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1.
Journal of Investigative Dermatology ; 142(8):S61, 2022.
Article in English | EMBASE | ID: covidwho-1956220

ABSTRACT

Background: Teledermatology is an effective healthcare delivery model that has seen tremendous expansion over the last decade, which has been particularly pronounced during the Coronavirus Disease 2019 (COVID-19) pandemic. Objective: To better understand teledermatology utilization and patient demographic trends throughout the COVID-19 pandemic. Methods: National-level data were curated for all practices enrolled in the American Academy of Dermatology’s DataDerm registry from April 1, 2020, through June 30, 2021. Encounter utilization rates were collected for visit type (i.e., teledermatology versus in-person), sex, race, age, insurance provider, and location. Results: Data from up to 13,964,816 encounters across the United States were analyzed. Sex, race, age, insurance provider, and location were each found to have a significant association with telemedicine utilization (adjusted p<0.001). The proportion of women who utilized services via teledermatology (n=65,023, 66.0%) was greater than those who utilized in-person services (n=2,940,122, 58.3%). Non-white patients made up a higher percentage of teledermatology utilizers (n=8,920, 14.3%) when compared to in-person utilizers (n=394,680, 11.2%). Younger patients (age<40) contributed more to teledermatology service utilization (n=62,695, 83.2%) when compared to in-person services (n=1,329,218, 40.3%). Medicare and Private were larger payor contributors for in-person services (n=1,089,777, 25.2%;n=2712594, 62.6%) than for teledermatology services (n=8232, 5.4%;n=73940, 48.2%). Utilization by out-of-state patients was proportionally higher for teledermatology services (n=19,422, 14.6%) compared to in-person services (n=580,358, 4.2%). Conclusions: Teledermatology services may reach and benefit certain populations (females, younger patients, non-White races, out-of-state patients) more so than others.

2.
Journal of Investigative Dermatology ; 142(8):S61, 2022.
Article in English | EMBASE | ID: covidwho-1956219

ABSTRACT

Infantile hemangiomas (IH) are vascular tumors that often require timely treatment to reduce morbidity.1,2 The 2019 American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG) for the Management of IH recommend referral to dermatology prior to 4 weeks of age, enabling timely treatment initiation.1 This study examines adherence to national guidelines and aims to identify barriers to appropriate referral timing & treatment. This retrospective cohort study examined IH patients, ages 0 to 24 months, referred to Phoenix Children’s Hospital (PCH) Dermatology from 1/1/2019 to 12/31/2020, following release of AAP CPG. Patients were categorized into age appropriate (≤4wks) or late (>4wks) referral groups. Associations of referral age w/ demographics/treatments were examined. Among 791 patients identified, 46 (6%) were appropriately referred at ≤4 weeks of age, 680 (86%) were referred late at >4 weeks of age, and 65 (8%) had missing referral dates. For the group of 343 patients who were referred and treated w/ propranolol, mean age at referral, initial dermatology visit, and propranolol initiation was 3.2, 3.8, & 4.2 months, respectively. No statistical differences (p≤0.05) were detected in gender, race, insurance, language, or rates of propranolol/timolol treatment between referral groups. Despite AAP recommendations, the vast majority of infants with IH are referred to PCH Dermatology after 4 weeks of age. Late referral has led to treatment initiation after the rapid growth phase in most patients, which is problematic for those w/ high-risk hemangiomas. Patient demographics were not correlated w/ referral category suggesting that other factors, such as primary care provider referral practices and the COVID-19 pandemic, may have contributed to delayed referrals. Based on mean age at referral and treatment initiation, patients may have already experienced complications from their hemangiomas, which could result in increased healthcare utilization, costs, & morbidity. References: 1) Krowchuk DP et al. Clinical Practice Guideline for the Management of Infantile Hemangiomas: American Academy of Pediatrics. Pediatrics, Jan 2019;143(1). 2) Tollefson MM and IJ Frieden. Early growth of infantile hemangiomas: what parents;photographs tell us. Pediatrics, Aug 2012;130(2): e314-20.

3.
American Journal of Translational Research ; 14(5):3525-3532, 2022.
Article in English | EMBASE | ID: covidwho-1955748

ABSTRACT

Objectives: To compare the number of deaths that occurred in the state of Amazonas and in Brazil, from March 16th to August 20th 2020, using the variables skin color, sex, place of death, age group and association with COVID-19, and secondly, to verify whether between 2019 and 2020, in the period from March 16th to August 20th, there was a significant change in the number of deaths from diseases not associated with COVID-19. Methods: We searched the databases of the Brazilian public agency "Transparency Portal" for the data on deaths that occurred in the state of Amazonas and Brazil in the period from March 16th to August 20th, 2019 and 2020. The absolute frequencies and percentages of the variables studied were used for statistical analysis. Results: COVID-19 was responsible for an 11.01% increase in deaths in Brazil;however, this rate quadrupled in the state of Amazonas. In relation to age group, there was a similar percentage between Amazonas and the national average. The stratified analysis showed significant differences between genders and races, with higher death rates in men and people of brown/black skin. The number of deaths at home increased significantly, especially those from causes not associated with COVID-19. Conclusions: The national drop in deaths from diseases not associated with COVID between March and August 2020 in Brazil is misleading and may be due to the result of misreported causes of death.

4.
Health Policy Open ; : 100074, 2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1956157

ABSTRACT

COVID-19 vaccines are an effective tool in preventing severe disease. Most states used an age-based prioritization for vaccine rollout. We examined the impact of a primarily age-based prioritization policy on reductions of severe disease in different racial and ethnic groups. We calculated age-specific rates of COVID-19 hospitalization and death by race/ethnicity in Denver, Colorado. To assess potentially averted hospitalizations and deaths by race/ethnicity, we then applied the first three phases of Colorado's primarily age-based vaccine rollout criteria to historical 2020 COVID-19 hospitalizations and deaths in Denver, Colorado. In the first 3 phases, 40% (1403/3473) of hospitalizations and 83% (503/604) of deaths occurred among those meeting age and long-term care facility criteria and could have been averted. Impacts varied by race/ethnicity with only 28% (440/1587) of hospitalizations and 74% (131/178) of deaths averted among Hispanic or Latino residents, compared to 57% (619/1094) of hospitalizations and 92% (252/274) of deaths among non-Hispanic White residents. We demonstrate using local data and policy that early age-based prioritization decisions disproportionately promoted reductions in severe disease among non-Hispanic White residents irrespective of COVID-19 risk in Denver, Colorado. These findings suggest that more equitable future vaccine prioritization policies, which lead with a goal of reducing health disparities through prioritizing susceptibility to adverse health outcomes rather than overall population-based cutoffs, are necessary. Our results have implications for future vaccination rollouts in limited vaccine resource conditions.

5.
Voprosy Ékonomiki ; (1)2021.
Article in Russian | ProQuest Central | ID: covidwho-1955503

ABSTRACT

Dramas of a unique pandemic of COVID-19, an unparalleled sharp recession and critically important presidential elections have put the difficult choices for the American society in 2020. Socio-economic development of the U.S. in XXI century has come through the series of crises, which had major impacts on the global development. The country has retained the leadership in the developed world by general economic might, innovations and dynamics of upturns. In the last three decades the demographics of the U.S. population have experienced the substantial changes, notably the number of citizens of Asian origin and Hispanic group have increased. The latter has surpassed the Afro-American group by a number of families and by an average income per family. Overall growth of income in the country has not eliminated large income disparities among social strata. Statistics of tax declarations indicate the inequality by social groups and by race. These disparities have probably played an important role in 2020 recession and pandemic development. As far as electoral behavior is concerned, the inequality factor is even more visible.Alternate :Драма уникальной пандемии, небывало острой рецессии и критически важных президентских выборов поставила общество США в 2020 г. перед трудным выбором. В социально-экономическом развитии США в XXI в. произошла серия потрясений, которые оказали огромное влияние на мировое развитие. Страна сохранила положение лидера среди развитых стран по совокупности экономической мощи, инновационному развитию, динамичности подъемов. В последние три десятилетия в США значительно изменился демографический состав населения в пользу граждан азиатского происхождения и испаноязычной группы, которая как по своей численности, так и уровню доходов на семью обогнала афроамериканскую. Общий рост благосостояния не ликвидировал большие диспаритеты по доходам между слоями общества. Статистика налоговых деклараций указывает на неравенство семей как социальное, так и по расовому признаку. По-видимому, оно сыграло значительную роль в 2020 г. и в рецессии, и в пандемии. А в электоральном поведении фактор неравенства виден еще резче.

6.
Front Med (Lausanne) ; 9: 850536, 2022.
Article in English | MEDLINE | ID: covidwho-1952372

ABSTRACT

The COVID-19 pandemic revealed the disproportionate risk of poor clinical outcomes among population subgroups. The study investigates length of stay (LOS), intensive care unit (ICU) admission, and in-hospital death across age, sex, and race among patients hospitalized with COVID-19. A pooled cross-sectional study analyzed hospital discharge data of state-licensed hospitals in Texas from April to December 2020. Of 98,879 patients, males accounted for 52.3%. The age distribution was 31.9% for the 65-79 age group, 29.6% for those aged 50-64, and 16.3% for those older than 79. Whites constituted the largest proportion (42.6%), followed by Hispanics (36.2%) and Blacks (13.1%). Higher in-hospital death rates were found among patients aged 80 and over (Adjusted Risk Ratio (aRR) 1.12, 95%CI 1.11-1.13) and patients aged 65-79 (aRR 1.08, 95%CI 1.07-1.09) compared to patients aged 19 and below. Hispanics (aRR 1.03, 95%CI 1.02-1.03) and other minorities (aRR 1.02, 95%CI 1.02-1.03) exhibited higher in-hospital death rates than whites, and these patients also had longer LOS and higher ICU admission rates. Patients aged 65-79, 50-64, and 80 and over all had longer hospital stays and higher ICU admission rates. Males experienced poor health outcomes in all assessed outcomes. Findings showed that disparities in clinical outcomes among population subgroups existed and remained throughout 2020. While the nation has to continue practicing public health measures to minimize the harm caused by the novel virus, serious consideration must be given to improving the health of marginalized populations during and beyond the pandemic.

7.
BMJ Open ; 12(7), 2022.
Article in English | ProQuest Central | ID: covidwho-1950150

ABSTRACT

IntroductionThe COVID-19 pandemic is forcing changes to clinical practice within traditional addiction treatment programmes, including the increased use of telehealth, reduced restrictions on methadone administration (eg, increased availability of take-home doses and decreased requirements for in-person visits), reduced reliance on group counselling and less urine drug screening. This paper describes the protocol for a mixed-methods study analysing organisational-level factors that are associated with changes in clinic-level practice changes and treatment retention.Methods and analysisWe will employ an explanatory sequential mixed-methods design to study the treatment practices for opioid use disorder (OUD) patients in New York State (NYS). For the quantitative aim, we will use the Client Data System and Medicaid claims data to examine the variation in clinical practices (ie, changes in telehealth, pharmacotherapy, group vs individual counselling and urine drug screening) and retention in treatment for OUD patients across 580 outpatient clinics in NYS during the pandemic. Clinics will be categorised into quartiles based on composite rankings by calculating cross-clinic Z scores for the clinical practice change and treatment retention variables. We will apply the random-effects modelling to estimate change by clinic by introducing a fixed-effect variable for each clinic, adjusting for key individual and geographic characteristics and estimate the changes in the clinical practice changes and treatment retention. We will then employ qualitative methods and interview 200 key informants (ie, programme director, clinical supervisor, counsellor and medical director) to develop an understanding of the quantitative findings by examining organisational characteristics of programmes (n=25) representative of those that rank in the top quartile of clinical practice measures as well as programmes that performed worst on these measures (n=25).Ethics and disseminationThe study has been approved by the Institutional Review Board of NYU Langone Health (#i21-00573). Study findings will be disseminated through national and international conferences, reports and peer-reviewed publications.

8.
BMJ : British Medical Journal (Online) ; 378, 2022.
Article in English | ProQuest Central | ID: covidwho-1950086

ABSTRACT

Boris Johnson’s greatest attribute was to sell hope, although Martin McKee argues that Johnson’s empty promises, including those on health, leave him well placed in the race to be the UK’s worst prime minister (doi:10.1136/bmj.o1707).1 One of those hopes was that the covid pandemic was “over” in February (https://www.dailymail.co.uk/news/article-10493765/Boris-Johnson-declares-Covid-rules-MONTH.html),2 a political gambit to lift all restrictions that defied hard evidence and cold logic (doi:10.1136/bmj.o1, doi:10.1136/bmj.o1555, doi:10.1136/bmj-2021-069881).345 SARS-CoV-2 never went away, even if its impact was dulled, and it is now most definitely back, sending people to hospital and intensive care (doi:10.1136/bmj.o1702).6 Hospitals are reintroducing masking for staff (doi:10.1136/bmj.o1712),7 although the general public seems blissfully ignorant of the latest omicron variant. By invoking the Dunning-Kerner effect, David Oliver calls on experts to speak up, in plain language and accessible formats, to counter the “false belief systems that are over-confidently asserted by inexpert people” (doi:10.1136/bmj.o1701).8 One answer is to keep going and caring, even when it’s hard (doi:10.1136/bmj.o1689).9 Another, and not mutually exclusive, is to seek hope in a new health secretary’s desire to cut through commercial determinants, although any hope that he will stop listening to industry, and start “listening to public health experts and GPs” (doi:10.1136/bmj.o1704),10 seems a forlorn one (doi:10.1136/bmj.o1687).11 The many deep rooted problems of population health, as highlighted by the NHS Race and Health Observatory’s inaugural conference on racism in health and medicine last week (doi:10.1136/bmj.o1699, doi:10.1136/bmj.o1715, doi:10.1136/bmj.o1710),121314 are beyond the quick fix of a structural reorganisation of the health system (doi:10.1136/bmj.o1682).15 Other than the covid misadventures of rich countries, a major reason why covid is still troubling us is our collective inability to deliver vaccines to poor countries and increase vaccine uptake. The challenge extends beyond vaccine hesitancy and includes supply restrictions and distribution challenges, especially to remote rural populations (doi:10.1136/bmj-2021-069596).16 Canada is destroying 14 million covid vaccine doses, not because it was unwilling to donate them but because of “distribution and absorption” challenges in recipient countries (doi:10.1136/bmj.o1700).17 Another reason why covid still troubles us is that—as with climate change, poverty, and war—it’s easy to downplay the effects if you’ve never experienced it.

9.
Ageing and Society ; 42(8):1735-1759, 2022.
Article in English | ProQuest Central | ID: covidwho-1947117

ABSTRACT

Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.

10.
J Econ Race Policy ; : 1-11, 2022 May 25.
Article in English | MEDLINE | ID: covidwho-1943785

ABSTRACT

This study examined the economic impact of the COVID-19 pandemic on US older entrepreneurs' businesses using the Health and Retirement Study. We estimated logistic regression models to document the odds of experiencing economic impact. The COVID-19 pandemic has affected nearly 76% of US older entrepreneurs but has disproportionately impacted the businesses of Black, Hispanic, Asian/other races, and women entrepreneurs. Older Black entrepreneurs had significantly higher odds of facing business closure (OR = 2.31, p < .01), implementing new procedures (OR = 2.44, p < .01), workers quitting (OR = 2.95, p < .001), and difficulty paying regular bills (OR = 2.88, p < .001) than their White counterparts. Older Hispanic entrepreneurs also had significantly higher odds of instituting new procedures (OR = 2.27, p < .05), workers quitting (OR = 2.26, p < .01), and difficulty paying regular bills (OR = 2.35, p < .01) than their White counterparts. Similarly, older Asian/other races entrepreneurs were significantly more likely to report difficulty paying regular bills since the start of the pandemic than their White counterparts (OR = 3.11, p < .01). Women entrepreneurs were significantly more likely to close their businesses than their male counterparts (OR = 2.11, p < .001). These significant associations persisted after controlling for confounders. Support for underserved racial/ethnic groups and older women entrepreneurs should focus on accessibility to financial services, capital, and support packages as well as legislative support for ensuring business continuity and success.

11.
The Journal of Educational Foundations ; 35(1):5-32, 2022.
Article in English | ProQuest Central | ID: covidwho-1939939

ABSTRACT

Indiana University South Bend hosted the Symposium on Educational Inclusion on Nov 12-13, 2021. The Nove 12 event consisted of a panel and other programming. Here, Davis et al present an initial transcription of the panel that featured Bryan McKinley Jones Brayboy, Nicholas D. Hartlep, Marvin Lynn, and Teresa Sosa.

12.
Journal of Adolescent Health ; 70(4):S21, 2022.
Article in English | EMBASE | ID: covidwho-1936661

ABSTRACT

Purpose: Studies have shown adolescent and young adult (AYA) participation in voting and other forms of civic engagement is associated with future optimism, increased life satisfaction and decreased health-related risk behaviors. Yet, AYA aged 18-24 are the least represented demographic at voting polls across the US. Recognizing voting and civic engagement may be an important health intervention for this population, we sought to determine factors associated with future voting intention (planning to vote in the next election) among AYA attending an urban adolescent clinic during the COVID-19 pandemic. Methods: We added four voting-related questions (Do you plan to vote in the next election? Did you vote in the last election? Are you registered to vote? Do you want to know how to register to vote?) to our pre-visit questionnaire distributed to all adolescent clinic patients ages 13-26 years. Both before and after the November 2020 election (i.e., July 2020 to March 2021), we collected 634 patient questionnaires;77% (N=487) were from patients who were age eligible to vote on November 3, 2020. We limited the current analysis to questionnaires from age eligible patients with complete responses of yes or no to all four voting questions (N=258). Using bivariate and multivariable logistic regression we examined associations between voting intention and the following factors: age, gender, race, registration status, voting in last election, and weeks to/from November 2020 election. Age was dichotomized to 17-21 vs. 22-26 years based on Locally Weighted Scatterplot Smoothing and race to Black vs. non-Black. This project was approved by the Johns Hopkins IRB. Results: Mean age was 20.7 years (SD=2.1);63.2% were 17-21 years. Sixty-five percent were female, 88% were Black, 73% were registered to vote, 48% voted in last election, and 76% had future voting intention. Mean weeks to/from November election was -1.26 (SD=10.2). In the adjusted model, older patients were nearly 70% less likely to declare future voting intention than younger patients (aOR=0.32, 95% CI=0.14-0.76);males were half as likely as females (aOR=0.45, 95% CI=0.21-0.96). Voting in the last election (aOR=18.63, 95% CI=5.51-62.97) and being registered to vote (aOR=6.12, 95% CI=2.82-13.27) predicted future voting intention. Future voting intention was not associated with race or weeks to/from November election in either the unadjusted or adjusted models. Conclusions: Our findings from a clinic sample of urban AYA point to a subgroup of youth who may be more vulnerable to disenfranchisement. The COVID-19 pandemic introduced new challenges for AYA voting and this study highlighted how providers might harness the health care visit to promote AYA voting. Registration status, one of the variables most strongly associated with future voting intention, is modifiable and easily evaluated during a healthcare visit. Future qualitative investigation will explore the differences in future voting intention by age and gender to identify other factors that may also be modifiable or addressed by adolescent providers in clinical settings. Sources of Support: Thomas Wilson Foundation (PI:Fields), NICHD T32HD052459 (PI:Trent).

13.
Supportive Care in Cancer ; 30:S77, 2022.
Article in English | EMBASE | ID: covidwho-1935803

ABSTRACT

Introduction Granulocyte colony stimulating factor (G-CSF) is a crucial supportive care medication, used for the prevention of febrile neutropenia in patients undergoing chemotherapy. Early in the COVID-19 pandemic, experts began discussing whether increased use of G-CSF in cancer patients and the minimization of the neutropenic period could provide benefit in that patient population. Concerns were soon raised, however, regarding the potential synergy between the pro-inflammatory COVID-19 disease process and immune stimulation from G-CSF administration. It was noted that COVID-19 patients exposed to G-CSF were developing markedly elevated Neutrophil to Lymphocyte Ratios (NLR), indicating an excessive inflammatory response and an increased risk of ARDS and inhospital mortality. The purpose of this study is to better understand the potential harm caused by this synergy. Methods We used TriNetX, a global health research network providing access to electronic medical records from approximately 85 million patients in 64 large healthcare organizations. The platform only contains de-identified data as per the de-identification standard defined in Section 164.514(a) of the HIPAA Privacy Rule. SARS-CoV-2 infection was determined by laboratory codes 9088, 94309-2, and 94500-6, indicating the presence of COVID-19 RNA. Use of G-CSF was determined by J-code J1442, indicating its administration through having been billed to the patient. Two neutropenic (ANC <1,000/microliter) cohorts were then generated, one having COVID-19 infection and G-CSF administration within the subsequent 2 weeks, and the other with COVID-19 infection and no G-CSF administration. Both cohorts were balanced for age, gender, race, and ethnicity. Most importantly, the cohorts were balanced for average initial neutrophil count to rule out the potential sampling error of more severely neutropenic patients having worse outcomes. These criteria resulted in cohorts of 715 patients each. The cohorts were then evaluated for the outcome of “ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing” via procedure code 1014859. Results Patients who received G-CSF within 2 weeks following COVID-19 infection were 3.7 times more likely to end up on a ventilator (p<0.0001), and had 3.5 times greater 60-day mortality (6.557% vs 1.878%, p<0.0001). Conclusions SARS-CoV-2 infection is associated with a significant inflammatory response, and the use of G-CSF in neutropenic patients within 2 weeks of infection is associated with a significant increased risk of need for mechanical ventilation and increased risk of 60-day mortality. Use of G-CSF in this patient population should be discouraged in favor of broadspectrum antibiotic coverage.

14.
Sex Roles ; 86(7-8): 441-455, 2022.
Article in English | MEDLINE | ID: covidwho-1942540

ABSTRACT

The COVID-19 pandemic placed new teaching demands upon faculty that may have exacerbated existing race and gender disparities in the amount of emotional labor they perform. The present study surveyed 182 full-time tenured and tenure-track faculty from three small private liberal arts colleges to examine the effect of social and professional statuses on emotional labor (i.e., managing the expression of emotions to meet job requirements) during the emergency switch to remote instruction in spring 2020. Ordinary least squares (OLS) regression revealed that white cisgender men performed less emotional labor than Black, Indigenous, and People of Color (BIPOC) cisgender men, BIPOC cisgender women, and white cisgender women and gender non-conforming (GNC) faculty. Student demands for special favors fully mediated the relationship between intersectional race and gender identity and self-directed emotional labor and partially mediated its relationship with student-directed emotional labor. We conclude that the status shield afforded white cisgender men by their race and gender protected them from student demands that would have required them to engage in as much emotional labor as faculty with other intersectional race and gender identities during the pandemic. We discuss considering differences in emotional labor when making personnel decisions. Supplementary Information: The online version contains supplementary material available at 10.1007/s11199-021-01271-0.

15.
Pediatr Radiol ; 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-1941532

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) disproportionately affected children from underrepresented minorities and marginalized populations, but little is understood regarding the pandemic's effect on non-COVID-19-related illnesses. OBJECTIVE: To examine the effect of the COVID-19 pandemic and related stay-at-home orders on pediatric emergency department (ED) imaging of non-COVID-19-related diseases across patient demographic groups. MATERIALS AND METHODS: We retrospectively reviewed radiology reports from advanced imaging (US, CT, MRI and fluoroscopy) on children in the ED during the month of April for the years 2017, 2018, 2019 and 2020, excluding imaging for respiratory illness and trauma. We used imaging results and the electronic medical record to identify children with positive diagnoses on advanced imaging, and whether these children were admitted to the hospital. Demographic variables included age, gender, race/ethnicity and insurance type. We used multivariable Poisson regression models to report rate ratio (RR) and binomial logistic regression models to report odds ratio (OR) with 95% confidence interval (CI). RESULTS: We included 1,418 ED encounters for analysis. Compared to pre-2020, fewer children underwent ED imaging in April 2020 (RR 0.63, 95% CI 0.52, 0.76). The odds of positive imaging results increased (OR 2.18, 95% CI 1.59, 3.00) overall, and for all racial/ethnic groups except Hispanic patients (OR 0.83, 95% CI 0.34, 2.03). No differences occurred in admission rates for positive imaging results in 2020 compared to pre-2020. CONCLUSION: In April 2020 compared to pre-2020, there were decreased imaging and increased positivity rates for imaging for non-respiratory and non-trauma ED visits. COVID-19 stay-at-home advisories might have resulted in triaging for urgent health care by families or referring clinicians during this month of the pandemic.

16.
Entrepreneurship Research Journal ; 0(0), 2022.
Article in English | Web of Science | ID: covidwho-1938473

ABSTRACT

The topics of gender and entrepreneurship have been of great scholarly interest since the eighties. In this invited editorial, we provide an overview of the evolution of the field of gender and entrepreneurship. Specifically, we consider the evolution of the field by highlighting the importance of context and the need to consider gender in all future research examining' entrepreneurial activity. Drawing on a contextualized approach we provide an overview of the six articles in this curated special issue with the aim of increasing our understanding of women's entrepreneurial activity. Finally, we conclude with some suggestions for future research. We hope this invited editorial will spur deeper research at the intersections between gender and entrepreneurship.

17.
Global Spine Journal ; 12(3):121S-122S, 2022.
Article in English | EMBASE | ID: covidwho-1938250

ABSTRACT

Introduction: The use of telemedicine has expanded amid the COVID-19 pandemic. Previous studies have described the feasibility of telemedicine, however, little has been reported on the patient perception and preferences within orthopaedics. The purpose of our current study is to evaluate satisfaction and preferences of telemedicine from the perspective of patients within an orthopedic spine clinic. Material and Methods: A cross-sectional, anonymous survey was implemented as a prospective quality improvement initiative. The survey was sent to patients who had an in-office visit or a telemedicine visit with a provider in our orthopaedic spine clinic. The survey consisted of ten questions with a combination of multiple choice and yes/no questions. Four questions pertained to patient demographics including age range, race, gender, and proximity to the orthopaedic clinic. The remaining questions pertained to previous exposure to telemedicine, reasons patients would prefer telemedicine or in-office visits, for what types of visits patients would accept a telemedicine visit, and overall satisfaction with the visit. Univariate analysis was utilized to compare survey responses among groups. Results: The survey was sent to 1129 patients and a total of 316 patients responded. Twenty-one percent of respondents had a telemedicine appointment. There was no difference in satisfaction among patients who had a telemedicine or in-office visit (p = 0.288). Those that had telemedicine appointments were more likely to have had a previous experience with this type of visit (p = 0.004) and were more inclined to use it in the future (p < 0.001). Patients preferred telemedicine because of the ability to get earlier appointments (p < 0.001) and the convenience of the visits (p < 0.001). Patients preferred in-office visits because they received hands-on physical exams (p = 0.003) or imaging (p = 0.041). Conclusion: Telemedicine is a viable alternative to in-office appointments as spine patients had similar levels of patient satisfaction when compared to traditional, in-office appointments. Sooner appointments and convenience are attractive elements of telemedicine visits, while the desire for a physical examination and imaging-often needed during new patient appointments-remain potential barriers to further adoption in this population.

18.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938114

ABSTRACT

Background: Patients hospitalized with COVID-19 who develop cardiopulmonary arrest often have poor prognosis, prompting discussions with families about goals of care. The relationship between clinical and social determinants of code status change is poorly understood. Methods: This retrospective study included adult COVID-19 positive patients admitted to the intensive care unit with cardiac arrest in a multihospital center over the first 9 months of the pandemic (3/1/2020-12/1/2020). Data on medical and social factors was collected and adjudicated. Results: We identified 208 patients over the study timeline. The mean age was 63.7 ± 14.5 years and 54.3% (n=113) were male. The majority of patients with cardiopulmonary arrest had pulseless electrical activity (PEA) as their initial rhythm (91.3%, n=190). Code status was changed in 56.3% (n=117) of patients. The majority of COVID-19 patients with cardiac arrest were Hispanic (53.4%, n=111), followed by African American (27.9%, n=58), and White patients (13.5%, n=28). Race/ethnicity did not affect the rate of code status change. COVID-19 patients who had a code status change were statistically more likely to have a lower salary ($54,838 vs $62,374), have a history of stroke/transient ischemic attack (15.4 vs 4.4%, 18:4), or heart failure (28.2 vs 15.6%, 33:14), all with P<0.05. Patients with code status change had shorter courses of cardiopulmonary resuscitation (11.9 vs 16.9 minutes, P<0.05). Both groups had similar levels of aggressive care received including continuous renal replacement therapy, vasopressor and broad-spectrum antibiotics requirements. Insurance status, ethnicity, religion, and education did not lead to statistically significant changes in code status in COVID patients. Conclusion: Patients hospitalized with cardiopulmonary arrest and positive for COVID-19 are more likely to have a change in code status. This code status change is affected by cardiovascular comorbidities such as stroke and heart failure, along with lower income but not by insurance status, ethnicity, religion, and educational level.

19.
Circulation: Cardiovascular Quality and Outcomes ; 15, 2022.
Article in English | EMBASE | ID: covidwho-1938111

ABSTRACT

Background: Impact of social isolation associated with the COVID-19 pandemic on the severity and frequency of cardiac symptoms has not been well investigated. Material and methods: This was a single tertiary center cohort study of inpatients admitted with a primary diagnosis of either CHF or acute myocardial infarction. Each patient rated the extent of isolation related to the pandemic and severity and frequency of symptoms during an in-person interview. Results: The study cohort included 54 patients, 48.1% females (26 of 54), 70.2+/-13.5 years old, who reported moderate or severe isolation in 57% (31 of 54). Symptom severity worsening was reported in 48% (26 of 54) of patients and was more common in socially isolated patients (74 vs. 29%, p=0.001;17 of 23 vs. 9 of 31). Symptom frequency increase was reported in 43% (24 of 54) and was also more common in socially isolated patients (61 vs. 33%, p=0.036;14 of 23 vs. 10 of 31). There was no difference in mortality between the two groups (p=0.6971). There was a trend of increased hospitalizations, on average, among patients who reported drastic isolation than patients who maintained social contacts (0.826+/-1.614 vs. 0.484+/-0.996 admissions, p=0.349). These findings were not affected by the diagnosis (CHF vs. MI), age, gender, race, and co-morbidities including HTN, DM, atril fibrillation, COPD or asthma, and/or chronic renal insufficiency. Likewise, there was no association between symptom worsening and GDT utilization including beta-blockers, RAAS inhibitors, MRA, anticoagulants, ICD or PPM placement. Conclusions: Our findings suggest that independent of age, gender, race, LVEF, recorded comorbidities, and recorded active therapeutics, the COVID-19 pandemic resulted in a significant cardiac symptom increase in patients who reported social isolation. Interventions aimed at reducing social isolation require investigation and implementation.

20.
Alcoholism: Clinical and Experimental Research ; 46:207A, 2022.
Article in English | EMBASE | ID: covidwho-1937897

ABSTRACT

Purpose: To evaluate endorsement of health (coping) behaviors by history of Alcohol Use Disorder (AUD) during the COVID-19 pandemic, and to examine how endorsement relates to participants' self-reported drinking motives and behaviors, perceived stress, mental health and loneliness. Methods: 448 participants (Mean Age = 45 years;51.8% Female;50.2% White;56.5% non-AUD) completed baseline assessments of the NIAAA COVID-19 Pandemic Impact on Alcohol Study. Questionnaires were completed by phone and online, and asked whether participants were doing any of the following due to the COVID-19 pandemic: taking media breaks, taking care of your body, engaging in healthy behaviors (e.g. exercise, healthy diet, refraining from substances), making time to relax, and connecting with others. Data: Latent class analysis (LCA) identified distinct patterns of positive coping behavior endorsement. Multiple regression models controlling for age, gender, race, marital status and income level were used to examine latent class differences in alcohol use (AUDIT), coping motives (DMQ Coping), perceived stress (PSS), anxiety (GAD-7) and depressive symptoms (PHQ-9), loneliness (UCLA), and test history of AUD as a potentialmoderator. Results: The two-class solution yielded optimal model fit in the LCA. Class 1 had moderate- to-high probabilities of endorsing positive coping behaviors (High Positive Coping, 82.1%). Class 2 had low probabilities of endorsement (Low Positive Coping, 17.9%). Low Positive Coping participants had significantly greater AUDIT, DMQ Coping, PSS, GAD-7 and PHQ-9 scores than High Positive Coping participants. Participants with AUD had significantly greater AUDIT, DMQ Coping, PSS, GAD-7, PHQ-9 and UCLA scores than participants without AUD. Associations between Positive Coping and AUDIT, GAD-7 and PHQ-9 scores weremoderated by history of AUD such that Low Positive Coping individuals with AUD demonstrated the highest scores, and High-Positive Coping dampened the effect of history of AUD on these outcomes. Conclusions: Most participants had high probabilities of endorsing positive coping behaviors, but those with low probabilities demonstrated significantly greater alcohol use, coping motives, perceived stress, anxiety and depressive symptoms and loneliness. Positive coping behaviors may help mitigate alcohol problems and mental health symptoms in individuals with AUD. Future alcohol interventions should target populations with poor coping behaviors.

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