Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 290
Filter
1.
Vet Anaesth Analg ; 49(6): 580-588, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1984186

ABSTRACT

OBJECTIVE: To determine the effects of the COVID-19 associated restrictions on the ability of owners in Michigan (MI), USA versus Ontario (ON) and British Columbia (BC), Canada, to obtain care for their chronically painful dogs. STUDY DESIGN: Cross-sectional survey. POPULATION: A total of 90 owners met the inclusion criteria for the study. METHODS: An anonymous electronic survey was distributed to owners at four veterinary integrative medicine (IM) clinics during July and August 2020. Two clinics in MI and one each in ON and BC were recruited. Owners were asked about availability of IM care preceding and during COVID-19 restrictions and their opinions of the impact of COVID-19 on their dog's health. The survey asked where owners sought care for their dogs, types of chronic conditions treated, therapeutic modalities used, and if owners had a medical background. Comparisons were made within and between groups. Thematic analysis, Fisher's exact test, chi-square analyses, McNemar's and Wilcoxon signed-rank tests for paired comparisons were performed (p < 0.05). RESULTS: During COVID-19 restrictions, access to IM care was better for dogs in ON and BC than in MI (p < 0.001). The negative effect of the pandemic restrictions to IM care on quality of life was perceived greater by owners in MI than those in ON and BC (p < 0.001). The owners' medical backgrounds had no effect on attempts to access care during this time (p = 0.76). CONCLUSIONS AND CLINICAL RELEVANCE: The results suggest that a widespread disease in humans had an adverse impact on animal welfare. Providers of veterinary care should use this experience to establish protocols to ensure continuity of care for chronically painful animals in the event of a similar situation in the future.


Subject(s)
COVID-19 , Dog Diseases , Veterinary Medicine , Animals , Dogs , Humans , British Columbia , Cross-Sectional Studies , Dog Diseases/therapy , Michigan , Ontario , Quality of Life , Surveys and Questionnaires , Health Services Accessibility/statistics & numerical data , Veterinary Medicine/statistics & numerical data , Social Control Policies/legislation & jurisprudence , Social Control Policies/statistics & numerical data , Pain/prevention & control , Pain/veterinary
3.
J Am Coll Surg ; 234(2): 191-202, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1713819

ABSTRACT

BACKGROUND: Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality. RESULTS: During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use. CONCLUSION: Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.


Subject(s)
COVID-19/epidemiology , General Surgery/statistics & numerical data , Office Visits/statistics & numerical data , Pandemics , Telemedicine/statistics & numerical data , Adult , Aged , Ambulatory Surgical Procedures , Computer Literacy , Ethnicity/statistics & numerical data , Female , Health Services Accessibility/statistics & numerical data , Humans , Insurance Coverage/statistics & numerical data , Logistic Models , Male , Massachusetts/epidemiology , Middle Aged , Public Health , Racial Groups/statistics & numerical data , Retrospective Studies , Socioeconomic Factors , Telephone/statistics & numerical data
4.
Am J Public Health ; 112(3): 518-526, 2022 03.
Article in English | MEDLINE | ID: covidwho-1709096

ABSTRACT

Objectives. To quantify the relationship between the segregation of Black, Indigenous, and Latinx communities and COVID-19 testing sites in populous US cities. Methods. We mapped testing sites as of June 2020 in New York City; Chicago, Illinois; Los Angeles, California; and Houston, Texas; we applied Bayesian methods to estimate the association between testing site location and the proportion of the population that is Black, Latinx, or Indigenous per block group, the smallest unit for which the US Census collects sociodemographic data. Results. In New York City, Chicago, and Houston, the expected number of testing sites decreased by 1.29%, 3.05%, and 1.06%, respectively, for each percentage point increase in the Black population. In Chicago, Houston, and Los Angeles, testing sites decreased by 5.64%, 1.95%, and 1.69%, respectively, for each percentage point increase in the Latinx population. Conclusions. In the largest highly segregated US cities, neighborhoods with more Black and Latinx residents had fewer COVID-19 testing sites, likely limiting these communities' participation in the early response to COVID-19. Public Health Implications. In light of conversations on the ethics of racial vaccine prioritization, authorities should consider structural barriers to COVID-19 control efforts. (Am J Public Health. 2022;112(3):518-526. https://doi.org/10.2105/AJPH.2021.306558).


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Health Services Accessibility/statistics & numerical data , Residence Characteristics/statistics & numerical data , Social Segregation , Bayes Theorem , Cities , Humans , United States
5.
Antimicrob Resist Infect Control ; 11(1): 34, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1679967

ABSTRACT

BACKGROUND: The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. METHODS: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. RESULTS: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. CONCLUSION: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in 'normal' circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.


Subject(s)
Health Services Accessibility/standards , Poverty/statistics & numerical data , Public Health/standards , Social Determinants of Health/standards , Animals , COVID-19/epidemiology , COVID-19/prevention & control , Global Health/standards , Global Health/statistics & numerical data , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Humans , Public Health/statistics & numerical data , Social Determinants of Health/economics , Social Determinants of Health/statistics & numerical data , Tanzania/epidemiology
6.
PLoS One ; 17(1): e0262472, 2022.
Article in English | MEDLINE | ID: covidwho-1650442

ABSTRACT

OBJECTIVES: Some of community mitigation efforts on COVID-19 created challenges to ongoing public health programs, including HIV care and prevention services among men who have sex with men (MSM). The goal of the current study was to explore sociodemographic factors and the impact of COVID-19 on HIV testing among Chinese MSM during state-enforced quarantine. METHODS: We conducted a community based survey between May 1st to June 30th, 2020 on COVID-19 related impacts on HIV testing among 436 China MSM during the COVID-19 state-enforced quarantine. RESULTS: One-third (33.7%) of MSM received HIV testing during the quarantine period. Few participants reported difficulty accessing facility-based testing (n = 13, 3.0%) or obtaining HIV self-test kit online (n = 22, 5.0%). However, 12.1% of participants reported being afraid of getting facility-based HIV test due to concerns about the risk of COVID-19. In the multivariate logistic regression model, participants who were married (aOR: 1.89, 95%CI: 1.19-3.01), reported increased quality of sleep (aOR: 2.07, 95%CI: 1.11-3.86), and increased difficulty in accessing health care (aOR: 2.34, 95%CI: 1.37-3.99) were more likely to get an HIV test during the state-enforced quarantine. CONCLUSION: The mitigation measures of COVID-19 have created various barriers to access HIV related prevention services in China, including HIV testing. To mitigate these impacts on HIV prevention and care services, future programs need to address barriers to HIV-related services, such as providing high-quality HIV self-testing. Meanwhile, psychological services or other social services are needed to those experiencing mental distress.


Subject(s)
COVID-19/psychology , HIV Infections/diagnosis , HIV Testing/statistics & numerical data , Sexual Behavior/psychology , Sexual and Gender Minorities/psychology , Adolescent , Adult , COVID-19/epidemiology , China/epidemiology , Cross-Sectional Studies , HIV Infections/epidemiology , Health Services Accessibility/statistics & numerical data , Humans , Male , Middle Aged , Quarantine/psychology , Risk Factors , SARS-CoV-2/pathogenicity , Stress, Psychological/epidemiology
7.
Dermatol Online J ; 27(10)2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1643787

ABSTRACT

Social distancing requirements associated with the COVID-19 pandemic have allowed for the expansion of different healthcare delivery modalities. Namely, there has been an increase in the utilization of remote diagnostic services for both primary and specialist care. Dermatology care has traditionally been inaccessible to many pediatric patients; this is due in part to a limited number of practicing pediatric dermatologists, as well as a maldistribution of the pediatric dermatology workforce with the majority of providers located in large metropolitan areas. There is therefore a need for an accessible alternative for care to reach underserved patient populations. This commentary highlights evidence from recent studies on remote dermatology care (teledermatology) and how it has not only improved access to dermatologic care but also quality of care. Although teledermatology does not completely replace traditional in-person visits and is limited by poor broadband access in traditionally underserved areas, teledermatology can, in some instances, be a cost-effective and efficient alternative for pediatric patients otherwise lacking dermatologic care.


Subject(s)
COVID-19/epidemiology , Dermatologists/supply & distribution , Dermatology/methods , Health Services Accessibility , Telemedicine , Child , Child, Preschool , Dermatology/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Infant , Infant, Newborn , Pediatricians/supply & distribution , Telemedicine/statistics & numerical data
8.
Curr Opin Psychiatry ; 34(4): 434-443, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1637741

ABSTRACT

PURPOSE OF REVIEW: To reduce the spread of infection from the coronavirus disease 2019 (COVID-19), mental healthcare facilities were forced to make the rapid transition from face-to-face services to virtual care. This systematic review aims to synthesize the extant literature reporting on barriers of telemental health (TMH) during the COVID-19 pandemic and how facilities have worked to overcome these barriers, to inform best practices for TMH delivery. RECENT FINDINGS: Most recent findings came from case studies from mental health professionals which reported on barriers related to institutional, provider and patient factors, and how these barriers were overcome. Common barriers identified in the literature include: technological difficulties; issues regarding safety, privacy and confidentiality; therapeutic delivery and the patient-provider relationship; and a loss of sense of community. Studies also reported on the benefits to TMH interventions/tools, as well as suggestions for improvements in the delivery of TMH services. SUMMARY: As the COVID-19 pandemic evolves, mental healthcare providers continue to find creative and feasible solutions to overcome barriers to the delivery of TMH. Dissemination of these solutions is imperative to ensure the best quality of mental healthcare for patients across the globe.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility/statistics & numerical data , Mental Disorders/therapy , Mental Health Services , Quality Improvement , Telemedicine/methods , COVID-19/psychology , Humans , Mental Disorders/psychology , Pandemics , SARS-CoV-2
9.
Ital J Pediatr ; 48(1): 10, 2022 Jan 18.
Article in English | MEDLINE | ID: covidwho-1632835

ABSTRACT

BACKGROUND: Italy was the first European country to experience a massive outbreak of Sars-coV-2 in March 2020. Severe measures were introduced to face the pandemic, significantly impacting all healthcare services, including pediatric palliative care (PPC) networks. We investigated how the Covid-19 pandemic modified the provision of PPC services in Friuli Venezia Giulia, Italy. Both the acute and long-term impacts on the families were addressed. METHODS: We administered a retrospective three-sections online questionnaire to the eligible families assisted by our regional PPC network. Inclusion criteria were: child needing specialistic PPC, adequate knowledge of the Italian language, being in charge of the PPC regional network of Friuli Venezia Giulia from February 1, 2020. The three sections examined the same issues in different periods: the pre-covid period (until February 29, 2020), the lockdown period (March 1, 2020, to April 30, 2020), and the post-lockdown period (May 2021). RESULTS: Twelve patients were included. During the lockdown period, 54.6% of children had to stop physiotherapy sessions, while, among those who continued, 80.0% experienced a reduction in the sessions' frequency. In the post-lockdown period, 45.5% of children did not have physiotherapy as often as before the pandemic onset. Overall, the access to medical visits during the lockdown and after its end was significantly reduced (p = 0.01). The level of support perceived by the families descended from grade 3 (intermediate) in the pre-covid period to 2 (low) during the lockdown (p < 0.05) and returned to grade 3 in the post-lockdown period. CONCLUSION: The COVID-19 pandemic and the related restrictions impacted the families and caused a transitory contraction of the perceived support. The most significant change was reduced access to medical visits and physiotherapy, which lasted over a year after the start of the pandemic.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility/statistics & numerical data , Palliative Care , Quarantine/statistics & numerical data , Adolescent , Child , Child, Preschool , Family/psychology , Female , Humans , Infant , Italy/epidemiology , Male , Retrospective Studies , SARS-CoV-2 , Social Support/psychology , Surveys and Questionnaires
10.
PLoS One ; 17(1): e0261145, 2022.
Article in English | MEDLINE | ID: covidwho-1613349

ABSTRACT

BACKGROUND: With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. METHODS: Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). RESULTS: A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. CONCLUSION: Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.


Subject(s)
Attitude/ethnology , Health Services Accessibility/statistics & numerical data , Homeless Persons/psychology , Surveys and Questionnaires/statistics & numerical data , Telemedicine/methods , Trust/psychology , Female , Homeless Persons/statistics & numerical data , Humans , Hungary , Male , Middle Aged
12.
J Cyst Fibros ; 20 Suppl 3: 31-38, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1587346

ABSTRACT

BACKGROUND: Depression and anxiety are two to four times more prevalent in people with CF (pwCF) than the general population. COVID-19 may exacerbate mental health challenges, increasing demand for psychological services, while decreasing their availability. We assessed the impact of the pandemic on depression and anxiety in pwCF, including how COVID-19 affected the frequency of mental health screening and the types of services provided. METHODS: A 38-item internet survey, completed in June 2020, assessed how COVID-19 affected: 1) the mental health clinician's role and screening processes; 2) barriers to screening and resource needs; 3) impact of COVID-19 on depression and anxiety, and 4) positive outcomes and confidence in sustaining mental health screening and treatment, including telehealth services, after the pandemic. RESULTS: Responses were obtained from 131 of the 289 US CF programs. Overall, 60% of programs (n=79) continued mental health screening and treatment, although less frequently; 50% provided individual tele-mental health interventions, and 9% provided telehealth group therapy. Clinically elevated depression symptoms (PHQ-9≥10; moderate to severe), were found in 12% of 785 pwCF, with 3.1% endorsing suicidal ideation. Similarly, elevated anxiety (moderate to severe; GAD-7≥10) was found in 13% of pwCF (n=779). CONCLUSIONS: The COVID-19 pandemic created an opportunity to implement innovative solutions to disruptions in mental health screening and treatment in CF programs. We found that pwCF had increased access to psychological interventions during the pandemic via telehealth, supporting the continued integration of tele-mental health screening and treatment into CF care.


Subject(s)
Anxiety , COVID-19 , Cystic Fibrosis , Depression , Mental Health , Psychosocial Intervention , Telemedicine , Anxiety/diagnosis , Anxiety/physiopathology , Anxiety/therapy , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Delivery of Health Care/methods , Delivery of Health Care/trends , Depression/diagnosis , Depression/physiopathology , Depression/therapy , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Mass Screening/methods , Needs Assessment , Psychosocial Intervention/methods , Psychosocial Intervention/trends , Psychosocial Support Systems , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiology
19.
Surgery ; 171(3): 793-798, 2022 03.
Article in English | MEDLINE | ID: covidwho-1537090

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic prompted a surge in telemedicine, with the presumption that patients had computer and internet access. We sought to determine, in a population-based sample, how many Americans were using computers and the internet before the pandemic, and whether disparities existed in this. METHODS: The National Health Interview Survey is conducted annually by the Centers for Disease Control and Prevention and is representative of the entire United States civilian non-institutionalized population. In 2018, questions were fielded regarding computer and web utilization. We evaluated sociodemographic factors associated with this. RESULTS: Twenty-five thousand and forty-nine people, representing 245,842,992 in the population, responded to these questions. Of the responses, 19% stated they used a computer "never or almost never," 18% stated they did not use the internet, and 25% did not use email. Over the previous 12 months, 55% of responders stated they had looked up health information on the internet, 11% had filled a prescription online, 16% had scheduled a medical appointment on the internet, and 17% had communicated with a healthcare provider by email. Internet usage varied by region, age, race, education, family income, and insurance status, but not by gender. CONCLUSION: As telemedicine becomes more prevalent, sociodemographic factors limiting computer and internet use may disadvantage certain segments of the population.


Subject(s)
Health Services Accessibility/statistics & numerical data , Healthcare Disparities , Telemedicine , Adult , Aged , Aged, 80 and over , COVID-19 , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , Young Adult
20.
PLoS One ; 16(11): e0259995, 2021.
Article in English | MEDLINE | ID: covidwho-1533419

ABSTRACT

INTRODUCTION: Digital technology has the potential to improve health outcomes and health system performance in fragmented and under-funded mental health systems. Despite this potential, the integration of digital technology tools into mental health systems has been relatively poor. This is a protocol for a synthesis of qualitative evidence that will aim to determine the barriers and facilitators to integrating digital technologies in mental health systems and classify them in contextual domains at individual, organisational and system levels. METHODS AND ANALYSIS: The methodological framework for systematic review of qualitative evidence described in Lockwood et al. will be applied to this review. A draft search strategy was developed in collaboration with an experienced senior health research librarian. A systematic search of Medline, Embase, Scopus, PsycInfo, Web of Science and Google Scholar, as well as hand searching of reference lists and reviews will identify relevant studies for inclusion. Study selection will be carried out independently by two authors, with discrepancies resolved by consensus. The quality of selected studies will be assessed using JBI Critical Appraisal Checklist for Qualitative Research. Data will be charted using JBI QUARI Data Extraction Tool for Qualitative Research. Findings will be defined and classified both deductively in a priori conceptual framework and inductively by a thematic analysis. Results will be reported based on the Enhancing transparency in reporting the synthesis of qualitative research. The level of confidence of the findings will be assessed using GRADE-CERQual. ETHICS AND DISSEMINATION: This study does not require ethics approval. The systematic review will inform policy and practices around improving the integration of digital technologies into mental health care systems.


Subject(s)
Health Services Accessibility/trends , Mental Health Services/trends , Systematic Reviews as Topic/methods , Checklist , Consensus , Digital Technology/trends , Evaluation Studies as Topic , Government Programs , Health Services Accessibility/statistics & numerical data , Humans , Medical Assistance , Mental Health/trends , Policy , Qualitative Research
SELECTION OF CITATIONS
SEARCH DETAIL