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1.
Journal of Clinical and Diagnostic Research ; 16(4):DC01-DC05, 2022.
Article in English | EMBASE | ID: covidwho-1818679

ABSTRACT

Introduction: Ever since the Coronavirus Disease 2019 (COVID-19) pandemic hit, there have been constant efforts to develop rapid, sensitive and specific diagnostic methods to detect the virus in order to curb the further spread of the disease. There is an array of tests available for the detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Time being a very crucial factor, Rapid Antigen Testing (RAT) is very helpful in detecting the virus. Aim: To discuss the importance of rapid testing among symptomatic and asymptomatic cases in different age groups and gender with association to infection. Materials and Methods: This retrospective study was conducted in Department of Microbiology, Autonomous State Medical College and SNM Hospital, Firozabad, Uttar Pradesh, India, from April 2020-August 2021. A total of 16,258 samples were collected from symptomatic patients having Influenza Like Illness (ILI), Severe Acute Respiratory Illness (SARI), those seeking hospitalisation, contacts (symptomatic and asymptomatic) and travellers were subjected to antigen detection by the Standard Q COVID-19 antigen kit following proper precautions. The cases were divided into Group A of patients who presented with symptoms ≤7 days, Group B of patients who presented with signs and symptoms >7 days and group C comprised of asymptomatic patients. The Chi-square test was done to test the statistical significance of association of symptomatic patients with outcome of the antigen test. Results: Of the total 16,258 samples tested, the maximum number of positive cases were found in the age group 30-39 years (p-value <0.05) followed by 20-29 years. The least number of positive cases (six) was found in the higher (90 years) and lower (below 9 years) age groups. No significant impact was found on the positivity rates on the basis of gender. The percentage positivity as detected by rapid antigen was 2% and maximum patients were found in the group having symptoms <7 days (p<0.05). Conclusion: Rapid Antigen Detection Test (RADT) for SARS-CoV-2 is a simple, portable, fast and easy to perform test. It could be easily used in rural areas as it does not require special laboratory set up. It could be used for mass testing and helped as a good epidemiological tool. However, few symptomatic cases which could not be detected by rapid testing had to be cross checked with Real Time-Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Thus, when used in conjunction with molecular methods, the sensitivity of the test increased.

2.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816932

ABSTRACT

Background: Food insecurity can negatively impact adherence to and receipt of high-quality cancer care. The purpose of the study was to (1) compare the prevalence of COVID-19 associated food insecurity among cancer survivors to adults without a history of cancer and (2) examine determinants associated with COVID-19 related food insecurity among cancer survivors. Methods: We used nationally-representative data from the COVID-19 Household Impact Survey (n = 10,760), collected at three time points: April 20-26, May 4-10, and May 30-June 8 of 2020. Our primary exposure was cancer survivor status, based on participant's self-report of a cancer diagnosis (n=854, 7.1%). Primary outcomes of food insecurity were categorized on how often (response options: often true, sometimes true, never true) participants reported the following: “We worried our food would run out before we got money to buy more” or “The food that we bought just didn't last, and we didn't have money to get more”;respondents were categorized as food insecure if they chose often true or sometimes true. We also examined use of food pantry assistance or Supplemental Nutrition Assistance Program benefits during the pandemic period;respondents were also categorized as food insecure if they received or applied for these benefits. We compared reported food insecurity among cancer survivors to other U.S. adults using Chi-square tests. Multivariable Poisson regression was used to identify demographic determinants of food insecurity among cancer survivors. Results: Thirty-two percent of cancer survivors were food insecure. Cancer survivors aged 30-44 years and those aged ≥60 were more likely to report being food insecure compared to respondents without a history of cancer in the same age categories (30-44 years, 59.9% versus 41.2% p = 0.01, ≥60 years 27.2% versus 20.2%, p = 0.01). Cancer survivors without a high school diploma were more likely to report food insecurity compared to adults without a high school diploma and no history of cancer (87.0% versus 64.1%, p = 0.001). In examining determinants of food insecurity among cancer survivors, adults aged 45-49 years when compared to those ages ≥60 (aPR = 1.54, 95% CI 1.16-2.03), adults with no high school diploma (aPR = 2.63, 95% CI 1.53-4.50) or a high school degree (aPR = 1.94, 95% CI 1.08-3.49) compared to those with a baccalaureate or above, adults with an annual household income <$30,000 (aPR: 2.16, 95% CI: 1.15-4.07) compared to those earning ≥$100,000, and cancer survivors in rural areas (aPR = 1.51, 95% CI 1.07-2.12) compared those living in urban areas were more likely to report being food insecure. Uninsured cancer survivors (aPR: 2.39, 95% CI: 1.46-3.92) and those on Medicaid (aPR: 2.10, 95% CI: 1.40-3.17) were more likely to report being food insecure than their counterparts. Conclusions: Food insecurity during the COVID-19 pandemic is vast but varies considerably among cancer survivors and adults without a history of cancer. Among cancer survivors, differences in food insecurity were observed by age, SES, and area of residence.

3.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816882

ABSTRACT

Background: Colorectal cancer (CRC) mortality is disproportionately higher in Appalachian counties of Kentucky than in non-Appalachian regions. Part of the mortality gap can be explained by lower screening rates in Appalachian counties. Researchers at Markey Cancer Center partnered with primary care clinics in eastern Kentucky to address this disparity by identifying strategies to implement evidence-based interventions (EBIs) to improve CRC screening and follow-up in Appalachian Kentucky. Methods: Members of the research team conducted formative research activities to identify multilevel barriers to CRC screening. A menu of EBIs was then created to address these barriers, and clinic champions selected EBIs that were feasible in their respective practices. However, because of restrictions during COVID-19, clinics experienced multiple changes to workflow and operations, necessitating modifications to program activities. Over a series of virtual meetings, clinic champions selected adaptations that could allow clinics to continue promoting CRC screening in their practices despite COVID-related limitations. Results: Changes in clinic staffing and workflow resulting from COVID-19 included provider furloughs, a state-mandated pause in elective procedures, mandatory parking lot visits for many in-person visits, and an increase in telehealth. Among our clinic partners, total in-person visits were reduced by nearly half from first to second quarter of 2020, whereas telehealth visits were 23 times higher, though telehealth visits were cut in half by third quarter. To match these changing modes of practice, clinics adapted creative strategies for communicating CRC screening recommendations to patients, including shifting from paper to digital educational tools, promoting screening via telehealth visits, and prioritizing recommendations for stool-based tests over colonoscopy for average-risk patients. As a result, orders for FIT and FIT-DNA were 2 and 3 times higher, respectively, from second to third quarter of 2020. Conclusion: Rural primary care clinics in Appalachia continue to promote CRC screening despite the multiple challenges related to COVID-19. One relevant reference for clinicians is the National Colorectal Cancer Roundtable's playbook for reigniting CRC screening during COVID-19, a document that promotes stool-based screening for average-risk patients. While elective procedures remain backlogged in rural areas due to state regulations, research partners should emphasize the need to prioritize stool-based CRC screening for average-risk populations and reserve scheduling colonoscopies for high-risk individuals or those with abnormal stool-based test results. While our clinical partners had previously focused on a “colonoscopy first” approach to screening, our findings suggest that our clinic partners increased orders for stool-based CRC tests. Nevertheless, continued outreach is needed to ensure CRC screening rates remain optimal.

4.
Open Access Macedonian Journal of Medical Sciences ; 10:498-505, 2022.
Article in English | EMBASE | ID: covidwho-1798869

ABSTRACT

BACKGROUND: Low availability of medical care and low level of comfort living in rural areas, underdeveloped infrastructure, and difficult working conditions lead to the deterioration of health of rural residents. Rural areas are characterized by less comfortable living conditions than in the city, which can affect health-related quality of life. AIM: The purpose of this study was to assess the satisfaction of the population with the quality of life in rural areas as well as to study the quality of life of the rural population of the Republic of Kazakhstan related to health. METHODS: This study was a one-stage cross-sectional study. Online questionnaire was asked by 411 local residents, of which only 302 were suitable for processing. RESULTS: The results showed that almost a third of the respondents are unemployed (27.2%). In the course of the survey, respondents could subjectively assess their own health, for example, almost a third of respondents (35.76%) assess their health as “poor” and “below average.” At the same time, 18.21% of respondents are not satisfied with the quality of medical services provided in rural areas. The coefficients of correlation between the desire to move to the city and age, income level, family composition, marital status, and type of housing were established. The universal social functioning-36 index was 0.6 (±0.02) for women and 0.55 (±0.033) for men CONCLUSIONS: We can say that the quality of life of the rural population remains quite low. This is evidenced by low income, high unemployment, and the problem of drinking water. Quarantine measures related to COVID-19 also had an impact on the increase in unemployment, however, during the quarantine, there is a deterioration in mental health indicators among men compared to women. The results of the study confirmed that the issue of accessibility of medical services remains very urgent for rural residents.

5.
Atmospheric Environment ; 277, 2022.
Article in English | EMBASE | ID: covidwho-1797154

ABSTRACT

Nitrogen oxides (NOx = NO + NO2) are key precursors of tropospheric ozone (O3) together with volatile organic compounds (VOC) and carbon monoxide (CO). Since O3 has positive radiative forcing and is harmful to human health, the reduction of anthropogenic emissions of NOx is thought to be beneficial from the perspectives of climate change and air pollution in principle. However, there have been discussions contending that the reduction of NOx emissions is not necessarily beneficial for the mitigation of climate change and improvement of air quality, since 1) it decreases the atmospheric mixing ratio of hydroxyl radicals (OH), which increases the atmospheric lifetime of methane (CH4), and 2) O3 formation is VOC-limited in urban areas and the decrease of NOx emission would increases urban O3 by facilitating the NO titration effect. In order to scrutinize such discussion, literature review have been made on the temporal variations of the increasing rate of tropospheric CH4 in the last 30 years, and on urban/rural O3 issues related to the NOx-limited/VOC-limited regime. Based on the review, it may be concluded that the variation of emissions of CH4 itself paly a dominant role, and the variation of consumption rate by OH play a minor role for the recent variation of CH4. It has been suggested that NOx and NMVOC should be reduced simultaneously in order to avoid the adverse effect on climate change mitigation. From the review on policy-related discussion of NOx-limited and VOC-limited O3 formation, the increase of O3 by the decrease in NOx emissions has generally been seen in winter and nighttime when photochemical production is minimal, and the higher percentile or diurnal maximum mixing ratios of O3 in summer tends to decrease with the decrease in NOx emissions. We suggested that the NOx-limited/VOC-limited approach is not appropriate as a long-term policy guideline for ozone control, since it is unreasonable that NOx reduction is not recommended when ambient NOx levels are high, while further NOx reduction is recommended only when the VOC/NOx ratio gets high after NOx control has been achieved based on other policy principle. Simultaneous reduction of NOx and NMVOC would be beneficial for reducing global, regional, and urban O3 to alleviate climate change and human health impacts. The ultimate reduction of anthropogenic emissions of NOx can be envisioned toward a denitrified (de-NOx) society along with a decarbonized (de-CO2) society.

6.
Journal of Clinical and Diagnostic Research ; 16(4):LC33-LC36, 2022.
Article in English | EMBASE | ID: covidwho-1791827

ABSTRACT

Introduction: Coronavirus Disease-19 (COVID-19) infection is associated with high rates of pulmonary and extrapulmonary complications that may continue to incur morbidity, disability and delayed mortality in survivors. These include hyperglycaemia, cardiac injury, acute ischaemic or haemorrhagic stroke, neurological deficits, acute kidney injury and liver injury. Aim: To describe symptoms and complications being faced by COVID-19 recovered patients, as well their socio-demographic profile and co-morbidities. Materials and Methods: This was a cross-sectional descriptive study conducted for the period of 12 months from April 2020-March 2021. Out of nearly 10,000 recovered COVID-19 patients, 1000 (calculated sample size) patients were selected randomly. The patients were categorised gender-wise (male and female) and locality-wise (urban and rural) and an attempt was made to find if any significant difference exists in the symptoms and complications based on above categorisation. The test used for this purpose was Chi-square test and Fisher’s-exact test. Results: Mean age of participants was 50.2±15.7 years and 43.8% had co-morbidities. Common complications included hyperglycaemia (n=28), acute kidney injury (n=8), acute liver injury (n=5), cardio-vascular accident and stroke (n=5), septicaemia (n=8), ischaemic heart disease (n=7), deep vein thrombosis (n=2), cytokine release syndrome (n=10) and post COVID-19 fibrosis (n=3). For septicaemia, a statistically significant difference (p<0.001) was found between urban and rural areas whereas no significant difference in post COVID-19 complications between males and females was observed. conclusion: The most common co-morbidity was diabetes mellitus and most common complication reported was hyperglycaemia.

7.
2021 IEEE International Humanitarian Technology Conference, IHTC 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1784505

ABSTRACT

Access to the Internet is necessary to ensure equity for the right to education. However, about 75% of school-age children in rural areas of the world do not have access to the Internet at home. In the Ecuadorian context, only 5.1% of the rural population uses the Internet in public/state schools. Therefore, actions are necessary to reduce the digital gap to improve the quality of education in rural communities in Ecuador. An initiative of IEEE Ecuador, with the support of IEEE SIGHT and the Municipality of Nabón, allowed the rehabilitation of a data network in 40 schools in the Nabón community in 2020. This paper examines the impact of the project, through of the collection of quantitative and qualitative data through stakeholder surveys, to evaluate the impact of data network rehabilitation in the community during the first year of operation. The results show that the Internet in schools has improved the quality of education for students, has allowed children and young people to have access to online education during the COVID-19 pandemic, and has decreased the dropout rate in the benefited schools. The Internet service in schools has also allowed families to save money and entertain themselves. The paper also reports on the evaluation of the social impact of the project, through a Social Return On Investment (SROI) analysis. © 2021 IEEE.

8.
Front Public Health ; 10: 823804, 2022.
Article in English | MEDLINE | ID: covidwho-1785440

ABSTRACT

At the end of 2019, the coronavirus virus COVID-19 has brought the whole world a serious disaster. During this special time, some rural communities were least affected by the epidemic, mainly reflected on the rational utilization of natural biological resources, including edible and medicinal plants and the management of the home gardens. This paper deconstructed the self-responses of rural communities during the pandemic time and tried to provide some suggestions for local government on policymaking. In the end, the future development of ethnobiology in China has been discussed.


Subject(s)
COVID-19 , Plants, Medicinal , COVID-19/epidemiology , China/epidemiology , Humans , Pandemics , Rural Population
9.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779484

ABSTRACT

Background: The prolonged global threat imposed by covid 19 pandemic's first and second wave has created immense stress among the breast cancer due to interruptions of standard oncological care. The frequent lockdown imposed had tremendous impact on the patients' financial status and posed hinderance in transportation to oncological centre. In our hospital, majority of the treatment population are from distant places and below poverty line. We conducted a questionnaire based study to assess the psychological impact in this situation affecting their quality of life(QOL) and their perspective in this current situation. MATERIALS AND METHODS:Breast cancer patients who had been diagnosed and registered in our department from 1st January to 1stApril 2020 before the covid out break were tracked from the medical records. The patients details, disease status dates of follow up and the treatment details were collected.Defaulted patients were contacted.Post one year, in April 2021, these patients were assessed clinically and questioned regarding the treatment perspective. Psychological status and health related quality of life were analysed with GAD-7 (Generalised anxiety disorder questionnaire), PHQ-9 (patient health questionnaire) and EORTC QLQ-C30 questionnaire. Results:A total of 202 breast cancer patients were included. 83 patients(41%) were diagnosed with early breast cancer of which 67(33%) patients were started on Sadjuvant chemotherapy after surgery, 16 (8%)were registered for hormonal therapy. 54(27%) patients with locally advanced, were on neoadjuvant chemotherapy. 65(32%)had metastatic disease at presentation. 23 of 65 metastatic patients were in visceral crisis and were on supportive management for the same. 35 patients had been started on palliative chemotherapy. Out of the 156 patients who had been in initiated with various chemotherapy, only 62(31%) patients were able to review at correct interval for the scheduled chemotherapy. 45 patients(22%) reviewed in the day care irregularly. Among the 45, 28 patients had locally advanced breast cancer and 22 patients had clinical progression due to prolonged gap. 38 patients(19%) had defaulted completely.Of the 38, 16 had advanced disease and presented with clinical progression of disease and switched to second line chemotherapy. 15 patients progressed to have distant metastases and are started on palliative chemotherapy or supportive care. 7 patients who were on adjuvant chemotherapy are kept under close follow up. 11 patients with metastatic breast cancer had died during the past one year. 3 patients had committed suicide.112(55 %) patients were within the city. 71 patients(35%) were from suburban areas. 19 patients(10%) were from adjacent rural areas. 113(56%) were educated.176 (87 %) were desperate to continue treatment inspite of pandemic, while remaining patients main concern was to avoid infection than to get oncological management. While the most common reason for defaulting was travel restrictions, few also documented financial issues and ignorance about progression of cancer. 46 (22%)of patients who had been visiting the day care had turned covid positive. Except for 2 patients who succumbed to the infection, none had major complications. 51%, 42%, 7% had mild, moderate and severe anxiety. 69%, 25%, 6% had mild, moderate and severe depression. The severe anxiety and depression was significant with metastatic breast cancer and educated patients. There were 3 suicides. The overall heath score had a mean of 4. The overall QOL had a mean score of 3 (1-very poor to 7-excellent). CONCLUSION: In patients who were already psychologically affected by onset of cancer, the chaos created by the pandemic added to it further. Hence the patients also need counseling appropriately during oncological treatment.

10.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779471

ABSTRACT

Background. Black women diagnosed with breast cancer are 40 percent more likely to die than their Caucasian peers. They are often diagnosed with higher staged cancers, when treatments are more toxic and costly (Centers for Disease Control, 2018). In addition, Black women have worse stage-specific survival than white women (American Cancer Society, Cancer Facts and Figures for African Americans 2019-2021). Lack of medical knowledge and social isolation are contributing factors to health care disparities. To address these factors, in fall 2019 a member of the board of directors of Living Beyond Breast Cancer approached LBBC to design an educational program for Black patients newly diagnosed with early-stage and metastatic breast cancer. The overarching program goal was to address health care disparities for Black people. The program aimed to increase knowledge about breast cancer and about the implicit and explicit bias Black patients encounter in health care settings, and to provide tools to address it. The program also prepared patients to be informed partners in their health care and connected them to existing resources and to other Black patients for peer support. Methods. LBBC convened an advisory board of ten Black community leaders with expertise in oncology, health care disparities, social and practical support, and advocacy. Most had a personal history of breast cancer. A consultant with expertise in program development and health disparities was hired to oversee the project. The advisory board met monthly to develop content, format, outreach, and speaker recommendations. Initial plans were to deliver the program as a one-day symposium attached to LBBC's fall conference. Because of the COVID-19 pandemic, the advisory board decided to offer the program virtually using a combination of live sessions supplemented with video content. Learnings were intended to prepare participants to more effectively communicate with health care professionals and empower them with practical steps to access appropriate care. An evaluation was designed, and participants received an emailprompting them to offer feedback after each session. Results. The program was delivered from September through October 2020. Speakers were Black oncologists, social workers, researchers, and advocates. The first session was an on-demand video offering guidance to recently diagnosed Black breast cancer patients. Three live sessions were delivered weekly on the topics of identifying barriers to accessing care, early-stage breast cancer treatment, and metastatic breast cancer treatment. The last two sessions focused on self-care and advocacy, with the final session delivered at LBBC's virtual fall conference. LBBC registered 436 people from 36 states and Washington, DC, Canada, and the United Kingdom. Participants ranged from age 27 to 83 and lived in urban, suburban, and rural areas. In all, 307 registrants identified as Black, and 40 reported a breast cancer diagnosis in the last six months. Of participants who completed program evaluations, 75 percent reported an increase in knowledge of breast cancer, 77 percent reported increased understanding of treatment, 82 percent reported increased confidence to have conversations with loved ones or health care providers, and 85 percent said they learned strategies to address implicit and explicit bias. An informal assessment of open-field responses demonstrated that attendees valued the programmatic focus on their unique needs as Black breast cancer patients. Conclusions. An educational program led and designed by Black health care professionals and patients can be successfully delivered in a combination live and virtual content format to improve knowledge, communication skills, and feelings of self-efficacy for Black people with breast cancer.

11.
Osteoarthritis and Cartilage ; 30:S407-S408, 2022.
Article in English | EMBASE | ID: covidwho-1768344

ABSTRACT

Purpose: Osteoarthritis (OA) affects more than 300 million people worldwide with the knee and hip joints among the most clinically prevalent. Pain, stiffness, and physical disability are hallmark symptoms that impair quality of life. Good Life with osteoArthritis from Denmark (GLA:D®) is an evidence-based program providing education and exercise-therapy for people with knee and hip OA, now offered in 8 countries. A key barrier to GLA:D® is the need to attend 14 in-person sessions over 8-weeks, particularly for those in rural areas or with substantial occupational or family caring responsibilities. In the COVID-19 pandemic we expanded implementation support for GLA:D®in Australia to provide it via telehealth. The aim of this mixed methods project was to evaluate the implementation of GLA:D® via telehealth in Australia using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Methods: Quantitative: People with knee or hip OA who reported completing GLA:D® via telehealth-only or a hybrid model of in-person and telehealth (minimum 3 telehealth sessions) at 3-month follow-up from March 2020-October 2021 were identified from the GLA:D®Australia registry. RE-AIM dimensions were examined descriptively. For the effectiveness domain mean differences [MD, (95% confidence intervals (CI)), effect size (ES)] from baseline to 3-month follow-up were calculated for pain (visual analogue scale, 0-100) and joint-related quality of life (knee injury and osteoarthritis outcome score or hip disability and osteoarthritis outcome score -quality of life sub-scales). Participants rated perceived recovery on a global rating of change (scale -3 to 3;1-3=recovered) and how satisfied they were with the GLA:D® program (scale 1-5;4,5=satisfied) at 3-month follow-up. Qualitative: One-on-one semi-structured interviews were conducted with 23 GLA:D® trained physiotherapists (n=12 telehealth adopters;n=11 non-adopters) from diverse (private/public practice, urban/rural) settings. Interviews were transcribed and analysed using a reflexive thematic approach guided by the RE-AIM QuEST framework. Results: Reach: 138 people (39 telehealth-only and 99 hybrid model;69% female) completed GLA:D.® Mean (SD) age and BMI were 64 (9) years 29.8 (5.5) kg/m2, respectively. Key themes on patient barriers and enablers for telehealth reach were technology literacy and access, personal preference and perceived value of telehealth, and availability of exercise equipment. Pandemic restrictions limiting access to in-person GLA:D® was an enabler. Effectiveness: For telehealth-only, average pain [MD=-10 (95%CI=-16, -4), ES=-0.54] and joint-related quality of life [MD=9 (95%CI=3, 14), ES=0.51] improved significantly. This was similar for hybrid model with average pain [MD=-11 (95%CI=-16, -6, ES=-0.43)] and joint-related quality of life [MD=12 (95%CI=8, 16, ES=0.65)] also improved. At 3-months, 81% of participants reported recovery and 88% were satisfied with GLA:D®. Most physiotherapists who adopted GLA:D® telehealth believed it was as effective as in-person for most patients and felt patients were better able to continue exercising at home upon completion. Adoption: 92 physiotherapists (74 health services) delivered GLA:D® via telehealth. Most physiotherapists who had adopted GLA:D® via telehealth stated it had become a normal part of their practice. Barriers to adoption included preferring, and greater confidence with providing, in-person GLA:D®. Implementation: Both education sessions were attended by 70% (n=96) of participants and 91% (n=125) attended more than 10 exercise-therapy sessions. GLA:D® telehealth implementation involved program modifications, including to assessment, exercise instruction, equipment modifications, and reduced fee structures. Maintenance: GLA:D® telehealth participants completed 3-month follow-ups throughout the entire study timeframe, with 16 (12%) in the final 2 months of evaluation, indicating ongoing participant engagement. Physio herapists stated GLA:D® telehealth was an opportunity for increased program access to immunocompromised, rural, and working patients. Barriers to sustainability identified included lack of personnel capacity, low patient demand, and a need for future telehealth training and support. Conclusions: Telehealth delivery of GLA:D® in Australia during the pandemic was most used as part of a hybrid model, combined with in-person delivery. Patient outcomes following GLA:D® via telehealth were comparable to published data related to in-person delivery, indicating it is an effective method to implement group-based care for OA. Yet, implementation was limited, impeded by low perceived value by patients and lack of confidence and training of physiotherapists. This evaluation will guide new strategies and training to support GLA:D via telehealth as a viable mode of program delivery in the future in Australia and internationally.

12.
European Heart Journal, Supplement ; 23(SUPPL F), 2021.
Article in English | EMBASE | ID: covidwho-1766449

ABSTRACT

The proceedings contain 200 papers. The topics discussed include: an ultra-rare case of Hutchinson-Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl;pulse dose corticosteroid improves clinical outcome in pulmonary hypertension patient: a potential of immense affordability and availability medication in suburban area;infected femoral artery pseudoaneurysm with klebsiella pneumoniae bacteremia in injected drug abuser: a case report;cardiac complications in immunocompromised patient : a case report;cardiac arrest in COVID-19 patient presenting with takotsubo cardiomyopathy;cardiac amyloidosis: a great pretender of left ventricular hypertrophy with systemic manifestation;and managing acute decompensated heart failure with exacerbation of chronic obstructive pulmonary disease in rural area: a case report.

13.
Archives of Cardiovascular Diseases Supplements ; 14(1):107, 2022.
Article in English | EMBASE | ID: covidwho-1757021

ABSTRACT

Background: Healthy lifestyle, which are keystones in management of chronic cardiac patients, could be challenged during the lockdown. Purpose: In patients with Chronic coronary syndrome (CCS) or congestive heart failure (CHF), to evaluate the impact of the place of residence during the Covid-19 lockdown on lifestyle behaviours. Methods: Randomly selected subjects among 250 patients with CCS (from RICO survey) and 150 patients with CHF (from a HF clinic) were invited to answer to a phone-call questionnaire during the 1st COVID-19 lockdown. Urban zone was defined as ≥ 2000 inhabitants. Psychological distress was assessed by Kessler-6 score. Results: 344 questionnaires were fit for analysis (220 CCS and 124 CHF), including 66.6% male, with median (IQR) age at 70(59-78) y (Table 1). Rural location of lockdown residence was frequent (53%), and associated with less lifestyle impairment (i.e. decrease in physical activity and increase in screen-time). In contrast, patients living in urban area felt more often cramped and had a higher psychologic distress. Conclusions: During the 1st lockdown, chronic cardiac subjects from rural areas reported less unhealthy behaviors and lower rate of psychological impairment. These data may help to implement preventive action targeting urban patients.

14.
BMC Health Serv Res ; 22(1): 299, 2022 Mar 04.
Article in English | MEDLINE | ID: covidwho-1724483

ABSTRACT

BACKGROUND: The COVID-19 pandemic has exerted an unprecedented and universal impact on global health system, resulting in noticeable challenges in traditional chronic disease care, of which diabetes was reported to be most influenced by the reduction in healthcare resources in the pandemic. China has the world's largest diabetes population, and current diabetes management in China is unsatisfactory, particularly in rural areas. Studies in developed countries have demonstrated that physician-pharmacist collaborative clinics are efficient and cost-effective for diabetes management, but little is known if this mode could be adapted in primary hospitals in China. The aim of this proposed study is to develop and evaluate physician-pharmacist collaborative clinics to manage type 2 diabetes mellitus (T2DM) in primary hospitals in Hunan province. METHODS: A multi-site randomized controlled trial will be conducted to evaluate the effectiveness and cost-effectiveness of the physician-pharmacist collaborative clinics compared with usual care for Chinese patients with T2DM. Six primary hospitals will participate in the study, which will recruit 600 eligible patients. Patients in the intervention group will receive services from both physicians and pharmacists in the collaborative clinics, while the control group will receive usual care from physicians. Patients will be followed up at the 3rd, 6th, 9th and 12th month. Comparison between the two groups will be conducted by assessing the clinical parameters, process indicators and costs on diabetes. A satisfaction survey will also be carried out at the end of the study. DISCUSSION: If effective, the physician-pharmacist collaborative clinics can be adapted and used in primary hospitals of China to improve glycemic control, enhance medication adherence, decrease incidence of complications and reduce patients' dependence on physicians. Findings from the present study are meaningful for developing evidence-based diabetes care policy in rural China, especially in the COVID-19 pandemic era. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2000031839 , Registered 12 April 2020.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Interprofessional Relations , Pharmacists , Physicians , COVID-19/epidemiology , China/epidemiology , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Hospitals , Humans , Multicenter Studies as Topic , Pandemics , Randomized Controlled Trials as Topic
15.
Inflammatory Bowel Diseases ; 28(SUPPL 1):S31, 2022.
Article in English | EMBASE | ID: covidwho-1722439

ABSTRACT

BACKGROUND: The COVID19 pandemic has introduced new challenges to the diagnosis and management of pediatric Inflammatory Bowel Disease (IBD). Many patients have had limited access to their providers through telemedicine and may choose to delay non-emergent treatment for fear of risking exposure in healthcare settings. Additionally, the “hygiene hypothesis” would suggest that decreased microbial exposure secondary to social isolation may result in greater incidence of new IBD diagnoses and worsened exacerbations of preexisting disease, particularly in urban populations. We hypothesize that these factors resulted in worsened disease status upon admission. METHODS: We conducted a retrospective chart review of pediatric patients with IBD admitted to a tertiary care center before the onset of the COVID19 pandemic (01/01/18 - 03/01/20) and during the pandemic (03/01/20 - 08/01/21). All patients ≤18 yrs old who were admitted for a flare or new diagnosis of IBD were included. Variables collected included: demographics, admission indication, length of stay, laboratory markers of disease severity, surgical or endoscopic procedures performed during admission, and new treatments started on discharge. Data were analyzed using paired ttests. Study was IRB approved. RESULTS: The pre-COVID (N=50) and during-COVID (N=52) populations were similar in regard to demographic and clinical characteristics. More patients during-COVID19 underwent major surgical interventions (11.5% vs. 0%, p=0.007), and were started on biologic therapies or steroids (38.5% vs. 26%, p=0.09 and 11.5% vs. 0%, p=0.007 respectively). Length of stay was also increased during-COVID (5.5 days vs. 4.9 days, p=0.3). UC patients admitted during-COVID exhibited more severe thrombocytosis (483 vs. 419, p=0.2) while CD patients admitted during-COVID exhibited more severe anemia (10.7 vs. 11.6, p=0.1) and hypoalbuminemia (2.7 vs. 3.1, p=0.04). Although not significant, more patients during-COVID were admitted from urban areas (63.5% vs. 56%, p=0.2). DISCUSSION: Increased length of stay and incidence of major surgical interventions and biologic therapy initiation suggest that pediatric patients admitted for a flare or new diagnosis of IBD during the COVID19 pandemic experienced worsened disease severity. More severe thrombocytosis, anemia, and hypoalbuminemia upon admission supports this correlation. We hypothesize that many families chose to delay presentation given fear of exposure to COVID19. Furthermore, partial department closures may have led to delays in seeing patients in-person and ultimately admission. Lastly, we suspect that during-COVID fewer patients were admitted from rural areas given they experienced less emotional stress and physical isolation than their urban peers. Uninterrupted exposure to farm animals and peers at school may have had a protective effect on microbiome balance and stress level.

16.
European Heart Journal ; 43(SUPPL 1):i224, 2022.
Article in English | EMBASE | ID: covidwho-1722400

ABSTRACT

Background: World is facing Coronavirus disease (COVID-19) pandemic since December 2019. [1, 2]. COVID-19 has significantly decreased the influx of patients presenting with cardiovascular diseases at hospitals. The aim of this study was to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19 era and to assess the awareness regarding telemedicine and wiliness to adopt if offered in future. Methods: This cross sectional study was carried out on patients presenting to the outpatient department in a National Institute of Cardiovascular Diseases. Data was collected after verbal consent from patients. The collected data was entered using IBM SPSS version 21, mean ± SD was calculated for continuous variables and frequency and percentages were calculated for the categorical variables. Results: A total of 404 patients were interviewed, 42% female and 58% male with 77.5% from urban areas and 22.5% from rural areas. A total of 32.1% patients presented with shortness of breath, 28.8% with chest pain and 19% with palpitations. Regarding cardiovascular diagnosis 69.5% had ischemic heart disease, 38.3% had hypertension, 29.3% suffered from heart failure and 10.3% had valvular heart disease. A total of 26.7% visited the emergency room during the pandemic, 81.9% were compliant with medication and only 66% were compliant with a healthy lifestyle. A total of 52.8% patients found it difficult to attend the out patients department due to limited appointments, 24% due to limited mobility due to lockdown, 18.2% due to financial issues, 14.2% due to fear of acquiring infection from the hospital. Regarding telemedicine, 11.2% of the patients were aware of it and only 4.5% had previously used it, with 41.3% patients willing to opt for telemedicine in future. Regarding barriers to usage of telemedicine, a total of 40.7% of patients had no access to internet, 32.7% did not have a smart device and 11.6% were afraid of being diagnosed incorrectly. Conclusion: It was found that distancing measures, lockdowns and restricted mobility of the masses has made it difficult for patients to visit the clinics which has led to patients visiting the emergency room. Telemedicine awareness was found to be limited, however many patients were willing to adopt provided their limitations can be overcame. (Figure Presented).

17.
Journal of Clinical Oncology ; 40(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1708843

ABSTRACT

Background: Prevailing methods for patient recruitment in large prospective studies can be time consuming, expensive, and introduce selection bias against patients with low health literacy or reduced access to healthcare. Previous clinical trials have reported low recruitment of women, minorities, and individuals who face socioeconomic barriers;a concern which has been exacerbated by the COVID-19 pandemic. Here we describe a novel recruitment strategy that helps to address healthcare disparities. This study will support a pre-market approval application to the FDA for a multi-factor RNA-FIT assay for detection of colorectal neoplasia in average-risk individuals between the ages of 45-75. Methods: A decentralized clinical trial (CRC-PREVENT) was launched through a digital campaign (https://www.colonscreeningstudy.com/;NCT04739722) after the RNA-FIT test system entered design-lock. Online advertisements were published on multiple social media sites and engagement with materials directed patients to an online screener. Participants who completed the screener were considered eligible for enrollment if they met CRC-PREVENT inclusion/ exclusion criteria and were willing to complete all components of the clinical trial, including providing a stool sample prior to an optical colonoscopy. Results: After 3 months of active enrollment, 51,588 individuals have engaged with digital advertisements and completed pre-screener surveys to determine eligibility. In total, 35,280 individuals were deemed eligible based on survey response, and 13,294 eligible individuals also expressed interest in the CRC-PREVENT clinical trial. Of these individuals, 48% were female and 34% were over the age of 60 years old. Regarding race, interested individuals directly represented the intended use population: 17% were Black or African American, 2.7% were Asian, and 1.3% were Native Hawaiian, Pacific Islander, American Indian, or Alaskan Native. With respect to ethnicity, 8.4% identified as Hispanic or Latinx. The decentralized approach also permitted access to individuals with socioeconomic healthcare inequities: 27% had income under $29,999 and 14% were on Medicaid. Individuals were derived from all 48 continental United States, and of those who reported their residential location, approximately 3% were from rural areas. Conclusions: Use of a decentralized recruitment strategy permitted highly successful enrollment in the face of challenges associated with COVID-19. With respect to race, ethnicity, socioeconomic status, and geography, all metrics represented significantly more diverse populations than observed in traditional clinical studies. Decentralized enrollment mitigated selection bias, and will result in data more reflective of the intended use population.

18.
Physiotherapy (United Kingdom) ; 114:e208-e209, 2022.
Article in English | EMBASE | ID: covidwho-1705031

ABSTRACT

Keywords: Undergraduate Physiotherapists;Career choice;Rural practice Purpose: Sub-optimal distribution of physiotherapists in Scotland between urban and rural settings in Scotland have lead to problematic staff shortages. There are well documented difficulties in recruiting and retaining NHS staff within rural and remote areas. As a result of COVID-19 we have witnessed the workforce pressures and capacity challenges within our NHS, exacerbating this issue. Despite deployment of healthcare students to support workforce capacity during this time, there remains a preference for employment in metropolitan areas, making recruitment to more remote locations challenging. Brexit through its influence on immigration has further magnified such pressures. Measures to increase domestic training capacity have been implemented within Scotland and there is an urgent need to explore influences on job preferences for undergraduate physiotherapy students entering the workforce. The main purpose in undertaking this research recognises that it is crucial to recruit and retain health workers within rural areas. Aim: To identify factors which influence physiotherapy students’ preferences of location and type of post-graduation employment in Scotland. Objectives: • To describe reasons why physiotherapy students choose their profession. • To explore preferred choices of location for employment post-graduation. • To explore influences on preferences for type of post graduate employment. Methods: Participants (n = 22) were final year pre-registration physiotherapy students from Queen Margaret University (QMU): 4th year BSc (Hons) and 2nd year Masters (MSc). A phenomenological qualitative approach was employed, with data collected through three focus groups (face-to-face). A semi-structured interview format was facilitated by the researcher. Interview transcripts were subjected to thematic analysis. Results: Five themes emerged from the analysis relating to influences on participants’ preferences for location and type of work. These themes were (1) Previous exposure to physiotherapy, (2) One's upbringing, (3) Clinical placement, (4) Job characteristics, (5) Desirable work/life environment. Themes 1, 4 and 5 appeared to influence student's preference for location, whereas themes 2 and 3 were influencers of the preferred type of physiotherapy practice. These themes were comprised of associated subthemes. Urban practice was the location preferred overall. Clinical placement experiences had the ability to overpower influential factors prior to studying and change one's preferences for type of physiotherapy practice. Conclusion(s): A combination of factors influenced preferences for post-graduation employment and these varied based on individual experiences. Interestingly, some of the largest influences were modifiable characteristics which may well be of significance to managers if incentive policies are to be developed to attract more employees to underserviced areas and combat the previously mentioned spatial maldistribution of employment. For example, recruiting physiotherapy students from rural areas, developing supportive mentoring and or developmental structures may be an effective way. Impact: Policymakers can design strategies to attract more physiotherapy students to remote and rural areas, such as better targeting and promotion of such jobs to students from rural areas and promoting supportive work environments. Funding acknowledgements: This work was not funded.

19.
Journal of Clinical Oncology ; 40(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1704378

ABSTRACT

Background: In the US, pts living in rural areas have higher CRC mortality rates than urban areas. Clinical guidelines recommend testing for BRAF and RAS mutations and deficient mismatch repair/microsatellite instability in pts with mCRC. However, data on biomarker testing rates in rural communities compared with urban areas are limited. We surveyed ONC in the US who practice in rural areas or urban clusters to identify biomarker testing patterns and barriers (data previously reported) and conducted interviews with a select group of respondents to further understand key differences that may contribute to substandard biomarker testing rates in rural areas. Methods: A 2-part (quantitative and qualitative) survey was conducted with ONC who spend > 40% of their time providing direct care to pts in rural areas or urban clusters and who had treated ≥2 pts with stage IV mCRC in the month prior to the survey. After screening, a subset of those who completed the quantitative survey participated in the qualitative survey (a 30- minute, web-assisted, telephone interview). The interview questions targeted 6 areas: clinical practice description, biomarker and genomic testing patterns, pathology and molecular tumor board, tumor tissue journey, electronic health records, and training/educational opportunities. Results: Of the 99 ONC who responded to the quantitative survey, 17 were interviewed for the qualitative survey from June 16-29, 2021. A key finding of the quantitative survey was that although ONC reported being familiar with biomarkers relevant to mCRC, the reported rate of biomarker testing was suboptimal. The interviews probed reasons why testing does not align with current guidelines and found that challenges exist throughout the tumor tissue journey including insufficient tumor tissue available for testing (especially in the relapsed/refractory setting);lack of or limited protocols, clinical decision support systems, reflexive testing, and molecular tumor boards;lengthy and difficult-to-navigate next-generation sequencing reports;and financial toxicity surrounding biomarker tests (especially for underinsured pts), among other barriers. Despite these challenges, ONC reported easy access to third-party reference labs and electronic references, such as NCCN and UpToDate. Although telehealth visits have nearly quadrupled during the COVID pandemic, access to telehealth may be limited for pts living in rural areas or urban clusters. Conclusions: The ONC surveyed reported that practicing in rural/urban clusters poses unique challenges related to tissue acquisition, practice resources, pts' ability to pay, and clinical knowledge gaps that may affect biomarker testing rates in pts with mCRC. Addressing these gaps is warranted if optimal utilization of precision medicine tools is to be realized.

20.
Journal of Investigative Medicine ; 70(2):538, 2022.
Article in English | EMBASE | ID: covidwho-1701808

ABSTRACT

Purpose of Study Prior to the COVID-19 pandemic, we initiated a randomized clinical trial for childhood obesity. The trial consented 131 and randomized 104;6-12 year old patients who reside in rural regions in 4 member states (DE, NE, SC, and WV) of the ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) Approximately 6 weeks into the 10-week recruitment period, the trial was forced to pause all study activity due to the COVID-19 pandemic. This pause necessitated a substantial revision in recruitment and study methods to using virtual procedures. This descriptive paper outlines ways to recruit and manage clinical trial participants using technology to obtain informed consent, obtain height and weight measurements by video, and maintain participant engagement throughout the duration of the trial. Methods Used We reviewed multiple data sources to describe the transition to virtual study procedures. These include research electronic data capture (REDCap) surveys conducted both during the pause and at the completion of the study to identify readiness for each site to conduct virtual recruitment and other study procedures as well as at the end of the study to identify issues that each site encountered during the virtual phase of the project. We also reviewed meeting notes and study enrollment figures. Summary of Results The IRB approved study changes allowed for variability between clinical sites in terms of virtual communication platforms and methods for participant consent and height/weight assessment. Identified advantages of the study included ability to conduct visits during all times of the day or evening, and reduced travel requirements. Challenges included poor Internet reliability in some rural areas;additional participant contacts for consent and eligibility screening;shipping delays of materials;reliance on family to perform height and weight measures;increased costs for materials and shipping. Despite the added challenges, all sites were able to meet the study enrollment objectives. Flexibility was key in implementation of virtual procedures given the variations in site resources. Conclusions While each study site had certain challenges unique to their location during the pandemic, we also identified several common issues with the transition to remote procedures. Lessons learned from this study can assist other study groups in navigating challenges, especially when recruiting and implementing studies with a difficult to reach rural and underserved populations or during challenging events like the pandemic.

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