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2.
PLoS One ; 16(8): e0255343, 2021.
Article in English | MEDLINE | ID: covidwho-1344153

ABSTRACT

BACKGROUND: Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. OBJECTIVE: To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. DESIGN: Observational cohort study. SETTING: Outpatient and emergency care. PATIENTS: 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. INTERVENTIONS: Nasopharyngeal PCR test for SARS-CoV-2 infection. MEASUREMENTS: Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. RESULTS: We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. LIMITATIONS: Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. CONCLUSION: Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.


Subject(s)
COVID-19 Testing/trends , COVID-19/diagnosis , Socioeconomic Factors , Adult , Aged , COVID-19/economics , COVID-19/psychology , COVID-19 Testing/methods , Cohort Studies , Comorbidity , Female , Hospitalization , Humans , Male , Mass Screening/methods , Mass Screening/psychology , Middle Aged , Ohio/epidemiology , Pandemics , Risk Factors , SARS-CoV-2/pathogenicity
3.
PLoS One ; 16(7): e0251708, 2021.
Article in English | MEDLINE | ID: covidwho-1311280

ABSTRACT

BACKGROUND: COVID-19 is an emerging infectious disease which is a major public health problem worldwide. Given the serious threats imposed by COVID-19 and the absence of vaccines until August 2020, preventive measures play an essential role in reducing infection rates and controlling its spread. This shows the necessity of public adherence for preventive and control measures, which is affected by their knowledge, attitudes, and practices. OBJECTIVE: This study aimed to determine knowledge, attitude, and practice (KAP) towards COVID-19 and associated factors among outpatient service visitors, Debre Markos compressive specialized hospital, north-west,Ethiopia. METHOD: Institutional-based cross-sectional study design with a systematic random sampling technique was conducted from July to August 2020. Among a total of 404 participants, 398 were recruited. Data were collected using a structured questionnaire. The data was edited, coded, and entered into Epi data version 4.6 and exported to SPSS-25 for analysis. Bivariable and multivariable logistic regression models were employed to identify factors associated with KAP. A p-value of <0.05 was considered statistically significant. RESULT: The prevalence of poor knowledge, attitude and practice among the outpatient service visitors were 27.1%, 30.7% and 44%, respectively. The mean age of the participants was 33.4 ±10.9 years. Variables like; educational status, ''can't read and write" [AOR = 3.76, 95% CI (1.36-10.42), P = 0.01], read and write [AOR = 5.90, 95% CI (2.39-14.98), P = 0.01], rural residence [AOR = 3.04, 95% CI (1.43-6.46), P = 0.01] and having no television [AOR = 0.8, 95% CI (0.79-0.89), P = 0.03] were significantly associated with poor knowledge. While, educational status of "can't read and write", [AOR = 6.71, 95% CI (2.78-16.16), P = 0.01] and rural residence [AOR = 2.03, 95% CI (1.14-3.61), P = 0.02] were significantly associated with poor attitude. Additionally, poor knowledge, [AOR = 22.73, 95% CI (10.5-49.21), P = 0.01], rural residence [AOR = 2.08, 95% CI (1.08-4.88), P = 0.04] and having no television [AOR = 2.24, 95% CI (1.05-4.79), P = 0.01] were significantly associated with poor practice. CONCLUSION: In this study, knowledge, attitude, and practice among outpatient service visitors was poor which needs targeted health education and interventions from the health professional to enhance their knowledge, attitude, and practice towards COVID-19. In parallel with this, special attention should be given for the rural community and for those with an educational status of can't read and write.


Subject(s)
COVID-19/psychology , Health Knowledge, Attitudes, Practice , Outpatients/psychology , Adolescent , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Educational Status , Ethiopia , Female , Humans , Income , Male , Mass Screening/psychology , Middle Aged , Quarantine/psychology , Rural Population/statistics & numerical data
4.
Front Public Health ; 8: 589372, 2020.
Article in English | MEDLINE | ID: covidwho-1058471

ABSTRACT

Background: The COVID-19 pandemic has created a global health emergency requiring an effective public health response including citizen's roles in preventing spread and controlling the pandemic. Little is known about public knowledge, beliefs and behaviors in-relation to the pandemic in Nepal. This study aims to assess knowledge, attitude and practices (KAP) toward COVID-19 among the general public and to identify associated factors. Methods: A cross-sectional survey was conducted between May-June 2020 with a sample of 645, recruited from 26 hospitals across Nepal. We conducted telephone interviews using a semi-structured questionnaire related to KAP regarding COVID-19. T-test and one-way ANOVA was conducted to determine group differences for socio-demographic variables. Linear regression and correlational analysis were performed to identify associated factors and measure strength and direction of relationships. Results: Overall mean scores for knowledge, attitude and practice were 11.6 (SD 4.5), 2.7 (SD 1.8), and 9.9 (SD 1.93) respectively, but differed by socio-demographic characteristics. Positive but weak linear correlations were observed between knowledge-practice (r = 0.19, p < 0.01) and attitude-practice (r = 0.08, p < 0.05). The relationship between knowledge and education was fairly strong (r = 0.34, p < 0.01). Province, place of residence, ecological area, age, gender and caste/ethnicity were also significantly associated with KAP score of participants. Conclusion: The study found varying degrees of correlation between Knowledge, Attitude and Practice that may increase as the pandemic evolves in Nepal. Knowledge and level of education had positive associations with attitude and adherence to precautionary measures. The findings suggest a need for targeted community awareness interventions for the most vulnerable populations, men, those with no school education, the elderly and people living in rural areas.


Subject(s)
Attitude to Health , COVID-19/prevention & control , COVID-19/psychology , Mass Screening/psychology , Pandemics/prevention & control , Patient Participation/psychology , Public Health/methods , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/epidemiology , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Nepal/epidemiology , Patient Participation/statistics & numerical data , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
5.
Am J Perinatol ; 37(12): 1271-1279, 2020 10.
Article in English | MEDLINE | ID: covidwho-695307

ABSTRACT

OBJECTIVE: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety. STUDY DESIGN: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13, 2020 and April 26, 2020. Semistructured interviews were conducted via telephone at 1 and 2 weeks posthospitalization to assess maternal mental health. Depression screening was conducted using the patient health questionnaire-2 (PHQ-2). An online survey of labor and delivery health care workers assessed job satisfaction and job-related anxiety before and during the novel coronavirus disease 2019 (COVID-19) pandemic, as well as employees' subjective experience with universal testing. Patient and employee responses were analyzed for recurring themes. RESULTS: A total of 318 asymptomatic women underwent SARS-CoV-2 testing during this 2-week period. Six of the eight women (75%) who tested positive reported negative in-hospital experiences secondary to perceived lack of provider and partner support and neonatal separation after birth. Among the 310 women who tested negative, 34.4% of multiparous women reported increased postpartum anxiety compared with their prior deliveries due to concerns about infectious exposure in the hospital and lack of social support. Only 27.6% of women, tested negative, found their test result to be reassuring. Job satisfaction and job-related anxiety among health care workers were negatively affected. Universal testing was viewed favorably by the majority of health care workers despite concerns about delays or alterations in patient care and maternal and neonatal separation. CONCLUSION: Universal testing for SARS-CoV-2 in obstetric units has mixed effects on maternal mental health but is viewed favorably by labor and delivery employees. Ongoing evaluation of new testing protocols is paramount to balance staff and patient safety with quality and equality of care. KEY POINTS: · Women with SARS-CoV-2 had a negative hospital experience.. · A negative SARS-CoV-2 test was not reassuring for patients.. · COVID-19 negatively impacts healthcare workers' well-being..


Subject(s)
Attitude to Health , Coronavirus Infections/diagnosis , Health Personnel/psychology , Mass Screening/psychology , Patient Isolation/psychology , Pneumonia, Viral/diagnosis , Postpartum Period/psychology , Pregnant Women/psychology , Social Support , Adult , Anxiety , Asymptomatic Infections/psychology , Attitude of Health Personnel , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Female , Hospitalization , Humans , Infant, Newborn , Job Satisfaction , Midwifery , Nurses/psychology , Obstetric Nursing , Occupational Stress/psychology , Pandemics , Parturition , Patient Health Questionnaire , Physicians/psychology , Pregnancy , SARS-CoV-2
6.
Med Health Care Philos ; 23(3): 519-536, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-597906

ABSTRACT

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of personal autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA.


Subject(s)
HIV Infections/diagnosis , Mass Screening/ethics , Mass Screening/psychology , Personal Autonomy , Africa South of the Sahara/epidemiology , HIV Infections/epidemiology , Human Rights , Humans , Philosophy, Medical
8.
Prenat Diagn ; 40(10): 1265-1271, 2020 09.
Article in English | MEDLINE | ID: covidwho-343193

ABSTRACT

OBJECTIVE: Advances in prenatal genetics place additional challenges as patients must receive information about a growing array of screening and testing options. This raises concerns about how to achieve a shared decision-making process that prepares patients to make an informed decision about their choices about prenatal genetic screening and testing options, calling for a reconsideration of how healthcare providers approach the first prenatal visit. METHODS: We conducted interviews with 40 pregnant women to identify components of decision-making regarding prenatal genetic screens and tests at this visit. Analysis was approached using grounded theory. RESULTS: Participants brought distinct notions of risk to the visit, including skewed perceptions of baseline risk for a fetal genetic condition and the implications of screening and testing. Participants were very concerned about financial considerations associated with these options, ranking out-of-pocket costs on par with medical considerations. Participants noted diverging priorities at the first visit from those of their healthcare provider, leading to barriers to shared decision-making regarding screening and testing during this visit. CONCLUSION: Research is needed to determine how to restructure the initiation of prenatal care in a way that best positions patients to make informed decisions about prenatal genetic screens and tests.


Subject(s)
Decision Making , Genetic Testing , Prenatal Care , Adult , Attitude to Health , Cell-Free Nucleic Acids/analysis , Cell-Free Nucleic Acids/blood , Female , Genetic Testing/economics , Genetic Testing/methods , Genetic Testing/standards , Humans , Mass Screening/economics , Mass Screening/organization & administration , Mass Screening/psychology , Mass Screening/standards , Maternal Serum Screening Tests/economics , Maternal Serum Screening Tests/psychology , Maternal Serum Screening Tests/standards , Office Visits/economics , Patient Participation/psychology , Patient Participation/statistics & numerical data , Perception , Pregnancy , Prenatal Care/economics , Prenatal Care/organization & administration , Prenatal Care/psychology , Prenatal Care/standards , Prenatal Diagnosis/economics , Prenatal Diagnosis/methods , Prenatal Diagnosis/psychology , Prenatal Diagnosis/standards , Risk Assessment , United States
9.
Disaster Med Public Health Prep ; 14(5): 684-686, 2020 10.
Article in English | MEDLINE | ID: covidwho-31086

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19) caused by the virus SARS-CoV-2 is expanding globally. South Korea is one of the countries most affected by COVID-19 from the very early stages of this pandemic. Explosive outbreaks occurred across South Korea in the first two months, and efforts to control this new virus have involved everyone across the country. To curb the transmission of the virus, health-care professionals, committees, and governments have combined many approaches, such as extensive COVID-19 screening, effective patient triage, the transparent provision of information, and the use of information technology. This experience could provide some valuable ideas and lessons to others who are fighting against COVID-19.


Subject(s)
COVID-19/complications , Delivery of Health Care/methods , Adaptation, Psychological , COVID-19/psychology , Delivery of Health Care/standards , Humans , Mass Screening/methods , Mass Screening/psychology , Mass Screening/standards , Pandemics/prevention & control , Quarantine/psychology , Quarantine/standards , Republic of Korea
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