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4.
JAMA Netw Open ; 4(12): e2141233, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1596574

ABSTRACT

Importance: The COVID-19 pandemic led to the implementation of alternative care modalities (eg, teleconsultations and task shifting) that will continue to be implemented in parallel to traditional care after the pandemic. An ideal balance between alternative and traditional care modalities is unknown. Objectives: To quantify the ideal postpandemic balance between alternative and traditional care modalities among patients with chronic illness and to qualify the circumstances in which patients consider it appropriate to replace traditional care with alternative care. Design, Setting, and Participants: This survey study invited 5999 adults with chronic illness in ComPaRe, a French nationwide e-cohort of adults with chronic conditions who volunteer their time to participate in research projects, to participate in this study, which was performed from January 27 to February 23, 2021. Main Outcomes and Measures: Participants rated the ideal proportion at which they would use 3 alternative care modalities instead of the traditional care equivalent on a 0% to 100% scale (with 0% indicating using alternative care modalities for none of one's future care and 100% indicating using alternative care modalities for all of one's future care) of their overall future care: (1) teleconsultations, (2) online symptom-checkers to react to new symptoms, and (3) remote monitoring to adapt treatment outside consultations. The median ideal proportion of alternative care use was calculated. Perceived appropriate circumstances in which each alternative modality could replace traditional care were collected with open-ended questions. Analyses were performed on a weighted data set representative of patients with chronic illness in France. Results: Of the 5999 invited individuals, 1529 (mean [SD] age, 50.3 [14.7] years; 1072 [70.1%] female) agreed to participate (participation rate, 25.5%). Participants would choose teleconsultations for 50.0% of their future consultations (IQR, 11.0%-52.0%), online symptom-checkers over contacting their physician for 22.0% of new symptoms (IQR, 2.0%-50.0%), and remote monitoring instead of consultations for 52.3% of their treatment adaptations (IQR, 25.4%-85.4%). Participants reported 67 circumstances for which replacing traditional with alternative care modalities was considered appropriate, including 31 care activities (eg, prescription renewal and addressing acute or minor complaints), 25 patient characteristics (eg, stable chronic condition and established patient-physician relationship), and 11 required characteristics of the alternative care modalities (eg, quality assurance). Conclusions and Relevance: Results of this survey study suggest that after the pandemic, patients would choose alternative over traditional care for 22% to 52% of the time across different care needs. Participants proposed 67 criteria to guide clinicians in replacing traditional care with alternative care. These findings provide a guide for redesigning care in collaboration with patients after the pandemic.


Subject(s)
COVID-19 , Chronic Disease/therapy , Delivery of Health Care/methods , Pandemics , Patient Acceptance of Health Care , Patient Preference , Adult , Female , France , Humans , Male , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine
5.
Biomed Pharmacother ; 145: 112385, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1565522

ABSTRACT

Chemically modified mRNA represents a unique, efficient, and straightforward approach to produce a class of biopharmaceutical agents. It has been already approved as a vaccination-based method for targeting SARS-CoV-2 virus. The COVID-19 pandemic has highlighted the prospect of synthetic modified mRNA to efficiently and safely combat various diseases. Recently, various optimization advances have been adopted to overcome the limitations associated with conventional gene therapeutics leading to wide-ranging applications in different disease conditions. This review sheds light on emerging directions of chemically modified mRNAs to prevent and treat widespread chronic diseases, including metabolic disorders, cancer vaccination and immunotherapy, musculoskeletal disorders, respiratory conditions, cardiovascular diseases, and liver diseases.


Subject(s)
COVID-19/prevention & control , Chronic Disease/prevention & control , Chronic Disease/therapy , Genetic Therapy/methods , Immunotherapy/methods , Pandemics/prevention & control , RNA, Messenger/chemistry , SARS-CoV-2/immunology , Vaccines, Synthetic , Biological Availability , Drug Carriers , Forecasting , Gene Transfer Techniques , Genetic Vectors/administration & dosage , Genetic Vectors/therapeutic use , Humans , Immunotherapy, Active , RNA Stability , RNA, Messenger/administration & dosage , RNA, Messenger/immunology , RNA, Messenger/therapeutic use , SARS-CoV-2/genetics , Vaccines, Synthetic/administration & dosage , Vaccines, Synthetic/immunology , /immunology
7.
J Clin Epidemiol ; 142: 45-53, 2022 02.
Article in English | MEDLINE | ID: covidwho-1482687

ABSTRACT

OBJECTIVE: Methodological challenges for investigating the changes in healthcare utilization during COVID-19 pandemic must be considered for obtaining unbiased estimates. STUDY DESIGN AND SETTING: A population-based study in the Lombardy region (Italy) measured the association between the level of epidemic restrictions (increasing exposure during pre-epidemic, post-lockdown, and lockdown periods) and the recommended healthcare (outcome) for patients with schizophrenia, heart failure, chronic obstructive pulmonary disease, breast cancer, and pregnancy women. Two designs are applied: the self-controlled case series (SCCS) and the usual cohort design. Adjustments for between-patients unmeasured confounders and seasonality of medical services delivering were performed. RESULTS: Compared with pre-epidemic, reductions in delivering recommended healthcare during lockdown up to 73% (95% confidence interval: 63%-80%) for timeliness of breast cancer surgery, and up to 20% (16%-23%) for appropriated gynecologic visit during pregnancy were obtained from SCCS and cohort design, respectively. Healthcare provision came back to pre-epidemic levels during the post-lockdown, with the exception of schizophrenic patients for whom the SCCS showed a reduction in continuity of care of 11% (11%-12%). CONCLUSION: Strategies for investigating the changes in healthcare utilization during pandemic must be implemented. Recommendations for taking into account sources of systematic uncertainty are discussed and illustrated by using motivating examples.


Subject(s)
COVID-19/epidemiology , Chronic Disease/therapy , Health Services Accessibility/trends , COVID-19/economics , Chronic Disease/economics , Cohort Studies , Cost of Illness , Health Services Accessibility/statistics & numerical data , Humans , Italy , Quarantine
8.
Int J Mol Sci ; 22(20)2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1477961

ABSTRACT

Chronic diseases and viral infections have threatened human life over the ages and constitute the main reason for increasing death globally. The rising burden of these diseases extends to negatively affecting the economy and trading globally, as well as daily life, which requires inexpensive, novel, and safe therapeutics. Therefore, scientists have paid close attention to probiotics as safe remedies to combat these morbidities owing to their health benefits and biotherapeutic effects. Probiotics have been broadly adopted as functional foods, nutraceuticals, and food supplements to improve human health and prevent some morbidity. Intriguingly, recent research indicates that probiotics are a promising solution for treating and prophylactic against certain dangerous diseases. Probiotics could also be associated with their essential role in animating the immune system to fight COVID-19 infection. This comprehensive review concentrates on the newest literature on probiotics and their metabolism in treating life-threatening diseases, including immune disorders, pathogens, inflammatory and allergic diseases, cancer, cardiovascular disease, gastrointestinal dysfunctions, and COVID-19 infection. The recent information in this report will particularly furnish a platform for emerging novel probiotics-based therapeutics as cheap and safe, encouraging researchers and stakeholders to develop innovative treatments based on probiotics to prevent and treat chronic and viral diseases.


Subject(s)
Chronic Disease/therapy , Probiotics/administration & dosage , Cardiovascular Diseases/metabolism , Cardiovascular Diseases/therapy , Fatty Acids, Volatile/metabolism , Gastrointestinal Microbiome , Humans , Immune System/metabolism , Inflammation/metabolism , Inflammation/pathology , Neoplasms/metabolism , Neoplasms/therapy , Virus Diseases/immunology , Virus Diseases/metabolism , Virus Diseases/therapy
9.
PLoS One ; 16(9): e0258015, 2021.
Article in English | MEDLINE | ID: covidwho-1443852

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, telehealth became a vital resource to contain the virus's spread and ensure continuity of care of patients with a chronic condition, notably arterial hypertension and heart disease. This paper reports the experience based on a telehealth platform used at scale to manage chronic disease patients in the Italian community. METHODS AND FINDINGS: Patients' health status was remotely monitored through ambulatory blood pressure monitoring (ABPM), resting or ambulatory electrocardiogram (ECG), spirometry, sleep oximetry, and cardiorespiratory polysomnography performed in community pharmacies or general practitioners' offices. Patients also monitored their blood pressure (BP), heart rate (HR), blood oxygen saturation (SpO2), body temperature, body weight, waist circumference, blood glucose, and lipids at home through a dedicated smartphone app. All data conveyed to the web-based telehealth platform were used to manage critical patients by doctors promptly. Data were analyzed and compared across three consecutive periods of 2 months each: i) before the national lockdown, ii) during the lockdown (from March 9 to May 17, 2020), and iii) after the end of the containment measures. Overall, 13,613 patients visited community pharmacies or doctors' offices. The number of overall tests dropped during and rose after the lockdown. The overall proportion of abnormal tests was larger during the outbreak. A significant increase in the prevalence of abnormal ECGs due to myocardial ischemia, contrasted by a significantly improved BP control, was observed. The number of home users and readings exchanged increased during the pandemic. In 226 patients, a significant increase in the proportion of SpO2 readings and a significant reduction in the entries for all other parameters, except BP, was observed. The proportion of abnormal SpO2 and BP values was significantly lower during the lockdown. Following the lockdown, the proportion of abnormal body weight or waist circumference values increased. CONCLUSIONS: Our study results support the usefulness of a telehealth solution to detect deterioration of the health status during the COVID-19 pandemic. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov at number NCT03781401.


Subject(s)
COVID-19/psychology , Disease Management , Telemedicine/trends , Adult , COVID-19/therapy , Chronic Disease/epidemiology , Chronic Disease/therapy , Communicable Disease Control , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Physical Distancing , SARS-CoV-2/pathogenicity
10.
Biosci Trends ; 15(4): 219-230, 2021 Sep 22.
Article in English | MEDLINE | ID: covidwho-1436242

ABSTRACT

The COVID-19 pandemic has affected not only the emergency medical system, but also patients' regular ambulatory care, as such decrease in the number of patients visiting outpatient clinics decreased in 2020 than in 2019, or the ban lifting of subsequent visits by telephone for outpatient clinics since March 2020 in lieu of ambulatory care for chronic diseases. In this context, we investigate the impact of the COVID-19 pandemic on ambulatory care at Japanese outpatient clinics for patients with chronic neurological diseases during 2020. We collected data from the administrative claims database (DeSC database) covering more than 1 million individuals. Serial changes in the frequency of subsequent outpatient visits to clinics or hospitals (excluding large hospitals) for chronic ambulatory care of epilepsy, migraine, Parkinson's disease (PD), and Alzheimer's disease (AD) in 2020 were measured. As a result, since April 2020, the monthly outpatient visits for epilepsy, PD, and AD decreased slightly but significantly (approximately 0.90 in relative risk [RR]) but visits for migraine increased (RR = 1.15). Telephone visit was most frequently used in April-May, in less than 5% of monthly outpatient clinic visits for the examined neurological diseases. Outpatient visits for migraine treatment were more likely to be done by telephone than in case of other diseases (adjusted Odds ratio = 2.08). These results suggest that the impact of COVID-19 pandemic on regular ambulatory care for several chronic neurological diseases yielded different effect depending on the disease, in terms of the frequency or type of outpatient visits.


Subject(s)
Ambulatory Care , COVID-19/epidemiology , Communicable Disease Control , Nervous System Diseases/therapy , Pandemics , Administrative Claims, Healthcare , Aged , Chronic Disease/therapy , Female , Humans , Japan , Male , Middle Aged , Retrospective Studies , Telephone
11.
J Natl Med Assoc ; 112(2): 115-116, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-1382559
12.
PLoS One ; 16(7): e0255534, 2021.
Article in English | MEDLINE | ID: covidwho-1332018

ABSTRACT

BACKGROUND: Burgeoning burden of non-communicable disease among older adults is one of the emerging public health problems. In the COVID-19 pandemic, health services in low- and middle-income countries, including Bangladesh, have been disrupted. This may have posed challenges for older adults with non-communicable chronic conditions in accessing essential health care services in the current pandemic. The present study aimed at exploring the challenges experienced by older Bangladeshi adults with non-communicable chronic conditions in receiving regular health care services during the COVID-19 pandemic. MATERIALS AND METHODS: The study followed a cross-sectional design and was conducted among 1032 Bangladeshi older adults aged 60 years and above during October 2020 through telephone interviews. Self-reported information on nine non-communicable chronic conditions (osteoarthritis, hypertension, heart disease, stroke, hypercholesterolemia, diabetes, chronic respiratory diseases, chronic kidney disease, cancer) was collected. Participants were asked if they faced any difficulties in accessing medicine and receiving routine medical care for their medical conditions during the COVID-19 pandemic. The association between non-communicable chronic conditions and accessing medication and health care was analysed using binary logic regression model. RESULTS: Most of the participants aged 60-69 years (77.8%), male (65.5%), married (81.4%), had no formal schooling (58.3%) and resided in rural areas (73.9%). Although more than half of the participants (58.9%) reported having a single condition, nearly one-quarter (22.9%) had multimorbidity. About a quarter of the participants reported difficulties accessing medicine (23%) and receiving routine medical care (27%) during the pandemic, and this was significantly higher among those suffering from multimorbidity. In the adjusted analyses, participants with at least one condition (AOR: 1.95, 95% CI: 1.33-2.85) and with multimorbidity (AOR: 4.75, 95% CI: 3.17-7.10) had a higher likelihood of experiencing difficulties accessing medicine. Similarly, participants with at least one condition (AOR: 3.08, 95% CI: 2.11-4.89) and with multimorbidity (AOR: 6.34, 95% CI: 4.03-9.05) were significantly more likely to face difficulties receiving routine medical care during the COVID-19 pandemic. CONCLUSIONS: Our study found that a sizeable proportion of the older adults had difficulties in accessing medicine and receiving routine medical care during the pandemic. The study findings highlight the need to develop an appropriate health care delivery pathway and strategies to maintain essential health services during any emergencies and beyond. We also argue the need to prioritise the health of older adults with non-communicable chronic conditions in the centre of any emergency response plan and policies of Bangladesh.


Subject(s)
COVID-19/epidemiology , Chronic Disease/therapy , Pandemics/prevention & control , Aged , Bangladesh/epidemiology , Cross-Sectional Studies , Female , Health Services Accessibility , Humans , Income , Male , Middle Aged , Multimorbidity
14.
Am J Manag Care ; 27(6): 256-260, 2021 06.
Article in English | MEDLINE | ID: covidwho-1281053

ABSTRACT

Individuals with multiple chronic conditions (MCCs) represent a growing proportion of the adult population in the United States, particularly among lower-income individuals and people of color. Despite ongoing efforts to characterize this population and develop approaches for effective management, individuals with MCCs continue to contribute substantially to health care expenditures. Based on a review of recent literature, several identified barriers limit the effectiveness of care for patients with MCCs. Health care delivery system structural limitations, evidence-based care concerns, patient-clinician relationship constraints, and barriers to inclusion of patient-centered priorities may singly or in combination negatively affect outcomes for individuals with MCCs. The COVID-19 pandemic has shed further light on inequities contributing to suboptimal MCC patient management. Awareness of the prevalence and demographic attributes of patients with MCCs and the identified barriers to care may help improve patient engagement and treatment outcomes for this high-cost population. This paper provides recommendations for enhancing MCC patient care outcomes in the current and post-COVID-19 health care delivery settings.


Subject(s)
Chronic Disease/therapy , Delivery of Health Care/organization & administration , Multimorbidity , COVID-19/epidemiology , Evidence-Based Medicine , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Prevalence , Quality Improvement , SARS-CoV-2
15.
J Rural Health ; 37(3): 460-466, 2021 06.
Article in English | MEDLINE | ID: covidwho-1280349

ABSTRACT

PURPOSE: In an era of the COVID-19 pandemic, improving health outcomes for diverse rural communities requires collective and sustained actions across transdisciplinary researchers, intersectoral partners, multilevel government action, and authentic engagement with those who carry the burden-rural communities. METHODS: Drawing from an analysis of transcriptions and documents from a national workshop on the "State of Rural Health Disparities: Research Gaps and Recommendations," this brief report underscores the gaps and priorities for future strategies for tackling persistent rural health inequities. FINDINGS: Four overarching recommendations were provided by national thought leaders in rural health: (1) create mechanisms to allow the rural research community time to build sustainable community-based participatory relationships; (2) support innovative research designs and approaches relevant to rural settings; (3) sustain effective interventions relevant to unique challenges in rural areas; and (4) recognize and identify the diversity within and across rural populations and adapt culturally and language-appropriate approaches. CONCLUSION: The COVID-19 public health crisis has exacerbated disparities for rural communities and underscored the need for diverse community-centered approaches in health research and dedicated funding to rural service agencies and populations.


Subject(s)
Health Status Disparities , Healthcare Disparities , Rural Health , Rural Population , COVID-19 , Chronic Disease/therapy , Humans , Pandemics , Research , SARS-CoV-2
17.
Int Immunopharmacol ; 96: 107761, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1253056

ABSTRACT

Since the discovery of lymphocytes with immunosuppressive activity, increasing interest has arisen in their possible influence on the immune response induced by vaccines. Regulatory T cells (Tregs) are essential for maintaining peripheral tolerance, preventing autoimmune diseases, and limiting chronic inflammatory diseases. However, they also limit beneficial immune responses by suppressing anti-infectious and anti-tumor immunity. Mounting evidence suggests that Tregs are involved, at least in part, in the low effectiveness of immunization against various diseases where it has been difficult to obtain protective vaccines. Interestingly, increased activity of Tregs is associated with aging, suggesting a key role for these cells in the lower vaccine effectiveness observed in older people. In this review, we analyze the impact of Tregs on vaccination, with a focus on older adults. Finally, we address an overview of current strategies for Tregs modulation with potential application to improve the effectiveness of future vaccines targeting older populations.


Subject(s)
Autoimmune Diseases/therapy , Chronic Disease/therapy , Inflammation/therapy , T-Lymphocytes, Regulatory/physiology , Vaccines/immunology , Age Factors , Aged , Aged, 80 and over , Animals , Autoimmune Diseases/immunology , Humans , Immunologic Factors/pharmacology , Immunomodulation/physiology , Immunosuppressive Agents/pharmacology , Inflammation/immunology , Membrane Proteins/metabolism , Middle Aged , Vaccination
18.
J Med Internet Res ; 23(5): e22959, 2021 05 25.
Article in English | MEDLINE | ID: covidwho-1231299

ABSTRACT

Artificial intelligence-driven voice technology deployed on mobile phones and smart speakers has the potential to improve patient management and organizational workflow. Voice chatbots have been already implemented in health care-leveraging innovative telehealth solutions during the COVID-19 pandemic. They allow for automatic acute care triaging and chronic disease management, including remote monitoring, preventive care, patient intake, and referral assistance. This paper focuses on the current clinical needs and applications of artificial intelligence-driven voice chatbots to drive operational effectiveness and improve patient experience and outcomes.


Subject(s)
Artificial Intelligence , COVID-19 , Communication , Delivery of Health Care/methods , Speech Recognition Software , Telemedicine/methods , Voice , Cell Phone , Chronic Disease/therapy , Critical Care/methods , Humans , Pandemics , Referral and Consultation , Triage
19.
J R Coll Physicians Edinb ; 51(1): 85-90, 2021 03.
Article in English | MEDLINE | ID: covidwho-1194768

ABSTRACT

Telemedicine use has expanded rapidly to cope with increasing demand on services by delivering remote clinical review and monitoring of long-term conditions. Triaging individual patients to determine their suitability for telephone, video or face-to-face consultations is necessary. This is crucial in the context of COVID-19 to ensure doctor-patient safety. Telemedicine was shown to be safe and feasible in managing certain chronic diseases and providing patient education. When reviewing newly referred or long-term patients, different specialty clinics have different requirements for physical examination. Clinicians prefer face-to-face consultations at the initial visit to establish a doctor-patient relationship; telephone or video consultations are reasonable options for long-term patients where physical examination may not be needed. Video consultations, often aided by sophisticated devices and apps or medical assistants, are useful to facilitate remote physical examination. Most patients prefer telemedicine as it saves time and travel cost and provides better access to appointments.


Subject(s)
Ambulatory Care , COVID-19 , Chronic Disease/therapy , Physical Examination/methods , Remote Consultation , Telemedicine , Ambulatory Care/methods , Ambulatory Care/standards , Ambulatory Care/trends , COVID-19/epidemiology , COVID-19/prevention & control , Forecasting , Humans , Long-Term Care/trends , Physician-Patient Relations , Remote Consultation/methods , Remote Consultation/standards , SARS-CoV-2 , Telemedicine/methods , Telemedicine/standards
20.
J Wound Care ; 30(Sup4): S42-S52, 2021 Apr 01.
Article in English | MEDLINE | ID: covidwho-1187162

ABSTRACT

OBJECTIVE: Management of chronic wounds remains one of the major challenges for health professionals and patients. An evidence-based decision is important to ensure that patients are receiving the best treatment proven to reduce healing time and improve outcomes, including economic benefits and patients' health-related quality of life (HRQoL). Due to recent restrictions because of the COVID-19 pandemic, including closure of wound care centres within hospitals and a drop in patient volume, chronic wound management needs simple-to-use dressings which are still effective and evidence-based solutions. This systematic review was conducted to identify the clinical evidence available on a sucrose octasulfate dressing (TLC-NOSF, UrgoStart dressing range, Laboratoires Urgo, France) to explore its efficacy in the management of chronic wounds, particularly lower limb ulcers, diabetic foot ulcers and pressure ulcers. METHOD: A literature search of PubMed, Cochrane Library and Google Scholar was conducted based on the PICO model (patient/population, intervention, comparison and outcomes) to retrieve publications of different levels of evidence in order to evaluate outcomes of the use of TLC-NOSF dressings. RESULTS: A total of 21 publications of different levels, ranging from double-blind randomised control trials to case reports, involving over 12,000 patients, were identified through PubMed, with a further eight publications through Google Scholar and two publications through Cochrane Library. A total of seven results were omitted due to the lack of relevance or repetition. CONCLUSION: All the evidence provided suggest that these dressings provide clinicians with an evidence-based option for the management of chronic wounds; that the TLC-NOSF dressings are beneficial in promoting the healing process, reducing healing times, enhancing patients' HRQoL, and in allowing a more cost-effective procedure.


Subject(s)
Bandages, Hydrocolloid , Chronic Disease/therapy , Diabetic Foot/therapy , Pressure Ulcer/therapy , Sucrose/analogs & derivatives , Sucrose/therapeutic use , Wound Healing/physiology , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , France , Humans , Male , Middle Aged
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