Policy and Economics ; 25(SUPPL 1):S28, 2022.
Article in English | EMBASE | ID: covidwho-1913108

ABSTRACT

Background: The COVID-19 pandemic prompted a reformulation of all health services shifting towards care for patients infected by the SARS-COV-2 virus. Among these health services, those dedicated to patients with addiction disorders might also be affected, in a time for which the need might actually have increased. Aims of the Study: To assess the impact of the COVID-19 pandemic on the activity of Portuguese addiction treatment services, according to the pattern of addictions (alcohol, substance use or behavioural). Methods: A national retrospective observational study was carried out based on the analysis of Portuguese secondary data, between March 2019 and July 2021, related to the activity of addiction treatment services, according to the addiction's pattern (i.e. alcohol, behavioural and substance use addictions). Number of consultations and new users were used as the main outcomes. To account for seasonal variation only time periods between March to July of each year were considered. Results: In the study period, behavioural addictions were the reason for 45590 (9.21%) consultations, being the addiction pattern with the lowest number. Substance use disorders totalled 6391712 (63.92%) consultations, showing the highest value. From March to July 2020, there were 73996 (29.04%) consultations and 1867 (57.80%) new patients admitted less than in the same period of 2019. This reduction was observed in the three patterns of addiction, with alcohol addiction showing the highest relative reduction on the number of new patients admitted (65.02%) and on the number of consultations (30.38%). In 2021, there was a general increase of 73.21%, 78.52% and 85.33% in the number of new patients admitted for alcohol addiction, behavioural addiction and substance use disorders, respectively. However, the number of consultations and new patients admitted is, respectively, 93.85% and 24.27% of the values for the respective period in 2019. Discussion and Limitations: Despite potential increase of some addictions during the pandemic, namely alcohol or behavioural addictions, there was a decrease in the number of new patients admitted to addiction intervention services when comparing the periods from March to July 2019 and 2021. Moreover, behavioural addiction is still a minority when compared to alcohol addiction and substance use disorder, which may be because in Portugal addiction intervention services are still mainly focused on the management and treatment of substance use disorders. One of this study's limitations is inherent to the fact that it is based on the reuse of data collected for purposes other than research. Implications for Health Policies: Understanding the impact that the COVID-19 pandemic had on health care services, namely on addiction intervention services, as well as on the epidemiological picture and further needs, is essential for better health care planning. Health system plans should consider such needs and potential scarcity of provision for better adaptation after the pandemic. Implications for Further Research: To study if the current needs of addiction patients are being covered should be done in order to adapt health policies to that. Qualitative studies should also be considered.

17.
Missouri medicine ; 118(1):45-49, 2021.
Article in English | Scopus | ID: covidwho-1888177

ABSTRACT

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response. Copyright 2021 by the Missouri State Medical Association.

18.
Heart Rhythm ; 19(5):S88-S89, 2022.
Article in English | EMBASE | ID: covidwho-1866206

ABSTRACT

Background: Social distancing restrictions resulted in increased utilization of virtual visits (VVs) for arrhythmia care in 2020. Over time, there has been a return to in-person visits (IPVs);however, utilization of VVs may continue to offer advantages for patients. Objective: To assess characteristics of patients durably adopting virtual care. Methods: All appointments in our arrhythmia clinics from March 2020 through November 2021 were analyzed. Completed appointments by EP providers were categorized as VV or IPV. The VV rate was calculated as number of VVs divided by total Visits (IPVs and VVs). Pt characteristics collected included self-identified race and ethnicity as well as age, gender, and insurance status. We compared VV rates amongst patients of different ethnicity, race, and insurance status. We also assessed enrollment in an internet-based patient portal that interfaces with the electronic medical record (EMR) and allows for communication with providers. Results: A total of 6,084 VVs and 10,942 IPVs were included in the analysis. In 2020, 3,550 VVs comprised the majority (52.8% of 6,723) of all outpatient visits, whereas in 2021, this proportion dropped to 24.6% (2,534/10,303) as IPVs became more common. The largest reduction in VV utilization was amongst Black patients (65.2% reduction to a 19% VV rate) followed by Hispanics (62.3% reduction to a 15.8% VV rate). Both groups had a significantly reduced VV utilization rate compared to others in 2021 (P<0.01). There was no significant difference in VV rates for underinsured patients in 2020 or 2021, indicating social but not economic influence on telehealth adoption. Enrollment in the EMR patient portal during the study period was significantly reduced for Black and Hispanic patients (67.4% and 63.1% vs 80.6%;P<0.01) but did not significantly change over time. Conclusion: There was a large reduction in the overall use of VVs for arrhythmia care from 2020 to 2021. The largest reductions in VV utilization were observed in the Black and Hispanic communities, where digital health resources appeared to be underutilized. [Formula presented]

19.
Journal of Kermanshah University of Medical Sciences ; 26(1), 2022.
Article in English | EMBASE | ID: covidwho-1870029

ABSTRACT

Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identifica-tion of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics.

20.
Endocrine Practice ; 27(6):S192, 2021.
Article in English | EMBASE | ID: covidwho-1859550

ABSTRACT

Objective: Before COVID-19, telemedicine had gained traction as a clinical tool, which was reflected by the adoption of new billing codes. Here we report outcomes in our Endocrine practice, which rapidly switched to exclusively tele-health in March 2020 with no pre-existing systems or protocols for this transition. We hypothesized that barriers to care, including patients’ health literacy, access to technology/internet, and access to remote monitoring tools such as blood pressure cuffs and weight scales, would make the transition to tele-health less successful in a low-income urban setting than in the suburbs. Methods: We measured show rates at Temple Endocrinology outpatient clinic sites using the CPT coding system to compare all scheduled appointments with all completed visits. We selected periods from April 1st to July 31st of 2019 and the same dates in 2020, because outpatient visits were exclusively in-person (2019) or exclusively tele-health (2020). Appointments included both faculty and fellow clinics. Data were stratified by service location amongst four major clinic sites that serve patients of different socioeconomic and ethnic backgrounds – namely, Temple University Hospital (TUH) in North Philadelphia, an urban federally designated medically underserved area, Temple Fort Washington (FW) serving a high-income suburban area, Temple Center City (CC) serving a high-income urban area, and Temple Jeanes, serving a middle-income suburban area. Results: Surprisingly, the proportion of completed outpatient visits at TUH increased from 68.2% (n = 2,965/4,346) in 2019 to 72.9% (n = 2,997/4,109) in 2020 (p = 0.00001), with an absolute increase of 1.01% in our completed encounters. In contrast, at FW, the proportion of completed outpatient visits decreased from 89.8% (n = 378/421) in 2019 to 79.3% (n =211/266) in 2020 (p = 0.00014). At CC, 90.2% (n = 342/379) visits were completed in 2019 and 89.5% (n = 366/409) in 2020 (p = 0.73). At Jeanes, rates were 75.8% (n = 485/640) in 2019 and 76.7% (n = 615/802) in 2020 (p = 0.69). Discussion/Conclusion: Despite the speed with which we transitioned to an entirely tele-health-based practice at the start of the pandemic, we found that we were equally – if not more able – to complete clinical Endocrinology visits with our population of underserved patients in North Philadelphia. In contrast, at our suburban FW campus, the show rates fell. We are currently examining disease acuity, transportation issues related to in-person visits, and internet access through smartphones in the populations served by TUH and FW. Overall, our data suggest that tele-health can be a successful option for Endocrine practice in an underserved urban area.

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