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2.
J Am Geriatr Soc ; 68(8): 1657-1660, 2020 08.
Article in English | MEDLINE | ID: covidwho-767516

ABSTRACT

OBJECTIVES: Long-term care (LTC) facilities are particularly dangerous places for the spread of COVID-19 given that they house vulnerable high-risk populations. Transmission-based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers' second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and/or adult relatives (double- and triple-duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]). DESIGN: A descriptive secondary analysis of data collected as part of the final wave of the Work, Family and Health Study. SETTING: Thirty nursing home facilities located throughout the northeastern United States. PARTICIPANTS: A subset of 958 essential facility-based LTC workers involved in direct patient care. MEASUREMENTS: We present information on LTC workers' demographic characteristics, health, features of their LTC occupation, additional paid work, wages, and double- or triple-duty caregiving roles. RESULTS: Most LTC workers were CNAs, followed by LPNs and RNs. Overall, more than 70% of these workers agreed or strongly agreed with this statement: "When you are sick, you still feel obligated to come into work." One-sixth had a second job, where they worked an average of 20 hours per week, and more than 60% held double- or triple-duty caregiving roles. Additional paid work and unpaid care work characteristics did not significantly differ by occupational group, although the prevalence of second jobs was highest and accompanying work hours were longest among CNAs. CONCLUSION: LTC workers commonly hold second jobs along with double- and triple-duty caregiving roles. To slow the spread of COVID-19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports. J Am Geriatr Soc 68:1657-1660, 2020.


Subject(s)
Caregivers/statistics & numerical data , Coronavirus Infections/prevention & control , Employment/statistics & numerical data , Long-Term Care/statistics & numerical data , Occupations/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , Female , Health Services Needs and Demand , Humans , Licensed Practical Nurses/statistics & numerical data , Male , New England , Nurses/statistics & numerical data , Nursing Assistants/statistics & numerical data , Nursing Homes , Work-Life Balance
3.
Age Ageing ; 49(5): 696-700, 2020 08 24.
Article in English | MEDLINE | ID: covidwho-759920

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.


Subject(s)
Aging , Chronic Disease , Coronavirus Infections , Delivery of Health Care , Health Services Accessibility/standards , Pandemics , Pneumonia, Viral , Rehabilitation , Aged , Aging/physiology , Aging/psychology , Betacoronavirus , Chronic Disease/epidemiology , Chronic Disease/rehabilitation , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Coronavirus Infections/rehabilitation , Delivery of Health Care/methods , Delivery of Health Care/trends , Forecasting , Health Services Needs and Demand , Humans , Organizational Innovation , Physical Functional Performance , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/rehabilitation , Recovery of Function , Rehabilitation/methods , Rehabilitation/organization & administration , Rehabilitation/trends
4.
Braz Oral Res ; 34: e114, 2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-750900

ABSTRACT

The aim of the present infodemiological study was to evaluate whether the COVID-19 outbreak has influenced the volume of content related to the dental treatment needs of Brazilian Twitter users to summarize the trends, and to identify the perceptions of the treatment needed. We collected tweets related to dental care needs of individuals exposed to the COVID-19 outbreak scenario between March 23 to May 4, 2020 and of those not exposed to the COVID-19 pandemic (unexposed group) on the same reported days of 2019 using the terms "dentista (dentist), dente (tooth), siso (third molar), and aparelho (orthodontic appliance)." Descriptive analysis was performed to provide summary statistics of the frequencies of tweets related to different dental treatment needs and also the differences in volume content between the years 2019 and 2020. Moreover, the data were analyzed by qualitative analysis using an inductive approach. A total of 1,763 tweets from 2020 and 1,339 tweets from 2019 were screened. Those tweets posted by non-Brazilian users, duplicates, and those unrelated to dental treatment needs were removed and, therefore 1,197 tweets from 2020 and 719 tweets from 2019 were selected. Content volume related to dental treatment needs greatly increased during the COVID-19 outbreak. Findings from the word cloud and content analysis suggest that dental pain, related or not to the third molar, and problems with orthodontic appliances were the topics most commonly related to dental treatment needs discussed during the COVID-19 outbreak, mainly conveying anxiety and distress. The volume of tweets related to dental treatment needs posted by Brazilian users increased during the COVID-19 outbreak and self-reported pain and urgencies were the most popular topics.


Subject(s)
Coronavirus Infections/epidemiology , Dentistry/statistics & numerical data , Health Services Needs and Demand/statistics & numerical data , Pneumonia, Viral/epidemiology , Betacoronavirus , Brazil , Humans , Pandemics , Self Report , Social Media
5.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 507-512, 2020 May 28.
Article in English, Chinese | MEDLINE | ID: covidwho-745333

ABSTRACT

OBJECTIVES: To discuss the demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 (COVID-19) in large general hospital. METHODS: By analyzing patients' demands, outpatient service system and emergency system complemented each other with the help of "internet medical" to provide online medical treatment, self-diagnosed pneumonia program, online pharmacies, outpatient appointment and online pre-examination services, open green channels for special patients, and to provide referral services for critical patients. The COVID-19 suspected patients and other common fever patients were separated from other patients. RESULTS: From January 28 to March 1, we have received 26 000 patients online, 1 856 special patients, 2 929 suspected patients and common fever patients including 31 confirmed patients, 0 case of misdiagnosis and cross-infection. CONCLUSIONS: Targeting patient's demands and taking appropriate measures are effective on meeting the needs of outpatients' and emergency patients' medical services.


Subject(s)
Coronavirus Infections/epidemiology , Health Services Needs and Demand , Hospitals, General/organization & administration , Outpatients , Pneumonia, Viral/epidemiology , Betacoronavirus , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Emergency Medical Services/organization & administration , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control
6.
S Afr Med J ; 110(7): 625-628, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-743569

ABSTRACT

The COVID-19 pandemic has brought discussions around the appropriate and fair rationing of scare resources to the forefront. This is of special importance in a country such as South Africa (SA), where scarce resources interface with high levels of need. A large proportion of the SA population has risk factors associated with worse COVID-19 outcomes. Many people are also potentially medically and socially vulnerable secondary to the high levels of infection with HIV and tuberculosis (TB) in the country. This is the second of two articles. The first examined the clinical evidence regarding the inclusion of HIV and TB as comorbidities relevant to intensive care unit (ICU) admission triage criteria. Given the fact that patients with HIV or TB may potentially be excluded from admission to an ICU on the basis of an assumption of lack of clinical suitability for critical care, in this article we explore the ethicolegal implications of limiting ICU access of persons living with HIV or TB. We argue that all allocation and rationing decisions must be in terms of SA law, which prohibits unfair discrimination. In addition, ethical decision-making demands accurate and evidence-based strategies for the fair distribution of limited resources. Rationing decisions and processes should be fair and based on visible and consistent criteria that can be subjected to objective scrutiny, with the ultimate aim of ensuring accountability, equity and fairness.


Subject(s)
Coronavirus Infections , HIV Infections/epidemiology , Health Care Rationing/methods , Intensive Care Units , Pandemics , Patient Selection/ethics , Pneumonia, Viral , Resource Allocation , Triage , Tuberculosis/epidemiology , Betacoronavirus/isolation & purification , Coinfection , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/standards , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Resource Allocation/ethics , Resource Allocation/legislation & jurisprudence , South Africa/epidemiology , Triage/economics , Triage/ethics , Triage/legislation & jurisprudence
7.
S Afr Med J ; 110(7): 621-624, 2020 06 17.
Article in English | MEDLINE | ID: covidwho-743568

ABSTRACT

Infectious diseases pandemics have devastating health, social and economic consequences, especially in developing countries such as South Africa. Scarce medical resources must often be rationed effectively to contain the disease outbreak. In the case of COVID-19, even the best-resourced countries will have inadequate intensive care facilities for the large number of patients needing admission and ventilation. The scarcity of medical resources creates the need for national governments to establish admission criteria that are evidence-based and fair. Questions have been raised whether infection with HIV or tuberculosis (TB) may amplify the risk of adverse COVID-19 outcomes and therefore whether these conditions should be factored in when deciding on the rationing of intensive care facilities. In light of these questions, clinical evidence regarding inclusion of these infections as comorbidities relevant to intensive care unit admission triage criteria is investigated in the first of a two-part series of articles. There is currently no evidence to indicate that HIV or TB infection on their own predispose to an increased risk of infection with SARS-CoV-2 or worse outcomes for COVID-19. It is recommended that, as for other medical conditions, validated scoring systems for poor prognostic factors should be applied. A subsequent article examines the ethicolegal implications of limiting intensive care access of persons living with HIV or TB.


Subject(s)
Coronavirus Infections , HIV Infections/epidemiology , Health Care Rationing/methods , Intensive Care Units , Pandemics , Pneumonia, Viral , Triage/organization & administration , Tuberculosis/epidemiology , Betacoronavirus/isolation & purification , Coinfection , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand/organization & administration , Humans , Intensive Care Units/economics , Intensive Care Units/standards , Pandemics/economics , Patient Selection , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Prognosis , Risk Assessment , South Africa/epidemiology
8.
Ann Glob Health ; 86(1): 100, 2020 08 13.
Article in English | MEDLINE | ID: covidwho-736810

ABSTRACT

Background: Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective: To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods: The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings: Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions: Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.


Subject(s)
Coronavirus Infections , Health Services Accessibility/organization & administration , Intensive Care Units/supply & distribution , Pandemics , Patient Care Management , Pneumonia, Viral , Private Sector/statistics & numerical data , Public Sector/statistics & numerical data , Bed Occupancy/statistics & numerical data , Betacoronavirus , Brazil/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Health Services Needs and Demand , Humans , Infection Control/organization & administration , Infection Control/standards , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/organization & administration , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Severity of Illness Index
10.
Pflege ; 33(4): 237-245, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-724668

ABSTRACT

Health behaviours and needs of people with COPD during COVID-19 pandemic: a document analysis Abstract. Background: The government's guidelines affected people with COPD on different levels during the COVID-19 pandemic. In addition to belonging to a group of particularly vulnerable persons, they had to adapt their health behaviours, in particular physical activity, to recommendations provided in order to prevent negative effects on disease progression. There is little knowledge regarding how this group of patients coped with these challenges during the COVID-19 pandemic. OBJECTIVE: To describe the health behaviours and needs people with COPD convey during nursing phone consultations and which nursing interventions have been carried out. METHODS: A document analysis of 50 nursing phone consultations was performed. The data were summarised descriptively and analysed thematically. RESULTS: The main topics were the adaptation of physical activity, the implementation of the recommendations to the individual life situation, the detection of a COVID-19 infection and questions concerning the planning of medical appointments. CONCLUSION: The COVID-19 pandemic poses additional challenges to the disease management of people with COPD. The increased need for care brought on by the pandemic was able to be met by the knowledge provided in the nursing phone consultations. What remains to be established is what role the consultations play in a sustainable change in behaviour and in dealing with negative emotions.


Subject(s)
Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Self Care/psychology , Adaptation, Psychological , Health Behavior , Health Services Needs and Demand , Humans , Pulmonary Disease, Chronic Obstructive/nursing
11.
Pflege ; 33(4): 237-245, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-722575

ABSTRACT

Health behaviours and needs of people with COPD during COVID-19 pandemic: a document analysis Abstract. Background: The government's guidelines affected people with COPD on different levels during the COVID-19 pandemic. In addition to belonging to a group of particularly vulnerable persons, they had to adapt their health behaviours, in particular physical activity, to recommendations provided in order to prevent negative effects on disease progression. There is little knowledge regarding how this group of patients coped with these challenges during the COVID-19 pandemic. OBJECTIVE: To describe the health behaviours and needs people with COPD convey during nursing phone consultations and which nursing interventions have been carried out. METHODS: A document analysis of 50 nursing phone consultations was performed. The data were summarised descriptively and analysed thematically. RESULTS: The main topics were the adaptation of physical activity, the implementation of the recommendations to the individual life situation, the detection of a COVID-19 infection and questions concerning the planning of medical appointments. CONCLUSION: The COVID-19 pandemic poses additional challenges to the disease management of people with COPD. The increased need for care brought on by the pandemic was able to be met by the knowledge provided in the nursing phone consultations. What remains to be established is what role the consultations play in a sustainable change in behaviour and in dealing with negative emotions.


Subject(s)
Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Self Care/psychology , Adaptation, Psychological , Health Behavior , Health Services Needs and Demand , Humans , Pulmonary Disease, Chronic Obstructive/nursing
12.
Global Health ; 16(1): 75, 2020 08 19.
Article in English | MEDLINE | ID: covidwho-721311

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) has been found in more than 200 countries worldwide since December, 2019. In China, a major reason for the rapid transmission of the COVID-19 in early stage of the outbreak is the huge numbers of passengers boarding their "last train home" to meet family members during the Spring Festival. Most of these travelers were internal migrant workers. In order to reduce the risk of the COVID-19 transmission, public transportation networks were suspended, and many migrant workers who returned to their hometowns needed to be quarantined for 2 weeks, which led to the delay of returning back to cities to work. Many businesses have temporarily closed because of the risk of COVID-19 transmission, leading to unemployment of many workers. Sudden loss of income and further quarantine enforcement in cities can exacerbate existing mental health problems or trigger new mental disorders among affected migrant workers. However, to date no specific guidelines or strategies about mental health services of migrant workers have been released. Health authorities and professionals should pay more attention to this vulnerable group and provide timely mental health service support for those in need.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Emergency Services, Psychiatric , Health Services Needs and Demand , Pneumonia, Viral/epidemiology , Transients and Migrants/psychology , China/epidemiology , Humans , Pandemics
13.
Aging (Albany NY) ; 12(15): 15186-15195, 2020 08 12.
Article in English | MEDLINE | ID: covidwho-713796

ABSTRACT

Italy was the first European nation to be affected by COVID-19. The biggest cluster of cases occurred in Lombardy, the most populous Italian region, and elderly men were the population hit in the hardest way. Besides its high infectivity, COVID-19 causes a severe cytokine storm and old people, especially those with comorbidities, appear to be the most vulnerable, presumably in connection to inflammaging. In centenarians inflammaging is much lower than predicted by their chronological age and females, presenting survival advantage in almost all centenarian populations, outnumber males, a phenomenon particularly evident in Northern Italy. Within this scenario, we wondered if: a) the COVID-19 mortality in centenarians was lower than that in people aged between 50 and 80 and b) the mortality from COVID-19 in nonagenarians and centenarians highlighted gender differences.We checked COVID-19-related vulnerability/mortality at the peak of infection (March 2020), using data on total deaths (i.e. not only confirmed COVID-19 cases). Our conclusion is that excess mortality increases steadily up to very old ages and at the same time men older than 90 years become relatively more resilient than age-matched females.


Subject(s)
Aging , Betacoronavirus/physiology , Coronavirus Infections , Health Services for the Aged/statistics & numerical data , Inflammation , Mortality , Pandemics , Pneumonia, Viral , Age Factors , Aged , Aged, 80 and over , Aging/physiology , Aging/psychology , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Female , Health Services Needs and Demand , Health Status Disparities , Humans , Inflammation/epidemiology , Inflammation/virology , Italy/epidemiology , Male , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Public Health/methods , Sex Factors , Vulnerable Populations
16.
Can J Aging ; 39(3): 333-343, 2020 09.
Article in English | MEDLINE | ID: covidwho-709581

ABSTRACT

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L'Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.


Subject(s)
Aging , Communicable Disease Control/methods , Coronavirus Infections , Health Services for the Aged/organization & administration , Pandemics , Patient Care Management , Patient Care Team , Pneumonia, Viral , Aged , Aging/physiology , Aging/psychology , Betacoronavirus/isolation & purification , Canada/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Services Needs and Demand , Humans , Interdisciplinary Communication , Mental Health , Patient Care Management/methods , Patient Care Management/standards , Patient Care Management/trends , Patient Care Team/organization & administration , Patient Care Team/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Quality Improvement
20.
BMJ Open ; 10(8): e037466, 2020 08 05.
Article in English | MEDLINE | ID: covidwho-695785

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN: Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING: Residential long-term care. PARTICIPANTS: 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS: Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION: Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.


Subject(s)
Coronavirus Infections/therapy , Long-Term Care , Palliative Care/standards , Pandemics , Physicians , Pneumonia, Viral/therapy , Skilled Nursing Facilities , Terminal Care/standards , Adult , Aged , Alberta , Attitude of Health Personnel , Betacoronavirus , Coronavirus Infections/virology , Family , Female , Frail Elderly , Frailty , Health Services Needs and Demand , Hospice Care , Humans , Male , Middle Aged , Pneumonia, Viral/virology , Qualitative Research , Respect , Specialization
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