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1.
MMWR Morb Mortal Wkly Rep ; 70(4): 109-113, 2021 Jan 29.
Article in English | MEDLINE | ID: covidwho-1112895

ABSTRACT

On March 19, 2020, the governor of California issued a statewide stay-at-home order to contain the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* The order reduced accessibility to and patient attendance at outpatient medical visits,† including preventive services such as cervical cancer screening. In-person clinic visits increased when California reopened essential businesses on June 12, 2020.§ Electronic medical records of approximately 1.5 million women served by Kaiser Permanente Southern California (KPSC), a large integrated health care system, were examined to assess cervical cancer screening rates before, during, and after the stay-at-home order. KPSC policy is to screen women aged 21-29 years every 3 years with cervical cytology alone (Papanicolaou [Pap] test); those aged 30-65 years were screened every 5 years with human papillomavirus (HPV) testing and cytology (cotesting) through July 15, 2020, and after July 15, 2020, with HPV testing alone, consistent with the latest recommendations from U.S. Preventive Services Task Force.¶ Compared with the 2019 baseline, cervical cancer screening rates decreased substantially during the stay-at-home order. Among women aged 21-29 years, cervical cytology screening rates per 100 person-months declined 78%. Among women aged 30-65 years, HPV test screening rates per 100 person-months decreased 82%. After the stay-at-home order was lifted, screening rates returned to near baseline, which might have been aided by aspects of KPSC's integrated, organized screening program (e.g., reminder systems and tracking persons lost to follow-up). As the pandemic continues, groups at higher risk for developing cervical cancers and precancers should be evaluated first. Ensuring that women receive preventive services, including cancer screening and appropriate follow-up in a safe and timely manner, remains important.


Subject(s)
/prevention & control , Delivery of Health Care, Integrated , Early Detection of Cancer/statistics & numerical data , Quarantine/legislation & jurisprudence , Uterine Cervical Neoplasms/prevention & control , Adult , Aged , California/epidemiology , Female , Humans , Middle Aged , Young Adult
2.
Int J Environ Res Public Health ; 18(4)2021 02 10.
Article in English | MEDLINE | ID: covidwho-1112722

ABSTRACT

This study describes self-reported physical activity (PA), motivation to exercise, physical and mental health and feelings towards PA during the March-May 2020 COVID-19 lockdown in New Zealand. Adults over the age of 18 years (n = 238; 80.2% female) completed the International Physical Activity Questionnaire (IPAQ), the Behavioural Regulation in Exercise Questionnaire 3, the Short Form-36 and open-ended questions about PA through an anonymous online survey. Regular exercise was undertaken by 85% of respondents prior to lockdown, but only 49.8% were able to maintain their usual level of PA. Although respondents were considered sufficiently physically active from the IPAQ, 51.5% reported not being able to maintain their usual level of PA primarily due to the closure of their gym facilities. Sixty percent of respondents reported that PA had a positive effect on their overall wellbeing. When asked to specify which aspects of wellbeing were affected, the effect on mental health was reported the most while the effect on body image or fitness was reported the least. Strategies to increase or maintain engagement in physical activity during lockdowns should be encouraged to promote positive mental health during the COVID-19 pandemic.


Subject(s)
/psychology , Exercise , Mental Health , Pandemics , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , New Zealand/epidemiology , Self Report , Young Adult
3.
Int J Environ Res Public Health ; 18(4)2021 02 10.
Article in English | MEDLINE | ID: covidwho-1112719

ABSTRACT

The COVID-19 outbreak had a negative impact on psychological status among elderly subjects, negatively affecting their health-related quality of life (HRQoL). Psychological factors that promote resilience might beneficially contribute also to promoting a better HRQoL among elderly subjects. The main purpose of the present study was to investigate the contribution of dispositional optimism and expressive flexibility on the HRQoL of elderly outpatients during the COVID-19 outbreak. The outpatients were recruited from October 2018 to October 2019, and then followed-up during April 2020, by evaluating their HRQoL. The baseline sample consisted of 141 elderly outpatients (mean age 80.31 ± 6.84 years); the final number of outpatients included in the follow-up evaluation was 104 (mean age 80.26 ± 6.39). Univariate and multivariate linear regressions were developed to explore significant associations with the physical and mental component of HRQoL. Baseline dispositional optimism was a predictor of the mental component of HRQoL at follow-up; the flexible suppression of emotional expression was a predictor of the physical component of HRQoL at follow-up. From a psychogeriatric perspective, the accurate assessment of psychological factors, such as dispositional optimism and expressive flexibility, might help physicians and psychologists to recognize additional patients' vulnerabilities during the current emergency.


Subject(s)
/psychology , Mental Health , Pandemics , Quality of Life , Aged , Aged, 80 and over , Emotions , Health Status , Humans , Optimism
4.
Int J Environ Res Public Health ; 18(4)2021 02 09.
Article in English | MEDLINE | ID: covidwho-1112710

ABSTRACT

The aim of the study was to examine whether, and to what extent, fear of contracting Covid-19 and compliance with the mandatory rules of isolation affected Polish adults' nutritional behaviors. The online study was carried out during the first wave of the pandemic on a sample of 926 adults. Through cluster analysis, three groups of respondents were isolated: 1. People who fear a Covid-19 infection and follow the isolation rules (FFR), 2. People moderately afraid of the disease and following the rules loosely (MFFR), 3. People who are not afraid of the infection and do not follow the rules of isolation. (NFFR). The clusters were profiled with consideration of different aspects of eating behaviors as well as socio-demographic and economic features. The results of the study show a close relationship between the level of fear of contracting Covid-19 and the degree to which isolation rules are followed. These two factors were found to have a significant impact on eating behaviors, such as food purchases, eating patterns, and levels of consumption. It was stated that the FFR group changed their eating behaviors the most in terms of food purchasing, eating habits (excluding diversity and quality of diet), and food product consumption. The greatest stability in the majority of the analyzed areas of nutritional behaviors was observed in the MFFR cluster. The NFFR group shown the greatest decrease both in regularity and quality of their meals. This group also exhibited a significant increase in the consumption of alcoholic beverages. The results of the study can be useful in the decision making process when introducing restrictions or managing information. They also point to the need for extensive nutritional education focused on explaining the relationship between nutrition and health during a pandemic.


Subject(s)
/psychology , Consumer Behavior , Fear , Feeding Behavior , Adolescent , Adult , Aged , Communicable Disease Control , Female , Humans , Male , Middle Aged , Pandemics , Poland , Young Adult
5.
F1000Res ; 9: 1286, 2020.
Article in English | MEDLINE | ID: covidwho-1110755

ABSTRACT

Background: Case fatality rate of COVID-19 patients in Surabaya is higher than global cases. Thus, it is important to identify risk factors to reduce the mortality rate. This study aimed to assess the factors associated with hospital mortality of COVID-19 patients, and develop a prediction score based on these findings. Methods: We analyzed 111 patients, who were diagnosed with COVID-19 based on reverse-transcriptase polymerase chain reaction. The following patient characteristics were obtained from records: age, gender, type of symptoms, onset of symptoms, neutrophil lymphocyte ratio (NLR), absolute lymphocyte count, chest x-ray abnormalities, lung involvement, type of lesion, radiographic assessment of the quantity of lung edema (RALE) score, and mortality. Data were analyzed using SPSS 25.0. Results Multivariate analysis showed that age >50 years ( p=0.043), NLR score >5.8 ( p=0.016) and RALE score >2 ( p=0.002) can predict the mortality of COVID-19 patients in the hospital. ROC curve analysis of the score ability to predict mortality showed an area under the curve of 0.794. The cut-off point is 4.5, with a sensitivity of 96.7% and specificity of 49.4% to predict the mortality of COVID-19 patient in the hospital. Conclusions Age, NLR score and RALE score were associated with mortality of COVID-19 patients in the hospital and could be used as a predictor for discharge probability of COVID-19 patients in low health care resource setting. The prediction score may be useful for frontline physicians to effectively manage patients with a higher score to prevent mortality.


Subject(s)
Age Factors , Edema/diagnostic imaging , Hospital Mortality , Lymphocytes/cytology , Neutrophils/cytology , Adult , Aged , Female , Humans , Lung/diagnostic imaging , Lung/physiopathology , Male , Middle Aged , Respiratory Sounds , Retrospective Studies
7.
Ann Intern Med ; 174(2): JC16, 2021 02.
Article in English | MEDLINE | ID: covidwho-1110694

ABSTRACT

SOURCE CITATION: Stone JH, Frigault MJ, Serling-Boyd NJ, et al. Efficacy of tocilizumab in patients hospitalized with Covid-19. N Engl J Med. 2020;383:2333-44. 33085857.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Respiratory Insufficiency/drug therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , Respiratory Insufficiency/mortality , Respiratory Insufficiency/virology
8.
J Sports Med Phys Fitness ; 61(2): 294-300, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1106688

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the Italian government took security measures to try to limit infections. Restrictive measures included social distancing, home confinement and the closure of all public structures like gyms and swimming pools. The impact of these limitations on health and lifestyle was inevitably negative. The purpose of this study was to establish the level of physical activity (PA), expressed as energy expenditure (MET-minute/week) in a Southern Italian population before and during the COVID-19 lockdown. METHODS: An adapted version of the International Physical Activity Questionnaire-short form (IPAQ-SF) was published on the official website of the National Institute of Gastroenterology IRCCS S. de Bellis, Castellana Grotte, Bari, Italy and on several social media in May 2020. RESULTS: Three hundred ten replies (72% women) from Apulia (60%), Calabria (28%), Campania (11%) and Sicily (1%) were included in the study. The COVID-19 lockdown had a negative effect on the vigorous PA intensity level and on walking, but not on the moderate PA intensity level. Additionally, daily time spent sitting down increased by more than 12% during the COVID-19 lockdown. CONCLUSIONS: Isolation changed PA behaviors. The decreased energy expenditure (MET-minute/week) during the lockdown had a negative impact in both genders, especially on the young adults and adults' groups.


Subject(s)
/epidemiology , Communicable Disease Control , Exercise , Adult , Aged , Cross-Sectional Studies , Energy Metabolism , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Sitting Position , Surveys and Questionnaires , Walking
9.
Rev. Nutr. (Online) ; 33: e200174, 2020. graf
Article in English | LILACS (Americas) | ID: covidwho-1105898

ABSTRACT

ABSTRACT It has been documented that the older adults of the population are at the greatest risk of mortality due to the coronavirus disease; consequently, they could be the population most affected by the measures of social isolation and reduction of virus contagion implemented worldwide. Social isolation can expose older adults to an increased nutritional risk due to factors such as socioeconomic insecurity, which could affect food acquisition and the need for support in daily tasks and meals. The institutionalized older adults often depend on food donations, which may have reduced due the economic crisis caused by the pandemic, and the aging process itself causes changes in nutritional necessitie and eating habits. In the coronavirus pandemic, nutritionists and dietitians can offer remote nutritional follow-up. Moreover, the government actions, such as the implementation of educational and social service programs, should be applied to support healthy aging and minimize exposure to nutritional risks and coronavirus disease.


RESUMO Tem sido documentado que os idosos são a população de maior risco para mortalidade por COVID-19. Consequentemente, pode ser a mais afetada pelas medidas de isolamento social e de redução de contágio pelo vírus implementadas em todo o mundo. O isolamento social pode expor os idosos ao risco nutricional aumentado devido a alguns fatores, como: a insegurança socioeconômica, a qual pode afetar a aquisição de alimentos; a necessidade de apoio nas tarefas e nas refeições diárias; a possível redução de doações de alimentos para idosos institucionalizados, em virtude da crise econômica ocasionada pela pandemia; e o próprio processo do envelhecimento, que causa alterações das necessidades nutricionais e do hábito de se alimentar. Contudo, no contexto da pandemia do novo coronavírus, nutricionistas podem oferecer acompanhamento nutricional remoto. Além disso, ações governamentais, como a implementação de programas educacionais e de serviço social, devem ser aplicadas para o envelhecimento saudável e para a minimização da exposição ao risco nutricional e à COVID-19.


Subject(s)
Humans , Middle Aged , Aged , Aged, 80 and over , Aged , Coronavirus , Pandemics , Nutritional Requirements
10.
Span J Psychol ; 24: e8, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1101609

ABSTRACT

In the midst of the COVID-19 epidemic, Spain was one of the countries with the highest number of infections and a high mortality rate. The threat of the virus and consequences of the pandemic have a discernible impact on the mental health of citizens. This study aims to (a) evaluate the levels of anxiety, depression and well-being in a large Spanish sample during the confinement, (b) identify potential predictor variables associated to experiencing both clinical levels of distress and well-being in a sample of 2,122 Spanish people. By using descriptive analyses and logistic regression results revealed high rates of depression, anxiety and well-being. Specifically, our findings revealed that high levels of anxiety about COVID-19, increased substance use and loneliness as the strongest predictors of distress, while gross annual incomes and loneliness were strongest predictors of well-being. Finding of the present study provide a better insight about psychological adjustment to a pandemic and allows us to identify which population groups are at risk of experiencing higher levels of distress and which factors contribute to greater well-being, which could help in the treatments and prevention in similar stressful and traumatic situations.


Subject(s)
Adaptation, Psychological , Anxiety Disorders/psychology , Depressive Disorder/psychology , Mental Health , Psychological Distress , Substance-Related Disorders/psychology , Adolescent , Adult , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Cross-Sectional Studies , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Female , Health Surveys , Humans , Income , Internet , Loneliness/psychology , Male , Middle Aged , Pregnancy , Quality of Life/psychology , Risk Factors , Spain/epidemiology , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Young Adult
12.
Medicine (Baltimore) ; 100(6): e24141, 2021 Feb 12.
Article in English | MEDLINE | ID: covidwho-1101918

ABSTRACT

BACKGROUND: The global neo-coronary pneumonia epidemic has increased the workload of healthcare institutions in various countries and directly affected the physical and psychological recovery of the vast majority of patients requiring hospitalization in China. We anticipate that post-total knee arthroplasty kinesiophobia may have an impact on patients' postoperative pain scores, knee function, and ability to care for themselves in daily life. The purpose of this study is to conduct a micro-video intervention via WeChat to verify the impact of this method on the rapid recovery of patients with kinesiophobia after total knee arthroplasty during neo-coronary pneumonia. METHODS: Using convenience sampling method, 78 patients with kinesiophobia after artificial total knee arthroplasty who met the exclusion criteria were selected and randomly grouped, with the control group receiving routine off-line instruction and the intervention group receiving micro-video intervention, and the changes in the relevant indexes of the two groups of patients at different time points on postoperative day 1, 3 and 7 were recorded and analyzed. RESULTS: There were no statistical differences in the scores of kinesiophobia, pain, knee flexion mobility (ROM) and ability to take care of daily life between the two groups on the first postoperative day (P > .05). On postoperative day 3 and 7, there were statistical differences in Tampa Scale for kinesiophobia, pain, activities of daily living scale score and ROM between the two groups (P < .01), and the first time of getting out of bed between the two groups (P < .05), and by repeated-measures ANOVA, there were statistically significant time points, groups and interaction effects of the outcome indicators between the 2 groups (P < .01), indicating that the intervention group reconstructed the patients' postoperative kinesiophobiaand hyperactivity. The level of pain awareness facilitates the patient's acquisition of the correct functional exercises to make them change their misbehavior. CONCLUSIONS: WeChat micro-video can reduce the fear of movement score and pain score in patients with kinesiophobia after unilateral total knee arthroplasty, shorten the first time out of bed, and improve their joint mobility and daily living ability. ETHICS: This study has passed the ethical review of the hospital where it was conducted and has been filed, Ethics Approval Number: 20181203-01.


Subject(s)
Arthroplasty, Replacement, Knee/psychology , Phobic Disorders/psychology , Pneumonia/epidemiology , Activities of Daily Living , Aged , Arthroplasty, Replacement, Knee/adverse effects , /diagnosis , Case-Control Studies , China/epidemiology , Female , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Male , Middle Aged , Pain, Postoperative/diagnosis , Pain, Postoperative/psychology , Pneumonia/virology , Postoperative Period , Prospective Studies , Range of Motion, Articular , Recovery of Function , Rehabilitation/methods , Rehabilitation/psychology , Videoconferencing/instrumentation , Videoconferencing/statistics & numerical data
13.
Hu Li Za Zhi ; 68(1): 43-53, 2021 Feb.
Article in Chinese | MEDLINE | ID: covidwho-1100322

ABSTRACT

BACKGROUND: Because of the COVID-19 epidemic, people are mostly isolated at home and must seek medical advice over the internet. In addition, government authorities are currently investing greater efforts in developing internet hospitals. PURPOSE: The purpose of this essay was to assess how outpatients feel about online outpatient clinics and to analyze the factors that affect their satisfaction and willingness to return to these clinics. The results provide advice regarding how to more effectively encourage patients to use online outpatient clinics. METHODS: A self-developed questionnaire was used to survey 191 patients who had visited the online outpatient clinic of a tertiary hospital in Sichuan Province from January to July 2019. A descriptive analysis was conducted on the collected data, and factors influencing satisfaction were identified. RESULTS: The majority of the surveyed patients were young or middle-aged (92.7%) and 42.9% held a college degree or higher. Nearly three-quarters (72.2%) expressed feeling satisfied or better with the online outpatient clinic, with 31.4% of these expressing feeling very satisfied. Nearly all (91.1%) expressed the opinion that the online outpatient clinic had improved their awareness of health self-management . Furthermore, 176 (92.1%) were willing to use the online outpatient clinic again. The results of univariate analysis showed that the main factors negatively influencing re-use of the online outpatient clinic were: failure to solve the problem in a timely manner (χ2 = 8.603, p = .045), the complicated process of online registration (χ2 = 8.322, p = .016), the failure of the online physical examination (χ2 = 8.958, p = .015), and unreliable quality (χ2 = 15.373, p = .004). CONCLUSIONS: The participants surveyed in this study reported a lower satisfaction for their online outpatient clinic experience than reported in similar surveys of traditional outpatient services. However, many reported that their health-related self-management awareness had improved after use, indicating that they feel better about the online outpatient clinic. The factors that affected willingness to reuse to the online outpatient clinic related mainly to imperfections related to the clinic and its inability to adequately meet patient needs. Online outpatient clinics should simplify the process of registration, improve functions, and increase service functions such as online examination appointments and follow-up visits to improve patient satisfaction.


Subject(s)
Aged , Ambulatory Care Facilities , Humans , Middle Aged , Patient Satisfaction , Retreatment , Surveys and Questionnaires
14.
BMJ Open ; 11(2): e045482, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1096995

ABSTRACT

OBJECTIVES: Recent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes. DESIGN: We analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection. SETTING: Patients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included. PARTICIPANTS: Admitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics. PRIMARY AND SECONDARY OUTCOMES MEASURES: The primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors. RESULTS: We included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91). CONCLUSIONS: The accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.


Subject(s)
Aged , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , Treatment Outcome
15.
BMJ Open ; 11(2): e043721, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1096993

ABSTRACT

OBJECTIVES: Although the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic. DESIGN: A retrospective cross-sectional study. SETTING: Two acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively. PARTICIPANTS: Adult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions. RESULTS: Out of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%). CONCLUSIONS: The index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.


Subject(s)
Early Warning Score , Hospital Mortality , Adult , Aged , /therapy , Cross-Sectional Studies , Female , Humans , Male , Patient Admission , Retrospective Studies , Risk Assessment/methods , United Kingdom/epidemiology
16.
Epidemiol Health ; 43: e2021007, 2021.
Article in English | MEDLINE | ID: covidwho-1094290

ABSTRACT

OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea's nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score-adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS: As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.


Subject(s)
/statistics & numerical data , Healthcare Disparities/economics , Insurance, Health/statistics & numerical data , Pandemics , Adult , Aged , Aged, 80 and over , Databases, Factual , Female , Humans , Insurance Claim Review , Male , Middle Aged , Republic of Korea/epidemiology , Retrospective Studies , Socioeconomic Factors , Young Adult
17.
BMC Surg ; 21(1): 97, 2021 Feb 22.
Article in English | MEDLINE | ID: covidwho-1094031

ABSTRACT

BACKGROUND: In patients who are critically ill with COVID-19, multiple extrapulmonary manifestations of the disease have been observed, including gastrointestinal manifestations. CASE PRESENTATION: We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and peritonitis. Emergent laparotomy was performed and we found bowel necrosis in two sites. CONCLUSIONS: Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high mortality rate.


Subject(s)
Intestinal Diseases , Aged , /therapy , Humans , Intestinal Diseases/pathology , Intestinal Diseases/virology , Male , Necrosis , Severity of Illness Index
18.
J Prim Care Community Health ; 12: 2150132721996278, 2021.
Article in English | MEDLINE | ID: covidwho-1094016

ABSTRACT

INTRODUCTION: Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era. METHODS: The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit. RESULTS: Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish. CONCLUSIONS: Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.


Subject(s)
Ambulatory Care Facilities/organization & administration , Medically Underserved Area , Ophthalmology , Telemedicine/organization & administration , Academic Medical Centers , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Ohio/epidemiology , Retrospective Studies , Tertiary Care Centers
20.
JAMA Netw Open ; 4(2): e2037640, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1092150

ABSTRACT

Importance: Medical research has not equitably included members of racial/ethnic minority groups or female and older individuals. There are limited data on participant demographic characteristics in vaccine trials despite the importance of these data to current trials aimed at preventing coronavirus disease 2019. Objective: To investigate whether racial/ethnic minority groups and female and older adults are underrepresented among participants in vaccine clinical trials. Design, Setting, and Participants: This cross-sectional study examined data from completed US-based vaccine trials registered on ClinicalTrials.gov from July 1, 2011, through June 30, 2020. The terms vaccine, vaccination, immunization, and inoculation were used to identify trials. Only those addressing vaccine immunogenicity or efficacy of preventative vaccines were included. Main Outcomes and Measures: The numbers and percentages of racial/ethnic minority, female, and older individuals compared with US census data from 2011 and 2018. Secondary outcome measures were inclusion by trial phase and year of completion. Results: A total of 230 US-based trials with 219 555 participants were included in the study. Most trials were randomized (180 [78.3%]), included viral vaccinations (159 [69.1%]), and represented all trial phases. Every trial reported age and sex; 134 (58.3%) reported race and 79 (34.3%) reported ethnicity. Overall, among adult study participants, White individuals were overrepresented (77.9%; 95% CI, 77.4%-78.4%), and Black or African American individuals (10.6%; 95% CI, 10.2%-11.0%) and American Indian or Alaska Native individuals (0.4%; 95% CI, 0.3%-0.5%) were underrepresented compared with US census data; enrollment of Asian individuals was similar (5.7%; 95% CI, 5.5%-6.0%). Enrollment of Hispanic or Latino individuals (11.6%; 95% CI, 11.1%-12.0%) was also low even among the limited number of adult trials reporting ethnicity. Adult trials were composed of more female participants (75 325 [56.0%]), but among those reporting age as a percentage, enrollment of participants who were aged 65 years or older was low (12.1%; 95% CI, 12.0%-12.3%). Black or African American participants (10.1%; 95% CI, 9.7%-10.6%) and Hispanic or Latino participants (22.5%; 95% CI, 21.6%-23.4%) were also underrepresented in pediatric trials. Among trials reporting race/ethnicity, 65 (48.5%) did not include American Indian or Alaska Native participants and 81 (60.4%) did not include Hawaiian or Pacific Islander participants. Conclusions and Relevance: This cross-sectional study found that among US-based vaccine clinical trials, members of racial/ethnic minority groups and older adults were underrepresented, whereas female adults were overrepresented. These findings suggest that diversity enrollment targets should be included for all vaccine trials targeting epidemiologically important infections.


Subject(s)
Clinical Trials as Topic/standards , Ethnic Groups/statistics & numerical data , Patient Selection , Sexism/statistics & numerical data , Vaccines , Adult , African Continental Ancestry Group/ethnology , African Continental Ancestry Group/statistics & numerical data , Aged , Aged, 80 and over , Asian Continental Ancestry Group/ethnology , Asian Continental Ancestry Group/statistics & numerical data , Clinical Trials as Topic/statistics & numerical data , Continental Population Groups/ethnology , Continental Population Groups/statistics & numerical data , Cross-Sectional Studies , European Continental Ancestry Group/ethnology , European Continental Ancestry Group/statistics & numerical data , Female , Humans , Male , Middle Aged , Oceanic Ancestry Group/ethnology , Oceanic Ancestry Group/statistics & numerical data , Sexism/ethnology
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